Physical Medicine/Osteopathic Manipulative Medicine

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21767

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    ENHANCING PATIENT AND DOCTOR EXPERIENCE IN AN OUTPATIENT OSTEOPATHIC MANIPULATIVE MEDICINE (OMM) CLINIC VIA UTILIZATION OF ELECTRONIC MEDICAL RECORD (EMR) SCRIBES
    (2014-03) Mason, David; Myers, John
    Survey-based study to identify whether employing a scribe in an osteopathic manipulative medicine (OMM) office increases physician and/or patient satisfaction. Purpose (a): Osteopathic Manipulative Medicine (OMM) is both patient-centered and hands-on. Therefore, successfully integrating electronic medical records (EMR) into the OMM physician’s practice presents a unique challenge. The purpose of our study was to determine whether the presence of scribes (people trained to take notes for the doctor while they interview, examine, and treat the patient) within an OMM clinic would increase both physician and patient satisfaction by allowing physicians to devote increased attention to the patient. Similar research had been conducted in emergency departments and allopathic outpatient offices, but we believed the benefit in an osteopathic manipulative environment would be higher because EMR physically prevented the osteopath from performing manipulative techniques. Methods (b): The study was conducted by a scribe who was employed within the Osteopathic Manipulative Medicine (OMM) outpatient office at the University of North Texas-Health Science Center (UNTHSC) during the time period of June 10 through July 11, 2013. The study was structured to gather data via two sets of surveys. One survey was given to all practice physicians before the scribe on-boarding date and again after termination of scribe employment. This survey’s purpose was to judge scribe impact on physician satisfaction. The second survey was given to each patient who visited the practice between June 10 and July 11. It’s purpose was to determine scribe impact on patient satisfaction. Results (c): The findings of the study were inconclusive. It was not possible to determine whether scribe presence influenced either physician or patient satisfaction. This outcome was the result of factors that were not taken into account at project commencement. For example, third year medical students sometimes took notes for physicians in the Osteopathic Manipulative Medicine (OMM) office. This confused patients: many believed the student was a scribe which skewed study results. Conclusions (d): Despite these difficulties, we continue to believe scribes would be beneficial for the Osteopathic Manipulative Medicine (OMM) outpatient office environment. Therefore, we anticipate further studies will be undertaken which better elucidate this theory.
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    OSTEOPATHIC MANIPULATIVE TREATMENT IN HISPANIC PATIENTS: A RETROSPECTIVE CHART STUDY
    (2014-03) Patel, Asmani; Patterson, Rita M.; Mason, David
    Purpose (a): To understand the incidence of Hispanic patients presenting to the Osteopathic Manipulative Medicine (OMM) Clinic, and to compare their demographics to the Hispanic and other ethnic populations in Tarrant County. Methods (b): Data for this retrospective chart study was collected for Hispanics patients who had visited the OMM Clinic from June 25, 2012 to June 25, 2013. Patient charts were reviewed for the following data: demographics, somatic dysfunction, osteopathic manipulative treatment, and assessment/diagnosis. Data for demographics of the population in Tarrant County was obtained through HealthyNorthTexas.Org. Results (c): The data for patients attending the OMM Clinic showed that 75.9% of patients were White, Non-Hispanic and 7.6% of the patients were Hispanic. In Tarrant County, 50.7% of the population is White, Non-Hispanic and 27.4% of the population is Hispanic. 82.5% of the White, Non-Hispanic population and 47.5% of the Hispanic population has health insurance. When comparing the data from the OMM Clinic and Tarrant County, it is evident that 41.8% of the White, Non-Hispanics in Tarrant County should be coming to the OMM Clinic based on health insurance status, and 13% of the Hispanics should be coming to the OMM Clinic. The Hispanics come into the OMM Clinic at a rate of 1:10 (1 Hispanic patient for every 10 White, Non-Hispanic patients). However, Hispanics should be coming to the OMM Clinic at a rate of 1:3. Conclusions (d): The study established that the Hispanic population does not come into the OMM Clinic at the same rate as the White, Non-Hispanic population does, despite having health insurance. Therefore, it is necessary to educate the Hispanic population on the benefits of Osteopathic Manipulative Treatment (OMT).
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    THE EFFECT OF LYMPHATIC PUMP TECHNIQUE ON PRIMARY TUMOR GROWTH IN RATS
    (2014-03) McCormick, Callum G.; Carter, KiahRae J.; Orlowski, Ashley; Hodge, Lisa M.
    Purpose (a): Background: Osteopathic Physicians perform lymphatic pump treatments (LPT) to improve lymphatic circulation, enhance immunity and reduce hospital stay in patients with infection and edema. Cancer is a contraindication for the use of LPT, which limits clinical practice; however, there are no published studies to support this conclusion. The purpose of this study was to determine if LPT enhances primary tumor growth. Specifically, we hypothesized that LPT would not increase the size of primary breast tumours. Methods (b): Breast cancer was induced in female rats by subcutaneous injection in the right mammary fat pad with MTLn3 tumor cells. The infected rats were randomized into Control Diseased (Dz), Sham LPT (Sham), and LPT. Healthy(Hy) animals were also included for disease comparison. Rats were weighed weekly to calculate percent body weight change. LPT and Sham were performed as previously described under isoflurane anesthesia on days 14 to 24 post-induction. On day 25 the rats were euthanized and cardiac puncture was performed for a blood differential count. The primary tumor, spleen, lung and axillary lymph nodes(LNs) were also removed and weighed. Results (c): There was no change in primary tumor size across the groups. Body weight increased in all groups until day 14. Of interest, Dz and Hy continued to gain weight while Sham and LPT decreased in size between days 14-25 of disease. There were no differences between groups in the size of the opposite LN, spleens or lung tissue. However, the adjacent LN in Dz, Sham and LPT increased in size compared to Hy, suggesting sentinel node disease. The blood differential showed leukocytosis with predominant neutrophils in Dz compared to Hy, indicating a cancer-induced inflammatory response. Sham and LPT response were lower in comparison to Dz, suggesting the inflammatory response was impaired in these animals. Conclusions (d): Our data demonstrates that LPT did not enhance primary tumor growth. MTLn3 induced an inflammatory response, which was impaired during Sham and LPT; however, the effect of this impairment on disease metastasis was not measured. In addition, Sham and LPT induced weight loss during disease. Anesthetics have been shown to suppress appetite and immunity. This may account for the decreased body weight and immune response in Sham and LPT. Future studies on metastasis and secondary growth are required to ascertain whether LPT is safe in patients with breast cancer.
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    DETERMINATION OF GENETIC FACTORS ASSOCIATED WITH RESPONSE TO OSTEOPATHIC MANIPULATIVE TREATMENT IN INDIVIDUALS WITH CHRONIC LOWER BACK PAIN
    (2014-03) Richardson, Kayla; Cross, Deanna; Kearns, Cathy; Planz, John; Licciardone, John C.
    OMT (Osteopathic Manipulative Treatment) is an often overlooked, low risk treatment option for management of (Chronic Lower Back Pain) CLBP. My overarching hypothesis is that genetics contributes to OMT response. The study used 216 samples consisting of 111 individuals who received OMT, and a placebo group of 105 individuals who received a sham treatment. Genetic differences between subjects who benefited from OMT (responders) and those who did not benefit from OMT (non-responders) were compared. We found an association between 3 genes (IL-8, GCH1, and LARGE) and response to OMT in individuals who suffer from CLBP. Purpose (a): OMT (Osteopathic Manipulative Treatment) is an often overlooked, low risk treatment option for management of (Chronic Lower Back Pain) CLBP. Underutilization of OMT is partially due to an undefined mechanism of action for the therapy. Our overarching hypothesis is through analysis of genotypic attributes; it is possible to determine which individuals are more likely to respond to OMT leading to insights into mechanisms of action. The current study investigated potential polymorphisms associated with OMT and pain reduction using data previously collected from a CLBP clinical study, which was part of The OSTEOPATHIC Trials. Methods (b): We performed a candidate gene study using single nucleotide polymorphisms (SNPs) within genes previously associated with pain: Catechol-o-methyltransferase (COMT), beta 2 adrenergic receptor (ADRB2), GTP cyclohydrolase GCH1, Interleukin 1 alpha (IL1A), interleukin 1 beta (IL1B), interleukin 1 receptor antagonist (IL1RN), Interleukin 8 (IL8), and like- glycosyltransferase (LARGE). Genotypes from subjects who benefited from OMT (responders) were compared to subjects who did not benefit from OMT (non-responders) using a chi-square analysis to test for associations. For SNPs that showed significance (α=0.05) an odds ratio (O.R.) was calculated. The study utilized 216 samples consisting of 111 individuals who received OMT, and a placebo group of 105 individuals who received a sham treatment. Results (c): SNPs in IL-8, GCH1, and LARGE showed significance (α=0.05) in the OMT group only: IL-8 SNP rs2227543 (O.R. 2.2824 CT, confidence interval (C.I.) 1.0053-5.1818), LARGE SNP rs240070 (O.R. 2.8546 TA, 1.0508-7.7548), and GCH1 SNP rs998259 (O.R. 0.4016 GA, C.I. 0.1600-1.0080). A SNP by SNP interaction was detected within GCH1 between rs998259 and rs3783641. When the rs998259 genotype is GG, rs3783641 is associated with response to OMT (α=0.05, O.R. 2.9630 TA, C.I. 1.1269-7.7907). Conclusions (d): There is an association between genetics and response to OMT in individuals who suffer from CLBP. Individuals with genotype CT in rs2227543 or TA in rs240070 are more likely to respond to OMT whereas individuals with genotype GA in rs998259 are less likely to respond to OMT. Furthermore, if an individual has genotype GG in rs998259 and TA in rs3783641 they are more likely to respond to OMT. Genes in neuronal, immunological, and muscular pathways affect OMT response.