Osteopathic medicine and primary care最新文献

{"title":"Osteopathic manipulative treatment for pandemic influenza: many questions, few answers.","authors":"Brent W Sanderlin, John C Licciardone","doi":"10.1186/1750-4732-1-12","DOIUrl":"https://doi.org/10.1186/1750-4732-1-12","url":null,"abstract":"","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26821078","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":"Identification of the patient with enlarged prostate: diagnosis and guidelines for management.","authors":"Steven A Kaplan","doi":"10.1186/1750-4732-1-11","DOIUrl":"https://doi.org/10.1186/1750-4732-1-11","url":null,"abstract":"<p><p>Benign enlargement of the prostate, also referred to as benign prostatic hyperplasia, is a common condition in men. Because enlarged prostate (EP) was viewed historically as a symptomatic condition, management of voiding symptoms with alpha-blockers was often the goal of therapy. However, it is now recognized that EP is a progressive disorder, which may be complicated by acute urinary retention and which may eventually require EP-related surgery. The 5alpha-reductase inhibitors decrease dihydrotestosterone levels, which slow disease progression by causing regression of the prostate epithelial cells. These agents are considered disease modifying, and they may reduce the progression of prostate enlargement. This article reviews evaluation, diagnosis, and treatment strategies for EP, and it provides a practical algorithm for management of patients with EP.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26821129","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":"A practical approach for implementation of a basal-prandial insulin therapy regimen in patients with type 2 diabetes.","authors":"Steven Edelman,&nbsp;George Dailey,&nbsp;Thomas Flood,&nbsp;Louis Kuritzky,&nbsp;Susan Renda","doi":"10.1186/1750-4732-1-9","DOIUrl":"https://doi.org/10.1186/1750-4732-1-9","url":null,"abstract":"<p><p>Basal-prandial insulin therapy is a physiologic approach to insulin delivery that utilizes multiple daily injections to cover both basal (ie, overnight fasting and between-meal) and prandial (ie, glucose excursions above basal at mealtime) insulin needs. While basal-prandial therapy with multiple daily injections is an important therapeutic option for patients with type 2 diabetes, there is a common perception that this therapy is difficult to initiate in the primary care setting. To address this issue, a panel of clinical experts convened to develop practical recommendations on how to initiate basal-prandial therapy in patients with type 2 diabetes, focusing on patient selection, simple dosing and titration, and monitoring. Patients with type 2 diabetes who are appropriate candidates for basal-prandial insulin therapy include those who: 1) are unable to achieve glycemic control on oral antidiabetic drugs, 2) are unable to achieve glycemic control on split-mixed/premixed insulin regimens, 3) are newly diagnosed but unlikely to respond to oral antidiabetic drugs alone (ie, the patient has severe hyperglycemia or a markedly elevated glycosylated hemoglobin A1C level for which oral antidiabetic drug therapy alone is unlikely to achieve goals), and 4) prefer this therapy due to socioeconomic or other individual considerations. Basal-prandial insulin can be initiated in a simple stepwise manner, starting first with the addition of basal insulin to the existing oral antidiabetic drug regimen, followed by the introduction of 1 prandial insulin injection to the basal insulin plus oral antidiabetic drug regimen (after basal insulin has been optimized). Subsequently, other injections of prandial insulin may be added when needed. Based on home glucose monitoring data, patients may be converted from split-mixed or premixed insulin regimens to basal-prandial regimens with similar ease. Basal-prandial therapy using newer insulin formulations, such as long- and rapid-acting insulin analogs, can be relatively simple to use in patients with type 2 diabetes and is an appropriate methodology for application by primary care clinicians.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26677997","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 utility of a health risk assessment in providing care for a rural free clinic population.","authors":"Paula D Scariati,&nbsp;Cyndy Williams","doi":"10.1186/1750-4732-1-8","DOIUrl":"https://doi.org/10.1186/1750-4732-1-8","url":null,"abstract":"<p><strong>Background: </strong>Free clinics are an important part of our country's health safety net, serving a working poor uninsured population. With limited resources and heavily dependent upon volunteer health care providers, these clinics have historically focused on stopgap, band-aid solutions to the population's health problems. Embracing a new paradigm, free clinics are now prioritizing resources for disease prevention and health promotion.</p><p><strong>Methods: </strong>We initiated a Healthy Friday Clinic project in a rural, southwest Virginia free clinic. The clinic operated every Friday and was open to all people eligible for care in the free clinic. Each participant completed a 43 question Health Risk Appraisal which was used to calculate current risk age (age as determined by current lifestyle choices), optimal risk age (age with optimal lifestyle choices) and potential risk years gained (current risk age - optimal risk age) as well as a ranked listing of modifiable risk factors.</p><p><strong>Results: </strong>The total sum of potential risk years gained in the free clinic population of 186 subjects was 371.4. Frequency distributions on potential risk years gained by each of the eleven modifiable risk factors revealed the following, in order of impact: quitting smoking could result in a total of 173.5 risk years gained; reducing alcohol consumption, 64.2 years gained; reducing blood pressure, 50.8 years gained; increasing seatbelt use, 38.2 years gained; weight reduction, 24.7 years gained; having regular mammograms, 6.8 years gained; reducing cholesterol levels, 5.8 years gained; reducing frequency of speeding while driving, 3.5 years gained; having regular pap tests, 2.3 years gained; improving HDL levels, 0.9 years gained; and reducing use of smokeless tobacco, 0.8 years gained. Each person received an individualized letter explaining his evaluation along with resources for making changes.</p><p><strong>Discussion: </strong>Health risk assessments play a role in changing health beliefs and behaviors by providing subjects with individualized feedback on how their lifestyle choices impact their health and well-being. Summed data from health risk appraisals can also be a useful tool in determining the allocation of limited health resources. Whether health risk assessments impact health outcomes directly needs to be studied.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26623010","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 research: elephants, enigmas, and evidence.","authors":"John C Licciardone","doi":"10.1186/1750-4732-1-7","DOIUrl":"10.1186/1750-4732-1-7","url":null,"abstract":"<p><strong>Background: </strong>The growth and acceptance of osteopathic physicians as conventional medical practitioners in the United States has also raised questions about the distinctive aspects of osteopathic medicine. Although the use of osteopathic manipulative treatment (OMT) and a focus on primary care are most often cited as rationales for the uniqueness of osteopathic medicine, an osteopathic professional identity remains enigmatic.</p><p><strong>Discussion: </strong>The fledgling basic osteopathic research efforts of the early and mid-twentieth century have not been sustained and expanded over time. Thus, there is presently a scarcity of basic mechanistic and translational research that can be considered to be uniquely osteopathic. To be sure, there have been advances in osteopathic clinical trials, particularly those involving OMT for low back pain. Meta-analysis of these low back pain trials has provided evidence that: (1) OMT affords greater pain reduction than active or placebo control treatments; (2) the effects of OMT are comparable regardless of whether treatment is provided by fully-licensed osteopathic physicians in the United States or by osteopaths in the United Kingdom; and (3) the effects of OMT increase over time. However, much more clinical research remains to be done. The planning and implementation of a large longitudinal study of the natural history and epidemiology of somatic dysfunction, including an OMT component, represents a much-needed step forward. Osteopathic medicine's use of OMT and its focus on primary care are not mutually exclusive aspects of its uniqueness. The intersection of these fundamental aspects of osteopathic medicine suggests that the profession may successfully adopt a generic strategy of \"focused differentiation\" to attain a competitive advantage in the health care arena. While there are both requisite demands and risks for the osteopathic profession in adopting such a strategy, these are reasonable in relation to the potential rewards to be attained. To help promote an osteopathic identity, \"omtology\" and its derivative terms are recommended in referring to the study of OMT.</p><p><strong>Conclusion: </strong>The osteopathic profession should adopt a coherent strategy for developing and promoting its identity. Failure to do so will likely ensure that osteopathic medicine remains \"stuck in the middle.\"</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613766","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":"A case-control study of osteopathic palpatory findings in type 2 diabetes mellitus.","authors":"John C Licciardone,&nbsp;Kimberly G Fulda,&nbsp;Scott T Stoll,&nbsp;Russell G Gamber,&nbsp;A Clifton Cage","doi":"10.1186/1750-4732-1-6","DOIUrl":"https://doi.org/10.1186/1750-4732-1-6","url":null,"abstract":"<p><strong>Background: </strong>Although type 2 diabetes mellitus is often managed by osteopathic physicians, osteopathic palpatory findings in this disease have not been adequately studied.</p><p><strong>Methods: </strong>A case-control study was used to measure the association between type 2 diabetes mellitus and a series of 30 osteopathic palpatory findings. The latter included skin changes, trophic changes, tissue changes, tenderness, and immobility at spinal segmental levels T5-T7, T8-T10, and T11-L2 bilaterally. Logistic regression models that adjusted for age, sex, and comorbid conditions were used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between type 2 diabetes mellitus and each of these findings.</p><p><strong>Results and discussion: </strong>A total of 92 subjects were included in the study. After controlling for age, sex, hypertension, and clinical depression, the only significant finding was an association between type 2 diabetes mellitus and tissue changes at T11-L2 on the right side (OR, 5.54; 95% CI, 1.76-17.47; P = .003). Subgroup analyses of subjects with type 2 diabetes mellitus and hypertension demonstrated significant associations with tissue changes at T11-L2 bilaterally (OR, 27.38; 95% CI, 1.75-428; P = .02 for the left side and OR, 24.00; 95% CI, 1.51-382; P = .02 for the right side). Among subjects with type 2 diabetes mellitus and hypertension, there was also a strong diabetes mellitus duration effect for tissue changes at T11-L2 bilaterally (OR, 12.00; 95% CI, 1.02-141; P = .05 for short duration vs. OR, 32.00; 95% CI, 2.29-448; P = .01 for long duration on the left side; and OR, 17.33; 95% CI, 1.39-217; P = .03 for short duration vs. OR, 32.00; 95% CI, 2.29-448; P = .01 for long duration on the right side).</p><p><strong>Conclusion: </strong>The only consistent finding in this study was an association between type 2 diabetes mellitus and tissue changes at T11-L2 on the right side. Potential explanations for this finding include reflex viscerosomatic changes directly related to the progression of type 2 diabetes mellitus, a spurious association attributable to confounding visceral diseases, or a chance observation unrelated to type 2 diabetes mellitus. Larger prospective studies are needed to better study osteopathic palpatory findings in type 2 diabetes mellitus.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613765","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":"Overcoming obstacles to implementing a primary care research framework.","authors":"Roberto Cardarelli, Margaret Seater, Elizabeth Palmarozzi","doi":"10.1186/1750-4732-1-4","DOIUrl":"10.1186/1750-4732-1-4","url":null,"abstract":"<p><strong>Background: </strong>Primary care research has recently garnered greater attention at the national level. Yet, primary care (i.e., family medicine, internal medicine, pediatrics, and obstetrics and gynecology) departments within academic institutions struggle to develop and sustain strong research frameworks.</p><p><strong>Methods: </strong>This paper discusses a successful model that was developed in the department of family medicine at the University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine.</p><p><strong>Results: </strong>Overall, the framework revolves around three core values: training future primary care researchers, providing resources to emerging and junior faculty members, and creating a partnership with the community and clinicians to conduct primary care clinical research.</p><p><strong>Conclusion: </strong>Significant effort is required to establish a successful research framework in family medicine. The framework presented herein serves as an example for other departments to use and adapt in developing their research division.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613763","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":"Educating primary care clinicians about health disparities.","authors":"Roberto Cardarelli,&nbsp;Ana L Chiapa","doi":"10.1186/1750-4732-1-5","DOIUrl":"https://doi.org/10.1186/1750-4732-1-5","url":null,"abstract":"<p><p>Racial and ethnic health disparities inarguably exist in the United States. It is important to educate primary care clinicians regarding this topic because they have the ability to have an impact in the reduction of health disparities. This article presents the evidence that disparities exist, how clinicians contribute to these disparities, and what primary care clinicians can do to reduce disparities in their practice. Clinicians are able to impact health disparities by receiving and providing cross-cultural education, communicating effectively with patients, and practicing evidence-based medicine. The changes suggested herein will have an impact on the current state of health of our nation.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613760","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":"A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003-2004.","authors":"John C Licciardone","doi":"10.1186/1750-4732-1-2","DOIUrl":"10.1186/1750-4732-1-2","url":null,"abstract":"<p><strong>Background: </strong>Osteopathic philosophy is consistent with an emphasis on primary care and suggests that osteopathic physicians may have distinctive ways of interacting with their patients.</p><p><strong>Methods: </strong>The National Ambulatory Medical Care Survey (NAMCS) was used to derive national estimates of utilization of osteopathic general and family medicine physicians during 2003 and 2004 and to examine the patient characteristics and physician-patient interactions of these osteopathic physicians. All analyses were performed using complex samples software to appropriately weigh outcomes according to the multistage probability sample design used in NAMCS and multivariate modeling was used to control for potential confounders.</p><p><strong>Results and discussion: </strong>When weighted according to the multistage probability sample design used, the 6939 patient visits studied represented an estimated 341.4 million patient visits to general and family medicine specialists in the United States, including 64.9 million (19%) visits to osteopathic physicians and 276.5 million (81%) visits to allopathic physicians. Osteopathic physicians were a major source of care in the Northeast (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.42-6.08), providing more than one-third of general and family medicine patient visits in this geographic region. Pediatric and young adult patients (OR, 0.64; 95% CI, 0.45-0.91), Hispanics (OR, 0.63; 95% CI, 0.40-1.00), and non-Black racial minority groups (OR, 0.39; 95% CI, 0.18-0.82) were less likely to visit osteopathic physicians. There were no significant differences between osteopathic and allopathic physicians with regard to the time spent with patients, provision of five common preventive medicine counseling services, or a focus on preventive care during office visits.</p><p><strong>Conclusion: </strong>Osteopathic physicians are a major source of general and family medicine care in the United States, particularly in the Northeast. However, pediatric and young adult patients, Hispanics, and non-Black racial minorities underutilize osteopathic physicians. There is little evidence to support a distinctive approach to physician-patient interactions among osteopathic physicians in general and family medicine, particularly with regard to time spent with patients and preventive medicine services.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613761","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: a new journal for changing times.","authors":"John C Licciardone,&nbsp;Roberto Cardarelli","doi":"10.1186/1750-4732-1-1","DOIUrl":"https://doi.org/10.1186/1750-4732-1-1","url":null,"abstract":"<p><p>Osteopathic Medicine and Primary Care is dedicated to the rapid and universal dissemination of peer-reviewed research and scholarly work within its scope. It aims to bridge diverse professional communities by providing a common forum for the publication of research relevant to the clinical practice of primary care.</p>","PeriodicalId":87450,"journal":{"name":"Osteopathic medicine and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-4732-1-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26613764","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}