scholarly journals Athletic Trainers' Concussion-Assessment and Concussion-Management Practices: An Update

2020 ◽  
Vol 55 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Landon B. Lempke ◽  
Julianne D. Schmidt ◽  
Robert C. Lynall
Keyword(s):  
Decision Making ◽  
Health Care Providers ◽  
Clinical Examination ◽  
Management Practices ◽  
Athletic Trainers ◽  
Assessment Tools ◽  
Care Providers ◽  
Convenience Sample ◽  
Assessment Battery ◽  
National Athletic Trainers Association

Context Athletic trainers (ATs) are often the first health care providers to conduct concussion assessments and carry out postinjury management. Best practices for concussion evaluation and management have changed rapidly in recent years, outdating previous reports of ATs' concussion practices. Objective To examine ATs' current concussion-assessment and -management techniques. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants A random convenience sample of 8777 ATs (response rate = 15.0% [n = 1307]; years certified = 15.0 ± 10.6) from the National Athletic Trainers' Association membership. Main Outcome Measure(s) Survey Web links were e-mailed to prospective participants, with 2 follow-up e-mails sent by the National Athletic Trainers' Association. The survey collected demographic information, the number of concussions assessed, the concussion-recovery patterns, and the assessment and return-to-participation (RTP) decision-making methods used. Results The ATs reported assessing a median of 12.0 (range = 0–218) concussions per year. A total of 95.3% (953/1000) ATs cited clinical examination as the most frequently used concussion-assessment tool, followed by symptom assessment (86.7%; 867/1000). A total of 52.7% (527/1000) ATs described a 3-domain minimum multidimensional concussion-assessment battery. Published RTP guidelines were the most common RTP decision-making tool (91.0%; 864/949), followed by clinical examination (88.2%; 837/949). The ATs with master's degrees were 1.36 times (95% confidence interval [CI] = 1.02, 1.81) more likely to use a 3-domain concussion-assessment battery than ATs with only bachelor's degrees (χ2 = 4.44, P = .05). Collegiate ATs were 2.12 (95% CI = 1.59, 2.84) and 1.63 (95% CI = 1.03, 2.59) times more likely to use a 3-domain concussion-assessment battery than high school and clinic-based ATs, respectively (χ2 = 26.29, P < .001). Conclusions Athletic trainers were using the clinical examination, standardized assessment tools, and a 3-domain concussion-assessment–battery approach more frequently in clinical practice than previously reported. However, despite practice improvements, nearly half of ATs were not using a 3-domain minimum concussion-assessment battery. Clinicians should strive to implement multidimensional concussion assessments in their practices to ensure optimal diagnosis and management.

scholarly journals Concussion-Assessment and -Management Techniques Used by Athletic Trainers

2013 ◽  
Vol 48 (6) ◽  
pp. 844-850 ◽  
Author(s):  
Robert C. Lynall ◽  
Kevin G. Laudner ◽  
Jason P. Mihalik ◽  
Justin M. Stanek
Keyword(s):  
Clinical Examination ◽  
Management Practices ◽  
Athletic Trainers ◽  
Assessment Tools ◽  
Self Report ◽  
Annual Number ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Web Based ◽  
National Athletic Trainers Association

Context: Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients. Objective: To assess current clinical concussion diagnostic and return-to-participation practices among ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A link to the survey was sent randomly to a convenience sample of 3222 members of the National Athletic Trainers' Association. A total of 1053 (32.7%) certified ATs (experience as an AT = 11.2 ± 9.1 years) responded to the survey. Intervention(s): Prospective participants received electronic correspondence informing them of the purpose of the study and providing a link to the Web-based survey instrument. A reminder e-mail was sent approximately 6 weeks later, and the survey remained online for a total of 8 weeks. Main Outcome Measure(s): We collected information on the annual number of concussions assessed and tools employed to diagnose, manage, and safely return an athlete to participation. Descriptive statistics were computed for each variable. Results: Participants reported observing 10.7 ± 11.0 concussions per year. Clinical examination (n = 743, 70.6%) was the most commonly reported means for evaluating and diagnosing concussion. Less than half of our respondents employed the Standardized Assessment of Concussion (n = 467, 44.3%), any variation of the Romberg test (n = 461, 43.8%), and computerized neuropsychological testing (n = 459, 43.6%). Clinical examination (n = 773, 73.4%), return-to-participation guidelines (n = 713, 67.7%), physician recommendation (n = 660, 62.7%), or player self-report (n = 447, 42.5%) contributed to the return-to-participation decisions of ATs. Only 20.8% (n = 219) of ATs reported using all 3 recommended domains of the concussion battery. Conclusions: Our study demonstrated a growth in the number of ATs incorporating objective clinical measures of concussion as a part of their concussion management. Conversely, fewer ATs reported using a standard clinical examination in their concussion assessment. These findings suggest ATs must continue to increase their use of both objective concussion assessment tools and the standard clinical examination.

scholarly journals National Athletic Trainers' Association Position Statement: Management of Individuals With Patellofemoral Pain

2018 ◽  
Vol 53 (9) ◽  
pp. 820-836 ◽  
Author(s):  
Lori A. Bolgla ◽  
Michelle C. Boling ◽  
Kimberly L. Mace ◽  
Michael J. DiStefano ◽  
Donald C. Fithian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Athletic Trainers ◽  
Treatment Strategies ◽  
Patellofemoral Pain ◽  
Care Providers ◽  
National Athletic Trainers Association

Objective:  To present recommendations for athletic trainers and other health care providers regarding the identification of risk factors for and management of individuals with patellofemoral pain (PFP). Background:  Patellofemoral pain is one of the most common knee diagnoses; however, this condition continues to be one of the most challenging to manage. Recent evidence has suggested that certain risk factors may contribute to the development of PFP. Early identification of risk factors may allow clinicians to develop and implement programs aimed at reducing the incidence of this condition. To date, clinicians have used various treatment strategies that have not necessarily benefitted all patients. Suboptimal outcomes may reflect the need to integrate clinical practice with scientific evidence to facilitate clinical decision making. Recommendations:  The recommendations are based on the best available evidence. They are intended to give athletic trainers and other health care professionals a framework for identifying risk factors for and managing patients with PFP.

scholarly journals National Athletic Trainers' Association Position Statement: Environmental Cold Injuries

2008 ◽  
Vol 43 (6) ◽  
pp. 640-658 ◽  
Author(s):  
Thomas A. Cappaert ◽  
Jennifer A. Stone ◽  
John W. Castellani ◽  
Bentley Andrew Krause ◽  
Daniel Smith ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Providers ◽  
Athletic Trainers ◽  
Position Statement ◽  
Care Providers ◽  
Certified Athletic Trainers ◽  
Problem Solving Skills ◽  
Work Related ◽  
National Athletic Trainers Association

Abstract Objective: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries. Background: Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk. Recommendations: These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.

scholarly journals Concussion Knowledge and Clinical Experience Among Athletic Trainers: Implications for Concussion Health Care Practices

2020 ◽  
Vol 55 (7) ◽  
pp. 666-672
Author(s):  
Landon B. Lempke ◽  
Julianne D. Schmidt ◽  
Robert C. Lynall
Keyword(s):  
Clinical Experience ◽  
Online Survey ◽  
Management Practices ◽  
Athletic Trainers ◽  
Signs And Symptoms ◽  
Assessment Tools ◽  
Return To Play ◽  
Management Tools ◽  
Convenience Sample ◽  
Concussion Knowledge

Context Athletic trainers (ATs) are heavily involved in concussion assessment and return-to-play (RTP) decision making. Despite ATs' crucial role, few researchers have directly examined ATs' knowledge of concussions or whether concussion knowledge or clinical experience affects clinical concussion-management practices. Objective To determine the overall concussion knowledge of ATs and whether concussion knowledge and clinical experience affect concussion-assessment and -management practices. Design Cross-sectional study. Setting Online survey. Patients or Other Participants Random convenience sample of 8725 (15.0% response rate [1307/8725]; certified, 14.8 ± 10.6 years) ATs surveyed from the National Athletic Trainers' Association membership. Main Outcome Measure(s) The survey collected demographics, concussion-assessment and -management tools used, and concussion knowledge (patient-clinician scenarios, signs and symptoms recognition). We used multiple logistic regression models to determine the odds ratios (ORs) for using assessment and management tools based on signs and symptoms recognition and years of clinical experience. Results The ATs correctly identified 78.0% ± 15.1% of concussion signs and symptoms. Approximately 46% (357/770) of ATs indicated an athlete could RTP if the athlete stated he or she had a “bell rung.” Every additional year of clinical experience decreased the odds of using standardized sideline-assessment tools by 3% (OR = 0.97, 95% Confidence Interval [CI] = 0.95, 0.99). The odds of using standardized sideline tools (OR = 0.98, 95% CI = 0.96, 0.99) and symptom checklists (OR = 0.98, 95% CI = 0.97, 0.99) for RTP assessment were significantly decreased for each additional year of clinical experience. No other tools used for RTP assessment were influenced by signs and symptoms recognition (P ≥ .136) or clinical experience (P ≥ .158). Conclusions The ATs with greater clinical experience had lower odds of using concussion-assessment and -management tools. Athletic trainers should frequently review and implement current consensus guidelines into clinical practice to improve concussion recognition and prevent improper management.

scholarly journals Improving Communications With Patients and Families in Geriatric Care. The How, When, and What

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Shirley Chien-Chieh Huang ◽  
Alden Morgan ◽  
Vanessa Peck ◽  
Lara Khoury
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Tertiary Care ◽  
Care Providers ◽  
Telephone Interviews ◽  
Written Information ◽  
Geriatric Unit ◽  
Patient Health

There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

scholarly journals Men’s perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tulani Francis L. Matenga ◽  
Joseph Mumba Zulu ◽  
Sharon Nkwemu ◽  
Perfect Shankalala ◽  
Karen Hampanda
Keyword(s):  
Reproductive Health ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Sexual And Reproductive Health ◽  
Decision Makers ◽  
Care Providers ◽  
Convenience Sample ◽  
Essential Information ◽  
Women Living With Hiv ◽  
The Family

Abstract Background Although health care providers are beginning to focus on men’s roles as fathers and husbands, there is limited understanding of how men view their ability to promote sexual and reproductive health in families affected by HIV and their experiences with receiving education through antenatal care. This paper aims to explore men’s perceptions of the education they need regarding sexual and reproductive health within the family in the context of HIV. Methods We interviewed a convenience sample of 18 male partners of pregnant women living with HIV in Lusaka, Zambia. Atlas.ti was used to facilitate data management and content analysis. Results Men reported being the primary decision-makers regarding sexual and reproductive issues in the family; however, they admitted far-reaching unmet needs in terms of information on sexual and reproductive health in the context of HIV. Most men felt that antenatal care was not a conducive setting to fully educate men on sexual and reproductive health because it is a woman’s space where their health concerns were generally neglected. There was a strong desire for more education that was specific to men’s sexual and reproductive health, especially because all the couples were affected by HIV. Men especially requested education on sexual preparedness, safe sex, the use of condoms in sero-concordant and sero-discordant relationships and general health information. Although men stated they were the main decision-makers regarding sexual and reproductive issues such as pregnancy, most men were not confident in their ability to promote sexual and reproductive health in the family because of limited knowledge in this area. Conclusion There is need to change the environment and messaging of antenatal care, as well as offer relevant education opportunities outside health facility settings to empower men with essential information for meaningful involvement in sexual and reproductive health in the context of HIV.

scholarly journals Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong

2009 ◽  
Vol 16 (3) ◽  
pp. 148-154 ◽  
Author(s):  
CA Graham ◽  
WO Kwok ◽  
YL Tsang ◽  
TH Rainer
Keyword(s):  
Health Care ◽  
Hong Kong ◽  
Health Care Providers ◽  
Waiting Time ◽  
Health Care Professionals ◽  
Waiting Times ◽  
Medical Advice ◽  
Care Providers ◽  
Convenience Sample ◽  
Waiting Area

Objective To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED. Methods The study recruited 249 semi-urgent and non-urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire. Results From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal-Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%). Conclusion Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.

scholarly journals Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting

2020 ◽  
Vol 11 (05) ◽  
pp. 764-768
Author(s):  
Karolin Ginting ◽  
Adrienne Stolfi ◽  
Jordan Wright ◽  
Abiodun Omoloja
Keyword(s):  
Decision Making ◽  
Health Care Providers ◽  
Medical Decision Making ◽  
Pediatric Population ◽  
Private Insurance ◽  
Medical Decision ◽  
Ambulatory Setting ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals

Abstract Background Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making. Objectives The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal. Methods A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures). Results One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making. Conclusion PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

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