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Post-exercise recovery for the endurance athlete with type 1 diabetes: a consensus statement.
Scott, SN, Fontana, FY, Cocks, M, Morton, JP, Jeukendrup, A, Dragulin, R, Wojtaszewski, JFP, Jensen, J, Castol, R, Riddell, MC, et al
The lancet. Diabetes & endocrinology. 2021;(5):304-317
Abstract
There has been substantial progress in the knowledge of exercise and type 1 diabetes, with the development of guidelines for optimal glucose management. In addition, an increasing number of people living with type 1 diabetes are pushing their physical limits to compete at the highest level of sport. However, the post-exercise recovery routine, particularly with a focus on sporting performance, has received little attention within the scientific literature, with most of the focus being placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout. The post-exercise recovery period presents an opportunity for maximising training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight. The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error, or adhere to guidelines that have been developed for people without diabetes. This Review provides an up-to-date consensus on post-exercise recovery and glucose management for individuals living with type 1 diabetes. We aim to: (1) outline the principles and time course of post-exercise recovery, highlighting the implications and challenges for endurance athletes living with type 1 diabetes; (2) provide an overview of potential strategies for post-exercise recovery that could be used by athletes with type 1 diabetes to optimise recovery and adaptation, alongside improved glycaemic monitoring and management; and (3) highlight the potential for technology to ease the burden of managing glycaemia in the post-exercise recovery period.
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Prehabilitation: finally utilizing frailty screening data.
Carli, F, Bessissow, A, Awasthi, R, Liberman, S
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(3):321-325
Abstract
The elderly colorectal cancer patients tend to be frail, at nutrition risk with multiple comorbidities. In view of the stress on the body by surgery and recovery, it makes sense if patients are prepared before appropriately so that they can recover earlier and better. Prehabilitation prior to major surgery has attracted the attention of clinicians recently, and this review highlights the steps that need to be taken to implement a multidisciplinary program. Such programs requires a paradigm shift in the sense that all players need to be working in team for the benefit of patinets' outcome.
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3.
Left ventricular assist device recovery: does duration of mechanical support matter?
Pham, BN, Chaparro, SV
Heart failure reviews. 2019;(2):237-244
Abstract
Heart failure is a widespread condition in the United States that is predicted to significantly increase in prevalence in the next decade. Many heart failure patients are given a left ventricular assist device (LVAD) while they wait for a heart transplant, while those that are not able to undergo a heart transplant may be given an LVAD permanently. However, past studies have observed a small subset of heart failure patients that recovered cardiac function of their native heart after being placed on an LVAD. As a result, some patients have been able to have their LVAD explanted and no longer needed a heart transplant. In this review, we analyzed the data of 15 studies that observed recovery of cardiac function in LVAD patients in order to investigate the effects that duration of LVAD support has on patient outcomes. From our review, we identified that there may be negative consequences of prolonged duration of mechanical support such as myocardial atrophy and abnormal calcium cycling as well as circumstances that may allow for a longer duration of LVAD support such as in patients using a continuous-flow LVAD, non-ischemic cardiomyopathy patients, and the specific pharmacological therapy.
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4.
[Alvimopan for recovery of bowel function after radical cystectomy].
Kranz, J, Krabbe, LM
Der Urologe. Ausg. A. 2018;(2):207-210
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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.
Wischmeyer, PE, Carli, F, Evans, DC, Guilbert, S, Kozar, R, Pryor, A, Thiele, RH, Everett, S, Grocott, M, Gan, TJ, et al
Anesthesia and analgesia. 2018;(6):1883-1895
Abstract
Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.
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Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis.
Clunie, GM, Kinshuck, AJ, Sandhu, GS, Roe, JWG
Current opinion in otolaryngology & head and neck surgery. 2017;(3):195-199
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Abstract
PURPOSE OF REVIEW Adult laryngotracheal stenosis is a rare, multifactorial condition which carries a significant physical and psychosocial burden. Surgical approaches have developed in recent years, however, voice and swallowing function can be affected prior to treatment, in the immediate postoperative phase, and as an ongoing consequence of the condition and surgical intervention. In this study we discuss: the nature of the problem; surgical interventions to address airway disorders; optimal patterns of care to maximize voice and swallowing outcomes. RECENT FINDINGS Studies in this field are limited and focused on surgical outcomes and airway status with voice and swallowing a secondary consideration. Retrospective studies of swallowing have focused on factors such as the duration of dysphagia symptoms following airway surgery and made comparisons between type of surgery, use of stent, and length of swallowing problems. The literature suggests that patients are likely to return to their preoperative diet. There has been a focus on voice outcomes following cricotracheal resection which results in a postoperative decrease in the fundamental frequency. However, study comparisons are limited by the use of inconsistent outcome measures (for both voice and swallowing) which are often not validated, with heterogeneous groups and varying surgical techniques. SUMMARY The limited literature suggests that swallowing function is more likely to recover to presurgical status than voice function. Further prospective studies incorporating consistent instrumental, clinician, and patient-reported outcome measurement are required to understand the nature and extent of dysphagia and dysphonia resulting from this condition and its treatment.
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The role of the retino-colliculo-extrastriate pathway in visual awareness and visual field recovery.
Bertini, C, Grasso, PA, Làdavas, E
Neuropsychologia. 2016;:72-9
Abstract
Patients with visual field defects resulting from post-chiasmatic lesions experience loss of visual function in up to one half of their visual field, with consequent impairments in their daily life activities. Therefore, effective strategies for compensating for the visual field loss are of great clinical relevance. After lesions to the primary visual pathway -which conveys visual information from the retina to the lateral geniculate nucleus, the optic radiations and, then, to the striate cortex-an alternative visual pathway, which projects from the superior colliculus to the extrastriate cortex, is usually spared in patients with visual field defects. In the present review, evidence for spared functioning of this alternative pathway in patients with visual field defects will be presented, both in terms of residual visual abilities, without awareness, for stimuli presented in the blind field, and the ability to integrate unseen visual signals presented in the blind field with concurrent auditory stimuli. Crucially, this review will discuss how the spared retino-colliculo-extrastriate pathway might be a useful tool for compensating for the loss of visual perception. Accordingly, evidence for the compensatory effects of systematic multisensory audio-visual stimulation in patients with visual field defects will be reviewed.
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Enhanced recovery after gastro-intestinal surgery: The scientific background.
Mariani, P, Slim, K
Journal of visceral surgery. 2016;(6S):S19-S25
Abstract
Enhanced recovery programs (ERP) are without any doubt a major innovation in the care of surgical patients. This multimodal approach encompasses elements of both medical and surgical care. The goal of this in-depth review is to analyze the surgical aspects of ERP, underlining the scientific rationale behind each element of ERP after surgery and in particular, the role of mechanical bowel preparation before colorectal surgery, the place of minimal access surgery, the utility of nasogastric tube, abdominal drainage, bladder catheters and early re-feeding. Publication of factual data has allowed many dogmas to be discarded.
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Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review.
Lawford, BJ, Walters, J, Ferrar, K
Clinical rehabilitation. 2016;(6):523-36
Abstract
OBJECTIVE To establish the effectiveness of walking alone and walking compared to other non-pharmacological management methods to improve disability, quality of life, or function in adults with chronic low back pain. DATA SOURCES A systematic search of the following databases was undertaken: Medline, Embase, CINAHL, Scopus, Pedro, SportDiscus, Cochrane Central Register of Controlled Trials. The following keywords were used: 'back pain' or 'low back pain' or 'chronic low back pain' and 'walk*' or 'ambulation' or 'treadmill*' or 'pedometer*' or 'acceleromet*' or 'recreational' and 'disability' or 'quality of life' or 'function*'. REVIEW METHODS Primary research studies with an intervention focus that investigated walking as the primary intervention compared to no intervention or any other non-pharmacological method in adults with chronic low back pain (duration >3 months). RESULTS Seven randomised controlled trials involving 869 participants were included in the review. There was no evidence that walking was more effective than other management methods such as usual care, specific strength exercises, medical exercise therapy, or supervised exercise classes. One study found over-ground walking to be superior to treadmill walking, and another found internet-mediated walking to be more beneficial than non-internet-mediated walking in the short term. CONCLUSION There is low quality evidence to suggest that walking is as effective as other non-pharmacological management methods at improving disability, function, and quality of life in adults with chronic low back pain.
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Are compression garments effective for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis.
Marqués-Jiménez, D, Calleja-González, J, Arratibel, I, Delextrat, A, Terrados, N
Physiology & behavior. 2016;:133-48
Abstract
PURPOSE The aim was to identify benefits of compression garments used for recovery of exercised-induced muscle damage. METHODS Computer-based literature research was performed in September 2015 using four online databases: Medline (PubMed), Cochrane, WOS (Web Of Science) and Scopus. The analysis of risk of bias was completed in accordance with the Cochrane Collaboration Guidelines. Mean differences and 95% confidence intervals were calculated with Hedges' g for continuous outcomes. A random effect meta-analysis model was used. Systematic differences (heterogeneity) were assessed with I(2) statistic. RESULTS Most results obtained had high heterogeneity, thus their interpretation should be careful. Our findings showed that creatine kinase (standard mean difference=-0.02, 9 studies) was unaffected when using compression garments for recovery purposes. In contrast, blood lactate concentration was increased (standard mean difference=0.98, 5 studies). Applying compression reduced lactate dehydrogenase (standard mean difference=-0.52, 2 studies), muscle swelling (standard mean difference=-0.73, 5 studies) and perceptual measurements (standard mean difference=-0.43, 15 studies). Analyses of power (standard mean difference=1.63, 5 studies) and strength (standard mean difference=1.18, 8 studies) indicate faster recovery of muscle function after exercise. CONCLUSIONS These results suggest that the application of compression clothing may aid in the recovery of exercise induced muscle damage, although the findings need corroboration.