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Patient Care Is More Than Skin Deep
Medical Coverage From the PPE to HPV


We all know that sports medicine involves much more than sprains, strains, and fractures. We at THE PHYSICIAN AND SPORTSMEDICINE have always stressed the importance of treating the entire patient, and this concept has been foremost in two significant projects underway this year: (1) the third edition of The Preparticipation Physical Evaluation (PPE), set to be released in August, and (2) the launch of our Sports Dermatology Series this month.

Much has changed since we published the second edition of the PPE in 1997. More reviews, studies, and recommendations have appeared, and team physicians have gained more experience. Some form of PPE is administered annually to about 12 million children and adolescents in the US. However, there remains little consistency with respect to the questions asked, the format and extent of the physical examination, or the criteria for participation inclusion or exclusion.

Starting last fall, an expert working group from six leading medical societies has been striving to standardize the PPE process. For the third edition, the writers have expanded into several new topics, including new sections on disabled athletes; future considerations like an electronic, Web-based PPE; and privacy issues like HIPAA and FERPA compliance. The monograph will also feature standards for the timing and setting of the exam, updated clearance recommendations for cardiovascular conditions, and a more detailed physical exam. (Incidentally, McGraw-Hill research shows that 85% of physicians recommend the PPE for "nonathletes.")

The working group comprises representatives from the American Academy of Family Physicians, the American Academy of Pediatrics, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, and, new to the project with this edition, the American College of Sports Medicine. The group has been reviewing medical evidence for updating the content and has established standardized questions based on published research, focus-group feedback, and clinical experience that can be tested for sensitivity and specificity. These physicians are also setting the stage for an electronic, Web-based version that will use a sport- and age-specific questionnaire to detect problems and have a summary for the examining physician. Electronic data entry will also yield a database that will advance knowledge about sports, health, disease, and PPE improvements.

This group of consensus experts has impressed me with its commitment and dedication to improving the PPE. The experts have met face to face, participated in countless e-mail exchanges, evaluated written documents, and edited each others' work. In the end, we will have a monograph that advances the PPE considerably.

Of course, caring for active patients doesn't end with the PPE. Continuity of whole-patient care includes the largest organ of the body, which is what our new Sports Dermatology Series reflects.

Series editor (and editorial board member) William Dexter, MD, has compiled an impressive array of practical articles on the skin conditions you're most likely to see in your busy practice. Each article will contain helpful photos and diagnostic tips, as well as details on effective treatment and return-to-play decisions. This month's article (page 33) focuses on friction- and pressure-induced conditions. Other articles will cover bacterial dermatoses; viral infections; metabolic conditions like eczema, psoriasis, and exercise-induced urticaria; lacerations and abrasions; fungi and parasites; and environment-related problems.

Let us know if we're missing anything! Meanwhile, enjoy the musculoskeletal content in this issue, too, including articles on knee injury (pages 26 and 41).

Gordon O. Matheson, MD, PhD