Volume 119, Issue 7

Context Cystic fibrosis (CF) is an autosomal recessive genetic disorder primarily affecting the lungs and digestive system. Patients with CF often have multiorgan dysfunction, including chronic lung infections, pancreatic insufficiency, chronic constipation, and distal intestinal obstructive syndrome (DIOS). Objective To understand the impact of osteopathic manipulative treatment (OMT) on the prevention and management of gastrointestinal symptoms in patients with CF. Methods This study used OMT for physical manipulation of the viscera, spine, and other somatic components to improve bowel symptoms and prevent DIOS. These effects were achieved by releasing myofascial restrictions found in the abdomen and somatic structures with the intent to optimize the autonomic and lymphatic systems and improve range of motion. Results Four of 5 participants had a decrease in pain, and 3 participants had a reduced need for laxatives during treatment. Four participants had an overall increase in satisfaction with their bowel movements while being treated with OMT. Conclusion These findings support the use of OMT as a method for the management of chronic constipation and DIOS in the CF population. However, because of the small population size, more research with larger populations is needed.

Context Early detection provides the best opportunity for lung cancer survival; however, lung cancer is difficult to detect early because symptoms do not often appear until later stages. Current screening methods such as x-ray and computed tomographic imaging lack the sensitivity and specificity needed for effective early diagnosis. Dogs have highly developed olfactory systems and may be able to detect cancer in its primary stages. Their scent detection could be used to identify biomarkers associated with various types of lung cancer. Objective To determine the accuracy of trained beagles’ ability to use their olfactory system to differentiate the odor of the blood serum of patients with lung cancer from the blood serum of healthy controls. Methods Over the course of 8 weeks, operant conditioning via clicker training was used to train dogs to use their olfactory system to distinguish blood serum from patients with malignant lung cancer from blood serum from healthy controls in a double-blind study. After training, non–small cell lung cancer and healthy control blood serum samples were presented to the dogs, and the sensitivity and specificity of each dog were analyzed. Results Four dogs were trained for the study, but 1 was unmotivated by training and removed from the study. Three dogs were able to correctly identify the cancer samples with a sensitivity of 96.7%, specificity of 97.5%, positive predictive value of 90.6%, and negative predictive value of 99.2%. Conclusion Trained dogs were able to identify non–small cell lung cancer samples from healthy controls. The findings of this study provide a starting point for a larger-scale research project designed to explore the use of canine scent detection as a tool for cancer biomarkers.

Context Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain. Objective To investigate whether surgical intervention reduces opioid requirements by patients taking opioids for back pain and whether there is a difference between county and managed care hospitals in this postoperative reduction of opioid requirement. Methods A retrospective medical record review of 118 patients who underwent elective lumbar fusion at 4 hospitals (2 county hospitals and 2 managed care hospitals) was conducted. Opioid requirements before and after surgical intervention and at the 30-day outpatient follow-up were evaluated. Results Forty medical records were included in the study. An overall decrease in opioid use was found in the postoperative follow-up phase after lumbar fusion in both the county and managed care hospitals. This reduction was statistically significant at 3 of 4 hospitals ( P <0.01). When the data were pooled by facility type, the significance remained for county facilities ( P <.01) but not managed care facilities ( P =.18). Moreover, there was a significant decrease in opioid use during the postoperative inpatient phase for county compared with managed care facilities ( P =.0427). The pain rating reported by patients during the hospital stay was significantly higher at county compared with managed care hospitals ( P =.0088); however, the difference at discharge was not significant ( P =.14). Conclusion Our study indicates that lumbar fusion is associated with a significant decrease in opioid use ( P <.05) compared with nonsurgical management. Overall, the difference in decreased opioid use between county and managed care hospitals after lumbar fusion was not significant.

Context Exertional rhabdomyolysis (ER) is a medical condition in which excessive and unaccustomed physical activity results in skeletal muscle damage in otherwise healthy individuals. Objective To assess the overall outcomes of patients who presented to the emergency department with ER. Methods This retrospective study was conducted across 4 hospitals. The study included nonpregnant adults with no history of renal function impairment or myopathy disorder who had a diagnosis of ER in the emergency department setting. Medical records were reviewed for patient demographics, length of stay, complications, mechanism(s) of injury involved, impact of nutritional supplements, spectrum of creatine kinase (CK) responses, prevalence of hospital readmissions, and overall mortality. Results Of the 800 rhabdomyolysis cases identified during the 24-month study period, 41 were included in the study. The mean age was 29 years, and the patients were predominantly male (33 [80.5%]) and white (25 [61%]). The median length of stay was 2 days, and it correlated significantly with initial and peak CK levels ( R =0.45, P =.004, and R =0.52, P <.001, respectively). Median initial and peak CK were noted to be 16,888 (range, 342-194,403) U/L and 18,534 (range, 342-287,565) U/L, respectively. Median discharge CK was 5287 (range, 10-61,617) U/L. The most commonly cited mechanism of injury was weight lifting (16 [39%]). In terms of overall outcomes, transient kidney injury was noted in 3 cases (7.4%), and no mortality was recorded during the admission or at 12 months of follow-up. Compartment syndrome or severe electrolyte abnormalities were not observed. There were only 2 uncomplicated readmissions (4.8%) due to high-intensity interval training. Conclusion Hospitalized patients with ER without a history of renal impairment tend to have relatively low risks of complications and readmission.

Context Several advantages of telemedicine have been reported, such as improved patient satisfaction, reduced costs, and broader access to specialists. However, most studies have focused on patient satisfaction with telemedicine services. A literature gap exists in evaluating health care professionals’ (both referring and performing professionals) satisfaction in delivering telemedicine services. A clear picture of professionals' telemedicine satisfaction has the potential to improve care quality, care accessibility, and telemedicine adoption and to reduce overall health care costs. Objectives To develop a framework to evaluate health care professionals’ satisfaction in delivering telemedicine services and to articulate the factors that can contribute to their satisfaction. Methods We developed an initial conceptual framework based on existing literature and the research team's expertise. The initial framework was validated by a convenience group of 12 osteopathic and allopathic physicians, and the framework was further revised and refined according to their input. Results The refined framework includes 5 main components (professionals’ demographics, care settings, motivations, experiences, and overall satisfaction) that can contribute to health care professionals' satisfaction or dissatisfaction in delivering telemedicine services. Detailed itemization is provided under each component, including hierarchical organizations of the items, definitions, and potential value sets. Conclusions The refined conceptual framework may provide a comprehensive evaluation reference for measuring professionals’ satisfaction in delivering telemedicine. Further customization according to the specific setting of telemedicine services is needed. This refined conceptual framework can also be used to identify areas that can be improved and to ultimately improve telemedicine services and care quality.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown origin, characterized by profound postexertional malaise and fatigue, unrefreshing sleep, cognitive impairments, immune dysfunction, pain, autonomic dysfunction, and neuroendocrine symptoms. Although ME/CFS is well documented within the medical literature, it remains difficult to diagnosis and manage. Some of the current challenges include an absence of diagnostic markers, differing diagnostic criteria, and an overall lack of awareness within the medical community. As a result, patients are often frustrated by the difficulties in acquiring a diagnosis and from the overall lack of available treatments. In an effort to increase awareness, this review discusses disease pathophysiology, clinical presentation, and treatment options, while also highlighting the benefits of an osteopathic approach.

In spring 2013, the West Virginia School of Osteopathic Medicine (WVSOM) reformatted its Anatomy Lab Tour Program to include interactive stations in the gross anatomy laboratory. The design of the outreach program introduces high school and allied health learners to osteopathic medicine while working through anatomy laboratory stations and how the tenets of osteopathic medicine relate to a person's overall health and wellness. Throughout the history of the program, first- and second-year osteopathic medical students at WVSOM have helped teach visiting learners in the laboratory experience. The new program design allows more time for one-on-one time between the student teachers and the learners. Exit surveys have reported that the current program design creates a synergistic learning environment in which both the learners and student teachers benefit through the encounter. The authors present this case study of the WVSOM Anatomy Lab Tour Program to establish a baseline for the collection of information gained through participant surveys to assess the impact of the program on learners and student teachers.

Carpal tunnel syndrome (CTS) is a common nerve compression syndrome that includes symptoms of numbness and tingling in the median nerve distribution. Medical cupping therapy has been used for managing a variety of medical conditions, but, to the author's knowledge, the cupping device has not been directly applied over the carpal tunnel as a form of treatment. This case report involves a 27-year-old woman who presented with symptoms of CTS in the right hand and palpatory restriction over the right carpal canal. Electrodiagnostic testing confirmed mild CTS, and neuromuscular ultrasonography revealed a mildly enlarged median nerve at the wrist, which was also consistent with CTS. The patient was taught to use a cupping device that would allow her to apply suction over the ventral wrist daily. The patient noted improvement over several weeks and was asymptomatic at her 3-month follow-up visit. Repeated testing revealed that initial abnormalities in the wrist had resolved. Suction decompression of the carpal tunnel may be a viable alternative treatment for patients with mild CTS.