JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION最新文献

{"title":"Communication Skills of Grandview/Southview Medical Center General Surgery Residents.","authors":"Wesley Johnson,&nbsp;Nhat-Anh Ngo,&nbsp;Michael Elrod","doi":"10.7556/jaoa.2020.122","DOIUrl":"https://doi.org/10.7556/jaoa.2020.122","url":null,"abstract":"<p><strong>Context: </strong>In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism.</p><p><strong>Objectives: </strong>To assess strengths and weaknesses of residents' interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT).</p><p><strong>Methods: </strong>From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language.</p><p><strong>Results: </strong>The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: \"greeted me in a way that made me feel comfortable\" (#1), \"talked in terms I could understand\" (#8), \"encouraged me to ask questions\" (#10), \"involved me in decisions as much as I wanted\" (#11), \"showed care and concern\" (#13), and \"spent the right amount of time with me\" (#14).</p><p><strong>Conclusions: </strong>Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9483742","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":"Mobitz Type II Atrioventricular Heart Block After Candlenut Ingestion.","authors":"Andrew L Koons,&nbsp;Lexis T Laubach,&nbsp;Kenneth D Katz,&nbsp;Gillian A Beauchamp","doi":"10.7556/jaoa.2020.136","DOIUrl":"https://doi.org/10.7556/jaoa.2020.136","url":null,"abstract":"<p><p>The candlenut is a highly accessible seed marketed as a natural weight-loss supplement. However, there is little known about the exact mechanism of action for weight loss nor for the many adverse symptoms it causes, such as nausea, vomiting, fatigue, cardiac dysrhythmias, and even death. In this case report, the authors present a 44-year-old woman who developed a second-degree, Mobitz type II atrioventricular block after consumption of a candlenut supplement. She presented to the emergency department with syncope and her cardiac rhythm indicated a second-degree heart block soon after ingesting candlenuts recommended by her treating physician. Interestingly, a detectable digoxin concentration obtained on hospital day 2 was measured but of unclear significance given no obvious exposure to a cardioactive glycoside. The patient's rhythm normalized on hospital day 2 and she was discharged uneventfully.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38457604","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":"Remdesivir for the Treatment of Severe COVID-19: A Community Hospital's Experience.","authors":"Stephen Lee,&nbsp;Anthony Santarelli,&nbsp;Kristen Caine,&nbsp;Sarah Schritter,&nbsp;Tyson Dietrich,&nbsp;John Ashurst","doi":"10.7556/jaoa.2020.156","DOIUrl":"https://doi.org/10.7556/jaoa.2020.156","url":null,"abstract":"<p><strong>Context: </strong>Following the emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), researchers sought safe and effective treatment modalities. Remdesivir is currently being evaluated for clinical efficacy and safety in patients with COVID-19.</p><p><strong>Objective: </strong>To describe the clinical outcomes of COVID-19 patients following treatment with remdesivir at a community hospital.</p><p><strong>Methods: </strong>A retrospective review of medical records was conducted in August 2020 for all patients given remdesivir while hospitalized for severe COVID-19 between May 1 and August 19, 2020. A convenience sample of consecutive patients with treatment including remdesivir, antibiotics, convalescent plasma, dexamethasone, or a combination of multiple drugs was included in the analysis. Patients receiving remdesivir were administered a 5-day treatment course. Patients with a glomerular filtration rate of less than 30 mL/min, those with liver function tests 5 times the normal reference range, and those who were pregnant were excluded from treatment with remdesivir. Differences in between men and women were detected with χ2 and independent samples t tests. The degree to which presenting symptoms influenced patient outcomes was analyzed with a stepwise logistic regression.</p><p><strong>Results: </strong>Among the 76 patients who received remdesivir, the mean (95% confidence interval, CI) age was 63 years (59.8-66.2). Thirty-six (47.4%) were men and 40 (52.6%) were women. Forty-nine (64.5%) were White and 27 (35.5%) were nonWhite. The majority of patients (54; 71.1%) had at least 1 comorbid condition, with hypertension being the most common (43; 56.6%). The mean (95% CI) length of stay for patients who received remdesivir was 10.09 days (8.6-11.6) and the mean (95% CI) duration of oxygen therapy was 9.42 days (8.0-10.8). A total of 14 (18.4%) patients given remdesivir were admitted to the intensive care unit (ICU) with an mean (95% CI) length of stay of 9.29 days (5.6-13.0). Women administered remdesivir were more likely to be admitted to the ICU (11 [27.5%] vs 3 [8.3%]; P=.031). The mortality rate was 14 patients (18.4%), with no statistically significant difference observed between men (5; 13.9%) and women (9; 22.5%; P=.33). No significant difference was seen amongst sexes for duration of oxygen therapy (men, 8.0 days [6.2-9.8] vs women, 10.76 days [8.8-12.8]; P=.051) or length of stay (men, 8.61 days [6.7-10.5] vs women, 11.43 days [9.3-13.5]; P=.058). There was no statistically significant difference in pooled racial groups (White vs nonWhite) for in-hospital mortality, number admitted to the ICU, days spent in the ICU, duration of oxygen use, or length of stay.</p><p><strong>Conclusion: </strong>Remdesivir may show clinical efficacy for the treatment of severe COVID-19 in a community setting. Although this was a small-scale study with limited patien","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38659995","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":"Septic Pulmonary Emboli With Feeding Vessel Sign.","authors":"Tyler Kemnic,&nbsp;Rohan Prasad","doi":"10.7556/jaoa.2020.130","DOIUrl":"https://doi.org/10.7556/jaoa.2020.130","url":null,"abstract":"Submitted August 5, 2020; revision received August 17, 2020; accepted August 21, 2020. A 42-year-old woman with emphysema and a history of intravenous drug abuse and smoking presented to the emergency department for shortness of breath. She had a 2-week duration of dyspnea at rest, a left foot wound, and fevers. Initial vital signs were 103.8 ̊F, 139 bpm, and 60 rpm. She required supplemental oxygen. Physical examination revealed diffuse bilateral wheezes and a left foot abscess. Blood cultures and polymerase chain reaction revealed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Chest computed tomography angiography demonstrated diffuse bilateral pulmonary cavitation with the dominant lesion having a feeding vessel sign (image). The patient was diagnosed with MRSA endocarditis on echocardiogram with septic pulmonary emboli. Vancomycin was administered; however, the patient needed to be intubated. Lymphatic drainage was contraindicated in the patient because of the risk of systemic infection, bacteremia, and possible further dislodging emboli. Due to further decompensation, the family chose to pursue comfort care measures. A septic pulmonary embolism is a blood vessel that is obstructed, usually by an infected thrombus. The pathogenesis consists of an embolic or ischemic event followed by an infection causing inflammation, which may form an abscess. Abscesses are most commonly caused by staphylococcal species, especially from infective endocarditis. On imaging, the “feeding vessel sign,” also known as “fruits on the branch sign,” is a combination of a distinct vessel leading directly to a nodular or mass. This finding can indicate one of the following: hematogenous origin near the small pulmonary vessels, a lung metastasis, or arteriovenous malformation. (doi:10.7556/jaoa.2020.130)","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38412364","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":"Osteopathic Approach to the Treatment of a Patient With Idiopathic Iliohypogastric Neuralgia.","authors":"David B Fuller","doi":"10.7556/jaoa.2020.150","DOIUrl":"https://doi.org/10.7556/jaoa.2020.150","url":null,"abstract":"<p><p>Iliohypogastric neuralgia is an uncommon etiology of lower abdominal pain caused by entrapment of the iliohypogastric nerve. Conventional management consists of medications, injections, and surgery; previous literature has not explored the use of osteopathic manipulative medicine for management of iliohypogastric neuralgia. Here, the author discusses the case of a 72-year-old woman who presented with 2 years of right lower abdominal pain, having failed multiple treatments, including exploratory laparoscopy and appendectomy. Following management of the patient's somatic dysfunctions with osteopathic manipulative treatment and a heel lift, her iliohypogastric neuralgia was significantly improved.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38514587","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":"Toward Resilience: Medical Students' Perception of Social Support.","authors":"Sharon Casapulla,&nbsp;Jason Rodriguez,&nbsp;Samantha Nandyal,&nbsp;Bhakti Chavan","doi":"10.7556/jaoa.2020.158","DOIUrl":"https://doi.org/10.7556/jaoa.2020.158","url":null,"abstract":"<p><strong>Context: </strong>There is strong evidence that social support-particularly perceived social support-functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social support they experience.</p><p><strong>Objective: </strong>To determine how osteopathic medical students perceive social support, understand the factors that influence their perceptions, and explore how group participation in a cocurricular, academic program could affect student perceptions.</p><p><strong>Methods: </strong>In this cross-sectional study of 983 medical students at a multicampus osteopathic medical school in the Midwest, potential respondents were invited by email in March 2018 to participate in a self-reported evaluation of their perceived social support using a 40-question Interpersonal Support Evaluation List (ISEL). The demographic variables included gender, race, age, current phase in medical school, Hispanic heritage, campus assignment, and hometown population type. A total score for each type of social support and a summative score for overall perceived social support were calculated. Descriptive statistics were applied to provide a summary of the distribution of study variables. Bivariate analyses were conducted using student t test and analysis of variance (ANOVA) statistic to determine distribution of 4 social support constructs and overall social support by all the study variables; α < .05 was considered statistically significant. Linear regression analysis was performed to determine the association between all study variables and 4 social support constructs. Pairwise interactions were calculated to determine whether the association differed by any of the study variables.</p><p><strong>Results: </strong>Self-esteem support was the lowest type of perceived social support overall in the total sample (mean [SD], 23.5[2.0]). Hispanic students reported lower overall mean perceived social support than those who did not identify as Hispanic (100 vs 104; P=.04). Older study participants had higher mean tangible support compared with their younger counterparts (26.25 vs. 25.60, P=.018; t [264]=1.18). Older study participants also had higher mean appraisal support compared with their younger counterparts (26.57 vs. 25.92, P=.06; t [266]=1.27). Female medical students reported lower levels of belonging support overall (mean [SD] 26.79, [2.10]). Students from rural hometowns reported a higher sense of belonging support than any other group. Female students from suburban and urban hometowns reported lower levels of belonging support compared with women from rural hometowns (Adj. β=-0.96, P=.01). Students who participated in the rural and urban underserved program had higher self esteem support compared with those who did not participate in the rural and urban underserved program (Adj. β=-1.30, P=.05). Students in the clinical phase of medical education reported lower levels of belonging support than st","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38582408","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":"Comparison of State Medical Licensing Board Disclosures Regarding Resident Performance for United States Allopathic, Osteopathic, and Foreign Medical Graduates.","authors":"Michal Gajewski,&nbsp;Machteld Hillen,&nbsp;Daniel Matassa,&nbsp;Anastasia Kunac,&nbsp;Michael Anana,&nbsp;Lisa Pompeo,&nbsp;Neil Kothari,&nbsp;Tiffany Murano","doi":"10.7556/jaoa.2020.152","DOIUrl":"https://doi.org/10.7556/jaoa.2020.152","url":null,"abstract":"<p><strong>Context: </strong>While recent streamlining of the graduate medical education process signals an important change from the traditional dichotomy between doctors of osteopathic medicine (DOs) and US-trained doctors of medicine (USMDs), this new uniformity does not continue into the process for licensure, including state medical licensing verification of training (VOT) forms for DOs, MDs, and foreign medical graduates (FMGs). Wide variability remains.</p><p><strong>Objective: </strong>To document the differences in the performance metrics program that directors are required to disclose to state medical licensing boards for DOs and FMGs compared with USMDs.</p><p><strong>Methods: </strong>VOT forms were collected from all osteopathic and allopathic licensing boards for all US states, Washington DC, and US territories. The authors then reviewed VOT forms for questions pertaining to trainee performance only in states where VOT forms differed for DOs, USMDs, and FMGs. Licensing board questions were categorized as relating to disciplinary action, documents placed on file, resident actions, and nondisciplinary actions by the program.</p><p><strong>Results: </strong>Fifty-six states and territories were included in the study (50 US states; Washington, DC; and 5 US territories). Most states and territories (46; 82.1%) used the same VOT form for DOs and USMDs. All states and territories except New York used the same form for FMGs and USMDs (55; 98.2%). Of the 14 states with an osteopathic board, Nevada used Federation Credentials Verification Service (FCVS) for DOs only, and 8 states used a unique osteopathic VOT form. Of these 8 osteopathic boards, 3 VOT forms did not ask any questions regarding resident performance during training. Of the remaining 5 forms, all asked about disciplinary actions. Ten states and 1 territory (US Virgin Islands) required the FCVS for both USMDs and FMGs, but not for DOs, while New York required FCVS only for FMGs. Nevada required FCVS only for DOs.</p><p><strong>Conclusion: </strong>Although VOT requirements for FMGs and USMDs were mostly the same within states, performance metric question sets varied greatly from state to state and within states for osteopathic vs allopathic licensing boards. Implementation of a standardized VOT form for all applicants that includes academic performance metrics may help ensure that medical licensure is granted to all physicians who demonstrate academic competency during training, regardless of their degree.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38659996","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 Use of Osteopathic Manipulative Medicine in the Management of Recurrent Mastitis.","authors":"Caitlin Jackson,&nbsp;Brian Loveless","doi":"10.7556/jaoa.2020.143","DOIUrl":"https://doi.org/10.7556/jaoa.2020.143","url":null,"abstract":"<p><p>Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38532588","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":"Dysphagia Lusoria.","authors":"Karl Andersen,&nbsp;Ryan Hoff,&nbsp;Dean Silas","doi":"10.7556/jaoa.2020.139","DOIUrl":"https://doi.org/10.7556/jaoa.2020.139","url":null,"abstract":"Submitted February 9, 2020; revision received August 25, 2020; accepted September 15, 2020. A 68-year-old man presented to the emergency room with decreased appetite and regurgitation of food for several months. The patient's history was notable for developmental delay, well-controlled gastroesophageal reflux disease without esophagitis, and imperforate anus status post colostomy. A fluoroscopic swallow evaluation showed no aspiration. A barium esophagram showed a calcified aortic arch trapping the proximal esophagus anteriorly and posteriorly, resulting in the bayonet sign (image A). Computed tomography angiography of the chest confirmed compression of the esophagus by the anomalous aortic arch, marked by increased tortuosity and a right circumflex cervical aortic arch causing esophageal compression high in the mediastinum (image B). The patient was treated with dietary modifications and had satisfactory results. Dysphagia lusoria is a rare, intrathoracic vascular abnormality, usually due to an aberrant right subclavian artery, resulting in esophageal compression and dysphagia. Dysphagia lusoria usually presents with difficulty swallowing solid foods, cough, thoracic pain, or Horner syndrome. The mean age of symptom onset is 50 years. The diagnosis is usually achieved with an initial barium esophagram, followed by computed tomography or magnetic resonance imaging scan. Mild to moderate symptoms may respond to lifestyle and dietary modifications, whereas more severe cases may require surgery. (doi:10.7556/ jaoa.2020.139)","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38482531","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":"[PREPRINT] \"Somebody Who Does Something Other Than Osteopathy\".","authors":"Nicholas B Sajjadi, Samuel Shepard","doi":"10.7556/jaoa.2020.159","DOIUrl":"10.7556/jaoa.2020.159","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38599768","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}