JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION最新文献

Context: Concussions can cause cognitive impairment, somatic symptoms, and behavioral changes. Symptoms may vary in severity, depending on the degree of traumatic force. Due to the biomechanical nature of this trauma, cranial somatic dysfunctions may commonly be seen in patients with concussion.

Objective: To determine whether patients were more likely to have nonphysiologic cranial somatic dysfunctions than physiologic cranial somatic dysfunctions after sustaining a concussion.

Methods: College athletes who had a concussion based on the Immediate Post-Concussion Assessment and Cognitive test were evaluated by a physician within 1 week of the injury. Patients were evaluated for somatic dysfunctions of the cranium. Cranial somatic dysfunctions were documented; test scores and force vectors were compared with the type of strain pattern using SPSS, with P<.05 demonstrating statistical significance.

Results: Sixteen patients were included in the study: 10 with nonphysiologic cranial strain somatic dysfunctions and 6 with physiologic dysfunctions. Compared with lateral forces, forces of impact with anterioposterior vectors were associated 1.5 times more often with nonphysiologic rather than physiologic cranial somatic dysfunctions (P=.697). An analysis of specific cranial strain patterns and impact force vectors showed no statistical significance (P=.096).

Conclusion: There was no statistically significant association showing that concussion patients were more likely to have nonphysiologic cranial somatic dysfunctions compared with physiological cranial somatic dysfunctions. However, nonphysiologic cranial somatic dysfunctions did show a trend toward association with concussion. Further studies are needed to better understand the potential association between concussion and cranial somatic dysfunctions.

The authors present the case of a 24-year-old man who sustained multiple injuries during a hard landing following a parachute jump. These injuries included a right sacral fracture, bilateral femoral fractures, a separated pubic symphysis, and compression fractures of the fifth and sixth thoracic vertebrae. He was treated with a right sacroiliac joint fixation, pubic symphysis fixation, open reduction internal fixation of his bilateral femurs, and fusion of the third through seventh thoracic vertebrae. The patient experienced back pain, bilateral hip pain, and bilateral knee pain resistant to chiropractic and medical treatments. The patient presented 2 years after his aforementioned surgical procedures for treatment of persistent postoperative pain at the Physical Medicine and Rehabilitation service at the Veterans Affairs Medical Center in Hampton, Virginia. His treatment involved gait correction achieved using a left-sided heel lift and a transition to custom molded orthotics that incorporated the lift. This treatment leveled his sacral base and resulted in a simultaneous decrease in his self-reported pain scores.

Context: Doppler sonography is a noninvasive method to evaluate the hemodynamic status of the kidney, and its parameters are used as direct and indirect predictors of certain parenchyma and renovascular diseases. However, the effect of hydration on kidney hemodynamics has not been explored via Doppler sonography.

Objective: To examine differences in arterial Doppler velocities of normal adult kidney before and after hydration.

Methods: A total of 60 native kidneys in 30 normal adult participants (mean age, 26 years) were assessed using Doppler sonography. Quantitative ultrasound Doppler parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) of the main renal artery and the intrarenal (interlobar) arteries were measured immediately before and 1 hour after ingestion of 500 mL of water. We tested differences in Doppler parameters before and after hydration using a paired t test, analyzed the correlation of the increase in PSV to the increase in EDV after hydration using Pearson correlation coefficient (PCC), and examined intraobserver reliability using intraclass correlation coefficient (ICC).

Results: Statistical analyses revealed that the differences in PSV and EDV values before and after hydration at the main renal artery and interlobar arteries of the kidney were significant (P<.001), whereas the RI at the main renal artery and interlobar arteries were not (P>.05). PCC for the correlation of the increase in PSV to the increase in EDV was greater than 0.80. ICC for intraobserver repeatability in performing kidney Doppler sonography was 0.92.

Conclusion: Our results suggest that Doppler sonography is able to demonstrate changes in kidney hemodynamics within 1 hour after hydration. The normal kidney reflects proportional increases in PSV and EDV at the main renal artery and interlobar arteries, while maintaining vascular resistance. Doppler flow velocities of renal arteries can be considered as noninvasive quantitative markers for evaluating the response of kidney hemodynamics to hydration.

Context: The first exposure to opioids for many women of reproductive age follows childbirth. Current data show a significant correlation between the number of days supplied and continued use/abuse of opioids. The number of women with opioid dependency in pregnancy is steadily increasing, and opioid use is directly linked to an increase in maternal and neonatal morbidity and mortality. However, there are no clear opioid-prescribing guidelines for the postpartum period.

Objective: To compare the number of opioid pills prescribed with the number used by patients in the postpartum period.

Methods: Patients were recruited to this pilot study at the time of admission to the labor and delivery unit at a community hospital in Oklahoma City, Oklahoma; 84 patients gave informed consent to participate. Medical records were reviewed to determine the number of opioids prescribed. Phone surveys were conducted 4 to 6 weeks after discharge to identify the number of opioids used during the postpartum period. Welch t test was used to determine P values.

Results: After exclusion criteria were applied, records of 23 patients with vaginal deliveries and 14 patients with cesarean sections were included in the study. Patients who were prescribed opioids after a vaginal delivery were prescribed significantly more pills than were used (P<.001); a mean of 10 opioid pills per patient remained unused. Patients prescribed opioids after cesarean section were also often prescribed more opioid pills than used (P<.05); an average of 7.5 opioid pills per patient remained unused. Of 37 patients, only 2 disposed of unused opioid pills.

Conclusion: The data in this study show a clear example of overprescibing opioids after vaginal and cesarean deliveries leading to increased opioid pill availability within the community.

Context: Diagnosis of somatic dysfunction is based on subjective palpatory osteopathic assessments. This subjectivity has posed a challenge for researchers in studying osteopathic medicine. The development and use of radiological imaging techniques to objectively confirm or quantify muscle tissue stiffness associated with somatic dysfunction could be of benefit in osteopathic clinical practice, training, and further research.

Objectives: To investigate the feasibility of ultrasound shear wave elastography (SWE) to quantify muscle tissue stiffness in somatic dysfunction before and after osteopathic manipulative treatment (OMT).

Methods: In this prospective study, we assessed lumbar spine somatic dysfunction in 20 adult patients before and after a single OMT session using standard osteopathic palpatory assessments by osteopathic physician faculty members in the Department of Osteopathic Principle and Practice at Rocky Vista University College of Osteopathic Medicine (Utah campus). Shear wave velocity (SWV, m/s) was measured in lumbar paraspinal muscle tissue using a commercial ultrasonography scanner on all participants immediately before and after OMT. In this study, OMT techniques targeted the iliocostalis lumborum and included the articulatory technique, balanced ligamentous tension, facilitated positional release, high-velocity, low-amplitude technique, muscle energy, myofascial release, and the Still technique at the discretion of the osteopathic physician. The difference in SWV between muscle tissues with and without dysfunction, and differences in SWV of dysfunctional tissue before and after OMT were examined using unpaired and paired t tests, as appropriate. The correlation between SWV measurements and osteopathic assessments was examined by the Spearman rank correlation. Intra- and interobserver reliability was analyzed using intraclass correlation coefficient.

Results: The difference in SWV between muscle tissues with and without somatic dysfunction was significant before OMT (mean [SD], 1.93 [0.44] vs 1.69 [0.19]; P=.03) and was not significant after OMT (mean [SD], 1.69 [0.19] vs 1.53 [0.31]; P=.05). The difference in SWV in the same tissue with somatic dysfunction before and after OMT was significant (mean [SD], 1.93 [0.44] vs 1.52 [0.3]; P<.001). The SWV value highly correlated with manual osteopathic assessments (r=0.72). Intra- and interobserver reliability for performing SWE in somatic dysfunction was good (intraclass correlation coefficient >0.80).

Conclusions: The results of this study show that ultrasound SWE can objectively assess muscle tissue stiffness for diagnosis of somatic dysfunctions and for muscle tissue stiffness changes after OMT.

Left bundle branch block complicates electrocardiogram interpretation of acute myocardial infarction (MI) because ST segment elevations, commonly used as evidence of MIs, are largely hidden by the repolarization vector. To better diagnose acute MI in cases of left bundle branch block, modified Sgarbossa criteria can be used as a clinical tool to help diagnose or exclude MI with high specificity and sensitivity. However, while clinical tools are often helpful, a clinician cannot solely rely on clinical decision-making algorithms. We describe the case of an 84-year-old man experiencing acute cardiopulmonary symptoms who was negative for modified Sgarbossa criteria, but later had a confirmed diagnosis of MI on transfer to a cardiac center. This case illustrates the necessity of good clinical judgment and a high index of suspicion for atypical presentation alongside any diagnostic algorithm.

Context: Patients with severe traumatic brain injury (TBI) often have multiple autonomic disturbances that interfere with normal gastrointestinal motility. Many of the pharmacologic agents used in the intensive care unit (ICU) also adversely affect gastrointestinal motility. The body is further subjected to excessive levels of sympathetic discharge in states of traumatic injury and extreme stress, which can interfere with the proper absorption of fluids and nutrients.

Objective: To determine whether mesenteric lift, an osteopathic manipulative treatment technique, is effective in relieving constipation in patients with TBI who are intubated in the ICU.

Methods: This retrospective medical record review examined the effect of mesenteric lift on intubated patients with significant TBI who were unable to have a bowel movement within 72 hours of admission. The primary endpoint was the return of normal bowel function within 24 hours. A control group consisted of intubated patients with TBI during the same period who did not receive mesenteric lift.

Results: Of patients who received mesenteric lift, 77% experienced bowel movements (n=27 of 35), compared with 36% (n=16 of 44) in the control group (P=.01).

Conclusion: The application of mesenteric lift to intubated patients with severe TBI in the intensive care unit significantly increased patients' ability to resume normal bowel function and expel waste.

The University of New England College of Osteopathic Medicine (UNE COM) was founded by a group of osteopathic physicians who wanted to ensure that the practice of Osteopathic Medicine would endure in northern New England and that patients in the region would continue to receive the best health care possible. UNECOM merged with St. Francis College in 1978 to form the University of New England (UNE). 1 UNE has grown and developed over the years, building on the shared Franciscan and osteopathic traditions of integrating philosophy and intellect. Following the 1996 merger with Westbrook College in Portland, Maine, UNE now comprises 3 campuses, 13 additional health profession programs, 6 Centers of Excellence in Research, and strong undergraduate programs that link the environment, people, and community in a "One Health" concept.