Facofp Andrew Eilerman Do, Ryan Jay Oms, Chelsey Smith PharmD, C. F. Do, Jill Porter Do, Tejal Patel Do, Jennifer Reynolds Lsw
Objectives: To determine Lean management's ability to improve the efficiency of residents and increase osteopathic manipulative treatment (OMT) in a family medicine residency clinic. Methods: A Key Performance Indicator Board (KPI), a process of Lean management, was created in a residency clinic by various staff. Patient wait times were chosen for the quality measure and daily huddles took place to track progress. A “5-why” was conducted to determine the reasons for failure to meet goals. Faculty used this information to create the 5 “S” of Efficiency method to help residents improve timeliness in caring for complicated patients. Comparisons of the number of patient visits failing wait time goals and total OMT performed before and after the intervention was analyzed. Chi-square was used for statistical analysis and the p-value was set at 0.05. Results: Implementation of the 5 “S” of Efficiency method resulted in a significantly lower percentage of days failing the wait time goal in comparison to months before the intervention (p = 0.00001): the average percentage of failed days decreased from 43.1% to 10.4% with the intervention. Enacting Lean management also resulted in a significantly greater percentage of billed OMT billing codes (6.8% vs. 5.3%) (p = 0.03). Conclusion: This study indicates that the use of Lean may reduce patient wait times and lead to increased OMT use among family medicine residents. Use of Lean or the 5 “S” of Efficiency method may help other osteopathic programs attempting to improve care; however, further research is indicated.
目的:确定精益管理在家庭医学住院医师诊所提高住院医师工作效率和增加整骨手法治疗(OMT)的能力。方法:采用精益管理的方法，在某住院医师诊所由各科室人员创建关键绩效指标板(KPI)。病人的等待时间被选为质量衡量标准，并每天召开会议来跟踪进展。“5个为什么”被用来确定未能达到目标的原因。学院利用这些信息创建了效率的5个“S”方法，以帮助住院医生提高照顾复杂病人的及时性。比较患者就诊次数失败的等待时间目标和总OMT进行干预前后进行了分析。统计学分析采用卡方法，p值设为0.05。结果:与干预前几个月相比，实施效率5“S”方法导致未达到等待时间目标的天数百分比显著降低(p = 0.00001):干预后，未达到等待时间目标的平均天数百分比从43.1%下降到10.4%。实施精益管理还显著提高了OMT计费代码的百分比(6.8% vs. 5.3%) (p = 0.03)。结论:本研究表明，使用精益可以减少病人的等待时间，并导致家庭医学住院医师使用OMT的增加。使用精益或5“S”效率方法可以帮助其他骨科项目试图改善护理;然而，还需要进一步的研究。
{"title":"Use of Lean Management to Increase Efficiency and Osteopathic Manipulative Treatment in a Family Medicine Residency","authors":"Facofp Andrew Eilerman Do, Ryan Jay Oms, Chelsey Smith PharmD, C. F. Do, Jill Porter Do, Tejal Patel Do, Jennifer Reynolds Lsw","doi":"10.33181/13021","DOIUrl":"https://doi.org/10.33181/13021","url":null,"abstract":"Objectives: To determine Lean management's ability to improve the efficiency of residents and increase osteopathic manipulative treatment (OMT) in a family medicine residency clinic. \u0000\u0000Methods: A Key Performance Indicator Board (KPI), a process of Lean management, was created in a residency clinic by various staff. Patient wait times were chosen for the quality measure and daily huddles took place to track progress. A “5-why” was conducted to determine the reasons for failure to meet goals. Faculty used this information to create the 5 “S” of Efficiency method to help residents improve timeliness in caring for complicated patients. Comparisons of the number of patient visits failing wait time goals and total OMT performed before and after the intervention was analyzed. Chi-square was used for statistical analysis and the p-value was set at 0.05. \u0000\u0000Results: Implementation of the 5 “S” of Efficiency method resulted in a significantly lower percentage of days failing the wait time goal in comparison to months before the intervention (p = 0.00001): the average percentage of failed days decreased from 43.1% to 10.4% with the intervention. Enacting Lean management also resulted in a significantly greater percentage of billed OMT billing codes (6.8% vs. 5.3%) (p = 0.03). \u0000\u0000Conclusion: This study indicates that the use of Lean may reduce patient wait times and lead to increased OMT use among family medicine residents. Use of Lean or the 5 “S” of Efficiency method may help other osteopathic programs attempting to improve care; however, further research is indicated.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"1 1","pages":"10-15"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42326449","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}
C. Haddad, Do Christopher Scuderi, Judelle Haddad-Lacle, R. Grewal, Jeffery Jacqmein, Fasn Pradeep Kadambi
The world as we knew it changed at the beginning of 2020 with the explosion of the global pandemic caused by SARS-CoV-2, a.k.a. COVID-19. As of January 10, 2021, the novel coronavirus has infected over 89 million people worldwide and killed over 1.9 million. In the U.S., there have been 22 million people infected and 373,000 deaths. It has never been more important to protect our vulnerable patients and staff from infectious disease, especially during the time they spend in our offices and clinics. It quickly became apparent that there was a need for a dedicated location where patients could be seen that were too ill to be evaluated via telemedicine, but not ill enough to be sent to the Emergency Department (ED). To fill this need, our primary care network developed the Respiratory Evaluation Clinic (REC) concept. These were two geographical locations where the outlying clinics could send potentially infectious patients to evaluate and test COVID-19. Some recommendations, adaptations, lessons learned and the REC clinics' expansions to other locations throughout our network are discussed.
{"title":"Rapid Development and Deployment of Respiratory Evaluation Clinics in Response to the COVID-19 Pandemic to Keep Staff and Patients Safe","authors":"C. Haddad, Do Christopher Scuderi, Judelle Haddad-Lacle, R. Grewal, Jeffery Jacqmein, Fasn Pradeep Kadambi","doi":"10.33181/13025","DOIUrl":"https://doi.org/10.33181/13025","url":null,"abstract":"The world as we knew it changed at the beginning of 2020 with the explosion of the global pandemic caused by SARS-CoV-2, a.k.a. COVID-19. As of January 10, 2021, the novel coronavirus has infected over 89 million people worldwide and killed over 1.9 million. In the U.S., there have been 22 million people infected and 373,000 deaths. It has never been more important to protect our vulnerable patients and staff from infectious disease, especially during the time they spend in our offices and clinics. It quickly became apparent that there was a need for a dedicated location where patients could be seen that were too ill to be evaluated via telemedicine, but not ill enough to be sent to the Emergency Department (ED). To fill this need, our primary care network developed the Respiratory Evaluation Clinic (REC) concept. These were two geographical locations where the outlying clinics could send potentially infectious patients to evaluate and test COVID-19. Some recommendations, adaptations, lessons learned and the REC clinics' expansions to other locations throughout our network are discussed.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47843951","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}
Oms-Iii Beth Kolongowski, Do Mba Facoep Lindsay Tjiattas-Saleski
Cannabidiol, commonly abbreviated CBD, is one of the hundreds of compounds present in the flowering cannabis plant, along with its more well-known structural isomer, Δ9-tetrahydrocannabinol or THC. CBD can be extracted from the plant and utilized in many forms, from topical oils to smokable flowers. Recently, availability, interest in and use of CBD across the nation have grown exponentially, with internet searches for CBD increasing 160% between 2017 and 2018 and 14% of Americans citing current CBD use. Users of this compound endorse numerous perceived benefits, including anxiolysis, analgesia and much more. Most users claim to employ CBD to treat specific medical conditions spanning from autoimmune, to psychiatric, to musculoskeletal. Evidence supports some of these reported effects in recent studies, as CBD has demonstrated anticonvulsant, antipsychotic and antinociceptive properties, among others. However, the implications of these findings are still in their infancy. As of June 2018, one FDA-approved pure CBD product for seizure treatment, Epidiolex®, is available for prescription use and many more are in various stages of testing. However, numerous safety and legal concerns remain regarding off-label and over-the-counter CBD usage. Physicians and other health care professionals are likely to encounter CBD use by their patients. As usage continues to grow, so does the duty of care providers to understand its role and serve as a source of evidence-based information for their community on this relevant health topic.
{"title":"Cannabidiol: Background and Literature Review of Potential Treatments","authors":"Oms-Iii Beth Kolongowski, Do Mba Facoep Lindsay Tjiattas-Saleski","doi":"10.33181/13022","DOIUrl":"https://doi.org/10.33181/13022","url":null,"abstract":"Cannabidiol, commonly abbreviated CBD, is one of the hundreds of compounds present in the flowering cannabis plant, along with its more well-known structural isomer, Δ9-tetrahydrocannabinol or THC. CBD can be extracted from the plant and utilized in many forms, from topical oils to smokable flowers. Recently, availability, interest in and use of CBD across the nation have grown exponentially, with internet searches for CBD increasing 160% between 2017 and 2018 and 14% of Americans citing current CBD use. Users of this compound endorse numerous perceived benefits, including anxiolysis, analgesia and much more. Most users claim to employ CBD to treat specific medical conditions spanning from autoimmune, to psychiatric, to musculoskeletal. Evidence supports some of these reported effects in recent studies, as CBD has demonstrated anticonvulsant, antipsychotic and antinociceptive properties, among others. However, the implications of these findings are still in their infancy. As of June 2018, one FDA-approved pure CBD product for seizure treatment, Epidiolex®, is available for prescription use and many more are in various stages of testing. However, numerous safety and legal concerns remain regarding off-label and over-the-counter CBD usage. Physicians and other health care professionals are likely to encounter CBD use by their patients. As usage continues to grow, so does the duty of care providers to understand its role and serve as a source of evidence-based information for their community on this relevant health topic.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":"16-23"},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355718","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}
Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals. MBIs have shown benefit in pain patients. MBIs teach the individual the concept of pain coping, encouraging cognitive flexibility and attempting to discourage the fear or alarm reaction of pain, instead focusing on the quality of life and functionality. Mindfulness-based stress reduction (MBSR) showed a 30% significant improvement in pain intensity and pain coping at six months in patients with chronic low back pain, compared to opiates and NSAIDs, which showed no benefit. MBIs have also shown benefit in addiction, as they help the individual relearn to control cravings, habit modification and attempt to restore the natural reward system while improving regulation of emotions. Applications to opiate use disorder are significant as patients learn to enjoy the lifestyle of recovery and learn to believe they can improve. Additionally, other comorbid conditions are known to improve with MBIs and mindfulness-based principles support the holistic principle of mind, spirit and body consistent with osteopathic medicine.
{"title":"Mindfulness: Principles and Application to Decrease Opiate Use in Primary Care With an Osteopathic Component","authors":"D. Frasca","doi":"10.33181/13023","DOIUrl":"https://doi.org/10.33181/13023","url":null,"abstract":"Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals. \u0000MBIs have shown benefit in pain patients. MBIs teach the individual the concept of pain coping, encouraging cognitive flexibility and attempting to discourage the fear or alarm reaction of pain, instead focusing on the quality of life and functionality. Mindfulness-based stress reduction (MBSR) showed a 30% significant improvement in pain intensity and pain coping at six months in patients with chronic low back pain, compared to opiates and NSAIDs, which showed no benefit. \u0000MBIs have also shown benefit in addiction, as they help the individual relearn to control cravings, habit modification and attempt to restore the natural reward system while improving regulation of emotions. Applications to opiate use disorder are significant as patients learn to enjoy the lifestyle of recovery and learn to believe they can improve. Additionally, other comorbid conditions are known to improve with MBIs and mindfulness-based principles support the holistic principle of mind, spirit and body consistent with osteopathic medicine.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45361487","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}
A. Maiden, Shannon C. Scott, Erin C. Raney, Marisa Strobridge
Nonalcoholic fatty liver disease (NAFLD) comprises a continuum of conditions associated with insulin resistance and obesity in the absence of secondary causes of hepatic steatosis (alcohol, medication, genetic disorders, hepatitis, etc.) The milder, benign form of NAFLD is simple fatty liver or steatosis. Fatty infiltration affects more than 5% of the liver.1 This is determined by histologic exam, direct quantification or imaging. The range progresses to nonalcoholic steatohepatitis (NASH) and culminates in fibrosis and cirrhosis. Histologic changes include ballooning degeneration of hepatocytes, the presence of Mallory bodies, macrovesicular steatosis, lobular or portal inflammation.2 NAFLD is now the foremost cause of childhood, adolescent and adult chronic hepatic disease. The pediatric and adult obesity epidemic makes NAFLD a potentially ubiquitous hepatic pathology amongst all patients.3,4,5 The increase of obese children and adults with obesity correlates to the rise of NAFLD cases. In adults, the rate of NAFLD increase is paired with the epidemics of obesity and Type 2 Diabetes (T2DM).4,5 Data proposes hepatic-related mortality may be due to NASH ultimately progressing to cirrhosis.3,4 NAFLD is linked to pediatric and adult cardiovascular risk and morbidity.4,6 Non-invasive biomarkers and the gold standard of liver biopsy not only diagnose but assist in targeted therapies.6 Most pharmacologic therapy for NAFLD is in trial stages for patients of all ages. Pioglitazone is favored in adults who have NAFLD/NASH and T2DM.7 The gut biome is also impactful. Lifestyle modifications of diet and exercise can reduce the public health burden of this disease.7,8,9,10
{"title":"Nonalcoholic Steatohepatitis: Case-Based Focused on Pediatric and Adult Guidelines","authors":"A. Maiden, Shannon C. Scott, Erin C. Raney, Marisa Strobridge","doi":"10.33181/13024","DOIUrl":"https://doi.org/10.33181/13024","url":null,"abstract":"Nonalcoholic fatty liver disease (NAFLD) comprises a continuum of conditions associated with insulin resistance and obesity in the absence of secondary causes of hepatic steatosis (alcohol, medication, genetic disorders, hepatitis, etc.) The milder, benign form of NAFLD is simple fatty liver or steatosis. Fatty infiltration affects more than 5% of the liver.1 This is determined by histologic exam, direct quantification or imaging. The range progresses to nonalcoholic steatohepatitis (NASH) and culminates in fibrosis and cirrhosis. Histologic changes include ballooning degeneration of hepatocytes, the presence of Mallory bodies, macrovesicular steatosis, lobular or portal inflammation.2 \u0000NAFLD is now the foremost cause of childhood, adolescent and adult chronic hepatic disease. The pediatric and adult obesity epidemic makes NAFLD a potentially ubiquitous hepatic pathology amongst all patients.3,4,5 The increase of obese children and adults with obesity correlates to the rise of NAFLD cases. In adults, the rate of NAFLD increase is paired with the epidemics of obesity and Type 2 Diabetes (T2DM).4,5 Data proposes hepatic-related mortality may be due to NASH ultimately progressing to cirrhosis.3,4 NAFLD is linked to pediatric and adult cardiovascular risk and morbidity.4,6 Non-invasive biomarkers and the gold standard of liver biopsy not only diagnose but assist in targeted therapies.6 Most pharmacologic therapy for NAFLD is in trial stages for patients of all ages. Pioglitazone is favored in adults who have NAFLD/NASH and T2DM.7 The gut biome is also impactful. Lifestyle modifications of diet and exercise can reduce the public health burden of this disease.7,8,9,10","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46982428","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}
Oms-Iii Adel Elnashar, Oms-Iii Zachary Lodato, Do Faao Sheldon Yao
Hearing loss is a common complaint with extensive cognitive, physical, emotional, social and financial implications. Many adults are expected to present with varying degrees of hearing loss by the age of 60 to 69 years old that can be classified according to the cause into conductive, sensorineural and mixed. There can be associated symptoms, like tinnitus, vertigo and otalgia and/or abnormal behaviors such as social withdrawal and difficulty with interpersonal communication. Somatic dysfunctions can accompany hearing troubles and range from fluid problems such as fluids accumulation in the middle ear, lymphatic congestion of the head and neck, and structural dysfunctions in the eustachian tube, neck musculature, thoracic spine, ribs and the cranial rhythmic impulse in addition to other neurologic dysfunctions such as sympathetic hyperactivity and viscerosomatic changes. In this review, we provide several suggestions that may assist the osteopathic family physician in identifying the various causes behind the hearing loss, especially life-threatening or quality-of-life limiting causes. We will also provide an effective treatment addressing the cause of the hearing loss presentation and associated somatic dysfunctions, alone or in conjunction with other appropriately trained health care providers, based on the understanding of the five models of osteopathic medicine and how they can apply toward the anatomical and physiological components of adult hearing loss.
{"title":"Adult Hearing Loss: Applying the Five Models of Osteopathic Medicine to Diagnose and Treat","authors":"Oms-Iii Adel Elnashar, Oms-Iii Zachary Lodato, Do Faao Sheldon Yao","doi":"10.33181/13012","DOIUrl":"https://doi.org/10.33181/13012","url":null,"abstract":"Hearing loss is a common complaint with extensive cognitive, physical, emotional, social and financial implications. Many adults are expected to present with varying degrees of hearing loss by the age of 60 to 69 years old that can be classified according to the cause into conductive, sensorineural and mixed. There can be associated symptoms, like tinnitus, vertigo and otalgia and/or abnormal behaviors such as social withdrawal and difficulty with interpersonal communication. Somatic dysfunctions can accompany hearing troubles and range from fluid problems such as fluids accumulation in the middle ear, lymphatic congestion of the head and neck, and structural dysfunctions in the eustachian tube, neck musculature, thoracic spine, ribs and the cranial rhythmic impulse in addition to other neurologic dysfunctions such as sympathetic hyperactivity and viscerosomatic changes. In this review, we provide several suggestions that may assist the osteopathic family physician in identifying the various causes behind the hearing loss, especially life-threatening or quality-of-life limiting causes. We will also provide an effective treatment addressing the cause of the hearing loss presentation and associated somatic dysfunctions, alone or in conjunction with other appropriately trained health care providers, based on the understanding of the five models of osteopathic medicine and how they can apply toward the anatomical and physiological components of adult hearing loss.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69516648","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}
The purpose of this article is to provide background information and the current understanding of a less familiar cause of female breast cancer; exposure to ultraviolet light at night. Breast cancer is a common disease that causes significant morbidity and mortality in women. There are several risk factors for breast cancer, most of which are genetic and environmental in nature. An often-overlooked risk factor is exposure to blue light during night shift work, which decreases melatonin production. One of the many cancer-preventing properties of melatonin is to limit estrogen production. Increased lifetime exposure to estrogen is a well-known cause of breast cancer. Awareness of nighttime blue light exposure as a breast cancer risk factor by women doing night shift work and those exposed to nighttime light via smartphones and laptops, is essential information to know so that protective measures can be taken.
{"title":"Nighttime Blue Light Exposure and Breast Cancer","authors":"David Jaynes, P. Switzer","doi":"10.33181/13013","DOIUrl":"https://doi.org/10.33181/13013","url":null,"abstract":"The purpose of this article is to provide background information and the current understanding of a less familiar cause of female breast cancer; exposure to ultraviolet light at night. Breast cancer is a common disease that causes significant morbidity and mortality in women. There are several risk factors for breast cancer, most of which are genetic and environmental in nature. An often-overlooked risk factor is exposure to blue light during night shift work, which decreases melatonin production. One of the many cancer-preventing properties of melatonin is to limit estrogen production. Increased lifetime exposure to estrogen is a well-known cause of breast cancer. Awareness of nighttime blue light exposure as a breast cancer risk factor by women doing night shift work and those exposed to nighttime light via smartphones and laptops, is essential information to know so that protective measures can be taken.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":"30-33"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69516655","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}
Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.
{"title":"Lateral Epicondylitis: A Common Cause of Elbow Pain in Primary Care","authors":"Donald J Fleming, D. Muller, D. Lambert","doi":"10.33181/13014","DOIUrl":"https://doi.org/10.33181/13014","url":null,"abstract":"Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69516687","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}
DO Julie Kim, Javier Romero, DO Amanda Frugoli, Graal Diaz, Mlis Janet Hobbs
The novel nature of the SARS-CoV-2 virus inherently creates a paucity of reliable and validated data. Implementing evidence-based and data-driven protocols have been exceedingly difficult. As new information is released and integrated into the complex system, the health care delivery workflow must adapt. Incorporating changes on a frequent, if not daily basis, has led to confusion, frustration and loss of confidence among clinicians across the nation. This report illustrates the negative impact that false-positive COVID-19 results can have on the health delivery workforce and the emotional implications that false-positive results cast on health care providers.
{"title":"Implications of False Positive SARS-CoV-2 by PCR Test in the Health Care Work Force","authors":"DO Julie Kim, Javier Romero, DO Amanda Frugoli, Graal Diaz, Mlis Janet Hobbs","doi":"10.33181/13015","DOIUrl":"https://doi.org/10.33181/13015","url":null,"abstract":"The novel nature of the SARS-CoV-2 virus inherently creates a paucity of reliable and validated data. Implementing evidence-based and data-driven protocols have been exceedingly difficult. As new information is released and integrated into the complex system, the health care delivery workflow must adapt. Incorporating changes on a frequent, if not daily basis, has led to confusion, frustration and loss of confidence among clinicians across the nation. This report illustrates the negative impact that false-positive COVID-19 results can have on the health delivery workforce and the emotional implications that false-positive results cast on health care providers.","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41557135","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}
DO William Forgach, Oms-Iii Erik Krueger, Do Mba Facoep Lindsay Tjiattas-Saleski
{"title":"Bilateral Foot Pain and Swelling","authors":"DO William Forgach, Oms-Iii Erik Krueger, Do Mba Facoep Lindsay Tjiattas-Saleski","doi":"10.33181/13016","DOIUrl":"https://doi.org/10.33181/13016","url":null,"abstract":"","PeriodicalId":53642,"journal":{"name":"Osteopathic Family Physician","volume":"13 1","pages":"43-45"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69516695","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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