Physical training in patients with chronic heart failure: An elaboration of the statements from the Committee on Cardiac Rehabilitation of the Netherlands Society of Cardiology and the Netherlands Heart Foundation and review of studies on physical training in chronic heart failure

Chronic heart failure (CHF) can be defined as a complex of symptoms and signs caused by cardiac dysfunction. Dyspnoea on exertion, fatigue, reduced exercise tolerance and fluid retention are hallmarks of the syndrome.Reduced peripheral blood flow, endothelial dysfunction, alterations in skeletal muscle structure and function, an increased activity of the muscle ergoreflex, as well as autonomic and neurohormonal activation reduce exercise performance, ultimately leading to physical deconditioning in CHF patients.The beneficial effects of physical training for CHF patients are increasingly acknowledged. Based on European and American guidelines on physical training in CHF, results from controlled randomised trials (summarised in this paper) and expert opinions, the Dutch Committee on Cardiac Rehabilitation has formulated statements on physical training in CHF.In addition, recommendations implementing physical training programmes in CHF patients are given. The selection criteria, contraindications and methods, and duration of a physical training programme in heart failure are discussed. Concomitant with the training programme, a multidisciplinary intervention programme is needed to stimulate patients to adopt and maintain an active and healthy lifestyle.     

On-the-Job Evidence-Based Medicine Training for Clinician-Scientists of the Next Generation

Clinical scientists are at the unique interface between laboratory science and frontline clinical practice for supporting clinical partnerships for evidence-based practice. In an era of molecular diagnostics and personalised medicine, evidence-based laboratory practice (EBLP) is also crucial in aiding clinical scientists to keep up-to-date with this expanding knowledge base. However, there are recognised barriers to the implementation of EBLP and its training. The aim of this review is to provide a practical summary of potential strategies for training clinician-scientists of the next generation.Current evidence suggests that clinically integrated evidence-based medicine (EBM) training is effective. Tailored e-learning EBM packages and evidence-based journal clubs have been shown to improve knowledge and skills of EBM. Moreover, e-learning is no longer restricted to computer-assisted learning packages. For example, social media platforms such as Twitter have been used to complement existing journal clubs and provide additional post-publication appraisal information for journals.In addition, the delivery of an EBLP curriculum has influence on its success. Although e-learning of EBM skills is effective, having EBM trained teachers available locally promotes the implementation of EBM training. Training courses, such as Training the Trainers, are now available to help trainers identify and make use of EBM training opportunities in clinical practice. On the other hand, peer-assisted learning and trainee-led support networks can strengthen self-directed learning of EBM and research participation among clinical scientists in training. Finally, we emphasise the need to evaluate any EBLP training programme using validated assessment tools to help identify the most crucial ingredients of effective EBLP training.In summary, we recommend on-the-job training of EBM with additional focus on overcoming barriers to its implementation. In addition, future studies evaluating the effectiveness of EBM training should use validated outcome tools, endeavour to achieve adequate power and consider the effects of EBM training on learning environment and patient outcomes.     

青年教师如何在医学微生物教学中提高教学水平

青年教师是高等院校未来的主力军,学校可持续发展的后备力量,是学校事业发展的希望,因此,提高青年教师的教学水平至关重要。大学青年教师在专业技能、思想政治素质、业务水平、掌握阅读专业书刊能力、自身的教学经验和反思等方面具有良好的基础,但在教育学、心理学、一般教学方法、学习情况分析等方面不够深入了解,因此需要对大学青年教师进行严格系统性培养,本文针对青年教师一对一导师制专业技能培训、观摩教学、继续教育培训等方面进行阐述,旨在为青年教师早日进入角色,尽快胜任教育教学工作提供参考。     

Simple training programme for ambulance personnel in the management of cardiac arrest in the community.

The extended training for ambulance personnel in Nottinghamshire includes a period of training in cardiac resuscitation by defibrillation, and defibrillators are now part of the standard equipment of vehicles used on the accident and emergency service. Comparison of recent results with previous attempts in the City of Nottingham to provide a service for out of hospital cardiac arrest has shown that an elementary training course and the provision of defibrillators on emergency vehicles enables the ambulance service to save the lives of a reasonable proportion of those who suffer sudden death in the community. The extended training programme as a whole has proved acceptable to ambulance personnel and we believe that this programme could be the basis for a more widespread introduction of post basic training.     

A systematic review of the effects of physical training on load carriage performance

Soldiers are often required to carry heavy loads during military operations. This article reports on a systematic literature review examining the influence of physical training on load carriage performance. Several literature databases, reference lists, and other sources were explored to find studies that quantitatively examined the effects of physical training on the time taken for individuals to complete a set distance carrying an external load, with the majority of the load contained in a backpack. Effect sizes (Cohen's d statistic) were used in meta-analyses to examine the changes in load carriage performance after various modes of physical training. Effect sizes quantified training-related changes in terms of SD units. Ten original research studies met the review criteria. Meta-analysis indicated that large training effects (≥0.8SD units) were apparent when progressive resistance training was combined with aerobic training and when that training was conducted at least 3 times per week, over at least 4 weeks. When progressive load-carriage exercise was part of the training program, much larger training effects were evident (summary effect size [SES] = 1.7SD units). Field-based training that combined a wide variety of training modes and included progressive load-carriage exercise was also very effective in improving load carriage performance (SES = 1.1SD units). Aerobic training alone or resistance training alone had smaller and more variable effects, depending on the study. This review indicates that combinations of specific modes of physical training can substantially improve load carriage performance.     

Relationship between the training of young recruits and values of bite forces

Analysis of masticatory function is the basis of clinical work in almost all fields of dentistry. Bite forces are the expression and measure of masticatory function. Physical training has an effect on the development of functional ability, motoric ability of the organism and the formation of desired physical proportions. The purpose of this study was to examine the association between physical fitness and bite force values. Because of strictly defined regulations in the army with regard to training and nutrition, Croatian Army recruits were ideal examinees for this examination. The examinees were 135 recruits. Bite forces were measured on three places (area of the central incisors, left and right in the area of the first molars) before and after three-months of training. Of all the examinees, 108 had increased their body weight, 12 had decreased it and 15 had not changed their body weight. The median of measured forces in the recruits prior to training was 291 N in the right (lateral quadrant), 285.5 N in the left lateral quadrant and 205 N in the anterior area. After training the median of measured forces in the right quadrant was 312 N, in the left 313 N and in the anterior area 216 N Greater bite forces after training on all measured places were statistically proved. Increased activity of masticatory muscles can have the same effect on the values of bite forces as bite training. There are few data on the correlation between physical muscles and values of bite forces. The results of those studies are doubtful. In this study, after three months of conditional training, the body mass of the recruits had increased and they expressed greater values of bite forces. However, correlation between body mass and bite forces cannot be proved with certainty.     

Biofeedback-aided relaxation and meditation in the management of hypertension

Based on clinical, epidemiological, and experimental work, a possible pathogenesis of essential hypertension is outlined. In the light of this possible pathogenesis, a behavioral treatment program is suggested which centers on the regular use of systematic relaxation training. Several controlled studies are described in which experimental patients given such training show clinically significant and lasting reductions in systolic and diastolic pressure. Following training, experimental patients also show quicker recovery of blood pressures to baseline levels after exposure to standardized laboratory stressors. Probable long-term benefits of relaxation training are suggested. Such benefits, however, can only be maintained if the patient regularly practices relaxation and integrates this into his everyday activities. How to motivate symptomless hypertensives to accept this requirement is discussed in the light of the writer's personal experience.     

A brief review: factors affecting the length of the rest interval between resistance exercise sets

Research has indicated that multiple sets are superior to single sets for maximal strength development. However, whether maximal strength gains are achieved may depend on the ability to sustain a consistent number of repetitions over consecutive sets. A key factor that determines the ability to sustain repetitions is the length of rest interval between sets. The length of the rest interval is commonly prescribed based on the training goal, but may vary based on several other factors. The purpose of this review was to discuss these factors in the context of different training goals. When training for muscular strength, the magnitude of the load lifted is a key determinant of the rest interval prescribed between sets. For loads less than 90% of 1 repetition maximum, 3-5 minutes rest between sets allows for greater strength increases through the maintenance of training intensity. However, when testing for maximal strength, 1-2 minutes rest between sets might be sufficient between repeated attempts. When training for muscular power, a minimum of 3 minutes rest should be prescribed between sets of repeated maximal effort movements (e.g., plyometric jumps). When training for muscular hypertrophy, consecutive sets should be performed prior to when full recovery has taken place. Shorter rest intervals of 30-60 seconds between sets have been associated with higher acute increases in growth hormone, which may contribute to the hypertrophic effect. When training for muscular endurance, an ideal strategy might be to perform resistance exercises in a circuit, with shorter rest intervals (e.g., 30 seconds) between exercises that involve dissimilar muscle groups, and longer rest intervals (e.g., 3 minutes) between exercises that involve similar muscle groups. In summary, the length of the rest interval between sets is only 1 component of a resistance exercise program directed toward different training goals. Prescribing the appropriate rest interval does not ensure a desired outcome if other components such as intensity and volume are not prescribed appropriately.     

NP岗位设置对促进住院医师规范化培训的探索与思考

高级职业护师是一些发达国家护理队伍中的重要组成部分。通过介绍如何通过注册护士岗位设置与住院医师规范化培训相结合,探索注册护士对规范化培训的影响与作用,以期为推进高品质的住院医规范化培训提供借鉴。     

Strategies for the reduction of live animal use in microsurgical training and education

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80-100%. For an even more enhanced, "closer-to-real-life" scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.     

研究型医院研究生培养的几点想法

研究型医院是指以完成临床医疗工作为基本任务,以培养优秀人才为突出优势,以创新性科学研究为重要使命,以制定和修定临床医学标准和规范为水平标志的大型综合型医院。其是我国医院管理界的新生事物。要走研究型医院快速、持续发展之路,提高医院的整体诊治水平,就必须大力培育复合型人才。研究生培养作为研究型医院优秀人才培养的重要组成部分,在培养过程中必然需要新的培养方式。建立与研究型医院发展相适应的研究生培养机制,诱导研究生国际视野,培养研究生创新意识,激发研究生求知欲望,训练研究生专项特长,树立研究生转化医学思维,才能培养出适应研究型医院发展需要的研究生。本文就研究型医院研究生培养的几点想法与同行共享。     

音乐在黑猩猩采血训练中的应用初探

为探究外源促性腺激素对伊拉兔(Oryctolagus cuniculu)生殖器官中表皮生长因子(EGF)表达水平及其作用特点的影响,本实验以伊拉兔为研究对象,随机选取30只(雄兔6只,雌兔24只),将雌兔随机分为超排处理组(n = 12),即肌肉注射70 U 孕马血清促性腺激素(PMSG)和100 U人绒毛膜促性腺激素(hCG)和对照组(不注射任何激素,n = 12)。并运用实时定量PCR(qRT-PCR)、蛋白免疫印迹(Western-blot)及免疫组化方法,研究经超排处理的伊拉兔卵巢、输卵管和子宫中表皮生长因子的表达与定位情况。结果显示,在超排处理后的伊拉兔卵巢、输卵管和子宫中,表皮生长因子mRNA与蛋白的表达量极显著高于对照组的卵巢、输卵管和子宫(P < 0.01),其阳性信号分别定位于卵巢的初级卵母细胞、颗粒细胞、内膜细胞、间质细胞和血管内皮细胞,输卵管的纤毛细胞、基细胞、黏膜上皮和肌层中,以及子宫的上皮细胞和内膜细胞中。研究表明,超排使用的外源促性腺激素可促进卵巢、输卵管和子宫中表皮生长因子表达量升高,提示其可能参与伊拉兔的生殖过程并调节卵巢、输卵管和子宫的功能。     

Are the Effects of Response Inhibition on Gambling Long-Lasting?

A recent study has shown that short-term training in response inhibition can make people more cautious for up to two hours when making decisions. However, the longevity of such training effects is unclear. In this study we tested whether training in the stop-signal paradigm reduces risky gambling when the training and gambling task are separated by 24 hours. Two independent experiments revealed that the aftereffects of stop-signal training are negligible after 24 hours. This was supported by Bayes factors that provided strong support for the null hypothesis. These findings indicate the need to better optimise the parameters of inhibition training to achieve clinical efficacy, potentially by strengthening automatic associations between specific stimuli and stopping.     

Effects of exercise on the biomechanical,biochemical and structural properties of tendons

Tendon has been shown to undergo remodeling in response to strength or endurance training, however, compared to muscle, studies of the effects of exercise on tendon are limited and the information is inconsistent. Exercise may influence the structure, chemical composition and/or mechanical properties of tendon. Studies that have examined mechanical changes of tendon in response to endurance training suggest that ultimate failure strength and stiffness increase with training. Available reports indicate that increases in tensile strength and stiffness are probably not associated with increases in collagen concentration or with tendon hypertrophy. The paucity of data renders it impossible to evaluate the response of other structural, chemical and mechanical parameters to training. Furthermore, few investigators have included discrete measures of structural, biomechanical and biochemical variables within a single study. The lack of integrative studies makes it difficult to definitively associate changes in the mechanical properties of tendon with chemical composition and structure.     

Increased cortical thickness in sports experts: a comparison of diving players with the controls

Sports experts represent a population of people who have acquired expertise in sports training and competition. Recently, the number of studies on sports experts has increased; however, neuroanatomical changes following extensive training are not fully understood. In this study, we used cortical thickness measurement to investigate the brain anatomical characteristics of professional divers with extensive training experience. A comparison of the brain anatomical characteristics of the non-athlete group with those of the athlete group revealed three regions with significantly increased cortical thickness in the athlete group. These regions included the left superior temporal sulcus, the right orbitofrontal cortex and the right parahippocampal gyrus. Moreover, a significant positive correlation between the mean cortical thickness of the right parahippocampal gyrus and the training experience was detected, which might indicate the effect of extensive training on diving players' brain structure.     

Task-Specific Response Strategy Selection on the Basis of Recent Training Experience

The goal of training is to produce learning for a range of activities that are typically more general than the training task itself. Despite a century of research, predicting the scope of learning from the content of training has proven extremely difficult, with the same task producing narrowly focused learning strategies in some cases and broadly scoped learning strategies in others. Here we test the hypothesis that human subjects will prefer a decision strategy that maximizes performance and reduces uncertainty given the demands of the training task and that the strategy chosen will then predict the extent to which learning is transferable. To test this hypothesis, we trained subjects on a moving dot extrapolation task that makes distinct predictions for two types of learning strategy: a narrow model-free strategy that learns an input-output mapping for training stimuli, and a general model-based strategy that utilizes humans'' default predictive model for a class of trajectories. When the number of distinct training trajectories is low, we predict better performance for the mapping strategy, but as the number increases, a predictive model is increasingly favored. Consonant with predictions, subject extrapolations for test trajectories were consistent with using a mapping strategy when trained on a small number of training trajectories and a predictive model when trained on a larger number. The general framework developed here can thus be useful both in interpreting previous patterns of task-specific versus task-general learning, as well as in building future training paradigms with certain desired outcomes.     

The Pattern and Loci of Training-Induced Brain Changes in Healthy Older Adults Are Predicted by the Nature of the Intervention

There is enormous interest in designing training methods for reducing cognitive decline in healthy older adults. Because it is impaired with aging, multitasking has often been targeted and has been shown to be malleable with appropriate training. Investigating the effects of cognitive training on functional brain activation might provide critical indication regarding the mechanisms that underlie those positive effects, as well as provide models for selecting appropriate training methods. The few studies that have looked at brain correlates of cognitive training indicate a variable pattern and location of brain changes - a result that might relate to differences in training formats. The goal of this study was to measure the neural substrates as a function of whether divided attentional training programs induced the use of alternative processes or whether it relied on repeated practice. Forty-eight older adults were randomly allocated to one of three training programs. In the SINGLE REPEATED training, participants practiced an alphanumeric equation and a visual detection task, each under focused attention. In the DIVIDED FIXED training, participants practiced combining verification and detection by divided attention, with equal attention allocated to both tasks. In the DIVIDED VARIABLE training, participants completed the task by divided attention, but were taught to vary the attentional priority allocated to each task. Brain activation was measured with fMRI pre- and post-training while completing each task individually and the two tasks combined. The three training programs resulted in markedly different brain changes. Practice on individual tasks in the SINGLE REPEATED training resulted in reduced brain activation whereas DIVIDED VARIABLE training resulted in a larger recruitment of the right superior and middle frontal gyrus, a region that has been involved in multitasking. The type of training is a critical factor in determining the pattern of brain activation.     

Forming of the visual cognitive structures in the monkey conditioned-reflex behaviour: the dependence on the sensory information

In monkeys, changes in size and shape of figures led to a significant decrease of correct solutions in training and a considerable increase of refusals from solution of tasks as well as the time of their motor response. The invariance of differentiation in this case was achieved after additional training. The data obtained show that, based on the stimulus sensory processing in conditioned-reflex training, in the long-term memory some differentiating signs are formed: the cognitive structures (the functional neurophysiological mechanisms) maintaining the classification of visual images. With these structures, temporary conditioned connection will be established. Their formation will be determined by the type of sensory information and provided for by existence in the long-term memory of separate subsystems for spatial as well as non-spatial information.     

Heart-Alert: emergency resuscitation training in the community

One approach to reducing avoidable mortality from coronary artery disease is to provide resuscitation capability in the community. In Manitoba this is the function of the Heart-Alert program, sponsored by the Manitoba Heart Foundation. The program is based on public and professional education dealing with the recognition and immediate care of cardiac emergencies, including cardiopulmonary resuscitation (CPR). The three components to the program are (a) training in basic CPR for all health care and community rescue groups; (b) training in definitive CPR for physicians, critical care nurses and advanced emergency medical technicians; and (c) education of the public to recognize the signs of impending or actual cardiac emergencies and to take appropriate action to summon quickly an emergency rescue team.The initial emphasis of the program has been on developing an organizational structure and a training network for basic CPR. A corps of instructor-trainers and instructors has been certified to implement CPR training in the medical and community target groups. Developmental problems include problems of quality control, of providing for self-sustaining and continued expansion, and of evaluation of the overall results.It is suggested that widespread implementation of CPR training is facilitated by the incorporation of CPR into existing training activities, particularly those of the medical, nursing and other health care disciplines, those of community protection agencies such as police, fire and ambulance departments, and those of volunteer groups concerned with rescue work and first-aid. If the impetus, organizational structure and instructor training are provided by a strategic agency, wide dissemination of CPR training is then possible at relatively modest cost.     

Resistance training enhances the stability of sensorimotor coordination

Strategies for the control of human movement are constrained by the neuroanatomical characteristics of the motor system. In particular, there is evidence that the capacity of muscles for producing force has a strong influence on the stability of coordination in certain movement tasks. In the present experiment, our aim was to determine whether physiological adaptations that cause relatively long-lasting changes in the ability of muscles to produce force can influence the stability of coordination in a systematic manner. We assessed the effects of resistance training on the performance of a difficult coordination task that required participants to synchronize or syncopate movements of their index finger with an auditory metronome. Our results revealed that training that increased isometric finger strength also enhanced the stability of movement coordination. These changes were accompanied by alterations in muscle recruitment patterns. In particular, the trained muscles were recruited in a more consistent fashion following the programme of resistance training. These results indicate that resistance training produces functional adaptations of the neuroanatomical constraints that underlie the control of voluntary movement.