Journal of Osteopathic Medicine最新文献

Context: Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors.

Objectives: This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]).

Methods: We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns.

Results: Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02).

Conclusions: Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.

Sudden cardiac death (SCD) is a rare yet devastating event that can occur in young athletes. Although hypertrophic obstructive cardiomyopathy is the most common cause of SCD, some other genetic abnormalities have been identified as proarrhythmic. However, there is not routine screening for these other genetic abnormalities. Furthermore, consumption of caffeine, stimulant medication, or prolonged exercise can potentiate the underlying arrhythmic potential. In the event of SCD, advanced cardiac life support (ACLS) should be performed immediately and exactly. The authors present a case of an otherwise healthy young male who collapsed during a marathon and could not be resuscitated despite aggressive measures. After aggressive resuscitative efforts, the patient ultimately expired. A postmortem autopsy revealed no cardiac structural abnormalities, and the cause of death was determined to be cardiac arrhythmia of undetermined etiology. Postmortem genetic testing revealed a heterozygous variation in calcium voltage-gated channel auxiliary subunit beta 2 (CACNB2), a gene associated with arrhythmia and calcium channelopathy. Toxicology showed therapeutic levels of amphetamine. This case highlights the eminent risk of cardiac death in young athletes with proarrhythmic genetic variations, especially in the setting of endurance sport.

Context: The ideal format for residency and fellowship interviews has been consistently debated. Secondary to the COVID-19 pandemic, many institutions, including all hand surgery fellowship programs, transitioned interviews to an all-virtual format. In the past year, with ease of travel restrictions, some programs have transitioned back to in-person interviews, while others remain solely virtual. Hand surgery fellowship programs are continually assessing what are the best means for conducting these interviews, with little perspective regarding the applicant's preferences.

Objectives: The purpose of this study was to examine hand surgery fellowship applicants' perspectives regarding in-person and virtual interviews. It was hypothesized that applicants would value interpersonal relationships between faculty when deciding upon their ideal hand surgery fellowship, which would be easier to appreciate in-person.

Methods: All hand fellowship interviewees at a single institution were given a voluntary, electronic survey. The survey consisted of questions examining different aspects of the program's interview day and supplemental resources. Responses were recorded after the in-person interview for the years 2018-2020. Questions were altered for the virtual 2021 and 2022 interviews. Questions were scored on a Likert scale.

Results: For the in-person interview cycles, there were 60/86 respondents (69.8 %). For the virtual interview cycles, there were 45/73 respondents (61.6 %). During the in-person interview cycles, applicants reported that the current fellows' perspective talk was the most helpful component. Many applicants commented that they enjoyed meeting their potential co-fellows. The virtual interviewees felt that they had the best understanding of the program's core values/culture and the worst understanding of faculty personalities and personal/family life. Twenty-nine (64.4 %) of virtual applicants would prefer an all in-person interview. Of the 16 respondents who did not advocate for a completely in-person interview, 56.3 % preferred the option for an in-person site visit.

Conclusions: Hand surgery fellowship applicants desire interpersonal interactions to better understand prospective fellowship programs, which can be difficult to convey with an all-virtual interview. The results of this survey can help guide fellowship programs as they continue to optimize in-person, virtual, and hybrid interview formats and refine recruitment resources.

Context: Diabetic ketoacidosis (DKA) is an endocrine emergency that can occur in people with diabetes. Its incidence is estimated to be 220,340 hospital admissions each year. Treatment algorithms include fluid resuscitation, intravenous (IV) insulin infusion, and scheduled electrolyte and glucose monitoring. The misdiagnosis of DKA in the setting of hyperglycemic emergencies results in overtreatment and unnecessary increases in healthcare utilization and costs.

Objectives: The aims of this study were to determine how often DKA is overdiagnosed in the context of other acute hyperglycemic emergencies, to describe the baseline characteristics of patients, to determine the hospital treatments for DKA, and to identify the frequency of endocrinology or diabetology consultation in the hospital setting.

Methods: A retrospective chart review was conducted utilizing charts from three different hospitals within a hospital system. Charts were identified utilizing ICD-10 codes for admissions to the hospital for DKA. If the patient was over 18 and had one of the diagnostic codes of interest, the chart was reviewed for further details regarding the criteria for DKA diagnosis as well as admission and treatment details.

Results: A total of 520 hospital admissions were included for review. DKA was incorrectly diagnosed in 28.4 % of the hospital admissions reviewed, based on a review of the labs and DKA diagnostic criteria. Most patients were admitted to the intensive care unit (ICU) and treated with IV insulin infusion (n=288). Consultation of endocrinology or diabetology occurred in 40.2 % (n=209) of all hospital admissions, and 128 of those consults occurred in ICU admissions. The diagnosis of DKA was incorrect in 92 of the patients admitted to the medical surgical unit (MSU) and in 49 of patients admitted to the ICU.

Conclusions: Almost one third of hospital admissions for hyperglycemic emergencies were misdiagnosed and managed as DKA. DKA diagnostic criteria are specific; however, other diagnoses like hyperosmolar hyperglycemic syndrome (HHS), hyperglycemia, and euglycemic DKA can make an accurate diagnosis more complicated. Education directed at improving the diagnostic accuracy of DKA among healthcare providers is needed to improve diagnostic accuracy, ensure the appropriate use of hospital resources, and potentially reduce costs to the healthcare system.