Journal of Osteopathic Medicine最新文献

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: 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: 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: 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.