Journal of Osteopathic Medicine Journal of Osteopathic Medicine最新文献

{"title":"The association between operating margin and surgical diversity at Critical Access Hospitals","authors":"W. Hopper, R. Zeller, R. Burke, Tom Lindsey","doi":"10.1515/jom-2022-0028","DOIUrl":"https://doi.org/10.1515/jom-2022-0028","url":null,"abstract":"Abstract Context Surgical volume is correlated with increased hospital profitability, yet many Critical Access Hospitals (CAHs) offer few or no inpatient surgical services. Objectives This study aims to investigate the impact of the presence of different inpatient surgical services on CAH profitability. Methods The study design was a cross-sectional analysis of financial data from the most recent fiscal year (FY) of 1299 CAHs. Multiple linear regression was utilized to assess how the operating margin was affected by the number of different inpatient surgical services offered per hospital. Covariates known to be associated with hospital profitability included occupancy rate, case mix index (CMI), system affiliation, ownership status (public, private, or nonprofit), and geographic region. Results The regression model for the CAH operating margin returned an R2 value of 0.18. Each additional inpatient surgical service corresponded to a 1.5% increase in operating margin (p=0.0413). Each 10% increase in occupancy rate and 0.1 increase in CMI corresponded to a 0.9% increase in operating margin (p=0.0032 and p=0.0176, respectively). The number of surgical services offered per CAH showed positive correlations with occupancy rate (r=0.23, p<0.0001) and CMI (r=0.59, p<0.0001). Conclusions A positive correlation exists between operating margin and the diversity of inpatient surgical specialties available at CAHs. Furthermore, providing surgery allows CAHs to accommodate higher occupancy rates and case mixes, both of which are significantly and positively correlated with CAH operating margin.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"C-20 1","pages":"339 - 345"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85069289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of osteopathic manipulative treatment in telehealth settings to maximize patient outcomes and minimize adverse effects","authors":"Steven P. Gawrys, Justin T Bradshaw, Lawsen M. Parker","doi":"10.1515/jom-2021-0266","DOIUrl":"https://doi.org/10.1515/jom-2021-0266","url":null,"abstract":"We commend Kramer and De Asis [1] for their findings indicating the utilization of osteopathic manipulative treatment (OMT) via telemedicine for pediatric patients. Their results demonstrated significant decreases in pain for the majority of their patients, addressing their chief complaints [1]. These findings are incredibly insightful for further research and have the potential to help many patients in the future if replicated properly. However, Kramer and De Asis discovered that some patients in the study noted mild temporary worsening of pain that was slightly higher than the rate reported in the literature for in-person OMT visits, which could possibly be attributed to parental misapplication of technique or force [1]. In an effort to enhance the potential for OMT via telehealth and prevent the adverse outcomes noted by Kramer and De Asis, we have collected sources that could be utilized in future research to promote more widespread, standardized use of telehealth in osteopathic medicine. Research into standardization of OMT via telehealth can maximize the positive findings of Kramer and De Asis for all osteopathic physicians to implement while minimizing the potential risk factors of increased pain for patients [2]. While we are hopeful to see the end of the COVID-19 pandemic, telehealth is projected to remain a vital part of ensuring adequate healthcare for several patient populations [3]. Benefits of telehealth include a reduced number of emergency room visits, preventing the spread of COVID-19, conservation of PPE, reduced costs to patients living in remote areas, and improving the management of outpatient visits [3]. Recent research of musculoskeletal, neurological, and cardiovascular physical exams in a telehealth setting lay a framework for future research into the telehealth osteopathic physical examination [4–7]. Specifically, some of these studies provide images demonstrating the proper techniques for patient movements and positions [5–7]. Research into the standardization of OMT with the use of images and other visual aides to demonstrate proper technique would help prevent misapplication of the osteopathic examination and treatment, thus preventing injuries. Standardized guidelines can also help address pertinent contraindications of OMT procedures. As these studies do not include osteopathic assessment tools, research conducted by leaders of osteopathic medicine into the standardization of OMT recommended during telehealth visits, such as promoting a standard of patient education for identifying a somatic dysfunction and performing subsequent treatment through telemedicine, would also be beneficial in creating reproducible results in large sample sizeswhilemaintaining patient safety in fragile populations. It is unlikely that patient care via telehealth technology will ever fully match the trained, palpatory skills of an osteopathic physician. However, based on the research of telehealth utilization, including the commendable art","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"29 1","pages":"377 - 378"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86062707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of medication-assisted treatment for opioid use disorder","authors":"Nessreen Ghanem, Devin Dromgoole, AhmadNewafhaj Hussein, R. Jermyn","doi":"10.1515/jom-2021-0163","DOIUrl":"https://doi.org/10.1515/jom-2021-0163","url":null,"abstract":"Abstract Context The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. Objectives This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. Methods The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. Results Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. Conclusions The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"28 1","pages":"367 - 374"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90510291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical cancer screening among women with comorbidities: a cross-sectional examination of disparities from the Behavioral Risk Factor Surveillance System","authors":"Jordyn Austin, Paul Delgado, Ashton Gatewood, Mackenzie Enmeier, Brooke Frantz, B. Greiner, M. Hartwell","doi":"10.1515/jom-2021-0044","DOIUrl":"https://doi.org/10.1515/jom-2021-0044","url":null,"abstract":"Abstract Context Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist. Objectives This study aims to analyze whether CC screening rates differ among women with comorbidities—body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer—compared to women without these comorbidities. Methods Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2–4, 5+). Confidence intervals (CIs) were reported at 95%. Results Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83–0.97) as were those with COPD (AOR: 0.77; CI: 0.67–0.87) and kidney disease (AOR: 0.81; CI: 0.67–0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05–1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities. Conclusions Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"40 1","pages":"359 - 365"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85695950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting utilization of CT scan following ultrasound evaluation of suspected appendicitis","authors":"Adam Zisman, B. Novi, J. Gaughan, Lauren Carr","doi":"10.1515/jom-2021-0251","DOIUrl":"https://doi.org/10.1515/jom-2021-0251","url":null,"abstract":"Abstract Context When evaluating a pediatric patient in the emergency department for suspected appendicitis, a provider is often faced with the dilemma of deciding if a computed tomography (CT) scan is warranted when—as is most often the case—ultrasound results do not yield a definitive diagnosis. The potential risks of radiation must be weighed against numerous aspects of a patient’s background, physical exam, and already-obtained workup. Objectives This study aims to aid in future decision making of providers in their evaluation of patients with suspected appendicitis, to help facilitate a more comprehensive answer to the “next-steps” in the question of equivocal ultrasound, and to create a pathway utilizing lab results, physical exam findings, and pertinent positives and negatives in patient history to facilitate a more objective decision-making process for ordering a CT scan. Methods A retrospective chart review was performed for patients who were evaluated for possible appendicitis at our institution between October 2016 and October 2017 and whose ultrasound results were equivocal. We determined what factors led to increased frequency of obtaining CT scans. Results Statistical analysis showed that several factors were independently associated with the increased likelihood of having a CT scan performed. When considered in combination with the other parameters, it was found that older children, males, report of right lower quadrant (RLQ) pain, and presence of RLQ tenderness on physical exam were all associated with a significantly higher likelihood of having a CT scan performed. Conclusions When combined with present algorithms and protocols already in use, this information can assist the provider in making prudent decisions for their patients with the potential for reduced provider bias.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"13 1","pages":"313 - 318"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91543931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Os trigonum identified after trauma to heel","authors":"Mackenzie Pargeon, Lindsay Tjiattas-Saleski","doi":"10.1515/jom-2021-0270","DOIUrl":"https://doi.org/10.1515/jom-2021-0270","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"63 1","pages":"271 - 272"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78209786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of self-efficacy on nonoperative treatment of atraumatic shoulder pain","authors":"Louis C. Grandizio, Lisa J. Choe, Lisa Follett, Andrew J. Laychur, Amanda J. Young","doi":"10.1515/jom-2021-0132","DOIUrl":"https://doi.org/10.1515/jom-2021-0132","url":null,"abstract":"Abstract Context Atraumatic shoulder pain is frequently encountered in primary care and surgical clinics. With increased recognition of the biopsychosocial model, there has been an increased emphasis on identifying patient factors associated with less effective coping strategies such as pain catastrophizing. It remains uncertain what impact self-efficacy has on the response to nonoperative treatment of shoulder pain. Objectives Our purpose is to determine the influence of patient coping strategies (self-efficacy) on the outcome of nonoperative treatment of atraumatic shoulder pain. We hypothesize that higher levels of self-efficacy are associated with increased self-reported function after nonoperative treatment. Methods We conducted a retrospective case-control study for a consecutive series of patients seen in our clinic with nonoperatively managed atraumatic shoulder pain. Baseline demographics and range of motion were recorded. Patients completed the Simple Shoulder Test (SST), PROMIS Pain Interference (PI), and PROMIS Self-Efficacy for Managing Symptoms (SE). After 3 months of nonoperative treatment, patients were placed into two groups: patients who clinically improved (Group 1) and those that did not (Group 2), with clinical improvement defined as an increase of 2 or greater on the SST. Results Seventy-eight patients returned for follow-up and completed all questionnaires. There were no statistically significant differences for age, sex, or tobacco use between the two groups. Half of the patients in our series had symptoms for >12 months, with rotator cuff syndrome being the most frequent diagnosis (40.0%). Patients in Group 1 had significantly higher PROMIS SE scores (42 vs. 39, p=0.0094) at initial evaluation. At 3-month follow-up, patients in Group 1 also had significantly lower Numeric Pain Rating Scale (NPRS) scores (4.5 vs. 6.5, p=0.0067), compared to Group 2. Conclusions Patients who experience clinical improvement with nonoperative treatment of atraumatic shoulder conditions demonstrate higher self-efficacy than patients who fail to improve. Guiding patients with atraumatic shoulder pain and low self-efficacy toward interventions aimed at improving coping strategies, rather than addressing musculoskeletal factors alone, may contribute to the goal of improving outcomes.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"12 1","pages":"297 - 302"},"PeriodicalIF":0.0,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86539470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frontmatter","authors":"","doi":"10.1515/jom-2022-frontmatter4","DOIUrl":"https://doi.org/10.1515/jom-2022-frontmatter4","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"177 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74601717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frontmatter","authors":"","doi":"10.1515/jom-2022-frontmatter2","DOIUrl":"https://doi.org/10.1515/jom-2022-frontmatter2","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"23 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77765906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frontmatter","authors":"","doi":"10.1515/jom-2022-frontmatter1","DOIUrl":"https://doi.org/10.1515/jom-2022-frontmatter1","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90993288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}