FROM OUR EXPERTS
LESSONS FROM UPSTATE
Broken jaw may indicate concussion Concussions caused by sports injuries and active-duty military combat have garnered lots of publicity lately. Specialists at Upstate are now calling attention to a concussion that can result from a forceful punch to the jaw. Patients with isolated mandible fractures should be screened for concussion and referred to a concussion clinic, say the authors of a paper published in October in Facial Plastic Surgery, a publication of the Journal of the American Medical Association. Seventy-five percent of patients with mandibular fractures were found to have concussions during a yearlong study at Upstate University Hospital, according to research by otolaryngologists Robert Kellman, MD, and Robert Kopp, MD, nurse practitioner Ronald Walsh and Lindsay Sobin, MD, an Upstate otolaryngology resident who is doing a fellowship at Boston Children’s Hospital. Their research included 16 patients between June 2013 and June 2014 with a median age of 27½ years old. Fourteen were male. Twelve were injured in assaults. Twelve broke their jaws in two places. Eleven reported losing consciousness.
Although half of the patients admitted drinking alcohol, the authors found no relationship between the rates of concussion and the use of alcohol. Significant force is required to break a human jaw, which is designed to protect the brain. “The horseshoe shape of the mandible and its relationship with the skull base allows it to absorb rather than transmit forces to the middle cranial vault, which often leads to fractures in two locations, providing a degree of protection to the brain,” the authors write, pointing out that highvelocity impact can overcome such evolutionary advantage. Also, they note, with increasing force, the likelihood of intracranial and cervical spine injury increases. The otolaryngologists urge medical colleagues to be alert for concussions in patients with jaw fractures. “Given the high rates of potential concussion seen in our study, and the low rates previously reported, we recommend an awareness of concussive symptoms and a high index of suspicion for mild traumatic brain injury,” they conclude. Reach Upstate’s Department of Otolaryngology at 315-464-4636. Contact Upstate’s Concussion Management Program at 315-464-8986. ●
How to train doctors who will care for the underserved An analysis of the mission statements for every American medical school reveals a recipe for producing doctors who will provide primary care to communities in need. Many students begin medical school idealistically, with a desire to become primary care doctors who care for patients from underserved populations. Some then change their minds during medical school. “We know from our own studies and those of others that idealism appears to trail off as medical students become more worried about debt, lifestyle, the prestige of their career path and specialty,” says Chris Morley, PhD, interim chair of public health and preventive medicine at Upstate, vice chair for research in family medicine and lead author of the study Kenneth Slack, aabout studentmission statements published last year athlete Le Moyne College’s in the on journal Family Medicine. soccer team, is part of a
For hisgroup research, control for the Morley study. assembled a panel of about three dozen medical school leaders, administrators, professors, researchers and students who read and rated the public mission statement of each medical school in the U.S. Then the research team looked at the percent of graduates from each medical school who go on to specialize in primary care, in designated health professional shortage areas, or with medically underserved populations. They found that schools that specify something about caring for the underserved in their reason for existence are the ones that produce the most doctors who go into primary care or practice in underserved communities.
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WHAT IS PRIMARY CARE? Primary care is comprehensive first contact and continuing medical care, as provided by physicians such as pediatricians, obstetricians and family and internal medicine specialists. Nurse practitioners and physician assistants may also provide primary care.
Morley says medical schools are not producing enough primary care doctors to replace those who are retiring, because so many new doctors — for a variety of reasons — choose specialties other than family or internal medicine, obstetrics and pediatrics. What can be done? “Medical schools as institutions can be introspective and think about their culture and the messages they give to students,” Morley says. At Upstate, in addition to being the public teaching hospital for 17 counties, a number of programs are designed to attract students who will be devoted to providing primary care in underserved areas. One focuses on rural medicine, and another combines a master’s of public health with a medical degree. Upstate offers distance learning for practitioners who care for underserved populations, and the regional branch campus in Binghamton focuses mostly on primary care. Upstate also offers training for physician assistants and nurse practitioners, health professions that have a strong focus on primary care. ●
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