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.
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.
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