Osteopathic medicine and primary care最新文献

{"title":"Treatment of specific macrovascular beds in patients with diabetes mellitus.","authors":"Allison M Petznick, Jay H Shubrook","doi":"10.1186/1750-4732-4-5","DOIUrl":"10.1186/1750-4732-4-5","url":null,"abstract":"<p><p> In 2007, over 23 million people had diabetes in the United States and death from cardiovascular disease is estimated to occur in 80% of those Americans. Risk factor reduction is the most important therapy for primary and secondary prevention of macrovascular disease in patients with and without diabetes mellitus. Despite this, presentation and response to therapy is often different for patients with diabetes compared to their non-diabetic counterparts. This paper will review the current targets for therapy of cardiovascular disease, peripheral vascular disease, and cerebrovascular disease in patients with diabetes.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29181935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning outcomes from a biomedical research course for second year osteopathic medical students.","authors":"des Anges Cruser,&nbsp;Sarah K Brown,&nbsp;Jessica R Ingram,&nbsp;Alan L Podawiltz,&nbsp;Bruce D Dubin,&nbsp;John S Colston,&nbsp;Robert J Bulik","doi":"10.1186/1750-4732-4-4","DOIUrl":"https://doi.org/10.1186/1750-4732-4-4","url":null,"abstract":"<p><strong>Background: </strong>A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts.</p><p><strong>Methods: </strong>This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year.</p><p><strong>Results: </strong>We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score.</p><p><strong>Conclusions: </strong>This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-4-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29106655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteopathic manipulative treatment for pneumonia.","authors":"Murray Goldstein","doi":"10.1186/1750-4732-4-3","DOIUrl":"https://doi.org/10.1186/1750-4732-4-3","url":null,"abstract":"<p><p> The pneumonias due to infection continue to be a meaningful threat to the health and viability of persons, particularly those in high risk groups: children, the aged and the debilitated. Noll and colleagues provide us with the results of a well-designed and well-executed multi-institutional controlled clinical trial to evaluate the efficacy of osteopathic manipulative treatment (OMT) in the treatment of pneumonia. The data obtained indicate that by intention-to-treat analysis, the addition of OMT to conventional care did not improve the designated outcomes when compared to conventional care only. A disappointing but important finding. However, by per-protocol analysis, the addition of OMT or of light touch decreased length of hospital stay, the duration of intravenous antibiotics and the incidence of respiratory failure and death relative to conventional care only. Further study is called for to explain these surprising results.Meeting the need for randomized clinical trials of the role and efficacy of OMT is a responsibility of high priority for the osteopathic profession in this age of evidence-based medicine. The American Osteopathic Association (AOA) needs to consider reinstating a dues-generated financial set-aside both to increase its support of osteopathic research and to initiate a program of physician-investigator career development awards to recruit and help establish osteopathic clinical investigators in a career in translational and clinical research.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-4-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28845767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial.","authors":"Donald R Noll,&nbsp;Brian F Degenhardt,&nbsp;Thomas F Morley,&nbsp;Francis X Blais,&nbsp;Kari A Hortos,&nbsp;Kendi Hensel,&nbsp;Jane C Johnson,&nbsp;David J Pasta,&nbsp;Scott T Stoll","doi":"10.1186/1750-4732-4-2","DOIUrl":"https://doi.org/10.1186/1750-4732-4-2","url":null,"abstract":"<p><strong>Background: </strong>The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia.</p><p><strong>Methods: </strong>406 subjects aged >/= 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score.</p><p><strong>Results: </strong>Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group.</p><p><strong>Conclusions: </strong>ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-4-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28845765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteopathic Medicine and Primary Care: one journal, two audiences.","authors":"John C Licciardone","doi":"10.1186/1750-4732-4-1","DOIUrl":"https://doi.org/10.1186/1750-4732-4-1","url":null,"abstract":"<p><p>Osteopathic Medicine and Primary Care (OMPC) enters its fourth year of operation in 2010 under the umbrella of BioMed Central. Osteopathic Medicine and Primary Care strives to promote and advance research and scholarly work within the fields of osteopathic medicine and primary care. In so doing, OMPC welcomes submissions from clinicians within both the osteopathic and allopathic medical professions, and from other professionals having interests in primary care, including health care delivery, public health, and evidence-based medicine. Osteopathic Medicine and Primary Care offers fair and expeditious peer review (mean time from submission to publication, 118 days), retention of copyright for authors, unlimited online distribution and access without charge to readers, indexing in PubMed, and archiving in PubMed Central. In 2010, there will be an increased availability of waivers or discounts of article processing charges via several mechanisms for eligible authors who submit qualified manuscripts, especially in the field of primary care.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-4-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28705497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The primary care workforce: a critical element in mending the fractured US health care system.","authors":"Roberto Cardarelli","doi":"10.1186/1750-4732-3-11","DOIUrl":"https://doi.org/10.1186/1750-4732-3-11","url":null,"abstract":"<p><p> A focus on the primary care workforce is critical when discussing plans to address the fractured United States health care system. However, we must first address the primary care physician shortage crisis when planning for health care reform which focuses on increasing access to the US population. Initial strategies may include improving reimbursement rates for primary care services, incentivizing medical schools in making primary care training a priority, and developing robust loan-forgiveness programs for those who enter and work in primary care specialties. Planning with congressional representatives about these elements will better ensure sustainable health reform efforts are implemented.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28442084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomedical research competencies for osteopathic medical students.","authors":"des Anges Cruser,&nbsp;Bruce Dubin,&nbsp;Sarah K Brown,&nbsp;Lori L Bakken,&nbsp;John C Licciardone,&nbsp;Alan L Podawiltz,&nbsp;Robert J Bulik","doi":"10.1186/1750-4732-3-10","DOIUrl":"https://doi.org/10.1186/1750-4732-3-10","url":null,"abstract":"<p><strong>Background: </strong>Without systematic exposure to biomedical research concepts or applications, osteopathic medical students may be generally under-prepared to efficiently consume and effectively apply research and evidence-based medicine information in patient care. The academic literature suggests that although medical residents are increasingly expected to conduct research in their post graduate training specialties, they generally have limited understanding of research concepts.With grant support from the National Center for Complementary and Alternative Medicine, and a grant from the Osteopathic Heritage Foundation, the University of North Texas Health Science Center (UNTHSC) is incorporating research education in the osteopathic medical school curriculum. The first phase of this research education project involved a baseline assessment of students' understanding of targeted research concepts. This paper reports the results of that assessment and discusses implications for research education during medical school.</p><p><strong>Methods: </strong>Using a novel set of research competencies supported by the literature as needed for understanding research information, we created a questionnaire to measure students' confidence and understanding of selected research concepts. Three matriculating medical school classes completed the on-line questionnaire. Data were analyzed for differences between groups using analysis of variance and t-tests. Correlation coefficients were computed for the confidence and applied understanding measures. We performed a principle component factor analysis of the confidence items, and used multiple regression analyses to explore how confidence might be related to the applied understanding.</p><p><strong>Results: </strong>Of 496 total incoming, first, and second year medical students, 354 (71.4%) completed the questionnaire. Incoming students expressed significantly more confidence than first or second year students (F = 7.198, df = 2, 351, P = 0.001) in their ability to understand the research concepts. Factor analyses of the confidence items yielded conceptually coherent groupings. Regression analysis confirmed a relationship between confidence and applied understanding referred to as knowledge. Confidence scores were important in explaining variability in knowledge scores of the respondents.</p><p><strong>Conclusion: </strong>Medical students with limited understanding of research concepts may struggle to understand the medical literature. Assessing medical students' confidence to understand and objectively measured ability to interpret basic research concepts can be used to incorporate competency based research material into the existing curriculum.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28433620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease.","authors":"Donald R Noll, Jane C Johnson, Robert W Baer, Eric J Snider","doi":"10.1186/1750-4732-3-9","DOIUrl":"10.1186/1750-4732-3-9","url":null,"abstract":"<p><strong>Background: </strong>The use of manipulation has long been advocated in the treatment of chronic obstructive pulmonary disease (COPD), but few randomized controlled clinical trials have measured the effect of manipulation on pulmonary function. In addition, the effects of individual manipulative techniques on the pulmonary system are poorly understood. Therefore, the purpose of this study was to determine the immediate effects of four osteopathic techniques on pulmonary function measures in persons with COPD relative to a minimal-touch control protocol.</p><p><strong>Methods: </strong>Persons with COPD aged 50 and over were recruited for the study. Subjects received five, single-technique treatment sessions: minimal-touch control, thoracic lymphatic pump (TLP) with activation, TLP without activation, rib raising, and myofascial release. There was a 4-week washout period between sessions. Protocols were given in random order until all five techniques had been administered. Pulmonary function measures were obtained at baseline and 30-minutes posttreatment. For the actual pulmonary function measures and percent predicted values, Wilcoxon signed rank tests were used to test within-technique changes from baseline. For the percent change from baseline, Friedman tests were used to test for between-technique differences.</p><p><strong>Results: </strong>Twenty-five subjects were enrolled in the study. All four tested osteopathic techniques were associated with adverse posttreatment changes in pulmonary function measures; however, different techniques changed different measures. TLP with activation increased posttreatment residual volume compared to baseline, while TLP without activation did not. Side effects were mild, mostly posttreatment chest wall soreness. Surprisingly, the majority of subjects believed they could breathe better after receiving osteopathic manipulation.</p><p><strong>Conclusion: </strong>In persons with COPD, TLP with activation, TLP without activation, rib raising, and myofascial release mildly worsened pulmonary function measures immediately posttreatment relative to baseline measurements. The activation component of the TLP technique appears to increase posttreatment residual volume. Despite adverse changes in pulmonary function measures, persons with COPD subjectively reported they benefited from osteopathic manipulation.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28424442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of calvarial structure motion by MRI.","authors":"William T Crow, Hollis H King, Rita M Patterson, Vincent Giuliano","doi":"10.1186/1750-4732-3-8","DOIUrl":"10.1186/1750-4732-3-8","url":null,"abstract":"<p><strong>Background: </strong>Practitioners of manual medicine/manual therapy (MM/MT) who utilize techniques thought to have some impact upon and move the solid structures of the human head have been criticized for lack of evidence of cranial bone motion. The present study utilized magnetic resonance imagery (MRI) technology to address the question of whether or not inherent (non-operator initiated) calvarial structure motion can be assessed.</p><p><strong>Methods: </strong></p><p><strong>Subjects: </strong>Twenty healthcare professionals, (physicians, nurses, medical students, pharmacists) between the ages of 24 and 52 were recruited. Seven females (ages 25-47, mean age 36.7) and 13 males (ages 25-53, mean age 31.2) volunteered. Technology: MRI scans were acquired at 450 ms per slice, in a 1.5 Tesla Signa Excite HD closed MRI system. The same scan prescription was repeated serially every 45 seconds to obtain eight serial slices for each subject. Image analysis was accomplished using ImageJ software (ImageJ 1.33 u National Institutes of Health, USA). Data from all eight images for each of the 20 subjects were analyzed to determine the two images with the largest differences in the parameters measured.</p><p><strong>Results: </strong>Difference values for the measures of area, width, height, major axis, and feret were statistically different whereas the measures for perimeter and minor axis were not. However, only the difference values for area were both statistically different (p < 0.003) and exceeded the resolution threshold of 0.898 mm/pixel.</p><p><strong>Discussion: </strong>The statistically significant difference value for area is suggestive of inherent motion in calvarial structures, and adds to the body of evidence supportive of biomechanically measurable calvarial structure motion in general. That the total intracranial area appeared to expand and recede was consistent with theory and prior studies suggestive of calvarial structure motion due to intracranial fluid volume changes.</p><p><strong>Conclusion: </strong>The use of MRI technology was able to demonstrate calvarial structure motion at a level exceeding the resolution threshold, and provides a means for further research on phenomena related to the cranial concept. It may be just a matter of time until increased resolution of MRI technology and image analysis provide the ability to examine more detailed areas of specific cranial bone motion.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28384818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment.","authors":"Brian C Clark,&nbsp;Stevan Walkowski,&nbsp;Robert R Conatser,&nbsp;David C Eland,&nbsp;John N Howell","doi":"10.1186/1750-4732-3-7","DOIUrl":"https://doi.org/10.1186/1750-4732-3-7","url":null,"abstract":"<p><strong>Background: </strong>Muscle functional magnetic resonance imaging (mfMRI) measures transverse relaxation time (T2), and allows for determination of the spatial pattern of muscle activation. The purposes of this pilot study were to examine whether MRI-derived T2 or side-to-side differences in T2 (asymmetries) differ in low back muscles between subjects with acute low back pain (LBP) compared to asymptomatic controls, and to determine if a single osteopathic manipulative treatment (OMT) session alters these T2 properties immediately and 48-hours after treatment.</p><p><strong>Methods: </strong>Subjects with non-specific acute LBP (mean score on 110 visual analog score = 3.02 +/- 2.81) and asymptomatic controls (n = 9/group) underwent an MRI, and subsequently the LBP subjects received OMT and then underwent another MRI. The LBP subjects reported back for an additional MRI 48-hours following their initial visit. T2 and T2 asymmetry were calculated from regions of interest for the psoas, quadratus lumborum (QL), multifidus, and iliocostalis lumborum/longissimus thoracis (IL/LT) muscles.</p><p><strong>Results: </strong>No differences were observed between the groups when T2 was averaged for the left and right side muscles. However, the QL displayed a significantly greater T2 asymmetry in LBP subjects when compared to controls (29.1 +/- 4.3 vs. 15.9 +/- 4.1%; p = 0.05). The psoas muscle also displayed a relatively large, albeit non-significant, mean difference (22.7 +/- 6.9 vs. 9.5 +/- 2.8%; p = 0.11). In the subjects with LBP, psoas T2 asymmetry was significantly reduced immediately following OMT (25.3 +/- 6.9 to 6.1 +/- 1.8%, p = 0.05), and the change in LBP immediately following OMT was correlated with the change in psoas T2 asymmetry (r = 0.75, p = 0.02).</p><p><strong>Conclusion: </strong>Collectively, this pilot work demonstrates the feasibility of mfMRI for quantification and localization of muscle abnormalities in patients with acute low back pain. Additionally, this pilot work provides insight into the mechanistic actions of OMT during acute LBP, as it suggests that it may attenuate muscle activity asymmetries of some of the intrinsic low back muscles.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28368748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}