Concussion occurrence and recognition in professional boxing and MMA matches: toward a concussion protocol in combat sports.

Objectives: Determine, through video reviews, how often concussions occur in combat sport matches, what influence they have on the outcome, and how well non-physician personnel can be trained to recognize concussions.Methods: This is a retrospective video analysis by an 8-person panel of 60 professional fights (30 boxing and 30 mixed martial arts). Through video review, physician and non-physician personnel recorded details about each probable concussion and determined if and when they would have stopped the fight compared to the official stoppage time.Results: A concussion was recorded in 47/60 fights. The mean number of concussions per minute of fight time was 0.061 (0.047 for boxers and 0.085 for MMA). When stratifying by outcome of the bout, the mean number of concussions per minute for the winner was 0.010 compared to the loser at 0.111 concussions per minute. The fighter that sustained the first concussion ultimately lost 98% of the time. The physician and non-physician raters had high agreement regarding the number of concussions that occurred to each fighter per match. The physician raters judged that 24 of the 60 fights (11 boxing [37%]; 13 MMA [43%]) should have been stopped sooner than what occurred.Conclusion: Recognizing that the concussions often occur in combat sport matches, that the losing fighter almost always is concussed first and tends to sustain more concussions during the fight, along with the demonstration that non-physician personnel can be taught to recognize concussion, may guide policy changes that improve brain health in combat sports.

Concussion management in combat sports: consensus statement from the Association of Ringside Physicians.

Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines. 1-7 To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself. Accordingly, management and treatment of concussion in combat sports should, and must, be more stringent than for non-combat sports counterparts.The Association of Ringside Physicians (an international, non-profit organisation dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish management guidelines that ringside physicians, fighters, referees, trainers, promoters, sanctioning bodies and other healthcare professionals can use in the ringside setting. We also provide guidelines for the return of a combat sports athlete to competition after sustaining a concussion. This consensus statement does not address the management of moderate to severe forms of traumatic brain injury, such as intracranial bleeds, nor does it address the return to competition for combat sports athletes who have suffered such an injury. These more severe forms of brain injuries are beyond the scope of this statement. This consensus statement does not address neuroimaging guidelines in combat sports.

Crystal structure of tris-(3-methyl-1H-pyrazol-1-yl)methane.

The title mol-ecule, C13H16N6, crystallizes from hexane as a mol-ecular crystal with no strong inter-molecular inter-actions (the shortest C-H⋯N contact is longer than 3.38 Å). A relatively short intra-molecular contact (3.09 Å) has a C-H⋯N angle of 118° which is quite small to be still considered a hydrogen bond. The three pyrazole rings form a propeller-like motif, with one methylpyrazole unit almost perpendicular to the mean plane of the three rings [82.20 (6)°]. The other two methylpyrazole units, with nitrogen donor atoms oriented in opposite directions, are oriented at 67.26 (6) and 72.53 (6)° to the mean plane.

Determining brain fitness to fight: Has the time come?

Professional boxing is associated with a risk of chronic neurological injury, with up to 20-50% of former boxers exhibiting symptoms of chronic brain injury. Chronic traumatic brain injury encompasses a spectrum of disorders that are associated with long-term consequences of brain injury and remains the most difficult safety challenge in modern-day boxing. Despite these concerns, traditional guidelines used for return to sport participation after concussion are inconsistently applied in boxing. Furthermore, few athletic commissions require either formal consultation with a neurological specialist (i.e. neurologist, neurosurgeon, or neuropsychologist) or formal neuropsychological testing prior to return to fight. In order to protect the health of boxers and maintain the long-term viability of a sport associated with exposure to repetitive head trauma, we propose a set of specific requirements for brain safety that all state athletic commissions would implement.

Tris(5-methylpyrazolyl)methane: synthesis and properties of its iron(II) complex.

The new ligand, tris(5-methylpyrazolyl)methane (1), has been prepared by the reaction of n-butyl lithium with tris(pyrazolyl)methane followed by trimethylation of the tetralithiated species with methyl iodide. The BF(4)(-), ClO(4)(-), and BPh(3)CN(-) salts of the Fe(II) complex of this ligand were also synthesized. The X-ray crystal structure of the BF(4)(-) complex (2) at 100 K had Fe-N bond lengths of 1.976 Å, indicative of a low spin Fe(II) complex, while at room temperature, the structure of this complex had a Fe-N bond distance close to 2.07 Å, indicative of an admixture of approximately 50% low-spin and 50% high-spin. The solid-state structure of the complex with a ClO(4)(-) counterion was determined at 5 different temperatures between 173 and 293 K, which allowed the thermodynamic parameters for the spin-crossover to be estimated. Mössbauer spectra of the BF(4)(-) complex further support spin-state crossover in the solid state with a transition temperature near 300 K. UV-visible spectroscopy and (1)H NMR studies of 2 show that the transition temperature in solution is closer to 400 K. No spin-crossover was observed for [Fe(1)(2)](2+)·2BPh(3)CN(-). The results allow the separation of effects of groups in the 3-position from those in the 5-position on tpm ligands, and also point toward a small cooperative effect in the spin-crossover for the Fe(II) complex.

Incidentally discovered solid pancreatic masses: imaging and clinical observations.

PURPOSE: The purpose of this study was to review the CT findings and clinical outcome in patients with incidentally discovered solid pancreatic masses. MATERIALS AND METHODS: Over an 8-year period, from 2001 to 2009, we identified 24 patients with solid pancreatic masses incidentally detected by CT. There were 13 females and 11 males, with a mean age of 67 years. We determined the indication for initial CT, analyzed the CT features, and ascertained the clinical follow-up in all the patients. RESULTS: All of the solid masses were malignant. There were 14 adenocarcinomas and 10 neuroendocrine tumors. The most common indications for the initial CT were surveillance of an extrapancreatic malignancy (n = 10) and evaluation for hematuria (n = 6). On the initial CT, 16 of the patients (67%) had a clearly visible pancreatic mass. In eight patients isoattenuating masses were identified, only recognized by subtle signs including unexplained dilatation of the pancreatic duct (n = 5) or minimal contour deformity or density of the pancreas (n = 3). The mean survival time for the patients with adenocarcinoma was 21.6 months, and 42 months for the patients with neuroendocrine tumors. CONCLUSION: Although uncommon, incidentally discovered solid pancreatic masses are malignant neoplasms, either ductal adenocarcinomas or neuroendocrine tumors. Unlike incidentally discovered small cystic lesions, solid pancreatic lesions are often biologically aggressive.

Laxatives or methylnaltrexone for the management of constipation in palliative care patients.

BACKGROUND: Constipation is common in palliative care; it can generate considerable suffering due to the unpleasant physical symptoms. In the first Cochrane Review on effectiveness of laxatives for the management of constipation in palliative care patients, published in 2006, no conclusions could be drawn because of the limited number of evaluations. This article describes the first update of this review. OBJECTIVES: To determine the effectiveness of laxatives or methylnaltrexone for the management of constipation in palliative care patients. SEARCH STRATEGY: We searched databases including MEDLINE and CENTRAL (The Cochrane Library) in 2005 and in the update to August 2010. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating laxatives for constipation in palliative care patients. In the update we also included RCTs on subcutaneous methylnaltrexone; an opioid-receptor antagonist that is now licensed for the treatment of opioid-induced constipation in palliative care when response to usual laxative therapy is insufficient. DATA COLLECTION AND ANALYSIS: Two authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity. MAIN RESULTS: We included seven studies involving 616 participants; all under-reported methodological features. In four studies the laxatives lactulose, senna, co-danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated. In three methylnaltrexone.In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; in combined analysis (287 participants) methylnaltrexone, in comparison with a placebo, significantly induced laxation at 4 hours (odds ratio 6.95; 95% confidence interval 3.83 to 12.61). In combined analyses there was no difference in the proportion experiencing side effects, although participants on methylnaltrexone suffered more flatulence and dizziness. No evidence of opioid withdrawal was found. In one study severe adverse events, commonly abdominal pain, were reported that were possibly related to methylnaltrexone. A serious adverse event considered to be related to the methylnaltrexone also occurred; this involved a participant having severe diarrhoea, subsequent dehydration and cardiovascular collapse. AUTHORS' CONCLUSIONS: The 2010 update found evidence on laxatives for management of constipation remains limited due to insufficient RCTs. However, the conclusions of this update have changed since the original review publication in that it now includes evidence on methylnaltrexone. Here it found that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed. However, the safety of this product is not fully evaluated. Large, rigorous, independent trials are needed.

How to keep score of acuity and dependency.

This article describes how the introduction of an acuity and dependency tool at University Hospitals Coventry and Warwickshire NHS Trust has provided nurses with a structure for gathering evidence about patient care levels, and discusses how this information is shared throughout the trust to improve patient outcomes and safety.

Evaluating student nurse learning in the clinical skills laboratory.

This small study was undertaken at Coventry University as part of a wider Nursing and Midwifery Council (NMC) project to determine whether learning that occurs in the clinical skills laboratories (CSLs) can be counted as practice hours or should remain as theory hours. At Coventry University, 3rd-year student nurses were educated on how to teach drug administration skills. They then delivered this teaching to 1st-year student nurses. Both adult and mental health students were involved in this process. All participants in the study were asked for their views of this learning experience. Mentors in practice were also asked how this learning impacted on the students' performance in placement. The findings identify that students considered this to be a good way to learn because the safe environment of the CSL built up their confidence. Mentors also identified it as useful because students came better prepared to their placement, thereby reducing their workload.

Bis[bis(3-phenylpyrazol-1-yl)(pyrazol-1-yl)methane]copper(II) bis(perchlorate) acetonitrile disolvate.

The title copper(II) complex, [Cu(C22H18N6)2](ClO4)2.2C2H3N, comprises two neutral substituted tris(pyrazol-1-yl)methane ligands bonded to a central Cu(II) ion, which is positioned on a crystallographic inversion center. Six Cu-N bonds are arranged in a distorted octahedral fashion. The unsubstituted pyrazole rings on each ligand are oriented trans with respect to each other, interdigitated with the two 3-phenylpyrazole rings of the other ligand.

Constipation management in palliative care: a survey of practices in the United kingdom.

Fifty percent of patients admitted to hospices cite constipation as a concern. This study evaluates how constipation was managed in 11 hospices. Patients and nurses completed questionnaires at two time points: baseline and 7-10 days later. Outcomes were evaluated using a Constipation Visual Analogue Scale and a satisfaction with management of constipation questionnaire. A total of 475 patients participated; 413 completed both assessments. Forty-six percent of patients reported no constipation and 15% of patients reported severe constipation. For 75% of patients, no change in the perception of constipation was observed over the study period. Patients expressed satisfaction with their constipation management. The severity of constipation was overestimated by nurses in many patients. The findings indicate that constipation was being prevented or reasonably well managed. However, severe constipation continues to be a problem. Assessment of patients' bowel function needs to be more rigorous and those identified as severely constipated need daily monitoring.

District nurses' referrals to home-based palliative nursing services.

This study investigated district nurses' considerations of the Marie Curie Nursing Service. Most saw the primary service as respite care and referred patients to it during late stages of illness rather than palliative phases. The MCNS is valued, but confusion exists about appropriate referral times and the services provided. Improvement in communication and education is needed. The provision of this home palliative nursing service helps to promote the principle of palliative care in optimising the quality of life of patients who have life-limiting diseases and their families.

Developing a fair use of resourcesThe recent British Medical Association report, Healthcare Funding Review ( BMA 2001 ), has thrown the issue of healthcare rationing into the spotlight again. Margaret Goodman looks at attempts to prioritise healthcare in other countries and draws lessons for the UK.

The UK is not alone in facing increased pressures on health care within the context of finite resources. So is there is anything to be learned from the experiences of other countries and should their methods be adopted for the NHS?

Is there a place for euthanasia in palliative care?

In the current debate about the legalization of euthanasia the' distinction between giving care and bringing about death is blurred. Alongside this there is an apparent increased commitment to the further development of palliative care. Difficulties arise in palliative care when euthanasia is discussed as there is an inference that a request for euthanasia results from a failure on the part of the carers. Palliative care aims to relieve distress and suffering, but problems arise from unrealistic expectations of what can actually be achieved. There is a need for professionals to emphasize what is possible in relation to palliative care, to acknowledge that there are limitations, and to set realistic and carefully identified goals which are more likely to be achieved than impossible expectations which could induce individuals to consider euthanasia when impossible expectations are not reached. Euthanasia has an impact on the relationships between health-care professionals and their patients which give rise to a potential alteration of the traditional role.