Journal of Osteopathic Medicine最新文献

Context: This pilot study assessed participants adherence rate and the effect size needed to determine the sample size for a full-scale study evaluating the effectiveness of forward head posture (FHP) correction on temporomandibular disorders (TMDs) and symptoms. Moreover, the potential impact of adding FHP correction to a standard conservative protocol for treatment of TMD severity, pain, and pain-free mouth opening range is explored.

Objectives: The primary objective was to investigate the additional effect of FHP correction by a cervical extension traction (CET) orthotic on myogenic TMD symptoms of pain and function.

Methods: A total of 21 participants (19 females) were enrolled and completed the study. The participants' mean age was 21.99±2.06 years, body mass index (BMI) 22.92±4.27 kg/m². A randomized clinical trial was conducted with participants who were randomly divided into two groups: 1) an experimental group with 10 participants receiving a FHP CET orthotic and a conservative TMD protocol; and 2) a control group with 11 participants receiving the conservative TMD protocol and a placebo CET device utilizing a standard pillow. Outcome assessments included: TMD severity with Fonseca's questionnaire, numerical rating scale for pain intensity, maximum mouth opening (MMO), and the craniovertebral angle (CVA) to measure FHP. Assessments were performed at three time points (baseline, 3rd week, 6th week), and three treatment sessions per week for six consecutive weeks were administered.

Results: Both groups achieved a high adherence rate to the study protocol (≥90 %). Within-group analysis for both groups, across the three time points, identified significant differences utilizing Friedman's test (p<0.001) between measures for orofacial pain, TMD severity, MMO, and CVA. Between-group comparison identified no difference at the follow-up assessments for orofacial pain or MMO measures (p>0.05). The Mann-Whitney U test for between-group comparisons identified a statistically significant difference in CVA at week 3 (p=0.01) and at the 6th week (p<0.001) favoring the experimental group. For the TMD severity score, no difference was found at week 3 (p=0.11) but there was a significant difference between groups at week 6 (p=0.02) favoring the experimental group.

Conclusions: These preliminary findings suggest that adding FHP correction through the application of a CET orthotic might offer short-term selected benefits for chronic TMD symptoms, which would need to be confirmed in a full-scale trial. High adherence rates were found with a moderate effect size that provided data indicating that at least 38 participants would be required for a full-scale study.

Context: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication and repetitive behaviors. Its etiology is influenced by a combination of genetic and environmental factors. Variations in the methylenetetrahydrofolate reductase (MTHFR) gene, which is implicated in folate metabolism and neurodevelopment, are widespread in the autism population. Understanding the relationship between MTHFR gene variations and ASD may be critical for early diagnosis and intervention.

Objectives: This study aims to investigate the association between MTHFR gene variations and the severity of ASD symptoms in a clinical cohort. The goal is to determine whether reduced MTHFR activity correlates with increased symptom severity, thus offering insights into potential mechanisms and intervention strategies.

Methods: A cohort of 78 patients diagnosed with ASD who had previously undergone genetic testing to measure MTHFR activity levels were recruited. ASD severity was assessed utilizing DSM-5 criteria. Statistical analyses were performed to evaluate the relationship between MTHFR activity and ASD symptom severity.

Results: The analysis identified a significant negative correlation between MTHFR activity levels and ASD severity (p<0.05). Patients with lower MTHFR activity exhibited more severe ASD symptoms, as measured by DSM-5 classifications. These findings emphasize the potential link between MTHFR gene variations and neurodevelopmental outcomes in ASD.

Conclusions: This study highlights the role of MTHFR gene variations in modulating ASD severity. The results support the potential for utilizing MTHFR activity as a biomarker for early screening and tailoring targeted interventions for individuals with MTHFR deficiencies. Due to a small sample size, any conclusions drawn from this study are limited and may be misleading in future studies. Further research is warranted to explore the underlying mechanisms and to develop clinical strategies that mitigate the impact of these genetic variations on ASD progression.

Context: In an era in which clinical research plays a crucial role in advancing medical knowledge and contributing to the resume of medical students attempting to match into a residency, the creation of sustainable and effective research opportunities within medical education is paramount. Colleges of Osteopathic Medicine (COMs) face unique challenges in creating these opportunities in a scalable and cost-efficient manner. Without these opportunities, osteopathic medical students may find themselves at a disadvantage compared to their allopathic counterparts in residency placements and academic career paths.

Objectives: We have created a template for providing perpetual, streamlined, scalable, cost-effective clinical research at our institution, and we believe that it can be implemented at other COMs. This abstract describes our research template and its outcomes.

Methods: Our template for creating clinical research opportunities has been in operation for the past 3 years. All of our studies are structured as retrospective analyses of data obtained from the electronic medical records of patients admitted to the hospital over a specific time frame. Initially, a broad-based research proposal is submitted to the hospital Institutional Review Board (IRB) on a particular topic. From this, multiple initial IRB research projects are generated. First- and second-year medical students go through a standardized application and onboarding process prior to participation in research. Students are then subdivided into research groups of four students each. Each research group is assigned a research topic and a faculty mentor who will help them navigate through the research project.

Results: Since 2022, a total of 295 medical students have participated in clinical research through this model, supported by 11 faculty research mentors. Across four completed research cycles, 64 projects have been conducted, resulting in 62 poster presentations (97 %), 15 peer-reviewed publications (23 %), and 6 additional manuscripts (9 %) currently under review.

Conclusions: Clinical research opportunities at COMs are needed now more than ever before. Over the past 3 years, our clinical research template has been proven to provide perpetual, streamlined, scalable, cost-effective clinical research. We believe that our template can be utilized to provide increased clinical research opportunities at other COMs.

This article examines the sentiments of a Phoenix-area hospitalist who feels underpaid despite earning an objectively high salary. While physician compensation in the United States, including that of hospitalists (around $365,000 in Phoenix), ranks among the highest globally and places them in the top income percentiles domestically, the perception of being "underpaid" persists. The piece argues this feeling is a complex value judgment, influenced by the immense effort, sacrifice, and societal contribution inherent in the profession, often perceived as inadequately reflected by market-driven compensation. Cognitive biases, such as the Intrinsic Worth Fallacy and Social Comparison Bias, further shape this perception. Systemic healthcare issues, including administrative burdens and professional disempowerment, also contribute, leading to dissatisfaction where salary becomes a primary, yet seemingly insufficient, metric of worth. The article concludes that true professional value transcends monetary figures, calling for systemic changes to better acknowledge and support physicians, ensuring their profound contributions are recognized beyond financial metrics.

Context: Healthcare inequities disproportionately affect underprivileged groups, leading to negative health outcomes. Challenges are compounded in regions like Appalachian Ohio, where rurality and poverty exacerbate issues such as access to care and environmental stressors, significantly impacting conditions like asthma. In severe cases of asthma, sinus surgery is sometimes indicated, because it has been shown to improve asthma-related symptoms. However, the specialists who perform these procedures, such as otolaryngologists, may be less available to certain underprivileged groups.

Objectives: The purpose of this study was to compare the effects of social determinants of health on the prevalence and treatment of asthma in Appalachian vs. non-Appalachian regions of Ohio, and how those factors affect the rate at which sinus surgery is performed in different populations.

Methods: This cross-sectional study utilized public data gathered in the year 2021 from the Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) to compare asthma prevalence, emergency visit and hospitalization rates, sinus surgery frequencies, and social determinants of health in Appalachian vs. non-Appalachian regions.

Results: Both the average prevalence rate of asthma (p<0.001) and the number of emergency department visits as a complication of asthma (p<0.01) in Appalachian Ohio counties were significantly higher than non-Appalachian counties. Interestingly, the ratio between sinus surgery prevalence and the number of procedures was not statistically different between Appalachian and non-Appalachian counties. This included balloon sinuplasty (p=0.4), septoplasty (p=0.4), and functional endoscopic sinus surgery (FESS, p=0.4). Additionally, several social determinants of health, specifically the poverty rate (r=0.9, p<0.001), uninsured rate (r=0.4, p<0.001), unemployment rate (r=0.5, p<0.001), and housing burden rate (r=0.6, p<0.001) were shown to have a significant correlation with the rate of asthma prevalence among adults in Ohio.

Conclusions: Asthma prevalence and treatment availability differ significantly between Appalachian and non-Appalachian regions of Ohio, highlighting the need to improve access to specialists and address barriers to care in rural populations.

Context: Patients with Ehlers-Danlos Syndrome (EDS) and hypermobility spectrum disorder (HSD) often complain of palpitations, presyncope/syncope, attributable to postural orthostatic tachycardia syndrome (POTS). Occasionally, the etiology of these complaints is not positional, unclear, and may require further cardiac evaluation, including cardiac monitoring. To our knowledge, the utility of implantable loop recorders (ILRs) has yet to be explored in this population.

Objectives: This study aimed to evaluate the utility of the ILRs in diagnosing and/or excluding arrhythmias not attributable to POTS in symptomatic patients with EDS and HSD.

Methods: Patients with EDS and HSD were referred from the New York Institute of Technology (NYIT) Ehlers-Danlos Syndrome/Hypermobility Treatment Center to the Long Island Heart Rhythm Center (LIHRC) for cardiac evaluation between January 2019 and November 2023. A retrospective analysis of observational de-identified data from the LIHRC was permitted by the NYIT College of Osteopathic Medicine Institutional Review Board (BHS-1465). Patients were monitored monthly, and the utility of the ILRs was assessed based on a correlation of symptoms to an arrhythmia, the ability of the device to monitor therapy efficacy, and/or to rule out an arrhythmia as the explanation of symptoms. Data is reported as percentages and mean ± standard deviation (SD).

Results: A total of 116 hypermobile patients (81 EDS/35 HSD) were evaluated. Among these patients, 31 (26.7 %) received an ILR (length of follow-up, 27.3 months ± 14.0 months), 29 females/2 males, 28 patients had EDS, 3 patients had HSD, age 34.1 ± 11.4 years. Symptomatic sinus tachycardia (ST) occurred in 16 patients (51.6 %), and ST helped diagnose POTS and/or monitor therapy in 15 (48.4 %). Symptomatic premature ventricular complexes (PVCs) occurred in 8 patients (25.8 %), supraventricular tachycardia (SVT) in 6 (19.4 %), and ventricular tachycardia (VT) in 1 (3.2 %). In 2 patients, ILR findings led to further interventions, including PVC ablation and an implantable cardioverter-defibrillator (ICD) for symptomatic VT. The ILR demonstrated utility in all patients.

Conclusions: This study demonstrated the utility of the ILR in identifying symptomatic arrhythmias in patients with EDS and HSD. ILR monitoring also aided in solidifying a POTS diagnosis and guiding patient management/treatment efficacy. Further evaluation in a larger cohort is needed to further understand the impact of ILR monitoring in hypermobile patients.

Context: There is currently no clinical research investigating the effect of osteopathic manipulation on the milk supply of lactating patients. Herbal and prescription galactagogues are limited and have the potential for serious side effects.

Objectives: The objective of this study was to determine whether osteopathic manipulative treatment (OMT) can increase milk supply in lactating people with low milk supply (hypogalactia).

Methods: The patients presented in this series participated in an Institutional Review Board (IRB)-approved prospective pilot study. All participants were aged 18-40 years old and 2-28 weeks postpartum with the desire to exclusively breastfeed with infants who weighed at least 2,500 g at birth. At 1 h, the measured milk production was <1 oz expressed through a hospital-grade pump. Participants were ineligible if they were utilizing prescription galactagogues or had a contraindication to OMT. They were treated with an OMT protocol plus ad lib OMT once a week for 4 weeks. The study was suspended and ultimately closed due to the SARS-CoV-2 pandemic.

Results: All three participants demonstrated an increase in milk production from baseline at each visit. Given the small number of participants, these results are not statistically significant. Power analysis calculated a need for 10 subjects. Therefore, these patients are presented as a case series.

Conclusions: These results show promise for the use of osteopathic manipulation to increase human milk production. A study with a larger number of participants is needed.

Context: There is not much current literature looking at anxiety and depression in athletes transitioning out of college sports into the real world. This study identified gaps in the current mental health literature for former college athletes and what interventions are currently being offered to help them. By utilizing the gaps identified in the current literature, we provided recommendations for educational programs that are modeled on the programs that professional sports leagues offer while utilizing the existing college infrastructure. We also encourage future research to perform longitudinal studies following these athletes as they transition from sports.

Objectives: Collegiate sports participation is integral to culture and identity. Transitioning from athletics to regular life often leads to significant mental health concerns. Abrupt lifestyle and identity changes can result in dietary, career, and health consequences that impact athletes' mental well-being. While some data addresses this transition, research focused on developing best practices to support athletes during this period remains limited. This study aims to conduct a systematic review to identify the existing research and gaps concerning the described supports in mental health, particularly depression and anxiety, in retired athletes.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines. We analyzed original research, literature reviews, systematic reviews, meta-analyses, clinical trials, and case studies. Articles were sourced from PubMed (MEDLINE), Embase, Scopus, Cochrane, and Web of Science.

Results: A total of 169 articles were identified, with 61 selected for full-text screening and nine included in the study. These nine articles comprised four cross-sectional studies analyzing survey data, four systematic or scoping reviews, and one qualitative analysis. While all articles addressed depression or anxiety, most focused on individuals returning to exercise post-injury and quality of life.

Conclusions: Current research highlights the needs of collegiate, professional, and retired athletes. Limited literature exists on former collegiate athletes, with available studies emphasizing university programs to ease transitions and help athletes apply their skills in retirement. Research gaps include examining programs across divisions and sports, minimizing self-reporting surveys, and conducting longitudinal studies. Future efforts should focus on addressing these gaps to better support athletes transitioning to life beyond sports.