The annual rate of cervical cancer death has been in slow decline in part due to the broad implementation of screening technology. This annual death rate is also affected by risk factor exposure and discovery of new treatments. While the current rate, 2.2 deaths in 100,000 women, is the lowest recor...

Renal cell carcinoma (RCC) is the most common type of renal cancer, and it is usually found incidentallyin asymptomatic individuals. Despite an increase in prevalence, RCC mortality has improved.Advancements have been made over the years in diagnostic and treatment modalities and screeni...

Background: Smoking is the most important preventable cause of adverse outcomes in pregnancy;however, most smokers who become pregnant continue to smoke and/or relapse following delivery.The identification of patients at risk can be challenging, and the treatment options available can benebulous, in...

Coccydynia is characterized by pain or discomfort in the coccyx region, most frequently caused bydirect trauma. This condition, exacerbated by sitting on flat or hard surfaces, may cause immobility andadversely impact activities of daily living. Standard treatment options include ergonom...

For a printable version to share with your patients, please download the PDF. MAP 1. High-risk regions for contracting travelers’ diarrhea Map 1 created by authors using Microsoft Excel. WHAT IS TRAVELERS’ DIARRHEA? Travelers’ diarrhea is a condition related to the ingestio...

For a printable version to share with your patients, please download the PDF. WHAT DOES BLOOD PRESSURE MEASURE? Blood pressure measures the force with which blood pushes against the arteries. Arteries carry blood from the heart to the rest of the body. When your blood pressure is high, it mea...

For a printable version to share with your patients, please download the PDF. If there was a way to protect yourself from the most common cancer in the United States, would you do it?Knowledge about skin cancer and its prevention is one of the most powerful tools to protect yourself from it. Th...

Dear Members, As President of the American College of Osteopathic Family Physicians (ACOFP), I am delighted to extend a warm welcome to the readers of this summer issue of the Osteopathic Family Physician . This issue holds particular significance as we commemorate several remarkable milestones ...

Medicine is challenging. Added to this are the struggles our patients face on a day-to-day basis. They have been exposed to situations that were unthinkable or not common 20 years ago. Some of these situations have changed, for better or worse, due to societal problems. In 2012, the Centers fo...

For a printable version to share with your patients, please download the PDF. This handout provides essential information about childhood cancers, including types, causes, symptoms, diagnosis, treatment options, and prevention. TYPES OF CHILDHOOD CANCERS The most common types of cancers that ...

Past iterations of the Diabetes Prevention Program (DPP) have demonstrated success in reducingthe risk of developing type 2 diabetes in high-risk individuals, including studies that focused onlow-carbohydrate or ketogenic approaches. The program emphasizes dietary modifications,phy...

Historically, the osteopathic profession has met challenges and adversities with renewed passion, increased vigor and a stronger and more viable spirit. When osteopathic physicians were excluded from serving as physicians during the Second World War, the AOA met the challenge head on. As such, by t...

We are well into 2020, and spring, along with the ACOFP conference in New Orleans, is right around the corner. The Associate Editor, Paula Gregory, DO, and I will be at the conference to present the Attending Paper of the Year to a few of our distinguished authors of 2019. It is always a privilege ...

This article is designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHAT IS COLORECTAL CANCER? Colorectal cancer is a form of cancer that affects the colon and/or rectum. Early detection of this cancer can be challenging as it does not typically present ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading WHAT IS PAP SMEAR SCREENING FOR? The Papanicolaou test, otherwise known as a “Pap test” or “Pap smear,” is used to screen for cervical cancer. WHY IS IT IMPORTANT TO SCREEN FOR CERVIC...

This lesion was followed at the patient’s subsequent 2-month well- child check and is depicted in Figure 2, with gradual changes noted in the lesion. Figure 3 shows the continuation of hyperpigmentation and verrucous transformation of the skin lesion at the 4-month well-child check. The pa...

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints. The condition causes inflammation, pain, stiffness, and sometimes deformity in the affected joints. RA can also affect other parts of the body, including the lungs, heart, and eyes, and it can lead to long-...

Colorectal cancer is a leading cause of morbidity and mortality in the United States. Family physicians play an integral role in educating patients about the current screening recommendations and modalities of available screening to improve early detection and allow treatment at its earl...

Primary care physicians are crucial in diagnosing and managing hand and wrist pain. As the first point of contact for patients, primary care physicians develop individualized treatment plans, which may involve prescribing medications, recommending physical therapy, providing joint inject...

Hip pain and disorders are commonly seen in adults and children in the primary care setting. Primary care physicians can manage many of these disorders through physical examinations and basic radiographs, but some may pose a challenge requiring advanced imaging and specialist interventio...

Dear Members, As I embark on my role as President, I am excited and deeply honored to guide us along a strategic path to fortify our profession and our impact together. This critical juncture provides a compelling chance to invigorate our collective initiatives and redefine the future of osteopath...

There is no better feeling of accomplishment than when a student matches into a desired residency program! This milestone means that students, faculty, administration, and staff have achieved a monumental task. All their planning, strategies, and work have culminated in that one special word: “Ma...

Stand for Quality report Stand for Quality, a coalition of more than 165 organizations from across the health care spectrum, released a framework to the Administration and Congress on improving quality and affordability of health care. The framework makes six recommendations: Set national pri...

Night sweats can be a symptom of several life-threatening conditions such as lymphoma, HIV infection, or bacterial endocarditis. They may also be an indication of several endocrine problems, sleep apnea, or GERD. This article reviews a differential diagnosis and the appropriate diagnosti...

Nursing shortage in rural America is a catastrophe about to be realized. Countless agencies, both government and private, have discussed this issue. Policies, legislative acts, diatribes, plans suggested, and much hand-wringing has taken place over the past few years, but we seem to be n...

Latent autoimmune diabetes in adults (LADA), an increasingly recognized form of type 1 diabetes mellitus (DM1), often initially presents in middle-aged adults and is often misdiagnosed as type 2 diabetes mellitus (DM2). However, like DM1, patients often have autoantibodies directed again...

Determination of waist circumference is now being recommended as a routine office measurement to identify women with metabolic syndrome and to monitor clinical response to therapeutic interventions. As such, the accuracy of measurement is important. In this study, we tested accuracy of a...

If you speak with anyone who likes to cook, they may tell you that there are certain herbs that they always have on hand such as parsley or thyme. They could also tell you that of late they have been using some new ones with more regularity. The trick is finding the ones that go well together, crea...

Since its inception, the ACOFP has had the goal, “To advance the standards of (family) practice in the field of osteopathic medicine . . .” To that end, over the past 58 years, the ACOFP has published various newsletters and scientific journals. In 2000, the A...

Examining the doctor-patient encounter as a drama reveals opportunities to maximize positive therapeutic outcomes by exploring the “roles” of the participants. Through education, realistic goal setting, and explicitly negotiated expectations, revising the customary “scripts” each cast me...

Earlier this year, ACOFP President Jan Zieren, DO, MPH, FACOFP dist., wrote to the US Congress expressing support for three pieces of legislation. The article also offers an update on MedPAC. ...

Lack of computer expertise, cost, and safety and HIPAA concerns as well as resistance from the office staff have contributed to only about 15% of all physicians sending prescriptions electronically. Adoption of electronic prescribing in the office is easy and relatively inexpensive with ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Introduction ‌ Providing quality, cost-effective health care has been the benchmark of the Veterans Administration’s (VA) Health Care System since its inception. However, it should be ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Hansen’s disease, or leprosy, is a rare finding in the United States; the National Hansen’s Disease Program reported 137 new cases in 2006.Most of these cases are found in immigran...

Exercise stress testing has not been recommended by the American Heart Association or the American College of Cardiology as a screening tool in the asymptomatic population because such testing has limited value in this population. It was the goal of this study to investigate family physi...

Time is a rather important measurement for physicians. We measure time to understand our patients’ conditions—how long have you experienced this pain? Or to determine the length of treatment—you require six months of physical therapy or 10 days of antibiotics. Time also measures our own education— ...

Federal Trade Commission again delays implementation of ”Red Flag” rule On Wednesday, July 29, 2009, the Federal Trade Commission announced yet another delay in the implementation of the “Red Flag” rule to protect patient identity theft in med-ical billing. This is the third delay in implementatio...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Introduction Medical acupuncture is a holistic method of diagnosis and treatment by physicians. Acupuncture is both old and new and has been found in various forms in different cultures...

‌Tobacco dependence is a chronic disease that deserves treatment. Effective strategies have now been identified and should be used with every current and former smoker. The Quick Reference Guide for Clinicians provides point of care access and the tools necessary to effectively identify and assess t...

Crohn’s disease is one of the two major types of idiopathic, chronic intestinal inflammation known asinflammatory bowel disease. It is a significant disease process, especially in populations of NorthernEuropean ancestry, of chronic relapsing disease along with an increased risk of morta...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Introduction A 2004 Institute of Medicine report, “Health Literacy: A Prescription to End Confusion,” reported that 90 million people lack the “capacity to obtain, proce...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. The osteopathic family physician (OFP) has three choices when interacting with complementary/alternative medicine (CAM) providers in the community: rejecting their participa- tion in ...

E-mail address: president@acofp.org . when and where they need and want it in a culturally and linguistically appropriate manner. Quality and safety are hallmarks of the medical home: Practices advocate for their patients to support the attain- ment of optimal, patient-centered outcomes t...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. MedPAC September 2009 report In preparation for the March 2010 report to Congress, Medi- care Payment Advisory Commission (MedPAC) commis- sioners were given the latest projections of ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. With the hands-on care that osteopathic physicians pro- vide and the unique benefits that osteopathic manipulative therapy (OMT) offers the patient, the osteopathic brand of medicine ho...

The underlying holistic principle and philosophy of osteopathic medicine provides a strategic advantage for osteopathic physician participation in bioethical decision making for the benefit of patients; the broad-based education, training, and experience of the osteopathic family physici...

Postinfectious glomerulonephritis is the most common cause of nephritic syndrome and acute renal failure in children. This condition usually results from a recent group A streptococcal infection and the diagnosis is based on clinical suspicion and laboratory data. This case describes a c...

Epstein-Barr virus (EBV), a member of the herpesvirus family, is one of the most common human viruses affecting more than 90% of the world's population. The most common manifestation of primary infection is a self-limited clinical syndrome that most frequently affects adolescents and you...

CONTEXT:Although the overall prevalence of tuberculosis (TB) in the United States is declining, correctional facilities continue to encounter a higher prevalence of this disease. Despite mandatory reporting laws for active TB, data for latent TB infection (LTBI) remains sketchy because reporting it ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Introduction Chronic rhinosinusitis (CRS) is one of the most common reasons that persons seek medical care. Experts estimate that about 31 million people in United States are affecte...

With each new calendar year comes an opportunity for a new beginning, setting new goals, and learning new practices. In Osteopathic Family Physician ’s first year as a medical journal, we will continue to strive to provide information that you can use in your day-to-day practice. We invite your ac...

In a recent cleaning frenzy of stacks and piles stored in my office, I came across an article that I had ripped out of Patient Care dated October 30, 1982 and written by Dr. Raymond Saloom, the President of the American College of General Practitioners (ACGP) in Osteopathic Medicine and Surgery a...

If “a picture is worth a thousand words,” how can we capture this concept to enhance physician and patient communication and improve the overall relationship? How can medical educators help medical students and residents put their patient education points into more memorable language? Th...

The preparticipation physical examination in the athlete is commonly encountered and performed in Family Practice. The primary care physician needs to take care during this examination to be alert to the various risks and warning signs that may signal a risk for sudden cardiac death. Thi...

A 58-year-old African-American female presented to the ophthalmology clinic from the local emergency department with a history of sudden visual loss in her right eye. The patient originally presented to the emergency department with the complaint of sudden painless monocular visual loss...

Major risk factors for addiction include those of the environment, more likely to affect initiation of use, and of the individual, where genetic factors are more likely to affect progression from use to dependence. An understanding of these risk factors will help the physician to counsel...

Diabetes mellitus is a significant risk factor for morbidity and mortality in hospitalized patients. The purpose of this study is to evaluate the treatment of diabetic patients with regard to glucose control. ...

I am constantly reminded of the importance of lifelong education. The practicing family physician must have a broad knowledge base to address the variety of problems that present themselves each and every day. Family medical journals help to keep me abreast of not only those topics that I am alrea...

To the Editor:Osteopathic manual medicine has been spread all overthe world by Martin Littlejohn, DO, and William Smith,MD, both pupils of A. T. Still, MD, DO. There are privateosteopathy schools, many of which are loosely regulated bythe local countries; they have no standardiza...

The paper is a case study of an 81-year-old female with an acute onset of idiopathic thrombocytopenic purpura (ITP). This diagnosis is rare in adults, and this article discusses the patient's clinical presentation and a review of ITP. ...

Osteopathic medicine has taken a different direction internationally than it has in just the United States. A. T. Still's initial practice of osteopathy was predominantly manually based, because he believed the use of medications by the orthodox medical profession at that time was often ...

In recent decades, the Western medical establishment has become more cognizant of the connection between our environment and our health, a relationship Eastern medicine has respected for centuries. Throughout history, physicians, scientists, and scholars have postulated that the health o...

The first cases of 2009 pandemic influenza A (H1N1) virus infection were documented in March 2009 and have subsequently caused a worldwide outbreak. The World Health Organization declared the first phase 6 global influenza pandemic of the century on June 11, 2009. As of November 2009, mo...

This issue focuses on osteopathic medicine and its relationship with the outside world. Specifically this issue addresses global medicine, osteopathic education, and the environment, while highlighting recent advances in travel and digital communication that have changed all of our lives. In the co...

Editor’s Response: I would like to thank Dr. Urse for her Letter to the Editor. We welcome the sentiment of this letter and agree whole- heartedly that we have a great opportunity to highlight osteopathic principles and osteopathic manipulation with our article selections for this journal. Althoug...

To the Editor: After reading the article on Management of Chronic Rhinosinusitis by Adarsh Gupta, DO, MS, and Ashmit Gupta, MD, MPH, in the January/February 2010 issue of Osteopathic Family Physician , I am disappointed that there is no mention of utilizing OMM in the management of this commo...

From the American Osteopathic Association, Washington, DC. MedPAC recommendations on graduate medical education payment During its April 1 meeting, the Medicare Payment Advisory Commission (MedPAC) considered recommendations on graduate medical education (GME) payment for inclusion in ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading Electronic medical records (EMRs) are likely to become mandatory in the near future so now is the time for osteo- pathic family physicians to start thinking about how EMR implementation ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading Introduction Current challenges faced by the medical sector call for a dramatic shift in how professionals across the United States deliver health care. Primary Care Medical Home (PC...

BACKGROUND:Many articles exist outlining the possible benefits of the medical home model on enhanced patient care and reduced over-utilization of the medical system. So far, these articles have focused mainly on the viewpoint of physicians and their perceptions of what patients prefer, with re...

Primary care continues to suffer a loss of interest among graduates of medical school. The patient-centered medical home (PCMH) provides a potential vehicle to redefine primary care as chronic disease increases in prevalence in the United States. The model, as developed by the American O...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. The population of the United States is aging. Current health care costs are nearing 17% of the gross national product (GNP). 1 These costs are projected to increase sig- nificantly ...

1877-573X/$ -see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.osfp.2010.05.001 88 Osteopathic Family Physician, Vol 2, No 4, July/August 2010 Everyone agrees that electronic health records are a central aspect of the PCMH. Useful resource...

Corresponding author: Dr. Keith Studdard, 330 E. Algonquin Road, Arlington Heights, IL 60005. E-mail address: kstuddard@osteopathic.org . payments to each hospital with certain associated pro- gram costs. The report should be publicly accessible and should clearly identify each hospital, indi...

The purpose of this article is to help osteopathic family physicians prepare a scientific article and show all the steps from the rough manuscript to the published paper. ...

Functional gastrointestinal disorders are a common ailment that often results in extensive and costly diagnostic workups as well as significant chronic suffering to the afflicted. The following is a case review and discussion of the use of osteopathic manipulative treatment in a patient ...

Myocardial infarction (MI) is more frequent in patients older than 45 years of age; however, it can occur in young patients and it is important to include in the differential diagnosis of chest pain. In this case, a 29-year-old male presented to the emergency department with chest pressu...

Beta-blockers (β-blockers) are some of the most commonly prescribed therapeutic agents and are used for a wide variety of medical conditions. In addition to being commonly used in conditions such as high blood pressure, heart failure, acute coronary syndrome, and atrial fibrillation, β-b...

The use of information technology in health care has lagged behind other industries but provides great promise in improving the quality and efficiency of health care delivery. Computerized disease registries can provide an affordable and practical way for physicians to improve the manage...

This issue of the Osteopathic Family Physician focuses on cardiovascular disease. Despite major gains in the reduction of cardiovascular deaths in the United States, the established risk factors that contribute to cardiovascular disease are still a substantial threat to public health. Approximate...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. The Centers for Medicare and Medicaid Services (CMS)and the Office of the National Coordinator rolled out thef inal rule on the Electronic Health Record Incentive Pro-gram on Tuesday...

‌ Response to Letter to the Editor ‌ To the Editor: We would like to thank Dr. Findlay for his input and welcome his expertise. We agree that the WHO has not adopted the definitions of “osteopathic physicians” versus an “osteopath.” The WHO Guidelines on Basic Training and Safety in Osteopat...

Comments on “Commentary on the globalization of osteopathic medicine” Dear Dr. Shubrook: I would like to offer a few comments that I believe are needed to correct errors in “Commentary on the globaliza- tion of osteopathic medicine” (Qureshi and Kusienski) in the May/June 2010 issue of Osteopa...

Our health can be negatively affected by chronic stress. Stress can be normal variable hassles of daily life, life events, or sleep disruption, or it can be the more chronic social stresses related to personal role in community, economic status, or status incongruity. Socioeconomic stres...

A man presented with double vision. After a careful physical examination, it was discovered that the patient had a pupil-sparing cranial nerve III palsy. This article will review the case presentation and explore etiologies and treatments for this relatively common condition. ...

With more than 23.6 million Americans living with diabetes mellitus and a growing rate of 1.6 million new cases per year, improved control and the prevention of secondary complications is imperative. Reliance on hemoglobin A1c reading alone can be misleading to the physician and its valu...

It has been said that certain early osteopathic physicians could estimate random blood sugar by touch. This questionable statement was put to test with a simple protocol. Forty diabetic patients were evaluated for tissue texture change by palpation. The degree of subcutaneous tissue text...

This study reviewed intermediate diabetes outcomes including hemoglobin A1c (A1C) values, blood pressure, and low-density lipoprotein (LDL) cholesterol levels in individuals 65 years and older with type 2 diabetes (T2DM), and then compared outcomes between those managed by a geriatrician...

Chronic disease creates many risks for physician burnout. Seemingly every year we are confronted with yet another set of screening and management mandates, a new collection of target lab values, and of course another crop of brand-new medications that are sure to have an impact this time. In th...

Primary care workforce grants Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced $130.8 million in grants to strengthen and expand the health professions workforce. Six areas are targeted: (1) primary care workforce training, (2)oral health workforce ...

Parental education about the use of age-appropriate child restraints is an essential aspect of all routine well-child examinations. Despite this guidance, automobile accidents remain the leading cause of death in children 8 years of age and younger. The evolution of the car seat began in...

Cauda equina syndrome is a rare but serious condition that is brought on by an acute disc herniation; however, it may also occur in the patient with chronic back pain. The latter case complicates the diagnosis for a variety of reasons, especially if the diagnosis is not considered. Repor...

In the past decade, leptospirosis has emerged as a globally important infectious disease. Mortality remains significant; this may be related to delays in diagnosis because of lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include i...

To determine interest in and details of electronic mail (e-mail) use by patients and residents in a residency primary care facility, and to uncover barriers, as well as areas of interests for its use.OBJECTIVE:To determine interest in and details of electronic mail (e-mail) use by patients and...

The purpose of this study, conducted in 2007, was to assess and explore the applicability and usefulness of the organizational culture of a Department of Family Medicine.OBJECTIVE:The purpose of this study, conducted in 2007, was to assess and explore the applicability and usefulness of the or...

Chronic cough is a common problem for primary care physicians, with prevalence rates of up to 22%. The pathogenic triad of upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD) are either solely or partly responsible for up to 95% of patients who present ...

As another year passes, it is time to pause and reflect. The OFP Editorial team thanks all of the dedicated people who have contributed to the success of our journal. Our transition has exceeded expectations in several areas, including the many authors who have submitted their work to OFP , the ...

Congress passes one-year Sustainable GrowthRate (SGR) fix In early December, the House and Senate approved legilation preventing implementation of a 24.9% cut in Medicare physician payments scheduled to take effect on January 1,2011. The “Medicare and Medicaid Extenders Act of 2010”(H.R. 4994) ext...

This case illustrates the clinical difficulty in making the diagnosis of mesenteric ischemia and in particular superior mesenteric venous thromboembolism. There is no definitive sign, symptom, laboratory or diagnostic criteria to establish the diagnosis, rather a constellation of data al...

Curcumin is a therapeutically active, natural biomolecule found in the spice turmeric. The antitumor, antioxidant, antiarthritic, and antiinflammatory effects on the body highlight the medicinal versatility of the compound. Turmeric has been used in traditional Ayurvedic medicine in Indi...

Nitric oxide (NO), originally discovered as an endothelium-derived relaxing factor, is now known to participate in the physiologic processes of the nervous, renal, gastrointestinal, and cardiovascular systems. NO is an important mediator of vasodilation and is a potent inhibitor of plate...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Gastroesophageal reflux disease (GERD) is a common problem that occurs in both adult and pediatric populations in the United States (US). The economic impact of GERD is enormous; typi...

CONTEXT:Colorectal cancer is the third leading cause of cancer-related death in the United States. Colonoscopy is a proven effective screening tool for precancerous polyps.OBJECTIVE:To assess indications, findings, and technical performance of colonoscopies by a single general surgeon in...

OBJECTIVES: Improper medical disposal is a threat to both the environment and individual communities. The purpose of this study was to determine physician education, knowledge, and perceived need for drug disposal guidelines.METHODS: An anonymous electronic 14-item survey eliciting year and state of...

Gastroenterology symptoms are some of the most common complaints addressed by family physicians. Obtaining a thorough history and a careful physical examination are critical for a correct diagnosis. Osteopathic structural findings can also be very helpful in sorting out the diagnosis in conditions ...

Summary of legal challenges to the Affordable Care Act As of February 17, 2011, there have been many lawsuits filed throughout the United States challenging the constitutionality of the Patient Protection and Affordable Care Act(ACA) (Public Law 111-148). As the litigation has progressed, the majo...

Physicians interact with pharmaceutical representatives on a frequent basis and such interactions may influence one's prescribing habits. Providing educational and training opportunities for physicians to interact with pharmaceutical representatives in a meaningful manner speaks directly...

A 27-year-old Hispanic woman (G5 P4 004) presented to the labor and delivery unit at 38 weeks' and 6 days' gestation with onset of active labor. Approximately 24 hours postpartum, the patient had sudden onset of lightheadedness, hypotension, and labored breathing. After evaluation of the...

Acute pain is of sudden onset, intense, sharp or severe cramping. It may be described as local or diffuse, and if corrected takes a short course. It is often associated with nausea, emesis, diaphoresis, and anxiety. It may vary in intensity of expression by a woman's cultural worldview o...

Human papillomavirus (HPV) affects 20 million people across the globe each year. The prevalence of HPV is vast. The Centers for Disease Control and Prevention report that at least 50% of all sexually active men and women will contract HPV at some point in their lives. The most drastic an...

Oral contraceptives are not appropriate for all women and their efficacy is hindered by many factors, including adverse effects and patient compliance. In the past, the oral route was the most popular method for contraception. Today, the routes and methods of contraception are varied, ra...

Metabolic syndrome is a term used to describe the common sequelae found in the context of obesity and includes hypertension, hypertriglyceridemia, dyslipidemia, and impaired glucose regulation, which lead to increased cardiovascular and metabolic risks. In women with metabolic syndrome, ...

Continuing with 2011 themed journal issues, the editorial committee and staff present an issue focused on women’s health. I recall prescribing birth control as a relatively simple task. The women who requested birth control were relatively young, there were no complicating factors, and there ...

Medicare payment advisory committee meeting The situation involving the Sustainable Growth Rate (SGR) is deteriorating, said MedPAC chairman Glenn Hackbarth, as the commission discussed policy considerations for ad- justments and alternatives. The commissioners discussed several options from repea...

Rapidly rising medical malpractice insurance costs are causing reduced access to health care services. Physicians and other health care professionals are limiting or discontinuing high-risk procedures and services to reduce their malpractice insurance cost and potential liability; patien...

Pain is a very common complaint from patients that physicians encounter in their office and hospital practice. Access to pain care is a problem in the United States. Chronic pain is a major health care concern and the cost of inadequate pain control is enormous. There are many barriers t...

Healthcare is a critical issue in our nation. This information was presented to the United States Senate on July 14, 2009. This is a study of the literature concerning Health ER. Barriers and incentives are explored and represented in charts and graphs to indicate the cost of the essenti...

The class Arachnida of the phylum Arthropoda comprises an estimated 100,000 species worldwide. However, only a handful of these species can cause clinical effects in humans because many are unable to penetrate the skin, whereas others only inject prey-specific venom. The bite from a wido...

OBJECTIVE:Chronic pain is an important cause of morbidity among adults worldwide. Its manage- ment presents a greater challenge in the unique demographic of Appalachia. “Physician reluctance to prescribe opioids” has been identified as a major barrier to effective management of chronic pain na...

Adequate food access is key to the health of individuals; yet, lack of access to food for an active, healthy life—food insecurity—continues in more than 17 million households across the United States, according to the most recent (2008) estimates. This paper examines food insecurity in A...

In 2002, West Virginia doctors had had enough—mal- practice insurance for some specialties was running up- wards of $75,000 per year and physicians in that mostly rural state were receiving no assistance, either in the form of new tort legislation or renegotiating of contracts. Some doctors who li...

Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease that results from multihormonal dysregulation and is frequently accompanied by a number of comorbidities and complications. Improved glycemic control has been associated with improved microvascular outcomes, but the relati...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. In this special edition of “Washington, D.C. update” I wish to acknowledge the loss of our strongest voice advocating for osteopathic family medicine and co-author of this colum...

It is widely accepted that males with cryptorchidism, or undescended testes, are at an increased risk of developing testicular cancer, specifically germ cell tumors. Seminomas are the most common type of germ cell tumors and typically affect males between the ages of 30 and 45. They comm...

Altitude illness is a spectrum of conditions that affect the majority of travelers to high elevations (>8200 ft [2500 m]). The rapid decrease in arterial oxygen saturation with increasing altitude is the physiologic basis for this group of disorders. Many travelers to high altitudes w...

B12 (cobalamin) is essential to maintain proper neurologic functioning. Patients with vitamin B12 deficiency may suffer from fatigue, neurologic disease, paresthesia, and megaloblastic anemia. Overall, the prevalence of B12 deficiency is difficult to assess because there is no consistent...

Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the second leading cause of cancer deaths in the United States. It is estimated that there will have been 150,000 new cases diagnosed in the United States in 2010 and more than 50,000 deaths as a result of ...

Benign prostatic hyperplasia (BPH) has a profound impact on the quality of life of the aging male, with as many as 80% to 90% of men showing histological changes by age 80. Medical history and physical examination are essential for diagnosing and grading BPH. Symptoms often encountered i...

The diversity seen in Family Medicine is matched by no other specialty. In single day, a family physician can see people at the far ranges of the life span, perform minor surgeries, participate in a community program, and see people with illnesses varying from strep throat to inflammatory bowel to ...

Kawasaki disease is rare form of vasculitis especially affecting the coronary arteries of children under the age of five years. There is no known infectious agent of origination associated with the vasculitis. We report a case of recurrent Kawasaki disease, which makes it a more unusual ...

Cavernous angioma is one of several vascular malformations whose presentation is usually seizures, headaches, or neurological deficits. The frequency of such malformations is controversial and appears to be more common than once thought because of the availability of magnetic resonance i...

The purpose of this study was to determine whether the influence of environmental, economic, and insurance barriers affect the immunization process for adolescents. The study attempted to determine whether physician knowledge was positively associated with the implementation of vaccinati...

Sexually transmitted diseases (STDs) comprise a diverse group that includes blood-borne diseases, sexually transmitted infections (STIs), and ulcerative lesions. This area of medicine has been the cornerstone for many abstinence and safe-sex programs, research into new vaccinations, scre...

The anatomic core is important in the functional stabilization of the body during static and dynamic movement. This functional stabilization is an integral component of proprioception, balance performance, and compensatory postural activation of the trunk muscles. The structures that def...

There is a certain pace in life that corresponds with the seasons of the year that affects chronic disease management. In winter, for example, Americans “bunker up” indoors, decreasing their exercise levels. Couple this with the holiday “binge eating” season and it’s a real challenge that often has...

As our osteopathic specialty has evolved over the past decades, so does its identity as perceived by its practitioners, other specialties, government agencies, and the public. That identity will undergo a formal transition effective January 1, 2012 when “family practice” is changed to “family medi...

Nonmelanoma skin cancer, consisting of squamous and basal cell carcinoma, is the most common malignancy in the United States. The most common risk factor is exposure to ultraviolet radiation; however, these malignancies have also developed at sites of exposure to industrial agents, ioniz...

BACKGROUND:Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder char- acterized by localized or diffuse swelling of an affected patient’s face, neck, larynx, visceral organs, extremities, and trunk. There is also an acquired form of angioedema that has been described in pa...

Toenail removal is a common procedure that family physicians routinely perform in the office. This article highlights the acute and chronic indications for toenail removal and its contraindications, potential complications, and procedural details including digital block anesthesia. A sam...

Cutaneous metastasis is a rare occurrence but may be the presenting sign of a primary internal malignancy. Skin, breast, lung, gastrointestinal, and kidney are the most common primary malignancies to metastasize to skin. Common regions for cutaneous metastasis include the scalp, abdomen,...

Osteopathic manipulative treatment (OMT) is a unique aspect of osteopathic medicine that has served as a useful adjunct to traditional surgical and pharmacological treatment of medical conditions for more than 100 years. Using an approach based on five basic body functions, as well as tr...

Several studies have assessed interexaminer correlation of diagnosis of somatic dysfunction (SD). This study looks at the simple task of palpating the anterior superior iliac spine (ASIS) of both a live and a fixed plastic model to determine whether examination results are reliable. It i...

Osteopathic medicine has made great strides in modern medicine. Once we struggled for acceptance; now we strive for distinctiveness. Many features make osteopathic medicine unique, but one of the clearest areas of distinctness is the integration of osteopathic diagnosis and treatment in the overall...

To the Editor: The American people are becoming aware that many pharmacies have recently begun offering generic medica- tions for only $4 for a one-month supply and $9 for a three-month supply. Although this is a very commendable and fiscally responsible act to benefit consumers, consumers could...

Pseudohypoparathyroidism is a complex endocrine disorder caused by various possible biochemical receptor abnormalities of the parathyroid hormone. Phenotypical features that result depend heavily on the type of pseudohypoparathyroidism and genetic inheritance (maternal versus paternal in...

Concussions are extremely common injuries, especially among student athletes. With emerging guidelines that will require physicians to make decisions regarding injured athletes' return to physical activity, the family physician will soon be faced with more frequent questions from injured...

On September 28, 2001, the United Nations Security Council adopted Security Council resolution 1373 on counter-terrorism in which it noted with concern the close connection between international terrorism and transnational organized crime, illicit drugs, money laundering, illegal arms tr...

Major limb amputation, traumatically or nontraumatically induced, is a major life-changing event, often precipitating chronic pain, dysfunction, and altered self-image. This article explores the relevance of osteopathic manipulative treatment in management of the patient with major limb ...

Primary care providers are often the first encounter a patient has with medical care and are increasingly being expected by current health care models to extend their case care management role to the Centers for Medicare and Medicaid Services' “Advanced Primary Care model, also known as ...

It was about 10 PM in Maine and I was reading in bed when the phone rang. The voice at the other end of the line was not the hospital and not a family member, but my friend and classmate, Jim, known to his Army peers as Major James O. Hill, DO, calling me from the Green Zone in Baghdad. “Just had...

A 64-year-old white male was followed for three months outpatient for urinary retention with a history of benign prostatic hypertrophy. A 2-cm urinary bladder calculus was found on renal ultrasound, and the patient underwent an elective suprapubic prostatectomy. The bladder calculus was ...

Lisfranc fractures comprise only 0.2% of all fractures and are missed as much as 20% during initial presentations. When misdiagnosed and left untreated, Lisfranc fractures could lead to significant chronic pain and permanent disability. This case presentation illustrates how a Lisfranc i...

The purpose of this research (1983-2010) was to examine the nutritional influences on the development of cervical neoplasia and thereby formulate a strategy for prevention. Articles retrieved from Ovid: Medline and Alt HealthWatch Databases were reviewed. The major topics of review inclu...

Frozen shoulder is a clinical condition characterized by a relatively sudden onset, variable degrees of pain, restricted range of motion, and normal radiographic imaging techniques. Although the disease occurs in a small segment of the population, its management presents the clinician wi...

Plantar fasciitis (PF) is a common problem presenting to the family practice office. It is seen in approximately 10% of the population and is more common in women than men. It presents with pain on the plantar surface of the foot overlying the calcaneus. The pain is most intense in the m...

With the May/June 2012 issue of Osteopathic Family Physician , my tenure as your Editor-in-Chief comes to an end. I have enjoyed serving as your Editor. I remember when I was approached by Joel Kase, DO, my editorial predecessor, to join the Editorial committee. He worked so hard to transform t...

To the Editor: What is the difference between the differential diagnosis of a DO and that of an MD? That question is the defining difference between these two schools of patient care. The osteopathic physician has an expanded differential diagnosis, and because of this expanded differential, this ...

The incidence of Ehrlichia infection has been increasing since it was first discovered in 1986. Ehrlichia is transmitted by ticks and is endemic to many areas of the United States. Patients with symptoms of Ehrlichia may present to their primary care provider or an emergency department. ...

Lifelong learning has undergone significant change over the past decade. The Institute of Medicine report “Health Professions Education: A Bridge to Quality” recommended the transformation of continuing medical education to go far beyond traditional lectures to include innovative educati...

The osteopathic medical profession traditionally has distinct attributes. The purpose of this study is to identify current perceptions among osteopathic medical students, residents, and practicing physicians (teaching and nonteaching) to gauge the dynamics and perspectives of the distinc...

This article reviews the anatomy, physiology, and pathophysiology of the renal and urinary systems. The clinically relevant interactions and contributions with the musculoskeletal system of interest and use to the osteopathic family physician will be discussed, and an osteopathic manipul...

Given the unprecedented growth of the osteopathic profession in the past few decades, osteopathic clinical education has been turbulent. Maintaining a unique osteopathic professional identity during the years of clinical training has been difficult because of limited DO preceptors, time ...

Every medical student who works with me is expected, at some point, to deliver a brief explanation of osteopathic medicine to a patient in my office. I do this partially because it’s good training for the student (who will be giving vari- ants of this talk for the rest of her career) and partially ...

Re: Approach and management of spider bites for the primary care physician (Ashurst et al. Osteopathic Family Physician 3(4):149-153, 2011) To the Editor: In the article “Approach and management of spider bites for the primary care physician” by Ashurst et al, the overall message stated in the co...

Re: Approach and management of spider bites for the primary care physician (Ashurst et al. Osteopathic Family Physician 3(4):149-153, 2011) To the Editor: In the article “Approach and management of spider bites for the primary care physician” by Ashurst et al, the overall message stated in the ...

Spontaneous hypoglycemia is rare. However, in healthy individuals with recurrent symptoms of spontaneous hypoglycemia, an insulinoma should be suspected. Patients with an insulinoma typically present with neuroglycopenic symptoms and are commonly misdiagnosed as having a psychiatric or n...

Approximately 10,000 snake bites occur each year in the United States. Although rarely fatal, 70% of envenomations require antivenom therapy. The rattlesnake, a member of the Crotalinae family, causes the most bites and fatalities each year. First aid techniques such as arterial tourniqu...

Increasing overweight and obesity are major risk factors for the development of type 2 diabetes. The risk is higher when the weight gain occurs during adulthood. In fact, evidence shows that body mass index (BMI) is directly and continuously related to the risk of type 2 diabetes. Indivi...

Endometrial biopsy is one of the most common outpatient gynecologic procedures and is rapid, safe, and inexpensive. It is a procedure that family physicians can easily perform in the office. Indications for endometrial biopsy include abnormal uterine bleeding (especially if the patient i...

MEN-1 is a rare autosomal dominant disorder characterized by the occurrence of tumors, both benign and malignant, of the parathyroid glands, the pancreas, and the anterior pituitary gland. Its incidence varies and it can occur as a sporadic event or as a familial trait. Multiple other as...

The ability to measure hemoglobin A1c in populations under the care of physicians or physician groups has become increasingly important with the advance of system-based interventions that can affect this outcome and with payment linked to levels of diabetes control. ...

Before we understood the organs involved, the effects of the endocrine system must have seemed like a kind of magic. What single body part could cause a patient to suddenly begin drinking lots of water, developing fungal rashes, lose weight, and breathe the scent of rotten fruit? Was it a curse? Wa...

Functional gastrointestinal disorders (FGIDs) describe patients who present with symptoms that arise from the gastrointestinal (GI) tract yet have failed to be explained by a standard GI work-up. Somatic findings at midthoracic levels correspond to localized visceral dysfunction such as ...

Insomnia is a prevalent condition and a significant source of psychosocial impairments. It is associated with numerous comorbidities that affect quality of life. An adequate assessment is key to developing an efficacious treatment strategy. This paper provides a basic overview of current...

The defining symptom of an overactive bladder (OAB) is urgency. OAB is a condition that 16% of Americans suffer from. There is a direct cost of more than $6 billion annually. Symptoms of an OAB affect both men and women in almost equal percentages, especially with advancing age. Most med...

This article describes the process of peer review from receipt of an article by a journal to publication. The need for timely response is explained. The importance and method of completing a helpful peer review is detailed. Specifically the areas of originality, structure, language, and ...

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by family physicians, often as a direct result of significant stressors. Many conditions can present in similar fashion to IBS. Standard criteria using the Rome definition of IBS can assist in...

OBJECTIVE:Family-based approaches have proven successful in the treatment of adolescents with anorexia nervosa (AN). This observational study aimed to demonstrate that a family physician with a multidisciplinary team, using a family-based approach, could successfully treat adolescents with and...

I still remember learning the digestive system in fifth grade science class, probably because my father made me memorize the vocabulary words: “absorption: the passage of simple substances into the internal parts of a plant or animal; assimilation: the changing of simple substances into substances ...

Adding glucagon-like peptide-1 (GLP-1) receptor agonists to insulin therapy for patients with type 2 diabetes mellitus (T2DM): why and how patients with T2DM who progress to insulin therapy usually do so by starting with a single injection of a long-acting insulin analog, added to oral a...

Incretin-based therapies include glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) based therapies. Both classes of agents are predicated on the knowledge that GLP-1, a gut-derived hormone, plays a major role in glucose homeostasis, a fact that has been...

The sheer numbers of patients with type 2 diabetes, a chronic illness with multifactorial pathophysiology, common comorbidities, exacerbated by an obesity epidemic and a lack of specialists to care for them may seem daunting. However, new treatment options and treatment guidelines that t...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Diabetes management for outpatient accounts for millions of office encounters annually. Successful care for the patient with type 2 diabet...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Diabetes management for outpatient accounts for millions of office encounters annually. Successful care for the patient with type 2 diabetes mellitus (T2DM) re...

Langerhans cell histiocytosis (LCH) is a relatively rare dendritic cell disorder with an unclear etiology. The incidence is 2:1 million and it is most commonly seen in children from 5 to 10 years of age. The diagnosis is confirmed by biopsy with treatment options varying from simple obse...

Jaundice is a potentially life-threatening condition that continues to affect at-risk newborns, accounting for continued hospital readmissions. As family physicians, we should be cognizant of neonates who may be at risk for jaundice, including those with pathologic jaundice as well as ne...

Environmental allergens that induce a type I immune hypersensitivity present a widespread and significant reduction in the quality of life for our patients while imposing a stifling cost upon health care and the economy. A prompt, accurate clinical diagnosis with an appropriate managemen...

Each year, over three-fourths of the women of reproductive age in the United States seek family planning services from primary care clinicians. Women and their doctors should be informed of all effective family planning options and their respective effects on a woman's reproductive healt...

There is an iconic family photo at my parents’ house of my big brother holding his newborn sister and looking into the camera with an expression that can most charitably be described as ambivalent. I am told that when I was placed in his lap he flinched away and said, “I am afraid I will break her!...

An update on weight-loss medications To the Editor: This is an update to the article published in September/ October 2012th issue of Osteopathic Family Physician entitled “Diabetes obesity: Link how to lower your risk of diabetes with weight management.” As that article was originally submitted...

Granuloma annulare and stasis dermatitis are two common cutaneous disorders encountered by primary care physicians. Stasis dermatitis is an inflammatory skin disorder and is often seen in patients with chronic venous insufficiency. Similarly, granuloma annulare is a benign inflammatory d...

Dyspeptic symptoms are very common in the general population. Expert consensus has proposed to define dyspepsia as pain or discomfort centered in the upper abdomen. The more common causes of dyspepsia include peptic ulcer disease, gastritis, and gastroesophageal reflux disease.4 At some ...

This paper proposes to introduce a method of performing the diabetic foot examination through introduction of a modified version of the cardinal techniques of examination (inspection, palpation, peripheral vascular or neurologic assessment, and auscultation), more consistent with the seq...

The author defines critical care, reviews the time element of critical care codes, and clarifies what CPT codes are classified as critical care. He follows with recommendations to ensure you are paid for the time and services provided. ...

Chronic lung diseases carry a significant amount of morbidity and mortality. Obstructive lung diseases in particular are the fourth leading cause of death in the United States. Easily implemented in the primary care office, spirometry is a portable and useful tool to diagnose and monitor...

March is conference time, and this spring our members will descend on Las Vegas to network, to socialize, and, most importantly, to continue our education. It may be that some of the topics are beyond your usual focus or involve clinical pictures you usually refer out. This year my challenge to all...

Clinical testing is an easy and inexpensive tool that provides an informative guide toward initial diagnosis for shoulder joint dysfunctions. Clinical tests can be a powerful aid toward a correct diagnosis or at the least narrowing the differential diagnosis. Family physicians with good ...

Ganglion cysts, benign soft-tissue tumors that can occur at any joint, are the most common masses occurring in the hand and comprise 50%-70% of all hand soft-tissue tumors. Despite the high frequency of occurrence, ganglion cyst etiology remains uncertain and perhaps even more elusive is...

Migraines are perhaps the most studied of the headache syndromes secondary to the high incidence and have significant effect on the quality of life of those suffering from this condition. Despite the high prevalence of migraines, an estimated two-thirds of sufferers either have never con...

Among many changes made to the current healthcare system, the Patient Protection and Affordable Care Act now provides coverage for “wellness visits” for Medicare part B beneficiaries. There are just over 45 million Medicare enrollees across the country which represents about 16% of the t...

Osteopathic family medicine offers a unique perspective to Parkinson disease (PD). Patients with PD present with a common set of concerns and symptoms. Application of evidence-based osteopathic manipulative treatment approaches can be utilized to address these clinical issues. This artic...

My grandmother Claire was the quintessential Yankee stoic: unflappable, enduring, and never wearing her heart on her sleeve. She would have made a great poker player, because although dynamic, she rarely revealed her feelings through an unconscious facial expression. For this reason, there was a gr...

Adults with diabetes, heart disease, and chronic lung diseases are susceptible to increased morbidity and mortality from infectious diseases. Utilization of vaccinations for disease prevention in this population is low. The Centers for Disease Control and Prevention provide vaccine guida...

Adolescent Idiopathic Scoliosis is a relatively common orthopedic condition, affecting approximately 0.5%-3.0% of the pediatric population. Although the condition is often self-limiting, the consequences of a late or delayed diagnosis, coupled with the potential for rapid progression of ...

Medical care is under constant reform. Physicians are encouraged to stay current and well informed to receive maximum reimbursement, while still providing high-quality medical care to our patients. The trend has been that insurers are following the Centers for Medicare and Medicaid stand...

With the geriatric population steadily increasing and receiving primary care, it is important for the osteopathic family physician to have knowledge about safely prescribing to the geriatric patient. Polypharmacy, the use of 5 or more medications or the use of any medication that is not ...

Bullying is a prevalent public health problem that often involves physical, verbal, and psychological forms of aggression. Approximately, 33% of students experienced bullying during the 2007-2008 school year and 25% of school administrators reported bullying as a daily occurrence. Bullyi...

EDITOR ’ S MESSAGE An eye on bullying In April 1999, 2 young men in trench coats walked into their high school in Littleton, Colorado, and opened fire. Although there will never be a satisfying answer for the many anguished voices asking “ why? ” , one of the possible explanations kept coming up...

In the years of conducting use-effectiveness studies in the various natural methods of family planning, there has been very little effort placed into the better understanding of the statistical measures upon which family planning systems are actually studied. There has been an emphasis to try to ma...

To the Editor: I read with interest the review article in the January- February 2013 issue of Osteopathic Family Physician entitled, “ Fertility Awareness-Based Methods of Family Planning: A Review of Effectiveness for Avoiding Preg- nancy Using SORT ” (Manhart M.D., Duane M., Lind A., Sinai...

Cardiac auscultation skills amongst many physicians are lacking. This brief report discusses 2 mobile apps designed to improve cardiac auscultation skills. ...

Heat- and cold-related illnesses represent a broad spectrum of preventable common conditions affecting diverse populations every year. Clinicians treating patients near areas of outdoor recreation and nursing homes or who potentially see critical pediatric, indigent, or intoxicated patie...

Among cancers in the United States, colorectal cancer is the third most commonly diagnosed, and the second leading cause of death. Most colon cancers are thought to develop from adenomatous polyps through the adenoma-carcinoma sequence, which emphasizes the importance of screening colono...

Background: Physicians have long understood that the privilege of professional autonomy would only continue to be granted to the profession by demonstration of effective self-regulation.Discussion: Although initiatives in demonstration of continued fitness for practice are sometimes look...

Acne vulgaris is one of the most common conditions presented to the family physician. The vast array of topical and systemic medications available can make choosing an appropriate treatment seem overwhelming. Because every case of acne is different, the choice of medication should be sel...

Acute ankle sprains are one of the most common musculoskeletal injuries evaluated and treated by primary care physicians. Ankle sprains are common in adolescents and young adults and typically occur during athletic activity. Risk factors include a previous ankle sprain and body mass inde...

In the summer of 1996 I was in a motel on the way to med school when I watched Kerri Strug's Olympic vault, which led to a victory for her team and a horrible sprain for her. She is not a big person but I knew enough about physics to know that she was driving a lot of force onto her rolled ankle, a...

Medical knowledge is developing at an ever-advancing rate. This brief report discusses 1 mobile app designed to help clinicians understand and review pivotal landmark trials and another app that provides point-of-care learning and clinical decision support. ...

The Centers for Medicare and Medicaid Services (CMS) is encouraging the use of reporting programs to satisfactorily report data on quality measures. In turn, they are offering incentive payments to practices with eligible professionals for compliance. Beginning in 2015, CMS will also app...

Binge-eating disorder (BED) is a newly defined eating disorder that has a significant effect on an individual's emotional and physical health and is an important public health problem. It is important for primary care providers to have a better understanding of BED—its signs and symptoms...

Approximately 16% of children in the United States have developmental delay, many of whom are not diagnosed until school age. Surveillance of pediatric developmental milestones alone is insufficient for identification of developmental disorders. Based on current evidence, recommendations...

Cultural competency applies not only to minority ethnic or religious groups but also to nontraditional family structures. A review of the evidence-based literature and clinical practice tips will be highlighted for the following family types: children being raised in multicultural or bil...

I do not know what a traditional family is, even though “ family ” is a key part of my job title. If you were to ask an Inuit, a Jew, and a member of the Mafia, each of the 3 would have very different definitions of the word, and which people should be included under its umbrella. And, as my anthro...

The Patient-Centered Medical Home (PCMH) is a model of care based on the patient, their doctor and the healthcare team working together. The team tries new ways to work for the patient to have good health. One focus is on the patient doctor bond and to help the patient be more active in ...

The US population is predicted to increase by 18% between 2005 and 2025. The over 65 population will increase by 73% during this same period.1 These are contributors the predicted shortage of primary care physicians in the United States. The American Academy of Family Practice (AAFP) has...

Stroke affects nearly 800,000 people in the United States, and is a leading cause of disability and mortality. Increasing age is one of the most significant risk factors for stroke, and as our population continues to age, stroke is expected to become more prevalent. Strokes are categoriz...

Hypoglycemia is a common and serious complication of diabetes management. There is no uniformly accepted clinical definition of hypoglycemia. The American Diabetes Association (ADA) recommends that people with diabetes consider treating hypoglycemia when the self-monitored blood glucose ...

Spirometry in the primary care office is a valuable tool that can be used to assist with thediagnosis of respiratory symptoms and the management of obstructive and restrictive lung disease. With the most common obstructive diseases, spirometry use has been shown to lead to more&nbs...

The Patient-Centered Medical Home is a redesign of office practice that maintains the core values of traditional family medicine, creates health care teams that track and improve patient care, improves access, satisfaction and patient-centeredness, and is supported by reformed reimbursem...

office birthday was marked with a cake, every sad event was marked with a card, and she always dressed up on Halloween. People who have not been my patients for years still tell me how much they appreciated the way she always made each of them feel special and important. In other words, she...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Prevent concussions by wearing seatbelts in the car and buckling children in safety seats. Do not drive after drinki...

Research into evidence-based medicine has yielded a large number of clinical calculators and nomograms to aid physicians with the care of patients. This article describes three apps that make these evidence-based tools easily accessible and readily available at the point of care of the p...

Sutures have traditionally been used in the emergency room and in the primary care setting for wound and laceration closure, but over the past several decades we have seen alternative methods of wound closure emerge. Tissue adhesives are starting to become the front-runner as the alterna...

Hallucinations often occur in the context of a variety of psychiatric, substance use, and medical conditions. Recent research has also shown that hallucinatory events may occur in the absence of any organic or known psychiatric disorders. This article reviews the types of hallucina...

Insomnia, one of the most common complaints seen in the primary care office, affects at least 30% of the U.S. adult population at an estimated cost to the healthcare system of $241 billion annually.A number of medications—both over-the-counter (OTC) and prescription—are used to tre...

Forty-seven states and Washington D.C. have passed legislation in protecting student-athletes, but concussions still occur. Symptoms can involve somatic, cognitive, and behavioral disturbances. Moreover, many athletes underreport their symptoms. Currently, the Concussion Reco...

In November 2013, PBS released a documentary titled “League of Denial”, which chronicled the supposedly secret phenomenon of chronic traumatic encephalopathy in the NFL. Neurological findings were present in several retired football players, and current superstars, including Brett Favre, disclos...

Landro, Laura, “The Talking Cure- improving the ways doctors communicate with their patients can lead to better health care- and lower costs.” The Wall Street Journal. April 9, 2013, R1. Kamp, Jon, “Updating Doctors’ Offices Via Cloud Services”. The Wall Street Journal. April 17, 2013, B7. DeC...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Oral Hygiene Good oral hygiene is important to your health. Brush your teeth and floss between teeth 2-3 times a da...

Two weeks after announcement of the AOA/AACOM unified residency accreditation system with the Accreditation Council for Graduate Medical Education (ACGME), the ACOFP Congress of Delegates passed a Resolution – AOA/AACOM Unified Residency Accreditation System – seeking greater disclosure of the agr...

Pheochromocytoma is a catecholamine secreted tumor, which is derived from chromaffin cells. These tumors are estimated to occur in 2-8 out of 1 million people per year. In this case, a 50-year-old Caucasian female presented to a primary care physician’s office with a 10-year history of s...

Many factors should be considered when managing a joint injection for an osteoarthritic knee. Along with the type of needle, medication to be injected, and how often the injections need to be done, the actual step-by-step procedure should be carefully considered. Studies have shown varia...

Team-based care is a key element of a successful primary care practice or patient centered medical home (PCMH). The Patient Centered Medical Home (PCMH) is a concept that has evolved over the last 40 years and has the potential to take good primary care practices to great. However, befor...

The oral cavity is the window to the body and is often the area where systemic disease first presents itself. The various tissues including lips, tongue, gingiva, mucosal surfaces, dentition and bone are involved in the presentation of disease state. This review introduces an organized s...

Then How the Reindeer Loved Him The story of Rudolph is a familiar one: a member of the community, once ostracized, demonstrates that he has a unique and special skill and is consequently welcomed into the fold as an important contributor. We never hear any follow up verse in which Rudolph mo...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Birth Control Birth control is a way to prevent unplanned pregnancy. There are many types of birth control such as...

Apps on mobile devices have revolutionized point-of-care decisions for the practicing physician. This brief report discusses two mobile apps designed to save time and improve bedside decision making for physicians regarding antibiotic and pediatric issues. ...

For individuals with West Nile Virus (WNV) who develop West Nile Neuroinvasive Disease (WNND) symptoms of fatigue, muscle pain, muscle weakness persist > 90 days. Recovery of physical health, cognitive health, and functional health is achieved in only one-third of individuals at 18 mo...

America’s health care system is currently designed to drive up costs through inefficiency: Its fee-for-service formula endorses an episodic relationship between physicians and patients which places primary care providers in a perpetual state of troubleshooting and leads them to order a v...

As our country’s population ages, there are more patients with advanced chronic illness and increasingly complex care needs. Our rapidly changing healthcare environment now recognizes the importance of improving care quality to achieve better health outcomes while lowering cost and impro...

Menopause typically begins in the early fifties, although the exact age of menopause will vary from woman to woman. There are several symptoms associated with menopause that can be bothersome, and prompt women to seek treatment from their primary care provider. The purpose of this review...

Multiple hormonal contraception methods are available to prevent unintended pregnancies. The initial selection of a hormonal method includes consideration of contraception cost, frequency of use, failure rates, timing to return to fertility after discontinuation, and medical contraindica...

of a barrier, and the concern that this would lead to female promiscuity without consequence. Whether for or against, to call the Pill “revolutionary” would not be an overstatement. Although I do not know of any clinician who longs for the days of restricted reproductive choice, I know of ...

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The diagnosis of laterally-based ankle and hindfoot pain is comprehensive and the possibilities of injury origin can be easily overlooked. Injury misdiagnosis can result in improper treatment and can lead to exacerbated injuries, persistent pain, and chronic problems. Success...

A 26-year-old presented to the ER with symptoms of unknown infection. Upon admission and hospitalization, the patient’s vitals, labs, and hemodynamic function decreased; therefore, he was placed in the ICU for further management. After blood cultures came back positive for Salmonella typ...

Diabetic macrovascular disease, a significant contributor to the morbidity and mortality of individuals, is an occult problem which is frequently only identified after the occurrence of an ischemic event. Evaluating arterial pulsations of the foot using a hand held Doppler can suggest th...

Clostridium difficile infection (CDI) or Clostridium difficile colitis is an infection that causes significant morbidity and mortality. It accounts for 20-30% of antibiotic associated diarrhea and is occurring more often in the absence of antibiotics. It is the leading cause of hos...

Nephrolithiasis is a common, costly, condition that occurs most frequently in Caucasian adult males but can be seen in all ages and demographics [1]. Nephrolithiasis often reoccurs without proper management and is associated with the development of systemic disorders such as coronary art...

My college roommate committed suicide a few years after we graduated. I was horrified and saddened but not truly surprised; in her 26 years she had seen a lot of suffering, much of it at the hands of her own parents, who were savagely abusive to her and her eight siblings, while remaining outwar...

Warfarin (brand name Coumadin) is a medication for people who are at increased risk of making blood clots due to an abnormal heart rhythm, certain replaced heart valves, and some clotting disorders. Warfarin is also used in patients who have had blood clots in the heart, brain, lungs, an...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A generally healthy 57-year-old male noted an enlarging skin lesion on the lateral mid-calf area of his right leg...

Patients with atrial fibrillation are at an increased risk of stroke and systemic embolic events. Anticoagulation therapy significantly reduces such risks and is an integral part of standard of care for patients with atrial fibrillation. Increased anti-coagulation options for patients wi...

Incidence of false positive enzyme-linked immunosorbent assay (ELISA)/enzyme immunoassay (EIA) and indeterminate western blots are expected to rise as the United States Preventive Services Task Force (USPSTF) expands its human immunodeficiency virus HIV testing recommendations to include...

The limited access to practicing psychiatrists elevates the importance of primary care physicians to offer both diagnostic and therapeutic services for their patients experiencing depression. This article discusses screening tools that can be utilized under the time constraints and withi...

Context: As diabetes epidemic is gaining momentum in the society, the use of complementary and alternative medicine (CAM) either in conjunction or as an alternative to conventional medicines is now common and popular. The use of CAM supplement is commonly ignored by physicians and patien...

I am no longer married to my children’s father, and obviously we have our differences. The temptation to make every conversation hostile and polarizing can be substantial, particularly when we are discussing topics about which we feel passionately. However, at the end of the day, the well- be...

"Osteopathy for the Over 50s" presents crucial insights into osteopathic care tailored specifically for aging patients. Authored by experts in the field, this comprehensive resource covers a spectrum of topics, from foundational anatomy to clinical considerations. Emphasizing gentle treatment modali...

High Blood Pressure is a common medical condition. If it is not checked or treated, it can damage body organs such as the brain, heart, and kidneys. A number of problems such as heart disease and stroke are caused by high blood pressure. Blood pressure is measured by taking the systolic ...

Informational and financial exchanges, which take place among groups of like-minded people with a specific directive or purpose, are referred to as crowdsourcing and crowdfunding, respectively. Crowdsourcing is an open call for intellectual contributions; it is a means by which individua...

Benzodiazepines are one of the most widely used medications for the treatment of generalized anxiety. Due to their quick onset of action, efficacy and tolerability, benzodiazepines are widely prescribed by clinicians and utilized by patients. Although benzodiazepines have been beneficial...

The use of dietary supplements occurs in the majority of American adults >20 years old and has been reported to be on the rise by the National Health and Nutrition Examination Survey. People are not only taking more dietary supplements, but taking them without the advice of a he...

Hypertension remains a significant cause of mortality and morbidity in the United States and is seen routinely in the primary care setting. Family physicians are frequently encountering individuals with hypertension and are primarily responsible for the initial diagnosis and initia...

The editor reflects on the dichotomy between evidence-based medicine and individualized patient care, as exemplified by two former roommates embodying "left brain" and "right brain" approaches to medical practice. The narrative delves into the complexities of adhering to clinical guidelines while re...

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Purpose:This epidemiologic study gives insight on management of fighters both in and out of the ring.Methods:Data from 304 professional fighters in 152 fights were included.Study Selection:The Fighters’ Complaints, Physician Diagnosis, Imaging Results, and mechanism of win/loss wer...

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We report a case of wound tetanus in a previously immunized patient. The patient developed generalized tetanus requiring IV antibiotic therapy & human tetanus immune globulin (HTIG) therapy. This is only the 15th case reported this year in the United States. ...

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Cooper Medical School of Rowan University, Camden, NJ ...

New oral anticoagulants have been developed over the past several years. These include the factor Xa inhibitors and direct thrombin inhibitors. These anticoagulants have been tested for safety and efficacy against standard therapies including subcutaneous enoxaparin or oral warfarin. The following i...

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Background:Osteopathic manipulative therapy has been reported to improve dizziness and neck pain, which are symptoms commonly seen in concussion. Conceivably OMT could be used to treat similar symptoms secondary to concussion. To our knowledge there has not been any studies that linked OMT to ...

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In 2012, the Food and Drug Administration revised their guidelines on sunscreen in an attempt to cease the misleading and unsubstantiated claims commonly published on sunscreen product labels. Skin cancer is the most frequently diagnosed form of cancer in the United States with cases of skin cancer ...

Background:Chronic pain is prevalent and often managed by family medicine-OMT (FM-OMT) physicians. By triggering the body’s own healing mechanisms, prolotherapy embraces Osteopathy’s second tenet, “The body is capable of self-regulation, self-healing, and health maintenance.” Little has been r...

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Summer Musings Sunny weather is here and we have an article on sunscreens. As I sit here with the worst sunburn in years, it is clear to me that knowing and doing are two different things. Reapplication is very important and physical barriers are mentioned that include shade, clothing, hats and...

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Mood disorders are a group of mental health conditions that afflict an estimated 21 million American adults each year. Due to the high incidence of mood disorders, including depression and bipolar disorder, in the general population, a family physician must be prepared to...

The treatment of dyslipidemia is evolving. New guidelines from the American College of Cardiology(ACC)/American Heart Association (AHA) and National Lipid Association (NLA) have brought changes to the previous standards of care. The ACC/AHA update no longer suggests treating to specific cholesterol...

Sexual intimacy has been considered to be an important element in determining the quality of life. Cardiovascular diseases (CVD) often attribute to many sexual disorders that may have a lasting impact on both the quality of life and functioning of both the patient and their partners. Due to its sens...

Type 2 diabetes mellitus ( T2DM) is a chronic, progressive disease, control of which typically requiresmultiple therapies. Current guidelines suggest that, in addition to improving glycemic control, antihyperglycemic therapy should be chosen on the basis of its effects on body weight and ...

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Th e decision to prescribe statins or not to prescribe statins is made multiple times a day in the o ffi ces of osteopathic family physicians. Th e estimation of overall cardiovascular risk is key to deciding response to the lipid panels we order daily. Employer based insurance plans require patie...

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Urinary tract infections are one of the most common infections faced by the primary care physician with nearly half of all women being diagnosed during their lifetime. Although easily treated with anti-microbial agents, urinary tract infections typically recur or are often incompletely resolved. N...

Acute mechanical small bowel obstruction (AMSBO) is a common emergency and a significant cause of hospitalization. Due to the variation in small bowel obstruction-related symptomatology, many patients are unaware of the seriousness of their clinical condition and do not seek immediate medical attent...

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Asthma is a long-term lung condition in which the airways become inflamed and narrow leading to difficulty breathing and wheezing. It often affects people with a family history of allergies. A variety of triggers have been identified such as pollens, molds, animal dander a...

A 13-year-old white female presented with a two-day history of a rash on the dorsum of her nose. The patient stated she was outside all weekend playing soccer in the sun without sun protection prior to appearance of the rash. The patient described an itchy sensation to the d...

Ovarian cancer remains a highly lethal and prevalent disease in the United States currently being the fifth leading cause of cancer-related death for women for the year of 2014. Despite advances in surgical and medi- cal management, this disease usually carries a poor prognosis. Current guidelines t...

As the number of patients who have cardiovascular and metabolic disease grows, tobacco cessation should be a prime target for risk reduction. Physicians, already rushed during chronic care visits, often do not have the time to thoroughly address or follow up with smoking cessation efforts. As there ...

This article provides an evidence-based review of assessment and treatment tools for childhood obesity that can be implemented under the time constraints and within the skill set of a family medicine physician. Family medicine practitioners often form long-term relationships with ...

Asthma is a common heterogeneous syndrome characterized by airflow obstruction, bronchial hyper-responsiveness, and underlying inflammation. It is a major cause of lost work and school, lower quality of life and increased emergency room visits. Treatment involves a comprehensive step-wise approach t...

Background: Very little research has been performed examining obesity and non-pandemic flu contracture in pediatric patients. The hypothesis of this study was that patients aged 2 through 12 years of age with a body mass index (BMI) of greater than or equal to the 85th percentile for th...

Charting a Course for the Future ...

Be the Author of the Article You Want to Read...

Constipation is difficulty having a bowel movement or when you have fewer bowel movements than usual. The stool can be hard, dry, and sometimes painful to pass. You may also have stomach pain, fullness, bloating, the feeling of rectal pressure, and the need to strain. Common causes of constipation i...

Osteopathic Family Medicine has evolved throughout time. With the advent of new technology and new educational training methods, Graduate Osteopathic Family Medicine Education could benefit from mandating a Simulation component in their training of residents. Simulation is an ACGME Residency Require...

Wegner's Granulomatosis, now known as Granulomatosis with Polyangiitis, is a fairly uncommon vasculitis with varying presentations. Patients may present with ongoing sinusitis unresponsive to common treatments, or patients may present in respiratory distress and failure. The treatment of GPA has pro...

Constipation, though usually not associated with life-threatening disease, is a common condition that impairs quality of life. Patients describe a variety of symptoms associated with a diagnosis of constipation. Primary constipation may be related to dysfunction of the pelvic floor, anorectal struct...

Very few studies have been conducted to examine osteopathic family medicine residents’ views on natural family planning (NFP). This study surveyed osteopathic family medicine residents to better understand their knowledge, views, and education of the topic. The study also examined residents’ thought...

To improve the well-being of residents, several initiatives, including work-hour restrictions, have been implemented. The efficacy of these initiatives has not been widely studied. As such, the purpose of the current study was to evaluate burnout and depression in Osteopathic family medicine residen...

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Amy J. Keenum, DO, PharmD, Editor, Osteopathic Family Physician In the current issue of Osteopathic Family Physician , two articles about residents are featured. One is about mandating a simulation component in residency training and the other looks into burnout and depression rates among resi...

The American Diabetes Association (ADA) recently published their updated guidelines for the care of patients with diabetes. The standards address the importance of an individualized, patient-centered approach. It also stressed a team-based approach towards helping patients with diab...

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Psoriasis is chronic, hyperproliferative skin disorder that affects approximately 2% of the U.S. population. Treatment approaches focus on education, communication, and medications to control the disease and lessen the visible skin findings. These treatments can include moisturizers, topical steroid...

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Chest pain is one of the most common reasons for patients to seek medical care, accounting for about 1 to 3% of office visits to a primary care provider. The most common cause of chest pain is musculoskeletal in origin. A thorough osteopathic history and physical will help accurately diagnose muscul...

Diabetes has become a national epidemic. Nearly 50% of American adults have either prediabetes or diabetes.1Further if trends continue, by 2050, 1 in 3 American adults will have overt diabetes.2The American Diabetes Association (ADA) publishes annual Standards of Medical Care in Diabetes...

2015 - 2016 ACOFP President ...

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This month we serve up articles that relate to what we treat daily. Approaches to chest pain and COPD each have their own articles. Both discuss the underlying disease and the musculoskeletal components of the treatment with both osteopathic principles and manual treatments. COPD for example often i...

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Dysuria is defined as burning, pain, or discomfort with urination. Dysuria is a very common presenting complaint in family medicine clinics accounting for 5% to 15% of visits. It does occur more commonly in females, but may occur in males as well, especially in older males. Dysuria can be caused by ...

Constipation in adults is a common complaint seen in family practice that can broadly be defined as infre- quent stools and/or difficult stool passage. Constipation can be classified as primary (functional) consti- pation or secondary constipation. Primary constipation can further be differentiated ...

Empathy is widely viewed as essential to every patient encounter. There is evidence that empathy in the patient-physician encounter improves increases diagnostic accuracy, compliance, and patient outcomes. Patient satisfaction is higher when physicians demonstrate empathy. Empathy also reduces malpr...

Foot and ankle disorders are commonly encountered in the primary care setting. Many of these disorders can be successfully managed by primary care physicians, allowing for early detection and prompt treatment. However, there are circumstances when patients require a referral to a foot and ankle spec...

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Anemia is defined as a medical condition in which the body does not have enough healthy red blood cells in order to provide oxygen to the body tissue. This article serves to review the clinical presentation, work-up and management of anemia, specifically anemia that is seen in pre/postoperative pati...

Interest in probiotic use for certain clinical conditions has substantially increased over the past few years. There is much research regarding probiotics as preventive, adjuvant, and primary therapeutic agents. While many studies have shown that probiotics have some efficacy, there is difficulty in...

Fibromyalgia can be a debilitating syndrome that can frustrate patients and physicians alike. Understanding the etiology and methods for diagnosis can allow for improved patient interactions and better introduction of an overall care plan for the patient. Management of the the patient with fibromyal...

According to the CDC, the second leading cause of death in females is cancer, with breast cancer being the most common type of female cancer and the second deadliest. It is predicted that there will be over 200,000 diagnoses of breast cancer made this year in the United States, with nearly 40,000 de...

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Amy J. Keenum, DO, PharmD, Editor, Osteopathic Family Physician The lead topic of my personal life this calendar year has been the female breast mass. My closest friends, (friends of twenty years variety) have been diagnosed with breast cancer as well as some of my dearest patients. They all had ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Obesity can put you at risk for developing a number of conditions such as high blood pressure, diabetes, heart dise...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. QUESTIONS: What is the moste likely diagnosis? Candida Ecthyma Insect bites Porphyria cutanea...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 61 year old African American male presented to the emergency department with a chief complaint of a three wee...

Discrepancies in leg length are extremely common among the general population. Most people have few if any problems from a leg length inequality, but for some it can cause low back pain and other symptoms that are collectively termed Short Leg Syndrome. Low back pain stemming from Short Leg Syndrome...

Acute otitis media (AOM) is one of the most common diagnoses made by physicians treating children. Approximately 80% of children will have at least one episode of AOM by one year of age, and up to 90% will have AOM by two to three years of age. AOM has been the most common condition for which antibi...

Obstructive sleep apnea has become much more prevalent and is now considered the third most common respiratory condition affecting approximately 20 million Americans and an estimated 100 million people worldwide. It affects men, women and children alike. Obesity is thought to be one of the major con...

Obesity is a common, serious problem affecting many patients in every osteopathic family physi- cian’s practice and is also quickly becoming a pressing public health concern. The proper treatment of the obese patient rests on three pillars: proper nutrition, increased physical activity, and behav- i...

In the previous Issue of Osteopathic Family Physician, we looked at the new CMS category of Clinical Practice Improvement Activities (CPIA’s). Since that issue, CMS has released the final payment Rule for 2017 and beyond. This article contains information from the Final Rule (MACRA), released Octo...

Sleep disorders and treatment is the lead article for this issue paired with an article on FDA approved medications for the treatment of obesity. The editors decided on the pairing due to the common nature of obstructive sleep apnea and obesity as the most common cause of the most frequently diag...

Respiratory tract infections are any infection that affect the nose, sinuses, and throat (i.e. the upper respiratory tract) or airways and lungs (i.e. the lower respiratory tract). Viruses are the main cause of the infections, but bacteria can cause some. You can spread the infection to others thro...

A thin 65-year-old African American female with a past medical history of hypertension presented to her primary care physician with a chief complaint of bilateral “eye bumps”. She stated that they were present for years and only decided to come to the office after her relatives insisted it be ev...

Background: PPROM complicates 3% of pregnancies, the most commonly identified etiology is infection. Appendicitis is a well-known cause of peritonitis and systemic illness, complicating approximately 1/1700 pregnancies.Case: A healthy 26 year old primagravida female at 24 weeks gestation...

Delirium is a common acute geriatric syndrome with a fluctuating course that is characterized by inattention and cognitive changes that may not be attributed to dementia. Older patients, those with comorbidities or history of psychiatric illness as well as those with cognitive disorders ...

The incidence of knee pain is increasing due to the rising prevalence of obesity, sedentary lifestyles, and aging baby boomer population in the United States. Both acute and chronic knee conditions can result in the increased utilization of pain medications and a decreased quality of lif...

Respiratory tract infections are a common reason for office visits in primary care settings. Respiratory tract infections can often be managed in an outpatient setting, however hospitalization may be necessary in some more emergent and life threatening cases. A thorough history and physi...

Introduction: Occipital nerve blocks and trigger point injections are often used to treat headaches of various etiologies. The extent and duration of benefit from these injections reported in the literature varies widely. In one community neurology clinic, patients who receive these therapies often ...

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The holidays are over and winter has dug in. Snow for some and colder temperatures for others throughout the United States. Respiratory illnesses abound. So appropriately, our lead article this month is Osteopathic Consideration in the Infections of the Respiratory Tract. It emphasizes t...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Erectile dysfunction (impotence) is the inability to obtain and maintain an erection. Some of the common causes inc...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 1-year-old male presented with a history of an upper respiratory infection and fever for 48 hours followed by two pa...

Abstract:Erectile dysfunction (ED) is a relatively important issue in men’s health that warrants further discussion and consideration amongst primary care physicians. While it was originally believed that the underlying mechanism of ED was more psychogenic in nature, over the last 40 years suc...

Abnormal weight loss is a frequently occurring condition among adults and is linked to a host of adverse health outcomes, including higher mortality rates, and a number of progressive debilitating illnesses. While this condition commonly presents with a contributing disorder, many patients present w...

of education in the waiting room.Objective:To date little empirical data exists assessing physician preferences on use of education resources in the waiting room. This study is designed to examine physicians’ preferences for use, their role in selection, their perception of patients’ satisfact...

Aim:This study aimed to understand the knowledge and perceptions related to electronic nicotine delivery systems (ENDS) among healthcare providers (HCP) practicing in the family and general practice settings.Methods:HCPs that practice in the family and general practice settings were recr...

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The article, Physicians’ Perspective and Influence on Patient Education Resources Used in the Waiting Room reviews a 20-item survey of 50 family physicians about their office waiting rooms. No surprise to find that the doctors who had ownership of the practice were more interested in what happe...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. ...

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Sleep disorders are a common complaint in the primary care setting and have important medical and social consequences. Diagnosis can usually be made through history and physical. Polysomnography is useful for the diagnosis of obstructive sleep apnea and limb movement disorders. Insomnia ...

Pain is among the most common reasons that patients seek help from their physicians in the United States: it is estimated that chronic pain results in up to $635 billion per year in health care costs and lost productivity.The management of chronic pain is complex and can be problematic f...

This review article takes an evidence-based approach in the discussion of circumcision. International and national statistics are described to give context to the practice. The article reviews preventative health benefits of circumcision. There is also a summary of the bioethical reasons...

Objective: This study assessed: 1) the effectiveness of a Motivational Interviewing (MI) training program to improve the skills of family practice residents, and 2) resident and Standardized Patient’s perception of the effectiveness of training and beliefs about MI in clinical practice.M...

As osteopathic physicians, we are living in uncertain times. The changes in healthcare continues, and we are all trying to adapt to this new normal. The foundation upon which we stand keeps shifting when once that same foundation was stable. How we are educated, practice, get paid and certi...

Yes, Healthcare is complicated. Are family doctors doing circumcisions? Osteopathic family physicians rounding in the nursery or delivering babies have done so for many years. The article this month is not a procedural publication but is more about the ethical discussion around the idea of circu...

A 13-month-old black female presented to her family practice office with a four-day history of fever, nasal congestion, and loose stools. Her maximum temperature was 103.9 degrees Fahrenheit, obtained rectally. Symptoms accompanying the fever included diminished appetite, irritability, a...

Anxiety disorders are one of the most common psychiatric disorders presenting to the family physician. Anxiety disorders are both biologic and psychologic in origin. Anxiety is a signal alerting the individual of ‘danger.’ This danger can be unknown, internal, conflictual and vague. The ...

It has been nearly 20 years since the first Adverse Childhood Experiences (ACEs) study was published. It is time for the osteopathic profession to embrace these findings – that adversity and trauma in childhood foster ill health in adults and children. We need to champion a well-informed...

The incidence of newly diagnosed malignant melanoma is rapidly increasing. In 2016, it is estimated that there will be 76,380 new cases with 10,130 deaths in the United States. Incidence has increased from 1 in 1500 persons born in the early 1900s to 1 in 50 of Caucasian persons born in ...

Objective: To determine the consequences of tobacco use on a person’s sleep.Methods: Active duty service members self-disclosing their tobacco use participated in a one month study during which time they completed standardized self-assessment scales which included the Pittsburg Insomnia ...

The ACOFP is constantly looking for ways to make our members’ lives as physicians easier and to increase stability in these challenging times. The most common thing that members are struggling with, especially in solo, small and rural practices, is making sense of the CMS Quality Payment Program...

Are you having a little anxiety while you are learning the government regulations this summer for the new requirements for the quality measurement program that will apply to your future? OFP has you covered with an article on Osteopathic Approach to Anxiety . You can do this. Thought y...

A 21-year-old white female presented to the emergency department with intermittent right lower quadrant pain associated with a palpable nodularity that has waxed and waned in size and tenderness over the past year. The lesion seems to be more prominent around the time of her menses. Her ...

Non-organic or functional, abdominal pain is pain that exists free of a pathologic state. This is the most common type of chronic abdominal pain in children. It interrupts a child’s normal daily activities and causes stress and anxiety amongst families. In the past, it has been poorly tr...

The potential causes of shoulder pain are numerous, ranging from trauma, to disease, to hereditary issues. Here we report on a rare, but emerging potential culprit. Parsonage-Turner Syndrome (PTS) is a neurologic disorder affecting peripheral nerves, usually the upper trunk of the brachi...

Menopausal-related symptoms, which include hot flushes, night sweats, vaginal dryness, difficulty sleeping, sexual dysfunction, and depression/anxiety, among others, are experienced by roughly 80% of women and are therefore a common complaint in the primary care setting. Systemic high-do...

Family physicians are on the front line of diabetes care. This year, the American Diabetes Association’s (ADA) Standards of Medical Care features a more robust section on lifestyle management, which is always a critical component of diabetes management. In addition, the ADA recently publ...

Family Medicine is the “gateway” to health care in America, with the goal to ensure that all consumers have access to primary care services and understand the components of the “medical neighborhood.” Our patients should think of Family Medicine first, the guardians of well-care. The place where...

A review article related to the everyday non-pharmacologic management of diabetes is included this month. This is a common challenge to most osteopathic family physicians. When patients with diabetes are diagnosed, present for their annual visit, or have evidence that further changes are required...

Movement disorders affect about 28% of the U.S. population aged 50-89. They are conditions that affect how we move. The most common movement disorder is an essential tremor. An essential tremor usually affects the hands. It is an unwanted shaking that is present at rest and worsens with ...

Gout is a form of arthritis that causes a sudden episode of swelling and pain in joints. It usually only affects one joint, but some people can have it in more than one joint. Increased levels of uric acid in the blood stream can form sharp needle-like crystals that build up in joints, c...

A 78-year-old African American male presents to his primary care office with a minimally tender mass on the lateral aspect of his 2nd digit. His history was negative for fever, chills, and trauma to the area. He endorsed joint pain diffusely with multiple episodes on podagra in the past....

Movement disorders are a heterogeneous group of complex sensorimotor neurological conditions involving involuntary abnormal movements, deficiencies or changes in normal motion. Parkinson’s disease, restless leg syndrome, and essential tremor are the most common movement disorders, and th...

Diabetes mellitus has become a public health pandemic. Nearly 1 in 9 adults in the U.S. have diabetes. This is expected to grow to 1 in 3 Americans by 2030. Diabetes management is time consuming for both the patient and the physician. It is recommended that people with diabetes perform s...

Team-based care is a key element of a successful primary care practice or patient centered medical home (PCMH). However, before practices can transform to PCMHs, they have to transform their staff to assume new roles and develop needed skills in the new practice paradigm. As medical prac...

Being heard is important. It is important to our patients, it is important to ACOFP members, and to each of you personally. ACOFP made a bold move in July 2017 to establish its own legislative voice by hiring a Washington, DC - based medical lobbying firm - Alston & Bird. ACOFP is working wi...

This month we lead with a nuts and bolts “how to article” article on downloading glucose meters. This is typically done in the endocrinology’s office, why not in the osteopathic family physician office? Insurance companies dictate the glucose meter they will cover on specific insurance plans and ...

Paronychia is a skin infection that occurs around a fingernail or toenail. It can be acute lasting less than six weeks or can be chronic and persist for more than six weeks. It is most likely to occur following a break in the skin, such as with trauma, nail-biting, and ingrown nails. It ...

Many people experience sports and recreation-related eye injuries each year. In fact, the number is estimated to be around 100,000 with approximately 42,000 going to the ER for treatment. Sports-related injuries cause over 13,000 people to go blind yearly and is the leading cause of blin...

The aorta is the main blood vessel that carries blood from the heart to all the arteries in the body. It travels down the back of the chest and abdomen and then branches into two large arteries by the hips. An aneurysm is a stretch or bulge in the vessel that is caused by long-term vesse...

As osteopathic family physicians, we have the privilege of taking care of patients. In a way, we already enter into a relationship with a patient the minute we walk through the exam door. Whether the osteopathic family physician chooses to communicate with their patients in a controlled, safe sett...

A 14-year-old caucasian male presents to the emergency department after being struck by a baseball to the left side of his face. The patient reports that while playing the outfield, he was hit by a line drive to the eye after losing the ball in the sun. He denies wearing glasses or conta...

A 73-year-old female with past a medical history of diabetes mellitus type II, hypertension and thyroid disease presented to the Urgent Care Center with right distal thumb pain and swelling (Figure 1). She had been seen two days prior, diagnosed with paronychia and prescribed cephalexin ...

Giant cell arteritis, also known as temporal arteritis, is a condition that can present in patients with a headache, scalp tenderness, anemia, jaw claudication, diplopia or sudden severe vision loss. The main differential diagnosis is non-arteritic anterior ischemic optic neuropathy. Upo...

Aortic aneurysms (AA) are permanent, localized abnormal dilation of the wall of the aorta, the largest artery in the body, occurring as a result of medial degeneration of the arterial wall, generally, as a result of increased aortic hypertension or genetic predisposition. Risk factors fo...

When the world changes around you and when it changes against you – what used to be a tail wind is now a head wind – you have to lean into that and figure out what to do because complaining isn’t a strategy. I’ve been practicing osteopathic medicine for 39 years, and have held appointed and ...

We recently placed a call for patient education handout submission, and the response was strong both in number and quality. Osteopathic physicians know what it means to write information at the literacy level of the patient, and we are all getting practice with this in our respective electronic h...

Thrombotic Thrombocytopenic Purpura (TTP) is a rare blood disorder that results in tiny blood clots affecting small blood vessels. This leads to low levels of platelets (blood clotting cells) in the blood and numerous small red-purple skin discolorations. TTP can affect any organ system ...

Erythema nodosum is a type of inflammation of the fat tissue beneath the skin. It is a skin reaction that can be present from many different causes, as noted below. Your physician can diagnose this condition with a complete history and physical examination, although a skin biopsy may be ...

E-cigarettes are devices that produce a nicotine-containing vapor that is inhaled. The vapor is designed to look like regular cigarette smoke, but does not produce an odor. For this reason it is sometimes called vaping. Many devices resemble cigarettes, pipes and cigars. They have been l...

An 81-year-old female with a past medical history of osteoporosis, hypertension, hypercholesterolemia, and gastroesophageal reflux disease presented to her family practice office in hospital follow-up of a right leg injury she sustained six weeks prior. She had a mechanical fall at home ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 27-year-old African American male presented to the office with a two-month history of intermittent chills without...

Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome is an acute illness with abnormalities in multiple organ systems. Patients typically present with thrombotic microangiopathy, thrombocytopenia, and microangiopathic hemolytic anemia without another apparent cause. Additional f...

Electronic cigarettes are becoming increasingly popular in the United States, but misperceptions among consumers are common. There is a sense that they are safer than traditional cigarettes, however, there is limited research on long-term effects regarding the safety of these devices. Th...

Aim: Develop a greater understanding of healthcare providers’ beliefs on patients’ medication adherence with an emphasis on the factors clinicians perceive being the most contributory toward non-adherence in type 1 (T1DM) and type 2 diabetes patients (T2DM). Methods: A 40-item survey was...

I cannot believe that it has been a year since I joined with you at the 2017 ACOFP Annual Convention to start my term as ACOFP President. It has been a most meaningful year for me due to the people I met and the conversations we had. Many talked about what a quandary medicine is in today, follo...

Winter is always the best time for reading. A fire, a cup of cocoa, and the Osteopathic Family Physician . In this edition we have a review article on electronic cigarettes. When asking about smoking, is the question phrased in a way that the patient might be talking about electronic cigarette...

There are around 100,000 species of spiders worldwide. Spiders can be found in garages, basements, attics, cabinets, sheds, gardens, woodpiles, in garbage, under tree bark, and inside of homes. Spiders have four pairs of legs and fangs at the ends of their mouths to bite prey and inject ...

Pain is one of the leading reasons for primary care visits in the U.S. Opioids are a type of pain medication used for acute and chronic pain; side effects can include nausea, vomiting, constipation, physical dependence, addiction, and respiratory depression. Due to these side effects and...

Eczema or atopic dermatitis is a skin condition that causes the skin to become dry, flaky, and itchy. It occurs in individuals of every gender, race, and age. The cause is unknown but it has been found to be more severe in individuals with environmental or food allergies. Symptoms includ...

CASE #1A generally healthy 39-year-old male presented to his local emergency department with a progressively enlarging area of erythema on his left upper extremity for three days. The patient worked at a water treatment plant and was reaching to grab something while working in a water tower when he ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. ANSWERS What is the most likely diagnosis? Correct answer: B) Eczema herpeticum Eczema herpeticum is charac...

In light of the current opioid epidemic, this article reviews natural chronic pain management agents along with evidence-based documentation of their effectiveness, recommended dosing and administration, mechanism of action and potential side effects. ...

Objective: This study was designed with the intent to serve as an exploratory pilot and first step toward integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) clinical education into the curriculum of Osteopathic and southeastern medical schools. Methods: Using a quasi-experimental...

Objectives: To evaluate the effects of teaching Osteopathic Manipulative Treatment (OMT) and Principles and Practice (OPP) at a combined didactic conference having both allopathic (MD) and osteopathic (DO) family medicine residents. Methods: A self-administered pre/post-conference survey...

I pledge to you, as your new President, and along with the other Board members, to keep “ACOFP weird,” – a reference to our recent Convention host city’s slogan, “Keep Austin Weird.” That is to say, keep ACOFP diverse – in practice type, ethnicity, geography, and gender. It is in the com...

Welcome, or welcome back to the Osteopathic Family Physician ! As the new Editor-in-Chief, it is my pleasure to introduce the May/June issue for 2018. As an osteopathic physician, I am always interested in discovering new things and connecting to issues and items related to, but perhaps not di...

Introduction: Addressing the current trends of underreporting concussion-related symptoms by adolescent athletes is a critical aspect of improving adolescent athlete health and longevity. The literature is replete with papers on educational interventions regarding concussion symptomatolo...

A 43-year-old man presents to the Fast Track of the Emergency Department with chief complaint of injury and pain to the middle finger of his left hand. ...

Symptoms of an allergic reaction can involve many parts of the body. The lungs, stomach and skin are just a few. ...

Concussion is the most common and sometimes serious type of brain injury. It is most often caused by a sudden direct blow or bump to the head. ...

The well-being of physicians has been a trending topic among professionals in the field, medical organizations, and the media in recent years. The increased attention placed on burnout is with good reason, as research indicates that burnout among physicians is increasing at an alarming r...

Food allergies are currently a trendy topic due to their increasing prevalence in the population. An everincreasing sector of the US population suffers from some degree of a food allergy, with the current prevalence somewhere between 4 and 10%. The most common food allergies are cow’s mi...

As I write this Editor’s message, World Cup football (American translation = soccer) is in full swing. Lucky for our readers, the Osteopathic Family Physician comes out every couple of months, instead of every four years! ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Polyarthritis is joint pain that affects five or more joints. Joints that are inflamed are often red, warm, and swo...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Zika virus disease (Zika) has been in the media and a hot topic for travelers. Children may have many questions about...

A 55-year-old Caucasian female presented to the emergency department with fever and flu-like symptoms for the past three days. ...

Meralgia Paresthetica is the diagnostic term used to describe a neuropathy of the lateral femoral cutaneous nerve and typically presents with numbness, tingling, paresthesias or any other sign of nerve impingement along the anterior and lateral thigh. This condition is quite debilitating...

Mosquito-borne viruses have been on the rise in recent years. This becomes especially critical when you consider a virus with a particularly harrowing consequence, like the Zika virus (ZIKV) and infant microcephaly. From its obscure history in Africa, ZIKV diverged into an African and As...

Context: Concussion has emerged as one of the most challenging conditions in medicine. With the currently changing and evolving diagnosis and treatment paradigms in concussion management, a comprehensive review of the current literature was necessary. This article focuses on the in-offic...

Complaints of joint pain are commonly seen in clinical practice. Primary care physicians are frequently the first practitioners to work up these complaints. Polyarthritis can be seen in a multitude of diseases. It can be a challenging diagnostic process. In this article, we review the ap...

As family physicians, we care for extended families: mothers, fathers, brothers, sisters, etc. That is how many family physicians view their patients. The family link defines who they are to each other, and to the family physician who treats them. ...

Welcome to autumn! As the cooler season comes upon us, this issue of OFP has some timely articles of interest. With the changing of seasons comes a return to the gridiron, and for those physicians participating, as sideline physicians for football, the article on concussions will be of v...

Objective: To determine which factors contribute to parental decision making in order to increase childhood vaccination rates against HPV. Methods: An IRB-approved survey was placed in the four Rowan University School of Osteopathic Medicine Family Medicine offices asking parents of chil...

Objective: There are three main options for women seeking prenatal care: Obstetricians (OB), Midwives (MW), and Family Medicine physicians (FM). This study aims at determining how women choose prenatal care providers, at what point in pregnancy women choose their provider, what factors g...

After more than two years of debate and careful consideration, the March 2019 ACOFP Congress of Delegates will consider Constitution & Bylaws Amendments to allow medical doctors (MDs) to become Active Members of the ACOFP. ...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. WHEN TO SEEK MEDICAL ATTENTION: Remember that good nutrition is needed for proper growth. If your child is not g...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. Irregular menstrual bleeding (irregular periods) can come in many forms. It is defined as any type of bleeding that i...

Strong evidence-based guidelines exist for the evaluation and treatment of the acute medical consequences of urolithiasis, however, less emphasis has been placed on the assessment of acute and chronic musculoskeletal effects. In our case report, a 35-year-old male who develops a chronic ...

Abnormal uterine bleeding (AUB) is a concern across the female reproductive lifespan. The initial evaluation focuses on identifying the underlying cause, either related or unrelated to structural abnormalities. Treatment options are then matched to the individual needs of the patient, wh...

Newborn disorders vary widely, from premature birth to a myriad of genetic disorders. Although they are commonly encountered in hospital and primary care settings, existing therapies are neither definitive nor distinct, and research is still ongoing. Such disorders of concern include pre...

These are exciting times to be in osteopathic family medicine! The opening of numerous osteopathic medical schools, consolidation in graduate medical education under ACGME, changes in Medicare fee schedules, and the decoupling of AOA membership related to board certification are just a few events...

ANSWER: What is the most likely diagnosis? Correct Answer: D) Confluent and reticulated papillomatosis DISCUSSION CARP is an uncommon dermatologic condition characterized by the presence of small, hyperpigmented, hyperkeratotic or verrucous papules that coalesce to form plaques with a periphe...

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, hepatocellular carcinoma and cirrhosis with at least 185 million people infected worldwide, causing 399,000 deaths annually. HCV is transmitted through blood or body fluids. Transmission most commonly occurs thr...

Chronic abdominal pain (CAP) has become a common diagnosis in the primary care setting. It is characterized by intermittent abdominal pain lasting for at least six months. The list of causes in the differential diagnosis is extensive. The costs associated with diagnostic workup is an exp...

Skin and soft tissue Infections (SSTIs) encompass a broad range of pathologies and represent a significant reason for outpatient visits. It is important to distinguish between complicated and uncomplicated SSTIs, which differ in terms of its presentation, severity, and treatment options....

The key to successful wound care lies in the provider’s ability to accurately identify etiology of the wounds and recognize factors that may contribute to their chronicity. Some of the most commonly encountered and clinically significant barriers include macro- or micro-angiopathic disea...

Myasthenia gravis is an autoimmune disorder affecting 36,000 – 60,000 Americans. This article reviews the incidence, presentation, immune system markers and various treatment options for this illness. Family physicians must be aware of this disorder as they may be the first health profes...

Along with the ACOFP Board of Governors and Past Presidents, I would like to recognize the important work and years of dedication of our recently-retired Executive Director, Peter Schmelzer, MBA, CAE. Pete’s accomplishments include winning the American Osteopathic Association’s Bob E. Jo...

Background: With the Accreditation Council for Graduate Medical Education implementation of a Single Accreditation System through which allopathic programs can obtain osteopathic recognition, it is vital to continue to support the development of resident osteopathic skills, which could b...

Many patients present to the primary care physician with complaints relating to the eye. While many are benign, others can be vision threatening. Performing a thorough history and physical can quickly assess the severity. More common, often benign conditions include conjunctivitis, keratoconjunctivi...

ABSTRACT: Intestinal gas production is a normal physiologic progress. However, there are many pathophysiologic processes that can cause patients to experience bloating, abdominal pain, and distension from abnormal gas production or mobility. It is important for primary care physicians to...

Abstract: Treatment for hypogonadism is increasing, particularly in the senior population, but low testosterone levels are also on the rise in young men. Hypogonadism treatment represents a unique challenge to clinicians due to label warnings and the negative stigma of being diagnosed an...

Ronald Januchowski, DO, FACOFP, Editor, Osteopathic Family Physician ...

The 2019 ACOFP Annual Convention was the culmination of a great year for osteopathic family medicine. Through the leadership of Dr. Duane Koehler this past year, our profession has a very bright and exciting future. The ACOFP Board and I, as the 2019-2020 President, will continue with pr...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 76-year-old male presents with complaints of frequent eyelid and eye infections. He notes constant dry, yet watering eyes and mattering of...

Some Family Medicine residency training programs are going through changes since the Single Graduate Medical Education (GME) Accreditation System was implemented. In this time of exponential growth this is the time for incorporating curriculum on patients with developmental disabilities ...

The scaphoid is the most commonly fractured bone within the carpals, accounting for up to 70% of all carpal fractures and frequently occurs following a fall onto an outstretched hand. Despite the high frequency of injury and a common mechanism of injury, it is common for a scaphoid fract...

Greater trochanteric pain syndrome is a common office complaint in primary care. It encompasses a constellation of clinical conditions, including greater trochanteric bursitis, teninopathies affecting the gluteus medius and gluteus minimus, inflammation of the iliotibial band and abducto...

Background: The incidence and prevalence of Peripheral Arterial Disease (PAD) is rising, yet physician awareness is insufficient. This review aims to increase awareness and detection of asymptomatic PAD in primary care, dermatologic, or podiatric practices through observable symptoms and subtl...

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading. A 91-year-old afebrile female with a history of bilateral below- the-knee amputations and congestive heart failure presents to the emergency department by ambulance with...

As the rate of obesity-related diseases rise, physicians are spending more time in their practices working to motivate patients to lose weight. Historically, to change the lifestyle behaviors of patients, physicians have detailed the consequences of excess weight gain and offered predict...