Tackle Situation Research Articles

Patient safety: a flipped classroom curriculum for family medicine residents.

Addressing patient safety incidents is a complicated and challenging issue for physicians. At present, there is little training in residency programs to help prepare learners to tackle situations where harm arises as a result of healthcare delivery. In response to new accreditation mandates, we piloted a flipped classroom patient safety curriculum to help train family medicine residents to identify and address patient safety incidents in practice. Family medicine programs could consider similar case-based training for their learners to help prepare them to respond to these events and address contributory factors.

Risk Factors for Concussion in Under 18, Under 22 and Professional Men's Rugby Union: A Video Analysis of 14,809 Tackles

ObjectiveThis study aimed to identify the risk factors for tackle-related concussion observed in matches involving under (U) 18, U 22 and professional men’s Rugby Union players through video analysis.Study DesignDescriptive epidemiology study.MethodsTwenty Rugby Union matches each for high school (U18), university/college (U22) and professional (Elite) were randomly selected from 202 matches in the 2018/2019 season. Both one-on-one and tackles involving multiple tacklers were analyzed for the 60 matches. The 28 categorical and continuous variables (e.g., tackle characteristics and duration before the tackle) were applied as risk factors to a least absolute shrinkage and selection operator (Lasso) regression analysis. To identify high-risk situations, a simulation model with coefficients obtained from the Lasso regression was used. Statistical analysis was conducted according to tackle direction.ResultsA total of 14,809 tackles and 41 concussions involving 1800 players were included in the analyses. The incidence rate of concussions (injuries/1000 tackles) was greater in Elite players (4.0) compared with U18 (1.9) and U22 (2.4) players. The factors most highly associated with concussions were head-in-front tackles (where the tackler’s head is placed forward, impeding a ball carrier’s forward movements, 11.26/1000 tackles), and were more often observed among U18 players. A simulation model predicted that the highest risk tackle situation in Elite players was a head-in-front, side-on tackle below the hip of the ball carrier (predicted incidence rate 18.07/1000 tackles).ConclusionThe risk factors associated with concussion need to be assessed cautiously. Avoiding head-in-front, side-on tackles to the lower extremities of a ball carrier should be considered to reduce injury risks.

Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

IntroductionRenal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach.Case presentationThis is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment.ConclusionThis case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients’ autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

What Cognitive Mechanism, When, Where, and Why? Exploring the Decision Making of University and Professional Rugby Union Players During Competitive Matches.

Over the past 50 years decision making research in team invasion sport has been dominated by three research perspectives, information processing, ecological dynamics, and naturalistic decision making. Recently, attempts have been made to integrate perspectives, as conceptual similarities demonstrate the decision making process as an interaction between a players perception of game information and the individual and collective capability to act on it. Despite this, no common ground has been found regarding what connects perception and action during performance. The differences between perspectives rest on the role of stored mental representations, that may, or may not facilitate the retrieval of appropriate responses in time pressured competitive environments. Additionally, in team invasion sports like rugby union, the time available to players to perceive, access memory and act, alters rapidly between specific game situations. Therefore, the aim of this study was to examine theoretical differences and the mechanisms that underpin them, through the vehicle of rugby union. Sixteen semi-elite rugby union players took part in two post-game procedures to explore the following research objectives; (i) to consider how game situations influence players perception of information; (ii) to consider how game situations influence the application of cognitive mechanisms whilst making decisions; and (iii) to identify the influence of tactics and/or strategy on player decision making. Deductive content analysis and elementary units of meaning derived from self-confrontation elicitation interviews indicate that specific game situations such as; the lineout, scrum or open phases of play or the tackle situation in attack or defence all provide players with varying complexity of perceptual information, formed through game information and time available to make decisions. As time increased, players were more likely to engage with task-specific declarative knowledge-of the game, stored as mental representations. As time diminished, players tended to diagnose and update their knowledge-in the game in a rapid fashion. Occasionally, when players described having no time, they verbalised reacting on instinct through a direct connection between perception and action. From these findings, clear practical implications and directions for future research and dissemination are discussed.

Incidence and Factors Associated With Concussion Injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments.

To determine the concussion incidence and to identify factors associated with concussion in South African youth rugby union players. Prospective cohort study. Injury surveillance was completed at the South African Rugby Union Youth Week tournaments (under-13, under-16, and under-18 age groups). South African youth rugby union players. A total of 7216 players participated in 531 matches between 2011 and 2014. None. Concussion incidence was calculated per 1000 player-match-hours with 95% CIs. Poisson regression was used to calculate the incidence rate ratio (IRR) between factors (age, time period, playing position, and activity at the time of concussion) potentially associated with concussions. The concussion incidence was 6.8/1000 player-match-hours (95% CI, 5.5-8.1) across all age groups. Under-13s (IRR, 1.5; P = 0.09) and under-16s (IRR, 1.7; P = 0.03) had higher concussion incidence rates than the under-18 age group. The incidence was higher in the third (IRR, 2.1; P = 0.04) and fourth (IRR, 2.5; P = 0.01) quarters of matches compared with the first quarter. Sixty-two percent of concussions occurred in the tackle situation. The tackler had a 4-fold greater concussion rate (IRR, 4.3; P < 0.001) compared with the ball carrier. The hooker and loose forwards had higher incidence rates than several other player positions (P < 0.05). The reported concussion incidence falls within the broad range previously reported in youth rugby. The evidence highlighted in this study may contribute to targeted concussion prevention strategies and provide a baseline against which the effectiveness of future interventions can be measured.

RISUS study: Rugby Injury Surveillance in Ulster Schools

ObjectiveTo examine injury patterns in adolescent rugby players and determine factors associated with injury risk.DesignProspective injury surveillance study.SettingN=28 Grammar Schools in Ulster, Ireland (2014–2015 playing season).Participants825 adolescent rugby players, across...

Tackle-injury epidemiology in &lt;i&gt;koshuis&lt;/i&gt; rugby players at Stellenbosch University

Background. The tackle is an important component of rugby union. The tackle situation carries the highest risk for injury for both the ball carrier and tackler. Little is known about the epidemiology of tackle injuries in koshuis rugby players.Objectives. To (i) calculate the tackle-related injury rate, (ii) determine if the tackler or ball carrier is more susceptible to injury, and (iii) determine the most common location and type of injury during tackles.Methods. Data were collected by means of injury report forms from the medical centre during koshuis matches of 2012 and 2013. All data collected were captured into an online database. Only data related to tackle injuries were evaluated for this retrospective, descriptive epidemiological study.Results. The tackle led to 61% of all injuries (11.4 injuries/1 000 playing hours). The tackler sustained 23% more injuries than the ball carrier. Injuries to the face (3.1 injuries/1 000 playing hours, 95% confidence interval (CI) 2.8 - 3.3) were most prevalent. The most common type of injury was lacerations (3.4 injuries/1 000 playing hours, 95% CI 3.2 - 3.7).Conclusion. The tackle contributed to 61% of all injuries, making it the most dangerous phase of play. The tackler is more at risk than the ball carrier, especially for injuries to the face, with lacerations having the highest prevalence. For the ball carrier the location of the most injuries was the head, although joint sprains were the most common type of injury for the ball carrier.

Tackle-related injury rates and nature of injuries in South African Youth Week tournament rugby union players (under-13 to under-18): an observational cohort study

ObjectivesThe tackle situation is most often associated with the high injury rates in rugby union. Tackle injury epidemiology in rugby union has previously been focused on senior cohorts but less...

THEORETICAL MODEL FOR THE RELATIONSHIP BETWEEN THE NUMBER OF TACKLES A PLAYER ENGAGES IN, TACKLE INJURY RISK AND PERFORMANCE IN RUGBY UNION

BackgroundThe tackle in rugby union is a physical contest between opposing players contending for territory and ball possession. During an 80-minute rugby match, a player will physically engage in the...

Severe Domestic Squalorby SnowdonJohn, HallidayGraeme, and BenerjeeSube. United Kingdom, Cambridge University Press, 2012, 223 pp., $85.00.

Severe Domestic Squalorby SnowdonJohn, HallidayGraeme, and BenerjeeSube. United Kingdom, Cambridge University Press, 2012, 223 pp., $85.00.

Characteristics of an ‘effective’ tackle outcome in Six Nations rugby

Rugby is a full contact sport that frequently comprises of tackle situations between two or more players. At present there is no research available that has quantified the defining elements that lead to ‘effective’ tackle outcomes in matches or whether they factor in the success or failure of teams. The purpose of this study was to understand the actions of the tackler during contact with the ball-carrier and relate them to the ‘effectiveness’ of the tackle outcome, during rugby match play. Matches (n=15) from the 2007 Six Nations Tournament were analysed. ‘Effective’ tackling was assessed with regards to the territorial change of the ball-carrier from the point of contact with the tackler to completion of the tackle, and characterised in terms of the tackler's body position, the angle at which the tackler approached the tackle and the outcome. The ‘less effective’ tackle is 34% more prevalent (P<0.001) than the ‘effective’ tackle during match play. Winning teams were involved in fewer tackle situations and made 3% more ‘effective’ tackles and 4% fewer ‘less effective’ tackles than losing teams. ‘Effective’ tackle outcomes were found to have a greater percentage of the player's torso leaning forward and oblique angle approaches to the ball-carrier. The difference in the frequency of upright and back foot characteristics differentiated winning from losing teams. This was the first study to describe the characteristics of an ‘effective’ tackle outcome and serves as a basis from which further research can be done on the tackle situation.

Foul or dive? Motor contributions to judging ambiguous foul situations in football

Football (soccer) referees frequently face situations in which they have to distinguish dives and fouls. Yet, little is known about the contributing factors that characterise the ability to judge these ambiguous situations correctly. To this end, in the current article we tested the hypothesis that motor experience of observers contributes to the visual identification of deceptive actions. Thereto, we asked skilled football referees, skilled football players, wheelchair bounded football fans (thus with limited motor experience) and novices to judge whether potential tackle situations in football were either fouls or dives. Results revealed that the referees (accuracy 72.2%, s=6.2) and players (accuracy 72.0%, s=6.4) were better at discriminating fouls and dives than the fans (accuracy 61.1%, s=7.2) and the novices (accuracy 57.4%, s=7.0) (P < 0.001). The results seem to point to an added value of motor experience in detecting deceptive movements.

Epidemiology of Adolescent Rugby Injuries: A Systematic Review

Despite recent increases in the volume of research in professional rugby union, there is little consensus on the epidemiology of injury in adolescent players. We undertook a systematic review to determine the incidence, severity, and nature of injury in adolescent rugby union players. In April 2009, we performed a computerized literature search on PubMed, Embase, and Cochrane Controlled Trials Register (via Ovid). Population-specific and patient-specific search terms were combined in the form of MEDLINE subject headings and key words (wound$ and injur$, rugby, adolescent$). These were supplemented with related-citation searches on PubMed and bibliographic tracking of primary and review articles. Prospective epidemiologic studies in adolescent rugby union players. A total of 15 studies were included, and the data were analyzed descriptively. Two independent reviewers extracted key study characteristics regarding the incidence, severity, and nature of injuries and the methodologic design. Wide variations existed in the injury definitions and data collection procedures. The incidence of injury necessitating medical attention varied with the definition, from 27.5 to 129.8 injuries per 1000 match hours. The incidence of time-loss injury (>7 days) ranged from 0.96 to 1.6 per 1000 playing hours and from 11.4/1000 match hours (>1 day) to 12-22/1000 match hours (missed games). The highest incidence of concussion was 3.3/1000 playing hours. No catastrophic injuries were reported. The head and neck, upper limb, and lower limb were all common sites of injury, and trends were noted toward greater time loss due to upper limb fractures or dislocations and knee ligament injuries. Increasing age, the early part of the playing season, and the tackle situation were most closely associated with injury. Future injury-surveillance studies in rugby union must follow consensus guidelines to facilitate interstudy comparisons and provide further clarification as to where injury-prevention strategies should be focused.

Rugby Union Contact Skills Alter Evasive Agility Performance during Attacking Ball Carries

Rugby union is a collision sport where evasive agility running patterns and the tackle contest determine the effectiveness of attacking ball carries. This study used three-dimensional kinematic analysis to examine the running technique of eight highly trained rugby union players during three rugby based reactive (in response to a defender positioned at the side-step) agility conditions (non-contact, contact and fend). The fend condition involved pushing a defender away with the upper body during the side-step and both fend and contact conditions required impact with an additional defender at the straighten-step, simulating a rugby tackle. Results demonstrated that a reduction in the relative height of the centre of mass relative to standing height (%CM) occurred at the straighten-step during the contact condition (47.2 ±1.9 %CM) compared to the non-contact condition (49.1 ±1.8 %CM, p &lt;.001). The fend condition was then shown to increase %CM at the straighten-step (48.4 ±2.7 %CM) when compared to the contact condition (47.2 ±1.9 %CM, p = .017). However this difference was not observed at tackle impact during the straighten-step, with similar %CM values for fend (45.1 ±3.4 %CM) and contact conditions (44.6 ±2.6 %CM, p = .205). Further analysis showed that the number of steps displayed between the side-step and straighten-step ( transition phase) altered the %CM, with one step during the transition phase increasing %CM (49.3 ±1.5 %CM) compared to two transition phase steps (46.9 ±1.6 %CM, p &lt; .001) and no transition phase steps (46.5 ±1.6 %CM, p &lt; .001). The changes to running technique during agility conditions involving tackle situations highlight the need for running programs in rugby union to meet the specific requirements of match-play activities.

How Embodied Cognitions Affect Judgments: Height-Related Attribution Bias in Football Foul Calls

Many fouls committed in football (called soccer in some countries) are ambiguous, and there is no objective way of determining who is the "true" perpetrator or the "true" victim. Consequently, fans as well as referees often rely on a variety of decision cues when judging such foul situations. Based on embodiment research, which links perceptions of height to concepts of strength, power, and aggression, we argue that height is going to be one of the decision cues used. As a result, people are more likely to attribute a foul in an ambiguous tackle situation to the taller of two players. We find consistent support for our hypothesis, not only in field data spanning the last seven UEFA Champions League and German Bundesliga seasons, as well as the last three FIFA World Cups, but also in two experimental studies. The resulting dilemma for refereeing in practice is discussed.

A comparison of performance indicators between the four South African teams and the winners of the 2005 Super 12 Rugby competition. What separates top from bottom?

The South African regional teams participating in the Super 12 rugby union competition seem to under-perform compared to the performance of the national team in the Tri-Nations competition against similar Australasian opposition. The aim of this study was to compare various performance parameters between the four South African Super 12 teams (Bulls, 3rd position; Stormers, 9th position; Cats, 11th position; and Sharks, 12th position) and the eventual winners, the Crusaders from New Zealand. Nine games from the 2005 Super 12 season were analysed. These nine games included the four South African teams playing against the Crusaders and against each other (one game, Stormers v Sharks, was lost due to technical problems). All game analyses were performed after the tournament using a digital analysis software program (Sportscode Elite version 5.4.24, Sportstec, Australia). Ball possession, tries scored and various performance indicators associated with successful ball retention and attacking effectiveness in the tackle situation (as obtained through a panel of elite coaches and analysts) were quantified.There were no statistically significant differences between the teams for the total amount of ball possession per match (Crusaders 1057±216s, Bulls 1048±158s, Cats 852±73s, Sharks 1078±84s and Stormers 984±186s) or time of each movement involving ball possession (Crusaders 15.2±3.0s, Bulls 15.5±1.9s, Cats 13.0±1.0s, Sharks 16.9±2.3s and Stormers 15.0±3.8s). There were no significant differences between the number of tries scored (Crusaders 6±4, Bulls 4±3, Cats 3±1, Sharks 3±2 and Stormers 2±1 tries), number of offloads (Crusaders 19±12, Bulls 12±4, Cats 13±5, Sharks 15±4 and Stormers 17±5 offloads), turnovers won (Crusaders 3±3, Bulls 4±2, Cats 5±1, Sharks 2±1 and Stormers 5±1 turnovers) or conceded (Crusaders 4±1, Bulls 3±2, Cats 4±2, Sharks 5±1 and Stormers 6±2 turnovers). There were no statistically significant differences between the number of times the different teams committed 0, 1, 2 or 3 support players when they were tackled. There were also no statistical differences in the number of times the various teams committed 0, 1, 2 and 3 support players to counter-ruck once they had made a tackle.Due to the relatively small sample size, there is a risk of making a type II error (i.e. missing significant differences) between the variables analysed. However when these data are inspected using a visually striking box and whisker plot, there are noticeable differences between the styles of play of the teams. Future studies should investigate whether this form of data analysis is valid, particularly when having to give feedback to coaches of elite teams, involving analyses in which the sample size may always lack statistical power.

An Assessment of Football Referees’ Decisions in Incidents Leading to Player Injuries

Purpose To assess whether match injuries to footballers occurred as a result of players’ noncompliance with the rules of the game, match referees could reliably identify the legality of incidents leading to injury, and the rules of football were adequate to protect players from injury. Methods Video recordings of incidents leading to injury in 12 FIFA tournaments were used to identify parameters. Team physicians reported the details of match injuries. Two panels of FIFA referees reassessed the legality of incidents from these tournaments that resulted in injuries. Results In total, 148 general injuries and 84 head/neck injuries were assessed. For the general injuries, the match referees identified 47% and the referees’ panel identified 69% as fouls. For head injuries, the match referees identified 40% and the referees’ panel identified 49% as fouls. Conclusions Decisions made on the legality of tackles leading to injury indicated that the current rules of football were adequate for the majority of tackle situations, although the reliability with which referees could identify fouls during some match conditions was low. For incidents leading to head/neck injuries, the match referees and the referees’ panel both identified a smaller proportion of injury situations as fouls.

Rugby union injuries to the cervical spine and spinal cord.

Injuries to the cervical spine are among the most serious injuries occurring as a result of participation in rugby. Outcomes of such injuries range from complete recovery to death, depending on the degree of spinal cord damage sustained. Much information has been gained regarding the mechanisms and frequency of such injuries, from case reports and case series studies. The most commonly reported mechanism of injury has been hyperflexion of the cervical spine, resulting in fracture dislocation of C4-C5 or C5-C6. Tracking both the trends of incidence of spinal injuries, and the effectiveness of injury prevention initiatives has proved difficult because of a lack of properly conducted epidemiological studies. Within the constraints of the research published to date, it appears that hookers and props have been at disproportionate risk of cervical spine injury, predominantly because of injuries sustained during scrummaging. While the scrum was the phase of play most commonly associated with spinal injuries throughout the 1980s in most rugby playing countries, there has been a trend through the 1990s of an increasing proportion of spinal injuries occurring in the tackle situation. The majority of injuries have occurred early in the season, when grounds tend to be harder, and players are lacking both practice and physical conditioning for the physical contact phases of the sport. A number of injury prevention measures have been launched, including changes to the laws of the game regarding scrummaging, and education programmes aimed at enforcing safe techniques and eliminating illegal play. Calls for case-registers and effective epidemiological studies have been made by researchers and physicians in most countries where rugby is widespread, but it appears to be only recently that definite steps have been made towards this goal. Well-designed epidemiological studies will be able to provide more accurate information about potential risk factors for injury such as age, grade, position, gender and ethnicity. Research into the long-term effects of participation in rugby on the integrity of the spinal column is warranted.