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Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women.

BACKGROUND: To study the effects of resistance training on muscle strength and size in older people, we enrolled 8 men and 17 women (mean age 68.2 +/- 1 SEM) into a one-year exercise trial. METHODS: Subjects were randomly assigned to exercise or control groups. Muscle biopsies were obtained from 11 subjects (8 exercisers/3 controls) at baseline and after 15 weeks; exercisers underwent another biopsy at 30 weeks. After testing maximum strength using the 1-RM method, the exercisers began a 12-exercise circuit (3 sets of 8 repetitions at 75% of 1-RM), 3 times a week. The controls repeated the strength testing every 15 weeks. They were asked to continue usual activities and not to start any exercise program. RESULTS: With exercise, muscle strength increased, average increases ranging from 30% (hip extensors) to 97% (hip flexors). Strength increased rapidly over 3 months, then plateaued for the duration of the experiment. No strength changes were observed in sedentary controls. Cross-sectional area of type 1 muscle fibers increased in exercisers by 15 weeks (29.4 +/- 1%, p < .02) and after 30 weeks (58.5 +/- 13.7%, p < .002) compared to baseline. Type 2 fiber area did not change at 15 weeks, but increased by 30 weeks of training (66.6 +/- 9.5%, p < .0002). CONCLUSIONS: These results suggest that prolonged moderate to high intensity resistance training may be carried out by healthy older adults with reasonable compliance, and that such training leads to sustained increases in muscle strength. These improvements are rapidly achieved and are accompanied by hypertrophy of both type 1 and type 2 muscle fibers.

Aged↗

Restoration of competency to stand trial: a training program for persons with mental retardation.

This article describes the development and use of a formal training tool for restoration of competency in clients with mental retardation who are incompetent to stand trial. The program was developed at Eleanor Slater Hospital within the Rhode Island Department of Mental Health, Retardation and Hospitals. This article describes the development of The Slater Method, the training tool format, the procedure for use of the Slater Method, and the duration of treatment to restore competency to stand trial in clients with mental retardation. Although the developmentally disabled population is not limited to persons with mental retardation, we have used the phrase mental retardation instead of developmentally disabled because the judicial system more commonly uses mental retardation.

Crime↗

Teaching occupational and environmental medicine in primary care residency training programs: experience using three approaches during 1984-1991.

There is a critical shortage of physicians trained to recognize and treat occupational and environmental health problems. We implemented several required teaching programs for internal medicine and family medicine residents that focus on providing primary care for these problems. Clinical experiences were developed using the university and medical center as an example of a workplace with chemical and physical hazards. On-site experiences were also provided at local industries, but when resident stipend support for this aspect was discontinued, that part of the program was suspended. Didactic programs were associated with a statistically significant improvement in house staff knowledge scores. These occupational and environmental health issues can be introduced during residency, resulting in increased expertise in this discipline.

Curriculum↗

Successful treatment of malignant neurocardiogenic syncope with repeated tilt training program.

Recent reports have shown that repeated tilt-table testing or tilt training is a very effective therapy for the treatment of neurocardiogenic syncope induced by head-up tilt testing. The present patient experienced repeated syncopal or presyncopal attacks and had shown prolonged asystole on an electrocardiogram during syncope. The presyncope could be reproducibly induced by head-up tilt testing. Oral propranolol and/or disopyramide therapies failed to prevent his symptoms. Tilt training (2 sessions/day) was repeated every day for 4 weeks at home, and then head-up tilt testing was performed again. The syncope or presyncope was not induced by head-up tilt testing. The patient has continued with this training and has had no symptoms during the follow-up period of 1 year.

Electrocardiography↗

Resident training in neurosurgical oncology: results of the survey of North American training programs by the AANS/CNS Section on Tumors.

OBJECTIVE: The AANS/CNS Section on Tumors is involved in the education of practitioners managing patients with tumors involving the nervous system. We report the results of a survey commissioned by this body to investigate how neurosurgical residents are trained in the neurosurgical oncology subspecialty. METHODS: One hundred six North American training centers were anonymously surveyed regarding faculty background; resident rotations, research opportunities, and caseload; and post-graduate neuro-oncology-related activities. Additionally, the AANS membership database was searched to quantify self-identified neuro-oncologists. RESULTS: Forty-four of 106 (41.5%) programs responded to the survey. Over 90% of responding programs have a faculty member specializing in neurosurgical oncology. Neurosurgical oncology fellowships or dedicated neuro-oncology resident rotation were found only in a small number of programs. Most residency programs support resident research, including exposure to brain tumor clinical trials. Twenty-nine (66%) programs reported their residents are exposed to >100 surgical cases of primary brain tumors. Twenty (46%) programs reported their residents are exposed to <50 skull base tumors. Thirty (70%) programs reported their resident would be exposed to <50 spine and peripheral nerve tumor cases. Half of the responding programs indicated that graduates of their programs had taken faculty positions focusing on neurosurgical oncology. Fifty-two members of the tumor section are in leadership positions for their given residency programs. CONCLUSIONS: Neuro-surgical oncology training appears to be strong at the programs that responded to our survey. However, resident training in neurosurgical oncology can be improved and residents with interests in this subspecialty need support to further this field.

Clinical Competence↗

Establishment of a laparoscopic cholecystectomy training program.

A recently developed alternative to traditional laparotomy and cholecystectomy is laparoscopic-guided cholecystectomy. This procedure has the advantages of reduced hospital stay, early return to work, diminished abdominal wall scarring, and less patient discomfort. The complex nature of this procedure and the current lack of extensive clinical experience preclude the traditional "hands-on" training normally practiced in surgical residency programs. At the University of Maryland, we have developed a program to instruct both surgeons and surgical residents in the techniques of laparoscopic surgery. Technical competence is achieved under the close supervision and guidance of an experienced laparoscopic surgeon. Training of residents in this procedure, therefore, is not very different than that for other general surgical procedures. Surgeons already in clinical practice, however, gain experience under somewhat different circumstances. Initial training involves didactic instruction through laparoscopic surgical atlases and educational videotapes. Further training uses a simulation device which enables the trainee to practice techniques of laparoscopic suturing, knot-tying, and clip application. Actual operative experience is acquired primarily in experimental animal preparations. Laparoscopic-guided removal of the gallbladder is performed in young swine (20-25 kg) under conditions that mimic those in the operating room. Further clinical experience can be acquired by assisting on several laparoscopic operations, usually involving diagnostic or pelvic procedures. Actual operative experience with laparoscopic cholecystectomy, of course, comprises the final phase of the educational program. The introduction of clinical laparoscopic training into general surgery residency programs should influence the widespread adoption of this new procedure.

Cholecystectomy↗

Stapedectomy results in a residency training program.

As the total number of stapedectomy procedures has declined, the adequacy of residency training for this procedure must be evaluated. Results of 5 years of stapedectomies performed by the resident otology service at the Massachusetts Eye and Ear Infirmary from Oct 1, 1979, through Sept 30, 1984, are reviewed and compared with other published results. A suggestion is made for improving the residency teaching program.

Adolescent↗

Computer skills enhance a hospital pharmacy residency training program.

Hospital pharmacy residents participated in a program designed to introduce them to computer systems useful in pharmacy practice and to provide them with access to a variety of computer resources that could be helpful in completing their residency projects. Using existing computer facilities, various short courses and individual tutorials were employed to train residents in a variety of computer skills. These courses provided a useful vehicle for recent pharmacist graduates to acquire necessary computer skills not obtained during their academic training. Because the program provided residents with the tools needed for the management and analysis of large data sets, a marked increase occurred in the number of residency projects acceptable for publication in peer-reviewed pharmacy journals. Thus, residency projects improved in quality and faculty preceptors were more motivated to get involved in such projects.

Computers↗