Management of radiology services during the 2022 FIFA football (soccer) World Cup.

Diagnostic imaging is the predominant medical service sought for the assessment and staging of musculoskeletal injuries in professional sports events. During the 2022 FIFA Football (soccer) World Cup, a centralized medical care infrastructure was established. This article provides a comprehensive account of the radiological services implemented during this event, encompassing the deployment of equipment and human resources, the structuring of workflows to uphold athlete confidentiality, and initiatives aimed at enhancing communication. Communication channels were refined through radiology consultations held with national teams' health care providers and the adoption of audiovisual reports available in multiple languages, which could be accessed remotely by team physicians. Our established framework can be replicated in international professional football events for seamless integration and efficacy.

Medical services at the FIFA world cup Qatar 2022.

OBJECTIVE: The Football World Cup is among the biggest sporting events in the world, but data to inform the requirements of medical care for such tournaments are limited. This study describes the athlete and team medical services at the FIFA World Cup Qatar 2022 . METHODS: Three different medical service entities were identified through a needs analysis based on expert advice, team physician interviews and questionnaires prior to the event: 'Team Services' to provide any workforce or equipment needs of the teams, a 'Polyclinic' to manage any acute medical demands, and a 'recovery centre' to improve game readiness throughout the tournament. All services had been set up prior to the tournament and thoroughly tested. RESULTS: Of a total of 832 athletes, ~1300 team delegation and ~130 match officials, 167 individuals including 129 (77%) athletes and 38 (23%) non-athletes were assessed in the polyclinic. For the 129 athletes (median 4 players per team), medical imaging was the most requested service, which peaked during the group phase of the tournament. Most requests were received during normal working hours despite many games finishing late at night. 30 of the 32 participating teams solicited medical services for their players at least once. Three teams made use of the recovery facilities, and 17 teams requested additional medical equipment or clinical assistance. CONCLUSION: Central imaging services was the most used medical resource at the FIFA World Cup Qatar 2022, and over half of teams required additional medical equipment or personnel. These data may inform planning of medical services for similar events in the future.

Environmental surface contamination with SARS-CoV-2 in professional football clubs.

Background: We assessed SARS-CoV-2 contamination of random surfaces in football training facilities in an environment with a high prevalence of infections.Methods: In six clubs of the Qatar Stars League, surfaces of random locations (high-touch areas, ventilation systems, toilets, cleaning tools, freezers, pantries) in routinely cleaned training facilities, locker rooms, medical and administrative areas were swabbed for SARS-CoV-2. The swabs were screened for the presence of viral RNA using a SARS-CoV-2 qPCR Probe Assay.Results: None of the 103 swabs reached a cycle threshold (cT) value ≤30 (strong viral presence, suggestive of potential surface transmission). Four samples showed cT values >30 and <35 (low quantity of virus) and 16 swabs returned a cT value ≥35 and <40 (inactive virus remnants). The remaining 83 samples were negative (cT value ≥40). Most samples with viral or viral remnant presence originated from high-touch areas.Conclusion: We did not find evidence for potential surface transmission in football club facilities when routine cleaning procedures are in place despite the presence of infected subjects.

A novel method for internal fixation of basal fifth metatarsal fracture in athletes: a cadaveric study of the F.E.R.I. technique (Fifth metatarsal, Extra-portal, Rigid, Innovative).

PURPOSE: One of the main problems of Kirschner wire fixation of fifth metatarsal base fractures (in combination with a tension band wiring technique) seems to be hardware intolerance and several studies in athletes also report failure after isolated fixation with a screw only. These reports prompted us to look at new materials and a novel technique through fixation with an intramedullary screw combined with a high-resistance suture via the presented F.E.R.I. (Fifth metatarsal, Extra-portal, Rigid, Innovative) technique. METHODS: This cadaveric study describes F.E.R.I. TECHNIQUE: On a cadaver, through two mini portals, a full reduction and solid internal fixation with an intramedullary screw and suture cerclage with Fiberwire of a fifth metatarsal base fracture is achieved. In this article, the cadaveric study and proposed surgical technique are explained and illustrated step by step. RESULTS: The presented internal fixation F.E.R.I. technique is indicated in acute proximal fractures, stress fractures or non-union of metatarsal 5 (Zone 2-3 by Lawrence and Botte) and it resulted feasible and stable during manual stress test. The authors intend to study this technique in the clinical setting in the near future. CONCLUSIONS: Fifth metatarsal base fractures gain specific interest when occurring in athletes. In this group of patients, internal fixation is often required to obtain a satisfactory outcome and time to return to play. The aim of the presented cadaveric study is to illustrate an innovative concept of internal fixation, named F.E.R.I.

Necrotising fasciitis: an 8.5-year retrospective case review in a New Zealand intensive care unit.

BACKGROUND: Necrotising fasciitis is a rare, rapidly progressive soft tissue infection associated with extensive necrosis, profound shock and high morbidity and mortality. Incidence worldwide is thought to be increasing. OBJECTIVE: To investigate the demographics, comorbidities, microbiological features, resource use and outcome of patients with necrotising fasciitis. We aimed to identify factors associated with mortality. DESIGN, PARTICIPANTS AND SETTING: A retrospective case and chart review was performed in consecutive patients with necrotising fasciitis admitted to the intensive care unit of a tertiary hospital between January 2000 and June 2008. RESULTS: 58 patients with necrotising fasciitis were admitted during the study period. Pacific Islander and Maori peoples were overrepresented. Comorbidities were consistent with previous studies except for a high incidence of gout. Lower limb was the most frequent site of infection (53%). Swelling (83%) and severe pain (76%) were the most common presenting features. Type 2 infection (52%) was more common than type 1 (43%). Mortality was 29%. Recent non-steroidal antiinflammatory drug use was reported by 43% of patients but not associated with mortality. Logistic regression modelling identified Acute Physiology and Chronic Health Evaluation (APACHE) II score, pre-existing abnormal renal function and gout to be associated with mortality. CONCLUSIONS: There is an higher incidence of necrotising fasciitis at our hospital in South Auckland than reported elsewhere. Maori and Pacific Islander people are at increased risk. In our patient sample APACHE II score, preexisting abnormal renal function and gout were associated with mortality.

The effect of a simulation-based training intervention on the performance of established critical care unit teams.

OBJECTIVE: We evaluated the effectiveness of a simulation-based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises and compared simulation-based learning and case-based learning on scores for performance. DESIGN: Self-controlled randomized crossover study design with blinded assessors. SETTING: A simulated critical care ward, using a high-fidelity patient simulator, in a university simulation center. SUBJECTS: Forty teams from critical care units within the region comprising one doctor and three nurses. INTERVENTION: At the beginning and end of the 10-hr study day, each team undertook two preintervention and two postintervention assessment simulations (one airway, one cardiac on both occasions). The study day included presentations and discussions on human factors and crisis management, and airway and cardiac skills stations. For the intervention, teams were randomized to case-based learning or simulation-based learning for cardiac or airway scenarios. MEASUREMENTS AND MAIN RESULTS: Each simulation was recorded and independently rated by three blinded expert assessors using a structured rating tool with technical and behavioral components. Participants were surveyed 3 months later. We demonstrated significant improvements in scores for overall teamwork (p ≤ .002) and the two behavioral factors, "Leadership and Team Coordination" (p ≤ .002) and "Verbalizing Situational Information" (p ≤ .02). Scores for clinical management also improved significantly (p ≤ .003). We found no significant difference between simulation-based learning and case-based learning in the context of this study. Survey data supported the effectiveness of study day with responders reporting retention of learning and changes made to patient management. CONCLUSIONS: A simulation-based study day can improve teamwork in multidisciplinary critical care unit teams as measured in pre- and postcourse simulations with some evidence of subsequent changes to patient management. In the context of a full-day course, using a mix of simulation-based learning and case-based learnings seems to be an effective teaching strategy.

Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams.

INTRODUCTION: Teamwork failures contribute to adverse events causing harm to patients. Establishing and maintaining a team and managing the tasks are active processes. Medical education largely ignores teamwork skills. However, lack of robust instruments to measure teamwork limits evaluation of interventions to improve it. The authors aimed to develop and validate an instrument to measure teamwork behaviours. METHODS: From existing literature, the authors developed an instrument, gaining rater consensus that the final 23 items were comprehensive, comprehensible and observable. Data on the instrument were obtained from three expert raters who scored videotaped simulations of 40 critical care teams (one doctor, three nurses) participating in four simulated emergencies. Exploratory Factor Analysis, Generalisability Analysis and rater interviews on assessor performance provided information on the properties of the instrument. RESULTS: Exploratory Factor Analysis found items clustered into three factors: Leadership and Team Coordination; Mutual Performance Monitoring; and Verbalising Situational Information. Internal consistencies (Cronbach's α) for these factors were 0.917, 0.915 and 0.893, respectively. The Generalisability coefficient for overall team behaviour was 0.78 and the G coefficients for the three factors were 0.85, 0.4 and 0.37, respectively. Variance Components and interview data provided insight into individual item performance. Significantly improved performance with time and seniority supported construct validity. DISCUSSION: The instrument performed well as an overall measure of team behaviour and reflected three dimensions of teamwork. Triangulation of information on the instrument, the factors and individual items will allow a methodical and informed approach to further development of the instrument. The ultimate goal is an instrument that can robustly evaluate interventions to improve team function in healthcare.

Effects of nursing industrial action on relatives of Intensive Care Unit patients: a 16-month follow-up.

AIMS: In December 2001, nursing industrial action occurred at Christchurch Hospital. This study assesses the effect industrial action had on relatives of those Intensive Care Unit (ICU) patients involved. METHOD: A written questionnaire was sent to the relatives of the 17 patients on Intensive Care around the time of the strike; 11 of these patients had needed to be transferred to out of region hospitals for continuing care, whilst the others remained in the intensive care unit. Comparisons were made with a control group of 26 next-of-kin. RESULTS: Compared with relatives of patients not involved in the strike, relatives involved during the strike were significantly more angry (p<0.007) and less trusting that the patients had received the best possible care (p<0.05). Compared to the control group, they were also more negative in their continuing view of the healthcare system (p<0.05). Those relatives involved in air transfers were more distressed (p<0.05), angry (p<0.001), and less trusting than those not involved in a transfer (p<0.005). CONCLUSION: The study shows that industrial action caused measurable distress and anxiety to the relatives involved some 16 months after the strike, especially in patients who were transferred. A persistent negative perception of the healthcare system in New Zealand could be demonstrated in this group.

Transport services under stress: patient air transfers due to industrial action in Christchurch.

AIMS: On 2 and 3 December 2001, widespread industrial action by nursing staff in the five public hospitals in Christchurch resulted in a minimal number of nurses being available for inpatient care. The major hospital affected was Christchurch Public Hospital. Mass transfer of patients (and relatives) occurred, by road to local, private nursing homes, and by air to hospitals throughout New Zealand. This caused disruption at both a local and national level. This paper discusses the process by which air transfers took place and the lessons learnt from the experience. METHODS: The reduction of inpatient numbers in this tertiary referral hospital was necessary in anticipation of a full withdrawal of labour by the nursing staff. All patients identified as potentially transferable were individually assessed as to the risk of remaining in an understaffed hospital versus that of transfer. The Intensive Care Unit (ICU) coordinated the triage of patients and organised air transfers. All elective work was suspended. Following strike action, all patients transferred were returned to Christchurch as rapidly as possible. RESULTS: Eighty four patients were identified for air transfer. Eight were unfit for transfer and, of the remainder, 43 were transferred with their relatives in a six-day period before the industrial action began. This required the services of all medical air transport facilities within New Zealand, placing the aeromedical retrieval services under considerable stress. The hospital was reduced to 20% capacity at strike commencement (from 650 beds to 148). Intensivists performed nursing duties in the ICU. CONCLUSIONS: Two days of strike action resulted in 15 days of local and national disruption. Central coordination of all aero-medical transfer services, hospital teams, ambulance and social services was essential. The provision of 'family packages' was useful in assisting with the marked disruption experienced by patients and relatives.