Association of Functional Movement Screen and Y-Balance Test Scores With Injury in High School Athletes.

ABSTRACT: Lisman, P, Hildebrand, E, Nadelen, M, and Leppert, K. Association of functional movement screen and Y-Balance Test scores with injury in high school athletes. J Strength Cond Res 35(7): 1930-1938, 2021-The purpose of this study was to determine the association between functional movement screen (FMS) and Y-Balance Test (YBT) performance and lower extremity injury in a sample of male high school athletes. A total of 124 high school football (n = 89), lacrosse (n = 25), and baseball (n = 10) players underwent FMS and YBT before the start of their competitive seasons. Time loss lower extremity injury incidence data were tracked by each team's certified athletic trainer and used for analysis. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cutpoints for FMS composite score (CS) and YBT measures, including CS and reach distance asymmetry for anterior, posteromedial, and posterolateral directions, for predicting injury. No cutpoints on the ROC curves maximized sensitivity and specificity; therefore, FMS CS and YBT measures (CS and asymmetry) were analyzed as continuous variables. Logistic regression models adjusted for age and sport revealed no significant associations between FMS CS and lower extremity injury (odds ratio [OR] = 0.99; 95% confidence interval [CI] = 0.83-1.20). Similar findings were found for YBT asymmetry in all directions (ORs ranged from 0.98 to 1.08) and CS (OR = 0.99; 95% CI = 0.95-1.04). There were also no significant associations between the presence of asymmetry and low score (score of 1) on any individual FMS test and injury. Overall, FMS and YBT were not associated with increased risk of lower extremity injury in this sample of high school athletes. These findings do not support the use of FMS and YBT as stand-alone injury risk assessments in high school athletes.

Comparison of Electric Resistive Heating Pads and Forced-Air Warming for Pre-hospital Warming of Non-shivering Hypothermic Subjects.

INTRODUCTION: Victims of severe hypothermia require external rewarming, as self-rewarming through shivering heat production is either minimal or absent. The US Military commonly uses forced-air warming in field hospitals, but these systems require significant power (600-800 W) and are not portable. This study compared the rewarming effectiveness of an electric resistive heating pad system (requiring 80 W) to forced-air rewarming on cold subjects in whom shivering was pharmacologically inhibited. MATERIALS AND METHODS: Shivering was inhibited by intravenous meperidine (1.5 mg/kg), administered during the last 10 min of cold-water immersion. Subjects then exited from the cold water, were dried and lay on a rescue bag for 120 min in one of the following conditions: spontaneous rewarming only (rescue bag closed); electric resistive heating pads (EHP) wrapped from the anterior to posterior torso (rescue bag closed); or, forced-air warming (FAW) over the anterior surface of the body (rescue bag left open and cotton blanket draped over warming blanket). Supplemental meperidine (to a maximum cumulative dose of 3.3 mg/kg) was administered as required during rewarming to suppress shivering. RESULTS: Six healthy subjects (3 m, 3 f) were cooled on three different occasions, each in 8°C water to an average nadir core temperature of 34.4 ± 0.6°C (including afterdrop). There were no significant differences between core rewarming rates (spontaneous; 0.6 ± 0.3, FAW; 0.7 ± 0.2, RHP; 0.6 ± 0.2°C/h) or post-cooling afterdrop (spontaneous; 1.9 ± 0.4, FAW; 1.9 ± 0.3, RHP; 1.6 ± 0.2°C) in any of the 3 conditions. There were also no significant differences between metabolic heat production (S; 74 ± 20, FAW; 66 ± 12, RHP; 63 ± 9 W). Total heat gain was greater with FAW (36 W gain) than EHP (13 W gain) and spontaneous (13 W loss) warming (p < 0.005). CONCLUSIONS: Total heat gain was greater in FAW than both EHP, and spontaneous rewarming conditions, however, there were no observed differences found in rewarming rates, post-cooling afterdrop or metabolic heat production. The electric heat pad system provided similar rewarming performance to a forced-air warming system commonly used in US military field hospitals for hypothermic patients. A battery-powered version of this system would not only relieve pressure on the field hospital power supply but could also potentially allow extending use to locations closer to the field of operations and during transport. Such a system could be studied in larger groups in prospective trials on colder patients.

Characteristics of team briefings in gynecological surgery.

Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-operative team briefings in one department of an academic hospital. Twenty-four team briefings were observed and video recorded. Communication was analyzed and social network metrics were created based on the team member verbal interactions. Introductions occurred in only 25% of the briefings. Network analysis revealed that average team briefings exhibited a hierarchical structure of communication, with the surgeon speaking the most frequently. The average network for resident-led briefings displayed a non-hierarchical structure with all team members communicating with the resident. Briefings conducted without a standardized protocol can produce variable communication between the role leading and the team members present.

A pilot study of non-routine events in gynecological surgery: Type, impact, and effect.

OBJECTIVE: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. METHODS: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. RESULTS: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3%), teamwork (26.7%), or equipment (21.3%). The circulating nurse was most frequently affected by NREs (43.2%) followed by the entire surgical team (13.7%). There was no statistically significant difference in non-routine events based on surgical approach. CONCLUSION: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.

Functional movement screen and Y-Balance test scores across levels of American football players.

Few studies have investigated differences in functional movement assessment performance across scholastic levels of competition. This study examined Functional Movement Screen (FMS) performance in middle school (MS), high school (HS) and collegiate (COL) American football players and Y-Balance test (YBT) scores in MS and HS players. Functional movement measurements were collected for MS (N = 29; age = 12.8 ± 0.7 years), HS (N =52; age = 15.7 ± 1.2 years), and COL (N =77; age = 19.9 ± 1.4 years) football players prior to each group's competitive season. Differences in composite FMS and YBT measurements were examined using Welch's ANOVA and Mann-Whitney U-tests, respectively. Chi-square analyses examined normality of score distributions for individual FMS tests. The MS group displayed a lower composite FMS (12.9 ± 1.9) than both HS (14.0 ± 1.7) and COL (14.1 ± 2.1) groups (p = 0.019). COL players scored significantly lower on the Shoulder Mobility (SM) but higher on the Deep Squat (DS), In-line Lunge (ILL), Active Straight-Leg Raise (ASLR) and Push-Up (PU) than both HS and MS groups. No differences were found between MS and HS groups for any YBT normalized reach distances and side-to-side reach distance differences. FMS performance varied with football competition level whereas YBT performance did not. The results suggest that football competition levels normative data and injury-risk thresholds should be established when using FMS scores to guide performance and injury prevention programming.

Better instructions for use to improve reusable medical equipment (RME) sterility.

OBJECTIVE: The objective was to evaluate human-factors-based instructional aids on endoscope reprocessing. BACKGROUND: The project stems from recent failures in reprocessing (cleaning) endoscopes, contributing to the spread of harmful bacterial and viral agents between patients. A previous study discovered three themes that represent a majority of problems: (1) lack of visibility (parts and tools were difficult to identify), (2) high memory demands, and (3) insufficient feedback. METHOD: In an effort to improve completion rate and reduce error, the authors designed instructional aids utilizing human factors principles that would replace existing manufacturer-provided visual aids. Then, they conducted a usability test, which compared the endoscope reprocessing performance of novices using the standard manufacturer-provided visual aids and the new instructional aids. RESULTS: Participants in the experimental group successfully completed 87.1% of the reprocessing procedure with the use of the instructional aids, compared to 44.7% in the control group using only existing support materials. Of 60 subtasks, 27 showed significant improvement in completion rates. CONCLUSION: When given an instructional aid designed with human factors principles, participants were able to more successfully complete the reprocessing task. This resulted in an endoscope that was more likely to be safe for use on patients. APPLICATION: The human factors design elements utilized to create the instructional aids could be transferred to a dynamic electronic-based system to improve patient safety.