Scott, Steven

Abstract Objective To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). Methods Information sources : Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. Eligibility criteria : Systematic reviews and meta‐analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. Data : Target diseases, model components used ( n = 11), and six outcomes (disease‐specific, generic health‐related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). Synthesis : Narrative synthesis, including proportion of reviews documenting outcome benefits. Results More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes ( n = 22), depression ( n = 16), heart disease ( n = 12), aging ( n = 11), and kidney disease ( n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease‐specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. Conclusions Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.

We evaluated injury patterns at two wrestling tourna ments involving 1742 participants, aged 6 to 16 years. The overall injury rate was 12.7%. Injuries requiring withdrawal from the tournament occurred in 4.6% of the participants. Of all participants, 3% sustained an injury in their first match, and 1.1 % sustained an injury during their first match that required withdrawal from the tournament. Primary areas of injury were the upper extremity (33%) and the neck and back (24%). Wil coxon rank-sum tests revealed that increasing age and increasing weight were correlated with injury, whereas multiple logistic regression analysis revealed that only increasing age was correlated with injury. These find ings suggest the need for medical supervision at large wrestling tournaments, where it is likely that severe injuries will occur. In addition, older wrestlers and per haps heavier wrestlers are at an increased risk for injury.