Gastroenterology trainee experience, confidence and satisfaction in nutrition training: a cross-sectional survey in the UK.

Introduction: Nutrition is an essential part of gastroenterology specialist training. There is limited evidence of trainee experience in this area. The shorter training programme introduced in 2022 may lead to reduced exposure to this subspecialty. We aimed to explore and describe current nutrition training experiences, confidence and satisfaction to inform future improvements. Methods: Gastroenterology trainees were invited to participate in an online survey from 20 May 2022 to 18 July 2022. The questionnaire consisted of 27 questions with a range of free-text and Likert scale responses. Results: 86 responses were received. 39.5% had undertaken an advanced training programme or core placement in nutrition. 52.9% of these felt 'fairly confident' or 'very confident' in managing intestinal failure vs 5.8% of those who had not completed a nutrition placement. Obesity and eating disorders management received the lowest ratings. Nutrition training was described as 'fairly important' or 'very important' by 98.8% and 47.0% included nutrition as part of their preferred future practice. 53.1% of ST6/7 trainees were 'fairly confident' or 'very confident' their training offered adequate experience in nutrition. Participants reported barriers including a lack of education and training opportunities, and limited early rotations offering nutrition training. Conclusion: Gastroenterology trainees believe nutrition training to be important. Nutrition placements increase trainee confidence, knowledge and experiences overall, but there is variability in this. Improved structuring of placements, increased educational opportunities and exposure to this subspecialty at an earlier stage are required to ensure competency in nutrition is reliably achieved during gastroenterology training.

Residential social vulnerability among healthcare personnel with and without severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in Five US states, May-December 2020.

OBJECTIVE: To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection. DESIGN: Case-control study. SETTING: This study analyzed data collected in May-December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon. PARTICIPANTS: Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed. METHODS: HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase- polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression. RESULTS: Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS: These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.

A recombinant porcine reproductive and respiratory syndrome virus type 2 field strain derived from two PRRSV-2-modified live virus vaccines.

A porcine reproductive and respiratory syndrome virus (PRRSV) type 2 (PRRSV-2) isolate was obtained from lung samples collected from a 4.5-month-old pig at a wean-to-finish site in Indiana, USA, although no gross or microscopic lesions suggestive of PRRSV infection were observed in the lung tissue. Phylogenetic and molecular evolutionary analyses based on the obtained virus sequences indicated that PRRSV USA/IN105404/2021 was a natural recombinant isolate from Ingelvac PRRS® MLV and Prevacent® PRRS, which are PRRSV-2-modified live virus vaccines commercially available in the United States. This study is the first to report the detection of a PRRSV-2 recombinant strain consisting entirely of two modified live virus vaccine strains under field conditions. Based on clinical data and the absence of lung lesions, this PRRSV-2 recombinant strain was not virulent in swine, although its pathogenicity needs to be confirmed by clinical trials.

Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May-December 2020.

To determine risk factors for coronavirus disease (COVID-19) among US healthcare personnel (HCP), we conducted a case-control analysis. We collected data about activities outside the workplace and COVID-19 patient care activities from HCP with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (cases) and from HCP with negative test results (controls) in healthcare facilities in 5 US states. We used conditional logistic regression to calculate adjusted matched odds ratios and 95% CIs for exposures. Among 345 cases and 622 controls, factors associated with risk were having close contact with persons with COVID-19 outside the workplace, having close contact with COVID-19 patients in the workplace, and assisting COVID-19 patients with activities of daily living. Protecting HCP from COVID-19 may require interventions that reduce their exposures outside the workplace and improve their ability to more safely assist COVID-19 patients with activities of daily living.

Practices and activities among healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection working in different healthcare settings-ten Emerging Infections Program sites, April-November 2020.

Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.

Problem-based learning case studies: Delivery of an educational method and perceptions at two schools of pharmacy in Italy.

BACKGROUND AND PURPOSE: Problem-based learning (PBL) case studies are not currently offered in the pharmacy school curriculum in Italy. This study sought to assess the perceptions of a PBL case study activity delivered at two pharmacy schools in Italy. EDUCATIONAL ACTIVITY AND SETTING: A total of 64 pharmacy students and three pharmacy faculty from Italy participated in the live PBL activity. They collaborated on teams with pharmacy students from the United States to discuss a patient case and prepare drug therapy recommendations. A cross-sectional survey was performed to assess the Italian participants' perceptions before and after partaking in the PBL activity. FINDINGS: Results from the survey utilizing a five-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) demonstrated that students and faculty from both pharmacy schools in Italy perceived the value in applying information learned in PBL to their current or future practices (4.48 ± 0.79) and in collaborating with a team to improve patient care (4.66 ± 0.79). In addition, the vast majority (93%) of participants agreed or strongly agreed that they would be interested in continuing to participate in PBL in the future. SUMMARY: Students and faculty at two pharmacy schools in Italy found the delivery of a PBL exercise to be beneficial for their professional development. This may suggest an opportunity for pharmacy schools in Italy to add the PBL case-based teaching method into their curriculum.

Improving safety for medical students and patients during medical electives-a novel simulation-based course.

INTRODUCTION: The medical elective is a common component of undergraduate medical education in the UK and Ireland. These are often undertaken in varied hospitals and countries across the world, most of which are not related to their parent institutions, in order to explore specialties and regions of interest. However experiences are varied, with goals not always established beforehand, or indeed reached, when present. METHODS: Using a novel 20-item, self-administered questionnaire distributed via social media to 436 medical students and doctors in the UK and Republic of Ireland, we sought to delineate common elective experiences and establish what procedures and clinical scenarios medical students commonly undertake and manage during their medical electives, in order to ascertain their confidence level with each of these tasks at the time of their medical electives. We also looked to determine if there are any adverse effects or events related to these situations. Following this, we developed a simulation-based course to address knowledge and skill gaps identified in the above fields. This course was delivered to two groups of medical students from St George's University London and King's College London medical schools by the same faculty over two separate afternoons. RESULTS: We found that a significant proportion of medical students feel pressured to perform skills, which are beyond their competence level during their elective placements, putting both patient and student safety at risk. Our simulation course was successful in significantly improving key technical and non-technical skills, which would be useful for students during their medical electives.

Breast Infection: A Review of Diagnosis and Management Practices.

Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the management of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity.

The effects of intensified training on resting metabolic rate (RMR), body composition and performance in trained cyclists.

BACKGROUND: Recent research has demonstrated decreases in resting metabolic rate (RMR), body composition and performance following a period of intensified training in elite athletes, however the underlying mechanisms of change remain unclear. Therefore, the aim of the present study was to investigate how an intensified training period, designed to elicit overreaching, affects RMR, body composition, and performance in trained endurance athletes, and to elucidate underlying mechanisms. METHOD: Thirteen (n = 13) trained male cyclists completed a six-week training program consisting of a "Baseline" week (100% of regular training load), a "Build" week (~120% of Baseline load), two "Loading" weeks (~140, 150% of Baseline load, respectively) and two "Recovery" weeks (~80% of Baseline load). Training comprised of a combination of laboratory based interval sessions and on-road cycling. RMR, body composition, energy intake, appetite, heart rate variability (HRV), cycling performance, biochemical markers and mood responses were assessed at multiple time points throughout the six-week period. Data were analysed using a linear mixed modeling approach. RESULTS: The intensified training period elicited significant decreases in RMR (F(5,123.36) = 12.0947, p = <0.001), body mass (F(2,19.242) = 4.3362, p = 0.03), fat mass (F(2,20.35) = 56.2494, p = <0.001) and HRV (F(2,22.608) = 6.5212, p = 0.005); all of which improved following a period of recovery. A state of overreaching was induced, as identified by a reduction in anaerobic performance (F(5,121.87) = 8.2622, p = <0.001), aerobic performance (F(5,118.26) = 2.766, p = 0.02) and increase in total mood disturbance (F(5, 110.61) = 8.1159, p = <0.001). CONCLUSION: Intensified training periods elicit greater energy demands in trained cyclists, which, if not sufficiently compensated with increased dietary intake, appears to provoke a cascade of metabolic, hormonal and neural responses in an attempt to restore homeostasis and conserve energy. The proactive monitoring of energy intake, power output, mood state, body mass and HRV during intensified training periods may alleviate fatigue and attenuate the observed decrease in RMR, providing more optimal conditions for a positive training adaptation.

Effect of Intensified Endurance Training on Pacing and Performance in 4000-m Cycling Time Trials.

Studies examining pacing strategies during 4000-m cycling time trials (TTs) typically ensure that participants are not prefatigued; however, competitive cyclists often undertake TTs when already fatigued. This study aimed to determine how TT pacing strategies and sprint characteristics of cyclists change during an intensified training period (mesocycle). Thirteen cyclists regularly competing in A- and B-grade cycling races and consistently training (>10 h/wk for 4 [1] y) completed a 6-wk training mesocycle. Participants undertook individually prescribed training, using training stress scores (TrainingPeaks, Boulder, CO), partitioned into a baseline week, a build week, 2 loading weeks (designed to elicit an overreached state), and 2 recovery weeks. Laboratory-based tests (15-s sprint and TT) and Recovery-Stress Questionnaire (RESTQ-52) responses were repeatedly undertaken over the mesocycle. TT power output increased during recovery compared with baseline and loading weeks (P = .001) with >6-W increases in mean power output (MPO) detected for 400-m sections (10% bins) from 1200 to 4000 m in recovery weeks. Decreases in peak heart rate (P < .001) during loading weeks and postexercise blood lactate (P = .005) during loading week 2 and recovery week 1 were detected. Compared with baseline, 15-s sprint MPO declined during loading and recovery weeks (P < .001). An interaction was observed between RESTQ-52 total stress score with a 15-s sprint (P = .003) and with a TT MPO (P = .04), indicating that participants who experienced greater stress during loading weeks exhibited reduced performance. To conclude, intensified endurance training diminished sprint performance but improved 4000-m TT performance, with a subtle change in MPO evident over the last 70% of TTs.

New approaches to determine fatigue in elite athletes during intensified training: Resting metabolic rate and pacing profile.

BACKGROUND: Elite rowers complete a high volume of training across a number of modalities to prepare for competition, including periods of intensified load, which may lead to fatigue and short-term performance decrements. As yet, the influence of substantial fatigue on resting metabolic rate (RMR) and exercise regulation (pacing), and their subsequent utility as monitoring parameters, has not been explicitly investigated in elite endurance athletes. METHOD: Ten National-level rowers completed a four-week period of intensified training. RMR, body composition and energy intake were assessed PRE and POST the four-week period using indirect calorimetry, Dual-Energy X-Ray Densitometry (DXA), and three-day food diary, respectively. On-water rowing performance and pacing strategy was evaluated from 5 km time trials. Wellness was assessed weekly using the Multicomponent Training Distress Scale (MTDS). RESULTS: Significant decreases in absolute (mean ± SD of difference, p-value: -466 ± 488 kJ.day-1, p = 0.01) and relative RMR (-8.0 ± 8.1 kJ.kg.FFM-1, p = 0.01) were observed. Significant reductions in body mass (-1.6 ± 1.3 kg, p = 0.003) and fat mass (-2.2 ± 1.2 kg, p = 0.0001) were detected, while energy intake was unchanged. On-water 5 km rowing performance worsened (p < 0.05) and an altered pacing strategy was evident. Fatigue and total mood disturbance significantly increased across the cycle (p < 0.05), and trends were observed for reduced vigour and increased sleep disturbance (p < 0.1). CONCLUSION: Four weeks of heavy training decreased RMR and body composition variables in elite rowers and induced substantial fatigue, likely related to an imbalance between energy intake and output. This study demonstrates that highly experienced athletes do not necessarily select the correct energy intake during periods of intensified training, and this can be assessed by reductions in RMR and body composition. The shortfall in energy availability likely affected recovery from training and altered 5 km time trial pacing strategy, resulting in reduced performance.

12 days of altitude exposure at 1800 m does not increase resting metabolic rate in elite rowers.

Four elite rowers completed a 12-day altitude training camp living at 1800 m, and training at 1800 m and 915 m, to assess changes in resting metabolic rate (RMR). RMR and body composition were assessed pre- and postcamp. Downward trends in RMR and body composition were observed postaltitude: absolute RMR (percent change: -5.2%), relative RMR (-4.6%), body mass (-1.2%), and fat mass (-4.1%). These variations are likely related to the hypoxic stimulus and an imbalance between training load and energy intake.

Four Weeks of Classical Altitude Training Increases Resting Metabolic Rate in Highly Trained Middle-Distance Runners.

High altitude exposure can increase resting metabolic rate (RMR) and induce weight loss in obese populations, but there is a lack of research regarding RMR in athletes at moderate elevations common to endurance training camps. The present study aimed to determine whether 4 weeks of classical altitude training affects RMR in middle-distance runners. Ten highly trained athletes were recruited for 4 weeks of endurance training undertaking identical programs at either 2200m in Flagstaff, Arizona (ALT, n = 5) or 600m in Canberra, Australia (CON, n = 5). RMR, anthropometry, energy intake, and hemoglobin mass (Hbmass) were assessed pre- and posttraining. Weekly run distance during the training block was: ALT 96.8 ± 18.3km; CON 103.1 ± 5.6km. A significant interaction for Time*Group was observed for absolute (kJ.day-1) (F-statistic, p-value: F(1,8)=13.890, p = .01) and relative RMR (F(1,8)=653.453, p = .003) POST-training. No significant changes in anthropometry were observed in either group. Energy intake was unchanged (mean ± SD of difference, ALT: 195 ± 3921kJ, p = .25; CON: 836 ± 7535kJ, p = .75). A significant main effect for time was demonstrated for total Hbmass (g) (F(1,8)=13.380, p = .01), but no significant interactions were observed for either variable [Total Hbmass (g): F(1,8)=1.706, p = .23; Relative Hbmass (g.kg-1): F(1,8)=0.609, p = .46]. These novel findings have important practical application to endurance athletes routinely training at moderate altitude, and those seeking to optimize energy management without compromising training adaptation. Altitude exposure may increase RMR and enhance training adaptation,. During training camps at moderate altitude, an increased energy intake is likely required to support an increased RMR and provide sufficient energy for training and performance.

Improving the quality of the operating room to intensive care unit handover at an urban teaching hospital through a bundled intervention.

STUDY OBJECTIVE: To evaluate the efficacy of a bundled intervention to improve the quality of the operating room to intensive care unit (ICU) clinical handover. DESIGN: Prospective, interventional study. SETTING: An urban, public teaching hospital with more than 1500 direct postoperative ICU admissions each year. INTERVENTIONS: A bundled intervention to include the addition of a direct anesthesia provider to ICU nurse telephone report, a mnemonic to standardize the handover process, and improved template for postoperative documentation by the anesthesia team. MEASUREMENTS: Preintervention (baseline) and postintervention survey data were solicited from key stakeholders, which included anesthesia providers and ICU nursing staff. MAIN RESULTS: Anesthesia provider and ICU nursing staff satisfaction levels rose significantly following implementation of the bundled intervention. In addition, perceived effectiveness of the handover process and note increased significantly. The satisfaction level of the ICU nurses with respect to the phone report received before patient arrival in the ICU nearly doubled. CONCLUSIONS: The implementation of a bundled handover intervention was associated with increased stakeholder satisfaction as well as a perception of increased efficacy and quality of the overall handover process and postoperative anesthesia documentation.

The Ventilation-Corrected ParvoMedics TrueOne 2400 Provides a Valid and Reliable Assessment of Resting Metabolic Rate (RMR) in Athletes Compared With the Douglas Bag Method.

The aim of the current study was to determine if a single ParvoMedics TrueOne 2400 metabolic cart provides valid and reliable measurement of RMR in comparison with the criterion Douglas Bag method (DB). Ten endurance-trained participants completed duplicate RMR measurements on 2 consecutive days using the ParvoMedics system in exercise mode, with the same expirate analyzed using DB. Typical error (TE) in mean RMR between the systems was 578.9 kJ or 7.5% (p = .01). In comparison with DB, the ParvoMedics system over-estimated RMR by 946.7 ± 818.6 kJ. The bias between systems resulted from ParvoMedics VE(STPD) values. A regression equation was developed to correct the bias, which reduced the difference to -83.3 ± 631.9 kJ. TE for the corrected ParvoMedics data were 446.8 kJ or 7.2% (p = .70). On Day 1, intraday reliability in mean RMR for DB was 286.8 kJ or 4.3%, (p = .54) and for ParvoMedicsuncorrected, 359.3 kJ or 4.4%, (p = .35), with closer agreement observed on Day 2. Interday reliability for DB was 455.3 kJ or 6.6% (p = .61) and for ParvoMedicsuncorrected, 390.2 kJ or 6.3% (p = .54). Similar intraday and interday TE was observed between ParvoMedicsuncorrected and ParvoMedicscorrected data. The ParvoMedics TrueOne 2400 provided valid and reliable RMR values compared with DB when the VE(STPD) error was corrected. This will enable widespread monitoring of RMR using the ParvoMedics system in a range of field-based settings when DB is not available.

Four weeks of IV iron supplementation reduces perceived fatigue and mood disturbance in distance runners.

PURPOSE: To determine the effect of intravenous iron supplementation on performance, fatigue and overall mood in runners without clinical iron deficiency. METHODS: Fourteen distance runners with serum ferritin 30-100 µg · L(-1) were randomly assigned to receive three blinded injections of intravenous ferric-carboxymaltose (2 ml, 100 mg, IRON) or normal saline (PLACEBO) over four weeks (weeks 0, 2, 4). Athletes performed a 3,000 m time trial and 10 × 400 m monitored training session on consecutive days at week 0 and again following each injection. Hemoglobin mass (Hbmass) was assessed via carbon monoxide rebreathing at weeks 0 and 6. Fatigue and mood were determined bi-weekly until week 6 via Total Fatigue Score (TFS) and Total Mood Disturbance (TMD) using the Brief Fatigue Inventory and Brunel Mood Scale. Data were analyzed using magnitude-based inferences, based on the unequal variances t-statistic and Cohen's Effect sizes (ES). RESULTS: Serum ferritin increased in IRON only (Week 0: 62.8 ± 21.9, Week 4: 128.1 ± 46.6 µg · L(-1); p = 0.002) and remained elevated two weeks after the final injection (127.0 ± 66.3 µg · L(-1), p = 0.01), without significant changes in Hbmass. Supplementation had a moderate effect on TMD of IRON (ES -0.77) with scores at week 6 lower than PLACEBO (ES -1.58, p = 0.02). Similarly, at week 6, TFS was significantly improved in IRON vs. PLACEBO (ES -1.54, p = 0.05). There were no significant improvements in 3,000 m time in either group (Week 0 vs. Week 4; Iron: 625.6 ± 55.5 s vs. 625.4 ± 52.7 s; PLACEBO: 624.8 ± 47.2 s vs. 639.1 ± 59.7 s); but IRON reduced their average time for the 10 × 400 m training session at week 2 (Week 0: 78.0 ± 6.6 s, Week 2: 77.2 ± 6.3; ES-0.20, p = 0.004). CONCLUSION: During 6 weeks of training, intravenous iron supplementation improved perceived fatigue and mood of trained athletes with no clinical iron deficiency, without concurrent improvements in oxygen transport capacity or performance.

Reversal of small, dense LDL subclass phenotype by weight loss is associated with impaired fat oxidation.

Adiposity is more prevalent among individuals with a predominance of small, dense low-density lipoprotein (LDL) (pattern B) particles than among those with larger LDL (pattern A). We tested for differences in resting energy expenditure (REE) and respiratory quotient (RQ) in overweight men with pattern A (n = 36) or pattern B (n = 60). Men consumed a standardized isoenergetic diet for 3 weeks after which a ~9 kg weight loss was induced by caloric deficit for 9 weeks, followed by 4 weeks of weight stabilization. REE and RQ were measured by indirect calorimetry before and after weight loss. Results were analyzed separately in pattern B men who converted to pattern A (B→A; n = 35) and those who did not (B→B; n = 25). At baseline, B→B men had higher trunk fat, triacylglycerol (TG) and insulin concentrations, homeostasis model assessment of insulin resistance (HOMA(IR)), and smaller LDL particles compared to B→A men and baseline pattern A men who remained pattern A (A→A; n = 35). REE normalized to fat-free mass did not change after weight loss. RQ decreased in A→A men, increased in B→A men, and did not change significantly in B→B men after weight loss. Calculated fat oxidation rates paralleled the RQ results. Baseline plasma TG concentrations were positively correlated with RQ and inversely correlated with the magnitude of weight loss achieved for a given prescribed energy reduction in the entire study population. Pattern B men who converted to pattern A with weight loss may have an underlying impairment in fat oxidation that predisposes to both dyslipidemia and an impaired ability to achieve weight loss by energy restriction.