Pub Date : 2024-02-27DOI: 10.1093/med/9780190276201.001.0001
Anne Jones, Kristin Bertsch, Joanna Petrides, Kaitlin R. Lilienthal, Meagan Vermeulen
Osteopathic family physicians embody the philosophy of whole-person care, including using a biopsychosocial approach to incorporate mental health into patient care. The creation of the Behavioral Health Integration Collaborative increased support for a system-level adoption of whole-person care in primary care settings. With the increase in both mental health symptoms and diagnoses among Americans, and the increasing support for integrated physical and behavioral healthcare in the primary care setting, this paper shares various approaches, as well as challenges to, adapting integrated care in the primary care office. This includes reviewing best practices for implementing this care approach. The two leading models for integrated care are the Primary Care Behavioral Health (PCBH) model and Collaborative Care model (CoCM). Both models include clinically embedding licensed mental health professionals into the primary care setting, thus increasing access to colleagues with this specialized approach. The PCBH model utilizes a warm hand-off approach, resulting in a collaboration between physician and mental health provider in the care of the patient. The CoCM focuses on a registry of patients who are overseen by a behavioral health manager with treatment decisions guided by a consulting psychiatrist. Blended models are also emerging to better suit the needs for different practices and the patient populations they serve. Challenges to full implementation include acquiring buy-in from practice leadership, hiring appropriately trained mental health providers, and defining billing and coding procedures.
{"title":"Integrating Behavioral Health and Primary Care","authors":"Anne Jones, Kristin Bertsch, Joanna Petrides, Kaitlin R. Lilienthal, Meagan Vermeulen","doi":"10.1093/med/9780190276201.001.0001","DOIUrl":"https://doi.org/10.1093/med/9780190276201.001.0001","url":null,"abstract":"Osteopathic family physicians embody the philosophy of whole-person care, including using a biopsychosocial approach to incorporate mental health into patient care. The creation of the Behavioral Health Integration Collaborative increased support for a system-level adoption of whole-person care in primary care settings. With the increase in both mental health symptoms and diagnoses among Americans, and the increasing support for integrated physical and behavioral healthcare in the primary care setting, this paper shares various approaches, as well as challenges to, adapting integrated care in the primary care office. This includes reviewing best practices for implementing this care approach. The two leading models for integrated care are the Primary Care Behavioral Health (PCBH) model and Collaborative Care model (CoCM). Both models include clinically embedding licensed mental health professionals into the primary care setting, thus increasing access to colleagues with this specialized approach. The PCBH model utilizes a warm hand-off approach, resulting in a collaboration between physician and mental health provider in the care of the patient. The CoCM focuses on a registry of patients who are overseen by a behavioral health manager with treatment decisions guided by a consulting psychiatrist. Blended models are also emerging to better suit the needs for different practices and the patient populations they serve. Challenges to full implementation include acquiring buy-in from practice leadership, hiring appropriately trained mental health providers, and defining billing and coding procedures.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jack Gomperts, Lisa Carroll, Bethany Powers, Arley Rodriguez
Many osteopathic textbooks include treatment modalities and techniques that could improve frequently experienced ailments of pregnancy, such as nausea, vomiting, gastroesophageal reflux disease, constipation, and edema. However, there is little scientific evidence to support the use of osteopathy for these conditions, particularly among the pregnant population. The aim of this literature review is to identify and evaluate current evidence regarding the use of osteopathy in the management of common discomforts of pregnancy. Several search engines and journals were used to identify peer-reviewed articles written between 2003 and 2023. Eleven articles were included in total, including a variety of case reports, pilot studies, and journal articles. The results show that although osteopathy does appear to be safe to perform during the third trimester and its efficacy in the treatment of these conditions is promising, current evidence is insufficient to guide treatment protocols. Further research is needed to establish efficacy and determine osteopathic treatment regimens.
{"title":"Application Of Osteopathic Treatment for Non-Pain–Related Discomforts of Pregnancy","authors":"Jack Gomperts, Lisa Carroll, Bethany Powers, Arley Rodriguez","doi":"10.33181/16103","DOIUrl":"https://doi.org/10.33181/16103","url":null,"abstract":"Many osteopathic textbooks include treatment modalities and techniques that could improve frequently experienced ailments of pregnancy, such as nausea, vomiting, gastroesophageal reflux disease, constipation, and edema. However, there is little scientific evidence to support the use of osteopathy for these conditions, particularly among the pregnant population. The aim of this literature review is to identify and evaluate current evidence regarding the use of osteopathy in the management of common discomforts of pregnancy. Several search engines and journals were used to identify peer-reviewed articles written between 2003 and 2023. Eleven articles were included in total, including a variety of case reports, pilot studies, and journal articles. The results show that although osteopathy does appear to be safe to perform during the third trimester and its efficacy in the treatment of these conditions is promising, current evidence is insufficient to guide treatment protocols. Further research is needed to establish efficacy and determine osteopathic treatment regimens.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Histiocytic sarcoma is a rare and frequently missed diagnosis. With unusual and varied presentations, it typically indicates a rapid patient decline and poor outcomes. The diagnosis requires a high degree of clinical suspicion. In this case, we explore the progression of illness in a 56-year-old white male who initially presented with a 2-week history of soft-tissue nodules scattered throughout his head, neck, torso, and limbs, as well as shortness of breath and knee pain. After a thorough workup including computed tomography imaging of the neck, chest, and lower extremity, as well as a biopsy of a nodule with immunoperoxidase staining, a diagnosis of histiocytic sarcoma was established. Due to the severity of his malignancy, his hospital course was complicated by a deep vein thrombosis. Clinicians should be mindful of the risk of acute decompensation in such cases and can employ the various tenets of osteopathic theory to improve patient quality of life. Depending on the severity of illness, physicians may proceed to facilitate end-of-life measures with grace and dignity.
{"title":"Histiocytic Sarcoma","authors":"Varintha Baddam, Jasraj Kahlon, Emma Talbott","doi":"10.33181/16104","DOIUrl":"https://doi.org/10.33181/16104","url":null,"abstract":"Histiocytic sarcoma is a rare and frequently missed diagnosis. With unusual and varied presentations, it typically indicates a rapid patient decline and poor outcomes. The diagnosis requires a high degree of clinical suspicion. In this case, we explore the progression of illness in a 56-year-old white male who initially presented with a 2-week history of soft-tissue nodules scattered throughout his head, neck, torso, and limbs, as well as shortness of breath and knee pain. After a thorough workup including computed tomography imaging of the neck, chest, and lower extremity, as well as a biopsy of a nodule with immunoperoxidase staining, a diagnosis of histiocytic sarcoma was established. Due to the severity of his malignancy, his hospital course was complicated by a deep vein thrombosis. Clinicians should be mindful of the risk of acute decompensation in such cases and can employ the various tenets of osteopathic theory to improve patient quality of life. Depending on the severity of illness, physicians may proceed to facilitate end-of-life measures with grace and dignity.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"32 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140427476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human parechovirus (HPeV) infections have been increasing in the United States since May 2022, according to the Centers for Disease Control and Prevention. HPeVs are a member of the Picornaviridae family and share similarities with enteroviruses, though they differ in genomic structure. HPeV commonly affects children, with disease manifestations ranging anywhere from an asymptomatic infection to severe disease. HPeV typically affects the gastrointestinal and respiratory tracts but may rarely also cause severe infection of the central nervous system (CNS), leading to sepsis-like illness, meningitis, and encephalitis. Of the 19 established serotypes of HPeV, serotypesA1 and A3 are most commonly identified in humans. HPeV serotype A3 is of particular importance as it more commonly causes sepsis and CNS infection, especially in children. In the United States between 2014 and 2016, a total of 2758 cases of enteroviruses and parechoviruses were reported to the National Enterovirus Surveillance System. Of those cases, 2.3% were distinguished as HPeVA3. This case details the clinical course of an eight-day-old infant with HPeV meningoencephalitis. The infant initially presented with fever and other nonspecific symptoms, which later progressed to include diffuse erythroderma and seizure activity. Although current management of HPeV meningoencephalitis involves supportive care and close monitoring, determining HPeV as a cause of infection is important due to the long-term sequelae that patients may develop. Potential complications of infection include white matter lesions of the brain, cerebral palsy, developmental delay, and visual impairment. This case was documented to increase awareness of the rising incidence of HPeV infections in children in the United States, as well as to detail the signs and symptoms of HPeV meningoencephalitis in a neonate.
{"title":"Human Parechovirus Meningoencephalitis In an Eight-Day-Old Infant","authors":"Katlin Hencak, Nicole Iven, Hanna Sahhar","doi":"10.33181/16105","DOIUrl":"https://doi.org/10.33181/16105","url":null,"abstract":"Human parechovirus (HPeV) infections have been increasing in the United States since May 2022, according to the Centers for Disease Control and Prevention. HPeVs are a member of the Picornaviridae family and share similarities with enteroviruses, though they differ in genomic structure. HPeV commonly affects children, with disease manifestations ranging anywhere from an asymptomatic infection to severe disease. HPeV typically affects the gastrointestinal and respiratory tracts but may rarely also cause severe infection of the central nervous system (CNS), leading to sepsis-like illness, meningitis, and encephalitis. Of the 19 established serotypes of HPeV, serotypesA1 and A3 are most commonly identified in humans. HPeV serotype A3 is of particular importance as it more commonly causes sepsis and CNS infection, especially in children. In the United States between 2014 and 2016, a total of 2758 cases of enteroviruses and parechoviruses were reported to the National Enterovirus Surveillance System. Of those cases, 2.3% were distinguished as HPeVA3. This case details the clinical course of an eight-day-old infant with HPeV meningoencephalitis. The infant initially presented with fever and other nonspecific symptoms, which later progressed to include diffuse erythroderma and seizure activity. Although current management of HPeV meningoencephalitis involves supportive care and close monitoring, determining HPeV as a cause of infection is important due to the long-term sequelae that patients may develop. Potential complications of infection include white matter lesions of the brain, cerebral palsy, developmental delay, and visual impairment. This case was documented to increase awareness of the rising incidence of HPeV infections in children in the United States, as well as to detail the signs and symptoms of HPeV meningoencephalitis in a neonate.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"41 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alissa O'Neill, Brandon Goodwin, Riyaz Abidi, Philip Collins
Chronic limb-threatening ischemia (CLTI) is an advanced form of peripheral vascular disease with high rates of morbidity and mortality. Patients often present with claudication, impaired walking, and ischemic pain. Screening for CLTI and peripheral arterial disease is recommended with ankle-brachial indexing. To prevent progression to CLTI, family medicine physicians can intervene with lifestyle modification of hyperlipidemia, obesity, smoking, and encouraging well-rounded high-fiber diets. OMT can be useful in increasing lower-extremity circulation and collateral-vessel development. If refractive to optimized medical management and lifestyle modification, surgical intervention is required. Regardless of intervention, CLTI maintains a high rate of morbidity and mortality, with halting progression being the primary objective.
{"title":"Chronic Limb-Threatening Ischemia: Management Updates and Common Questions","authors":"Alissa O'Neill, Brandon Goodwin, Riyaz Abidi, Philip Collins","doi":"10.33181/16101","DOIUrl":"https://doi.org/10.33181/16101","url":null,"abstract":"Chronic limb-threatening ischemia (CLTI) is an advanced form of peripheral vascular disease with high rates of morbidity and mortality. Patients often present with claudication, impaired walking, and ischemic pain. Screening for CLTI and peripheral arterial disease is recommended with ankle-brachial indexing. To prevent progression to CLTI, family medicine physicians can intervene with lifestyle modification of hyperlipidemia, obesity, smoking, and encouraging well-rounded high-fiber diets. OMT can be useful in increasing lower-extremity circulation and collateral-vessel development. If refractive to optimized medical management and lifestyle modification, surgical intervention is required. Regardless of intervention, CLTI maintains a high rate of morbidity and mortality, with halting progression being the primary objective.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"51 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140424061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Varnita Vishwanath, Shanen Jean, John Ashurst, Farshad Agahi
Infertility affects one in four female physicians in the United States, yet the topic of fertility among female physicians is understudied and warrants focused strategies to implement change. Factors that exacerbate the rates of infertility in female physicians include intentional delays in family planning that are driven by the length of medical training and career advancements, age, long working hours, and physician burnout. While the effects of COVID-19 on reproductive health remain uncertain, the virus may have played a role in illuminating an already existing issue in women’s reproductive health. Burnout rates among female physicians have reached record highs contributing to reproductive disorders that warrant well-deserved attention to this issue. Initiatives should focus on fertility education in undergraduate medical education, organizational-level interventions, better insurance coverage for infertility treatments, and addressing burnout. Collaborative efforts between individuals, institutions and organizations are needed to prioritize reproductive health among female physicians.
{"title":"Addressing Infertility and Other Reproductive Outcomes Among Female Physicians","authors":"Varnita Vishwanath, Shanen Jean, John Ashurst, Farshad Agahi","doi":"10.33181/16102","DOIUrl":"https://doi.org/10.33181/16102","url":null,"abstract":"Infertility affects one in four female physicians in the United States, yet the topic of fertility among female physicians is understudied and warrants focused strategies to implement change. Factors that exacerbate the rates of infertility in female physicians include intentional delays in family planning that are driven by the length of medical training and career advancements, age, long working hours, and physician burnout. While the effects of COVID-19 on reproductive health remain uncertain, the virus may have played a role in illuminating an already existing issue in women’s reproductive health. Burnout rates among female physicians have reached record highs contributing to reproductive disorders that warrant well-deserved attention to this issue. Initiatives should focus on fertility education in undergraduate medical education, organizational-level interventions, better insurance coverage for infertility treatments, and addressing burnout. Collaborative efforts between individuals, institutions and organizations are needed to prioritize reproductive health among female physicians.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"10 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Abend, Leonard Powell, Abiram Sivanandam, Rahul Nayar
Bronchiectasis is an uncommon chronic obstructive lung disease caused by chronic airway inflammation leading to irreversible bronchial dilation and destruction of medium-sized airways. In this case, we treated a bronchiectasis patient with a combination of osteopathic manipulative treatment (OMT) techniques including myofascial release and lymphatic techniques as adjunctive treatments in addition to other pharmacologic and nonpharmacologic therapies; OMT was shown to improve subjective symptoms of airway congestion as well as reduce frequency of emergency room visits and hospital admissions for this patient.
{"title":"Osteopathic Manipulative Treatment for Chronic Bronchiectasis","authors":"David Abend, Leonard Powell, Abiram Sivanandam, Rahul Nayar","doi":"10.33181/13106","DOIUrl":"https://doi.org/10.33181/13106","url":null,"abstract":"Bronchiectasis is an uncommon chronic obstructive lung disease caused by chronic airway inflammation leading to irreversible bronchial dilation and destruction of medium-sized airways. In this case, we treated a bronchiectasis patient with a combination of osteopathic manipulative treatment (OMT) techniques including myofascial release and lymphatic techniques as adjunctive treatments in addition to other pharmacologic and nonpharmacologic therapies; OMT was shown to improve subjective symptoms of airway congestion as well as reduce frequency of emergency room visits and hospital admissions for this patient.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"79 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Trivelas, Kirby Slaughter, Kenneth Zaremski, Carol Kirila
Urinary incontinence is a nuanced and stigmatized condition that causes significant challenges for a large number of people in the United States and imposes a large financial and community burden. We provide an overview of major categorizations of incontinence by type as well as potential etiologies. We discuss how this condition impairs self-image, interferes with socialization, and can lead to depression and isolation; these elements inter-relate with access to care and implementation of the therapeutic options, further exacerbating patient suffering. We recognize the key components of patient evaluation regarding history and physical examination. Medicinal, surgical, and assistive device use are reviewed. Osteopathic manipulative treatments addressing the structures of the pelvis are also reviewed in detail. We illustrate how these techniques can be used to optimize outcomes. Utilizing a holistic approach to mitigate the multiple challenges that this condition presents can lead to greater success, reduced distress, and improved patient satisfaction.
{"title":"An Osteopathic Approach to Urinary Incontinence Including Biopsychosocial Aspects and Multiple Modalities for a Holistic Approach to Optimize Ongoing Care","authors":"Nicholas Trivelas, Kirby Slaughter, Kenneth Zaremski, Carol Kirila","doi":"10.33181/13104","DOIUrl":"https://doi.org/10.33181/13104","url":null,"abstract":"Urinary incontinence is a nuanced and stigmatized condition that causes significant challenges for a large number of people in the United States and imposes a large financial and community burden. We provide an overview of major categorizations of incontinence by type as well as potential etiologies. We discuss how this condition impairs self-image, interferes with socialization, and can lead to depression and isolation; these elements inter-relate with access to care and implementation of the therapeutic options, further exacerbating patient suffering. We recognize the key components of patient evaluation regarding history and physical examination. Medicinal, surgical, and assistive device use are reviewed. Osteopathic manipulative treatments addressing the structures of the pelvis are also reviewed in detail. We illustrate how these techniques can be used to optimize outcomes. Utilizing a holistic approach to mitigate the multiple challenges that this condition presents can lead to greater success, reduced distress, and improved patient satisfaction.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"37 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen Yang, Jessica Oleske, Sami E Rishmawi, Hanna Sahhar
Dacryocystitis is the inflammation of the nasolacrimal sac and is due to obstruction of the nasolacrimal system or lacrimal stagnation, leading to favorable environments for infection. Any disruptions to the nasolacrimal pathway can increase the risk of dacryocystitis. Here is a unique case of Prevotella denticola dacryocystitis that progressed into cellulitis and abscess formation in a 7-year-old female with a medical history of Goldenhar syndrome, recurrent dacryocystitis, and periodontal disease. The patient presented with standard dacryocystitis symptoms—tenderness to palpation, erythema, and edema to the medial canthus. The patient was treated empirically with vancomycin, ceftriaxone, and clindamycin. She was discharged home on clindamycin with symptomatic improvement and plans for dacryocystorhinostomy. Goldenhar syndrome is a rare congenital craniofacial malformation disorder due to aberrant morphogenesis in structures derived from the first and second branchial arches. P. denticola is an anaerobic gram-negative bacillus significant to the oral microbiome. There is currently limited research suggesting the relationship between Goldenhar syndrome and dacryocystitis complicated by Prevotella denticola. Based on the patient’s medical history, we predict that her complex presentation was secondary to the dissemination of Prevotella from her oral cavity. This case report emphasizes the importance of gram-negative anaerobic coverage in complicated dacryocystitis in patients with nasolacrimal defects.
{"title":"Prevotella Denticola Dacryocystitis and Abscess in a Child with Goldenhar Syndrome","authors":"Karen Yang, Jessica Oleske, Sami E Rishmawi, Hanna Sahhar","doi":"10.33181/13107","DOIUrl":"https://doi.org/10.33181/13107","url":null,"abstract":"Dacryocystitis is the inflammation of the nasolacrimal sac and is due to obstruction of the nasolacrimal system or lacrimal stagnation, leading to favorable environments for infection. Any disruptions to the nasolacrimal pathway can increase the risk of dacryocystitis. Here is a unique case of Prevotella denticola dacryocystitis that progressed into cellulitis and abscess formation in a 7-year-old female with a medical history of Goldenhar syndrome, recurrent dacryocystitis, and periodontal disease. The patient presented with standard dacryocystitis symptoms—tenderness to palpation, erythema, and edema to the medial canthus. The patient was treated empirically with vancomycin, ceftriaxone, and clindamycin. She was discharged home on clindamycin with symptomatic improvement and plans for dacryocystorhinostomy. Goldenhar syndrome is a rare congenital craniofacial malformation disorder due to aberrant morphogenesis in structures derived from the first and second branchial arches. P. denticola is an anaerobic gram-negative bacillus significant to the oral microbiome. There is currently limited research suggesting the relationship between Goldenhar syndrome and dacryocystitis complicated by Prevotella denticola. Based on the patient’s medical history, we predict that her complex presentation was secondary to the dissemination of Prevotella from her oral cavity. This case report emphasizes the importance of gram-negative anaerobic coverage in complicated dacryocystitis in patients with nasolacrimal defects.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"31 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Up to 15% of concussed patients experience persistent symptoms and functional impairment following injury. This is often related to headaches, dizziness, imbalance, and visual disturbances.
Objectives: To perform a systematic review of the evidence for interventions used to manage postconcussion symptoms in working-aged adults falling within the headache-migraine, ocular, and vestibular postconcussion symptom cluster subtypes.
Methods: A literature search was performed according to the PRISMA statement. PubMed, OVID, Cochrane Central, PEDro, OSTEMED, and the grey literature checklist were searched from the dates of creation of each database through December 29, 2020. The outcome measures were compared by generating the standardized mean difference (SMD) with 95% confidence intervals. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to rate the overall quality of the evidence.
Results: The literature search identified 496 candidate studies. After removing duplicates, 352 studies remained. The titles and abstracts of the remaining studies were screened for eligibility and 343 studies were excluded. The full text of the remaining nine studies was assessed for eligibility and risk of bias. None of these studies was excluded. This left nine studies for qualitative and quantitative analysis.
Conclusions: Moderate-quality evidence suggests 4 interventions show promise for treating adults with headache-migraine, ocular, and vestibular postconcussion subtype symptoms.
{"title":"A Systematic Review of Treatments for Mild Traumatic Brain Injury in Adults","authors":"James Price","doi":"10.33181/13100","DOIUrl":"https://doi.org/10.33181/13100","url":null,"abstract":"Context: Up to 15% of concussed patients experience persistent symptoms and functional impairment following injury. This is often related to headaches, dizziness, imbalance, and visual disturbances.
 Objectives: To perform a systematic review of the evidence for interventions used to manage postconcussion symptoms in working-aged adults falling within the headache-migraine, ocular, and vestibular postconcussion symptom cluster subtypes.
 Methods: A literature search was performed according to the PRISMA statement. PubMed, OVID, Cochrane Central, PEDro, OSTEMED, and the grey literature checklist were searched from the dates of creation of each database through December 29, 2020. The outcome measures were compared by generating the standardized mean difference (SMD) with 95% confidence intervals. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to rate the overall quality of the evidence.
 Results: The literature search identified 496 candidate studies. After removing duplicates, 352 studies remained. The titles and abstracts of the remaining studies were screened for eligibility and 343 studies were excluded. The full text of the remaining nine studies was assessed for eligibility and risk of bias. None of these studies was excluded. This left nine studies for qualitative and quantitative analysis.
 Conclusions: Moderate-quality evidence suggests 4 interventions show promise for treating adults with headache-migraine, ocular, and vestibular postconcussion subtype symptoms.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135990790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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