Journal of Osteopathic Medicine最新文献

{"title":"Quantitative ultrasound to assess efficacy of treatment for neck somatic dysfunctions: a feasibility study.","authors":"Anthony Tran,&nbsp;Thien Ngo,&nbsp;Tanner Roberts,&nbsp;Eric Ko,&nbsp;Jackson G Holmgren,&nbsp;Chris Edwards,&nbsp;Michele Coleman,&nbsp;Jing Gao","doi":"10.1515/jom-2022-0216","DOIUrl":"https://doi.org/10.1515/jom-2022-0216","url":null,"abstract":"<p><strong>Context: </strong>Neck pain is a common complaint in healthcare clinics. Although the pathogenesis of neck pain is often multifactorial, trapezius muscle dysfunction has been commonly linked to neck pain. Osteopathic manipulative treatment (OMT) has been demonstrated to be an effective treatment modality in treating trapezius muscle dysfunction and neck pain. However, there is a current lack of objective, quantitative measures to assess the effectiveness of OMT. Through previous research, ultrasound technology has been shown to be promising in its ability to quantify tissue changes both pre- and post-OMT.</p><p><strong>Objectives: </strong>The objectives of this study are to evaluate the feasibility of shear wave elastography (SWE) in assessing upper trapezius muscles with pain and hypertonicity, as well as the changes in these muscles post-OMT for cervical somatic dysfunctions.</p><p><strong>Methods: </strong>After obtaining approval from the Rocky Vista University Institutional Review Board and written informed consent from participants, SWE and osteopathic assessments were performed on 22 adult participants with and without cervical spine somatic dysfunction. Participants with positive osteopathic assessments of tissue texture, asymmetry, restricted motion, and/or tenderness (TART) were treated utilizing OMT. Shear wave velocity (SWV, m/s) and shear wave velocity rate [SWVR = (SWV _contraction - SWV _relaxation)/ SWV _relaxation] of the upper trapezius muscles with and without pain and hypertonicity, and before and after OMT, were examined utilizing a two-tailed <i>t</i>-test.</p><p><strong>Results: </strong>SWV in muscle contraction and SWVR were significantly lower in muscles with pain compared to muscles without pain (p≤0.01). SWV in muscle contraction was also significantly lower in hypertonic muscles compared to normotonic muscles (p<0.01). Following OMT, SWV in muscle contraction and SWVR in muscles with pain and hypertonic increased significantly (p≤0.01). Overall TART score of all muscles with somatic dysfunction (SD) after OMT significantly decreased (p<0.01). SWV in muscle contraction and SWVR in hypertonic muscles were also significantly increased (p≤0.03), with an improvement index of 0.11 and 0.20.</p><p><strong>Conclusions: </strong>This study's results demonstrate the feasibility of utilizing SWE to evaluate somatic dysfunctions of the upper trapezius musculature and the efficacy of OMT for neck somatic dysfunctions.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"443-450"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097188","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 effect of perceived weight status and BMI perception on food attitudes and food relationships.","authors":"Sahil K Patel,&nbsp;Ryan Gericke,&nbsp;Jaime Dougherty,&nbsp;Adarsh Gupta","doi":"10.1515/jom-2022-0211","DOIUrl":"https://doi.org/10.1515/jom-2022-0211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Obesity has been a national epidemic throughout the United States due to the increasingly sedentary western lifestyle, paired with calorically dense abundant low-nutritional food options. Discussing weight necessitates the conversation of not only the numerical value (body mass index [BMI]) associated with obesity but also the perceived weight or how an individual categorizes their weight, irrespective of their calculated BMI classification. Perceived weight can influence food relationships, overall health, and lifestyle habits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes among three groups: those correctly identifying as \"obese\" with a BMI &gt;30 (BMI Corrects [BCs]), those incorrectly identifying as \"obese\" with a BMI &lt;30 (BMI Low Incorrect [BLI]), and those incorrectly identifying as \"nonobese\" with a BMI &gt;30 (BMI High Incorrect [BHI]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An online cross-sectional study was conducted from May 2021 to July 2021. Participants (n=104) responded to a 58-item questionnaire regarding demographics (n=9), health information (n=8), lifestyle habits (n=7), dietary habits (n=28), and food attitudes (n=6). Frequency counts and percentages were tabulated, and analysis of variance (ANOVA) testing was conducted to examine the associations utilizing SPSS V28 at a statistical significance level of p&lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants incorrectly identifying as \"obese\" with a BMI &lt;30 (BLI) had higher food attitude scores, indicating worse food attitudes, behaviors, and relationships with food compared to participants correctly identifying as \"obese\" with a BMI &gt;30 (BC) and incorrectly identifying as \"non-obese\" with a BMI &gt;30 (BHI). When comparing BC, BLI, and BHI participants, no statistically significant differences were found in dietary habit scores, lifestyle habit scores, weight change, or nutritional supplement or diet started. However, overall, BLI participants had worse food attitude scores and consumption habits when compared to BC and BHI participants. Even though dietary habit scores were not significant, an examination of specific food items revealed significant findings, in which BLI participants had higher consumption of potato chips/snacks, milk, and olive oil/sunflower oil, compared to BHI participants. BLI participants had higher beer and wine consumption compared to BC participants. Additionally, BLI participants had higher carbonated beverages, low-calorie beverages, and margarine and butter consumption compared to BHI and BC participants. BHI participants had the lowest hard liquor consumption, BC had the second lowest hard liquor consumption, and BLI participants had the highest consumption of hard liquor products.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings of this study have shed light on the intricate relationship that exists between perceived weight status from ","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"415-426"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10090369","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":"Acute generalized exanthematous pustulosis with systemic involvement.","authors":"Sama Alazawi","doi":"10.1515/jom-2022-0173","DOIUrl":"https://doi.org/10.1515/jom-2022-0173","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 10","pages":"505-507"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472297","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":"Associations of clinical personnel characteristics and controlled substance prescribing practices.","authors":"Robert Millhollon,&nbsp;Covenant Elenwo,&nbsp;Alex Lundberg,&nbsp;Will Roberts,&nbsp;Jason Beaman,&nbsp;Natasha Bray,&nbsp;Micah Hartwell","doi":"10.1515/jom-2022-0234","DOIUrl":"https://doi.org/10.1515/jom-2022-0234","url":null,"abstract":"<p><strong>Context: </strong>Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors.</p><p><strong>Objectives: </strong>This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]).</p><p><strong>Methods: </strong>We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns.</p><p><strong>Results: </strong>Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02).</p><p><strong>Conclusions: </strong>Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"451-458"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099965","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":"Critical care medicine training in the age of COVID-19.","authors":"Walter Mickey","doi":"10.1515/jom-2022-0244","DOIUrl":"https://doi.org/10.1515/jom-2022-0244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;The COVID-19 pandemic caused the largest disruption to graduate medical education in modern history. The danger associated with SARS-CoV-2 necessitated a paradigm shift regarding the fundamental approach to the education of medical residents and fellows. Whereas prior work has examined the effect of the pandemic on residents' experiences during training, the effect of the pandemic on academic performance of critical care medicine (CCM) fellows is not well understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study examined the relationship between CCM fellow's lived experiences during the COVID-19 pandemic and performance on in-training examinations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This mixed-methods study consisted of a quantitative retrospective analysis of critical care fellows' in-training examination scores and a qualitative, interview-based phenomenological examination of fellows' experiences during the pandemic while training in a single large academic hospital in the American Midwest. &lt;i&gt;Quantitative&lt;/i&gt;: Prepandemic (2019 and 2020) and intrapandemic (2021 and 2022) in-training examination scores were analyzed utilizing an independent samples &lt;i&gt;t&lt;/i&gt; test to determine whether a significant change occurred during the pandemic. &lt;i&gt;Qualitative:&lt;/i&gt; Individual semi-structured interviews were conducted with CCM fellows exploring their lived experiences during the pandemic and their perception of the effect on their academic performance. Transcribed interviews were analyzed for thematic patterns. These themes were coded and categorized, and subcategories were developed as indicated during the analysis. The identified codes were then analyzed for thematic connections and apparent patterns. Relationships between themes and categories were analyzed. This process was continued until a coherent picture could be assembled from the data to answer the research questions. Analysis was performed from a phenomenological perspective with an emphasis on interpretation of the data from the participants' perspectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;&lt;i&gt;Quantitative&lt;/i&gt;: Fifty-one in-training examination scores from 2019 to 2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the final analysis. A significant difference was found between mean total prepandemic and intrapandemic in-service examination scores (&lt;i&gt;t&lt;/i&gt; &lt;sub&gt;49&lt;/sub&gt;=2.64, p=0.01), with mean intrapandemic scores being 4.5 points lower than prepandemic scores (95 % CI, 1.08-7.92). &lt;i&gt;Qualitative:&lt;/i&gt; Interviews were conducted with eight CCM fellows. Thematic analysis of the qualitative interviews revealed three main themes: psychosocial/emotional effects, effects on training, and effects on health. The factors that most effected participants' perceptions of their training were burnout, isolatio","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"427-434"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10102406","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":"Sudden cardiac death in a young male endurance athlete.","authors":"Kevin D Seely,&nbsp;Kentlee B Crockett,&nbsp;Andrew Nigh","doi":"10.1515/jom-2023-0097","DOIUrl":"https://doi.org/10.1515/jom-2023-0097","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) is a rare yet devastating event that can occur in young athletes. Although hypertrophic obstructive cardiomyopathy is the most common cause of SCD, some other genetic abnormalities have been identified as proarrhythmic. However, there is not routine screening for these other genetic abnormalities. Furthermore, consumption of caffeine, stimulant medication, or prolonged exercise can potentiate the underlying arrhythmic potential. In the event of SCD, advanced cardiac life support (ACLS) should be performed immediately and exactly. The authors present a case of an otherwise healthy young male who collapsed during a marathon and could not be resuscitated despite aggressive measures. After aggressive resuscitative efforts, the patient ultimately expired. A postmortem autopsy revealed no cardiac structural abnormalities, and the cause of death was determined to be cardiac arrhythmia of undetermined etiology. Postmortem genetic testing revealed a heterozygous variation in calcium voltage-gated channel auxiliary subunit beta 2 (CACNB2), a gene associated with arrhythmia and calcium channelopathy. Toxicology showed therapeutic levels of amphetamine. This case highlights the eminent risk of cardiac death in young athletes with proarrhythmic genetic variations, especially in the setting of endurance sport.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 10","pages":"461-465"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10098278","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":"Optimal hand surgery fellowship interview format.","authors":"Lauren E Dittman,&nbsp;Nicholas F Munaretto,&nbsp;Peter C Rhee","doi":"10.1515/jom-2023-0044","DOIUrl":"https://doi.org/10.1515/jom-2023-0044","url":null,"abstract":"<p><strong>Context: </strong>The ideal format for residency and fellowship interviews has been consistently debated. Secondary to the COVID-19 pandemic, many institutions, including all hand surgery fellowship programs, transitioned interviews to an all-virtual format. In the past year, with ease of travel restrictions, some programs have transitioned back to in-person interviews, while others remain solely virtual. Hand surgery fellowship programs are continually assessing what are the best means for conducting these interviews, with little perspective regarding the applicant's preferences.</p><p><strong>Objectives: </strong>The purpose of this study was to examine hand surgery fellowship applicants' perspectives regarding in-person and virtual interviews. It was hypothesized that applicants would value interpersonal relationships between faculty when deciding upon their ideal hand surgery fellowship, which would be easier to appreciate in-person.</p><p><strong>Methods: </strong>All hand fellowship interviewees at a single institution were given a voluntary, electronic survey. The survey consisted of questions examining different aspects of the program's interview day and supplemental resources. Responses were recorded after the in-person interview for the years 2018-2020. Questions were altered for the virtual 2021 and 2022 interviews. Questions were scored on a Likert scale.</p><p><strong>Results: </strong>For the in-person interview cycles, there were 60/86 respondents (69.8 %). For the virtual interview cycles, there were 45/73 respondents (61.6 %). During the in-person interview cycles, applicants reported that the current fellows' perspective talk was the most helpful component. Many applicants commented that they enjoyed meeting their potential co-fellows. The virtual interviewees felt that they had the best understanding of the program's core values/culture and the worst understanding of faculty personalities and personal/family life. Twenty-nine (64.4 %) of virtual applicants would prefer an all in-person interview. Of the 16 respondents who did not advocate for a completely in-person interview, 56.3 % preferred the option for an in-person site visit.</p><p><strong>Conclusions: </strong>Hand surgery fellowship applicants desire interpersonal interactions to better understand prospective fellowship programs, which can be difficult to convey with an all-virtual interview. The results of this survey can help guide fellowship programs as they continue to optimize in-person, virtual, and hybrid interview formats and refine recruitment resources.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 10","pages":"467-473"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097698","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":"Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.","authors":"Mandy Cho,&nbsp;Robert Hostoffer","doi":"10.1515/jom-2023-0037","DOIUrl":"https://doi.org/10.1515/jom-2023-0037","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"459-460"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103315","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 effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs.","authors":"Harrison A Patrizio,&nbsp;Riley Phyu,&nbsp;Thomas Boyle,&nbsp;Todd Schachter","doi":"10.1515/jom-2022-0213","DOIUrl":"https://doi.org/10.1515/jom-2022-0213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;In light of the COVID-19 pandemic, healthcare-associated infections have taken center stage. Healthcare has adjusted workflows to accommodate for more robust disinfecting regiments to help protect the community. This has resulted in the need for medical institutions to reevaluate the current disinfection protocols down to the student level. The osteopathic manipulative medicine (OMM) laboratory provides an optimal avenue for assessing the effectiveness of medical students' ability to clean examination tables. With OMM laboratories having a high level of interaction, adequate disinfection is important for the health and safety of students and teaching faculties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study will evaluate the effectiveness of the current disinfection protocols in the medical school OMM labs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional, nonrandomized study was performed on 20 OMM examination tables utilized for osteopathic training. Tables were chosen based on their close proximity to the podium. Close proximity was utilized as a criteria to increase the probability of utilization by students. The sampled tables were observed to ensure their use by students during class. Initial samples were collected in the morning after disinfection by Environmental Services. Terminal samples were collected after Osteopathic medical students utilized and disinfected the OMM examination tables. Samples were collected from the face-cradle and midtorso regions and analyzed utilizing adenosine triphosphate (ATP) bioluminescence assays with an AccuPoint Advanced HC Reader. This reader provides a digital readout of the quantity of light measured in relative light units (RLUs), which is directly correlated to the amount of ATP present in the sample, providing an estimated pathogen count. For statistical analysis, a Wilcoxon signed-rank test was utilized to find statistical differences in RLUs in samples after initial and terminal disinfection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The face cradle showed a 40 % increase in failure rate in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed an estimated pathogen level for face cradle that was significantly higher after terminal disinfection (median, 4,295 RLUs; range, 2,269-12919 RLUs; n=20) compared to initial disinfection (median, 769 RLUs; range, 29-2,422 RLUs; n=20), &lt;i&gt;z&lt;/i&gt;=-3.8, p=0.00008, with a large effect size, &lt;i&gt;d&lt;/i&gt;=2.2. The midtorso region showed a 75 % increase in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed that the estimated pathogen levels for midtorso were significantly higher after terminal disinfecting (median, 656 RLUs; range, 112-1,922 RLUs; n=20) compared to initial disinfecting (median, 128 RLUs; range, 1-335 RLUs; n=20), &lt;i&gt;z&lt;/i&gt;=-3.9, p=0.00012, with a large effect size, &lt;i&gt;d&lt;/i&gt;=1.8.&lt;/p&gt;&lt;p&gt;&lt;s","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 9","pages":"435-441"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097200","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":"Diabetic ketoacidosis diagnosis in a hospital setting.","authors":"Amber M Healy,&nbsp;Mallory Faherty,&nbsp;Zeryab Khan,&nbsp;Naveen Emara,&nbsp;Cody Carter,&nbsp;Andrew Scheidemantel,&nbsp;Musa Abu-Jubara,&nbsp;Robert Young","doi":"10.1515/jom-2023-0019","DOIUrl":"https://doi.org/10.1515/jom-2023-0019","url":null,"abstract":"<p><strong>Context: </strong>Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.</p><p><strong>Objectives: </strong>The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to identify the frequency of endocrinology or diabetology consultation in the hospital setting.</p><p><strong>Methods: </strong>A retrospective chart review was conducted utilizing charts from three different hospitals within a hospital system. Charts were identified utilizing ICD-10 codes for admissions to the hospital for DKA. If the patient was over 18 and had one of the diagnostic codes of interest, the chart was reviewed for further details regarding the criteria for DKA diagnosis as well as admission and treatment details.</p><p><strong>Results: </strong>A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4 % of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. Most patients were admitted to the intensive care unit (ICU) and treated with IV insulin infusion (n=288). Consultation of endocrinology or diabetology occurred in 40.2 % (n=209) of all hospital admissions, and 128 of those consults occurred in ICU admissions. The diagnosis of DKA was incorrect in 92 of the patients admitted to the medical surgical unit (MSU) and in 49 of patients admitted to the ICU.</p><p><strong>Conclusions: </strong>Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":"123 10","pages":"499-503"},"PeriodicalIF":1.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10098306","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}