Doganbradford9359

Physician leadership of the interdisciplinary sports medicine team depends on fundamental leadership skills that often are overlooked in medical school. These leadership skills include effective communication, emotional intelligence, teamwork, selfless service, integrity, and critical thinking while utilizing an athlete-centered approach. Development of these skills will help to navigate team management and important decisions, such as return to play. The leadership session at the Advanced Team Physician Course sought to acknowledge the gap in medical training regarding leadership education and began to address it in a forum specifically for team physicians. Here we provide a summary of the lectures and presentations from the 2018 Advanced Team Physician Course in an effort to benefit a broader physician audience. This material should act as a framework for current and future team physicians to solidify their role as the leader of the medical team in caring for the athlete.As interest and participation in recreational endurance exercise has steadily increased, the number of masters level recreational endurance athletes also has increased. While the benefits of regular and moderate physical activity on cardiovascular health are well established, recent data have raised concern that long-term endurance exercise participation is associated with adverse cardiovascular outcomes. In this review, we discuss the supporting evidence and limitations of prior research focused on these recent controversies. Specifically, we address the association between extreme levels of endurance exercise and longevity, risk of atrial fibrillation, accelerated coronary artery atherosclerosis, and arrythmogenic cardiac remodeling. We aim to provide sports medicine practitioners with knowledge of these contemporary controversies in sports cardiology and will highlight the importance of shared decision making in situations of clinical uncertainty.PURPOSE OF REVIEW The present article aims to provide clinicians with an overview of coagulation testing in individuals with liver disease, to discuss available procoagulants and the rationale for their use, and to provide management strategies in a variety of common clinical scenarios. RECENT FINDINGS Clinicians and researchers are gaining an increased understanding of the shortfalls of assessing bleeding risk using traditional tests of coagulation. The use of global tests of clot formation, including viscoelastic testing and thrombin generation analysis, continues to evolve and guide the management of these patients. SUMMARY Abnormal coagulation testing in individuals with cirrhosis leads to a variety of difficult clinical scenarios that can be challenging for practitioners. With advanced liver disease, changes in the traditional tests of hemostasis such as the international normalized ratio reflect decreased synthesis of procoagulant factors but do not capture concomitant decreases in anticoagulant factors. In this setting, transfusion thresholds targeting platelet and fibrinogen goals may provide an effective strategy to optimize clot formation. STING inhibitor C-178 in vitro Global tests of clot formation provide practical information to clinicians and can help guide decision making, although optimal target levels have not been validated.PURPOSE OF REVIEW As cancer treatments improve more patients than ever are living for longer with the side effects of these treatments. Radiation enteritis is a heterogenous condition with significant morbidity. The present review aims to provide a broad overview of the condition with particular attention to the diagnosis and management of the condition. RECENT FINDINGS Radiation enteritis appears to be more prevalent than originally thought because of patient underreporting and a lack of clinician awareness. Patient-related and treatment-related risk factors have now been identified and should be modified where possible. Medical and surgical factors have been explored, but manipulation of the gut microbiota offers one of the most exciting recent developments in disease prevention. Diagnosis and treatment are best approached in a systematic fashion with particular attention to the exclusion of recurrent malignancy and other gastrointestinal conditions. Surgery and endoscopy both offer opportunities for management of the complications of radiation enteritis. Experimental therapies offer hope for future management of radiation enteritis but large-scale human trials are needed. SUMMARY Radiation enteritis is an important clinical problem, but awareness is lacking amongst patients and physicians. Clinical guidelines would allow standardised management which may improve the burden of the disease for patients.PURPOSE OF REVIEW Chronic kidney disease (CKD) is a pervasive and growing health concern that has a significant impact on mortality and morbidity, putting stress on global healthcare systems. CKD affects ∼14% of general populations and ∼36% of high-risk populations and is projected to rise in the coming decade due to increasing rates of diabetes and hypertension. RECENT FINDINGS Screen, triage, and treat programs aim to detect early stage disease with the intention of promoting medical and lifestyle interventions in line with a patient's level of risk that may slow disease progression and reduce morbidity and mortality. Early detection facilitates appropriate risk stratification and coordination of care among patients, primary care and nephrology ensuring resources are utilized appropriately. SUMMARY By using readily available laboratory measures, screening for CKD in high-risk populations is cost effective and beneficial to both individuals and healthcare systems. Program models such as Kidney Early Evaluation Program and First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis have proven the efficacy of screening initiatives in these groups, but improvements are required to maximize the benefits of early CKD detection.PURPOSE OF REVIEW The erythrocyte is the most abundant cell type in our body, acting as both a carrier/deliverer and sensor of oxygen (O2). Erythrocyte O2 delivery capacity is finely regulated by sophisticated metabolic control. In recent years, unbiased and robust human metabolomics screening and mouse genetic studies have advanced erythroid research revealing the differential role of erythrocyte hypoxic metabolic reprogramming in normal individuals at high altitudes and patients facing hypoxia, such as sickle cell disease (SCD) and chronic kidney disease (CKD). Here we summarize recent progress and highlight potential therapeutic possibilities. RECENT FINDINGS Initial studies showed that elevated soluble CD73 (sCD73, converts AMP to adenosine) results in increased circulating adenosine that activates the A2B adenosine receptor (ADORA2B). Signaling through this axis is co-operatively strengthened by erythrocyte-specific synthesis of sphingosine-1-phosphate (S1P). Ultimately, these mechanisms promote the generation of 2,3-bisphosphoglycerate (2,3-BPG), an erythrocyte-specific allosteric modulator that decreases haemoglobin--O2-binding affinity, and thus, induces deoxygenated sickle Hb (deoxyHbS), deoxyHbS polymerization, sickling, chronic inflammation and tissue damage in SCD.