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4. The Treatment of Coccydynia and Headache with Transrectal OMT: A Case Report

Author

Nourani, Bobby, Gilbert, Ross, and Rabago, David

Abstract

Abstract Coccydynia is debilitating pain of the coccyx that substantially impacts quality of life. Although most cases resolve with conservative therapy, pain can become chronic and involve other anatomical areas. Treatment options include physical therapy, manual medicine, injection, and surgery with mixed results. Manual medicine options vary depending on provider and physical exam findings. Little is known about transrectal therapy. We present a case of a 21-year-old female with coccydynia and subsequent headaches that failed conventional work-up and conservative therapy but resolved with osteopathic manipulative treatment (OMT).

Published
2020

11. Contributors

Author

Bodor, Marko, primary, Buford, Don, additional, Desai, Rahul Naren, additional, Malanga, Gerard, additional, Markle, Jason, additional, Mautner, Ken, additional, Andersen, Wyatt, additional, Atluri, Sairam, additional, Bean, Allison C., additional, Berkoff, David J., additional, Bishop, Virlyn, additional, Black, Carolyn, additional, Blaichman, Jason Ian, additional, Blatz, Brice W., additional, Boddu, Navneet, additional, Bodor, Marko, additional, Bohart, Zach, additional, Borg-Stein, Joanne, additional, Bowen, Jay E., additional, Bowers, Robert, additional, Centeno, Christopher J., additional, Chan, Otto, additional, Colberg, Ricardo E., additional, Conley, Kevin, additional, Cui, Di, additional, Davis, Brian, additional, De Luigi, Arthur Jason, additional, Derrington, Stephen, additional, D’Hemecourt, Pierre, additional, Elbaridi, Nidal, additional, Epstein, Max H., additional, Erickson, Michael, additional, Everts, Peter A., additional, Finnoff, Jonathan T., additional, Foster, Lisa, additional, Hackel, Josh, additional, Hall, Mederic M., additional, Hayano, Todd, additional, Haym, Romain, additional, Henning, Phillip, additional, Hirahara, Alan M., additional, Hoffman, Douglas, additional, Hyde, Nicola, additional, Iwan, Katarzyna, additional, Jamali, Amir A., additional, Jayaram, Prathap, additional, Jerome, Mairin A., additional, Jones, Jacob, additional, Jurado, Javier A., additional, Keogh, Brian Hart, additional, Kneer, Lee, additional, Kruse, Ryan C., additional, Lal, Sonali, additional, Lam, Stanley K.H., additional, Landrum, Orlando, additional, Lee, Kenneth S., additional, Lockrem, Justin R., additional, Lueders, Daniel, additional, Maffulli, Nicola, additional, Manocha, Vivek, additional, Mills, Catherine, additional, Monfared, Hassan, additional, Negron, Giorgio A., additional, Olufade, Oluseun, additional, Onishi, Kentaro, additional, Panero, Alberto J., additional, Patel, Jaymin, additional, Patel, Shiv J., additional, Patel, Shounuck I., additional, Perone, Abby, additional, Pitts, John, additional, Podesta, Luga, additional, Pourcho, Adam M., additional, Rabago, David, additional, Reeves, Kenneth D., additional, Reisner, Jacob, additional, Saffel, Heather Lynn, additional, Sajkowicz, Natalie, additional, Sampson, Steven, additional, Sandhu, Diya, additional, Schroeder, Allison N., additional, Sellon, Jacob, additional, Sherrier, Matthew, additional, Shiple, Brian J., additional, Smith, Alyssa A., additional, Smith, Jay, additional, Speciale, Alyssa Neph, additional, Stafford, Cleo D., additional, Strakowski, Jeffrey A., additional, Street, Adam, additional, Sussman, Walter I., additional, Takyi, Selorm L., additional, Tefera, Yodit, additional, Vincent, Hunter, additional, Williams, Chris J., additional, Wolfson, John J., additional, Wood, Colton L., additional, Yeh, Peter Chia, additional, and Zielinski, Maria-Cristina, additional

Published
2022
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12. Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Central Pennsylvania Adults Early in the Pandemic: A Mixed Methods Cross-Sectional Survey

Author

Van Scoy, Lauren Jodi, Miller, Erin L., Snyder, Bethany, Wasserman, Emily, Chinchilli, Vernon M., Zgierska, Aleksandra E., Rabago, David, Lennon, Courtney L., Lipnick, Daniella, Toyobo, Olubukola, Ruffin, Mack T., IV, and Lennon, Robert P.

Subjects
Epidemics -- Surveys -- Psychological aspects -- Pennsylvania, Health attitudes -- Surveys, Medical advice systems -- Surveys -- Psychological aspects, Health, Science and technology
Abstract

PURPOSE To explore public knowledge, understanding of public health recommendations, perceptions, and trust in information sources related to COVID-19. METHODS A cross-sectional survey of central Pennsylvanian adults evaluated self-reported knowledge, and a convergent, mixed methods design was used to assess beliefs about recommendations, intended behaviors, perceptions, and concerns related to infectious disease risk, and trust of information sources. RESULTS The survey was completed by 5,948 adults. The estimated probability of correct response for the basic knowledge score, weighted with confidence, was 0.79 (95% CI, 0.79-0.80). Knowledge was significantly higher in patients with higher education and nonminority race. While the majority of respondents reported that they believed following CDC recommendations would decrease the spread of COVID-19 in their community and intended to adhere to them, only 65.2% rated social isolation with the highest level of belief and adherence. The most trusted information source was federal public health websites (42.8%). Qualitative responses aligned with quantitative data and described concerns about illness, epidemiologic issues, economic and societal disruptions, and distrust of the executive branch's messaging. The survey was limited by a lack of minority representation, potential selection bias, and evolving COVID-19 information that may impact generalizability and interpretability. CONCLUSIONS Knowledge about COVID-19 and intended adherence to behavioral recommendations were high. There was substantial distrust of the executive branch of the federal government, however, and concern about mixed messaging and information overload. These findings highlight the importance of consistent messaging from trusted sources that reaches diverse groups. Key words: novel coronavirus; COVID-19; messaging; communication; knowledge; perceptions; pandemic Annals 'Online First' article., INTRODUCTION Effective communication is critical for successful pandemic management. (1-6) Ineffective messaging may result in failure of the public to comply with precautionary measures, propagation of fears and misconceptions, preventable [...]

Published
2021
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14. Prevalence of moral injury, burnout, depression, and anxiety among healthcare workers during COVID-19

Author

Lennon, Robert, Mantri, Sneha, Talbot, Simon, Rabago, David, Zhou, Shouhao, Wasserman, Emily, and Lagerman, Makayla

Subjects
Anxiety -- Surveys -- Statistics -- Risk factors, Burn out (Psychology) -- Surveys -- Statistics -- Risk factors, Ethical problems -- Surveys -- Health aspects -- Psychological aspects, Medical personnel -- Health aspects -- Psychological aspects -- Surveys, Health, Science and technology
Abstract

Context: A Moral Injury (MI) inventory (MISS-HP) has been validated for physicians and been used to demonstrate a stable burnout prevalence with increasing moral injury during the COVID-19 pandemic. However, that instrument relies on the Duke Religiosity Index, which may undercount healthcare workers, who have lower religiosity than their peers. Objective: We sought to identify burnout and moral injury across healthcare workers of all types in a large healthcare system using a more inclusive MI survey. Methods: Study Design: Cross-sectional online survey. Setting: Healthcare workers affiliated with a large academic medical center in a mid-Atlantic state. Population: All employees. Instrument: The survey screened for depression (PHQ-9), anxiety (GAD-7), burnout (CBI), and moral injury using the MISS-HP, and a novel, more inclusive inventory, the Inclusive Moral Injury Inventory (IMII). Outcomes: Prevalence of conditions based on their respective screening tools. Results: Response rate was 11.4% (n=1,945 completed surveys). Respondents primarily self-identified as white (92.3%), non-Hispanic (97.8%), and female (76.9%). They worked in rural (22.8%), suburban (71.5%), and urban (5.7%) settings, in academic (56.0%) and non-academic (44.1%) roles. Respondents included physicians (21.5%), licensed independent practitioners (8.0%), nurses (25.4%), administrators (11.1%), and support staff with (14.1%) and without (11.0%) direct patient contact. Overall, 25.4% screened positive for major depressive disorder (PHQ-9 [greater than or equal to] 10); 24.8% screened positive for generalized anxiety disorder (GAD-7 [greater than or equal to] 10); and 8.1% had been bothered by thoughts they would be better off dead or of hurting themselves 'several days' or more frequently. CBI scores (mean [+ or -] SD) were 53.2 [+ or -] 22.7 for personal burnout, 51.4 [+ or -] 24.6 for work-related burnout, and 36.1 [+ or -] 26.0 for patient-related burnout. (CBI score 50-74 is moderate burnout; 75-99 is high burnout). Significant impairment from moral injury was reported by 40.6% (MISS-HP [greater than or equal to] 36). Conclusions: Our results paint a grim picture of healthcare workers' well-being, with the average worker in this sample experiencing moderate burnout in personal and work life, about 25% having anxiety and/or depression, and many experiencing moral injury to a level of moderate or greater functional impairment. Most disturbing, nearly 1 in 12 respondents regularly had thoughts that they would be better off dead or of hurting themselves., Presenters Robert Lennon, MD, FAAFP, JD, JD, Sneha Mantri, Simon Talbot, MD, David Rabago, MD, Shouhao Zhou, PhD, Emily Wasserman, Makayla Lagerman, [...]

Published
2023

15. Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic

Author

Lennon, Robert P., primary, Parascando, Jessica, additional, Talbot, Simon G., additional, Zhou, Shouhao, additional, Wasserman, Emily, additional, Mantri, Sneha, additional, Day, Philip G., additional, Liu, Ryan, additional, Lagerman, Makayla, additional, Appiah, Annette, additional, Rabago, David, additional, and Dean, Wendy, additional

Published
2023
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17. Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial

Author

Wing Shan Sit, Regina, Wing Keung Wu, Ricky, Rabago, David, Reeves, Kenneth Dean, Cheong Chun Chan, Dicken, Hon Kei Yip, Benjamin, Chi Ho Chung, Vincent, and Yeung Shan Wong, Samuel

Subjects
Injections, Intra-articular -- Usage -- Methods, Dextrose -- Usage -- Methods, Knee pain -- Care and treatment, Glucose -- Usage -- Methods, Osteoarthritis -- Care and treatment, Health, Science and technology
Abstract

PURPOSE To test the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA). METHODS A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with KOA (n = 76) were randomly allocated (1:1) to DPT or NS groups for injections at weeks 0, 4, 8, and 16. The primary outcome was the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 0-100 points) pain score. The secondary outcomes were the WOMAC composite, function and stiffness scores; objectively assessed physical function test results; visual analogue scale (VAS) for knee pain; and EuroQol-5D score. All outcomes were evaluated at baseline and at 16, 26, and 52 weeks using linear mixed model. RESULTS Randomization produced similar groups. The WOMAC pain score at 52 weeks showed a difference-in-difference estimate of -10.34 (95% CI, -19.20 to -1.49, P = 0.022) points. A similar favorable effect was shown on the difference-in-difference estimate on WOMAC function score of -9.55 (95% CI, -17.72 to -1.39, P = 0.022), WOMAC composite score of -9.65 (95% CI, -17.77 to -1.53, P = 0.020), VAS pain intensity score of -10.98 (95% CI, -21.36 to -0.61, P = 0.038), and EuroQol-5D VAS score of 8.64 (95% CI, 1.36 to 5.92, P = 0.020). No adverse events were reported. CONCLUSION Intra-articular dextrose prolotherapy injections reduced pain, improved function and quality of life in patients with KOA compared with blinded saline injections. The procedure is straightforward and safe; the adherence and satisfaction were high., INTRODUCTION Knee osteoarthritis (KOA) is ubiquitous in primary care, leading to pain, disability, and substantial patient and societal costs. (1,2) Conservative care is limited. While exercise and weight reduction are [...]

Published
2020
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31. Student Perceptions of a New Course Using Argumentation in Medical Education

Author

Foy,Andrew, Vrana,Kent, Haidet,Paul, Hausman,Bernice, Adams,Nancy, Ropson,Ira, Wolpaw,Daniel, Rabago,David, Mailman,Richard, Huang,Xuemei, Foy,Andrew, Vrana,Kent, Haidet,Paul, Hausman,Bernice, Adams,Nancy, Ropson,Ira, Wolpaw,Daniel, Rabago,David, Mailman,Richard, and Huang,Xuemei

Abstract

Andrew J Foy,1,2,* Kent E Vrana,3 Paul Haidet,1,2 Bernice L Hausman,2,4 Nancy E Adams,5 Ira Ropson,6 Daniel R Wolpaw,1 David Rabago,2,7 Richard B Mailman,3,8 Xuemei Huang3,8– 10,* 1Penn State Department of Medicine, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 2Penn State Department of Public Health Science, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 3Penn State Department of Pharmacology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 4Penn State Department of Humanities, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 5Harrel Library Foundational Sciences, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 6Penn State Department of Biochemistry and Molecular Biology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 7Penn State Department of Family and Community Medicine, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 8Penn State Department of Neurosurgery, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 9Penn State Department of Neurology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 10Penn State Department of Kinesiology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA*These authors contributed equally to this workCorrespondence: Andrew J Foy, Penn State Milton S Hershey Medical Center and College of Medicine, Penn State Heart and Vascular Institute, Division of Cardiology, Hershey, PA, USA, Email afoy@pennstatehealth.psu.eduPurpose: Critical thinking and the ability to engage with others of differing views in a civil manner is essential to the practice of medicine. A new format for medical student education (“Argue-to-Learn”) that uses staged debates f

Published
2023

34. Infrapatellar bursal injection with dextrose and saline are both effective treatments for Osgood–Schlatter disease. Letter to editor for: No superiority of dextrose injections over placebo injections for Osgood–Schlatter disease: a prospective randomized double‑blind study https://doi.org/10.1007/s00402-019-03297-2

Author

Rabago, David, Reeves, Kenneth Dean, Topol, Gastón Andrés, Podesta, Leandro Ariel, Cheng, An-Lin, and Fullerton, Bradley D.

Published
2020
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35. Epicondylosis

Author

Rabago, David, primary, James, Sarah, additional, and Zgierska, Aleksandra, additional

Published
2018
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37. Contributors

Author

Abel, Robert, primary, Ali, Ather, additional, Balk, Judith, additional, Barrett, Bruce, additional, Becker, David K., additional, Bergquist, Paul E., additional, Bodemer, Apple A., additional, Bonakdar, Robert Alan, additional, Bora, Samudragupta, additional, Bora, Suhani, additional, Brown, Amy C., additional, Coeytaux, Remy R., additional, Dahmer, Stephen, additional, Dandurand, Douglas E., additional, Dattner, Alan M., additional, Degenhardt, Brian, additional, Desai, Gautam J., additional, Devries, Stephen, additional, Dowling, Dennis J., additional, Drisko, Jeanne A., additional, Dusek, Jeffery, additional, Earl, Connie J., additional, Edwards, Robert Z., additional, Eichenseher, Joseph, additional, Figurski, Ann C., additional, Filippelli, Amanda C., additional, Fortney, Luke, additional, Gaby, Alan R., additional, Gagné, Louise, additional, Gardiner, Paula, additional, Gaudet, Tracy, additional, Geller, Jeffrey, additional, Gergen-Barnett, Katherine, additional, Gordon, Andrea, additional, Greenfield, Russell H., additional, Grobel, Hana, additional, Guilliams, Thomas G., additional, Gurgevich, Steven, additional, Hameed, Fasih A., additional, Hampton, Adrienne, additional, Hanaway, Patrick J., additional, Harbaugh, Joshua, additional, Harrington, John W., additional, Harvie, James, additional, Hayer, Supriya, additional, Hernke, Michael, additional, Hewitt, Michael J., additional, Horwitz, Randy J., additional, Houston, Mark, additional, Humphreys, Corene, additional, Ilkevitch, Alexandra, additional, Ivker, Robert S., additional, Jacobs, Bradly, additional, James, Sarah, additional, Jeong, Hwee Soo, additional, Jernberg, Julia, additional, Jonas, Wayne, additional, Karpowicz, Scott, additional, Kaufman, Amanda J., additional, Kearney, David J., additional, Kemper, Kathi J., additional, Kiefer, David, additional, Klein-Patel, Marcia, additional, Kligler, Benjamin, additional, Kogan, Mikhail, additional, Kohatsu, Wendy, additional, Kuphal, Greta J., additional, Langhorst, Jost, additional, Lawler, Taryn, additional, Lee, Richard T., additional, Lee, Roberta, additional, Lemmon, Russell, additional, Lessens, David M., additional, Levy, Sanford H., additional, Linkner, Edward (Lev), additional, Litbarg, Natalia O., additional, Lo, Yue Man Onna, additional, Locke, Amy B., additional, Love, Abigail, additional, Low Dog, Tieraona, additional, Lupiani, Junelle H., additional, Maizes, Victoria, additional, Mallory, D. Jill, additional, Mann, John Douglas, additional, Marchand, Lucille R., additional, Mark, John D., additional, Martinez, Michelle E., additional, McKinney, Richard, additional, Mertz, Michelle J., additional, Michelfelder, Aaron J., additional, Minichiello, Vincent J., additional, Moher, Matthew, additional, Muller, Daniel, additional, Mullin, Gerard E., additional, Murphy, Sarah A., additional, Myers, Harmon, additional, Naiman, Rubin, additional, Nanavati, Kaushal, additional, Nicolai, James P., additional, Nourani, Bobby, additional, Olshansky, Brian, additional, Pai, Sunil T., additional, Parian, Alyssa M., additional, Perlman, Adam I., additional, Pierce, Surya, additional, Plotnikoff, Gregory A., additional, Podein, Rian, additional, Rabago, David, additional, Rakel, David, additional, Redmer, Jacqueline, additional, Reed, Eric, additional, Rhode, Robert, additional, Rindfleisch, J. Adam, additional, Ring, Melinda, additional, Roseen, Eric J., additional, Rosenberger, Lisa, additional, Rossi, Maret, additional, Rossman, Martin L., additional, Saigal, Pooja, additional, Sakallaris, Bonnie R., additional, Sawni, Anju, additional, Schneider, Craig, additional, Schubiner, Howard, additional, Selfridge, Nancy J., additional, Sethi, Tanmeet, additional, Simmons, Adam D., additional, Simpson, Tracy L., additional, Smith, Coleen, additional, Spar, Myles, additional, Sridhar, Srivani, additional, St. John, Tina M., additional, Stewart, James A., additional, Stoler, Larry, additional, Sudak, Nancy L., additional, Takahashi, Jonathan, additional, Temple, Leslie Mendoza, additional, Utzinger, Malynn L., additional, Warne, Donald, additional, Warshowsky, Allan, additional, Weber, Michael J., additional, Weil, Andrew, additional, Weydert, Joy A., additional, Wilhite, Myrtle, additional, Wissink, Theodore, additional, Wolf, Andrew J., additional, Wolpert, Daniel, additional, Wu, Jimmy, additional, and Zgierska, Aleksandra, additional

Published
2018
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46. Examining the association between the gastrointestinal microbiota and Gulf War illness: A prospective cohort study

Author

Kates, Ashley, primary, Keating, Julie, additional, Baubie, Kelsey, additional, Putman-Buehler, Nathan, additional, Watson, Lauren, additional, Godfrey, Jared, additional, Deblois, Courtney L., additional, Suen, Garret, additional, Cook, Dane B., additional, Rabago, David, additional, Gangnon, Ronald, additional, and Safdar, Nasia, additional

Published
2022
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49. Integrating Oral Health into Health Professions School Curricula

Author

Gill, Stephanie A., Quinonez, Rocio B., Deutchman, Mark, Conklin, Charles E., Rizzolo, Denise, Rabago, David, Haidet, Paul, Silk, Hugh, Gill, Stephanie A., Quinonez, Rocio B., Deutchman, Mark, Conklin, Charles E., Rizzolo, Denise, Rabago, David, Haidet, Paul, and Silk, Hugh

Abstract

Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.

Published
2022

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