Osteopathic medicine and primary care最新文献

{"title":"Time for the osteopathic profession to take the lead in musculoskeletal research.","authors":"John C Licciardone","doi":"10.1186/1750-4732-3-6","DOIUrl":"https://doi.org/10.1186/1750-4732-3-6","url":null,"abstract":"<p><p> Musculoskeletal conditions, such as low back pain, are prevalent in the United States. These conditions exact an enormous toll on society, both in terms of their detrimental impact on quality of life and on the costs of treatment and lost productivity. Osteopathic physicians, as common providers of primary care services and spinal manipulation, are ideally positioned to lead future research efforts in this field. The emergence of data and standards relevant to osteopathic manipulative treatment outcomes, refinement of research methodologies to enhance evidence-based medicine, and investments in developing osteopathic research infrastructure are all critical elements in moving this field of research forward.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28395646","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":"Management of progressive type 2 diabetes: role of insulin therapy.","authors":"Ramachandra Rahul V Chemitiganti,&nbsp;Craig W Spellman","doi":"10.1186/1750-4732-3-5","DOIUrl":"https://doi.org/10.1186/1750-4732-3-5","url":null,"abstract":"<p><p> Insulin is an effective treatment for achieving tight glycemic control and improving clinical outcomes in patients with diabetes. While insulin therapy is required from the onset of diagnosis in type 1 disease, its role in type 2 diabetes requires consideration as to when to initiate and advance therapy. In this article, we review a case study that unfolds over 5 years and discuss the therapeutic decision points, initiation and advancement of insulin regimens, and analyze new data regarding the advantages and disadvantages of tight management of glucose levels.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28282812","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":"Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States.","authors":"Gary Fryer,&nbsp;Christopher M Morse,&nbsp;Jane C Johnson","doi":"10.1186/1750-4732-3-4","DOIUrl":"10.1186/1750-4732-3-4","url":null,"abstract":"<p><strong>Background: </strong>Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States.</p><p><strong>Methods: </strong>A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the \"frequently\" and \"always\" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests.</p><p><strong>Results: </strong>One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic manipulative techniques used (83%), document somatic dysfunction with Fryette nomenclature (64%), and bill for osteopathic manipulative treatment (92%).</p><p><strong>Conclusion: </strong>Respondents reported the use of a broad range of assessment and treatment approaches. Results suggest a higher use of myofascial release and cranial technique and lower use of high-velocity techniques in this group of physicians compared to previous studies.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28108626","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":"School-based health centers: A four year experience, with a focus on reducing student exclusion rates.","authors":"James E Foy,&nbsp;Kathy Hahn","doi":"10.1186/1750-4732-3-3","DOIUrl":"https://doi.org/10.1186/1750-4732-3-3","url":null,"abstract":"<p><p> We describe a four year collaborative experience with an on-site, community school-based health center that is staffed by the Vallejo City Unified School District and supervised by the pediatric faculty of the Touro University College of Osteopathic Medicine, with particular attention to first grade student exclusion rates.Patient demographics (including payer source), first grade enrollment statistics, and first grade exclusion rates were analyzed using school district enrollment and exclusion data, billing data, and Child Health Disability Program data.An ethnically diverse patient population is described, with the payer source in 99% of patients being the State of California Child Health Disability Program or no insurance source. Ninety-one percent of office visits were for well child care and immunizations. First grade student exclusion rates for failure to meet the state-mandated physical examination requirement fell 74% over the first four years of the school-based health center's operation.In summary, our school-based health center serves a patient population that is primarily uninsured. Reduction in first grade student exclusion rates enhances student education and reduces the loss of attendance-based state matching funds. Additionally, our school-based health center has been well accepted by the local community.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28043039","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 looks forward to 2009.","authors":"John C Licciardone","doi":"10.1186/1750-4732-3-2","DOIUrl":"https://doi.org/10.1186/1750-4732-3-2","url":null,"abstract":"<p><p> Osteopathic Medicine and Primary Care, which enters its third year of operation in 2009 under the umbrella of BioMed Central, continues to promote and advance open access publishing through universal online access without charge, indexing in PubMed and archiving in PubMed Central, retention of authors' copyright, and expeditious peer review. Notable accomplishments during 2008 included a median lag time of four months from initial manuscript submission to publication, designation of eight articles as \"highly accessed,\" and achievement of a balanced proportion of publications in our core topic areas of osteopathic medicine and primary care. In October 2008, Springer Science+Business Media, a major publisher of journals in science, technology, and medicine, acquired the BioMed Central Group. Our 2009 Editorial Board is presented herein, as well as a new mechanism for posting book reviews on the Osteopathic Medicine and Primary Care website. We continue to encourage manuscript submissions and reader comments on our articles. Waivers or discounts of article processing charges are available via several mechanisms for eligible authors who submit qualified manuscripts.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-3-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27966579","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":"Impact of predisposing, enabling, and need factors in accessing preventive medical care among U.S. children: results of the national survey of children's health.","authors":"Ka-Ming Lo, Kimberly G Fulda","doi":"10.1186/1750-4732-2-12","DOIUrl":"10.1186/1750-4732-2-12","url":null,"abstract":"<p><strong>Background: </strong>Preventive care in the United States has been a priority, especially for children under 18 years of age. The objective of this analysis was to determine which predisposing, enabling, and need factors affect access to preventive health care for children.</p><p><strong>Methods: </strong>Data were obtained from the National Survey of Children's Health (NSCH), a cross-sectional study of children in the United States. The current analysis examined whether predisposing, enabling, and need factors included in Andersen's Socio-Behavioral Model significantly affect having received preventive medical care among children 3-17 years of age. Logistic regression was used to compute odds ratios and 95% confidence intervals.</p><p><strong>Results: </strong>63,924 out of 85,151 subjects were reported as having received preventive medical care. After stratifying by geographical region, the following factors were significant for predicting having received preventive care. Age was negatively associated with having received care in all four regions. Household education of less than a college degree and being white (compared to black) were negatively associated with having received care in the Northeast, Midwest, and South. Having fewer than 4 children was negatively associated in Northeast but positively associated in the West with having received care. Being male, having less than 3 children in the household, having less than 3 adults in the household, and being Hispanic were positively associated with having received care in the West only. Not having insurance and having a lower socioeconomic status were negatively associated with having received care; while, having a personal doctor or nurse was positively associated in all four regions. Primary language other than English was negatively associated with having received care in the Northeast only. Currently needing medicine was also positively associated with having received care in all four regions; while, having limited abilities to do things was positively associated in the West only.</p><p><strong>Conclusion: </strong>Older children whose family resides in Northeast, Midwest, and South regions with low household education and poverty levels experience insufficient preventive health care. Medicaid or SCHIP coverage should be expanded for children who are still uninsured. For children in the West, gender, family size, ethnicity, and their ability to do things should also be considered when providing assistance for receiving preventive care.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27882923","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 epidemiology and medical management of low back pain during ambulatory medical care visits in the United States.","authors":"John C Licciardone","doi":"10.1186/1750-4732-2-11","DOIUrl":"10.1186/1750-4732-2-11","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common symptom.</p><p><strong>Methods: </strong>Patient visits attributed to LBP in the National Ambulatory Medical Care Survey (NAMCS) during 2003-2004 served as the basis for epidemiological analyses (n = 1539). The subset of patient visits in which LBP was the primary reason for seeking care (primary LBP patient visits) served as the basis for medical management analyses (n = 1042). National population estimates were derived using statistical weighting techniques.</p><p><strong>Results: </strong>There were 61.7 million (SE, 4.0 million) LBP patient visits and 42.4 million (SE, 3.1 million) primary LBP patient visits. Only 55% of LBP patient visits were provided by primary care physicians. Age, geographic region, chronicity of symptoms, injury, type of physician provider, and physician specialty were associated with LBP patient visits. Age, injury, primary care physician status, type of physician provider, and shared physician care were associated with chronicity of LBP care. Osteopathic physicians were more likely than allopathic physicians to provide medical care during LBP patient visits (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.75-3.92) and chronic LBP patient visits (OR, 4.39; 95% CI, 2.47-7.80). Nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics were ordered during 14.2 million (SE, 1.2 million) and 10.5 million (SE, 1.1 million) primary LBP patient visits, respectively. Drugs (OR, 0.29; 95% CI, 0.13-0.62) and, specifically, NSAIDs (OR, 0.40; 95% CI, 0.25-0.64) were ordered less often during chronic LBP patient visits compared with acute LBP patient visits. Overall, osteopathic physicians were less likely than allopathic physicians to order NSAIDs for LBP (OR, 0.43; 95% CI, 0.24-0.76). Almost two million surgical procedures were ordered, scheduled, or performed during primary LBP patient visits.</p><p><strong>Conclusion: </strong>The percentage of LBP visits provided by primary care physicians in the United States remains suboptimal. Medical management of LBP, particularly chronic LBP, appears to over-utilize surgery relative to more conservative measures such as patient counseling, non-narcotic analgesics, and other drug therapies. Osteopathic physicians are more likely to provide LBP care, and less likely to use NSAIDs during such visits, than their allopathic counterparts. In general, LBP medical management does not appear to be in accord with evidence-based guidelines.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27853299","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":"Recommendations for primary care physicians to improve HPV vaccination rates during clinical encounters.","authors":"Roberto Cardarelli,&nbsp;Kathryn M Cardarelli","doi":"10.1186/1750-4732-2-10","DOIUrl":"https://doi.org/10.1186/1750-4732-2-10","url":null,"abstract":"<p><p> The availability of the human papillomavirus (HPV) vaccine has positioned primary care physicians to play an active role in ensuring its successful implementation. However, physicians must be aware of common knowledge, attitudes, and belief barriers associated with HPV and the vaccine that are often encountered during clinical visits. This editorial provides primary care physicians an overview of these barriers and realistic recommendations utilizing the \"5A's\" - Awareness, Assess, Address, Acceptability, and Activate. This mnemonic can help facilitate a physician's systematic approach to increasing HPV vaccination rates during the clinical encounter.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-2-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27815092","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":"Rediscovering the classic osteopathic literature to advance contemporary patient-oriented research: A new look at diabetes mellitus.","authors":"John C Licciardone","doi":"10.1186/1750-4732-2-9","DOIUrl":"https://doi.org/10.1186/1750-4732-2-9","url":null,"abstract":"<p><p> Patient care experiences represent opportunities for establishing theories, testable hypotheses, and data to assess the potential use of osteopathic manipulative treatment in various disease conditions. The re-analysis of Bandeen's 1949 raw data described herein summarizes the effects of osteopathic manipulative treatment involving pancreatic stimulatory and inhibitory techniques in diabetic and non-diabetic patients seen over a 25-year period of clinical practice. Bandeen's data demonstrate a reduction in blood glucose levels at 30 and 60 minutes following pancreatic stimulation in 150 diabetic patients, and an elevation in blood glucose levels at 30 and 60 minutes following pancreatic inhibition in 40 non-diabetic patients. Such patient-oriented research conducted during the classic era of osteopathy in the United States provides a foundation and data for generating hypotheses about the potential mechanisms of action of osteopathic manipulative treatment. Osteopathic investigators would be well-served to rediscover the classic osteopathic literature to help advance contemporary evidence-based medicine.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-2-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27552148","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":"Osteopathy may decrease obstructive apnea in infants: a pilot study.","authors":"Yvan Vandenplas,&nbsp;Etienne Denayer,&nbsp;Thierry Vandenbossche,&nbsp;Luc Vermet,&nbsp;Bruno Hauser,&nbsp;Jean Deschepper,&nbsp;Agnes Engelen","doi":"10.1186/1750-4732-2-8","DOIUrl":"https://doi.org/10.1186/1750-4732-2-8","url":null,"abstract":"<p><strong>Background: </strong>Obstructive apnea is a sleep disorder characterized by pauses in breathing during sleep: breathing is interrupted by a physical block to airflow despite effort. The purpose of this study was to test if osteopathy could influence the incidence of obstructive apnea during sleep in infants.</p><p><strong>Methods: </strong>Thirty-four healthy infants (age: 1.5-4.0 months) were recruited and randomized in two groups; six infants dropped out. The osteopathy treatment group (n = 15 infants) received 2 osteopathic treatments in a period of 2 weeks and a control group (n = 13 infants) received 2 non-specific treatments in the same period of time. The main outcome measure was the change in the number of obstructive apneas measured during an 8-hour polysomnographic recording before and after the two treatment sessions.</p><p><strong>Results: </strong>The results of the second polysomnographic recordings showed a significant decrease in the number of obstructive apneas in the osteopathy group (p = 0.01, Wilcoxon test), in comparison to the control group showing only a trend suggesting a gradual physiologic decrease of obstructive apneas. However, the difference in the decline of obstructive apneas between the groups after treatment was not significant (p = 0.43).</p><p><strong>Conclusion: </strong>Osteopathy may have a positive influence on the incidence of obstructive apneas during sleep in infants with a previous history of obstructive apneas as measured by polysomnography. Additional research in this area appears warranted.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-2-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27544513","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}