Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: a randomized controlled pilot trial

Inspiratory muscle training (IMT) has been shown to improve exercise capacity in diseased populations. We chose to examine the effects of eight weeks of IMT on exercise capacity and spontaneous physical activity in elderly individuals. Eighteen moderately active elderly subjects (68.1 +/- 6.8 years [mean +/- SD]; range 58 - 78 years) were randomly assigned to either an experimental group (n = 9) or a control group (n = 9) in a double-blind manner. All subjects underwent inspiratory muscle testing, treadmill exercise testing and a four-day measurement period of spontaneous physical activity (using accelerometry) both pre- and post-intervention. The experimental group underwent eight weeks of incremental IMT using a pressure threshold device, while the control group underwent sham training using identical devices. After IMT training, inspiratory muscle strength (mean + 21.5 cm H (2)O; 95 % CI: 9.3, 33.7; p = 0.002), V.O (2peak) (+ 2.8 ml x min (-1) x kg (-1); 95 % CI: 0.5, 5.2; p = 0.022), time to exhaustion during a fixed workload treadmill test (+ 7.1 min; 95 % CI: 1.8, 2.4; p = 0.013) and time engaged in moderate-to-vigorous physical activity (+ 59 min; 95 % CI: 15, 78; p = 0.008) improved. Except for a decline in moderate-to-vigorous physical activity, no significant changes were seen in the control group. Therefore, IMT may be a useful technique for positively influencing exercise capacity and physical activity in elderly individuals.

Exercise after acute hyperbaric oxygenation: is there an ergogenic effect?

The purpose of this study was to determine the effects of a 1-h exposure to 2.0 atm abs (202.6 kPa) and 100% oxygen on subsequent maximal O2 consumption (VO2max), ventilation threshold (VT), lactate threshold (LT), and muscle oxygenation (%Mox) during incremental exercise to maximum on a cycle ergometer. Two baseline exercise tests (T1 and T2) were performed on separate occasions without prior exposure to hyperbaric oxygen (HBO2) and a third test (T3-HBO2) was performed after (22.5 +/- 5.6 min) HBO2 Near infared spectroscopy was used to monitor oxygenation of the left vastus lateralis muscle during T2 and T3-HBO2. No significant differences were observed between VO2max VT, or LT among any of the exercise tests. There was no significant difference in %Mox between T2 and T3-HBO2 except at 235 W where there was a significant elevation in %Mox during T3-HBO2 relative to T2. These results suggest that prior exposure to HBO2 (100% O2 at 2 atm abs for 1 h) has no ergogenic effect on subsequent incremental exercise performance.

Effectiveness of nurse triage in the emergency department of an urban county hospital

The effectiveness of patient triage by a specially trained registered nurse in the emergency department of an urban county hospital, San Francisco General Hospital, was evaluated over a three-month period. Ambulatory patients thought to have nonemergent illnesses were directed to the Walk-In Service for physician evaluation and treatment; the remainder were seen in the Emergency Service. In three months, 11,329 patients registered for care, and 4,150 (37%) were referred to the Walk-In Service. Of the 77 admitted patients, six were thought to require treatment within a few hours, 67 within hours to days, and four were considered elective admissions. There were no deaths. Error in triage was about equally divided between mistaken diagnosis and underestimated severity of illnes. The overall accuracy of triage was 98%.

Postpartum laparoscopy for sterilization

The necessity of performing sterilization in the immediate postpartum period is evident in many areas of the world. Tubal ligation via laparotomy may extend the postpartum stay and entail a certain morbidity. We have applied the technique of tubal coagulation and or resection via laparoscope to a large series of patients shortly after parturition. The technique is readily acquired, complications have been minimal, and in most instances, postpatum stay is not extended. A portion of these patients were followed by hysterosalpingogram approximately 3 months postpartum at which time tubal occlusion was demonstrated. We conclude that this procedure is not contraindicated in the postpartum period.