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Context: Girls' high school volleyball is a popular sport with a high rate of overuse injuries and sport specialization. Health professionals perceive that high school athletes are reluctant to follow treatment plans involving sport activity reduction. This study's purpose was to describe high school girls' volleyball athletes' self-reported shoulder and knee pain, the likelihood of adhering to medical advice, and the association of factors that influence the likelihood of reporting overuse injuries and sport specialization. Study Design: Cross-sectional. Methods: Participants completed an online survey (demographics, sport participation measures, shoulder and knee pain information, medical adherence likelihood [4-point Likert: not at all likely to extremely likely], and factors influencing overuse injury reporting intentions). A 2 × 2 chi-square analysis compared factors that influence athletes' intentions to "not report an overuse injury" (eg, I thought my coach would get mad; yes/no) and sport specialization (nonhighly specialized/highly specialized athletes). Results: There were 150 participants (highly specialized = 56%, grade: ninth = 33%, 10th = 28%, 11th = 22%, 12th = 17%). At least 60% reported shoulder and knee pain related to an overuse mechanism. Most reportedly did not seek rehabilitation led by a medical provider (shoulder pain = 66%, knee pain = 60%). Only 11% of athletes reported they were "extremely likely" to rest from sporting activity during the regular season if advised by a medical professional. Highly specialized athletes were more likely to report the pursuit of a college scholarship as a factor that influences their intention to report an overuse injury compared to nonhighly specialized athletes (13% vs 3%, respectively, P =.04). Conclusions: Most girls' volleyball athletes did not treat their pain with guided rehabilitation, which may increase their risk of a worse overuse injury or even acute injury. Clinicians, athletes, parents, and coaches need to work together to create a sport culture that empowers athletes to discuss their pain and overuse injuries with medical professionals. [ABSTRACT FROM AUTHOR]

ObjectivesWe aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.DesignSystematic scoping review.Setting and participantsED patients with cognitive impairment and/or their care partners.MethodsInformed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.ResultsFrom 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.Conclusions and implicationsThis scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.

Context: As youth sport participation grows, athletic trainers (ATs) continue to be important health care providers in managing growth-related injuries. Objective: To examine secondary school ATs' reported knowledge on diagnosing and treating growth-related injuries and reported confidence for determining growth status and to report methods secondary school ATs use to determine patient growth status. Design: Cross-sectional. Setting: An online questionnaire was distributed to secondary school ATs in the United States. Data collection occurred in the summer of 2021 over a 6-week period. Patients or Other Participants: A total of 430 secondary school ATs (highest degree earned: master's degree 5 66%). Main Outcome Measures: The questionnaire contained secondary school ATs' confidence in determining if an athlete was going through a growth spurt, level of knowledge on diagnosing and treating growth-related injuries, methods secondary school ATs use to determine growth status in their athletes, and demographics. Results: Most secondary school ATs believed that growth spurts affected sport-related injury risk (88%); however, only 37% of secondary school ATs were "fairly" or "completely" confident in their ability to determine if an athlete was going through a growth spurt. For those 37% of secondary school ATs, 89% of them used history or observation over time, but no formal method, for determining growth status of their patients. Patient self-assessed Tanner stages (32%) and clinical evaluation of Tanner stages (28%) were the next most used methods for assessing growth. Conclusions: In accord with Domain I of athletic training, secondary school ATs could benefit from improved knowledge on how to measure and manage growth in their patient population. To aid education in this area, future researchers should focus on assessing barriers secondary school ATs face in implementing methods for measuring growth and exploring secondary school ATs' knowledge levels on risk management programs for youth athletes going through growth spurts.

Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and a research project. Evaluation strategies and feedback have allowed for significant curricular changes as well as customization of the fellowship experience for individual fellows. Key successes include an improved collaborative relationship with geriatrics faculty that has led to additional initiatives and projects and former fellows already becoming regional and national leaders in GEM. The most critical challenges have been ensuring adequate funding and recruiting new fellows each year who are interested in this clinical area. We believe that interest in GEM fellowships will grow and that opportunities exist to combine GEM fellowship training with a focus in research, administration, or health policy to create unique new types of highly impactful specialized training. Future research may include exploring former fellows' postfellowship experiences, careers, accomplishments, and contributions to GEM to better understand the impact of GEM fellowships.

Background: Youth sport specialization is a growing trend in youth sports and is associated with an increased risk of injuries and burnout. However, it is unknown how sport specialization is perceived to be affecting the working environment of secondary school athletic trainers (ATs). The purpose of this paper is to describe how ATs perceive youth sport specialization impacting their workload and whether they perceive it to impact patient safety. Hypothesis: ATs will perceive that youth sport specialization impacts their workload and could impact patient safety. Study Design: A sequential, explanatory mixed methods design with 2 phases: (1) cross-sectional surveys and (2) individual interviews. Level of Evidence: Level 3. Methods: A total of 487 secondary school ATs completed the online survey (access rate, 8.4%; completion rate, 85.4%). The survey consisted of Likert questions and included sections about aspects of workload impacted by specialization, impacts on patient safety, demographics. Ten participants were selected to complete a semi-structured interview via video conference. Results: Approximately two-thirds of ATs perceive that sport specialization impacts their workload. (Somewhat, 38.6%; Quite a bit, 25.5%; A great deal, 5.5%) Attempts to reduce or modify patient activity and a patient's time for rehabilitation were the highest rated aspects of workload impacted by sport specialization. Approximately 30% ATs (29.9%) perceive that sport specialization impacts their workload to where it may influence patient safety (Somewhat, 21.6%; Quite a bit, 6.4%; A great deal, 1.9%). Three themes and subsequent subthemes were identified from the qualitative interviews: (1) current youth sport expectations, (2) conflict between school and club sports, and (3) AT job impacts. Conclusion: Secondary school ATs perceive their workload to be negatively impacted by youth sport specialization and some believe it may impact patient safety. Clinical Relevance: Youth sport specialization is impacting youth sport stakeholders, including ATs, in a variety of ways. [ABSTRACT FROM AUTHOR]

Context: Studies have illustrated that overuse injuries occur in adolescent athletes more often than previously reported. The general purpose of this study was to provide a thorough report of secondary school athletic trainers encounters, practices, and perceptions of overuse injury in adolescent athletes. Design: Cross-sectional. Methods: An anonymous online questionnaire was distributed via email to athletic trainers in the secondary school setting. The questionnaire was sent to participants during the summer of 2021 and 430 participants (highest educational degree earned: master's degree = 66%) completed the survey. Various survey methods were used to evaluate athletic trainers (1) demographics, (2) estimations about what percentage of injuries evaluated and treated were classified as overuse, (3) methods for treating overuse injuries, (4) confidence in treating overuse injuries and the complete implementation of their treatment plan, (5) perceptions of various barriers to treating overuse injuries, and (6) perception as to why patients did not want to reduce activity to treat their overuse injuries. Results: Participants reported that about half of all evaluations and treatments in a year were overuse injuries and they were "fairly" or "completely" confident (90%) in their ability to treat these injuries. The most common treatments cited were stretching (91%) and reducing activity (90%). Only 61% of participants were "fairly" or "completely" confident in the complete implementation of their treatment plan. Participants believed that patients' reluctance to reduce sport activities (82% "moderate" or "extreme" barrier) was the most significant barrier to treatment. Participants cited athletes' avoidance of missing games as the most common reason athletes were reluctant to reduce sporting activity. Conclusions: Participants felt confident in treating overuse injuries yet faced significant barriers in treating these injuries. Clinicians should be prepared to have conversations about the importance of reducing sporting activity to allow proper healing for overuse injuries in adolescent athletes. [ABSTRACT FROM AUTHOR]

Objective: Little is known about cognition's effect on jump-landing movement patterns. Design: Participants completed three baseline cognitive tasks. Then, participants performed three jump-landing trials per condition (dual-task trials (DT)): Stroop Color Word test (SCWT), Symbol Digits Modalities test (SDMT), Brooks Visuospatial task (BVT), and no concurrent cognitive task (single-task). Main Outcome Measures: Total Landing Error Scoring System (LESS) scores were used to evaluate movement patterns. Participant's reaction time (RT) for the jump-landing task was recorded. Results: LESS scores were not different between conditions (F[subscript 3], 17 = 1.77, p = 0.16). RT was different between DT-SCWT and single-task (difference = -0.107 sec, SD = 0.095) and DT-SDMT and single-task (difference = -0.164 sec, SD = 0.245). Additionally, correctness on the BVT (t[subscript 19] = 2.57, p = 0.019) and SDMT (t[subscript 19] = 2.93, p = 0.009) decreased significantly during the dual-task condition relative to baseline task scores. Conclusion: Individuals slowed their RT and were less accurate on the cognitive task during a dual-task condition to create an appropriate jump-landing movement.

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral. [ABSTRACT FROM AUTHOR]

Introduction: Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED.Methods: We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults. Patients’ charts were abstracted for demographic and clinical information including vital signs, via automated electronic methods. We used bivariate analysis to investigate the relationship between vital sign abnormalities and severe illness or injury, defined as intensive care unit (ICU) admission or ED death. In addition, we calculated likelihood ratios for normal and abnormal vital signs in predicting severe illness or injury.Results: 4,873 visits by patients aged 75 and above were made to the ED during 2007, and of these 3,848 had a complete set of triage vital signs. For these elderly patients, the sensitivity and specificity of an abnormal vital sign taken at triage for predicting death or admission to an ICU were 73% (66,81) and 50% (48,52) respectively (positive likelihood ratio 1.47 (1.30,1.60); negative likelihood ratio 0.54 (0.30,0.60).Conclusion: Emergency provider assessment and triage scores that rely primarily on initial vital signs are likely to miss a substantial portion of critically ill older adults. [West J Emerg Med. 2013;14(5):453–460.]

Attitudes and beliefs of parents about sport specialization may indicate why youth athletes decide to specialize. The purpose of this study was to determine the association between sport specialization level, ice hockey position, and the parent/guardians' attitudes and beliefs on sport specialization. Our results demonstrate that goalies were the most likely to specialize, and parents of specialized ice hockey players tend to believe that sport specialization helps their child achieve future sporting aspirations. Increased sport specialization may put ice hockey goalies at an increased risk for overuse injuries, and parents' beliefs about sport specialization may impact their child's sporting behaviors. [ABSTRACT FROM AUTHOR]

Although the return to sports during COVID-19 has been associated with improvements in mental health and quality of life (QOL), whether these benefits are primarily due to increases in physical activity (PA) is unknown. To determine whether PA increases were responsible for the improvements in mental health and QOL among adolescents who returned to sport during the COVID-19 pandemic. Cross-sectional study. Wisconsin secondary schools. A total of 559 adolescent athletes (age = 15.7 + 1.2 years, females = 43.6%) from 44 schools completed a survey in October 2020. Demographic information, whether they had returned to sport participation, school instruction type, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), QOL (Pediatric Quality of Life Inventory 4.0), and PA (Hospital for Special Surgery Pediatric Functional Activity Brief Scale). Mediation analysis was used to assess whether the relationships between sport status and anxiety, depression, and QOL were mediated by PA. At the time of the study, 171 (31%) had returned to play and 388 (69%) had not. Athletes who had returned to play had less anxiety (3.6 ± 0.4 versus 8.2 ± 0.6, P <.001) and depression (4.2 ± 0.4 versus 7.3 ± 0.6, P <.001) and higher QOL (88.1 ± 1.0 versus 80.2 ± 1.4, P <.001) and more PA (24.0 ± 0.5 versus 16.3 ± 0.7, P <.001). Physical activity explained a significant, but small, proportion of the difference in depression (22.1%, P =.02) and QOL (16.0%, P =.048) but not anxiety (6.6%, P =.20) between athletes who had and those who had not returned to play. Increased PA was responsible for only a small portion of the improvements in depression and QOL among athletes who returned to sports. This suggests that most of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic were independent of the benefits of increased PA. [ABSTRACT FROM AUTHOR]

Context: Sport specialization among youth athletes has been associated with increased risk of overuse injuries . Previous research demonstrates that children perceive specialization to be beneficial in making their high school team and receiving athletic college scholarships. Previous research demonstrates that parents play a significant role in their child's sport experience. However, it is unknown if parents and children answer questions related to specialization factors in a similar manner . Objective: To evaluate the beliefs of youth athletes and parents on factors related to sport specialization and evaluate the level of agreement between dyads on sports specialization . Design: Cross-sectional . Setting. Online and paper surveys . Patients or Other Participants : Aim 1 : 1998 participants (993 children and 1005 parents ). Aim 2 : 77 paired parent-child dyads . Interventions : Sel f-administered survey . Main Outcome Measures : The responses were summarized via frequency and proportions (%). Chi - squares were calculated between parent and child responses. Kappa coefficients were calculated for dyads to determine level of agreement. Sport specialization was classified using a common 3-point scale. Results: The parents were more concerned about risk of injury in sports compared with children (P < .001, X2 = 231.4; parent: extremely: 7.1%; child: extremely: 3.7%). However, children were more likely to believe that specialization was associated with their chances of obtaining an athletic college scholarship compared with parents (P < .001, %2 = 201.6; parent: very/extremely likely: 13.7%; child: very/extremely likely: 15.8%). Dyad subanalysis indicated a moderate level of agreement for "quitting other sports to focus on one sport" (E= .50) and a low level of agreement for " identifying a primary sport " (x =. 30) and "training >8 months per year in primary sport" (K =. 32 ). Conclusions : Parents and youth athletes had differing beliefs on the factors related to sport specialization. Dyad analysis shows that parents and children answer sport specialization classification questions differently. Health care providers should be aware of these differences, and messaging should be individualized to the audience. [ABSTRACT FROM AUTHOR]