Journal of Osteopathic Medicine最新文献

Context: Many studies have suggested that participation in pre-clerkship volunteering opportunities is associated with higher confidence in clinical skills, improved perspectives on social barriers, and greater soft skills and empathy. While these studies have described a positive impact on subjective qualities, few studies have investigated the impact on objective standards such as third-year evaluations.

Objectives: The aim of this study was to explore the relationship between volunteer hours and third-year evaluations, with the hypothesis being that these previously studied, perceived benefits of volunteerism would translate to better evaluations.

Methods: This retrospective cohort study stratified a class of 161 medical students by volunteer hours completed during pre-clerkship years and self-recorded into the Translating Osteopathic Understanding into Community Health (TOUCH) reporting system. Preceptor evaluations were gathered utilizing the school's report system and were analyzed in categories that included communication, problem solving, clinical skills, osteopathic manipulative medicine (OMM), medical knowledge, and professional/ethical standards. The statistical analyses utilized included Pearson and Spearman correlations.

Results: At the time of data accruement, only 127 of the 161 students had completed all required rotations and had completed evaluations. Therefore, the final sample size analyzed was 127 students and 1,321 evaluations. The average overall score on evaluations was 4.47, and the average number of logged TOUCH hours was 65.63. After Pearson and Spearman correlational analyses, no statically significant results were found (p>0.05).

Conclusions: Although previous studies suggest the positive impact of volunteering on confidence in clinical abilities, this study suggests no statistically significant correlation between TOUCH hours and preceptor evaluations. Current literature suggests that this may be due to preceptor subjectivity, evaluator and clinical engagement, and grade inflation. Given that evaluations are an important factor in residency interview selection, this study raises the question on how to adapt volunteerism and evaluation standards to better prepare osteopathic medical students for residency and beyond.

Context: The etiology of cranial base strains (CBS) in newborns is poorly elucidated in historical and current literature. There have only been a handful of studies examining the prevalence of CBS in newborns or vaginal birth presentation prevalence individually, let alone their relationship. Defining this link could help to further the applications of osteopathic manipulative medicine in neonates.

Objectives: The objective of this review was to consolidate all historical and current research on the potential link between vaginal birth presentation and CBS in infants.

Methods: A review of historical and current literature was completed in October 2023 by all authors utilizing the PubMed database and Google Scholar with the following search terms: cranial strain, osteopathy, fetal, molding, pediatric, birth presentation, delivery, and labor. These terms were utilized in various combinations and individually. Inclusion criteria included description of infant skull morphology, CBS patterns, and vaginal birth presentation. Exclusion criteria included studies with noninfant populations that did not address cranial morphology and/or discussed plagiocephaly unrelated to birth. There was no date range in the exclusion criteria due to the scarcity of research. Texts that included an evaluation and treatment of children at various ages were selected for partial reviews, only including the sections relevant to infancy. The best judgment of the authors was utilized to recognize reliable articles and texts. Extensive research returned very few recorded associations of CBS caused by vaginal birth and their accompanying mechanisms; thus, a review of citations in articles sought for retrieval was also completed. Most of the information procured was found in academic and historical texts rather than research articles.

Results: The results of this review are inconclusive and can only align with the theory that physiological CBS are the most common and that pathological CBS are uncommon; no relationship to vaginal birth presentation can be concluded with the available research. However, the literature reviewed illustrates a statistically significant increase in somatic dysfunction/cranial asymmetry in infants after prolonged labor, an increase in the rates of plagiocephaly in infants born to nulliparous women and/or the use of assistive devices, improvement of symmetry with the administration of osteopathic manipulative treatment (OMT), and the improvement of symptomatology after OMT.

Conclusions: More research needs to be completed on this topic to increase knowledge in the field of infantile CBS. A better understanding of the effect of vaginal birth presentation on infant CBS and occipital flattening could optimize infant development and the prevention of common diagnoses such as plagiocephaly, developmental delay, torticollis, colic, and feeding diffic

Context: People experiencing homelessness are at a disproportionately greater risk for developing traumatic brain injury (TBI) than the general population. There has been minimal research to evaluate the prevalence of TBI or the long-term cognitive impacts of TBI among the population experiencing homelessness within the United States. There is minimal literature that examines individuals who are living unsheltered, especially regarding TBI.

Objectives: This study aimed to assess primarily whether those experiencing unsheltered homelessness had a higher prevalence of TBI than those in shelter. Furthermore, we examined the differences in the prevalence of repeated TBIs, TBI by age of respondent, loss of consciousness (LOC), and cognitive symptoms in people experiencing homelessness across three housing strata (sheltered, low-barrier sheltered, and unsheltered) within a small midwestern city.

Methods: Participants were recruited utilizing a convenience sampling of patients who utilized street medicine healthcare services. The study enrolled 102 patients during the interval of October 2022 through March 2024 from three housing strata (sheltered, low-barrier sheltered, and unsheltered) in Lansing, Michigan. We employed the Ohio State TBI Identification Method, abbreviated for ease of use. Results were analyzed for associations between TBI and health conditions utilizing chi-squared tests and a single difference-of-proportions test.

Results: Seventy-five of 102 (73.5 %) of participants reported at least one TBI, with 48 % experiencing their first TBI more than 20 years ago. There was a significant difference in TBI prevalence across housing strata. Ninety percent (90 %) of unsheltered survey respondents reported at least one previous TBI, with 50 % reporting three or more previous TBIs. These rates exceeded those of respondents in shelter (58 % prevalence, 21 % 3+ TBIs) and low-barrier shelter (65.1 % prevalence, 26 % 3+ TBIs), all of which exceeded the reported TBI prevalence for the general population (21.7 %). TBI prevalence did not vary significantly by age. LOC following TBI among participants significantly exceeded that of the general population (48 vs. 12 %). The prevalence of severe TBI was significantly greater than the general population for low-barrier shelter (16 vs. 2.6 %) and unsheltered respondents (23 %), but not for sheltered participants. Many respondents (62.6 %) developed cognitive symptoms as a result of TBI, although no statistical difference emerged between the groups. Cognitive sequalae were most common among those with three or more TBIs.

Conclusions: Taken together, these results suggest that the likelihood of TBI and the associated risks present a greater threat to those experiencing homelessness. There is a propensity to most strongly affect those living unsheltered.

Context: Osteopathic manipulative treatment (OMT) has been shown to improve athletic performance by enhancing shoulder range of motion, flexibility, and balance in various sports. However, its effects on sprint performance, particularly in competitive environments, remain understudied. Sprinting is a high-intensity activity that depends on anaerobic capacity, neuromuscular efficiency, and volume of oxygen (VO2) max. Although OMT has demonstrated potential in enhancing muscle function, its acute impact on 60-m sprint performance has not been established.

Objectives: This randomized controlled study, approved by the Rocky Vista University Institutional Review Board (IRB), aimed to evaluate whether OMT could improve 60-m sprint times in competitive athletes and explore its potential integration into sideline protocols.

Methods: Participants were 31 young adults recruited from the community. After providing informed consent, participants completed a standardized 10-min dynamic warm-up, followed by their first timed 60-m sprint trial. Participants were then randomized into two groups: a treatment group receiving a 5-min lower-extremity OMT protocol administered by an osteopathic physician, and a control group receiving 5 min of sham therapeutic ultrasound (STU). A second 60-m sprint was performed under identical conditions to the first trial. Sprint times were measured individually to ensure consistency.

Results: Statistical analysis revealed modest improvements in sprint times within both groups. The treatment group showed a mean improvement of 0.0693 s, while the control group demonstrated a 0.0275 s improvement. Further paired t-test analyses showed that the results were not significant.

Conclusions: Although these improvements were not statistically significant, they indicate a slight trend favoring OMT. Between-group analysis did not reveal significant differences (p=0.477), suggesting that the observed changes were comparable across groups. Although OMT produced slight improvements in sprint performance, these changes were not statistically significant. This suggests that OMT may not yield immediate measurable benefits for 60-m sprint times in young adults. However, the observed trend warrants further investigation. Future studies with larger sample sizes, varied athletic populations, and alternative treatment protocols may help clarify the acute effects of OMT on sprint performance. These findings contribute to the growing body of research on OMT and raise new questions regarding its potential role in enhancing performance in athletic activities.

Context: As Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 has changed to Pass/Fail scoring, residency programs that required minimum Level 1 scores for applicant consideration may choose to focus on COMLEX-USA Level 2-Cognitive Evaluation (Level 2-CE) target scores for applicant selection. Therefore, finding ways to predict passing and high Level 2-CE performance based on students' past performance and to guide their study accordingly is essential for helping students succeed in and beyond medical school.

Objectives: The purpose of this retrospective study is to evaluate the predictive value of major performance measures from pre-admission to clerkship years on Level 2-CE. Then, based on the predictive value of those measures, the objective is to establish a predictive model and optimal cutoff scores with strong predictors to advise students on their preparation of Level 2-CE.

Methods: School-based performance measures for 948 first-time takers of the Level 2-CE Testing Cycles of 2019/20 to 2023/24 were analyzed. Correlational and multiple regression analyses were utilized to establish a predictive model utilizing: (1) preadmission and preclerkship performance (Medical College Admission Test [MCAT], undergraduate science grade point average [GPA], and preclerkship examination average); (2) national examination performance including the new COMLEX-USA Level 1 pass/fail-only status, individual and average clinical subject Comprehensive Osteopathic Medical Achievement Test (COMAT) scores, and the less studied Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) Phase 2; and (3) clinical evaluation scores by preceptors. Then, receiver operating characteristic (ROC) curves were utilized to identify the optimal cutoff scores on the average clinical subject COMATs and COMSAE Phase 2 for student advising.

Results: A predictive model of COMLEX Level 2-CE was established with average clinical subject COMAT scores, first-time COMSAE Phase 2, preclerkship examination mean, and COMLEX Level 1 Pass/Fail status as the significant predictors. This model explained 73.9 % of the variance in Level 2-CE performance. Optimal cutoffs of the average clinical subject COMAT scores and first-time COMSAE Phase 2 performance were identified for passing Level 2-CE (COMSAE=447, average COMAT score=94.4) as well as having a high performance of Level 2-CE (650 & 700, respectively).

Conclusions: This study not only added evidence in support of previous studies on the bivariate associations between Level 2-CE and individual major performance measures from the preadmission to clerkship years, but also explored the use of the less-studied COMSAE Phase 2 in predicting Level 2-CE outcomes and provided a better predictive model utilizing the combination of individual performance measures. Most importantly, the current stud

We present a unique case of necrobiosis lipoidica (NL) arising within a port-wine stain (PWS), which, to our knowledge, has not been previously reported. NL is a rare granulomatous disorder often associated with diabetes mellitus, characterized by chronic inflammation and microvascular dysfunction. PWS, a congenital vascular malformation, results from defective endothelial differentiation and capillary malformation. The coexistence of these conditions suggests a potential link in their pathophysiological mechanisms, including inflammation, endothelial dysfunction, and shared signaling pathways such as mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K), and tumor necrosis factor (TNF)-alpha. Our patient's NL lesions demonstrated improvement with topical ruxolitinib, a Janus kinase (JAK) inhibitor, after failing conventional therapies, including clobetasol, tacrolimus, and pulsed dye laser. To our knowledge, this is the first reported case of NL successfully treated with topical ruxolitinib monotherapy. This case highlights the emerging role of JAK inhibitors in managing granulomatous disorders and raises intriguing questions about the shared pathophysiologic mechanisms between inflammatory and vascular processes. Further investigation into cytokine dysregulation, immune responses, and targeted therapies for these overlapping pathologies could inform more effective treatment strategies and improve patient outcomes.