bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated pulmonary valve endocarditis in a patient with aplastic anaemia
Authors: Nishanth K R , Seshadri Shubha , Pandit Vinay , Krishnanand N 
Published: March 2013

A 42-year-old female patient of aplastic anaemia on maintenance blood transfusion presented with a 3-week history of fever, cough, dyspnoea and pedal oedema. Upon examination she was found to have severe pallor, temperature of 101°F, tachycardia, bilateral pitting pedal oedema, raised jugular venous pressure, ejection systolic murmur (grade 2/6) in pulmonary area and petechiae over extensor aspect of both lower limbs. Blood investigations revealed low haemoglobin, thrombocytopaenia and mild increase in serum creatine. Chest x-ray was normal. Initial 2D trans thoracic echocardiography performed after hospital admission was normal. Antibiotics were started empirically to treat a possible underlying infection. Subsequently, three sets of blood cultures grewEnterococcus faecalis. Upon searching for the source, repeat echocardiograph done showed 2×0.5 cm vegetation on both pulmonary leaflets with severe pulmonary regurgitation, all other valves were free of vegetations. She was treated with intravenous antibiotics for the endocarditis and improved.
Psychophysiological and neuromotor indicators of brain concussion
Authors: Le Bouthillier Éric , Caouette Michel , Guérin Fanny 
Published: March 2013

ObjectivePost-concussion symptoms disappear from days up to 3 months in adults after a 1st concussion. 15% of adults have persistent sequelae. The athletes have a higher probability of experiencing a second concussion and to suffer from both prolonged due to the cumulative effect of these neurological injuries. Lower cognitive and physical skills of the athlete are more documented after concussion. Specifically, the impacts of concussion on neuromotor and neurophysiological functions are investigated.DesignCase studies.SettingsRehabilitation in public and private practices.PatientsThree athletes who sustained a concussion with persistent symptoms after several months to one year.InterventionsMeasures of frequency and heart rate variability at night; percentage of cardiac reserve on daily tasks of different intensities and a neuromotor assessment were performed.Main OutcomeAll three athletes show a cardiac reactivity to a task in mismatch with the actual engineering costs of the various tasks performed and, several months to one year post-concussion. They show motor strategies disorders and slower processing of visual information.ConclusionsCardiac monitoring and neuromotor assessment provides additional indicators in the detection of concussion, as a complement to the neurocognitive assessment, and should be included routinely in the management concussion protocols of athletes. These data are also valuable clinically to help reduce post-concussion symptoms. However research is needed to understand their impact on the recovery of the athlete so as to promote a safe return to play.Competing interestsNeurosport is a private pratice who offers services to athlete for post-concussion assessment and neurorehabilitation.
Montreal cognitive assessment (MoCA): baseline evaluation of cognition in the athletic population
Authors: Debert C T , Benson B W , Dukelow S 
Published: March 2013

ObjectiveTo assess baseline pre-season cognitive function in a young adult athletic population using the Montreal Cognitive Assessment Tool (MoCA).DesignBaseline case series of normative data.SettingSport Medicine Clinic at the University of Calgary, Alberta, Canada.ParticipantsMale and female athletes (n=347) were recruited from the University of Calgary varsity athletic teams, Southern Alberta Institute of Technology college teams and Canadian National sports teams. Athletes (aged 18–40 years) underwent pre-season face-to-face standardised cognitive screening interviews.InterventionsBaseline biographical information and a pre-season MoCA test were performed.Main Outcome MeasurementsThe MoCA is a one page global cognitive assessment tool with a maximum score of 30 points.ResultsAll subjects had grade 12 education or greater. Fifty-nine percent of the population was male. The average age was 22.02±3.49. The overall mean MoCA score was 26.62±2.20. One hundred and one subjects (29%) scored less than 26. For contact/collision sport athletes and non-contact sport athletes the mean MoCA scores were 26.41±2.28 and 26.97±2.01 respectively. There was a significant difference (p=0.018) between the contact/collision and non-contact sport athletes scores.ConclusionsApproximately 29% of the athletic population surveyed had MoCA scores less than what is considered normal (<26). Contact/collision sport athletes had significantly lower MoCA's scores than non-contact sport athletes. Scores less than 26 have been associated with mild cognitive impairment and Alzheimer's dementia in other studies. Multiple factors (eg, previous concussion, non-documented head injuries, malingering, etc) may play a role in explaining the present findings.Competing interestsNone.
Sport concussion knowledge base, clinical practices, and needs for continuing medical education: a survey of family physicians and cross-border comparison
Authors: Lebrun Constance M , Mrazik Martin , Prasad Abhaya , Joel Tjarks B , Dorman Jason C , Bergeron Michael F , Munce Thayne A , Valentine Verle D 
Published: March 2013

ObjectiveTo identify sport concussion knowledge base, practice patterns and current/preferred methods of Knowledge Transfer and Exchange (KTE) in two distinct populations of family physicians.DesignCross-sectional study, using a survey design.SettingAlberta, Canada (CAN); North/South Dakota, USA (US). Rural (64.4% US, 27.5% CAN; p=<0.001); walk-in/acute care (28.8% CAN, 12.9% US; p=0.008).ParticipantsRecruitment: CAN physicians by mail: 80/3154 responses (2.5%); US physicians: American Academy of Family Physicians database: 109/545 responses (20%).Intervention/InstrumentOn-line survey questionnaire.Outcome MeasuresRelative percentages diagnosing/treating concussions; comparison of management strategies (including return-to-play), and current/preferred KTE.ResultsEtiologies: Sports/recreation (52.5% CAN); organised sports (76.5% US). Tools: Clinical examination (93.8% CAN, 88.1% US); Sport Concussion Assessment Tool (SCAT/SCAT2) (33.8% CAN, 26.7% US); balance testing (25.0% CAN, 26.7% US); concussion grading scales (26.7% US, 8.8% CAN, p=0.002); computerised neurocognitive testing (19.8% US, 1.3% CAN; p≤0.001); Standardised Assessment of Concussion (21.8% US, 7.5% CAN; p=0.008). Treatment: Physical rest (83.8% CAN, 75.5% US); cognitive rest (47.5% CAN, 28.4% US; p=0.008). Return-to-play: Clinical examination (89.1% US, 73.8% CAN; p=0.007); neurocognitive testing (29.7% US, 5.0% CAN; p≤0.001); guidelines (63.4% US, 23.8% CAN; p≤0.001). KTE sources: Colleagues (31.3% CAN, 8.8% US; p≤0.001), websites (27.5% CAN, 15.7% US; p=0.052); medical school (35.0% CAN, 12.7% US; p≤0.001). KTE Preferences: Continuing Medical Education (CME) courses (65.0% CAN, 37.3% US; p≤0.001), and online CME (47.5% Can, 29.4% US; p=0.012).ConclusionsDespite evolution of concussion diagnosis/management guidelines, significant knowledge gaps exist between evidence-based recommendations clinical practice patterns. This predicates enhanced and innovative CME initiatives for KTE.Competing interestsNone.
Baseline concussion symptom report in college athletes: comparison of scores on SCAT2 versus impact
Authors: Lebrun Constance M , Mrazik Martin , Matthews-White Joan , Lemke Nicole , Naidu. Dhiren 
Published: March 2013

ObjectiveTo investigate differences between baseline self-report of concussion symptoms with two commonly used concussion assessment tools.DesignRetrospective, cross-sectional.SettingUniversity of Alberta.SubjectsOne hundred and ninety-four varsity athletes (117 males; 77 females).InterventionPrior to the competitive season, subjects completed baseline testing, including self-report of concussion symptoms, with the Subjective Concussion Assessment Tool (SCAT2) and the on-line computerised Immediate Post-Concussion Assessment of Cognition (ImPACT) test, under supervision of an athletic therapist. Testing was counterbalanced to control for serial position effect.Outcome MeasuresThe 18 shared self-report concussion symptoms were compared, and a general linear model used to identify possible interactions between gender and group type (SCAT2 vs ImPACT). Finally correlations were calculated.ResultsThere was an interaction between gender and group type for 1 symptom (trouble falling asleep). Surprisingly, pairwise comparisons identified differences (p≤ 0.05) on 10/18 paired symptoms, with correlations ranging from 0.08 to 0.58.ConclusionsSubjects respond differently when self-reporting concussion symptoms, depending on type of instrument used, and mode of administration. Despite test items being similar in content, there are significant differences in symptom reports in the same subject between SCAT2 and ImPACT tests. Use of similar data collection methods for baseline testing, assessment post-injury and prior to return-to-play is indicated, to increase both the diagnostic and prognostic utility of such tests. This further emphasises current recommendations that these tests not be used in isolation to make therapeutic decisions regarding athletes with concussion; and underscores the importance of serial clinical evaluations by a suitably qualified physician.Competing interestsNone. All authors have signed the disclosure form.
The effect of age, sex, and concussion history on preseason ImPACT values of elite Canadian youth ice hockey players
Authors: McKay Carly D , Brooks Brian L , Meeuwisse Willem H , Mrazik Martin , Jubinville Andrea L , Emery. Carolyn A 
Published: March 2013

ObjectiveTo examine the effect of age, sex, and concussion history on preseason scores from the ImPACT computer-based neurocognitive test battery in elite 12–17-year-old ice hockey players.DesignCross-sectional.SettingParticipants were recruited from the most elite divisions (AA, AAA) of youth ice hockey leagues in Calgary and Edmonton, Alberta, Canada.Participants714 Bantam (ages 12–14) (47 female, 161 male) and Midget (ages 15–17) (67 female, 439 male) hockey players.Assessment of Risk FactorsPlayers completed a preseason ImPACT test before the 2011–2012 season.Outcome MeasuresOutcomes were composite scores <25th percentile (based on sample distribution) for verbal memory, visual memory and impulse control, and scores >75th percentile for visual motor speed, reaction time, and total symptoms.ResultsUsing multivariate Poisson regression, adjusted for cluster by team, those aged 16–17 years were less likely to score <25th percentile in verbal memory (IRR=0.85; 95% CI 0.78 to 0.98) or >75th percentile in reaction time (IRR=0.79; 95% CI 0.69 to 0.91), but were more likely to score >75th percentile in visual motor speed (IRR=1.27; 95% CI 1.17 to 1.37) and total symptoms (IRR=1.14; 95% CI 1.04 to 1.25). Males were less likely to score <25th percentile in verbal memory (IRR=0.85; 95% CI 0.78 to 0.92), but more likely to score >75th percentile in visual motor speed (IRR=1.20; 95% CI 1.05 to 1.38) and total symptoms (IRR=1.21; 95% CI 1.02 to 1.44). Previous concussion was not predictive of ImPACT scores in the poorest quartile on any subscale.ConclusionsAge and sex influence preseason ImPACT scores, although concussion history does not appear to have an effect.AcknowledgementsThe Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge the funding from the McCarthy Tetrault Award, Alberta Innovates Health Solutions, and the Alberta Children's Hospital Research Institute for Child and Maternal Health.Competing interestsAuthor B Brooks declares research grant support from CNS Vital Signs (neurocognitive test battery publisher) and PAR, Inc (test publisher).
Test-retest reliability of the sport concussion assessment tool 2 (SCAT2) for uninjured children and young adults
Authors: Chan Monica , Vielleuse Jannick Vicky , Vokaty Stephanie , Wener Matthew Ari , Pearson Isabelle , Gagnon Isabelle 
Published: March 2013

ObjectiveTo establish test-retest reliability of the Sport Concussion Assessment Tool 2 (SCAT2) in healthy elementary school children and young adults.DesignRepeated-measures design.SettingElementary Schools in the Montreal area (children) and McGill University Athletics Department (adults).ParticipantsTwenty-two children (14 females and eight males; mean age 10.3±0.5 years) and 73 young adults (42 female, 31 males; mean age 22.6±1.8 years) from University students participated in this study.InterventionNone.Main Outcome MeasurementsParticipants were tested using the Sport Concussion Assessment Tool-2 (SCAT2) on two occasions, 1-week apart (6.4±2.7 days). The SCAT2 measures several domains of functioning such as delayed memory, balance and post-concussion symptoms. Test-retest reliability was assessed for the total SCAT2 score as well as for the SCAT2 components separately.ResultsIntraclass Correlation Coefficients for the total SCAT2 score were only fair for both groups of participants (ICC=0.367 for young adults and 0.446 for children). The ICCs were also below 0.5 for individual components of the SCAT2 in young adults. In children, individual components yielded better reliability than the total score (Balance ICC=0.725; SAC ICC=0.523; symptom severity ICC=0.488).ConclusionsThe results indicate that in view of the low levels of test-retest reliability achieved for the total SCAT2 score, professionals should be cautious when using change in score over time for clinical decisions. Recommending the use of the SCAT2 as a standard of care to diagnose a concussion or to ascertain recovery from one may be premature at this time.AcknowledgmentsParticipants and their families, The Priory School, Gardenview Elementary School for allowing testing within their institutions, Fonds de recherche du Québec-Santé, School of Physical and Occupational Therapy McGill University.Competing interestsNone.
Do Canadian sport and exercise medicine physicans and emergency physicians give consistent sport-related concussion management advice?
Authors: Carson James , Purcell Laura , Davidson Bruce , Garel Alisha , Bell Margaret , Moineddin Rahim 
Published: March 2013

ObjectiveTo identify differences and gaps in the recommendations to patients for the management of sport-related concussion among sport and exercise medicine physicians and emergency physicians.DesignA self-administered multiple-choice survey, which had been validated for content validity.SettingCanada.SubjectsPhysicians who have passed the diploma examination of the Canadian Academy of Sport and Exercise Medicine (CASEM-MDs) and physicians on the Canadian Association of Emergency Physicians (CAEP-MDs) database.InterventionThe survey link was emailed to 470 CASEM-MDs and to 789 CAEP-MDs across Canada.Outcome MeasuresKey survey questions identified sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after a sport-related concussion.ResultsOnly 71% of CASEM-MDs usually use the SCAT2, whereas 86% of CAEP-MDs never use the SCAT2. 75% of CASEM-MDs usually advise time off of work or school after a sport-related concussion and 64% of CAEP-MDs do likewise. Only 75% of CASEM-MDs usually utilise balance testing. When queried how cognitive rest can best be achieved after a sport-related concussion, many choices were appealing with no consistent consensus.ConclusionsWe identified a lack of consistency in the implementation of recommendations for sport-related concussion patients. It appears that the SCAT2 is utilised more in the office setting than in the emergency department. More recent strategies such as balance testing have not gained consistent usage, even among physicians with recognised expertise in concussion management. Better knowledge translation efforts should target both of these groups of physicians.AcknowledgementsSpecial thanks go to Paul Krueger, Leigh Hayden and the other 18 participants in the validation of our survey.Competing interestsNone.
Comprehensive analysis of ‘knockouts’ in Mixed Martial Arts (MMA)
Authors: Hutchison Michael , Cusimano Michael , Lawrence David , Singh Tanveer 
Published: March 2013

ObjectiveTo quantify and identify potential risk factors for knockouts (KOs) and technical KOs (TKOs) in Mixed Martial Arts fighters.SettingUltimate Fighting Championship (UFC).DesignRetrospective. Fight card and fighter data was collected from all numbered UFC events over a 4-year period ending in 2009. Publicly available databases and digital video images were used to retrieve all pertinent information.Outcome MeasuresEvent characteristics(eg, location, date, etc),fighter demographics(eg, age, nationality, time since last match),match characteristics(eg, match significance, rounds fought), and injury mechanism.ResultsA total of 503 matches were reviewed of which 36% ended in either KO (58; 12%; 57.7 per 1000 AE) or TKO (119; 24%; 118.4 per 1000 AE). The prevalence of KOs was highest in fighters between ages 36 and 40 (20.6%). The mechanism of contact resulting in a KO was predominately a direct blow to the head by a fist. 20% of all TKOs occurred in the heavyweight class. 33.9% of title matches result in TKOs and one in five of all KOs occurred during the first minute of a round.ConclusionMost often the mechanism of contact resulting in a KO was direct blow to the head. We have identified factors which were associated with a higher incidence of KO or TKO including age, weight, fight significance, time within the round, and time since last fight.AcknowledgementsThe Canadian Institutes of Health Research (CIHR) Strategic Team in Applied Injury Research funded this research.Competing interestsNone.
How the new taekwondo rules have decreased the injuries and concussions since 2008
Authors: Viscogliosi Paul 
Published: March 2013

Before 2008, the rules of taekwondo to score points required powerful feet or hand movements to the trunk and feet movements to the head. Under this system the insurance statistics (Statistics of Mutuelle des Sports France) showed that taekwondo was a safe sport and that concussion was rare.The rules were changed 2 years ago with the adoption of an electronic scoring system for the trunk hits and valid head scoring with light feet taps only (without power).The electronic trunk protector's scoring system scores relative power in relation to the weight category.Statistics from three competitions that took place during 2011 and 2012 were analysed including theWorld TaekwondoFederation (WTF) World championships, the WTF World qualification tournament for the Olympic Games and the European Qualification tournament for Olympic Games and then compared to an earlier WTF World qualification tournament for Olympics Games ruled by the previous rule system (2008).Under the old system, we determined that out of 380 fights analysed, 55 injuries occurred, 3 were knocked down; which equates to 14.5% injuries and 0.8% KO.Under the new rules, we found that out of 1180 fights, there were 15 injuries and 2 knock down; which equates to 1.3% injuries and 0.17% KO.ConclusionWith the new rules, the injuries were 11 times less likely to occur and the KOs 5 times less likely to occur.The next step for 2016 is to adopt an electronic headgear to make the sport of taekwondo even safer.
National Hockey League players' experiences with career-ending concussions
Authors: Caron Jeffrey G , Bloom Gordon A , Johnston Karen M , Sabiston Catherine M 
Published: March 2013

ObjectiveThis study investigated the experiences of National Hockey League (NHL) players who retired due to medically diagnosed concussions they incurred during their playing careers.DesignAn Interpretative Phenomenological Analysis (IPA; Smithet al, 2009) was used to examine the interview data. IPA is a qualitative research methodology used to understand and explore how people make sense of important life experiences and has been commonly used in health research (Smith, 2011).SettingInterviews were conducted in various cities in North America.ParticipantsFive former NHL players whose professional careers spanned more than 10 seasons were interviewed for this project.ResultsParticipants in this study articulated the type and intensity of the physical (eg, headaches, visual impairments) and psychological (eg, isolation, depression, suicidal ideation) concussion symptoms they endured during their careers, including how these symptoms impacted their professional careers, quality of lives, and relationships with family members and medical professionals. Participants said they continued to experience physical symptoms such as headaches, sensitivity to bright lights, and concentration problems after their careers, which has affected their post-athletic lives and has disturbed their daily functioning.ConclusionsThese are the first results to empirically document the experiences of professional athletes who suffered career-ending concussions. Findings from this study concur with McCroryet al's (2009) call for longitudinal research to better understand the implications of concussive injury. Additionally, our results indicate a need for psychological counselling in conjunction with medical guidance during rehabilitation from concussion and transition to post-athletic lives.Competing interestsNone.
Classification analyses of pediatric concussion assessment battery
Authors: Gioia Gerard , Isquith Peter , Vaughan Christopher 
Published: March 2013

ObjectiveDemonstrate classification statistics (OR, Likelihood Ratios) of a pediatric multi-component battery of neurocognitive tests, child and parent symptom report to identify the presence or absence of concussion.DesignProspective cohort design.SettingOutpatient clinic, teaching hospital.ParticipantsTwo groups of children, ages 5–7 years (n=22 per group) and ages 8–12 years (n=67 per group) (≤7 days post-concussion) were compared to gender/age-matched groups of non-injured children.InterventionsPredictor variables: Response Speed Composite, Child and Parent Post-Concussion Symptom Inventory (PCSI) symptom scores.Main Outcome MeasurementsGroup membership—concussion, control.ResultsMANOVAs revealed significant group differences for the Response Speed Composite, Child and Parent PCSI symptom scores for both age groups. Discriminant function analyses conducted on the Child and Parent PCSI scores and Neurocognitive Composite scores independently and in combination indicate parent and child PCSI symptoms and Response Speed demonstrate adequate classification independently; in combination offered greatest rates. For the 5–7 year age group, 73% were correctly classified by the three combined scores (Positive Likelihood Ratio=3.5, Negative Likelihood Ratio=0.58, OR=6.0, 80% Area Under Curve (AUC)). 84% of 8–12 age group were identified correctly by the three combined scores (LR+=47.0, LR−=.30, OR=155, 94% AUC). Relative differences between scores will be demonstrated.ConclusionThe multi-component pediatric battery demonstrates appropriate capability to classify children referred for a suspected concussion. Increased parent and child PCSI symptom ratings and decreased neurocognitive performance (Response Speed) increases diagnostic accuracy, assisting the clinician in their clinical decision-making.Competing interestsDrs Gioia, Isquith and Vaughan are co-authors of Pediatric ImPACT battery.