Hydration testing in collegiate wrestlers undergoing hypertonic dehydration.

UNLABELLED: Because dehydration (DEH) violates assumptions used in the assessment of body composition, hydration testing has become an integral part of minimal weight (MW) assessment. PURPOSE: To determine the accuracy of hydration tests for the detection and quantification of hypertonic DEH. METHODS: Twenty-five male collegiate wrestlers (mean +/- SD, age: 20.0 +/- 1.4 yr, height: 175.0 +/- 7.1 cm, body mass: 81.7 +/- 15.3 kg) had their hydration assessed under well-controlled conditions of euhydration (EUH) and DEH. The DEH phase occurred on the same day as EUH, after subjects acutely dehydrated 2-6% of body weight through fluid/food restriction and exercise in a hot environment. RESULTS: All hydration tests except plasma potassium significantly increased from EUH to DEH, and meaningful cutoff values could be established for most tests. Cutoff values for urine tests were 586 mOsm.L(-1) for osmolality and 71 mEq.L(-1) for potassium. Plasma cutoff values were 293 mOsm.L(-1) for osmolality, 140 mEq.L(-1) for sodium, 103 mEq.L(-1) for chloride, and 3.5 pg.mL(-1) for arginine vasopressin. For ratio tests, a urine:plasma osmolality of 2.06 and an extracellular:intracellular water of 0.533 measured by the bioelectrical impedance spectroscopy were cutoff values. For urine specific gravity, a cutoff value of 1.020 g.mL(-1) had a sensitivity and specificity of 96% each for the automated harmonic oscillation technique and 87% and 91% (respectively) for the dipstick technique. Protein (by dipstick) was detected in 5% of subjects in EUH, and 100% of subjects in DEH. Correlations between hydration tests and dehydration were only low to moderate. CONCLUSION: This study supports a specific gravity cutoff of 1.020 g.mL(-1) for the identification of hypertonic DEH. Future research should test the cutoff values established in this study and explore the relationship between DEH and urine protein.

The effect of dehydration on wrestling minimum weight assessment.

UNLABELLED: Given that some wrestlers arrive for minimum weight (MW) testing in a dehydrated condition, it is important to understand the effects of dehydration on MW assessment methods. PURPOSE: To determine the effect of dehydration on the assessment of MW by three-site skinfolds with the Lohman formula (SF), leg-to-leg bioelectrical impedance analysis (BIA), and multifrequency bioelectrical impedance spectroscopy (BIS) compared with a four-component (4C) criterion. METHODS: Twenty-two male collegiate wrestlers (mean +/- SD, age: 19.9 +/- 1.4 yr, height: 174.0 +/- 6.8 cm, body mass: 77.4 +/- 9.1 kg) had their body composition assessed by the 4C criterion, hydrostatic weighing (HW), SF, BIA, and BIS in euhydration (EUH) and dehydration (DEH). Subjects dehydrated 2-5% of body weight through fluid restriction and exercise in a hot environment. RESULTS: In EUH, the total error (TE) for HW (1.75 kg) and SF (2.15 kg) were not significantly different, but the TE for HW and SF methods were significantly lower than the TE for both BIS (3.68 kg) and BIA (3.77 kg). In DEH, SF, BIA, and BIS methods had a TE approaching or exceeding 4 kg (8.8 lb). Dehydration increased the TE for SF and BIA through an artificial lowering of body weight and for BIS by an increased error in intracellular water prediction. CONCLUSION: Acute thermal dehydration violates assumptions necessary for the accurate and precise prediction of MW by SF, leg-to-leg BIA, and multifrequency BIS.

Central nervous system trauma management of concussions in athletes.

The care of athletes with concussions is challenging because each patient has different symptoms. An athlete should never be returned to play until completely asymptomatic. Classification systems for concussions are not based on scientific evidence and represent some practitioners' best guess at what is safe for young athletes. Many experienced team physicians believe they can allow an athlete to play safely if there are no symptoms at rest and no symptoms with increasing intensity of exercise. Abbreviated neuropsychological testing and balance tests show promise for use in the field to increase the sensitivity of our neurological evaluation on injured athletes. Any neuropsychological or balance evaluation is more helpful if baseline data is collected on athletes before they are injured.

Herpes and tinea in wrestling: managing outbreaks, knowing when to disqualify.

The two most troublesome skin infections in wrestlers are herpes gladiatorum and tinea gladiatorum. Determining whether athletes should or should not be disqualified from practice or competition because of these infections requires some expertise. Recommendations are presented to assist the practitioner in the care of these conditions in wrestlers and other athletes who have frequent skin-to-skin contact.

Treating and avoiding herpes and tinea infections in contact sports.

Sports that require skin-to-skin contact between competitors, such as wrestling, create environments where infections can spread. Skin screening checks are made before any wrestling competition, but this usually doesn't happen with other sports. Two of the most common skin infections are herpes gladiatorum (caused by the same virus that causes cold sores) and tinea gladiatorum, also known as ringworm (caused by a fungus). These skin infections can spread rapidly among teammates, coaches, and opponents, so it is very important to treat the infection as soon as it is discovered. Athletes who have active skin infections can be disqualified from competition and withheld from practice.

SBAR M&M: a feasible, reliable, and valid tool to assess the quality of, surgical morbidity and mortality conference presentations.

BACKGROUND: The Surgical Morbidity and Mortality (M&M) conference is considered the golden hour of surgical education. However, evaluation methods for ensuring that quality M&M presentations efficiently contribute to resident education have not been clearly defined. To provide surgical trainees with the skills required to present a quality M&M presentation it is essential to have a robust tool to measure presentation skill and guide formative feedback. METHODS: A prospective observational study was conducted to develop an assessment tool for M&M conference. Literature review and expert consensus provided content for tool development. The tool, created using the situation, background, assessment, and recommendation format, was refined successively based on assessor feedback and assessed for reliability (internal consistency, interassessor reliability) and construct validity. RESULTS: Three successive iterations of the tool were developed. Internal consistency and interassessor reliability improved from the first to third versions. A trend also was shown for increasing construct validity with the third iteration of the tool. CONCLUSIONS: A psychometrically robust assessment tool based on the situation, background, assessment, and recommendation format was developed and validated to identify and improve the overall quality and educational value of the surgical M&M conference.

Pediatric residency education: is sports medicine getting its fair share?

INTRODUCTION: Sports are the leading injury-related cause for pediatric primary care visits. Pediatric residency education guidelines suggest incorporating sports medicine (SM) education into curricula; however, research is lacking regarding effective teaching methods. OBJECTIVE: To assess reported US pediatric residency SM curricula, teaching methods, and resident evaluation of SM education. DESIGN/METHODS: Chief residents (CRs) and third-year residents (PL3s) from 100 randomly selected US Accreditation Council for Graduate Medical Education-accredited residency programs, stratified by size and geographic location, received surveys regarding programs' SM curriculum and teaching methods and individuals' methods for learning SM. RESULTS: Response rates were 63% and 39% for CRs and PL3s, respectively. According to CRs, 34% of programs had no one in charge of their SM curriculum. Lecture (77%) was the primary method used for teaching SM. Hands-on teaching (37%) was used less frequently. CRs stated that 29% of programs did not include musculoskeletal examination teaching in their curriculums; 24% did not include formal teaching of concussion management, and 29% did not include reasons for medical disqualification. PL3s rated teaching of joint examinations and the preparticipation physical as the most poorly taught components of the physical examination. PL3s rated hands-on teaching and patient experience as the best methods for improving SM education. CRs reported that only 36% of programs have discussed incorporating more SM into their curriculum. CONCLUSIONS: SM education is deficient in US pediatric residency programs. Standardized curricula should be developed with a focus on hands-on training as a means for teaching SM to pediatric residents.

Training issues in elite young athletes.

Over the past decade, there has been a surge in the number of sports opportunities available to young athletes. Although physicians, parents, and coaches should promote healthy activity and participation, intense training at a young age can predispose exuberant young athletes to certain difficulties. Elite young athletes are at risk for overuse and growth plate injuries in certain sports. Intense training combined with inadequate nutrition may cause growth delay in elite young athletes, but this delay does not appear to affect permanent adult height. Weight training, when done properly, is safe and effective for prepubescent and pubescent athletes. Awareness of neurobehavioral development can help guide the process for appropriate sports participation. Young athletes should be closely monitored for signs of excessive physical and emotional stress so that sports participation can be fun and rewarding.

Prevention of pediatric sports injuries.

With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.

Chest Pain in Active Young People.

In brief Chest pain in children and adolescents is usually benign and noncardiac, unlike that in adults. Some of the more common causes are activity related, such as chest wall trauma and exercise-induced asthma. A careful history and physical examination will often provide a diagnosis, though about one third of causes are idiopathic. Most patients will not require extensive testing or referral. Education and reassurance are essential for relieving patient and parent anxiety.