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Lawrence E. Armstrong and Rebecca M. Lopez

Context:

Exertional heat exhaustion (HEX) is the most common form of heat illness experienced by athletes, laborers, and military personnel. Both dehydration stemming from a water and/or salt deficiency and a high ambient temperature must exist for HEX to occur. In the field, appropriate therapy can reduce recovery time.

Objective:

This manuscript provides clinical guidance regarding return to activity. The primary focus of this paper is to describe the evaluation of residual effects and the underlying personal characteristics that initially predispose the athlete to HEX. Attention to these factors will reduce the risk of future episodes.

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Kailin C. Parker, Rachel R. Shelton and Rebecca M. Lopez

Clinical Scenario: In the last few years, there have been several studies examining alternative cooling strategies in the treatment of exertional heat stroke (EHS). Morbidity and mortality with EHS are associated with how long the patient’s core body temperature remains above the critical threshold of 40.5°C. Although cold-water immersion (CWI) is the gold standard of treatment when cooling a patient with EHS, more recent alternative cooling techniques have been examined for use in settings where CWI may not be feasible (ie, remote locations). Clinical Question: Do alternative cooling methods have effective core body temperature cooling rates for hyperthermia compared with previously established CWI cooling rates? Summary of Key Findings: The authors searched for studies using alternative cooling methods to cool hyperthermic individuals. To be included, the studies needed a PEDro score ≥6 and a level of evidence ≥2. They found 9 studies related to our focused clinical question; of these, 5 studies met the inclusion criteria. The cooling rates for hand cooling, cold-water shower, and ice-sheet cooling were 0.03°C/min, 0.08°C/min, and 0.06°C/min, respectively, whereas the tarp-assisted cooling with oscillation (TACO) method was the only method that had an acceptable cooling rate (range 0.14–0.17°C/min). Clinical Bottom Line: When treating EHS, if CWI is not available, the tarp-assisted cooling method may be a reasonable alternative. Clinicians should not use cold shower, hand cooling, or ice-sheet cooling if better cooling methods are available. Clinicians should always use CWI when available. Strength of Recommendation: Five level 2 studies with PEDro scores ≥6 suggest the TACO method is the only alternative cooling method that decreases core body temperature at a similar, though slower, rate of CWI. Hand cooling, cold showering, and ice-sheet cooling do not decrease core body temperature at an appropriate rate and should not be used in EHS situations if a modality with a better cooling rate is available.

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Megan N. Sears, Dani M. Moffit and Rebecca M. Lopez

Clinical Question: Do cultural-competence-based educational interventions improve the cultural competence of athletic training students, based on the constructs of the Campinha-Bacote model? Clinical Bottom Line: Athletic training programs can improve athletic training students’ cultural awareness, knowledge, skill, encounters, and desire by incorporating cultural-competence-based independent readings, lecture presentations, in-class discussions, and self-awareness activities.

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Brendon P. McDermott, Douglas J. Casa, Susan W. Yeargin, Matthew S. Ganio, Rebecca M. Lopez and Elizabeth A. Mooradian

Context:

Previous field research has not identified sweat rates (SR), fluid consumption (FC), or the efficacy of an educational intervention (EI) for youth during football camp.

Objective:

To measure hydration status and rehydration performance and examine EI using these data.

Design:

Observational with EI randomized comparison.

Participants:

Thirty-three boys (mean ± SD: 12 ± 2 y, 52.9 ± 13.6 kg, 156 ± 12 cm) volunteered during a 5-d camp with 3 (~2-h) sessions per day (WBGT: 25.6 ± 0.5°C).

Main Outcome Measures:

Hydration status, SR, and FC.

Results:

Urine osmolality averaged 796 ± 293 mOsm/L for days 2-5. Game SR (1.30 ± 0.57 L/h) was significantly greater than practice SR (0.65 ± 0.35 L/h; P = .002). Subjects dehydrated during free time but matched fluid losses with FC (0.76 ± 0.29 L/h) during football activities.

Conclusions:

Subjects arrived at camp hypohydrated and maintained this condition. They matched FC and SR during, but dehydrated when not playing, football. This may impair recovery and subsequent performance. Hydration EI seemed to have a positive influence on hydration practices.

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Emily A. Hall, Dario Gonzalez and Rebecca M. Lopez

Clinical Question: Does the medical model of organizational structure compared to either the academic or traditional models have a greater influence on job satisfaction and quality of life in collegiate athletic trainers? Clinical Bottom Line: Based on the quality of the person-oriented evidence available, the recommendation to adopt the medical model for athletic training staff would receive a Strength of Recommendation Taxonomy (SORT) grade of B.

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Stephanie M. Mazerolle, Rebecca Lopez, Tutita M. Casa and Douglas J. Casa

Edited by Shane Caswell