Band 117, Heft 3

Context : The incidence of skin cancer, the most common type of cancer in the United States, is increasing. Sunburn is a major modifiable risk factor for skin cancer, and its prevalence among the US population is high. Objectives : To identify predictors of having had a red or painful sunburn in the past 12 months among people living in Florida. Methods : Florida residents were recruited from public places and online. They were asked to complete an anonymous cross-sectional survey that assessed demographic information, dermatologic history, as well as knowledge, attitude, and behavior factors associated with sunburn. Results : A total of 437 participants whose data were complete for all variables were included in the multivariate analysis. In multivariate logistic regression, younger age (18-29 years) was the most significant predictor of sunburn (OR, 15.26; 95% CI, 5.97-38.98; P <.001). Other significant predictors included identifying as nonwhite (OR, 0.51; 95% CI, 0.29-0.90; P <.02), having had a full-body skin examination by a physician (OR, 1.8; 95% CI, 1.03-3.14; P <.04), reporting higher levels of skin sensitivity to the sun (OR, 4.63; 95% CI, 2.07-10.34; P <.001), having a less favorable attitude toward sun protection (OR, 0.88; 95% CI, 0.81-0.94; P <.001), having high perceived vulnerability to skin cancer (OR, 1.21; 95% CI, 1.05-1.41; P <.009), and spending less than 1 hour outside between 10 am and 4 pm on weekends (OR, 0.46; 95% CI, 0.22-0.96; P <.04). The model was statistically significant at P <.001 and correctly classified 78% of participants. Conclusions : Sunburn prevention programs that osteopathic physicians can readily implement in clinical practice are urgently needed, particularly for young adult patients. This study identified 7 predictors of sunburn in Florida residents. With additional research findings, promoting attitude change toward sun protection may be a viable strategy.

Context : Osteopathic physicians (ie, DOs) in primary care may play a critical role in the early detection of skin cancer. Dermoscopy improves diagnostic accuracy; however, its use among primary care DOs remains understudied. Objectives : To document dermascope use among DOs in primary care, to examine physician and practice characteristics associated with having used and having heard of a dermascope, and to examine the barriers to dermascope use. Methods : Osteopathic physicians were recruited to complete an anonymous survey assessing demographic factors, physician and practice characteristics, confidence in differentiating skin lesions, knowledge and dermascope use, and barriers to dermascope use. Bivariate analyses were conducted, and the significant factors were entered into 2 separate logistic regressions. Results : A total of 768 participants were included in the study. Four hundred ten (54%) had heard of a dermascope, and 123 (15%) had used one. The statistically significant multivariate predictors for having used a dermascope (model 1) were graduating from medical school after 1989 and having greater confidence in differentiating skin lesions (OR, 2.2; 95% CI, 1.66-2.79). Those who graduated after 2009 were 9.5 times more likely and those graduating between 2000 and 2009 were 4.3 times more likely to have used a dermascope than those graduating before 1990 (95% CI, 4.29-20.90 and 95% CI, 2.04-9.23, respectively). Ever having heard of a dermascope (model 2) was associated with being female (OR, 1.4; 95% CI, 1.02-1.87); practicing in a group (OR, 1.6; 95% CI, 1.05-2.36), academic (OR, 2.2; 95% CI, 1.26-3.86), or community center (OR, 2.2; 95% CI, 1.20-4.00); and having greater confidence in differentiating skin lesions (OR, 1.3; 95% CI, 1.15-1.55). Both models were statistically significant and correctly classified 605 (84.1%) (model 1) and 444 (58.4%) participants (model 2). Conclusion : Dermascope use could help primary care DOs improve their diagnostic accuracy for skin cancer and reduce unnecessary referrals to specialists. Efforts to disseminate knowledge about the benefits of using a dermascope to primary care DOs are needed.

Context : Repeated overhead throwing in baseball players alters range of motion (ROM), contributing to shoulder injury. The Spencer technique has been used, anecdotally, to reduce the effects of throwing-induced limitations in ROM. Objective : To quantify the effects of a single administration of the Spencer technique on the ROM and performance of collegiate baseball pitchers. Methods : Pitchers from the Seton Hill University men’s baseball team were randomly assigned to 2 treatment groups: Spencer technique or sham therapy. The first week consisted of baseline outcome measurements (1 week before treatment), including ROM (flexion, extension, abduction, adduction, internal rotation, and external rotation) of the dominant throwing arm, 10 maximum velocity throws, and self-reported performance using the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES). The second week consisted of pretreatment ROM measurement, followed by a single treatment and repeated measurement of all outcomes. Results : Of 16 players, 15 met inclusion criteria. An effect of training on ROM between weeks 1 and 2 for all players consisted of significantly decreased internal rotation ( P =.02) and increased external rotation ( P =.04). A differential effect of treatment was found on the mean difference in internal rotation after treatment, compared with the mean difference before treatment on the same day ( P =.01). Additionally, a trend toward statistical significance for abduction ( P =.08) was noted. Analyses reveal that these effects were caused by significant increases in the internal rotation and abduction for the Spencer group only ( P =.02). All other analyses of ROM, as well as performance measured by maximum velocity throws and the KJOC-SES, revealed no differential effect of treatment. Conclusion : The results of this study support the use of the Spencer technique in counteracting the potentially negative effects of repeated throwing on internal rotation. However, a single administration did not affect functional ability in this study. Future studies of longer duration and including differing levels of play, injury status, and playing position will be needed to further evaluate the full potential of the Spencer technique in athletes who engage in repeated overhead arm movements.

Context : Osteopathic manipulative treatment (OMT) is integral in osteopathic medical education. The timing of the loss of interest, leading to decreasing clinical use, is unclear. Osteopathic medical students’ activities during laboratories or rotations are determined by laboratory or preceptor requirements and do not characterize students’ interest in or how they value OMT. Students who practice OMT when they are not required to may demonstrate that they are interested in, perceive a positive value of, and have confidence in using OMT. Objective : To characterize preclinical students practicing OMT during their school break. Methods : First- and second-year students at the Touro University College of Osteopathic Medicine-CA and the University of New England College of Osteopathic Medicine were surveyed about whether they practiced OMT during winter break, types of conditions addressed, OMT technique(s) used, their practice partners’ response to OMT, and reasons for not practicing OMT, if applicable. Students were also asked if they would have practiced more OMT if they had setups similar to those of the practice environment at school. Results : Of the 499 surveys sent, 407 (81.6%) were returned. Of 407 students, 269 (66.1%) reported that they practiced OMT during winter break, and they used a full range of OMT techniques. Students reported a total of 551 practice partners and 602 complaints. Overall, 429 of 497 practice partners (86.3%) reported they were much improved or improved, and 6 of 497 (1.2%) felt worse or much worse. The most common reasons for not practicing OMT were that no one had complaints (56.3%) and that there was no place to practice (37.3%). Conclusion : More than half of surveyed students showed an interest in practicing OMT when it was not required of them. These findings may imply the need for curriculum changes at osteopathic medical schools to ensure student competency with using OMT techniques that take less time and can be done in a variety of settings and with discussing OMT with practice partners.

Context : Since 1993, the Health Policy Fellowship (HPF) has trained osteopathic professionals in health policy and leadership. Although almost 250 fellows have graduated from the program, many of whom have assumed leadership roles within the osteopathic medical profession, the HPF has, to the authors’ knowledge, never been subjected to scholarly analysis. Objective : To understand the HPF’s professional significance as a health policy and leadership training program that has enrolled mostly osteopathic physicians. Methods : Semistructured interviews were conducted with graduates supplemented by interviews with other professionals involved with the HPF. Using an inductive grounded theory approach, we coded interviews for major themes. Results : Forty-three interviews were conducted, 38 of which were with graduates of the program and 5 of which were with HPF staff. The data suggest that although the content of the HPF is applicable to all medical professionals, the program’s language and structure are designed to accommodate specific needs of osteopathic professionals. Specifically, the language of the fellowship emphasizes the “high ground” (considering multiple perspectives on an issue), and the structure of the fellowship allows fellows to continue in their jobs but travel to several COMs and to Washington, DC, throughout the year. Conclusion : Closer examination of the HPF helped convey the relevance of this program, and perhaps programs like it, for a minority medical profession still finding its voice within the policy climate of US health care.

Bullous pemphigoid is an autoimmune blistering dermatosis with separation of the epidermis from the dermis. This disease process is common among elderly patients and manifests with subepidermal vesicles and tense bullae. Patients with bullous pemphigoid are more likely to have also received a previous diagnosis of a neurologic disorder. Gabapentin is an antiepileptic that is used to manage neuropathic pain. The authors describe, to their knowledge, the first report of gabapentin-induced bullous pemphigoid in an elderly man with no history of rashes or reactions to other medications.

Isaacs syndrome is a rare neuromuscular disorder characterized by chronic muscle stiffness, cramping, fasciculations, myokymia, and hyperhidrosis. Pathogenesis includes autoimmunity, paraneoplastic disorders, genetic predisposition, or toxin exposure. There is no known cure for Isaacs syndrome. This case report describes a patient who had been given the diagnosis of Isaacs syndrome and received osteopathic manipulative treatment to manage fascial and cranial dysfunctions and reduce nervous system hyperexcitability. Long-term decrease of myokymia and reduction of severity and frequency of exacerbations resulted.