Integrated Osteopathic-Neurologic Exams With Musculoskeletal Treatment: The ONE Approach

2021 ◽  
pp. 10.1212/CPJ.0000000000001121
Author(s):  
Charles R Joseph ◽  
Michael D Lockwood ◽  
Michael P Cargill ◽  
Alyssa M Jackson ◽  
Jessica K Morris
Keyword(s):  
Neurological Examination ◽  
Point Of Care ◽  
Physician Satisfaction ◽  
Treatment Modalities ◽  
Global Burden ◽  
Neurologic Injury ◽  
Neurologic Disorders ◽  
Somatic Dysfunction ◽  
The One ◽  
Manipulative Techniques

AbstractThe global burden of neurologic disorders are a leading cause of disability and death worldwide and has increased the demand for treatments and rehabilitation. Our proposed integrated Osteopathic-Neurological Examination (ONE) provides the physician with expanded diagnostic and point of care treatment modalities while allowing the physician to make a more tangible impact in patient care. By incorporating the osteopathic structural somatic examination with the complete neurological evaluation, somatic dysfunction, occurring as a consequence or independent of neurologic injury, can be identified and treated using osteopathic manipulative techniques at time of visit. Utilizing the proposed integrated examination, the physician can determine the interplay between structural and neurological findings to identify patterns of change that coincide with more specific diagnoses and the chronicity of a condition. Tangible benefits from the ONE approach translate to more accurate clinical assessment and enhanced patient and physician satisfaction.

eOutcomes-H&N: Development of an electronic point-of-care outcomes collection system for head and neck cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 247-247
Author(s):  
Elizabeth Lockhart ◽  
Eric Gutierrez ◽  
Padraig Richard Warde ◽  
Davin Dubeau ◽  
Sophie Huang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Survival Data ◽  
Web Application ◽  
Point Of Care ◽  
Physician Satisfaction ◽  
Treatment Modalities ◽  
Collection System ◽  
The Impact

247 Background: Outcomes data increases the ability to understand the impact of cancer treatment and helps ensure that we direct appropriate investments to achieve improvements in quality of care. Cancer Care Ontario (CCO) has developed an outcomes data collection system for patients with head and neck cancer treated with radiotherapy. Methods: Clinicians involved in the care of these patients agreed on 5 key clinical outcomes to collect as a part of this initiative: local failure, regional failure, distant metastasis, second primaries, and treatment toxicity. Based on the Princess Margaret Hospital Head and Neck Cancer Anthology of Outcomes process, CCO has developed a similar system to collect outcomes data at the point-of-care on a provincial scale. The population-based provincial system aims to provide practice efficiencies and allow for evolution of the system in response to user feedback and expansion to other clinical areas. Results: The system includes a secure web application and iPad mobile application to facilitate the collection and management of outcomes data for head and neck cancer patients treated with radiotherapy in Ontario. Cancer centres upload patient clinic schedule details (including patient identifiers and appointment dates) prior to clinics. A list of patient summaries, including corresponding diagnosis, radiotherapy information and previously recorded outcomes is then generated. In clinic, physicians use these lists to capture outcomes noted at the point-of-care. Data captured are then transferred in real time to a secure central database. Following initial testing, the application was piloted to assess usability, system reliability, and overall satisfaction. Initial results show high physician satisfaction and no documented issues with system availability. Feedback has identified potential improvements and will inform future modifications. Conclusions: The identification of potential variation in recurrence, toxicity and survival data will inform the areas in which quality improvement initiatives or additional investments may be needed. The intent is to leverage project learnings for future outcomes initiatives in other diseases and treatment modalities.

scholarly journals Comparison of Four Commercially Available Point-of-Care Tests to Detect Antibodies against Canine Parvovirus in Dogs

Viruses ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 18
Author(s):  
Michèle Bergmann ◽  
Mike Holzheu ◽  
Yury Zablotski ◽  
Stephanie Speck ◽  
Uwe Truyen ◽  
...  
Keyword(s):  
Test Performance ◽  
Point Of Care ◽  
Reference Method ◽  
Canine Parvovirus ◽  
P Value ◽  
Important Indicator ◽  
Specificity And Sensitivity ◽  
Specific Pathogen ◽  
The One ◽  
Point Of Care Tests

Measuring antibodies to evaluate dogs´ immunity against canine parvovirus (CPV) is useful to avoid unnecessary re-vaccinations. The study aimed to evaluate the quality and practicability of four point-of-care (POC) tests for detection of anti-CPV antibodies. The sera of 198 client-owned and 43 specific pathogen-free (SPF) dogs were included; virus neutralization was the reference method. Specificity, sensitivity, positive and negative predictive value (PPV and NPV), and overall accuracy (OA) were calculated. Specificity was considered to be the most important indicator for POC test performance. Differences between specificity and sensitivity of POC tests in the sera of all dogs were determined by McNemar, agreement by Cohen´s kappa. Prevalence of anti-CPV antibodies in all dogs was 80% (192/241); in the subgroup of client-owned dogs, it was 97% (192/198); and in the subgroup of SPF dogs, it was 0% (0/43). FASTest® and CanTiCheck® were easiest to perform. Specificity was highest in the CanTiCheck® (overall dogs, 98%; client-owned dogs, 83%; SPF dogs, 100%) and the TiterCHEK® (overall dogs, 96%; client-owned dogs, 67%; SPF dogs, 100%); no significant differences in specificity were observed between the ImmunoComb®, the TiterCHEK®, and the CanTiCheck®. Sensitivity was highest in the FASTest® (overall dogs, 95%; client-owned dogs, 95%) and the CanTiCheck® (overall dogs, 80%; client-owned dogs, 80%); sensitivity of the FASTest® was significantly higher compared to the one of the other three tests (McNemars p-value in each comparison: <0.001). CanTiCheck® would be the POC test of choice when considering specificity and practicability. However, differences in the number of false positive results between CanTiCheck®, TiterCHEK®, and ImmunoComb® were minimal.

Post-Reduction Stability of the Proximal Interphalangeal Joint after Dorsal Fracture Dislocation—A Cadaveric Study

2016 ◽  
Vol 21 (03) ◽  
pp. 382-387 ◽  
Author(s):  
Andre Eu-Jin Cheah ◽  
Tun-Lin Foo ◽  
Janice Chin-Yi Liao ◽  
Min He ◽  
Alphonsus Khin-Sze Chong
Keyword(s):  
Traction Force ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Treatment Modalities ◽  
Full Extension ◽  
Early Motion ◽  
Fracture Dislocations ◽  
Reduction Stability ◽  
The One

Background: Proximal interphalangeal joint (PIPJ) dorsal fracture dislocations (DFD) are challenging injuries. Treatment aims to achieve stability of the PIPJ after reduction so that early motion can be initiated. We studied how increasing articular destruction would affect post reduction stability and investigate the amount of traction and PIPJ flexion needed to maintain the reduction. Methods: Increasing amounts (20%, 40% and 60%) of damage to the volar lip of the middle phalanx in cadaveric specimens were created to represent PIPJ DFD that were stable, of tenuous stability and frankly unstable. Traction forces and PIPJ flexion needed to maintain the reduction were then measured. Results: The PIPJ DFD with 20% damage were stable and did not subluxe while the one with 40% articular involvement was stable after reduction. For unstable the PIPJ with 60% involvement, the more the PIPJ was flexed, the less traction force was needed to hold the joint in reduction. For PIPJ flexion of 20 degrees, a minimum 4.4N of force is needed to maintain reduction while PIPJ flexion of 10 degrees required a minimum 5.0N of force. No amount of force could maintain PIPJ reduction if traction was performed in full extension. Conclusions: In our model, PIPJ DFD with less than 30% articular damage are stable while those with 30% to 50% of involvement have tenuous stability. For the unstable PIPJ DFD, traction obviates the need for excessive flexion of the PIPJ to maintain joint reduction. This information should be considered in treatment modalities for PIPJ DFD, as well in the design of external traction devices for the treatment of PIPJ DFD.

scholarly journals Nelson's Syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1392-1396 ◽  
Author(s):  
Alia Munir ◽  
John Newell-Price
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumour ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease ◽  
Treatment Modalities ◽  
Pituitary Mass ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Great Heterogeneity ◽  
The One

Nelson's syndrome is a potentially severe complication of bilateral adrenalectomy performed in the treatment of Cushing's disease, and its management remains difficult. Of all of the features of Nelson's syndrome, the one that causes most concern is the development of a locally aggressive pituitary tumour, which, unusually for pituitary disease, may occasionally cause death from the tumour itself. This feature is especially pertinent given the increasing use in Cushing's disease of laparoscopic bilateral adrenal surgery as a highly effective treatment modality to control cortisol-excess. Despite numerous studies and reports, there is no formal consensus of what defines Nelson's syndrome. Thus, some will define Nelson's syndrome according to the classical description with an evolving pituitary mass after bilateral adrenalectomy, whereas others will rely on increasing plasma ACTH levels, even in the absence of a clear pituitary mass lesion on MRI. These factors need to be borne in mind when considering the reports of Nelson's syndrome, as there is great heterogeneity, and it is likely that overall the modern 'Nelson's syndrome' represents a different disease entity from that of the last century. In the present paper, clinical and epidemiological features of Nelson's syndrome, as well as its treatment modalities, are reviewed.

scholarly journals Biosensors for the Detection of Bacterial and Viral Clinical Pathogens

Sensors ◽  
2020 ◽  
Vol 20 (23) ◽  
pp. 6926
Author(s):  
Luis Castillo-Henríquez ◽  
Mariana Brenes-Acuña ◽  
Arianna Castro-Rojas ◽  
Rolando Cordero-Salmerón ◽  
Mary Lopretti-Correa ◽  
...  
Keyword(s):  
Quantum Dots ◽  
New Technologies ◽  
Point Of Care ◽  
Graphene Quantum Dots ◽  
Electrospun Nanofibers ◽  
Comprehensive Review ◽  
Measurement Devices ◽  
Clinical Pathogens ◽  
And Performance ◽  
The One

Biosensors are measurement devices that can sense several biomolecules, and are widely used for the detection of relevant clinical pathogens such as bacteria and viruses, showing outstanding results. Because of the latent existing risk of facing another pandemic like the one we are living through due to COVID-19, researchers are constantly looking forward to developing new technologies for diagnosis and treatment of infections caused by different bacteria and viruses. Regarding that, nanotechnology has improved biosensors’ design and performance through the development of materials and nanoparticles that enhance their affinity, selectivity, and efficacy in detecting these pathogens, such as employing nanoparticles, graphene quantum dots, and electrospun nanofibers. Therefore, this work aims to present a comprehensive review that exposes how biosensors work in terms of bacterial and viral detection, and the nanotechnological features that are contributing to achieving a faster yet still efficient COVID-19 diagnosis at the point-of-care.

scholarly journals Clinical Application of Whole Exome Sequencing to Identify Rare but Remediable Neurologic Disorders

2020 ◽  
Vol 9 (11) ◽  
pp. 3724
Author(s):  
Min-Jee Kim ◽  
Mi-Sun Yum ◽  
Go Hun Seo ◽  
Yena Lee ◽  
Han Na Jang ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Genetic Diagnosis ◽  
Intractable Epilepsy ◽  
Episodic Ataxia ◽  
Treatment Modalities ◽  
Congenital Myasthenic Syndrome ◽  
Early Application ◽  
Whole Exome ◽  
Neurologic Disorders

Background: The aim of this study was to describe the application of whole exome sequencing (WES) in the accurate genetic diagnosis and personalized treatment of extremely rare neurogenetic disorders. Methods: From 2017 to 2019, children with neurodevelopmental symptoms were evaluated using WES in the pediatric neurology clinic and medical genetics center. The clinical presentation, laboratory findings including the genetic results from WES, and diagnosis-based treatment and outcomes of the four patients are discussed. Results: A total of 376 children with neurodevelopmental symptom were evaluated by WES, and four patients (1.1%) were diagnosed with treatable neurologic disorders. Patient 1 (Pt 1) showed global muscle hypotonia, dysmorphic facial features, and multiple anomalies beginning in the perinatal period. Pt 1 was diagnosed with congenital myasthenic syndrome 22 of PREPL deficiency. Pt 2 presented with hypotonia and developmental arrest and was diagnosed with autosomal recessive dopa-responsive dystonia due to TH deficiency. Pt 3, who suffered from intractable epilepsy and progressive cognitive decline, was diagnosed with epileptic encephalopathy 47 with a heterozygous FGF12 mutation. Pt 4 presented with motor delay and episodic ataxia and was diagnosed with episodic ataxia type II (heterozygous CACNA1A mutation). The patients’ major neurologic symptoms were remarkably relieved with pyridostigmine (Pt 1), levodopa (Pt 2), sodium channel blocker (Pt 3), and acetazolamide (Pt 4), and most patients regained developmental milestones in the follow-up period (0.4 to 3 years). Conclusions: The early application of WES helps in the identification of extremely rare genetic diseases, for which effective treatment modalities exist. Ultimately, WES resulted in optimal clinical outcomes of affected patients.

scholarly journals THE EFFECT OF ANKLE AND SUBTALAR JOINT SOMATIC DYSFUNCTION CORRECTION TO IMPROVE ORIENTEER STATIC BALANCE

2016 ◽  
Vol 3 ◽  
pp. 553
Author(s):  
Baiba Smila ◽  
Andra Fernāte ◽  
Velga Zaļaiskalna
Keyword(s):  
Effective Means ◽  
Static Stability ◽  
Ankle Injuries ◽  
Static Balance ◽  
Effectiveness Analysis ◽  
Somatic Dysfunction ◽  
Balance Exercises ◽  
Ankle Joints ◽  
Osteopathic Treatment ◽  
The One

The most frequent injuries among sports orienteers are the ankle injuries. The one of the most effective means to prevent the ankle injuries and recurrent ankle injuries is balance and stability development. The aim of this study is to find out the most effective method to develop static stability in the previously injured ankle for orienteers: osteopathic treatment of the ankle and subtalar joints or balance exercises, or the combination of osteopathic treatment of the ankle and subtalar joints and balance exercises. The effectiveness analysis of the intervention methods was conducted with the use of Digital Balance Analyzer (DBA) for the assessment of statical balance. 36 orienteers (12 to 18 years old) were randomized in three groups to an intervention, after being assessed at baseline and then reassessed one week later. Static balance improvements are only when using osteopathy and ankle joints subtalar somatic dysfunction correction together with balance exercises. Separate osteopathy or balance exercises will not give results as effective as the combination of these two effects.

Management of Elevated Intracranial Pressure

2002 ◽  
Vol 15 (2) ◽  
pp. 167-185 ◽  
Author(s):  
Beth A. Vanderheyden ◽  
Brian D. Buck
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Blood Volume ◽  
Vital Signs ◽  
Elevated Intracranial Pressure ◽  
Neurologic Injury ◽  
Barbiturate Coma ◽  
Therapeutic Modalities ◽  
Neurologic Disorders ◽  
Pharmacologic Management ◽  
The Relationship

Elevated intracranial pressure (ICP) is a primary cause of morbidity and mortality for many neurologic disorders. The relationship between ICP and brain volume is influenced by autoregulatory processes that can become dysfunctional. As a result, neurologic damage can occur by systemic and intracranial insults such as ischemia and excitatory amino acids. Therefore, survival is dependent on optimizing ICP and cerebral perfusion pressure. Treatment of intracranial hypertension requires intensive monitoring and aggressive therapy. Intracranial pressure monitoring techniques such as intraventricular catheters are useful for determining ICP elevations before changes in vital signs and neurologic status. Therapeutic modalities, generally aimed at reducing cerebral blood volume, brain tissue, and cerebrospinal fluid (CSF) volume, include nonpharmacologic (CSF removal, controlled hyperventilation, and elevating the patient’s head) and pharmacologic management. Mannitol and sedation are first-line agents used to lower ICP. Barbiturate coma may be beneficial in patients with elevated ICP refractory to conventional treatment. The use of prophylactic antiseizure therapy and optimal nutrition prevents significant complication. Currently, investigations are directed at discovering useful neuroprotective agents that prevent secondary neurologic injury.

scholarly journals Abnormal uterine bleeding in adolescence

2018 ◽  
Vol 7 (4) ◽  
pp. 1296 ◽  
Author(s):  
Sunita Samal ◽  
Ashwini Vishalakshi
Keyword(s):  
Treatment Options ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Treatment Modalities ◽  
Dysfunctional Uterine Bleeding ◽  
Gnrh Analogues ◽  
Combined Oral Contraceptives ◽  
Common Cause ◽  
Inflammatory Drugs ◽  
The One

Abnormal uterine bleeding (AUB), which is defined as excessively heavy, prolonged and/or frequent bleeding of uterine origin, is a frequent cause of visits to the Emergency Department and/or health care provider. While there are many etiologies of AUB, the one most likely among otherwise healthy adolescents is dysfunctional uterine bleeding (DUB), which is characterizing any AUB when all possible underlying pathologic causes have been previously excluded. The most common cause of DUB in adolescence is anovulation, which is very frequent in the first 2-3 post-menarchal years and is associated with immaturity of the hypothalamic-pituitary-ovarian axis. Management of AUB is based on the underlying etiology and the severity of the bleeding and primary goals are prevention of complications, such as anemia and reestablishment of regular cyclical bleeding, while the management of DUB can in part be directed by the amount of flow, the degree of associated anemia, as well as patient and family comfort with different treatment modalities. Treatment options for DUB are: combined oral contraceptives (COCs), progestogens, non-steroidal anti-inflammatory drugs (NSAIDs), tranexamic acid (anti-fibrinolytic), GnRH analogues, Danazol and Levonorgestrel releasing intra uterine system (LNG IUS).

scholarly journals Repetitive Transcranial Magnetic Stimulation and Stroke Rehabilitation

2018 ◽  
Vol 1 (1) ◽  
pp. 01-02
Author(s):  
Berthold Kepplinger
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Wide Spectrum ◽  
Single Pulse ◽  
Brain Structures ◽  
Treatment Modalities ◽  
Neurologic Injury ◽  
Cortical Regions ◽  
Stimulation Technique

Neurorehabilitation involves a wide spectrum of different approaches of treatment modalities and is a notable period for patient after stabilization of patient’s neurologic injury. In 1985 Barker and co-authors introduced transcranial magnetic stimulation (TMS) as a noninvasive and safe brain stimulation technique. TMS can be delivered via single-pulse, double-pulse, paired-pulse and low or high frequency repetitive pulses (rTMS). Depending on stimulation parameters i.e. frequency, rate, and duration, application of repetitive stimuli to cortical regions can enhance or decrease the excitability of the affected brain structures. In the last years the development of stimulators significantly progressed, specially discharging at high frequencies up to 100 Hz and the application of TMS expanded into the areas of behavioral and cognitive functions assessment, as well.

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