Journal of Osteopathic Medicine最新文献

{"title":"Medical student perceptions of psychiatric conditions and the impact of stigmatizing language.","authors":"Zach Monahan, Vivian Stevens, Micah Hartwell, Alicia Ito Ford","doi":"10.1515/jom-2024-0263","DOIUrl":"10.1515/jom-2024-0263","url":null,"abstract":"<p><strong>Context: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"427-433"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department wait times in concordance with blood alcohol content and subsequent alcohol use disorder.","authors":"Sean Hayes, Kaylee Mach, Jennifer Briggs, Micah Hartwell","doi":"10.1515/jom-2024-0168","DOIUrl":"10.1515/jom-2024-0168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;In the United States, nearly 80 % of the adult population reported lifetime alcohol use, with 50 % of those reporting alcohol consumption within the past 30 days in 2019. The expense of excess alcohol intake was estimated to have an annual associated healthcare cost of $28 billion, and there was greater than $221 billion in additional costs due to the detrimental effects of excess alcohol intake on productivity and societal setbacks over the last year. Alcohol use disorder (AUD) provides a major barrier for patients seeking medical treatment, because AUD is consistently regarded as one of the most stigmatized disorders globally. Provider-based discrimination toward patients with AUD may lead to providing a lower quality of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our objective was to assess whether patients with a history of AUD and/or positive blood alcohol content (BAC+) affect emergency department (ED) wait times. We hypothesized that patients presenting to the ED with AUD+/BAC+ would have longer wait times. Secondarily, we investigated the impacts of sociodemographics within these analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional analysis of the 2019-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS). Individuals' primary diagnosis had to be of musculoskeletal origin based on ICD-10 codes starting with 'S' for skeletal or bodily injuries or 'M' for diagnoses related to musculoskeletal or connective tissue conditions. Wait time was quantified from time of entry into the triage system to the time patients were seen by the first provider. We included data points with or without a recorded history of alcohol misuse or dependence (AUD&lt;sup&gt;+/-&lt;/sup&gt;) in their chart and those with a positive or negative blood alcohol content (BAC&lt;sup&gt;+/-&lt;/sup&gt;).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;ED wait times among individuals presenting with musculoskeletal injuries with a current history of AUD presenting with BAC- at the time of triage were not significantly different from those without a history of AUD. Individuals who were BAC+ at the time of triage had shorter wait times regardless of AUD history - and only AUD-/BAC+ had shorter wait times. Our binary regression and adjusted models showed that individuals who were AUD-/BAC+ had a significantly shorter wait time (minimum -18.43, standard error [SE]=1.92, &lt;i&gt;t&lt;/i&gt;=-9.59, p&lt;0.001; SE=2.97; &lt;i&gt;t&lt;/i&gt;=-5.62, p&lt;0.001) compared to individuals who were AUD-/BAC- respectively. Those who were AUD+/BAC+ also had shorter wait times compared to AUD-/BAC- (min=-11.11, SE=4.05; t=-2.75, p=0.006).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Overall, our study showed no significant difference in ED wait times between individuals with and without a history of AUD - indicating that AUD history does not delay being seen. Shorter wait times for those entering the ED BAC+ may be due to their immediate need for treatment due to toxicity or alcohol withdrawal syndrome, having more ","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"553-559"},"PeriodicalIF":1.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical distribution of osteopathic urology residents and match trends in the United States.","authors":"Ryan Wong, Bebe Eke, Andrew D Vogel, Bracken Burns, Kristen Conrad-Schnetz","doi":"10.1515/jom-2024-0252","DOIUrl":"10.1515/jom-2024-0252","url":null,"abstract":"<p><strong>Context: </strong>Applying into urology residency is highly competitive. Disparities in osteopathic (Doctor of Osteopathic Medicine [DO]) representation exist within the current urology workforce.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>R</i> 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 %).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"533-537"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: The predictive validity of MCAT scores and undergraduate GPA for COMLEX-USA licensure exam performance of students enrolled in osteopathic medical schools.","authors":"Kenneth D Royal, Christian Meyer, Erik Guercio, Mark Speicher, Joseph Flamini, Jeanne M Sandella, Tsung-Hsun Tsai, Cynthia A Searcy","doi":"10.1515/jom-2025-2001","DOIUrl":"10.1515/jom-2025-2001","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"467"},"PeriodicalIF":1.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swelling and skin changes: an osteopathic approach to pediatric lymphedema management.","authors":"Stephanie Jackson, Afreen Hussaini, Julisa Galan, Tsz Chun Chung, Britani Javed","doi":"10.1515/jom-2024-0235","DOIUrl":"10.1515/jom-2024-0235","url":null,"abstract":"<p><strong>Context: </strong>Pediatric lymphedema is a progressive condition of chronic swelling and soft-tissue damage, caused by impaired lymphatic function. It affects nearly 1 in 100,000 children in the United States, raising challenges of clinical management and strategies for preventing disease progression. Traditional therapies, such as complex decongestive therapy (CDT), provide limited value due to a lack of research on the pediatric population and low compliance in adolescents, highlighting the need to seek alternative approaches. Multiple osteopathic manipulative treatment (OMT) modalities, such as myofascial release (MFR) and lymphatic pump, enhance lymphatic flow and have emerged as promising adjunctive therapies.</p><p><strong>Objectives: </strong>The objective of this study was to systematically review and evaluate the evidence supporting the effectiveness of OMT in managing pediatric lymphedema and compare it to traditional therapies such as CDT.</p><p><strong>Methods: </strong>A systematic review was conducted from July 2024 to October 2024 across PubMed, DynaMed, and Google Scholar databases. Searches followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the following Medical Subject Headings (MeSH) terms: \"pediatric lymphedema,\" \"primary lymphedema,\" \"osteopathic manipulative treatment,\" and \"lymphatic drainage techniques.\" Inclusion criteria involved peer-reviewed articles published in English between 2015 and 2024 with full-text access, focusing on lymphedema management and pediatric cases. Grey literature and non-English studies were excluded. A total of four authors conducted independent screenings, resolving disagreements through consensus. Data on outcomes, patient demographics, and treatment efficacy were extracted and analyzed to compare OMT with CDT.</p><p><strong>Results: </strong>Out of 7,261 records identified, 7,153 were excluded (duplicates and nonrelevant studies). Thus, 108 full texts were assessed, with 18 studies meeting the eligibility criteria. Findings indicated that OMT techniques, such as lymphatic pump treatment (LPT), may help with limb volume reduction and wound closure. In a pediatric cohort, OMT demonstrated significant patient compliance and satisfaction due to its noninvasive nature and reduced session times compared to other therapeutic counterparts. Moreover, studies on fibroblast morphology suggest cellular benefits of OMT in reducing chronic inflammatory markers, promoting tissue repair, and improving lymphatic flow.</p><p><strong>Conclusions: </strong>OMT shows promise as an adjunctive therapy for pediatric lymphedema, offering advantages of enhanced lymphatic drainage, reduced edema, and prompt wound healing with better patient tolerance. Further large-scale trials are needed to validate the clinical utility of OMT, aiming to establish comprehensive management protocols for pediatric lymphedema.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"507-514"},"PeriodicalIF":1.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: associations of provider enrollment in OKCAPMAP with social deprivation, child abuse, and barriers to access in the state of Oklahoma, USA.","authors":"Micah Hartwell, Rakel Haas, Amanda Miller, Christina Brent, Osekpamen Wickliffe, Swapna Deshpande, Sara Coffey","doi":"10.1515/jom-2024-0186","DOIUrl":"10.1515/jom-2024-0186","url":null,"abstract":"<p><strong>Context: </strong>Oklahoma has one of the highest per capita rates of mental health needs in the United States; however, 72 of the 77 counties are designated as Health Professional Shortage Areas (HPSAs) in mental health services. In October 2022, after a year of planning, the Oklahoma Child and Adolescent Psychiatry and Mental Health Access Program (OKCAPMAP) was launched to deliver mental health and psychiatric consultation services to primary care providers across the state. Project planning incorporated a provider recruitment committee to target providers in rural communities and other areas with barriers to mental health services.</p><p><strong>Objectives: </strong>This study's primary objective was to determine if, after 18 months of activity, provider enrollment aligned with this mission.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of data from OKCAPMAP. We report the number and type of enrolled providers and information extracted from consultation requests including generalized patient demographics and the mental health conditions for which the request was made. We then utilized the sum of providers pooled at the zip code tabulation area (ZCTA) level to measure correlations with the Social Deprivation Index (SDI), frequency of child abuse filings, and other barriers associated with access for individuals seeking treatment.</p><p><strong>Results: </strong>As of April 30th, 2024, OKCAPMAP had enrolled 384 providers in 37 of the 77 counties of Oklahoma. Correlations of providers enrolled at the ZCTA showed significant (p<0.01) positive relationships with frequency of child abuse filings (<i>R</i>=0.39), percent of rented households (R=0.36), those with high housing cost burden (<i>R</i>=0.27), percent of households lacking a vehicle (<i>R</i>=0.19), single parent household (<i>R</i>=0.17), and the SDI (<i>R</i>=0.10).</p><p><strong>Conclusions: </strong>OKCAPMAP data show successful recruitment of providers where there are high rates of pediatric trauma and in areas where household access to psychiatric services may be limited. By creating an accessible framework to provide free mental health consultations to pediatric-serving primary care providers in these areas, OKCAPMAP will likely have a significant impact on families and communities across Oklahoma.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"371-377"},"PeriodicalIF":1.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Carpal tunnel dimensions following osteopathic manipulation utilizing dorsal carpal arch muscle energy: a pilot study.","authors":"Lilian Zhan, Juanita Brown, Sharon Gustowski, Patrick Davis, Mario Loomis","doi":"10.1515/jom-2025-3002","DOIUrl":"10.1515/jom-2025-3002","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"425-426"},"PeriodicalIF":1.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing fundamental clinical skills of osteopathic medical students.","authors":"John R Boulet, Jeanne M Sandella, John Gimpel, Richard LaBaere","doi":"10.1515/jom-2024-0225","DOIUrl":"10.1515/jom-2024-0225","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Clinically based performance assessments, including those employing standardized patients (SPs), have been utilized to educate and assess medical students and graduates. Starting in the 1990s, demonstrating competency on these types of assessments became part of the medical licensure pathway in some countries, and was re-added to the licensure pathway in the United States in 2004. Studies have been published to support the validity of the scores and associated pass/fail decisions obtained from SP assessments. With the onset of the COVID-19 pandemic, testing organizations were forced to suspend many of their in-person clinical skills assessments. There is widespread recognition that clinical skills are necessary for high-quality patient care. Nevertheless, there has been disparate interest in reestablishing national assessments of these skills.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Based on the recommendations of the Special Commission on Osteopathic Medical Licensure Assessment, the National Board of Osteopathic Medical Examiners (NBOME) established the Core Competency Capstone for Doctors of Osteopathic Medicine (C3DO). The objectives of this study were to describe the assessment and to ascertain the feasibility of administering it at multiple colleges of osteopathic medicine (COMs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Surveys of osteopathic medical school personnel and students taking the assessment were conducted to gather data on the feasibility of administering the C3DO, the challenges associated with a distributed model, and the educational value of the assessment. Reports submitted by the medical schools provided information on the cost of the assessment. Some psychometrics analyses of Phase 1 C3DO pilot data were conducted, including the quantification of measurement errors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The NBOME, in collaboration of the COMs, was able to administer the C3DO to almost the entire class at four osteopathic medical schools. Although there were challenges, including data transfer from the schools, summary scores were derived for a total of 811 students, including nine repeat test takers. Medical students across sites indicated that the C3DO was a valuable educational assessment activity. The reliability of the ratings derived from the checklists (history building [HB], physical examination [PE]) and Communication and Respectfulness Evaluation (CARE) tool were adequate. Based on a variance components analysis, there was some evidence to suggest that at a given school, the choice of an SP portraying and scoring the case could have an impact on the student scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The C3DO-distributed site model, which includes centrally developed cases, standardized training of SPs, and independent scoring of osteopathic manipulative treatment (OMT), provides the means to assess the clinical skills of osteoapthic medical students at different testing sites. The implementation of a dis","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"469-476"},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signs and symptoms of vertebrobasilar insufficiency secondary to atherosclerosis: a systematic review.","authors":"Chris Moors, Claire Stapleton","doi":"10.1515/jom-2024-0203","DOIUrl":"10.1515/jom-2024-0203","url":null,"abstract":"<p><strong>Context: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"519-532"},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a community care coordination team to reduce emergency department utilization and hospital readmissions for the highest utilizers.","authors":"Stacia Shipman, Kelly Painter, Lindsey Claire Epperson, Keri Smith","doi":"10.1515/jom-2024-0255","DOIUrl":"10.1515/jom-2024-0255","url":null,"abstract":"<p><strong>Context: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":"457-463"},"PeriodicalIF":1.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}