Training and academic demands are associated with sleep quality in high-performance "dual career" student swimmers

Dual career collegiate athletes, who combine sporting endeavours with academic studies, are commonplace in high-performance sport. Sleep is an important aspect of physical and psychological recovery for athletes, plays a role in memory and learning and is associated with academic achievement. The aim of this study was to assess variations in sleep characteristics of collegiate swimmers to understand the incidence of poor sleep, and which stressors might contribute towards this. A total of 22 (male n = 13, female n = 9) high-performance student swimmers (mean ± SD; age 20 ± 2 years) participated in this study. Sleep/wake behaviour was assessed using the Pittsburgh Sleep Quality Index each month over a 12-month period. Additionally, academic and sporting commitments were quantified on a monthly basis and summarised as 4 stressors: average weekly training hours, total number of competitive races, total number of academic assessments, and average weekly learning hours. On average across the 12-month period, 41.7% of athletes reported poor sleep. The latest bedtimes, wake times and longest sleep durations were found in the months where academic and training demands were lowest. A statistically significant positive association was identified between median sleep quality scores and mean number of academic assessments (ρ₍₁₂₎ = 0.71, p=0.005). Hierarchal linear modelling analysis determined that number of academic assessments best predicted sleep quality within this cohort. The present study highlights the need for those working with athletes who have competing academic demands to consider sleep quality, and its potential impact on performance and wellbeing.

Normobaric hyperoxia training in elite female hockey players

BACKGROUND

Supplemental oxygen use may offer recovery benefits to team sport athletes both in training and match play. A blinded independent measures study was used to investigate the effect of supplementary oxygen use during recovery from high-intensity exercise on performance.

METHODS

Fifteen female international hockey players underwent a 6 week running based training program with a 2:1 work to rest ratio. The subjects were split into 3 groups; normobaric hyperoxia (HXA), normoxia (NXA) and control (CTR). In between exercise sets HXA received 100% oxygen for 1 minute whilst NXA received a placebo in the same manner. CTR received no treatment and were not supervised. Maximal aerobic speed (MAS) was measured pre and post. Distance covered was measured along with peak heart rate (HRpeak), peak blood lactate concentration ([La-]peak) and rate of perceived exertion (RPE).

RESULTS

MAS improved in HXA, NXA and CTR. However, distance ran in training was not different between groups. There was a likely positive effect on HRpeak in HXA (lower in HXA). RPE and [La-]peak response was not different between groups.

CONCLUSIONS

Inhaling supplementary oxygen during recovery between high-intensity intervals did not improve physiological performance of high-level team sport players. The normobaric hyperoxia treatment had no effect on maximal aerobic (distance covered), metabolic ([La-]peak), and perception (RPE) parameters. It is not recommended as an ergogenic aid to training at sea level.

Guiding Principles for Pharmaceutical Physicians from the Ethical Issues Committee of the Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the UK

Medical practitioners practising in the field of pharmaceutical medicine, whether in industry, regulatory bodies or an academic environment, are bound by the same ethical standards which apply to all doctors. Their work, however, leads to some very specific ethical considerations which may not be fully explored in ethical codes based in clinical medicine. This document aims to establish some guiding principles which should underpin a working ethical framework for pharmaceutical physicians. It clearly places the protection of patients (and research subjects) and the doctor's duties to wider society ahead of responsibilities to an individual employer while emphasising the importance of adherence to high standards of research, including dissemination of findings. These principles form the basis of a fuller report which offers more specific practical advice on possible ethical conflicts or dilemmas.

Ethics and pharmaceutical medicine -- the full report of the Ethical Issues Committee of the Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the UK

The practice of pharmaceutical medicine brings with it ethical challenges and dilemmas often very different from those encountered in the practice of clinical medicine. Having established a framework of guiding ethical principles, this report aims to look in some detail at specific areas of possible ethical concern to pharmaceutical physicians, offering practical advice and guidance on good practice. The report covers issues related to pharmaceutical research, including dissemination of research findings, communication with other health professionals and patients and involvement of pharmaceutical physicians and companies in the provision of patient services. The primacy of the interests of patients and the wider public is emphasised, and the possible impact of new developments in pharmaceutical technology is explored. It is hoped that the report will help those working in pharmaceutical medicine and act as a stimulus for wider discussion and debate.

Juggling law, ethics, and intuition: practical answers to awkward questions

The eclectic problem solving methodology used by the British Medical Association (BMA) is described in this paper. It has grown from the daily need to respond to doctors' practical queries and incorporates reference to law, traditional professional codes, and established BMA policies-all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah's Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the BMA's approach. The author's overall conclusion is that although the BMA resorts to a lengthier list of things to consider, the solutions that emerge are often likely to coincide with the four principles approach.

Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.

Fostering Nursing Research Among Nurse Clinicians in an Australian Area Health Service

BACKGROUND

The Nursing Research Centre for Adaptation in Health and Illness (NRCAHI) is a collaborative effort of the University of Sydney and Central Sydney Area Health Service (CSAHS) in Sydney, Australia. This article reports findings of a research needs-analysis of clinical nursing staff in CSAHS that was conducted to provide research training.

METHOD

A questionnaire was administered to a random sample of nurses working in CSAHS. The questionnaire gathered information about employment and demographic information, interest in research participation, current and future levels of research skills, and areas where skill and knowledge enhancement is desired.

RESULTS

Overall, nurses expressed low levels of perceived confidence, knowledge, and research skills. Results were used as the basis for developing a range of strategies designed to enhance research confidence and participation. These strategies were sufficiently flexible to cater for the needs of nurses with varying levels of research experience.

CONCLUSION

Strategies implemented by the NRCAHI in its first 4 years of operation have produced positive outcomes in terms of increased research participation.

Genetic privacy: orthodoxy or oxymoron?

In this paper we question whether the concept of "genetic privacy" is a contradiction in terms. And, if so, whether the implications of such a conclusion, inevitably impact on how society comes to perceive privacy and responsibility generally. Current law and ethical discourse place a high value on self-determination and the rights of individuals. In the medical sphere, the recognition of patient "rights" has resulted in health professionals being given clear duties of candour and frankness. Dilemmas arise, however, when patients decline to know relevant information or, knowing it, refuse to share it with others who may also need to know. This paper considers the notions of interconnectedness and responsibility to others which are brought to the fore in the genetic sphere and which challenge the primacy afforded to personal autonomy. It also explores the extent to which an individual's perceived moral obligations can or should be enforced.

Euthanasia: the institutional response

For health institutions, euthanasia represents an increasingly complex but increasingly inescapable debate, in which the expectations of health professionals have moved away from the declaratory answer in search of greater sophistication and clarity. The House of Lords' Committee on Medical Ethics drew attention to the unavoidable complexity of future medical decisions at the end of life, the inexorably changing doctor-patient relationship and the demographic shift resulting in greater numbers surviving longer to face chronic, degenerative conditions. The committee proved a watershed in many respects, not least in the moral debate it triggered in the public and among health professionals. Arguably it aired questions which still have not been conclusively answered. Its questioning mirrored the trend observable among the institutions' membership for rigour and detail to justify the positions adopted. It represents one facet of the pressure on health institutions, whose previous mode of dealing with the euthanasia debate was by declaration and some would say by pontification. Their reticence to probe deeper was undoubtedly based partly on the conviction that detailed debate about euthanasia was an anathema within professional groups committed to the traditional life-preserving goal of medicine. Also influential has been the assumption that it would be otiose for professional bodies to issue guidance on matters unambiguously covered by law. Arguably, both of these views should have been challenged if not dispelled by the effort involved in contributing evidence to the House of Lords' Committee. That exercise exposed the need for guidance and the ambiguities at law but it remains to be seen how the debate will be taken forward, or not, by health institutions.

Limiting risks by curtailing rights: a response to Dr Ryan

It has been argued that the inherent risks of advance directives made by healthy people are disproportionate to the potential benefits, particularly if the directive is implementable in cases of reversible mental incapacity. This paper maintains that the evidence for such a position is lacking. Furthermore, respect for the principle of autonomy requires that individuals be permitted to make risky choices about their own lives as long as these do not impinge on others. Even though health professionals have an obligation to try and ensure that patients have appropriate information about possible future treatment options, they cannot predict and describe every eventuality but nor can they disregard firm decisions knowingly made on the basis of incomplete information by competent adults. To attempt to do so would be to reinstate notions of medical paternalism which are contrary to current public expectations.

Remembrance of conversations past: oral advance statements about medical treatment

Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.