Care of Water Polo Players.

Water polo is a team sport that combines swimming with overhead throwing and wrestling. This places water polo players at risk for a unique group of illnesses and injuries. In addition to the medical problems and injuries seen in competitive swimmers, water polo players are at risk for a variety of traumatic injuries, including concussions, eye injuries, tympanic membrane perforation, fractures, dislocations, and lacerations. Repetitive overhead throwing also places these athletes at risk for related injuries, such as shoulder problems, including rotator cuff strain and impingement, and elbow problems, such as ulnar collateral ligament injuries, posteromedial impingement, and osteochondritis dissecans of the radial capitellum. This article serves as an overview of these illnesses and injuries, as well as how the aquatic environment affects pathogenesis, treatment, and return to play.

Estimating lung resection risk: a pilot study of trainee and practicing surgeons.

BACKGROUND: Most surgeons believe that experience-based risk estimates for major lung resection are reliable. Elements that influence such estimates are poorly understood. METHODS: Clinical vignettes were created for patients who underwent lung resection; 48 patients who had major complications were matched to 48 patients without complications. Ten senior surgical trainees and 9 practicing thoracic surgeons blinded to outcomes estimated the risk of complications using a seven-point scale (uninformed estimates). After review of a calculated risk score, risk was again estimated (informed estimates). RESULTS: Risk estimates did not differentiate between patient groups with and without complications (4.8 versus 4.9; p=0.94 for trainees; 4.5 versus 4.2; p=0.21 for practicing surgeons). The accuracy of predicting complications was only fair, but was better for practicing surgeons than for trainees (58% versus 51%; p=0.041). Risk estimates correlated moderately well with baseline pulmonary function and possibly with age, but not with performance status or extent of resection. Knowledge of a calculated risk score resulted in more frequent alterations of trainee risk scores, improved interobserver agreement in both groups, and aligned trainee and practicing surgeon estimates more closely. CONCLUSIONS: Surgeon estimates are not accurate in predicting lung resection complications using vignette-based, matched-pair methodology. Practicing surgeons and trainees base risk estimates on limited objective clinical data. Trainee estimates are more susceptible to modification by a standard risk score than are estimates of practicing surgeons. Prospective studies are necessary to further explore the etiology, accuracy, and utility of surgeon risk estimates.