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Miles KH, Clark B, Fowler PM, Gratwicke MJ, Martin K, Welvaert M, Miller J, Pumpa KL. ɑ-Lactalbumin Improves Sleep and Recovery after Simulated Evening Competition in Female Athletes. Med Sci Sports Exerc 2021; 53:2618-2627. [PMID: 34649262 DOI: 10.1249/mss.0000000000002743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the efficacy of α-lactalbumin (A-LAC) supplementation for improving sleep and performance recovery after simulated evening competition in female athletes. METHODS Sixteen trained women (mean ± SD: age, 27 ± 7 yr; mass, 62 ± 10 kg; stature, 167 ± 8 cm) participated in this randomized double-blind three-arm crossover study. Participants completed a simulated evening competition before consuming either an A-LAC whey protein, whey protein placebo (PLA), or water control (CON) beverage. Sleep was monitored via polysomnography, and participants completed a series of physical, cognitive, and perceptual assessments before, and 14 and 24 h after simulated competition. RESULTS Non-rapid eye movement stage 2 sleep increased after competition in A-LAC (pre, 199 ± 44 min; post, 212 ± 37 min) but decreased in CON (pre, 228 ± 43 min; post, 195 ± 40 min) and PLA (pre, 224 ± 25 min; post, 211 ± 35 min; P = 0.012). In addition, Yo-Yo Intermittent Recovery Test Level 1 distance improved over time in A-LAC (baseline, 664 ± 332 m; 14 h post, 667 ± 326 m; 24 h post, 781 ± 427 m) compared with CON (baseline, 741 ± 366 m; 14 h post, 648 ± 351 m; 24 h post, 720 ± 407 m) and PLA (baseline, 763 ± 394 m; 14 h post, 636 ± 366 m; 24 h post, 720 ± 396 m; P < 0.001). CONCLUSIONS The findings indicate that A-LAC supplementation may be useful for retaining some sleep characteristics after evening competition, leading to improved physical performance in female athletes.
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Affiliation(s)
| | - Brad Clark
- Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | - Peter M Fowler
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, AUSTRALIA
| | - Madeleine J Gratwicke
- Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | | | - Marijke Welvaert
- Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | - Joanna Miller
- AIS Operations, Australian Institute of Sport, Bruce, Canberra, AUSTRALIA
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Fowler PM, Murray A, Farooq A, Lumley N, Taylor L. Subjective and Objective Responses to Two Rugby Sevens World Series Competitions. J Strength Cond Res 2019; 33:1043-1055. [PMID: 29016478 DOI: 10.1519/jsc.0000000000002276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fowler, PM, Murray, A, Farooq, A, Lumley, N, and Taylor, L. Subjective and objective responses to two rugby sevens world series competitions. J Strength Cond Res 33(4): 1043-1055, 2019-The purpose was to examine the utility of subjective and objective measures of player preparedness, interpreted at both group level and individual level, during 2 consecutive competitions of the World Rugby Sevens Series (WRSS). Subjective (sleep, energy, and muscle soreness ratings) and objective (heart rate [HR] at rest [HRREST] and in response to submaximal exercise [HREX]) measures were obtained from 16 male rugby 7s players from 1 team for 3 consecutive days (D1-3) at home (HOME) and on arrival at 4 tournament (T1-4) locations (T1-New Zealand; T2-USA; T3-Hong Kong; and T4-Tokyo) across 2 WRSS competitions (2 tournaments per competition) separated by 1 month. At a group level, energy ratings were significantly lower in T2 and T4 compared with HOME, and on D1 T2 compared with D1 T1 (p ≤ 0.05). Greatest variability in subjective ratings was observed during T1 and T3 at an individual level, particularly for sleep quality. Although at a group level HRREST and HREX significantly decreased in T1-4 compared with HOME (p ≤ 0.05), there was only a ∼50% agreement between the direction of change in HR indices at an individual level. Results from this study suggest that relocation between tournaments within WRSS competitions disrupts player preparedness measures to the largest degree. Hence, this period could be targeted by practitioners with appropriate recovery and/or sleep-promoting interventions or modulation of match-/training-load. Moreover, subjective rather than objective measures seem to be of greater use to inform player preparedness decision making, particularly at an individual level compared with a group level.
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Affiliation(s)
- Peter M Fowler
- ASPETAR-Orthopaedic and Sports, Medicine Hospital, Athlete Health and Performance Research Center, Doha, Qatar
| | - Andrew Murray
- Athletics Department, University of Oregon, Eugene, Oregon
| | - Abdulaziz Farooq
- ASPETAR-Orthopaedic and Sports, Medicine Hospital, Athlete Health and Performance Research Center, Doha, Qatar
| | - Nick Lumley
- Scottish Rugby Union, Edinburgh, United Kingdom
| | - Lee Taylor
- ASPETAR-Orthopaedic and Sports, Medicine Hospital, Athlete Health and Performance Research Center, Doha, Qatar.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Stevens CJ, Thornton HR, Fowler PM, Esh C, Taylor L. Long-Haul Northeast Travel Disrupts Sleep and Induces Perceived Fatigue in Endurance Athletes. Front Physiol 2018; 9:1826. [PMID: 30618835 PMCID: PMC6306418 DOI: 10.3389/fphys.2018.01826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Long-haul transmeridian travel is known to cause disruptions to sleep and immune status, which may increase the risk of illness. Aim: This study aimed to determine the effects of long-haul northeast travel for competition on sleep, illness and preparedness in endurance athletes. Methods: Twelve trained (13.8 ± 3.2 training h/week) masters (age: 48 ± 14 years) triathletes were monitored for sleep (quantity via actigraphy and quality via self-report), mucosal immunity (salivary immunoglobulin-A) and stress (salivary cortisol) as well as self-reported illness, fatigue, recovery and preparedness. Baseline measures were recorded for 2 weeks prior to travel for all variables except for the saliva samples, which were collected on three separate days upon waking. Participants completed normal training during the baseline period. Measures were subsequently recorded before, during and after long-haul northeast travel from the Australian winter to the Hawaiian summer, and in the lead up to an Ironman 70.3 triathlon. Results: All comparisons are to baseline. There was a most likely decrease in sleep duration on the over-night flight (-4.8 ± 1.2 h; effect size; ±90% confidence limits = 3.06; ±1.26) and a very likely increase in sleep duration on the first night after arrival (0.7 ± 1.0 h; 1.15; ±0.92). After this time, sleep duration returned to baseline for several days until it was very likely decreased on the night prior to competition (-1.2 ± 1.0 h; 1.18; ±0.93). Nap duration was likely increased on the first day after arrival (36 ± 65 min; 3.90; ±3.70). There was also a likely increase in self-reported fatigue upon waking after the first night in the new destination (1.1 ± 1.6 AU; 0.54; ±0.41) and there were three athletes (25%) who developed symptoms of illness 3-5 days after arrival. There were no changes in sleep quality or mucosal measures across study. Discussion: Long-haul northeast travel from a cool to a hot environment had substantial influences on sleep and self-reported fatigue, but these alterations had returned to pre-departure baseline 48 h after arrival. Endurance athletes undertaking similar journeys may benefit from optimizing sleep hygiene, especially on the first 2 days after arrival, or until sleep duration and fatigue levels return to normal.
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Affiliation(s)
- Christopher J. Stevens
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia
- Centre for Athlete Development, Experience and Performance, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Heidi R. Thornton
- Newcastle Knights Rugby League Club, Newcastle, NSW, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Peter M. Fowler
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Christopher Esh
- Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Lee Taylor
- Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Fowler PM, Knez W, Crowcroft S, Mendham AE, Miller J, Sargent C, Halson S, Duffield R. Greater Effect of East versus West Travel on Jet Lag, Sleep, and Team Sport Performance. Med Sci Sports Exerc 2018; 49:2548-2561. [PMID: 28719491 DOI: 10.1249/mss.0000000000001374] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the recovery timeline of sleep, subjective jet lag and fatigue, and team sport physical performance after east and west long-haul travel. METHODS Ten physically trained men underwent testing at 0900 h and 1700 h local time on four consecutive days 2 wk before outbound travel (BASE), and the first 4 d after 21 h of outbound (WEST) and return (EAST) air travel across eight time zones between Australia and Qatar. Data collection included performance (countermovement jump, 20-m sprint, and Yo-Yo intermittent recovery level 1 [YYIR1] test) and perceptual (jet lag, motivation, perceived exertion, and physical feeling) measures. In addition, sleep was measured via wrist activity monitors and self-report diaries throughout the aforementioned data collection periods. RESULTS Compared with the corresponding day at BASE, the reduction in YYIR1 distance after EAST was significantly different from the increase in WEST on day 1 after travel (P < 0.001). On day 2, significantly slower 20-m sprint times were detected in EAST compared with WEST (P = 0.03), with large effect sizes (ES) also indicating a greater reduction in YYIR1 distance in EAST compared with WEST (d = 1.06). Mean sleep onset and offset were significantly later and mean time in bed and sleep duration were significantly reduced across the 4 d in EAST compared with BASE and WEST (P < 0.05). Lastly, mean jet lag, fatigue, and motivation ratings across the 4 d were significantly worse in EAST compared with BASE and WEST (P < 0.05) and WEST compared with BASE (P < 0.05). CONCLUSIONS Long-haul transmeridian travel can impede team sport physical performance. Specifically, east travel has a greater detrimental effect on sleep, subjective jet lag, fatigue, and motivation. Consequently, maximal and intermittent sprint performance is also reduced after east travel, particularly within 72 h after arrival.
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Affiliation(s)
- Peter M Fowler
- 1Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, QATAR; 2The University of Queensland, School of Human Movement and Nutrition Sciences, QLD, AUSTRALIA; 3Sport and Exercise Discipline Group, University of Technology Sydney, NSW, AUSTRALIA; 4Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, SOUTH AFRICA; 5Physiology, Australian Institute of Sport, Canberra, ACT, AUSTRALIA; and 6Appleton Institute, Central Queensland University, Adelaide, SA, AUSTRALIA
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Thornton HR, Miller J, Taylor L, Sargent C, Lastella M, Fowler PM. Impact of short- compared to long-haul international travel on the sleep and wellbeing of national wheelchair basketball athletes. J Sports Sci 2017; 36:1476-1484. [PMID: 29099652 DOI: 10.1080/02640414.2017.1398883] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Currently, very little is known about the impact of short- or long-haul air travel on the sleep and wellbeing of wheelchair basketball athletes. Eleven national wheelchair basketball athletes wore actigraphy monitors prior, during, and after air travel to the United Kingdom. Upon arrival, participants rated their subjective jet-lag, fatigue, and vigor. Individuals traveled to the United Kingdom from different locations in Australia, the United States, and Europe and were categorised according to travel length [LONG (up to 30.2 h) or SHORT (up to 6.5 h)]. Linear mixed models determined effects of travel length on sleep and subjective ratings of jet-lag, fatigue, and vigor. During competition, subjective fatigue and jet-lag were substantially higher (ES = 0.73; ±0.77) and (ES = 0.57; ±0.60), subjective vigor was lower (ES = 1.94; ±0.72), and get-up time was earlier (ES = 0.57; ±0.60) for LONG when compared to SHORT. Travelling greater distances by airplane had a larger effect on subjective ratings of jet-lag, fatigue and vigor, rather than sleep. Irrespective of travel group, sleep and subjective responses were compromised, reflecting the travel requirements, competition-mediated influences, and/or due to a change in environment.
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Affiliation(s)
- Heidi R Thornton
- a La Trobe Sport and Exercise Medicine Research Centre , La Trobe University Bundoora Campus , Melbourne , Victoria , Australia
| | - Joanna Miller
- b Australian Institute of Sport, Physiology, Bruce, Canberra, ACT , Australia
| | - Lee Taylor
- c ASPETAR, Athlete Health and Performance Research Centre , Doha , Qatar.,d School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , UK
| | - Charli Sargent
- e Central Queensland University , Appleton Institute for Behavioural Science , Wayville , SA , Australia
| | - Michele Lastella
- e Central Queensland University , Appleton Institute for Behavioural Science , Wayville , SA , Australia
| | - Peter M Fowler
- c ASPETAR, Athlete Health and Performance Research Centre , Doha , Qatar
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Fowler PM, Paul DJ, Tomazoli G, Farooq A, Akenhead R, Taylor L. Evidence of sub-optimal sleep in adolescent Middle Eastern academy soccer players which is exacerbated by sleep intermission proximal to dawn. Eur J Sport Sci 2017. [DOI: 10.1080/17461391.2017.1341553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter M. Fowler
- ASPETAR – Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar
| | - Darren J. Paul
- Football Excellence Project, ASPETAR – Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gustavo Tomazoli
- Football Excellence Project, ASPETAR – Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- ASPETAR – Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar
| | - Richard Akenhead
- Football Excellence Project, ASPETAR – Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Lee Taylor
- ASPETAR – Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Fowler PM, Miller J, Sargent C, Lastella M, Thornton H, Taylor L. Long Compared To Short Haul Travel Effects On Wheelchair Basketball Player’S Preparation For The World Championships. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517735.20352.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Fowler PM, McCall A, Jones M, Duffield R. Effects of long-haul transmeridian travel on player preparedness: Case study of a national team at the 2014 FIFA World Cup. J Sci Med Sport 2016; 20:322-327. [PMID: 28109712 DOI: 10.1016/j.jsams.2016.08.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/24/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Describe the effects of eastward long-haul transmeridian air travel on subjective jet-lag, sleep and wellness in professional football (soccer) players prior to the 2014 FIFA World Cup in Brazil. DESIGN Single cohort involving twenty-two male professional football players representing a national football team. METHODS Data was collected from players prior to and following international travel from Sydney, Australia to Vitoria, Brazil. In total there were three flights, 19-h and 14,695km of travel east across 11 time-zones. Training load and wellness measures were obtained in the week prior to and following travel, whilst sleep and jet-lag measures were collected on the day prior to travel (Pre), the day of arrival and for five days following travel (Post 1-5). RESULTS Compared to Pre, perceived jet-lag was significantly increased on Post 1 to 4, with significantly greater levels on Post 1 compared to Post 5 (p<0.05). Self-reported sleep duration during travel was 5.9 (4.8-7.0) h, which was significantly lower than all other nights (p˂0.01), except for the night of arrival, where time in bed and sleep duration were significantly reduced compared to Post 1-4 (p˂0.01). Lastly, compared to the week prior to travel, mean wellness was significantly reduced during the week following travel (p˂0.01). CONCLUSIONS Self-reported sleep disruption during and following eastward long-haul transmeridian air travel, together with exacerbated jet-lag symptoms may result in reduced player wellness. Consequently, player preparedness for subsequent training and competition may be impeded, though physical performance data is lacking.
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Affiliation(s)
- Peter M Fowler
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
| | - Alan McCall
- Sports Medicine Department, Football Federation Australia; Research and Development Department, Arsenal Football Club, United Kingdom; Research and Development Department, Edinburgh Napier University, United Kingdom
| | - Mark Jones
- Sports Medicine Department, Football Federation Australia
| | - Rob Duffield
- Sports Medicine Department, Football Federation Australia; Sport & Exercise Discipline Group, University of Technology Sydney, Australia
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Taylor L, Chrismas BCR, Dascombe B, Chamari K, Fowler PM. The Importance of Monitoring Sleep within Adolescent Athletes: Athletic, Academic, and Health Considerations. Front Physiol 2016; 7:101. [PMID: 27047387 PMCID: PMC4797717 DOI: 10.3389/fphys.2016.00101] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/02/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lee Taylor
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopedic and Sports Medicine HospitalDoha, Qatar
| | - Bryna C. R. Chrismas
- Sport Science Program, College of Arts and Sciences, Qatar UniversityDoha, Qatar
| | - Ben Dascombe
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, LaTrobe UniversityMelbourne, VIC, Australia
| | - Karim Chamari
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopedic and Sports Medicine HospitalDoha, Qatar
| | - Peter M. Fowler
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopedic and Sports Medicine HospitalDoha, Qatar
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Taylor L, Chrismas BCR, Dascombe B, Chamari K, Fowler PM. Sleep Medication and Athletic Performance-The Evidence for Practitioners and Future Research Directions. Front Physiol 2016; 7:83. [PMID: 27014084 PMCID: PMC4779957 DOI: 10.3389/fphys.2016.00083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/19/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Lee Taylor
- Qatar Orthopedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre Aspire Zone ASPETAR, Doha, Qatar
| | - Bryna C R Chrismas
- Sport Science Program, College of Arts and Sciences, Qatar University Doha, Qatar
| | - Ben Dascombe
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, LaTrobe University Melbourne, VIC, Australia
| | - Karim Chamari
- Qatar Orthopedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre Aspire Zone ASPETAR, Doha, Qatar
| | - Peter M Fowler
- Qatar Orthopedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre Aspire Zone ASPETAR, Doha, Qatar
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Fowler PM, Duffield R, Morrow I, Roach G, Vaile J. Effects of sleep hygiene and artificial bright light interventions on recovery from simulated international air travel. Eur J Appl Physiol 2014; 115:541-53. [PMID: 25387805 DOI: 10.1007/s00421-014-3043-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/28/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Peter M Fowler
- School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, 2795, Australia,
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Abstract
A randomized controlled trial was conducted to compare three forms of diabetes follow-up: (1) general practitioner care, (2) a system of care shared between the general practitioner (GP) and clinic and (3) conventional clinic care. Two hundred and six diabetic patients without significant diabetes-related or other medical complications were randomized to one of these follow-up systems. Metabolic control and blood pressure improved significantly and equally in all three groups (p < 0.05). The shared care group performed as well as or better than either of the other two groups in all other outcome measures. In particular, final attendance rates were 72% for shared care compared with only 35% for GP care and 53% for clinic care. Data collection rates for shared care were comparable with the clinic group for random blood glucose (88.9% vs 95.1%), weight (93.5% vs 98.3%), and blood pressure (94.8% vs 92.7%). Only in the case of glycosylated haemoglobin did shared care have poorer data collection (66.0% vs 98.4%). In all these parameters, except blood pressure, shared care out-performed the GP group. We conclude that with adequate support from and communication with hospital-based diabetes services, GPs are capable of providing care appropriate to the needs of uncomplicated diabetic patients.
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Affiliation(s)
- P L Hoskins
- Diabetes Centre, Royal Prince Alfred Hospital, N.S.W., Australia
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Constantino M, Hoskins PL, Fowler PM, Pech C, McFarlane R, Flack JR, Forrest J, Yue DK, Turtle JR. Interaction between diabetic patients, their general practitioners and a hospital diabetic clinic. Med J Aust 1991; 155:515-8. [PMID: 1943929 DOI: 10.5694/j.1326-5377.1991.tb93886.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN Prospective recruitment of consecutive referrals. SETTING The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.
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Affiliation(s)
- M Constantino
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW
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Abstract
It is generally accepted that people with diabetes should be encouraged to abstain from smoking but there are few data on the best strategy to implement this. In a preliminary survey of our diabetic patients, knowledge of the general and specific health effects of smoking was poor. In a prospective study of 70 diabetic smokers, only 50% agreed to participate in an anti-smoking programme, and the drop-out rate was high irrespective of whether the content of the programme was general or specific for diabetes. The enrollment rate was best 2 months after the diagnosis of diabetes and the drop-out rate was highest in patients recruited immediately following diagnosis. According to self-reported data, cigarette consumption fell after the first session of the anti-smoking programme but this could not be verified by the measurement of plasma cotinine. It is concluded that an anti-smoking counselling programme based on provision of information, within the context of a specialized diabetes centre, is not cost-effective.
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Affiliation(s)
- P M Fowler
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Yue DK, Dunn SM, Fowler PM, Pech CM, Forrest JM, Handelsman DJ, Turtle JR. The compliance of diabetic patients: relationship between subjective assessment by physicians and objective measurement of patient performance. Diabetes Res 1984; 1:39-43. [PMID: 6529883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
During a survey period of 9 months, diabetic patients attending an outpatient clinic were asked routinely by the nursing staff to produce their home urine/glucose monitoring charts and diet charts. If they could not do so, the importance of bringing these charts was explained and they were instructed to bring their charts at subsequent visits. In addition, the individual responses of 109 consecutive patients were monitored as index cases. The physicians of these 109 patients were asked to grade each patient according to their estimate of the patient's compliance. This subjective rating was correlated with the actual performance of the patients in bringing charts. During the survey the overall number of patients attending the clinic who brought urine/blood charts increased from 31% to 59%. The corresponding figures for diet charts were 6% and 21%. Before intervention, the group rated "high compliance" was more likely than the "low compliance" rated group to bring urine/glucose charts. However, after adjustment for this baseline difference the subsequent performances of the high and low rated groups were comparable. These two groups of patients also performed similarly with respect to diet charts. It is concluded that patients judged subjectively to have poor compliance were able to modify their behaviour similarly to those assessed as having good compliance.
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