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Dancers frequently present to health care professionals with musculoskeletal impairments. The role of the health care practitioner, whether physician, physical therapist, or acupuncturist, is to decrease pain and restore function in the short term and to restore adaptive potential and neural connectivity in the long term. When dysfunction is treated, pain improves. Acupuncture and dry needling improve tissue perfusion by improving vasomotor control and can improve strength by removing motor inhibition. Acupuncture and dry needling are safe, complementary modalities aimed at improving the function of the dancer.

Background and Purpose:The rural-urban life-expectancy gap is widening, but underlying causes are incompletely understood. Prior studies suggest stroke care may be worse for individuals in more rural areas, and technological advancements in stroke care may disproportionately impact individuals in more rural areas. We sought to examine differences and 5-year trends in the care and outcomes of patients hospitalized for stroke across rural-urban strata.Methods:Retrospective cohort study using National Inpatient Sample data from 2012 to 2017. Rurality was classified by county of residence according to the 6-strata National Center for Health Statistics classification scheme.Results:There were 792 054 hospitalizations for acute stroke in our sample. Rural patients were more often white (78% versus 49%), older than 75 (44% versus 40%), and in the lowest quartile of income (59% versus 32%) compared with urban patients. Among patients with acute ischemic stroke, intravenous thrombolysis and endovascular therapy use were lower for rural compared with urban patients (intravenous thrombolysis: 4.2% versus 9.2%, adjusted odds ratio, 0.55 [95% CI, 0.51–0.59],PPPP=0.086; large towns, 1.05 [1.01–1.09],P=0.009; small towns, 1.10 [1.06–1.15],PPPPPConclusions:Rural patients with stroke were less likely to receive intravenous thrombolysis or endovascular therapy and had higher in-hospital mortality than their urban counterparts. These gaps did not improve over time. Enhancing access to evidence-based stroke care may be a target for reducing rural-urban disparities.

PURPOSE Rural-urban health disparities have received increasing scrutiny as rural individuals continue to have worse health outcomes. However, little is known about how insurance status contributes to urban-rural disparities. This study characterizes how rural uninsured patients compare to the urban uninsured, determines whether rurality among the uninsured is associated with worse clinical outcomes, and examines how clinical outcomes based on rurality have changed over time. METHODS We conducted a retrospective cohort study of the 2012-2016 National Inpatient Sample hospital discharge data including 1,478,613 uninsured patients, of which 233,816 were rural. Admissions were broken into 6 rurality categories. Logistic regression models were used to determine the independent association between rurality and hospital mortality. FINDINGS Demographic and clinical characteristics differed significantly between rural and urban uninsured patients: rural patients were more often white, lived in places with lower median household income, and were more often admitted electively and transferred. Rurality was associated with significantly higher in-hospital mortality rates (1.44% vs 1.89%, OR 1.32, P

Objectives: Dicoidin Domain Receptor 2 (DDR2) is a tyrosine kinase receptor which binds the most common extracellular matrix protein, fibrillar collagen type 1. Expression of DDR2 is critical for invasion and migration of ovarian cancer tumor cells. Clinically, high DDR2 expression has been shown to be associated with advanced stage disease and decreased survival. It is not known how BRCA mutation status, a known marker for treatment sensitivity, impacts this relationship between DDR2 expression and survival. This study aimed to determine whether DDR2 expression was correlated with BRCA mutation status and to quantify the effects of this relationship on survival. Methods: Immunohistochemical (IHC) analysis of DDR2 expression in two ovarian cancer tissue microarrays (TMA) was performed. DDR2 staining on the membrane of tumor cells was scored microscopically according to the intensity and percentage of cells positive for DDR2 expression compared to controls. High DDR2 staining was defined as >70% and low staining Results: The cohort included 164 patients diagnosed between 2/1994 and 1/2017. The majority had advanced stage disease (79%) and high-grade serous histology (76%). Germline mutation status was known in 93 patients (57%). BRCA1 was the most common mutation in 38 patients (64%) followed by BRCA2 in 20 patients (34%). 34 patients had negative germline testing. DDR2 expression was significantly associated with mutational status. Patients without a germline mutation had significantly higher DDR2 expression (64%) compared to BRCA1 (37%) (p=0.002) and BRCA2 had significantly higher DDR2 expression (55%) compared to BRCA1 (37%) (p=0.03). DDR2 expression did not vary by stage, grade or platinum sensitive status. In survival analysis, patients with high DDR2 expression had significantly lower overall survival (33mo vs 83mo, HR 1.94, p=0.002) and progression free survival (17mo vs 34mo, HR 1.668, p=0.04) compared to patients with low DDR2 expression. When survival analysis was stratified by mutation status and DDR2 expression, survival differences were seen. In patients without a germline mutation, high DDR2 expression was associated with worse overall survival (42mo vs 147mo, HR=2.818, p=0.04) compared to low DDR2 expression. Conclusions: Tumor DDR2 expression is correlated with mutation status and when combined, provides useful prognostic information. Studies are ongoing to identify additional BRCA deficient tumors for further survival analysis.

There has been a growing interest in the use of office-based orthobiologics, which are defined as the use of biological tissues to optimize musculoskeletal/orthopedic injuries, for treatment of tendons for four reasons. First, the emergence of the musculoskeletal (MSK) ultrasound for diagnosis and evaluation of tendons allows improved procedural outcomes by offering higher accuracy and less pain than palpation-guided injections. Second, the field has seen a significant increase in research and understanding of tendinopathy, and we understand that there are several growth factors that are important for tendon healing. Third, our veterinary and oral surgical colleagues utilizing orthobiologics with animal models have demonstrated promising outcomes. Finally, there is a growing body of evidence demonstrating short-term relief from corticosteroid injections, but poor long-term outcomes with potential tendon degeneration and rupture. Thus, other injection alternatives such as platelet-rich plasma, bone marrow aspirate concentration, adipose tissue, and amniotic tissue are being sought.

Introduction The global pandemic due to SARS‐CoV‐2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. Objective To describe results from a quality improvement initiative during rapid adoptive phase of telemedicine during the pandemic. Design Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during early adoptive phase (April 6‐17, 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. Primary Outcome Measures Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performing telemedicine. Results Surveys were completed by 119 patients (289 telemedicine encounters, response rate 41%) and 13 physiatrists. Telemedicine was utilized primarily for follow‐up visits (n=74, 70.6%) and most common duration was 15‐29 minutes. Patients rated their telemedicine visit as “excellent” or “very good” across measures (91.6‐95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved in excess of 30 minutes. Rate of no‐show was 2.8%. Most physicians (62%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1‐4 sessions (69%). Nearly all physicians (92%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. Conclusions In summary, rapid expansion of telemedicine during COVID‐19 pandemic was well‐received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices. This article is protected by copyright. All rights reserved.

For women diagnosed with breast cancer, healthy weight and enhanced nutrition may improve outcomes. The goal of this study is to examine the nutrition education services available on National Cancer Institute (NCI)-Designated Cancer Centers' websites. In 2017, websites of all 61 NCI-Designated Cancer Centers that provide adult clinical care were reviewed at least twice. Websites were analyzed for the existence and type of expert-directed nutrition education services for breast cancer survivors. Of the 61 websites analyzed, 49 (80%) provided information about nutrition education. Twenty (33%) included only nutrition counseling, three (5%) only nutrition classes, and 26 (42%) both counseling and classes. Forty-six websites included information about nutrition counseling; of these, 39 had an easily identifiable description. Thirty-seven class options were offered, 22% were specific to breast cancer, 16% to subgroups such as young women, 41% were nutrition-only classes, and 24% included skills education. Nutrition services are an important part of breast cancer treatment. This study demonstrated that most NCI-designated cancer centers offered counseling. However, the type of information that was offered varied and services were not always specific to patients with breast cancer. Further research is needed to confirm the presence of services, assess patient access, and demonstrate their efficacy in promoting optimal survivor outcomes.

The rural-urban life-expectancy gap is widening. Stroke is an important contributor to this deficit, and outcomes have been shown to vary by rurality and race. Technological advancements in stroke care and variation in Medicaid expansion may disproportionately impact individuals in more rural areas

1. Masters athletes may experience low back pain from multiple sources. Masters athletes with discogenic back pain should avoid or modify sports with combined rotational and compressive forces; individuals with facet-mediated pain should avoid or modify sports with excessive extension and rotation. 2. Optimization of flexibility, strength, endurance, and core control is critical. Sports specific training, realistic goal setting, and counseling are of maximal importance. 3. Overall, the health benefits of continued sports and athletic participation outweigh the potential risks of spinal degeneration in middle-aged athletes. There is little correlation between radiographic appearance of the spine and symptoms; therefore, symptoms should serve as the primary guide when determining activity modifications. Overall, masters athletes should be encouraged to remain active and fit to enhance their quality of life and reduce the risk of cardiovascular disease.