JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION最新文献

{"title":"Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students.","authors":"Katherine M Stefani,&nbsp;Jesse R Richards,&nbsp;Jessica Newman,&nbsp;Kenneth G Poole,&nbsp;Shannon C Scott,&nbsp;Caleb J Scheckel","doi":"10.7556/jaoa.2020.060","DOIUrl":"https://doi.org/10.7556/jaoa.2020.060","url":null,"abstract":"<p><strong>Context: </strong>Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty.</p><p><strong>Objective: </strong>To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision.</p><p><strong>Methods: </strong>Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties.</p><p><strong>Results: </strong>The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P<.0001). Students entering PC were more likely to report prestige and income level to be \"no or minor influence\" compared with students entering non-PC specialties (P<.0001). Debt level was more likely to be a \"major influence\" to students choosing to enter non-PC specialties than to those entering PC (P<.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%).</p><p><strong>Conclusion: </strong>Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 6","pages":"380-387"},"PeriodicalIF":1.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37974502","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":"Implied Evidence of the Functional Role of the Rectus Capitis Posterior Muscles.","authors":"Richard C Hallgren,&nbsp;Jacob J Rowan","doi":"10.7556/jaoa.2020.061","DOIUrl":"https://doi.org/10.7556/jaoa.2020.061","url":null,"abstract":"Abstract Context Osteopathic physicians often target the rectus capitis posterior minor (RCPm) and rectus capitis posterior major (RCPM) muscles when using muscle energy or soft tissue cervical techniques to treat patients with head and neck pain. The RCPm and RCPM muscles are located deep within the posterior occipitoatlantal and atlantoaxial interspaces, respectively. Objective To characterize the functional role of RCPm and RCPM muscles by comparing electromyographic (EMG) activation patterns of these muscles with EMG activation patterns of specific flexor and extensor muscles of the head and neck, the sternocleidomastoid (SCM), and the splenius capitis (SC) muscles, respectively. Methods Asymptomatic participants were recruited from the Michigan State University College of Osteopathic Medicine student body. Disposable 25-gauge, bipolar fine-wire intramuscular electrodes were used to collect EMG data from the right and left RCPm and RCPM muscles. Surface electrodes were used to collect EMG data from the right and left SCM and SC muscles. Data were collected as participants performed 4 cycles of flexion and extension with an external 4-lb force applied to the back of the head and the forehead. Results In RCPM muscles, EMG activity was significantly greater (P<.003) during flexion and extension of the head and neck when an external force was applied to the back of the head. EMG activity in SCM muscles was significantly greater (P<.0001) during flexion and extension of the head and neck when an external force was applied to the forehead. The authors observed that EMG activity in SC muscles was significantly greater (P<.015) during flexion and extension of the head and neck when an external force was applied to the back of the head. No significant difference was found in EMG activity in RCPm muscles (P<.834) during flexion and extension of the head and neck, regardless of whether the external force was applied to the back of the head or the forehead. Conclusion The EMG activation patterns of the RCPm muscles suggest that their functional role may be to stabilize the occipitoatlantal joint by helping maintain congruency of the joint surfaces. In contrast, the EMG activation patterns of the RCPM muscles suggest that their functional role may be to contribute to extension of the head, primarily at the occipitoatlantal and the atlantoaxial joints.","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 6","pages":"395-403"},"PeriodicalIF":1.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37973978","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":"Graves Orbitopathy.","authors":"Stefano Natali,&nbsp;Paul Shogan","doi":"10.7556/jaoa.2020.068","DOIUrl":"https://doi.org/10.7556/jaoa.2020.068","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 6","pages":"425"},"PeriodicalIF":1.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37973982","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":"Influence of Research on Osteopathic Medical Student Residency Match Success.","authors":"Jonathan W Lowery,&nbsp;Julia M Hum,&nbsp;Ivie Obeime,&nbsp;Sarah Zahl,&nbsp;Christopher P Parr,&nbsp;Bryan Larsen,&nbsp;Tamara King,&nbsp;Glen Kisby","doi":"10.7556/jaoa.2020.057","DOIUrl":"https://doi.org/10.7556/jaoa.2020.057","url":null,"abstract":"We read with interest the 2019 study by Matthews et al that examined the influence of research experience and accomplishments on the residency match success of osteopathic and allopathic medical students. We congratulate the authors on an important study; their work extends and complements an existing body of literature reporting that research experience increased the likelihood of allopathic medical students matching into their desired residency program for many, but not all, specialties. Their research provides the first quantitative data on this topic for osteopathic medical students. The 2018 National Residency Match Program (NRMP) Program Director survey revealed that, for certain specialties (eg, radiation oncology, plastic surgery, neurological surgery, interventional radiology), more than 75% of program directors view “demonstrated involvement and interest in research” as a key factor in the selection of applicants for an interview. Our survey among 328 first-year osteopathic medical students at 4 colleges of osteopathic medicine indicated that 315 students (96%) view research participation during medical school as important, with the predominant perceived benefit being increased competitiveness for residency applications (274 [83.5%] of respondents). Other perceived benefits include interacting with faculty (222 [67.7%]), developing skills for conducting research as a physician (219 [66.8%]), and deepened understanding of curricular concepts (212 [64.6%]). However, for both years of NRMP data analyzed by Matthews et al (ie, 2016 and 2018), the availability of residency placement through the American Osteopathic Association rather than the Accreditation Council for Graduate Medical Education led to a select pool of osteopathic medical students using the NRMP system. Therefore, since the American Osteopathic Association does not report information on research experience or accomplishments among matched vs unmatched candidates, the actual influence of research on residency match success for osteopathic medical students overall is still unknown—despite strong perception among osteopathic medical students that research experience leads to enhanced competitiveness, as revealed by our work. We look forward to similar analyses being performed on NRMP match results for 2020, which is the first year of the single graduate medical education accreditation system and the earliest opportunity to directly compare the influence of research on residency match for osteopathic and allopathic medical students. Until then, we respectfully suggest that it is best to view the available NRMP data as historical, rather than prospective, as it pertains to the influence of research on osteopathic medical student residency match success. (doi:10.7556/jaoa.2020.057)","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 6","pages":"368-369"},"PeriodicalIF":1.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37974500","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":"Empathy in Medicine Self and Other in Medical Education: Initial Emotional Intelligence Trend Analysis Widens the Lens Around Empathy and Burnout.","authors":"Gail Singer-Chang,&nbsp;Fanglong Dong,&nbsp;Michael Seffinger,&nbsp;Natalie Nevins,&nbsp;Janice Blumer,&nbsp;Helen Musharbash,&nbsp;Scott Helf","doi":"10.7556/jaoa.2020.069","DOIUrl":"https://doi.org/10.7556/jaoa.2020.069","url":null,"abstract":"<p><strong>Context: </strong>Integral to emotional intelligence (EI), empathy is frequently studied in medical students. While important, given the implications for patient safety and physician well-being, traits such as self-regard may also affect physician efficacy. Emotional intelligence offers a holistic framework from which to study empathy, allowing it to be explored with coexisting traits and offering opportunities to identify related risk factors.</p><p><strong>Objective: </strong>To identify trends in osteopathic medical student EI to help mitigate burnout, with specific attention to empathy and self-regard.</p><p><strong>Methods: </strong>Eight hundred eighty-five students at Western University of Health Sciences College of Osteopathic Medicine of the Pacific from classes 2014-2016 were offered the Emotional Quotient Inventory 2.0 (EQ-i) at the start of school, completion of their second year, and at graduation. Participants completed all 3 inventories, yielding a response rate of 16.3%. Repeated measurement analysis of variance analyses were conducted using SAS software for Windows version 9.3.</p><p><strong>Results: </strong>A total of 144 students participated. The total EI score shifted from mean (SD) 100.2 (12.4) at baseline to 96.1 (12.8) midway to 96.8 (13.3) at graduation (P=.0161) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Empathy declined from 103 (13.1) to 99.9 (12.7) to 99.6 (12.6) (P=.0481) with significant decreases between baseline and midway (P<.001) and baseline and final administrations (P<.001). Self-regard declined from 98.6 (14.1) to 95.8 (15.1) to 95.5 (14.7) (P=.135) with significant decreases between baseline and midway (P=.0021) and baseline and final administrations (P<.001).</p><p><strong>Conclusion: </strong>This study's findings support further investigation of potential roles played by EI, empathy, and self-regard in physician burnout.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 6","pages":"388-394"},"PeriodicalIF":1.1,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37974503","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":"Buying Time: Using OMM to Potentially Reduce the Demand for Mechanical Ventilation in Patients With COVID-19.","authors":"Michael Emerson Stenta","doi":"10.7556/jaoa.2020.064","DOIUrl":"10.7556/jaoa.2020.064","url":null,"abstract":"<p><p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic is causing an increased need for mechanical ventilation for a significant percentage of people who present to the hospital for treatment. This increase in demand could surpass the supply of ventilators and lead to an increase in mortality due to a lack of ventilator vacancies. There is significant evidence that osteopathic manipulative medicine (OMM) can alleviate pulmonary symptoms and aid in quicker recoveries from various respiratory ailments. OMM has the potential to play a significant role in helping reduce a patient's need for mechanical ventilation by delaying the onset of acute respiratory distress syndrome stemming from SARS-Cov2 infections.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37961389","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":"Dermatofibrosarcoma Protuberans.","authors":"Stefano Natali,&nbsp;Cara Borelli,&nbsp;Paul Shogan","doi":"10.7556/jaoa.2020.056","DOIUrl":"https://doi.org/10.7556/jaoa.2020.056","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 5","pages":"362"},"PeriodicalIF":1.1,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37874877","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":"Antithrombotic Therapy for Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention.","authors":"Andrew S Tseng,&nbsp;Fadi E Shamoun,&nbsp;Lisa A Marks,&nbsp;Neera Agrwal","doi":"10.7556/jaoa.2020.053","DOIUrl":"https://doi.org/10.7556/jaoa.2020.053","url":null,"abstract":"<p><p>1. What is the clinical question? What combination antithrombotic therapy is recommended for patients with atrial fibrillation with acute coronary syndrome or patients undergoing percutaneous coronary intervention? 2. What does the evidence say? Double therapy (DT) with clopidogrel and direct oral anticoagulants (specifically, dabigatran, rivaroxaban, and apixaban) is noninferior to warfarin-based therapies for most patients. Double therapy is noninferior to triple therapy (TT) and has less bleeding complications. 3. What is the take-home message for physicians? According to the latest guidelines by the ACC, AHA, ESC, and HRS, in patients with AF undergoing PCI, DT with DOACs (specifically dabigatran, rivaroxaban and apixaban) plus clopidogrel is acceptable. Patients undergoing PCI or with high ischemic risk may still benefit from TT for at least 1 month and up to 6 months before switching to DT. Currently, there is no specific guidance on long-term antiplatelet therapy in these patients. Duration of antiplatelet therapy, whether with DT or TT, should be based on current DAPT guidelines (depending on indication and type of intervention) and discussions with each patient's cardiologist.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 5","pages":"345-349"},"PeriodicalIF":1.1,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37874911","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":"Rhinitis: The Osteopathic Modular Approach.","authors":"Shan Shan Wu,&nbsp;Kelsey Graven,&nbsp;Michelle Sergi,&nbsp;Robert Hostoffer","doi":"10.7556/jaoa.2020.054","DOIUrl":"https://doi.org/10.7556/jaoa.2020.054","url":null,"abstract":"<p><p>Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is primarily an aberrant immunologic reaction caused by cytokines secreted from lymphocytes that traverse the lymphatic pathway throughout the body. Several studies have documented that, when manipulated, the lymphatic system enhanced the motion of these lymphocytes to important immune structures in both human and animal models. Additionally, modulation of both sympathetic and parasympathetic outflow has been found either to inhibit or enhance secretion and/or drainage of important allergic sites. Osteopathic approaches to rhinitis play an effective role in the comprehensive management of rhinitis, and techniques based on these approaches are therapeutic options for rhinitis. This article provides an up-to-date literature review about the management of rhinitis using the 5 models of osteopathic medicine: biomechanical, respiratory-circulatory, metabolic, neurologic, and behavioral.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 5","pages":"351-358"},"PeriodicalIF":1.1,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37874912","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":"Does the Halo Effect for Level 1 Trauma Centers Apply to High-Acuity Nonsurgical Admissions?","authors":"Ann E Hwalek,&nbsp;Anai N Kothari,&nbsp;Elizabeth H Wood,&nbsp;Barbara A Blanco,&nbsp;McKenzie Brown,&nbsp;Timothy P Plackett,&nbsp;Paul C Kuo,&nbsp;Joseph Posluszny","doi":"10.7556/jaoa.2020.049","DOIUrl":"https://doi.org/10.7556/jaoa.2020.049","url":null,"abstract":"<p><strong>Context: </strong>The halo effect describes the improved surgical outcomes at trauma centers for nontrauma conditions.</p><p><strong>Objective: </strong>To determine whether level 1 trauma centers have improved inpatient mortality for common but high-acuity nonsurgical diagnoses (eg, acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia [PNA]) compared with non--level 1 trauma centers.</p><p><strong>Methods: </strong>The authors conducted a population-based, retrospective cohort study analyzing data from the Healthcare Cost and Utilization Project State Inpatient Database and the American Hospital Association Annual Survey Database. Patients who were admitted with AMI, CHF, and PNA between 2006-2011 in Florida and California were included. Level 1 trauma centers were matched to non-level 1 trauma centers using propensity scoring. The primary outcome was risk-adjusted inpatient mortality for each diagnosis (AMI, CHF, or PNA).</p><p><strong>Results: </strong>Of the 190,474 patients who were hospitalized for AMI, CHF, or PNA, 94,037 patients (49%) underwent treatment at level 1 trauma centers. The inpatient mortality rates at level 1 trauma centers vs non-level 1 trauma centers for patients with AMI was 8.10% vs 8.40%, respectively (P=.73); for patients with CHF, 2.26% vs 2.71% (P=.90); and for patients with PNA, 2.30% vs 2.70% (P=.25).</p><p><strong>Conclusion: </strong>Level 1 trauma center designation was not associated with improved mortality for high-acuity, nonsurgical medical conditions in this study.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 5","pages":"303-309"},"PeriodicalIF":1.1,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37874908","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}