bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implications of attention deficit and hyperactivity disorders on neurocognitive performance and recovery in collegiate student–athletes
Authors: Ketcham Caroline , Patel Kirtida , Hall Eric 
Published: November 2017

BackgroundApproximately 3–13% of college-aged students have a diagnosis of Attention Deficit/Hyperactivity Disorder (ADD/ADHD) which is characterised by impulsivity, inattention, and cognitive speed deficits which affects academic, athletic, and occupational performance even when treated.ObjectiveThe purpose of this study was to examine baseline neurocognitive differences in collegiate student-athletes with diagnosis of ADD/ADHD as well as recovery time from concussion.DesignCross-sectional.SettingCollegiate campus in North CarolinaParticipantsParticipants of this study included 1161 student-athletes (varsity, n=272 and club, n=889). 89 participants were followed post-concussion with 8 having diagnosis of ADD/ADHD.Assessment of risk factorsDiagnosis of ADD/ADHD and days of recovery following concussion.Outcome measuresParticipants completed the Immediate Post-Concussion Assessment and Cognitive Testing which generated composite scores on Verbal Memory, Visual Memory, Visuomotor Speed, and Reaction Time as well as Total Symptom Scores.Main resultsThere were no significant differences between groups for Visual Memory, Reaction Time and Total Symptom Scores (p>0.05). Those with diagnosis of ADD/ADHD (n=146) had lower verbal memory(mno=85.3, %95 CI: [84.6, 86] vs. madd=82.5, %95 CI:[80.7, 84.3], F(1, 1145)=8.6, p=0.003) and slower visuomotor speed (mno=41.7, %95 CI: [41.3, 42.7] vs. madd=40.5, %95: CI:[39.5,41.5],F(1,1145)=8.6,p=0.027) compared to those without a diagnosis. Those with ADD/ADHD took almost two times longer to recover than those without (mno=7.3 days, %95 CI: [6.2, 8.4] vs. madd=13.3 days, %95 CI:[9.4, 17.2], F(1, 89)=9.8, p=0.002).ConclusionsStudent-athletes with diagnosis of ADD/ADHD may benefit from targeted interventions as part of return to play/learn protocols. Previous research has shown that practice may help rehabilitate those with cognitive and visuomotor processing speed deficits following a concussion.Competing interestsNone.
Factors associated with post-concussion syndrome in high school student-athletes
Authors: Kerr Zachary, Y , Wasserman Erin, B , Zuckerman Scott, L , Yengo-Kahn Aaron, M , Dompier Thomas, P 
Published: November 2017

ObjectiveThis study examined factors predictive of post-concussion syndrome (PCS; i.e., concussion-related symptoms lasting ≥4 weeks) among high school (HS) student-athletes during the 2011/12-2013/14 academic years.DesignProspective cohort.SettingConcussion data originated from the National Athletic Trainers Injury and Outcomes Network (NATION), a nationwide surveillance program comprised of a convenience sample of 127 HS. All concussions were diagnosed and reported by athletic trainers and team physicians.SubjectsOur sample included 1846 concussed HS student-athletes from 22 sports (73.7% male). For student-athletes with multiple concussions, only the most recent concussion was considered.InterventionFactors potentially related to PCS (i.e., sex, sport contact level, recurrent concussion, presence of symptoms) were examined.Outcome measuresThe 215 concussed student-athletes with PCS were compared to 1119 concussed student-athletes with symptoms lasting <2 weeks. Those with symptoms lasting 2-4 weeks were excluded (n=512). Logistic regression predicted the odds of PCS.ResultsIn multivariate analysis, concussion symptoms associated with increased odds of PCS were somatic symptoms including: disorientation [odds ratio (OR)=1.86, 95% confidence interval (CI):1.04–3.33]; balance issues (OR=1.76, 95% CI: 1.00–3.10); visual impairments (OR=2.21, 95% CI: 1.23–3.97); noise sensitivity (OR=1.80, 95% CI: 1.02–3.17); and cognitive symptoms including: retrograde amnesia (OR=3.01, 95% CI: 1.31–6.91); and difficulty concentrating (OR=2.72, 95% CI:1.56–4.77). Sex, sport contact level, and recurrent concussion were not associated with PCS.ConclusionsAs in previous research, various somatic and cognitive symptoms were associated with PCS. The identification of risk factors potentially associated with PCS may assist clinicians in providing timely interventions to shorten symptom resolution and recovery time.Competing interestsNone
Gender differences in clinical presentation and recovery of sports related concussion
Authors: Bauman Shannon , Ray Mira , Joseph Paul P 
Published: November 2017

ObjectiveTo determine if gender plays a role in clinical presentation and recovery in concussion.DesignRetrospectiveSettingone clinicParticipants207 athletes (115 females, 92 males) presenting to clinic from September 2014 – January 2016. 79 athletes achieved clearance. Inclusion: sports or exercise, age 10–60 yrs.Exclusionnon-sportsOutcome measuresAthletes completed computerised neurocognitive testing and physical assessments. A physician-led interdisciplinary team treated each athlete until resolution of signs and symptoms. Athletes were grouped by gender into recovery time groups (0–2 mo.; 3–5 mo.;≥ 6 mo.). An analysis by gender, age, symptoms, neurocognitive data, and concussion features was performed.Main resultsFemales report higher post-concussion symptom scores than males (p<0.0002).Females had a higher total number of features 4.5 to 3.6(p<0.00003). With respect to recovery, 34% of all males in our study were discharged within 0–2 mo. of injury date, compared to 12% of females. Females continued to experience symptoms at ≥ 6 months. Overall, females had a longer recovery period than males (p<0.002). Among discharged females, those requiring longer treatment (≥3 mo) were of a more mature age (23.8±13.2), presented later to clinic (t=3.3±3.6 mo.)and reported moresymptoms (PCSS=40.83±19.53).ConclusionsFemale athletes present with higher post- concussion symptom scores and clinical features than their male counterparts. Mature females who later for treatment have a protracted recovery. Athletes of both genders who seek care earlier in the injury process have a shorter recovery.Competing interestsNone.
Retrospective analysis of the first year of an elite sports multidisciplinary complex concussion service in the uk
Authors: Richard Sylvester , Akbar de Medici , Ademola Adejewon 
Published: November 2017

ObjectiveTo define the characteristics, investigation, diagnosis and management of elite athletes attending a complex concussion service.DesignRetrospective analysis of case notes.SettingSecondary care single centre.ParticipantsAll patients (n=38, aged 16-35, 79% male) seen between April 2015 and April 2016.OutcomesPatient characteristics (sport, position played in rugby, previous concussion history), referral reason, investigations, diagnosis, interventions.Main resultsMost referrals came from Rugby (74% Rugby, 16% soccer, 8% other). Back row (57%) and centre (25%) were the commonest rugby positions seen. The average number of previous concussions of this cohort was 2.5 (95% CI±0.85). Referral reasons included chronic symptoms following concussion (53%), delayed GRTP (21% of which 28% were due to reduced performance on computerised neuropsychological testing), multiple concussions (18%) and severe injury (8%). 95% of patients had brain MRI imaging (with SWI sequences) and 4 patients (10%) had abnormalities (cortical cavernoma, brainstem cavernoma, diffuse axonal injury, obstructive hydrocephalus). 30% of patients required additional vestibular and/or neuropsychological assessment in addition to screening. Post-traumatic migraine was the commonest single diagnosis (36%) followed by isolated vestibular dysfunction (16%). 30% had multiple diagnoses (usually migraine, vestibular dysfunction and mood disorder). 8% did not have concussion. Intervention with medical management for migraine was initiated in 40%, vestibular rehabilitation in 20% and psychological intervention in 15%.ConclusionsA proportion of elite athletes with sports related concussion in the UK have complex needs. These require expert MDT assessment and management. The limited provision of such services needs to be addressed.Competing interestsNone.
Should our treatments be gender-specific? effect of gender on recovery from persistent post-concussion symptoms in children and adolescents participating in an active rehabilitation intervention
Authors: Gagnon Isabelle , Gauvin-Lepage Jérôme , Friedman Debbie , Grilli Lisa , Kocilowicz Helen 
Published: November 2017

ObjectiveTo estimate the extent to which gender contributes to severity of post-concussion symptoms (PCS) in youth with concussion, who are slow to recover and who receive an active rehabilitation intervention as part of their standard care.DesignA retrospective analysis of a prospective cohortSettingConcussion Clinic of a Paediatric Trauma Centre in Canada.Participants355 youth with persistent PCS (188 girls; 167 boys). All Concussion patients’ information is entered prospectively in a clinical database and participants were selected for this study if they met the following criteria: 1) aged 6 to 17 years (mean=14.34, SD=2.22 years); 2) presenting with at least one PCS interfering with daily activities (mean total PCS score at initial assessment=24.50, SD=18.88), and 3) beginning an active rehabilitation intervention 4 weeks post injury (mean=30.46, SD=3.74 days).Outcome measuresSeverity of post-concussion symptoms, measured by the PCS scale included in the SCAT3, was the dependent variable. PCS were assessed 3 times over a 4-week follow-up period.Main resultsBoys presented with significantly less symptoms than girls 4 weeks post-injury, when starting the active rehabilitation intervention (PCSS total score mean; &male;=19.9, &female;=28.5, p<0.001, CI [−14.8, −6.4]). They continued to do so 2 and 4 weeks later, but the rate of recovery was slightly faster for girls over the follow-up period.ConclusionsAlthough there are gender differences in the levels of PCS 4-weeks post-injury, and while boys may recover earlier from persistent PCS, both boys and girls benefit from participating in an active rehabilitation intervention.Competing interestsNone.
Sleep disorders after mild traumatic brain injuries in elements with professional athletic activity
Authors: Ch.Syrmos Nikolaos , Mylonas Argyios , Gavridakis Georgios , Giannouli Vaitsa 
Published: November 2017

IndroductionSleep disturbances are common situations after traumatic brain injuries.AimAim of this study was to evaluate sleep disorders in elements professional athletic activity after mild traumatic brain injuries.Material and methodsEvaluation of 10 professional athletes was performed, 7 men–70% and 3 women −30%(range 18–38 years and mean age 28) with sleep disturbances after mild traumatic brain injuries. The most common disturbances are insomnia in 6, 60% increased sleep need in 2–20%, and excessive daytime sleepiness in 2–20%. We suggest in all 10, 100%, cognitive-behavioural therapy and appropriate medication, under psychiatric surveillance. 8 of them 80% returned with safe results in the physical activity after 2 or 3 months.ResultsThe most common disturbances were insomnia in 5, 50%, increased sleep need in 2–20%, and excessive daytime sleepiness in 3–30%. We suggest in all 10,100%, cognitive-behavioural therapy and appropriate medication, under psychiatric surveillance. 7 of them 70% returned with safe results in the physical activity after 2 or 3 months.ConclusionsWe need more investigation but seems that cognitive-behavioural therapy and medication could be helpful in these situation.Competing interestsNone.
What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? A systematic review
Authors: Echemendia Ruben J , Broglio Steven P , Davis Gavin A , Guskiewicz Kevin M , Hayden K. Alix , Leddy John J , Meehan William P , Putukian Margot , Sullivan S John , Schneider Kathryn J , McCrory Paul 
Published: November 2017

ObjectivesSeveral iterations of the Sport Concussion Assessment Tool (SCAT) have been published over the past 16 years. Our goal was to systematically review the literature related to the SCAT and provide recommendations for improving the tool. To achieve this goal, five separate but related searches were conducted and presented herein.DesignSystematic literature review.Data sourcesMedline, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, SPORTDiscus and PubMed.Eligibility criteriaOriginal, empirical, peer-reviewed findings published in English and included sports-related concussion (SRC). Review papers, case studies, editorials and conference proceedings/abstracts were excluded. The age range for the ChildSCAT was 5–12 years and for the Adult SCAT was 13 years and above.ResultsOut of 2961 articles screened, a total of 96 articles were included across the five searches. Searches were not mutually exclusive. The final number of articles included in the qualitative synthesis for each search was 21 on Adult SCAT, 32 on ChildSCAT, 21 on sideline, 8 on video/observation and 14 on oculomotor.Summary/conclusionsThe SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available. There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC, with and without baseline data. The addition of an oculomotor examination seems indicated, although the most valid method for assessing oculomotor function is not clear. Video-observable signs of concussion show promise, but there is insufficient evidence to warrant widespread use at this time.
Evaluation of a novel intervention providing insight into the tobacco industry to prevent the uptake of smoking in school-aged children: a mixed-methods study
Authors: Szatkowski Lisa , Taylor John , Taylor Amy , Lewis Sarah , Wu Qi , Parrott Steve , McNeill Ann , Britton John , Bauld Linda , Jones Laura L , Bains Manpreet 
Published: November 2017

ObjectivesEvidence from the USTruthcampaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing youth smoking uptake. We developed, piloted and evaluated a school-based intervention based on this premise.MethodsExploratory study students in years 7–8 (aged 11–13) in two UK schools receivedOperation Smoke Storm, comprising three 50 min classroom-based sessions in year 7, an accompanying family booklet and a 1-hour classroom-based booster session in year 8. We compared the risk and odds of ever smoking and susceptibility to smoking in year 8 students in study schools postintervention with students in control schools. Focus groups and interviews with students, teachers and parents evaluated the acceptability of the intervention.ResultsIn intervention schools, the combined prevalence of ever smoking and susceptibility increased from 18.2% in year 7 to 33.8% in year 8. There was no significant difference in the odds of a year 8 student in an intervention school being an ever smoker or susceptible never smoker compared with controls (adjusted OR (aOR) 1.28, 95% CI 0.83 to 1.97, p=0.263) and no significant difference in the odds of ever smoking (aOR 0.82, 95% CI 0.42 to 1.58, p=0.549). Teachers highlighted differences by academic ability in how well the messages presented were understood. Use of the family component was low but was received positively by parents who engaged with it.ConclusionsOperation Smoke Stormis an acceptable resource for delivering smoking-prevention education, but it does not appear to have reduced smoking and susceptibility.
Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study
Authors: Heutmekers Marloes , Naaldenberg Jenneken , Verheggen Sabine A , Assendelft Willem J J , Lantman - de Valk Henny M J van Schrojenstein , Tobi Hilde , Leusink Geraline L 
Published: November 2017

ObjectivesTo investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency.DesignCross-sectional routine data-based study.SettingTwo GP cooperatives providing out-of-hours primary care in an area in the Netherlands.Population432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID.Main outcome measuresGP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency.ResultsOf the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent.ConclusionPeople with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.
Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: a mixed-methods intervention study
Authors: Curry Leslie A , Brault Marie A , Linnander Erika L , McNatt Zahirah , Brewster Amanda L , Cherlin Emily , Flieger Signe Peterson , Ting Henry H , Bradley Elizabeth H 
Published: November 2017

BackgroundHospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.MethodsThis is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.ResultsWe observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.ConclusionsInvesting in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.
Endobronchial valves for emphysema: an individual patient-level reanalysis of randomised controlled trials
Authors: Klooster Karin , Slebos Dirk-Jan , Zoumot Zaid , Davey Claire , Shah Pallav L , Hopkinson Nicholas S 
Published: November 2017

IntroductionEndobronchial valve placement has potential as a treatment for patients with chronic obstructive pulmonary disease (COPD). However, a robust evidence base will be needed to convince commissioners of healthcare that it is a high-value treatment. We sought to develop the evidence base by performing an individual patient-level analysis of randomised controlled trials in people with heterogeneous emphysema and an absence of collateral ventilation.MethodsA literature search (PROSPERO register CRD42016048127) identified two trials meeting these criteria, the BelieVeR-HIFi and STELVIO studies. Anonymised individual patient data were obtained from investigators and analysed. The primary outcome measure was a comparison of change in forced expiratory volume in 1 s (FEV1) from baseline between the treatment and control groups. Secondary end points were change from baseline in 6 min walk distance (6MWD), Medical Research Council dyspnoea score and St George’s Respiratory Questionnaire (SGRQ).Results114 individuals were treated with 3-month to 6-month follow-up data available for 101 individuals. FEV1improved by 23.1 (±28.3)% in patients treated with valves with a mean (95% CI) difference in response between groups of 17.8 (26.5, 9.2)% (p<0.0001). Relative to controls valve placement was associated with a fall in residual volume of 0.64 (0.43, 0.86) L (p<0.0001), a 9.5 (3.5, 15.6) unit fall in SGRQ (p=0.0022) and a 64.2 (94.0, 34.5) m increase in 6MWD. There were three deaths in the treatment arm and the pneumothorax rate was 15%.ConclusionsThese data strengthen the evidence that endobronchial valve treatment can produce clinically meaningful improvements in appropriately selected COPD patients.
Stopping antithrombotic therapy after acute upper gastrointestinal bleeding is associated with reduced survival
Authors: Siau Keith , Hannah Jack L , Hodson James , Widlak Monika , Bhala Neeraj , Iqbal Tariq H 
Published: November 2017

AbstractIntroductionAntithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear.ObjectiveTo assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes.DesignRetrospective cohort study.SettingUniversity hospital between May 2013 and November 2014, with median follow-up of 259 days.PatientsPatients who underwent gastroscopy for AUGIB while on antithrombotic therapy.InterventionsContinuation or cessation of antithrombotic(s) at discharge.Main outcomes measuresCause-specific mortality, thrombotic events, rebleeding and serious adverse events (any of the above).ResultsOf 118 patients analysed, antithrombotic treatment was stopped in 58 (49.2%). Older age, aspirin monotherapy and peptic ulcer disease were significant predictors of antithrombotic discontinuation, whereas dual antiplatelet use predicted antithrombotic maintenance. The 1-year postdischarge mortality rate was 11.3%, with deaths mainly due to thrombotic causes. Stopping antithrombotic therapy at the time of discharge was associated with increased mortality (HR 3.32; 95% CI 1.07 to 10.31, P=0.027), thrombotic events (HR 5.77; 95% CI 1.26 to 26.35, P=0.010) and overall adverse events (HR 2.98; 95% CI 1.32 to 6.74, P=0.006), with effects persisting after multivariable adjustment for age and peptic ulcer disease. On subgroup analysis, the thromboprotective benefit remained significant with continuation of non-aspirin regimens (P=0.016). There were no significant differences in postdischarge bleeding rates between groups (HR 3.43, 0.36 to 33.04, P=0.255).ConclusionIn this hospital-based study, discontinuation of antithrombotic therapy is associated with increased thrombotic events and reduced survival.