Team physician consensus statement

The objective of the Team Physician Consensus Statement is to provide physicians, school administrators, team owners, the general public, and individuals who are responsible for making decisions regarding the medical care of athletes and teams with guidelines for choosing a qualified team physician and an outline of the duties expected of a team physician. Ultimately, by educating decision makers about the need for a qualified team physician, the goal is to ensure that athletes and teams are provided the very best medical care. The Consensus Statement was developed by the collaboration of six major professional associations concerned about clinical sports medicine issues: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. These organizations have committed to forming an ongoing project-based alliance to "bring together sports medicine organizations to best serve active people and athletes."     

Sideline preparedness for the team physician: consensus statement

The objective of the Sideline Preparedness Statement is to provide physicians who are responsible for making decisions regarding the medical care of athletes with guidelines for identifying and planning for medical care and services at the site of practice or competition. It is not intended as a standard of care and should not be interpreted as such. The Sideline Preparedness Statement is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care professional. Individual treatment will turn on the specific facts and circumstances presented to the physician at the event. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. The Sideline Preparedness Statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.     

The role of the chief ethics officer in a physician's office

The unique role of the chief ethics officer in a sports medicine office is described and guided by the four principles of ethics, as well as the principles and codes of ethics of the American Medical Association, the International Sports Medicine Federation, and the American Academy of Orthopaedic Surgeons. The chief ethics officer should understand and be conversant with these principles and these codes of medical ethics, and transmit this information in order to further patient goals, physician goals, and employee goals.     

Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.     

EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2

These guidelines summarize the current views of the European Association of Nuclear Medicine Neuroimaging Committee (ENC). The purpose of the guidelines is to assist nuclear medicine practitioners when making recommendations, performing, interpreting, and reporting the results of brain perfusion single photon emission computed tomography (SPECT) studies using ^99mTc-labelled radiopharmaceuticals. The aim is to achieve a high quality standard for brain perfusion SPECT imaging, which will increase the diagnostic impact of this technique in clinical practice. The present document replaces a former version of the guideline published in 2001 which was inspired by the Society of Nuclear Medicine Procedure Guideline for Brain Perfusion SPECT [1], the views of the Society of Nuclear Medicine Brain Imaging Council [2], and the individual experience of experts in European countries. The guidelines are intended to present information specifically adapted to European practice. The information provided should be taken in the context of local conditions and regulations.     

美国退伍军人医院前列腺癌粒子植入医疗不良事件介绍

放射性粒子植入作为早期前列腺癌的标准治疗手段,在美国已广泛开展。美国近距离治疗协会及美国医学物理学家协会有明确的指南来加以规范,但是仍有部分医院不能按照指南要求植入粒子,导致部分患者出现严重并发症。本文调研了美国放射性粒子植入相关医疗事件,对美国2002年以来发生的粒子植入医疗事件进行了梳理,分析其发生的原因,提出相应的解决方案,为我国粒子植入从业人员提供参考,以防类似事件发生,保障粒子植入术的健康发展。     

2018 International Olympic Committee consensus statement on prevention,diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.     

Compendium of fractionation choices for gynecologic HDR brachytherapy—An American Brachytherapy Society Task Group Report

PurposeThe purpose of this study was to report a list of accepted fractionation schemes for high-dose-rate (HDR) brachytherapy for gynecological cancers in a definitive, neoadjuvant, or adjuvant setting.Methods and MaterialsMembers of the American Brachytherapy Society (ABS) Task Force with expertise in gynecological brachytherapy reviewed the literature and existing ABS guidelines regarding various dose-fractionation schedules for HDR brachytherapy to create this compendium. Other resources include current guidelines published by medical societies, clinical trials, the published medical literature, and the clinical experience of the ABS Task Force members. The ABS consensus statements for HDR brachytherapy practice were reviewed for these fractionation schemes and form the major source for this report. Specific recommendations for therapy and recommendations for further investigations were made when there was agreement.ResultsA variety of dose-fractionation schedules for HDR brachytherapy alone or integrating brachytherapy with external-beam radiation exist. The choice of a given fractionation schedule may be appropriate depending on the practice situation for the patient and the resources available. While there is no single optimal dose-fractionation scheme for any disease site or clinical situation, higher doses per fraction with fewer fractions per regimen have been known to increase toxicity. The corresponding 2-Gray (Gy) per fraction radiobiologic equivalent doses have been provided (normalized therapy dose) to compare the various regimens where indicated and can be used to estimate isoeffective schedules.ConclusionsThis compendium of HDR brachytherapy fractionation schedules provides various options to the gynecologic brachytherapist and a ready reference for clinical use in the management of gynecological cancer treatments.     

Automated external defibrillators in health and fitness facilities

Background: Exercise is encouraged to promote health, but it can be a trigger for sudden cardiac arrest (SCA) in individuals with underlying cardiovascular disease. In 2002, the American Heart Association and the American College of Sports Medicine issued recommendations for the presence of automated external defibrillators (AEDs) in health and fitness facilities. Objective: To assess emergency response planning for SCA and review the prevalence and past utilization of AEDs in health and fitness facilities in King County, WA. Methods: A cross-sectional survey was conducted in 2008 of health and fitness facilities (N = 136) in King County, WA, assessing the 2002 American Heart Association guidelines on AEDs and emergency response planning for SCA. Results: Sixty-three (46%) of 136 facilities completed the survey. Thirty-five percent of the total facilities had < 500 members, 21% had 500 to 1500 members, 16% had 1501 to 2500 members, and 29% had > 2500 members. Sixty-eight percent had an established emergency response plan for SCA. Only 40% of facilities had ≥ 1 AED on site (mean, 1.7; range, 0-6). Fitness centers with > 1500 members (71%) were more likely to have an AED on site compared with those with < 1500 members (14%) (P < 0.0001). Of the staff trained in cardiopulmonary resuscitation, 83% were fitness instructors, 73% were administrators, and 58% were front desk personnel. Four facilities reported an incident of SCA within the 12 months prior to completing the survey, which was a 6.4% incidence of SCA in responding facilities. All SCA cases occurred in facilities with > 1500 members. Only 2 of the 4 facilities with an SCA had an on-site AED. The individuals who had SCA were all men aged 50 to 65 years, with 2 men successfully resuscitated at the facility. Conclusion: There is a substantial gap in guideline implementation between national recommendations and current emergency response planning for SCA in health and fitness facilities. Health and fitness facilities are strategic locations to place AEDs in an effort to improve outcomes from exercise-related SCA. Facilities with general memberships of > 1500 are encouraged to have on-site AEDs, given the high incidence of SCA.     

Publication rates of abstracts presented at Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

A study was carried out to determine the fate of abstracts presented at the Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine. All abstracts presented at the 1997 and 1999 Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine were entered into a database. A Medline search was performed in November 2003 for each abstract to determine whether a full publication resulted from the abstract. The rate of publication and the journals in which they were published were determined. The overall rate of publication from the 1997 and 1999 meetings were 34.6 and 39.3%, respectively. The most common journals for subsequent publication were Arthroscopy: The Journal of Arthroscopic and Related Surgery, American Journal of Sports Medicine, and Knee Surgery, Sports Traumatology, Arthroscopy. Research presented in abstract form at scientific meetings provides an early look at ongoing research projects. These abstracts are not subjected to the full peer-review process required of publications in journals. Many of the abstracts presented at the Biennial Meetings of the International Society of Arthroscopy, Knee Surgery and Sports Medicine did not result in a full journal publication. While it is not possible to determine the reason for abstracts failing to lead to journal publications, it is possible that some of these projects did not meet the scientific scrutiny of the peer-review process required for full publication.     

解读美国甲状腺协会和临床内分泌医师协会2011年甲亢诊治指南

最近,美国甲状腺协会和临床内分泌医师协会联合发表了甲亢诊治指南,总共提出了100项指南性的参考建议.该指南系统介绍了甲亢的诊断和治疗,重点强调了131I治疗、抗甲状腺药物治疗和手术治疗的适应证、禁忌证、治疗准备、治疗方法和随诊策略,并详细介绍了儿童甲亢、妊娠期甲亢、甲亢突眼和一些少见甲亢的诊治原则.     

Heat injury prevention practices in high school football.

OBJECTIVE: To survey high school American football programs regarding current prevention measures for reducing heat injuries during the football season. DESIGN: Web-based survey of 27 questions based on consensus statement guidelines by the American College of Sports Medicine on reducing heat injury risk in youth football. SETTING: National (United States) and community-based. PARTICIPANTS: High school programs receiving survey distribution from their state athletic association and the National Federation of State High School Associations. MAIN OUTCOME MEASURES: Responses (percentage and incidence) to questions on preseason acclimatization procedures, practice modification protocols, preparticipation risk factors, hydration management strategies, rest period strategies, heat injury education and policies, and preparation for heat-related emergency care. RESULTS: A total of 540 high school football programs from 26 states completed the survey. The reported number of preseason heat injuries per program (1.38+/-2.08) was greater (P<0.001) compared to during the regular season (0.98+/-1.84). Programs modified equipment configurations during preseason (no helmets or pads, 31.3%; just helmets, 57.0%; helmets and shoulder pads only, 33.5%) or altered the practice schedule when there was excessive heat. Hydration management, education, and preparation for dealing with an acute heat injury varied among programs. CONCLUSIONS: Greater implementation of effective prevention measures to reduce the incidence of heat-related injury and death in high school American football is needed. Strategies should focus on modifying practices appropriately on a day-to-day basis to minimize heat strain and optimize hydration, identifying and educating at-risk individuals during the preparticipation period, and developing an emergency action plan for effectively managing heat injuries.     

American College of Sports Medicine position stand: prevention of cold injuries during exercise

It is the position of the American College of Sports Medicine that exercise can be performed safely in most cold-weather environments without incurring cold-weather injuries. The key to prevention is use of a comprehensive risk management strategy that: a) identifies/assesses the cold hazard; b) identifies/assesses contributing factors for cold-weather injuries; c) develops controls to mitigate cold stress/strain; d) implements controls into formal plans; and e) utilizes administrative oversight to ensure controls are enforced or modified. The American College of Sports Medicine recommends that: 1) coaches/athletes/medical personnel know the signs/symptoms and risk factors for hypothermia, frostbite, and non-freezing cold injuries, identify individuals susceptible to cold injuries, and have the latest up-to-date information about current and future weather conditions before conducting training sessions or competitions; 2) cold-weather clothing be chosen based on each individual's requirements and that standardized clothing ensembles not be mandated for entire groups; 3) the wind-chill temperature index be used to estimate the relative risk of frostbite and that heightened surveillance of exercisers be used at wind-chill temperatures below -27 degrees C (-18 degrees F); and 4) individuals with asthma and cardiovascular disease can exercise in cold environments, but should be monitored closely.     

Interventional Radiology Clinical Practice Guideline Recommendations for Neurovascular Disorders Are Not Based on High-Quality Systematic Reviews

BACKGROUND:In recent years, clinical practice guidelines have been criticized for biased interpretations of research evidence, and interventional radiology is no exception.PURPOSE:Our aim was to evaluate the methodologic quality and transparency of reporting in systematic reviews used as evidence in interventional radiology clinical practice guidelines for neurovascular disorders from the Society of Interventional Radiology.DATA SOURCES:Our sources were 9 neurovascular disorder clinical practice guidelines from the Society of Interventional Radiology.STUDY SELECTION:We selected 65 systematic reviews and meta-analyses.DATA ANALYSIS:A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) tools were used to assess the methodologic quality and reporting transparency of systematic reviews. Radial plots were created on the basis of average scores for PRISMA and AMSTAR items.DATA SYNTHESIS:On the basis of AMSTAR scores, 3 (4.62%) reviews were high-quality, 28 reviews (43.08%) were moderate-quality, and 34 reviews (52.31%) were low-quality, with an average quality score of 3.66 (34.32%; minimum, 0%; maximum, 81.82%). The average PRISMA score was 18.18 (69.41%).LIMITATIONS:We were unable to obtain previous versions for 8 reviews, 7 of which were from the Cochrane Database of Systematic Reviews.CONCLUSIONS:The methodologic quality of systematic reviews needs to be improved. Although reporting clarity was much better than the methodologic quality, it still has room for improvement. The methodologic quality and transparency of reporting did not vary much among clinical practice guidelines. This study can also be applied to other medical specialties to examine the quality of studies used as evidence in their own clinical practice guidelines.

Clinical practice guidelines (CPGs) are used by clinicians to provide patients the most appropriate care. Through the Medicare Improvements for Patients and Providers Act of 2008, the Institute of Medicine created the Committee on Standards for Developing Trustworthy Clinical Practice Guidelines to ensure that CPGs have “information on approaches that are objective, scientifically valid, and consistent.”¹ In addition to these standards, CPGs should incorporate high-quality studies, especially high-quality systematic reviews (SRs) when available.In recent years, CPGs have been criticized for biased interpretations of research evidence, and interventional radiology is no exception. One study compared the American College of Cardiology/American Heart Association guidelines (developed in collaboration with the Society of Interventional Radiology [SIR]),² with 4 international guidelines for carotid stenosis treatment. Investigators expected recommendations across guidelines to be similar because they drew from the same literature³; however, considerable differences were found between the American College of Cardiology/American Heart Association and the 4 other guidelines concerning the recommendations for carotid artery stent placement and carotid endarterectomy. Investigators noted that the differences may have resulted from bias when interpreting the source literature, and they concluded that the American College of Cardiology/American Heart Association recommendations may be misleading or incorrect. A critical analysis of the underlying evidence in cases like this would help establish the strength and validity of guideline recommendations.SRs synthesize results from similar studies to produce a pooled-effect estimate. The evidence presented in reviews provides clinicians a means to weigh the outcomes, safety, and efficacy of various procedures and make evidence-based recommendations.⁴ SRs that include low-quality studies are subject to bias that may decrease the validity of the review and result in misleading conclusions.⁵ Some of these biases may stem from low methodologic quality, yet it has been established that guideline developers may not always take into account the methodologic quality of the SRs they reference.^6–8 For example, publication bias (including only published studies in the SR) may influence the magnitude or direction of summary effect sizes. Language bias may result when only studies published in English are included in the SR.Tools have been developed to evaluate methodologic quality and transparency in reporting of SRs. The Preferred Reporting Items for SRs and Meta-Analyses (PRISMA) checklist has been acknowledged for its use in critically appraising the reporting quality of SRs and meta-analyses even though it was originally developed for authors to improve the quality of their reviews.⁹ However, the quality of reporting does not necessarily equate to methodologic quality in SRs; this difference necessitates independent use of tools that assess both qualities.¹⁰A Measurement Tool to Assess Systematic Reviews (AMSTAR) is an 11-item measure used to determine the methodologic quality of SRs.^11,12 AMSTAR has been acknowledged as a valid and reliable tool with high interrater reliability, construct validity, and feasibility.^13,14Here, we evaluate the methodologic quality and transparency of reporting in SRs used as evidence in interventional radiology CPGs for neurovascular disorders from the SIR.     

A report on the Academic Emergency Medicine 2015 consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization”

In May 2015, the Academic Emergency Medicine consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization” was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use.     

Musculoskeletal ultrasound education for sports medicine fellows: a suggested/potential curriculum by the American Medical Society for Sports Medicine

The following musculoskeletal ultrasound (MSK US) curriculum was developed by the American Medical Society for Sports Medicine (AMSSM) to provide a pathway by which a sports medicine fellow can obtain adequate MSK US training during their fellowship to meet the requirements of competency outlined by the American Institute of Ultrasound in Medicine (AIUM) Training Guidelines for the Performance of MSK US Examination. Many fellowship programmes may not be able to follow all of the recommendations outlined by this document owing to their available resources. However, this curriculum can be used as a suggested/potential guideline for MSK US training within a sports medicine fellowship, and may assist programmes in developing or modifying their own internal training methods.