Olympic Medical Center is a medical organization located in Port Angeles and Sequim, Washington which provides services to patients in Clallam and Jefferson counties. The principal operating location is Olympic Memorial Hospital in Port Angeles. This location consists of 126 in-patient hospital beds and many other hospital services and has one of two Level III trauma centers in the state.Olympic Medical Center was established on November 1, 1951, with the founding of the hospital. The organization has grown into the largest employer on the Olympic Peninsula with over 1500 employees..
Osteochondritis dissecans (OCD) frequently affects the knee joint, causing instability or separation of an osteochondral fragment, which often leads to pain, mechanical symptoms, and, if left untreated, early-onset osteoarthritis. The pathogenesis of OCD is multifactorial, involving a number of anatomical, mechanical, vascular, genetic, and biological factors. Imaging plays a critical role in the diagnosis, decision-making, and follow-up of OCD lesions. Management can be surgical or non-surgical, depending on patient age and lesion characteristics. This article aims to synthesize the recent literature and provide a simple treatment algorithm to assist clinicians in optimizing the management of knee OCD.
In order to possibly better match the needs of youth athletes, the SEMS pre-participation questionnaire has undergone some significant adaptations for this group of patients. One of the changes is the usage of the more personal first-name address in either of the Swiss national languages (German, French, Italian). Some smaller modifications include for example inquiring about the parent’s height or adapting the assessment of a voluntary weight change (apart from normal growth-related changes). The most relevant addition is that of new safeguarding questions. These aim to give athletes an opportunity to make their voices heard when they experience misconduct or abuse. It is of high importance that affirmative responses are taken seriously. Of equally important note is the possibility of the athlete’s request for discretion. To what extent the questions are accepted by both the examiner and the athletes remains to be seen. De-tabooing the topic might however be one of many ways to help to create safer training environments for our young athletes, and to avoid serious short- and long-term consequences.
Posterior cruciate ligament (PCL) ruptures can cause severe knee instability and disability and thus, appropriate management is crucial for the successful restoration of patients' knee function. Rupture of the PCL can occur during sporting activity but more often, as a part of high-energy trauma. The diagnosis can be made using various clinical tests, such as the posterior drawer test or the quadriceps active test. MRI is the gold standard in imaging. PCL injuries can be classified from grade I to grade III, with increasing severity. Treatment can be conservative or surgical and should be personalized based on patients' demographic characteristics, grade of injury, level of instability, associated injuries and activity levels.
BACKGROUND Patients with cancer seen in rural and underserved areas disproportionately face barriers to access genetic services. Genetic testing is critical to inform treatment decisions, for early detection of another cancer, and to identify at-risk family members who may benefit from screening and prevention. OBJECTIVE To examine medical oncologists' genetic testing ordering trends for patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This prospective quality improvement study was performed in 2 phases over 6 months between August 1, 2020, and January 31, 2021, at a community network hospital. Phase 1 focused on observation of clinic processes. Phase 2 incorporated peer coaching from cancer genetics experts for medical oncologists at the community network hospital. The follow-up period lasted 9 months. MAIN OUTCOMES AND MEASURES The number of genetic tests ordered was compared between phases. RESULTS The study included 634 patients (mean [SD] age, 71.0 [10.8] years [range, 39-90 years]; 409 women [64.5%]; 585 White [92.3%]); 353 (55.7%) had breast cancer, 184 (29.0%) had prostate cancer, and 218 (34.4%) had a family history of cancer. Of the 634 patients with cancer, 29 of 415 (7.0%) received genetic testing in phase 1, and 25 of 219 (11.4%) received genetic testing in phase 2. Of the 29 patients who received testing in phase 1, 20 (69.0%) had germline genetic testing; 23 of 25 patients (92.0%) had germline genetic testing in phase 2. Uptake of germline genetic testing increased by 23.0% between phases, but the difference was not statistically significant (P=.06). Uptake of germline genetic testing was highest among patients with pancreatic cancer (4 of 19 [21.1%]) and ovarian cancer (6 of 35 [17.1%]); the National Comprehensive Cancer Network (NCCN) recommends offering genetic testing to all patients with pancreatic cancer and ovarian cancer. CONCLUSIONS AND RELEVANCE This study suggests that peer coaching from cancer genetics experts was associated with an increase in ordering of genetic testing by medical oncologists. Efforts made to (1) standardize gathering of personal and family history of cancer, (2) review biomarker data suggestive of a hereditary cancer syndrome, (3) facilitate ordering tumor and/or germline genetic testing every time NCCN criteria are met, (4) encourage data sharing between institutions, and (5) advocate for universal coverage for genetic testing may help realize the benefits associated with precision oncology for patients and their families seeking care at community cancer centers.
Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder.Les blessures de l’épaule sont fréquentes chez le sportif. Elles peuvent être secondaires à un traumatisme ou liées à une surcharge mécanique. Les lésions traumatiques diffèrent peu des lésions que l’on peut retrouver dans la population non sportive. Par contre, concernant les lésions de surcharge, on constate des blessures spécifiques du sportif, en lien avec la gestuelle du sport pratiqué. Une grande partie de la littérature vient des États-Unis à travers l’étude du lanceur au baseball (pitcher). Les concepts physiopathologiques ont largement été appliqués à d’autres sports nécessitant une gestuelle au-dessus des épaules (overhead athlete). Nous parcourons brièvement les principales spécificités et tableaux cliniques de l’épaule douloureuse chez le sportif.
