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An Osteopathic Approach to Anemia 贫血的骨病疗法
Q4 Medicine Pub Date : 2022-10-01 DOI: 10.33181/13085
Raena Pettitt, Glynn Horkott, Dillon Reno, Bryce Grohol
With close to 2 billion people affected globally, anemia is a commonly seen condition worldwide. Diagnosed by a patient’s low hemoglobin, and then subsequently differentiated through red blood cell indices, a complete blood count should be performed on every patient presenting with the classic symptoms of anemia. Iron studies, as well as the corrected reticulocyte count and peripheral blood smears, can also be of use to further specify the exact type of anemia. Additionally, tests including colonoscopies, upper endoscopies and gynecologic procedures should be considered to identify the different underlying causes of the disease. The most common microcytic anemias include iron deficiency, thalassemia and anemia of inflammation. Deficiencies in folate and B12—also known as cobalamin—are the most common etiologies of macrocytic anemia. Treatment of each of these types of anemia is tailored to the individual patient based on the severity of their condition as well as the specific underlying cause. Osteopathically, anemia falls largely into the respiratory-circulatory model, as well as the metabolic-energy model, which can also be used to guide treatment. For a family physician, identifying symptoms, making accurate diagnoses and properly treating patients with anemia is of the utmost importance.
全球有近20亿人受到影响,贫血是全世界常见的疾病。通过患者的低血红蛋白进行诊断,然后通过红细胞指数进行鉴别,应该对每一位出现贫血典型症状的患者进行全面的血液计数。铁研究,以及校正的网织红细胞计数和外周血涂片,也可以用于进一步确定贫血的确切类型。此外,应考虑进行结肠镜检查、上内镜检查和妇科手术等检查,以确定疾病的不同根本原因。最常见的微细胞贫血包括缺铁、地中海贫血和炎症性贫血。叶酸和B12(也称为钴胺素)缺乏是大细胞性贫血最常见的病因。每种类型的贫血的治疗都是根据患者病情的严重程度以及具体的潜在原因而量身定制的。从骨病学角度来看,贫血主要属于呼吸循环模型和代谢能量模型,也可用于指导治疗。对于家庭医生来说,识别症状、准确诊断和正确治疗贫血患者至关重要。
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引用次数: 0
Low-back pain in adolescents with an osteopathic component 青少年腰痛与骨科成分
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.33181/13078
Puneet Tung
Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.
腰痛(LBP)是青少年常见的症状。大多数青少年背部疼痛是良性的和肌肉骨骼的性质,由于创伤或先天性异常。其他不太常见的原因包括感染、炎症或肿瘤。全面的病史和体格检查,包括姿势、肌肉压痛、活动范围、肌肉力量和神经功能,对于了解腰痛的病因至关重要。确定腰痛的危险因素将有助于临床医生管理他们的病人。治疗包括休息、避免引起疼痛的活动、物理治疗、整骨疗法手法治疗、有限使用非甾体抗炎药以及家庭和患者教育。评估严重的腰痛原因的警告信号或危险信号是临床评估的基本部分。从睡眠中醒来的疼痛、持续时间超过4周的疼痛、突发性疼痛、全身症状(如发烧或体重减轻)以及神经系统异常症状,应立即进行评估,因为这些症状可能提示有严重的感染性疾病、恶性肿瘤或骨折。本文综述了青少年腰痛的流行病学、相关解剖学、生物力学、病因和主要危险因素。一种诊断算法利用一步一步的方法也被引入,以帮助临床医生在病人的管理。最后,文章提出了青少年腰痛的治疗指南,包括保守治疗、药物治疗和整骨疗法。从meta分析数据和随机对照试验中回顾了关于整骨疗法治疗的循证建议。
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引用次数: 0
Multiple sclerosis: A comprehensive review for the osteopathic provider 多发性硬化症:整骨医生的全面综述
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.33181/13079
Ethan Charles Blocher-Smith, Anthony Izokaitis
Multiple sclerosis (MS) is an uncommon neurological pathology frequently initially discovered by primary care providers in their workup of new focal neurological deficits. Many cases go undiagnosed for years despite multiple flares, with risk of cumulative disability. Early treatment is key to slowing or preventing the accumulation of this disability and maximizing function in the long term. This literature review covers all aspects of MS, including pathophysiology, diagnostic testing and differential diagnosis, disease classification, and disease-modifying agents for acute and chronic treatment. This study also summarizes support services, including osteopathic manipulative treatment, that help to maximize patient function and independence. While better therapeutics continue to emerge, significant limitations, side effects and continued progression—despite optimal therapy—result in progressive and irreversible loss of function for many patients. Heightened awareness of current progress in MS diagnosis criteria and initial testing amongst primary care providers can shorten the time to treatment and formal diagnosis, allowing patients to live their best lives despite their MS diagnosis.
多发性硬化症(MS)是一种罕见的神经系统病理,通常是由初级保健提供者在检查新的局灶性神经功能缺陷时发现的。许多病例尽管多次发作,但多年未被诊断出来,有累积残疾的风险。早期治疗是减缓或防止这种残疾积累和长期发挥最大功能的关键。这篇文献综述涵盖了MS的各个方面,包括病理生理学、诊断测试和鉴别诊断、疾病分类、急慢性治疗的疾病调节剂。本研究还总结了支持服务,包括骨科手法治疗,有助于最大限度地提高患者的功能和独立性。虽然更好的治疗方法不断出现,但显著的局限性、副作用和持续的进展——尽管有最佳的治疗——导致许多患者进行性和不可逆转的功能丧失。初级保健提供者提高对MS诊断标准和初始检测的当前进展的认识,可以缩短治疗和正式诊断的时间,使患者能够过上最好的生活,尽管他们被诊断为MS。
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引用次数: 0
Persistent red eye in a patient with IgA nephropathy IgA肾病患者持续性红眼
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.33181/13081
Leonid Skorin, Jr., DO, OD, MS, FAAO, FAOCO, Lucas J. Asfeld, Ragna Godtland
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引用次数: 0
The impact of climate change on our patients’ health and the family physician’s role 气候变化对病人健康的影响以及家庭医生的角色
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.33181/13080
Raena M. Pettitt, Tharini M. Gara, Meghan E. Izak, Ethan R. Steele
Climate change continues to have a detrimental effect on the overall health of people globally. The average yearly temperature has continually risen since the late 19th century and is projected to continue rising for decades ahead. Increased temperature has been linked to decreased sleep quality and increased heat strokes and pregnancy complications. Adverse effects on cardiopulmonary health have been linked to climate change. Air pollution is correlated to an increased risk of myocardial infarctions and aggravation of symptoms pertaining to asthma and chronic obstructive pulmonary disorder. Lengthening of the pollination season because of warmer weather due to climate change has led to an increase in allergy-related rhinitis and asthma. Temperature increases have caused a lengthening of the transmission season of infectious disease, especially vector and water-borne diseases. Infectious disease has begun to spread to new areas globally due to increased temperatures, rainfall and flooding attributed to climate change. The mental health impacts attributed to climate change, including depression and anxiety, are escalating. With increased floods and hurricanes, people of certain geographic areas can experience an increase in acute stress, which may lead to chronic post-traumatic stress disorder. Family physicians are at the forefront of advising patients on how to handle the health effects of climate change. In addition to climate change's impact on health, patients of lower socioeconomic status are more at risk because of lack of adequate resources and financial stability. Through detailed histories, family physicians have an opportunity to identify affected patients and intervene earlier.
气候变化继续对全球人民的整体健康产生不利影响。自19世纪末以来,年平均气温一直在上升,预计未来几十年将继续上升。温度升高与睡眠质量下降、中暑和妊娠并发症增加有关。对心肺健康的不利影响与气候变化有关。空气污染与心肌梗死风险增加以及哮喘和慢性阻塞性肺病症状加重有关。由于气候变化导致天气变暖,授粉季节延长,导致过敏性鼻炎和哮喘的增加。气温升高导致传染病传播季节延长,尤其是媒介和水传播疾病。由于气候变化导致的气温、降雨量和洪水增加,传染病已开始在全球范围内传播到新的地区。气候变化对心理健康的影响,包括抑郁和焦虑,正在升级。随着洪水和飓风的增加,某些地理区域的人们可能会经历急性压力的增加,这可能导致慢性创伤后应激障碍。家庭医生站在为患者提供如何应对气候变化对健康影响的建议的最前沿。除了气候变化对健康的影响外,由于缺乏足够的资源和财务稳定,社会经济地位较低的患者面临的风险更大。通过详细的病史,家庭医生有机会识别受影响的患者并尽早进行干预。
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引用次数: 0
2022 adult immunization schedule updates 2022年成人免疫计划更新
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.33181/13077
Stanley E. Grogg, DO, FACOP, FAAP
Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.
每年,美国疾病控制与预防中心(CDC)都会发布成人疫苗接种时间表。2022年成人疫苗计划有几个变化,将在以下手稿中讨论。免疫实践咨询委员会通常在10月或11月的会议上审查初步时间表。以下专业协会也批准了2022年出版前的成人时间表:美国医师学会(ACP)、美国家庭医师学会(AAFP)、美国妇产科医师学会(ACOG)、美国助产士护士学会(ACNM),美国医师助理学会(AAPA)和美国医疗流行病学学会(SHEA)。一旦最终草案获得美国疾病控制与预防中心的批准,它将发表在《发病率和死亡率周报》(MMWR)上,并向医疗保健提供者和公众发布,其中包括封面、表格、注释,以及2022年时间表的新附录,其中包含不同获批疫苗的禁忌症和注意事项。
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引用次数: 0
Osteopathic student training on preventing domestic violence 骨科学生预防家庭暴力培训
Q4 Medicine Pub Date : 2022-05-01 DOI: 10.33181/13071
Carrie Downing-Larick, M. Moore, Mackenzie Dreher, Alexis M. Stoner, Natalie Fadel, Ning Cheng
Introduction: Domestic violence is a serious and preventable public health issue. Student Training on Preventing Domestic Violence (STOP-DV) is an extracurricular program that educates medical students on domestic violence. This study sought to determine if STOP-DV is an effective method to increase the knowledge of domestic violence among medical students. Methods: This study utilized a quasi-experimental research approach. Participants were recruited through a convenience sample of first- and second-year medical students from an osteopathic medical school with three campuses. The intervention group included the campus where STOP-DV was implemented and was then compared to the control group (the other two campuses) without the program. Intervention and control groups were given the same pre-survey and post-survey to assess for baseline knowledge, awareness, self-efficacy and health-seeking behaviors. Bivariate and multivariate statistical analysis of matched pre-surveys and post-surveys was completed during the 2018 and 2019 school year.Results: Medical students in the intervention group (n=100) showed a statistically significant increase in self-efficacy and in the ability to recognize domestic violence in patients (p<0.001) and to discuss domestic violence with patients (p=0.004) compared to the control group (n=47). Based upon general linear regression analysis, survey stage significantly contributed to participants self-efficacy and domestic violence knowledge in both cohorts. Additionally, intervention group significantly contributed to participants’ medical domestic violence knowledge. Conclusions: This study was successful in implementing a domestic violence program and increasing awareness in medical students. The ultimate goal is to encourage schools to utilize a similar program to understand how domestic violence affects patients and their communities.
引言:家庭暴力是一个严重的、可预防的公共卫生问题。预防家庭暴力学生培训(STOP-DV)是一个对医学生进行家庭暴力教育的课外项目。本研究旨在确定STOP-DV是否是增加医学生家庭暴力知识的有效方法。方法:本研究采用准实验研究方法。参与者是通过一所有三个校区的整骨医学院的一年级和二年级医学生的方便样本招募的。干预组包括实施STOP-DV的校区,然后与没有该项目的对照组(其他两个校区)进行比较。干预组和对照组接受相同的调查前和调查后评估基线知识、意识、自我效能和健康寻求行为。在2018和2019学年完成了配对调查前和调查后的双变量和多变量统计分析。结果:与对照组(n=47)相比,干预组(n=100)的医学生在自我效能感和识别患者家庭暴力的能力(p<0.001)以及与患者讨论家庭暴力(p=0.004)方面表现出统计学上的显著提高。基于一般线性回归分析,调查阶段对两组参与者的自我效能感和家庭暴力知识有显著贡献。此外,干预组对参和者的医疗家庭暴力知识有显著贡献。结论:本研究成功地实施了家庭暴力计划,提高了医学生的意识。最终目标是鼓励学校利用类似的项目来了解家庭暴力如何影响患者及其社区。
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引用次数: 0
The effects of OMT on progressive massive fibrosis: A brief report of an adjunctive therapy to improve respiratory function in Appalachian coal miners OMT对进行性大面积纤维化的影响:阿巴拉契亚煤矿工人呼吸功能改善辅助治疗的简要报告
Q4 Medicine Pub Date : 2022-05-01 DOI: 10.33181/13075
Joshua Raven, Paige Lewis, Antoinette Justice, James B Crum, Danny Driskill
Recently in Central Appalachia, there has been a resurgence of the more complicated form of black lung disease known as progressive massive fibrosis (PMF). This brief report was aimed at determining the effects osteopathic manipulative treatment (OMT) could have to improve the lives of these individuals. This brief report involved a former Appalachian Coal Miner diagnosed with PMF. Over the course of a year, the patient was seen and treated with OMT. Though the patient reported improvement in his activities of daily living compared to previous, there was no significant data according to spirometry or quality of life metrics. This study illustrates that OMT has the potential to provide adjunctive treatment for patients with PMF. Limitations due to sample size and socioeconomic deficits of former Appalachian coal miners warrant further study.
最近在阿巴拉契亚中部,被称为进行性大规模纤维化(PMF)的更复杂形式的黑肺病又死灰复燃了。这篇简短的报告旨在确定骨科手法治疗(OMT)对改善这些患者生活的影响。这篇简短的报道涉及一位被诊断患有PMF的前阿巴拉契亚煤矿工人。在一年的时间里,病人接受了OMT治疗。虽然患者报告的日常生活活动与先前相比有所改善,但肺活量测定或生活质量指标没有显著数据。本研究表明,OMT有可能为PMF患者提供辅助治疗。由于样本量的限制和前阿巴拉契亚煤矿工人的社会经济赤字值得进一步研究。
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引用次数: 0
Knee dislocations and multi-ligament knee injuries: A review 膝关节脱位和多韧带损伤:综述
Q4 Medicine Pub Date : 2022-05-01 DOI: 10.33181/13073
Jason Cinti, Griffin Elbert, A. Lamb, Petros Frousiakis, S. Sweet
Acute knee dislocations are a relatively rare type of injury that can lead to serious neurovascular compromise and ligament instability. These injuries can be potentially limb threatening if not properly identified and managed. The following review discusses the relevant anatomy of the knee joint and different classification systems of dislocations in order to highlight the complications that could occur. Timely evaluation and management, including reduction, is paramount to ensure stability and determine the need for additional imaging or urgent consultation. Knee dislocations are also associated with the unique presentation of a multi-ligament injury. This text provides an overview of multi-ligament knee injuries and the various surgical modalities currently being used. Finally, considerations are given on the role of the osteopathic approach in restoring function of the knee in the context of a dislocation.
急性膝关节脱位是一种相对罕见的损伤,可导致严重的神经血管损伤和韧带不稳定。如果没有正确识别和管理,这些损伤可能会对肢体造成潜在威胁。以下综述讨论了膝关节的相关解剖结构和脱位的不同分类系统,以强调可能发生的并发症。及时的评估和管理,包括减少,对于确保稳定性和确定是否需要额外的成像或紧急咨询至关重要。膝关节脱位也与多韧带损伤的独特表现有关。本文概述了膝关节多韧带损伤和目前使用的各种手术方式。最后,考虑了整骨方法在脱位情况下恢复膝关节功能的作用。
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引用次数: 0
Glaucoma: A review for the family physician 青光眼:给家庭医生的复查
Q4 Medicine Pub Date : 2022-01-01 DOI: 10.33181/13063
E. H. Harrison, Leonid Skorin, Jr., DO, OD, MS, FAAO, FAOCO
Glaucoma is an insidious disease process that causes damage to the optic nerve head and retinal nerve fiber layer, resulting in progressive vision loss. Multiple factors play a role in its pathophysiology, but intraocular pressure is a significant yet modifiable risk factor and therefore is targeted by all current treatment modalities. Its high prevalence and potential for irreversible damage necessitate an understanding of the condition by primary care physicians, who will undoubtedly be managing conditions and medications that can influence glaucomatous progression. This article will explore the pathophysiologic basis of glaucoma, discuss some of the common subtypes and highlight important clinical considerations.
青光眼是一种隐匿性的疾病过程,它引起视神经头和视网膜神经纤维层的损伤,导致进行性视力丧失。多种因素在其病理生理中起作用,但眼压是一个重要但可改变的危险因素,因此是目前所有治疗方式的目标。它的高患病率和潜在的不可逆损害需要初级保健医生了解这种情况,他们无疑将管理影响青光眼进展的条件和药物。本文将探讨青光眼的病理生理基础,讨论一些常见亚型,并强调重要的临床注意事项。
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引用次数: 0
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Osteopathic Family Physician
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