Association of the Functional Movement Screen™ with match-injury burden in men's community rugby union

Evidence supporting use of the Functional Movement Screen (FMS^TM) to identify athletes' risk of injury is equivocal. Furthermore, few studies account for exposure to risk during analysis. This study investigated the association of FMS^TM performance with incidence and burden of match-injuries in adult community rugby players. 277 players performed the FMS^TM during pre-season and in-season time-loss injuries and match exposure were recorded. The associations between FMS^TM score, pain, and movement-pattern asymmetries with match-injury incidence (≥8-days time-loss/1000hours), severe match-injury incidence (>28-days time-loss/1000hours), and match-injury burden (total time-loss days/1000hours for ≥8-days match-injuries) were analysed using Poisson regression. Multivariate analysis indicated players with pain and movement-pattern asymmetry during pre-season had 2.9 times higher severe match-injury incidence (RR, 90%CI = 2.9, 0.9-9.7) and match-injury burden (RR, 90%CI = 2.9, 1.3-6.6). Players with a typically low FMS^TM score (mean - 1SD threshold) were estimated to have a 50% greater match-injury burden compared to players with a typically high FMS^TM score (mean + 1SD threshold) as match-injury burden was 10% lower per 1-unit increase in FMS^TM score. As the strongest association with injury outcome was found for players with pain and asymmetry, when implementing the FMS^TM it is advisable to prioritise these players for further assessment and subsequent treatment.

Shoulder Injuries in English Community Rugby Union

The aim of this study was to describe the incidence, severity and type of shoulder injuries resulting from match play in adult community rugby union between 2009-2013. A total of 254 time-loss shoulder injuries were reported, an overall incidence of 2.2 per 1 000 h (95% CI: 1.9 to 2.4), and a mean injury severity of 9.5 weeks missed (95% CI: 8.2 to 10.8). The semi-professional group had an incidence of 2.8 injuries per 1 000 h (95% CI: 2.2 to 3.5), which was higher than the recreational group at 1.8 injuries per 1 000 h (95% CI: 1.4 to 2.2, p=0.004). The incidence of acromioclavicular joint injury for semi-professional players was 1.2 per 1 000 h (95% CI: 0.8 to 1.6); which was significantly higher than the incidence of this injury type in recreational players (0.5 per 1 000 h 95% CI: 0.3 to 0.7, p=0.002). Overall, back row players sustained the highest incidence of all shoulder injuries for a given playing position, 2.9 injuries per 1 000 h (95% CI: 2.2 to 3.6). The tackle was the main event associated with injury. Injury prevention programs and coaching strategies that consider tackle technique and physical conditioning of the shoulder region are therefore considered important.

The efficacy of a movement control exercise programme to reduce injuries in youth rugby: a cluster randomised controlled trial

Background

Injuries to youth rugby players have become an increasingly prominent health concern, highlighting the importance of developing and implementing appropriate preventive strategies. A growing body of evidence from other youth sports has demonstrated the efficacy of targeted exercise regimens to reduce injury risk. However, studies have yet to investigate the effect of such interventions in youth contact sport populations like rugby union.

Objective

To determine the efficacy of an evidence-based movement control exercise programme compared with a sham exercise programme to reduce injury risk in youth rugby players. Exercise programme compliance between trial arms and the effect of coach attitudes on compliance will also be evaluated.

Setting

School rugby coaches in England will be the target of the researcher intervention, with the effects of the injury prevention programmes being measured in male youth players aged 14–18 years in school rugby programmes over the 2015–2016 school winter term.

Methods

A cluster-randomised controlled trial with schools randomly allocated to either a movement control exercise programme or a sham exercise programme, both of which are coach-delivered. Injury measures will derive from field-based injury surveillance, with match and training exposure and compliance recorded. A questionnaire will be used to evaluate coach attitudes, knowledge, beliefs and behaviours both prior to and on the conclusion of the study period.

Outcome measures

Summary injury measures (incidence, severity and burden) will be compared between trial arms, as will the influence of coach attitudes on compliance and injury burden. Additionally, changes in these outcomes through using the exercise programmes will be evaluated.

Trial registration number

ISRTCNN13422001.

Simultaneous irradiation of the breast and regional lymph nodes in prone position using helical tomotherapy

OBJECTIVE

We investigated dosimetric advantages of using helical tomotherapy to simultaneously irradiate the breast and regional lymph nodes for patients positioned prone, and compared tomotherapy plan qualities for the prone position with those previously published for the supine position.

METHODS

Tomotherapy plans for 11 patients (5 left breast, 6 right) simulated with the involved breast suspended downward were generated. Each target (ipsilateral breast and supraclavicular, axillary and internal mammary chain nodes) was to receive 45 Gy.

RESULTS

For targets, V(40.5)≥99.9% and V(42.8)≥99.5% for all patients, where V(40.5) and V(42.8) denote the relative target volume receiving at least 40.5 and 42.8 Gy, respectively. The targets' maximum dose was, on average, approximately 49.5 Gy. The mean doses to the contralateral lung and heart were lower for right-breast cases (2.8 Gy lung, 2.7 Gy heart) than for left-breast cases (3.8 Gy lung, 8.7 Gy heart). Mean organ doses to the ipsilateral lung (9.3 Gy) and contralateral breast (2.3 Gy) from the prone breast tomotherapy plans were similar to those reported for conventional radiotherapy techniques. For the left breast with regional nodes, tomotherapy plans for prone-positioned patients yielded lower mean doses to the contralateral breast and heart than previously reported data for tomotherapy plans for supine-positioned patients.

CONCLUSION

Helical tomotherapy with prone breast positioning can simultaneously cover the breast and regional nodes with acceptable uniformity and can provide reduced mean dose to proximal organs at risk compared with tomotherapy with supine position. The similarity of plan quality to existing data for conventional breast radiotherapy indicates that this planning approach is appropriate, and that the risk of secondary tumour formation should not be significantly greater.

The case for early treatment of dislocations of the cervical spine with cord involvement sustained playing rugby

The most common injury in rugby resulting in spinal cord injury (SCI) is cervical facet dislocation. We report on the outcome of a series of 57 patients with acute SCI and facet dislocation sustained when playing rugby and treated by reduction between 1988 and 2000 in Conradie Hospital, Cape Town. A total of 32 patients were completely paralysed at the time of reduction. Of these 32, eight were reduced within four hours of injury and five of them made a full recovery. Of the remaining 24 who were reduced after four hours of injury, none made a full recovery and only one made a partial recovery that was useful. Our results suggest that low-velocity trauma causing SCI, such as might occur in a rugby accident, presents an opportunity for secondary prevention of permanent SCI. In these cases the permanent damage appears to result from secondary injury, rather than primary mechanical spinal cord damage. In common with other central nervous system injuries where ischaemia determines the outcome, the time from injury to reduction, and hence reperfusion, is probably important.

In order to prevent permanent neurological damage after rugby injuries, cervical facet dislocations should probably be reduced within four hours of injury.

Repeat 90Y-microsphere radioembolization for hepatic malignancies: Safety and patient selection issues

15177

Background: Liver tolerance to reirradiation with multiple doses of 90Y-microspheres is not known. Many patients (pts) have also received external beam radiotherapy to the liver or through the liver and are surviving long enough to be considered for a second and third liver treatments with internal radiation. Methods: The experience of a single center treating liver tumors with resin 90Y-microspheres was used. Pts that received liver radiation prior to or after resin microsphere therapy were studied. Endpoints were toxicity, tumor response, disease type, latency period between radiation treatments, shunting to lung, and effects on liver volume and function. The delivery activity of microspheres selected was not reduced below that which was typically chosen for patients without prior liver radiation which was 25% reduced from the manufacturer’s BSA dose calculation method. All patients received bilobar microsphere delivery during a single session. Results: A total of 40 pts were identified; 14 women, 26 men, treated 6/2003 to 12/2006, with 35 pts receiving 2 courses and 5 pts with 3 courses of liver radiation. Retreatment with resin microspheres 26 pts, prior external beam radiation in 7 pts, prior glass microspheres in 2pts, prior systemic radiotherapy in 2 pts, and prior stereotactic liver radiation in 1 pt. Liver function was stable and adequate in all patients after additional liver radiation, and no pts developed radiation-induced liver dysfunction (RILD) or veno-occlusive disease (VOD). The percentage of shunting to the lung decreased with retreatment. Tumors treated: 14 carcinoid, 11 colorectal, 6 hepatocellular and cholangiocarcinoma, 2 sarcoma, 3 unknown primary, 1 each of breast, esophagus, and head and neck primaries. Conclusions: Repeated radiation to the liver with 90Y-microspheres appears safe in patients that have sufficient normal liver function and reserve based on known laboratory parameters already used for selection of microsphere therapy. No acute life-threatening, fatal, or late liver damage was observed, i.e. RILD or VOD. No specific dose reduction is recommended for retreatment of the liver.

No significant financial relationships to disclose.

Using intranasal lidocaine to reduce food intake

OBJECTIVE

Develop a dose-response curve for the effect of intranasal lidocaine on food intake.

DESIGN

Healthy obese subjects had food intake, ratings of hunger, desire to eat, craving and fullness measured at lunch after an overnight fast. Four treatments were given as nose drops (0.5-0.6 ml per nostril) 5 min before the meal in a double-blind manner with a four period crossover design including a 7-day washout between periods. The treatments were saline, 2.5, 10 and 25 mg lidocaine per nostril. The order of administration was randomly assigned to each subject. Electrocardiograms, vital signs, chemistry panels, complete blood counts (CBC) and nasal inspections were carried out before and after each dose.

SUBJECTS

Forty-seven subjects were screened, 34 were randomized and 20 subjects completed all four study periods in the trial. The subjects were 39+/-12.5 (s.d) years of age, had a weight of 91+/-13.0 kg, a height of 167+/-10.3 cm, 56% were women, 47% were African-American and 53% were Caucasian.

MEASUREMENTS

Food intake, rating of hunger, desire to eat, craving and fullness are measures of efficacy. Adverse events, electrocardiograms, vital signs, chemistry panels, nasal inspections, CBC and physical exams are measures of safety.

RESULTS

The mean reduction in food intake vs saline control in the 20 subjects completing all four study periods was 3.3+/-7% (s.d), 4.2+/-8.5% and 7.4+/-7.3% in the 2.5 mg, 10 and 25 mg per nostril groups, respectively (P=NS). Hunger and desire to eat in subjects who completed at least one study period decreased dose dependently (P<0.03, at the 25 mg per nostril dose). There were no clinically significant changes in safety measures, electrocardiograms, vital signs, chemistry panels, CBC or nasal inspections.

CONCLUSION

Intranasal lidocaine reduced hunger and the desire to eat, but this did not translate into a significant reduction in food intake suggesting that intranasal lidocaine will not have value in treating obesity.

Analysis of nurse conversation: methodology of the process recording

Analysis of nurse conversation: methodology of the process recording The study explored elements of effective nurse-client interaction between a nurse and a nursing home resident on the third day of the client's recovery from surgery. The interaction was recorded from memory in the form of a process recording then divided into unique conversation segments. Two nurses independently used seven typologies to classify segments of the conversation. Cohen's coefficient kappa for inter-rater reliability of the classifications was 0.98. Findings from the study revealed that two-thirds of the nurse's conversation was effective and consistent with the orientation phase of the nurse-client relationship. The nurse communicated her role through the provision of leadership, resources and help, and technical expertise. Her approaches were rather evenly divided between making requests, giving information, and affirming the client's experience. One-third of the conversation was oriented toward assessment and diagnosis, one half toward treatment of the client's experiences, and the rest toward planning and evaluation. Themes identified in the client's conversation included issues of dependency, disorientation to time, unresolved grief, separation anxiety, and the client's need for validation. These findings are valuable for illuminating the contribution that nurse conversation makes to evidence-based clinical practices. They also have implications for further refinements in the use of the process record and multiple coding schemes for the study of the nurse-client relationship.

Commentary. Balancing sedation and analgesia in the critically ill

The authors have presented a template for a systematic approach to comforting critically ill patients that can be modified to suit institutional preferences. In this algorithm, the cause of patient discomfort is sought with the priority given to pain and then to anxiety. Special attention is directed to the identification of correctable causes of pain and anxiety with application of nonpharmacologic techniques or medications to control patient discomfort. This step is followed by subsequent reassessment of the need for sedation or anxiolysis and titration or discontinuation of therapy as able. The benefits of protocol-driven care are becoming increasingly evident, and the authors believe the algorithm outlined here provides a rational and practical approach to patient management. It also prompts the caregiver to reevaluate patients' needs and to keep to patients at target sedation levels. Doing so can promote cost effectiveness, reduce side effects caused by drugs, and decrease morbidity and ICU stay. Any treatment protocol or algorithm is simply a guide to therapy and cannot address every clinical situation. The importance of individualized care and physician or care team judgment must be emphasized.

Morphological diversity of dying cells during regression of the human tail

During normal human development a number of transient structures form and subsequently regress completely. One of the most prominent structures that regress during development is the human tail. We report here a histological and ultrastructural study of cell death in the cranial and caudal (tail) parts of the neural tube in 4 to 6-week-old human embryos. Initially, the human tail is composed of tail bud mesenchyme which differentiates into caudal somites, secondary neural tube, notochord and tail gut. Later on, these structures gradually regress by cell death. During the investigated period, we observed two morphologically distinct types of dying cells. The well-described apoptotic type of cell death was observed only in the cranial neural tube that forms during primary neurulation. The other type of cell death characterized by necrotic morphology was observed in the tail mesenchyme and in the caudal neural tube that forms during secondary neurulation. This morphological diversity suggests that besides differences in origin and fate there are different mechanisms of developmental cell death between two parts of the human neural tube. We can speculate that the apoptotic type of cell death is associated with the precise control of cell numbers and that the other morphologically distinct type of cell death is responsible for the massive removal of transitory structures.

The carotid artery as alternative access for endoluminal aortic aneurysm repair

Endograft treatment of aortic aneurysms has become a common procedure in many centers. However, not all patients are candidates for this new technology, because of their vascular anatomy and device limitations. One common problem is iliofemoral occlusive disease, which when present, even in a moderate degree, may preclude introduction of the large-diameter delivery devices currently in use. We present a case of a high-risk male patient with a thoracic aortic aneurysm and severe occlusive disease of the iliac arteries. An alternative approach for device delivery through the carotid artery was used and the procedure was successful with no neurologic complications. We recommend this technique for highly selected patients with an aneurysm who can undergo tube endograft repair without feasible access through the iliac or femoral arteries.

Self-coherence, emotional arousal and perceived health of adult children caring for a brain-impaired parent

An important concern for nurses is the ability of adult children to provide effective care to a dependent parent without sacrificing their own health and well-being. The purpose of the study was to examine 'sense of self-coherence' as an inner resource for the attenuation of distress in a sample of 168 adult children who were involved with the care of a brain-impaired parent. Subjects were interviewed twice in their homes in order to obtain data on variables for: self-coherence, emotional arousal, perceived health, and crisis. Findings from the study indicate that adult children with crisis experience in the previous 6 months of caregiving had higher scores for emotional arousal, lower scores for self-coherence, and lower ratings of perceived health than did adult children with no crisis experience. In addition, there was a negative relationship between self-coherence and emotional arousal and a positive relationship between self-coherence and perceived health. Both of these relationships were significantly stronger in the presence of crisis experience than in the absence of crisis experience. Finally, there was a negative relationship between emotional arousal and perceived health that was equally apparent in both the presence and absence of crisis experience. The findings suggest that self-coherence is an inner resource that emerges in filial crisis to modulate the emotional impact of the situation. The implication is that measures of self-coherence could be used to assess an adult child's preparedness to appraise and cope with emotional responses to filial crisis events. This information could help nurses anticipate and target resources for vulnerable adult children so that they are less adversely affected by the demands of parent care.

Theoretical and psychometric analysis of caregiver strain

The purpose of the study was to establish the validity and reliability of an instrument for the measurement of caregiver strain, the Parent Caregiver Strain Questionnaire (PCSQ), with data from 283 adult children who were providing care to a neurologically impaired patient. Principal axis factor analysis of data rotated to an oblimin solution revealed five well-defined, first-order factors that explained 59% of the total variance in caregiver strain. The five-factors were interrelated with caregiver strain as theoretically predicted. Coefficient alphas for the five factors were in the range from .74 to .93. The findings provide beginning evidence of the adequacy of the PCSQ, and favor continued investigation into the theoretical and psychometric properties of the instrument.

Salutogenic psychosocial nursing practice

Public affirmation of core principles for relating with clients is needed in order to assure continued viability of quality nursing practice in this era of competition and managed health care. Practitioners of professional nursing can reassert their legitimate claim to quality nursing care through an emphasis on the practice of salutogenic psychosocial nursing. The presumption is that clients, families, and communities who benefit from salutogenic nursing care are more likely to heal and stay well because they have developed competencies for managing the details of their health situations. This paper presents key characteristics of salutogenic psychosocial nursing, along with their implications for assuring quality nursing practice.

Sense of relatedness and interpersonal network of adult offspring caregivers: linkages with crisis, emotional arousal, and perceived health

A descriptive correlational design was used to explore factors that influence the well-being of 168 adult offspring who were caring for a dependent parent. Subjects were queried about their health, relationships within their interpersonal networks, and experiences with crisis in the previous 6 months of caregiving. The findings suggest that although relatedness and interface with an interpersonal network are interrelated with one another in both crisis and noncrisis situations, relatedness appears to be more important for adult offsprings' sense of well-being in the presence of crisis than in the absence of crisis. In contrast, adult offsprings' interface with an interpersonal environment appears to be more important for their sense of well-being in the absence of crisis than in the presence of crisis. The results have implications for ways in which nurses can help adult offspring sustain the will and strength to thrive in the role of filial caregiver.

Content domain for caregiver planning identified by adult offspring caregivers

The purpose of the study was to generate a description of caregiver planning and explain how the concept advanced knowledge of lay caregiver decision-making. Nearly 2,000 decisions of 168 adult offspring caregivers were classified into one of 12 categories using an a priori taxonomic structure for caregiver planning. Coefficient kappas for intra- and inter-rater reliability of the classifications ranged from .97 to .81. The computer program, Ethnograph, and existence theory then were used to organize the classifications in a more detailed manner given the a priori taxonomic structure. Findings from the study showed that the content of the subjects' decisions produced a relatively detailed, complete, and reliable description of caregiver planning. This information can help nurses and lay caregivers to further develop an ongoing pattern of decision-making about caregiving.

Effects of variations in flow on aortic valve area in aortic stenosis based on in vivo planimetry of aortic valve area by multiplane transesophageal echocardiography

This study provides evidence that acute changes in stroke volume and cardiac output do not result in significant alterations in the anatomic AVA measured with multiplane TEE in patients with AS of moderate or severe degree. Thus, TEE could be useful in the assessment of severity of AS in both low- and high-output states.

Validation of an enzyme immunoassay for serodiagnosis of acute Q fever

An enzyme immunoassay was validated for the serodiagnosis of acute Q fever. Minimum positive tests were determined for both serial dilutions and a single dilution of patient sera. To establish the specificity of the test, 152 serum samples were tested from individuals with no evidence of past Coxiella burnetii infection. Diagnostic titers were set at > or = 128 for the IgM and IgG responses to phase I, at > or = 512 for the IgM response to phase II and at > or = 1,024 for the IgG response to phase II Coxiella burnetii. These titers gave a false-positive rate of < or = 1%. Alternatively, testing a single dilution of sera (1:128) gave specificities ranging from 97.3 to 98.7%. Tests with the greatest sensitivities, using serially diluted early convalescent-phase sera, were the IgM (84%) and IgG (80%) responses to phase II Coxiella burnetii. At a single serum dilution, 92% of early convalescent sera had a positive IgG response to phase II Coxiella burnetii. With a high specificity and good sensitivity, the EIA can be used to diagnose acute Q fever with a single convalescent serum specimen. The duration of a positive response was greater than five years.

Crisis and the filial caregiving situation of African American adult offspring

Although there is emerging knowledge about caregiver strain and health, little is known about this linkage from the perspective of African Americans who care for a demented parent. A two-group comparison design was used to examine the caregiving situation and experience of crisis in a preliminary sample of 38 African American adult offspring. Findings showed that subjects spent an average of 4 hours a day on parent care in the previous 6 months, and reported significant caregiver strain. The 17 subjects with crisis experience reported greater caregiver strain in the form of exhaustion and emotional arousal when compared with those who reported no crisis experience (n = 21). They were more likely to associate feelings of uncertainty and a low sense of mastery with the crisis experience and to associate feelings of frustration and confinement with lower ratings of perceived health. In addition, these subjects associated their distress in the caregiving situation with their health, childhood experiences, family strains, and death. The findings are evidence that distressed African American adult offspring with high caregiver burden and low health ratings can be at risk for failing to thrive in their situation and may need critical supportive care.

Outcome of pregnancy in diabetic women in Soweto, South Africa 1983-1992

A specialized service for pregnant diabetic women of African ethnic origin from Soweto was introduced in May 1983 at Baragwanath Hospital. Modern methods of management were used, including home blood glucose monitoring. A total of 354 pregnancies (147 gestational, 207 pregestational) were managed over an 8 1/2 year period. All but 12 women were treated with insulin. Mean capillary blood glucose (+/- SD) ranged from 5.8 +/- 0.8 mmol l-1 in the insulin-dependent group to 6.2 mmol l-1 in the gestational group (p < 0.01). Although maternal hypoglycaemia was common (14.4%) in the insulin-dependent patients, no ill effects were noted. The highest Caesarean section rate was in the gestational group (56%), the lowest in the insulin-dependent group (39.8%) (p < 0.01). Mean (+/- SD) neonatal weights were similar in the insulin-dependent and non-insulin-dependent groups (3131 +/- 627.9 g and 3236 +/- 674.3 g resp. p = NS); offspring of the gestational group were heavier than the insulin-dependent group (3384.4 +/- 657.5 g) (p < 0.01). Neonatal hypoglycaemia occurred in less than 5% of offspring overall. The combined perinatal mortality was 6.1%, stillbirths accounting for the majority (63.6%) of deaths. Major congenital abnormalities occurred in 6(1.7%) of the offspring. The perinatal mortality of the 'control' group of 146 women was 26.1%. Glucose intolerance persisted in at least 34.7% of gestational diabetic women postpartum. This study suggests that a specialized service for pregnant diabetic women from a Third World community can be implemented with good effect and limited expense. Late presentation of pregestational diabetic women is a problem.

Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe

Multiplane transesophageal echocardiography is a new exciting development in echocardiography. We examined the methodology and echo-anatomic correlations of multiplane transesophageal echocardiography and its clinical applications in 100 patients. We used a 5-MHz phased array multiplane (OmniPlane) transesophageal probe. In this instrument, the transducer array can be steered through 180 degrees from any transducer location. This provides a vast assembly of imaging planes, allowing for detailed visualization of all dimensions of cardiac anatomy. This report presents our observations on the echocardiographic anatomy seen in various image planes and the unique clinical potential of multiplane transesophageal echocardiography in the diagnostic assessment of cardiovascular disorders. This technique appears to provide incremental diagnostic information that enhances the interpretative ability. Less esophageal probe manipulation is required with consequent decrease in patient discomfort. We conclude that multiplane transesophageal echocardiography enhances the versatility of transesophageal examination and offers many new avenues for developments such as three-dimensional echocardiography.

Measurement of thyroid size by ultrasound, palpation and scintiscan

Thyroid gland size was calculated from grey-scale ultrasound images in twenty patients with goitre. Results were compared with measurements by palpation and in some cases with measurements by scintiscan and at operation. There was a good correlation between ultrasound measurements and both the size of surgical specimens and clinicians' estimations, although clinicians under-estimated the size of large (greater than 40 ml) goitres compared with ultrasound and surgical specimens. Gland size calculated from scintiscan did not correspond well with measurements by ultrasound or palpation.

Ultrasonography in the diagnosis of a cystic hygroma

The use of ultrasonography in the diagnosis of soft tissue lesions is described and exemplified in a 33-year-old female with a cystic hygroma in the submandibular region.