The UNC Triathlete Health and Fitness Survey: An Epidemiological Cohort Study of Training Practices and Injury Patterns in North Carolina Triathletes

The sport of triathlon is a physically demanding activity that has seen great growth in popularity among physically active individuals in recent years. Because of the potential risks involved in training for and competing in triathlons, it is the responsibility of the public health and medical community to assess the safety issues with the intent of offering injury prevention methods for those involved with the sport. Triathlon is traditionally composed of swimming, biking, and running- usually in that order. Lengths of triathlons vary, ranging from the sprint triathlon (0.5 mile swim, 12 mile bike, and 3.1 mile run) to the Ironman triathlon (2.4 mile swim, 112 mile bike, and 26 mile run). Intermediate lengths include the Olympic (1 mile swim, 24 mile bike, and 6.2 mile run) and half-Ironman (half the length of the Ironman) distances. All such races are considered full triathlons. The purpose of this paper is to: 1) provide a systematic review of the epidemiological injury literature concerning triathletes, 2) compare this body of literature to similar epidemiological survey studies in the component disciplines of swimming, cycling, and running, and 3) offer a study design to more accurately characterize the needs for injury prevention in triathletes based on lessons learned from existing literature.Master of Public Healt

Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series

The Use of Telehealth in Australia During the Coronavirus (COVID-19) Pandemic for Medical Practitioners: A retrospective epidemiological analysis: Telehealth usage during COVID-19

Introduction: New Medicare Benefits Schedule (MBS) telehealth item codes were added in 2020 to allow Australians to gain access to medical services during COVID-19 lockdown restrictions. Previous studies have been conducted on the utilisation of specific MBS item codes however none have been conducted on all medical practitioner telehealth item codes. Objective: This retrospective epidemiological analysis aims to determine the utilisation rate of newly introduced medical practitioner telehealth MBS item codes and compare them with the usage of existing in-person item codes Methods: The utilisation of 319 MBS item codes were extracted from the Medicare Statistics Database between March 2020 to March 2021. Using count and population statistics a population adjusted rate was generated and a linear regression analysis undertaken. Results: A total of 199,059,309 in-person and telehealth services (Male, n=84,007,935; 42.2%, Female, n=115,051,374; 57.8%) were utilised during the study period. 147,697,104 were in-person compared to 51,191,898 telehealth services. In-person usage decreased by 27.5% while telehealth increased by 358.8%. In-person utilisation increased by 32.4% as the year continued while the telehealth utilisation decreased by 40.7%. There was a non-significant increase in total in-person item code utilisation (p=0.76) and a non-significant decrease (p=0.32) in the total telehealth item codes used Conclusion: There was initially increased usage of telehealth especially during lockdown restrictions. However, when lockdowns eased, usage of telehealth decreased while in-person increased. Regardless, telehealth item codes continued to be used despite changes to eligibility criteria and lockdown restrictions easing. Hence, it appears that patients are accepting of telehealth as a healthcare delivery method

Conservative Sharp Wound Debridement by Nurses in the Outpatient Management of Diabetic Foot Ulcers

Category: Diabetes Introduction/Purpose: With approximately 29.1 million diabetics in the United States and estimated total annual cost of $245 billion, diabetes and its associated complications continue to be an increasing burden on society. The management of diabetic foot ulcers accounts for a significant portion of those expenses. We propose a safe, efficacious and economically prudent model for the outpatient treatment of uncomplicated diabetic foot ulcers. Methods: Enrolled patients had initial sharp wound debridement by one of two foot and ankle fellowship trained orthopaedic surgeons. Patients were treated with total contact casting and subsequently evaluated every two weeks by nurses who utilized a clinical management algorithm and performed conservative sharp wound debridement (CSWD). Results of healing and complications were recorded. Digital photographs of the ulcers from each clinical encounter were retrospectively reviewed in a blinded fashion by two orthopaedic foot and ankle surgeons and compared to the nursing decisions at the time of treatment. Financial calculations estimated the potential cost savings by having nurses perform CSWD. State boards of nursing were systematically surveyed to assess current policies related to CSWD. Results: Average time to clinical healing was 6.03 weeks. There were no identified complications of CSWD performed by nurses. The sensitivity for the timely identification of wound deterioration was 100$774.60 per patient. When extrapolated to the estimated number of diabetic foot ulcers annually within the United States, this could approach $1.8 to$2.1 billion in potential annual healthcare savings. Conclusion: CSWD of diabetic foot ulcers and calluses by trained nurses is a safe, effective and fiscally responsible clinical practice supported by greater than 90% of state boards of nursing. Utilizing a clinical decision algorithm, nursing evaluation and appropriate referral of ulcers at risk demonstrated 100% sensitivity and 89.58% accuracy. There were no complications associated with nurses performing conservative sharp debridement. When considering the most recent CDC estimates of 29.1 million diabetics with an 8% annual incidence of DFU, implementation of this clinical model on a national scale could result in approximately $2 billion in annual healthcare savings