Decision-Making in Sport During a Pandemic.

OBJECTIVE: The COVID-19 pandemic has affected all elements of global society, and sport is not exempt. Many sporting events have been either postponed or canceled, and national sporting organizations have had to make highly complex decisions in the face of scientific uncertainty and risk. This article applies these lessons to the world of sport with the goal of assisting sporting organizations to make sound and reasoned decisions during a pandemic. DATA SOURCES: A narrative approach using both academic literature sources and live examples from the authors' experience. We use Daniels and Sabin's accountability for reasonableness framework to facilitate decision-making in the face of such uncertainty. MAIN RESULTS: Decision-making in the context of uncertainty has the potential to create conflict and disengagement from key stakeholders. Evidence from recent pandemics has illustrated that an ethical approach to decision-making results in reasoned decision-making and confers a legitimacy to decisions that ultimately supports engagement and satisfaction from stakeholders. CONCLUSIONS: The incorporation of ethical considerations into risk assessment and management when making complex decisions, which incorporate high levels of uncertainty, will assist sporting organizations have positive outcomes.

Comparing visual acuity, range of vision and spectacle independence in the extended range of vision and monofocal intraocular lens.

IMPORTANCE: This study is the first to compare the extended range of vision (ERV) intraocular lens (IOL) targeted at micro-monovision to a monofocal targeted at binocular emmetropia. BACKGROUND: Compares visual acuity, range of vision and spectacle independence in monofocal and ERV IOLs. DESIGN: Assessor-blinded retrospective cohort study. PARTICIPANTS: Eighty-eight participants (176 eyes) with bilateral IOL implants at 5+ month postoperative review. METHODS: Regression analyses (general estimating equations and multiple linear regression) tested associations between IOL type (ZA9002 Tecnis 3-piece or Tecnis ZCT monofocal; and Tecnis Symfony ERV IOL) and visual acuity, adjusting for key confounders including residual astigmatism. MAIN OUTCOME MEASURES: Monocular and binocular visual acuity measured with and without distance refractive correction at distance (3.00 m), intermediate (1.00 and 0.63 m) and near (0.40 m) (logMAR units); near vision reading test used British 'N' notation; self-reported spectacle independence. RESULTS: There was no significant difference between ERV and monofocal groups in uncorrected binocular visual acuity at distance (P = 0.595). Binocular uncorrected visual acuity at intermediate (0.63 m: monofocal 0.24, ERV 0.09, P < 0.001) and near (0.40 m: monofocal 0.42, ERV 0.18, P < 0.001) were significantly better in the ERV group. Binocular uncorrected near vision: all the ERV group read N8 or better, compared to 36% in the monofocal group (P < 0.001); 93% of the ERV group reported spectacle independence at near compared to 33% in the monofocal group (P < 0.001). CONCLUSIONS AND RELEVANCE: The ERV IOL, targeted to achieve micro-monovision, demonstrated superior range of visual acuity and spectacle independence compared to the monofocal targeted to achieve emmetropia.

Peribulbar anesthesia causing bilateral orbital hemorrhage.

We report a case of bilateral orbital hemorrhage as a complication of peribulbar anesthesia in a 78 year old man. Initially, unilateral orbital hemorrhage occurred but quickly spread to the contralateral side. Neuroophthalmological assessment revealed a proptosed tense globe with normal retinovascular findings. Visual acuity was adversely affected and this was conservatively managed with no lasting ophthalmic sequela. This patient's case was reported as it illustrates an unusual complication of bilateral spread of orbital hemorrhage secondary to peribulbar anesthesia. It highlights how early ophthalmic assessment can ensure a good visual outcome in the setting of appropriate ophthalmic monitoring. The mechanisms of orbital hemorrhage spread and appropriate management options are discussed.

Australasian College of Sports Physicians-position statement: the place of mesenchymal stem/stromal cell therapies in sport and exercise medicine.

PURPOSE AND SCOPE: This Position Statement has been written expressly for members of the Australasian College of Sports Physicians (ACSP); however, it may also be of interest to the wider medical community, sporting organisations, athletes and the general community. It has been informed by a comprehensive review of the scientific literature and the opinions of kindred organisations. This statement outlines the use of mesenchymal stem cell (MSC) therapies in the broad context of Sport and Exercise Medicine, recognising that every medical practitioner should respect: (1) the evidence for the therapeutic use of MSCs and (2) the priority for patient health and welfare.

Drug misuse in sport: a New Zealand perspective.

AIMS: Drug misuse in elite sport is a world-wide phenomenon. This article explores the culture of contemporary sport, provides estimates of doping prevalence, discusses dietary supplementation and highlights major factors influencing high-performance athletes and their support personnel. The aim is to stimulate discussion, informed by the World Anti-Doping Code (WADC), which is particularly relevant to doctors caring for athletes. METHODS: Online databases were searched for relevant peer-reviewed research from 2009 to 2015. Comparative New Zealand data have been included. RESULTS: Estimates of the prevalence of sports doping range from less than 1% to as high as 52%, dependent upon the demographics of the identified cohort. The culture of elite sport, personal stressors, competitive demands, financial reward and the influence of an 'entourage' of support personnel were identified as critical determinants of drug misuse. CONCLUSIONS: The culture of elite contemporary sport is seductive to many aspiring young athletes. To combat drug misuse, effective education should embody moral, ethical and clinical dangers, recognising the importance of support at times of increased athlete vulnerability. Inadvertent doping from product contamination is a recognised risk of unsupervised dietary supplementation. Doctors responsible for the care of high-performance athletes must be cognisant of these issues and the provisions of the WADC.