Journal of Osteopathic Medicine最新文献

Context: The COVID-19 pandemic disrupted clinical research in many medical and surgical fields, resulting in research waste and loss of treatment for patients. Although other areas have been explored, the extent of the pandemic's influence on osteoarthritis (OA) trials is currently unknown.

Objectives: This study aims to explore the reasons for termination of clinical trials investigating OA during the COVID-19 pandemic.

Methods: We searched ClinicalTrials.gov for OA trials and characterized their reason for discontinuation, noting where trialists directly cited the COVID-19 pandemic as the reason for trial discontinuation. We also coded other common reasons for trial discontinuation. Descriptive and inferential statistics were performed to determine the difference in enrollment, funding source, trial phase, allocation, and intervention type between the trials terminated early due to pandemic and nonpandemic reasons.

Results: Out of 135 clinical trials, 119 were included and 27 (22.7 %) of them reported the COVID-19 pandemic as a primary reason for discontinuation, which was the overall most common reason for OA trial discontinuation during the study period. We found statistically significant differences for trials discontinued due to pandemic vs. non-pandemic-related reasons, with trials having sites outside the United States, randomized allocation, and drug or device intervention type being most affected. However, there was no statistically significant difference between groups regarding trial phase, funding source, or enrollment.

Conclusions: This study highlights the impact of the COVID-19 pandemic on the clinical trials related to OA. We found that many trials reported discontinuation directly due to the pandemic, which may lead to the loss or delay of novel treatments for OA. To avoid such discontinuation in the future, alternative methods for conducting OA-related clinical trials should be explored and implemented.

Context: A 25-pound weight limit is currently set on containerized instrumentation sets by the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI), in order to reduce strain on the staff and ensure that the sets are not too crowded in order to preserve sterilization and drying of the instruments. This is pushing companies to reduce the weight and number of instrumentation sets for the operating room. One solution has been to explore the viability of new, lighter materials such as Onyx.

Objectives: The goal of this study is to evaluate the novel material Onyx as a viable material utilized in reusable total knee arthroplasty (TKA) instrumentation sets utilizing traditional steam sterilization as the sterilization method.

Methods: Mechanical and biocompatibility tests according to the American Society for Testing Materials (ASTM) and International Organization for Standardization (ISO) 10,993 were run to evaluate the Onyx Material to see if it would be a viable alternative to the stainless and martensitic steel that is currently being utilized.

Results: Gross warping and cracking after 10 rounds of sterilization was observed. This was qualitatively worse in the Onyx without a carbon fiber component. The Onyx material did not meet biocompatibility standards for its application.

Conclusions: Onyx was determined to not be a viable material for TKA instruments regarding multiple high-pressure and -temperature sterilizations and cytotoxic cell testing.

Context: Medical professionals commonly fail to follow best practice guidelines. Drift, or a return to previous tendencies, is abundant in healthcare even when guidelines are followed initially. This "drift" was found internally at Temple University Hospital with preoperative electrocardiograms (ECGs). Best-practice guidelines were instituted and followed as a first step, but sustaining performance improvement was the ultimate goal.

Objectives: The objectives are to improve and maintain adherence to published guidelines for preoperative ECG testing at Temple University Hospital in a physician-led, nurse practitioner (NP)-staffed preadmission testing (PAT) clinic.

Methods: To start this quality improvement (QI) project, a retrospective chart review was completed to determine the number of ECGs performed in PAT at Temple University Hospital in 2017. New guidelines for ordering preoperative ECGs were then implemented, and Plan-Do-Study-Act (PDSA) cycles were performed over 3 years. A repeat retrospective chart review was completed and looked at ECGs ordered from 2018 through 2020. The number of ECGs completed in PAT before and after implementation of the new guidelines was then compared. In addition, the complexity of our surgical patients was estimated by looking at the yearly average American Society of Anesthesiology Physical Health Status (American Society of Anesthesiology [ASA] status) values assigned. Finally, the cost of performing each ECG was calculated, and the cost savings to the hospital over 4 years was determined.

Results: The baseline ECG rate for PAT in 2017, 2018, 2019, and 2020 at Temple University Hospital was 54.0 , 20.7, 22.3, and 21.9 %, respectively, which was a statistically significant decrease in ECG performance rate in the years after implementation of the PDSA project. The ASA status average remained constant, demonstrating that while patients' medical diagnoses remained on average the same, reinforced training had been effective in preventing a return to previous liberal ordering tendencies. Over the course of 4 years, the reduction in unnecessary ECGs led to an estimated direct cost savings of $213,000.

Conclusions: Self-adoption of best-practice guidelines among clinicians is often poor; however, the barriers to adoption can be overcome with education and individual feedback. Sustaining performance improvement gains is challenging, but possible, as shown by example in one urban, academic teaching hospital's physician-led, NP-staffed outpatient clinic.

Context: Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit.

Objectives: The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians.

Methods: More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables.

Results: Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (β=0.332, p=0.00, se=0.052) and Satisfaction with the visit (β=0.209, p=0.01, se=0.081) only when the physician was a DO.

Conclusions: Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

Context: Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened.

Objectives: Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities.

Methods: We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease.

Results: More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14-3.85), anxiety (AOR 2.98, CI 2.64-3.37), hypertension (AOR 1.21, CI 1.02-1.44), and asthma (AOR 1.37; CI 1.17-1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders.

Conclusions: Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care.

Context: Osteopathic manipulative treatment (OMT) is utilized by clinicians to diagnose and treat a variety of musculoskeletal conditions including acute and chronic pain, and other medical conditions. Previous studies have examined attitudes of allopathic (MD) residents toward OMT and have implemented residency-based curricula; however, literature is lacking on the attitudes of MD students toward OMT.

Objectives: The objective of this study was to determine MD students' familiarity with OMT and to evaluate their interest in an elective osteopathic curriculum.

Methods: A 15-item online survey was electronically sent to 600 MD students at a large allopathic academic medical center. The survey assessed familiarity with OMT, interest in OMT and in participating in an OMT elective, educational format preference, and interest in pursuing primary care. Educational demographics were also collected. Descriptive statistics and Fisher's exact test were utilized for categorical variables, and nonparametric tests were utilized for the ordinal and continuous variables.

Results: A total of 313 MD students submitted responses (response rate=52.1 %), of which 296 (49.3 %) responses were complete and utilized for analysis. A total of 92 (31.1 %) students were aware of OMT as a modality in treating musculoskeletal disorders. Among the respondents who indicated "very interested" in learning a new pain treatment modality, the majority: (1) observed OMT in a prior clinical or educational setting (85 [59.9 %], p=0.02); (2) had a friend or family member treated by a DO physician (42 [71.2 %], p=0.01); (3) were pursuing a primary care specialty (43 [60.6 %], p=0.02); or (4) interviewed at an osteopathic medical school (47 [62.7 %], p=0.01). Among those interested in developing some OMT competency, the majority: (1) were pursuing a primary care specialty (36 [51.4 %], p=0.01); (2) applied to osteopathic schools (47 [54.0], p=0.002); or (3) interviewed at an osteopathic medical school (42 [56.8 %], p=0.001). A total of 230 (82.1 %) students were somewhat or very interested in a 2-week elective course in OMT; among all respondents, hands-on labs were the preferred method for delivery of OMT education (272 [94.1 %]).

Conclusions: The study found a strong interest in an OMT elective by MD students. These results will inform OMT curriculum development aimed at interested MD students and residents in order to provide them with OMT-specific theoretical and practical knowledge.

Context: Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries.

Objectives: Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices.

Methods: Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury.

Results: Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001).

Conclusions: The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.