Will your practice skills be fit for the 21st century?

The year is 2001-just 3 years from now and the true beginning of the new millennium. It turns out that computers do not practice medicine, physicians still do. Primary care physicians are no longer called "gatekeepers" (which made it sound as if they fixed rusty hinges). They are both numerous and popular because they see the big picture, the whole patient and they don't restrict the flow of patients to specialists. Many take care of entire families.

How to prevent death in weight-cutting wrestlers.

One advantage of wrestling as a varsity sport in high school and college is its weight-class system. Little guys are as valuable as big guys. Ask a wrestler why he chose the sport and he is likely to tell you, "Because I'm too small to play football."

Weight training: strength for everyone.

In prehistoric times, competitive swimmers never lifted weights. The conventional wisdom was that weight training would make their muscles too bulky and would slow them down. This turned out to be untrue. Weight training made swimmers stronger and they moved through the water like trout.

Gluing minor skin wounds.

Super Glue (Pacer Technology, Rancho Cucamonga, California) and Krazy Glue (Elmer's Products, Inc, Columbus, Ohio) revolutionized home improvement. A small drop instantly bonds most things together, including your thumb and index finger.

Activating internal medicine.

Until the past few years, it seemed to me that most physicians who were trained in internal medicine, as I was, were uninterested in anything that moved faster than 3 miles per hour. Not so, now. At the American College of Physicians (ACP) annual meeting last month on San Diego's spectacular harbor, the sessions on sports medicine were jammed. People who were not in their seats 10 minutes early were kept out in the hallway by fire marshals. Why all the interest?

Toward better concussion management.

For assessing brain function in the conscious athlete, neuropsychological testing, the subject of ongoing clinical research, promises to be a quantum leap ahead of traditional neurologic assessments (see the news brief "Baseline Neurologic Testing Grows"). For the past 50 years, we've been forced to use not-so-subtle tests like subtracting serial sevens, which many athletes-and doctors-can't do even in their normal mental state.

Exercise made easy.

It is widely recognized that regular exercise can improve almost anyone's fitness, sense of well-being, and often even longevity. The bad news is that even knowing this, most people don't make exercise a priority.

My Final Editor's Notes.

Since 1986, I have been editor-in-chief of The Physician and Sportsmedicine. My vision, from the beginning, has been to produce a journal of practical importance-specifically, to help you treat the next patient who walks through the door.

Accidental strangulation by a motor vehicle window.

OBJECTIVE: To describe a child who was asphyxiated by a motor vehicle window and to review the relevant literature. DESIGN: Case report. SETTING: A 402-bed tertiary care medical center in La Crosse, WI. PATIENT: Four-year-old girl. INTERVENTIONS: Supportive pediatric critical care. MAIN OUTCOME MEASURES: None. RESULTS: The patient did not survive. CONCLUSIONS: Parents must assume responsibility for restraining their children in motor vehicles. Parents must not leave children alone in motor vehicles. Parents must become "more injury literate."

Critical care pediatrician-led aeromedical transports: physician interventions and predictiveness of outcome.

This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport; and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. There were 109 children transported by helicopter during the one-year study period. Thirty percent of the patients (43% of trauma patients and 22% of medical patients) had no interventions at all, 18% of medical patients and 10% of trauma patients were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determined that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients.

Dietary carbohydrate, muscle glycogen, and exercise performance during 7 d of training.

The effects of moderate- or high-carbohydrate diets on muscle glycogen and performance in runners and cyclists over 7 consecutive days of training were determined. Muscle biopsies were performed on 4 separate days before exercise for 1 h at 75% peak oxygen consumption (VO2) followed by five, 1-min sprints. After the training session on day 7, subjects ran or cycled to exhaustion at 80% peak VO2. Muscle glycogen for cyclists and runners was maintained with the high-carbohydrate diet but was reduced 30-36% (P < 0.05) with the moderate-carbohydrate diet. All subjects completed all training sessions, and there were no differences in times to exhaustion on day 7. For cyclists and runners, consuming a moderate-carbohydrate diet over 7 d of intense training reduces muscle glycogen but has no apparent deleterious effect on training capability or high-intensity exercise performance. A high-carbohydrate diet maintains muscle glycogen, but this has no apparent benefit on training capability or high-intensity exercise performance.

Keys to Successful Preparticipation Exams.

Timing, frequency, and types of screening tests can be hot topics of debate among physicians trying to determine how best to evaluate patients for athletic participation. Because of the wide range of opinions concerning many elements of preparticipation physical exams, we brought together three medical experts to discuss a few important aspects of these screenings.