Medical management of the athlete: evaluation and treatment of important issues in sports medicine.

Providing care to athletes involves much more than simply treating musculoskeletal injuries. Many of the illnesses and disease processes that affect the general population are also seen in competitive athletes. Medical management of these conditions, however, can be challenging. Treatment plans need to be tailored to the individual athlete and take into consideration the rigors and demands of his or her particular sport. Important conditions that all physicians who provide care for athletes should be familiar with are sudden cardiac death, hypertension, concussion, methicillin-resistant Staphylococcus aureus infections, the female athlete triad, diabetes mellitus, and asthma.

Increasing rates of influenza vaccination during pregnancy: a multisite interventional study.

BACKGROUND: Pregnancy is a high-risk indication for influenza vaccination; however, rates of vaccination fall short of Centers for Disease Control and Prevention-recommended guidelines. METHODS: Brief educational sessions with family physicians and obstetricians were undertaken in the fall of 2002. Notes reading "Think Flu Vaccine" were placed on active obstetric charts during the study period. Charts were reviewed at the end of influenza season for documentation of discussion or administration of influenza vaccination. Charts for the same period during the previous 2 years were also reviewed for baseline. RESULTS: Baseline rates of vaccination or discussion averaged 1.5% over the 2000-2002 influenza seasons. After intervention, the 2002-2003 rate of vaccination or discussion demonstrated an almost 15-fold increase to 21.9%. This was greater in family practices (3.2% to 44.9%) versus obstetric practices (1.2% to 19.4%), and in small (3.3% to 46.7%) versus large (1.1% to 16%) practices (all values were P < .001). CONCLUSIONS: Provider education with simple chart prompts seems an effective way to increase rates of physician discussion of influenza vaccination with pregnant women. The increased rates seen in this study across various practice settings also suggest that inclusion of influenza vaccination on standardized prenatal care flowsheets may achieve similar goals with less individualized effort and should be considered.

Influenza vaccination in pregnancy: current practices in a suburban community.

PURPOSE: The Centers for Disease Control (CDC) identify women in their second and third trimesters as a high-risk population warranting influenza vaccination. This study attempted to characterize understanding of these guidelines and obstacles to their implementation in a suburban community. METHODS: Family physicians and obstetricians with admitting privileges to a community-based hospital were surveyed regarding estimated vaccine availability and administration in their practices and regarding knowledge of indications and contraindications to influenza vaccination in pregnancy. RESULTS: Of the 20 obstetricians and 66 family physicians completing the survey, 68.4% of obstetricians and 90.5% of family physicians carried the vaccine in their offices (P =.027). Both obstetricians and family physicians incorrectly perceived multiple factors as contraindications to influenza vaccination in pregnancy. Obstetricians and family physicians reported similar proportions of their pregnant patients received the vaccine (35 versus 40%). CONCLUSIONS: In this study, more family physicians had the influenza vaccine available than obstetricians, but there was no difference in estimated rates of vaccination during pregnancy or in the understanding of its indications and contraindications. Finally, no physicians in our community reported providing influenza vaccination in pregnancy at recommended frequencies. Further research is needed to clarify methods of improving vaccination rates in both family practice and obstetric settings.

Wrist pain after a fall.

A 28-year-old right-handed man tripped down a flight of stairs, landing on his outstretched right hand. He developed immediate pain, swelling, and stiffness but did not seek medical attention. After 1 week without relief, he went to see his primary care provider. The patient did not have numbness or tingling, and he reported no previous injuries to the wrist. X-rays were obtained (figure 1), and the patient was referred to an orthopedist for further evaluation.

Vaccinations in pregnancy.

Adult immunization rates have fallen short of national goals partly because of misconceptions about the safety and benefits of current vaccines. The danger of these misconceptions is magnified during pregnancy, when concerned physicians are hesitant to administer vaccines and patients are reluctant to accept them. Routine vaccines that generally are safe to administer during pregnancy include diphtheria, tetanus, influenza, and hepatitis B. Other vaccines, such as meningococcal and rabies, may be considered. Vaccines that are contraindicated, because of the theoretic risk of fetal transmission, include measles, mumps, and rubella; varicella; and bacille Calmette-Guerin. A number of other vaccines have not yet been adequately studied; therefore, theoretic risks of vaccination must be weighed against the risks of the disease to mother and fetus. Inadvertent administration of any of these vaccinations, however, is not considered an indication for termination of the pregnancy.

When the darker eye has the smaller pupil.

Waardenburg and congenital Horner syndromes are both recognized causes of congenital hypochromic iris heterochromia. Each has been linked to disruptions in the pathway of tyrosinase induction, thus leading to a deficiency in melanin production of the iris. These syndromes must be considered in the differential diagnosis of a patient presenting with heterochromia iridis. We present the case of a 20-month old boy afflicted with both congenital Horner syndrome and Waardenburg syndrome, type II. In contrast to the more common presentation of congenital Horner syndrome, the affected iris in this case was the darker of the two because of the effects of the concomitant Waardenburg syndrome on the contralateral iris pigmentation. We are unaware of any other cases presenting with both Horner and Waardenburg syndromes and believe that this case serves as an excellent opportunity to briefly review the pathophysiology involved with these disorders.