Purpose: This study aimed to determine the effect of postexercise protein–leucine coingestion with CHO–lipid on subsequent high-intensity endurance performance and to investigate candidate mechanisms using stable isotope methods and metabolomics.

Methods: In this double-blind, randomized, crossover study, 12 male cyclists ingested a leucine/protein/CHO/fat supplement (LEUPRO 7.5/20/89/22 g·h⁻¹, respectively) or isocaloric CHO/fat control (119/22 g·h⁻¹) 1–3 h after exercise during a 6-d training block (intense intervals, recovery, repeated-sprint performance rides). Daily protein intake was clamped at 1.9 g·kg⁻¹·d⁻¹ (LEUPRO) and 1.5 g·kg⁻¹·d⁻¹ (control). Stable isotope infusions (1-¹³C-leucine and 6,6-²H₂-glucose), mass spectrometry–based metabolomics, and nitrogen balance methods were used to determine the effects of LEUPRO on whole-body branched-chain amino acid (BCAA) and glucose metabolism and protein turnover.

Results: After exercise, LEUPRO increased BCAA levels in plasma (2.6-fold; 90% confidence limits = ×/÷1.1) and urine (2.8-fold; ×/÷1.2) and increased products of BCAA metabolism plasma acylcarnitine C5 (3.0-fold; ×/÷0.9) and urinary leucine (3.6-fold; ×/÷1.3) and β-aminoisobutyrate (3.4-fold; ×/÷1.4), indicating that ingesting ∼10 g leucine per hour during recovery exceeds the capacity to metabolize BCAA. Furthermore, LEUPRO increased leucine oxidation (5.6-fold; ×/÷1.1) and nonoxidative disposal (4.8-fold; ×/÷1.1) and left leucine balance positive relative to control. With the exception of day 1 (LEUPRO = 17 ± 20 mg N·kg⁻¹, control = −90 ± 44 mg N·kg⁻¹), subsequent (days 2–5) nitrogen balance was positive for both conditions (LEUPRO = 130 ± 110 mg N·kg⁻¹, control = 111 ± 86 mg N·kg⁻¹). Compared with control feeding, LEUPRO lowered the serum creatine kinase concentration by 21%–25% (90% confidence limits = ±14%), but the effect on sprint power was trivial (day 4 = 0.4% ± 1.0%, day 6 = −0.3% ± 1.0%).

Conclusions: Postexercise protein–leucine supplementation saturates BCAA metabolism and attenuates tissue damage, but effects on subsequent intense endurance performance may be inconsequential under conditions of positive daily nitrogen balance.

Aim: To evaluate a system of monitoring allied health service provision, quality and outcomes. Method: A large third party funder piloted the introduction of a comprehensive care planning tool to investigate the potential for post-payment monitoring of service quality. Results: Practitioner perceptions of provider quality were quite different from what was measured and audited. The heterogeneity of allied health services means that no standardised classification system of interventions is appropriate for service benchmarking. There were large variations in service provision, within and between practitioners.

Conclusions: Ongoing monitoring should include easily auditable measures, such as occasions of service mapped against broad indicators of type of appointment. There is a need for ongoing systems of quality improvement to ensure the quality of patient care is optimised.

Background

Increasing demands for podiatry combined with workforce shortages due to attrition, part-time working practices and rural healthcare shortages means that in some geographic areas in Australia there are insufficient professionals to meet service demand. Although podiatry assistants have been introduced to help relieve workforce shortages there has been little evaluation of their impact on patient, staff and/or service outcomes. This research explores the processes and outcomes of a ‘trainee’ approach to introducing a podiatry assistant (PA) role to a community setting in the Australian Capital Territory (ACT) Government Health Service Directorate.

Method

A qualitative methodology was employed involving interviews and focus groups with service managers, qualified practitioners, the assistant, service users and consumer representatives. Perspectives of the implementation process; the traineeship approach; the underlying mechanisms that help or hinder the implementation process; and the perceived impact of the role were explored. Data were analysed using the Richie and Spencer Framework approach.

Results

Although the impact of the PA role had not been measured at the time of the evaluation, the implementation of the PA traineeship was considered a success in terms of enabling the transfer of a basic foot-care service from nursing back to podiatry; releasing Enrolled Nurses (ENs) from foot-care duties; an increase in the number of treatments delivered by the podiatry service; and high levels of stakeholder satisfaction with the role. It was perceived that the transfer of the basic foot-care role from nursing to podiatry through the use of a PA impacted on communication and feedback loops between the PA and the podiatry service; the nursing-podiatry relationship; clinical governance around the foot-care service; and continuity of care for clients through the podiatry service. The traineeship was considered successful in terms of producing a PA whose skills were shaped by and directly met the needs of the practitioners with whom they worked. However, the resource intensiveness of the traineeship model was acknowledged by most who participated in the programme.

Conclusions

This research has demonstrated that the implementation of a PA using a traineeship approach requires good coordination and communication with a number of agencies and staff and substantial resources to support training and supervision. There are added benefits of the new role to the podiatry service in terms of regaining control over podiatric services which was perceived to improve clinical governance and patient pathways.

AIM: To determine 1) whether the steadiness in precision contractions of one limb would be affected by muscle contractions of the contralateral limb; and 2) whether the motor unit firing rate (MUFR) would be affected by muscle contractions of the contralateral limb.

METHOD: Twelve healthy volunteers (6 M and 6 F, age range 20-­‐35 years) performed 12 s static knee extensions at 10% and 30% of the maximal voluntary contraction (MVC) force using the left leg, while the right leg was at rest or performed static knee extensions at 10% or 30%MVC 6 s after the commencement of the left leg contraction. The steadiness of contraction was assessed by the standard deviation (SD) of force variation against the target level. Motor unit action potentials were recorded from the left vastus lateralis muscle using a custom-­‐made high-­‐impedance quadrafilar needle electrode, and identified using custom-­‐written software for multichannel spike recognition (Kamen et al. 1995). An average of 154 motor units from each subject was analysed. The MUFR for each spike train was calculated for the first 6 s and the second 6 s period of each contraction. ANOVA with repeated measures and post-­‐hoc analysis with Bonferroni adjustment were performed to evaluate the main effect of individual conditions (ie. left leg force, right leg force and unilateral vs bilateral) and interactions between these conditions.

RESULTS: A significant effect (P

CONCLUSION: This study provided new evidence indicating that the steadiness of muscle force production could be affected by muscle contraction of the contralateral limb. The MUFR and its variation were also affected by the muscle contraction in the contralateral limb.

AIM: The aim of this study was to determine whether manual acupuncture or electroacupuncture at non-­‐ acupoints (sham points) could also induce bilateral strength gain.

METHODS: Fifty healthy young men (range 19-­‐27 years) voluntarily participated in the study (5 withdrew) and were randomly allocated into five groups: manual acupuncture (MAcu, n=9) and electroacupuncture (EAcu, n=10) on two acupoints (ST36 and ST39); manual acupuncture (MSham, n=8) and electroacupuncture (ESham, n=8) on two non-­‐acupoints on the tibialis anterior muscle; and control (CON, n=10). The participants (expect the CON) received 15-­‐30 minutes of acupuncture or electroacupuncture on the right leg in each session, three sessions per week for eight weeks, while the CON maintained their normal daily activities. Ankle dorsiflexion strength of both legs was measured in static contractions pre and post the experimental period.

RESULTS: Repeated measures ANOVA with Bonferroni adjustment identified significant and similar strength gains after the treatment (P0.05).

CONCLUSION: This study demonstrated in a randomised and controlled trial that eight weeks unilateral manual acupuncture or electroacupuncture at sham points could induce similar strength gain as those at the ST-­‐36 and ST-­‐39 acupoints in both limbs. These findings further confirmed the previous reports on the effects of acupuncture on muscle strength and produced new evidence that the strength gain might not require needling at specific acupoints or electric stimulation.

AIM: To investigate the efficacy of 12 weeks of Tai Chi practice on the lower limb muscular strength, strength ratios, and postural control in an older population.

METHODS: Twenty four older adults (72.0 ± 4.2 years) underwent 12 weeks of Tai Chi exercise (TCG) and fifteen were allocated into a control group (73.9 ± 4.1 years) (CG). Maximal isometric muscular strength (MVC) assessment of knee extensors (KE), knee flexors (KF), ankle plantarflexors (AP), and ankle dorsiflexors (AD) was conducted while surface electromyography (sEMG) was simultaneously recorded during each trail. Maximal sEMG amplitudes were measured along with antagonist coactivation levels. The Hamstring to Quadriceps Ratio (HQR) and Dorsiflexor to Plantarflexor Ratio (DPR) were calculated from these MVC values. Static stabilometry tests were conducted with Center of Pressure (COP) displacements recorded in the anterior-­‐posterior (AP) and medial-­‐lateral (ML) directions plus calculations of resultant distance (RD). Both Traditional and Diffusion analyses were calculated for all postural data.

RESULTS: All muscle groups of the TCG were significantly stronger post exercise [p0.05]. Only the KE and AP muscle activation significantly increased within the TC group [p0.05]. Only the KF of both groups showed significant changes in activation level when acting as an antagonist (coactivation).There were no significant changes in either the HQR or DPR for either the TCG or CG [p>0.05]. Of the eight postural measures, only mean velocity and sway area exhibited significant reductions post TC [p>0.05].

CONCLUSION: The TC exercise did not effectively attenuate or reverse the age related decline in postural control in this group of older adults. This might however be a product of exercise specificity as TC is a dynamic exercise and the postural control assessment was static. TC was found to be effective in improving muscular strength of the lower extremities of older adults which is often link to greater mobility and improved quality of living.

Methods: Patients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents.

Results: Survey respondents (n=102) had a mean age of 77.1 years (range 66–95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents.

Conclusions: This study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.

Keywords: Frequent hospitalisation, Frequent admission, Avoidable admission, Potentially preventable admission, Older people, Chronic disease, Rural, Australia, Social isolation.

This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breast feeding was not supporting women in Australia in sustaining breast feeding. We present the last 10 years of primary research on the topic, explore major policy initiatives and the establishment and growth of lactation consultants in Australia to see if this has made a difference to sustained rates of breast feeding. We present an analysis of the only consistently collected national statistics on breast feeding and compare this with national and state level government data collections from the last decade. We have found that the considerable effort invested in trying to improve duration of breast feeding amongst women in Australia appears to have failed to improve sustained breast-feeding rates. We argue that this situation might be related to losing sight of the embodied nature of breast feeding and the relationships that must exist between the mother and baby, the knowledge and skills women quickly develop, and a loss of woman to woman support. We conclude that midwives have a major role in avoiding us reproducing similar, unintended, negative consequences to those resulting from increasing obstetrician managed normal birth. These include midwifery scrutiny and involvement in policy development and institutional practices and the design of services.