The Focused Musculoskeletal Factory

Rheumatology has evolved rapidly over the past 20 years. The availability of numerous treatment interventions has dramatically altered patient outcomes and revitalized the specialty. At the same time, the economics of medical practice is challenging the practicing rheumatologist to seek more efficient and more attractive models of care delivery. These models of care must be attractive not only to rheumatologists and their patients but also to other interested parties as well, such as payers, government agencies, and accreditation bodies.

The Organizational Climate in Collegiate Athletics: An Athletic Trainer's Perspective

CONTEXT

  An organizational climate is largely based on an employee's perceptions of the working conditions in which he or she engages regularly. A multifaceted concept, the organizational climate is often formed by perceptions of employee welfare, rewards, and support. Achieving work-life balance is also a part of the climate.

OBJECTIVE

  To learn collegiate athletic trainers' perceptions of organizational climate and specifically how it may pertain to their work-life balance.

DESIGN

  Phenomenologic study.

SETTING

  Collegiate practice setting.

PATIENTS OR OTHER PARTICIPANTS

  Thirty athletic trainers working in the collegiate athletics setting took part in 1-on-1 phone interviews. The participants were 30.5 (interquartile range [IQR] = 7.75) years old and had been certified for 7 (IQR = 5) years and at their current position for 4 (IQR = 3) years.

DATA COLLECTION AND ANALYSIS

  Participants completed a phone interview that followed a semistructured framework. All transcribed interviews were analyzed using a phenomenologic approach. Researcher triangulation, expert review, and data saturation were used to establish credibility.

RESULTS

  Athletic trainers working in the collegiate athletics setting who had positive perceptions of their work-life balance described their organizational climate as family friendly. Our participants' supervisors allowed for autonomy related to work scheduling, which provided opportunities for work-life balance. These athletic trainers believed that they worked in a climate that was collegial, which was helpful for work-life balance. In addition, the importance of placing family first was part of the climate.

CONCLUSIONS

  The perceptions of our participants revealed a climate of family friendliness, supervisor support, and collegiality among staff members, which facilitated the positive climate for work-life balance. The mindset embraced the importance of family and recognized that work did not always have to supersede personal priorities.

New Vision for Health Promotion within Sports Medicine

Providing medical care for the treatment and prevention of injuries and health problems for competitive or recreational athletes is the most widely recognized role of sports medicine. However, the field is much broader and includes clinical practice and research in many areas related to physical activity in the prevention and treatment of chronic disease. Sports medicine and exercise science involve not only physicians and other licensed health care practitioners but also physiologists, social scientists, epidemiologists, kinesiologists, and other public health and medical professionals. There is overwhelming scientific evidence that a physically active lifestyle is important for optimal health. A key role of sports medicine is to focus the attention of a wide variety of health professionals, educators, and policy makers on developing and implementing strategies to help more individuals enjoy the many health-promoting benefits of regular physical activity.

Patient Perceptions of Athletic Trainers and Orthopaedic Medical Residents as Primary Clinical Support Staff in Sports Medicine Practice: A Randomized, Double-Blinded Prospective Survey

BACKGROUND

Orthopaedic sports medicine practices utilize a variety of healthcare professionals to assist physicians in the clinic. The purpose of this study was to investigate patients' perception of orthopaedic knowledge and clinical care provided by orthopaedic medical residents and athletic trainers (ATs).

HYPOTHESIS

ATs will be perceived similarly to orthopaedic medical residents in overall patient care and perceived education level.

STUDY DESIGN

Randomized, double-blind survey.

LEVEL OF EVIDENCE

2.

METHODS

New patients were randomly selected to receive the survey to complete during an office visit. The survey included 8 questions which rated the patient's perceived level of orthopaedic knowledge and level of patient care provided by the AT and orthopaedic medical residents. A total of 110 surveys were collected during the 2-year study period. The data were analyzed using a multivariate analysis of variance (MANOVA).

RESULTS

The multivariate effect (Pillai's trace) was not significant between clinicians, F(8,111)=0.122, p=0.695, partial η2=0.106. Univariate tests showed a significance between patient perceived level of clinician education, F(1,118)=5.361, p=0.632, partial η2=0.043. Univariate test showed no significant differences on any other dependent variables.

CONCLUSION

There is no evidence that patients' perception is different when comparing ATs and orthopaedic medical residents in orthopaedic knowledge and clinical care. Although a statistically significant difference was found in the perceived highest level of education attained, orthopaedic medical residents and ATs were each perceived to have a master's degree level of education. Physicians should continue to use ATs in their practices.

Going for gold: blood planning for the London 2012 Olympic Games

The Olympics is one of the largest sporting events in the world. Major events may be complicated by disruption of normal activity and major incidents. Health care and transfusion planners should be prepared for both. Previously, transfusion contingency planning has focused on seasonal blood shortages and pandemic influenzas. This article is the first published account of transfusion contingency planning for a major event. We describe the issues encountered and the lessons identified during transfusion planning for the London 2012 Olympics. Planning was started 18 months in advance and was led by a project team reporting to the Executive. Planning was based on three periods of Gamestime. The requirements were planned with key stakeholders using normal processes enhanced by service developments. Demand planning was based on literature review together with computer modelling. The aim was blood-stock sufficiency complimented by a high readiness donor panel to minimise waste. Plans were widely communicated and table-top exercised. Full transfusion services were maintained during both Games with all demands met. The new service improvements and high readiness donors worked well. Emergency command and control have been upgraded. Red cell concentrate (RCC) stock aged but wastage was not significantly increased. The key to success was: early planning, stakeholder engagement, service developments, integration of transfusion service planning within the wider health care community and conduct within an assurance framework.

[Medical service for sports events]

The medical service for sports events is for physicians and other healthcare professionals a particular challenge, depending on type and size of the event. Planning criteria exist but only in general terms and are often inadequate, so the preparation should based principally on experience. In addition to a good cooperation with the other partners of the emergency medical services, specific accidents and clinical pictures, as well as legal implications have to observed.

[On health protection for members of Russian Federation national sports teams]

The article covers main results of activities provided by Federal Medical and Biologic Agency on medical, sanitary and biologic support of Russian Federation national sport teams members. Through example of Bournazian FMBC of FMBA of Russian, Sports Medicine and Rehabilitation Center, the authors represented results of scientific, educational and clinical work of specific establishment in this sphere.

[Method of individual evaluation of athletes' tolerance of maximal physical exertion under exposure to changed hypoxic and hypothermal environment]

The article covers a program determining order and method of gradual examination of highly qualified athletes engaged into winter sports in Sports Medicine and Rehabilitation Center in Bournazian FMBC of the FMBA of Russia, to assess physical performance and individual tolerance in changed climate (hypoxic and hypothermal) conditions.

Paralympic medicine

Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.

[Sport medicine]

It is only since the late 20th century that Sport and Exercise Medicine has emerged as a distinct entity in health care. In Israel, sports medicine is regulated by a State Law and a sport physician is certified after graduating a structured program. In the past, sports medicine was related to the diagnosis and treatment of injuries encountered by top athletes. In recent years, the scope of sport medicine has broadened to reflect the awareness of modern society of the dangers of physical inactivity. In this perspective the American College of Sport Medicine (ACSM) recently launched a program--"Exercise is Medicine", to promote physical activity in order to improve health and well-being and prevention of diseases through physical activity prescriptions. This program is from doctors and healthcare providers, adjusted to the patient or trainee. The sport physician does not replace a medical specialist, but having a thorough understanding about the etiology of a sport-related injury enables him to better focus on treatment and prevention. Therefore, Team Physicians in Elite Sport often play a role regarding not only the medical care of athletes, but also in the physiological monitoring of the athlete and correcting aberrations, to achieve peak physical performance. The broad spectrum of issues in sport and exercise medicine cannot be completely covered in one issue of the Journal. Therefore, the few reports that are presented to enhance interest and understanding in the broad spectrum of issues in sports and exercise medicine are only the tip of the iceberg.

[The Luxembourg Society for Sports Medicine (SLM) after 60 years]

This review will mainly focus the last 10 years of the society's history because several important changes occurred during this relatively short period. The most important was the creation of the first clinical sports medicine department in Luxembourg in 2004. This modern new infrastructure was made possible by the recruitment of 2 highly competent sports physicians, the excellent collaboration of the governing board of the Centre Hospitalier de Luxembourg (CHL) and the support of the sports minister. In 2008 the new department received the label "Medical Olympic Centre of Luxembourg". One year later a Research Lab of Sports Medicine (CRP-Santé) completed the new concept. Thus within 4 years the structure of Luxembourgish sports medicine was completely rearranged and includes today orthopaedic surgery and traumatology, functional rehabilitation, sports cardiology, exercise physiology, physiotherapy and specific sports medicine research. An important new challenge of the SLMS will be to integrate the external sports physicians into this new infrastructure. Another ongoing mission of the SLMS will be the education and training of new young sports medicine specialists. Here the new department could play an outstanding role and the SLMS is in close negotiations with the University of Luxembourg, in charge of academic education in Luxembourg. A recruitment of new young sports physicians is necessary to perpetuate the routine sports medicine exams in the 15 regional centres in Luxembourg, where such an exam is mandatory in order to get an official sports licence. Since 2010 an ECG exam has been added for all new licence candidates, according to the recent recommendations of the scientific societies. New young sports physicians will also be needed to assure the medical attendance of the different national teams of Luxembourg. Until 1985 these activities were confined only to the Olympic teams every 4 years, but since the implementation of the Games of the Small European Countries in 1985, where rather big teams represent Luxembourg every two years, this mission has become more important. The history of the SLMS reflects the development both of sports and sports medicine during the last 60 years. At the beginning of the 21.century sports medicine is well settled in the Grand-duchy of Luxembourg.

Professional relations in sport healthcare: workplace responses to organisational change

This article examines the impact of organisational changes in UK elite sport on the professional relations among and between different healthcare providers. The article describes the processes by which demand for elite sport healthcare has increased in the UK. It further charts the subsequent response within medicine and physiotherapy and, in particular, the institutionalisation of sport-specific sub-disciplines through the introduction of specialist qualifications. Drawing on semi-structured interviews with 14 doctors and 14 physiotherapists, the article argues that organisational changes have led to intra-professional tensions within both professional groups but in qualitatively different forms reflecting the organisational traditions and professional identities of the respective disciplines. Organisational changes promoting multi-disciplinary healthcare teams have also fostered an environment conducive to high levels of inter-professional cooperation though significant elements of inter-professional conflict remain. This study illustrates how intra-professional relations are affected by specialisation, how legitimation discourses are used by different professions, and how intra- and inter-professional conflict and cooperation should be seen as highly interdependent processes.

Key factors for providing appropriate medical care in secondary school athletics: athletic training services and budget

CONTEXT

Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care.

OBJECTIVE

To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care.

DESIGN

Cross-sectional study.

SETTING

Mailed and e-mailed survey.

PATIENTS OR OTHER PARTICIPANTS

One hundred sixty-six South Carolina high schools.

INTERVENTION(S)

The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r = 0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables.

MAIN OUTCOME MEASURE(S)

The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a school's response to items relating to AMCSSAA guidelines.

RESULTS

Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R(2) = 0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget.

CONCLUSIONS

The AMCAT offers an evaluation of medical care provided by interscholastic athletics programs. In South Carolina schools, athletic training services and the sports medicine supply budget were associated with higher levels of medical care. These results offer guidance for improving the medical care provided for interscholastic athletes.

[Awareness of doctors in sportmedicine and sportsmen concerning stomatological health]

The questioning was carried out among 182 sportsmen of the age of 12--45 years living in Samara region and among the medical personnel serving the given group. Questioning had shown low awareness of sportsmen and sports doctors on questions of stomatologic diseases preventive measures.

Understanding organization structures of the college, university, high school, clinical, and professional settings

Athletes participate at many different levels of competition--from amateur to professional, from backyard sandlot to Yankee Stadium. There are as many different organized structures involved in providing medical care to athletes as there are types of athletes themselves. Although the organizational structures involved in providing medical care for a little league team in a small town are different from those involved in providing care for a professional baseball team, the mission is the same-caring for athletes. This is the central theme of this article. Though there are different organizational structures, there are more common threads than differences in the mission of those who provide medical care for athletes at any level.

Creating and promoting a sports performance service offering

Many private hospitals and physician groups are exploring the possibility of expanding their facilities to include advanced ancillary services. Services such as a sports performance center provide additional opportunities for quality patient care and at the same time augment the bottom line. By offering additional ancillary services, healthcare organizations such as an orthopaedics practice can become a full-service center enabling clinicians to more fully provide care to their patients. Marketing and promotion play a crucial role in this type of service. These activities must be designed and carried out in a way that encourages productive results and collaboration as the organization strives to position itself as a full-service center and as a sports specialist in its community.

Marathon Race Medical Administration

Marathon race medical coverage involves coordinating many organisations, personnel and government agencies. An infrastructure of aid stations, finish-line medical tents, ambulance services, communication networks and transport vehicles support the medical professionals covering the event. Knowledge of the volume and type of medical problems that arise during a marathon allow the medical director to assemble the necessary components for a safe event. Published data and/or historical race information will assist in planning for anticipated medical utilisation. Organisers must prepare for uncommon but possible catastrophic medical events such as cardiac arrest and exertional heat stroke. Advances in point-of-care medical devices and significant increases in training and education of medical professionals providing care at these events have greatly improved the quality of on-site medical care at marathon races.

Professional and collegiate team assistance programs: services and utilization patterns

Elite professional and collegiate athletes underuse stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.

Developmental Overview of Child and Youth Sports for the Twenty-first Century

This article presents an overview of sporting participation for children and adolescents from psychological, physical, social, developmental, and historical perspectives. The following areas are reviewed: (1) normal developmental readiness and sporting participation; (2) benefits and risks of athletic participation for the child and adolescent; (3) self concept and sporting participation; (4) adverse psychophysiological and somatoform effects of sports; (5) interactional and systemic contributions to adverse physical and psychological effects; (6) a historical/social perspective of sport in the United States; (7) the current and future role of psychiatrists in conjunction with sports medicine physicians; (8) the sports psychiatry interview of the child, family, and coach; and (9) summary and future challenges.