CONTEXT: Pain is a therapeutic challenge after total knee arthroplasty (TKA), and it could lead to the overuse of opioids. Few methodologically robust clinical studies have been performed to assess the effectiveness of o...CONTEXT: Pain is a therapeutic challenge after total knee arthroplasty (TKA), and it could lead to the overuse of opioids. Few methodologically robust clinical studies have been performed to assess the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care performed by non-US-trained osteopaths) for postsurgical pain. OBJECTIVE: To evaluate the effectiveness of standardized preoperative OMTh on early postoperative pain and opioid consumption after TKA. METHODS: This comparative, nonrandomized study took place from 2013 to 2015 and included patients who had primary unilateral TKA for osteoarthritis in a knee that had not undergone any previous surgery. Patients were divided into 2 consecutive groups: 1 group received traditional preoperative management, and the other group received associated preoperative OMTh (general OMTh [rhythmic mobilization of all the body joints, from the ankles to the skull, using long-lever manipulation] and myofascial relaxation). The primary evaluation criterion was knee pain at rest 1 month after surgery: 0 (no pain) to 100 (the worst imaginable pain). The secondary evaluation criteria were: (1) knee pain while walking 1 month after surgery, (2) average weekly knee pain during the first month after surgery, (3) the presence of night pain and the consumption of sleeping pills and opioids or morphine at least once per week, (4) the International Knee Society scores and the Western Ontario and McMaster University Osteoarthritis index at postoperative 6 months and 1 year. The number of patients needed for a superiority trial was determined. RESULTS: No eligible patient refused OMTh when proposed. Seventy patients were evaluated (mean [SD] age, 75 [8] years; 47 women and 23 men). The 2 treatment groups contained 35 patients each. At postoperative month 1, the OMTh group had significantly less pain at rest (mean [SD], 6.8 [6] vs 20.9 [17.3]; P=.00001) and while walking (7.9 [9.4] vs 23.5 [20.6]; P=.0001) compared with the group that received traditional preoperative management. The consumption of opioids during the first postoperative week was significantly lower in the OMTh group (P=.0001). No statistically significant difference was found in the International Knee Society or Western Ontario and McMaster University Osteoarthritis scores between the 2 groups at 6 months and 1 year of follow-up. CONCLUSION: Standardized preoperative OMTh was found to be effective in reducing pain in the first month after TKA for osteoarthritis and significantly reduced opioid consumption during the first postoperative week.
J Am Osteopath Assoc
· 2020 Jun · PMID 32584400
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CONTEXT: While existing data demonstrate that osteopathic physicians (ie, DOs) in primary care are more likely than allopathic physicians (ie, MDs) to practice in rural areas, no data exist on practice patterns of DO sur...CONTEXT: While existing data demonstrate that osteopathic physicians (ie, DOs) in primary care are more likely than allopathic physicians (ie, MDs) to practice in rural areas, no data exist on practice patterns of DO surgical subspecialists, such as ophthalmologists. Michigan has a relatively high number of DOs and, formerly, the most osteopathic ophthalmology residency programs in the United States. Analyzing the distribution of ophthalmologists in Michigan may reveal patterns and predict trends about the geographic distribution of DO surgical subspecialists across the country. OBJECTIVE: To compare geographic distributions of DO and MD ophthalmologists in Michigan and identify differences in community size and type (eg, urbanized area, urban cluster, or rural area) of practice. METHODS: A list of Michigan's ophthalmologists practicing in 2018 was developed using the Centers for Medicare and Medicaid Services, the American Osteopathic College of Ophthalmology, and the American Medical Association data sets. DOs and MDs were then analyzed by determining where each ophthalmologist practiced, identifying the size and type of community in which they practiced, and finally by comparing the percentage of DOs and MDs who practiced in various community sizes and each community type as defined by the US Census Bureau. A χ2 analysis was used to determine whether a difference existed in practice locations. RESULTS: A total of 643 ophthalmologists practiced in Michigan in 2018, including 85 DOs and 558 MDs. A greater proportion of DOs worked in rural areas and urban clusters (57 [67%]), whereas a greater proportion of MDs worked in urbanized areas (368 [66%]). Of DOs, 28 (33%) practiced in cities with a population of at least 50,000 vs 371 MDs (66%). Fourteen DOs (16%) practiced in communities with a population of at least 100,000 vs 207 MDs (37%). χ2 analysis showed a significant difference in the geographic distribution of ophthalmologist DOs and MDs (P<.01). CONCLUSION: Higher proportions of DOs practice ophthalmology in smaller, more rural Michigan communities compared with MDs, implying that a subgroup exists that tends to serve underserved areas.
J Am Osteopath Assoc
· 2020 Jun · PMID 32573734
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The influenza outbreak that occurred during 1918-1920 was a defining moment in the history of the world and osteopathic medicine. Despite the tremendous loss of human life, osteopathic physicians also observed greater su...The influenza outbreak that occurred during 1918-1920 was a defining moment in the history of the world and osteopathic medicine. Despite the tremendous loss of human life, osteopathic physicians also observed greater success in the treatment of patients with the disease, in contrast with their allopathic counterparts. Osteopathic physicians also succumbed to the deadly influenza effects while treating patients. A list of osteopathic physicians who died of influenza or related complications during the pandemic, obtained from osteopathic journals from that time, is provided, along with the historical context of the pandemic.
Voleti N, Gaspari MA, George E
… +2 more, Angelo N, Yao S
J Am Osteopath Assoc
· 2020 Jun · PMID 32451546
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CONTEXT: There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more subjective measures to evaluate this impo...CONTEXT: There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more subjective measures to evaluate this important association. To better understand this relationship, palpatory forces can be observed while diagnosing a somatic dysfunction. OBJECTIVE: To quantify the pressure applied in diagnosing lumbar somatic dysfunction, find a correlation between accuracy of diagnosis and palpation pressure, set the standards for palpation, and develop precise palpatory skills for osteopathic medical students. METHODS: The palpatory forces were evaluated between participants with varying experience levels (osteopathic medical students and attending physicians from the New York Institute of Technology College of Osteopathic Medicine). Two osteopathic physicians confirmed an L5 somatic dysfunction diagnosis in a volunteer standardized patient (SP), who served as the control. Participants then palpated the lumbar segment of the SP in a prone position with F-Scan System (TekScan) sensors, which recorded the amount of pressure and time used to reach a full diagnosis. RESULTS: Participants (11 osteopathic medical students and 10 attending physicians) who diagnosed an L5 somatic dysfunction consistent with the SP's diagnosis had less of a difference in peak force (mean [SD] difference, 62.50 [325.7] g/cm2) between the contact points (right hand vs left hand). In contrast, participants with a dissimilar L5 diagnosis from the SP's had a mean (SD) difference in peak force of 319.38 (703.1) g/cm2. Similarly, the difference in the mean (SD) force of palpation between the contact points was lower in participants who made the correct diagnosis (16.81 [117.4] g/cm2) vs those who made an incorrect diagnosis (123.92 [210.3] g/cm2). No statistical significance was found between the diagnostic accuracy of the students and physicians (P=.387) or the time taken to reach a diagnosis (P=.199). CONCLUSION: We observed that using equal pressures in both hands while palpating a lumbar segment correlates to more accurate somatic dysfunction diagnoses.
J Am Osteopath Assoc
· 2020 Jun · PMID 32451542
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Hip pain in adults is a common complaint. Secondary processes can often mask underlying conditions, prolonging the course to diagnosis and definitive treatment. In this case, a 74-year-old man presented to an outpatient...Hip pain in adults is a common complaint. Secondary processes can often mask underlying conditions, prolonging the course to diagnosis and definitive treatment. In this case, a 74-year-old man presented to an outpatient clinic after 6 weeks of right hip pain that began upon initiation of a rehabilitation program following coronary artery bypass graft surgery. Various imaging and treatment modalities (including radiography, osteopathic manipulative treatment, injection of the greater trochanteric bursa, L2-3 paravertebral block, magnetic resonance imaging, and intra-articular hip injection with 1% lidocaine) ultimately led to the definitive diagnosis of a labral tear. This case report highlights how a comprehensive osteopathic approach was used to evaluate and treat a patient with persistent unilateral hip pain because of an acetabular labral tear, associated psoas syndrome, and trochanteric bursitis, all within 2 months and with a positive clinical outcome.
J Am Osteopath Assoc
· 2020 Jun · PMID 32451541
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In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathi...In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.
J Am Osteopath Assoc
· 2020 Jun · PMID 32451540
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BACKGROUND: The sphenobasilar synchondrosis (SBS; also, sphenobasilar synostosis or sphenooccipital synchondrosis) plays a major role in the concept of osteopathic cranial manipulative medicine (OCMM) and craniosacral th...BACKGROUND: The sphenobasilar synchondrosis (SBS; also, sphenobasilar synostosis or sphenooccipital synchondrosis) plays a major role in the concept of osteopathic cranial manipulative medicine (OCMM) and craniosacral therapy. Previous research suggests that many individuals, from newborns to adults, present with single or multiple SBS strain patterns as a result of the birth process and other traumatic forces throughout life. To date, it is unclear whether specific SBS lesion patterns are present in altered health states and disease and how they compare with healthy controls. OBJECTIVE: To identify research that reports on specific SBS strain patterns compared with healthy controls. METHODS: A literature review of electronic databases and hand-search of publication bibliographies was performed. Observational studies of newborns, children, and adults were included if there was information on the occurrence of cranial strain patterns related to the SBS in individuals with impaired health states and a healthy control group. RESULTS: Of 1123 citations, 836 articles were screened after duplicate removal, and 42 articles were evaluated by full-text assessment. Three articles were included in this review, including 1 prospective and 2 retrospective studies. The age ranges of the populations studied were newborns aged 5 days or younger, children aged 4 to 14 years, and adults aged 45 to 90 years. In adults with Parkinson disease, no significant difference in SBS strain patterns between the Parkinson disease group and the age-matched healthy control group were seen. In contrast, different SBS strain patterns were observed between newborns with a range of health impairments, such as jaundice and respiratory and nervous symptoms, and children with learning disabilities compared with their healthy counterparts. However, no statistical analysis was conducted in these 2 studies; hence, results are difficult to interpret. Reporting in all 3 studies was limited; therefore, the methodologic quality of the 3 identified studies was deemed incapable of being judged. CONCLUSION: The study landscape of this review highlights the scarcity of, poor reporting on, and unclear methodologic quality of research on SBS strain patterns in disease and health. It is still unclear whether and to what extent specific SBS strain patterns occur in impaired health states compared with healthy controls. Future studies should seek to improve study methods and reporting and minimize the risk of bias.
J Am Osteopath Assoc
· 2020 Jun · PMID 32451539
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CONTEXT: Osteopathic physicians often target the rectus capitis posterior minor (RCPm) and rectus capitis posterior major (RCPM) muscles when using muscle energy or soft tissue cervical techniques to treat patients with...CONTEXT: Osteopathic physicians often target the rectus capitis posterior minor (RCPm) and rectus capitis posterior major (RCPM) muscles when using muscle energy or soft tissue cervical techniques to treat patients with head and neck pain. The RCPm and RCPM muscles are located deep within the posterior occipitoatlantal and atlantoaxial interspaces, respectively. OBJECTIVE: To characterize the functional role of RCPm and RCPM muscles by comparing electromyographic (EMG) activation patterns of these muscles with EMG activation patterns of specific flexor and extensor muscles of the head and neck, the sternocleidomastoid (SCM), and the splenius capitis (SC) muscles, respectively. METHODS: Asymptomatic participants were recruited from the Michigan State University College of Osteopathic Medicine student body. Disposable 25-gauge, bipolar fine-wire intramuscular electrodes were used to collect EMG data from the right and left RCPm and RCPM muscles. Surface electrodes were used to collect EMG data from the right and left SCM and SC muscles. Data were collected as participants performed 4 cycles of flexion and extension with an external 4-lb force applied to the back of the head and the forehead. RESULTS: In RCPM muscles, EMG activity was significantly greater (P<.003) during flexion and extension of the head and neck when an external force was applied to the back of the head. EMG activity in SCM muscles was significantly greater (P<.0001) during flexion and extension of the head and neck when an external force was applied to the forehead. The authors observed that EMG activity in SC muscles was significantly greater (P<.015) during flexion and extension of the head and neck when an external force was applied to the back of the head. No significant difference was found in EMG activity in RCPm muscles (P<.834) during flexion and extension of the head and neck, regardless of whether the external force was applied to the back of the head or the forehead. CONCLUSION: The EMG activation patterns of the RCPm muscles suggest that their functional role may be to stabilize the occipitoatlantal joint by helping maintain congruency of the joint surfaces. In contrast, the EMG activation patterns of the RCPM muscles suggest that their functional role may be to contribute to extension of the head, primarily at the occipitoatlantal and the atlantoaxial joints.
Singer-Chang G, Dong F, Seffinger M
… +4 more, Nevins N, Blumer J, Musharbash H, Helf S
J Am Osteopath Assoc
· 2020 Jun · PMID 32451538
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CONTEXT: Integral to emotional intelligence (EI), empathy is frequently studied in medical students. While important, given the implications for patient safety and physician well-being, traits such as self-regard may als...CONTEXT: Integral to emotional intelligence (EI), empathy is frequently studied in medical students. While important, given the implications for patient safety and physician well-being, traits such as self-regard may also affect physician efficacy. Emotional intelligence offers a holistic framework from which to study empathy, allowing it to be explored with coexisting traits and offering opportunities to identify related risk factors. OBJECTIVE: To identify trends in osteopathic medical student EI to help mitigate burnout, with specific attention to empathy and self-regard. METHODS: Eight hundred eighty-five students at Western University of Health Sciences College of Osteopathic Medicine of the Pacific from classes 2014-2016 were offered the Emotional Quotient Inventory 2.0 (EQ-i) at the start of school, completion of their second year, and at graduation. Participants completed all 3 inventories, yielding a response rate of 16.3%. Repeated measurement analysis of variance analyses were conducted using SAS software for Windows version 9.3. RESULTS: A total of 144 students participated. The total EI score shifted from mean (SD) 100.2 (12.4) at baseline to 96.1 (12.8) midway to 96.8 (13.3) at graduation (P=.0161) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Empathy declined from 103 (13.1) to 99.9 (12.7) to 99.6 (12.6) (P=.0481) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Self-regard declined from 98.6 (14.1) to 95.8 (15.1) to 95.5 (14.7) (P=.135) with significant decreases between baseline and midway (P=.0021) and baseline and final administrations (P<.001). CONCLUSION: This study's findings support further investigation of potential roles played by EI, empathy, and self-regard in physician burnout.
Stefani KM, Richards JR, Newman J
… +3 more, Poole KG, Scott SC, Scheckel CJ
J Am Osteopath Assoc
· 2020 Jun · PMID 32451537
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CONTEXT: Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are...CONTEXT: Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty. OBJECTIVE: To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision. METHODS: Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties. RESULTS: The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P<.0001). Students entering PC were more likely to report prestige and income level to be "no or minor influence" compared with students entering non-PC specialties (P<.0001). Debt level was more likely to be a "major influence" to students choosing to enter non-PC specialties than to those entering PC (P<.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%). CONCLUSION: Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.
Scheckel CJ, Richards JR, Newman JR
… +2 more, Fangman BD, Poole KG
J Am Osteopath Assoc
· 2020 Jun · PMID 32451536
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CONTEXT: The Public Service Loan Forgiveness (PSLF) program is among several repayment programs currently available for recipients of federal student loans. Medical education debt has continued to expand at a rapid pace...CONTEXT: The Public Service Loan Forgiveness (PSLF) program is among several repayment programs currently available for recipients of federal student loans. Medical education debt has continued to expand at a rapid pace in the decade since PSLF was created. Proposed changes to the Higher Education Act would substantially transform how future medical trainees finance and repay medical education debt. OBJECTIVE: To better understand relationships between debt and personal stress, as well as between repayment- and forgiveness-program use, in the context of competing legislation. METHODS: Surveys were sent to all Accreditation Council for Graduate Medical Education-accredited internal medicine residency programs (osteopathic and allopathic). RESULTS: From a potential pool of 579 residents, data were obtained from 403 unique respondents (response rate, 69.6%) at 12 residency programs, for a program response rate of 2.2%. Of these respondents, 290 (71.9%) completed the demographic portion of the survey. Median education debt was $225,000. Residents with the top quartile of debt burden were more likely to use PSLF (odds ratio [OR], 3.27; P=.02), more likely to enter loan forbearance (OR, 2.14; P=.03), and indicated a higher level of stress (OR, 5.94; P<.001) compared with those in the second and third quartiles. CONCLUSION: Proposed legislative changes to the Higher Education Act would scale back loan repayment options and also eliminate PSLF for future borrowers. Our data suggest that higher debt burdens are associated with increased debt-related stress. Given program popularity and growing use, along with growing concerns of physician burnout, policy makers should weigh the potential downstream effects of policy change on prospective future physicians.
J Am Osteopath Assoc
· 2020 May · PMID 32436581
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic is causing an increased need for mechanical ventilation for a significant percentage of people who present to the hospital for treatment. This incr...The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic is causing an increased need for mechanical ventilation for a significant percentage of people who present to the hospital for treatment. This increase in demand could surpass the supply of ventilators and lead to an increase in mortality due to a lack of ventilator vacancies. There is significant evidence that osteopathic manipulative medicine (OMM) can alleviate pulmonary symptoms and aid in quicker recoveries from various respiratory ailments. OMM has the potential to play a significant role in helping reduce a patient's need for mechanical ventilation by delaying the onset of acute respiratory distress syndrome stemming from SARS-Cov2 infections.
Desai PM, Mbachi C, Mathew M
… +2 more, Attar B, Mba B
J Am Osteopath Assoc
· 2020 May · PMID 32337570
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Hypernatremia is caused by a disproportionate balance of inadequate free water relative to sodium level. Frequent causes of hypernatremia include renal or gastrointestinal fluid loss, hypothalamic injury, and endocrine a...Hypernatremia is caused by a disproportionate balance of inadequate free water relative to sodium level. Frequent causes of hypernatremia include renal or gastrointestinal fluid loss, hypothalamic injury, and endocrine abnormalities. The authors describe a rare case of hypernatremia that manifested secondary to psychogenic adipsia in a 46-year-old woman presenting with intractable vomiting. Her presenting symptoms and laboratory abnormalities resolved after treatment was initiated for major depression. This case highlights the need for a holistic approach when confronted with a case of unexplained hypernatremia.
J Am Osteopath Assoc
· 2020 May · PMID 32337569
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Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. A...Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is primarily an aberrant immunologic reaction caused by cytokines secreted from lymphocytes that traverse the lymphatic pathway throughout the body. Several studies have documented that, when manipulated, the lymphatic system enhanced the motion of these lymphocytes to important immune structures in both human and animal models. Additionally, modulation of both sympathetic and parasympathetic outflow has been found either to inhibit or enhance secretion and/or drainage of important allergic sites. Osteopathic approaches to rhinitis play an effective role in the comprehensive management of rhinitis, and techniques based on these approaches are therapeutic options for rhinitis. This article provides an up-to-date literature review about the management of rhinitis using the 5 models of osteopathic medicine: biomechanical, respiratory-circulatory, metabolic, neurologic, and behavioral.