The effect of rest redistribution on kinetic and kinematic variables during the hang pull

The aim of this study was to compare the effects of rest redistribution (RR) on kinetics and kinematics during the hang pull (HP). Twenty-one male athletes (age 29.5 ± 4.3 years, height 1.78 ± 0.07 m, body mass 75.17 ± 11.11 kg, relative one repetition maximum [1RM] power clean [PC] 1.17 ± 0.14 kg.kg-1) performed the HP using 140% of 1RM PC with 3 traditional sets of 6 repetitions (TS), 9 sets of 2 repetitions with RR [45s rest after 2 repetitions] (RR45) and 6 sets of 3 repetitions with RR [72s rest after 3 repetitions] (RR72). Peak velocity (PV) was higher during RR72 (1.18 ± 0.11 m.s-1) compared to RR45 (1.14 ± 0.11 m.s-1) for the average of 18 repetitions (p = 0.025, g = 0.36). There was a main effect for set configuration with greater peak force (PF) (p < 0.001, g = 0.14) during RR72 compared to RR45, with greater PV and impulse (p < 0.001, g = 0.19-0.36) during RR72 compared to RR45. There was also greater peak velocity maintenance (PVM) (p = 0.042, g = 0.44) for RR72 compared to RR45. There were no significant or meaningful differences (p > 0.05, g = 0.00-0.59) between configurations for any other variables. Rest redistribution protocols did not result in significantly or meaningfully greater kinetics or kinematics during the HP when compared to a TS protocol; although performing RR72 resulted in higher PF, PV, and impulse, with improved PVM compared to RR45.

The Effect of Rest Redistribution on Kinetic and Kinematic Variables During the Countermovement Shrug

ABSTRACT

Meechan, D, McMahon, JJ, Suchomel, TJ, and Comfort, P. The effect of rest redistribution on kinetic and kinematic variables during the countermovement shrug. J Strength Cond Res 37(7): 1358-1366, 2023-This study compared the effects of rest redistribution (RR) on kinetic and kinematic variables during the countermovement shrug (CMS). Twenty-one male subjects (age 27.2 ± 3.3. years, height 1.78 ± 0.07 m, body mass 77.2 ± 10.6 kg, relative 1 repetition maximum (1RM) power clean [PC] 1.22 ± 0.16 kg·kg-1) performed the CMS using 140% of 1RM PC with 3 traditional sets of 6 repetitions (TS), 9 sets of 2 repetitions with RR [45 s rest after 2 repetitions] (RR45), and 6 sets of 3 repetitions with RR [72 s rest after 3 repetitions] (RR72). There were no significant or meaningful differences (p > 0.05, g = 0.00-0.15) between set configurations for any variables for the average of the 18 repetitions. There were no significant (p > 0.05) or meaningful (g = 0.00-0.14) differences for configuration and configuration × set for peak (PF) and mean force (MF), peak velocity (PV), impulse, phase duration, peak velocity decline, peak velocity maintenance, and rating of perceived exertion. There was significantly greater (p = 0.034) albeit small (g = 0.15) difference for mean velocity (MV) during TS compared with RR72. There were no significant or meaningful differences (p > 0.05, g = 0.00-0.09) between sets for PF, MF, PV, MV, impulse, and duration across TS, RR45, and RR72. Rest redistribution protocols did not result in greater kinetics or kinematics during the CMS compared with TS, when total rest time was equated. Thus, shorter more frequent rest periods during the CMS may not be required to maintain force-time characteristics.

Comparing biomechanical time series data across countermovement shrug loads

The effect of load on time-series data has yet to be investigated during weightlifting derivatives. This study compared the effect of load on the force-time and velocity-time curves during the countermovement shrug (CMS). Twenty-nine males performed the CMS at relative loads of 40%, 60%, 80%, 100%, 120%, and 140% one repetition maximum (1RM) power clean (PC). A force plate measured the vertical ground reaction force (VGRF), which was used to calculate the barbell-lifter system velocity. Time-series data were normalized to 100% of the movement duration and assessed via statistical parametric mapping (SPM). SPM analysis showed greater negative velocity at heavier loads early in the unweighting phase (12-38% of the movement), and greater positive velocity at lower loads during the last 16% of the movement. Relative loads of 40% 1RM PC maximised propulsion velocity, whilst 140% 1RM maximized force. At higher loads, the braking and propulsive phases commence at an earlier percentage of the time-normalized movement, and the total absolute durations increase with load. It may be more appropriate to prescribe the CMS during a maximal strength mesocycle given the ability to use supramaximal loads. Future research should assess training at different loads on the effects of performance.

A Comparison of Kinetic and Kinematic Variables During the Midthigh Pull and Countermovement Shrug, Across Loads

Meechan, D, Suchomel, TJ, McMahon, JJ, and Comfort, P. A comparison of kinetic and kinematic variables during the midthigh pull and countermovement shrug, across loads. J Strength Cond Res 34(7): 1830-1841, 2020-This study compared kinetic and kinematic variables during the midthigh pull (MTP) and countermovement shrug (CMS). Eighteen men (age: 29.43 ± 3.95 years, height: 1.77 ± 0.08 m, body mass: 84.65 ± 18.79 kg, and 1 repetition maximum [1RM] power clean: 1.02 ± 0.18 kg·kg) performed the MTP and CMS at intensities of 40, 60, 80, 100, 120, and 140% 1RM, in a progressive manner. Peak force (PF), mean force (MF), peak velocity, peak barbell velocity (BV), peak power, (PP), mean power (MP), and net impulse were calculated from force-time data during the propulsion phase. During the CMS, PF and MF were maximized at 140% 1RM and was significantly greater than the MTP at all loads (p ≤ 0.001, Hedges g = 0.66-0.90); p < 0.001, g = 0.74-0.99, respectively). Peak velocity and BV were significantly and meaningfully greater during the CMS compared with the MTP across all loads (p < 0.001, g = 1.83-2.85; p < 0.001, g = 1.73-2.30, respectively). Similarly, there was a significantly and meaningfully greater PP and MP during the CMS, across all loads, compared with the MTP (p < 0.001, g = 1.45-2.22; p < 0.001, g = 1.52-1.92). Impulse during the CMS was also significantly greater across all loads (p < 0.001, g = 1.20-1.66) compared with the MTP. Results of this study demonstrate that the CMS may be a more advantageous exercise to perform to enhance force-time characteristics when compared with the MTP, due to the greater kinetics and kinematic values observed.

A Comparison of Kinetic and Kinematic Variables During the Pull From the Knee and Hang Pull, Across Loads

Meechan, D, McMahon, JJ, Suchomel, TJ, and Comfort, P. A comparison of kinetic and kinematic variables during the pull from the knee and hang pull, across loads. J Strength Cond Res 34(7): 1819-1829, 2020-Kinetic and kinematic variables during the pull from the knee (PFK) and hang pull (HP) were compared in this study. Eighteen men (age = 29.43 ± 3.95 years; height 1.77 ± 0.08 m; body mass 84.65 ± 18.79 kg) performed the PFK and HP with 40, 60, 80, 100, 120, and 140% of 1-repetition maximum (1RM) power clean, in a progressive manner. Peak force (PF), mean force (MF), peak system velocity (PSV), mean system velocity (MSV), peak power (PP), mean power (MP), and net impulse were calculated from force-time data during the propulsion phase. During the HP, small-to-moderate yet significantly greater MF was observed compared with the PFK, across all loads (p ≤ 0.001; Hedges g = 0.47-0.73). Hang pull PSV was moderately and significantly greater at 100-140% 1RM (p = 0.001; g = 0.64-0.94), whereas MSV was significantly greater and of a large-to-very large magnitude compared with PFK, across all loads (p < 0.001; g = 1.36-2.18). Hang pull exhibited small to moderate and significantly greater (p ≤ 0.011, g = 0.44-0.78) PP at 100-140%, with moderately and significantly greater (p ≤ 0.001, g = 0.64-0.98) MP across all loads, compared with the PFK. Hang pull resulted in a small to moderate and significantly greater net impulse between 100 and 140% 1RM (p = 0.001, g = 0.36-0.66), compared with PFK. The results of this study demonstrate that compared with the PFK, the HP may be a more beneficial exercise to enhance force-time characteristics, especially at loads of ≥1RM.

Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study

OBJECTIVE

To assess the overall effect of the English urgent referral pathway on cancer survival.

SETTING

8049 general practices in England.

DESIGN

Cohort study. Linked information from the national Cancer Waiting Times database, NHS Exeter database, and National Cancer Register was used to estimate mortality in patients in relation to the propensity of their general practice to use the urgent referral pathway.

PARTICIPANTS

215,284 patients with cancer, diagnosed or first treated in England in 2009 and followed up to 2013.

OUTCOME MEASURE

Hazard ratios for death from any cause, as estimated from a Cox proportional hazards regression.

RESULTS

During four years of follow-up, 91,620 deaths occurred, of which 51,606 (56%) occurred within the first year after diagnosis. Two measures of the propensity to use urgent referral, the standardised referral ratio and the detection rate, were associated with reduced mortality. The hazard ratio for the combination of high referral ratio and high detection rate was 0.96 (95% confidence interval 0.94 to 0.99), applying to 16% (n=34,758) of the study population. Patients with cancer who were registered with general practices with the lowest use of urgent referral had an excess mortality (hazard ratio 1.07 (95% confidence interval 1.05 to 1.08); 37% (n=79,416) of the study population). The comparator group for these two hazard ratios was the remaining 47% (n=101,110) of the study population. This result in mortality was consistent for different types of cancer (apart from breast cancer) and with other stratifications of the dataset, and was not sensitive to adjustment for potential confounders and other details of the statistical model.

CONCLUSIONS

Use of the urgent referral pathway could be efficacious. General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer.

Specialist surgery for ovarian cancer in England

OBJECTIVE

The aim of this study is to evaluate the impact of the 1999 national recommendations for ovarian cancer surgery in England to be performed by specialist surgeons in specialist centres.

METHODS

A retrospective analysis of English cancer registry records, Hospital Episode Statistics (HES) data for all English NHS providers and General Medical Council (GMC) sub-specialty accreditation, to consider changes to the annual proportion of ovarian cancer (ICD10 C56-C57) patients undergoing major gynaecological surgery in gynaecological cancer centres (GCCs) or by specialist gynaecological oncologists (GOs).

RESULTS

From 2000 to 2009, 2428 consultants were responsible for surgery on 30,753 patients. There were significant increases in the proportions of patients undergoing surgery at GCCs (43% to 76%, P<0.001), by GMC accredited GOs (5% to 36%, P<0.001), and by high ovarian cancer caseload (≥18 cases) surgeons (22% to 56%, P<0.001).

CONCLUSION

There have been increased centralisation and specialisation of surgery for ovarian cancer patients since the NHS Cancer Plan (2000) and there has also been improved survival. However, by 2009, many ovarian cancer patients were still not receiving specialist surgery; the majority of patients were not operated on by GMC accredited gynaecological oncologists and there was considerable regional variation. Systems of accreditation should be reviewed and trusts should ensure that HES data accurately records clinical activity.

Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications)

BACKGROUND

There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.

METHODS

Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.

RESULTS

Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).

CONCLUSIONS

This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

Access, continuity of care and consultation quality: which best predicts urgent cancer referrals from general practice?

BACKGROUND

For some cancers, late presentation is associated with poor survival. In England, less than half of patients are diagnosed following a general practitioner-initiated urgent referral. We explore whether particular practice or practitioner characteristics are associated with use of the urgent referral system.

METHODS

The study sample was 603/614 practices in the East Midlands. Logistic regression models were fitted to investigate relationships between cancer detection rate, how easy it is to book appointments quickly, in advance or with a preferred doctor, and whether patients have confidence and trust in the doctor.

RESULTS

The percentage of patients who definitely have confidence and trust in the doctor was positively associated with the cancer detection rate [odds ratio = 1.08 (95% confidence interval (CI) 1.01, 1.15) per 10 percentage points]. When all four survey variables were modelled together, the percentage of patients who were able to see a preferred doctor was negatively associated with the cancer detection rate [odds ratio = 0.93 (95% CI 0.88, 0.98) per 10 percentage points].

CONCLUSIONS

Our analyses suggest that in the UK National Health Service, confidence and trust in the doctor may be more important in cancer detection than the ease of access or whether there is choice of doctor.

Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology

Background:

Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting.

Methods:

A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication.

Results:

Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3).

Conclusion:

This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.

Stage at diagnosis and ovarian cancer survival: evidence from the International Cancer Benchmarking Partnership

OBJECTIVE

We investigate what role stage at diagnosis bears in international differences in ovarian cancer survival.

METHODS

Data from population-based cancer registries in Australia, Canada, Denmark, Norway, and the UK were analysed for 20,073 women diagnosed with ovarian cancer during 2004-07. We compare the stage distribution between countries and estimate stage-specific one-year net survival and the excess hazard up to 18 months after diagnosis, using flexible parametric models on the log cumulative excess hazard scale.

RESULTS

One-year survival was 69% in the UK, 72% in Denmark and 74-75% elsewhere. In Denmark, 74% of patients were diagnosed with FIGO stages III-IV disease, compared to 60-70% elsewhere. International differences in survival were evident at each stage of disease; women in the UK had lower survival than in the other four countries for patients with FIGO stages III-IV disease (61.4% vs. 65.8-74.4%). International differences were widest for older women and for those with advanced stage or with no stage data.

CONCLUSION

Differences in stage at diagnosis partly explain international variation in ovarian cancer survival, and a more adverse stage distribution contributes to comparatively low survival in Denmark. This could arise because of differences in tumour biology, staging procedures or diagnostic delay. Differences in survival also exist within each stage, as illustrated by lower survival for advanced disease in the UK, suggesting unequal access to optimal treatment. Population-based data on cancer survival by stage are vital for cancer surveillance, and global consensus is needed to make stage data in cancer registries more consistent.

Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data

BACKGROUND

Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.

METHODS

Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995-2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985-2005.

FINDINGS

Relative survival improved during 1995-2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2-6% at 1 year and by 2-3% at 5 years.

INTERPRETATION

Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are broadly consistent with these trends in survival. Data quality and changes in classification are not likely explanations. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older.

FUNDING

Department of Health, England; and Cancer Research UK.

Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs

BACKGROUND

It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice.

AIM

To determine whether intervention practices made savings relative to controls.

METHOD

An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to take part and received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of 163,000 Pounds. Changes in prescribing patterns were investigated by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. Prescribing data (PACTLINE) were used to assess these changes. The measures used to take account of differences in the populations of the practices included the ASTRO-PU for overall prescribing and the STAR-PU for prescribing in specific therapeutic areas. Differences between intervention and control practices were subjected to Wilcoxon matched-pairs, signed-ranks tests.

RESULTS

The median (minimum to maximum) rise in prescribing costs per ASTRO-PU was 0.85 Pound (-1.95 Pounds to 2.05 Pounds) in the intervention practices compared with 2.55 Pounds (1.74 Pounds to 4.65 Pounds) in controls (P = 0.025). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around 347,000 Pounds higher.

CONCLUSION

This study suggests that the use of pharmacists did control prescribing expenditure sufficiently to offset their employment costs.