Expansion of osteopathic medicine practitioner education on substance use disorders.

CONTEXT: Medical school graduates are generally not well prepared to treat patients with substance use disorders (SUDs), even though opioid overdose deaths in the United States have increased in recent years. When it comes to training in SUDs, osteopathic medicine lags far behind allopathic medicine. It was only in 2019 that the American Osteopathic Association approved Board Certification in Addiction Medicine to help combat the opioid epidemic. Few articles have been published in the literature pertaining to substance use education for osteopathic students and trainees. OBJECTIVES: The goal of this study was to expand the education of osteopathic medical students and primary care residents in SUDs and measure the effect that education had on the attitudes and knowledge of student and residents about SUDs. METHODS: This study collected anonymous data in the form of a voluntary online survey from third- and fourth-year students at an osteopathic medical school and family medicine residents. The survey was completed by 115 students and 29 family medicine residents. Participants completed a pretest survey and then participated in the Physician Undergraduate and Resident Substance Use Education (PURSUE) curriculum developed by the researchers. This consisted of three online modules covering Screening, Brief Intervention, and Referral to Treatment (SBIRT), substance use assessments, and treatment of SUDs. Upon conclusion of the training modules, medical student participants then completed a posttest survey to assess for any changes in knowledge and attitude. Participants also answered questions related to clinical case scenarios involving patients at varying risk levels who were assessed utilizing SBIRT. RESULTS: Students and residents who participated in the training demonstrated an increase in their average scores between the pretest and posttest, indicating effectiveness in learning from the modules. The overall increase in average scores on the pretest and posttest was 6.5 %, which was determined to be statistically significant (p<0.01). Interestingly, participants who reported growing up in underprivileged circumstances performed worse than those participants who reported not growing up in underprivileged circumstances. CONCLUSIONS: The results of our project support the need and benefit of incorporating educational modules on this topic area within medical school curriculums and residency training. Expanding the number of healthcare workers proficient in providing this type of care in these types of settings will improve the quality of and access to medical care in some of our highest-need populations.

Mott Quantum Critical Points at Finite Doping.

We demonstrate that a finite-doping quantum critical point (QCP) naturally descends from the existence of a first-order Mott transition in the phase diagram of a strongly correlated material. In a prototypical case of a first-order Mott transition the surface associated with the equation of state for the homogeneous system is "folded" so that in a range of parameters stable metallic and insulating phases exist and are connected by an unstable metallic branch. Here we show that tuning the chemical potential, the zero-temperature equation of state gradually unfolds. Under general conditions, we find that the Mott transition evolves into a first-order transition between two metals, associated with a phase separation region ending in the finite-doping QCP. This scenario is here demonstrated solving a minimal multiorbital Hubbard model relevant for the iron-based superconductors, but its origin-the splitting of the atomic ground state multiplet by a small energy scale, here Hund's coupling-is much more general. A strong analogy with cuprate superconductors is traced.

Lifestyle Changes for Disease Prevention.

In primary care, physicians have the opportunity to address preventative causes of morbidity and mortality. Primary care physicians have a distinct opportunity to provide counseling regarding lifestyle changes and disease prevention in a variety of settings, both during the treatment of acute illnesses and with wellness examinations. Questions from patients regarding specific recommendations and interventions are common. In this article, we address barriers to and tools to encourage lifestyle changes in the areas of smoking cessation, weight loss, physical activity, mental health, and substance abuse/misuse.

Factors and Preferences in Patient Selection and Location of Care.

There are many factors that influence the decisions that patients make regarding where they receive care. Two hundred thirty-three patients were surveyed in the primary care setting to determine patient satisfaction and characteristics that led patients to seeking treatment at primary care offices, urgent care centers, or emergency rooms. Respondents rated quality of care highest at the primary care office (P < .001). Patients also demonstrated preference for in-person care compared with video conferencing or telephone visits (P < .001).

A prospective study of ¹8FDG-PET with CT coregistration for radiation treatment planning of lymphomas and other hematologic malignancies.

PURPOSE: This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[(18)F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma. METHODS AND MATERIALS: 118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients were used for analysis. RESULTS: 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined by NMPs. CONCLUSIONS: Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.

[¹8F]FDG-positron emission tomography coregistration with computed tomography scans for radiation treatment planning of lymphoma and hematologic malignancies.

PURPOSE: Positron emission-tomography (PET) using 2-[(18)F]fluoro-2-deoxyglucose (FDG-PET) increases sensitivity and specificity of disease detection in lymphoma and thus is standard in lymphoma management. This study examines the effects of coregistering FDG-PET and computed tomography (CT) (PET/CT) scans on treatment planning for lymphoma patients. METHODS AND MATERIALS: Twenty-nine patients (30 positive PET scans) underwent PET/CT treatment planning from July 2004 to February 2007 and were retrospectively studied. For each patient, gross tumor volume was blindly contoured on the CT-only and PET/CT studies by a radiation oncologist. Treatment plans were generated for both the CT-only and PET/CT planning target volumes (PTVs) for all patients. Normal tissue doses and PTV coverage were evaluated using dose--volume histograms for all sites. RESULTS: Thirty-two treatment sites were evaluated. Twenty-one patients had non-Hodgkin lymphoma, 5 patients had Hodgkin lymphoma, and 3 patients had plasma cell neoplasms. Previously undetected FDG-avid sites were identified in 3 patients during PET/CT simulation, resulting in one additional treatment field. Due to unexpected PET/CT simulation findings, 2 patients did not proceed with radiation treatment. The addition of PET changed the volume of 23 sites (72%). The PTV was increased in 15 sites (47%) by a median of 11% (range, 6-40%) and reduced in 8 sites (25%) by a median of 20% (range, 6%-75%). In six (19%) replanned sites, the CT-based treatment plan would not have adequately covered the PTV defined by PET/CT. CONCLUSIONS: Incorporation of FDG-PET into CT-based treatment planning for lymphoma patients resulted in considerable changes in management, volume definition, and normal tissue dosimetry for a significant number of patients.

Verification techniques and dose distribution for computed tomographic planned supine craniospinal radiation therapy.

A modified 3-field technique was designed with opposed cranial fields and a single spinal field encompassing the entire spinal axis. Two methods of plan verifications were performed before the first treatment. First, a system of orthogonal rulers plus the thermoplastic head holder was used to visualize the light fields at the craniospinal junction. Second, film phantom measurements were taken to visualize the gap between the fields at the level of the spinal cord. Treatment verification entailed use of a posterior-anterior (PA) portal film and placement of radiopaque wire on the inferior border of the cranial field. More rigorous verification required a custom-fabricated orthogonal film holder. The isocenter positions of both fields when they matched were recorded using a record-and-verify system. A single extended distance spinal field collimated at 42 degrees encompassed the entire spinal neuraxis. Data were collected from 40 fractions of craniospinal irradiation (CSI). The systematic error observed for the actual daily treatments was -0.5 mm (underlap), while the stochastic error was represented by a standard deviation of 5.39 mm. Measured data across the gapped craniospinal junction with junction shifts included revealed a dose ranging from 89.3% to 108%. CSI can be performed without direct visualization of the craniospinal junction by using the verification methods described. While the use of rigorous film verification for supine technique may have reduced the systematic error, the inability to visualize the supine craniospinal junction on skin appears to have increased the stochastic error compared to published data on such errors associated with prone craniospinal irradiation.