Journal of Osteopathic Medicine最新文献

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.

Context: Simulation-based medical education (SBME) is a method for enhancing learner skill prior to initiating care for real patients. Although the use of SBME continues to grow, there is limited data on simulations related to osteopathic medical training. Osteopathic manipulative medicine (OMM) applies hands-on techniques to facilitate healing. We hypothesized that the use of SBME to closely mimic OMM provided to the hospitalized patient would help to increase individual knowledge and comfort with OMM techniques and increase the likelihood of a learner utilizing OMM techniques on patients.

Objectives: This study aimed to determine the effectiveness of the SBME lab to enhance the learning of medical learners of OMM on hospitalized patients, and to determine the favorability of the OMM SBME experience by learners.

Methods: This was a single-institution pilot quality improvement project that utilized a novel simulation to provide OMM to critically ill and hospitalized patients. The simulation was a single instructor-led event lasting 2 h. The OMM experience utilized specialized simulation gowns and hospital beds to mimic the treatment of postsurgical ileus, acute respiratory failure, and congestive heart failure (CHF) exacerbation. Learners alternated between the role of physician (practicing technique) and the patient (wearing the simulation gown). Pre- and postsurveys evaluated learners' knowledge and comfort regarding OMM in hospitalized patients. Graduate medical residents/fellows from five osteopathic-recognized programs and medical students on rotations (n=35) participated in the simulation, and n=32 completed the postsimulation survey. The survey included 15 questions and utilized a 5-point Likert Scale. Results were analyzed with the chi-square test.

Results: The average knowledge pretest score ranged from 2.5 to 3.5 for the 15 questions. Learner knowledge improved for all areas evaluated, with a range of 3.6-4.6 for the postsurvey. The p-value was significant for each question. In addition, lab, simulation, and lecturers were evaluated and were received positively.

Conclusions: This study demonstrates that simulation may be an effective way to increase knowledge and comfort on how to apply OMM in a hospital setting.

Context: Research on the effects of osteopathic manipulative treatment (OMT) on visual functions and conditions is very limited. This study continues the exploration on the application of OMT with the intent of lowering intraocular pressure (IOP).

Objectives: A pilot randomized clinical trial was conducted to assess the impact of one OMT session on patients diagnosed with suspected ocular hypertension (OHT) or glaucoma.

Methods: Patients meeting the inclusion and exclusion criteria were randomized to OMT treatment or no-treatment control groups. Total n=16: treatment=9, control=7. The OMT included osteopathic cranial manipulative medicine (OCMM) along with myofascial release (MFR) and soft-tissue procedures. There were no adverse events reported in either cohort. Each patient was seen in AM and PM sessions for 5 days; the first 2 days established eligibility to be randomized to treatment or control cohorts after the Day 3 AM IOP assessment. Subjects in the control group laid on the treatment table with no OMT performed. Immediately after the intervention, the patient had a second Day 3 IOP assessment, then a PM IOP assessment. On Day 4, the patient received an AM and PM IOP assessment, and on Day 5, at the 1-week follow-up time period the patients again received AM and PM IOP assessments.

Results: In the OMT treatment group, significant IOP reductions were detected posttreatment with differences between the Day 3 initial AM pre-randomization IOP level and the immediate postintervention IOP (p=0.027; -1.361 mmHg), the Day 4 PM (p=0.016; -1.556 mmHg), and the Day 5 PM (p=0.014; 1.382 mmHg).

Conclusions: The application of OMT shows potential benefit in the reduction of IOP in patients with suspected OHT and patients with suspected glaucoma.

Context: Following the transition to a single graduate medical education (GME) accreditation system in 2020, leaders at American Association of Colleges of Osteopathic Medicine (AACOM) were interested in learning more about the research being done about osteopathic medical education leading up to that point in time.

Objectives: The objective of this scoping review was to identify trends in undergraduate and graduate osteopathic medical education and to determine where this information was being disseminated and the institutions who were creating the content.

Methods: Searches were conducted in eight databases: PubMed (National Center for Biotechnology Information [NCBI]), MEDLINE (Ovid), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature ([CINAHL], EBSCO), Education Research Complete (EBSCO) OSTMED.DR, Education Resources Information Center ([ERIC], Ovid), and Scopus (Elsevier). Gray literature sources were also identified. All 10 authors were involved in the search. Search terms were identified by utilizing Medical Subject Headings (MeSH), the Yale MeSH Analyzer, and through consultation with an expert searcher. Sources were excluded if they were not in English, were based outside of the United States, did not fit in the date range of being published between 2010 and 2020, and included information on COVID-19. The research team conducted title/abstract screening based on the inclusion and exclusion criteria.

Results: A total of 8,083 articles were identified and included through searches, ending in a total of 1,203 articles after full-text screening. Most sources for this osteopathic medical education review were journal articles (n=505) and conference proceedings (n=482). A total of 23 trends were identified, with the top three being residency (n=318), curriculum (n=235), and pedagogy (n=178). None of the other 23 primary trends were above 6.9 %.

Conclusions: Osteopathic medical education trends from 2010 to 2020 were primarily focused on residency, curriculum, and pedagogy. This information was disseminated evenly between published journal articles and conference presentations, and osteopathic institutions that have existed longer and have established research track records were more likely to publish and share information in this area.

Context: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

Objectives: The main objective of this study aimed to investigate recent match rate trends in orthopedic surgery within the past 5 years and to forecast match trends for both allopathic and osteopathic students to further analyze the future projection of the orthopedic surgery match.

Methods: This study utilized publicly available data from the National Residency Match Program (NRMP) Main Residency Match data. Data were collected retrospectively from 2020 to 2024 regarding students applying for orthopedic surgery residency. The number of matched Doctor of Osteopathic Medicine (DO) applicants, Doctor of Medicine (MD) applicants, overall applicants, and the proportion of matched applicants being DOs were forecasted over the next 10 years utilizing an Autoregressive Integrated Moving Average (ARIMA) model in SPSS 29.0. This model harvests data from previous instances (number of matched applicants from 2008 to 2024) to develop a close-fit model to predict future values and their respective confidence intervals (CIs). This study incorporated all applicants applying to orthopedic surgery, including international medical graduates (IMGs).

Results: There was an increase in the total applicants applying to orthopedic surgery residency positions for both allopathic and osteopathic students. The largest increase in applicants occurred between the 2021 and 2022 application cycles. There was a statistically significant difference in the total number of applicants overall over the 2020-2024 match cycle. The percentage of DOs to match into an orthopedic surgery residency position decreased from 63.28 % in 2020 to 45.70 % in 2024, and there was a statistically significant decline in the match percentage of DOs in orthopedic surgery residency over the 2020-2024 match cycle. Based on the ARIMA model projection utilizing data from 2008 to 2024, there is expected to be an average increase of 14.1 % in the total number of positions offered by 2034, to 1,045 positions total. There is expected to be a moderate increase in the number of matched DO applicants, from 128 in 2024 to 161 in 2034. Utilizing data from 2016 to 2024, there is expected to be

Context: The healthcare industry faces a critical shortage of qualified physicians. To address this growing concern, medical schools nationwide are increasing their efforts to recruit and train premedical students to fill this gap. Those efforts include adequately preparing premedical students with the competencies and skills to meet the application requirements and gain acceptance to the medical school of their choosing. These requirements include a Medical College Admission Test (MCAT) score at or above the mean of 504, a grade point average (GPA) at or above the mean of 3.61 for the total GPA and 3.53 for the science GPA. The application also requires demonstrating specific core competencies, including patient care, communication, and problem-solving skills evidenced by activities and achievements. Unfortunately, many premedical students are unsure of what activities and experiences fulfill these competencies, the expectations of medical school and clinical practice, and the roles and responsibilities in various settings. Therefore, early exposure and guidance when selecting these experiences and activities are vital in helping premedical students to make informed decisions and select experiences that align with their career goals. While obtaining clinical experiences can be challenging, these requirements may provide invaluable insights into the profession and fulfill competencies required for medical school admission. Furthermore, these experiences familiarize students with clinical and interprofessional settings early in their careers. Because premedical students are better equipped to gain admission to medical school, universities can expand their pool of qualified and adequately prepared candidates matriculating into medical training.

Objectives: This review aims to determine how US premedical osteopathic and allopathic students gain clinical experiences and extracurricular activities that enhance their application and increase their chances of admission into a medical school of their choice.

Methods: The authors conducted a comprehensive search of Education Resources Information Center (ERIC), Scopus, Excerpta Medica dataBASE (EMBASE), and other databases for original peer-reviewed studies of undergraduate, premedical, and medical students in the United States utilizing the deconstruction technique. The authors utilized thematic analysis to unearth overarching themes from the results and outcomes of these studies.

Results: The authors reviewed 14 studies published between 2004 and 2022. The articles addressed two main themes: the types of clinical experiences and extracurricular activities that increase medical school admission and those that meet the critical competencies required for medical school and osteopathic practice. Activities such as shadowing, research, healthcare, and volunteering were identified repeatedly. Self-reporting, researcher bi

Context: With the advent of the Single Accreditation System (SAS) within the Accreditation Council for Graduate Medical Education (ACGME), few programs have achieved Osteopathic Recognition (OR) status to date. OR is an accreditation that graduate medical education (GME) programs can achieve to distinctly acknowledge the additional focus on osteopathic training. There is an effort by national osteopathic organizations to determine barriers for programs to achieve OR and what innovative methods might help overcome them. In identifying its own barriers, a central Ohio hospital created a unique Program Director for Osteopathic Medical Education (PDOME) role to assist its 10 programs in achieving OR.

Objectives: The objectives of this study were to determine the effect that a PDOME role has through measures of the numbers of programs achieving OR and standards met, as well as the perceived 'helpfulness' of the role based on surveys of program leadership.

Methods: Upon initiation of the PDOME in July 2021, the PDOME assessed applications, citations, and curriculums of the 10 hospital programs with varied OR status to help determine curricular goals. Additional osteopathic activities, evaluation tools and faculty development were subsequently offered based on this information and needs assessments of the programs. A survey was sent to all programs at intervals of 12 and 18 months after role inception to be utilized as process improvement. Comparisons were made between surveys, as well as between the total number of programs with continued OR status and the total OR requirements achieved before and after PDOME. A chi-square test (or Fisher's exact test when the 'n' was too small) was utilized for significance, and the p value was set at 0.05.

Results: After the PDOME, there was a significant increase in the number of OR standards met across programs (p<0.001). Although not significant, the number of programs achieving continued OR increased from 4 to 8 (p=0.168). Due to many positive responses in both surveys, there was no significance between surveys in the "helpfulness" of PDOME; however, there was a significant increase in the number of respondents from 13/67 (or 19.4 %) to 32/67 (or 47.8 %) (p<0.001), indicating increased engagement among respondents.

Conclusions: This study suggests that a PDOME role in medical education may be well received and may assist GME programs in achieving OR. Implementation of a similar role elsewhere could help programs overcome barriers and stir growth in OR programs nationwide.

Context: The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges.

Objectives: This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors.

Methods: A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15-30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher's exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different.

Results: Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission.

Conclusions: Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.