Attitudes and behaviours of top-level junior rugby union coaches towards the coaching of proper contact technique in the tackle - a pilot study

Background. Coaching strategies for effective technique and injury prevention have been proposed for the tackle. Despite this, little is known about current coaching attitudes and the behaviours of coaches towards proper contact technique in the tackle, especially at the junior level. Objective. To report on the attitudes and behaviours of junior rugby union coaches towards coaching of proper contact technique in the tackle. Methods. Seven coaches of the top 8 rugby-playing schools (Premier Division) in the Western Province Rugby Union participated in the study (representing 88% of the entire population of top-level junior coaches in the region). Coaches completed a questionnaire, modelled on previous research, surveying attitudes and behaviours towards tackling. Results. Proper technique for injury prevention was rated as very important (57%) and important (29%), with 14% undecided. Proper technique to improve performance was rated as very important (57%) and important (43%). To further develop coaching knowledge and to develop new training methods, ‘coaching colleagues’ (very much – 71%; mean rating 4.7; 95% CI 4.3 - 5.2) was rated as the most often used. Conclusion. Collectively, the coaches in this study demonstrated a positive attitude towards injury prevention and performance. Additional means of communicating information to coaches, other than the traditional channels, have also been highlighted here

Infections in the management of rheumatic diseases: An update

Patients with inflammatory rheumatic conditions have an increased risk of infection. While this could be the  result of the underlying disease, it may also be caused by the use of immunosuppressive therapies, which are  needed to treat these disorders. An increasing number of patients with rheumatoid arthritis or other rheumatic diseases are using biologic therapies (biologics) in addition to the synthetic diseasemodifying anti-rheumatic drugs. The side-effects and complications of these relatively new agents are unknown to many specialists  (outside of rheumatology) and general practitioners. This article highlights updates on the most important  infections encountered in the daily management of patients with rheumatic diseases and discusses how these may be prevented

Knowledge, attitudes and behaviours of top-level junior (under-19) rugby union coaches towards training the tackle

Includes bibliographical references.Background: The tackle in rugby union is a dynamic and high impact contact situation that occurs frequently during matches and exposes players to high risk of injury and muscle damage. The inability to tackle will result in opposition players gaining territory and possibly scoring points. Indeed, the ability to effectively engage in tackle contact has been associated with team success. While the risk of injury may always be present during these physical contests between the ball-carrier and tackler, coaching of proper techniques and skills may reduce the risk of injury, and at the same time improve performance. With that said, little is known about the knowledge, attitudes and behaviours of rugby union coaches towards coaching the tackle. Therefore the aim of this study was to assess coaches’ knowledge, attitudes and behaviours towards coaching the tackle. Methods: The top 8 rugby-playing schools (Premier A Division) in the Western Province Rugby Union participated in the study (representing 100% of the entire population of top-level junior schools in the region). A questionnaire was used to assess coaches’ knowledge, attitude and reported behaviour. Tackle training behaviour was also observed over a period of 4 weeks at the start of the season. Results: Sixty-two percent of coaches rated proper tackle technique to reduce the risk of injury as very important and 75% of coaches rated proper tackle technique as very important for improving performance. The tackle was practiced in 16% (n=15) of the total practice sessions (n=96). Coaches did not emphasise safety during the tackle sessions. Tackle training was over-reported by 75% (n=5) of coaches during the 4-week observational period. Discussion/Conclusion: Majority of coaches are aware of the high risk of injury associated with the tackle. Most coaches believe that tackle technique can improve tackle performance and safety during the tackle event. Coaches develop new 2 methods mostly through resources such as coaching colleagues and watching televised and live rugby matches. During the observed training period however, only 15 tackle training sessions were observed. It may be important to identify how much tackle training should occur during the pre-season and competition phase of the season to adequately prepare players for competition without increasing the risk of injury. The latest research on ways to reduce the risk of injury and improve performance in the tackle should also be disseminated through the appropriate channels that coaches are known to use. Tackle training guidelines should be based on scientific evidence, and these guidelines should outline how coaches need to design their training to meet their team requirements. Further research should identify which coaching behaviours can be used to effectively train tackle safety and tackle performance during training sessions. Keywords: Rugby union, tackling, coaching, injury prevention, attitude, knowledge, behaviou

A sequential evaluation of left ventricular function in asymptomatic and symptomatic patients with chronic severe aortic regurgitation

The optimal timing of valve replacement surgery in chronic severe aortic regurgitation (AR) has remained a major clinical problem in the management of these patients. Although the onset of symptoms is the generally accepted indication for aortic valve replacement (AVR), the unpredictable development of pre-symptomatic left ventricular (LV) dysfunction as a result of prolonged volume overload has resulted in numerous reports attempting to formulate a risk profile for these patients. Although aortic root and LV cineangiography have been the "gold standard" for defining the severity of AR and its effect on LV performance, serial follow-up by these means is impractical. More recently numerous non-invasive measures of LV size (echocardiogram) and function both at rest and on exercise (echocardiogram and equilibrium radionuclide angiocardiography., ERNA) have been serially utilised~ In these endeavours, the thinking has been clouded by a tendency to equate these two measures and failing to appreciate that apparent preoperative LV dysfunction (particularly on exercise) may be rapidly reversible by AVR and the consequent changes in LV loading conditions. This study was a prospective, sequential evaluation of left ventricular function using both non-invasive and invasive techniques in symptomatic and asymptomatic patients with isolated chronic, severe (4+) AR at cardiac catheterisation. The aims of the study were to (I) Identify differences in the clinical, echocardiographic, resting and exercise haemodynamic and I radionuclide measures of left ventricular function in symptomatic and asymptomatic patients with chronic severe A.R. with particular reference to the incidence of presymptomatic development of left ventricular dysfunction. (II) Critically evaluate the role of exercise stress (both isotonic and isometric) in the assessment of patients with chronic severe A.R. (III) Evaluate the influence of time (sequential studies) on the haemodynamic burden in asymptomatic patients. (IV) Study the impact of successful aortic valve replacement on the reversibility of abnormal pre-operative LV function in an attempt to predict which patients would benefit from this therapeutic intervention and whether operation for symptoms alone is the correct clinical practice

Radical irradiation for carcinoma of the prostate

Ninety-three patients treated by radical irradiation for stage A2, Band C1 carcinoma of the prostate between 1979 and 1988 at a joint radiotherapy service were reviewed. The average age was 63 years, 84% of the patients were white and on histological examination the tumours were well or moderately differentiated in 88% of cases. Treatment was with 5 fractions per week in 71% while the remainder received 3 - 4 fractions per week. At a median follow-up of 62 months, the 5-year survival rate was 83% and the relapse-free rate was 73% (life table). The most important prognostic factor was tumour grade. In patients with grade 1 and 2 tumours, the 5-year survival rate and relapse-free rate was 91% and 76% respectively, while the survival for grade 3 tumour was 60% and 22% respectively (P < 0,05 logrank). There was a suggestion that patients diagnosed by trans-rectal needle biopsy did better than those diagnosed by trans-urethral resection, but this was not statistically significant. Disease stage did not influence survival. The crude late complication rate was 10% but this was significantly related to the use of less than 5 fractions of radiation per week. A separate group of 13 patients with local disease who had had failed previous hormonal treatment were not analysed. Their 5-year survival rate was 19%, which is statistically significantly worse (P< 0,001 logrank)

Infections in the management of rheumatic diseases: An update

Patients with inflammatory rheumatic conditions have an increased risk of infection. While this could be the result of the underlyingdisease, it may also be caused by the use of immunosuppressive therapies, which are needed to treat these disorders. An increasing numberof patients with rheumatoid arthritis or other rheumatic diseases are using biologic therapies (biologics) in addition to the synthetic diseasemodifyinganti-rheumatic drugs. The side-effects and complications of these relatively new agents are unknown to many specialists (outsideof rheumatology) and general practitioners. This article highlights updates on the most important infections encountered in the dailymanagement of patients with rheumatic diseases and discusses how these may be prevented

The subendothelial extracellular matrix modulates NF-κB activation by flow: a potential role in atherosclerosis

Atherosclerotic plaque forms in regions of the vasculature exposed to disturbed flow. NF-κB activation by fluid flow, leading to expression of target genes such as E-selectin, ICAM-1, and VCAM-1, may regulate early monocyte recruitment and fatty streak formation. Flow-induced NF-κB activation is downstream of conformational activation of integrins, resulting in new integrin binding to the subendothelial extracellular matrix and signaling. Therefore, we examined the involvement of the extracellular matrix in this process. Whereas endothelial cells plated on fibronectin or fibrinogen activate NF-κB in response to flow, cells on collagen or laminin do not. In vivo, fibronectin and fibrinogen are deposited at atherosclerosis-prone sites before other signs of atherosclerosis. Ligation of integrin α2β1 on collagen prevents flow-induced NF-κB activation through a p38-dependent pathway that is activated locally at adhesion sites. Furthermore, altering the extracellular matrix to promote p38 activation in cells on fibronectin suppresses NF-κB activation, suggesting a novel therapeutic strategy for treating atherosclerosis

South African guideline for the use of chronic opioid therapy for chronic non-cancer pain

Chronic pain may have a significant impact on health-related quality of life and can be difficult to manage. In carefully selected patients, and as part of a comprehensive pain management strategy, opioid analgesia may help to achieve long-term pain control with a manageable side-effect profile and a low risk of serious adverse effects. However, appropriate evaluation, including biopsychosocial screening and risk screening is essential before initiating an opioid and during continued therapy. This guideline aims to assist practitioners in screening and selecting appropriate patients with chronic non-cancer pain to initiate, monitor and continue pain management with opioid therapy.

South African guideline for the use of chronic opioid therapy for chronic non-cancer pain

Chronic pain may have a significant impact on health-related quality of life and can be difficult to manage. In carefully selected patients, and as part of a comprehensive pain management strategy, opioid analgesia may help to achieve long-term pain control with a manageable side-effect profile and a low risk of serious adverse effects. However, appropriate evaluation, including biopsychosocial screening and risk screening is essential before initiating an opioid and during continued therapy. This guideline aims to assist practitioners in screening and selecting appropriate patients with chronic non-cancer pain to initiate, monitor and continue pain management with opioid therapy.The development of this guideline was supported by an unrestricted grant from Mundipharma who did not participate in the development or writing of the guideline. Dr M Raff has received honoraria for consultancies and non-restricted research grants from Mundipharma, Pfizer, Janssen Pharmaceutica, AstraZeneca, MSD, Eli Lilly, Aspen and Abbott Laboratories. Drs J Crosier and S Eppel have received honoraria from Mundipharma. Prof. H Meyer has received honoraria for consultancies and non-restricted research grants from Janssen Pharmaceutica, Eli Lilly, MSD and Mundipharma. Dr B Sarembock has received honoraria for consultancies and non-restricted research grants from MSD, AstraZeneca, Pfizer and Mundipharma. Dr D Webb has received professional fees for services to Abbott Laboratories, Adcock Ingram, Alcon Laboratories, AstraZeneca, Eli Lilly, Janssen Pharmaceutica, Mundipharma, Novartis, and Reckitt Beckiser Pharmaceuticals.http://www.samj.org.zaam201