Journal of Osteopathic Medicine最新文献

Context: Few osteopathic physicians (Doctors of Osteopathic Medicine [DOs]) utilize osteopathic manipulative treatment (OMT) in their clinical practice, although all DOs are trained to do so. The reasons why many do not utilize OMT are not entirely clear. Anecdotally, these authors have observed that if a physician utilizes OMT, it is because they witnessed the efficacy for themselves in real-life clinical diagnoses found on patients or volunteers. This study seeks to explore this phenomenon.

Objectives: This study seeks to explore the relationship between witnessing the efficacy of OMT and the future use of OMT in clinical practice.

Methods: Surveys were sent to DOs who work with Des Moines University's College of Osteopathic Medicine (COM) clinical students as well as osteopathic medical students enrolled at the Des Moines University's COM. Survey data were analyzed by separating physicians into cohorts based on their use of OMT and students into cohorts based on their interest in utilizing OMT in future practice.

Results: DOs who practice OMT reported at least one, and often multiple, instances of witnessing the efficacy of OMT on real-life patients or volunteers while in their first 2 years of medical school. Those who do not utilize OMT reported few opportunities to witness the efficacy of OMT on a real-life patient. For physicians, 96.1 % of those who utilize OMT in their practice had the opportunity to see it work positively during the first 2 years of medical school, whereas only 7.4 % who do not utilize OMT had the opportunity. These findings are mirrored in the experience of current osteopathic medical students who are interested and uninterested in utilizing OMT in their future practice.

Conclusions: These findings emphasize the importance of exposing our medical students to some type of 'real-life' experience early in their careers; the data show that these experiences can be very beneficial in expanding the interest in utilizing osteopathic manipulative medicine (OMM) in future practice. COMs can consider the implementation of programs that provide this experience to students, including extracurricular activities dedicated to the use of OMT.

Context: Since William Garner Sutherland's inception of osteopathic cranial manipulative medicine (OCMM), osteopathic physicians have practiced with the knowledge that cranial sutures exhibit motion. We hypothesize that the complexity of suture interdigitation in humans may provide clues to elucidate the concept of OCMM.

Objectives: We compared the interdigitation of sagittal, coronal (left and right), and lambdoid (left and right) sutures in computed tomography (CT) scans of humans and five nonhuman primate species (Gorilla gorilla, Pongo pygmaeus, Pan troglodytes, Hylobates lar, and Nasalis larvatus).

Methods: Human ages are evenly distributed between 10 and 65 years of age, with an equal number of males (n=16) and females (n=16) in the sample. Nonhuman primates are all females, and the sample includes juveniles (n=6) and adults (n=34). Sutures were evaluated on a scale ranging from 0 to 3 (0: fused sutures; 1: no interdigitation; 2: low complexity; and 3: representing the highest degree of interdigitation and complexity).

Results: Based on ordinary least squares linear regression, we found no significant relationship between suture interdigitation and age in humans. Chi-square tests were utilized to assess sex differences within humans, species-level differences, and differences between humans and nonhuman primates across all five sutures. Humans exhibited a statistically significant greater degree of suture complexity than all five nonhuman species across all five sutures.

Conclusions: These findings indicate that human suture interdigitation is more complex than their closest living relatives (African apes) and other primates (Asian monkeys and apes). We theorize that this would enable subtle movement and serve to transmit forces at the cranial sutures from dietary or ethological behaviors, similar to the pattern observed in other mammals. While humans have a softer diet compared to other living primates, the uniqueness of human craniofacial growth and extended developmental period could contribute to the necessity for complex cranial sutures. More studies are needed to understand variation in human and nonhuman sutural complexity and its relationship to cranial motion.

Sexual abuse scandals in recent years have eroded some of the trust that is foundational for the physician-patient relationship. A closer analysis of some of these stories of abuse from the standpoint of medical professionalism, primarily utilizing the example of Larry Nassar, DO, yields potential ways in which instances of abuse may be reduced or eliminated. The goal of this paper is to elicit lessons that can be learned from these tragic sequences of events so that physicians, healthcare institutions, physician practices, medical boards, and even patients themselves can introduce measures that help prevent future stories like these.

Context: Over the past several decades, orthopedic surgery has seen a substantial increase in the number of surgeons completing fellowship training. Doctors of Osteopathic Medicine (DOs) continue to advance their orthopedic education through subspecialty fellowship training. DOs have represented between approximately 6 % and 15 % of American Orthopaedic Foot and Ankle Society (AOFAS) fellows. Although historical representation has been considered strong, the fellowship match years 2020 and 2021 have seen a decline in osteopathic orthopedic surgeons participating in foot and ankle fellowships. This deviates from the recent trends of increasing participation across orthopedic subspecialities.

Objectives: To investigate and review the trends of orthopedic foot and ankle fellowship training.

Methods: Data was reviewed from the AOFAS regarding number of fellows matched and degree obtained. Data from the Federation of State Medical Boards (FSMB), American Orthopaedic Foot and Ankle Society (AOFAS) and Association of American Medical Colleges (AAMC) were reviewed for physician trends and match statistics.

Results: Fellowship match years 2020 and 2021 have seen a decline in osteopathic orthopedic surgeons participating in foot and ankle fellowships, with only roughly 3% of AOFAS fellows being osteopathic trained.

Conclusions: Orthopedic surgery has the highest rate of subspecialty training of all surgical specialties. Although there is hope for an increasing osteopathic presence in orthopedic surgery, recent literature has pointed to potential for continued bias in opportunities for osteopathic students. We hope that increased participation of osteopathic graduates in orthopedic surgery training programs will result in the continued expansion of osteopathic orthopedic surgeons completing fellowship training, including in foot and ankle surgery.

Context: Alcohol consumption is responsible for numerous life-threatening diseases, including liver cirrhosis, heart disease, and various cancers. During the pandemic, alcohol-related deaths increased from 2019 to 2021, topping out at approximately 108,000 deaths related to alcohol. This trend also introduced the question whether heavy alcohol consumption and binge drinking increased during the pandemic, particularly in those 65 and older.

Objectives: The objective of this study is to determine whether heavy alcohol consumption and binge drinking increased during the pandemic in older adults in the United States.

Methods: We performed a cross-sectional analysis of the Behavioral Risk Factor Surveillance System (BRFSS) to determine whether rates of overall alcohol consumption, heavy consumption, or binge drinking deviated from 2017 through 2021. We utilized chi-square tests to determine changes in rates over the included years.

Results: Our findings show that the overall rate of alcohol use in populations 65 and older from 2017 through 2021 was approximately 42.1 %, which peaked in 2017 at 43.7 % and declined each year, resulting in the lowest rate (41.3 %) in 2021 (χ ² =8.96, p<0.0001). Binge and heavy drinking rates were 5.1 % and 4.2 % overall during this time frame, respectively, and the annual changes were not statistically significant.

Conclusions: The impact of COVID-19 on the drinking behavior of older US adults was minimal in terms of binge or heavy drinking, although the overall rates of alcohol consumption among this group declined. Reports among other US age groups showed increased consumption and deaths from alcohol use. Future research is needed to determine the causes for the overall decrease in consumption or adaptive measures that this group may have taken, which led to minimal changes in binge or heavy drinking in contrast to younger populations.

Context: Osteopathic (Doctor of Osteopathic Medicine [DO]) medical students account for more than 25 % of all medical students in the United States.

Objectives: This study examined the predictive validity of Medical College Admission Test (MCAT) total scores and cumulative undergraduate grade point averages (UGPAs) for performance on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 and Level 2-CE (Cognitive Evaluation) licensure examinations administered by the National Board of Osteopathic Medical Examiners (NBOME). Additionally, the study examined the degree to which MCAT total scores and UGPAs provide comparable prediction of student performance by key sociodemographic variables.

Methods: This study involved a collaborative effort between the Association of American Medical Colleges (AAMC), the American Association of Colleges of Osteopathic Medicine (AACOM) and the NBOME. Data were examined for 39 accredited DO-granting medical schools in the United States during the 2017 application cycle. Researchers utilized three regression models that included MCAT total scores, cumulative UGPA, and combined MCAT total scores and cumulative UGPA to determine predictive validity. Researchers also examined the comparability of prediction for sociodemographic variables by examining the differences between observed and predicted error for both scores and pass/fail success rates.

Results: Medium to large correlations were discernible between MCAT total scores, UGPA, and COMLEX-USA examination outcomes. For both COMLEX-USA Level 1 and Level 2-CE scores and pass/fail outcomes, MCAT scores alone provided superior predictive value to UGPA alone. However, MCAT scores and UGPA utilized in conjunction provided the best predictive value. When predicting both licensure examination scores and pass/fail outcomes by sociodemographic variables, all three models provided comparable predictive accuracy.

Conclusions: Findings from this comprehensive study of DO-granting medical schools provide evidence for the value-added benefit of taking MCAT scores and UGPA into consideration, particularly when these measures are utilized in conjunction. Further, findings provide evidence indicating that individuals from different sociodemographic backgrounds who enter medical school with similar MCAT scores and UGPA perform similarly on licensure examination outcome measures.