ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This article discusses the development, format, administration and scoring of the objective structured clinical examination (OSCE) to evaluate competency in sport medicine. The credentials committee of the Canadian Academy of Sport Medicine has developed an examination to evaluate the competency of practicing physicians in the field of sport medicine. The examination is based on a sport medicine matrix that includes five areas: (a) clinical patient care, (b) team and event coverage, (c) medical/legal issues, (d) teaching and administration, and (e) research. The emphasis is on clinical patient care followed by team and event coverage, with the other three areas having a lesser degree of importance. The OSCE format consists of a number of stations or scenarios based on this matrix. The candidates are evaluated on a check list that reflects the emphasis of each station. A typical clinical patient care problem includes check list items related to the history, physical examination, investigations, diagnosis, and treatment. The candidates are also evaluated for their attitudes and techniques on each station. The examination includes volunteer examiners and patients both simulated and real. The candidates are evaluated through the use of checklist that are filled in by the examiners on optical scoring sheets. These are collated and analyzed to generate comparisons between candidates and to determine the psychometric properties of the overall examination. The examination has consistently scored reliability coefficients of 0.8 or greater. The 1993 examination demonstrated reliability co-efficients of 0.89–0.97. Interrater reliability was also calculated, and these values ranged from 0.85 to 0.99. The examination also reflects both face and content validity. Construct or predictive validity has yet to be determined. In conclusion, this examination, as a method of assessing competency in sport medicine, has demonstrated excellent psychometric properties compared to other similar methods of evaluation.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We sought to evaluate the economic aspects and benefits of adding a limited screening echocardiogram to our annual athletic preparticipation examinations. It was our belief that this screening echocardiogram would add valuable information beyond the history and physical exam alone and could be included in our station-by-station format with little increase in time or cost. Controversy exists concerning the best method of detecting cardiovascular conditions that may predispose the athlete to sudden death. During our 1992 preparticipation examinations, we included a single-view parasternal long- and short-axis two-dimensional screening echocardiogram. This screening can detect four potentially fatal congenital heart defects. We performed a total of 2,997 echocardiograms at an average cost of $7.34 per examination. Overall 64 echocardiographic abnormalities were found. Mitral valve prolapse and bicuspid aortic valve were the two most common abnormalities. The sensitivity of the history and physical examination in detecting cardiovascular abnormalities was extremely low. Incorporating the echocardiogram into our station-to-station format did not add a significant amount of time to the overall process. We conclude that a screening echocardiogram provides important information and can be used efficiently and economically in the athletic preparticipation examination.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Musculoskeletal and neurologic injuries affecting shoulder strength are common in contact sports. Full-strength recovery is desired before resumption of competition. On-field assessment of shoulder strength is usually done by manual muscle testing, which lacks sensitivity and reliability. Our objective was to determine the reliability and validity of two field instruments capable of quantifying shoulder abduction strength. Twenty junior football players underwent bilateral isokinetic (60°/s) and isometric shoulder abduction strength measurements using a Cybex 340 isokinetic dynamometer. Test-retest measurements of both shoulders of each player were made using strain gauge (SG) and handheld dynamometer (HHD) instruments. Players were tested during rested and competition conditions. Within and between session reliabilities were calculated using the intraclass coefficient, and validity was assessed using Pearson's correlation coefficient. Overall reliability for each device was calculated using Lisrel analysis. SG was found to be superior to HHD in overall reliability and validity. Within-session reliability in the rested and competition states was 0.75 and 0.78, respectively, for SG and 0.60 and 0.81, respectively, for HHD. Between-session reliability in the rested and competition states dropped to 0.51 and 0.63, respectively, for SG and 0.55 and 0.70, respectively, for HHD. Validity was 0.41 and 0.70 for SG when correlated with Cybex at 0° and 60°/s respectively. Validity for HHD was 0.28 and 0.42 for Cybex speeds of 0° and 60°/s, respectively. SG reliability and validity were similar when testing was done one shoulder at a time or both shoulders concurrently. Mean (SD) dominant/no dominant SG ratios were 1.04 (0.11) when the player was rested and 1.09 (0.15) during competition. SG reliability and validity are superior to those of HHD. SG appears to be an acceptable quantitative tool for on-field measurement of shoulder abduction strength in football players.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Worldwide >40 million amateurs participate in the team sport of soccer. With 647,368 injuries occurring from 1989 through 1992, the risk of injury during the play of soccer is evident. Lower extremity injuries have been found to comprise 13.1% of the total injuries in soccer. To date, a comprehensive evaluation of protective equipment utilized to prevent lower extremity injuries in soccer has been lacking. This study utilized a 5th percentile Hybrid III female dummy to evaluate the effectiveness of shin guards in attenuating the forces which can lead to lower extremity injuries. A pendulum impact apparatus simulated one player being kicked by another. Impacts were delivered to the anterior tibial region of the Hybrid III dummy and peak loads were recorded. Load forces were reduced 41.2–77.1% with the utilization of shin guards. Even at extreme temperatures, the guards were found to be effective in lowering the amount of impact force transferred to the shin region. The results of this study indicate that the use of shin guards will attenuate the force of impact to the tibia and thus reduce the risk of injury.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was designed to investigate the effects of exercise as a strategy for weight management in overweight women. Specifically, the effects of exercise modality on resting energy expenditure (REE) and body composition [sum of skinfolds and fat-free mass (FFM)] were examined. Participants included 41 overweight, sedentary women aged 25–49 years who had a defined history of dieting. Experimental (n = 26) and control (n = 15) participants were recruited separately. Participants in the experimental group were randomly assigned to either an endurance-or a resistance-training exercise class. Exercise classes designed for a sedentary population were scheduled three times per week for a duration of 3 months. Results indicated that exercise modality had no effect on REE. Exercise, regardless of modality, had a significant effect on body composition (p = 0.0001) as shown by a significant decrease in the sum of skinfolds for the two exercise groups relative to the control group (p<0.0001). No differences in fat-free mass were observed between groups. Regardless of modality, exercise also resulted in an increased estimated maximum oxygen uptake (VO2max), based on a 1-mile walking test (p = 0.012). The pattern of weight change of the groups was different (p = 0.029) over the 3-month period. Whereas the exercise groups maintained their weight, the control group gained weight (∼2.5 kg). Thus, although exercise modality had no effect, the benefits of exercise per se, such as decreased body fat, increased fitness level, and weight maintenance, were observed in this population.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Athelets and nonathletes use anabolic-andogenic streroids (AAS) to improve their strength and enhance their appearance. Few studies have been undertaken in the 1990s to assess the use of AAS in adolescents, following changes in legislation. This study was conducted to determine the prevalence of AAS use by high school students in Denver, Colorado, an area with high sports participation. A confidential questionnaire was completed by 6,930 students (response rate 96.6%) at 10 Denver high schools. The prevalence of AAS use was 2.7% (4.0% for boys and 1.3% for girls). Prevalence was slightly higher in sport participants than nonparticipants. The mean age of starting AAS was 14 years (range 8–17 years). This study is the first documented detailed assessment of high school students' knowledge of the risks of AAS. It shows knowledge deficits regarding potential side effects. Users of AAS were less likely than nonusers to acknowledge the risks of AAS. Only 18% of students claim to have been informed about AAS by physicians. The results suggest that health care providers should provide more information to adolescents about AAS. If educational efforts are found effective, teaching efforts regarding AAS should start in junior high school or sooner and continue through high school.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Thirty competitors in the Hawaii Ironman Triathlon were prospectively studies to determine whether fluid and electrolyte disturbances were causes for seeking race-day medical care. Athlete weights were significantly (p<0.0001) decreased during the race, but decreases were not different in treated (n= 11; %Δ - 2.3 ± 2.9) versus not treated (n= 19; %Δ −2.0 ± 1.9) athletes. Hyponatremia occurred in nine athletes (30%), and hypomagnesemia in six (20%), but only half of athletes were either electrolyte imbalance sought care. Although athletes receiving medical care may have fluid and electrolyte problems, these abnormalities may also occur in healthy athletes.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The belief that dehydration poses significant health risks for endurance athletes, especially marathon and ultramarathon runners, stems from the classical 1969-study of Wyndham and Strydom entitled “The Danger of an Inadequate Water Intake During Marathon Running.” The subsequent influence of the paper relates more to its incorrect title than to its scientific content. For the authors did not study nor did they identify any dangers resulting from an inadequate water intake during marathon running. In fact, the most dehydrated runners in their studies were also the most successful, as they won the competitive races that were studied. The positive result of the study was to influence international rule changes to allow increased fluid intake during competitive running races. The less desirable effect was to induce a dogmatic zeal among sports medicine practitioners who began to extol the dangers of dehydration during exercise. The (il)logic spurring this zeal seems to have been the conclusion that progressive dehydration during exercise will cause heatstroke, which is the most important cause of collapse during exercise. Hence, (i) heatstroke during running can only be avoided if dehydration is prevented, and (ii) all persons who collapse in association with exercise will have a heat disorder, which must be treated with intravenous fluid therapy. This article reviews the evidence which shows (i) that the levels of dehydration commonly measured in endurance athletes (1–4% of body weight) cause measurable physiological change and impair exercise performance in the heat but are not associated with health risks such as heatstroke or acute renal failure; (ii) that most athletes collapse after exercise and have rectal temperatures that are no higher than values measured in control runners; and (iii) that no study has yet shown that collapsed runners are more dehydrated than controls. It is proposed that postural hypotension, unrelated to levels of dehydration, is the most common cause of the exercise-associated collapse that occursafterthe athlete stops exercising. Clinicians treating athletes with exercise-associated collapse should initiate treatment only after a thorough clinical evaluation has produced rationale differential diagnoses. Intravenous fluid therapy should be reserved only for those patients with clear clinical evidence for dehydration which contributes to their clinical presentation.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

An unusual case of acute axillary vein compression secondary to hypertrophy and intramuscular edema of the subscapularis muscle is described in a competitive swimmer. The signs and symptoms of this condition are similar to those of axillary vein thrombosis, including nonedematous swelling, discoloration, pain, and prominent cutaneous veins of the involved upper limb. Early recognition and diagnosis by means of venography are important to distinguish the condition from axillary vein thrombosis and to alert the practitioner to the potential of future axillary vein thrombosis in such a case. The treatment is primarily conservative.

ISSN:1050-642X    

出版商:OVID    

年代:1995

数据来源: OVID