Osteopathic Family Physician最新文献

{"title":"Lower Back Pain in Adolescents with an Osteopathic Component","authors":"Daniel Givner, John Luksch, Caroline Polansky, Christopher Mehallo","doi":"10.33181/13101","DOIUrl":"https://doi.org/10.33181/13101","url":null,"abstract":"Low back pain (LBP) is a common complaint in adolescents and has been increasingly reported in recent years. Affecting roughly 40% of adolescents, it leads to negative overall health, higher incidence of LBP in adulthood, and greater utilization of health care resources over one’s lifetime. LBP in adolescents differs from adult populations due to variations in structural anatomy, which contribute to differing approaches in diagnosis and treatment of this condition. The differential diagnosis of LBP in this population is extremely broad and can be attributed to many underlying etiologic factors. Clinicians must conduct a thorough history and physical examination and consider the appropriate diagnostic testing to accurately diagnose adolescents early on in their conditions to provide the most effectivetreatment. Treatment for this condition ranges from rest and rehabilitation, to oral medications, OMT, bracing, and rarely, surgery. Physicians must also be able to recognize clear risk factors and symptoms for serious underlying pathology that can be causing LBP. This article will focus on diagnosis and treatment of the most common causes of LBP in adolescents.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"383 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135990599","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":"Clinical Management of Polypharmacy in the Elderly Population","authors":"Bahram Badri, Stephen Stacey, Brianna Konwinski","doi":"10.33181/13102","DOIUrl":"https://doi.org/10.33181/13102","url":null,"abstract":"Polypharmacy is defined as use of multiple medications (>5) and is common in the elderly adult population. Polypharmacy typically results from the accumulation of treatments for chronic medical conditions such as hypertension, diabetes, coronary artery disease, and psychiatric illnesses. It is associated with problems such as increased risk of falls and adverse medication events. Elderly patients take an average of two to nine medicines per day, and prevalence of polypharmacy in the elderly is 11.5%–62.5%. Elderly patients are at higher risk of adverse drug reactions due to metabolic changes and reduced drug clearance. Evaluation of polypharmacy is an important part of clinical assessment of the elderly population. This process involves performing an adequate medication reconciliation, including supplements, followed by systematic evaluation of medications looking for benefits and harms. It then involves discussing goals of care with the patient and, if necessary, creating a deprescribing plan. Whenprescribing new medications, prescribers should consider starting at the lower end of the dosing range and increasing only after monitoring for benefits and harms.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135990792","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 Biomechanical Links Between Pelvic Floor Dysfunction and Testicular Pain: A Clinical Review","authors":"Cody Jackson, Lubayna Fawcett","doi":"10.33181/13103","DOIUrl":"https://doi.org/10.33181/13103","url":null,"abstract":"Chronic scrotal content pain affects 100,000 men in the United States annually. Up to 50% of these cases do not resolve by following conventional treatment algorithms and are deemed to be idiopathic. There is little peer-reviewed literature supporting the specific cause and effect relationship between pelvic floor dysfunction and chronic scrotal content pain. Additionally, the specificity of the physical exam in these types of patients is not present in the literature. Overall, the literature is deficient in proposed treatment algorithms that address the large number of cases that are deemed to be idiopathic. Patients presenting with chronic scrotal content pain may benefit from an osteopathic diagnostic and treatment approach. In these types of patients, we recommend osteopathic manipulative therapy (OMT) or pelvic floor manual therapy prior to surgical intervention. This conservative approach may reduce the large portion of cases that aredeemed to be idiopathic. The emphasis on structure and function within osteopathic medical education places osteopathic family physicians in a unique position to be able to properly diagnose and treat this type of pain. Since most cases of chronic scrotal content pain are initially addressed in the primary care setting, it is important for osteopathic primary care physicians to remain vigilant in considering musculoskeletal dysfunction when evaluating these types of patients. This clinical review is underscored by a unique case presentation of a male collegiate athlete who helps demonstrate the larger gap that is present in the literature on male pelvic floor and scrotal content pain.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135990791","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":"Managing Difficult Encounters","authors":"R. Lande","doi":"10.33181/13096","DOIUrl":"https://doi.org/10.33181/13096","url":null,"abstract":"Difficult doctor-patient relationships are a recognized aspect of modern healthcare, but the actual incidence, risk factors, ethical issues, and management strategies are less well-known. The author queried PubMed, ScienceDirect, and the Education Resources Information Center. The inclusion criteria consisted of the free-text terms “difficult patient” and “difficult client” and the Medical Subject Heading terms “patient participation” and “professional-patient relations” with searches further refined by focusing on adults, management, screening, and incidence among review and research articles published in academic journals in English. The author excluded articles focused on children, adolescents, and anger management. This study condenses a body of research spanning two decades and can help clinicians understand factors that contribute to difficult encounters, employ simple screening instruments, and implement management approaches that can minimize difficult encounters and maximize their successful resolutions. Based on the collected evidence, most doctor-patient relationships are trouble-free, but some, ranging between 10% and 20%, are dominated by difficulties of varying degrees and types.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46400032","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":"Common Orthopaedic Shoulder Diagnoses Encountered in the Primary Care Setting","authors":"W. Wardell, Brett Auerbach, Min Je Woo, Donald E. Phykitt","doi":"10.33181/13097","DOIUrl":"https://doi.org/10.33181/13097","url":null,"abstract":"Shoulder pain and shoulder disorders are commonly seen in the primary care setting. While many of these disorders can be managed by the primary care physician, some may pose a diagnostic dilemma. This article will review 10 common shoulder disorders, evaluating when conservative management is appropriate and when referral to a specialist is warranted.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48299349","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":"Combating Poor Mental Health in Emergency Responders: Helping Emergency Responders Overcome (HERO) Act","authors":"Brittany R. Derynda, Krishan Gupta, Shreya Bhattacharya, T. L. Hollar","doi":"10.33181/13099","DOIUrl":"https://doi.org/10.33181/13099","url":null,"abstract":"Suicide rates are alarmingly higher among emergency responders than the general public, and it is estimated that 30% of first responders develop behavioral health conditions compared with 20% in the general population. Emergency responders experience their share of work-related stresses, but mental health problems in this demographic are often under-reported. For example, only 40% of suicides committed by emergency responders are reported. Amid these issues, there is a lack of best practice guidelines for mental health treatment among emergency responders. Hence, the stage is set for legislation to focus on improving mental health among emergency responders. The Helping Emergency Responders Overcome (HERO) Act seeks to improve mental health among emergency responders through improved detection, prevention, and treatment, ultimately leading to decreased rates of suicide. The HERO Act would implement data systems to capture rates and risk factors related to suicide, establish behavioral health and wellness programs within emergency responder departments, and implement evidence-based best practices to identify, prevent, and treat post-traumatic stress disorder in emergency responders. Osteopathic family medicine physicians play a crucial role in screening and managing poor mental health among their patients. Caring for the body, mind, and spirit is a core tenet of osteopathic medicine; therefore, osteopathic family physicians are uniquely positioned to help emergency responders overcome their mental health struggles. Given the prevalence of emergency responders who receive care from such physicians, and the value osteopathic medicine can offer this population, we encourage the profession to contribute to discussions surrounding the HERO Act.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48256985","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 Manipulative Treatment of Chronic Pelvic Pain due to High-Tone Pelvic Floor Dysfunction","authors":"Morgan E. Barnett, Kyle K. Henderson, Teresa Elliott-Burke, Kurt P. Heinking","doi":"10.33181/13095","DOIUrl":"https://doi.org/10.33181/13095","url":null,"abstract":"Context: Chronic pelvic pain syndrome (CPPS) is a complex pain syndrome that affects 15%–30% of people of childbearing age (~10–20 million, US). Etiologies range from musculoskeletal conditions and visceral disease to neurological and psychological disorders. The interplay of many systems and disorders can manifest into a complex pathophysiology that is difficult to diagnose and treat. Dysfunction of the musculoskeletal system is often involved in patients with CPPS, either as the cause of pain or the result of underlying disease or dysfunction. Hypertonicity of pelvic floor muscles, myofascial trigger points, and dysfunctional shortening of the levator ani group of muscles contribute to the structural and functional abnormalities involved in CPPS. Osteopathic physicians are in a unique position to directly address this somatic dysfunction with a nonpharmacologic, nonsurgical approach: osteopathic manipulative treatment (OMT).\u0000\u0000Objectives: The purpose of this article is to review the literature on manual treatment efficacy for high-tone pelvic floor dysfunction (HTPFD) and the standardization of diagnosis to provide rational, medically based treatments. The second purpose is to elucidate the steps that the medical, and specifically the osteopathic profession can take to standardize pelvic floor evaluation, diagnosis, and treatment in the primary care setting.\u0000\u0000Methods: A search was conducted on the US National Library of Medicine’s PubMed database for studies involving manual therapy treatment for HTPFD. The authors excluded studies that described manual therapy interventions aimed at increasing pelvic floor muscle tone in patients with urinary incontinence and/or pelvic organ prolapse.\u0000\u0000Results: For perspective, the initial search using the keywords “chronic pelvic pain syndrome” led to 2,281 publications since 1974; the addition of “osteopathic” led to 10 results since 2009. The search for “high-tone pelvic floor dysfunction” led to 30 publications since 1992; the addition of “osteopathic” yielded no results. To evaluate the efficacy of manual therapy for HTPFD, the search was expanded to include any manual therapy protocols. While the consensus in the literature is that manual treatment for chronic pelvic pain (CPP) is efficacious, the finding is limited by the lack of a comprehensive protocol to appropriately diagnose and treat the patient. The authors propose a system to standardize the assessment of a patient with CPP in the primary care setting by an appropriately trained physician so that pelvic floor dysfunction is recognized, properly diagnosed and treated, or referred to specialized care.\u0000\u0000Conclusion: The literature supports that manual therapy is an effective treatment for CPP, and as primary care providers, osteopathic physicians are uniquely placed to recognize and treat patients with HTPFD, providing an empathetic, patient-centered approach. Standardization of the diagnosis and manual treatment of HTPFD is required to assess and mo","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46611055","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":"An Osteopathic Approach to the Management of Systemic Lupus Erythematosus","authors":"Alexander M. Hoelscher, Gretchen Sonnenberg, Meng Smith, Derek Fritz, Annie Bélanger, Royce Toffol","doi":"10.33181/13098","DOIUrl":"https://doi.org/10.33181/13098","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women and people of Hispanic, African, and Asian descent. The treatment goals are similar to other autoimmune diseases: preventing progressive damage to organs and decreasing disease activity to increase patient quality of life. Steroids can lead to rapid control of symptoms but have many long-term side effects; patients should be transitioned to steroid-sparing agents and new biologics when possible. Special populations require specific considerations, such as those experiencing renal or neuropsychiatric symptoms or drug side effects or those who are pregnant or planning to conceive. Sustained remission is very difficult to achieve, and current guidelines recommend targeting a low SLE activity state to optimize quality of life. An osteopathic approach to managing SLE attempts to reflect the principles of osteopathy into evidence-based medicine to optimize quality of life.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44946416","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":"Covid-19 Fatigue: Diagnosis and Treatment for the Osteopathic Physician","authors":"Violeta B. Foss, Nicole Maddie, Elisabeth Frankini, Scott Landman, Jennifer Maccagnano, Sheldon C. Yao","doi":"10.33181/13090","DOIUrl":"https://doi.org/10.33181/13090","url":null,"abstract":"The novel coronavirus disease 2019 (COVID-19) has given rise to a global pandemic, as well as a multitude of long-term sequelae that continue to perplex physicians around the world, including in the United States. Among the most common and impactful long-haul symptoms experienced by survivors is COVID-19 fatigue. This review will use long COVID-19, post-acute COVID-19 syndrome (PCS), and Post-Acute Sequelae of COVID-19 (PASC) as synonymous terms to refer to the chronic symptomatology; chronic fatigue associated with PASC will be referred to as COVID-19 fatigue. While the knowledge and research on the exact pathophysiological mechanisms involved in the disease is still limited, parallels have been drawn between fatigue as a component of long COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Current studies suggest applying principles of pathophysiology, diagnosis, and treatment similar to those for ME/CFS in order to aid in managing chronic fatigue in COVID-19 survivors, particularly in the primary care setting. The osteopathic family physician can use the proposed pharmacologic agents, along with osteopathic manipulative treatment (OMT), as therapeutic modalities that can be tailored to each patient’s unique case. Nevertheless, research on proven successful treatments is still scarce. For that reason, it is essential that COVID-19 fatigue is recognized early, especially since its longitudinal impacts may be debilitating for many. This review of the available literature on COVID-19 fatigue aims to help provide quality care and lessen the disease burden experienced by patients.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42874530","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":"Prostate Cancer with a Presenting Symptom of Lower Thoracic Back Pain","authors":"Vasundhara Malhotra, Chinar Singh, Allison Weening, Shreya Patel, B. Mayi, J. Migliozzi, Vikas Malhotra","doi":"10.33181/13092","DOIUrl":"https://doi.org/10.33181/13092","url":null,"abstract":"Back pain is a common complaint addressed by family physicians. This is an uncommon case of a patient presenting with back pain and subsequent workup revealing a new diagnosis of metastatic prostate cancer with bone metastasis. This case can be used to highlight an unusual presentation and to facilitate inclusion of prostate cancer in the differential diagnosis. A review of the literature calls attention to the clinical features that make such a scenario likely and guides the discussion of the current understanding of the mechanisms leading to such a presentation. Underlying risk factors of obesity, diabetes, and chronic kidney disease (CKD) may increase this risk. A high Gleason score with poorly differentiated features also increases the risk of de novo metastatic presentation.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44732395","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}