Acute Concussion vs Post-Concussion Syndrome (PCS): How Can We Prevent Progression?

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S17.3-S18
Author(s):  
Sheharzad Mahmood ◽  
Ann-Marie Przyslupski ◽  
Terry Lynn Defreitas ◽  
Martin Mrazik ◽  
Connie Lebrun
Keyword(s):  
Sports Medicine ◽  
Assessment Tool ◽  
Family Physicians ◽  
Retrospective Chart Review ◽  
Acute Injury ◽  
Close Monitoring ◽  
Post Concussion Syndrome ◽  
Management Plans ◽  
Appointment Time ◽  
The Individual

ObjectiveTo contrast the presentation and recovery of acute concussion and post-concussion syndrome (PCS) in order to identify factors for PCS prevention.BackgroundConcussions are classified as acute (<90 days to resolution) or post-concussion syndrome (PCS, = 90 days to resolution). PCS poses a great burden to the individual and to public health. Further investigation is warranted for understanding the progression of acute concussion to PCS and potential mitigating strategies.Design/MethodsRetrospective chart review of concussion patients seen by Sports Medicine and Exercise Physicians over a five-year period. Outcome measures included demographics, wait-times, injury mechanisms, Sport Concussion Assessment Tool (SCAT) scores, management plans, and recovery timelines.ResultsFour hundred ninety-six patients (289 male/207 female, 19.7 ± 9.4 years) presented with 561 concussions in 1,471 visits. Acute concussions accounted for 88% of injuries and 12% were PCS. Females (RR = 1.4) and adults = 25 years (RR = 3.6) were more likely to be diagnosed with PCS. In both, injuries occurred most commonly in hockey, football, and soccer. Family physicians were the most frequent referral provider (58% acute, 76% PCS). Median injury-appointment time was 11.0 days (acute) compared to 182.0 days (PCS). Initial total SCAT symptom score was significantly greater (p < 0.001) in PCS (56.0 ± 33.0) compared to acute concussion (39.8 ± 31.9). Therapies (i.e., referral, medication, intervention) were prescribed in 44% of acute injury visits compared to 73% of PCS visits. Recovery timelines for return to work, school, and sport were significantly longer in PCS patients than in those with acute concussions (p < 0.05).ConclusionsOur findings of the incidence/presentation of PCS agree with previous literature. Athletes who are female and/or = 25 years may be at greater risk for PCS progression, requiring close monitoring and further injury prevention efforts. Considering the number of referrals from family physicians, further concussion education may better optimize initial management and shorten delays in seeking necessary sports medicine consultation.

Biomonitoring of Fusarium spp. Mycotoxins: Perspectives for an Individual Exposure Assessment Tool

2010 ◽  
Vol 16 (3) ◽  
pp. 266-276 ◽  
Author(s):  
G. Cano-Sancho ◽  
S. Marin ◽  
A.J. Ramos ◽  
V. Sanchis
Keyword(s):  
Exposure Assessment ◽  
Dietary Habits ◽  
Assessment Tool ◽  
Fusarium Species ◽  
Risk Groups ◽  
Probabilistic Methods ◽  
Fusarium Spp ◽  
Individual Exposure ◽  
The Individual ◽  
Current Exposure

Fusarium species are probably the most prevalent toxin-producing fungi of the northern temperate regions and are commonly found on cereals grown in the temperate regions of America, Europe and Asia. Among the toxins formed by Fusarium we find trichothecenes of the A-type or B-type, zearalenone, fumonisins or nivalenol. The current exposure assessment consists of the qualitative and/or quantitative evaluation based on the knowledge of the mycotoxin occurrence in the food and the dietary habits of the population. This process permits quantifying the mycotoxin dietary intake through deterministic or probabilistic methods. Although these methods are suitable to assess the exposure of populations to contaminants and to identify risk groups, they are not recommended to evaluate the individual exposition, due to a low accuracy and sensitivity. On the contrary, the use of biochemical indicators has been proposed as a suitable method to assess individual exposure to contaminants. In this work, several techniques to biomonitor the exposure to fumonisins, deoxynivalenol, zearalenone or T-2 toxin have been reviewed.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

177Lu-dotatate use in chronic kidney disease patients: A single center experience

2021 ◽  
Vol 5 (3) ◽  
pp. 162-171
Author(s):  
Sandhya Manohar ◽  
Panagiotis Kompotiatis ◽  
Thorvardur R Halfdanarson ◽  
Timothy J Hobday ◽  
Matthew Thorpe ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Peptide Receptor Radionuclide Therapy ◽  
Retrospective Chart Review ◽  
Drug Dose ◽  
Hematological Toxicity ◽  
Close Monitoring ◽  
Novel Therapy ◽  
Single Center Experience ◽  
Safety Studies ◽  
Long Term Impact

Background: Peptide receptor radionuclide therapy with 177Lu-dotatate is a novel therapy for metastatic neuroendocrine cancers. It undergoes reabsorption at the proximal tubule; after the breakdown of the peptide fragment, 177Lu is retained and continues its decay process exposing the nephron to continuous low dose radiation. Pivotal NETTER-1 trial did not include patients with eGFR <50 and so its effects in CKD patients is not known. Methods: We performed a retrospective chart review of all consecutive adult patients that received 177Lu-dotatate over 1 year at Mayo Clinic, Rochester. We analyzed renal and hematological laboratory data obtained prior to each of four treatment cycles and at 3- and 6-month post completion of all treatment. We defined CKD as eGFR <60 ml/min and AKI as creatinine increase of ⩾0.3 from baseline by AKIN criteria. Results: Overall 86 patients were included in the study with 39 (45%) with known CKD. About three patients had CKD, four with eGFR of 20–30 ml/min. About 4 (4.6%) patients had AKI and the predominant cause being hypotension. Among the CKD patients the average eGFR improved after the first cycle of PRRT therapy from baseline of 49 (13) to 53.5 (17) ml/min ( p = 0.01) with no significant decline of renal function noted at 3- and 6-months post treatment follow up. Rate of thrombocytopenia and leukopenia were significantly more in the CKD patients starting even after single treatment. No drug dose correlation was noted. Conclusion: Patients with CKD are at a higher risk of hematological toxicity especially with thrombocytopenia and require close monitoring and ongoing dose adjustment. Ongoing safety studies to assess the long-term impact of 177Lu-dotatate on the kidney are needed.

scholarly journals The PUFFinCA scale: development of an instrument for evaluating the primary care functions of family physicians in childhood asthma

2018 ◽  
Vol 20 ◽  
Author(s):  
Ayşe Nur Usturali Mut ◽  
Zeliha Aslı Öcek ◽  
Meltem Çiçeklioğlu ◽  
Şafak Taner ◽  
Esen Demir
Keyword(s):  
Primary Care ◽  
Childhood Asthma ◽  
Assessment Tool ◽  
Asthma Management ◽  
Correlation Coefficients ◽  
Family Physicians ◽  
Principal Component ◽  
Care Assessment ◽  
Provision Of Services ◽  
Children With Asthma

AbstractAimTo develop the Primary care fUnctions oF Family physicians in Childhood Asthma (PUFFinCA) scale for evaluating the cardinal process functions of primary care services (accessibility, comprehensiveness, continuity and coordination) provided by family physicians (FPs) in the management of childhood asthma.BackgroundIn the literature on the functions of primary care, there is no assessment tool focusing on children with asthma. Primary care assessment scales adapted to various languages are not suitable to adequately address the needs of special patient groups, such as children with asthma.MethodsIn this methodological study, the instrument development process was completed in four stages: establishing the pool of items, evaluating the content validity, applying the scale and statistical analysis. The scale was applied to 320 children who had asthma and received care in the clinic of the Department of Pediatrics, Division of Allergy and Pulmonology at Ege University School of Medicine, Turkey. The Cronbach’s α and Spearman–Brown coefficient were calculated to determine the reliability of the scale. Principal component analysis was used to determine the construct validity of the scale.FindingsThe PUFFinCA scale was found to have four-factor structure and 25 items. Cronbach’s α coefficient was 0.93. It has been determined that the reliability was excellent and the item-total correlation coefficients were >0.30 each. The factors were titled FP’s ‘functions of accessibility, first contact and continuity’, ‘functions of coordination and comprehensiveness of health services related to asthma management’, ‘provision of preventive care related to asthma’ and ‘provision of services for paid vaccinations’.

scholarly journals THE PREVENTION METHOD OF SPORTS MEDICINE IMAGING MODELING

2021 ◽  
Vol 27 (8) ◽  
pp. 833-836
Author(s):  
Fei Wu ◽  
Xuejun Ma ◽  
Wenjiang Zhao ◽  
Shuhua Qu
Keyword(s):  
Sports Medicine ◽  
Main Type ◽  
Sports Injury ◽  
Acute Injury ◽  
Chronic Injury ◽  
Level Of Evidence ◽  
Prevention Method ◽  
High Level ◽  
And Control ◽  
Type Of Injury

ABSTRACT Introduction: Sports injury is an important reason to interfere with sports training and physical exercise since it will not only bring unnecessary pain to the injured body, but also bring out negative emotions in athletes. Objective: To study the sports injury characteristics of high level competitive aerobics athletes in China. Methods: Literature data, questionnaire survey, expert interviews, field observation, mathematical statistics and physiotherapy tracking were used. Results: Wrists, ankles, waist and knees were the most frequently injured parts in high level competitive aerobics athletes in China. The main type of injury was acute injury, but chronic injury (48.18%) could not be ignored. Ninety percent of active high-level competitive aerobics athletes train with injuries, and 10 percent of them completely stop training because of injuries. Conclusions: Athletes should pay attention to their physical reserve and strengthen physical training. They must also be attentive to self-supervision, their own subjective feelings, and control the amount of exercise done. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals Biologic therapy of rheumatoid arthritis

2009 ◽  
Vol 137 (3-4) ◽  
pp. 205-210 ◽  
Author(s):  
Nemanja Damjanov ◽  
Jelena Vojinovic
Keyword(s):  
Rheumatoid Arthritis ◽  
Social Impact ◽  
Biologic Therapy ◽  
Joint Damage ◽  
Chronic Arthritis ◽  
Close Monitoring ◽  
Biologic Drugs ◽  
Early Introduction ◽  
Improved Outcomes ◽  
The Individual

Rheumatoid arthritis (RA) and juvenile idiopathic/rheumatoid arthritis (JIA) are chronic, inflammatory, systemic, auto-immune diseases characterized by chronic arthritis leading to progressive joint erosions. The individual functional and social impact of rheumatoid arthritis is of great importance. Disability and joint damage occur rapidly and early in the course of the disease. The remarkably improved outcomes have been achieved initiating biologic therapy with close monitoring of disease progression. Biologic agents are drugs, usually proteins, which can influence chronic immune dysregulation resulting in chronic arthritis. According to the mechanism of action these drugs include: 1) anti-TNF drugs (etanercept, infiximab, adalimumab); 2) IL-1 blocking drugs (anakinra); 3) IL-6 blocking drugs (tocilizumab); 4) agents blocking selective co-stimulation modulation (abatacept); 5) CD 20 blocking drugs (rituximab). Biologics targeting TNF-alpha with methotrexate have revolutionized the treatment of RA, producing significant improvement in clinical, radiographic, and functional outcomes not seen previously. The new concept of rheumatoid arthritis treatment defines early diagnosis, early aggressive therapy with optimal doses of disease modifying antirheumatic drugs (DMARDs) and, if no improvement has been achieved during six months, early introduction of biologic drugs. The three-year experience of biologic therapy in Serbia has shown a positive effect on disease outcome.

610 Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Andrea C Grote ◽  
Alexandra M Lacey ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
Ellen Maniago ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Outpatient Basis ◽  
Close Monitoring ◽  
Burn Center ◽  
Increased Risk ◽  
Significant Difference ◽  
Pediatric Burns ◽  
Inpatient Management

Abstract Introduction American Burn Association guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small (&lt; 10% TBSA) burns in pediatric patients as outpatients with a non-daily dressing. The aim of this study was to determine if small pediatric burns could be managed in an outpatient manner and risk factors for failure. Methods A retrospective chart review was conducted from July 2016 to July 2019 at a single ABA-verified burn center. All patients under the age of 18 who presented for evaluation were included. Post burn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Results In total, 742 patients were included in our cohort (Table 1). The most common burn etiologies were scald (68%), contact (20%), and flame (5%). From initial presentation, 101 patients (14%), mean TBSA 9%, were admitted to the burn unit and 641 patients (86%), mean TBSA 3%, were treated outpatient. Of those, 613 (96%) were treated entirely outpatient and 28 (4%) were admitted at a later date. There were no significant differences in age (p=0.6) nor gender distribution between those who were successfully treated outpatient and those who failed. There was a significant difference (p &lt; 0.001) in TBSA between the patients who were treated successfully as outpatients (3±2%) versus those who failed outpatient care (4±3%). The primary reason for admission of these patients was nutrition optimization (61%). Conclusions The vast majority of small pediatric burns can be treated as an outpatient with a non-daily dressing with good results. Over 80% of pediatric patients seen in our clinic were successfully managed in this manner. As suspected, when the burns are larger in size (&gt;4% TBSA) there is a potential increased risk for admission especially with regards to poor PO intake, so this requires close monitoring and family education. Applicability of Research to Practice Pediatric patients with small burns can be safely managed in an outpatient setting with a non-daily dressing. Those who fail will most likely fail from poor PO intake at home.

scholarly journals Development and psychometric testing of an instrument for measuring social participation of adolescents: study protocol of a prospective mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e028529
Author(s):  
Tim Baerwalde ◽  
Britta Gebhard ◽  
Laura Hoffmann ◽  
Julia Roick ◽  
Olaf Martin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chronic Diseases ◽  
Social Participation ◽  
Assessment Tool ◽  
Physical Disabilities ◽  
Psychometric Testing ◽  
Mixed Methods Study ◽  
Assessment Instrument ◽  
Social Emotional Development ◽  
The Individual

IntroductionSocial participation is an important part of a young person’s life. It influences the social experience, social-emotional development and dimensions of competence experience. This applies to people with or without physical disabilities or chronic diseases. Currently, there is no reliable assessment tool for measuring social participation of adolescents in Germany although social participation is a central goal of rehabilitation. The aim of this study is to develop, test and pilot an instrument that assesses social participation for adolescents between the ages of 12 and 17 years and to start a psychometric test.Methods and analysisIn a sequential mixed-methods study, adolescents with and without physical disabilities or chronic diseases are asked about their experiences with social participation as well as the individual significance of self-determination through semistructured interviews. The perspective of adolescents is supplemented by focus groups that will be conducted first with experts from social paediatric care and second with legal guardians. Based on this, an assessment instrument will be developed, evaluated and implemented in exemplary social paediatric centres (SPCs) and rehabilitation clinics and psychometrically tested in a pilot study.Ethics and disseminationThe study will be conducted in accordance with the principles of the revised Helsinki Declaration. The study was approved by the Ethics Review Committee at the Martin-Luther-University Halle-Wittenberg. The developed assessment instrument can be used in science to identify disadvantaged groups and to compensate for the disadvantages that could impair development. For this purpose, the results will be presented at scientific conferences and published in international peer-reviewed journals. In practice, the instrument can be used to determine the goals of rehabilitation together with the adolescents and to evaluate the achievement of these goals. For this, implementation workshops and further training will be organised and carried out in children’s rehabilitation clinics and SPCs.Trial registration numberDRKS00014739; Pre-results.

scholarly journals Pain Perception in Taekwondo: Relationship to Injury, Experience, and Time Loss

2020 ◽  
Vol 4 (02) ◽  
pp. E53-E58
Author(s):  
Renee T. Zhao ◽  
Abdullah Kandil ◽  
Danh V. Nguyen ◽  
Luis Campos ◽  
Nirav H. Amin ◽  
...  
Keyword(s):  
Standard Error ◽  
Sports Medicine ◽  
Pain Perception ◽  
Rating Scale ◽  
Head Injuries ◽  
Positive Association ◽  
Numeric Rating Scale ◽  
Acute Injury ◽  
Time Loss ◽  
Significant Positive Association

AbstractWhile the majority of sports medicine literature discusses the incidence and rehabilitation of sports injuries, there is a paucity regarding an athlete’s perception of pain during these injuries. This study describes the relationship between the perception of pain from injuries in a Taekwondo collegiate conference and injury characteristics such as injury type, location, mechanism, time loss, and the athlete’s competitive experience. In our study, we obtained reports from 62 Taekwondo athletes who were injured during the 2008–2009 Pacific West Taekwondo Conference collegiate season. Pain was recorded using the Numeric Rating Scale for Pain during athletes’ acute injury and at two weeks, six weeks, and subsequent monthly follow-ups. Pain scores were highest for sprain/strains (mean 5.4, standard error 0.47) and injuries to the lower body (mean 5.6, standard error 0.36). By mechanism, falls (mean 5.8, standard error 0.67) reported the highest levels of pain. There was a significant positive association between pain and time loss, where an increase in pain score of 1 point was associated with about 0.85 days (standard error 0.37) of time lost from training (p=0.0284). Notably, head injuries, although potentially more devastating and attracting widespread concern, were considered less painful.

2.4 Performance Monitoring of Animals, Using On-line Computers

1981 ◽  
Vol 5 ◽  
pp. 41-46 ◽  
Author(s):  
M. J. B. Turner
Keyword(s):  
Egg Production ◽  
Performance Monitoring ◽  
Working Hours ◽  
Field Trials ◽  
Modern Technology ◽  
Progeny Testing ◽  
Close Monitoring ◽  
Agricultural Engineering ◽  
The Individual ◽  
Animal Handling

Increasing importance is being put on quality control of livestock both from performance and marketing aspects. The breeding of superior stock relies heavily on progeny testing, first in small numbers and later in larger scale field trials. With commercial stock, emphasis is placed on the food conversion efficiency; health of the individual, flock or herd; the market requirement and the likely date of attaining market readiness. All these factors rely heavily on close monitoring of the performance of the stock. However, with increasing pressures for shorter working hours and greater responsibilities per employee, close monitoring is likely to diminish rather than increase, unless modern technology comes to the aid of the producer. Already, electronics have been making inroads in this area. The advantages of using electronics for animal weighing were first demonstrated in the early 70's (Smith and Turner, 1974). Interest has been slow to build up but now most farmers and manufacturers recognize the potential. However, despite using electronic weight indication, the process of animal weighing remains a manual operation involving at least one man, more often two or three. Despite advances in animal handling procedures, in most manual weighing exercises there is always a risk of injury to both stock and men. A system of weighing which removes this risk and reduces stress on the animal would be welcomed by the producer. Electronic aids for milk yield recording and egg production have also been under development for some years (Burgess, 1980; Anon., 1980) but will not be dealt with here. This paper will deal solely with the prospects for fully automatic weight recording of live animals and describe some of the results of work conducted by the National Institute of Agricultural Engineering at Silsoe.

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