Volume 125, Issue 7

Context The widespread adoption of social media has transformed how individuals connect in medicine. This study explores how social media can be utilized as a conduit to connect osteopathic medical students and residents. By examining how these digital connections can support professional development, this study investigates social media’s role as a potential foundation for a mentorship program, fostering guidance, support, and career insights for osteopathic medical students within the surgical field. Objectives This study aimed to evaluate the effectiveness of “X” (formerly Twitter) in networking between osteopathic medical students and surgical residents, specifically assessing engagement rates and the potential of social media as a tool for mentorship in the osteopathic surgical community. Methods The Accreditation Council on Graduate Medical Education (ACGME)-approved surgical programs that the American College of Osteopathic Surgeons (ACOS) represents were identified online. Doctor of Osteopathic Medicine (DO) residents were identified retrospectively through an online search of publicly available data. Residents and programs were searched through X, and account handles were collected. Residents were contacted through X by direct messaging and subsequently directly commented in the initial ACOS Medical Student Section (ACOS-MSS) message. Descriptive statistics along with the chi-square and Fisher’s exact statistical tests were utilized for demographic and categorical variable analysis, respectively. Results There are 1179 DO surgical residents in ACGME programs, with 84.8 % of those being General Surgery residents. Among residents, 75 % of Cardiothoracic (CT) Surgery, 46.4 % of Urology, 28.6 % of Neurosurgery, 17.3 % of General Surgery, and 11.11 % of Plastic Surgery residents have X accounts. Specific surgical subspecialties are more likely to have an X account in comparison to General Surgery, including CT Surgery (odds ratio [OR], 11.13; p=0.02), Urology (OR, 4.13; p<0.0001), and Neurosurgery (OR, 0.842; p=0.047). After multiple attempts, 0 % of Plastic Surgery, 2.9 % of General Surgery, 7.8 % of Urology, 18.8 % of Neurosurgery, and 33.3 % of CT Surgery residents signed up for the mentorship program, totaling 13 residents. Conclusions The study reveals low social media engagement via X among osteopathic surgical residents, with notable variation across surgical specialties. This limited engagement suggests exploring and refining social media strategies that foster mentorship connections within the osteopathic surgical community. Future studies should examine other social media platforms and alternative engagement approaches to enhance the reach and impact of mentorship initiatives, ultimately supporting osteopathic medical students as they navigate career paths in surgery.

The role of lifestyle has taken a renewed importance in disease prevention and chronic disease management. Osteopathic medicine has long focused on comprehensive, holistic care for our patients, and the tenets support the role of lifestyle medicine (LM) in osteopathic clinical care. In this commentary, the authors make the argument for incorporating LM more formally into the clinical curriculum at colleges of osteopathic medicine and will draw parallels with these two programs.

Context Urinary incontinence (UI) in the powerlifting community has been a hot topic due to its noticeability during competition and the burden it places on female athletes who experience it. UI is even experienced in those we least expect: young, high-performing, females with no history of pregnancy. Current studies have utilized primarily survey methodology, thus there is a lack of clinical information on this topic. Furthermore, the top athletes are underrepresentedbecause previous surveys were open to anyone reporting themselves as a powerlifter, regardless of competition level. Objectives The objectives of this study were to determine whether UI in elite female powerlifters is correlated with any musculoskeletal diagnoses and to further evaluate potentially contributing factors for UI within this group. Methods Subjects underwent an osteopathic structural examination and then completed two surveys: the Incontinence Severity Index (ISI/Sandvik Test for Urinary Incontinence) and the Study Questionnaire. Results In total, there were 31 female participants, all of whom were in the top 2 % of powerlifters in the world between the ages of 20 and 30  years old (as of May 21, 2023) and reside in the United States. The survey results displayed a moderately positive relationship between age (rho=0.449, where rho refers to Spearman’s rho), history of pelvic floor examination (rho=0.413), and self-care practice with ISI (rho=0.340). Other survey information such as weight class, height, best total in competition, number of years training, average duration of training day, confidence in ability to contract pelvic floor muscles, history of abdominal or pelvic surgery, history of urinary tract infection (UTI), and sexual activity status all had rho values less than 0.300. With atlantoaxial (AA) rotation to the right, there was an increase in ISI score (p=0.009). Similarly, with AA rotation to the left, there was a decrease in ISI score (p=0.030). All patients with severe ISI had nonphysiologic sacral dysfunctions (p=0.051). Severe ISI-scored participants were more likely to yield a dysfunctional clavicle upon screening (p=0.027). There was a strong correlation between increasing severity of UI and findings of a restricted right clavicle and/or AA rotation to the right (p=0.010). In addition, there were only two individuals with both a restricted right clavicle and AA rotation to the right, and these two individuals both scored severe on the ISI (p=0.012). A pelvic diaphragm dysfunction was present in 74.2 % of the participants. Extension diagnoses of the lumbar spine were found in those with mild UI over those with severe UI (p=0.012). Most other diagnoses were largely unremarkable due to a wide distribution across all ISI scores. Conclusions Our study revealed a relationship between UI and somatic dysfunctions in this population. These findings may help providers, especially in the fields of primary care, sports medicine, and urogynecology, to expand treatment options for UI in this group in the future. Survey results yielded a positive relationship of moderate strength between age, history of pelvic floor exination, and engaging in leakage prevention practices with ISI. No survey category was found to have a relationship of high strength with ISI. These findings contribute to our knowledge on factors that do (or do not) contribute to incontinence severity.

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 Gun violence negatively impacts not only victims but also their families and surrounding communities. Resources and counseling services may be available to support families affected by gun violence, but the families and their clinicians may not know about these resources or how to access them. Objectives The objective of this study was to investigate the impact of a clinician-directed educational program on patient reports of their discussions with their physician regarding gun violence, prevention, and available resources for support and treatment. Methods This quasi-experimental, cross-sectional, survey-based, quality-improvement study included pre-, mid-, and posttraining surveys administered to patients and clinicians participating in an educational program at two urban healthcare centers in Philadelphia. The educational program included office enhancements (handouts and posters) and lunchtime presentations for clinicians regarding gun violence prevalence, prevention strategies, local support resources, and impacts on mental health for patients and their families. The anonymous patient survey was offered to all patients seen at two urban healthcare centers in Philadelphia during three nonconsecutive weeks over 3 months. Results Among 542 patients seen over the 3 weeks of survey collection, 428 completed the survey (response rate of 79 %). Sixty-four percent acknowledged being impacted by gun violence including the death of a loved one, witnessing a shooting, or being shot themselves. Over the course of the educational program, patients reported significant increases in (1) awareness of materials related to gun violence in the waiting areas, by 17.2 %, (2) discussions of gun violence with their clinician, by 12.1 %, and (3) discussions of methods to prevent gun injury, by 9.7 %. At the end of the study, 19.3 % of patients reported having discussions with their clinician about gun violence, and 14.3 % discussed strategies to prevent gun injury. Participating clinicians reported high levels of satisfaction and increased confidence when talking to patients about gun violence at the end of the program. Conclusions Providing clinician-directed education and printed materials increased the frequency with which clinicians discussed gun violence, prevention, and available resources with their patients. Increases were modest, with opportunities for improvement. A holistic and multifaceted approach is required to support families affected by gun violence, including education for clinicians and dissemination of information for families.