scholarly journals Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States

2021 ◽  
Vol 121 (1) ◽  
pp. 57-61
Author(s):  
Colson J. Healy ◽  
Matthew D. Brockway ◽  
Benjamin B. Wilde
Keyword(s):  
United States ◽  
Healthcare Delivery ◽  
Female Gender ◽  
The United States ◽  
Initial Distribution ◽  
Chi Square ◽  
Institutional Practice ◽  
Sample Test ◽  
Osteopathic Physicians

Abstract Context Updated data on the use of Osteopathic Manipulative Treatments (OMT) by osteopathic physicians in the United States is overdue. This data would provide an up-to-date point of reference for evaluating the current use of OMT as a distinguishing feature of the osteopathic profession. Objective To determine the prevalence of OMT use, barriers to its use, and factors that correlate with increased use. Methods The American Osteopathic Association (AOA) distributed its triannual survey on professional practices and preferences of osteopathic physicians, including questions on OMT, to a random sample of 10,000 osteopathic physicians in August 2018 through Survey Monkey (San Mateo, CA). Follow-up efforts included a paper survey mailed to nonrespondents one month after initial distribution and three subsequent email reminders. The survey was available from August 15, 2018 to November 5, 2018. The OMT questions focused on frequency of OMT use, perceived barriers, and basic demographic information of osteopathic physician respondents. Statistical analysis (including a one sample test of proportion, chi-square, and Spearman’s rho) was performed to identify significant factors influencing OMT use. Results Of 10,000 surveyed osteopathic physicians, 1,683 (16.83%) responded. Of those respondents, 1,308 (77.74%) reported using OMT on less than 5% of their patients, while 958 (56.95%) did not use OMT on any of their patients. Impactful barriers to OMT use included lack of time, lack of reimbursement, lack of institutional/practice support, and lack of confidence/proficiency. Factors positively correlated with OMT use included female gender, being full owner of a practice, and practicing in an office-based setting. Conclusion Our data suggest that OMT use among osteopathic physicians in the US continues to decline. Barriers to its use appear to be related to the difficulty that most physicians have with successfully integrating OMT into the country’s insurance-based system of healthcare delivery. Follow-up investigations on this subject in subsequent years will be imperative in the ongoing effort to monitor and preserve the distinctiveness of the osteopathic profession.

Socioeconomic disparities among uninsured cancer patients: A free clinic study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18110-e18110
Author(s):  
Madeline MacDonald ◽  
Yuanyuan Lu ◽  
Ethan Song ◽  
Noura Ayoubi ◽  
Katherine Robinson ◽  
...  
Keyword(s):  
United States ◽  
Cancer Patients ◽  
Retrospective Chart Review ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Free Clinics ◽  
Chi Square ◽  
Cancer Data ◽  
Bay Area

e18110 Background: Cancer is the second leading cause of death in the United States and approximately 38.4% of Americans will be diagnosed with cancer during their lifetime. Cancer treatment and follow-up care is expensive and uninsured individuals may face barriers to receiving necessary treatments. Minorities may encounter additional barriers to accessing healthcare. There is limited research about socioeconomic disparities in uninsured cancer patients seen at free clinics in the United States. Methods: A retrospective chart review was conducted to collect chronic disease parameters from electronic medical records and paper charts at nine free clinics in the Tampa Bay area in Florida. Demographics were compared between cancer patients and the non-cancer population via chi-square test or independent samples t-test. Results: Between January 2016 and December 2017, 9127 uninsured patients were seen at nine free clinics. 2137 patients were excluded from the study because there was no cancer data in their charts. Of the patients included in the study, 221 (3.2%) had a current or past diagnoses of cancer. Cancer patients were more likely to be female (n = 145, 65.9), p = 0.048, compared to non-cancer patients. Cancer patients were more likely to be Caucasian (n = 106, 89.1%), p < 0.001 compared to non-cancer patients (n = 2489, 69.3%). Cancer patients were less likely to be African American compared to non-cancer patients (n = 6, 5.0% vs. n = 754, 21%), p < 0.001. Cancer patients were significantly older than non-cancer patients (M = 54.1, SD = 12.0) vs. (M = 41.0, SD = 16.7), p < 0.001. Patients who had cancer were more likely to be unemployed compared to non-cancer patients (n = 78, 54.9% vs. n = 1685, 46.6%), p = 0.050. Conclusions: The study revealed that uninsured cancer patients are more likely to be unemployed, female, of older age, and Caucasian compared to non-cancer patients. It appears that uninsured African Americans are not utilizing free clinics for their healthcare and may be lost to follow-up. A variety of factors may have contributed to these disparities in this vulnerable population including lack of transportation, lack of awareness of free resources in the area, and more. This study increases awareness of disparities in uninsured, cancer patients.

scholarly journals Natural History and Evolution of Anti-Interferon-γ Autoantibody-Associated Immunodeficiency Syndrome in Thailand and the United States

2019 ◽  
Vol 71 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Gloria H Hong ◽  
Ana M Ortega-Villa ◽  
Sally Hunsberger ◽  
Ploenchan Chetchotisakd ◽  
Siriluck Anunnatsiri ◽  
...  
Keyword(s):  
United States ◽  
Natural History ◽  
The United States ◽  
Interferon Γ ◽  
Mycobacterium Abscessus ◽  
Annual Data ◽  
Persistent Infections ◽  
Ifn Γ ◽  
Immunodeficiency Syndrome

Abstract Background The natural history of anti-interferon-γ (IFN-γ) autoantibody-associated immunodeficiency syndrome is not well understood. Methods Data of 74 patients with anti-IFN-γ autoantibodies at Srinagarind Hospital, Thailand, were collected annually (median follow-up duration, 7.5 years). Annual data for 19 patients and initial data for 4 patients with anti-IFN-γ autoantibodies at the US National Institutes of Health were collected (median follow-up duration, 4.5 years). Anti-IFN-γ autoantibody levels were measured in plasma samples. Results Ninety-one percent of US patients were of Southeast Asian descent; there was a stronger female predominance (91%) in US than Thai (64%) patients. Mycobacterium abscessus (34%) and Mycobacterium avium complex (83%) were the most common nontuberculous mycobacteria in Thailand and the United States, respectively. Skin infections were more common in Thailand (P = .001), whereas bone (P &lt; .0001), lung (P = .002), and central nervous system (P = .03) infections were more common in the United States. Twenty-four percent of Thai patients died, most from infections. None of the 19 US patients with follow-up data died. Anti-IFN-γ autoantibody levels decreased over time in Thailand (P &lt; .001) and the United States (P = .017), with either cyclophosphamide (P = .01) or rituximab therapy (P = .001). Conclusions Patients with anti-IFN-γ autoantibodies in Thailand and the United States had distinct demographic and clinical features. While titers generally decreased with time, anti-IFN-γ autoantibody disease had a chronic clinical course with persistent infections and death. Close long-term surveillance for new infections is recommended.

scholarly journals Understanding and Promoting Racial Diversity in Healthcare Settings to Address Disparities in Pandemic Crisis Management

2021 ◽  
Vol 12 ◽  
pp. 215013272110183
Author(s):  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
Alanna Barrios ◽  
Kuchalambal Agadi ◽  
Sindhu Thevuthasan ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Racial Discrimination ◽  
Clinical Training ◽  
Minority Groups ◽  
Mental Health Problems ◽  
Minority Group ◽  
Healthcare Delivery ◽  
The United States ◽  
Majority Group

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

scholarly journals SAT0172 UTILIZATION OF HYDROXYCHLOROQUINE AND CORTICOSTEROIDS AMONG LUPUS PATIENTS WITH INCIDENT END-STAGE RENAL DISEASE (ESRD) ONSET: A LONGITUDINAL STUDY USING USRDS REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1027.2-1027
Author(s):  
A. R. Broder ◽  
W. Mowrey ◽  
A. Valle ◽  
B. Goilav ◽  
K. Yoshida ◽  
...  
Keyword(s):  
United States ◽  
Lupus Nephritis ◽  
Renal Disease ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnostic Code ◽  
Prescribing Practices ◽  
Part D ◽  
Stage Renal Disease

Background:The development of ESRD due to lupus nephritis is one of the most common and serious complications of SLE. Mortality among SLE ESRD patients is 4-fold higher compared to lupus nephritis patients with preserved renal function1Mortality in SLE ESRD is also twice as high compared with non-SLE ESRD, even though SLE patients develop ESRD at a significantly younger age. In the absence of ESRD specific guidelines, medication utilization in SLE ESRD is unknown.Objectives:The objective of this study was to investigate the real-world current US-wide patterns of medication prescribing among lupus nephritis patients with new onset ESRD enrolled in the United States Renal Disease Systems (USRDS) registry. We specifically focused on HCQ and corticosteroids (CS) as the most used medications to treat SLE.Methods:Inclusion: USRDS patients 18 years and above with SLE as a primary cause of ESRD (International Classification of Diseases, 9thRevision (ICD9) diagnostic code 710.0, previously validated2). who developed ESRD between January 1st, 2006 and July 31, 2011 (to ensure at least 6 months of follow-up in the USRDS). Patients had to be enrolled in Medicare Part D (to capture pharmacy claims). The last follow-up date was defined as either the last date of continuous part D coverage or the end of the study period, Dec 31, 2013.Results:Of the 2579 patients included, 1708 (66%) were HCQ- at baseline, and 871 (34%) were HCQ+ at baseline. HCQ+ patients at baseline had a slightly lower duration of follow-up compared to HCQ- patients at baseline, median (IQR) of 2.32 (1.33, 3.97) years and 2.55 (1.44, 4.25) years, respectively, p= 0.02. During follow-up period, only 778 (30%) continued HCQ either intermittently or continuously to the last follow-up date, 1306 (51%) were never prescribed HCQ after baseline, and 495 (19%) discontinued HCQ before the last follow-up date. Of the 1801 patients who were either never prescribed or discontinued HCQ early after ESRD onset, 713 (40%) were prescribed CS to the end of the follow-up period: 55% were receiving a low dose <10mg/daily, and 43 were receiving moderate dose (10-20mg daily)Conclusion:HCQ may be underprescribed and CS may be overprescribed in SLE ESRD. Changing the current prescribing practices may improve outcomes in SLE ESRDReferences:[1]Yap DY et al., NDT 2012.[2]Broder A et al., AC&R 2016.Acknowledgments :The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.Funding: :NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader)Disclosure of Interests: :Anna R. Broder: None declared, Wenzhu Mowrey: None declared, Anna Valle: None declared, Beatrice Goilav: None declared, Kazuki Yoshida: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

scholarly journals Results from the United States CTEPH Registry (US-CTEPH-R): Enrollment Characteristics and 1-Year Follow-up

CHEST Journal ◽  
2021 ◽  
Author(s):  
Kim M. Kerr ◽  
C. Greg Elliott ◽  
Kelly Chin ◽  
Raymond L. Benza ◽  
Richard N. Channick ◽  
...  
Keyword(s):  
United States ◽  
The United States

Feel the Burn! Fireworks-related Otolaryngologic Trauma

2021 ◽  
pp. 000348942110081
Author(s):  
Alexander J. Straughan ◽  
Luke J. Pasick ◽  
Vrinda Gupta ◽  
Daniel A. Benito ◽  
Joseph F. Goodman ◽  
...  
Keyword(s):  
United States ◽  
Head And Neck ◽  
Emergency Departments ◽  
Closed Head Injury ◽  
Penetrating Trauma ◽  
The United States ◽  
Neck Injuries ◽  
Chi Square ◽  
Injury Surveillance System ◽  
Cross Sectional

Objectives: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019. Methods: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed. Results: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P < .001), as well as fireworks type by age group (chi-square P < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P < .001); these included children 5 years and younger and adults older than 30 years. Conclusions: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

Short-term follow-up systems for positive newborn screens in the Washington Metropolitan Area and the United States

2015 ◽  
Vol 116 (4) ◽  
pp. 226-230 ◽  
Author(s):  
Sarah Viall ◽  
Sneha Jain ◽  
Kimberly Chapman ◽  
Nicholas Ah Mew ◽  
Marshall Summar ◽  
...  
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
The United States ◽  
Short Term

scholarly journals Association of patients’ perception of quality of healthcare received and colorectal cancer screening uptake: An analysis of two national surveys in the United States

2020 ◽  
Author(s):  
Karan Chawla ◽  
Angesom Kibreab ◽  
Victor & Scott ◽  
Edward L. Lee ◽  
Farshad Aduli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
United States ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Crc Screening ◽  
Fair Poor ◽  
National Trends

Objective: It is unknown whether patients’ ratings of the quality of healthcare services they receive truly correlate with the quality of care from their providers. Understanding this association can potentiate improvement in healthcare delivery. We evaluated the association between patients’ ratings of the quality of healthcare services received and uptake of colorectal cancer (CRC) screening. Subject and Methods: We used two iterations of the Health Information National Trends Survey (HINTS) of adults in the United States. HINTS 2007 (4,007 respondents; weighted population=75,397,128) evaluated whether respondents were up-to-date with CRC screening while HINTS 4 cycle 3 (1,562 respondents; weighted population=76,628,000) evaluated whether participants had ever received CRC screening in the past. All included respondents from both surveys were at least 50 years of age, had no history of CRC, and had rated the quality of healthcare services that they had received at their healthcare provider’s office in the previous 12 months. Results: HINTS 2007 data showed that respondents who rated their healthcare as good, or fair/poor were significantly less likely to be up to date with CRC screening compared to those who rated their healthcare as excellent. We found comparable results from analysis of HINTS 4 cycle 3 data with poorer uptake of CRC screening as the healthcare quality ratings of respondents’ reduced. Conclusion: Our study suggested that patients who reported receiving lower quality of healthcare services were less likely to have undergone and be compliant with CRC screening recommendations. It is important to pay close attention to patient feedback surveys in order to improve healthcare delivery.

Abstract 177: Credentials of Staff Performing Echocardiography in the United States: Insights from the Intersocietal Accreditation Commission

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Matthew W Parker ◽  
Diana Sobieraj ◽  
Mary Beth Farrell ◽  
Craig I Coleman
Keyword(s):  
United States ◽  
Cardiovascular Diseases ◽  
The United States ◽  
Chi Square ◽  
Volume Number ◽  
National Board ◽  
Formal Level ◽  
Chi Square Test ◽  
Level 3 ◽  
Medical Directors

Background: Little has been published on the practice of echocardiography (echo) in the United States. We used the Intersocietal Accreditation Commission-Echocardiography (IAC-Echo) applications database to describe the personnel in echo laboratories seeking accreditation. Methods: We used de-identified data provided on IAC-Echo applications to characterize facilities by hospital association, census region, annual volume, number of sites, previous accreditation, and numbers of physicians and sonographers as well as National Board of Echocardiography (NBE) testamur status of physicians and registered credential status of sonographers. We categorized Medical Directors by board certification in cardiovascular diseases, internal medicine, other specialty, or none. Medical Director echo training could be formal Level 2 or 3 or experiential by ≥3 years of practice. Frequencies, means, and medians were compared between groups using the chi-square test, t-test, or Mann Whitney test, respectively. Results: From 2011 to 2013, 1926 echo labs representing 10618 physicians and 6870 sonographers applied for IAC-Echo accreditation or re-accreditation. The majority of medical directors were board certified in cardiovascular diseases and 34.1% of medical directors and 27.2% of staff physicians held NBE testamur status; 79.5% of sonographers held registered credentials. Most echo labs were in the Northeast or South census regions, have an average of 1.75 sites, and are based outside of hospitals (Table). Compared to nonhospital echo labs, medical directors of hospital-based echo labs were more likely to be Level 3 trained (19.8% versus 30.8%, p<0.01) and be NBE testamurs (28.9% versus 45.6%, p<0.01). Markers of echo lab size, region, previous accreditation, and credentialed sonographers were associated with accreditation versus delay decisions; there was a trend toward accreditation among facilities with NBE medical directors. Conclusion: Among facilities seeking IAC-Echo accreditation, the minority of echo physicians hold NBE testamur status. Hospital and nonhospital facilities are different in the credentials of their personnel.

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