Disparities in sports medicine health care

Most days of the week I see my pediatric sports medicine patients in two very different clinics:  one is within the inner city of Columbus, Ohio itself; and one is in the foothills of Appalachia, a region described in the recent bestseller, Hillbilly Elegy.  Among the patients I frequently see, I have many who could be described as urban poor (the former location), and many as rural poor (the latter).

In my care of these patients, I frequently see them (and their families) struggle with several barriers to excellent care — these range from financial issues, to issues of transportation and distance traveled, to issues of understanding related to educational levels, to a relative lack of resources at their home schools or clubs (e.g. no certified athletic trainers).  I feel at a great loss, at times, in trying to help them achieve the same results I would want for any of my patients.

I read with great interest then, in the November 2017 CJSM, a newly published, original research study: Disparities in Athletic Training Staffing in Secondary School Sport: Implications for Concussion Identification.  I found it so impactful, that I wanted to talk with the author — and so I tracked down Emily Kroshus ScD, MPH for this episode of the CJSM podcast.

Dr. Kroshus is a Research Assistant Professor of Pediatrics at the University of Washington, who is developing a body of academic work that focuses on “….identifying social and contextual determinants of help seeking behaviors, with an overarching interest in addressing disparities related to gender, race, sexual orientation, and socioeconomic status.”(1)

I hope you are as interested in this sort of research as much as I am.  So take a listen to the podcast on iTunes or go to the CJSM website for the podcast (look for the radio button) and the study itself.

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(1) Dr. Kroshus’ biography can be found at the University of Washington faculty page:  https://depts.washington.edu/uwgenped/directory/emilykroshus

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Deck the halls.

Advent is here — a time of anticipation.  When I was a child, my mother would get all of us children an Advent Calendar, and each day I’d eagerly open up the windows of the calendar to find the chocolate inside.  You too?

I enjoy the holiday spirit that inspires many of the people/organizations I follow on social media.  Even the staid ones play with the mistletoe, so to speak.  The British Medical Journal (BMJ), for instance, puts on the holly and the ivy, and has a very clever, festive theme on its Twitter feed for the month of December:  a daily “Christmas Cracker,”(#BMJChristmasCrackers) that leads one to ponder issues like…whether Santa is a healthy role model or whether eating turkey really can make one sleepy.

Not quite Advent chocolate, but, at my age, I could use something low calorie. As the saying goes, you can’t outrun a bad diet (and, furthermore, I can’t run any more).

We, too, get festive this time of year at CJSM, notwithstanding the hard work our Editor-in-Chief (EIC) Chris Hughes will be doing throughout the Yuletide season taking care of his charges as a team physician for a Premiership football side. While you (and I) will likely be enjoying a quiet Boxing Day, he (and many team docs) will be taking care of business for the sides they cover.

Our elves busy at work packaging up the next edition of CJSM

Our last issue of the year (published in November)  is a bit like an Advent Calendar — open up the pages of the issue, and you’ll find a veritable smorgasbord of interesting topics to sample.  One I particularly liked explores disparities in access to athletic trainers and how this impacts concussion management in high school athletes.  The EIC himself has given a nod to a systematic review on the treatment of acute patellar dislocation.

Too busy to read because you’re travelling?  We’ll have a new podcast to add soon to the ever growing list of ones CJSM has already posted to iTunes.  So subscribe to the feed and listen to your heart’s content.

Whatever your plans this Season, if you are in sports medicine, be sure to include CJSM along with the requisite eggnog and fruitcake.

Ho ho ho!!!!

 

Ice Hockey & Head Injury — can we have one without the other? The podcast

I am pleased to introduce our most recent guest to the CJSM podcast: Aynsley Smith, RN, PhD of the Mayo Clinic.  She is the lead author of a new General Review in our September 2017 issue: Concussion In Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis.

Dr. Smith and the Mayo Clinic have been at the forefront of research into the prevention, diagnosis and management of concussion in ice hockey.  The Mayo Clinic has hosted three semi-annual ‘ice hockey concussion summits,’ the most recent having just taken place at the end of September

It’s probably always a good time to talk about concussions in ice hockey, but perhaps never better than the start of the NHL season  [my hometown Columbus Blue Jackets open their season tonight!]

In our conversation, Dr. Smith and I cover a lot of ground:  old time Stanley Cup drama, fighting, promising new developments in objective diagnoses, and the potential for rules changes and more to minimize the risk in this exciting, fast-moving contact sport.

The review is open access — which means it’s freely available.  So….subscribe to the CJSM podcast on iTunes, or go directly to our website for a listen to the conversation I had with Aynsley.  And then get the article itself for your weekend reading.

How do you evaluate your ACL reconstructed patients? The CJSM Podcast.

I have an interest in patient-reported outcome measures (PROMs).  In fact, one of the manuscripts I have published in the pages of CJSM addresses the reliability and validity of a pediatric back pain PROM (the Micheli Functional Scale).

I read with great interest, therefore, work recently published in CJSM on another PROM, the ACL Quality of Life (QOL) questionnaire: Validity, Reliability and Responsiveness of the ACL QOL Measure: A Continuation of its Overall Validation.

When I approached the lead author, Mark Lafave, about doing a possible podcast on this study, he demurred. The person I really needed to talk with was the his mentor, and the developer of the measure 30 years ago: Dr. Nicholas Mohtadi.

Dr. Mohtadi is an orthopaedic surgeon and Director of the Sports Medicine Centre at the University of Calgary, Alberta Canada.  He is a past president of CJSM’s affiliated society, the Canadian Academy of Sport and Exercise Medicine.  He is also on the CJSM editorial board and has been a prolific author in our pages these last 26 years.

He made for a wonderful guest on the podcast.  Check it out, and don’t forget you can see all the CJSM podcasts and sign up for the iTunes feed by going here.

 

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