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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It’s a long way from Boston to Denver — 5 Questions with David Howell

David Howell, alongside one of many of the research posters he has produced

When I now think of my friend, David Howell, I have this beautiful John Denver song in my head:

It’s a long way from LA to Denver
It’s a long time to hang in the sky
It’s a long way home to Starwood in Aspen
A sweet Rocky Mountain paradise
Oh, my sweet Rocky Mountain paradise

Granted, David just moved to Denver from Boston, not LA, but I can’t separate the melody from his journey, and the visions I have of him hanging out in the Rockies…..

David Howell PhD, ATC–and the team of researchers with whom he most recently worked at Children’s Hospital, Boston–has been one of the more prolific authors for CJSM in the last several years.  This summer, he moved to Children’s Hospital, Colorado, where he continues the pioneering research into kids’ sports safety that has been the hallmark of his career.

As lead author of two recently published CJSM studies, he was a natural interview for this, our most recent blog post and contribution to the recurring “5 Questions with CJSM” column.

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1) CJSM just published your new study, “Near Point of Convergence and Gait Deficits in Adolescents after Sport-Related Concussion.”  What would you state are the most important, new contributions to the literature your team made with this study?  And are there specific take-home points that the practicing clinician can use in their assessment of concussed teenagers?

DH: The idea of combining visual and gait-based measures in patients with a concussion was a result of an interdisciplinary collaboration. I was fortunate to work alongside colleagues from optometry/ophthalmology (Aparna Raghuram PhD, OD, and Ankoor Shah, MD, PhD) and sports medicine (William Meehan, MD and Michael O’Brien, MD) on this study. Based on our discussions, we were interested in the value and association of instrumented gait measures and vergence measures, since both have documented value for use within concussion evaluations. Additionally, both tests were relatively easy to administer within the sport concussion clinic at Boston Children’s Hospital. Read more of this post

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.

Concussions around the globe

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Brandenburg Gate, Berlin

How do you get from Bethesda, MD to San Francisco to Berlin all in a month, during the busiest time of your year?

I don’t know — but my good friend Christina Master does.

Dr. Chistina Master is an esteemed colleague from Children’s Hospital, Philadelphia (CHOP), whom I am privileged to see at some medical conferences we both frequent, including the American Medical Society for Sports Medicine (AMSSM) and Pediatric Research in Sports Medicine (PRISM) meetings.   She is an associate professor of clinical pediatrics at the Perelman School of Medicine at the University of Pennsylvania, a prolific researcher, and a busy clinician with a focus on pediatric sports medicine.

She is also an avid runner and, it seems, world traveler.  A definite ‘must follow’ on Twitter if you want to stay up to date on pediatric sports medicine (or just enjoy her many photos of the beautiful trails on which she runs, or the great dining spots she hits on her travels). #OnTheMove may be the hashtag that best describes her!

Not being able to attend any one of the three fantastic meetings she hit this October, I asked her to share with the CJSM readership her reflections on the current state of concussion understanding from around the globe.  What follows are her first hand reports from the proceedings of the National Institutes of Health (NIH) Pediatric Concussion Workshop (Bethesda), the American Academy of Pediatrics (AAP) Council on Sports Medicine & Fitness meeting (San Francisco), and the “Concussion in Sports Group” (Berlin)

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Dr. Christina Master (2nd from left) with some friends from CHOP

October is usually a busy month for concussions with all the fall sports in full swing. This October was also busy for concussions in a different way, with three important meetings focusing on the topic.  In mid October, the NIH convened a Pediatric Concussion Workshop, gathering an interdisciplinary group of researchers, clinicians and stakeholders together in Bethesda, MD to discuss the current state of the evidence in our understanding of pediatric concussion, particularly in those younger than high school.  It was an honor to present along with Bill Meehan and Kevin Guskiewicz among other experts at this workshop.  Topics addressed included Read more of this post

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