Journal of Osteopathic Medicine最新文献

Context: The coronavirus disease 2019 (COVID-19) pandemic necessitated a rapid transformation in medical education and research. Online learning became the standard to supplement in-person training and maintain accreditation requirements. Scholar 12 was constructed from the Scholar Series foundational lectures and a Master of Science in Medical Education thesis into a comprehensive research development platform accessible to all learners and institutions (https://scholar12.org).

Objectives: The objectives of this study were to involve students and faculty in a free, interactive virtual platform to address osteopathic literature deficits and scholarly activity criteria, promote new generational learning of research skills, build scholarly culture, and to employ Scholar 12 in a group-mentor research poster project to encourage osteopathic medical student participation in osteopathic-focused research.

Methods: A blinded, multi-campus, optional presurvey was digitally administered to third-year osteopathic medical students, prior to completing the Scholar 12 program, in collaboration with junior faculty mentors, during their Geriatrics/Osteopathic Principles and Practices (OPP) core rotation. Students self-reported their research skill competency relevant to each learning unit, on a 5-point Likert scale, before and after completing Scholar 12. Additional survey questions assessed the efficacy of the group mentor model and the quantity of further research presentations.

Results: Students' self-reported research skill competency scores significantly improved (p=4.53 × 10e^-8) after completion of Scholar 12, in comparison of the composite presurvey (n=1,800, 75.0 % response rate) vs. postsurvey responses (n=1,200, 50.0 % response rate), over four academic years (2020-24). Poster presentations for institutional research day grew an average of 166 % per academic year, after the introduction of Scholar 12, from 40 posters in 2019-2020 to 278 posters in 2023-2024.

Conclusions: The successful Scholar 12 implementation into a medical school curriculum demonstrated sustainable institutional scholarly activity growth through four consecutive academic years. Scholar 12 offers an accessible research learning platform relevant to undergraduate and graduate medical education objectives.

Context: Although a large proportion of US emergency physicians are osteopathic physicians (Doctor of Osteopathic Medicine [DOs]), the frequency of osteopathic manipulative medicine (OMM) use in emergency departments (EDs) is unknown.

Objectives: We aimed to estimate the frequency of OMM in EDs across the US and describe the cohort who received OMM.

Methods: We performed a retrospective cohort study of ED patients from 2018 to 2021 in the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Encounters with OMM were identified by diagnosis and procedure codes. We calculated weighted frequencies of encounters with OMM per 100,000 ED encounters with 95 % confidence intervals (CIs) by year, accounting for the complex survey design of NEDS.

Results: We identified 9,576 encounters with OMM during the study period. The weighted frequency of encounters with OMM per 100,000 ED encounters was 6.9 (95 % CI, 3.8 to 11.5) for 2018, 8.6 (4.3-15.5) for 2019, 12.6 (3.5-32.0) for 2020, and 5.5 (3.3-8.5) for 2021. Most patients were female (5,669, 59.2 %) with a median age of 53 (interquartile range [IQR] 36 to 67). The majority were from metropolitan teaching hospitals (7,094, 74.1 %), and about half were admitted (4,565, 47.7 %). The most common osteopathic diagnosis code was segmental and somatic dysfunction of the thoracic region (4,202 of 21,358 [19.7 %] codes).

Conclusions: OMM is infrequently provided across hospital-owned US EDs. Further research is needed to describe the frequency of OMM across all acute care settings.

Context: Osteopathic manipulative treatment (OMT) is an emerging nonpharmacological intervention utilized to address various health conditions, particularly among the elderly population. This scoping review aims to examine the available evidence regarding the effectiveness of OMT in improving pain, balance, and quality of life in geriatric patients, identifying gaps in the current research and suggesting future directions.

Objectives: This scoping review aims to evaluate the efficacy of OMT in elderly patients by analyzing selected studies that specifically explore its effects on balance, quality of life, and pain management. Additionally, this review will assess the current quality of evidence regarding these outcomes.

Methods: Selected articles from December 2012 to September 2024 focused on OMT in individuals aged 65 and older. We conducted a systematic literature search utilizing Medical Subject Headings (MeSH) and free-text terms combined with the Boolean operator "AND," including: OMT, osteopathic manipulative treatment, osteopathic medicine, aging, older adult, elderly, aged, and geriatric people. Databases, including PubMed, SCOPUS, Cochrane Library, and others, were searched from June 3, 2024 to September 3, 2024 following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Three authors (L.M., E.N., L.M.) reviewed the titles, abstracts, and full texts to determine eligibility. Disagreements were resolved through discussion. Filters included studies involving human subjects and studies published in English, Spanish, or Italian. Exclusions were made for literature reviews, protocols, commentaries, and nonosteopathic manual techniques.

Results: A total of 2,478 articles were identified; then, after removing 1,564 duplicates, 917 articles remained for screening. These articles were assessed based on their titles and abstracts, leading to the exclusion of 873 articles according to the established exclusion criteria. In the final phase, the remaining 44 articles underwent a full-text evaluation. This process resulted in the exclusion of 21 articles that were not randomized controlled trials (RCTs) and 14 articles that did not meet the required outcome measures. Ultimately, a total of nine articles were included in the systematic review.

Conclusions: This study highlights the effectiveness of OMT in improving pain, balance, and quality of life in geriatric patients. The findings underscore the value of OMT as a personalized therapeutic approach, promoting healthier aging and enhancing overall well-being in the elderly population. Further research is encouraged to explore the full potential of OMT, supporting its integration as a key component of osteopathic care for geriatric patients.

Context: Mental health conditions have been subject to significant societal stigma, which impacts the self-perception of people with mental illness and can impact their decision to seek treatment. General practitioners in the United States report overall negative attitudes toward people with severe mental illness; however, there are few studies into the beliefs of medical students on people with mental illnesses as well as the impact of stigmatizing language on these beliefs.

Objectives: The objectives of this survey were to evaluate the impact of stigmatizing language on medical students' responses to case presentations of mental illnesses, and to determine how these perceptions vary across the course of medical education.

Methods: We conducted an online survey wherein medical student participants reviewed psychiatric case vignettes, which varied in their use of either person-centered language (PCL) or stigmatizing language. All current students at the authors' institution were sent the survey link via email. Participants rated the case for symptom severity, their likelihood to recommend hospitalization, their level of comfort and safety when interviewing the patient, the trustworthiness of the patient's report, and the likelihood that the condition would improve over the next year. For analysis, these responses were summed to yield a Student Perception Index Score from 1 to 60, with 60 being the "most stigmatizing" perspective (i.e., lowest comfort, most likely to hospitalize, etc.).

Results: There were 87 total respondents, of which 44 answered the Stigmatizing vignettes and 43 answered the PCL vignettes, with roughly even respondents per year in school. Overall, there was not a significant difference between the PCL and stigmatizing language versions (p=0.73 for the major depression case; p=0.29 for the schizophrenia case). However, compared to first-year medical students, third-year students had significantly higher Student Perception Index Scores for the stigmatizing depression case (p=0.002), and fourth-year students had significantly higher stigma scores for the PCL depression case (p=0.02).

Conclusions: Although there was no overall difference between the average Index Scores for the PCL and stigmatizing versions of the case presentations, significant differences in the Index Scores of certain presentations for students undergoing clinical education indicate that some targeted education on mental health stigma may be beneficial for third- and fourth-year medical students. Teaching empathetic approaches to patients with mental illness, regardless of whether their presentation was "stigmatizing," emphasizes the holistic care expected through the osteopathic tenet describing the interconnectedness of mind, body, and spirit.

Context: Applying into urology residency is highly competitive. Disparities in osteopathic (Doctor of Osteopathic Medicine [DO]) representation exist within the current urology workforce.

Objectives: This study aimed to examine the number of DO graduates in urology residency programs over time and map their current distribution throughout the United States.

Methods: All US urology residency programs for the 2023-2024 academic year were identified, and residents' postgraduate year and degrees, and the program's states, were collected from each program's websites. DO residents were stratified by their postgraduate years to observe the trends in the number of urology residents over the past 5 years. Their geographical distribution was evaluated. The number of DO urology residents per state and their ratio among all urology residents per state were examined.

Results: Among 135 urology residency programs analyzed, 1753 urology residents were identified. Ninety-nine residents hold a DO degree from a total of 39 urology programs (28.9 %). The number of DOs that matched into urology has been steadily increasing from 15 in 2019 to 26 in 2023 (R ²=0.8556, p=0.0244). Michigan had the greatest number of DO urology residents (n=35). Pennsylvania (n=10, 7.81 %) and South Carolina (n=10, 40 %) had the second highest. Illinois (n=7, 7.14 %) had the third highest. More than half of the states with urology residency programs had no DO residents (n=27, 62.8 %).

Conclusions: Osteopathic medical training plays an important role in the urology workforce, and there is an increased recognition of DOs within urology residency programs in the United States. In the era of urologist shortages, efforts to support the contributions of DOs in underserved and rural communities may have a profound impact in this field.

Context: Clinicians face a difficult challenge in identifying vertebrobasilar insufficiency (VBI) resulting from atherosclerosis. VBI is a term utilized to describe a reduction in blood flow to the vertebral and basilar arteries that supply the posterior cerebral system. For musculoskeletal clinicians, diagnostic differentiation of VBI is essential, because its presence directly impacts the clinical use of manual treatment interventions. Clinical guidelines provide a set of cardinal symptoms (inclusive of Coman's 5D's) in which VBI may manifest, the accuracy of which is under contestation because literature provides evidence suggesting a wider set of symptoms.

Objectives: The objectives of this study were to gather all relevant literature reporting features of VBI pertaining to atherosclerosis, with the aim to help provide evidence that may guide clinical practice in the use of manual therapy interventions and to raise awareness of the manifestations that VBI may present.

Methods: Six databases were searched from inception to September 2024 (Allied and Alternative Medicine Database [AMED], AgeLine, SPORTDiscus, Medical Literature Analysis and Retrieval System Online [MEDLINE], Cochrane, and Cumulative Index of Nursing and Allied Health (CINAHL Plus). Articles were screened in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, The included articles required a diagnosis of VBI through clinical examination with radiological evidence of atherosclerotic lesions, without evidence of existing or previous neurological infarcts, concomitant arterial pathology, or any other form of pathological mechanism. Primary data were extracted utilizing a template, and the methodological quality was assessed utilizing the Joanna Briggs Institute critical appraisal tool. Findings were summarized utilizing a narrative synthesis and a table of descriptive statistics.

Results: Two hundred and eighty-three papers were identified, and 15 were included (93 cases, 50M/43F, age 64 years old ± 9 standard deviation [SD] yrs). Vertigo was the most common reported symptom, within a total of 37 different symptoms reported either in isolation or combination. Symptoms inclusive to Coman's 5D's accounted for 22 % of reported features.

Conclusions: Vertigo is the most common symptom (27.7 %) of VBI induced by atherosclerosis. However, there is not sufficient data to make concrete conclusions, although results do instill doubt over the sole use of Coman's 5D's in clinical practice. Prospective observational studies with standardized data extraction for VBI symptoms and their pattern of behavior are warranted.

Context: A small percentage of patients comprise a high proportion of healthcare utilization, particularly the costs associated with Emergency Department (ED) visits and inpatient hospitalization readmissions.

Objectives: The purpose of this study was to demonstrate a decrease in ED utilization and hospital readmissions in a selected group of super-utilizers post-intervention by a Community Care Coordination (CCC) team and to determine cost avoidance.

Methods: This was a retrospective chart analysis of selected super-utilizers enrolled in our CCC program. Each patient served as their own historical control to compare utilization rates, and a cost-benefit analysis was performed.

Results: A total of 368 patients participated in the CCC program during the specified time period. We found a significant reduction in ED visits and hospital admissions post-enrollment. The cost-benefit analysis showed an overall cost avoidance of $2,508,899.40, which is a 46 % cost reduction.

Conclusions: Our study demonstrates a reduction in healthcare utilization and provides critical information to fix the significant, national burden that ED super-utilizers impose on the healthcare system. This program aligns well with the osteopathic principles of the whole-person approach, emphasizing prevention and wellness and prioritizing dignity in healthcare.

Context: Research and scholarship are core drivers of medicine in the modern era. Evidence-based practice continues to replace expert opinion and long-held practice beliefs. Involvement in the development and writing of these guidelines is critical for Doctors of Osteopathic Medicine (DOs) to maintain a seat at the academic table. According to the American Osteopathic Association (AOA), 11 % of practicing physicians in the US are DOs. This number is growing, as nearly 25 % of current medical students attend an osteopathic medical school. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine.

Objectives: To quantify the contribution of DOs to the body of literature guiding practice, author information was extracted from all US-based guidelines published in the years 2021, 2022, and 2023 listed in the Emergency Care Research Institute (ECRI) Guidelines Trust database.

Methods: Authors of US-based guidelines listed in the ECRI Trust database from the years 2021-2023 were counted and categorized into one of three groups based on terminal degree: MD holders, DO holders, and Other-degree holders. Authors whose degrees could not be identified were counted as "Unidentifiable." Additional data including sponsoring organization, organization type, and specialty were collected.

Results: A total of 674 guidelines were published by US organizations in 2021, 2022, and 2023, with 604 reporting author information. A total of 9,376 authors were counted. Of that, 7,253 held an MD (77 %), 110 held a DO (1.2 %), and 1,848 held another terminal degree (19.7 %); meanwhile, 1.66 % of counted authors did not have an identifiable degree. A total of 604 guidelines published by US organizations were identified. Of these, 88 (14.6 %) contained at least one DO author in their author list. Sixty-two unique specialties were identified, along with 130 unique sponsoring organizations. Of those specialties, 28 (44.4 %) had at least one DO author of at least one guideline. Of 130 sponsoring organizations, 44 (33.8 %) developed at least one guideline with at least one DO author. No osteopathic sponsoring organizations were identified.

Conclusions: Based on these results, we conclude that DOs are underrepresented in the development of guidelines.