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Fractures, Glycemic Control, and Bone Mineral Density in Females With Type 1 Diabetes Mellitus: A Critically Appraised Topic

Antoinette Lee, Nancy A. Uriegas, Morgan G. Adams, and Amy F. Hand

Clinical scenarios have risen where females with Type 1 diabetes mellitus (T1-DM), whose demographics are similar to their male counterparts, have sustained bone injuries, whereas the males with T1-DM have not. These scenarios bring into question the effect of T1-DM on various aspects of bone health and injury risk in females. The purpose of this study was to investigate the impact of T1-DM in females on their fracture risk, glycemic control abilities, and bone mineral density when compared to their male counterparts. Results were consistent across all studies, indicating that individuals with T1-DM had poor glycemic control abilities during ages within peak bone accrual, had significantly lower bone mineral density, and had a greater fracture incidence. Given these results, there is a need for future education to emphasize the importance of glycemic management, future research to investigate differences in physically active populations, and for clinicians to recognize their at-risk patients and take the necessary measures to prevent injury.

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NATA News & Notes

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Continuing Education Assessment

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Volume 28 (2023): Issue 4 (Jul 2023)

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The Effectiveness of Advanced Cardiac Testing on Identifying Risk for Sudden Cardiac Arrest/Death in Athletes Following COVID-19 Infection During Preparticipation Examination: A Critically Appraised Topic

Sydney Wysmierski, Emily A. Hall, Greg Garofalo, and Rebecca Lopez

Clinical Scenario: Due to the potential side effects in athletes, there is a need to evaluate for cardiac-related side effects due to COVID-19 infection during preparticipation examinations. Clinical Question: Does advanced cardiac testing during preparticipation examinations in athletes who have contracted the COVID-19 virus identify cardiac abnormalities? Summary of Key Findings: The literature was searched based on athletes’ post–COVID-19 infection who were tested for risk of sudden cardiac arrest/death. The initial search yielded 32 studies, but 7 were excluded based on abstract content. Of the remaining 25 studies, 17 were excluded based on patient age or non-athletic populations. Four relevant studies met the inclusion criteria and were included. The need for cardiac screening and advanced cardiac testing was supported to identify risk of sudden cardiac arrest/death during preparticipation examinations in COVID-19–positive patients. Clinical Bottom Line: The use of advanced cardiac testing along with a comprehensive symptom and history questionnaire is essential to reduce cardiac complications due to COVID-19. Symptom-based questionnaires following COVID-19 infection can detect possible COVID-19–related cardiac abnormalities better than the standard cardiac symptom-based questionnaires alone. These combined screening measures for patients with a COVID-19 infection can safely help return athletes to sports. Strength of Recommendation : This recommendation has a strength of B based on Oxford Centre for Evidence-Based Medicine due to consistently lower quality limited evidence that supports the use of advanced cardiac testing in identifying heart-related complications and risk of sudden cardiac arrest/death in COVID-19–positive patients.

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Transcranial Direct Current Stimulation for Improving Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Paper

Tricia L. Majewski-Schrage and Kelli R. Snyder

Focused Clinical Question: Is there evidence to suggest that transcranial direct current stimulation improves clinical and patient-reported outcomes in patients with chronic ankle instability? Clinical Bottom Line: Evidence from two clinical studies supports the use of transcranial direct current stimulation for improving outcomes in patients with chronic ankle instability.

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NATA News & Notes

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Continuing Education Assessment

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Volume 28 (2023): Issue 3 (May 2023)

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American Football Soft-Shell Helmet Covers Reduce Head Impact Severity: A Critically Appraised Topic

Kayla O’Connell, Christopher Brown, and Patricia M. Tripp

Focused Clinical Question: Do soft-shell helmet covers reduce head impact severity in American football helmets? Clinical Bottom Line: There is consistent SORT level C evidence to support that soft-shell helmet covers reduce measures of head impact severity and measures of linear and rotational acceleration. The impact reductions occurred at magnitudes less than the average reported concussive impact, which limits the application of the evidence with respect to concussion incidence or risk among American football players.