The Availability and Delivery of Health Care to High School Athletes in Alabama

In brief: A sports medicine survey of 119 public high schools in Alabama showed that the smaller schools are farther from medical facilities and have less space and equipment for injury management than larger schools. Primary care or family physicians are used most often as team physicians, but the availability of physicians at practice and at sports events other than football is limited. Many schools have no team physician, most lack athletic trainers, and about half of the coaches do not feel prepared to handle a medical emergency. Many of the schools rated the delivery and quality of medical care to their athletes as fair to very poor.     

Primary Care Sports Medicine: A Full-Timer's Perspective

In brief: This article describes the history and structure of the Sports Medicine Center of Akron, Ohio, which was established in 1983 with a family physician as its medical director. The author discusses the direct and indirect patient care services offered and the types of injuries seen at the center. He also outlines the opportunities and potential for primary care physicians who wish to enter the field of sports medicine on a full-time basis, particularly in the capacity of medical director of a center like the one described. Advantages, disadvantages, and pitfalls of such a career change are presented, along with steps to take in preparation for pursuing such an endeavor.     

Diagnosing Kidney Injuries in Athletes

In brief: The University of Wisconsin in Madison has been a forerunner in the field of sports medicine. The initial goals of the program (education, research, and the establishment of a sports medicine clinic) have been reached. For example, residents in pediatrics, family practice, internal medicine, and physical medicine can now elect a rotation in sports medicine. Research activities have resulted in improved treatment and rehabilitation methods that have become the standard for sports and nonsports injuries alike. In addition, the University Hospital Sports Medicine and Fitness Center includes a clinic, a fitness evaluation center, a rehabilitation center, and a fitness center. The current goals of the sports medicine program are to anticipate and meet community needs, offer up-to-date educational programs, and provide optimal medical care for athletes.     

Effective Injury Prevention in Soccer

Abstract

Sports participation is accompanied by risk of injury, and each specific sport has its own unique injury profile. One of the goals of a sports medicine professional is injury prevention, and the past decade has seen numerous reports on the outcomes of injury-prevention studies. Health care professionals have been particularly vigilant in attempting to reduce common injuries in soccer, beginning with work in the early 1980s to the rigorous randomized trials of today. The use of a structured, generalized warm-up program has been shown to be effective in preventing common soccer injuries, reducing overall injury rates by approximately 30%. Given the number of individuals who play soccer worldwide, any injury reductions will likely have an impact on public health. It is an important goal of the sports medicine community to inform physicians and other sports medicine professionals about the effectiveness of prevention programs to increase use and compliance.     

Book review

Because the primary care physician is the cornerstone of the managed care system, opportunities for primary care physicians to practice sports medicine under managed care will likely increase. Access to a vast array of resources and an emphasis on patient education and preventive services has contributed to the success of sports medicine at the Kaiser Permanente Medical Care Program in California. As sports medicine enters the managed care arena, issues of efficient service delivery, cost effectiveness, and interdisciplinary care will require closer scrutiny.     

Predicting Athletic Performance

In brief Athletes and others who ingest purified L-tryptophan as a dietary supplement are at risk of developing eosinophilia-myalgia syndrome (EMS), which may result in serious morbidity and mortality. Commonly characterized by severe myalgias and eosinophilia, EMS is caused by a contaminant formed during the process of purifying L-tryptophan. An epidemic in 1989 resulted in a halt of the sale of purified L-tryptophan in March 1990. Although this curtailed the incidence of EMS, physicians and other sports medicine health care workers should be aware of this syndrome and warn athletes to discard any stocks of purified L-tryptophan.     

New Agent May Help in Soft Tissue Therapy

In brief: Little is known about the motivating factors, training regimens, and injuries in child distance runners, Forty participants (ages 8 to 15) in a 10-km road race completed a questionnaire indicating previous training and race experience. Twenty percent of the runners ran six to seven days per week, and 40% logged more than 15 miles a week. Eighteen percent had experienced an overuse injury. Enjoyment and parental encouragement were common motivating factors. Medical care providers can help promote aerobic exercise and minimize the risks, but the increasing involvement of children in running may have outstripped the knowledge of physicians who practice sports medicine.     

Exerting Yourself

Most sports medicine physicians are affected in some way by the multitude of HMOs and PPOs that have sprung up nationwide. Some have welcomed the patients and the assured payments these organizations bring. Others say these plans have interfered with medical care and have stunted innovation in sports medicine.     

Injury Patterns in Youth Sports

In brief: Millions of US children participate in recreational activities, organized youth leagues, and interscholastic sports programs. Although they enjoy and obtain health benefits from these activities, 3% to 11% of these children are injured while participating in sports programs each year. Epidemiologic studies show that different sports pose different types and degrees of risk and that injuries among children differ from those among adolescents. An awareness of injury patterns in youth sports helps physicians and others who care for children to identify variables associated with injury. Measures must be taken in all youth sports programs to modify such variables in an effort to prevent injuries.     

sportspages

In Brief

Proper understanding of coding, billing, and other practice economics issues in sports medicine is vital for practice success. Lack of accuracy and understanding in these areas may lead to problems that range from lost income to practice audits and potentially steep fines. A basic understanding of current procedural terminology (CPT), awareness of International classification of diseases (ICD-9) and healthcare common procedure coding system (HCPCS) codes, and the knowledge of how to apply them benefit sports medicine physicians.     

Subsartorial Entrapment of the Saphenous Nerve of a Competitive

Physicians are being forced to compete for their share of a changing health care market. Two traditional concerns of sports medicine—fitness and preventive care—may help some physicians keep their practice healthy.     

Sports Medicine Directory 1983

Recent research on the causes of hypertension could influence the care given by sports medicine physicians to black patients in general, and to black athletes in particular.     

Hands-On Sports Medicine Training for Residents

In brief: Primary care sports medicine is a rapidly growing field of interest; however, there are relatively few training programs in this field. The author describes the development of a one-month training program at the University of California, Davis, Medical Center. The education strategies used in the program include clinical teaching (50%), on-the- field education (20%), experiential learning (20%), and didactic instruction (10%). The most innovative part of the program is the experiential learning component, through which students learn basic sports medicine skills by actively participating in sports, exercises, strength training, and a fitness program.     

The careers of primary care sports medicine physicians in the United States: a survey study.

OBJECTIVE: This study examined the scope of practice, career satisfaction, and self-perceived skills of primary care sports medicine (PCSM) family physicians. DESIGN: A cross-sectional analysis of data, using self-reported survey results. SETTING: N/A. PARTICIPANTS: PCSM family physicians who completed fellowship training after 1998 and who had passed the Certificate of Added Qualification examination. INTERVENTION: A survey instrument that contained questions about demographics, scope of practice, and career satisfaction was mailed to the study participants. Analyses consisted of chi-square and t tests to explore relationships between prespecified variables of interest. MAIN OUTCOMES: N/A. RESULTS: There was a 71% response rate. The study group was 84% male, with a median age of 37. More than 90% reported that they were satisfied with their careers and felt they were less likely than their generalist counterparts to refer musculoskeletal problems to orthopedists. CONCLUSIONS: Our results indicate that the vast majority of PCSM fellowship-trained family physicians are satisfied with their careers, seem to fill a consultant role, and have maintained their generalist skills. PCSM physicians who see mostly patients with musculoskeletal complaints seem less confident than their peers that they have maintained their general medical skills, but they are more likely to have a higher salary. As PCSM evolves during the next decade, the role of PCSM physicians will be further defined.     

AIDS and Athletes

In brief: AIDS is the most significant public health problem of our generation and has implications for athletes and their health care professionals. A growing body of scientific data supports the position that most individuals infected with the human immunodeficiency virus (HIV) can and should remain physically active and may participate in most sports. Current public health guidelines regarding transmission of HIV also apply to the training room and to organized sports. In addition, physicians and athletic trainers who disseminate the facts about AIDS and HIV are invaluable assets in the worldwide effort to eradicate AIDS.     

HMOs: Directing the Future of Sports Medicine?

Health maintenance organizations may be the best thing to happen to sports medicine since the fitness boom. Or they may hinder patient care and frustrate physicians. It depends on who is asked.     

Dodging the Malpractice Bullet

Guarding against malpractice may seem a matter of common sense and good basic care. Nevertheless, sports medicine physicians who review the obvious areas of exposure may prevent the frivolous and not-so-frivolous lawsuits.     

A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?

OBJECTIVE: To evaluate the interobserver agreement between physicians regarding a abnormal cardiovascular assessment on athletic preparticipation examinations. DESIGN: Cross-sectional clinical survey. SETTING: Outpatient Clinic, United States Military Academy, West Point, NY. PARTICIPANTS: We randomly selected 101 out of 539 cadet-athletes presenting for a preparticipation examination. Two primary care sports medicine fellows and a cardiologist examined the cadets. INTERVENTIONS: After obtaining informed consent from all participants, all 3 physicians separately evaluated all 101 cadets. The physicians recorded their clinical findings and whether they thought further cardiovascular evaluation (echocardiography) was indicated. MAIN OUTCOME MEASURES: Rate of referral for further cardiovascular evaluation, clinical agreement between sports medicine fellows, and clinical agreement between sports medicine fellows and the cardiologist. RESULTS: Each fellow referred 6 of the 101 evaluated cadets (5.9%). The cardiologist referred none. Although each fellow referred 6 cadets, only 1 cadet was referred by both. The kappa statistic for clinical agreement between fellows is 0.114 (95% CI, -0.182 to 0.411). There was no clinical agreement between the fellows and the cardiologist. CONCLUSIONS: This pilot study reveals a low level of agreement between physicians regarding which athletes with an abnormal examination deserved further testing. It challenges the standard of care and questions whether there is a need for improved technologies or improved training in cardiovascular clinical assessment.     

Primary Care Provider Awareness of IR: A Single-Center Analysis

PurposeTo evaluate primary care provider awareness of interventional radiology (IR) services at a tertiary care academic medical center to identify areas of IR practice that require additional education and awareness initiatives.Material and MethodsAn internet-based survey was distributed via email to primary care providers, including internal medicine (IM), family medicine (FM), obstetrics and gynecology (OBGYN), and hospital medicine (HM) physicians in the region. The survey consisted of 17 questions regarding provider demographics, experiences with IR in their practice, awareness of IR training, and awareness of IR procedures and services.ResultsA total of 234 of 533 invited physicians completed the survey (40% IM, 22% FM, 22% HM, and 16% OBGYN). Providers rated their knowledge of IR as poor (49, 20.3%), adequate (137, 56.9%), good (49, 20.3%), and excellent (6, 2.5%). Although 235 (97.5%) had consulted IR previously, only 141 (58.5%) had referred a patient directly to IR for an elective procedure. IR was offered as an alternative to surgical procedures never (42, 17.6%), a quarter of the time (101, 42.3%), half of the time (61, 25.5%), three-quarters of the time (27, 11.3%), and every time (8, 3.35%). Most respondents (161, 67.4%) learned the most about IR procedures during residency. Most (180, 75.3%) indicated that they would like to learn more about IR.ConclusionsThese findings indicate that more can be done to educate providers about the potential role of IR in patient care. Provider awareness is limited regarding procedures that are increasingly popular in the IR community. This study helps to identify specific areas of IR in which awareness of can be increased.     

Gambling as an addictive disorder among athletes: clinical issues in sports medicine

This article examines the role of gambling as an addictive disorder experienced by athletes, both college and professional. Gambling may often be seen as a comorbid factor with other addictions and with depression among athletes. The focus on addictions among athletes has gained considerable attention among sports medicine clinicians. Diagnostic indicators, risk and protective factors, and a stage model of addiction among athletes are addressed. An algorithm and pathway of care for athletes with an addictive disorder is offered as are recommendations that sports physicians, sports medicine specialists, coaches and counsellors need to address athletes who have an addictive disorder.