Identifying sports chiropractic global research priorities: an international Delphi study of sports chiropractors.

Objectives: Developing a research agenda is one method to facilitate broad research planning and prioritise research within a discipline. Despite profession-specific agendas, none have specifically addressed the research needs of the specialty of sports chiropractic. This study determined consensus on research priorities to inform a global sports chiropractic research agenda. Methods: A Delphi consensus methodology was used to integrate expert opinions. Clinicians, academics and leaders from the international sports chiropractic specialty were recruited using purposive sampling to participate in (1) a Delphi panel involving three voting rounds to determine consensus on research priorities and (2) a priority importance ranking of the items that reached consensus. Results: We identified and contacted 141 participants, with response rates for rounds 1, 2 and 3, of 44%, 31% and 34%, respectively. From the original 149 research priorities, 66 reached consensus in round 1, 63 in round 2 and 45 items in round 3. Research priorities reaching consensus were collapsed by removing redundancies, and priority ranking identified 20 research priorities, 11 related to collaboration and 6 to research themes. Conclusions: The top-ranked items for research priorities, research themes and collaborations included the effects of interventions on performance, recovery and return to play; clinical research in sport; and collaborations with researchers in chiropractic educational institutions, respectively. Implications: The prioritisation of research items can be evaluated by key stakeholders (including athletes) and implemented to develop the first international research agenda for sports chiropractic.

Discomfort, pain and stiffness: what do these terms mean to patients? A cross-sectional survey with lexical and qualitative analyses.

BACKGROUND: While pain is often the focus of clinical interventions, other clinical outcomes (e.g., discomfort, stiffness) might also contribute to patients' functionality and well-being. Although researchers and clinicians may view discomfort, pain and stiffness as different constructs, it remains unclear how patients perceive and differentiate between these constructs. Therefore, the purpose of this study was to explore patients' perceptions of pain, discomfort, and stiffness. METHODS: Chiropractic patients were invited to complete an online cross-sectional survey and describe what 'discomfort', 'pain' and 'stiffness' meant to them using their own words. Lexical and inductive qualitative content analyses were conducted independently and then triangulated. RESULTS: Fifty-three chiropractic patients (47.2% female, mean age: 39.1 ± 15.1 years) responded. The most common combinations of words to describe discomfort were "can be ignored" and "less severe than". "Cannot be ignored" and "sharp shooting" were used to describe pain. "Limited range of motion" was used to describe stiffness. Qualitatively, five themes were developed: impact, character, feeling, intensity and temporality. Stiffness was described as limited movement/mobility. Although discomfort and stiffness impacted patients' activities, patients remained functional; pain was described as stopping/limiting activities. Discomfort was described as dull and tingling, pain as sharp and shooting, and stiffness as tight and restricted. Patients felt displeased and annoyed when experiencing discomfort and stiffness but hurt and in danger of harm when experiencing pain. Discomfort and stiffness were described as less intense than pain, with shorter/intermittent duration; however, all constructs could be experienced constantly. CONCLUSION: Patients perceived discomfort, pain and stiffness as different, yet overlapping constructs. This preliminary work advances our knowledge of how patients conceptualize these constructs, contributing to better understanding of what patients mean when reporting these experiences, potentially improving the clinician-patient communication.

Effects of Hospital Volume on Patient Outcomes and Costs in Infants With Pyloric Stenosis.

BACKGROUND: There is a well-established relationship between surgical volume and outcomes after complex pediatric operations. However, this relationship remains unclear for common pediatric procedures. The aim of our study was to investigate the effect of hospital volume on outcomes after hypertrophic pyloric stenosis (HPS). METHODS: The Kid's Inpatient Database (2003-2012) was queried for patients with congenital HPS, who underwent pyloromyotomy. Hospitals were stratified based on case volume. Low-volume hospitals performed the lowest quartile of pyloromyotomies per year and high-volume hospitals managed the highest quartile. Outcomes included complications, mortality, length of stay (LOS), and cost. RESULTS: Overall, 2137 hospitals performed 51,792 pyloromyotomies. The majority were low-volume hospitals (n = 1806). High-volume hospitals comprised mostly children's hospitals (68%) and teaching hospitals (96.1%). The overall mortality rate was 0.1% and median LOS was 2 d. High-volume hospitals had lower overall complications (1.8% versus 2.5%, P < 0.01) and fewer patients with prolonged LOS (17.0% versus 23.5%, P < 0.01) but had similar rates of individual complications, similar mortality, and equivalent median LOS as low-volume hospitals. High-volume hospitals also had higher costs by $1132 per patient ($5494 versus $4362, P < 0.01). Regional variations in outcomes and costs exist with higher complication rates in the West and lower costs in the South. There was no association between mortality or LOS with hospital volume or region. CONCLUSIONS: Patients with pyloric stenosis treated at high-volume hospitals had no clinically significant difference in outcomes despite having higher costs. Although high-volume hospitals offer improved outcomes after complex pediatric surgeries, they may not provide a significant advantage over low-volume hospitals in managing common pediatric procedures, such as pyloromyotomy for congenital HPS.

Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals.

BACKGROUND: Variations in the management of pediatric patients at children's hospitals (CHs) and non-CHs (NCHs) have been well described, especially within the trauma literature. However, little is known about the outcomes and costs of common general surgical procedures at NCHs. The purpose of this study was to evaluate the effect of CH designation on the outcomes and costs of appendectomy and cholecystectomy. METHODS: The Kids' Inpatient Database (2003-2012) was queried for patients aged under 18 y who underwent appendectomy or cholecystectomy at CHs and NCHs. Outcomes analyzed included disease severity, complications, laparoscopy, length of stay (LOS), and cost. RESULTS: Most of appendectomies and cholecystectomies were performed at NCHs. Overall, CHs cared for younger children were more likely to be teaching hospitals, had higher costs, and longer LOS. On multivariate analysis for appendectomies, CHs were associated with higher rates of perforated appendicitis (OR = 1.53, 95% CI = 1.42-1.66, P < 0.001), less complications (OR = 0.68, 95% CI = 0.61-0.75, P < 0.001), increased laparoscopy (OR = 2.93, 95% CI = 2.36-3.64, P < 0.001), longer LOS (RR = 1.13, 95% CI = 1.09-1.17, P < 0.001), and higher costs (exponentiated log $ = 1.19, 95% CI = 1.13-1.24, P < 0.001). Multivariate analysis for cholecystectomies revealed that CHs were associated with less laparoscopy (OR = 0.58, 95% CI = 0.50-0.67, P < 0.001), longer LOS (RR = 1.26, 95% CI = 1.19-1.34, P < 0.001), and higher costs (exponentiated log $ = 1.29, 95% CI = 1.22-1.37, P < 0.001) with similar complications. Independent predictors of LOS and cost included CH designation, negative appendectomy, perforated appendicitis, complications, younger age, black patients, and public insurance. CONCLUSIONS: Variations in surgical management, outcomes, and costs after appendectomy and cholecystectomy exist between CHs and NCHs. CHs excelled in treating complicated appendicitis. NCHs effectively performed cholecystectomies. These differences in outcomes require further investigation to identify modifiable factors to optimize care across all hospitals for these common surgical diseases.

Perianal abscess mimicking levator ani syndrome: a case report and approach to the differential diagnosis of anorectal pain.

OBJECTIVE: To present the clinical management and comprehensive differential diagnosis of a patient with anorectal pain from a perianal abscess. CLINICAL FEATURES: A 41-year-old woman presented with pain localized to her perianal and gluteal region, accompanied by internal and external rectal pain. Prior to presentation, the patient had received a working diagnosis of levator ani syndrome. INTERVENTION AND OUTCOME: An interdisciplinary management approach was utilized. Diagnostic imaging confirmed the clinical suspicion of a perianal abscess and the patient underwent surgical drainage. SUMMARY: Anorectal pain is complex and multifactorial and a diagnosis such as an abscess should not be overlooked. This case emphasized that practitioners must be diligent in their evaluation and management of patients with anorectal pain, including recognizing situations that require further imaging and interdisciplinary management.

OBJECTIF: Présenter le traitement clinique et le diagnostic différentiel complet d'une patiente atteinte de douleur ano-rectale découlant d'un abcès périanal. CARACTÉRISTIQUES CLINIQUES: Une femme de 41 ans se présente avec une douleur dans la région périanale et fessière, accompagnée de douleur rectale interne et externe. Avant la présentation, la patiente a reçu un diagnostic de travail de syndrome du muscle élévateur de l'anus. INTERVENTION ET RÉSULTATS: On a utilisé une approche de prise en charge interdisciplinaire. L'imagerie diagnostique a permis de confirmer le soupçon clinique d'abcès périanal et la patiente a subi un drainage chirurgical. RÉSUMÉ: La douleur ano-rectale est complexe et multifactorielle; il ne faut pas négliger un diagnostic tel qu'un abcès. Ce cas souligne que les praticiens doivent faire preuve de diligence lors de leur évaluation et prise en charge des patients qui souffrent de douleur anorectale, y compris reconnaître des situations nécessitant une imagerie et une prise en charge interdisciplinaire supplémentaires.

Opinions of sports clinical practice chiropractors, with sports specialty training and those without, about chiropractic research priorities in sports health care: a centering resonance analysis.

INTRODUCTION: A Canadian sports chiropractic research agenda has yet to be defined. The Delphi method can be utilized to achieve this purpose; however, the sample of experts who participate can influence the results. To better inform sample selection for future research agenda development, we set out to determine if differences in opinions about research priorities exist between chiropractors who have their sports specialty designation and those who do not. METHODS: Fifteen sports clinical practice chiropractors who have their sports fellowship designation and fifteen without, were interviewed with a set of standardized questions about sports chiropractic research priorities. A centering resonance analysis and cluster analysis were conducted on the interview responses. RESULTS: The two practitioner groups differed in their opinions about the type of research that they would like to see conducted, the research that would impact their clinical practice the most, and where they believed research was lacking. However, both groups were similar in their opinions about research collaborations. CONCLUSION: Sports clinical practice chiropractors, with their sports specialty designation and those without, differed in their opinions about sports chiropractic research priorities; however, they had similar opinions about research collaborations. These results suggest that it may be important to sample from both practitioner groups in future studies aimed at developing research agendas for chiropractic research in sport.

INTRODUCTION: Un programme canadien de recherche en chiropratique sportive n'a pas encore été établi. La méthode Delphi peut être utilisée pour atteindre cet objectif; cependant, l'échantillon d'experts qui participent peut influencer les résultats. Afin de mieux informer la sélection d'échantillons pour le développement futur du programme de recherche, nous avons entrepris de déterminer si des différences d'opinions sur les priorités de recherche existent entre les chiropraticiens qui sont spécialisés dans les disciplines sportives et ceux qui ne le sont pas. MÉTHODOLOGIE: Quinze chiropraticiens spécialisés en sport ayant une désignation de spécialiste dans le domaine et quinze autres sans cette désignation ont répondu à un ensemble de questions normalisées sur les priorités de la recherche en chiropractie sportive. Les réponses données durant les entretiens ont fait l'objet d'une analyse par recoupement et d'une analyse qui représente les termes dans un réseau qui met en évidence leur fréquence, leur importance et leur influence (centering resonance analysis). RÉSULTATS: Les deux groupes de praticiens ont exprimé des opinions divergentes quant au type de recherche qu'ils souhaitaient voir menée, à la recherche qui aurait le plus d'impact sur leur pratique clinique et aux domaines qui devaient faire l'objet de recherche. Cependant, les deux groupes avaient des réponses similaires sur les collaborations en recherche. CONCLUSION: Les chiropraticiens spécialisés en sport ayant une désignation de spécialiste dans le domaine et ceux sans cette désignation ont des points de vue différents sur les priorités de la recherche en chiropractie sportive; cependant, ils avaient des opinions similaires sur les collaborations en recherche. Ces résultats suggèrent qu'il peut être important d'inclure des représentants des deux groupes dans les futures études visant à développer des programmes de recherche pour la recherche en chiropratique sportive.

Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

Omohyoid muscle syndrome is a rare cause of an X-shaped bulging lateral neck mass that occurs on swallowing. This is a diagnostic case report of a 22-year-old mixed martial arts athlete who acquired this condition.

How to write a scholarly book review for publication in a peer-reviewed journal: a review of the literature.

PURPOSE: To describe and discuss the processes used to write scholarly book reviews for publication in peer-reviewed journals and to provide a recommended strategy and book appraisal worksheet to use when conducting book reviews. METHODS: A literature search of MEDLINE, EMBASE, CINAHL, and the Index to Chiropractic Literature was conducted in June 2009 using a combination of controlled vocabulary and truncated text words to capture articles relevant to writing scholarly book reviews for publication in peer-reviewed journals. RESULTS: The initial search identified 839 citations. Following the removal of duplicates and the application of selection criteria, a total of 78 articles were included in this review including narrative commentaries (n = 26), editorials or journal announcements (n = 25), original research (n = 18), and journal correspondence pieces (n = 9). DISCUSSION: Recommendations for planning and writing an objective and quality book review are presented based on the evidence gleaned from the articles reviewed and from the authors' experiences. A worksheet for conducting a book review is provided. CONCLUSIONS: The scholarly book review serves many purposes and has the potential to be an influential literary form. The process of publishing a successful scholarly book review requires the reviewer to appreciate the book review publication process and to be aware of the skills and strategies involved in writing a successful review.

Golf-related stress fractures: a structured review of the literature.

BACKGROUND: Stress fractures are troublesome injuries. Sites of occurrence are activity-related and specific anatomical sites are endemic to certain sports. Little is known about stress fracture patterns in golf. OBJECTIVE: A structured review of the literature was conducted to identify the occurrence and injury sites of golf-related stress fractures. METHODS: A literature search of MEDLINE, CINAHL, and SPORTDiscus was conducted using a combination of controlled vocabulary and truncated text words to capture all articles relevant to golf-related stress fractures. Articles meeting inclusion criteria were descriptively analyzed. RESULTS: The search resulted in 164 articles, of which 13 met the inclusion, and reported 44 cases of golf-related stress fractures. Seven anatomical injury sites were identified with rib stress fracture being the most commonly reported. Stress fractures occurred on the golfer's lead-side in 80% of cases. CONCLUSION: Golf-related stress fractures are infrequent injuries. The ribs were the most common stress fracture site, and a predilection for lead-side involvement was reported.

Coronary artery stent fracture.

Coronary stent fracture is a rare but potentially serious complication of coronary artery stenting. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. In order to ensure rapid recognition and treatment of this entity, physicians must be aware of its existence and its possibility under the right circumstances. We present the case of a 61-year-old Guyanese male who presented with unstable angina secondary to a stent fracture within two weeks of elective percutaneous coronary intervention (PCI) for in-stent restenosis.