Abstract Context Surgical volume is correlated with increased hospital profitability, yet many Critical Access Hospitals (CAHs) offer few or no inpatient surgical services. Objectives This study aims to investigate the impact of the presence of different inpatient surgical services on CAH profitability. Methods The study design was a cross-sectional analysis of financial data from the most recent fiscal year (FY) of 1299 CAHs. Multiple linear regression was utilized to assess how the operating margin was affected by the number of different inpatient surgical services offered per hospital. Covariates known to be associated with hospital profitability included occupancy rate, case mix index (CMI), system affiliation, ownership status (public, private, or nonprofit), and geographic region. Results The regression model for the CAH operating margin returned an R2 value of 0.18. Each additional inpatient surgical service corresponded to a 1.5% increase in operating margin (p=0.0413). Each 10% increase in occupancy rate and 0.1 increase in CMI corresponded to a 0.9% increase in operating margin (p=0.0032 and p=0.0176, respectively). The number of surgical services offered per CAH showed positive correlations with occupancy rate (r=0.23, p<0.0001) and CMI (r=0.59, p<0.0001). Conclusions A positive correlation exists between operating margin and the diversity of inpatient surgical specialties available at CAHs. Furthermore, providing surgery allows CAHs to accommodate higher occupancy rates and case mixes, both of which are significantly and positively correlated with CAH operating margin.
{"title":"The association between operating margin and surgical diversity at Critical Access Hospitals","authors":"W. Hopper, R. Zeller, R. Burke, Tom Lindsey","doi":"10.1515/jom-2022-0028","DOIUrl":"https://doi.org/10.1515/jom-2022-0028","url":null,"abstract":"Abstract Context Surgical volume is correlated with increased hospital profitability, yet many Critical Access Hospitals (CAHs) offer few or no inpatient surgical services. Objectives This study aims to investigate the impact of the presence of different inpatient surgical services on CAH profitability. Methods The study design was a cross-sectional analysis of financial data from the most recent fiscal year (FY) of 1299 CAHs. Multiple linear regression was utilized to assess how the operating margin was affected by the number of different inpatient surgical services offered per hospital. Covariates known to be associated with hospital profitability included occupancy rate, case mix index (CMI), system affiliation, ownership status (public, private, or nonprofit), and geographic region. Results The regression model for the CAH operating margin returned an R2 value of 0.18. Each additional inpatient surgical service corresponded to a 1.5% increase in operating margin (p=0.0413). Each 10% increase in occupancy rate and 0.1 increase in CMI corresponded to a 0.9% increase in operating margin (p=0.0032 and p=0.0176, respectively). The number of surgical services offered per CAH showed positive correlations with occupancy rate (r=0.23, p<0.0001) and CMI (r=0.59, p<0.0001). Conclusions A positive correlation exists between operating margin and the diversity of inpatient surgical specialties available at CAHs. Furthermore, providing surgery allows CAHs to accommodate higher occupancy rates and case mixes, both of which are significantly and positively correlated with CAH operating margin.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"C-20 1","pages":"339 - 345"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85069289","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}
Steven P. Gawrys, Justin T Bradshaw, Lawsen M. Parker
We commend Kramer and De Asis [1] for their findings indicating the utilization of osteopathic manipulative treatment (OMT) via telemedicine for pediatric patients. Their results demonstrated significant decreases in pain for the majority of their patients, addressing their chief complaints [1]. These findings are incredibly insightful for further research and have the potential to help many patients in the future if replicated properly. However, Kramer and De Asis discovered that some patients in the study noted mild temporary worsening of pain that was slightly higher than the rate reported in the literature for in-person OMT visits, which could possibly be attributed to parental misapplication of technique or force [1]. In an effort to enhance the potential for OMT via telehealth and prevent the adverse outcomes noted by Kramer and De Asis, we have collected sources that could be utilized in future research to promote more widespread, standardized use of telehealth in osteopathic medicine. Research into standardization of OMT via telehealth can maximize the positive findings of Kramer and De Asis for all osteopathic physicians to implement while minimizing the potential risk factors of increased pain for patients [2]. While we are hopeful to see the end of the COVID-19 pandemic, telehealth is projected to remain a vital part of ensuring adequate healthcare for several patient populations [3]. Benefits of telehealth include a reduced number of emergency room visits, preventing the spread of COVID-19, conservation of PPE, reduced costs to patients living in remote areas, and improving the management of outpatient visits [3]. Recent research of musculoskeletal, neurological, and cardiovascular physical exams in a telehealth setting lay a framework for future research into the telehealth osteopathic physical examination [4–7]. Specifically, some of these studies provide images demonstrating the proper techniques for patient movements and positions [5–7]. Research into the standardization of OMT with the use of images and other visual aides to demonstrate proper technique would help prevent misapplication of the osteopathic examination and treatment, thus preventing injuries. Standardized guidelines can also help address pertinent contraindications of OMT procedures. As these studies do not include osteopathic assessment tools, research conducted by leaders of osteopathic medicine into the standardization of OMT recommended during telehealth visits, such as promoting a standard of patient education for identifying a somatic dysfunction and performing subsequent treatment through telemedicine, would also be beneficial in creating reproducible results in large sample sizeswhilemaintaining patient safety in fragile populations. It is unlikely that patient care via telehealth technology will ever fully match the trained, palpatory skills of an osteopathic physician. However, based on the research of telehealth utilization, including the commendable art
我们赞扬Kramer和De Asis b[1]的研究结果表明，通过远程医疗对儿科患者使用骨科手法治疗(OMT)。他们的结果表明，大多数患者的疼痛明显减轻，解决了他们的主诉。这些发现对进一步的研究具有不可思议的洞察力，如果复制得当，将来有可能帮助许多患者。然而，Kramer和De Asis发现，研究中一些患者的疼痛轻微暂时加重的发生率略高于文献报道的面对面OMT就诊率，这可能是由于父母对技术或力量的误用[1]。为了通过远程医疗提高OMT的潜力，并防止Kramer和De Asis指出的不良后果，我们收集了可用于未来研究的资料，以促进远程医疗在骨科医学中更广泛、标准化的使用。通过远程医疗对OMT标准化进行研究，可以最大限度地发挥Kramer和De Asis的积极成果，让所有骨科医生实施，同时最大限度地减少患者疼痛增加的潜在风险因素。虽然我们希望看到COVID-19大流行结束，但预计远程医疗仍将是确保若干患者群体获得适当医疗保健的重要组成部分。远程医疗的好处包括减少急诊室就诊次数、防止COVID-19的传播、保护个人防护装备、降低偏远地区患者的费用以及改善门诊就诊管理。最近对远程医疗环境下的肌肉骨骼、神经系统和心血管体检的研究为未来远程医疗骨科体检的研究奠定了框架[4-7]。具体来说，其中一些研究提供了图像，展示了患者运动和位置的正确技术[5-7]。研究OMT的标准化，并使用图像和其他视觉辅助工具来展示正确的技术，将有助于防止误用整骨疗法的检查和治疗，从而防止损伤。标准化的指导方针也可以帮助解决OMT程序的相关禁忌症。由于这些研究不包括整骨疗法评估工具，因此由整骨疗法医学的领导者对远程医疗访问期间推荐的OMT标准化进行的研究，例如促进患者教育标准以识别躯体功能障碍并通过远程医疗进行后续治疗，也将有利于在大样本中创造可重复的结果，同时保持脆弱人群的患者安全。通过远程医疗技术进行的病人护理不太可能完全与训练有素的整骨疗法医生的触诊技能相匹配。然而，基于远程医疗利用的研究，包括Kramer和De Asis发表的值得赞扬的文章[1]，我们呼吁在远程医疗环境中进一步研究、调查和标准化OMT，为指导患者通过OMT的医生提供培训和安全协议。通过远程医疗对OMT的研究将调查几个组成部分，包括对儿童患者的父母或监护人的最佳指导，对成人患者的陪伴指导，以及对自我实施OMT的调查。在这种情况下，对各种整骨疗法的调查可以为更多的患者群体打开大门，增加整骨疗法药物的使用，同时最大限度地降低不良反应的风险。*通讯作者:Steven P. Gawrys, OMS II, Rocky Vista大学骨科医学院，南犹他校区，255 E. Center Street, Ivins, UT 84738, USA, E-mail: steven.gawrys@rvu.edu Justin T. Bradshaw,OMS II和LawsenM。Parker,OMS II, Rocky Vista University College Osteopathic Medicine，南犹他校区，Ivins, UT, USA J Osteopath Med 2022;aop
{"title":"Standardization of osteopathic manipulative treatment in telehealth settings to maximize patient outcomes and minimize adverse effects","authors":"Steven P. Gawrys, Justin T Bradshaw, Lawsen M. Parker","doi":"10.1515/jom-2021-0266","DOIUrl":"https://doi.org/10.1515/jom-2021-0266","url":null,"abstract":"We commend Kramer and De Asis [1] for their findings indicating the utilization of osteopathic manipulative treatment (OMT) via telemedicine for pediatric patients. Their results demonstrated significant decreases in pain for the majority of their patients, addressing their chief complaints [1]. These findings are incredibly insightful for further research and have the potential to help many patients in the future if replicated properly. However, Kramer and De Asis discovered that some patients in the study noted mild temporary worsening of pain that was slightly higher than the rate reported in the literature for in-person OMT visits, which could possibly be attributed to parental misapplication of technique or force [1]. In an effort to enhance the potential for OMT via telehealth and prevent the adverse outcomes noted by Kramer and De Asis, we have collected sources that could be utilized in future research to promote more widespread, standardized use of telehealth in osteopathic medicine. Research into standardization of OMT via telehealth can maximize the positive findings of Kramer and De Asis for all osteopathic physicians to implement while minimizing the potential risk factors of increased pain for patients [2]. While we are hopeful to see the end of the COVID-19 pandemic, telehealth is projected to remain a vital part of ensuring adequate healthcare for several patient populations [3]. Benefits of telehealth include a reduced number of emergency room visits, preventing the spread of COVID-19, conservation of PPE, reduced costs to patients living in remote areas, and improving the management of outpatient visits [3]. Recent research of musculoskeletal, neurological, and cardiovascular physical exams in a telehealth setting lay a framework for future research into the telehealth osteopathic physical examination [4–7]. Specifically, some of these studies provide images demonstrating the proper techniques for patient movements and positions [5–7]. Research into the standardization of OMT with the use of images and other visual aides to demonstrate proper technique would help prevent misapplication of the osteopathic examination and treatment, thus preventing injuries. Standardized guidelines can also help address pertinent contraindications of OMT procedures. As these studies do not include osteopathic assessment tools, research conducted by leaders of osteopathic medicine into the standardization of OMT recommended during telehealth visits, such as promoting a standard of patient education for identifying a somatic dysfunction and performing subsequent treatment through telemedicine, would also be beneficial in creating reproducible results in large sample sizeswhilemaintaining patient safety in fragile populations. It is unlikely that patient care via telehealth technology will ever fully match the trained, palpatory skills of an osteopathic physician. However, based on the research of telehealth utilization, including the commendable art","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"29 1","pages":"377 - 378"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86062707","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}
Nessreen Ghanem, Devin Dromgoole, AhmadNewafhaj Hussein, R. Jermyn
Abstract Context The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. Objectives This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. Methods The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. Results Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. Conclusions The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.
{"title":"Review of medication-assisted treatment for opioid use disorder","authors":"Nessreen Ghanem, Devin Dromgoole, AhmadNewafhaj Hussein, R. Jermyn","doi":"10.1515/jom-2021-0163","DOIUrl":"https://doi.org/10.1515/jom-2021-0163","url":null,"abstract":"Abstract Context The American opioid epidemic has necessitated the search for safe and effective means of treatment for opioid use disorder (OUD). Medication-assisted treatment (MAT) encompasses select medications that are proven effective treatments for OUD. Understanding the mechanisms of action, indications, and implementation of MAT is paramount to increasing its availability to all individuals struggling with opioid addiction. Objectives This review is based on an educational series that aims to educate healthcare providers and ancillary healthcare members on the use of MAT for the treatment of OUD. Methods The database PubMed was utilized to retrieve articles discussing the implementation of MAT. Boolean operators and Medical Subject Headings (MeSHs) were applied including: MAT and primary care, MAT and telehealth, methadone, buprenorphine, naltrexone, MAT and osteopathic, MAT and group therapy, and MAT and COVID-19. Results Three medications have been approved for the treatment of OUD: methadone, naltrexone, and buprenorphine. Identifying ways to better treat and manage OUD and to combat stigmatization are paramount to dismantling barriers that have made treatment less accessible. Studies suggest that primary care providers are well positioned to provide MAT to their patients, particularly in rural settings. However, no study has compared outcomes of different MAT models of care, and more research is required to guide future efforts in expanding the role of MAT in primary care settings. Conclusions The coronavirus disease 2019 (COVID-19) pandemic has led to changes in the way MAT care is managed. Patients require a novel point-of-care approach to obtain care. This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT. Increasing the availability of MAT treatment will allow for greater access to comprehensive treatment and will set the standard for accessibility of novel OUD treatment in the future.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"28 1","pages":"367 - 374"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90510291","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}
Jordyn Austin, Paul Delgado, Ashton Gatewood, Mackenzie Enmeier, Brooke Frantz, B. Greiner, M. Hartwell
Abstract Context Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist. Objectives This study aims to analyze whether CC screening rates differ among women with comorbidities—body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer—compared to women without these comorbidities. Methods Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2–4, 5+). Confidence intervals (CIs) were reported at 95%. Results Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83–0.97) as were those with COPD (AOR: 0.77; CI: 0.67–0.87) and kidney disease (AOR: 0.81; CI: 0.67–0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05–1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities. Conclusions Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.
{"title":"Cervical cancer screening among women with comorbidities: a cross-sectional examination of disparities from the Behavioral Risk Factor Surveillance System","authors":"Jordyn Austin, Paul Delgado, Ashton Gatewood, Mackenzie Enmeier, Brooke Frantz, B. Greiner, M. Hartwell","doi":"10.1515/jom-2021-0044","DOIUrl":"https://doi.org/10.1515/jom-2021-0044","url":null,"abstract":"Abstract Context Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist. Objectives This study aims to analyze whether CC screening rates differ among women with comorbidities—body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer—compared to women without these comorbidities. Methods Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2–4, 5+). Confidence intervals (CIs) were reported at 95%. Results Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83–0.97) as were those with COPD (AOR: 0.77; CI: 0.67–0.87) and kidney disease (AOR: 0.81; CI: 0.67–0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05–1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities. Conclusions Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"40 1","pages":"359 - 365"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85695950","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}
Abstract Context When evaluating a pediatric patient in the emergency department for suspected appendicitis, a provider is often faced with the dilemma of deciding if a computed tomography (CT) scan is warranted when—as is most often the case—ultrasound results do not yield a definitive diagnosis. The potential risks of radiation must be weighed against numerous aspects of a patient’s background, physical exam, and already-obtained workup. Objectives This study aims to aid in future decision making of providers in their evaluation of patients with suspected appendicitis, to help facilitate a more comprehensive answer to the “next-steps” in the question of equivocal ultrasound, and to create a pathway utilizing lab results, physical exam findings, and pertinent positives and negatives in patient history to facilitate a more objective decision-making process for ordering a CT scan. Methods A retrospective chart review was performed for patients who were evaluated for possible appendicitis at our institution between October 2016 and October 2017 and whose ultrasound results were equivocal. We determined what factors led to increased frequency of obtaining CT scans. Results Statistical analysis showed that several factors were independently associated with the increased likelihood of having a CT scan performed. When considered in combination with the other parameters, it was found that older children, males, report of right lower quadrant (RLQ) pain, and presence of RLQ tenderness on physical exam were all associated with a significantly higher likelihood of having a CT scan performed. Conclusions When combined with present algorithms and protocols already in use, this information can assist the provider in making prudent decisions for their patients with the potential for reduced provider bias.
{"title":"Factors affecting utilization of CT scan following ultrasound evaluation of suspected appendicitis","authors":"Adam Zisman, B. Novi, J. Gaughan, Lauren Carr","doi":"10.1515/jom-2021-0251","DOIUrl":"https://doi.org/10.1515/jom-2021-0251","url":null,"abstract":"Abstract Context When evaluating a pediatric patient in the emergency department for suspected appendicitis, a provider is often faced with the dilemma of deciding if a computed tomography (CT) scan is warranted when—as is most often the case—ultrasound results do not yield a definitive diagnosis. The potential risks of radiation must be weighed against numerous aspects of a patient’s background, physical exam, and already-obtained workup. Objectives This study aims to aid in future decision making of providers in their evaluation of patients with suspected appendicitis, to help facilitate a more comprehensive answer to the “next-steps” in the question of equivocal ultrasound, and to create a pathway utilizing lab results, physical exam findings, and pertinent positives and negatives in patient history to facilitate a more objective decision-making process for ordering a CT scan. Methods A retrospective chart review was performed for patients who were evaluated for possible appendicitis at our institution between October 2016 and October 2017 and whose ultrasound results were equivocal. We determined what factors led to increased frequency of obtaining CT scans. Results Statistical analysis showed that several factors were independently associated with the increased likelihood of having a CT scan performed. When considered in combination with the other parameters, it was found that older children, males, report of right lower quadrant (RLQ) pain, and presence of RLQ tenderness on physical exam were all associated with a significantly higher likelihood of having a CT scan performed. Conclusions When combined with present algorithms and protocols already in use, this information can assist the provider in making prudent decisions for their patients with the potential for reduced provider bias.","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"13 1","pages":"313 - 318"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91543931","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":"Os trigonum identified after trauma to heel","authors":"Mackenzie Pargeon, Lindsay Tjiattas-Saleski","doi":"10.1515/jom-2021-0270","DOIUrl":"https://doi.org/10.1515/jom-2021-0270","url":null,"abstract":"","PeriodicalId":16639,"journal":{"name":"Journal of Osteopathic Medicine Journal of Osteopathic Medicine","volume":"63 1","pages":"271 - 272"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78209786","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}
Louis C. Grandizio, Lisa J. Choe, Lisa Follett, Andrew J. Laychur, Amanda J. Young
Abstract Context Atraumatic shoulder pain is frequently encountered in primary care and surgical clinics. With increased recognition of the biopsychosocial model, there has been an increased emphasis on identifying patient factors associated with less effective coping strategies such as pain catastrophizing. It remains uncertain what impact self-efficacy has on the response to nonoperative treatment of shoulder pain. Objectives Our purpose is to determine the influence of patient coping strategies (self-efficacy) on the outcome of nonoperative treatment of atraumatic shoulder pain. We hypothesize that higher levels of self-efficacy are associated with increased self-reported function after nonoperative treatment. Methods We conducted a retrospective case-control study for a consecutive series of patients seen in our clinic with nonoperatively managed atraumatic shoulder pain. Baseline demographics and range of motion were recorded. Patients completed the Simple Shoulder Test (SST), PROMIS Pain Interference (PI), and PROMIS Self-Efficacy for Managing Symptoms (SE). After 3 months of nonoperative treatment, patients were placed into two groups: patients who clinically improved (Group 1) and those that did not (Group 2), with clinical improvement defined as an increase of 2 or greater on the SST. Results Seventy-eight patients returned for follow-up and completed all questionnaires. There were no statistically significant differences for age, sex, or tobacco use between the two groups. Half of the patients in our series had symptoms for >12 months, with rotator cuff syndrome being the most frequent diagnosis (40.0%). Patients in Group 1 had significantly higher PROMIS SE scores (42 vs. 39, p=0.0094) at initial evaluation. At 3-month follow-up, patients in Group 1 also had significantly lower Numeric Pain Rating Scale (NPRS) scores (4.5 vs. 6.5, p=0.0067), compared to Group 2. Conclusions Patients who experience clinical improvement with nonoperative treatment of atraumatic shoulder conditions demonstrate higher self-efficacy than patients who fail to improve. Guiding patients with atraumatic shoulder pain and low self-efficacy toward interventions aimed at improving coping strategies, rather than addressing musculoskeletal factors alone, may contribute to the goal of improving outcomes.
摘要背景非外伤性肩痛在初级保健和外科诊所中经常遇到。随着对生物心理社会模型认识的增加，人们越来越重视识别与疼痛灾难化等不太有效的应对策略相关的患者因素。目前尚不清楚自我效能感对非手术治疗肩痛的反应有何影响。目的探讨患者应对策略(自我效能感)对非外伤性肩痛非手术治疗效果的影响。我们假设较高水平的自我效能与非手术治疗后自我报告的功能增加有关。方法:我们对在我院就诊的非手术治疗的非外伤性肩痛患者进行了回顾性病例对照研究。记录基线人口统计数据和活动范围。患者完成了简单肩部测试(SST)、PROMIS疼痛干扰测试(PI)和PROMIS症状管理自我效能测试(SE)。非手术治疗3个月后，将患者分为两组:临床改善的患者(1组)和未改善的患者(2组)，临床改善定义为SST增加2或更多。结果78例患者回访并完成问卷调查。两组在年龄、性别或吸烟方面没有统计学上的显著差异。在我们的研究中，有一半的患者症状持续了12个月以上，其中最常见的诊断是肩袖综合征(40.0%)。第1组患者在初始评估时的PROMIS SE评分明显更高(42比39,p=0.0094)。在3个月的随访中，与2组相比，1组患者的数字疼痛评定量表(NPRS)评分也显著降低(4.5 vs. 6.5, p=0.0067)。结论非外伤性肩周炎非手术治疗后临床改善的患者自我效能感高于未改善的患者。引导非外伤性肩痛和低自我效能的患者采取旨在改善应对策略的干预措施，而不是单独解决肌肉骨骼因素，可能有助于改善预后的目标。
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Pub Date : 2022-02-17DOI: 10.1515/jom-2022-frontmatter4
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Pub Date : 2022-01-14DOI: 10.1515/jom-2022-frontmatter2
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Pub Date : 2021-12-03DOI: 10.1515/jom-2022-frontmatter1
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