Screening college athletes for sexual violence: athletes' experiences and opinions on best practices.

OBJECTIVES: College athletes are at elevated risk for sexual violence, yet few formally report it and screening for sexual violence is uncommon. This study aimed to evaluate the nature of screening occurring among college athletes and collect athletes' opinions on how best to screen for sexual violence. METHODS: This was a mixed-methods study combining a cross-sectional survey with small group interviews. Intercollegiate and club athletes 18 years and older at a division I institution were recruited to complete an online, anonymous survey. Those who completed the survey were invited to participate in follow-up interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed inductively using thematic analysis. RESULTS: 165 athletes completed the survey. Only 25% of respondents reported past screening for any type of interpersonal violence, and only 22% reported past screening for sexual abuse and 21% for sexual harassment. 12 student-athletes participated in follow-up interviews. Athletes suggested several best practices including normalising conversation about sexual violence, empowering athletes to maintain a sense of control around disclosure, building trust and providing multiple opportunities for discussion and disclosure. CONCLUSION: Less than one-quarter of athletes in this study have been screened for sexual violence. Sensitive and effective screening practices should include providing safe environments, initiating the conversation, offering multiple opportunities for disclosure, and ensuring personnel completing screening are knowledgeable on what to do in case of a disclosure. These can inform screening and educational practices to decrease stigma, support those affected and ultimately decrease the incidence of sexual violence victimisation.

Risk Factors for Infection After Rotator Cuff Repair.

PURPOSE: To identify risk factors for infection after rotator cuff repair. We hypothesized that patient characteristics and surgical technique would affect the rate of infection. METHODS: The records of 1,824 rotator cuff repairs performed by a single surgeon from 1995 to 2010 were reviewed retrospectively. Fourteen patients had an early deep postoperative wound infection that was treated with surgical irrigation and debridement. One hundred eighty-five control patients who were treated with rotator cuff repair and did not develop an infection were selected randomly for comparison and statistical analysis. Data regarding preoperative and intraoperative risk factors for infection were recorded, and a multiple logistic regression was conducted to investigate predictors of infection. RESULTS: The infection rate was 0.77% (14/1,822). On average 2.1 (range 1 to 4) surgical debridements were performed in addition to treatment with intravenous antibiotics. Patients who had open or miniopen rotator cuff repair had a significantly greater risk of acute postoperative infection (odds ratio [OR] = 8.63, P = .002). Seventy-nine percent of the patients in the infection group had an open or miniopen repair, whereas only 28% of the control group had an open or miniopen repair. Male patients also had a significantly greater risk of acute postoperative infection (OR = 9.52, P = .042). A total of 92% of the infection patients were male compared with 58% of the control group. In addition, as body mass index increased there was a reduction in the odds of infection (OR = 0.81, P = .023). CONCLUSIONS: The results of this case control study demonstrate that open or miniopen surgical technique and male sex are significant risk factors for infection after rotator cuff repair. In our study, arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. LEVEL OF EVIDENCE: Level IV.

Family Medicine Musculoskeletal Medicine Education: A CERA Study.

BACKGROUND AND OBJECTIVES: Musculoskeletal (MSK) concerns constitute up to 40% of primary care outpatient visits. Despite Accreditation Council for Graduate Medical Education (ACGME) family medicine program requirements for musculoskeletal medicine and sports medicine training, previous studies have shown that family medicine residency graduates do not have adequate training to manage common musculoskeletal conditions. Factors for this may include deficiencies in education at both the undergraduate and graduate medical education training levels. METHODS: A Council of Academic Family Medicine Educational Research Alliance survey of 287 family medicine program directors assessed the current state of the delivery of musculoskeletal medicine education. Opinions were gathered on the scope and delivery of training requirements as well as potential areas for further curricular attention. RESULTS: Two hundred eighty-seven program directors responded to the survey (response rate 41.53%). Most (72.60%) were in university based or affiliated programs and had a fellowship-trained primary care sports medicine physician (59.85%) curricular lead. A majority (77.4%) did not feel that PGY-1 residents enter residency with the physical exam skills needed to evaluate common musculoskeletal (MSK) conditions , and most (81.15%) did not feel that there should be changes to the current ACGME requirements. An area highlighted for further investment is faculty development in point-of-care ultrasound (39.85%). CONCLUSIONS: Although program directors believe that current ACGME MSK curricular requirements are likely appropriate, they do not feel residents arrive with the examination skills needed to evaluate common MSK conditions.Therefore, further attention can be given to medical student education in musculoskeletal exam skills prior to residency. Future research should develop objective measures using multiple assessors-students, residents, teaching faculty, and patients-to assess both the baseline and graduating competency in MSK medicine of our residents.