JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION最新文献

Context: Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied.

Objective: To estimate the prevalence of low serum zinc concentrations among community-dwelling adults, and to characterize clinical features and risk factors associated with zinc deficiency.

Methods: This retrospective pilot prevalence study took place from 2014 to 2017 at an outpatient clinic in southeast Ohio. Patients aged 50 years or older with a stable health status were categorized into a case group with zinc deficiency (serum zinc concentration, <0.66 µg/mL) and a control group (serum zinc concentration, ≥0.66 µg/mL). Measurements included serum zinc concentration, nutritional biomarkers (ie, magnesium, calcium, albumin, and total 25-hydroxy vitamin D levels), patient history of fractures and events such as hospitalization, antibiotic use, and self-reported falls that occurred within 1 year prior to the date serum zinc concentration was measured (index date). Patients were excluded if they had a serum zinc measurement within 2 months after a hospitalization, severe renal insufficiency (3 patients with serum creatinine concentration above 2.5 mg/dL), or serum zinc concentration above 1.20 µg/mL.

Results: This study included 157 patients, consisting of a case group of 41 (26%) patients with zinc deficiency and a control group of 116 (74%) without zinc deficiency. Mean (SD) zinc concentrations of the case and control groups were 0.58 (0.05) µg/mL and 0.803 (0.13) µg/mL, respectively (P<.01). Patients in the case group were more likely to have had a history of hospitalization, antibiotic use, a fall within 1 year before the index date, and a history of fractures and hip fracture (P<.01 in each case). Patients taking gastric acid suppressants had increased odds of lower zinc concentrations (odds ratio, 2.24; 95% CI, 1.08-4.63). Both logistic and multivariate linear regression models revealed that past fractures, hip fractures, and hypoalbuminemia (albumin <3.5 g/dL) were associated with zinc deficiency or lower zinc concentrations.

Conclusion: This study revealed that 26% of patients in an outpatient adult clinic had zinc deficiency based on serum concentrations. Patients with fracture history and low serum albumin were at higher risk for zinc deficiency.

Context: Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modifications to daily behaviors can be very overwhelming, thus leading to diabetes-related distress.

Objective: To investigate the association between diabetes-related distress and perceived social support among people with type 2 diabetes.

Methods: This cross-sectional study surveyed a population with a lower socioeconomic status (Medi-Cal recipients, which are only given to low-income individuals) in Solano County, California. Patients who had type 2 diabetes mellitus, who were between 40 and 80 years old, and who had a medical appointment in the clinic(s) at least once between December 2015 and December 2016 were included. Patients who could not understand or speak English and patients whose primary care clinicians declined their participation in the study were excluded from the study. Each study participant was recruited at the end of their medical appointment, and the survey instrument in paper form was administered. The Problem Areas in Diabetes (PAID) scale, which indicates diabetes-related distress, and Multidimensional Scale of Perceived Social Support (MSPSS) with 3 subscales (family, friends, and significant others) were used in this study. Multiple linear regression models were used to analyze the associations between PAID and MSPSS surveys.

Results: For the 101 participants included in our study, multiple linear regression models showed statistically significant association between total MSPSS scores and total PAID scores (β = -.318; 95% CI, .577, -.0581; P=.017) as well as between MSPSS family subscale scores and total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012). Among the 3 MSPSS subscales, higher perceived support from family members was found to be significantly associated with lower total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012).

Conclusion: Our findings suggest that a higher level of perceived social support experienced was associated with lower diabetes-related distress among patients with type 2 diabetes. Osteopathic physicians have a central role in providing comprehensive, patient-centered, holistic care, and the attention to social support in chronic disease management can help remove barriers in providing optimal care.

Context: Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entrustable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country.

Objective: To review the status of EPA implementation at COMs nationally.

Methods: An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from "moderate implementation with reporting" to "full implementation with reporting." Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings.

Results: Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above "somewhat knowledgeable" toward "expert" regarding knowledge of EPAs, but 23 (64%) also indicated "no confidence" or "somewhat confident" regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the "foundational implementation" (10; 28%), "slight implementation" (11; 31%), and "moderate implementation" (11, 31%) categories, with a few schools indicating "no implementation" (2; 5%) or "progressive implementation" (2; 5%).

Conclusion: The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.

Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, "DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5," to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.

Context: The effectiveness of osteopathic manipulative treatment (OMT) on the lumbar spine has been studied qualitatively, but quantitative measurement of the effects of OMT has not been thoroughly investigated.

Objective: To quantitatively measure the palpated improvements of OMT on the lumbar spine using ultrasonography (US) and correlate palpatory diagnosis with US measurements of lumbar asymmetry.

Methods: From September to November 2018, we recruited 20 adult participants 18 years of age or older. Lumbar somatic dysfunction (SD) was identified via osteopathic palpation. US was then performed on all participants with standard machine settings (frequency, 7 MHz; depth, 7 cm; dynamic range, 60; tissue harmonic imaging; and single-image focus). Longitudinal images of each lumbar transverse process were recorded and saved bilaterally by an experienced radiologist and a medical student. The participant's SD was then managed using OMT, including Still technique, myofascial release, muscle energy technique, high-velocity low-amplitude technique, functional positional release, balanced ligamentous tension, and counterstrain. Following OMT, US was performed again in the same method. Measurements of the saved US images were reviewed using a Digital Imaging and Communications in Medicine viewer. These measurements were obtained by 3 separate observers (J.W., A.K., S.M.), using the same computer software. Statistical analysis included a 2-tailed paired t-test to analyze rotational asymmetry pre- and posttreatment, an intraclass correlation coefficient (ICC) to test intra- and interobserver reliability, and a Pearson correlation coefficient (PCC) to analyze the correlation between US findings and OMT.

Results: The difference in soft tissue thickness before and after OMT was significant (P=.014), indicating improvements in rotational asymmetry. Side-bending asymmetry did not demonstrate statistically significant improvement. US findings correlated with the physician's palpatory rotational diagnosis (PCC=0.62, P=.004). ICC was greater than 0.9 for intra- and interobserver reliability tests of both US operation and offline image processing.

Conclusion: The results of this study demonstrate that US is a feasible method of evaluating the efficacy of OMT. These results show good intra- and interobserver reliability of US acquisition and landmark measurement. Our study suggests that US assessment correlated closely with palpatory diagnosis. Our results also suggest that OMT can significantly improve lumbar rotational asymmetry, but did not improve side-bending asymmetry.

Asthma is among of the first ailments documented in the existing academic literature as being successfully managed with osteopathic manipulative treatment (OMT) techniques. Time-efficient and well-tolerated OMT techniques have been gradually added to the literature to manage this increasingly prevalent disease. In this narrative review, the authors discuss previously-published literature describing the history, diagnosis, and management of asthma related to osteopathic principles and practices and OMT application. They also present current and newly-approved medical managements, including biologics and inhaled corticosteroids. This article also includes supplemental videos showcasing OMT techniques for asthma management, which were developed by the authors based on recommendations indicated in the literature.

Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dysfunctions. If left untreated, these somatic dysfunctions can directly alter ligamentous tension on the pelvic floor and surrounding regions, resulting in perineal pain. Management of vulvodynia must be individualized due to the multifactorial etiology and complicated structure and function of the pelvic floor muscles. The authors present a case of vulvodynia in which osteopathic manipulative treatment was an effective management technique.

The risk of opioid use disorder among patients with sickle cell disease who are treated with chronic opioids remains unclear, but the complications associated with opioid use and overdose can be accentuated in those with sickle cell disease. In this case report, we describe a 13-year-old girl with sickle cell disease who presented to the emergency department after a morphine overdose causing renal infarction, acute kidney injury, acute respiratory distress syndrome, and posterior reversible encephalopathy syndrome.