Implementation of concussion guidelines in community Australian Football and Rugby League– the experiences and challenges faced by coaches and sports trainers

Objectives

While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them.
Design

Longitudinal study.
Methods

111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines.
Results

71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p = 0.002), football code (p = 0.015), and team role (p = 0.045). An interaction between team role and guideline use (p = 0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players.
Conclusions

This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports.

Development of guidelines for adults on how to communicate with adolescents about mental health problems and other sensitive topics: a Delphi study

There is little evidence-based information available to guide adults in the general community on communicating effectively with adolescents about mental health problems or other sensitive topics. The Delphi methodology was used to develop guidelines to fill this evidence gap. An online questionnaire containing potential guideline statements was developed following a literature search and input from two focus groups. Two expert panels (Youth Mental Health First Aid instructors and young consumer advocates) rated the questionnaire over three rounds, according to whether or not they believed that the statements should be included in the guidelines. Results were analyzed by comparing endorsement rates between the panels. Of the 175 statements presented, 80 were rated as essential or important by ≥90% of both panels and were included in the guidelines. The Delphi process has offered an effective way to achieve consensus between expert panels on useful tips to help adults communicate with adolescents.

Indigenous blood and ethical regimes in the United States and Australia since the 1960s

Blood samples collected from members of indigenous communities in the mid-20th century by scientists interested in human variation remain frozen today in institutional repositories around the world. This article focuses on two such collections-one established and maintained in the United States and the other in Australia. Through historical and ethnographic analysis, we show how scientific knowledge about the human species and ethical knowledge about human experimentation are coproduced differently in each national context over time. Through a series of vignettes, we trace the attempts of scientists and indigenous people to assemble and reassemble blood samples, ethical regimes, human biological knowledge, and personhood. In including ourselves-a U.S. historian of science and an Australian anthropologist-in the narrative, we show how humanistic and social scientific analysis contributes to ongoing efforts to maintain indigenous samples. [indigenous, biospecimens, science, genomics, postcolonial, ethics, cryopreservation].

Awareness of energy drink intake guidelines and associated consumption practices: a cross-sectional study

BACKGROUND: Despite concern regarding harms of energy drink (ED) consumption, no research has been conducted to determine awareness and compliance with ED intake guidelines displayed on product packaging in Australia (a novel approach internationally).

METHODS: A convenience sample of 1922 people completed an online survey. Participants reported their knowledge of maximum recommended daily ED intake according to Australian guidelines.

RESULTS: Guideline awareness was reported by 38, 23 and 19 % of past year consumers, lifetime, and non-consumers, respectively. Amongst past year consumers, 'accurate estimators' reported greater ED intake and were more likely to exceed intake guidelines and consume alcohol mixed with ED (AmED). After controlling for demographics and frequency of use, guideline awareness predicted increased likelihood of exceeding guidelines in ED sessions, but was not associated with exceeding ED guidelines in AmED sessions.

CONCLUSIONS: Australia is considered to have the most stringent regulatory approach to EDs internationally. However, advisory statements are not associated with greater awareness and compliance with intake guidelines. Failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, needs to be addressed.

Efficiency and portability: Guidelines to develop websites

The use of the Internet as a means of ensuring greater visibility for products, services and information offered by companies is gaining strength in recent decades. However, it is known that to ensure satisfaction and subsequent virtual customer loyalty, it is necessary to guarantee the quality of the websites, allowing indiscriminate access regardless of the resources used, as well as rapid responses to possible requests. In order to assist this process, this paper presents a set of guidelines for the development of websites having quality characteristics, efficiency and portability as per ISO 9126 norms. An observational analysis of e-commerce websites was done which showed that they are inadequate as to the proposed guidelines, making them difficult to access available content. Therefore, the adoption of the proposed guidelines can greatly contribute to increasing the quality of websites and, consequently, enable quick and effective access regardless of the resources used.

Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3)

Mucormycosis is an emerging cause of infectious morbidity and mortality in patients with hematologic malignancies. However, there are no recommendations to guide diagnosis and management. The European Conference on Infections in Leukemia assigned experts in hematology and infectious diseases to develop evidence-based recommendations for the diagnosis and treatment of mucormycosis. The guidelines were developed using the evidence criteria set forth by the American Infectious Diseases Society and the key recommendations are summarized here. In the absence of validated biomarkers, the diagnosis of mucormycosis relies on histology and/or detection of the organism by culture from involved sites with identification of the isolate at the species level (no grading). Antifungal chemotherapy, control of the underlying predisposing condition, and surgery are the cornerstones of management (level A II). Options for first-line chemotherapy of mucormycosis include liposomal amphotericin B and amphotericin B lipid complex (level B II). Posaconazole and combination therapy of liposomal amphotericin B or amphotericin B lipid complex with caspofungin are the options for second line-treatment (level B II). Surgery is recommended for rhinocerebral and skin and soft tissue disease (level A II). Reversal of underlying risk factors (diabetes control, reversal of neutropenia, discontinuation/taper of glucocorticosteroids, reduction of immunosuppressants, discontinuation of deferroxamine) is important in the treatment of mucormycosis (level A II). The duration of antifungal chemotherapy is not defined but guided by the resolution of all associated symptoms and findings (no grading). Maintenance therapy/secondary prophylaxis must be considered in persistently immunocompromised patients (no grading).

Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland

BACKGROUND: Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants. METHODS: A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined. RESULTS: A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at <32 weeks of gestation per year. This was also the case for the use of opioid analgesics and sucrose solution. Non-opioid analgesics were used more often in smaller units and in units with written guidelines. There was a broad variation in dosage of analgesics and sedatives within all groups. CONCLUSION: Pain assessment, documentation of pain and analgesic therapy are more frequently performed in NICU with written guidelines for pain management and in larger units with more than 50 preterm infants at <32 weeks of gestation per year.

Polychaete taxocenes in the Pevek Strait (Chaun Bay) and the Long Strait, Chukci Sea

In spite of similar abiotic conditions in the Long Strait and Chaun Bay, the polychaete taxocenes differ markedly. In some cases biomass, production, and assimilation of polychaetes in the Long Strait are lower, while rate of metabolism is higher than in the Chaun Bay. This may be related to appearance of an intermediate layer in the Long Strait during some years. The latter is characterized by positive temperatures in winter and by low content of oxygen; these conditions are unfavorable for Arctic polychaetes.

Annotated record and spectrochemical analyses of Mn nodules from Georgia Strait, British Columbia obtained during CNAV Laymore in 1970

A study of the distribution, dispersal and composition of surficial sediments in the Strait of Georgia, B.C., has resulted in the understanding of basic sedimentologic conditions within this area. The Strait of Georgia is: a long, narrow, semi-enclosed basin with a restricted circulation and a single, main, sediment source. The Fraser. River supplies practically all the sediment now being deposited in the Strait of Georgia, the bulk of it during the spring and summer freshet. This river is building a delta into the Strait from the east side near the south end. Ridges of Pleistocene deposits within the Strait and Pleistocene material around the margins, like bedrock exposures, provide local sources of sediment of only minor importance. Rivers and streams other than the Fraser contribute insignificant quantities of sediment to the Strait. Sandy sediments are concentrated in the vicinity of the delta, and in the area to the south and southeast. Mean grain size decreases from the delta toward the northwest along the axis of the Strait, and basinwards from the margins. Silts and clays are deposited in deep water west and north of the delta front, and in deep basins northwest of the delta. Poorly sorted sediments containing a gravel component are located near tidal passes, on the Vancouver Island shelf area, on ridge tops within the Strait, and with sandy sediments at the southeastern end of the study area. The Pleistocene ridges are areas of non-deposition, having at most a thin veneer of modern mud on their crests and upper flanks. The southeastern end of the study area contains a thick wedge of shandy sediment which appears to be part of an earlier delta of the Fraser River. Evidence suggests that it is now a site of active submarine erosion. Sediments throughout the Strait are compositionally extremely similar, with-Pleistocene deposits of the Fraser River drainage basin providing the principal, heterogeneous source. Gravels and coarse sands are composed primarily of lithic fragments, dominantly of dioritic to granodloritlc composition. Sand fractions exhibit increasing simplicity of mineralogy with decreasing grain-size. Quartz, felspar, amphibole and fine-grained lithic fragments are the dominant constituents of the finer sand grades. Coarse and medium silt fractions have compositions similar to the fine sands. Fine silts show an increase in abundance of phyllosilicate material, a feature even more evident in the clay-size fractions on Montmorillonite, illite, chlorite, quartz and feldspar are the main minerals in the coarse clay fraction, with minor mixed-layer clays and kaolinite. The fine clay fraction is dominated by montmorillonite, with lesser amounts of illite and chlorite. The sediments have high base-exchange capacities, related to a considerable content of montmorillonite. Magnesium is present in exchange positions in greater quantity in Georgia Strait sediments than in sediments from the Fraser River, indicating a preferential uptake of this element in the marine environment. Manganese nodules collected from two localities in the Strait imply slow sediment accumulation rates at these sites. Sedimentation rates on and close to the delta, and in the deep basins to the northwest, are high.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

Guidelines for controlling hazardous energy during maintenance and servicing.

Mode of access: Internet.

Guidelines for assessing the environmental impact of public mass transportation projects. Notebook 1: purpose and procedures. Final report.

Transportation Department, Office of Environment and Safety, Washington, D.C.

Ethical and legal considerations of patient care /

Mode of access: Internet.