Injuries in Youth Volleyball Players at a National Championship: Incidence, Risk Factors, and Mechanisms of Injury.

OBJECTIVE: To evaluate injury incidence rates, types, mechanisms, and potential risk factors in youth volleyball. DESIGN: Prospective cohort. SETTING: 2018 Canadian Youth National Volleyball Tournament. PARTICIPANTS: Thousand eight hundred seventy-six players [466 males, 1391 females, mean age 16.2 years (±1.26)] consented to participate (19.5%). ASSESSMENT OF RISK FACTORS: Sex (male/female), age group, position, and underage players. MAIN OUTCOME MEASURES: Players completed a questionnaire (demographic information, injury, and concussion history). Medical attention injuries were recorded by tournament medical personnel through an injury report form (eg, mechanism and type). Injury was defined as any physical complaint seeking onsite medical attention. Concussion was defined using the fifth International Consensus. Injury rates adjusted for cluster by team were calculated by sex. Exploratory multivariable Poisson regression was used to analyze potential risk factors (eg, sex, age group, position, and underage players) for injury, adjusted for cluster by team and offset by athlete exposures (AEs). RESULTS: There were 101 injuries in the 7-day tournament {IRFemale = 6.78 injuries/1000 AEs [95% confidence interval (CI), 5.27-8.72]; IRMale = 4.30 injuries/1000 AEs (95% CI, 2.55-7.24)}. Joint sprain (n = 29, 28.71%) and concussion (n = 26, 25.74%) were the most common. Most concussions were associated with ball-to-head contact (61.5%). There was no statistically significant difference in injury rate by sex (IRRF/M: 1.47; 95% CI, 0.80-2.69). The rates of injury in U14 were higher than U18 (IRRU14: 2.57; 95% CI, 1.11-5.98). CONCLUSIONS: Injury rates are high in youth volleyball tournament play, with the highest rates in U14. More research is needed to inform the development of volleyball-specific injury prevention strategies.

Jumper's Knee: A Prospective Evaluation of Risk Factors in Volleyball Players Using a Novel Measure of Injury.

OBJECTIVES: To examine potential intrinsic risk factors that may contribute to the onset of jumper's knee in elite level-male volleyball players. DESIGN: Prospective Cohort Study. SETTING: Varsity and National team volleyball gymnasiums. PARTICIPANTS: Sixty elite adult male volleyball players from Canada. ASSESSMENT OF RISK FACTORS: Players completed a series of risk factor assessments at the commencement of their seasons, including vertical jump (cm), ankle dorsiflexion range (degrees), dynamic balance (normalized distance reached; cm), dynamic knee alignment (degrees), and landing mechanics (degrees). MAIN OUTCOME MEASURE: Self-reported knee problems, captured via short message service. RESULTS: Knee problem prevalence was 75% [95% confidence intervals (CIs): 62.2-84.6] and the incidence rate for substantial injuries over the study period was 30 injuries/100 players/season (95% CI: 19.5-43.1). No risk factor was found to significantly predict the future occurrence of developing jumper's knee. The odds ratios were close to unity (range: 0.94-1.07) with narrow confidence intervals and P > 0.05. CONCLUSIONS: A more sensitive capture of overuse knee problems did not result in the identification of distinct risk factors for the development of jumper's knee. These findings highlight a lack of available methodology to accurately assess risk factors for overuse injuries.

Validation of a commercially available inertial measurement unit for recording jump load in youth basketball players.

A high incidence of overuse knee injuries among youth basketball players may be attributed to number of jumps. Wearable technology may be an effective tool for measuring jump load compared to traditional counting methods. The purpose of this study was to validate a commercially available jump counter (VERT® Classic) in youth basketball practices and games, and to identify the characteristics (i.e., height, direction, takeoff) of jumps recorded by the VERT® Classic. 46 (19F, 27M) youth basketball players wore a VERT® Classic and were recorded on video during games and practices. The number of jumps recorded by the VERT® Classic and evaluated by video raters were compared for each jump characteristic using intraclass correlation coefficient (ICC(3,k)), mean offset, and limits of agreement. The number and percent of VERT® Classic jumps and corresponding video jumps according to timestamp were reported. VERT® Classic jumps had excellent reliability with video-counted jumps over 15 cm (ICC(3,k) = 0.958), with a mean offset of -2.4 jumps (fewer VERT® Classic) and limits of agreement -12.6 to 7.8 jumps. Pairs of corresponding jumps represented 68.0% of total video jumps and 92.0% of VERT® Classic jumps. The VERT® Classic can provide an estimate of jump load in youth basketball.

The Effect of Injury Definition and Surveillance Methodology on Measures of Injury Occurrence and Burden in Elite Volleyball.

A time-loss injury definition continues to be the most widely used injury definition despite evidence that it fails to accurately capture overuse injuries. An overuse injury questionnaire, using an "all complaints" definition has been created to address the limitation of a time-loss definition. The main aim of this work was to determine the effect that injury definition and registration methodology has on the collection of knee injuries among elite level volleyball players. To reach this goal, seventy-two volleyball players were prospectively followed over 32-weeks. Time-loss injuries were captured using an individual injury report form (IIRF). Study participants completed an overuse injury questionnaire (mOIQ) via a weekly short message service (SMS). The IIRF captured 15 time-loss knee injuries in 72 study participants (20%). Based on the mOIQ, 84.7% of participants reported having a knee problem and 66.7% sustained a substantial knee problem. All IIRF knee injuries captured were also registered by the mOIQ. Agreement on the specific diagnosis occurred for 66.7% of injuries resulting in a moderate Kappa score of 0.51. In conclusion, an overuse injury questionnaire provided a greater understanding of the magnitude and burden of knee injuries in this population.

The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease: A Systematic Review and Meta-analysis.

BACKGROUND: The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear. PURPOSE: To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis. DATA SOURCES: Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials that evaluated the treatment of anemia with ESAs, including erythropoietin and darbepoetin, targeted higher versus lower hemoglobin levels, and used validated HRQOL metrics. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were scores on the Short Form-36 Health Survey (SF-36), Kidney Dialysis Questionnaire (KDQ), and other tools. DATA SYNTHESIS: Of 17 eligible studies, 13 reported SF-36 outcomes and 4 reported KDQ outcomes. Study populations consisted of patients not undergoing dialysis (n = 12), those undergoing dialysis (n = 4), or a mixed sample (n = 1). Only 4 studies had low risk of bias. Pooled analyses showed that higher hemoglobin targets resulted in no statistically or clinically significant differences in SF-36 or KDQ domains. Differences in HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis recipients. LIMITATION: Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias. CONCLUSION: ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD. PRIMARY FUNDING SOURCE: KRESCENT and Manitoba Health Research Council Establishment.

Honoring Our Hospital's History: A Preservation and Digitization Initiative.

There is limited literature on hospital archives projects. Hospitals understandably have a strong focus on patient care, but there is still a critical need to keep institutional archives. Among their many uses, institutional archives preserve corporate memory, provide evidence of interactions with community, and assist in contemporary decision making. This column describes a university-hospital partnership to undertake a one-year project to preserve, detail, and digitize ten boxes, or approximately 3.8 meters, of materials dating from 1980 to 2006. This project serves as a model for other hospital or health care facilities wanting to preserve and more actively engage with their archival collections.

Urinary, Plasma, and Serum Biomarkers' Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis.

BACKGROUND: Early accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear. STUDY DESIGN: Systematic review and meta-analysis. SETTING & POPULATION: Adult patients having cardiac surgery. SELECTION CRITERIA FOR STUDIES: EMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias. INDEX TESTS: Novel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (<24 hours). REFERENCE TESTS: AKI was defined according to the RIFLE, AKIN, or 2012 KDIGO criteria. RESULTS: We found 28 studies reporting intraoperative and/or early postoperative measurement of urine (n=23 studies) or plasma or serum (n=12 studies) biomarkers. Only 4 of these studies measured biomarkers intraoperatively. Overall, intraoperative discrimination by the urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) demonstrated AUROCs<0.70, whereas N-acetyl-ß-d-glucosaminidase (NAG) and cystatin C had AUROCs<0.75. In the immediate 24-hour postoperative period, the urine biomarkers NGAL (16 studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6 studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs for postoperative urine cystatin C, NAG, and interleukin 18 were ≤0.70. Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies) and cystatin-C (5 studies) were <0.70. LIMITATIONS: Heterogeneous AKI definitions. CONCLUSIONS: In adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery.

The cost effectiveness of erythropoietin-stimulating agents for treating anemia in patients on dialysis: a systematic review.

BACKGROUND: Anemia is a common complication associated with kidney failure and is marked by poor health and increased risk of morbidity and mortality. There are ongoing concerns with the use of Erythropoietin Stimulating Agents (ESAs) to treat anemia in patients with kidney failure on dialysis. Questions as to their benefits, harms and overall effect on quality of life are still relevant today. Our objective was to systematically review studies evaluating the cost-effectiveness of ESAs in patients with kidney failure on dialysis. METHODS: We performed a systematic review of studies determining the cost-effectiveness of ESAs in adult patients on dialysis. Databases, including PubMed, EMBASE, and Cochrane Database of Systematic Reviews, were searched from their establishment until June 2013. Studies that reported an incremental cost-effectiveness ratio of hemoglobin correction strategies based on ESA treatments in comparison to red blood cell transfusions, lower hemoglobin targets, or no ESA treatment were included. RESULTS: Seven studies met inclusion criteria. Reported cost/quality-adjusted life-year (QALY) ratios ranged from USD 931-677,749/QALY across five studies comparing ESAs to red blood cell transfusions. There was heterogeneity in results when considering higher hemoglobin targets, with studies finding higher targets to be both dominant and dominated. Mortality, hospitalization, and utility estimates were major drivers. CONCLUSIONS: There is substantial variability in the estimates of the cost-effectiveness of using ESAs in the dialysis population. New models incorporating recent meta-analyses for estimates of utility, mortality, and hospitalization changes would allow for a more comprehensive answer to this question.

Cost-effectiveness of primary screening for CKD: a systematic review.

BACKGROUND: Chronic kidney disease (CKD) is a major health problem with an increasing incidence worldwide. Data on the cost-effectiveness of CKD screening in the general population have been conflicting. STUDY DESIGN: Systematic review. SETTING & POPULATION: General, hypertensive, and diabetic populations. No restriction on setting. SELECTION CRITERIA FOR STUDIES: Studies that evaluated the cost-effectiveness of screening for CKD. INTERVENTION: Screening for CKD by proteinuria or estimated glomerular filtration rate (eGFR). OUTCOMES: Incremental cost-effectiveness ratio of screening by proteinuria or eGFR compared with either no screening or usual care. RESULTS: 9 studies met criteria for inclusion. 8 studies evaluated the cost-effectiveness of proteinuria screening and 2 evaluated screening with eGFR. For proteinuria screening, incremental cost-effectiveness ratios ranged from $14,063-$160,018/quality-adjusted life-year (QALY) in the general population, $5,298-$54,943/QALY in the diabetic population, and $23,028-$73,939/QALY in the hypertensive population. For eGFR screening, one study reported a cost of $23,680/QALY in the diabetic population and the range across the 2 studies was $100,253-$109,912/QALY in the general population. The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness. LIMITATIONS: Few studies evaluated screening by eGFR. Performance of a quantitative meta-analysis on influential assumptions was not conducted because of few available studies and heterogeneity in model designs. CONCLUSIONS: Screening for CKD is suggested to be cost-effective in patients with diabetes and hypertension. CKD screening may be cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy.

Association of frailty and physical function in patients with non-dialysis CKD: a systematic review.

BACKGROUND: Frailty is a condition characterized by a decline in physical function and functional capacity. Common symptoms of frailty, such as weakness and exhaustion, are prevalent in patients with chronic kidney disease (CKD). The increased vulnerability of frail patients with coexisting CKD may place them at a heightened risk of encountering additional health complications. The purpose of this systematic review was to explore the link between frailty, CKD and clinical outcomes. METHODS: We searched for cross sectional and prospective studies in the general population and in the CKD population indexed in EMBASE, Pubmed, Web of Science, CINAHL, Cochrane and Ageline examining the association between frailty and CKD and those relating frailty in patients with CKD to clinical outcomes. RESULTS: We screened 5,066 abstracts and retrieved 108 studies for full text review. We identified 7 studies associating frailty or physical function to CKD. From the 7 studies, we identified only two studies that related frailty in patients with CKD to a clinical outcome. CKD was consistently associated with increasing frailty or reduced physical function [odds ratios (OR) 1.30 to 3.12]. In patients with CKD, frailty was associated with a greater than two-fold higher risk of dialysis and/or death [OR from 2.0 to 5.88]. CONCLUSIONS: CKD is associated with a higher risk of frailty or diminished physical function. Furthermore, the presence of frailty in patients with CKD may lead to a higher risk of mortality. Further research must be conducted to understand the mechanisms of frailty in CKD and to confirm its association with clinical outcomes.

Volleyball Competition on Consecutive Days Modifies Jump Kinetics but Not Height.

PURPOSE: In volleyball, jump execution is critical for the match outcome. Game-play-related neuromuscular impairments may manifest as decreased jump height (JH) or increased jump total duration, both of which are pivotal for performance. To investigate changes in JH and kinetics with game play, the authors conducted a prospective exploratory analysis using minimal-effect testing (MET) and equivalence testing with the 2 one-sided tests procedure, univariate, and bivariate functional principal component analysis, respectively. METHODS: Twelve male varsity athletes completed 3-set matches on 2 consecutive days. Countermovement jumps were performed on a force platform immediately prematch and postmatch on days 1 and 2 and once on days 3 and 4. RESULTS: Across sessions, JH was equivalent (P < .022, equivalence test), while total duration reported inconclusive changes (P > .227). After match 2, MET indicated that relative force at zero velocity (P = .036) decreased, while braking duration (P = .040) and time to peak force (P = .048) increased compared with baseline. With the first and second functional principal components, these alterations, together with decreased relative braking rate of force development (P = .092), were already evident after match 1. On day 4, MET indicated that relative peak force (P = .049), relative force at zero velocity (P = .023), and relative braking rate of force development (P = .021) decreased, whereas braking duration (P = .025) increased from baseline. CONCLUSIONS: Impairments in jump kinetics were evident from variables related to the countermovement-jump braking phase, while JH was equivalent. In addition to these experimental findings, the present research provides information for the choice of sample size and smallest effect size of interest when using MET and 1- and 2-dimensional analyses for countermovement-jump height and kinetics.

Using the VERT wearable device to monitor jumping loads in elite volleyball athletes.

Sport is becoming increasingly competitive and athletes are being exposed to greater physical demands, leaving them prone to injuries. Monitoring athletes with the use of wearable technology could provide a way to potentially manage training and competition loads and reduce injuries. One such technology is the VERT inertial measurement unit, a commercially available discrete wearable device containing a 3-axis accelerometer, 3-axis gyroscope and 3-axis magnetometer. Some of the main measurement outputs include jump count, jump height and landing impacts. While several studies have examined the accuracy of the VERT's measures of jump height and jump count, landing impact force has not yet been investigated. The objective of this research study was to explore the validity of the VERT landing impact values. We hypothesized that the absolute peak VERT acceleration values during a jump-land cycle would fall within 10% of the peak acceleration values derived simultaneously from a research-grade accelerometer (Shimmer). Fourteen elite university-level volleyball players each performed 10 jumps while wearing both devices simultaneously. The results showed that VERT peak accelerations were variable (limits of agreement of -84.13% and 52.37%) and had a propensity to be lower (mean bias of -15.88%) when compared to the Shimmer. In conclusion, the validity of the VERT device's landing impact values are generally poor, when compared to the Shimmer.

"To Tech or Not to Tech?" A Critical Decision-Making Framework for Implementing Technology in Sport.

The current technological age has created exponential growth in the availability of technology and data in every industry, including sport. It is tempting to get caught up in the excitement of purchasing and implementing technology, but technology has a potential dark side that warrants consideration. Before investing in technology, it is imperative to consider the potential roadblocks, including its limitations and the contextual challenges that compromise implementation in a specific environment. A thoughtful approach is therefore necessary when deciding whether to implement any given technology into practice. In this article, we review the vision and pitfalls behind technology's potential in sport science and medicine applications and then present a critical decision-making framework of 4 simple questions to help practitioners decide whether to purchase and implement a given technology.

Validation of an inertial measurement unit for the measurement of jump count and height.

OBJECTIVES: To validate the use of an inertial measurement unit (IMU) for the collection of total jump count and assess the validity of an IMU for the measurement of jump height against 3-D motion analysis. DESIGN: Cross sectional validation study. SETTING: 3D motion-capture laboratory and field based settings. PARTICIPANTS: Thirteen elite adolescent volleyball players. INDEPENDENT VARIABLES: Participants performed structured drills, played a 4 set volleyball match and performed twelve counter movement jumps. MAIN OUTCOME MEASURES: Jump counts from structured drills and match play were validated against visual count from recorded video. Jump height during the counter movement jumps was validated against concurrent 3-D motion-capture data. RESULTS: The IMU device captured more total jumps (1032) than visual inspection (977) during match play. During structured practice, device jump count sensitivity was strong (96.8%) while specificity was perfect (100%). The IMU underestimated jump height compared to 3D motion-capture with mean differences for maximal and submaximal jumps of 2.5 cm (95%CI: 1.3 to 3.8) and 4.1 cm (3.1-5.1), respectively. CONCLUSION: The IMU offers a valid measuring tool for jump count. Although the IMU underestimates maximal and submaximal jump height, our findings demonstrate its practical utility for field-based measurement of jump load.

Dipeptidyl Peptidase-4 Inhibitors in Chronic Kidney Disease: A Systematic Review of Randomized Clinical Trials.

BACKGROUND: Chronic kidney disease (CKD) is common in patients with type 2 diabetes mellitus (T2DM) and limits therapeutic options. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel class of oral glucose-lowering agents and are known to be safe and effective in the general population. METHODS: We searched Cochrane, EMBASE, and PubMed from the time of their inception until March 2015. We included randomized controlled trials analyzing the efficacy (change in hemoglobin A1C [HbA1C]) and safety of DPP-4 agents in individuals with reduced kidney function (estimated glomerular filtration rate <60 mL/min/1.73 m2). We extracted study characteristics, participants' baseline characteristics, and safety outcomes from eligible studies. We performed a random effects meta-analysis to summarize the change in HbA1C and the relative risk of cardiovascular events in patients with T2DM and CKD. We also collected data on hypoglycemia, other serious adverse events, and mortality. RESULTS: We reviewed 12 studies with 4,403 patients with CKD and 239 on dialysis, finding a mean weighted decline in HbA1C of -0.48 (95% CI -0.61 to -0.35) with DPP-4 inhibitor therapy compared to placebo. DPP-4 inhibitors did not result in any additional adverse events, hypoglycemic episodes, or increased mortality. Restricting to studies with low risk of bias did not alter these findings. CONCLUSIONS: DPP-4 inhibitors can lower HbA1C without increasing the risk of cardiovascular or other major adverse events in patients with CKD. Few studies reported critical adverse events such as heart failure and hypersensitivity. If compared with other oral antiglycemic drugs, the effect of DPP-4 inhibitors is limited; however, their low risk of hypoglycemia may favor their use in patients with CKD. SUMMARY: This systematic review of DPP-4 inhibitors in CKD suggests that they reduce HbA1C by about 0.5%. Furthermore, there was not any increase in the risk for significant adverse events. More research is needed to determine the safety and efficacy of DPP-4 inhibitors in CKD.

Systematic review of preoperative physical activity and its impact on postcardiac surgical outcomes.

OBJECTIVES: The objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients' postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour. METHODS: A systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted. RESULTS: Eleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively. CONCLUSION: Due to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables. REGISTRATION: Trial registration number NCT02219815. PROSPERO number CRD42015023606.

Long-Term Effects of Postoperative Delirium in Patients Undergoing Cardiac Operation: A Systematic Review.

Delirium is an acute syndrome that involves fluctuating changes in attention and cognition. Although delirium is the most common neurologic complication after cardiac operation, data about its impact on long-term outcomes are lacking. The purpose of this systematic review was to examine the effect of postoperative delirium (PoD) on long-term outcomes, including morbidity, probability of death, cognitive decline, institutionalization, and health-related quality of life (HRQoL) in patients undergoing cardiac operation. After performing this systematic review we determined that PoD after cardiac operation is associated with an increased risk of probability of death and readmission to the hospital and a decrease in cognitive function, overall function, and HRQoL.

Necrotizing fasciitis resulting from human bites: A report of two cases of disease caused by group A streptococcus.

Necrotizing fasciitis is a serious and potentially life-threatening condition. Although bite wounds are common, they are not frequently reported as a cause of necrotizing fasciitis. In the present article, two cases of bite-associated necrotizing fasciitis caused by group A streptococcus are reported. Previously published cases are also reviewed.