Journal of Osteopathic Medicine最新文献

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.

Context: Long COVID, a debilitating condition characterized by persistent symptoms following acute Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, continues to pose a significant public health burden. Currently, research is ongoing regarding risk factors for developing Long COVID. Identifying patients susceptible to symptoms of Long COVID can assist with identifying those at risk, and developing preventative strategies for these individuals.

Objectives: The objectives of this study are to evaluate a cohort of patients who followed up in the Long COVID clinic who were experiencing cardiopulmonary symptoms 8-12 weeks from initial inoculation, and to retrospectively identify any statistically significant risk factors or clinical features present.

Methods: This retrospective cohort study examined patients identified between April 2021 and September 2022. Patients who were diagnosed with COVID-19 and developed persistent symptoms were subsequently referred to the post-COVID-19 pulmonary clinic. For the cohort of patients seen in post COVID-19 pulmonary clinic, pre-existing pulmonary and systemic disease, severity of COVID-19 illness, and treatments received were examined. Analysis was performed on these data utilizing Cox regression analysis.

Results: Two hundred forty-six (246) adult patients who had Long COVID symptoms 8-12 weeks post-COVID-19 infection were identified and included in this analysis. Cox regression analysis indicated that in this population, patients who had required oxygen support (supplemental oxygen, noninvasive ventilation, or intubation) during their initial COVID-19 hospitalization and who also had prior history of either obstructive sleep apnea (OSA) or chronic obstructive pulmonary disease (COPD) and were more likely to develop Long COVID symptoms. Patients with pre-existing OSA had an odds ratio (OR) of 3.6 and a 95 % confidence interval (CI) of 1.70-7.65 (p=0.0012). Patients with pre-existing COPD had an OR of 12.19 and a 95 % CI of 2.38-62.33 (p=0.0015).

Conclusions: Patients who required oxygen support during their initial COVID-19 hospitalization who also had previous history of either OSA or COPD were more likely to develop cardiopulmonary Long COVID symptoms. This suggests that pre-existing respiratory conditions and the severity of the initial COVID-19 illness may influence the development of these symptoms of Long COVID.

Context: Dermatology remains one of the most competitive medical specialties, with successful candidates often demonstrating outstanding academic performance, extensive research experience, and strong letters of recommendation. The integration of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) into a single accreditation system in 2020 was intended to streamline residency training, but it has raised concerns about how Doctor of Osteopathic Medicine (DO) applicants will perform in dermatology residency match.

Objectives: This study examines the differences in DO and MD match rates following the single graduate medical education (GME) accreditation system, focusing on the match performance of DO dermatology applicants. It also analyzes the match rates of DO students into traditional ACGME (formerly allopathic)- and former AOA-accredited programs.

Methods: A retrospective review of National Residency Matching Program (NRMP) annual reports and the Association of American Medical Colleges (AAMC) Electronic Residency Application Service (ERAS) statistics was conducted for dermatology applicants from 2020 to 2024. Data were analyzed to compare the number of DO and MD applicants and their match rates to traditional ACGME (former allopathic)-accredited and former AOA-accredited programs. Data on the degree types of current residents at all ACGME-accredited residency programs were collected and analyzed. Statistical analyses included chi-square testing and bootstrapping for categorical variables and proportions.

Results: The study included 137 ACGME-accredited dermatology programs, with 26 (18.98 %) having previously received AOA accreditation. The analysis found that there were substantial discrepancies in postgraduate year 2 (PGY-2) match rates (p<0.05) between 2020 and 2024, with DO applicants matching at a lower rate. Furthermore, more DO applicants consistently matched into former AOA-accredited programs than into ACGME-accredited programs. Matched MD candidates outperformed matched DO applicants in terms of United States Medical Licensing Examination (USMLE) Step 1 scores (p=0.002) and research production (p=0.001).

Conclusions: In summary, DO applicants continue to have lower match rates in dermatology than MD applicants, with fewer DOs matching into traditional (formerly allopathic) ACGME-accredited programs. There are several reasons for this disparity. Systemic changes and further studies are needed to improve the success rates of DO dermatology applicants in future application cycles.

Context: Evidence supports osteopathic manipulative medicine (OMM) as an effective manual therapy, although it remains underutilized by Doctors of Osteopathic Medicine (DOs).

Objectives: Understanding barriers preventing the broader adoption of OMM is essential to expanding access to it as a noninvasive treatment option. We set out to survey both DOs and non-DO clinicians to identify perceived barriers to OMM.

Methods: Survey items were adapted from prior studies utilizing an iterative refinement process that included cycles of pilot testing with revisions. Participants were recruited internally from Mayo Clinic Midwest - a large, multistate, healthcare system in the Midwest region of the United States - utilizing internal email. Participants were given a descriptive survey that was developed with support from the Mayo Clinic Survey Research Center.

Results: The survey was sent out to a total of 952 individuals, including 184 DOs and 768 non-DO clinicians (MD, Bachelor of Medicine, Bachelor of Surgery [MBBS], nurse practitioners, and physician assistants). Respondents included 76 DOs (41.3 % response rate) and 91 non-DOs (11.8 % response rate). Of the 76 DO respondents, 21 (27.6 %) reported utilizing OMM clinically. Commonly reported barriers include time limitations, poor public perception, and lack of training in residency, and time is allocated to other professional interests.

Conclusions: Within a large health system that includes primary care and specialty care, few DOs practice OMM, citing time constraints, lack of residency training, and competing professional interests as primary barriers. These challenges might successfully be addressed through targeted osteopathic manipulative treatment (OMT) education in residency programs, enhanced compensation, and improved referral pathways.

Context: Across eight classes at Lincoln Memorial University - DeBusk College of Osteopathic Medicine (DCOM), survey data reveal a decrease in students' identification with osteopathy, which is what distinguishes an osteopathic physician's values, attitudes, and commitment to the tenets of osteopathy. Without intervention, this trend of decreasing osteopathic identification may produce future generations of osteopaths who devalue the specific tenets of osteopathy.

Objectives: This study aims to determine factors that influence a student's identification with osteopathy, as quantified by Likert-style survey response data, and to precisely quantify these factors' predictive effect on osteopathic identification while simultaneously controlling for other possibly confounding factors. We hypothesize that preparedness and osteopathic manipulative medicine (OMM) skills will be the strongest predictors of osteopathic identification.

Methods: We utilized retrospective survey data from 1991 past DCOM students. Identifying data were redacted and replaced with research IDs. The survey contained an item that gauged respondents' identification with osteopathy. To explore our primary objective, we utilized paired samples t tests to determine changes in osteopathic identification from matriculation to graduation within each class, as well as Pearson's correlation coefficient to determine each item's correlation with osteopathic identification. To explore objective 2, we utilized multiple regressions and structural equation modeling (SEM) path analyses to quantify these factors' ability to predict osteopathic identification.

Results: Osteopathic identification decreased between matriculation and graduation for each class (10-21 % decrease, p<0.001). Feeling highly motivated to serve the community correlated best with osteopathic identification upon matriculation (r=0.2; p<0.001). One's perception of one's OMM skills - both in explaining OMM philosophy (r=0.5; p<0.001) and utilizing OMM (r=0.5; p<0.001) - as well as feeling happy to be an osteopath (r=0.6; p<0.001), best correlated with osteopathic identification upon graduation. OMM Skills have the greatest direct predictive effect on osteopathic identification, with an effect size of 0.4 (p<0.001). Commitment to Organization, mediated by both OMM Skills and Preparedness, has the greatest overall predictive effect on osteopathic identification, with an effect size of 0.6 (p<0.001).

Conclusions: The current study builds on past research by utilizing SEM path analysis to elucidate the predictive value of multiple factors on osteopathic identification. Application of the current study should consider looking at interventions geared toward increasing students' OMM skills as well as their commitment to their institution, field, and career overall.