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RHODE ISLAND M EDICAL J OURNAL SPECIAL SECTION SPORTS MEDICINE GUEST EDITOR: RAZIB KHAUND, MD October 2016 VOLUME 99 • NUMBER 10 ISSN 2327-2228 Your records are secure. Until they’re not. Data theft can happen to anyone, anytime. A misplaced mobile device can compromise your personal or patient records. RIMS-IBC can get you the cyber liability insurance you need to protect yourself and your patients. Call us. 401-272-1050 IN COOPERATION WITH RIMS-IBC 405 PROMENADE STREET, SUITE B, PROVIDENCE RI 02908-4811 MEDICAL PROFESSIONAL/CYBER LIABILITY PROPERTY/CASUALTY LIFE/HEALTH/DISABILITY RHODE ISLAND M EDICAL J OURNAL 18 Collaboration and Collegiality: The Fuel For Growth in Sports Medicine RAZIB KHAUND, MD GUEST EDITOR R. Khaund, MD 19 Preparticipation Physical Exams: The Rhode Island Perspective, A Call for Standardization PETER K. KRIZ, MD,FAAP, FACSM AILIS CLYNE, MD, MPH, FAAP SARA R. FORD, MD, FAAP On the cover P. Kriz, MD A. Clyne, MD S. Ford, MD Photos: CDC, Public Health Image 23 Current Concepts in Library/Amanda Mills Sports-related Concussion http://phil.cdc.gov/phil/home.asp JEFFREY P. FEDEN, MD J. Feden, MD 27 Diagnosis and Management of Meniscal Injury JACOB BABU, MD, MHA ROBERT M. SHALVOY, MD STEVE B. BEHRENS, MD J. Babu, MD R. Shalvoy, MD S. Behrens, MD 31 Understanding Athletic Pubalgia: A Review BRIAN COHEN, MD DOMINIC KLEINHENZ, MD JONATHAN SCHILLER, MD RAMIN TabaddOR, MD B. Cohen, MD D. Kleinhenz, MD J. Schiller, MD R. Tabaddor, MD RHODE ISLAND M EDICAL J OURNAL 8 COMMENTARY The Not-So-Near Death of Autopsies in the U.S. JOSEPH H. FRIEDMAN, MD Medical Decision-Making for Unrepresented Patients HERBERT RAKATANSKY, MD The Rio 2016 Polyclinic – An Athlete-Centered Experience in the Olympic Village CLIVE W. BRIDGHAM, MA, DC 9 LETTER TO THE EDITOR Changes in the Maintenance of Certification (MOC) process have not gone far enough LISA FRAPPIER, DO 16 RIMJ AROUND THE WORLD Accra, Ghana Mountain View, California Stykkishólmur, Iceland 62 RIMS NEWS Are you reading RIMS Notes? Vote Yes on Question 7 Working for You New officers inaugurated Special Event: Demystifying the Legislature Why You Should Join RIMS 87 HERItaGE Daughters of Asclepius: Early women physicians in Rhode Island MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS DEPT. OF HEALTH, AG OFFICE 71 76 STUDY ON SMARTPHONE APP give conditional approval to LMW Healthcare to teach sexual health (Westerly Hospital)/ Yale-New Haven affiliation to adolescent girls DANA-FARBER, LIFESPAN 71 77 RESEARCH EVALUATES sign MOU risk factors for postpartum depression in mothers of preterm infants BROWN LAUNCHES 72 MD/MPA program 77 WOMEN & INFANTS participating in National Pelvic EPIVAX AWARDED 72 Floor Disorders Network $600,000 NIH grant to improve H7N9 avian influenza vaccine 79 ENROLLMENT 100% in Prescription Drug Monitoring Program DRS. VIREN D’SA, BARRY LESTER 74 awarded $11.1M NIH grant to study 79 HEALTH CENTER FOR WEIGHT LOSS environmental influences on child health at Charlton earns national accreditation HASBRO 76 79 DR. LINDA J. RESNIK receives $1.8M from NIH to study at Providence VA awarded $2.5M for environmental influences on child health multi-center amputation care study PEOPLE F. DENNIS MCCOOL, MD 81 84 STEPHANIE CURRY, MD patient travels from joins CharterCARE Thailand to Memorial Medical Associates for a good night’s sleep 84 EDWARD HURLEY, MD ALAN MORRISON, MD 83 named President-elect research project at VA funded of Pediatric Research to study heart valve disease Society, Junior Section PATRICK SWEENEY, MD 83 receives ACCME’s 2016 Rutledge W. Howard, MD, award October 2016 VOLUME 99 • NUMBER 10 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL J OURNAL 99 PUBLISHER RHODE ISLAND MEDICAL SOCIETY 10 PRESIDENT 2016 SARAH J. FESSLER, MD October PRESIDENT-ELECT 4 BRADLEY J. COLLINS, MD VICE PRESIDENT PETER A. HOLLMANN, MD CONTRIBUTIONS secretary CHRISTINE BROUSSEAU, MD 35 The Decline of the Autopsy in Rhode Island and Nationwide: TREASURER Past Trends and Future Directions JOSE R. POLANCO, MD ALEX BAUMGARTNER, MD IMMEDIate past PRESIDENT DOUGLAS ANTHONY MD, PhD RUSSELL A. SETTipaNE, MD EXECUTIVE DIRECTOR 37 Fluid Choice Matters in Critically-ill Patients with Acute Pancreatitis: NEWELL E. wardE, PhD Lactated Ringer’s vs. Isotonic Saline MOHAMMED M. ABOELSOUD, MD EDITOR-IN-CHIEF OSAMA SIDDIQUE, MD JOSEPH H. FRIEDMAN, MD ALEXANDER MORALES, MD ASSOCIate EDITOR YOUNG SEOL, ScB SUN HO AHN, MD MAZEN O. AL-QADI, MD PUBLIcatION StaFF MANAGING EDITOR 42 A Five-Year Evolution of a Student-led Elective on Health Disparities MARY KORR at The Alpert Medical School [email protected] LUCINDA B. LEUNG, MD, MPH GRAPHIC DESIGNER JAMES E. SIMMONS, MD MARIANNE MIGLIORI JULIUS HO, BS ADVertISING STEVEN DETOY EMMA ANSELIN, BA SARAH STEVENS RIAN YalamaNCHILI, BA [email protected] JOSEPH S. RABATIN, MD EDITORIAL BOARD 47 Medical School Ranking and Student Research Opportunities JOHN J. CRONAN, MD JAMES P. CROWLEY, MD ANNIKA G. HAVNAER Edward R. FELLER, MD PAUL B. GREENBERG, MD JOHN P. FULTON, PhD PETER A. HOLLMANN, MD KENNETH S. KORR, MD MARGUERITE A. NEILL, MD CASE REPORT FRANK J. SCHABERG, JR., MD 53 Systemic Amyloidosis Masquerading as Intractable Cardiomyopathy LawrENCE W. VERNAGLIA, JD, MPH LINDSEY CILIA, MD NEWELL E. WARDE, PhD LESLIE PARIKH, MD MADHU M. OUSEPH, MD, PhD Edward STOpa, MD RHODE ISLAND MEDICAL JOURNAL (USPS 464-820), a monthly publication, is MICHAEL K. ATALAY, MD, PhD owned and published by the Rhode Island Medical Society, 405 Promenade Street, Suite A, Providence RI 02908, 401-331-3207. All rights reserved. ISSN 2327-2228. Published PUBLIC HEALTH articles represent opinions of the authors and do not necessarily reflect the official policy 56 HEALTH BY NUMBERS of the Rhode Island Medical Society, unless Community Health Teams: clearly specified. Advertisements do not im- ply sponsorship or endorsement by the Rhode A Healthcare Provider’s System Transformation Opportunity Island Medical Society. JAMES C. RAJOTTE, MS Advertisers contact: Sarah Stevens, RI Medical DEBORAH GARNEAU, MA Society, 401-331-3207, fax 401-751-8050, [email protected]. NANCY SUTTON, MS, RD, LDN AILIS CLYNE, MD, MPH © COPYRIGHT JANUARY 2013, RHODE ISLAND 60 Vital Statistics MEDICAL SOCIETY, ALL RIGHTS RESERVED. ROSEANN GIORGIANNI, DEPUTY STATE REGISTRAR With the right tools, you can do more than insure against risk. You can avoid it. At Coverys, we do more than insure against risk. We combine medical professional liability insurance with industry-leading business intelligence, education and risk management tools to increase patient safety and help improve outcomes for policyholders. So you can move from risk-averse to risk-prevention. To learn how Coverys uses business intelligence to improve clinical, operational & financial outcomes, call (844) 894-0686 or visit ThinkCoverys.com today. ProSelect Insurance Company 800.225.6168 www.coverys.com commentary The Not-So-Near Death of Autopsies in the U.S. JOSEPH H. FRIEDMAN, MD [email protected] 8 9 EN N EUROLOGICAL DIS - of Alzheimer’s disease, parkinsonism, which, despite being only orders are the most dif- and not what they were a general term for a syndrome, adequate ficult to diagnose. While expected to be. Occa- enough to understand the disease pro- imaging and genetic test- sional cases of Alzhei- cess, possibly do a Google search, etc. ing has advanced tremen- mer’s masquerades as My local colleagues learn as well, but dously over the past three other, rare disorders. In a only an occasional brain autopsy will decades, and our ability few years we will see that merit a case report. to diagnose has advanced much of what we believe Getting autopsies is not very easy, with it, the truth of the about Parkinson’s disease despite the extremely generous and matter is that we’re not so will be reframed based on hospitable nature of the neuropathology good at identifying most pathological and genetic group at Rhode Island Hospital, which is neurodegenerative disor- findings. Thirty percent where all brain autopsies are performed. ders in life that do not fit a clear pattern. of people diagnosed with Alzheimer’s It turns out that they do more than I Complicating the matter is the fact disease by dementia experts are proven thought, although less than they should. that it is not uncommon for different wrong at autopsy. We Parkinson’s dis- Autopsies, in general, are dwindling. disorders to have identical clinical ease experts even misdiagnose Parkin- In the U.S., in-hospital deaths were presentations. Probably the most com- son’s disease about 10–20% of the time, autopsied over half the time 50 years mon example is the problem of diag- especially during the early years. The ago, but now only about 5%. Obviously, nosing dementia with Lewy bodies. point of these references to esoterica is out-patient death autopsies are much This is quite simple if the patient with to establish that neurologists are unable less common, partly because the family dementia also has clear-cut features of to make diagnoses in a fair number of rarely knows how to proceed, and if they Parkinson’s disease. But, if the demen- cases, that we know a lot about what contact the attending physician, that tia precedes the motor dysfunction the we don’t know, but, like everyone else, person usually does not know how to diagnosis is made correctly in only don’t know what we don’t know, which proceed. And, even if the doctor is me, about half the cases if seen by a demen- is why autopsies are crucial if we are to the logistics are challenging and the tia specialist, and mostly diagnosed as make advances. family has to pay the funeral home to Alzheimer’s by other doctors, including I am not very good at getting autop- transport the body.