Sport-related concussion in para athletes: A scoping review of concussion incidence, assessment, and management.

ABSTRACT: Although research on sport-related concussion has grown substantially in the last decade, research on concussion in para sports remains limited. The aim of this scoping review is to synthesize and describe the current literature on the incidence, assessment, and management of sport-related concussion in para athletes. The literature search was conducted in CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science databases and identified 22 studies that addressed one of our research questions. A majority of studies addressed concussion in elite athletes; youth and collegiate para athletes were largely under-represented. Fewer studies addressed concussion assessment and management, in part due to limitations in accessibility of current assessment tools for athletes with varying disabilities. Moving forward, there is a need to capture a larger range of incidence data, create modified assessment tools with para-specific normative data, and develop risk prevention strategies for para athletes.

Impact of feedback generation and presentation on self-monitoring behaviors, dietary intake, physical activity, and weight: a systematic review and meta-analysis.

Self-monitoring of dietary intake, physical activity, and weight is a key strategy in behavioral interventions, and some interventions provide self-monitoring feedback to facilitate goal setting and promote engagement. This systematic review aimed to evaluate whether feedback increases intervention effectiveness, and which forms of feedback presentation (e.g., personalized vs. not personalized) and generation (i.e., human vs. algorithm-generated) are most effective. To achieve this aim, 5 electronic databases (PubMed/MEDLINE, Web of Science, CINAHL, PsycINFO, and Google Scholar) were searched in April 2022 and yielded 694 unique records, out of which 24 articles reporting on 19 studies were included (with a total of 3261 participants). Two reviewers independently screened titles and abstracts and then full texts and categorized articles as eligible or excluded according to the pre-registered criteria (i.e., availability of full text, peer reviewed manuscript in English; adult participants in a randomized controlled trial that included both self-monitoring and feedback; comparisons of different forms of feedback or comparisons of feedback vs. no feedback; primary outcomes of diet, physical activity, self-monitoring behavior, and/or weight). All included studies were assessed for methodological quality independently by two reviewers using the revised Cochrane risk-of-bias tool for randomized studies (version 2). Ten studies compared feedback to no feedback, 5 compared human- vs. algorithm-generated feedback, and the remaining 4 studies compared formats of feedback presentation (e.g., frequency, richness). A random effects meta-analysis indicated that physical activity interventions with feedback provision were more effective than physical activity interventions without feedback (d = 0.73, 95% CI [0.09;1.37]). No meta-analysis could be conducted for other comparisons due to heterogeneity of study designs and outcomes. There were mixed results regarding which form of feedback generation and presentation is superior. Limitations of the evidence included in this review were: lack of details about feedback provided, the brevity of most interventions, the exclusion of studies that did not isolate feedback when testing intervention packages, and the high risk of bias in many studies. This systematic review underlines the importance of including feedback in behavioral interventions; however, more research is needed to identify most effective forms of feedback generation and presentation to maximize intervention effectiveness.Trial registration (PROSPERO)CRD42022316206.

Sex differences in outcomes of exercise therapy for patients with intermittent claudication: A scoping review.

Exercise therapy is first-line treatment for intermittent claudication due to peripheral artery disease. We sought to synthesize the literature on sex differences in response to exercise therapy for the treatment of intermittent claudication due to peripheral artery disease. A scoping review was performed (1997 to 2023) using Ovid MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, SPORTDiscus, and Web of Science. Articles were included if they were a scientific report of any measures of health-related quality of life or walking performance after an intervention that included a structured walking program. Of the 13 studies, 11 included measures of walking distance; 7 included measures of walking time, 5 included measures of walking speed, and 4 included quality of life measures. Overall, exercise therapy resulted in significant improvements across most measures of walking performance for both men and females. When comparing magnitudes of outcome improvement by sex, results of walking-based measures were contradictory; some studies noted no difference and others found superior outcomes for men. Results of quality of life-based measures were also contradictory, with some finding no difference and others reporting substantially more improvement for females. Both men and females experienced considerable improvement in walking performance and quality of life with exercise therapy. Evidence regarding the differential effect of exercise therapy on outcomes by sex for intermittent claudication is limited and contradictory. Further efforts should be directed at using standardized interventions and metrics for measuring the outcomes that match the indications for intervention in these patients to better understand the expected benefits and any variance according to sex.

Clinical and Translational Science Personas: Expansion and use cases.

Twelve evidence-based profiles of roles across the Clinical and Translational Science (CTS) workforce and two patient profiles were developed by CTS Personas collaborators in 2019 as part of the CTSA Program National Center for Data to Health (CD2H). Based on feedback received from the community, CTS Personas team members collaborated to produce five additional Personas to broaden representation of the CTS workforce and enhance the existing portfolio. This paper presents the rationale and methodology used in the latest CTS Personas initiative. This work also includes an implementation scenario incorporating multiple Personas. Using the new National Institutes of Health's (NIH) Data Management and Sharing Policy as an example, we demonstrate how administrators, researchers, support staff, and all CTS collaborators can use the Personas to respond to this new policy while considering the needs of service providers and users, CTS employees with short- and long-term needs, and interdisciplinary perspectives.

Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review.

Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020.

BACKGROUND: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

Attainment of an Additional Graduate Degree Is Associated With Sustained Scholarly Activity Beyond Surgical Residency.

OBJECTIVE: To determine whether attainment of an additional graduate-level degree during general surgery residency, such as an MSc, MPH, MBA, or PhD, is associated with increased research productivity beyond completion of training. DESIGN: Observational cohort study comparing publication productivity of general surgery residency graduates who did and did not obtain a degree. PubMed queries and the Web of Science Core Collection were used to capture publication metrics. Graduate characteristics, including degree attainment, were obtained from an institutional database. Practice webpages were reviewed to designate an academic surgical practice, defined as an assistant, associate, or full professorship appointment. SETTING: Single academic general surgery residency program. PARTICIPANTS: Categorical general surgery residency graduates who performed at least 1 year of dedicated research. RESULTS: 1768 total publications, representing 1500 unique publications, were authored by 54 residents, of which 18 (33.3%) residents attained an additional graduate-level degree during dedicated research. 1369 (91.3%) publications had identifiable Journal Impact Factors and citation data. Degree attainers were more likely to be female (55.6% vs. 25.0%, p = 0.03) and spend more time in dedicated research (mean 2.2 vs. 1.8 years, p = 0.02). Overall, degree attainers published more frequently during residency (median 4.4 vs. 2.1 publications/year, p < 0.001) and fellowship (median 2.0 vs. 1.0 publications/year, p = 0.046). Analysis of the first 4 post-training years demonstrated degree attainers produced 1.2 more publications per year among all graduates (2.3 vs. 1.1 publications/year, p = 0.02) and 1.6 more publications per year among graduates practicing academic surgery (3.3 vs. 1.7 publications/year, p = 0.02). There were no differences in the Journal Impact Factor or publication citations per year among degree and nondegree attaining graduates. CONCLUSIONS: Attainment of an additional graduate-level degree was associated with increased research productivity that was sustained beyond surgical residency. Programs with the goal of training academic surgeons should support professional degrees during dedicated research years.

A prevalence survey of patients with indwelling urinary catheters on district nursing caseloads in the United Kingdom: The Community Urinary Catheter Management (CCaMa) Study.

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is common in both hospitals and the community. AIM: To investigate the prevalence of indwelling urinary catheters on district nursing caseloads in the UK. METHODS: Participants were recruited through the Infection Prevention Society (IPS). An electronic survey was undertaken on a single day between November 2017 and January 2018. Data were analysed using descriptive statistics. FINDINGS: A total of 49,575 patients were included in the survey, of whom 5352 had an indwelling urinary catheter. This gave a point prevalence of 10.8% (95% confidence interval [CI] = 10.53-11.07), which varied between organisations, ranging from 2.36% (95% CI = 2.05-2.73) to 22.02% (95% CI = 20.12-24.05). Of catheters, 5% were newly placed (within four weeks). Of these, most (77%) had a documented indication for insertion. Only half of patients with a newly placed catheter had a plan for its removal. This varied between organisations in the range of 20%-96%. Only 13% of patients had a patient-held management plan or 'catheter passport' but these patients were significantly more likely to also have an active removal plan (28/36 [78%] vs. 106/231 [46%]; P < 0.0001). Alternative bladder management strategies had been considered for 70/267 (26%) patients. DISCUSSION: The management of patients with an indwelling urinary catheter represents a significant component of district nursing caseloads. Given the high proportion of newly catheterised patients without an active management plan for removal of the catheter, the establishment of an optimal management pathway should be the focus of future prevention efforts.

COVID-19: considerations for the safe management and disposal of human excreta.

Management and disposal of human excreta is an essential element of healthcare practice. The potential for cross transmission of SARS-CoV-2 in faeces and urine has led global healthcare providers to examine different infection prevention and control practices not least the management and disposal of human excreta. There are two major systems in place to undertake this; one being the use of re-usable bedpans and urinals with reprocessing in a washer disinfectors (WD). The other is use of disposable system; either with pulp bedpans and urinals disposed of in a macerator or hygienic bags disposed of as waste. A review of the literature provided limited evidence to explore these different methods; both having pros and cons with regards to the environmental aspects as well as the infection prevention and control implications. Manual cleaning can pose associated infection risks to both staff and patients. Disinfection of re-usable bedpans may not achieve the level of disinfection required. Disposable systems offer an alternative that can overcome some of the infection prevention and control limitations of washer disinfectors. Adherence to infection prevention and control standards are paramount to the safe management and disposal of excreta.

Revised Infection Prevention Society (IPS) Competences 2018.

Competences for infection prevention and control (IPC) practitioners were first introduced by the Infection Control Nurses Association (ICNA) in 2000. In recent years, they have been revised by the Education and Professional Development Committee of the Infection Prevention Society (IPS). The competences are a multi-purpose tool to support and inform service and workforce development and management at an operational and strategic level. They can assist in designing education programmes, help with staff appraisal, personal development plans and support revalidation alongside developing team structures and requirements. They enable the practitioner to review their own current position of progression and clinical standing from the position of assisted, supervised and independent. These terms are designed to assist the user to express the level of competence at which they work. This may differ depending on the competences that are being explored. This current version of the IPS competences (2018) have been designed to reflect the current structures and practices within the health and social care economy. They have been redeveloped within an electronic interactive framework to encourage usability and assist with manageability and record keeping. The competency framework tool is intended as a guide; the idea is for the practitioner to focus on relevant aspects of the competences and combine with organisational and individual goals and revalidation where applicable.

Usability Testing as a Method to Refine a Health Sciences Library Website.

User testing, a method of assessing website usability, can be a cost-effective and easily administered process to collect information about a website's effectiveness. A user experience (UX) team at an academic health sciences library has employed user testing for over three years to help refine the library's home page. Test methodology used in-person testers using the "think aloud" method to complete tasks on the home page. Review of test results revealed problem areas of the design and redesign; further testing was effective in refining the page. User testing has proved to be a valuable method to engage users and provide feedback to continually improve the library's home page.

Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative.

Vascular access is an important part of many patient care management plans but has some unwanted risks. Previous work published by Moureau et al. (2012) inspired a working group led by the UK Infection Prevention Society (IPS) to produce a vessel health and preservation (VHP) framework. This was with the intention of producing a resource for frontline staff to be able to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. The working group produced a framework that used available evidence, expert opinion and some small scale testing of the components of the framework. The work so far has received positive feedback but further work is required to formally evaluate the VHP framework in clinical practice to measure both staff knowledge and patient outcomes.

Managing Clostridium difficile infection in hospitalised patients.

Checklists are not a new phenomenon and have been used in the aviation industry for some time as a means of ensuring safety and minimising harm. Checklists are now used commonly in health care to improve patient safety. This article describes the development and integration of a daily review checklist process to support the care and management of patients with Clostridium difficile infection in one NHS trust hospital. The aim of the checklist is to assist staff in early recognition of disease severity, identification of potential complications and prevention of cross-transmission of C.difficile.

A collaborative and progressive approach to basic life support.

This article discusses how emergency situations occur across a range of lay, community and hospital settings. Healthcare practitioners working in these environments need to be equipped to respond to these situations and be able to develop and expand on previously acquired skills and knowledge. They also need to be able to recognise and maximise other team members' contributions, especially in settings where there is a diverse interprofessional group. The approach outlined in this article is based on a model currently being used in a higher education institution.