Irritable bowel syndrome

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of irritable bowel syndrome

Patient Attitudes and Participation in Hand Co-Washing in an Outpatient Clinic Before and After a Prompt

Despite recent national emphasis, outpatient hand washing can be less than optimal. We tested a new approach involving both patient and physician hand washing. The study consisted of 384 questionnaires, 184 from phase 1 and 200 from phase 2. Patients stated doctors washed their hands 96.6% before examining them pre-intervention and 99.5% of the time post-intervention. Patients endorsed the importance of hand washing 98.7% of the time. “Co-washing” may offer a process to increase the practice of hand washing and decrease infection risk

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment

Cumulative effects of concussion in high school athletes

A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion. One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (chi(2) = 8.0, P = 0.005), anterograde amnesia (chi(2) = 5.5, P = 0.019), and confusion (chi(2) = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity. This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study's findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions

Incidence of Sports-Related Concussion among Youth Football Players Aged 8-12 Years

Objective To determine the risk of concussion among youth football players (ages 8-12 years). Study design Participants included 468 male youth football players in western Pennsylvania during the 2011 youth football season. Incidence rates (IRs) and incidence density ratios (IDRs) of concussion were calculated for games and practices and for age groups. Results There was a total of 11 338 (8415 practice and 2923 game) athletic exposures (AEs) in the study period, during which 20 medically diagnosed concussions occurred. A majority of concussions were the result of head-to-head (45%) contact. The combined concussion IR for practices and games was 1.76 per 1000 AEs (95% CI 0.99-2.54). The concussion IR was 0.24 per 1000 AEs (95% CI 0.04-0.79) in practices and 6.16 per 1000 AEs (95% CI 3.76-9.54) in games. The IDR for concussions in games to practices was 25.91 (95% CI 6.01-111.70). The IDR of concussions for youth aged 11-12 years compared with youth aged 8-10 years was 2.72 (95% CI 0.66-4.78). Conclusions The overall IR for concussion in youth football players aged 8-12 years was comparable with that reported previously for high school and collegiate samples. However, participation in games was associated with an increase in risk of concussion compared with practices, which was higher than rates previously reported for high school and collegiate athletes. Younger players were slightly less likely to incur a concussion than were older players. (J Pediatr 2013;163:717-20)

Outcomes after anterior cervical discectomy and fusion in professional athletes

BACKGROUND:: Significant controversy exists regarding when an athlete may return to contact sports after anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. OBJECTIVE:: The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries. METHODS:: Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded. RESULTS:: Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs. CONCLUSION:: After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP

Patient Attitudes and Participation in Hand Co-Washing in an Outpatient Clinic Before and After a Prompt

Despite recent national emphasis, outpatient hand washing can be less than optimal. We tested a new approach involving both patient and physician hand washing. The study consisted of 384 questionnaires, 184 from phase 1 and 200 from phase 2. Patients stated doctors washed their hands 96.6% before examining them pre-intervention and 99.5% of the time post-intervention. Patients endorsed the importance of hand washing 98.7% of the time. “Co-washing” may offer a process to increase the practice of hand washing and decrease infection risk