Δευτέρα, 3 Σεπτεμβρίου 2018

Pain Management in Athletes With Impairment: A Narrative Review of Management Strategies

imageObjective: To review the literature related to different treatment strategies for the general population of individuals with amputation, spinal cord injury, and cerebral palsy, as well as how this may impact pain management in a correlated athlete population. Data Sources: A comprehensive literature search was performed linking pain with terms related to different impairment types. Main Results: There is a paucity in the literature relating to treatment of pain in athletes with impairment; however, it is possible that the treatment strategies used in the general population of individuals with impairment may be translated to the athlete population. There are a wide variety of treatment options including both pharmacological and nonpharmacological treatments which may be applicable in the athlete. Conclusions: It is the role of the physician to determine which strategy of the possible treatment options will best facilitate the management of pain in the individual athlete in a sport-specific setting.

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“Deromanticising” the Image of Pain in Athletes

No abstract available

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Analgesic Management of Pain in Elite Athletes: A Systematic Review

imageObjective: To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes. Design: Systematic literature review. Data Sources: Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus. Eligibility Criteria for Selecting Studies: Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded. Main Results: Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared. Conclusions: Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.

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Cannabis and the Health and Performance of the Elite Athlete

imageObjective: Cannabis (marijuana) is undergoing extensive regulatory review in many global jurisdictions for medical and nonmedical access. Cannabis has potential impact on the health of athletes as well as on performance in both training and in competition. The aim of this general review is to identify and highlight the challenges in interpreting information with respect to elite athletic performance, and to point to important research areas that need to be addressed. Data Sources: A nonsystematic literature review was conducted using Medline and PubMed for articles related to cannabis/marijuana use and sports/athletic performance; abstracts were reviewed by lead author and key themes identified and explored. Main Results: Cannabis may be primarily inhaled or ingested orally for a range of medical and nonmedical reasons; evidence for efficacy is limited but promising for chronic pain management. Although evidence for serious harms from cannabis use on health of athletes is limited, one should be cognizant of the potential for abuse and mental health issues. Although the prevalence of cannabis use among elite athletes is not well-known, use is associated with certain high-risk sports. There is no evidence for cannabis use as a performance-enhancing drug. Conclusions: Medical and nonmedical cannabis use among athletes reflects changing societal and cultural norms and experiences. Although cannabis use is more prevalent in some athletes engaged in high-risk sports, there is no direct evidence of performance-enhancing effects in athletes. The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.

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Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants—SAFER Study VI

imageObjective: Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. Design: Cross-sectional study. Setting: 21.1-km and 56-km races. Participants: Seventy-six thousand six hundred fifty-four race entrants. Methods: Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. Main Outcome Measures: Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. Results: Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P

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Injectable Corticosteroids in Sport

imageObjective: To review the literature guiding all aspects of the use of injectable corticosteroids for painful musculoskeletal conditions, with a focus on the treatment of athletes. Data Sources: An extensive search of the literature was completed including search terms of corticosteroid, steroid, athlete, and injection, among others. Additional articles were used after being identified from previously reviewed articles. Main Results: Injections of corticosteroids for a variety of painful conditions of the extremities and the axial spine have been described. Numerous minor and major complications have been reported, including those with a high degree of morbidity. There is a dearth of published research on the use of corticosteroid injections in athletes, with most of the research on this topic focused on older, nonathlete populations. Generally, these injections are well tolerated and can provide short-term pain improvement with little or no long-term benefits. Conclusions: Corticosteroid injections should be used cautiously in athletes and only after a full consideration of the pharmacology, pathogenesis of disease, potential benefits, complications, factors specific to the athlete, and rules of athletic governing bodies. Corticosteroid injections are just one component of a comprehensive rehabilitation plan available to the physician providing care to athletes.

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Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications

imageObjective: To assess and evaluate the long-term safety of local anesthetic injections before or during games in professional rugby league players. Design: Retrospective case series. Setting: Professional rugby league team. Participants: Sydney Roosters players over a 6-year period (2008-2013), who had been administered a local anesthetic injection for an injury before or during a match to aid return to play. Interventions: Follow-up survey (no active intervention). Main Outcome Measures: Player self-reported satisfaction. Survey results were compared with a previous cohort who had received local anesthetic injection from 1998 to 2007. Results: Thirty-two players who had been injected with local anesthetic on 249 occasions for 81 injuries completed the current survey at an average of 5.64 years postinjection. In the cohort of 2008 to 2013, fewer injections were performed to areas deemed higher risk compared with the 1998 to 2007 cohort (P

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Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations

imageAbstract: Persistent pain is common in elite athletes. The current review arose from a consensus initiative by the International Olympic Committee to advance the development of a standardized, scientific, and evidence-informed approach to management. We suggest that optimal management of persistent pain in elite athletes requires an understanding of contemporary pain science, including the rationale behind and implementation of a biopsychosocial approach to care. We argue that athletes and clinicians need to understand the biopsychosocial model because it applies to both pain and the impact of pain with special reference to the sport setting. Management relies on thorough and precise assessment that considers contributing factors across nociceptive, inflammatory, neuropathic, and centrally acting domains; these can include contextual and psychosocial factors. Pain management seeks to remove contributing factors wherever possible through targeted education; adjustment of mechanical loading, training, and performance schedules; psychological therapies; and management of inflammation.

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Injectable Nonsteroidal Anti-Inflammatory Drugs in Sport

imageObjective: The primary objective of this article is to review the basic science of nonsteroidal anti-inflammatory drugs (NSAIDs), their clinical effects, indications, potential complications, and ethical issues associated with the use of injectable NSAIDs in the treatment of athletes. These objectives are presented taking into consideration the contemporaneous issues associated with the treatment of amateur and professional athletes. Data Sources: A nonformal review of the published medical literature and lay media focusing on the use of injectable NSAIDs in athletes was used for this article. Main Results: All NSAIDs work through the inhibition of the cyclooxygenase (COX) pathway (either one or both subtypes) to reduce inflammation and inhibit pain by reducing prostaglandin and thromboxane synthesis. Complications related to NSAID use involve primarily the gastrointestinal, renal, and cardiovascular systems through this COX pathway inhibition. Ketorolac is the only NSAID currently available in an injectable form. Despite its analgesic efficacy comparable with opioid medication, injectable ketorolac has the potential to cause bleeding in collision athletes resulting from impaired hemostasis. Conclusions: Nonsteroidal anti-inflammatory drug medications are currently used at every level of competition. Injectable ketorolac is an effective analgesic and anti-inflammatory drug. However, its potential effectiveness must be weighed against the risk of potential complications in all athletes, especially those who participate in contact/collision sports. The team physician must balance the goal of treating pain and inflammation with the ethical implications and medical considerations inherent in the administration of injectable medications solely to prevent pain and/or return the athlete to competition.

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Management of Pain in Elite Athletes: Identified Gaps in Knowledge and Future Research Directions

Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

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Myocontrol is closed-loop control: incidental feedback is sufficient for scaling the prosthesis force in routine grasping

Sensory feedback is critical for grasping in able-bodied subjects. Consequently, closing the loop in upper-limb prosthetics by providing artificial sensory feedback to the amputee is expected to improve the pr...

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Placebos mit Heilkraft? Placeboeffekt und -einsatz in der (Schmerz-)Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 574-578
DOI: 10.1055/a-0636-1776



Georg Thieme Verlag KG Stuttgart · New York

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Knieendoprothetik: Adduktorenkanalblockade oder lokale Infiltrationsanalgesie?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 567-568
DOI: 10.1055/a-0668-3904



Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Grundlagen und Praxis der Neuroanästhesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 618-630
DOI: 10.1055/s-0043-111004

Zentrale Aspekte der Anästhesieführung bei neurochirurgischen Operationen sind das Aufrechterhalten der zerebralen Homöostase sowie die Vermeidung sekundärer Hirnschäden. Die wichtigsten Variablen sind zerebraler Metabolismus, zerebraler Blutfluss, zerebraler Perfusionsdruck, zerebrales Blutvolumen und ihr Einfluss auf den intrakraniellen Druck. Die Ausgewogenheit dieser Faktoren ist Ziel bei jeder neurochirurgischen Operation oder Intervention.
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Georg Thieme Verlag KG Stuttgart · New York

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Musikermedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 568-569
DOI: 10.1055/a-0668-3886



Georg Thieme Verlag KG Stuttgart · New York

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Placebo-Nocebo-Ethik für die Patientenkommunikation

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 592-604
DOI: 10.1055/s-0043-121685

Die Patientenaufklärung ist „täglich Brot" des klinisch tätigen Anästhesisten und gleichzeitig ein zentrales Rechtfertigungselement medizinischer Behandlungsmaßnahmen. Durch Auslösen von Placebo- und Noceboeffekten kann sie den Behandlungserfolg aber auch selbst maßgeblich beeinflussen. Einem daraus drohenden Konflikt verschiedener medizinethischer Prinzipien kann mit entsprechenden praktischen Strategien wirksam begegnet werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Tiefe Relaxierung kann laparoskopische Eingriffe erleichtern

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 568-568
DOI: 10.1055/a-0668-3958



Georg Thieme Verlag KG Stuttgart · New York

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Weiterbildung in der Anästhesie nach Novellierung der Musterweiterbildungsordnung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 635-638
DOI: 10.1055/a-0591-1169

Schlichtungsstellen für Arzthaftpflichtfragen bieten Patienten, Ärzten und Versicherern eine Möglichkeit, Arzthaftungsstreitigkeiten außergerichtlich zu klären. In der Rubrik „Fälle der Schlichtungsstelle" stellen wir abgeschlossene Fälle aus der Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern vor.
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Georg Thieme Verlag KG Stuttgart · New York

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Critical-Illness-Polyneuromyopathie verschlechtert Outcomes auf Intensivstation

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 569-570
DOI: 10.1055/a-0668-3750



Georg Thieme Verlag KG Stuttgart · New York

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Placeboeffekte in der Akutschmerztherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 579-590
DOI: 10.1055/s-0043-121684

Placebo- und Noceboeffekte stehen aktuell sehr im Fokus der klinischen und experimentellen Schmerzforschung. Neuro- sowie psychophysiologische Prozesse scheinen eine wichtige Rolle bei der Entstehung sowie Vermittlung zu spielen. So werden Placebo- und Noceboeffekte im Wesentlichen über das Netzwerk des opioidergen, absteigenden, schmerzmodulierenden Systems vermittelt. Für das Zustandekommen eines Placeboeffektes wiederum werden 3 psychologische Mechanismen verantwortlich gemacht: klassische Konditionierung, soziales Lernen sowie die Schmerzerwartung. Eine offene Analgetikagabe, eine ausführliche Aufklärung über Wirkung und Nebenwirkung (ohne diese zu sehr in den Fokus zu stellen) der im perioperativen Bereich eingesetzten Medikamente und Interventionen sowie eine Einbindung des Patienten in die Therapie (z. B. durch patientenkontrollierte Systeme) können zu einer additiven Verbesserung der Akutschmerztherapie (bis zu 30%) führen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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50 Jahre Plastische Chirurgie und 25 Jahre Facharzt für Plastische Chirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 572-572
DOI: 10.1055/a-0667-9094



Georg Thieme Verlag KG Stuttgart · New York

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Placeboeffekte bei chronischen Schmerzen: Forschungsstand und klinische Anwendung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 605-617
DOI: 10.1055/s-0043-121683

Spielte der Placeboeffekt ehemals vorwiegend eine (eher unliebsame) Rolle bei randomisierten kontrollierten Studien, so treten nun vermehrt die mit dem Placeboeffekt verbundenen Chancen in den Vordergrund. Dieser Beitrag bespricht bisherige Forschungserkenntnisse zum Placeboeffekt bei chronischen Schmerzen und zeigt, wie durch eine gezielte Beeinflussung des therapeutischen Kontexts die Wirksamkeit pharmakologisch aktiver Schmerzmedikamente gesteigert werden kann.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Warnhinweis auf rezeptfreien Schmerzmitteln soll künftig Risiken verringern

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 572-573
DOI: 10.1055/a-0667-9117



Georg Thieme Verlag KG Stuttgart · New York

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Kinderanästhesie: Risikopatienten profitieren von intravenöser Einleitung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 566-567
DOI: 10.1055/a-0668-3940



Georg Thieme Verlag KG Stuttgart · New York

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Rapid Sequence Induction

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 631-634
DOI: 10.1055/a-0628-3122

Die „Rapid Sequence Induction and Intubation" (RSI oder RSII) ist bei Patienten mit erhaltener Kreislauffunktion die Standardmethode, um schnellstmöglich eine Atemwegssicherung im Rahmen einer Notfallsituation bzw. Narkose durchzuführen. Ziel einer RSI ist es, eine Aspiration durch die schnelle endotracheale Intubation und den Verzicht auf eine Zwischenbeatmung zu verhindern.Auch heute besitzen nur wenige europäische Länder eine explizite Handlungsempfehlung zur Durchführung einer RSI. In der täglichen klinischen Routine hat sich die Kopfhochlagerung etabliert, die gegenüber den anderen Lagerungsarten gewisse Vorteile bietet. Eine liegende Magensonde sollte i. d. R. während der RSI belassen werden und muss nicht zwingend in den Ösophagus zurückgezogen werden. Wenn keine Magensonde gelegt wurde bzw. bereits lag, ist die Einlage einer Magensonde nach Intubation sinnvoll. Vor der RSI sollte im Normalfall ein Opioid appliziert werden, da die Dosis kreislaufwirksamer Hypnotika und die hämodynamische Stimulation bei der Intubation reduziert werden können.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Right Lobe Split Liver Graft Versus Whole Liver Transplantation: A Systematic Review by updated traditional and Cumulative Meta-analysis

Advancements in surgical techniques and experience of donor–recipient pairing has led to a wider use of right split liver grafts in adults. An update meta-analysis was conducted to compare right split liver graft (RSLG) and whole liver transplantation (WLT) using traditional and cumulative approaches.

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Analysis of endoscopic features for histologic discrepancies between biopsy and endoscopic submucosal dissection in gastric neoplasms: 10-year results

The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD.

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Right Lobe Split Liver Graft Versus Whole Liver Transplantation: A Systematic Review by updated traditional and Cumulative Meta-analysis

Advancements in surgical techniques and experience of donor–recipient pairing has led to a wider use of right split liver grafts in adults. An update meta-analysis was conducted to compare right split liver graft (RSLG) and whole liver transplantation (WLT) using traditional and cumulative approaches.

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Analysis of endoscopic features for histologic discrepancies between biopsy and endoscopic submucosal dissection in gastric neoplasms: 10-year results

The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD.

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Adolescent Stress Management in a Primary Care Clinic

The American Academy of Pediatrics recommends that adolescents be screened for mental health concerns and receive anticipatory guidance on stress management strategies.

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Child Maltreatment Red Flags: Two Cases of Bruising in Premobile Infants

Child maltreatment is a serious public health concern in the United States. Young infants and children younger than 3 years are at the highest risk of being abused and can experience both acute injuries and long-term developmental, behavioral, and mental health problems. Health care providers are mandated reporters of suspected abuse but may misdiagnose potentially abusive injuries because of lack of knowledge in recognizing maltreatment. Premobile infants rarely have bruising or intraoral injuries without a reported accident or underlying systemic disease and should raise concern for abuse.

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Increased human stretch reflex dynamic sensitivity with height‐induced postural threat

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Abstract

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.



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A New Look at Familial Risk of Inflammatory Bowel Disease in the Ashkenazi Jewish Population

Abstract

Background and Aims

The inflammatory bowel diseases (IBD) are particularly common among the Ashkenazi Jewish (AJ) population. Population-specific estimates of familial risk are important for counseling; however, relatively small cohorts of AJ IBD patients have been analyzed for familial risk to date. This study aimed to recruit a new cohort of AJ IBD patients, mainly from the UK, to determine the familial occurrence of disease.

Methods

A total of 864 AJ IBD patients were recruited through advertisements, hospital clinics, and primary care. Participants were interviewed about their Jewish ancestry, disease phenotype, age of diagnosis, and family history of disease. Case notes were reviewed.

Results

The 864 probands comprised 506 sporadic and 358 familial cases, the latter with a total of 625 affected relatives. Of the UK cases, 40% had a positive family history with 25% having at least one affected first-degree relative. These percentages were lower among those recruited through hospital clinics and primary care (33% for all relatives and 22% among first-degree relatives). Examining all probands, the relative risk of IBD for offspring, siblings, and parents was 10.5, 7.4, and 4, respectively. Age of diagnosis was significantly lower in familial versus sporadic patients with Crohn's disease.

Conclusions

This study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families.



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Patient and Caregiver Attitudes and Practices of Exercise in Candidates Listed for Liver Transplantation

Abstract

Background

Impaired physical capacity increases peri-liver transplant complications. Patient perceptions regarding exercise prior to transplantation are not known.

Aims

This study aimed to assess patient and caregiver activity levels, perceptions of willingness to exercise, and of provider advice.

Methods

Consecutive patients listed for liver transplant and caregivers presenting for routine outpatient visits were evaluated over a 3-month interval. Anonymous surveys adapted to patients and caregivers addressed the importance and safety of exercise, type and duration of exercise performed, barriers, willingness to wear a monitoring device, and perceived provider recommendations. Responses were logged on a Likert scale from 1 to 5.

Results

Three hundred and sixty-eight responses were received. Most participants perceived exercise as important. Patients exercised three times per week for 30 min. Eighty percent endorsed walking (median response: 2—agree; IQR 1–2). Most did not jog, swim, cycle, or strength train. Fatigue, reported by 70%, was the major barrier (2, IQR 1–3). Over 90% of caregivers endorsed exercise as important (1—strongly agree, IQR 1–2) and encouraged exercise (median response 2, IQR 1–2). Over 60% of patients (median response 2, IQR 1–3) and caregivers (median response 2, IQR 2–3) felt providers encouraged exercise.

Conclusions

Patients and caregivers are willing to exercise to optimize physical fitness prior to liver transplantation.



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Upper Gastrointestinal Bleeding of Unusual Causation



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A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

Abstract

Background

Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett's esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.

Methods

An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS3D). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables.

Results

The survey response rate was 84% (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS3D. Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10–29%) and highest for VLE (30%, IQR 20–50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001).

Conclusion

These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.



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Overlap Between Gastric and Esophageal Motility Disorders: A Contractual Arrangement?



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Feedforward‐ and motor effort‐dependent increase in prefrontal oxygenation during voluntary one‐armed cranking

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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In vivo evidence for reduced ion channel expression in motor axons of patients with amyotrophic lateral sclerosis

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Cover Image

Pediatric Anesthesia, Volume 28, Issue 9, Page i-i, September 2018.


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Tracheobronchial angles in children: can it change during anesthesia?

Pediatric Anesthesia, Volume 28, Issue 9, Page 826-826, September 2018.


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Abstracts

Pediatric Anesthesia, Volume 28, Issue 9, Page 819-824, September 2018.


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In this issue: September 2018

Pediatric Anesthesia, Volume 28, Issue 9, Page 755-755, September 2018.


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Artificial ventilation during transport: A randomized crossover study of manual resuscitators with comparison to mechanical ventilators in a simulation model

Pediatric Anesthesia, Volume 28, Issue 9, Page 788-794, September 2018.


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Issue Information

Pediatric Anesthesia, Volume 28, Issue 9, Page ii-iv, 753, September 2018.


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Anesthesia in a patient with Montgomery tube in situ: difficult to easy!

Pediatric Anesthesia, Volume 28, Issue 9, Page 825-825, September 2018.


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MacGyver or Machiavellian approaches to delivery of sevoflurane in neonates

Pediatric Anesthesia, Volume 28, Issue 9, Page 756-757, September 2018.


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Feedback-related neurophysiology in children and their parents: Developmental differences, familial transmission, and relationship to error-monitoring

Publication date: Available online 2 September 2018

Source: International Journal of Psychophysiology

Author(s): Jason S. Moser, Megan Fisher, Brian M. Hicks, Robert A. Zucker, C. Emily Durbin

Abstract

The feedback negativity (FN) and reward positivity (RewP) are event-related brain potentials (ERPs) that follow the presentation of negative and positive feedback information, respectively, and have become the focus of recent research on psychopathology because of their associations with symptom severity of and risk for depression. We advanced our understanding of these feedback-related ERPs by examining developmental differences, familial transmission, and associations with error-monitoring ERPs. Parents and their children completed parallel, developmentally-tailored guessing and go/no-go tasks while feedback- and error-related ERPs were measured. We found that the Δ FN and RewP amplitudes increased with age and were larger in males than females among the child participants. The RewP also demonstrated familial transmission between fathers and their children. Finally, the FN and RewP were associated with error-related ERPs in children and adults, albeit in different ways. The current findings demonstrate that the FN and RewP have promise as developmentally-sensitive neural markers of reward and action monitoring processes associated with risk for psychopathology.



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Ethnic Inequalities in Psychological Distress: A Population Data Linkage Study on the Pacific Island of Guåhån/Guam

Abstract

Psychological distress and mental illness has been found to be elevated in migrant groups living in sovereign countries, as well as for indigenous people living under colonial or administrative rule. The north Pacific island of Guam is unusual in its ethnic composition as it has no majority ethnic group, has a large indigenous population and remains a territory of the U.S. This study aimed to identify ethnic differences in self-reported psychological distress between the main ethnic groups on Guam. The study uses a cross sectional design with data linkage methodology, drawing on the Guam Census and the Behavioral Risk Factor Surveillance System health survey for Guam. The results showed that the native Chamorro population had worse self-reported psychological distress (defined as a 'mental health condition or emotional problem') than White/Caucasians (OR 2.09, 95% CI 1.52–2.87), particularly for severe distress (OR 3.61, 95% CI 1.33–2.77). This relationship persisted even after adjusting for a wide range of socio-demographic and economic factors (OR 2.58, 95% CI 1.15–5.76). Other Pacific Islanders also had higher psychological distress compared to White/Caucasians, but this association was largely explained by the adjusted factors. The findings are discussed in terms of social and economic disadvantage for Pacific Island peoples on Guam, as well as the impact of colonial administration, disaffection, and lack of autonomy for the Chamorro of Guam. Recommendations are made to improve psychiatric treatment for these groups by considering wider socio-political factors in assessment and treatment, as well as broader implications for the national dialogue on self-determination.



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Role of CYP1A1, ABCG2, CYP24A1 and VDR gene polymorphisms on the evaluation of cardiac iron overload in thalassaemia patients

Objectives Iron-burden-induced arrhythmia and heart failure are among the leading causes of morbidity and mortality in β-thalassaemia major patients. T2* cardiac magnetic resonance remains the only reliable noninvasive method for the heart iron excess assessment. We explored the role of single nucleotide polymorphisms involved in vitamin D metabolism, transport and activity and in deferasirox (DFX) metabolism on cardiac iron burden. Patients and methods One hundred and five β-thalassaemia patients, treated with DFX, were enrolled in the present study. Drug plasma Ctrough was measured by a high-performance liquid chromatography-ultraviolet method. Allelic discrimination was carried out using the real-time PCR. Results CYP1A1*1189 CC, ABCG2 421 GA, CYP24A1 8620 GG and VDR TaqI CC single nucleotide polymorphisms influenced T2* values. Age, serum ferritin, ABCG2 421 GA, ABCG2 1194 +928 TC/CC, CYP24A1 22776 TT and VDR TaqI TC/CC were retained in linear regression model. Conclusion Our results suggested, for the first time, the role of DFX and vitamin D pharmacogenetics on cardiac iron overload. * Antonio Piga and Antonio D'Avolio contributed equally to the writing of this article. Correspondence to Sarah Allegra, BSc, MSc, Laboratory of Clinical Pharmacology and Pharmacogenetics, Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, ASL Città di Torino, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy Tel: +39 011 439 3979; fax: +39 011 439 3882; e-mail: sarah.allegra@gmail.com Received May 4, 2018 Accepted August 15, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Poststroke Depression: A Long-Term Problem for Stroke Survivors Erratum

No abstract available

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