The Journal Of The American Osteopathic Association[JOURNAL]
Sun
200 papers
2020 AOA Research Abstracts and Poster Competition.
J Am Osteopath Assoc · 2020 Dec · PMID 33227128 · Publisher ↗
Abstract loading — click title to view on PubMed.
Communication Skills of Grandview/Southview Medical Center General Surgery Residents.
Johnson W, Ngo NA, Elrod M
J Am Osteopath Assoc · 2020 Dec · PMID 33227127 · Publisher ↗
CONTEXT: In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accredit...
CONTEXT: In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism. OBJECTIVES: To assess strengths and weaknesses of residents' interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT). METHODS: From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language. RESULTS: The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: "greeted me in a way that made me feel comfortable" (#1), "talked in terms I could understand" (#8), "encouraged me to ask questions" (#10), "involved me in decisions as much as I wanted" (#11), "showed care and concern" (#13), and "spent the right amount of time with me" (#14). CONCLUSIONS: Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.
[PREPRINT] "Somebody Who Does Something Other Than Osteopathy".
Sajjadi NB, Shepard S
J Am Osteopath Assoc · 2020 Nov · PMID 33185658 · Publisher ↗
Abstract loading — click title to view on PubMed.
Toward Resilience: Medical Students' Perception of Social Support.
Casapulla S, Rodriguez J, Nandyal S … +1 more , Chavan B
J Am Osteopath Assoc · 2020 Dec · PMID 33165568 · Publisher ↗
CONTEXT: There is strong evidence that social support-particularly perceived social support-functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social sup...
CONTEXT: There is strong evidence that social support-particularly perceived social support-functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social support they experience. OBJECTIVE: To determine how osteopathic medical students perceive social support, understand the factors that influence their perceptions, and explore how group participation in a cocurricular, academic program could affect student perceptions. METHODS: In this cross-sectional study of 983 medical students at a multicampus osteopathic medical school in the Midwest, potential respondents were invited by email in March 2018 to participate in a self-reported evaluation of their perceived social support using a 40-question Interpersonal Support Evaluation List (ISEL). The demographic variables included gender, race, age, current phase in medical school, Hispanic heritage, campus assignment, and hometown population type. A total score for each type of social support and a summative score for overall perceived social support were calculated. Descriptive statistics were applied to provide a summary of the distribution of study variables. Bivariate analyses were conducted using student t test and analysis of variance (ANOVA) statistic to determine distribution of 4 social support constructs and overall social support by all the study variables; α < .05 was considered statistically significant. Linear regression analysis was performed to determine the association between all study variables and 4 social support constructs. Pairwise interactions were calculated to determine whether the association differed by any of the study variables. RESULTS: Self-esteem support was the lowest type of perceived social support overall in the total sample (mean [SD], 23.5[2.0]). Hispanic students reported lower overall mean perceived social support than those who did not identify as Hispanic (100 vs 104; P=.04). Older study participants had higher mean tangible support compared with their younger counterparts (26.25 vs. 25.60, P=.018; t [264]=1.18). Older study participants also had higher mean appraisal support compared with their younger counterparts (26.57 vs. 25.92, P=.06; t [266]=1.27). Female medical students reported lower levels of belonging support overall (mean [SD] 26.79, [2.10]). Students from rural hometowns reported a higher sense of belonging support than any other group. Female students from suburban and urban hometowns reported lower levels of belonging support compared with women from rural hometowns (Adj. β=-0.96, P=.01). Students who participated in the rural and urban underserved program had higher self esteem support compared with those who did not participate in the rural and urban underserved program (Adj. β=-1.30, P=.05). Students in the clinical phase of medical education reported lower levels of belonging support than students in the preclinical phase (26.14 vs. 26.69, P=.05; t[256]=1.07). CONCLUSIONS: It is critical to understand the ways medical students experience social support and the factors that contribute to it. Longitudinal studies following medical students over time would contribute to a more complete understanding of social support in medical students as they move from preclinical to the clinical phases of medical school.
Comparison of State Medical Licensing Board Disclosures Regarding Resident Performance for United States Allopathic, Osteopathic, and Foreign Medical Graduates.
Gajewski M, Hillen M, Matassa D … +5 more , Kunac A, Anana M, Pompeo L, Kothari N, Murano T
J Am Osteopath Assoc · 2020 Dec · PMID 33136165 · Publisher ↗
CONTEXT: While recent streamlining of the graduate medical education process signals an important change from the traditional dichotomy between doctors of osteopathic medicine (DOs) and US-trained doctors of medicine (US...
CONTEXT: While recent streamlining of the graduate medical education process signals an important change from the traditional dichotomy between doctors of osteopathic medicine (DOs) and US-trained doctors of medicine (USMDs), this new uniformity does not continue into the process for licensure, including state medical licensing verification of training (VOT) forms for DOs, MDs, and foreign medical graduates (FMGs). Wide variability remains. OBJECTIVE: To document the differences in the performance metrics program that directors are required to disclose to state medical licensing boards for DOs and FMGs compared with USMDs. METHODS: VOT forms were collected from all osteopathic and allopathic licensing boards for all US states, Washington DC, and US territories. The authors then reviewed VOT forms for questions pertaining to trainee performance only in states where VOT forms differed for DOs, USMDs, and FMGs. Licensing board questions were categorized as relating to disciplinary action, documents placed on file, resident actions, and nondisciplinary actions by the program. RESULTS: Fifty-six states and territories were included in the study (50 US states; Washington, DC; and 5 US territories). Most states and territories (46; 82.1%) used the same VOT form for DOs and USMDs. All states and territories except New York used the same form for FMGs and USMDs (55; 98.2%). Of the 14 states with an osteopathic board, Nevada used Federation Credentials Verification Service (FCVS) for DOs only, and 8 states used a unique osteopathic VOT form. Of these 8 osteopathic boards, 3 VOT forms did not ask any questions regarding resident performance during training. Of the remaining 5 forms, all asked about disciplinary actions. Ten states and 1 territory (US Virgin Islands) required the FCVS for both USMDs and FMGs, but not for DOs, while New York required FCVS only for FMGs. Nevada required FCVS only for DOs. CONCLUSION: Although VOT requirements for FMGs and USMDs were mostly the same within states, performance metric question sets varied greatly from state to state and within states for osteopathic vs allopathic licensing boards. Implementation of a standardized VOT form for all applicants that includes academic performance metrics may help ensure that medical licensure is granted to all physicians who demonstrate academic competency during training, regardless of their degree.
Remdesivir for the Treatment of Severe COVID-19: A Community Hospital's Experience.
Lee S, Santarelli A, Caine K … +3 more , Schritter S, Dietrich T, Ashurst J
J Am Osteopath Assoc · 2020 Dec · PMID 33136164 · Publisher ↗
CONTEXT: Following the emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), researchers sought safe and effective treatment modalities. Re...
CONTEXT: Following the emergence of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), researchers sought safe and effective treatment modalities. Remdesivir is currently being evaluated for clinical efficacy and safety in patients with COVID-19. OBJECTIVE: To describe the clinical outcomes of COVID-19 patients following treatment with remdesivir at a community hospital. METHODS: A retrospective review of medical records was conducted in August 2020 for all patients given remdesivir while hospitalized for severe COVID-19 between May 1 and August 19, 2020. A convenience sample of consecutive patients with treatment including remdesivir, antibiotics, convalescent plasma, dexamethasone, or a combination of multiple drugs was included in the analysis. Patients receiving remdesivir were administered a 5-day treatment course. Patients with a glomerular filtration rate of less than 30 mL/min, those with liver function tests 5 times the normal reference range, and those who were pregnant were excluded from treatment with remdesivir. Differences in between men and women were detected with χ2 and independent samples t tests. The degree to which presenting symptoms influenced patient outcomes was analyzed with a stepwise logistic regression. RESULTS: Among the 76 patients who received remdesivir, the mean (95% confidence interval, CI) age was 63 years (59.8-66.2). Thirty-six (47.4%) were men and 40 (52.6%) were women. Forty-nine (64.5%) were White and 27 (35.5%) were nonWhite. The majority of patients (54; 71.1%) had at least 1 comorbid condition, with hypertension being the most common (43; 56.6%). The mean (95% CI) length of stay for patients who received remdesivir was 10.09 days (8.6-11.6) and the mean (95% CI) duration of oxygen therapy was 9.42 days (8.0-10.8). A total of 14 (18.4%) patients given remdesivir were admitted to the intensive care unit (ICU) with an mean (95% CI) length of stay of 9.29 days (5.6-13.0). Women administered remdesivir were more likely to be admitted to the ICU (11 [27.5%] vs 3 [8.3%]; P=.031). The mortality rate was 14 patients (18.4%), with no statistically significant difference observed between men (5; 13.9%) and women (9; 22.5%; P=.33). No significant difference was seen amongst sexes for duration of oxygen therapy (men, 8.0 days [6.2-9.8] vs women, 10.76 days [8.8-12.8]; P=.051) or length of stay (men, 8.61 days [6.7-10.5] vs women, 11.43 days [9.3-13.5]; P=.058). There was no statistically significant difference in pooled racial groups (White vs nonWhite) for in-hospital mortality, number admitted to the ICU, days spent in the ICU, duration of oxygen use, or length of stay. CONCLUSION: Remdesivir may show clinical efficacy for the treatment of severe COVID-19 in a community setting. Although this was a small-scale study with limited patients, it represents a point of reference for the use of remdesivir at other community hospitals.
Characteristics and Management of Pregnant Patients From a Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine Clinic.
Frank LD, Bhatia S, Snider KT
J Am Osteopath Assoc · 2020 Dec · PMID 33136162 · Publisher ↗
CONTEXT: Osteopathic manipulative medicine (OMM) is considered beneficial in the treatment of pregnant women, but few studies have outlined the presenting complaints and diagnoses that warrant consideration and utilizati...
CONTEXT: Osteopathic manipulative medicine (OMM) is considered beneficial in the treatment of pregnant women, but few studies have outlined the presenting complaints and diagnoses that warrant consideration and utilization of osteopathic manipulative treatment (OMT) in this population. OBJECTIVE: To describe the characteristics of pregnant patients receiving OMM at a neuromusculoskeletal medicine (NMM)/OMM specialty outpatient clinic, for the purpose of identifying patients who would benefit from referral to NMM specialty clinics or to be considered for treatment by DOs in non-NMM specialty clinics. METHODS: Electronic health records were reviewed from a single clinic for a 3-year period from October 2015 through September 2018 for patient encounters involving patients with an International Classification of Diseases 10th Revision code for pregnancy. Data regarding patient demographics, payment methods, presenting complaints, treatment modalities, regions treated, and assessment diagnoses were collected and analyzed. RESULTS: Records showed 465 clinical encounters with 194 pregnant patients (mean [SD] number of encounters per patient, 2.4 [2.0]). The most common presenting complaints involved the back (371; 55.4%), hip and pelvis (99; 14.8%), neck (62; 9.3%), and head (54; 8.1%). The most common clinical assessments were lumbar and thoracic spine neuromusculoskeletal diagnoses (420; 53.0%). There were 2604 somatic dysfunction assessments documented; lumbar (409; 15.7%) and sacral (396; 15.2%) somatic dysfunction were most commonly assessed. There were 2518 OMT techniques documented, and muscle energy was most frequently used (406; 16.1%). CONCLUSIONS: This data, which documents the most frequent presenting complaints of pregnant patients in an NMM/OMM clinic, may be used by clinicians to better understand the role of OMM as an obstetric adjunctive treatment approach and to identify conditions to investigate in future outcome studies.
Undergraduate Knowledge of Osteopathic Medicine: What Premedical Students Know About Osteopathic Medicine and Its Effect on Burnout.
Collins PB, Collins L, Darrow GB … +1 more , Sepede J
J Am Osteopath Assoc · 2020 Dec · PMID 33136141 · Publisher ↗
CONTEXT: Undergraduate student interest in becoming a physician continues to rise, but so too does the difficulty of earning acceptance to medical school. In this competitive environment, little is known about premedical...
CONTEXT: Undergraduate student interest in becoming a physician continues to rise, but so too does the difficulty of earning acceptance to medical school. In this competitive environment, little is known about premedical students' knowledge of their medical school options. Moreover, as undergraduate students' emotional health continues to decline, little is known about whether premedical students experience or are at increased risk for the burnout symptoms reported by medical students and other physicians in training. OBJECTIVE: To examine premedical undergraduate students' knowledge of osteopathic medicine, assess how they learned of osteopathic medicine, and collect information about any reported feelings of burnout. METHODS: In this institutional review board-approved study, we electronically distributed an anonymous survey to 342 premedical undergraduate students at a midsize, public research undergraduate institution. The survey included 56 questions. Students were surveyed on their preference of medical schools, knowledge of osteopathic medicine, and experience with burnout via the Maslach Burnout Inventory which measures exhaustion, cynicism, and professional efficacy. Of those who completed the survey, only those who confirmed that they currently considered themselves to be premedical students were included in our analysis. A 2×2 factorial analysis of variance (ANOVA) test was applied to assess main and interaction effects amongst respondents who preferred osteopathic or allopathic programs, whether they learned of osteopathic medicine programs by their own research, and their scores on the 3 measures of the Maslach Burnout Inventory: exhaustion, cynicism, and professional efficacy. Bivariate and factorial analyses were completed using SPSS v26 software (IBM). All tests were 2-tailed and used a .05 standard P value. RESULTS: Of 342 students to whom the survey was sent, 160 (46.8%) responded, and only 92 (26.9%) considered themselves premedical students. Of the 160 students analyzed in our study, 80 (50%) reported first learning of osteopathic medicine through their own research. A 2×2 factorial ANOVA revealed a significant interaction effect for cynicism in respondents who reported learning of osteopathic medicine programs on their own. Conversely, when respondents reported learning of osteopathic medicine programs from another source, they also reported significantly lower cynicism (F[1,1]5.23, P=.03) and exhaustion (F[1,13] 5.79, P=.02) scores. Of the 92 respondents, only 2 students (2.2%) answered all questions regarding general osteopathic medical knowledge correctly. CONCLUSION: The results of this study suggest that among premedical students, knowledge of osteopathic medicine may be incomplete and may be impeding medical school applications. Furthermore, respondents who reported interest in osteopathic medical schools and learned of this option through their own research seemed to experience greater burnout. Based on these findings, increased outreach and education have the potential to not only better inform students of the osteopathic profession, but also to reduce burnout.
Readmission Risk Factors and Heart Failure With Preserved Ejection Fraction.
Harmon D, Rathousky J, Choudhry F … +6 more , Grover H, Patel I, Jacobson T, Boura J, Crawford J, Arnautovic J
J Am Osteopath Assoc · 2020 Dec · PMID 33125031 · Publisher ↗
CONTEXT: Cases of heart failure with preserved ejection fraction (HFpEF) exacerbations continue to affect patients' quality of life and cause significant financial burden on our healthcare system. OBJECTIVE: To identify...
CONTEXT: Cases of heart failure with preserved ejection fraction (HFpEF) exacerbations continue to affect patients' quality of life and cause significant financial burden on our healthcare system. OBJECTIVE: To identify risk factors for readmission in patients discharged with a diagnosis of HFpEF. METHODS: Electronic health records of patients over 18 years of age with a primary diagnosis of HFpEF treated between August 1, 2017 and March 1, 2018 in a community hospital were retrospectively reviewed. The study population included patients with HFpEF greater than 40% who were screened but did not qualify for the ongoing CONNECT- HF trial being conducted by Duke Clinical Research. To be included, subjects had to fall into 1 of 2 classifications (NYHA Class II-IV or ACC/AHA Stage B-D) and have a life expectancy greater than 6 months. Patients were excluded if they had terminal illness other than HF, a prior heart transplant or were on a transplant list, a current or planned placement of a left ventricular assist device, chronic kidney disease requiring hemodialysis, inability to use mobile applications, or inability to participate in longitudinal follow up. Readmission rate was analyzed at 30 and 90 days along with patients' demographics and associated comorbidities, including peripheral vascular disease, anemia, pulmonary hypertension, arrythmia, and valvular heart disease. Patients were risk stratified using the LACE index readmission score and the Charlson comorbidity index. RESULTS: Of the 492 cases of HFpEF identified during the 7-month study period, 212 patients were included. The majority of patients were women (126; 59.4%), had a median body mass index above 30 kg/m2 (123; 58%), and had pulmonary hypertension (94; 44.3%), anemia (146; 68.8%), and arrhythmia (101, 47.6%). Forty-five (21.2%) patients were readmitted for HFpEF within 90 days of initial discharge; 32 of those (71.1%) were readmitted within 30 days of initial discharge. Patients with higher LACE and Charlson comorbidity index scores were more likely to be readmitted within 90 days. Peripheral vascular disease (P=.002), tricuspid regurgitation (P=.001), pulmonary hypertension (P=.049), and anemia (P=.029) were risk factors associated with readmissions. Use of ACEi/ARBs (P=.017) was associated with fewer readmissions. CONCLUSION: Anemia, peripheral vascular disease, pulmonary hypertension, and valvular heart disease are not only postulated mechanisms of HFpEF, but also important risk factors for readmission. These study findings affirm the need for continued research of the pathophysiology and associated comorbidities of the HFpEF population to improve quality of life and lower healthcare costs.
LETTER TO THE EDITOR.
Cain R
J Am Osteopath Assoc · 2020 Dec · PMID 33119729 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Use of Osteopathic Manipulative Medicine in the Management of Recurrent Mastitis.
Jackson C, Loveless B
J Am Osteopath Assoc · 2020 Dec · PMID 33108444 · Publisher ↗
Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology....
Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.
Osteopathic Approach to the Treatment of a Patient With Idiopathic Iliohypogastric Neuralgia.
Fuller DB
J Am Osteopath Assoc · 2020 Dec · PMID 33085958 · Publisher ↗
Iliohypogastric neuralgia is an uncommon etiology of lower abdominal pain caused by entrapment of the iliohypogastric nerve. Conventional management consists of medications, injections, and surgery; previous literature h...
Iliohypogastric neuralgia is an uncommon etiology of lower abdominal pain caused by entrapment of the iliohypogastric nerve. Conventional management consists of medications, injections, and surgery; previous literature has not explored the use of osteopathic manipulative medicine for management of iliohypogastric neuralgia. Here, the author discusses the case of a 72-year-old woman who presented with 2 years of right lower abdominal pain, having failed multiple treatments, including exploratory laparoscopy and appendectomy. Following management of the patient's somatic dysfunctions with osteopathic manipulative treatment and a heel lift, her iliohypogastric neuralgia was significantly improved.
An Evaluation of Reporting Guidelines and Clinical Trial Registry Requirements Among Addiction Medicine Journals.
Cooper CM, Gray H, Barcenas L … +3 more , Torgerson T, Checketts JX, Vassar M
J Am Osteopath Assoc · 2020 Dec · PMID 33075122 · Publisher ↗
CONTEXT: Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adhe...
CONTEXT: Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adherence to reporting guidelines and proper usage of clinical trial registries. Reporting guidelines and clinical trial registries have been shown to lead researchers to more ethical and transparent methodology. OBJECTIVES: To investigate the reporting guideline and clinical trial registration policies of addiction research journals and identify areas of improvement. METHODS: We used Google Scholar Metrics' h-5 index to identify the top 20 addiction research journals. We then examined the instructions for authors from each journal to identify whether they required, recommended, or made no mention of trial registration and reporting guidelines, including the Consolidated Standards of Reporting Trials (CONSORT), Meta-Analysis of Observational Studies in Epidemiology (MOOSE), Quality of Reporting of Meta-analyses (QUOROM), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Standards for Reporting Diagnostic Accuracy Studies (STARD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Animal Research: Reporting of In Vivo Experiments (ARRIVE), Case Reports (CARE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Standards for Reporting Qualitative Research (SRQR), Standards for Quality Improvement Reporting Excellence (SQUIRE), Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), Consolidated Criteria for Reporting Qualitative Research (COREQ), Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and the International Committee of Medical Journal Editors (ICMJE) guidelines. We performed the same analysis regarding requirements for clinical trial registration. RESULTS: Of the 20 journals included in this study, 10 journals (50%) did not require adherence to any reporting guidelines. Trial registration followed a similar trend; 15 journals (75%) did not mention any form of trial or systematic review registration, and ClinicalTrials.gov was only recommended by only 1 journal (5%). CONCLUSIONS: Among top addiction medicine journals, required adherence to reporting guidelines and clinical trial registry policies remains substandard. A step toward fulfilling the National Institute on Drug Abuses' call for improvement in transparency and reproducibility within addiction research should include all journals adopting a strict reporting guideline and clinical trial registry adherence policy.
Dysphagia Lusoria.
Andersen K, Hoff R, Silas D
J Am Osteopath Assoc · 2020 Dec · PMID 33048162 · Publisher ↗
Abstract loading — click title to view on PubMed.
Motivating High School Students From Rural Areas to Attend College and Pursue Careers as Osteopathic Physicians.
Kadavakollu S, Shindi RS, Nummerdor HR … +4 more , Singh VK, Pillai SB, Ontiveros SJ, Boyanovsky B
J Am Osteopath Assoc · 2020 Dec · PMID 33048133 · Publisher ↗
CONTEXT: One potential way to address critical current and future projected health care workforce shortages is through comprehensive programs that could potentially inspire high school students to pursue osteopathic medi...
CONTEXT: One potential way to address critical current and future projected health care workforce shortages is through comprehensive programs that could potentially inspire high school students to pursue osteopathic medical careers in underserved areas. OBJECTIVE: To determine whether a comprehensive, 5-week enrichment program could promote interest among rural high-school students in careers osteopathic medicine. METHODS: In May 2018, 116 high school students with a grade point average of 2.8 or higher from rural areas, including New Mexico and its surrounding rural areas in the US-Mexico border region, enrolled in а 5-week program offering American College Testing (ACT) preparation and biomedical sciences enrichment at Burrell College of Osteopathic Medicine (BCOM). During the program, students were offered more than 150 hours of interactive in-class lectures and hands-on activities with laboratories focusing on college preparedness, health sciences, and motivating students to pursue osteopathic medical career and practice medicine in rural areas. Clinically-oriented sessions covering osteopathic philosophy and osteopathic manipulative medicine were included. After completion, a voluntary and anonymous survey was sent to students who completed the program students through QualtricsXM©. Blinded ACT scores were collected from participants' schools, along with college enrollment status information. RESULTS: Of 116 enrolled students, 106 (91.4%) completed the program successfully. In their postcompletion survey responses, students reported that they had gained a realistic perception of the field of medicine and were motivated to attend college (mean [standard error, SE] score on 5-point Likert scale over 2 questions, 4.8 [0.06]) and osteopathic medical school (mean [SE], 4.7 [0.1]). Participants also felt more informed about physician shortage in rural areas (mean [SE], 4.7 [0.07]) and appeared to be inspired to practice medicine in rural areas (mean [SE], 4.6 [0.09]). Students also reported feeling better prepared to take the ACT after finishing this program (mean [SE], 4.9 [0.04]). Finally, we were able to collect the ACT scores of 51 participants (48.1%) who completed the program; the mean ACT score was 24.3, compared with a reported national mean of 20.7 on a scoring scale of 1-36. We also performed a follow-up inquiry showing that 78 of the 81 participating students (96%) who had graduated from high school were enrolled in college or university and 59 (73%) had elected in science, technology, engineering, mathematics, or health majors. CONCLUSION: Rural high school pipeline programs could be a tool to motivate high school students to attend college and ultimately to develop physicians who are interested to practice in medically underserved areas.
Associations Between Social Support and Diabetes-Related Distress in People With Type 2 Diabetes Mellitus.
Young CF, Shubrook JH, Valencerina E … +3 more , Wong S, Henry Lo SN, Dugan JA
J Am Osteopath Assoc · 2020 Nov · PMID 33033833 · Publisher ↗
CONTEXT: Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modificat...
CONTEXT: Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modifications to daily behaviors can be very overwhelming, thus leading to diabetes-related distress. OBJECTIVE: To investigate the association between diabetes-related distress and perceived social support among people with type 2 diabetes. METHODS: This cross-sectional study surveyed a population with a lower socioeconomic status (Medi-Cal recipients, which are only given to low-income individuals) in Solano County, California. Patients who had type 2 diabetes mellitus, who were between 40 and 80 years old, and who had a medical appointment in the clinic(s) at least once between December 2015 and December 2016 were included. Patients who could not understand or speak English and patients whose primary care clinicians declined their participation in the study were excluded from the study. Each study participant was recruited at the end of their medical appointment, and the survey instrument in paper form was administered. The Problem Areas in Diabetes (PAID) scale, which indicates diabetes-related distress, and Multidimensional Scale of Perceived Social Support (MSPSS) with 3 subscales (family, friends, and significant others) were used in this study. Multiple linear regression models were used to analyze the associations between PAID and MSPSS surveys. RESULTS: For the 101 participants included in our study, multiple linear regression models showed statistically significant association between total MSPSS scores and total PAID scores (β = -.318; 95% CI, .577, -.0581; P=.017) as well as between MSPSS family subscale scores and total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012). Among the 3 MSPSS subscales, higher perceived support from family members was found to be significantly associated with lower total PAID scores (β= -.761; 95% CI, -1.35, -.168; P=.012). CONCLUSION: Our findings suggest that a higher level of perceived social support experienced was associated with lower diabetes-related distress among patients with type 2 diabetes. Osteopathic physicians have a central role in providing comprehensive, patient-centered, holistic care, and the attention to social support in chronic disease management can help remove barriers in providing optimal care.
Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency.
Gau JT, Ebersbacher C, Kao TC
J Am Osteopath Assoc · 2020 Nov · PMID 33031508 · Publisher ↗
CONTEXT: Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied. OBJEC...
CONTEXT: Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied. OBJECTIVE: To estimate the prevalence of low serum zinc concentrations among community-dwelling adults, and to characterize clinical features and risk factors associated with zinc deficiency. METHODS: This retrospective pilot prevalence study took place from 2014 to 2017 at an outpatient clinic in southeast Ohio. Patients aged 50 years or older with a stable health status were categorized into a case group with zinc deficiency (serum zinc concentration, <0.66 µg/mL) and a control group (serum zinc concentration, ≥0.66 µg/mL). Measurements included serum zinc concentration, nutritional biomarkers (ie, magnesium, calcium, albumin, and total 25-hydroxy vitamin D levels), patient history of fractures and events such as hospitalization, antibiotic use, and self-reported falls that occurred within 1 year prior to the date serum zinc concentration was measured (index date). Patients were excluded if they had a serum zinc measurement within 2 months after a hospitalization, severe renal insufficiency (3 patients with serum creatinine concentration above 2.5 mg/dL), or serum zinc concentration above 1.20 µg/mL. RESULTS: This study included 157 patients, consisting of a case group of 41 (26%) patients with zinc deficiency and a control group of 116 (74%) without zinc deficiency. Mean (SD) zinc concentrations of the case and control groups were 0.58 (0.05) µg/mL and 0.803 (0.13) µg/mL, respectively (P<.01). Patients in the case group were more likely to have had a history of hospitalization, antibiotic use, a fall within 1 year before the index date, and a history of fractures and hip fracture (P<.01 in each case). Patients taking gastric acid suppressants had increased odds of lower zinc concentrations (odds ratio, 2.24; 95% CI, 1.08-4.63). Both logistic and multivariate linear regression models revealed that past fractures, hip fractures, and hypoalbuminemia (albumin <3.5 g/dL) were associated with zinc deficiency or lower zinc concentrations. CONCLUSION: This study revealed that 26% of patients in an outpatient adult clinic had zinc deficiency based on serum concentrations. Patients with fracture history and low serum albumin were at higher risk for zinc deficiency.
The Battle Between Politics and Science Is Costing Us a Timely Victory Over the COVID-19 Pandemic.
Hahn MB
J Am Osteopath Assoc · 2020 Nov · PMID 33030505 · Publisher ↗
Against the backdrop of the COVID-19 pandemic, the author discusses what he views as a persistent tension between the nature and aims of politics vs science. He outlines a call to action for osteopathic physicians to sta...
Against the backdrop of the COVID-19 pandemic, the author discusses what he views as a persistent tension between the nature and aims of politics vs science. He outlines a call to action for osteopathic physicians to stand with science, advocate for best practices, undertake dialogue with local and state health authorities, and act as role models for colleagues and patients alike.
Somatic Dysfunctions of Hip and Pelvis Overlooked in a Case of Vulvodynia.
Giovanis A, Zeszutek S
J Am Osteopath Assoc · 2020 Nov · PMID 33021627 · Publisher ↗
Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dy...
Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dysfunctions. If left untreated, these somatic dysfunctions can directly alter ligamentous tension on the pelvic floor and surrounding regions, resulting in perineal pain. Management of vulvodynia must be individualized due to the multifactorial etiology and complicated structure and function of the pelvic floor muscles. The authors present a case of vulvodynia in which osteopathic manipulative treatment was an effective management technique.
Ultrasonography to Assess the Efficacy of Osteopathic Manipulative Treatment for Lumbar Spine Asymmetry.
Winter J, Kimber A, Montenegro S … +1 more , Gao J
J Am Osteopath Assoc · 2020 Nov · PMID 33021624 · Publisher ↗
CONTEXT: The effectiveness of osteopathic manipulative treatment (OMT) on the lumbar spine has been studied qualitatively, but quantitative measurement of the effects of OMT has not been thoroughly investigated. OBJECTIV...
CONTEXT: The effectiveness of osteopathic manipulative treatment (OMT) on the lumbar spine has been studied qualitatively, but quantitative measurement of the effects of OMT has not been thoroughly investigated. OBJECTIVE: To quantitatively measure the palpated improvements of OMT on the lumbar spine using ultrasonography (US) and correlate palpatory diagnosis with US measurements of lumbar asymmetry. METHODS: From September to November 2018, we recruited 20 adult participants 18 years of age or older. Lumbar somatic dysfunction (SD) was identified via osteopathic palpation. US was then performed on all participants with standard machine settings (frequency, 7 MHz; depth, 7 cm; dynamic range, 60; tissue harmonic imaging; and single-image focus). Longitudinal images of each lumbar transverse process were recorded and saved bilaterally by an experienced radiologist and a medical student. The participant's SD was then managed using OMT, including Still technique, myofascial release, muscle energy technique, high-velocity low-amplitude technique, functional positional release, balanced ligamentous tension, and counterstrain. Following OMT, US was performed again in the same method. Measurements of the saved US images were reviewed using a Digital Imaging and Communications in Medicine viewer. These measurements were obtained by 3 separate observers (J.W., A.K., S.M.), using the same computer software. Statistical analysis included a 2-tailed paired t-test to analyze rotational asymmetry pre- and posttreatment, an intraclass correlation coefficient (ICC) to test intra- and interobserver reliability, and a Pearson correlation coefficient (PCC) to analyze the correlation between US findings and OMT. RESULTS: The difference in soft tissue thickness before and after OMT was significant (P=.014), indicating improvements in rotational asymmetry. Side-bending asymmetry did not demonstrate statistically significant improvement. US findings correlated with the physician's palpatory rotational diagnosis (PCC=0.62, P=.004). ICC was greater than 0.9 for intra- and interobserver reliability tests of both US operation and offline image processing. CONCLUSION: The results of this study demonstrate that US is a feasible method of evaluating the efficacy of OMT. These results show good intra- and interobserver reliability of US acquisition and landmark measurement. Our study suggests that US assessment correlated closely with palpatory diagnosis. Our results also suggest that OMT can significantly improve lumbar rotational asymmetry, but did not improve side-bending asymmetry.
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