Journal of Osteopathic Medicine最新文献

Context: Gun violence negatively impacts not only victims but also their families and surrounding communities. Resources and counseling services may be available to support families affected by gun violence, but the families and their clinicians may not know about these resources or how to access them.

Objectives: The objective of this study was to investigate the impact of a clinician-directed educational program on patient reports of their discussions with their physician regarding gun violence, prevention, and available resources for support and treatment.

Methods: This quasi-experimental, cross-sectional, survey-based, quality-improvement study included pre-, mid-, and posttraining surveys administered to patients and clinicians participating in an educational program at two urban healthcare centers in Philadelphia. The educational program included office enhancements (handouts and posters) and lunchtime presentations for clinicians regarding gun violence prevalence, prevention strategies, local support resources, and impacts on mental health for patients and their families. The anonymous patient survey was offered to all patients seen at two urban healthcare centers in Philadelphia during three nonconsecutive weeks over 3 months.

Results: Among 542 patients seen over the 3 weeks of survey collection, 428 completed the survey (response rate of 79 %). Sixty-four percent acknowledged being impacted by gun violence including the death of a loved one, witnessing a shooting, or being shot themselves. Over the course of the educational program, patients reported significant increases in (1) awareness of materials related to gun violence in the waiting areas, by 17.2 %, (2) discussions of gun violence with their clinician, by 12.1 %, and (3) discussions of methods to prevent gun injury, by 9.7 %. At the end of the study, 19.3 % of patients reported having discussions with their clinician about gun violence, and 14.3 % discussed strategies to prevent gun injury. Participating clinicians reported high levels of satisfaction and increased confidence when talking to patients about gun violence at the end of the program.

Conclusions: Providing clinician-directed education and printed materials increased the frequency with which clinicians discussed gun violence, prevention, and available resources with their patients. Increases were modest, with opportunities for improvement. A holistic and multifaceted approach is required to support families affected by gun violence, including education for clinicians and dissemination of information for families.

Context: With the advent of the Single Accreditation System (SAS) within the Accreditation Council for Graduate Medical Education (ACGME), few programs have achieved Osteopathic Recognition (OR) status to date. OR is an accreditation that graduate medical education (GME) programs can achieve to distinctly acknowledge the additional focus on osteopathic training. There is an effort by national osteopathic organizations to determine barriers for programs to achieve OR and what innovative methods might help overcome them. In identifying its own barriers, a central Ohio hospital created a unique Program Director for Osteopathic Medical Education (PDOME) role to assist its 10 programs in achieving OR.

Objectives: The objectives of this study were to determine the effect that a PDOME role has through measures of the numbers of programs achieving OR and standards met, as well as the perceived 'helpfulness' of the role based on surveys of program leadership.

Methods: Upon initiation of the PDOME in July 2021, the PDOME assessed applications, citations, and curriculums of the 10 hospital programs with varied OR status to help determine curricular goals. Additional osteopathic activities, evaluation tools and faculty development were subsequently offered based on this information and needs assessments of the programs. A survey was sent to all programs at intervals of 12 and 18 months after role inception to be utilized as process improvement. Comparisons were made between surveys, as well as between the total number of programs with continued OR status and the total OR requirements achieved before and after PDOME. A chi-square test (or Fisher's exact test when the 'n' was too small) was utilized for significance, and the p value was set at 0.05.

Results: After the PDOME, there was a significant increase in the number of OR standards met across programs (p<0.001). Although not significant, the number of programs achieving continued OR increased from 4 to 8 (p=0.168). Due to many positive responses in both surveys, there was no significance between surveys in the "helpfulness" of PDOME; however, there was a significant increase in the number of respondents from 13/67 (or 19.4 %) to 32/67 (or 47.8 %) (p<0.001), indicating increased engagement among respondents.

Conclusions: This study suggests that a PDOME role in medical education may be well received and may assist GME programs in achieving OR. Implementation of a similar role elsewhere could help programs overcome barriers and stir growth in OR programs nationwide.

Context: Vascular access malfunction and failure contribute to morbidity and hospitalization in hemodialysis populations. Although controversy still exists over the identification and appropriate management of access malfunction, recognition of sentinel signs during physical examination remains an efficient way to screen for access malfunction. Dialysis staff are on the front line of providing quality care to dialysis patients, often being the first ones who could detect early physical signs of access malfunction.

Objectives: The study's purpose is to determine the effect of an advanced vascular access educational module presented to hemodialysis nurses and technicians, focusing on physical examination findings to identify a dialysis access at risk for malfunction.

Methods: Utilizing a quasi-experimental pretest and posttest group design with a nonequivalent comparison control group, the effect of an advanced vascular access education module to improve vascular access knowledge and skill in recognition of sentinel signs of access malfunction was studied in a group of hemodialysis nurses (registered nurses [RNs]) and certified patient care technicians (PCTs).

Results: Knowledge post-test scores (RN, M=94.44, SD=7.05; PCT, M=90.83, SD=7.93) were significantly higher than pretest scores (RN, M=79.54, SD=12.47; PCT M=80.67, SD=7.99) in the intervention group (p<0.001) but not in the comparison group. There were no statistically significant differences in mean skill scores between dialysis nurses (p=0.38) and PCTs (p=0.826) or between intervention and comparison groups (p=0.332).

Conclusions: This study exposes a critical gap in the transition of vascular access knowledge to the practical skill of access assessment. The findings suggest the need for restructuring the clinical training of dialysis nurses and PCTs in vascular access management and care. Newer active learning educational strategies in physical assessment of hemodialysis vascular access should be explored to further support dialysis nurses and PCTs in providing optimal patient care.

Context: In 2020, the allopathic and osteopathic residency programs were merged into a single residency system, with the Accreditation Council for Graduate Medical Education (ACGME) as the sole accreditor for residencies and fellowships in the United States. As a result of this merger, osteopathic recognition (OR) emerged as a unique approach to promoting osteopathic training and practice. However, there is a lack of data on the effects of OR in residency, specifically university-based residency programs.

Objectives: The objective of this study is to investigate the impact of OR on retaining and applying osteopathic principles in a mixed cohort of residents in a single-center setting.

Methods: We conducted a prospective cohort study of allopathic and osteopathic-trained residents at varying years of postgraduate training in family medicine (FM), internal medicine (IM), and combined internal medicine-pediatric residencies at a single site. Participation in both the osteopathic curriculum and study was voluntary. We distributed a presurvey before the residents participated in the curriculum for that year and a follow-up 6 months later as a postsurvey. The surveys measured confidence levels based on a Likert scale and were aligned with the Osteopathic Recognition Milestones Project (ORMP). Statistical analysis with paired t tests and a Wilcoxon signed-rank test was conducted on participants who completed both surveys.

Results: We had 38 % (18/47) of participants complete both surveys. We observed significant improvements in confidence levels related to osteopathic principles (p=0.036). Residents reported statistically significant gains in their ability to conduct a literature review on osteopathic medicine (p=0.0288). Additionally, there was a trend toward significance in confidence levels regarding the patient's perception of touch (p=0.0741) and the osteopathic treatment plan (p=0.0635). Notably, content knowledge was significantly improved (p=0.0313) for all participants. Based on the postsurvey responses, we discovered that participants who not only reported higher confidence overall but also had practiced osteopathic manipulative treatment (OMT) in the last month were more likely to state they would practice osteopathic manipulative medicine (OMM) after residency.

Conclusions: We conducted a prospective cohort study to assess the effects of OR utilizing surveys aligned to the ORMP. We identified knowledge- and confidence-level gains on osteopathic principles and practice (OPP) in a single-center study. Residents in OR are more likely to utilize OMT after residency.

Endometriosis is defined as the presence of endometrial-like glands and stroma outside of the uterus. There are three types of endometriotic lesions: superficial or peritoneal endometriosis, ovarian endometrioma, and deep infiltrating disease. Endometriosis not only occurs in the pelvis but also can be found in extrapelvic sites such as the gastrointestinal tract, upper abdominal viscera, genitourinary tract, abdominal wall, diaphragm, and thoracic cavity. After thorough history and physical examination is performed, imaging, such as ultrasound or magnetic resonance imaging (MRI), should be obtained if there is high suspicion for deep-infiltrating endometriosis to better assess visceral involvement. Endometriosis can be suspected based on symptoms, physical examination findings, and imaging. However, a definitive diagnosis requires histopathologic confirmation. Treatment options include expectant, medical, and surgical management. Endometriosis is largely a quality-of-life issue, and treatment should be tailored accordingly with empiric medical therapy frequently utilized. Medical management focuses on symptom improvement. Surgical management with excision of endometriosis is preferred over ablation or fulguration of endometriotic lesions. In the case of deep or extrapelvic endometriosis, treatment with a multidisciplinary team with experience in the treatment of advanced-stage endometriosis is essential to minimizing morbidity and increasing long-term success.

This case report details the presentation, diagnosis, and management of a newborn Native American male with non-Herlitz junctional epidermolysis bullosa (JEB), a rare diagnosis specifically in the Native American population. Genetic analysis revealed a homozygous mutation in the COL17A1 gene. The management involved multidisciplinary care and highlighted the challenges in treatment, including pain management, wound care, and ethical considerations surrounding adoption within Indigenous communities. This case highlights the importance of tailored interventions and the need for further research into the genetic diversity and prevalence of epidermolysis bullosa (EB) among the Native American population.