Background In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. Methods We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. Results 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N ≤ 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. Conclusions The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.

Volleyball is considered a very explosive and fast-paced sport in which plyometric training is widely used. Our purpose was to review the effects of plyometric training on volleyball players’ performance. A systematic search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed, SciELO, SPORTDiscus, Medline, Scopus, Academic Search Complete, CINAHL and Web Science for articles published no later than December 2018. Any criteria were imposed for the included sample. The search focus was on interventional studies in which athletes underwent a plyometric program. To the 1831 articles found, another five were added, identified through other sources. Duplicated files were removed, titles and abstracts were screened, which left 21 remaining studies for extensive analysis. Results showed that the vertical jump (15 studies) was the major ability studied in plyometric training interventions, followed by strength (four studies), horizontal jump (four studies), flexibility (four studies) and agility/speed (three studies). In addition, it was observed that young (under 18 years old) female athletes were the most studied. The included studies indicated that plyometric training seems to increase vertical jump performance, strength, horizontal jump performance, flexibility and agility/speed in volleyball players. However, more studies are needed to better understand the benefits of plyometric training in volleyball players’ performance.

Physician–nurse task shifting in primary care appeals greatly to health policymakers. It promises to address workforce shortages and demands of high-quality, affordable care in the healthcare systems of many countries. This systematic review was conducted to assess the evidence about physician–nurse task shifting in primary care in relation to the course of disease and nurses’ roles. We searched MEDLINE, Embase, The Cochrane Library and CINAHL, up to August 2012, and the reference list of included studies and relevant reviews. All searches were updated in February 2014. We selected and critically appraised published randomized controlled trials (RCTs). Twelve RCTs comprising 22 617 randomized patients conducted mainly in Europe met the inclusion criteria. Nurse-led care was delivered mainly by nurse practitioners following structured protocols and validated instruments in most studies. Twenty-five unique disease-specific measures of the course of disease were reported in the 12 RCTs. While most (84 %) study estimates showed no significant differences between nurse-led care and physician-led care, nurses achieved better outcomes in the secondary prevention of heart disease and a greater positive effect in managing dyspepsia and at lowering cardiovascular risk in diabetic patients. The studies were generally small, of varying follow-up episodes and were at risk of biases. Descriptive details about roles, qualifications or interventions were also incomplete or not reported. Trained nurses may have the ability to achieve outcome results that are at least similar to physicians’ for managing the course of disease, when following structured protocols and validated instruments. The evidence, however, is limited by a small number of studies reporting a broad range of disease-specific outcomes; low reporting standards of interventions, roles and clinicians’ characteristics, skills and qualifications; and the quality of studies. More rigorous studies using validated tools could clarify these findings.

The aim of this study was two-fold: (i) to describe the training/match ratios of different external load measures during a full professional soccer season while analyzing the variations between different types of weeks (three, four and five training sessions/week) and (ii) to investigate the relationship between weekly accumulated training loads and the match demands of the same week. Twenty-seven professional soccer players (24.9 ± 3.5 years old) were monitored daily using a 10-Hz global positioning system with a 100-Hz accelerometer. Total distance (TD), running distance (RD), high-speed running (HSR), sprinting distance (SD), player load (PL), number of high accelerations (ACC), and number of high decelerations (DEC) were recorded during training sessions and matches. An individual training/match ratio (TMr) was calculated for each external load measure. Weeks with five training sessions (5dW) presented meaningfully greater TMr than weeks with four (4dW) or three (3dW) training sessions. Additionally, TDratio (TDr) was significantly greater in 5dW than in 3dW (mean differences dif: 1.23 arbitray units A.U.) and 4dW (dif: 0.80 A.U.); HSRr was significantly greater in 5dW than in 3dW (dif: 0.90 A.U.) and 4dW (dif: 0.68 A.U.); and SDr was significantly greater in 5dW than in 3dW (dif: 0.77 A.U.) and 4dW (dif: 0.90 A.U.). Correlations between the weekly training loads and the match demands of the same week were small for PL (r = 0.250 [0.13;0.36]), ACC (r = 0.292 [0.17;0.40]) and DEC (r = 0.236 [0.11;0.35]). This study reveals that ratios of above 1 were observed for specific measures (e.g., HSR, SD). It was also observed that training sessions are not adjusted according to weekly variations in match demands.

Vitamin B12 is often used to improve cognitive function, depressive symptoms, and fatigue. In most cases, such complaints are not associated with overt vitamin B12 deficiency or advanced neurological disorders and the effectiveness of vitamin B12 supplementation in such cases is uncertain. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) is to assess the effects of vitamin B12 alone (B12 alone), in addition to vitamin B12 and folic acid with or without vitamin B6 (B complex) on cognitive function, depressive symptoms, and idiopathic fatigue in patients without advanced neurological disorders or overt vitamin B12 deficiency. Medline, Embase, PsycInfo, Cochrane Library, and Scopus were searched. A total of 16 RCTs with 6276 participants were included. Regarding cognitive function outcomes, we found no evidence for an effect of B12 alone or B complex supplementation on any subdomain of cognitive function outcomes. Further, meta-regression showed no significant associations of treatment effects with any of the potential predictors. We also found no overall effect of vitamin supplementation on measures of depression. Further, only one study reported effects on idiopathic fatigue, and therefore, no analysis was possible. Vitamin B12 supplementation is likely ineffective for improving cognitive function and depressive symptoms in patients without advanced neurological disorders.

Background: General practitioners often care for patients with several concurrent chronic medical conditions (multimorbidity). Recent data suggest that multimorbidity might be observed more often than isolated diseases in primary care. We explored the age- and gender-related prevalence of multimorbidity and compared these estimates to the prevalence estimates of other common specific diseases found in Swiss primary care.Methods: We analyzed data from the Swiss FIRE (Family Medicine ICPC Research using Electronic Medical Record) project database, representing a total of 509,656 primary care encounters in 98,152 adult patients between January 1, 2009 and July 31, 2011. For each encounter, medical problems were encoded using the second version of the International Classification of primary Care (ICPC-2). We defined chronic health conditions using 147 pre-specified ICPC-2 codes and defined multimorbidity as 1) two or more chronic health conditions from different ICPC-2 rubrics, 2) two or more chronic health conditions from different ICPC-2 chapters, and 3) two or more medical specialties involved in patient care. We compared the prevalence estimates of multimorbidity defined by the three methodologies with the prevalence estimates of common diseases encountered in primary care.Results: Overall, the prevalence estimates of multimorbidity were similar for the three different definitions (15% [95%CI 11-18%], 13% [95%CI 10-16%], and 14% [95%CI 11-17%], respectively), and were higher than the prevalence estimates of any specific chronic health condition (hypertension, uncomplicated 9% [95%CI 7-11%], back syndrome with and without radiating pain 6% [95%CI 5-7%], non-insulin dependent diabetes mellitus 3% [95%CI 3-4%]), and degenerative joint disease 3% [95%CI 2%-4%]). The prevalence estimates of multimorbidity rose more than 20-fold with age, from 2% (95%CI 1-2%) in those aged 20–29 years, to 38% (95%CI 31-44%) in those aged 80 or more years. The prevalence estimates of multimorbidity were similar for men and women (15% vs. 14%, p=0.288).Conclusions: In primary care, prevalence estimates of multimorbidity are higher than those of isolated diseases. Among the elderly, more than one out of three patients suffer from multimorbidity. Management of multimorbidity is a principal concern in this vulnerable patient population.