Volume 119, Issue 5

Context The US Preventive Services Task Force (USPSTF) recommends a 1-time ultrasonography (US) screening for abdominal aortic aneurysm (AAA) to reduce AAA-specific mortality in men aged 65 to 75 years who have ever smoked. A 2015 study concluded that less than 50% of at-risk primary care patients are screened for AAA. To increase screening rates, it would be beneficial to train other health care professionals in accurately measuring abdominal aortic dimensions. Objective To determine whether osteopathic medical students can use handheld US machines to measure abdominal aortic diameters as accurately as an experienced US technologist. Methods Three osteopathic medical students underwent 8 hours of US training with a board-certified radiologist to measure abdominal aortic dimensions using a handheld US device. After the training, students independently conducted AAA US screenings at a clinic on participants meeting USPSTF AAA screening criteria. Transverse and anteroposterior measurements were taken at 3 sites: celiac axis, inferior to the renal arteries, and superior to the iliac bifurcation. A US technologist then measured the participants’ aortic diameters in the radiology department at another facility. The measurements from both reports were then compared using a 2-sample t test. Results The aortic diameter was measured in 16 participants with a mean (SD) body mass index of 26.7 (3.6). The mean (SD) difference between novice and expert measurement of the abdominal aorta was −0.15 (0.23) cm. No statistically significant difference was found between the US measurements completed by students and a US technologist ( t =−1.38, P =.09). None of the participants met the criteria for AAA (>3.0 cm), with the largest abdominal aorta scanned by experts measuring 2.86 cm. Conclusion When properly trained, osteopathic medical students can accurately measure abdominal aortic diameters using a handheld US device. Training more medical students in ultrasonography would offer increased screening opportunities and possibly reduce AAA-related mortality. Further studies are needed to assess the ability of osteopathic medical students to accurately measure AAAs, as no participants in this study met the criteria for AAA.

Context Emerging adults (aged 18-25 years) are increasingly seeking evaluation in acute-care clinics for sexual health–related concerns to receive treatment and education. Objective To assess the sexual health knowledge of emerging adult patients by gender at acute-care health centers. Methods A prospective, self-administered survey was distributed from August 2014 through May 2016 to patients aged 18 to 24 years who presented to 1 of 4 acute-care locations in a university town in a mid-Atlantic state. Analyses included descriptive statistics, as well as χ 2 and Fisher exact test crosstabulations to determine differences between genders. Results A total of 388 patients aged 18 to 24 years responded to the survey, with 81% of the sample identifying themselves as students and 64% identifying as female. Women were more likely than men to state that they sought sexual health advice at an urgent-care or walk-in clinic (70.3% vs 52.1%; P <.05). Human papillomavirus knowledge among women was significantly greater than among men ( P< .0001). Open-ended responses were widespread and often incorrect, specifically with regard to the human papillomavirus vaccine and routine testing for sexually transmitted infections. Conclusion Women were more knowledgeable about sexual health than men. However, both genders were not as knowledgeable overall on sexual health topics as hypothesized. A stronger emphasis on gender-specific programming for sexual health education via community- and school-based programs throughout adolescence, supplemented with greater emphasis on routine preventive health care during adolescence and emerging adulthood, is encouraged.

Context Although osteopathic manipulative treatment (OMT) is predominantly known for its benefits in improving musculoskeletal pain, many studies have examined the effects of OMT on hospitalized patients with a variety of conditions, showing improved outcomes in conditions such as pneumonia, postoperative and postpartum recovery, preterm newborn recovery, and newborn feeding dysfunction. Objective To determine the reasons osteopathic manipulative medicine (OMM) consultations are being ordered at a tertiary care teaching hospital. Methods This descriptive study was conducted at an academic medical center with a well-established electronic health record system. A retrospective review examined data on all OMM consultations between January 1, 2015, and June 30, 2015. Reasons for consultations in a free text field were grouped into categories of “primary reason for consult” by a single reviewer. Demographics and patient location were also assessed. Results Of 1310 total consultations included in the study, 620 (47.0%) listed a musculoskeletal complaint as the primary or only reason for a consultation, 231 (18.0%) of which were for back pain, followed by neck pain (69 [5.0%]) and headache (46 [4.0%]). The next most common reason for consultation was for newborn feeding difficulty (352 [27.0%]) or other newborn consultation (66 [5.0%]). A total of 272 consultations (21.0%) were not limited to musculoskeletal complaints and included general nonspecific discomfort (96 [7.0%]) or respiratory complaint (53 [4.0%]). A total of 209 (16.0%) consultations noted patients to be postoperative; 124 (9.5%) to be postpartum; 57 (4.4%) to have cystic fibrosis; and 21 (1.6%) to have constipation. Conclusion The majority of inpatient OMM consultations were placed for musculoskeletal complaints, followed by newborn feeding problems. Although it is clear that some physicians think that OMT will help their patients for the aforementioned conditions, the number was still quite low, suggesting that many physicians may be unaware that OMT can help patients with conditions such as respiratory disorder, postoperative recovery, and constipation. There are many opportunities for treatment teams to be ordering OMM consultations as a way to reduce morbidity in their patients.

Context Cannabis (or marijuana ) became legal for recreational use in Colorado in 2012, and this legislation change has created both challenges and opportunities in medicine. More patients are using cannabis, and more patients are now willing to admit cannabis use than in the past, which increases the likelihood that they will be forthcoming about use during medical questioning. Cannabis use may have implications during medical care, including procedural sedation. Objective To determine whether regular cannabis use had any effect on the dose of medication needed for sedation during endoscopic procedures. Methods A total of 250 medical records were reviewed from 1 endoscopy center and 1 endoscopist to minimize the variability in sedation technique for the study purposes. The cohort was reviewed with regard to age and gender to determine whether differences were present among different groups as to the relative amount of sedation medication required in cannabis users vs nonusers. Results Medical records from 250 patients were reviewed, and researchers found that compared with people who did not regularly use cannabis, people who regularly used cannabis required an amount of sedation for endoscopic procedures that was significantly higher ( P =.05). The statistical significance persisted when adjusted for age, sex, and use of alcohol, benzodiazepines, and opiates. Conclusion Determining cannabis use before procedural sedation can be an important tool for planning patient care and assessing both medication needs and possible risks related to increased dosage requirements during endoscopic procedures.

Osteopathy (manipulative care provided by foreign-trained osteopaths) emphasizes manual techniques as the cornerstone of patient care. Although osteopathic medicine has been well integrated into traditional health care systems in the United States, little is known about the role of osteopathy in traditional health care systems outside the United States. Therefore, it is incumbent on the osteopathy community to gather evidence in order to practice scientifically informed effective methods. This narrative review outlines the Cynefin framework for clinical reasoning and decision-making and encourages a broadening of the evidence base among osteopaths to promote health in an interdisciplinary care setting. This review also presents the concept of an osteopath's mindline , in which the osteopath combines information from a range of sources into internalized and collectively reinforced tacit guidelines.

Clostridium (or Clostridioides ) difficile infection affects more than 500,000 people annually in the United States, one-third of whom have recurrent symptoms. The evolution of C difficile as a resilient pathogen has to do with its ability to persist in the environment and in the host, leading to recurrence and environmental spread. Understanding the mechanisms by which this microbe interacts with the environment, the host, and the gut microbiota are critical to solving this problem. This article presents a brief clinical vignette; discusses the current state of understanding of colonization, transmission, and recurrence; and considers the role the host plays in eliminating this infection. The understanding of these mechanisms and application of osteopathic principles has the potential to improve patient outcomes.

The cause of prolonged or recurrent symptoms following the cessation of long-term benzodiazepine use is proposed to be related to downregulation and allosteric decoupling of the γ-aminobutyric acid/benzodiazepine receptor complex. This case series describes 2 patients with prolonged (>2 weeks) recurrent complications during attempted tapering of benzodiazepine doses after long-term treatment. Excited catatonia developed in a 90-year-old woman, and prolonged delirium developed in a 69-year-old woman. Both patients showed improvement of symptoms after resumption of higher doses of benzodiazepine treatment and recurrence of symptoms when the dose was again lowered. Caution should be exercised regarding the long-term use of benzodiazepines in older adults (aged ≥65 years). Tapering of benzodiazepines in older patients after long-term treatment may require slow decreases in dose over long periods. Psychotherapeutic interventions, such as brief cognitive therapy with psychoeducation and motivational enhancement, and osteopathic manipulative treatment to decrease paravertebral muscle tension may be beneficial during the tapering process.