2023 AOA Research Abstracts and Student Poster Competition

Investigating the Mechanism of Dextrose Prolotherapy on Fibroblast Cell Viability

¹Sarah Fox, OMS-III; ¹Bethany Harting, OMS-III; ²Thomas Motyka, DO, MHPE; ³Adam Foster, PhD; ⁴Amy Hinkelman, PhD

¹Department of Research, Campbell University-Jerry M. Wallace School of Osteopathic Medicine; ²Department of Osteopathic Manupulative Medicine, Campbell University-Jerry M. Wallace School of Osteopathic Medicine; ³Department of Anatomy, Campbell University-Jerry M. Wallace School of Osteopathic Medicine; ⁴Department of Microbiology, Campbell University-Jerry M. Wallace School of Osteopathic Medicine

Statement of Significance: It has been shown that ligaments can be strengthened by injection with a proliferative agent such as dextrose (1). Dextrose is popular due to its low cost and reduced side effect profile (2). Prolotherapy is thought to cause an inflammatory response stimulating cell proliferation and tissue repair. Increased cartilage thickness and decreased pain following prolotherapy treatment has been shown (3-5). However, there are limited studies investigating the mechanism and results have varied (2, 6-9).

Therefore, we hypothesize that hypertonic solutions of 10-25% dextrose will incite an initial inflammatory response followed by the production of growth factors and enhanced fibroblast proliferation. To determine if dextrose exposure has a significant impact on fibroblasts we quantified and measured the cell viability following exposure to a variety of dextrose concentrations under multiple conditions and over several time points.

Research Methods: MRC- 5 fibroblasts were exposed to varying concentrations of dextrose (5, 10, 15, 20, 25%) or a control for 15, 30, 60, or 120 minutes. After reaching the appropriate time point, the XTT assay was used to determine cell viability. This allowed us to quantify the immediate direct effect of dextrose on fibroblasts.

We also looked at the viability of the MRC-5 fibroblasts 48 hours after they were exposed to the dextrose treatments to determine recovery potential. The same protocol was followed as above except once the time point was reached, the dextrose treatment or control was replaced with fresh media for 48 hours before running the XTT assay. This allowed us to quantify the direct effect of dextrose on fibroblasts 48 hours after exposure.

Finally, we investigated how the response of dextrose-exposed fibroblasts might impact other cells that were not directly exposed to dextrose. The same protocol was followed as above except once the time point was reached, the dextrose treatment or control was replaced with fresh media for 8 hours. The supernatant fluid was then collected from the dextrose treated cells. The nascent fibroblasts were exposed to those supernatants for 48 hrs. After this time had elapsed, XTT assays were used to determine how secreted factors from dextrose-treated fibroblasts affect the cell viability of nascent fibroblasts that had never been exposed to dextrose.

Samples were run in duplicate or triplicate in five independent experiments for each of the three experiment types. Complete media was used as a control in all experiments. Results were placed into a mixed effect model and analyzed using ANOVA to compare control vs treatments. Ultimately, the data collected from these experiments can be used to inform and evaluate the proposed mechanism of dextrose prolotherapy. Which is a minimally invasive treatment that is potentially based around promoting the body’s self-healing to improve both structure and function.

Data Analysis: When comparing the viability of fibroblasts directly treated with dextrose solutions, we found that higher concentrations of dextrose or longer treatment times may initially reduce cell viability. Fibroblasts treated directly with 10% and 15% dextrose for 120 minutes, 20% dextrose for 60 minutes or longer, and 25% dextrose for 15 minutes or longer had significantly reduced cell viability (p <0.01) compared to the media control.

The findings evaluating cell viability 48 hours after dextrose exposure had similar results where higher concentrations of dextrose and longer treatment times decreased cell viability. However 48 hours after treatment with 20% dextrose for 60 minutes there was no longer a decrease in cell viability compared to the media control (p = 0.363). This demonstrates the potential for a recovery effect following initial dextrose exposure.

In contrast, exposure to the supernatant fluid from directly treated fibroblasts caused an increase in cell viability. The supernatant fluid from fibroblasts treated with 10% dextrose for 30 minutes or longer, 15% dextrose for 15 minutes or longer, or 20% dextrose for 30 - 60 minutes had a positive impact on cell viability (p< 0.05) of nascent fibroblasts that were not directly exposed to dextrose.

Conclusion: The results of our study support the hypothesis that dextrose prolotherapy may incite an initial inflammatory and damaging response that then stimulates the production of growth factors and cellular proliferation. Further exploration is needed to determine the optimal therapeutic dextrose concentration and what other factors are secreted into the joint space to generate this response. With this knowledge, we can better understand the mechanism by which dextrose prolotherapy improves function and reduces pain in musculoskeletal disease states such as osteoarthritis. Limitations to the in vitro study include not accounting for the heterogeneity of the joint space, knowing precisely how long dextrose persists in the joint, or at what concentration. Eventually, we hope this research will lead to improved clinical outcomes and evidence-based recommendations for the use of dextrose prolotherapy as an effective, nonsurgical option that is minimally invasive, inexpensive, and demonstrates few adverse events.

References

1. Hackett, G.S. Ligament and Tendon Relaxation. 3rd ed. Charles C Thomas; 1958.

2. Reeves KD, Sit RWS, Rabago DP. Dextrose Prolotherapy: A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations. Phys Med Rehabil Clin N Am. 2016;27(4):783-823. doi:10.1016/j.pmr.2016.06.001

3. Topol GA, Podesta LA, Reeves KD, et al. Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis. PM&R. 2016;8(11):1072-1082. doi:10.1016/j.pmrj.2016.03.008

4. Rabago D, Kansariwala I, Marshall D, Nourani B, Stiffler-Joachim M, Heiderscheit B. Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project. J Altern Complement Med. 2019;25(4):406-412. doi:10.1089/acm.2018.0361

5. Sit RWS, Reeves KD, Zhong CC, et al. Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis. Sci Rep. 2021;11:14638. doi:10.1038/s41598-021-94119-2

6. Woo MS, Park J, Ok SH, et al. The proper concentrations of dextrose and lidocaine in regenerative injection therapy: in vitro study. Korean J Pain. 2021;34(1):19-26. doi:10.3344/kjp.2021.34.1.19

7. Ekwueme EC, Mohiuddin M, Yarborough JA, et al. Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro. Clin Orthop Relat Res. 2017;475(8):2117-2127. doi:10.1007/s11999-017-5370-1

8. Güran Ş, Çoban ZD, Karasimav Ö, et al. Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. GULHANE Med J. 2018;60(2):42. doi:10.26657/gulhane.00016

9. Freeman JW, Empson YM, Ekwueme EC, Paynter DM, Brolinson PG. Effect of prolotherapy on cellular proliferation and collagen deposition in MC3T3-E1 and patellar tendon fibroblast populations. Transl Res. 2011;158(3):132-139. doi:10.1016/j.trsl.2011.02.008

Financial Disclosures: None reported.

Support: The project was made possible through internal support and funding provided by CUSOM.

Ethical Approval: This study does not involve human subjects. No human specimens or human subject information was collected, analyzed or generated. Therefore it was deemed IRB exempt.

Informed Consent: Not applicable to this study.

Poster No. *B-2

Abstract No. 2023-022

Category: Basic Science

Research Topic: Health Disparities-Social Determinants of Health

Global Health Didactic Education as a Tool for Teaching Cultural Competency in Preclinical Medical Education

¹Chloe Faith Haverkamp, OMS-II; ²Kathryn Vess; ³Alexis Stoner; ⁴Dean Sutphin; ¹David Redden; ¹Ana Jones

¹Edward Via College of Osteopathic Medicine -Auburn Branch Campus; ²Department of Medicine, Edward Via College of Osteopathic Medicine-South Carolina Branch Campus; ³Department of Public Health, Edward Via College of Osteopathic Medicine-South Carolina Branch Campus; ⁴Department of Public Health, Edward Via College of Osteopathic Medicine-South Carolina Branch Edward Via College of Osteopathic Medicine-Virginia

Statement of Significance: The implementation of cultural competency in medical education curricula varies among institutions, with little evidence supporting one method over another. The Global Seminar for Health and Environment is a course offered at the Edward Via College of Osteopathic Medicine (VCOM) that aims to improve students’ cultural competency. In this course, students examine and discuss public health issues and global solutions through a case-study approach.

The purpose of this study was to determine the impact of The Global Seminar for Health and Environment on preparing medical students of different backgrounds to become comfortable in the core competence domains as defined by the Global Health Seminar syllabus.

Research Methods: The effectiveness of this course was compared across ethnic and racial groups using a pre- and post-survey design. From 2018-2022, participants of The Global Seminar for Health and Environment (GSHE) completed pre- and post-course surveys to quantify the course’s effect on the student’s cultural competency. The surveys asked participants to rate their confidence level on a scale from 1-10 in the following domains: analysis of gender bias, analysis of social influences, analysis of cultural influences, awareness of international organizations and agencies interest and capacity to assist with global health problems, value of interpreters across languages to develop educational materials in native language, analysis of different belief systems, analysis of cultural profiles and histories to develop solutions, comparison of different countries health care systems, self-awareness of bias, value of interpreters across languages to derive solutions, analyze difficulties in communication across cultures, value of team approach to global health problems, and evaluation of culturally significant local treatments and remedies. The pre-survey data was averaged and then compared to the post-survey data of the same year to quantify changes. Previous years’ data was compared to the past year’s using a two-tailed ANOVA analysis. This comparison was then used to determine the differences in pre- and post-survey data from students by self-identified ethnicity or race. Students were separated into three categories to account for the sample size: white/Caucasian, Hispanic, and other, including Asian and Pacific Islander, and African American students. Significance level was determined as a p-value of less than 0.05.

Data Analysis: The survey was conducted on a sample of medical students in their didactic training who participated in an elective GSHE course in the US, the Dominican Republic, El Salvador, and Honduras from 2020-2022. The sample size consisted of 86 students in 2020, 123 students in 2021, and 88 students in 2022. In each year surveyed, there was statistically significant improvement from the pre to the post-course survey across all cultural competence domains (p<0.0001). Students who self-identified as Hispanic or Other, used in this study to describe Black and Asian and Pacific Islander students, were more likely to enter the course with a higher level of cultural competence compared to their white counterparts in 2021 and 2022 (p=0.02) There was no significant difference between pre-survey scores when students were evaluated based on medical school campus. This implies that Caucasian students showed a greater improvement in confidence in these competencies than the other groups following the completion of the course.

Conclusion: Despite varying levels of cultural competence entering the course, all students improved in competency, and all racial groups left the course with a comparable level of competence in these domains. This data suggests that this course is not only effective in teaching cultural competency but is even able to instill confidence in groups who perceive themselves as less competent. This may be in support of a collaborative learning environment rather than a lecture-based course for teaching these topics. After literature review, no studies were identified that examined the role of ethnicity in the efficacy of global health didactic education. Moving forward, global seminar pre and post course surveys could include questions addressing whether participants feel their race has impacted their cultural competence levels and how so. This information could then be used to build upon this study’s findings.

References

1. Khan OA, Guerrant R, Sanders J, eds. Global health education in U.S. medical schools. BMC Medical Education. 2013; 13(3).

2. Drain PK, Primack A, Hunt DD, eds. Global health in medical education: a call for more training and opportunities. Academic Medicine. 2007; 82(3): 226-230.

3. Thompson M, Huntington M, Hunt DD, et al. Educational effects of international health electives on US and Canadian medical students and residents. Academic Medicine. 2003; 78(3): 342-347.

4. Fox R. Cultural competence and the culture of medicine. New England Journal of Medicine. 2005; 353(13): 1316-1319.

5. Liu Y, Zhang Y, Liu Z, eds. Gaps in studies of global health education: an empirical literature review. Global Health Action. 2015; 8(1).

6. Brach C, Fraserichector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual models. Medical Care Research and Review. 2016; 57(1).

7. Haq C, Rothenberg D. Gjerde C, eds. New world views: preparing physicians in training for global healthwork. Fam Med. 2000; 32(8): 566-572.

8. College of Osteopathic Medicine: International Activities Report 2022. American Osteopathic Association. 2022.

9. Lu PY, Tsai JC, Tseng SYH. Clinical teachers’ perspectives on cultural competence in medical education. Medical Education. 2014; 48(2): 204-214.

10. Flores G, Gee D, Kastner B. The teaching of cultural issues in U.S. and Canadian schools. Academic Medicine. 2000; 75(5): 451-455.

11. Kripalani S, Bussey-Jones J, Katz MG, eds. A prescription for cultural competence in medical education. Journal of General Internal Medicine. 2006; 21(10): 1116-1120.

12. Supena I, Darmuki A, Hariyadi A. The influence of 4C (constructive, critical, creativity, collaborative) learning model on students’ learning outcomes. International Journal of Instruction. 2021; 14(3): 873-892.

13. The [output/code/data analysis] for this paper was generated using SAS software. Copyright © [2018] SAS Institute Inc. SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc., Cary, NC, USA.

14. Asgary R, Price J, Ripp J. Global health training starts at home: a unique US-based global health clinical elective for residents. Medical Teacher. 2012; 34(6): e445-e451.

15. Moschovis PP, Dinesh A. Boguraev AS, et al. Remote online global heatlh education among U.S. medical students during COVID-19 and beyond. BMC Medical Education. 2022: 353(22).

16. McKoy CL. Effects of selected demographic variables on music student teachers’ self-reported cross-cultural competence. National Association for Music Education. 2013; 60(4): 375-394.

17. Delgado Bernal D. “Critical Race Theory, Latino Critical Theory, and Critical Raced-Gendered Epistemologies: Recognizing Students of Color as Holders and Creators of Knowledge.” Qualitative Inquiry. 2016; 8(1).

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was deemed IRB exempt and has the following IRB number: 2018-030.

Informed Consent: Students who were enrolled in the Global Seminar for Health and Environment Course were invited to participate in pre- and post-course surveys. The students were assured these surveys were anonymous and would not impact their standing in the course.

Poster No. *B-3

Abstract No. 2023-028

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Cannabidiol (CBD) Treatment In Vivo Attenuates Hippocampal CA1 Nerve Cell Damage Via Oxidative Stress Mediated Mechanism

¹Anawin Tun Kitpowsong, OMS-IV; ²Dinesh Aryal, PhD; ¹William Wheeler, OMS-IV

¹Department of Osteopathic Medicine, Edward Via College of Osteopathic Medicine-Louisiana Branch Campus; ²Department of Pharmacology^, Edward Via College of Osteopathic Medicine-Louisiana Branch Campus

Statement of Significance: Diabetes mellitus(DM) is characterized by high blood sugar levels that can effect multiple organ systems.Insulin therapy to reverse hyperglycemia in Type 1 DM patients causes exposure to the complication of recurrent hypoglycemia depriving neurons of their energy source. No neuroprotective treatment options currently exist to improve neurological outcomes. This study hypothesizes that cannabidiol will provide neuroprotection against insulin induced hypoglycemic damage of hippocampal CA1 neurons.

To determine whether cannabidiol (CBD) treatment (dose dependently) in vivo attenuates hippocampal nerve cell damage in characterized recurrent-hypoglycemia experimental model by antioxidant-dependent mechanisms.

Research Methods: Male Sprague Dawley rats weighing 150-200 gs were divided into two groups; control and RH (n=15; in each group). Control group received normal saline whereas RH group received 10U/kg insulin (INS i.p.) on 1, 3, 5 & 7 days with blood glucose recording 1 hr after INS injection. Both groups were further divided into three subgroups (n=5) for CBD treatments, with doses of 0, 0.1 and 1mg/kg on days; 6 & 7. The recurrent hypoglycemia model was adapted from a well-documented protocol. Animals from each group were euthanized and brains were isolated, snap frozen with isopentane and stored at -80ºC for analysis. The harvested brains from all the rats were sectioned into 100µ using Leica Cryostat, the CA1 region were micro-punched into the microtube containing lysis buffer for protein assay analysis. The lysates were sonicated and analyzed for SOD levels with superoxide dismutase (SOD) -Elisa kit procured from Cayman Chemical, MI, USA.

Osteopathic significance: The comprehensive approach of the current study addresses the underlying cause of neuronal injury during hypoglycemic insult rather than merely treating hypoglycemia. Moreover, the body’s self-defense antioxidant mechanism can be a potential target for the preventive strategy towards nerve injury. The holistic approach of identifying the cause of illness and the potential target for the prevention of illness imparts the osteopathic significance of this study.

Data Analysis: The recurrent hypoglycemia (Blood glucose: 40-55mg/dl) were observed in RH group of rats. Whereas blood glucose for control groups showed (90-118 mg/dl). The dose dependent effects of CBD on recurrent hypoglycemia revealed no significant effects on blood-glucose levels in both RH rats and in control euglycemic rats. The SOD expressions were elevated significantly in RH rats treated with CBD at 1mg/kg (3.06 U/ml) vs CBD at 0 (2.38 U/ml). However, there were no significant changes in SOD levels in control group rats regardless of their three different CBD doses. (All the supplemental data can be provided upon request).

Conclusion: Overall, CBD has no direct effect on insulin function. CBD may protect the antioxidant function and eventually protect nerve cell injury via attenuating the degradation of superoxide dismutase. Oxidative stress is observed to be one of the targets for neuroprotective therapy during iatrogenic hypoglycemic insult. Further investigations are needed to evaluate whether the source of SOD is mitochondrial or cytosolic. Although CBD showed both neurotoxic and neuroprotective effects on hippocampal neurons in the in vitro setting, our study demonstrated a neuroprotective effect of CBD via cellular antioxidant mechanism in vivo.

References

1. Languren G, Montiel T, Ramirez-Lugo L, et al. Recurrent moderate hypoglycemia exacerbates oxidative damage and neuronal death leading to cognitive dysfunction after the hypoglycemic coma. J Cereb Blood Flow Metab. May 2019;39(5):808-821. doi:10.1177/0271678X177336402.

2. Uddin MM, Ibrahim MMH, Aryal D, Briski KP. Sex-dimorphic moderate hypoglycemia preconditioning effects on Hippocampal CA1 neuron bio-energetic and anti-oxidant function. Mol Cell Biochem. Oct 2020;473(1-2):39-50. doi:10.1007/s11010-020-03806-73.

3. Kim J, Choi JY, Seo J, Choi IS. Neuroprotective Effect of Cannabidiol Against Hydrogen Peroxide in Hippocampal Neuron Culture. Cannabis Cannabinoid Res. 2021;6(1):40-47. doi:10.1089/can.2019.0102

Financial Disclosures: The authors declare no financial conflicts of interest to disclose. None reported.

Support: This project is supported by a seed grant (Delta CRP # 1038512) from Edward Via College of Osteopathic Medicine.

Ethical Approval: The animal housing and experimental procedures were approved and carried out under the ethical guidelines of the Institutional Animal Care and Use Committee (IACUC) at the University of Louisiana at Monroe (Protocol # 21 NOV-KPB-01).

Informed Consent: All the experiments were carried out under the ethical guidelines and as per the informed consent of the authors.

Poster No. B-4

Abstract No. 2023-030

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

CNS4 Preferentially Potentiates Hypoglutamatergic Disease-causing Mutant GluN1/2A Subtype of NMDA Receptors

¹Seth Coats Boehringer, BS; ²Nakia Phillip; ²Patrick Rafael; ²Tullia Johnston; ²Alyssa Ingram; ³Pamela Vandevord; ² Blaise M. Costa, PhD

¹Department of Biochemistry, Edward Via College of Osteopathic Medicine-Virginia; ²Center for One Health Research, Edward Via College of Osteopathic Medicine-Virginia; ³Department of Biomedical Engineering, Edward Via College of Osteopathic Medicine-Virginia

Statement of Significance: The normal function of N-methyl D-aspartate receptors (NMDARs) plays a critical role in brain development and cognitive function. Mutations of the NMDARs subunits, that reduce glutamate potency, result in a condition known as GRIN disorder (1). Children born with GRIN disorder suffer from various neuropsychiatric disorders including epilepsy, major depression, developmental delay, and intellectual disability. Currently, there is no FDA-approved treatment for GRIN disorders.

To study the capability of CNS4, a novel agonist concentration-dependent NMDAR modulator (2), to preferentially potentiate hypoactive receptors.

Research Methods: L-glutamate is the primary excitatory neurotransmitter in the central nervous system. NMDAR is a subtype of glutamate receptor. Seven NMDAR genes have been identified: GluN1, GluN2A-D, and GluN3A-B. The functional NMDA receptor is a hetero-tetramer composed of two GluN1 subunits and one or two GluN2/3 subunits. Five disease-causing GluN2A mutants known to reduce glutamate potency by 4.4 (A548T), 126 (V685G), 2.9 (I694T), 6.6 (A716T), and 2913 (D731N) fold were generated, sequenced, and assayed using a two-electrode voltage clamp (TEVC) electrophysiology technique (3,4,5). Xenopus oocytes were microinjected with cRNA mixture of wildtype GluN1A and mutant GluN2A subunits and were incubated 2-4 days before TEVC. Glutamate dose-response curves with co-agonist 100 µM glycine were conducted in the presence or absence of 30 µM CNS4. EC50 values are reported as average ± SEM (µM). Additional TEVC tests were carried out to assess diheretomeric GluN1/2(A-D) and triheteromeric GluN1/2AB subunit potentiation by increasing CNS4 doses in sub-saturating concentrations of glutamate. CNS4 concentration ranged 0.3 µM-100µM. Activity response values are reported as average ± SEM (%) normalized to agonist-induced maximal activation of 100%. DIV14 rat brain cortical, striatal, and cerebellar neurons were used for a variety of assays to better understand effects of CNS4. Calcium assay using Fluo-8 dye was performed on neurons with 100 µM CNS4 and increasing concentration NMDA. MTS assay was performed on samples treated with CNS4 and CNS42, an analog of CNS4, all with 300 µM NMDA. In both experiments, One-way ANOVA Tukey’s multiple comparisons test was performed to identify statistical significance between groups with alpha level 0.05. CNS4 can be of osteopathic significance as COM treatments combined with CNS4 administration may yield significant results in treating neuropsychiatric disorders.

Data Analysis: Observed differences in glutamate potency in the presence of CNS4 (WC4) were mutant- and dose-dependent compared to the absence of CNS4 (NC4). A548T (EC50 = 4.68±0.70 NC4, n=11; 1.19±0.55 WC4, n=5) and V685G (EC50 = 91.67±25.3 NC4, n=18; 0.99±0.14 WC4, n=17) displayed generally increased potency with CNS4 at all glutamate concentrations. I694T exhibited generally increased potency with CNS4 at higher glutamate concentrations (EC50 = 25.88±7.88 NC4, n=10; 4.80±0.60 WC4, n=7). A716T exhibited increased glutamate potency only at low concentrations with generally decreased potency in the presence of CNS4 (EC50 = 3.44±0.64 NC4, n=12; 10.56±3.32 WC4, n=8). D731N showed a general increase in glutamate potency in the presence of CNS4 with a significant increase at 1 mM glutamate (p<0.05) (EC50 was non-determinable). General decreases in glutamate efficacy with CNS4 were observed at all dose concentrations in four of the five tested GluN2A mutants (A548T, V685G, A716T, D731N). Significant reductions were found in V685G at 100 µM (p<0.0001) and in D731N at 10 mM (p<0.05). TEVC of diheteromeric and triheteromeric NMDARs showed subunit- and concentration-dependent responses. Highly increased activity was observed in all wildtype NMDARS at low glutamate (0.3 µM) except in GluN1/2A: 116.6±5.9%, n=9. Increased activity at low glutamate 1/2B: 193.2±21.2%, n=4; 1/2C: 506.3±52.9%, n=10; 1/2D: 850.4±133.9%, n=10; 1/2B: 264.4±16.9, n=10. Calcium assay found increased intracellular calcium with 300 µM NMDA + 100 µM CNS4 compared to 300 µM NMDA (p<0.0001, n=9). MTS assay found increased viability with 100 µM CNS42 + 300 µM NMDA compared to control, 300 µM NMDA, and 50 µM memantine + 300 µM NMDA (p<0.0001, n=8).

Conclusion: CNS4 preferentially potentiates hypoglutamatergic disease-causing mutant GluN2A subtypes of NMDA receptors. Future studies could assess the potentiation effects of CNS4 on GluN2B mutants, which have incident rates comparable to that of GluN2A mutants (1). CNS4, and its analogs, will be an appropriate lead candidate for the development of clinically useful compounds to treat drug-resistant neuropsychiatric conditions such as GRIN disorders and anti-NMDA receptor encephalitis.

References

1. All About GRIN Disorder. CureGRIN Foundation. Published July 18, 2022. Accessed June 26, 2023. https://curegrin.org/grin-disorder/

2. Costa BM, Kwapisz LC, Mehrkens B, et al. A glutamate concentration-biased allosteric modulator potentiates NMDA-induced ion influx in neurons. Pharmacol Res Perspect. 2021;9(5):e00859. doi:10.1002/prp2.859

3. Functional variants center database. Emory.edu. Accessed June 26, 2023. https://webapp2.pharm.emory.edu/cferv/

4. Swanger SA, Chen W, Wells G, et al. Mechanistic insight into NMDA receptor dysregulation by rare variants in the GluN2A and GluN2B agonist binding domains. Am J Hum Genet. 2016;99(6):1261-1280. doi:10.1016/j.ajhg.2016.10.002

5. Lesca G, Rudolf G, Bruneau N, et al. GRIN2A mutations in acquired epileptic aphasia and related childhood focal epilepsies and encephalopathies with speech and language dysfunction. Nat Genet. 2013;45(9):1061-1066. doi:10.1038/ng.2726

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IACUC: 21-062, reviewed and approved

Informed Consent: N/A.

Poster No. *B-5

Abstract No. 2023-034

Category: Basic Science

Research Topic: Impact of OMM & OMT

Osteopathic Medical Students’ Preferences for Viewing Lectures at a Multi-Campus Medical School

¹Lindsey King, OMS-III; ¹Jessica Rodgers; ¹Eric Schmitz; ²Elizabeth A Beverly, PhD

¹Ohio University-Heritage College of Osteopathic Medicine; ²Department of Primary Care, Ohio University-Heritage College of Osteopathic Medicine

Statement of Significance: Virtual learning has been debated, with some studies finding it isolating and unengaging, while other research shows that it can be less intimidating and promotes participation. [1,2] Research is needed to find if virtual, in-person, or a hybrid of both is preferred by medical students. Student preference being considered is important because students feeling comfortable and supported in their learning environment increases both engagement and participation, which improves learning outcomes. [3]

The purpose of this study was to examine first and second year osteopathic medical students’ preferences for viewing lectures across a three-campus medical school.

Research Methods: In this descriptive, cross-sectional study, we assessed students’ preferences for viewing medical school lectures. The electronic, anonymous survey was distributed to all first and second year osteopathic medical students currently enrolled at the main campus and two distance campuses of the Ohio University Heritage College of Osteopathic Medicine. Chi-Square tests examined differences by gender, race, community of origin, and medical campus. Statistical significance was defined as a p-value less than 0.05. Analyses were conducted using SPSS statistical software version 28.0.

Data Analysis: Of the 424 students invited to participate, 230 completed the electronic, anonymous survey (mean age=24.7±2.9 years, 53.0% female, 78.7% White, 10.4% Asian, 4.8% Black, 56.1% OMS I) yielding a response rate of 54.2%. Participants preferences for viewing medical school lectures included 24.6% (n=56) in person, 34.6% (n=79) at home viewing, and 40.8% (n=93) hybrid. Comparisons by sociodemographic variables revealed that female participants preferred viewing lectures in person whereas as male participants preferred at home viewing (χ2=8.956; p=0.011). Viewing preferences did not differ by race or ethnicity (χ2=7.339; p=0.693); however, participants who grew up in small towns of 2,500 to 50,000 people preferred in person viewing, while participants from metropolitan areas preferred home viewing (χ2=19.893; p=0.030).

Conclusion: When surveying first- and second-year medical students about their preferences for learning, the most popular option was a hybrid model, or both in-person and virtual activities. Students may perceive virtual activities as less intimidating and more convenient. Importantly, students also benefit from being face-to-face with the instructor as well as other classmates. Forming a community within the cohort of students is an important aspect of learning, which also likely influenced most students to prefer at least some in-person instruction. Additional studies surveying other multi-campus institutions are needed to support these findings and their ability to be applied to the greater population. Further research on this topic can focus on which specific courses students prefer to be in-person or at home to view, as medical school curriculum varies widely in the amount of collaborative work or hands-on learning that is required for any given lesson. Other important areas of research for this topic include pinpointing exact reasons why students may desire one modality of instruction over another.

References

1. Kelly AP, Columbus R. College in the Time of Coronavirus: CHALLENGES FACING AMERICAN HIGHER EDUCATION. American Enterprise Institute; 2020:1-32. https://www.jstor.org/stable/resrep25358?seq=32

2. Ni AY. Comparing the Effectiveness of Classroom and Online Learning: Teaching Research Methods. Journal of Public Affairs Education. 2013;19(2):199-215. https://doi.org/10.1080/15236803.2013.12001730

3. Hu S, McCormick AC. An Engagement-Based Student Typology and Its Relationship to College Outcomes. Research in Higher Education. 2012;53(7):738-754. https://doi.org/10.1007/s11162-012-9254-7

Financial Disclosures: None reported.

Support: The research was funded by the Osteopathic Heritage Foundation Ralph S. Licklider, D.O. Endowed Professor Award to Dr. Elizabeth Beverly.

Ethical Approval: The study was approved by the Ohio University Office of Research Compliance (Institutional Review Board # 17-E-356).

Informed Consent: All participants provided electronic informed consent. Informed consent was completed prior to participation in the study.

Poster No. *B-6

Abstract No. 2023-035

Category: Basic Science

Research Topic: Musculoskeletal Injuries and Prevention

A Previously Undescribed Tendinous Connection Between the Fibularis Tendons and the Plantar Aponeurosis May Provide Insights into Causes and Treatments of Plantar Fasciitis

Sohil Gopal, OMS-III; Peter J. Ward, PhD

Department of Biomedical Sciences^, West Virginia School of Osteopathic Medicine

Statement of Significance: Plantar fasciitis is a common and debilitating cause of heel pain. The gold standard therapy is stretching exercises mainly consisting of dorsiflexion and plantarflexion techniques, but there may be gaps in anatomical knowledge that could support the need for additional planes of motion. For both management and treatment of plantar fasciitis, it is important to account for the anatomical structures within the region, particularly the central and lateral bands of the plantar aponeurosis.

To investigate possible connections between the fibularis (peroneus) tendons and fascia of the plantar aponeurosis and their potential role in enhancing osteopathic biomechanical models of treating plantar fasciitis.

Research Methods: The investigators conducted eight dissections of feet to analyze possible connections between the plantar aponeurosis and the fibularis tendons. Instead of removing the plantar aponeurosis, as is commonly done during deep dissection of the plantar foot, we followed the fibularis longus tendon across the lateral aspect of the foot and cuboid bone. The tendon of the fibularis longus was followed into the plantar foot and the overlying structures were removed but connections between the tendons, tendon sheaths, and plantar aponeurosis were maintained. We then defined and removed the abductor hallucis muscle, allowing us to follow the tendon further and maintain connections to the plantar aponeurosis. The lateral band of the plantar aponeurosis was then freed from its attachments, followed by the central band. Once freed, connections between the planar aponeurosis and fibularis longus tendon were examined.

Data Analysis: A stout bridge of connective tissue between the fibularis longus tendon and the plantar aponeurosis was discovered in six of the eight feet that were examined. The connection came directly from the tendon of the fibularis longus, passed inferior to the short plantar ligament, and inserted into the superior (deep) aspect of the plantar aponeurosis, near the separation between its lateral and central bundles. When the fibularis longus tendon was pulled, traction on the plantar aponeurosis was noted, particularly between its central and lateral bands. This connection was called the plantar frenular ligament to distinguish it from other frenular ligaments of the same tendon that insert on the bones of the foot. Continued dissection of the feet showed the common pathway of fibularis longus running from lateral to medial on the inferior side of the foot, while the plantar fascia connected the calcaneal tuberosity to each metatarsal.

Conclusion: The discovery of a direct connection between the fibularis longus muscle, which originates in the lateral leg, and the plantar aponeurosis poses several challenges to Osteopathic physicians treating plantar fasciitis. Standard stretching and manipulations targeted exclusively at the central band of the plantar aponeurosis may miss dysfunction that results from traction caused by the fibularis longus muscle in the lateral leg. This may also provide an explanation for plantar foot pain following an inversion injury as this stretches the fibularis muscles severely and this stretch is passed along their attachments. It also opens new potential routes to relieve the tension, swelling, and pain of plantar fasciitis. Additional research to firmly define the incidence of this plantar frenular ligament and its role in foot dysfunction will hopefully assist in the development of new therapies for plantar fasciitis.

References

1. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84(6):676-682.

2. Sichting F, Holowka NB, Ebrecht F, Lieberman DE. Evolutionary anatomy of the plantar aponeurosis in primates, including humans. Journal of Anatomy (2019)237:85-104. doi: 10:1111/joa13173

3. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis. Foot & Ankle International (2004)25:303-10. doi: 10.1177/107110070402500505

4. Benjamin M. The fascia of the limbs and back – a review. Journal of Anatomy (2009)214:1-18. doi: 10.1111/k.1469-7580.2008.01011.x

5. Moore K, Dalley A (2006) Lower Limb. Clinically Oriented Anatomy. Wilkins, Lippincott Williams and Wilkins, Philadelphia.

6. Patil V, Frisch NC, Ebraheim NA. Anatomical Variations in the Insertion of the Peroneus (Fibularis) Longus Tendon. Foot and Ankle International. 2007. 28:1179-1182. doi: 10.3113/FAI.2007.1179

7. Olewnik L. Is there a relationship between the occurrence of frenular ligaments and the type of fibularis longus tendon insertion? Annals of Anatomy (2019) doi: 10.1016/j.aanat.2019.03.002

8. Wynne M, Burns J, Eland D, Conatser R, Howell J. Effect of Counterstrain on Stretch Reflexes, Hoffmann Reflexes, and Clinical Outcomes in Subjects with Plantar Fasciitis. Journal of Osteopathic Medicine. 2006;106(9), 547-556. https://doi.org/10.7556/jaoa.2006.106.9.547

Financial Disclosures: None reported.

Support: This study was funded by an intermural research grant from the West Virginia School of Osteopathic Medicine.

Ethical Approval: We were granted exemption from IRB for this project.

Informed Consent: The Human Gift Registry is a whole body donation program in which donors can self-register or a donation is authorized by family member or other designee after death. A signed and witnessed Donor Registration Form is completed for the donation process.

Poster No. *B-7

Abstract No. 2023-040

Category: Basic Science

Research Topic: Musculoskeletal Injuries and Prevention

A Literature Review on the Potential Benefits of OMM on the Cervical Region for Race Car Drivers Before and After Motorsports Races

Tsz Chun Chung, OMS-II; Glenn Sicari; David Shoup; James F. Keane; Leonard B. Goldstein

A.T. Still University School of Osteopathic Medicine in Arizona

Statement of Significance: This literature review explored common racecar driver injuries, such as neck sprain and fatigue, secondary to sustained 4-5G forces exposure, vibration, overuse, and lactate accumulation. Muscle energy (ME) techniques analyzed from multiple articles improved cervical range of motion and pain, comparable to ketorolac injection for acute moderate to severe pain relief. This supports our hypothesis that ME could treat racecar driver injuries, an unfilled gap in the existing literature.

To identify if Osteopathic Manipulative Treatment is an appropriate or improved alternative to existing medical practices in the motorsports realm. In this literature review, our goals are to identify common methods of treatment inside the motorsports realm (ex: nascar, formula-1). We will also look outside of motorsports in areas such as: aeronautics, and performing arts. Based on this review we can apply these techniques to aid drivers in faster recovery and reduction of muscle strain.

Research Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, ResearchGate, and Defense Technical Information Center—the time frame for the literature search extended from the inception of these databases until June 2023.

Studies were included based on the following criteria:

1. If they were available in full text;

2. If they were peer-reviewed;

3. If they were written in or translated into English;

4. If they provided relevant insights regarding one of the following:

   1. the effects of G force exposure to race car drivers’ musculoskeletal pain or injuries

   2. the physiological stress experienced by race car drivers

   3. the effectiveness of osteopathic manipulation medicine on pain level reduction

   4. the common injuries experienced by race car drivers

Data Analysis: 16 studies that met the inclusion criteria were included in the review, involving more than 3,550 participants. Race car drivers experienced G forces ranging from 4-6 G in the anterior-posterior and mediolateral directions at speeds between 150-300 km/hour. Lateral G-forces exerted a force of 250N per turn on the head and neck, requiring straining maneuvers for stability. The average number of turns on an F1 track is 17, equal to 4,250N of force generated per lap. Any F1 driver would have a total counterbalancing force of roughly 255,000N, given 60 laps on average in each race. Survey data indicated that 90% of professional race car drivers experienced neck and leg muscle fatigue after races. Open-wheel drivers demonstrated 40-60% greater lateral neck flexion strength than non-race car drivers and aircraft pilots. Musculoskeletal symptoms commonly affected the lumbar, cervical, shoulder, and thoracic spine, with neck sprain accounting for 44.6% of injuries during races. Localized and generalized vibrations during races predisposed drivers to neck and back pain. Race car drivers exhibited elevated blood lactate levels of up to 3.2 mmol/L due to increased glucose metabolism and emotional stress. Lactate accumulation during high-intensity exercise heightened sensitivity to muscle pain by 62% via enhancing acid-sensing Na+ channels on ischemia-sensing neurons. Therefore, overuse injuries related-pain were common among race car drivers, primarily in the head, neck, abdominal region, and upper extremities during braking and high-speed turning. Beneficial Effects of Muscle Energy Techniques on Neck PainStudies found that muscle energy techniques (MET) of osteopathic manipulative medicine (OMM) were more effective than stretching in improving pain by 20% and the range of motion by 10% in a group of 58 patients. Another study found that MET was as effective as intramuscular Ketorolac in providing moderate to severe pain relief in 58 patients with acute neck pain.

Conclusion: This narrative literature review of 16 studies published between 1983 and 2021 included an estimation of 3,550 participants and identified the common stressors contributing to neck pain experienced by race car drivers, which included G-force exposure, high-magnitude of vibration during operations of race cars, overuse injuries, and lactate accumulation during the race. After carefully reviewing the literature, we feel that Muscle Energy can be a useful technique to incorporate into a driver’s repertoire for rapid recovery and reducing pain and inflammation associated with muscle strain on the head and neck. Further studies to consider may include the actual testing of Muscle Energy on these drivers and follow-up studies to assess the efficacy of treatment post-race. A combination of Ketorolac injection and Muscle Energy OMT may also be an avenue to explore for drivers who sustain moderate to severe neck strain during an intense race.

References

1. Shoup D, Matsushita S, Kanumalla R, Goldstein L. Inside Performing Arts Medicine. Practical Pain Mgmt J. 2019;18(7).

2. REID MB, LIGHTFOOT JT. The Physiology of Auto Racing. Med Sci in Sports Exerc. 2019;51(12):2548-2562. doi:10.1249/MSS.0000000000002070

3. Williams J. Review of the Physiological Responses to Open-Wheeled Racing with Current Trends in Testing and Strength Training. Published 2021.

4. Backman J, Häkkinen K, Ylinen J, Häkkinen A, Kyröläinen H. Neuromuscular Performance Characteristics of Open-Wheel and Rally Drivers. J Str Cond Res. 2005;19(4):777. doi:10.1519/R-16544.1

5. Baur H, Müller S, Hirschmüller A, Huber G, Mayer F. Reactivity, stability, and strength performance capacity in motor sports. Br J Sports Med. 2006;40(11):906-911. doi:10.1136/bjsm.2006.025783

6. Burton AK. Back pain in Grand Prix drivers. Br J Sports Med. 1983;17(4):150-151. doi:10.1136/bjsm.17.4.150

7. Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are Occupational Drivers at an Increased Risk for Developing Musculoskeletal Disorders? Spine. 1996;21(6):710-717. doi:10.1097/00007632-199603150-00010

8. Mansfield NJ, Marshall JM. Symptoms of musculoskeletal disorders in stage rally drivers and co-drivers. Br J Sports Med. 2001;35(5):314-320. doi:10.1136/bjsm.35.5.314

9. Minoyama O, Tsuchida H. Injuries in professional motor car racing drivers at a racing circuit between 1996 and 2000. Br J Sports Med. 2004;38(5):613-616. doi:10.1136/bjsm.2003.007674

10. Bovenzi M. Metrics of whole-body vibration and exposure–response relationship for low back pain in professional drivers: a prospective cohort study. Int Arch Occup Environ Health. 2008;82(7):893-917. doi:10.1007/s00420-008-0376-3

11. Immke DC, McCleskey EW. Lactate enhances the acid-sensing Na+ channel on ischemia-sensing neurons. Nat Neurosci. 2001;4(9):869-870. doi:10.1038/nn0901-869

12. Ebben WP, Suchomel TJ. Physical Demands, Injuries, and Conditioning Practices of Stock Car Drivers. J Strength Cond Res. 2012;26(5):1188-1198. doi:10.1519/jsc.0b013e31822d5306

13. Potkanowicz ES, Mendel RW. The case for driver science in motorsport: a review and recommendations. Sports Med. 2013;43(7):565-574. doi:10.1007/s40279-013-0040-2

14. Phadke A, Bedekar N, Shyam A, Sancheti P. Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial. Hong Kong Physiother J. 2016;35:5-11. doi:10.1016/j.hkpj.2015.12.002

15. Jalal Y, Ahmad A, Rahman AU, Irfanullah, Daud M, Aneela. Effectiveness of muscle energy technique on cervical range of motion and pain. J Pak Med Assoc. 2018;68(5):811-813.

16. McReynolds TM, Sheridan BJ. Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005;105(2):57-68.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: ATSU Institutional Review Board Determination of Non-jurisdiction: Approved, IRB number: 2023-120.

Informed Consent: N/A. No human subjects used.

Poster No. B-8

Abstract No. 2023-042

Category: Basic Science

Research Topic: Osteopathic Philosophy

Effectiveness of Osteopathic Tenet Integration into Basic Science Learning Objectives Using Generative Artificial Intelligence

¹Eric Harp, DO; ²Griffin Hughes

¹Department of Medical Education, Oklahoma State University Center for Health Sciences; ²Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences

Statement of Significance: Even with supportive efficacy, integration of osteopathy principles into basic science curriculum remains a challenge. It is, however, essential to a distinctive identity. Contributors include decreased contact hours, traditional separation from clinical education, presence of single accreditation of graduate programs, and education from either allopathic physicians or those otherwise not trained in the osteopathic tradition. Few studies provide strategies to specifically address this challenge.

To assess student responses to the embedding of osteopathic medicine tenets into basic science learning objectives encountered in the first two years of an osteopathic medical curriculum. The authenticity of machine generated content is additionally assessed. A generalizable goal is to explore the potential use of artificial intelligence platforms to aid educators in adding osteopathic principles to their curricular content.

Research Methods: Learning objectives from two foundational systems course events were entered into the open access artificial intelligence platform ChatGTP (GTP-3) preceded with a query to “integrate the osteopathic tenets into these learning objectives”. Events included a first year completed course and a second-year course yet to be studied, the goal being to evaluate for potential difference between prospective versus retrospective learning. Learning objectives with and without embedded osteopathic tenets became part of 2 surveys representing the different course events used to assess the effectiveness of the integrated osteopathic tenets. Effectiveness was measured by student reactions to statements covering 4 domains of osteopathic education including correlation of structure and function, integration of osteopathic principles into learning strategy, whole person patient approach and viewing overall health on a spectrum of wellness to dysfunction. Chosen domains represent a combination of the primary author’s experience as an osteopathic physician educator and published goals of education in the osteopathic tradition. A final question measured student impression of the authenticity of the machine-generated learning objectives. Survey was offered to 50 summer research students currently enrolled in the Doctor of Osteopathic Medicine program. Participating students were involved in psychological, biomedical science or evidence-based literature study with none specifically working on osteopathy-related projects. All students had recently completed year 1 of the osteopathic medicine curriculum. After a brief oral presentation, students were randomly provided 1 of the 2 surveys to be completed anonymously and independently. Social and academic desirability was minimized by optimizing anonymity. Both surveys included the same Likert scale questions to measure student impressions. Returned paper surveys were manually separated into the 2 groups, transcribed, and analyzed using Excel.

Data Analysis: A total of 31 of 50 (n=31) surveys were returned completed (62% response). 5-point Likert scale median response to all statements was positive (4/5) with the mean showing slightly positive (3.45/5). Median response for the prospective course was positive regarding the four osteopathic domains (4/5) and for authenticity of the machine-generated content (4/5), while the mean responses were slightly positive for both, (3.6/5) and (3.29/5) respectively. Median response for the retrospective course was neutral (3/5) regarding the four osteopathic domains and positive (4/5) for authenticity of the machine-generated content, while the mean responses were slightly positive (3.39/5) and just below neutral (2.93/5) respectively. Responses ranged from 1-5 for all questions. Individual mean responses for all questions were higher in the prospective learning group with the difference being significant by paired t-test (p = 0.0418). Highest mean positive response for both groups was to the statement regarding augmented integration of osteopathic principles into learning strategies and lowest for authenticity of the machine-generated content.

Conclusion: Student response to seeing osteopathic tenets integrated into basic learning objectives was mostly neutral to positive. Findings support the most benefit may be in enhancing the ability to integrate osteopathic principles into a learning strategy. Higher positive responses were observed in students seeing the osteopathic tenets embedded into learning objectives for content that had yet to be studied over that previously studied. The findings support value in providing an example of osteopathic principle integration as a context for prospective learning in the basic sciences. The findings are limited by small sample size (19% of a typical medical student class, 31 of 165), inherent limitations of Likert-type scales including averages being less meaningful with limited response options, and homogeneity of subjects (forthcoming second-year students involved in research). The latter, however, provided an opportunity for controlled comparison. Artificial intelligence platforms provide an available resource for educators in an osteopathic medical curriculum to incorporate osteopathic philosophy. The authenticity and ethics of such use continues to be a point of emerging discussion.

References

1. Core Competencies for Medical Students. American Association of Colleges of Osteopathic Medicine; 2012. https://www.aacom.org/docs/default-source/core-competencies/corecompetencyreport2012.pdf?sfvrsn=179c6097_4. Accessed June 13, 2023

2. Steele KM, Baker HH. Clearly distinct: outcomes of initiative to increase integration of osteopathic principles and practice at West Virginia School of Osteopathic Medicine. J Am Osteopath Assoc. 2009;109(11):579-590.

3. Ching LM, Burke WJ. Osteopathic distinctiveness in osteopathic predoctoral education and its effect on osteopathic graduate medical education. J Am Osteopath Assoc. 2011;111(10):581-584.

4. Reynolds TS, Frothingham C, Carreiro JE, et al. Report on 7 Years’ Experience Implementing an Undergraduate Medical Curriculum for Osteopathic Medical Students Using Entrustable Professional Activities. J Am Osteopath Assoc. 2020;120(8):529-539. doi:10.7556/jaoa.2020.087

5. Gimpel JR, Belanger SI, Knebl JA, et al. 2019 United States Osteopathic Medical Regulatory Summit: Consensus, Recommendations, and Next Steps in Defining Osteopathic Distinctiveness. J Am Osteopath Assoc. 2020;120(1):35-44. doi:10.7556/jaoa.2020.005

6. Ganguly P, Yaqinuddin A, Al-Kattan W, Kemahli S, AlKattan K. Medical education dilemma: How can we best accommodate basic sciences in a curriculum for 21st century medical students? 1. Can J Physiol Pharmacol. 2019;97(4):293-296. doi:10.1139/cjpp-2018-0428

7. Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014;89(4):573-577. doi:10.1097/ACM.0000000000000166

8. Cummings M. The Single Accreditation System: Risks to the Osteopathic Profession. Acad Med. 2021;96(8):1108-1114. doi:10.1097/ACM.0000000000004109

9. Gevitz N. The Transformation of Osteopathic Medical Education. Academic Medicine. 2009; 84 (6): 701-706. doi: 10.1097/ACM.0b013e3181a4049e.

10. Tenets of osteopathic medicine. American Osteopathic Association website.https://osteopathic.org/about/leadership/aoagovernancedocuments/tenets-of-osteopathic-medicine/. Accessed June 13, 2023

11. Davis GE, Hartwig WC, Riemer RB, Char C, McTighe A, Kremelberg D. Assessing patient experience of the tenets of osteopathic medicine [published online ahead of print, 2023 May 16]. J Osteopath Med. 2023;10.1515/jom-2023-0038. doi:10.1515/jom-2023-0038

12. Seffinger MA, King HH, Ward RC, Jones JM III, Rogers FJ, Patterson MM. Osteopathic philosophy. In: Chila AG, ed. Foundations of Osteopathic Medicine. 3rd ed. Lippincott Williams & Wilkins; 2011:3-22.

13. OpenAI.(2023). ChatGPT (v 3). Accessed June 5, 2003.

14. Lee H. The rise of ChatGPT: Exploring its potential in medical education [published online ahead of print, 2023 Mar 14]. Anat Sci Educ. 2023;10.1002/ase.2270. doi:10.1002/ase.2270

15. Feng S, Shen Y. ChatGPT and the Future of Medical Education [published online ahead of print, 2023 May 10]. Acad Med. 2023;10.1097/ACM.0000000000005242. doi:10.1097/ACM.0000000000005242

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: It is the policy of Oklahoma State University that all research involving human subjects conducted by faculty, students or staff of OSU, shall be submitted to the OSU Institutional Review Board for review before it is initiated. This is true regardless of the location where the research is conducted. Study proposal, summary, and protocol was reviewed by the Oklahoma State University-Center for Health Sciences IRB and deemed exempt. IRB # 2023062

Informed Consent: Study participants were notified that by opting into survey completion that they provided consent that their de-identified responses would be used for research purposes.

★Poster No. *B-9

Abstract No. 2023-043

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Ovariectomy Exacerbates Lung Allergic Responses, but not Vascular Endothelial Function in a Mouse Model of Asthma

¹Alexandra Crawford, OMS-II; ¹Amanda S. Hatcher; ²Lance Ridpath, MS; ¹Marina Diioia, PhD; ¹Dovenia S. Ponnoth, PhD; ¹Shinichi Asano, PhD

¹Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine; ²Department of Statistics, West Virginia School of Osteopathic Medicine

Statement of Significance: Clinical studies show the incidence of asthma is higher in boys than girls, but at the onset of puberty, these sex differences reverse¹. Interestingly, adult females develop more severe asthma compared to adult males, and these asthmatic females are at a higher risk of cardiovascular diseases(CVD)^2,3. These clinical observations suggest that sex hormones may have a role in female specific asthma related CVD, however, the mechanism by which sex hormones modulate CVD in asthmatics is unknown^4-6.

The goals of this study were to 1) shed light on the role of female sex hormones on lung inflammation in asthmatic states and 2) investigate how asthma induced lung allergic responses are related to vascular dysfunction. We tested the hypothesis that ovariectomy (OVX) would exacerbate lung inflammation in asthmatic mice, and that these lung allergic responses would be associated with vascular endothelial dysfunction.

Research Methods: Female C57/BL6 mice (n = 6-8 each group) were randomly sorted into four groups: 1) sham vehicle control (VC), 2) OVX VC, 3) sham asthma, and 4) OVX asthma. Asthma groups were sensitized with 30 µg ovalbumin (OVA) suspended in Imject alum by i.p. injections followed by 5% ovalbumin in 0.9% saline aerosol challenges. Vehicle groups received the identical treatment without ovalbumin. Bronchoalveolar lavage (BAL) was examined for cell counts and differential anti-OVA IgG antibodies. BAL fluid samples were analyzed for 42 inflammatory markers using Rodent MAP 4.0. Vascular reactivity was determined by isometric tension experiment. Endothelial dependent relaxation was measured by the stepwise addition of acetylcholine (Ach) with/without N-nitro l-arginine methyl ester (l-NAME). Endothelial independent relaxation was measured by sodium nitroprusside dose response.

Data Analysis: The mean uterine weight of OVX mice was 90% lower in comparison to ovary-intact mice, confirming sex hormone depletion (Sham VC 69.5 ± 23.1, OVX VC 5.9 ± 1.6, Sham asthma 59.4 ± 32.0, OVX asthma 6.7 ± 1.6 mg, p<0.0001). OVX asthma mice had the highest proportion of eosinophil recruitment (Sham asthma: 58 ± 9 vs. OVX asthma 76 ± 5 %, p < 0.05). In addition, in comparison to ovary-intact groups, OVX asthma had 85% higher anti-OVA IgG (Sham: 60.4 ± 11.4 vs. OVX asthma: 112.0 ± 21.2 ng/ml, p <0.01). Hierarchical clustering analysis revealed distinct BAL fluid cytokine profiles between Sham vs OVX asthma groups. Isometric tension experiments demonstrated that maximal Ach induced aortic dilation was reduced 24 % in both sham and OVX asthmatic mice compared with respective vehicle control mice. (p < 0.001), but there were no differences between sham and OVX asthmatic mice. Smooth muscle sensitivity to nitric oxide (NO) assessed by the response to sodium nitroprusside was not affected in all groups. The NO component of Ach induced dilation was significantly reduced in both asthma groups, suggesting both asthma groups had a similar degree of endothelial dysfunction compared to the control mice.

Conclusion: Our data demonstrated that ovariectomized asthmatic mice developed exacerbated allergic lung responses. This worsening of lung inflammation may suggest a potentially protective role of ovarian hormones in the lungs. Contrarily, ovariectomized asthmatic mice did not have the same aggravating effect in the vascular endothelium. While aortic endothelial dysfunction was observed in both asthmatic mice groups, ovariectomy did not worsen vascular function as anticipated. Therefore, further studies are necessary to identify the link between the lung inflammation we observed and factors regulating vascular function. Our study did have limitations, such as the utilization of ovalbumin as an allergen. Although ovalbumin is often used in animal studies to explore asthma pathophysiology, allergens in human asthma are more complex and variable. Taken together, our findings show asthmatic ovariectomized mice are a useful model for investigating the potential link between sex, lung inflammation, and vascular function.

References

1. Moulton VR. Sex Hormones in Acquired Immunity and Autoimmune Disease. Frontiers in Immunology. 2018;9. https://www.frontiersin.org/articles/10.3389/fimmu.2018.02279

2. Yu S, Lee SC, Hong JH, Han CH, Park SC, Jung JY. Cardiovascular and cerebrovascular mortality in patients with preceding asthma exacerbation. Respirology. 2023;28(3):281-286. doi:10.1111/resp.14444

3. Yung JA, Fuseini H, Newcomb DC. Sex hormones, gender and asthma. Ann Allergy Asthma Immunol. 2018;120(5):488-494. doi:10.1016/j.anai.2018.01.016

4. Tattersall MC, Guo M, Korcarz CE, et al. Asthma predicts cardiovascular disease events: the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35(6):1520-1525. doi:10.1161/ATVBAHA.115.305452

5. Hua ML, Li L, Diao LL. Bronchial asthma and risk of 4 specific cardiovascular diseases and cardiovascular mortality: a meta-analysis of cohort studies. Eur Rev Med Pharmacol Sci. 2022;26(14):5081-5091. doi:10.26355/eurrev_202207_29294

6. Adrish M, Hanania NA. Asthma and cardiovascular disease: A bidirectional association? Respirology. 2023;28(3):217-219. doi:10.1111/resp.14468

Financial Disclosures: None reported.

Support: The study was supported by National Institutes of Health Grants P20GM103434 (WV-INBRE) and 2U54GM104942 (WV-CTSI).

Ethical Approval: All animal protocols were approved by WVSOM Institutional Animal Care and Use Committee (IACUC # 2022-1). Guidelines from the Guide for the Care and Use of Laboratory Animals were followed.

Informed Consent: Not applicable.

Poster No. *B-10

Abstract No. 2023-048

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Osteopathic Cranial Manipulation and its Possible Application in Managing Hypertension for the Optimization of Care

¹Stephanie Jackson, OMS-II; ¹Tsz Chun Chung; ¹Alyssa Arellano; ²James Keane; ³Leonard Goldstein;

¹A.T. Still University School of Osteopathic Medicine in Arizona; ²Department of Osteopathic Medical Center, A.T. Still University School of Osteopathic Medicine in Arizona; ³Department of Clinical Education Development, A.T. Still University School of Osteopathic Medicine in Arizona

Statement of Significance: Approximately 50% of US adults suffer from hypertension, with 75% inadequately controlled. The baroreceptor reflex elicits vagal stimulation, reducing heart rate and blood pressure. Non-invasive osteopathic cranial manipulation (OCM), including occipito-atlantal (OA) release, may enhance vagal tone. This literature review examines the potential efficacy of OCM in optimizing hypertension management by augmenting vagal tone and subsequently reducing blood pressure.

To determine whether osteopathic cranial manipulation (OCM) may be utilized for blood pressure reduction and hypertension management via vagal nerve stimulation affecting the baroreceptor reflex. Specifically, we aim to investigate the effects occipito-atlantal (OA) release has on vagal tone and determine whether it has reasonable applications within hypertensive conditions.

Research Methods: Our group searched for credible literature sources on Still OneSearch, DynaMed, Google Scholar, PubMed, MEDLINE, and National Institutes of Health (NIH) online databases as well as the following journals: Frontiers in Neuroscience, Journal of Alternative and Complementary Medicine, and Medicines. The search strategy included keywords or a combination of keywords such as “hypertension or high blood pressure”, “baroreceptor reflex”, “vagal nerve stimulation”, and “osteopathy or osteopathic manual therapy or OMT or manual therapy or osteopathic medicine or osteopathic treatment” to discover related articles. Filters for peer reviewed sources with access to full text and publication dates between 2010-2023 were applied to our search, narrowing the results to only the most up-to-date information. Once studies of interest were selected, the articles were read and analyzed with pertinent components referenced throughout our literature review in accordance with AMA citation format. Altogether, this project demonstrates osteopathic significance because it emphasizes the value of osteopathic cranial manipulation (OCM), spreads awareness of Sutherland’s philosophies, and underscores the possibility of OCM applications in the treatment of hypertension. Furthermore, it describes how OCM can be used in combination with or as a safer alternative to managing hypertensive conditions, thus creating more options for providing quality healthcare.

Data Analysis: This literature review sought to examine the potential efficacy of HTN management through the utilization of osteopathic cranial manipulation. In the clinical and preclinical studies of vagus nerve stimulation (VNS) therapy, it was found that a 4-week-long VNS therapy significantly decreased mean arterial pressure and the number of arrhythmic episodes in rats with salt-induced hypertension, with a potential side effect being bradycardia due to asystole (1, 2). In theory, by initiating manual biomechanical alignment in the OA joint would improve vagus nerve function and thus increase parasympathetic function to the heart to reduce atrial contraction, comparable to VNS. A study examining 19 healthy, young adults who underwent cervical OMT and had their heart rates measured pre- and post-electrocardiography, revealed moderate enhancement of parasympathetic HR control (3). In another study of 63 subjects with hypertension who were treated with OMT for 1 year, it was found that their systolic blood pressure improved significantly (4). In a randomized controlled study, a combination of kneading and stretching of soft tissues and suboccipital decompression, there is an increase of 15% of parasympathetic modulation of heart rate with p=0.02 (3).

Conclusion: Research agrees that the instigation of parasympathetic activity through vagal nerve stimulation adjusts heart rate in the response to baroreceptors that detect arterial pressure changes within the heart (5). Giles et al demonstrated a positive relationship between the effects of OMT and acute heart rate variability (3). However, the relationship between heart rate and vagal activity is not linear, and has been previously difficult to clearly denote (6). Overall, this literature review demonstrates the significant impact hypertension has on society and the need for alternative treatments. In research conducted by Giles et al, OMT was proven to have an effect on heart rate variability in health individuals and although the research was not conducted on patients with somatic dysfunction, the data suggests that the effect on heart rate via OMT is measurable and definitive. This lends to a promising advancement in the relationship between OMT and heart rate in a diseased population. Assessment of this change in the frequency domain of autonomic control suggests necessary evaluation of the shift in sympathetic to parasympathetic states within chronic HTN patients. In evaluation of current research, it is not possible to draw a definitive conclusion about the effectiveness of OCM on the management of HTN. Future research should be conducted in the evaluation of OCM and the specific types of techniques that offer the greatest effect on both heart rate and blood pressure. Ideally these projects would determine the effectiveness of OCM through a dedicated, well-designed, controlled and blinded outcome study for the evaluation of statistically significant results. The data that would be extracted from these future studies could have profound impacts on the integration of OMT into the scheme of hypertension management and inform policy changes to enable it as a viable tool for treatment.

References

1. Capilupi MJ, Kerath SM, Becker LB. Vagus Nerve Stimulation and the Cardiovascular System. Cold Spring Harb Perspect Med. 2020;10(2):a034173. Published 2020 Feb 3. doi:10.1101/cshperspect.a034173

2. Annoni EM, Xie X, Lee SW, et al. Intermittent electrical stimulation of the right cervical vagus nerve in salt-sensitive hypertensive rats: effects on blood pressure, arrhythmias, and ventricular electrophysiology. Physiol Rep. 2015;3(8):e12476. doi:10.14814/phy2.12476

3. Giles PD, Hensel KL, Pacchia CF, Smith ML. Suboccipital decompression enhances heart rate variability indices of cardiac control in healthy subjects. J Altern Complement Med. 2013;19(2):92-96. doi:10.1089/acm.2011.0031

4. Cerritelli F, Carinci F, Pizzolorusso G, et al. Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension. J Bodyw Mov Ther. 2011;15(1):68-74. doi:10.1016/j.jbmt.2010.03.005

5. Shaffer F, Meehan ZM. A Practical Guide to Resonance Frequency Assessment for Heart Rate Variability Biofeedback [published correction appears in Front Neurosci. 2020 Dec 01;14:627512]. Front Neurosci. 2020;14:570400. Published 2020 Oct 8. doi:10.3389/fnins.2020.570400

6. Carnevali L, Lombardi L, Fornari M, Sgoifo A. Exploring the Effects of Osteopathic Manipulative Treatment on Autonomic Function Through the Lens of Heart Rate Variability. Front Neurosci. 2020;14:579365. Published 2020 Oct 7. doi:10.3389/fnins.2020.579365

7. Roland H, Brown A, Rousselot A, et al. Osteopathic Manipulative Treatment Decreases Hospital Stay and Healthcare Cost in the Neonatal Intensive Care Unit. Medicines (Basel). 2022;9(10):49. Published 2022 Sep 21. doi:10.3390/medicines9100049

8. Spiegel AJ, Capobianco JD, Kruger A, Spinner WD. Osteopathic manipulative medicine in the treatment of hypertension: an alternative, conventional approach. Heart Dis. 2003;5(4):272-278. doi:10.1097/01.hdx.0000080718.70719.88

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: ATSU, AZ Institutional Review Board (IRB): Non-Jurisdiction Approved (IRB number: 2023-122)

Informed Consent: N/A; no informed consent required, this is a literature review.

Poster No. *B-11

Abstract No. 2023-054

Category: Basic Science

Research Topic: Impact of OMM & OMT

The Efficacy of Osteopathic Manipulation Treatment (OMT) on Post-Operative Outcomes: An Abstract

Pranav Reddy, OMS-II; Keerthana Santhakumar

Department of Research, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Post-operative complications are a significant concern in surgical care, leading to prolonged hospital stays, delayed recovery, and reduced well-being[1]. Osteopathic Manipulation Treatment (OMT) is a non-invasive therapy that shows promise in improving postoperative outcomes and reducing complications[2]. While the use of OMT in managing musculoskeletal conditions has been extensively studied, its potential role in mitigating postoperative complications has not yet been fully documented[3].

To determine whether OMT significantly improves post-surgical outcomes, including postoperative complications in adult patients. This study aims to provide evidence-based recommendations on using OMT as an adjunctive therapy in post-operative care.

Research Methods: This study was a literature review on the efficacy of Osteopathic Manipulation Treatment (OMT) on Post-Operative Complications and explores the potential benefits of OMT in reducing complications following surgical procedures in adult patients. The application of OMT in the treatment of postoperative complications was thoroughly analyzed in recent studies. A comprehensive search of PubMed databases yielded relevant papers that were published between 2000 and 2020. "[OMM OR OMT OR osteopathic manipulative treatment OR osteopathic manipulative medicine OR osteopathic manipulation] AND [post-operative complications OR post-operative therapy OR post-operative care]" were among the search terms utilized. The chosen publications were then examined for possible advantages and disadvantages of this adjunctive therapy, the ideal patient demographics, and future paths of study.

Data Analysis: In a 2013 study, OMT was used postoperatively to treat patients after gastrointestinal surgery to address factors contributing to the development of postoperative ileus. The length of postoperative hospital stays (LOS) in patients who received OMT was an average of 6.1 days compared to an average of 11.5 days in the control group (p-value of 0.006). The average time to flatus was 3.1 days in patients who received OMT compared to 4.7 days in the control group (p-value of 0.035)[4]. Another study was done that assessed the effect of OMT on reducing postoperative complications, specifically on sternal pain levels in post-sternotomy patients. 40 patients received OMT concurrently with cardiorespiratory rehabilitation, and 40 patients solely received cardiac rehabilitation. The OMT significantly reduced pain scores assessed via visual analogue scale, increased mean inspiratory volume, and reduced length of hospitalization with p-values of 0.007, 0.01, and 0.04, respectively. The LOS in the control group had a 21.7 day stay compared to 19.1 days for the OMT group[5]. Shorter LOS were also seen in a 2000 study assessing the effect of OMT after knee or hip arthroplasty. 38 patients each were enrolled in the control and the OMT group which resulted in a significant 43% increase in ambulation distance on postoperative day 3 with a p-value of 0.008 [6]. The impact of OMT has also been assessed in patients immediately post-surgery, specifically in a 2005 study on patients after coronary artery bypass graft surgery. OMT was performed within 2 hours postoperatively and the difference in thoracic impedance, mixed venous oxygen saturation (SvO2), and cardiac index was assessed between the control and OMT groups. OMT was shown to significantly increase thoracic impedance and reduce central blood volume with a p-value of 0.02, increase SvO2 with a p-value of 0.005, and improve cardiac index with a p-value of 0.01 [7].

Conclusion: OMT was shown to have a significant impact on reducing post-operative complications and mitigating factors contributing to these complications in a postoperative setting. The studies analyzed in this literature review indicate that a variety of OMT techniques, including soft tissue techniques and myofascial release, can be used in a postoperative setting to improve patient recovery. Factors such as hospital length of stay, patient pain scores, ambulation, gastrointestinal complications, and hemodynamics postoperatively were all shown to significantly improve after OMT. These findings were associated in a variety of surgeries including gastrointestinal, orthopedic, and cardiovascular as well as with OMT being provided immediately postoperatively to several days after. The positive impact of OMT remains consistent throughout these variations due to its purpose of improving blood flow and lymphatic drainage as well as range of motion. As a result, OMT can be used as an alternative or as adjunctive therapy to current postsurgical protocol to help reduce adverse effects of any analgesic drugs given post-operatively.

For future direction, the specific OMT techniques that should be used to optimize efficient patient recovery can be more thoroughly investigated. This may include assessing the effectiveness of passive versus active techniques as well as direct versus indirect techniques in mitigating postoperative complications. Limitations to be addressed in future literature reviews include analyzing articles with a wider variation of OMT techniques and a wider age range as many of the current studies involved patients older than 60 years old.

References

1. Bartels H. [Postoperative complications--what is often? What is rare?]. Kongressbd Dtsch Ges Chir Kongr. 2001;118:332-5. Postoperative Komplikationen--Was ist haufig? Was ist selten?

2. Licciardone JC, Schultz MJ, Amen B. Osteopathic Manipulation in the Management of Chronic Pain: Current Perspectives. J Pain Res. 2020;13:1839-1847. doi:10.2147/JPR.S183170

3. Sposato NS, Bjersa K. Osteopathic Manipulative Treatment in Surgical Care: Short Review of Research Publications in Osteopathic Journals During the Period 1990 to 2017. J Evid Based Integr Med. Jan-Dec 2018;23:2515690X18767671. doi:10.1177/2515690X18767671

4. Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital length of stay in general surgical patients. J Am Osteopath Assoc. Mar 2013;113(3):204-9.

5. Racca V, Bordoni B, Castiglioni P, Modica M, Ferratini M. Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial. Ann Thorac Surg. Jul 2017;104(1):145-152. doi:10.1016/j.athoracsur.2016.09.110

6. Jarski RW, Loniewski EG, Williams J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. Altern Ther Health Med. Sep 2000;6(5):77-81.

7. AH OY, Carnes MS, Clearfield MB, Stoll ST, McConathy WJ. Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery. J Am Osteopath Assoc. Oct 2005;105(10):475-81.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Exempt

Informed Consent: Not relevant

Poster No. *B-12

Abstract No. 2023-055

Category: Basic Science

Research Topic: Musculoskeletal Injuries and Prevention

Mapping Limb Muscle Attachments in the Savannah Monitor Lizard Using Dissection and Contrast-Enhanced Imaging

Chloe Santoro, OMS-II; Nicole Sardella OMS-II; Julia Molnar PhD; Matthew Savallo OMS-III; Cassandra Turcotte PhD

Department of Anatomy, New York Institute of Technology

Statement of Significance: Varanid lizards span an enormous range of body sizes, and can contain muscles that are “scaled” to larger proportions. Scaling an animal to a larger size without changing body proportion or kinematics would result in a decrease in locomotive performance and an increase in stress induced muscle failure. 1 The article by Jenkins et. al details the functional anatomy of the shoulder of the Varanus exanthematicus species, but a map depicting the attachments has not previously been created. 2

With an understanding of the anatomical configurations, researchers can examine the physiological barriers and limitations for these Varanid species. This structure-function relationship is evidenced in the adaptations of sprawling tetrapod muscles. 3 We decided to investigate the muscles of the Savannah monitor by synthesizing information collected from gross dissection of the Savannah monitor to complete a muscle map specifically documenting the muscle attachments to the humerus and femur.

Research Methods: Three Varanus exanthematicus were raised in reptilian tanks and fed cat food once a day for 5 days out of a 7 day week. Lizards that did not survive in captivity were chosen for the experiment. Hindlimbs and forelimbs were grossly dissected and photographed to confirm the muscular anatomy (n=3). Muscle mapping was conducted through AMIRA software. Contrast enhanced micro-computed tomography was used to prepare a detailed account of each muscle attachment for accurate illustrations. Osteopathic considerations include how attachment sites contribute to sustained locomotion and the ability to adapt to mechanical load.

Data Analysis: The attachment sites for the pectoral girdle and pelvic girdle are consistent with what was seen by Dilkes in the data for the tuatara (Sphenodon punctatus), a reptile belonging to the closest living outgroup to squamates including Varanus exanthematicus.6 The data demonstrated that the pectoral girdle consisted of specific attachments, some of which include biceps brachii, latissimus dorsi, triceps brachii, deltoid, supracoracoideus. In reference to the pelvic girdle, a few attachments for Varanus exanthematicus, include pubioischiofemoralis externus and internus, iliofibularis, flexor tibialis externus and internus, and caudofemoralis longus.

Conclusion: In conclusion, this muscle map was created to support future research in how certain muscle attachments, or entheses, can facilitate tetrapod movement, particularly related to adaptations in mechanical loading, as demonstrated by Willie et. al. 7 Stresses on entheses can bring larger animals to physiological barriers at a faster rate. Thus, a thorough understanding of these attachment points can propel further research in the response of the entheses to load. Some limitations of the study include lizard life span and their ability to survive in captivity. Each lizard developed at different rates, therefore their muscles were of different sizes in relation to one another. Further research may also address how to properly raise these wild reptiles.

References

1. Dick, Taylor J. M., and Christofer J. Clemente. “How to Build Your Dragon: Scaling of Muscle Architecture from the World’s Smallest to the World’s Largest Monitor Lizard.” Frontiersin Zoology 13, no. 1 (February 18, 2016): 8. https://doi.org/10.1186/s12983-016-0141-5. 1

2. Jenkins FA Jr, Goslow GE Jr. The functional anatomy of the shoulder of the savannah monitor lizard (Varanus exanthematicus). J Morphol. 1983;175(2):195-216.doi:10.1002/jmor.1051750207. 2

3. Cieri, Robert L., Taylor J. M. Dick, and Christofer J. Clemente. “Monitoring Muscle Over Three Orders of Magnitude: Widespread Positive Allometry among Locomotor and Body Support Musculature in the Pectoral Girdle of Varanid Lizards (Varanidae).” Journal of Anatomy237, no. 6 (2020): 1114–35. https://doi.org/10.1111/joa.13273. 3

4. Dilkes, D. (1999). Appendicular myology of the hadrosaurian dinosaur Maiasaurapeeblesorum from the Late Cretaceous (Campanian) of Montana. Earth andEnvironmental Science Transactions of The Royal Society of Edinburgh, 90(2), 87-125.doi:10.1017/S0263593300007185. 4

5. Willie BM, Zimmermann EA, Vitienes I, Main RP, Komarova SV. Bone adaptation:Safety factors and load predictability in shaping skeletal form. Bone. 2020;131:115114.doi:10.1016/j.bone.2019.115114. 5

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IACUC approved protocol: 2022-JM-02A2

Informed Consent: N/A

Poster No. B-13

Abstract No. 2023-069

Category: Basic Science

Research Topic: Impact of OMM & OMT

Cranial Osteopathic Manipulation Alters Alzheimer’s Disease Phenotype in Wild Type and Transgenic Rats

¹De’Yana Hines, BS; ²Hope Tobey, DO; ²Lina Kwaspisz; ²Alyssa Ingram; ²Patrick Duggan; ³Seth Boehringer; ²Joseph Piwowarski; ²Anshul Ramanathan; ⁴Ramu Anandakrishnan

¹Department of Biomedical Engineering, Edward Via College of Osteopathic Medicine-Virginia; ²Edward Via College of Osteopathic Medicine-Virginia; ³Department of Biochemistry, Edward Via College of Osteopathic Medicine-Virginia; ⁴Center for One Health Research, Edward Via College of Osteopathic Medicine-Virginia

Statement of Significance: Reduced fluid circulation in the brain can lead to a build-up of macromolecules like amyloid beta (Aβ), which cause neuroinflammation and has been linked to Alzheimer’s [1,2]. Manipulating the CNS lymphatic vessels with Cranial Osteopathic Manipulation (COM) to increase fluid circulation has reduced Aβ, activated astrocytes, and improved excitatory neurotransmission for aged rats in our pilot study.

To study the effect of Cranial Osteopathic Manipulative Medicine on biochemical and cognitive function in transgenic and naturally aged rat models of Alzheimer’s disease.

Research Methods: This part of the study was split into two phases, Phase 4 & Phase 5. Phase 4 had 11 three-month-old wild-type rats while Phase 5 had 12 Fischer 344 transgenic rats. Male and female subjects were used for both phases. Phase 4 serves as a negative control group for Phase 5 and future studies, since subjects will not have a build-up of Aβ at a younger age. Rats that had open wounds or reproductive tumors were excluded from participating. All remaining rats that met this criterion were randomly split, using simple randomization, into COM (treated) and untreated (UT) groups, with the same number of males and females in each group before exclusion. To minimize treatment errors an osteopathic doctor performed the COM treatment. To quantify pressure applied to the occipital squama, FingerTPS nanosensor gloves were used. The gloves fit individually over each finger and have a sensor that can be calibrated per user. To assess changes in learning and memory the Morris Water Maze assay was used for both phases, and the Novel Object Recognition Assay (NORA) was used for rats in Phase 5. MWM assessed this by analyzing the path trajectory and quickness of a subject as they attempt to reach a platform located in one of four quadrants in a circular tub filled with water. MWM assay was performed over 8 days with days 1-4 being training days and 5-8 being experimental days. The platform was submerged on days 5-7 and missing on day 8. NORA was performed to assess the ability to recognize a novel object, under the principle that rodents prefer novelty. Handlers were blinded for both behavioral assays. To assess molecular changes, a proteome analysis was performed. The proteome analysis identified genes that were differentially expressed between COM and UT groups on the protein level. These experiments were conducted to evaluate the effect of COM on cognitive function.

Data Analysis: The average duration of COM treatment was 200-250 seconds for 6 rats from Phase 4. Average force varied with the male rats receiving less force on average than the female rats. For behavioral assays, the Holm-Šídák multiple comparisons T-Test for days 5-8 was used for analysis. Phase 4 had 15 measures that were statistically significant with p-values less than 0.05: (1) Shortest Visit to the NW Zone, (2) Maximum Distance from the NW Zone, (3) Maximum Distance from the Platform Zone, (4) Time Moving away from the Platform Zone, (5) Distance Traveled in the Platform zone, (6) Average Speed in the Platform Zone, (7) Average Absolute Heading Error to the Platform Zone, (8) Number of Entries to the NW Zone, (9) Number of Exits from the NW Zone, (10) Number of Line Crossings in the NW Zone, (11) Number of Entries to the Platform Zone, (12) Number of Exits from the Platform Zone, (13) Time in the Platform Zone, (14) Time Moving towards the Platform Zone, and (15) Number of Line Crossings in the Platform Zone. While Phase 5 had 10 measures: (1) Average speed, (2) Time Moving towards the NW Zone, (3) Signed Initial Heading Error, (4) Shortest Visit to the NW Zone, (5) Signed Initial Heading Error to the Platform Zone, (6) Maximum Distance to the Platform Zone, (7) Average Distance to the Platform Zone, (8) Path efficiency, (9) Clockwise Rotations of the Animal’s Body, and (10) Latency to Last Entry to the Platform Zone. For NORA the Phase 4 COM-treated rats spent numerically more time (COM, 31.4±13.7 vs 26.6±16.51s; UT, 15.5±3.25 vs 24.0 ±12.0s) exploring the novel object. For the proteomic analysis, the abundance ratio between COM and UT was used to identify p-values less than 0.05 for medium confidence and 0.01 for high confidence. The collected hippocampal tissue from the Phase 5 transgenic rats identified that COM significantly increased the expression of serine-threonine kinase P21-activated kinase (PAK3), and fifty other proteins.

Conclusion: These results indicate that COM induced improvements in spatial learning and memory behavior parameters for transgenic and wild-type rats. In addition, the proteome analysis highlights increased expression of proteins associated with Alzheimer’s Disease and other neurological disorders. Further analysis on two cohorts with larger sample sizes, Phase 6 and Phase 7, are underway to corroborate current findings. The outcomes of this study would help justify the clinical use of COM as a minimally invasive non-pharmacological treatment strategy for Alzheimer’s disease.

References

1. Iliff JJ, Wang M, Zeppenfeld DM, et al. Cerebral arterial pulsation drives paravascular CSF-interstitial fluid exchange in the murine brain. J Neurosci. 2013;33(46):18190-18199. doi:10.1523/JNEUROSCI.1592-13.2013

2. Louveau A, Smirnov I, Keyes TJ, et al. Structural and functional features of central nervous system lymphatic vessels [published correction appears in Nature. 2016 May 12;533(7602):278]. Nature. 2015;523(7560):337-341. doi:10.1038/nature14432

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IACUC Number: 22-054 The study was reviewed and approved.

Informed Consent: Not relevant.

Poster No. *B-14

Abstract No. 2023-071

Category: Basic Science

Research Topic: Osteopathic Philosophy

Efficacy of Virtual Reality Programs versus Traditional Lectures on Osteopathic Medicine Information Retention

¹Thomas Jewel Jacob, OMS-IV; ¹Rejath M. Jose, OMS-IV; ¹Adriel Abraham, OMS-IV; ¹Faiz Syed, OMS-IV; ¹Tiffany Tran

²Randy F. Stout, Jr., PhD; ¹Sheldon C. Yao, DO, FAAO

¹Department of Osteopathic Manupulative Medicine, New York Institute of Technology; ²Department of Biomedical Sciences, New York Institute of Technology

Statement of Significance: Virtual Reality (VR) has demonstrated efficacy in teaching anatomy and for surgical cases (Samadbeik et al., 2018). However, there are limited studies on the use of VR in helping students memorize information, especially in Osteopathic Manipulative Medicine; one such topic is Chapman reflex points (CRP). This study analyzes the effectiveness of VR in helping retain information compared to a traditional lecture (TL) among OMM-Naïve (OMM-N) and Third-year Osteopathic Medical Students (OMS-III).

To identify differences in the efficacy of virtual reality (VR) modules versus traditional lecture (TL) in helping OMM-naïve (OMM-N) and third year Osteopathic Medical Students (OMS-III) to retain information.

Research Methods: A VR OMM module was designed using Unity development software for CRPs. The module provides audio prompts to identify CRPs from different body systems. Subjects were recruited via fliers and announcements throughout the the campus. All participants were required to complete a pre-screening survey before participating in the study to ensure they could tolerate a VR environment. Inclusion criteria involved being a medical student at NYITCOM or an undergraduate student at NYIT. Exclusion criteria for the study involved subjects who are not in good academic standing, subjects who are repeating the first-year curriculum, subjects who get extremely motion sick, subjects who have any neurologic or vestibular issues or have any recent experiences (i.e., head injuries) that affect their balance or gait, and if they cannot tolerate flashing or intense light as well as any previous severe adverse events while using VR. Each participant used a VR module and a TL to learn different CRPs and was then given a quiz on the corresponding CRPs, thus, allowing for a comparison between the efficacy of VR versus TL. The VR module covered a total of ten CRPs. The TL covered ten different CRPs. After completing the VR module and TL, subjects completed two separate 6-question quiz on the CRPs they learned using either modality. To assess the quality of the VR module, participants completed a validated “Reduced Instructional Materials Motivation Survey” (RIMMS) survey, a 12-item inventory that assesses motivation when using an educational tool (Wang et al., 2020). The Mann-Whitney U test assessed differences in RIMMS scores between OMM-N and OMS-III. A paired t-test compared the quiz results between VR and TL, and an independent t-test compared the overall quiz results between OMM-N and OMS-III. This Osteopathic contribution of the current study is that it provides information on the effectiveness of VR in memorizing and retaining information related to Osteopathic Medicine.

Data Analysis: A total of 26 subjects (17 OMM-N and 8 OMS-III) were eligible to participate in the study after completing the pre-screening survey; however, only 17 subjects (9 OMM-N and 8 OMS-III) fully completed the VR module and the quiz and RIMMS. The mean score for attention was 3.93 +/- 1.27 among OMM-N and 4.29 +/- 0.624 among OMS-III. The mean score for relevance was 3.96 +/- 1.28 among OMM-N and 4.21 +/- 0.78 among OMS-III. The mean score for confidence was 3.67 +/- 1.54 among OMM-N and 4.50 +/- 0.659 among OMS-III. The mean score for satisfaction was 3.82 +/- 1.642 among OMM-N and 4.375 +/- 0.647 among OMS-III. The Mann-Whitney U test showed no statistically significant difference between OMM-N and OMS-III participants in attention (p = 0.60), relevance (p = 0.88), confidence (p = 0.073), and satisfaction (p = 0.83). The paired t-test showed a statistically significant increase in VR score compared to TL score for the quiz (p = 0.047). The independent t-test showed no significant difference in VR and TL scores between OMM-N and OMS-III participants. Participants were also asked which modality they liked better, and 78% (7/9) of OMM-N and 87% of OMS-III (7/8) said that they preferred the VR module over the TL.

Conclusion: VR is a powerful tool in education with many uses. The current study assesses the effectiveness of VR in helping students retain information. The RIMMS showed that both OMM-N and OMS-III participants were overall satisfied with the VR program in teaching them about CRPs, and it helped them become more confident in the subject matter. In addition, the CRP VR module was also able to keep the subjects’ attention, and participants felt that the subject matter being taught was overall relevant to their needs. The quiz results showed that scores after the VR module were higher than scores after the TL. More research must be done because the current study has a small sample size and cannot claim that a statistical significance in the current sample size will translate to a statistically significant result in the overall population of medical students. However, a majority of the students said that they preferred the VR module over the TL modality in order to learn about CRPs. Students were also asked for a reason for their choice between VR versus TL. Participants that picked TL said that the technical difficulties and the new environment created by VR were jarring for them. Participants that picked VR claimed that VR helped them visualize the information better and was more interactive overall, thus providing a better environment to learn. Future studies should involve more subjects and can also increase the number of CRPs being taught and the number of questions on the quiz.

References

1. Samadbeik M, Yaaghobi D, Bastani P, Abhari S, Rezaee R, Garavand A. The Applications of Virtual Reality Technology in Medical Groups Teaching. J Adv Med Educ Prof. 2018;6(3):123-129.

2. Wang S, Christensen C, Xu Y, Cui W, Tong R, Shear L. Measuring Chinese middle school students’ motivation using the reduced Instructional Materials Motivation Survey (RIMMS): A validation study in the Adaptive Learning Setting. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.01803

Financial Disclosures: None reported.

Support: AACOM supported the OMM department of New York Institute of Technology College of Osteopathic Medicine (NYITCOM) with a grant to buy new Quest 2 Virtual Reality (VR) headsets, which were used in the development and data collection for the current study. No other support was provided for or by any specific authors.

Ethical Approval: Expedited IRB for human subject research was submitted and approved prior to start of study (IRB# BHS-1848). The current study involves human subjects, but does not create any risks for the participants as the subjects will be stationary while using the Virtual Reality (VR) headset and there will be observers to ensure that all subjects are safe while using VR; therefore, we submitted for expedited IRB for human subjects, and was subsequently approved. The pre-screening survey also ensured that subjects with any relevant past medical conditions are not recruited to be part of the study.

Informed Consent: The benefits and shortcomings of Virtual Reality (VR) and the goal of the current study were explained to the participants in person. Participants were also informed of possible adverse events with VR and were encouraged to tell one of the observers if they felt any of the explained symptoms. Each participant was then given a consent form that reiterated the aforementioned points and were instructed to read and sign the consent form if they understood the risks and benefits of VR. Participants were also encouraged to stop using the VR headset if they felt uneasy or dizzy during the study.

Poster No. *B-15

Abstract No. 2023-079

Category: Basic Science

Research Topic: Osteopathic Philosophy

Differences in Learning Approach and Resource Utilization Between First- and Second-Year Osteopathic Medical Students

Rejath Jose, OMS-IV; Leslie Goldstein, PharmD

Clinical Specialties Department, New York Institute of Technology

Statement of Significance: There is a lack of research on Osteopathic Medical Students’ (OMS) learning behavior and resource utilization. This study builds on a previously validated survey, the “Approaches to Learning and Studying Inventory” (ALSI), which splits students into different learning approaches [1]. Differences in medical student self-confidence in correlation with learning approach and resource utilization can reveal the strategies and resources that are most effective among successful medical students.

To identify the differences in learning approach and resource utilization between first-year (OMS-I) and second-year (OMS-II) Osteopathic medical students, in correlation to their self-confidence on class exams and board exams.

Research Methods: A modified version of ALSI was used to analyze medical student learning behavior. ALSI splits students into four different learning approaches: Deep Approach (DA), Monitoring Studying (MS), Effort Management/ Organized Studying (EMOS), and Surface Approach (SA). DA entails thoroughly understanding concepts; MS is related to DA, but students use self-reflection to guide their studying; EMOS entails proper time management to complete needed tasks, and SA focuses on memorizing information without seeking understanding [1]. DA is associated with higher performance on exams, and SA is associated with lower performance on exams [2,3]. A resource utilization assay (RUA) with a comprehensive list of resources assessed the frequency of use of different medical resources. Additional questions on medical school exam scores and self-confidence on board exams were also included in the survey. The survey was sent to all (851 students) OMS-I (442 students) and OMS-II (414 students) from the New York Institute of Technology College of Osteopathic Medicine at Old Westbury (NYITCOM-OW) (629 students) and NYITCOM at Arkansas State (NYIT@AState) (222 students) campuses. The survey was sent out every two weeks for two months, between April – June 2023, to all 851 students. The inclusion criteria included being an OMS-I or OMS-II during the 2022-2023 academic year. The only exclusion criterion was not fully completing the whole survey. The Mann-Whitney U test analyzed the differences between OMS-I and OMS-II. The frequency scores from the RUA were extrapolated and Mann-Whitney U test analyzed any differences between OMS-I and OMS-II. Spearman’s rho was used to analyze for correlation of the learning approach against board-exam confidence and class-exam scores. Students were also asked open-ended questions on how they prepare for Osteopathic Manipulative Medicine practical exams (OMMPE), thus providing an understanding of how students are studying for their Osteopathic practical exams.

Data Analysis: 115 out of 851 students participated in the study; however, 14 only completed part of the survey, so they were omitted. 101 participants were included in the final data analysis, thus a response rate of 11.86%. 73.7% of students were from the NYITCOM-OW campus, and 26.3% were from the NYIT@AState campus. 51.8% of students were OMS-I, and 48.3% were OMS-II. There was a statistically significant difference in SA (p = 0.006), MS (p = 0.015), and DA (p = 0.042) between OMS-I and OMS-II as more OMS-I had a SA to learning, and more OMS-II had an MS or DA to learning. The RUA showed statistically significant more OMS-II used question banks such as USMLE-World (p < 0.001), COMQUEST (p < 0.001), and Amboss practice questions (p = 0.042). No statistically significant difference was found in the use of TrueLearn (p = 0.673) between OMS-I and OMS-II. More OMS-II also used review books and rapid review videos such as Boards and Beyond (p < 0.001), Pathoma (p < 0.001), First Aid Review Book (p < 0.001), Amboss online articles (p = 0.013), and Dirty Medicine (p < 0.001). There was no statistically significant difference between OMS-I and OMS-II in the use of USMLE RX Bricks (p = 0.231) and Sketchy medical videos (p = 0.139). A statistically significant positive correlation existed between DA and board exam confidence (rho = 0.206; p = 0.039). There was a slight positive correlation between DA and self-reported class exams; however, it was not statistically significant (rho = 0.138; p = 0.168). A statistically significant negative correlation existed between SA and board exam confidence (rho = -208; p = 0.037). A statistically significant negative correlation existed between SA and self-reported class exam scores (rho = -0.381; p < 0.001). In practicing for OMMPE, 51% of student responses had a DA, involving hands-on practice with a partner, and 49% of student responses had a SA, involving reading or skimming lab notes.

Conclusion: The ALSI and RUA can provide relevant information for medical educators and students. More OMS-I employed a SA to learn, whereas more OMS-II used a DA. Understanding the reason for this difference can help medical educators curate their lectures to meet the needs of students. Regarding resources, more OMS-II used question banks; however, OMS-I and OMS-II had a similar frequency in using TrueLearn. This could be explained by NYITCOM providing all OMS-I and OMS-II with a free TrueLearn account and assigning questions for each block. More OMS-II also used rapid-review resources; however, the use of USMLE RX Bricks and Sketchy Medical was similar between OMS-I and OMS-II. NYITCOM also provides all OMS-I and OMS-II with USMLE RX accounts; however, NYITCOM does not provide students with a Sketchy Medical subscription. This could indicate that students seek out and use Sketchy Medical videos as OMS-I and OMS-II due to the quality of the videos in helping students understand the material. The correlation between DA and better confidence on board exams could indicate that students who employ a DA prepare better for board exams, thus feeling more confident. Likewise, the negative correlation between SA and board exam confidence and class exam scores could indicate a maladaptive learning approach, hindering students from understanding information thoroughly. Finally, the near-even split of DA and SA in OMMPE prep could be explained by the fact that practice exams are are not give a number grade, unlike class exams. The OMMPE is also held during the same week as class exams, which could sway students to focus more on class exams over OMMPE. One limitation of this study is the low response rate, so these results may only partially indicate the learning approach and resource utilization of all OMS-I and OMS-II; however, this study fills a much needed gap in Osteopathic medical education, and can be improved by sending the survey to different Osteopathic medical schools.

References

1. Entwistle NJ. Approaches to learning and studying. Encyclopedia of the Sciences of Learning. Published online 2012:288-291. doi:10.1007/978-1-4419-1428-6_652

2. Piumatti G, Abbiati M, Gerbase MW, Baroffio A. Patterns of change in approaches to learning and their impact on academic performance among medical students: Longitudinal Analysis. Teaching and Learning in Medicine. 2020;33(2):173-183. doi:10.1080/10401334.2020.1814295

3. Bonsaksen T, Magne TA, Stigen L, et al. Associations between occupational therapy students’ academic performance and their study approaches and perceptions of the learning environment. BMC Medical Education. 2021;21(1). doi:10.1186/s12909-021-02940-0

Financial Disclosures: None reported.

Support: Rejath Jose: Scholar fund granted by NYITCOM for each scholar to use to conduct their scholar year research. Used scholar fund to compensate 20 random students with Amazon gift cards for participating in the study. Leslie Goldstein: None reported.

Ethical Approval: IRB Exemption received (IRB# ESB-1848). Survey responses cannot and will not be traced back to a single student and the survey is completely anonymous; therefore, IRB exemption was received.

Informed Consent: Students were recruited by direct email, which explained that no personal identifying information will be correlated to their responses (i.e. name, email, student ID, etc.), and that all information will be stored on REDCap and deleted once the study is completed. Since the study received IRB exemption, no physical/ digital consent form was required from each participant.

Poster No. *B-16

Abstract No. 2023-082

Category: Basic Science

Research Topic: Osteopathic Philosophy

Social congruence between Osteopathic medical students and figures of support at NYIT College of Osteopathic Medicine

¹Julie E. Doty, OMS-III; ²Nathan E. Thompson, PhD

¹Department of Academic Medicine Scholar, New York Institute of Technology; ²Department of Department of Anatomy, New York Institute of Technology

Statement of Significance: Medical students who lack support from their peers and institutions are at greater risk for depression and burn-out than students with support networks1. Thus, medical schools have an incentive to better support their students. Literature suggests students most value supporters who are relatable and have shared experiences (i.e. social congruence)2. Understanding the social congruence between students and who they contact for support may be crucial in improving medical student well-being.

This study aimed to identify the social congruence between students and possible figures of support at NYIT College of Osteopathic Medicine. It also investigated the correlation between who students utilize for support and for what reasons.

Research Methods: A RedCap survey was distributed to first- and second-year D.O. students at NYIT COM (637 students). The survey was designed to evaluate the presence of social congruence between students and the following types of support figures: faculty, Academic Medicine Scholars (AMS; 3rd year medical students at NYIT COM selected to train and assist in teaching and research), tutors (2nd year medical students at NYIT COM selected to tutor 1st year students), “Bigs” (2nd year students at NYIT COM paired with 1–2 first-year students to help guide them during the transition to medical school), peers within a class year, peers in another class year, Student Government Association (SGA) members, and Student Advisement and Mentoring (SAM) faculty mentors (faculty at NYIT COM paired with 1st year students to help guide them during the transition to medical school). For each of these support figures, respondents were asked to rate their relatability, approachability, and feelings of being understood on Likert scales (1-5). The survey also inquired from which of these figures students actually sought support (either academic assistance, general medical school advice, general personal advice, general mentoring, or mentorship in a specific field). Kruskal–Wallis tests with a post-hoc Dunn’s test and false discovery rate corrections were used to evaluate differences in feelings of relatability, approachability, and feeling understood between each category of supporting figure. Chi-square goodness of fit tests were used to compare relationships between frequencies of seeking support from each category, as well as to compare the proportions of participant’s reasons for reaching out to each figure group. In response to this study, Osteopathic medical schools can better train students to become competent Osteopathic physicians.

Data Analysis: Ninety-two participants completed the survey. There were significant differences in the relatability, approachability, and feeling understood, among support figure category (p<0.001). Peer groups (own class, other classes, AMS, and “Bigs”) achieved the highest rating for relatability (3.8–4.2), approachability (3.8–4.4), and the feeling of being understood (4.4–4.6), though the specific order of these peer groups changed depending on the variable. These peer groups received significantly higher ratings than faculty (relatability: 2.6; approachability: 3.5; and being understood: 3.5; p<0.01) and SAM faculty mentors (relatability: 2.0; approachability: 2.8; and being understood: 3.7; p<0.01).

When seeking support, most students contacted peers in the same class year (86), followed by “Bigs” (65), AMS (64), peers in another class year (63), faculty (58), tutors (38), SAM faculty mentors (24), and SGA members (12). Students’ reasons for seeking support were significantly related to who they contacted, but only for faculty, AMS, tutors, “Bigs”, peers in the same class year, and peers in another class year (p<0.01). For SAM faculty mentors and SGA members, there were no significant patterns in the reasons why students contacted them.

Tutors (35/38) and faculty (26/58) were most contacted by students seeking academic assistance. For both faculty and tutors, academic assistance was the primary reason a student would contact these groups. For general medical school advice, medical students most contacted peers in another class year (47/63) and "Bigs” (45/65). However, among all support groups, aside from faculty and tutors, general medical school advice was the primary reason for a student to contact a support figure. For general personal advice, students mostly contacted peers in their own class year (20/86). Faculty (12/58) and SAM faculty mentors (10/24) were contacted most for general mentorship, and faculty were contacted most for mentorship in a specific field (4/58).

Conclusion: The types of support figures that were most relatable, most approachable, and most understanding of students were the various types of peer groups (own class, other classes, AMS, and “Bigs”). It is assumed that these groups have the most social congruence with students because of these attributes. This also matches the findings of this study that suggest students utilized these peer groups the most for general medical school advice. Thus, social congruence may play a role in who students contact for support surrounding general medical school advice. This can be especially true during the first year of medical school, in which students face major career and social transitions.

In the context of academic assistance, this study identified tutors and faculty as the most contacted figures for support. Given their standing as slightly more senior students, tutors may be viewed as more socially congruent than faculty, explaining why tutors were more sought after for academic assistance. This is supported by previous literature that claims students felt their peers were more approachable and receptive to input than institutional figures 3.

Among U.S. medical schools, there is an increasing focus on student support through the implementation of mental health initiatives, additional academic support, and peer guidance programs. This study identifies a useful distinction that medical schools can utilize when implementing student support programs—that students most often seek support from figures with which they experience social congruence. Additionally, the reasons for support play a role in who a student first contacts. Osteopathic medical schools carry a responsibility to train future physicians that are competent in caring for their patients’ emotional, spiritual, and health needs. Utilizing this data, Osteopathic medical schools can create more nurturing support systems, placing students on the best pathway to fulfill the Osteopathic mission.

References

1. Thompson G, McBride RB, Hosford CC, Halaas G. Resilience Among Medical Students: The Role of Coping Style and Social Support, Teaching and Learning in Medicine. Teaching and Learning in Med. 2016;28(2):174-182. doi: 10.1080/10401334.2016.1146611

2. Lockspeiser TM, O’Sullivan P, Teherani A, Muller J. Understanding the experience of being taught by peers: the value of social and cognitive congruence. Adv Health Sci Educ Theory Pract. 2008;13(3):361–372. doi: 10.1007/s10459-006-9049-8.

3. Tayler N, Hall S, Carr N, Stephens J, Border S. Near peer teaching in medical curricula: integrating student teachers in pathology tutorials. Med Educ Online. 2015;20(1):e27921. doi: 10.3402/meo.v20.27921.

Financial Disclosures: None reported.

Support: Participants in this survey were entered into a raffle for one of 10 gift cards ($25 each). The funding for participant incentives was provided by the NYIT Academic Medicine Scholars Program.

Ethical Approval: This project was reviewed by the NYIT IRB and determined to be exempt (NYIT IRB BHS-1849).

Informed Consent: Participation in this survey-based study was entirely voluntary. Participants were able to skip any questions and terminate their participation at any time.

Poster No. *B-17

Abstract No. 2023-085

Category: Basic Science

Research Topic: Osteopathic Philosophy

Evaluation of Using 3D Printing to Design and Build Spinal Models for Osteopathic Education

John Matechak, OMS-III; Joy Zarandy, DO; Meagan Sherrington, MTS, OMS-IV; Madison Cohen, OMS-III

Philadelphia College of Osteopathic Medicine-Georgia Campus

Statement of Significance: Understanding spinal mechanics is the foundation for osteopathic manipulative medicine (OMM) training. With such knowledge, osteopathic physicians may confidently diagnose and treat spinal somatic dysfunctions. However, a dynamic and objective teaching tool to educate students on spinal mechanics has not been established. Using 3D printing and knowledge in biomechanical engineering to build a spinal model can provide an innovative and new teaching tool for Osteopathic Medical Students.

The primary objective of this study is to develop a working OMM model of the spine for educational and testing purposes that accurately emulates:

1. Normal spinal motion and somatic dysfunction in the rotational plane

2. Normal spinal motion and somatic dysfunction in the side-bending plane

3. A realistic palpatory experience of the human skin, soft tissue, and underlying vertebrae

Research Methods: This design-and-build project consisted of three phases of models. The initial phase utilized Lego blocks and sponges. Criteria 1 was achieved by manipulating the height of Lego stacks. For example, a right rotated vertebrae would be represented by a short stack of Legos on the left, and a taller stack on the right. We superglued sponges of varying thickness in between Legos to achieve Criteria 2 (side-bending); with a thin sponge on the left, and a thicker sponge on the right to represent a right side bent vertebrae. Criteria 3 (realistic human feel) was lacking from this model, which thus inspired the model of phase two.

In the second phase, a 3D printer was used to construct unique model pieces with anatomically accurate vertebral tops (Criteria 3) and Lego bases. Rotational dysfunction was achieved by printing the top piece with the spinous process slightly angled to the right or left (Criteria 1), but unfortunately, this model proved to be rather static and lacked side-bending capabilities (Criteria 2).

The third phase incorporated 3D-printed vertebrae suspended on a plastic tube over an adjustable cradle with three bolts. The bolt heights on either side of the base are adjusted to represent rotation (Criteria 1); if the left bolt is shortened, and the right bolt is lengthened to emulate a right-rotated dysfunction. The middle bolt is loosened to slide a vertebral unit left or right to represent a right or left sidebent dysfunction, respectively (Criteria 2). The natural recoil of the transverse processes beneath the tension of paraspinal muscles and spinal ligaments was created by attaching springs to the tips of each lateral bolt. Synthetic skin was placed over the mechanism to further contribute to the model’s realistic feel (Criteria 3). Minor adjustments were made to the dorsal aspect of the 3D-printed vertebrae to improve the palpatory feel of the spinous and transverse processes, as well as to the ventral aspect to ensure congruence with the base unit.

Data Analysis: The final model (Image III.c) accurately demonstrates sidebending and rotational components of Fryette’s Laws of spinal motion.5 The ability to maneuver the cradle base into various positions enables the potential to teach and test students’ understanding of somatic dysfunctions of the spine. For example, to demonstrate a Fryette’s Type I somatic dysfunction which is sidebent right and rotated left, the cradle base is translated to the left and the left cradle screw is lowered.

Conclusion: Future directions for this project are multifaceted. In terms of the model itself, a comparison of the spring constant between paraspinal connective tissue and the springs on the model could ensure palpatory realism. Additionally, while Type II (non-neutral) somatic dysfunction can be inferred by ipsilateral sidebending and rotation, flexion and extension are not represented with the current design. Immediate future studies will assess the subjective experience and diagnostic accuracy of osteopathic clinical faculty to determine its validity. The model will then be integrated as an educational tool for the first two years of OMM training, and subjective and objective student feedback will be collected. Eventually, the goal is for the model to be used to standardize testing of students’ diagnostic skills across osteopathic medical schools.

References

1. Snider EJ, Pamperin K, Johnson JC, Shurtz N, Degenhardt BF. “Assessing Palpation Thresholds of Osteopathic Medical Students Using Static Models of the Lumbar Spine.” The Journal of the American Osteopathic Association. 2014 June;114(6):460-9.

2. Moriles K, Ramnot A, Lai M, Jacobs RJ, Qureshi Y. “The use of 3D printing for osteopathic medical education of rib disorders.” J Osteopath Med. 2021 Mar 1;121(3):255-263. doi: 10.1515/jom-2020-0020.

3. Community, B. O. (2018). Blender - a 3D modelling and rendering package. Stichting Blender Foundation, Amsterdam. Retrieved from http://www.blender.org

4. Ultimaker. 2021. Ultimaker Cura 4.9.1. Retrieved December 15, 2022 from https://ultimaker.com/software/ultimaker-cura.

5. Nicholas AS, Nicholas EA. Atlas of Osteopathic Techniques. [Electronic Resource]. Fourth edition. Wolters Kluwer; 2023. Accessed April 5, 2023.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable.

Informed Consent: Not applicable.

Poster No. *B-18

Abstract No. 2023-094

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Impact of HSP70 on Intestinal Glucose Transport: Expression and Localization of SGLT-1

¹Ciena Pyter, OMS-III; ²Julia Moore; ²Matt Pytynia; ¹Kally Dey; ¹Nicole Eck; ²Kristina Martinez-Guryn; ²Mae Ciancio, PhD

¹Department of Osteopathic Medicine, Midwestern University/Chicago College of Osteopathic Medicine; ²Department of Biomedical Sciences, Midwestern University/Chicago College of Osteopathic Medicine

Statement of Significance: The prevalence of obesity is rising, contributing to increased rates of type 2 diabetes and mounting a great medical cost.¹ Heat shock proteins (HSP) are synthesized under stress to protect cells by stabilizing proteins. HSP70 maintains homeostasis in colonic epithelium and skeletal muscle.^2,3 Villin-driven intestinal expression of HSP70 (HSP70 transgenic mice; HSP70 TG) prevents insulin resistance and glucose intolerance induced by a high-fat diet compared to non-transgenic (NTG) littermates.⁴

The study aims to measure the effect of selective intestinal expression of HSP70 on glucose transport through the sodium glucose-dependent transporter 1 (SGLT-1) in the jejunum of HSP70 TG and NTG mice consuming a low-fat (LF) or high-fat (HF) diet. Secondly, to validate cellular localization of SGLT-1 by Western blot analysis of membrane and cytosolic proteins. This study tests the hypothesis that HSP70 expression in the small intestine up-regulates enterocyte SGLT-1 membrane expression.

Research Methods: Male HSP70 TG (n=12) and NTG (n=14) littermates received a LF diet (LFD; 10kcal% fat; Research Diets, Inc) or HF diet (HFD; 60kcal% fat). Body weights were recorded weekly. After 14 weeks, mice were euthanized and intestinal scrapings from the jejunum were collected, homogenized, and separated into membrane bound and cytosolic fractions (Mem-PER Plus Membrane Protein Extraction Kit: 89842). Relative SGLT-1 levels were determined by Western blot using anti-SGLT1 (cytosol) antibody (ThermoFisher; PA5-50571; 1:1000), anti-SGLT1 (membrane) antibody (ThermoFisher; PA5-88282; 1:1000), and anti-mouse IgG HRP-linked antibody (Cell Signaling Technology; #7076; 1:1000). Actin (Cell Signaling Technology; 8H10D10; 1:1000) served as the loading control for cytosolic and membrane blots. Western blots were imaged (ChemiDocTM MP Imaging System) and relative protein expression was determined by densitometry (Image Lab Software). All results were compared to LFD NTG controls. Two-way ANOVA and Turkey’s post-hoc tests were performed (GraphPad Prism p<0.05). Significance was determined by p<0.05. The ROUT method was used to remove outliers.

Learning to optimize the endogenous HSP70 protein highlights the body’s propensity for self-healing, health maintenance, and the interrelation of structure and function.

Data Analysis: HSP70 TG mice had significantly greater SGLT-1 relative expression in the membrane compared to NTG mice (NTG-LF 1.3 ± 0.4, TG-LF 3.0 ± 0.5, NTG-HF 3.1 ± 0.9, TG-HF 4.6 ± 1.4). Of the TG mice, SGLT-1 expression was greater in the HFD compared to LFD mice (LF 3.0 ± 0.5, HF 4.6 ± 1.4). Cytosolic expression of SGLT-1 was influenced by diet, with greater SGLT-1 expression in the HFD group, independent of genotype, compared to LFD (p= 0.09).

Conclusion: HSP70 TG mice are protected from hyperglycemia and diet-induced obesity on a HFD. This is evident by both normal systemic blood glucose levels and body weight. Concurrently, small intestinal HSP70 overexpression up-regulates SGLT-1 levels in the membrane. Limitations to this study include sample size and time to study. Future research assessing liver glycogen stores and portal blood glucose are necessary to understand the peripheral handling of glucose to prevent the hyperglycemia and insulin resistance demonstrated in the NTG, but not the HSP70 TG mice. Elevated and potentially therapeutic expression of HSP70 can be achieved via heat therapy, exercise, and by pharmacologic means.^5,6 The induction of HSP70 demonstrates promise for clinical use against pro-inflammatory states like obesity by protecting against hyperglycemia and insulin resistance in skeletal muscle.

References

1. Adult Obesity Facts. Center for Disease Control and Prevention. Updated May 17, 2022. Accessed April 16, 2022. https://www.cdc.gov/obesity/data/adult.html

2. Gorboulev V, Schürmann A, Vallon V, et al. Na (+)-D-glucose cotransporter SGLT1 is pivotal for intestinal glucose absorption and glucose-dependent incretin secretion. Diabetes. 2012;61(1):187-196. doi:10.2337/db11-1029

3. Hu, S., Zhu, X., Triggs, J. R., et al. Inflammation-induced, 3’UTR-dependent translational inhibition of Hsp70 mRNA impairs intestinal homeostasis. Am J Physiol Gastrointest Liver Physiol. 2009; 296(5), G1003-1011. doi:10.1152/ajpgi.00027.2009

4. Moore J, Dey K, Eck N, et al. HSP70-mediated regulation of small intestinal glucose uptake in diet-induced obesity. Gastroenterology. 2022; 162 (7), Supplement S-462.

5. Chung, J., Nguyen, A. K., Henstridge, D. C., et al. HSP72 protects against obesity-induced insulin resistance. Proc Natl Acad Sci U S A. 2008; 105(5), 1739-1744. doi:10.1073/pnas.0705799105

6. Evans CC, LePard KJ, Kwak JW, et al. Exercise prevents weight gain and alters the gut microbiota in a mouse model of high fat diet-induced obesity. PLoS One. 2014;9(3): e92193.

Financial Disclosures: None reported.

Support: Funding was provided by the Kenneth A Suarez Summer Research Fellowship and College of Graduate Studies at Midwestern University.

Ethical Approval: This study was reviewed and approved. IACUC Protocol number: 1803

Informed Consent: Not applicable.

Poster No. *B-19

Abstract No. 2023-095

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Pulmonary artery endothelial cells show evidence of potential endothelial-to-mesenchymal transition upon exposure to SARS-CoV spike protein

Jeff Alexander Tomes, OMS-IV; Lauren Farrell, OMS-II; Emily Snyder; Johnathan Brown, PhD; Audrey Vasauskas, PhD

Alabama College of Osteopathic Medicine

Statement of Significance: When endothelial cells are introduced to stressors, they produce inflammatory molecules leading to changes. (1,2) A potential mechanism for long-term vascular change in COVID-19, known as “long COVID”, is the binding of COVID-19 spike protein to Angiotensin Converting Enzyme 2 (ACE 2) cells that causes changes leading to endothelial to mesenchymal cell transition (EndMT). (3) Currently, there are studies that show evidence of EndMT in umbilical cells, but none in pulmonary vascular cells. (3)

Here, we hypothesized that EndMT is evident in pulmonary artery endothelial cells upon COVID spike protein exposure. We sought to investigate whether common markers of EndMT were evident and whether endothelial markers were downregulated under spike conditions in these cells.

Research Methods: Rat pulmonary arterial endothelial cells (rPAECs) were provided by the University of South Alabama. And human Pulmonary Endothelial Cells (hPAECs) were purchased from ATCC. Control endothelial cells (human or rat, respectively) were incubated in complete growth media, and treated with recombinant SARS-CoV-2-His-tagged (Bio-Techne) spike (100nM) or vehicle in complete growth media for 24 hours. RNA was harvested and reverse transcription was performed. Real-time comparative PCR was performed using Taq-man probes and Taq-man-Fast PCR reagents. Data was collected and analyzed using QuantStudio Design and Analysis Software. Both rat and human cells were analyzed for the EndMT markers alpha-smooth muscle actin (α-SMA) and transgelin (Tgln) and the endothelial markers PECAM, vWF (rat), and eNOS (human).

Data Analysis: Our preliminary data indicate a decrease in the expression of the endothelial marker PECAM in both human and rat PAECs. There was a 70% decrease in the human PAECs and a 30% reduction in rat PAECs. Tgln was increased by 50% in rPAECs. All other markers were largely unchanged between the two experimental groups; however, these results must be confirmed with additional experimentation.

Conclusion: This preliminary data indicates that the EndMT is possibly being initiated in PAECs upon exposure to the SARS-CoV spike protein. Further in vitro experiments are underway to confirm these data as well as experiments using prolonged time points with the spike protein. Animal studies are also planned.

References

1. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020 Jun;215:108427. doi: 10.1016/j.clim.2020.108427. Epub 2020 Apr 20. PMID: 32325252; PMCID: PMC7169933.

2. Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J. 2020 Sep 1;41(32):3038-3044. doi: 10.1093/eurheartj/ehaa623. PMID: 32882706; PMCID: PMC7470753.

3. Eapen MS, Lu W, Gaikwad AV, Bhattarai P, Chia C, Hardikar A, Haug G, Sohal SS. Endothelial to mesenchymal transition: a precursor to post-COVID-19 interstitial pulmonary fibrosis and vascular obliteration? Eur Respir J. 2020 Oct 15;56(4):2003167. doi: 10.1183/13993003.03167-2020. PMID: 32859681; PMCID: PMC7453738.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable.

Informed Consent: Not relevant.

Poster No. *B-20

Abstract No. 2023-105

Category: Basic Science

Research Topic: Impact of OMM & OMT

OMT Alleviated Migraine-Like Pain via Blockade of Trigeminal Activation

¹Kaitlyn Child, OMS-III; ¹Danny Fowler; ¹Yan Pan; ²Regina K. Fleming; ¹Jennifer Y. Xie

¹Department of Biomedical Sciences, New York Institute of Technology; ²Department of Osteopathic Manupulative Medicine, New York Institute of Technology

Statement of Significance: Migraines represent one of the leading causes of disability worldwide(1). In the United States, 14.2% of adults report experiencing a migraine (2). While the pathophysiology of migraine pain is complex, sensitization of the trigeminovascular pathway is implicated(3). Osteopathic manipulative treatment (OMT) has been used clinically to supplement pharmacologic treatment affected patients, but wide-spread adoption of these treatments has been limited by a lack of mechanistic support.

To determine if OMT is an effective method of treating the pain associated with an acute migraine, either prophylactically or abortively, and investigate its potential mechanisms of action.

Research Methods: Female Sprague-Dawley rats were randomly divided into various treatment groups and assessed by behavioral testing (n = 8/group) and immunohistochemical (IHC) staining (n = 4 - 8/group). Migraines were induced by a two-hit method. The animals were primed with Complete Freund’s Adjuvant (CFA) diluted 1:1 with saline via injection to the upper trapezius muscles bilaterally (5 x 10 μL/side, total 100 μL). Six days later, they were exposed to umbellulone (50 mM in 5% DMSO/95% DiH2O, 50 μL), a known human migraine trigger (4), via inhalation for 30 minutes. The presence of cutaneous allodynia at the periorbital and hindpaw areas was determined every hour for 5 hours after umbellulone inhalation using calibrated von Frey filaments to elicit a withdrawal response. Subjects receiving OMT were given 2 minutes of therapy directed at the cervical soft tissues and spinal articulations for 1 min each either before inhalation of umbellulone (prophylactic) or after inhalation (abortive). For the IHC studies, subjects were sacrificed at 2 hours post-umbellulone treatment via transcardiac perfusion of fixatives, and brain tissue was collected and cryodissected for immunostaining. Because of their implication in migraine pain, the trigeminal nucleus caudalis (TNC) and the trigeminal ganglion (TG) were analyzed to determine the activation of the second-order sensory neurons by measuring expression of calcitonin gene-related peptide (CGRP), a pivotal neuropeptide implicated in migraine pathophysiology (5), and c-fos, an immediate early response gene (6). The number of c-fos or CGRP positive cells for each animal were counted at 6 (TNC) or 4 (TG) independent (non-adjacent) fields and the average number for each subject was reported. The experimenter was blinded for the treatment groups.

Data Analysis: Our behavioral testing showed that umbellulone induced significant periorbital and hindpaw allodynia selectively in CFA-primed rats, which peaked at 2-3 hours post-umbellulone inhalation (P < 0.05 compared to baseline). OMT employed as an abortive measure, performed immediately after umbellulone administration, produced partial blockade of the development of cutaneous allodynia. For prophylactic treatment, OMT was performed three times at Days 1, 3, and 5 post-CFA. The multiple prophylactic episodes of OMT prevented the development of cutaneous allodynia associated with migraine-like pain induced by umbellulone. IHC analysis showed a significant increase of c-fos expression in TNC samples from subjects treated with CFA and umbellulone, which was blocked by prophylactic OMT. The number of c-fos positive cells at TNC was 492 ± 160 in the CFA + Umbellulone + OMT group, significantly lower than that of the CFA + Umbellulone + Sham group (1728 ± 249, P < 0.05). The expression of CGRP positive neurons in the TG samples increased significantly in subjects treated with CFA + umbellulone, which was normalized by prophylactic OMT (CFA+Umbellulone+OMT, 41±4 vs. CFA+Umbellulone+Sham, 111 ± 7, P<0.01).

Conclusion: Two osteopathic techniques demonstrated effectiveness in blocking and mitigating migraine development as both a prophylactic and abortive treatment, likely by inhibiting trigeminal activation triggered by migraines in our rodent model. These findings provide mechanistic insights into the efficacy of OMT for migraines and support its potential as a non-pharmacological approach for migraine management. One limitation of our study is the use of only two osteopathic techniques to treat migraine-like pain. Future studies aim to assess other forms of OMT, including osteopathic cranial manipulative medicine, as well as treatment directed to other regions of the head and neck associated with the trigeminovascular pathway. Further studies on OMT can lend additional credibility for its use as an appropriate tool in clinical migraine management.

References

1. Disease GBD, Injury I, Prevalence C. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(2017):1211-59.

2. Burch RC, Loder S, Loder E, Smitherman TA. The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies. Headache: The Journal of Head and Face Pain. 2015;55(1):21-34. doi:10.1111/head.12482

3. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154 Suppl 1(2013):S44-53.

4. Edelmayer RM, Le LN, Yan J, et al. ACTIVATION OF TRPA1 ON DURAL AFFERENTS: A POTENTIAL MECHANISM OF HEADACHE PAIN. Pain. 2012;153(9):1949-1958. doi:10.1016/j.pain.2012.06.012

5. Edvinsson L. Calcitonin gene-related peptide (CGRP) is a key molecule released in acute migraine attacks—Successful translation of basic science to clinical practice. J Intern Med. 2022;292(4):575-586. doi:10.1111/joim.13506

6. Kaube H, Keay KA, Hoskin KL, Bandler R, Goadsby PJ. Expression of c-Fos-like immunoreactivity in the caudal medulla and upper cervical spinal cord following stimulation of the superior sagittal sinus in the cat. Brain Research. 1993;629(1):95-102. doi:10.1016/0006-8993(9390486-7)

Financial Disclosures: None reported.

Support: This study is funded by an NIH R15 grant (award No.1R15AT011097-01) to JYXie.

Ethical Approval: All animal studies were conducted in accordance with the policies and recommendations of the National Institute of Health guidelines for laboratory animals under protocols approved by the Institutional Animal Care and Use Committee (IACUC) of Arkansas State University.

Informed Consent: Not applicable.

Poster No. *B-21

Abstract No. 2023-107

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Inhibition of HSPA9/Mortalin Disrupts Erythroid Maturation Through a TP53-Independent Mechanism in Human CD34+ Hematopoietic Progenitor Cells

Morgan Dunmire, OMS-I; Christopher Butler; Tuoen Liu

Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine (WVSOM)

Statement of Significance: Myelodysplastic syndromes (MDS) are a group of hematopoietic stem cell malignancies characterized by ineffective hematopoiesis, increased apoptosis of bone marrow cells, and anemia. Up to 25% of MDS patients harbor an interstitial deletion on the long arm of chromosome 5, also known as del(5q), creating haploinsufficiency for multiple genes including HSPA9. The HSPA9 gene encodes for the protein mortalin which belongs to HSP70 molecular chaperone family and mainly presents in mitochondria.

Our prior study showed that knockdown of HSPA9 induces TP53-dependent apoptosis in human CD34+ hematopoietic progenitor cells, consistent with cytopenia observed in MDS patients [1]. Since anemia is another featured symptom of MDS, we hypothesize that HSPA9 plays a role in regulating erythroid maturation. To test our hypothesis, we measured erythroid maturation after inhibiting HSPA9 expression in human CD34+ cells. We also examined whether the regulatory mechanism is TP53-dependent or not.

Research Methods: Cells and reagents: Human CD34+ hematopoietic progenitor cells were purchased from Fred Hutchinson Cancer Research Center. Cells were cultured in erythroid differentiation media containing expansion medium and cytokines. The chemical MKT-077 was purchased from Sigma-Aldrich Inc.

siRNA transduction: Cells were electroporated with HSPA9-targeting or non-targeting control siRNA using the Amaxa human CD34+ cell nucleofector kit and Nucleofector Device following the manufacturer’s protocol.

Lentiviral shRNA production and transduction: shRNAs targeting the HSPA9 gene were cloned into pLK0.1 vector carrying puromycin resistance gene and shRNAs targeting the TP53 gene were cloned in the same vector carrying hygromycin resistance gene following manufacture’s protocol. Lentiviral shRNAs were produced and transduced in cells following the standard procedure.

Western blotting assay: The expression of proteins was measured using Western blotting assay. Briefly, protein samples were loaded on an SDS-polyacrylamide gel, separated by electrophoresis, and subsequently transferred to a PVDF membrane. Membranes were blocked with 5% milk and then incubated with primary antibody followed by secondary antibody. Pierce supersignal chemiluminescent substrates were used, and images were captured by using the gel doc system.

Flow cytometry: Cell apoptosis and intracellular p53 levels were measured and analyzed by flow cytometry as described in publications.

Statistics: Statistical significance of the data between two groups was analyzed by the Student’s t test (Prism 8), and more than two groups was analyzed by one-way ANOVA with a Tukey posttest (Prism 8). Significance levels were set at least p <0.05.

Osteopathic significance: Our study provides a better understanding of the molecular and genetic mechanisms associated with MDS, thus allowing osteopathic physicians to better fulfill osteopathic tenets for patients and alleviating associated burdens on spirit and mind.

Data Analysis: Knockdown of HSPA9 by siRNA inhibited cell growth, increased cell apoptosis and p53 expression, and inhibited erythroid maturation. We found that HSPA9 siRNA significantly inhibited the cell growth (p<0.001), increased cell apoptosis (indicated by the percentage of annexin-V positive cells, p<0.001), and increased p53 expression (p<0.01) compared to control siRNA in human CD34+ cells. Flow cytometry was performed to measure erythroid maturation using CD71 as a critical marker. The percentage of immature erythroid cells (CD71-, glycophorin A-) is significantly lower in control siRNA treated cells compared to HSPA9 siRNA treated cells (p<0.001). HSPA9 siRNA also significantly inhibited the percentage of CD71+ cells compared to control siRNA (p<0.001), suggesting HSPA9 knockdown inhibited erythroid maturation using human CD34+ cells.

Pharmacologic inhibition of HSPA9 increased p53 expression and inhibited erythroid maturation. MKT-077 is an inhibitor of HSP70 protein family members including mortalin. The human CD34+ cells were treated with two concentrations (0.5 and 2 mM) of MKT-077, and mortalin expression was reduced in a dose-dependent manner. MKT-077 also increased the p53 expression levels (p<0.05) and inhibited the percentage of CD71+ cells (p<0.01) in human CD34+ cells, suggesting pharmacological inhibition of HSPA9/mortalin repressed erythroid maturation.

Erythroid maturation disrupted by HSPA9 inhibition is TP53-independent. We constructed shRNAs targeting the HSPA9 and TP53 genes and simultaneously transduced lentivirus containing these shRNAs in human CD34+ cells using double antibiotics selection (puromycin for shRNA targeting HSPA9 and hygromycin for shRNA targeting TP53). We found that reduction of TP53 reversed apoptosis induction, but could not reverse erythroid maturation, caused by HSPA9 knockdown in human CD34+ cells. This experiment confirmed that the regulation of apoptosis, but not erythroid maturation, by HSPA9 is a TP53-dependent process.

Conclusion: Typical symptoms of MDS include fatigue, easy bleeding, frequent infections, and bone pain, mainly due to abnormal hematopoiesis. TP53 a tumor suppressor gene which is commonly mutated in hematological malignancies including MDS. Whole genome sequencing analysis found that del(5q) and TP53 gene mutations co-occur in MDS patients. Our previous study showed that HSPA9 knockdown induces TP53-dependent apoptosis in human CD34+ hematopoietic progenitor cells, corresponding to peripheral blood cytopenia observed in MDS patients. In this study, we found that HSPA9/mortalin inhibition disrupts erythroid maturation through a TP53-independent mechanism in the same cells, indicating reduced HSPA9 level may contribute to anemia observed in del(5q) MDS patients. Currently, clinical treatment options of anemia in MDS patients include blood transfusion, erythropoiesis-stimulating agents such as EPO and G-CSF. Based on our findings, HSPA9 may also be a potential drug target to treat anemia in del(5q) MDS patients. Future studies designed to elucidate how HSPA9 regulates erythroid maturation and the role of del(5q) and TP53 genes are a high priority to improve the outcomes in treating patients with MDS.

Our studies suggested that phenotypes such as increased apoptosis or immature erythroid observed in patients caused by del(5q) genes haploinsufficiency may be specific gene dependent. The simultaneous loss of multiple genes on del(5q) likely contributes to the complex phenotypes observed in MDS. In other words, the cooperation of multiple del(5q) genes and/or genes on other chromosomes (e.g., TP53) may be needed to induce the clinical symptoms in patients.

In conclusion, our study not only uncovers some underlying mechanisms of del(5q) MDS, but also provides potential therapeutic indications through gene targeting in clinical MDS treatment. It provides a greater opportunity for osteopathic physicians to treat their patients with a more favorable recovery and clinical outcome.

References

1. Liu T, Krysiak K, Cara Lunn Shirai, et al. Knockdown of HSPA9 induces TP53-dependent apoptosis in human hematopoietic progenitor cells. PLoS One, 2017. 12(2): e0170470. doi:10.1371/journal.pone.0170470

Financial Disclosures: None reported.

Support: This work was supported by WVCTSI pilot and West Virginia School of Osteopathic Medicine intramural grants (Dr. Tuoen Liu).

Ethical Approval: The study was approved by the Institutional Biosafety Committee at West Virginia School of Osteopathic Medicine.

Informed Consent: Not relevant.

Poster No. *B-22

Abstract No. 2023-123

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Mechanisms for Infertility Caused by Quaternary Ammonium (QAC) Disinfectant Exposure

¹Ashley Jordan, OMS-II; ²Zach Kirkpatrick; ²Vanessa E. Melin; ¹Terry C. Hrubec

¹Department of Biomedical Sciences, Edward Via College of Osteopathic Medicine; ²Department of Biomedical Sciences, Virginia-Maryland College of Veterinary Medicine

Statement of Significance: QACs are used as antimicrobials, antistatics, and surfactants. QACs can be found in disinfectants, cleaners, cosmetics, hair and laundry products. Previous studies have shown that chronic QAC exposure causes infertility in male and female mice. This is of concern because a recent study found that everyone had QACs in their blood after the COVID-19 pandemic. Essential workers, medical personnel and janitorial staff (many of whom are racial and ethnic minority groups) were exposed at higher rates.

The aim of this study was to determine if QACs impact on reproduction in both males and females was through endocrine disruption or direct toxicity to gametes

Research Methods: To assess changes in reproductive hormones mice were dosed with 60 mg/kg/day of QAC in the diet. Blood samples were collected, and hormone concentrations were determined through competitive ELISA. Gestational estrogen and progesterone were determined at various stages of gestation. Prepubertal follicle stimulation hormone (FSH) and luteinizing hormone (LH) were determined in mice at 40 days of age. Metabolism in TM4 Sertoli cells was determined by resazurin reduction at exponential increases in QAC concentration. Blood-testes barrier permeability was determined in TM4 cells using a two-compartment in-vitro blood-testis-barrier model using. Once the barrier was established, media in the apical chamber was treated with exponential increases in QAC concentration. Measurements were recorded using an EVOM 2 voltmeter equipped with double electrodes. Cell cycle analysis was determined by flow cytometry. Cells were incubated for 24 h with undosed media or media containing cytotoxic concentrations of QAC. All parameters were analyzed using FloJo software (Treestar, Ashland, OR). To evaluation fertilization capacity, female mice were super-ovulated with pregnant mare serum gonadotropin (PMSG) and then human chorionic gonadotropin (hCG). Ovulated eggs were collected from dam oviducts 12-14 h after hCG injection and combined with 5 x 104 sperm, exhibiting high motility. Fertilization and early cleavage stages were identified. Two-way ANOVA, One-way ANOVA, and t-test were used to determine the statistical significance of the results with p ≥ 0.05.

Data Analysis: Estrogen concentration was significantly lower in QAC exposed mice compared to unexposed mice throughout early and mid-gestation (days 6-12). Progesterone concentration was significantly lower in QAC exposed mice compared to unexposed mice in mid and late gestation (days 12-16). LH concentration was significantly decreased in QAC exposed mice compared to unexposed mice of both sexes. FSH concentration was significantly decreased in QAC exposed mice compared to unexposed mice of both sexes. Metabolism in TM4 Sertoli cells was significantly reduced at QAC ≥ 0.0005%. The TM4 Sertoli cell barrier (BTB) was disrupted at ≥ 0.01% QAC a much higher concentration than needed to suppress Sertoli call function. The cell cycle distribution of TM4 Sertoli cells demonstrated G2/M cycle arrest and termination of mitosis with QAC exposure compared to unexposed control. Fertilizing capacity of sperm from males administered QACs and given a 10-day rest period compared to sperm from unrested or unexposed males indicated little direct toxicity to sperm, but rather a disruption in the spermatogenic cycle.

Conclusion: Together, these results suggest that QACs disrupt reproductive processes and cellular energetics rather than disruption of cell membranes and cell lysis as accepted mechanism of action. Decreased mitochondrial function could be partly responsible for these findings given their role in steroid hormone synthesis, normal cell cycling, and sperm motility and function. These findings are of concern as recent human studies indicate that post pandemic 100% of the population has QAC residues in their blood. Some individuals with presumed higher exposure had concentrations that were at the level that showed pathologic effects in animal studies.

References

N/A

Financial Disclosures: funded by the Passport Foundation

Support: Supported by the VCOM-VMCVM One Health Program

Ethical Approval: Virginia Tech IACUC Approved, IRB Exempt

Informed Consent: N/A

Poster No. *B-23

Abstract No. 2023-128

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Characterizing Cardiac Phenotype in an Adenine-Induced Chronic Kidney Disease Mouse Model

Nomrota Majumder, OMS-II; Puneet Dhaliwal; Saud Nasruddin; Danyang Ma; Michael Gao; Hina Gilani; Kelly A. Borges; Mohnish Singh, MS; Mugdha V. Padalkar, PhD; Olga V. Savinova, PhD

Department of Biomedical Sciences, New York Institute of Technology

Statement of Significance: Chronic Kidney Disease (CKD), a strong risk factor for Cardiovascular Disease (CVD), creates a pro-inflammatory state that leads to vascular calcification and atherosclerosis (1). We developed a reproducible adenine-induced CKD mouse model to study the development of CVD from CKD. Our previous study assessed CKD in low-density lipoprotein receptor (ldlr) mutant mice and found that co-treatment of adenine and a western diet resulted in a reduction of plasma triglycerides and atherosclerosis (2).

The goal of our study is to determine whether there exist any cardiac functional abnormalities and significant differences at the left ventricle in a reproducible adenine-induced CKD mouse model that concurrently reflects a paradoxical reduction in triglycerides and atherosclerosis. We hypothesized that on the background of reduced lipids, there is no significant left ventricular pathology at this stage despite significant CKD.

Research Methods: Mouse Model: Mice with a familial hypercholesterolemia mutation in the ldlr gene were obtained from Jackson Laboratory. Four to five mice per cage were kept at New York Institute of Technology College of Osteopathic Medicine with a 12-hour light and dark cycle.

Diets: The mice (n=48 24 female 24 male) were divided into two groups, a control group (western diet) and a CKD (western diet supplemented with 0.2% adenine) group, and treated for 8 weeks. Body weights were recorded at 10 weeks baseline and at 18 weeks.

Echocardiography: Cardiac physiology was analyzed with echocardiograms at 10 weeks and 18 weeks. Imaging was done with the Vevo 3100 ultrasound system (FujiFilm VisualSonics). Mice were anesthetized with isoflurane, starting from 2% and adjusted to 1-2%, and placed on a stage at 40-42 °C. HR (Heart Rate) was recorded. Images were analyzed with Vevo Lab software by tracing left ventricular internal diameter (LVID; mm), left ventricular posterior wall thickness (LVPW; mm), left ventricular mass (LVmass; mg), stroke volume (SV; uL), cardiac output (CO; mL/min), fractional shortening (FS; %), and ejection fraction (EF; %). All measurements except HR, FS, and EF were normalized to body weight (BW). Pulse Wave Velocity (PWV) was obtained by Doppler imaging at the carotid and femoral arteries.

Blood chemistry: At 18 weeks, the mice were sacrificed. Mice fasted 5 hours prior to blood collection by cardiac puncture. Cholesterol, triglycerides and Cystatin C (a kidney disease marker) were measured.

Statistics: Cardiac function was compared to see the effect of treatment. Data were analyzed with GraphPad Prism Software (San Diego, CA, USA). Data were compared by two-way ANOVA accounting for sex and treatment. Statistical significance was set to p<0.05.

Osteopathic Significance: Aligned with the respiratory-circulatory model of holistic osteopathic care, our study emphasizes the importance of monitoring for cardiovascular co-morbidities when treating patients with CKD.

Data Analysis: Consistent with our previous study, our CKD mice showed a reduction in triglycerides compared to their controls (p=0.0381), and no significant changes were observed in cholesterol levels (p=0.5002). Cystatin C was significantly higher in mice of both sexes co-treated with 0.2% adenine and a western diet, confirming CKD induction (p<0.0001). After 8-weeks on a western diet with 0.2% adenine treatment, CKD males and females both had lower body weights than their control counterparts (p<0.0001). There was no significant difference in HR in CKD female mice and their controls, but there was a significant decrease in HR in CKD males compared to their controls (p=0.0037). LVID/BW data exhibited a significant increase in LVID/BW in both female and male CKD compared to their controls (p<0.0001). There was no significant difference in LVMass/BW in CKD mice of both sexes when compared to their controls (p=0.3601). Similarly, there was no observed significant difference in FS in CKD mice of both sexes compared to their controls (p=0.3262). Similar to LVMass/BW, no significant differences in EF were noted in CKD mice of both sexes when compared to their controls (p=0.3273). There was no significant difference in SV/BW in CKD mice of both sexes when compared to their controls (p=0.3922). No significant difference in CO/BW was noted in CKD mice of both sexes when compared to controls (p=0.6975). Finally, PWV showed no significant change between CKD mice of both sexes and their corresponding controls (p=0.2448).

Conclusion: With the reduction of triglycerides in a reproducible, adenine-induced CKD model, the cardiac phenotype was protected, confirming our hypothesis. Low body weight and decreased HR are characteristics of CKD, as reflected in our CKD mice. LVID/BW increase is the result of left ventricular hypertrophy, present in one-third of CKD patients (3). Left ventricular overload leads to cardiomyocyte death, resulting in eccentric hypertrophy and then left ventricular dilatation, also characteristic in CKD (3). However, no statistically significant data on LVM/BW, FS, EF, SV/BW, CO/BW, or PWV suggests no cardiac functional abnormalities or significant left ventricular pathology. This can be the result of adenine’s potential role in lipid synthesis and metabolism that presumably protects cardiac phenotype and vascular function in CKD. Though further research is necessary to assess the relationship between CKD and CVD, adenine may have clinical significance in reducing hyperlipidemia and the development of CVD in CKD patients. We aim to investigate this phenomenon further and the effect of CKD-induced calcification in the progression and regression of atherosclerosis and cardiac physiology, hoping to reduce the cardiovascular effects in CKD patients widely. A limitation of our study is that though all CKD mice presented with significant CKD, there was a varying level of severity of CKD. We speculate that this is the result of variation of adenine mixtures, and this gives us an opportunity to analyze the spectrum of disease associated with CKD induction by adenine.

References

1. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease. Circulation. 2021;143(11):1157-1172. doi:10.1161/circulationaha.120.050686

2. Padalkar MV, Tsivitis AH, Gelfman Y, et al. Paradoxical reduction of plasma lipids and atherosclerosis in mice with adenine-induced chronic kidney disease and hypercholesterolemia. Front Cardiovasc Med. 2023;10:1088015. Published 2023 Feb 9. doi:10.3389/fcvm.2023.1088015

3. Bornstein AB, Rao SS, Marwaha K. Left Ventricular Hypertrophy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 30, 2023.

Financial Disclosures: None reported.

Support: New York Institute of Technology College of Osteopathic Medicine

Ethical Approval: Procedures and practices were approved and performed according to IACUC regulatory standards: IACUC protocol #2022-OS-01. Procedures also complied with the National Institutes of Health Office of Laboratory Animal Welfare Guidelines.

Informed Consent: Not applicable.

Poster No. *B-24

Abstract No. 2023-129

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Assessing Coronary Flow Velocity Reserve in a Mouse Model of Heart Failure with Preserved Ejection Fraction

Joanna Midura Paluch, OMS-II; David Sturm, OMS-II: Alex Malayev, OMS-I; Isabella Moshe, OMS-II; Saud Nasruddin; Mugdha V. Padalkar, PhD; Olga V. Savinova, PhD;

Department of Biomedical Sciences, New York Institute of Technology

Statement of Significance: It is thought that heart failure with preserved ejection fraction (HFpEF) is caused by mechanical stress and metabolic disease states, which lead to coronary microvascular inflammation (1). This can be measured by coronary flow velocity reserve (CFVR), which is the ratio of coronary flow velocity during hyperemia versus at rest (2, 3). CFVR was found to be diminished following high-fat diet and N-nitro-l-methyl ester (L-NAME), an inhibitor of nitric oxide synthase, in a recent animal model (3).

1. To establish an animal model for future therapeutic testing using CFVR as a measure of HFpEF.

2. To establish a time frame for the development of HFpEF pathology as a result of metabolic disease and mechanical stress.

3. To assess cardiac contractility and microvascular perfusion in response to metabolic disease and mechanical stress.

Research Methods: Animals: C57BL/6 mice (n= 5 male mice per group) were divided into control, high-fat diet (HFD), and HFD + L-NAME groups. HFD mice were fed a D12492 diet (60 kcal% fat, 7 kcal% sucrose) and control mice were fed a D12450J diet (10 kcal% fat, 7 kcal% sucrose; Research Diet Inc.). L-NAME was supplied in drinking water at a concentration of 0.5 g/L (3). Mice were treated for 10 weeks.

Echocardiography: Mice were anesthetized by inhalation of 1-2% isoflurane. Measurements were obtained at rest and after the induction of hyperemia (0.15 mg/kg i.p dobutamine). Images were taken in long axis B-mode, short axis M-mode; left main coronary artery flow was visualized by pulse wave Doppler on 3100 VevoLab ultrasound system (Visual Sonics). Measurements included heart rate (HR; bpm), left ventricular (LV) internal diameter (LVID; mm), LV posterior wall thickness (LVPW; mm), LV mass (LVmass; mg), stroke volume (SV; uL), cardiac output (CO; mL/min), fractional shortening (FS; %), and ejection fraction (EF; %). CFVR was defined as a fold increase in the peak velocity in the main left coronary artery. Myocardial reserve was determined as the percent change in LVPW between rest and hyperemia.

Analysis: Data were analyzed using one-way ANOVA to compare the HFD and HFD+L-NAME groups with the control diet group. Normality of data distribution was assessed using the D’Agostino-Pearson omnibus test. Data that were not normally distributed were log-transformed before analysis. The Brown-Forsythe test was used to test for equivalence of variances. Post-hoc analysis comparing each treatment group with the control group was done using Dunnette’s test.

Osteopathic Significance: HFpEF is challenging to treat due to its heterogeneity and unresponsiveness to medications. Musculoskeletal-based treatment, such as regular exercise, has shown to improve quality of life in HFpEF patients (4). Developing CFVR as a reliable diagnostic tool may lead to earlier diagnosis that can be managed holistically.

Data Analysis: There was a significant difference in body weights between HFD+L-NAME and control groups (p=0.0182). A reduction in body weights between HFD and control groups was observed, though it did not meet significance (p=0.0548). There were no significant differences in myocardial reserve between either treatment group and the control (HFD: p=0.4899; HFD+L-NAME: 0.9936). There were no significant differences in CFVR (HFD: p=0.9579; HFD+L-NAME: 0.9996). A significant difference in LVID/BW (p=0.0280) and LVPW/BW (p=0.0090) was observed between the HFD+L-NAME group and the control. There was a reduction in LVID/BW (p=0.0785) and LVPW/BW (p=0.0655) between HFD and control; however, these results were not significant. Similarly, there was a reduction in LVmass/BW between each treatment group and the control group without significance (HFD: p=0.5921; HFD+L-NAME: 0.1992). There were no significant differences in pre-dobutamine HR (HFD: p=0.7156; HFD+L-NAME: 0.7156), post-dobutamine HR (HFD: p=0.9495; HFD+L-NAME: 0.9505), SV/BW (HFD: p=0.2749; HFD+L-NAME: 0.2206), CO/BW (HFD: p=0.8852; HFD+L-NAME: 0.5735), FS (HFD: p=0.9340; HFD+L-NAME: 0.8752), pre-dobutamine EF (HFD: p=0.9116; HFD+L-NAME: 0.8778), or post-dobutamine EF (HFD: p=0.7988; HFD+L-NAME: 0.6211). However, there was a reduction in SV/BW between each treatment group and the control group.

Conclusion: In this study, we demonstrated the feasibility of CFVR measurement in mice, despite their small size and high heart rate. The absence of significant differences in myocardial reserve and CFVR between treatment and control groups suggests that a 10-week period of treatment with HFD or HFD+L-NAME is not sufficient to induce HFpEF pathology and microvascular dysfunction. However, the differences in SV/BW, though not significant, suggest that with prolonged treatment, these pathological differences could be observed. The observed differences in LVID/BW and LVPW/BW indicate a lack of compensatory increase in heart size and posterior wall thickening, respectively, relative to body weight within the HFD+L-NAME group. This also suggests progression toward microvascular and cardiomyocyte dysfunction with prolonged treatment. Interestingly, these differences were only significant between the HFD+L-NAME group and the control group, supporting the greater potential for dysfunction to develop in the two-hit group compared to HFD-only. This would be consistent with previous findings, in which it was determined that the HFD+L-NAME group developed a greater hypertrophic response and worsened diastolic function compared to the L-NAME-only group (3).

Limitations of this study include a small sample size of only five mice per group and limited treatment time, with measurements only being taken at one time point. A future study with a larger sample size would produce more reliable results for comparison with previous findings of induction of HFpEF pathology and diminished CFVR in mice treated with HFD and L-NAME (3). Additionally, prolonged treatment time and obtaining measurements of CFVR and cardiac contractility at several time points would allow for the assessment of differences between groups over time and a better understanding of the time frame necessary to induce HFpEF pathology in an animal model.

References

1. Mishra S, Kass DA. Cellular and molecular pathobiology of heart failure with preserved ejection fraction. Nature reviews Cardiology. 2021;18(6):400-23. Epub 2021/01/13. doi: 10.1038/s41569-020-00480-6. PubMed PMID: 33432192; PMCID: PMC8574228.

2. Civieri G, Montisci R, Kerkhof PLM, Iliceto S, Tona F. Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease. Diagnostics (Basel). 2023;13(2). Epub 2023/01/22. doi: 10.3390/diagnostics13020193. PubMed PMID: 36673004; PMCID: PMC9858233.

3. Schiattarella GG, Altamirano F, Tong D, French KM, Villalobos E, Kim SY, Luo X, Jiang N, May HI, Wang ZV, Hill TM, Mammen PPA, Huang J, Lee DI, Hahn VS, Sharma K, Kass DA, Lavandero S, Gillette TG, Hill JA. Nitrosative stress drives heart failure with preserved ejection fraction. Nature. 2019;568(7752):351-6. Epub 2019/04/12. doi: 10.1038/s41586-019-1100-z. PubMed PMID: 30971818; PMCID: PMC6635957.

4. Rogers FJ, Gundala T, Ramos JE, Serajian A. Heart Failure With Preserved Ejection Fraction. Journal of Osteopathic Medicine. 2015;115(7):432-42. doi: doi:10.7556/jaoa.2015.089.

Financial Disclosures: None reported.

Support: Joanna M. Paluch received support from the Summer Student Research Program at the New York Institute of Technology College of Osteopathic Medicine.

Ethical Approval: Procedures and practices were approved and performed according to IACUC regulatory standards: IACUC protocol #2022-OS-01.

Informed Consent: Not applicable.

Poster No. *B-25

Abstract No. 2023-143

Category: Basic Science

Research Topic: Impact of OMM & OMT

Relationship Between Student Specialty Choice and Intention to Utilize Osteopathic Manipulative Techniques

¹Pauline Huang, OMS-IV; ¹Helen Wong; ¹Naveed Tariq; ¹Lucas Hildreth; ¹Anisa Raidah; ²Min-Kyung Jung; ¹Michael Terzella; ¹Sheldon Yao, DO

¹Department of Osteopathic Manupulative Medicine, New York Institute of Technology; ²Department of Research, New York Institute of Technology

Statement of Significance: Osteopathic manipulative techniques (OMT) have many applications across medical specialties. However, physicians working in surgical and other subspecialties talk about and perform OMT less frequently compared to their primary care counterparts [1]. In our survey, we seek to determine if there are differences in perception towards utilization of OMT amongst medical specialties before students graduate from medical school.

Examine the relationship between specialty choice and intent to utilize OMT in future practice amongst osteopathic medical students

Research Methods: Using a research protocol deemed exempt by the New York Institute of Technology (NYIT) Institutional Review Board, a 43-item confidential questionnaire was distributed to all current medical students at NYIT College of Osteopathic Medicine using an email listserv to be self-administered on a voluntary basis. The data was collected using RedCap survey software. The questionnaire included items addressing student perceptions toward OMM, student exposure to OMT, student demographics, and desired specialty. Students were asked questions about their perceptions towards OMT and their responses were recorded using a Likert scale.

Survey responses were split into four groups based on desired specialty (medical subspecialty, primary care, surgical subspecialty, and other (eg. radiology, pathology) and their perception towards OMT was analyzed based on survey responses. The data was compared using a chi-squared test and significance is deemed as a p-value <0.05.

Data Analysis: Of the 249 survey respondents, 91 were first year, 87 were second year, 55 were third year, and 62 were fourth year medical students at the time of survey completion. Overall, 35.7% chose medicine as their desired specialty, 33.7% chose primary care, 20.5% chose surgery and 8.8% chose other specialties. Students who preferred primary care and medicine specialties were significantly more likely (39.6% and 38.7% respectively) to have intention to utilize OMT in their future practice compared to their counterparts who preferred surgical (15.1%) and other (6.6%) specialties. Chi-squared test produced a p-value of 0.05.

Conclusion: This study investigated the association between desired specialty and intention to utilize OMT in future practice. In our survey, we found that students who preferred primary care and medical specialties were significantly more likely to want to use OMT in their future practice compared to students who preferred surgical and other specialties with a p-value of 0.05. Further studies should investigate whether this is due to a difference in perception or due to lack of exposure to OMT in a wide range of clinical settings during osteopathic education.

References

1. Kerr AM, Nottingham KL, Martin BL, Walkowski SA. The effect of postgraduate osteopathic manipulative treatment training on practice: a survey of osteopathic residents. J Osteopath Med. 2022;122(11):563-569. https://doi.org/10.1515/jom-2021-0260

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study protocol was deemed exempt by the New York Institute of Technology Institutional Review Board. Exemption category 2. Protocol number BHS-1765.

Informed Consent: Informed consent was obtained from study participants who were informed of the purpose of the study, potential uses of survey data and possible negative effects of survey participation in the survey email.

Poster No. B-26

Abstract No. 2023-144

Category: Basic Science

Research Topic: Chronic Diseases & Conditions

Aortic Root Calcification Is Accelerated By Warfarin In the Setting of Dyslipidemia

Jaden Sterling Alexander, OMS-I; Puneet Dhaliwal; Benjamin P. Alexander; Kelly A. Borges, MBE; Mugdha V. Padalkar, PhD; Christopher Janton; Saud A. Nasruddin; Olga V. Savinova, PhD

Department of Biomedical Science, New York Institute of Technology

Statement of Significance: Cardiovascular disease (CVD) is the leading cause of death worldwide (1). Warfarin, a widely used anticoagulant, is known to accelerate vascular calcification, an independent indicator of CVD (2). Our study examined warfarin-induced myocardial and aortic root calcification in dyslipidemia to examine the impact of warfarin on heart function in atherosclerosis. The lack of guidelines regarding warfarin and CVD poses a need for research to complement an osteopathic approach to limit dyslipidemia.

The studied examined warfarin administration in mice genetically susceptible to vascular calcification (given their DBA/2J genetic background) and atherosclerosis (given low density lipoprotein receptor gene knock-out, LDLRKO) as these mice have shown to exhibit vascular side effects of warfarin use.The objective is to determine the relationship between myocardial calcification, aortic root calcification, and reduced heart function with exposure to warfarin in a mouse model in atherosclerosis.

Research Methods: NYITCOM’s Institutional Animal Care and Use Committee (Protocol number 2022-OS-01) approved the study. LDLRKO mice (DBA2/J genetic background) were randomly divided into two groups (n= 32, 50% female) and put on diets at 8 weeks old. For 15 weeks, the treatment and control group were fed a high-fat diet with vitamin K (1.5mg/g). The treatment group received warfarin (3.0mg/g). Cages sustained a 12-hour light/dark cycle at the NYITCOM animal facility.

Echocardiography:Mice were anesthetized with 2% isoflurane. Heart rate(HR) was monitored at 40-42°C. Echocardiographic images were taken in long and short axis B-mode and M-mode measurements were taken on FujiFilm Visual Sonics 3100 Vevo ultrasound system. Cardiac contractility metrics, including HR (BPM), left ventricular(LV) posterior wall thickness (LVPW; mm), LV internal diameter (LVID; mm), LV mass (mg), stroke volume (SV; uL), fractional shortening (FS; %), cardiac output (CO; mL/min), and ejection fraction (EF; %), were recorded from M-mode images.

MicroCT:Formalin-fixed mouse hearts dissected with aortic arches intact were scanned by microCT at 10 µm resolution. 3D-reconstructed microCT images were isolated, analyzed, and thresholded into standardized regions of interest (ROI) at calcium detection of 130 Hounsfield units with NRecon and Dragonfly software (Object Research Systems). Tissue volume to calcification was compared in slices of LV myocardium and aortic root.

Aligned with a wholistic cardiovascular model of osteopathic care, our study affirms the importance of monitoring for cardiovascular complications when utilizing medications (3).

Statistical Analysis was performed in GraphPad Prism software via Krushkal-Wallis, one-way and two-way ANOVA. D’Agostino-Pearson omnibus test assessed for normality. Abnormally distributed data were log-transformed. Brown-Forsy tested for equivalence of variances. Post-hoc analysis compared treatment and control groups using Dunnette’s Multiple Comparison’s test.

Data Analysis: Calcification of the ascending aorta significantly increased in both female and male mice treated with warfarin compared to the controls(p=0.0016). Warfarin treatment has a significant affect on decreasing BW (g) (p<0.0001). HR is significantly increased, independent of warfarin treatment, in males (P=0.0111), but not significantly affected by warfarin treatment (p=0.1866). LVID/BW (mm/g) (V1) was statistically increased in mice treated with Warfarin (p= 0.0130). Independent of treatment, the LVID/BW (mm/g) was significantly increased in female mice (p=0.0007). LV calcification was not significantly different between groups in either males or females (p=0.1301). LVPW/BW (mm/g) was not significantly affected by warfarin treatment (p=0.1311), but was significantly increased in females by sex independent of treatment (p=0.0071). LVmass/BW (mg/g) was not significantly affected by warfarin treatment (p=0.3569) or sex (p=0.2037). SV/BW (ul/g) was not significantly affected by warfarin treatment (p=0.4461) or sex (p=0.6160). EF, % (V1) in male and female mice were not significantly affected by warfarin treatment (p=0.1015). FS (%) was not significantly affected by sex (P=.1597) or warfarin treatment (P=.0562). CO/BW(ml/min*g-1) was not significantly affected by warfarin treatment (p=0.2717) or sex (p=0.1434). Aortic valve peak velocity(mm/s) was not significantly affected by warfarin treatment (p=0.2621) or sex (p=0.5302).

Conclusion: This study utilized a warfarin-induced mouse model of vascular calcification under dyslipidemic conditions to elucidate the relationship between warfarin exposure, vascular calcification, and heart function. The analysis contained two groups, each starting treatment diets at 8 weeks of age for 15 weeks. The control group received Vitamin K (1.5mg/g), and the treatment group received Vitamin K (1.5mg/g) and warfarin (3mg/g). At 23 weeks of age, echocardiographic and MicroCT were conducted to assess heart function and vascular calcification. Under dyslipidemic conditions, calcification of the aortic root and left ventricular internal diameter normalized to body weight significantly increased compared to the control group. The increase in left ventricular diameter and aortic root calcification possibly indicates a cause-and-effect of cardiomyocyte remodeling resulting from aortic root stiffness. Aortic Valve Peak Velocity was not significantly affected by warfarin treatment in mice, indicating valve stiffening but not warfarin-induced stenosis (4). Limitations of the study include treatment time and sample size. In future studies with a longer treatment time and a larger sample size, atherosclerosis progression and vascular calcification may be more pronounced. Therefore, further research is needed to examine a possible relationship between warfarin-induced valvular stiffening and aortic stenosis.

References

1. Wetmore JB, Roetker NS, Yan H, Reyes JL, Herzog CA. Direct-Acting Oral Anticoagulants Versus Warfarin in Medicare Patients with Chronic Kidney Disease and Atrial Fibrillation. American Heart Association Stroke. 2020;51(8):2364-2373. doi:10.1161/strokeaha.120.028934

2. Kosciuszek ND, Kalta D, Singh M, Savinova OV. Vitamin K antagonists and cardiovascular calcification: A systematic review and meta-analysis. Front Cardiovasc Med. 2022;9:938567. Published 2022 Aug 19. doi:10.3389/fcvm.2022.938567

3. Roberts A, Harris K, Outen B, et al. Osteopathic manipulative medicine: A brief review of the hands-on treatment approaches and their therapeutic uses. Medicines (Basel). 2022;9(5):33. doi:10.3390/medicines9050033

4. Maréchaux S, Tribouilloy C. Acceleration Time in Aortic Stenosis. Circulation: Cardiovascular Imaging. 2021;14(1). https://doi.org/10.1161/circimaging.120.012234

Financial Disclosures: None reported.

Support: New York Institute of Technology College of Osteopathic Medicine

Ethical Approval: Procedures and practices were approved and performed according to Institutional Animal Care and Use Committee (IACUC) regulatory standards: IACUC protocol #2022-OS-01. Procedures also complied with the National Institutes of Health Office of Laboratory Animal Welfare Guidelines.

Informed Consent: Not applicable.

Poster No. *B-27

Abstract No. 2023-147

Category: Basic Science

Research Topic: Osteopathic Philosophy

Factors contributing to or impeding the development of OPP knowledge and skills among COM students – A Cross-Sectional Survey

¹Tanner Roberts, OMS-III; ¹Tanner Roberts, OMS-IV; ²Mark Wardle, DO, MIH, FAAFP; ³Jan Pryor,DO, MPH, CNMM/OMM

¹Rocky Vista University College of Osteopathic Medicine; ²Department of Primary Care Medicine, Rocky Vista University College of Osteopathic Medicine; ³Department of Osteopathic Prinicple and Practices, Rocky Vista University College of Osteopathic Medicine

Statement of Significance: Students at colleges of osteopathic medicine (COMs) have varying knowledge, attitudes and practices (KAP) regarding the use of osteopathic principles and practice (OPP). There seems a growing portion of students chose not to cultivate this knowledge and skill beyond the minimum needed to pass exam requirements.1,2 This differential interest in OPP is a challenge to the relevance and continued existence of the osteopathic profession as being something distinct from conventional medicine.

Utilizing annual cross-sectional surveys of OPP-related KAP among Rocky Vista University College of Osteopathic Medicine (RVUCOM) students, this study intends to illuminate various factors that may contribute or impede the development of OPP knowledge and skills. It is to identify ways in which COMs might develop more effective learning and teaching interventions to augment the capacity of their graduates to incorporate OPP during their externships, residency training, and clinical practice.

Research Methods: RVUCOM Institutional Review Board approved this 4-phase study beginning with a cross-sectional study. The 20-item survey was designed from several validated surveys found in osteopathic motivational survey literature,3,4 the Reduced Instructional Materials Motivation Survey (RIMMS),5 and RVUCOM OPP course evaluations. Questions pulled from the mentioned surveys were modified by the investigators to gauge the students’ opinions about osteopathic philosophy and osteopathic manipulative medicine (OMM) curriculum. Students were provided with a consent form and asked to enter their student ID at the beginning of the survey with the agreement that all identifiable information will be de-identified before analysis, including their grades. Incentive was given via 10 gift cards valued at $50 each to be raffled to participants. The survey platform was Qualtrics and distributed to randomly selected students via email stating the survey will take approximately 10 minutes to complete. The survey was initially sent in October 2022 to 633 of 1329 students across both Utah and Colorado campuses for a total of 8 cohorts with a goal of 445 final respondents, 33.5% of total student population. A reminder email was sent two weeks after for final responses. Students that did not respond were removed from the participant list and new students were randomly selected in their place.

Data analysis was conducted using Epi Info 7 for Windows. Study variables were analyzed using appropriate statistical methods including frequency counts for categorical variables, cross-tabulations between exposure and outcome variables with calculations of appropriate measures of association, and chi-square and p values using a two-tailed p value < 0.05 to determine statistical significance.

Data Analysis: Across all four years and both campuses, 447 of 633 invited students completed the survey for an overall response rate of 70.6%. There was, however, a higher response rate at the Utah campus (77.4% of 257 invited) as compared to the Colorado campus (66.0% of 376 invited): p value = 0.0019. Response rates were highest among OMS I students on both campuses (74.3% in Colorado, and 94.9% in Utah) and lowest among OMS III students on both campuses (61.9% in Colorado, and 67.1% in Utah).Across all RVUCOM respondents, the teaching modalities thought to be most useful for learning OMM were noted in descending order as the OMM lab (93.2%), one-on-one clinical encounters (49.7%), lectures (26.8%), punch cards in OMM lab (25.1%), group grand rounds presentations (2.0%), with other experiences being noted as useful including work with the predoctoral OPP Fellows, competency or practical exams, and work with the OPP tutors.Across all RVUCOM respondents, future interventions that respondents thought might be useful in the OMM curriculum in descending order included small group learning (67.3%), animated videos (49.0%), OMM question banks (40.7%), student-run OMM activities (36.5%), related imaging (28.9%), a lab manual computer application (28.0%), and virtual reality applications (14.8%).Various other KAP relationships are under ongoing analysis and will be reported on later.

Conclusion: According to the survey, OMM lab was perceived as the most valuable learning modality for OMM, while grand rounds ranked the least useful. Mixed responses were received regarding one-on-ones, lectures, and punch cards, all of which were considered less valuable than OMM lab. The interventions presented in the survey also had mixed reviews, with small group learning receiving the most positive feedback and virtual reality applications receiving the least favorable response. Based on these results, it would likely be beneficial for RVUCOM to continue to prioritize OMM lab and consider implementing small group learning. Conversely, discontinuing grand rounds in the OMM curriculum would likely be met with approval by students. Additionally, including virtual reality in the curriculum is unlikely to be perceived as useful by students. These insights could be leveraged by RVUCOM to enhance the perceived usefulness of the OMM curriculum.Limitations must be acknowledged. First, the survey was conducted at a single school with two campuses, thereby limiting generalizability of the findings. Second, some currently employed teaching modalities were not included in the survey causing their impact on student perception to remain unknown. These aspects should be incorporated into future surveys. Further data analysis of other survey questions is needed to correlate students’ perception of the usefulness of the OMM curriculum and the likely application of OPP and OMM in practice.

References

1. Vazzana KM, et al. Perception-Based Effects of Clinical Exposure to Osteopathic Manipulative Treatment on First- and Second-Year Osteopathic Medical Students. J Osteopath Med. 2014;114(7):572-580.2.

2. Johnson SM, Kurtz ME. Diminished Use of Osteopathic Manipulative Treatment and Its Impact on the Uniqueness of the Osteopathic Profession: Acad Med. 2001;76(8):821-828.3.

3. Draper BB, et al. Osteopathic Medical Students’ Beliefs About Osteopathic Manipulative Treatment at 4 Colleges of Osteopathic Medicine. Med Educ.:16.4.

4. Sabesan VJ, et al. Musculoskeletal Education in Medical Schools: A Survey of Allopathic and Osteopathic Medical Students. J Am Acad Orthop Surg Glob Res Rev. 2018; 2(6):e019. 5.

5. Wang S, et al. Measuring Chinese Middle School Students’ Motivation Using the Reduced Instructional Materials Motivation Survey (RIMMS): A Validation Study in the Adaptive Learning Setting. Front Psychol. 2020; 11:1803.

Financial Disclosures: ​None reported.

Support: An Dang, PhD, Randall Anderson, MD, Jordan Jones, and Miranda Speth for assistance through the initial formulation of the project and IRB Application process.

Thank you to Rocky Vista University Shark Tank Program and Rocky Vista Department of Research for a total award of $1,000 used to compensate survey takers.

Ethical Approval: ​Rocky Vista University IRB considered ​Factors contributing to or impeding the development of OPP knowledge and skills among COM students - considerations for innovative curriculum, RVU IRB#2022-077. The IRB granted approval of the research and considered it ​exempt from full IRB oversight.

Informed Consent: Students were provided with a consent from and asked to enter their student ID at the beginning of the survey with the agreement that all identifiable information will be de-identified before analysis, including their grades.

Poster No. *B-28

Abstract No. 2023-151

Category: Basic Science

Research Topic: Impact of OMM & OMT

Evaluation of Using Three-Dimensional Sacral Models in the Education of Sacral Osteopathic Manipulative Treatment: A Quality Improvement Study

¹Gabriella Carr, OMS-IV; ¹Connor Schury, OMS-IV; ²Teri Hammer, DO; ²J’Aimee Lippert, DO; ³Lauren Azevedo, DO

¹Michigan State University College of Osteopathic Medicine; ²Department of Osteopathic Manupulative Medicine, Michigan State University College of Osteopathic Medicine; ³Department of Pediatrics, Michigan State University College of Osteopathic Medicine

Statement of Significance: Three-dimensional (3-D) printing is a method of building structures by laying down material layer by layer. Originally designed for building prototypes for business and engineering, the scope of 3-D printing has expanded into medical applications ranging from creating models for surgical planning and patient education, to creating prostheses and bioprinting tissues. Research is limited regarding applying these methods to education in osteopathic manipulative medicine (OMM).

The purpose of this quality improvement study is to analyze student satisfaction, efficiency, and retention of using 3-D printed models in the osteopathic education of sacral dysfunctions and treatment.

Research Methods: The study population includes first year osteopathic medical students across three sites in Michigan. As the OMM lab at this institution utilizes a flipped-classroom approach, all students reviewed a pre-recorded lecture and demonstration videos on sacrum diagnosis and treatment prior to attending their lab session. Two sites (approximately 250 students) received the traditional sacrum in-person lab experience utilizing other methods to conceptualize sacral motion and dysfunction. Previous methods used to convey concepts include paper, cardboard models, portraying the body as the sacrum, or a pillow. Another site (approximately 50 students) utilized 3-D printed sacral models. Students received a pre-test including four case-based multiple-choice questions on sacrum diagnosis and treatment. After the lab session, students received a post-test with the identical multiple-choice questions as the pre-test. Students were asked to evaluate the use of models and value of their learning session. A follow-up survey was completed approximately 6 months after the initial survey to determine the long-term effectiveness of using the sacral models. All surveys were administered through Qualtrics survey software.

Data Analysis: Statistics were completed using a cumulative link mixed model. The results showed higher scores at both the post-test (OR = 2.92, p < 0.001) and follow-up (OR = 1.68, p = 0.014) compared to pre-test for participants. The groups had a similar score on the pre-test (OR = 1.00, p = 0.996). There was no significant difference in the score at the post-test time point (OR = 1.04, p = 0.944), but there was significant difference at the follow-up time point (OR = 5.21, p = 0.003). This indicates that students utilizing the 3-D models showed a larger improvement from pre-test to 6-month follow-up than students that did not use the 3-D models group. While students reported improvement in their comfort diagnosing sacral dysfunctions from pre-test to post-test (OR = 19.46, p < 0.001) and follow-up (OR = 14.34, p < 0.001), there was no significant difference between the intervention groups at the time of post-test or follow-up.

Conclusion: Overall, this study indicates a possible relationship between use of 3-D printed models and long-term performance on questions related to sacral dysfunction. The limitations of this study include variable sample sizes between groups and different instructors between sites. Further areas of study would include assessment of understanding of OMT using other 3-D models, evaluation of confounding variables and review at additional time points.

References

None

Financial Disclosures: None reported.

Support: The authors would like to thank the MSU Center for Statistical Training and Consulting for assistance with statistical analysis. The authors would also like to thank Stephanie Marcincavage, Rose-Marie Higgins, and Macomb Community College for their assistance with 3-D printing and donation of the sacral models.

Ethical Approval: This study was categorized as exempt by Michigan State University IRB. Study number: STUDY00007382

Informed Consent: All students were provided a passage as part of the survey that explained the project, description of the study, that participation is voluntary and can withdraw without penalty from the investigators or their relationship with Michigan State University College of Osteopathic Medicine, and contact information of the investigators.

Poster No. *B-29

Abstract No. 2023-152

Category: Basic Science

Research Topic: Health Disparities-Social Determinants of Health

A Common Disinfectant Used During the COVID-19 Pandemic Alters the Gut Microbiome in Mice

¹Chris Kim, OMS-II; ²Terry Hrubec, DVM, PhD; ¹Alan Chiang; ¹Sarah Lowen; ¹Valerie McDonald

¹Edward Via College of Osteopathic Medicine-Virginia; ²Department of Biomedical Affairs, Edward Via College of Osteopathic Medicine-Virginia

Statement of Significance: Quaternary Ammonia Compound (QAC) disinfectants are commonly used in household and medical settings. Although long considered safe, it is now known that they cause infertility, birth defects, and alter immune function. Once absorbed into the body, they are eliminated through the gastrointestinal tract, putting an active disinfectant in contact with the gut microbiome and potentially changing its composition and thus immune function.

The aim of this study was to analyze the effect of disinfectant exposure on the gut microbiome. This research is particularly relevant and applicable to minority and underserved populations who work as janitorial/ housekeeping staff, and in food preparation industries. These individuals along with medical personnel were considered essential workers during the pandemic and all have high exposure to disinfectants and cleaners.

Research Methods: A three generation developmental immunotoxicity and microbiome test was conducted. Mice were separated into three groups – those dosed with 60mg/kg QAC in the feed (dosed), those indirectly exposed through normal use of QAC disinfectant in the mouse room (ambient), and those not exposed at all (control). Ten pairs of mice in each group (F0 generation) were exposed for 10 days and then were bred to produce litters. Exposure terminated at the weaning of the offspring of the F1 generation. All mice were then moved to a QAC-free environment. Ten pairs of F1 mice were bred to produce an F2 generation of progeny. The gut microbiome from the feces was analyzed at two time points for all treatment groups and generations. Bacterial DNA was extracted with phenol/chloroform and amplicons of the V4 region of the 16S rRNA gene were generated by PCR (Argon National Lab). Data analysis, segregated by sex, examined the relative abundance of bacteria at different taxonomic levels starting with phylum down to species. A two-sample t-test was conducted to compare the control to the dosed groups, as well as the ambient groups to the dosed groups. A paired t-test was used to compare differences between timepoints within the same experimental groups. Principal Coordinate Analysis showed differences in species number and species diversity in the F0, F1, and F2 generations. Changes in bacterial taxa were identified as significant when the p-value was less than 0.05.

Data Analysis: Results From Two-Sample t-test: In the F0 generation mice, there were significant changes in Actinobacteria (p = 0.039), Proteobacteria (p = 0.005), and Verrucomicroba (p = 0.014) between the control and dosed groups of the male mice. Whereas in the F0 female mice, there were significant changes in only Deferribacteres (p = 0.047) between control and dosed groups. In the F1 generation mice, there were significant differences in Actinobacteria (p = 0.05) and Deferribacteres (p = 0.018 at day 40, 0.023 at day 50, 0.004 at day 60) between the control and dosed groups of the male mice. In F1 female mice, there were also differences in Actinobacteria (p = 0.007 at day 40, 0.01 at day 50) but also Proteobacteria (p = 0.04) and Bacteroidetes (p = 0.044) between control and dosed groups. In the F2 generation mice, there were significant changes in Actinobacteria (p = 0.001 at day 21, 0.028 at day 40), Bacteroidetes (p = 0.007), Deferribacteres (p = 0.011), Firmicutes (p = 0.002), and Verrucomicrobia (p = 0.02) between the control and dosed groups of male mice. In F2 female mice, there were differences in Tenericutes (p = 0.024), Proteobacteria (p = 0.024 at day 21, 0.044 at day 40), and Actinobacteria species between control and dosed groups.

Results from paired t-test: In the F0 generation, there were significant changes in Bacteroidetes (p = 0.036) and Bacteroidales (p = 0.036) within the control group. Whereas in the dosed group of male mice, there was a significant change in Firmicutes (p = 0.05). In the F1 generation, there was a significant change in Actinobacteria (p = 0.05) within the dosed group of male mice. In the F2 generation, there were significant changes in Firmicutes (p < 0.001) and Firmicutes other (p = 0.039) within the control group. Whereas in the dosed group, there were significant changes in Firmicutes (p = 0.038) and Tenericutes (p = 0.006).

Conclusion: Overall, males exhibited greater changes to their microbiome than females, and QAC exposed mice demonstrated changes in their gut microbiome, and these changes persisted in subsequent generations, despite cessation of QAC exposure.

Financial Disclosures: None reported.

Support: Supported by the VCOM-VMCVM One Health Program

Ethical Approval: Virginia Tech IACUC Approved, IRB exempt

Informed Consent: Not relevant.

Poster No. *B-30

Abstract No. 2023-155

Category: Basic Science

Research Topic: Osteopathic Philosophy

Assessing the Quality and Quantity of Research Among Incoming First-Year Osteopathic Medical Students

¹Sarah Lynch, OMS-III; ¹Jonathan Byrne, OMS-III; ²Khavir Sharieff, DO MBA

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine; ²Department of Surgery, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine

Statement of Significance: Research participation in medical school has become an increasingly important metric used to distinguish residency applicants, partly due to the recent conversion of preclinical board exams to pass/fail grading (1). Despite this emphasis on research, there is little data regarding how best to support osteopathic medical student research. Understanding the prior research experience of first-year students may ultimately help develop strategies to bolster future research participation and outcomes.

To comprehensively investigate the extent of participation, the quality and quantity of projects, and specific outcomes of research engagements of incoming first-year osteopathic medical students.

Research Methods: A cross-sectional survey study of 381 first-year osteopathic students was conducted in January 2023 at a Florida osteopathic medical school. The anonymous survey contained 31 multiple-choice items, 14 of which allowed a single answer and 17 of which allowed multiple answer selections. The questions aimed to collect information including participant demographic information, research experience, quality and quantity of research, the extent of involvement, research expectations, and the outcomes of projects. Not all participants answered all 31 questions due to conditional logic and branching based on previous answer choices. Before distribution, the survey instrument was validated using student and faculty feedback. The survey was disseminated via email and remained open for four weeks; two email reminders were sent.

Data were collected using Google Forms and descriptive statistics were performed using Microsoft Excel (Microsoft Corporation. 2022. Microsoft Excel for Mac).

By aiming to quantify the extent of research participation of incoming osteopathic students, this study may allow osteopathic educators to further refine strategies to increase research participation among osteopathic medical students.

Data Analysis: Among the 381 participants surveyed, 51 completed the survey (response rate of 13.4%). No participants were excluded from the analysis. While 42 (82.3%) participants noted some type of participation in research prior to beginning medical school, just 24 (47.1%) participants ultimately had their research presented at a conference or published a paper. Twenty (39.2%) participants were included as an author for their research presented at a conference and 12 (23.5%) were included as first authors; only 7 (13.7%) participants presented at a national or international conference. Fourteen (27.5%) participants submitted research manuscripts for publication, with 9 (17.6%) ultimately being accepted for publication, and 8 (15.7%) citing first-authorship of their research. Of the 8 students who published a first-author manuscript, 5 participants cited three or more publications and 4 presented at national or international conferences.

Of only the people who conducted research, 52.9% of participants conducted at least one project in basic science/laboratory research, with the next most common category being clinical science research. The most common contributions to the research project were participant recruitment and data collection (78.6%) and manuscript preparation (64.3%). This aligns with the most common technical experience gained through research response being data and statistical analysis (73.2%). The most common responses to barriers to research in medical school amongst all participants regardless of research experience included lack of time (86.3%) and not knowing where to start (68.6%).

Conclusion: The results of this study indicate that a large number of respondents appear to have research experience upon entering medical school, but the quality and quantity of that experience varies.

While many students participated in some form of research, most students’ experience seemed confined to a particular aspect of the project such as data collection or data analysis and not to the overall planning and execution of the project. This limited scope of engagement may contribute to why many participants felt that a barrier to participating in research in medical school was “not knowing how to start.” In addition, a minority of the participants entered medical school with significant research experience. These vast differences in research experience and quality highlight the need for more individualized strategies to support osteopathic medical students in research.

While low response rate and response bias limit the extrapolation of this data, future studies may aim to improve response rate, further explore barriers to participation, or longitudinally follow a cohort of students and collect data on their research participation throughout medical school. Still, despite the limitations of this study, the respondents tend to view research as valuable and are eager to participate. This study and others like it may help characterize the research background and expectations of incoming osteopathic medical students, leading to improved research participation in medical school.

References

1. Wolfson RK, Fairchild PC, Bahner I, et al. Residency Program Directors’ Views on Research Conducted During Medical School: A National Survey [published online ahead of print, 2023 Apr 21]. Acad Med. 2023;10.1097/ACM.0000000000005256. doi:10.1097/ACM.0000000000005256

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The Nova Southeastern University IRB deemed this study (#2022-459) exempt on 12/09/2022.

Informed Consent: Informed Consent was obtained per IRB Protocol. An email invitation to participate was distributed to eligible participants with an attached consent document outlining the voluntary nature of the survey. Completion of the survey was considered implied consent.

Poster No. *C-1

Abstract No. 2023-001

Category: Clinical

Research Topic: Musculoskeletal Injuries and Prevention

Achilles Tendon Ruptures in Female Collegiate Gymnasts are Relatively More Frequent at Competition Sites than Training Sites and may be Prevented by Non-steroidal Anti-inflammatory Drug Use

Emily Muhlenhaupt, OMS-II; Harald Martin Stauss MD, PhD

Department of Biomedical Sciences, Burrell College of Osteopathic Medicine

Statement of Significance: 17.2% of female collegiate gymnasts experience Achilles tendon ruptures throughout their athletic career [1]. Chronic overtraining may promote tendinitis that weakens the tendon and ultimately results in ruptures during difficult gymnastics skills that put high strain on the tendon. This is likely to occur specifically during athletic competitions when gymnasts engage in challenging routines and are under high pressure to perform at their best, which may indirectly impact biomechanics.

The hypothesis of this study was that overtraining in female gymnasts results in chronic inflammation of the Achilles tendon which may result in tendon ruptures particularly when athletes perform demanding skills while under competitive pressure. To test this hypothesis, we investigated if anti-inflammatory drugs prevent Achilles tendon ruptures and if Achilles tendon ruptures occur more frequently during competition than during training.

Research Methods: Coaches and athletic trainers from 78 US collegiate female gymnastic teams were asked to invite their active athletes and alumni to complete a survey consisting of 34 questions. The survey assessed the prevalence and characteristics of Achilles tendon ruptures, non-steroidal anti-inflammatory drug (NSAID) use, age at which competitive gymnastics started and age at which Achilles tendon rupture occurred, and whether Achilles tendon ruptures occurred at the training or competition sites.

Data Analysis: 103 female NCAA gymnasts were included in the study. Of those, 21 (20.4%, 95% CI: 13.6% to 29.4%) experienced an Achilles tendon rupture. 19 ruptures were full ruptures and 2 were partial ruptures. 19 ruptures occurred while performing floor exercise, one on vault, and one was unspecified. Of the 21 ruptures, 20 occurred during takeoff. The prevalence of NSAID use was higher in gymnasts without tendon rupture (27.6%, 95% CI: 18.6% to 39.0%) compared to gymnasts with ruptures (5.5%, 95% CI: 0.6% to 35.5%). This effect of NSAID use was confirmed by multiple linear regression analysis, identifying NSAID use (P<0.05) and the age at which competitive gymnastics training was started (P<0.01) as negatively predicting factors, suggesting that NSAID use and a higher age at which competitive gymnastics is started protect from Achilles tendon ruptures. In average this cohort of gymnasts trained for 983±23 h/year (95% CI: 938 to 1028 h/year) at their home training sites. Assuming gymnasts went to an average of 12 competitions per year with an average of 3 h of gymnastics per competition site, gymnasts would spend an average of 36 h/year competing at various competition sites. Thus, gymnasts spend 27 times more time performing gymnastics at their home training site compared to external competition sites. Yet, similar numbers of Achilles tendon ruptures occurred at training sites (n=9) and competition sites (n=10). Two of the 21 gymnasts with Achilles tendon ruptures, did not disclose the site of the rupture. When expressing these data relative to the training hours, Achilles tendon ruptures occurred 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 training hours at the training site. In contrast, at external competition sites, Achilles tendon ruptures occurred 1.85±0.11 (95% CI: 1.60to 2.10) times per 1000 competition hours (P<0.05, Fig. 2). This correlates to 23 times more Achilles tendon ruptures per gymnastics hour at competition vs. training sites.

Conclusion: Our data, showing a protective effect of NSAID use and a higher relative incidence of Achilles tendon ruptures at competition versus training sites, suggest that overtraining in female gymnasts results in chronic inflammation of the Achilles tendon which may result in tendon ruptures specifically when athletes perform demanding skills while under competitive pressure. Preventive use of NSAIDs may initiate self-regulatory and self-healing processes as proclaimed by Andrew Tailor Still and therefore reduce the high incidence of Achilles tendon ruptures in female gymnasts.

References

1. Bonanno J, Cheng J, Tilley D, Abutalib Z, Casey E. Factors Associated With Achilles Tendon Rupture in Women’s Collegiate Gymnastics. Sports Health. May-Jun 2022;14(3):358-368. doi:10.1177/19417381211034510.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This survey-based study was reviewed by the Burrell College Institutional Review Board (BURRELL IRB 0109_2023) and determined to be exempt from the regulations of 45 CFR 46 (Common Rule) according to § 46.101(b).

Informed Consent: All study participants provided informed consent.

Poster No. C-2

Abstract No. 2023-003

Category: Clinical

Research Topic: Impact of OMM & OMT

Efficacy of Osteopathic Manipulation Therapy in the Treatment of Post-concussive Versus Primary Migraines

Jenny Song, DO; Tricia Hall; Michael Waddington

Department of Academic Affairs^, Eastern Connecticut Health Network

Statement of Significance: Migraines are a common disease that affects approximately 15% of Americans. It is manifested as moderate to severe paroxysmal, throbbing, and unilateral headaches, persisting between 4 hours to 3 days, and may occur concomitant with photophobia, phonophobia, osmophobia, allodynia, nausea, vomiting, and pain with motion [2]. There have been recent insights into migraine’s pathophysiology, yet adequate recognition and intervention remain unmet needs.

To evaluate the efficacy and safety of using osteopathic manipulation therapy (OMT) for treatment of post-concussive migraines compared to primary migraines, also examining the disparate biomechanical changes to the anatomy and physiology that take place in the two etiologies of migraine so to better encourage restoration of the body’s normal structure-function relationship.

Research Methods: This is a prospective observational study conducted at the Neuromuscular Medicine Clinic. No randomization has been used. Inclusion criteria consists of patients aged 18 years or older, exhibition of migraines after mild traumatic brain injury (TBI) with lingering symptoms beyond 2 weeks post incident, and patients with primary migraine headaches (not caused by another underlying medical condition; clinical diagnosis not requiring workup or imaging). Excluded from the study are patients who are younger than 18 years of age at time of consent, secondary causes (non-concussive) of migraines, currently on preventative or abortive migraine therapies, receiving nerve blocks/trigger point injections, undergoing physical/occupational therapy, or seeking chiropractic care. Patients with contraindications to OMT treatment, which include presence of active abscesses, localized infections, bacteremia, bone fractures, certain stages of carcinomas, thrombotic events, recent surgical wounds, and lymphoma, are also excluded. Study participants have been divided into two groups—post- concussive and primary migraine patients. OMT treatment will be applied to both groups to target somatic dysfunctions of the cranial, suboccipital, upper extremity, costal, thoracic, and abdominal regions. Quantitative pain measures will be extracted using the Visual Analogue Scale, Verbal Rating Scale, and Numerical Rating Scale. The aim is to recruit about 200 patients in total for the study and perform statistical analyses using Spearmon correlation and ANOVA variance analysis (via the IBM SPSS Statistics Software) to delineate the efficacy of OMT in the alleviation of post-concussive versus primary migraine symptoms. The biomechanical model of osteopathic medicine is employed in the study, as helping the body restore the correct alignment of its structures using external force encourages the flow of essential nutrients to promote innate body healing mechanisms and optimal functionality. ​

Data Analysis: Six study participants have been recruited to date, with three in the post-concussive migraine group and three in the primary migraine group. Both groups of patients experienced symptoms of moderate to severe unilateral head pain, associated with photophobia, phonophobia, nausea, and gradual, brief auras less than an hour in duration, mostly visual, which precede the migraine attacks. The post-concussive migraine patients also presented with daytime drowsiness, lack of focus/concentration, balance issues, dizziness, and insomnia [4], which were not present in patients with primary migraines. Comprehensive neurological examinations conducted in the office were unremarkable for both groups of patients. Patients were treated with OMT in office at four-week intervals and have attended on average two sessions so far with marked improvement/resolution of migraine symptoms (pain rating dropped from 9-10/10 to under 3/10, frequency of migraine attacks decreased from daily/continuous to monthly or less). During the visits, thoracic dysfunctions were released with balanced ligamentous tension, high velocity low amplitude thrust, and myofascial release techniques. Direct trapezial inhibition, scapular release, and suboccipital muscle stretch were administered bilaterally. Cranial strain pattern correction, cervical spinal/soft tissue release, autonomic nervous system normalization, lymphatic drainage stimulation, and supraclavicular restrictions were employed. Both direct and indirect techniques were utilized. The treatment course lasted approximately twenty minutes per visit and resolution of dysfunctions were rechecked post treatment. In the post-concussive migraine group, the additional symptoms also showed remarkable alleviation with OMT treatment, albeit to a lesser extent. Patients will continue to be followed in office for a minimum of four months with visits spaced at four-week intervals until complete symptomatic resolution.

Conclusion: Approximately 39 million people (about twice the population of New York) in the United States, and 1 billion globally, are afflicted with migraine headaches, making it one of the most common neurological diseases in the world. Migraines cost the US about $36 billion (about $110 per person in the US) annually in healthcare expenditure and lost productivity [5]. It is therefore of paramount importance to find novel and cost-effective ways to revolutionize management of the disorder. From our study perspective, OMT has been effective in stimulating the vagus nerve, which is part of the parasympathetic nervous system, and aids in normalization of blood flow to the brain and modulation of painful stimuli. It also promotes lymphatic drainage from the brain, allowing better removal of waste products and metabolites. OMT has been hypothesized to rebalance the vegetative nervous system (VNS) nuclei and diminish pro-inflammatory substances, both responsible for migraine-associated pain [1]. OMT also disrupts the cycle of muscle-spasm/spinal misalignment induced pain [3]. Patients in both groups exhibited significant migraine improvement/resolution post two OMT sessions, without simultaneously undertaking other treatment interventions, shedding light on the promise that OMT is an effective adjunctive or primary tool to provide lasting relief for patients suffering from migraines. Limitations to our study include confounding factors that affect pain perception/tolerance, such as the patients’ differing sporadic use of over-the-counter anti-inflammatories/painkillers, age and stress levels, genetic predispositions, nutritional/exercise status, alcohol/tobacco use, and support systems. Future research should probe into the role of underlying psychiatric conditions, such as cortical spreading of depression or anxiety, in inducing aura and prolonging migraine healing, as well as the interplay of an interprofessional team in migraine management.

References

1. Iyengar, S., Johnson, K. W., Ossipov, M. H., & Aurora, S. K. (2019). CGRP and the trigeminal system in Migraine. Headache: The Journal of Head and Face Pain, 59(5), 659–681. https://doi.org/10.1111/head.13529

2. Migraine headache - statpearls - NCBI bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK560787/

3. Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine? Gandolfi M, Geroin C, Valè N, et al. Eur J Phys Rehabil Med. 2018;54:1–12.

4. Postconcussive syndrome - StatPearls - NCBI Bookshelf. (n.d.-b). https://www.ncbi.nlm.nih.gov/books/NBK534786/

5. Read, E. T. min. (n.d.). Migraine statistics and facts. Migraine.com. https://migraine.com/migraine-statistics

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This is a prospective observational study, the data collected for this study does not contain any Health Insurance Portability and Accountability Act of 1996 (HIPAA) identifiers. Based on the Manchester Memorial Hospital Institutional Review Committee criteria for human subjects research, this type of research project does not meet criteria to be considered human subjects research. Since this is not considered human subjects research, the project does not require Institutional Review Committee review.

Informed Consent: This is an observational study that does not meet Manchester Memorial Hospital criteria for human subjects research. As a result, no informed consent is required for the research project.

Poster No. *C-3

Abstract No. 2023-006

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Age Related Differences in the Cardiovascular Phenotype of Patients with Ehlers-Danlos Syndrome

¹Casey Sciandra, OMS-IV; ¹Nolberto Jaramillo; ¹Anisa Raidah; ¹Bernadette Riley, DO; ²Todd J. Cohen, MD

¹Department of Research, New York Institute of Technology; ²Department of Clinical Specialities, New York Institute of Technology

Statement of Significance: Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder that is characterized by joint hypermobility (1). Common manifestations are chest pain, palpitations, and syncope. Patients are commonly diagnosed with postural orthostatic tachycardia syndrome (POTS), which is defined as a heart rate increase of 30 beats/minute within the first 10 minutes of standing (2). Persistent palpitations are monitored with implantable loop recorders (ILR) or echocardiograms.

The purpose of this study was to determine if there are any cardiac differences present between young and old patients with EDS.

Research Methods: This study retrospectively analyzed 67 EDS patients seen and evaluated at the Long Island Heart Rhythm Center from January 2019 to March 2023. This study was reviewed by the NYIT IRB and deemed exempt. Inclusion criteria included EDS patients with at least one complete physical exam. Cardiac symptoms, the prevalence of POTS, and ILR findings were compared using the Chi-square test. Left ventricular ejection fractions (EF) were compared using unpaired student’s t-test; p<0.05 was statistically significant. Data reported as mean ± standard deviation. The osteopathic principles focus on the interrelationship between structure and function as well as treating the body as a unit, which correlates to this study by characterizing cardiac manifestations in patients with EDS to improve upon our care.

Data Analysis: 67 patients with EDS were included in the study. Two cohorts were created, consisting of those above or below the median age (n=31 years), with an average age of 25 ± 3.59 years in the young cohort and 44 ± 9.97 years in the old cohort. Between the two cohorts, no significant difference was found between cardiac symptoms, the prevalence of POTS, ILR findings, or EF averages.

Conclusion: In conclusion, no significant difference was found between the cohorts in cardiac symptoms, the frequency of POTS, ILR findings such as sinus tachycardia, supraventricular tachycardia, or ventricular tachycardia, or average EFs. This may be due to the small sample size or limited age variable because all patients were above the age of 18 years old. Additional research is necessary to fully understand the role that age may play in the development of cardiac manifestations in patients with EDS.

References

1. Malfait, F, et al. The 2017 International Classification of the Ehlers-Danlos Syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):8–26.

2. Anjum, I., Sohail, W., Hatipoglu, B., & Wilson, R. Postural Orthostatic Tachycardia Syndrome and Its Unusual Presenting Complaints in Women: A Literature Minireview. Cureus. 2018;10(4):e2435. https://doi.org/10.7759/cureus.2435.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The research protocol was exempt by the NYIT IRB retrospective Long Island Heart Rhythm Center study.

Informed Consent: N/A.

Poster No. *C-4

Abstract No. 2023-009

Category: Clinical

Research Topic: Osteopathic Philosophy

Visual Health Impact of Online Learning During COVID-19 in Osteopathic Medical Students

¹Zurriat Syed, OMS-IV; ²Syed Quadri

¹Lincoln Memorial University-DeBusk College of Osteopathic Medicine; ²Department of Pharmacology, Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM)

Statement of Significance: Although previous studies have shown that online learning during COVID-19 has an impact on visual health, this has not yet been explored in adults. Studies in the past have shown that children who have participated in online learning during COVID-19 had a higher prevalence of eye disease and eye strain. These studies did not include adolescents or adults and were conducted to evaluate the effects of digital strain on visual health in China and India.

The purpose of this study is to determine if visual health in osteopathic medical students was impacted by online learning.

Research Methods: Retrospective survey study was conducted from 5/21-7/21. IRB approval was attained. A retrospective questionnaire was emailed to Lincoln Memorial University Class of 2023, 2024, and 2025. The survey was sent via email to 728 students through Qualtrics. A reminder regarding the questionnaire was emailed every week for three weeks. The National Eye Institute Visual Functioning Questionnaire was used to analyze the visual health outcomes. Incomplete surveys were included. Data variables were compared. ANOVA was used to find p value and analyze differences between genders and eye strain impact.

Data Analysis: There were 189 total surveys. This included 126 females and 63 males. Participants with previously excellent vision at 29.17% decreased to 20.83% and very good vision 31.25% decreased to 14.06% since COVID-19. 45.03% reported eye strain due to online learning. 45.51% reported difficulty in reading text online and in print since COVID-19. 55% females reported increased eye strain compared to 29% in men. Gender was analyzed with ANOVA and the p value of 0.00036 showed a significant different between groups. In addition, 25.73% reported changes in their vision since COVID-19 with needing a new prescription or glasses for the first time.

Conclusion: Visual health outcomes are negatively influenced by online learning with gender being a significant factor. Due to the ongoing COVID-19 pandemic, we continue to be reliant on online learning and we must take precaution to preserve vision.

References

1. Mohan A, Sen P, Shah C, et al. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian J Ophthalmol. 2021;69(1):140-144. doi:10.4103/ijo.IJO_2535_20

2. Nimavat N, Singh S, Fichadiya N, et al. Online Medical Education in India - Different Challenges and Probable Solutions in the Age of COVID-19. Adv Med Educ Pract. 2021;12:237-243. Published 2021 Mar 4. doi:10.2147/AMEP.S295728

3. Zhang Z, Xu G, Gao J, et al. Effects of E-Learning Environment Use on Visual Function of Elementary and Middle School Students: A Two-Year Assessment-Experience from China. Int J Environ Res Public Health. 2020;17(5):1560. Published 2020 Feb 28. doi:10.3390/ijerph17051560

4. Zhao Y, Guo Y, Xiao Y, et al. The Effects of Online Homeschooling on Children, Parents, and Teachers of Grades 1-9 During the COVID-19 Pandemic. Med Sci Monit. 2020;26:e925591. Published 2020 Sep 12. doi:10.12659/MSM.925591

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The IRB Committee has reviewed and approved this research study according to HHS 2018 45 CFR 46.104(2)(i) and assigned the study an IRB number 1004 V.0.

Informed Consent: N/A.

Poster No. *C-5

Abstract No. 2023-015

Category: Clinical

Research Topic: Chronic Diseases & Conditions

The Incidence of Hyperhomocysteinemia in a Rural Wound Care Clinic

¹Alexander S. Hernandez, OMS-III; ²Carli David, OMS-III; ³Kerry Thibodeaux, MD; ²Marcus Speyrer, RN

¹Department of Research, Edward Via College of Osteopathic Medicine-Louisiana Branch Campus; ²Wound Care Center, Opelousas General Health System

Statement of Significance: Compared to the general population, patients in the wound care setting have an increased incidence of elevated homocysteine levels (60% vs. 6%)¹. As a result, more screening needs to be implemented in order to improve patient outcomes. Our goal was to find a stealth mediator in elevated homocysteine levels as an indicator for wound chronicity. Our aim was to determine the incidence of hyperhomocysteinemia in a rural wound care setting to measure its impact on wound healing outcomes.

Our aim was to determine the incidence of hyperhomocysteinemia in a rural wound care setting to measure its impact on wound healing outcomes.

Research Methods: The target group for our research was a rural environment without a center with screening protocol for hyperhomocysteinemia. Our investigations took pace primarily in southern Louisiana, more specifically Beauregard parish and Vernon parish, which services a population of 82,000 people. Screening criteria was established to include diabetic status, body mass index (BMI >25 kg/ m3), neuropathy, tobacco use, or previous spinal cord injury. Patients with positive screenings were separated by age group, the most common comorbidities were documented, and wound measurements were taken; all wounds were assessed and cleansed with normal saline, then gauzes and wrappings were replaced.

Data Analysis: From a total of 706 patients, 150 met screening criteria for hyperhomocysteinemia. Briefly, 86 males and 64 females were screen with a total of 116 patients with elevated homocysteine levels yielding a 77% screening accuracy rate. The highest represented age group was 51-70 with 86 positive screens and 35 positive screens in the 71 and over age group. Sixteen patients were found to have homocysteine levels over 25 μmol/L. The most common patient comorbidities were hypertension (68%), diabetes mellitus (67%), hyperlipidemia (31%), and neuropathy (30%) with many patients presenting with multiple comorbidities.

Conclusion: In brief, in this patient population, screening criteria was effective in identifying individuals with hyperhomocysteinemia leading to initiation of appropriate treatment (vitamin B6, B9, and B12) yielding reduced levels of homocysteine levels and progression of wound approximation.

References

1. Boykin Jr. J, Baylis C. Homocysteine - A Stealth Mediator of Impaired Wound Healing: A Preliminary Study. Hmpgloballearningnetwork.com. Published 2022. https://www.hmpgloballearningnetwork.com/site/wounds/article/5581

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Our study was deemed exempt.

Informed Consent: N/A.

Poster No. *C-6

Abstract No. 2023-031

Category: Clinical

Research Topic: Osteopathic Philosophy

Examining Osteopathic Medical Students’ Experiences with Distance Learning and Social Connectedness

Jessica Rodgers, OMS-IV; Lindsey King, OMS-IV; Eric Schmitz, OMS-IV; Elizabeth A. Beverly, PhD

Department of Primary Care, Ohio University-Heritage College of Osteopathic Medicine

Statement of Significance: Several medical schools are opening regional campuses and delivering education via virtual activities. However, minimal research has assessed the impact of the multi-campus structure on medical students. The physical division between the campuses brings into question how social connectedness is affected. Peer and faculty interactions have an important impact on a student’s development. Positive student-faculty and peer relationships have benefits academically, socially, and psychologically.

The purpose of this study was to examine first and second year osteopathic medical students’ experiences with distance learning and level of social connectedness across a three-campus medical school.

Research Methods: In this descriptive, cross-sectional study, we assessed students’ ability to communicate purposefully in their environment and develop interpersonal relationships with their professors and peers. The electronic, anonymous survey was distributed to all first and second year osteopathic medical students currently enrolled at the main campus and two distance campuses of the Ohio University Heritage College of Osteopathic Medicine. Chi-Square tests examined differences by medical campus and communication comfort levels. Statistical significance was defined as a p-value less than 0.05. Analyses were conducted using SPSS statistical software version 28.0.

Data Analysis: Of the 424 students invited to participate, 230 completed the electronic, anonymous survey (mean age=24.7±2.9 years, 53.0% female, 78.7% White, 10.4% Asian, 4.8% Black, 56.1% OMS I) yielding a response rate of 54.2%. Only 48.3% (n=111) of participants felt interaction with faculty at other campuses was important, and 18.7% (n=43) felt interaction with students at other campuses was important. Further, 39.1% (n=90) of participants never interacted with faculty from another campus, and 34.3% (n=79) never interacted with students from another campus. Interestingly, only 22.2% (n=51) of participants felt very comfortable interacting with faculty from other campuses, and 14.3% (n=33) felt very comfortable interacting with students from other campuses. Lastly, participants at the regional campuses felt more comfortable interacting with faculty (χ2=8.301; p=0.016) and students (χ2=9.291; p=0.010) from the other campuses compared to participants from the main campus.

Conclusion: Interventions designed to enhance interaction are needed at this three-campus medical school. A significant number of participants did not interact, feel comfortable interacting, or felt that interaction was not important with students and faculty of other campuses. Additional research with a greater number of multicampus institutions is needed to support the generalizability of these findings. The impact of decreased interaction was not conducted with this study. Further, research is needed to see the impact on the development of interpersonal skills, social, and academic success within a multi-campus institution. It is significant to understand how a medical institution’s structure affects interpersonal and academic development. Comfortability with communication and cooperation are necessary skills that need to be advanced among medical students to enable them to effectively work within interprofessional healthcare teams.

References

1. Guzzardo, M.T., Khosla, N., Adams, A.L. et al. “The Ones that Care Make all the Difference”: Perspectives on Student-Faculty Relationships. Innov High Educ 46, 41–58 (2021). https://doi.org/10.1007/s10755-020-09522-w

2. Kim, Young K., and Linda J. Sax. “Student–Faculty Interaction in Research Universities: Differences by Student Gender, Race, Social Class, and First-Generation Status.” Research in Higher Education, vol. 50, no. 5, 2009, pp. 437–459, https://doi.org/10.1007/s11162-009-9127-x.

3. Laal, Marjan, and Seyed Mohammad Ghodsi. “Benefits of Collaborative Learning.” Procedia - Social and Behavioral Sciences, 13 Jan. 2012 www.sciencedirect.com/science/article/pii/S1877042811030205.

4. Wang, Gaofeng, and Weiwei Hu. “Peer Relationships and College Students’ Cooperative Tendencies: Roles of Interpersonal Trust and Social Value Orientation.” Frontiers in Psychology, vol. 12, 2021, https://doi.org/10.3389/fpsyg.2021.656412.

Financial Disclosures: None reported.

Support: The research was funded by the Osteopathic Heritage Foundation Ralph S. Licklider, D.O. Endowed Professor Award to Dr. Elizabeth Beverly.

Ethical Approval: The study was approved by the Ohio University Office of Research Compliance (Institutional Review Board # 17-E-356).

Informed Consent: All participants provided electronic informed consent. Informed consent was completed prior to participation in the study.

Poster No. C-7

Abstract No. 2023-033

Category: Clinical

Research Topic: Musculoskeletal Injuries and Prevention

Accuracy and Student Perceived Confidence of Varying Knee Aspiration Methods

¹Tommy Grayson Lindsey, II, DO, FACOS; ²Danielle Barron; ²Anna Deal; ²Emily German; ²Katelyn Hogge; ²Brooke Reese; ¹Stacey Stokes; ¹Tarraz Woo^druff, MHA

¹Department of Simulation, Edward Via College of Osteopathic Medicine-South Carolina Branch Campus; ²Edward Via College of Osteopathic Medicine-South Carolina Branch Campus

Statement of Significance: Ultrasound is a valuable learning tool for medical students and residents. Using ultrasound in a medical curriculum has shown greater satisfaction and higher confidence in translation of skills into clinical settings. The project aims to assess whether providing first-year medical students with ultrasound-guided education increases the accuracy and confidence when performing a knee aspiration on simulation models compared to the landmark guided arthrocentesis.

Students taught knee arthrocentesis on simulation models while using ultrasound will have higher accuracy and perceived confidence of performing the aspiration on a real patient compared to students who completed an arthrocentesis training using only anatomical landmarks.

Research Methods: 76 OMS-1 students at VCOM-Carolinas were randomly sorted into control or experimental groups. The students who learned knee arthrocentesis via anatomical landmarks were the control group; whereas the students who learned arthrocentesis via ultrasound guide were the experimental group. The control group attended a 30-minute presentation by VCOM faculty on anatomical landmark guided knee aspirations followed by hands-on practice with the simulation models. The experimental group was provided a powerpoint and video explaining ultrasound guided knee aspirations followed by time to practice with the ultrasound and simulation models. This video and powerpoint were modeled after the faculty led presentation to ensure all the same information was covered. Following the presentations and practice, students were asked to perform a knee aspiration using the technique they were taught. Each student got three attempts to successfully perform the procedure. Each student was graded on accuracy and immediately surveyed on their confidence in performing the procedure in a clinical setting. The survey consisted of a five-point Likert scale to assess student confidence on performing the aspiration.

Data Analysis: Sample Mean and Standard Deviation of Outcomes by Group Group No Ultrasound (n = 41) Ultrasound (n = 35) Number of Attempts 2.37 ± 1.11 1.54 ± 0.98 Confidence 2.73 ± 1.12 3.28 ± 1.10 Statistical Analysis: Analyses began by summarizing the outcomes using sample means and standard deviations by group. Due to the ordinal nature of the data, non-parametric methods, specifically the Wilcoxon Rank Sum test, was used to test for differences in outcomes between groups. A Type I error rate of 0.05 was used for each test. All tests were conducted using SAS 9.4

Conclusion: A statistically significant improvement in accuracy was shown in participants using the ultrasound guided technique for knee arthrocentesis. There was also a statistically significant increase in self-reported confidence between the experimental and control groups. Currently, there is no consensus or standardization of teaching or training of ultrasound among different institutions and countries for educational purposes or for assessment of practioners’ skills and accreditation.5 However, the increased use of point-of-care ultrasound imaging in the clinical setting suggests that medical students and medical curriculum should be dynamic and continue to advance forward with technology. Ultrasound has emerged to be a vital point of care testing tool so much that multiple meta-analyses call for more ultrasound in medical education.5 Our study demonstrated significant improvement in the accuracy of performing ultrasound guided knee arthrocentesis among first year medical students with those students reporting a statistically significant increase in confidence when performing the knee aspiration. The results of the study suggest that including ultrasound guided knee arthrocentesis to the current curriculum would be beneficial to OMS-1 students at VCOM-Carolinas.

References

1. Lafleur A, Demchuck G, Tremblay M-L, Simard C, Rivière É. Value of money in self-regulated procedural simulation. Clin Teach 2019; 16:615-22.

2. Jackson, Douglas W. MD; Evans, Nicholas A. MD; Thomas, Bradley M. MD. Accuracy of Needle Placement into the Intra-Articular Space of the Knee. The Journal of Bone & Joint Surgery 84(9):p 1522-1527, September 2002.

3. Berona K, Abdi A, Menchine M, et al. Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model. Am J Emerg Med. 2017;35(2):240-244. doi:10.1016/j.ajem.2016.10.056

4. Kondrashova, T., Coleman, C. Enhancing Learning Experience Using Ultrasound Simulation in Undergraduate Medical Education: Student Perception. Med.Sci.Educ. 27, 489–496 (2017). https://doi.org/10.1007/s40670-017-0416-2

5. Hani S, Chalouhi G, Lakissian Z, Sharara-Chami R. Introduction of Ultrasound Simulation in Medical Education: Exploratory Study. JMIR Med Educ. 2019;5(2):e13568. Published 2019 Sep 26. doi:10.2196/13568

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: No IRB. This was a quality improvement/quality assessment project.

Informed Consent: You have been asked to complete this survey as part of research conducted by Dr. Tom Lindsey (TL). The project, Accuracy and Student Perceived Confidence in Varying Knee Aspiration Methods is designed to compare the accuracy of aspiration and the confidence in the technique between students who were taught using landmark-guided aspiration vs ultrasound. Your responses are voluntary, and you may refuse to complete any part or all of this survey. This survey is anonymous, there should be no way to connect your responses with you. Do not sign your name on the survey or include information that is identifiable. By completing/submitting the survey, you affirm that you are at least 18 years old and consent for TL to use your answers in this research. If you have any questions about this research before or after you complete the survey, please contact tlindsey@vcom.edu. If you have any concerns or questions about your rights as a participant in this research, please contact the VCOM IRB.

Poster No. C-10

Abstract No. 2023-045

Category: Clinical

Research Topic: Impact of OMM & OMT

AOA Grant Award: 2061816723

The Influence of Osteopathic Manipulative Treatment (OMT) on Cognitive Performance and Recovery Following a Sport-Related Concussion

Ryan Bennett, PsyD; Zachary Peart, MS; Jonathan Brett, BS; Alessandra Posey, DO

Department of Sports Medicine, Nova Southeastern University Kiran C Patel College of Osteopathic Medicine

Statement of Significance: The research literature on the efficacy of OMT during concussion recovery is in its infancy, with previous studies primarily testing its influence on post-concussion symptomatology. Despite a scarcity of studies, research has generally suggested modest improvements in post-concussion symptoms.1-3 Thus, the effect of OMT on neuropsychological test performance and duration of recovery represents an important gap in the literature.

To investigate the influence of OMT on performance on a cognitive screening tool in a sample of student athletes recovering from a sports-related concussion.

Research Methods: Participants (N= 22) consisted of high school and collegiate athletes recruited from a university sports medicine clinic. All participants were administered the ImPACT cognitive screening tool during each post-injury testing session. Athletes were randomly assigned into either the OMT or control group. The OMT group consisted of athletes receiving OMT in addition to cognitive screening and symptom monitoring (n= 11, 62.5% female, Mage=16.53, Medu=9.32). The control group (n= 11, 45.5% female, Mage=17.91, Medu=11.4) received standard concussion protocol consisting of cognitive screening and post-concussion symptom monitoring. Data were included from each post-injury testing session. Groups did not statistically differ in age, sex, or education. ANCOVA was used to test for differences in cognitive performance between the OMT and control group.

Data Analysis: ANCOVA indicated a significant main effect of OMT on visual-motor speed performance (F = (1, 40) = 8.104, p=.007, ηp2 = .18). Mean comparisons of visual-motor composite scores revealed that the OMT group performed significantly worse (M = 37.97, SD = 6.4 than the control group (M = 43.44, SD = 5.4) with a medium effect size (η2 = .136). In addition, ANCOVA indicated a significant main effect of OMT on verbal-memory performance (F = (1, 40) = 7.739, p=.008, ηp2 = .17). Mean comparisons of verbal-memory composite scores revealed that the OMT group performed significantly worse (M = 83.86, SD = 9.4) than the control group (M = 90.45, SD = 8.6) with a medium effect size (η2 = .134). There were no significant differences observed in any other composite scores including visual memory, reaction time, or impulse control. Chi-square analysis indicated that the OMT and control groups did not significantly differ in reported post-concussion symptoms (p = .62). Additionally, descriptive statistics indicated that the OMT group took 18.43 days on average to recover while the control group took 10.9 days on average to recover.

Conclusion: Preliminary findings are not indicative of an added benefit associated with supplementing standard concussion recovery protocol with OMT. Interestingly, our data suggested that athletes who received OMT in addition to the standard concussion recovery protocol performed significantly worse on measures of visual-motor speed and verbal memory when compared to athletes receiving the standard protocol without OMT. These findings may be explained by previous research conducted by Tamburella et al, which found that OMT had immediate effects on brain perfusion, specifically decreased perfusion in the posterior cingulate cortex (PCC) and the superior parietal lobe (SPL). Given that the SPL has been primarily implicated in visuomotor functions, spatial cognition, and working memory, it follows that a decrease in perfusion of this region may account for the worse performance on both the visual-motor speed tasks and the verbal memory tasks in the treatment group when compared to the control group. In addition, the decreased perfusion seen in the PCC, being implicated in memory processes and visual-spatial processing, may further explain the differences seen in performance on the verbal-memory and visual-motor speed tasks. It is important to note, however, that these changes in brain perfusion were described in the study as immediate and were unlikely to persist for more than three days post-treatment, with the PCC showing enhanced perfusion three days post-treatment. Notably, we observed that receiving OMT was associated with a longer recovery duration. Our preliminary findings suggest that administering OMT during the acute phase of recovery from sports-related concussion may yield lower performances on cognitive screening measures and worse outcomes such as a protracted recovery. More research is needed to better understand the efficacy of OMT as a treatment for sports-related concussion, its effect on cognitive performance, and potential adverse effects in this population.

References

1. Baltazar GA, Kolwitz C, Petrone P, Stright A, Joseph D. Osteopathic Manipulative Treatment Relieves Post-concussion Symptoms in a Case of Polytrauma. Cureus. 2020;12(3):e7317. Published 2020 Mar 18. doi:10.7759/cureus.7317 2.

2. Yao SC, Zwibel H, Angelo N, Leder A, Mancini J. Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms [published online ahead of print, 2020 Aug 7]. J Am Osteopath Assoc. 2020;10.7556/jaoa.2020.099. doi:10.7556/jaoa.2020.099 3.

3. Mazzeo S, Silverberg C, Oommen T, et al. Effects of Osteopathic Manipulative Treatment on Sleep Quality in Student Athletes After Concussion: A Pilot Study [published online ahead of print, 2020 Aug 11]. J Am Osteopath Assoc. 2020;10.7556/jaoa.2020.100. doi:10.7556/jaoa.2020.100 4.

4. Tamburella F, Piras F, Piras F, Spanò B, Tramontano M, Gili T. Cerebral Perfusion Changes After Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Front Physiol. 2019;10:403. Published 2019 Apr 5. doi:10.3389/fphys.2019.00403

Financial Disclosures: None reported.

Support: AOA Grant - Funding for the present study was distributed across test materials, OMT intervention, faculty-protected time, and patient compensation. A major portion of the budget was devoted to the required supplies needed to provide neurocognitive testing to athletes. This was conducted via computerized and paper-pencil neuropsychological testing. In addition, travel expenses were factored into the budget for dissemination of research findings.

Ethical Approval: Reviewed and approved by Nova Southeastern University’s IRB.

Informed Consent: All participants were provided with a hard copy of the informed consent. This document was also verbally reviewed with participant prior to study to ensure understanding and address any questions. The informed consent outlined: 1. What is the research about? 2. Why are you asking me? 3. What will I be doing if I agree to be in the study? 4. What are the dangers to me? 5. Are there any benefits for taking part in this research study? 6. Will I get paid for being in the research study, and will it cost me anything? 7. How will you keep my information private? and 8. What if I do not want to participate, or I want to leave the study?

Poster No. *C-11

Abstract No. 2023-046

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Loss of T790M is Associated with Resistance and Shortened Progression Free Survival in Osimertinib Treated EGFR Mutant Non-Small Cell Lung Cancer Patients, a Meta-Analysis

¹Madalyn Thompson, OMS-II; ¹Elizabeth Ryder; ¹Annie Le; ¹Hannah Caldwell; ²Jun Wang, MD, PhD

¹Department of Research, Lincoln Memorial University-DeBusk College of Osteopathic Medicine; Department of Pathology, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

Statement of Significance: Third generation tyrosine kinase inhibitors (TKIs) were developed to treat non-small cell lung cancers resistant to first and second generation TKIs, especially those with T790M mutation. However, resistance to osimertinib, a third generation TKI, has been reported. Molecular studies have revealed that many of these osimertinib resistant patients lost detectable T790M following disease progression.

To investigate the likelihood of T790M loss in resulting osimertinib resistance, meta-analysis was performed using published clinical outcomes of EGFR mutant lung cancer patients treated with osimertinib.

Research Methods: Studies of clinical outcomes of osimertinib were collected through PubMed. 26 studies are included after screening for studies with similar methodologies that can be used for meta-analysis or frequency calculation. Probability of osimertinib resistance and/or progress free survival (PFS) were compared in patients with or without retained T790M.

Data Analysis: Loss of T790M is commonly seen in osimertinib resistant patients, ranging from 22-86%. An increased probability of osimertinib resistance is seen in patients with T790M loss, comparing with T790M retained patients (Odds ratio=1.84, 95% CI [1.08, 3.12], p=0.02). In addition, loss of T790M is associated with a significantly shortened progression free survival, comparing with those with detectable T790M (HR=2.09, 95% CI [1.59, 2.76], p<0.0001).

Conclusion: These findings suggest that loss of T790M is likely associated with osimertinib resistance in EGFR mutant lung cancers. Monitoring the presence of T790M, either though plasma or tumor re-biopsy, may help detecting tumor progression at early phases in these patients.

References

N/A

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB approved

1024 V.0

Informed Consent: N/A.

Poster No. *C-12

Abstract No. 2023-049

Category: Clinical

Research Topic: Health Disparities-Social Determinants of Health

Assessing the Need for Mental Health Screenings in a Student-Run Free Clinic & a Family Medicine Office

Alisha Basak, OMS-II; Sahil Parikh, OMS-IV; Emily Forester, OMS-III; Jennifer Walpow, OMS-II; Rebecca Chae, OMS-II; Sahiba Gill, OMS-II; Tara Pellegrino, DO

Community Health Center, Rowan-Virtua Community Health Center

Statement of Significance: There is a paucity of data on mental health care at student-run free clinics in the U.S. Major depression is a common and treatable mental health disorder (1). The Patient Health Questionnaire (PHQ-9) is a valid and reliable measure of depression severity while the GAD-7 is a valid and reliable measure of anxiety severity that can be administered by members of a health care team (1). This study will determine mental health care outcomes amongst patients seeking care at a student-run free clinic.

We hypothesize uninsured minorities are underrepresented in mental health screening efforts. Primary: What are the outcomes of mental health surveys at at the Rowan Community Health Cente (RCHC), a student-run free clinic located in Lindenwold, NJ.?

Secondary: Assess the outcomes of screening, management, and diagnosis for patients at the RCHC.

We will also compare outcomes of screening, management, and diagnosis between different groups (gender, race, income) using validated surveys.

Research Methods: Phase 1: Each study participant will be given both the PHQ-2 and GAD-2 surveys to screen for depression and anxiety and see if the participant fits the criteria for the PHQ-9 and GAD-7. Each study participant will be given an intake questionnaire when joining the study. The intake form consists of demographic information prior to screenings so that each participant can be followed up with.

Phase 2: Participants who score greater than or equal to 3 on the PHQ-2 will be considered screened positive for depression and will be given a PHQ-9 to diagnose and monitor the severity of depression. Participants who score less than 3 on the PHQ-2 will not be given the subsequent PHQ-9 survey and will be given the surveys again 6 months after. Participants will be given information on mental health resources and the surveys will be uploaded and included in the participant’s medical record.

Phase 3: Participants who score greater than or equal to 10 on the PHQ-9 will be evaluated by a clinician and be given a referral for a mental health specialist if participant agrees. The participant will also be given information on mental health resources and given a PHQ-9 follow-up survey 6 months after along with asking if they have used any of the resources given to them at the initial visit. Due to potential COVID-19 restrictions, follow-up surveys may be conducted via telephone or through Webex. Participants who score less than 10 on the PHQ-9 will be evaluated by a clinician and will be given a PHQ-2 follow-up survey 6 months after. The same protocol and score will be identical for GAD-2 and GAD-7 surveys.

Phase 4: Study participants from the Rowan Community Health Center will be compared to patients seen at a Family Medicine practice. Due to potential COVID-19 restrictions, it may be unfeasible to survey participants at a Family Medicine practice. If so, our survey data from the Rowan Community Health Center will be compared to insured groups from previously established data sets.

Data Analysis: A combined total of 49 patients from the RCHC and Family Med (FM) offices completed the PHQ-9 and GAD-7 scale. PHQ9 scores were grouped from 0-4 (RCHC n=30, FM n=7), 5-9 (RCHC n=3, FM n=1), 10-14(RCHC n=3, FM n=1, 15-19 (RCHC n=3, FM n=0), 20-27(RCHC n=1, FM n=0). GAD7 scores were grouped from 0-4 (RCHC n=30, FM n=8), 5-9 (RCHC n=2, FM n=1), 10-14(RCHC n=7, FM n=0), >15 (RCHC n=1, FM n=0). No significant difference in prevalence of minimal or mild-to-severe depression or anxiety based on: Income above or below the poverty line (p=0.16), Insurance status (p=1), Status of established care with a primary care physician (p=0.624), Gender (p=0.222), Primary language spoken (p=0.59), Location of care: RCHC vs FM office (p=0.662)> P-Values were determined using the Fischer Exact test.

Conclusion: Mental health care given at student-run free clinics has been found to be comparable to that provided to insured patients. Data collected from this ongoing study will add to the limited studies of mental health outcomes at student-run free clinics.

At the moment, there is not much research or data available about mental health care at student-run free clinics. As a result, we are conducting this study to fill this gap in knowledge and determine if the quality of mental-health care at the Rowan Community Health Center is comparable to insured practices.

As this project is still ongoing, the data shown on this poster is only a snapshot. Therefore, proportions of patients with specific mental health screening scores can be captured, but we cannot draw any significant conclusions at this time. Currently, none of the data is statistically significant due to the small sample size, especially in the Family Medicine office.

This limitation of a small sample size can be attributed to language barriers, patients’ discomfort with discussing mental health, and limited patients due to people being unaware of the services offered at the RCHC.

In the future, data should continue to be collected at both the RCHC and Family Medicine offices utilizing the Generalized Anxiety Disorder scale and Patient Health Questionnaire to increase the sample size in this study.

References

1. Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, et al. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.183922.

2. Cadzow, R. B., Servoss, T. J., & Fox, C. H. (2007). The health status of patients of a student-run free medical clinic in inner-city Buffalo, NY. The Journal of the American Board of Family Medicine, 20(6), 572–580. https://doi.org/10.3122/jabfm.2007.06.070036

3. Soltani M, Smith S, Beck E, Johnson M. Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic. Acad Psychiatry. 2015;39(3):259-266. doi:10.1007/s40596-014-0257-x

Financial Disclosures: None reported.

Support: Rowan-Virtua College of Medicine & Life Sciences.

Ethical Approval: This study has been reviewed and approved by the RowanSOM Institutional Review Board. IRB #: PRO-2020-87.

Informed Consent: When informing the patients of the study, we will first confirm their preferred language. If their preferred language is English, any member of the study will review the consent form with the participant and provide a copy of the form. The participant must verbalize their approval to be in the study and sign the consent form to be included as a subject. The consent form will be offered in two languages, English and Spanish, depending on the participant’s preferred language. If a non-English speaking participant were to enroll in the study, we would use a certified Spanish translator from the Rowan Community Health Center to verbalize the contents of the consent form in Spanish and get consent from the participant. A Spanish translator will be present for all future interactions with the participant for the duration of the study.

Poster No. *C-13

Abstract No. 2023-056

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Is Highly Effective Modulator Therapy Associated with Improvements in Lung Function and Biomarkers of Iron Homeostasis in People with Cystic Fibrosis?

¹Rachel Milia, OMS-III; ²Jonathan Zuckerman

¹Department of Osteopathic Medicine, University of New England College of Osteopathic Medicine; ²Department of Pulmonology, Maine Medical Center, Portland, ME

Statement of Significance: Cystic fibrosis (CF) results in dysregulation of the cystic fibrosis transmembrane conductance regulator (CFTR), leading to progressive lung dysfunction. It is linked to anemia and perturbed iron (Fe) homeostasis. CFTR modulators are agents that restore activity of CFTR in those with appropriate genotypes and may improve iron handling in CF. We therefore performed a study of adult people with CF (APwCF) followed at Maine Medical Center following the roll out of CFTR modulators.

In this retrospective cohort study, (chart-review) study, we hypothesize that in APwCF treatment with HEMT leads to improvement in lung function and indices of iron homeostasis.

Research Methods: APwCF followed at the Maine Medical Center Adult CF Clinic who had been started on highly effective modulator therapy (HEMT ; elexacaftor, tezacaftor, ivacaftor) were eligible for inclusion.

1. Those with the following laboratory data in the electronic medical record were included in the study cohort: serum hemoglobin (Hb), serum iron (Fe), and lung function test results.

2. Lung function was assessed with the following spirometric values: forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC.

3. Paired values of mean FEV1 pre- and post-initiation of HEMT were compared by two-tailed t-test. Similarly, serum Hb and Fe were compared, when paired samples were available. P values <0.05 were considered significant. The study was determined to be exempt from institutional review board (IRB) oversight by the MMC IRB.

Data Analysis: In a panel of 123 adult patients, 15 patients were selected who had iron studies performed as part of a routine evaluation for anemia during our study period and were also started on HEMT. 5 of these patients had paired pre and post Fe transferrin saturation levels. All of these participants had spirometry regularly performed as part of routine care.

Group mean hemoglobin levels before and after modulator therapy were 12.35 mg/dL and 12.37 mg/dL, respectively (p=0.81, n=15). Review of before-after and waterfall plots , however, did show individuals who had an increased in hemoglobin following initiation of HEMT.

Group mean FEV1 levels before and after modulator therapy were 1.79 L and 1.97 L, respectively (p=0.07, n=15). Review of before-after and waterfall plots, however, showed that 8 out of 15 individuals had an increase in FEV1.

Group mean Fe transferrin saturation levels before and after modulator therapy were 11.05% and 18.17%, respectively (p=0.31, n=5).

Conclusion: In our study population, there was no difference in hemoglobin levels following initiation of modulator therapy; however, there were individual patients in whom hemoglobin levels increased following initiation of the medication.

1. Consistent with other published reports, FEV1 increased following modulator initiation, though this was borderline statistical significance in our small cohort.

2. Transferrin saturation levels, in a subset of patients that had this testing increased following modulator initiation, though the change did not reach statistical significance

3. We are further testing our hypotheses by working with 3 other CF centers to increase sample size, enabling us to control for confounders such as use of Fe supplements, blood transfusions, nutritional status, lung infections and other co-morbidities.

References

1. Gifford AH, Heltshe SL, Goss CH. CFTR modulator use is associated with higher hemoglobin levels in individuals with cystic fibrosis. Annals of the American Thoracic Society. 2019;16(3):331-340. doi:10.1513/annalsats.201807-449oc

2. Gifford AH, Moulton LA, Dorman DB, et al. Iron homeostasis during cystic fibrosis pulmonary exacerbation. Clinical and Translational Science. 2012;5(4):368-373. doi:10.1111/j.1752-8062.2012.00417.x

3. Thee S, Gräber SY, Mall MA, Stahl M. P020 therapy with elexacaftor/tezacaftor/ivacaftor in a patient with compound heterozygous CFTR mutation and the complex CFTR-allele Phe508del; leu467phe. Journal of Cystic Fibrosis. 2023;22. doi:10.1016/s1569-1993(2300396-x)

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB Reference Number: 1730887-2 (exempt)

Informed Consent: Not applicable (exempt).

Poster No. *C-14

Abstract No. 2023-057

Category: Clinical

Research Topic: Health Disparities-Social Determinants of Health

Effects of Income and Language on Health Literacy: A study between a Student-Run Free Clinic & a Family Medicine Office

¹Alisha Basak, OMS-II; ¹Sahil Parikh, OMS-IV; ¹Emily Forester, OMS-III; ¹Arpan Bhagat, OMS-II; ¹Leah Cliatt, OMS-II; ¹Usmaan Al-Shehab, OMS-II; ²Rebecca Moore, DO

¹Community Health Center, Rowan-Virtua Community Health Center; ²Department of Family Medicine, Rowan-Virtua

Statement of Significance: Over one-third of the US population exhibit limited health literacy leading to negative health outcomes and lifestyle choices. By employing the NVS assessment, Rowan Community Health Center (RCHC), a student run free-clinic, sought to compare the health literacy levels of uninsured patients at their facility with those of insured patients at the Rowan Family Medicine office in Hammonton, NJ. This study aimed to assess specific factors that may influence health literacy levels.

We hypothesize that there will be a quantifiable difference in health literacy, as measured by the Newest Vital Sign survey, between patients visiting the Rowan Community Health Clinic (RCHC) and a private family medicine office. Our secondary hypothesis is that through proper intervention, we will be able to improve applicable health literacy.

Primary: The overall objective is to evaluate if there is a disparity in applicable health literacy between two different socioeconomic patient populations in Camden County, NJ. Secondary: We intend to develop and validate an intervention for improving health literacy.

Research Methods: This a cross-sectional study including 300 patients, 150 from the office of Dr. Moore, and 150 from the Rowan Community Health Center (RCHC). The patients will be selected randomly and will not be compensated for their time. Patients will be enrolled upon their visiting at the respective office. Patients will be asked to fill out a survey assessing health literacy. Data collection will occur at two sites; the office of Dr. Moore and the RCHC. Data will be collected and stored safely.

Health literacy will be measured by the newest vital sign (NVS), which will be used as a screening tool for health literacy in this research, with those scoring higher than 4 out 6 indicating adequate literacy versus less than 2 have a greater chance of marginal or inadequate literacy.

Data Analysis: Statistically significant increase in prevalence of limited literacy (score ≤3) compared to adequate literacy (score ≥4) among patients below the poverty line (p=0.038) and Spanish speaking patients (p=0.041). No significant difference between limited literacy (score ≤3) and adequate literacy (score ≥4) based on: Rowan Community Heath Center (RCHC) vs. Rowan Family Medicine (FM) office (p=1), Insurance status (p=0.342), Gender (p=0.808), Education level (p=0.18). The number of patients in each category. The number of individuals for each category RCHC v. FM with their corresponding Newest Vital Sign (NVS) score are listed as follows: RCHC NVS 0-1 (n=14), RCHC NVS 2-3 (n=7), RCHC NVS 4-6 (n=14), FM NVS 0-1 (n=11), FM NVS 2-3 (n=14), FM NVS 4-6 (n=15).

Conclusion: Among our participants, income below the poverty line and Spanish as a primary language played a significant role in health literacy. However, we determined that a language barrier was not a factor in our Spanish speaking population since we provided them with a nutrition label and had a Spanish interpreter available.

Overall, limited health literacy is highly prevalent in the US. Healthcare professionals need to be mindful of this so that we can better care for our patients. It is important that physicians allow more time during patient visits to explain medical jargon. Another way to practically implement health literacy is to utilize simple infographics and pamphlets.

Our study did involve some limitations, including a small sample size and lack of current interventions to address the low levels of health literacy among our at-risk patient population. In the future, we hope to design and implement a literacy course to see if this would be a successful literacy intervention.

References

1. Hersh L, Salzman B, Snyderman D. Health Literacy in Primary Care Practice. Am Fam Physician. 2015 Jul 15;92(2):118-24. PMID: 26176370.

2. Cha E, Kim KH, Lerner HM, Dawkins CR, Bello MK, Umpierrez G, Dunbar SB. Health literacy, self-efficacy, food label use, and diet in young adults. Am J Health Behav. 2014 May;38(3):331-9. doi: 10.5993/AJHB.38.3.2. PMID: 24636029; PMCID: PMC4039409.

3. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005 Nov-Dec;3(6):514-22. doi: 10.1370/afm.405. Erratum in: Ann Fam Med. 2006 Jan-Feb;4(1):83. PMID: 16338915; PMCID: PMC1466931.

Financial Disclosures: None reported.

Support: Rowan-Virtua College of Medicine & Life Sciences.

Ethical Approval: This study has been reviewed and approved by the RowanSOM Institutional Review Board. IRB #: PRO-2020-107.

Informed Consent: This study requires proper written consent signed by the subject. A consent form is provided to all subjects to sign consent for social behavioral research surveys.

Research participants will be provided written and verbal information on the study at the outset in the form of the alternate consent form and conversations with study personnel (respectively). They will be given an opportunity to ask questions to the research personnel before offering consent or declining to participate. The study will only begin once the participant voluntarily agrees to proceed.

Poster No. *C-16

Abstract No. 2023-063

Category: Clinical

Research Topic: Chronic Diseases & Conditions

A Comparison of Echocardiographic Parameters in Ehlers-Danlos Syndrome Patients With and Without Postural Orthostatic Tachycardia Syndrome (POTS)

Nolberto Jaramillo, Jr., OMS-II; Anisa Raidah; Casey Sciandra; Bernadette Riley; Todd Cohen

Clinical Specialties, New York Institute of Technology

Statement of Significance: Ehlers-Danlos Syndrome is a hereditary condition that is associated with postural orthostatic tachycardia syndrome, a condition of orthostatic intolerance defined by an increase in heart rate over 30 beats/min within 10 minutes of standing. Echocardiographic findings have not previously been compared in Ehlers-Danlos Syndrome patients with and without postural orthostatic tachycardia syndrome [1].

To test the hypothesis that echocardiographic differences may exist amongst Ehlers-Danlos Syndrome patients with and without postural orthostatic tachycardia syndrome.

Research Methods: This retrospective study deemed exempt from review by the NYIT institutional review board (IRB) included all Ehlers-Danlos Syndrome patients seen at the Long Island Heart Rhythm Center who had received an echocardiogram between January 2019 and March 2023. Exclusion criteria included patients without a complete echocardiogram report including the parameters studied herein. 35 total patients met these criteria from an initial cohort of 100 patients. The records were reviewed for patient demographics, EDS subtypes, and echocardiogram parameters including ejection fraction (EF), interventricular septal diameter (IVSd), left ventricular internal diameter in diastole (LVIDd), aortic diameter (AoD), left atrial diameter (LAD). Comparisons were made between patients with and without POTS, using the Wilcoxon rank sum test as the data was non-parametric. p<0.05 was statistically significant. Data reported as mean ± standard deviation. As osteopathic physicians strive to understand the body through the effects of structure on function, better understanding cardiac structural differences on echocardiogram in POTS patients may help to better treat the disease. Any further understanding of the etiology of POTS in these patients may also aid osteopathic physicians in better managing this condition.

Data Analysis: 35 patients had prior two-dimensional echocardiograms (34/35 were transthoracic; 1 transesophageal). There were 13 patients with postural orthostatic tachycardia syndrome (age 31 ± 8.6 years) and 22 patients without (age 40 ± 13 years). Between these two groups, no significant difference was identified between their left-ventricular ejection fractions, interventricular septal thickness, left ventricular diameter during systole and diastole, aortic diameter, and left atrial diameter. There was a trend towards significance with respect to left ventricular internal dimension during diastole in patients with postural orthostatic tachycardia syndrome (4.22 ± 0.52 cm) as compared to those without (4.56 ± 0.43 cm), p=0.056.

Conclusion: Patients with Ehlers-Danlos Syndrome and postural orthostatic tachycardia syndrome have normal echocardiogram parameters that are not significantly different from those without. A slight trend towards a smaller left ventricular internal dimension during diastole was observed in the postural orthostatic tachycardia syndrome group though it did not reach statistical significance. Further studies in a larger cohort are required to discern whether this trend was of any significance.

References

1. Miller AJ, Stiles LE, Sheehan T, et al. Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome. Auton Neurosci. 2020;224:102637. doi:10.1016/j.autneu.2020.102637

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Study was deemed exempt from IRB approval.

Informed Consent: Study was a retrospective chart review and informed consent was waived.

Poster No. *C-17

Abstract No. 2023-064

Category: Clinical

Research Topic: Osteopathic Philosophy

The Effect of Osteopathic Medical Students’ Age on Desired Specialty

Anisa Raidah, OMS-IV; Pauline Huang; Naveed Tariq; Helen Wong; Lucas Hildreth; Min-Kyung Jung; Sheldon Yao, DO, Michael Terzella

Department of Osteopathic Manupulative Medicine, New York Institute of Technology

Statement of Significance: Previous research links medical students’ age to specialty choices. A 2022 Arabian study found higher pathology preference among 21-23-year-olds compared to younger or older students [1]. In a 2004 Canadian study, students desiring family medicine were older than those who desired specialty medicine [2]. However, the impact of age on osteopathic students’ specialty selection remains unexplored.

Examine the impact of osteopathic medical students’ age on choice of specialty for residency.

Research Methods: A self-administered anonymous 43-item confidential questionnaire was distributed to all current medical students at New York Institute of Technology College of Osteopathic Medicine (NYITCOM) using an email listserv. The questionnaire included items addressing student perceptions toward OMM, demographic information, desired specialty, and previous occupations. 249 osteopathic medical students completed the questionnaire. The data was collected using RedCap Survey Software. Survey results were tabulated, and respondents were divided into three age groups: 20-25, 26-30, and >31 years old (based on similar studies that divided age into three groups, however here the 31 and over group was used). In the survey specialties were divided into primary care (Family, Peds, OB/GYN, Internal Med, etc.), medical subspecialty (Neuro, PM&R, NMM/OMM, Cardiology, Pulmonary, Emergency Med, etc.), surgical subspecialty (Orthopedics, Urology, Anesthesia, Ophthalmology, ENT, Plastics, etc.), diagnostic medicine (Radiology, Pathology, etc.), and other. Four specialty groups were used for analysis including medicine, primary, surgery, and other. Statistical analysis was performed using a chi-squared test and significance was deemed at p-value <0.05. This study holds significant osteopathic implications as it may inform future strategies for mentorship and guidance tailored to individual needs and aspirations.

Data Analysis: Out of 249 students who completed the questionnaire, 36.9% preferred medicine as their future specialty (n=92); primary care: 33.7% (n=84); surgery: 20.5% (n=51); other: 8.8% (n=22). The majority of participants were in the age group 20-25, followed by 26-30, and 31 and above. The age range was: 20 to 65 years. No significant difference was found between the age of osteopathic medical students and their desired specialty.

Conclusion: This study investigated the association between age and residency choices in a cohort of osteopathic medical students of all four years. We identified that there was no significant association between the two, indicating that other more important factors may be influencing their choices. Limitations to the study may include response accuracy issues: not all students responded to the survey. Further studies are required in a larger cohort to better understand this relationship.

References

1. Alomaish AR, El Hassan LAM, Mahfouz MS, Haidar WN, M Omer HO. Medical Students’ Perception Towards Choosing Pathology Program at Jazan University, Saudi Arabia. Adv Med Educ Pract. 2022;13:1465-1474. Published 2022 Dec 10. doi:10.2147/AMEP.S386194

2. Wright B, Scott I, Woloschuk W, Brenneis F, Bradley J. Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine [published correction appears in CMAJ. 2004 Aug 3;171(3):222] [published correction appears in CMAJ. 2004 Nov 23;171(11):1327]. CMAJ. 2004;170(13):1920-1924. doi:10.1503/cmaj.1031111

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was deemed IRB exempt.

Informed Consent: Informed Consent was waived.

Poster No. *C-18

Abstract No. 2023-065

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Contemporary Echocardiographic Findings in Ehlers-Danlos Syndrome Patients Observed at the Long Island Heart Rhythm Center (LIHRC)

Anisa Raidah, OMS-IV; Nolberto Jaramillo; Casey Sciandra; Bernadette Riley; Todd J. Cohen

Department of Clinical Specialitie, New York Institute of Technology

Statement of Significance: Ehlers-Danlos Syndrome is a genetically acquired connective tissue disorder that can manifest with symptoms such as joint hypermobility, blood vessel fragility and atrophic scarring [1]. Previous studies have demonstrated an association with aortic dilation and mitral valve prolapse, however echocardiogram findings have not been well studied following the change in Ehlers-Danlos Syndrome nosology in 2017 [2].

The objective of this study is to examine a cohort of Ehlers-Danlos Syndrome patients and report on contemporary echocardiographic findings in this population.

Research Methods: This retrospective study was deemed exempt from review by the NYIT institutional review board (IRB) and included all Ehlers-Danlos Syndrome patients seen by the LIHRC with echocardiograms from January 2019 to March 2023. Exclusion criteria included patients without a complete echocardiogram report. 36 total patients met these criteria from an initial cohort of 100 patients. Data was collected on patient demographics, EDS subtypes, echocardiogram findings including valvular abnormalities, ejection fraction, and chamber dilation. Descriptive statistics were prepared using Microsoft Excel. Data was reported as percentage, or mean ± standard deviation. EDS can affect various organ systems, which can be broken down into the osteopathic lens: respiratory-circulatory, metabolic, and behavioral. Thus understanding the cardiac manifestations of EDS would be useful for osteopathic physicians in their holistic approach to managing patients in this population.

Data Analysis: 36 Ehlers-Danlos Syndrome patients (age: 37.2 ± 12.3 years, range 21 to 61 years) were included in the study; 97% females (n=35) and 2.8% male (n=1). Ehlers-Danlos Syndrome subtypes included hypermobile (n=34), classical-like (n=1), vascular (n=1). 35 of 36 echocardiograms were transthoracic; one was transesophageal. All patients had normal left ventricular ejection fractions (60.2% ± 4.2%). Abnormalities were mostly mild and included mitral regurgitation: 5.6 % (n=2), tricuspid regurgitation: 11.1 % (n=4), concentric left ventricular hypertrophy: 2.8 % (n=1), left atrial dilation: 5.6 % (n=2), and right atrial dilation: 2.8 % (n=1); mitral valve prolapse was seen in 13.9 % (n=5). No aortic dilation was identified.

Conclusion: In this cohort, the echocardiographic findings were mostly normal. Mitral valve prolapse was seen in nearly 14% of patients, similar to previous reports. No aortic dilation was observed. Other abnormalities (valvular and left ventricular hypertrophy) were less common and typically mild. Additional patient recruitment would help determine the true prevalence of echocardiographic abnormalities in this population. Baseline echocardiogram screening is recommended in all Ehlers-Danlos Syndrome patients to detect abnormalities.

References

1. Malfait F, Wenstrup RJ, De Paepe A. Clinical and genetic aspects of Ehlers-Danlos syndrome, classic type. Genet Med. 2010 Oct;12(10):597-605. doi: 10.1097/GIM.0b013e3181eed412. PMID: 20847697.

2. Asher SB, Chen R, Kallish S. Mitral valve prolapse and aortic root dilation in adults with hypermobile Ehlers-Danlos syndrome and related disorders. Am J Med Genet A. 2018 Sep;176(9):1838-1844. doi: 10.1002/ajmg.a.40364. Epub 2018 Jul 31. PMID: 30063091.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was deemed IRB exempt.

Informed Consent: Informed Consent was waived.

Poster No. *C-19

Abstract No. 2023-068

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Comparative Analysis of Mitral Valve Prolapse and Aortic Root Diameter in Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder

¹Dragos Turturica, OMS-II; ¹Elizabeth Pottanat; ¹Nolberto Jaramillo; ¹Anisa Raidah; ¹Casey Sciandra; ²Bernadette Riley; ³Todd Cohen

¹Department of Clinical Specialties, New York Institute of Technology; ²Department of Family Medicine, New York Institute of Technology; ³Department of Clinical Specialities, New York Institute of Technology

Statement of Significance: Ehlers-Danlos Syndrome (EDS) and hypermobility spectrum disorder (HSD) are structural connective tissue conditions characterized by joint hypermobility, cutaneous hyperextensibility, and cardiovascular manifestations.[1] Although previous studies have evaluated an association of aortic root dilation and mitral valve prolapse (MVP) in EDS and HSD patients, this study will examine aortic root diameter and/or MVP in distinguishing the two conditions.[2]

To examine whether there is a difference between EDS and HSD patients with respect to aortic root diameter and/or MVP at the Long Island Heart Rhythm Clinic (LIHRC).

Research Methods: All EDS and HSD patients seen at the LIHRC between January 2019 and June 2023 who had two-dimensional echocardiograms were included in this retrospective study. The frequency of MVP and mean aortic root diameter was compared between the EDS and HSD groups using Chi-square testing and an unpaired student t-test respectively. Data was analyzed for additional trends with these variables that could distinguish the two groups. All data was reported as mean ± standard deviation and a p-value < 0.05 was considered statistically significant. Focusing on EDS and HSD patients, the study follows the principle of correlating structural modifications and their functional effects within the context of osteopathic medicine.

Data Analysis: 66 patients were identified during the study period; 48 EDS patients and 18 HSD patients. The EDS group had a mean age of 34.3 ± 12.3 years and 95.4 percent were female. Of the 48 EDS patients, 44 had hypermobile EDS, 3 had classical-like EDS, and 1 had vascular EDS. The HSD group had a mean age of 40.6 ± 13.7 years and 94.4 percent were female. 64 patients had echocardiographic evaluation of the aorta and mitral valve, however, two patients’ echocardiography reports failed to report the aortic root diameter. The mean aortic root diameter in the EDS group was 2.75 ± 0.47 cm (range: 1.6-3.5 cm) and in the HSD group was 2.72 ± 0.28 cm (range: 2.1-3.3 cm); (p=NS). None of the patients in this study had an abnormally large aortic root (≥4 cm).[3] However, 7 patients in the EDS group had aortic root diameters greater than 3.3 cm (1 EDS aortic root of 3.4 cm and 6 EDS aortic roots of 3.5 cm), whereas none of the HSD group had an aortic root diameter above 3.3 cm. An aortic root diameter of 3.4 cm or greater tended to be more prevalent in the EDS group when compared with the HSD group (p=0.07). MVP was present in 9 EDS patients (18.8 percent) but only present in 1 HSD patient (5.5 percent); p=0.18. A Chi-square analysis demonstrated that the combined prevalence of MVP and aortic root diameter ≥3.4 cm was significantly higher in the EDS group (n=14, 29.1 percent) compared to the HSD group (n=1, 5.5 percent, p=0.04).

Conclusion: In this cohort of hypermobile patients there was no significant difference in the prevalence of MVP or aortic root size between the EDS and HSD groups. Specifically, 9 EDS patients had MVP and 7 had aortic roots of 3.4 cm or more; whereas only 1 HSD patient had MVP and 0 had aortic roots of 3.4 cm or more. However, when those two observations were combined to include the presence of MVP and an aortic root size of 3.4 cm or more, a significant difference was identified in the EDS group as compared to those with HSD. This study highlights the importance of the echocardiographic evaluation with respect to MVP and aortic root diameter in EDS and HSD patients, and the presence of MVP together with a specific aortic root diameter value might help distinguish these two groups. Limitations of the study include its retrospective design and limited sample size. Additional studies (including prospective) in a larger hypermobile population are necessary to determine whether a specific aortic root diameter along with the presence of MVP can help differentiate EDS from HSD groups.

References

1. Rashed ER, Ruiz Maya T, Black J, et al. Cardiovascular manifestations of hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Vascular Medicine. 2022;27(3):283-289. doi:10.1177/1358863X211067566

2. Pietri-Toro JM, Gardner OK, Leuchter JD, DiBartolomeo G, Hunter JA, Forghani I. Prevalence of cardiovascular manifestations in patients with hypermobile Ehlers-Danlos syndrome at the University of Miami. Am J Med Genet A. 2023;191(6):1502-1507. doi:10.1002/ajmg.a.63168

3. Isselbacher EM, Preventza O, Black JH, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. Circulation. 2022;146(24). doi:10.1161/CIR.0000000000001106

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This retrospective study was deemed exempt from review by the NYIT institutional review board (IRB).

Informed Consent: Informed consent waived by NYITCOM IRB (BHS-1465).

Poster No. *C-20

Abstract No. 2023-072

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Exploring the Utilization of Psychoactive Drugs Between Patients with Ehlers-Danlos Syndrome and with Hypermobility Spectrum Disorder

¹Ian Ross Snyder, OMS-III; ¹Riya Kaushal; ¹David Matatov; ¹Nolberto Jaramillo; ¹Anisa Raidah; ¹Casey Sciandra; ²Bernadette Riley; ³Todd Cohen

¹Department of Clinical Specialties, New York Institute of Technology; ²Department of Family Medicine, New York Institute of Technology; ³Department of Clinical Specialities, New York Institute of Technology

Statement of Significance: Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorder (HSD) are complex connective tissue disorders characterized by hypermobile joints and increased skin elasticity.[1] Clinical observations have identified a higher prevalence of behavioral problems and psychiatric disorders within these hypermobile groups, as compared to the general population.[2-3] However, the significance of different psychoactive drug classes in these patients has yet to be conclusively demonstrated.

To examine an association between patients with EDS or HSD and psychoactive drugs at the Long Island Heart Rhythm Clinic (LIHRC).

Research Methods: A four-year retrospective analysis was conducted using the electronic medical record (EMR) system covering the period from January 2019 to June 2023, focusing on all EDS and HSD patients seen at the LIHRC. Psychoactive drugs were categorized as anticholinergics, anticonvulsants, antidepressants, antipsychotics, anxiolytics, mood stabilizers, opioid analgesics, sedative/hypnotics, stimulants, and tetrahydrocannabinol (THC), using the NIH National Library of Medicine.[4] All collected data was presented as mean ± standard deviation (SD), and statistical significance was set at p<0.05. To compare the utilization of psychoactive drugs between individuals with EDS and HSD, Chi-square testing and unpaired student t-test were employed. In the context of osteopathic practice, the study recognized the relationship between psychiatric manifestations and these hypermobility syndromes, emphasizing the significance for osteopathic physicians to refine and optimize their therapeutic strategies. By doing so, they can facilitate more effective and patient-centered care in managing individuals diagnosed with EDS and HSD.

Data Analysis: During the study period, a total of 116 patients were identified, consisting of 81 patients with EDS and 35 patients with HSD. The EDS group had a mean age of 34.8 ± 12.2 years, 94.8 percent female and 5.2 percent male. Of the 81 EDS patients, 77 had hypermobile EDS, 3 had classical-like EDS, and 1 had vascular EDS. In comparison, the HSD group had a mean age of 39.6 ± 13.9 years, 85.7 percent female and 14.3 percent male. Statistical analysis using an unpaired student t-test revealed a significant difference in the mean number of psychoactive drugs per patient in the EDS group (mean=1.73) and the HSD group (mean=1.09), yielding a p-value=0.03. Further analysis of individual psychoactive drug classes showed that the EDS group reported a higher utilization of anticonvulsants (p=0.01). However, no significant differences were observed between the two groups for the other classes of psychoactive drugs, including opioid analgesics (p=0.06), stimulants (p=0.06) sedatives/hypnotics (p=0.08), mood stabilizers (p=0.32), tetrahydrocannabinol (p=0.32), antidepressants (p=0.46), antipsychotics (p=0.58), anxiolytics (p=0.58), and anticholinergics (p=0.91). Furthermore, a Chi-square analysis examining the overall use of psychoactive drugs across all classes revealed a significantly higher utilization in the EDS patients (n=63, 77.9 percent) compared to the HSD group (n=16, 45.7 percent, p=0.0007).

Conclusion: This study demonstrated a significant difference in the prevalence of psychoactive medications between EDS and HSD patients. EDS patients were prescribed a significantly higher number of psychoactive medications compared to HSD patients. Notably, when analyzing individual psychoactive medication classes, only anticonvulsants were significantly different, though others (sedatives/hypnotics, stimulants, and opioids) tended towards significance. It is important to acknowledge the limitations of this study, including its retrospective design and limited sample size. A larger prospective study, investigating both psychiatric diagnoses and related medications, would be helpful in order to further understand the differences between EDS and HSD patients.

References

1. Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):8-26. doi:10.1002/ajmg.c.31552

2. Hershenfeld SA, Wasim S, McNiven V, et al. Psychiatric disorders in Ehlers-Danlos syndrome are frequent, diverse and strongly associated with pain. Rheumatol Int. 2016;36(3):341-348. doi:10.1007/s00296-015-3375-1

3. de Vries J, Verbunt J, Stubbe J, et al. Generalized joint hypermobility and anxiety in adolescents and young adults, the impact on physical and psychosocial functioning. Healthcare (Basel). 2021;9(5):525. doi:10.3390/healthcare9050525

4. NIH National Library of Medicine. MedlinePlus. Accessed June 20, 2023. https://medlineplus.gov/.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was reviewed by the NYIT IRB and deemed exempt

Informed Consent: Informed consent waived by NYITCOM IRB (BHS-1465).

Poster No. *C-21

Abstract No. 2023-073

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Mesenchymal Stem Cell Therapy for Amyotrophic Lateral Sclerosis: A Narrative Review

¹Vrushank Shah, OMS-II; ¹Usmaan Al-Shehab; ²Alexander King

¹Department of Research, Rowan-Virtua School of Osteopathic Medicine; ²Neuromuscular Institue, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Lou Gehrig disease is a fatal neurodegenerative condition that affects motor neurons in the brain and spinal cord, leading to muscle weakness, atrophy, and paralysis. No cure exists, and supportive care is the standard approach. MSC therapy using multipotent stem cells shows potential to differentiate into neurons and provide immunomodulatory benefits. Four trials examined MSC therapy’s safety and efficacy, assessing survival, disease progression, and quality of life, as a novel approach for ALS

To determine the efficacy and safety of mesenchymal stem cell therapy in the management of ALS

To determine the survival rate of use of mesenchymal stem cells in Lou Gehrig’s Disease

To assess the quality of life from treatment with stem cells

To explore a different solution to supportive care

To shed light on a novel approach to treatment of ALS

Research Methods: The methodology used in the study involved double blind, placebo controlled randomized clinical trials. The two phase II consisted of a total of 68 participants that would undergo treatment by mesenchymal stem cells. The inclusion criteria consisted of participants ranging between the ages of 18-75 years of age and had a ALS Functional Rating Scale (ALSFRS-R) at least above 20. The patients with a stable level of Riluzole were included in the study. All patients underwent a pretreatment period and later bone marrow aspiration (BMA). MSC cells were produced from the bone-marrow aspiration. The treatment procedures involved the participants receiving 1-4 intrathecal injections of bone marrow-derived mesenchymal stem cells between intervals of 0 - 6 months. The researchers and participants were unaware of their group assignments, either control or experimental groups. The statistical methods used include standardization of the points/month ALSFRS-R slope, p values, and mean improvement rate.The osteopathic significance of ALS and mesenchymal stem cells is that osteopathic physicians are adept at using muscle energy and mobilization techniques to address muscle stiffness and pain that individuals with ALS may experience. Although OMT may provide symptomatic relief, it is important for osteopathic physicians to incorporate groundbreaking technology in their practice alongside OMT. Through the emphasis of holistic medicine in the field of Osteopathy, mesenchymal stem cells will be a supportive tool for osteopathic physicians to expand their clinical aptitude, especially healthcare practitioners working in sports medicine and rehabilitation, focused on improving the quality of life of patients with ALS.

Data Analysis: Based on the results of the clinical trials and to address heterogeneity, a responder analysis showed that a higher proportion of treated participants experienced ≥1.5 points/month ALSFRS-R slope improvement compared to placebo at all time points. In both clinical trials this was the case as the other clinical trial showed a mean monthly change of 1.036 ± 0.88 compared to the placebo group. The outcome measure involved the monthly change and percentage of ALSFRS-R improvement. In one trial, the monthly rate of progression in ALSFRS-R was improved by more than 25% with a p-value of 0.0038, while the other trial reported a 3.9 % increase after standardization and a p-value of 0.046. In addition, severe adverse events were minimal in both clinical trials and were mild or independent of the stem cell transplantation. Moreover, there was no statistical significance reported in forced vital capacity for either trial, however, there was not a negative impact shown on respiratory function. Through these results it is clear that mesenchymal stem cells are safe and the efficacy is inconsistent based on the limited data present, however, through future studies, the statistical validity of MCS on ALS can be further explored and may benefit the field of Osteopathy as an additional tool for treatment of complex disorders.

Conclusion: In conclusion, while mesenchymal stem cell therapy for ALS shows promise in terms of safety, the treatment’s efficacy remains unknown. Limitations include the lack of standardization for specific parameters, such as efficacy and multiple phase I, 2, and 3 trials due to a lack of literature that is available on the topic. Other limitations include, levels of neuroinflammation and CSF findings which could elucidate the impact of MCS on inflammation. More research is needed to fully understand the potential benefits of MSC therapy and to determine the best treatment strategy for ALS patients.

References

1. Hardiman O, van den Berg LH, Kiernan MC. Amyotrophic lateral sclerosis: pathophysiology and current management. Nat Rev Neurol. 2017;13(6):323-334. doi:10.1038/nrneurol.2017.63.

2. Sykova E, Cizkova D, Kubinova S. Mesenchymal Stem Cells in Treatment of Spinal Cord Injury and Amyotrophic Lateral Sclerosis [published correction appears in Front Cell Dev Biol. 2021 Oct 28;9:770243]. Front Cell Dev Biol. 2021;9:695900. Published 2021 Jul 6. doi:10.3389/fcell.2021.695900

3. Gordon PH, Miller RG, Moore DH. ALSFRS-R. Amyotroph Lateral Scler Other Motor Neuron Disord. 2004;5 Suppl 1:90-93. doi:10.1080/17434470410019906

4. Cudkowicz ME, Lindborg SR, Goyal NA, et al. A randomized placebo-controlled phase 3 study of mesenchymal stem cells induced to secrete high levels of neurotrophic factors in amyotrophic lateral sclerosis [published correction appears in Muscle Nerve. 2022 Oct;66(4):E26-E27]. Muscle Nerve. 2022;65(3):291-302. doi:10.1002/mus.27472

5. Petrou P, Kassis I, Yaghmour NE, Ginzberg A, Karussis D. A phase II clinical trial with repeated intrathecal injections of autologous mesenchymal stem cells in patients with amyotrophic lateral sclerosis. Front Biosci (Landmark Ed). 2021;26(10):693-706. doi:10.52586/4980

6. Atassi N, Berry J, Shui A, et al. The PRO-ACT database: design, initial analyses, and predictive features. Neurology. 2014;83(19):1719-1725. doi:10.1212/WNL.0000000000000951

7. Barczewska M, Maksymowicz S, Zdolińska-Malinowska I, Siwek T, Grudniak M. Umbilical Cord Mesenchymal Stem Cells in Amyotrophic Lateral Sclerosis: an Original Study. Stem Cell Rev Rep. 2020;16(5):922-932. doi:10.1007/s12015-020-10016-7

8. Berry JD, Cudkowicz ME, Windebank AJ, et al. NurOwn, phase 2, randomized, clinical trial in patients with ALS: Safety, clinical, and biomarker results. Neurology. 2019;93(24):e2294-e2305. doi:10.1212/WNL.0000000000008620

9. Siwek T, Jezierska-Woźniak K, Maksymowicz S, et al. Repeat Administration of Bone Marrow-Derived Mesenchymal Stem Cells for Treatment of Amyotrophic Lateral Sclerosis. Med Sci Monit. 2020;26:e927484. Published 2020 Dec 10. doi:10.12659/MSM.927484

10. Glass JD, Hertzberg VS, Boulis NM, et al. Transplantation of spinal cord–derived neural stem cells for ALS: Analysis of phase 1 and 2 trials. Neurology. 2016;87(4):392-400. doi: 10.1212/WNL.0000000000002919

11. Kim H, Cho KJ, Kim YH, et al. Human umbilical cord blood mesenchymal stem cells alleviate ALS in a humanized ALS model. Nat Commun. 2020;11(1):97. doi: 10.1038/s41467-019-13810-x

12. Park SY, Han J, Kim HJ, et al. MSC-based cell fusion therapy for CNS diseases: A potential approach for neurometabolic disorders and neurodegenerative diseases. Int J Mol Sci. 2019;20(14):3363. doi: 10.3390/ijms20143363

13. Zhang Z, Yang L, Liu W, et al. Mesenchymal stem cells protect neurons against ischemia-reperfusion injury via inhibiting parthanatos, necroptosis, and apoptosis, but not autophagy. Cell Mol Neurobiol. 2020;40(6):831-847. doi: 10.1007/s10571-019-00755-4

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Study exempt

Informed Consent: N/A.

Poster No. *C-23

Abstract No. 2023-080

Category: Clinical

Research Topic: Impact of OMM & OMT

Accuracy of Lumbar Somatic Dysfunction Diagnosis in Comparison to Muscle Stiffness Measured by Myotonometry

Anoushka Guha, OMS-II; Taylor Castro, OMS-IV; Abeer Naeem, OMS-III; Nicole Companion, OMS-IV; Reem Abu-Sbaih, DO; Jordan Keys, DO; Sheldon Yao, DO

New York Institute of Technology

Statement of Significance: Accuracy of osteopathic diagnosis is necessary for proper evaluation of osteopathic manipulative treatment (OMT). Poor interexaminer reliability in lumbar spine diagnosis has been shown. Interexaminer reliability can be improved over time with training. The MyotonPRO myotonometer is proven to accurately assess muscle tension [3]. This study examined the correlation of somatic dysfunction diagnosis by NMM/OMM specialist and tissue texture changes measured as muscle stiffness/tone overlying the area.

To investigate whether the MyotonPro reading for stiffness compares to the segmental lumbar rotational diagnoses made by a physician.

Research Methods: Three NMM/OMM board-certified physicians diagnosed lumbar somatic dysfunctions in subjects in the L1 and L3 segments of the lumbar spine. Stiffness and frequency (tone) was measured bilaterally at the levels of paraspinal muscle via the MyotonPro by a separate research team investigator blinded to the physician diagnosis.

Data Analysis: MyotonPro data was analyzed from 7 healthy female subjects, 168 unique measurements using statistical analysis. 38.8% of all the somatic dysfunction (SD) diagnosis made by the physicians correlated with the MyotonPro’s measurement of increased stiffness, while 41% of the diagnoses correlated with increased measured tone. 28.6% of type 1 somatic dysfunction diagnosis correlated with measured tone and 34.3% correlated with measured stiffness. While 50% of type 2 somatic dysfunctions correlated with measured tone and 43.8% correlated with measured stiffness.

Conclusion: Less than half of all somatic dysfunctions diagnoses made by the physician aligned with the objective readings of stiffness and tone. Type 2 SD had a higher correlation to the myotonometer-measured tone and stiffness. This may be due to increased muscle hypertonicity and stiffness because rotation and side bending are in the same direction. However, this displays the need for a way to cross-check readings and have a non-biased form of objective measurement during OMT treatments. Other possibilities include the inability of the myotonometer to assess type 1 and type 2 dysfunctions of the lumbar spine. Limitations include small sample size and varying physician diagnostic styles. Further research is required to determine the benefits of utilizing the MyotonPro to assist in confirming somatic dysfunction diagnosis.

References

1. Spring F, Gibbons P, Tehan P, Intra-examiner and inter-examiner reliability of a positional diagnostic screen for the lumbar spine. Journal of Osteopathic Medicine, Volume 4, Issue 2, 2001, Pages 47-55, ISSN 1443-8461, https://doi.org/10.1016/S1443-8461(01)80002-2.

2. Degenhardt BF, Johnson JC, Snider KT, Snider EJ. Maintenance and improvement of interobserver reliability of osteopathic palpatory tests over a 4-month period. J Am Osteopath Assoc. 2010 Oct;110(10):579-86. PMID: 21068222.

3. Taş S, Yaşar Ü, Kaynak BA. Interrater and Intrarater Reliability of a Handheld Myotonometer in Measuring Mechanical Properties of the Neck and Orofacial Muscles. J Manipulative Physiol Ther. 2021 Jan;44(1):42-48. doi: 10.1016/j.jmpt.2020.08.002. Epub 2020 Nov 26. PMID: 33248749.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB #1521 approved

Informed Consent: ​The test subjects were all informed of the use and reporting of their somatic diagnoses as well as osteopathic manipulative treatment.

Poster No. *C-24

Abstract No. 2023-081

Category: Clinical

Research Topic: Impact of OMM & OMT

Comparison of Prevalence of Chapman’s Points In Subjects With Dysmenorrhea

Abeer Naeem, OMS-III; Taylor Castro; Anoushka Guha; Nicole Companion; Reem Abu-Sbaih; Jordan Keys, Sheldon Yao, DO

Department of Osteopathic Manpulitive Medicine, New York Institute of Technology

Statement of Significance: Chapman’s points are specific palpable areas which are tender to the touch indiciating “fascial congestions” displaying viscerosomatic reflexes of the body¹. The phases of the menstrual cycle have varying hormonal fluctuations of estrogen and progesterone causing pain which can be severe in patients with dysmenorrhea. However, there is limited research about the prevalence of muscle tenderness/Chapman’s points throughout the phases of the cycle.

To investigate the frequency of Chapman’s points in subjects with dysmenorrhea.

Research Methods: Subjects with a diagnosis of dysmenorrhea were recruited for a study investigating the effects of Osteopathic Manipulative Treatment (OMT) on symptoms. Subjects received 6 OMT sessions over 3 weeks prior to their menstrual cycle. Two NMM/OMM board-certified osteopathic physicians screened the subjects for anterior or posterior Chapman’s points for the uterus, broad ligament, or ovaries. The presence of a Chapman’s point was confirmed by subject reported tenderness on palpation.

Data Analysis: Chapman’s points were analyzed for 7 healthy female subjects, 127 unique tender points, using SPSS statistical software. Uterine points were found in 34.65% of subjects, broad ligament points were found in 33.86%, and ovarian points were found in 31.49% of subjects.

The lowest frequency of Chapman’s points occurred during week 2 (3.88 points) and the highest frequency of points occurred during week 4 4.67 points). Although the means trended higher during week 4, there was not a statistically significant change.

Conclusion: Uterine Chapman’s points proved most prevalent in subjects with dysmenorrhea. There was also an increase in the frequency of points during the course of the menstrual cycle towards the end of the luteal phase may be related to a progesterone peak. Limitations include small sample size and subjective scale of tenderness. Further research is needed to confirm the presence of Chapman’s points and effects of OMT on the points and clinical significance.

References

1. Luz LL, Fernandes EC, Sivado M, Kokai E, Szucs P, Safronov BV. Monosynaptic convergence of somatic and visceral C-fiber afferents on projection and local circuit neurons in lamina I: a substrate for referred pain. Pain. 2015;156(10):2042-2051. doi:10.1097/j.pain.0000000000000267

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: NYIT IRB #1521 Approved

Informed Consent: Subjects were asked to join the study and provided with a consent form which explains the research study and their role. They were allowed to ask any questions about anything they did not understand and were notified that they can quit at any time without fear of penalty or loss of benefits.

Poster No. C-25

Abstract No. 2023-083

Category: Clinical

Research Topic: Impact of OMM & OMT

AOA Grant Award: 078084

Safety and Efficacy of Osteopathic Manipulative Treatment (OMT) in the Pediatric Oncology Inpatient Setting

¹Amber Brown, DO, MS; ²Lauren Hoffman, OMS; ²Eyovel Eyassu, OMS; ²Paul Cooke, OMS; ²Devanshi Patel, OMS; ²Megan Schroeder, OMS; ²Steven Wooten, OMS; ³Jennifer Belsky, DO, MS

¹Indiana University Riley Hospital for Children at IU Health; ² Department of Osteopathic Medicine, Marian University College of Osteopathic Medicine; ³Department of Pediatric Oncology, Indiana University Riley Hospital for Children at IU Health

Statement of Significance: Pediatric patients undergoing treatment for cancer are frequently hospitalized^1,2 and experience therapy-induced side effects that diminish quality of life.^3,4 Osteopathic manipulative treatment (OMT) is a medical intervention that utilizes manual techniques to diagnose and treat body structures. Few studies have investigated the implementation of OMT in the pediatric oncology outpatient setting. To date, no studies have investigated the safety of OMT in the pediatric oncology inpatient setting.

To investigate the safety and efficacy of OMT in the pediatric oncology inpatient setting.

Research Methods: Single institution, observational case series evaluating children and adolescents and young adults (AYAs) aged 2-39 years undergoing treatment for an oncologic diagnosis at Riley Hospital for Children (Riley) who were hospitalized on the Riley pediatric inpatient oncology unit for cancer-related treatment or management of treatment-related complications. Approval was obtained from the Riley Institutional Review Board. Patients were evaluated daily with history and physical exam as part of routine inpatient management. Patients who reported chemotherapy side effects were offered OMT. Verbal informed consent/assent was obtained from caregivers/patients prior to patients receiving OMT. OMT was provided by trained osteopathic medical students under the supervision of a board-certified osteopathic physician and included techniques commonly taught in first- and second-year osteopathic medical school curricula. Safety was assessed by a validated pain (FACES) scale pre/post-OMT and by adverse event grading per Common Terminology Criteria for Adverse Event (CTCAE) 24 hours post-OMT. Between September 2022 and January 2023, a total of 9 patients received OMT, for a total of 34 separate OMT encounters. All data were summarized using descriptive statistics. Osteopathic significance is demonstrated by the novelty of investigating the safety and efficacy of OMT in hospitalized pediatric patients with cancer.

Data Analysis: A total of 9 patients received OMT, with 34 separate OMT encounters and 37 chief complaints included in the analysis. All patients had a diagnosis of leukemia or lymphoma. The majority of the patients were male (n=6, 66.7%) with a median age of 17 years at the time of OMT (range 12.9-29.3 years). Primary chief complaints included musculoskeletal pain (n=20, 54.1%), headache (n=5, 13.5%), and lower extremity edema (n=7, 18.9%). Additional chief complaints included neuropathic pain or neurologic symptoms (n=2, 5.4%), constipation (n=2, 5.4%), and epigastric pain (n=1, 2.7%). There were no reported adverse events attributed to OMT. Furthermore, there were no FACES scores that correlated with worsening pain or symptomatology. Pre/post-OMT FACES scores were collected for 43 separate body regions during 24 OMT encounters. Median FACES scores pre- and post-OMT were 6 and 3, respectively. All FACES scores post-OMT were unchanged or decreased in all encounters and for all body regions assessed.

Conclusion: Hospitalized children and AYAs with cancer received OMT safely. Limitations include single institutional data, small sample size, and limited representation of oncologic diagnoses. However, these findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology inpatient setting and to a broader inpatient pediatric oncology population.

References

1. Steineck A, Chow EJ, Doody DR, Mueller BA. Hospitalization and mortality outcomes in the first 5 years after a childhood cancer diagnosis: a population-based study. Cancer Causes Control. Jul 2021;32(7):739-752. doi:10.1007/s10552-021-01425-12

2. Russell HV, Okcu MF, Kamdar K, et al. Algorithm for analysis of administrative pediatric cancer hospitalization data according to indication for admission. BMC Med Inform Decis Mak. Oct 1 2014;14:88. doi:10.1186/1472-6947-14-883

3. Varni JW, Limbers CA, Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. Jul 16 2007;5:43. doi:10.1186/1477-7525-5-434

4. Ramirez LY, Huestis SE, Yap TY, Zyzanski S, Drotar D, Kodish E. Potential chemotherapy side effects: what do oncologists tell parents? Pediatr Blood Cancer. Apr 2009;52(4):497-502. doi:10.1002/pbc.21835

Financial Disclosures: None reported.

Support: AOA Grant Funding

Ethical Approval: Approval was obtained from the Riley Institutional Review Board. IRB #11059

Informed Consent: Verbal informed consent/assent was obtained prior to osteopathic manipulative treatment (OMT).

★Poster No. *C-26

Abstract No. 2023-084

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Improved Cardiac Auscultation Competency Interweaving Visual, Auditory, and Tactical Stimuli: A Preliminary Study

¹Harrison A. Patrizio, OMS-III; ¹Riley Phyu; ¹Bum Kim; ²Nils Brolis

¹Department of Medical Education, Rowan-Virtua School of Osteopathic Medicine; ²Simulation Center, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Cardiac auscultation proficiency is integral to osteopathic medicine’s patient-centered, holistic approach. (1) However, proficiency is waning, indicating a need for new teaching strategies. (2–4) While simulation mannequins exist at institutions, their high cost and limited availability warrant accessible, cost-effective alternatives. (5,6) Our study examines the efficacy of multisensory teaching methods—utilizing visual, auditory, and tactile stimuli—to proficiency in cardiac auscultation.

To explore interweaving visual, auditory, and tactical stimulus into traditional education methods to improve cardiac auscultation teaching outcomes.

Research Methods: This study utilized a randomized controlled design to compare heart sound recognition proficiency between students taught with traditional methods versus a multisensory approach. The study recruited 32 first-year medical students, with no prior cardiac auscultation training or clinical experience, randomly assigned to control and interventional groups. Both groups received a 10-minute pre-recorded slide presentation; however, the interventional group’s material was enhanced with 3D cross-sectional cardiac cycles and haptic synchronization. Post-training, participants’ competency in recognizing and explaining the pathophysiology of five heart sounds (S1/S2, S3, S4, crescendo-decrescendo, and mid-systolic click) was assessed through a multiple-choice exam. Nonparametric Mann-Whitney U and Cohen’s d tests were used for statistical analysis of diagnostic accuracy and knowledge acquisition.

Data Analysis: For diagnostic accuracy, the multisensory interventional group scored an average of 85% compared to the control group’s 58.75%. This superiority was statistically significant (Median = 100% versus 60%; p = 0.042) with the multisensory group demonstrating a 66% higher mean rank and a large effect size (Cohen’s d = 0.93). Similarly, knowledge acquisition saw the interventional group average at 76.25% outperforming the control group’s 46.25%. The multisensory group also had a statistically significant betterment (Median = 80% versus 50%; p = 0.031), a 54% higher mean rank, and a large effect size (Cohen’s d = 1.3). Therefore, the multisensory learning approach demonstrated significantly improved competency in cardiac auscultation skills compared to traditional methods.

Conclusion: Our study establishes that multisensory education significantly enhances cardiac auscultation training. This improved proficiency in identifying heart sounds and understanding their pathophysiological basis can enable a more thorough and comprehensive patient assessment, vital in osteopathic practice. These promising findings suggest that adopting multisensory teaching strategies could strengthen healthcare provider competencies, leading to improved patient outcomes in line with the osteopathic commitment to promoting health and wellness in their patients. However, due to the preliminary nature of our study and the potential influence of extraneous and confounding variables, these results should be interpreted with caution. Further research should confirm these findings across larger, more diverse sample sizes and various medical institutions, and explore the effectiveness of multisensory education in teaching other clinical skills. By illuminating the potential benefits of multisensory education as a compelling alternative to traditional methods and costly simulation tools, our study opens avenues for enriching osteopathic medical education and improving healthcare delivery.

References

1. Montinari MR, Minelli S. The first 200 years of cardiac auscultation and future perspectives. J Multidiscip Healthc. 2019;12:183-189. doi:10.2147/JMDH.S193904

2. Vukanovic-Criley JM, Criley S, Warde CM, Boker JR, Guevara-Matheus L, Churchill WH, et al. Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: a multicenter study. Arch Intern Med. 2006;166(6):610-616. doi:10.1001/archinte.166.6.610

3. Tokuda Y, Matayoshi T, Nakama Y, Kurihara M, Suzuki T, Kitahara Y, et al. Cardiac auscultation skills among junior doctors: effects of sound simulation lesson. J Int Assoc Med Sci Educ. 2020;11:107-110. doi:10.5116/ijme.5eb6.70c6

4. Goldsworthy S, Gomes P, Coimbra M, Patterson JD, Langille J, Perez G, et al. Do basic auscultation skills need to be resuscitated? A new strategy for improving competency among nursing students. Nurse Educ Today. 2021;97:104722. doi:10.1016/j.nedt.2020.104722

5. Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simul Technol Enhanc Learn. 2020;6(2):87-94. doi:10.1136/bmjstel-2018-000370

6. Lin K, Travlos DV, Wadelin JW, Vlasses PH. Simulation and introductory pharmacy practice experiences. Am J Pharm Educ. 2011;75(10):209. doi:10.5688/ajpe7510209

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Study was Approved by the Rowan-Virua IRB. IRB number: PRO-2022-137

Informed Consent: Informed consent was collected in writing before data collection began from all participants. Participants were aware of the nature of the study when filling out the consent forms.

Poster No. *C-27

Abstract No. 2023-087

Category: Clinical

Research Topic: Impact of OMM & OMT

Investigation of Osteopathic Manipulation of Spine and Pelvis on Lacrosse Shot Accuracy and Power

Steven P. Gawrys, Jr., OMS-IV; Alexander Matthias, BS; Andrew J. Roush, BS; David VanderMerwe, BS; Evan G. Starr, BS Westin J. Wong, BS; Lawsen M. Parker, BS; Jillian M. Nicholas, BS; Holly Wilson, BS

Rocky Vista University College of Osteopathic Medicine-Colorado

Statement of Significance: Musculoskeletal biomechanics are an essential component for optimal sports performance.1,2,3 Lacrosse is a technical sport that requires precise biomechanics for players to effectively shoot the bal.4,5 Prior studies suggest improved biomechanics of the hips and spine contributing to improved outcomes for major lacrosse actions. 6,7,8,9,10 Osteopathic Manipulative Treatment (OMT) has been shown to improve many different components of biomechanics.11,12, 13,14

To Evaluate the Effect of Osteopathic Manipulative Treatment (OMT) and key biomechanics contributing to lacrosse shot power and accuracy.

Research Methods: This prospective interventional study recruited participants from the Salt Lake Storm, a Men’s Senior-A Box Lacrosse Team in the Box Lacrosse League (BLL). Players were instructed of the risks and benefits of OMT and given the option to participate. Players who elected to participate in the study were anonymously assigned a number to collect their lacrosse shot performance statistics. 13 players elected to participate in the study. Players were evaluated for lacrosse shot speed and accuracy. Speed was evaluated by giving the players two attempts at a high velocity lacrosse shot and the highest miles per hour (MPH) was recorded. Accuracy was evaluated by players shooting 10 yards (9.144 meters) from the goal. Accuracy was assessed by the proportion of the 5 shots that hit the 20.5” by 20.5” by 30” target. Once baseline shot data was recorded, players were treated utilizing osteopathic techniques including muscle energy, high-velocity low-amplitude, counterstrain, and Still’s technique. OMT was limited to the pelvis, sacrum, and lumbar regions. Shot accuracy and speed were re-evaluated using the same methodology as baseline data collection. A paired, two-tailed t-test was used to compare the quantitative results of accuracy and speed before and after OMT.

Data Analysis: A total of 13 players participated in the study. All participants were adults that identified as male. A paired, two-tailed t-test resulted in a mean accuracy difference of a marginal improvement of 0.08 (p=0.829, 95% CI –0.68 - 0.84) and a slight mean speed increase of 0.23 MPH (p=0.804, 95% CI –1.75 - 2.21).

Conclusion: Based on the results of the study, OMT focused on the lumbar and pelvis regions has failed to demonstrate a statistically significant benefit on shot accuracy or throwing power in a Men’s Senior-A Box Lacrosse Team in the Box Lacrosse League. However, these findings can be of use to researchers investigating OMT’s effect on sports performance by either improving upon the limitations that are inherent for this study’s design or investigating other body regions to optimize the biomechanics of athletes. Additional studies can give further insight to the potential benefit of OMT to athletes and help promote athlete performance.

References

1. Meron A, Saint-Phard D. Track and Field Throwing Sports: Injuries and Prevention. Curr Sports Med Rep. 2017;16(6):391-396. doi:10.1249/JSR.0000000000000416

2. Knudson D. Top cited research over fifteen years in Sports Biomechanics. Sports Biomech. 2020;19(6):808-816. doi:10.1080/14763141.2018.1518478

3. Schofield M, Cronin JB, Macadam P, Hébert-Losier K. Rotational shot put: a phase analysis of current kinematic knowledge. Sports Biomech. 2022;21(3):278-296. doi:10.1080/14763141.2019.1636130

4. Hanks MM, Schnorenberg AJ, Lee KK, Slavens BA. Three-Dimensional Biomechanics of the Trunk and Upper Limb during Overhead Throwing in Wheelchair Lacrosse Athletes with Spinal Cord Injury [published online ahead of print, 2022 Feb 11]. Am J Phys Med Rehabil. 2022;10.1097/PHM.0000000000001989.

5. Braun HJ, Shultz R, Malone M, Leatherwood WE, Silder A, Dragoo JL. Differences in ACL biomechanical risk factors between field hockey and lacrosse female athletes. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):1065-1070. doi:10.1007/s00167-014-2873-0

6. Vincent HK, Chen C, Zdziarski LA, Montes J, Vincent KR. Shooting motion in high school, collegiate, and professional men’s lacrosse players. Sports Biomechanics. 2015;14(4):448-458. doi:10.1080/14763141.2015.1084034

7. Donatelli R, Dimond D, Holland M. Sport-specific biomechanics of spinal injuries in the athlete (throwing athletes, rotational sports, and contact-collision sports). Clin Sports Med. 2012;31(3):381-396. doi:10.1016/j.csm.2012.03.003

8. Thijs Y, Van Tiggelen D, Willems T, De Clercq D, Witvrouw E. Relationship between hip strength and frontal plane posture of the knee during a forward lunge. Br J Sports Med. 2007;41(11):723-727. doi:10.1136/bjsm.2007.037374

9. Vincent HK, Vincent KR. Core and Back Rehabilitation for High-speed Rotation Sports: Highlight on Lacrosse. Current Sports Medicine Reports. 2018;17(6):208-214. doi:10.1249/JSR.0000000000000493

10. Wasser JG, Chen C, Vincent HK. Kinematics of Shooting in High School and Collegiate Lacrosse Players With and Without Low Back Pain. Orthop J Sports Med. 2016;4(7):2325967116657535. Published 2016 Jul 25. doi:10.1177/2325967116657535

11. Hill CN, Romero M, Rogers M, Queen RM, Brolinson PG. Effect of osteopathic manipulation on gait asymmetry. J Osteopath Med. 2021;122(2):85-94. Published 2021 Nov 18. doi:10.1515/jom-2021-0046

12. Bohlen L, Schwarze J, Richter J, et al. Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial. Sci Rep. 2022;12(1):16953. Published 2022 Oct 10. doi:10.1038/s41598-022-20452-9

13. Bolin DJ. The application of osteopathic treatments to pediatric sports injuries. Pediatr Clin North Am. 2010;57(3):775-794. doi:10.1016/j.pcl.2010.02.002

14. Gunnar Brolinson P, McGinley SMG, Kerger S. Osteopathic Manipulative Medicine and the Athlete. Current Sports Medicine Reports. 2008;7(1):49-56. doi:10.1097/01.CSMR.0000308664.13278.a7

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This was exempt from IRB approval (IRB #2022-090) by Rocky Vista University.

Informed Consent: Participants were chosen from the Salt Lake Storm, a Men’s Senior A Box Lacrosse Team in the Box Lacrosse League (BLL). They were instructed of risks and benefits of OMT and given informed consent to the study. Players who opted to join the study filled out informed consent and a questionnaire concerning health history pertaining to conditions that would contraindicate OMT treatment (e.g., malignancy, fracture, osteoporosis, etc.). Deindentified information and pertinent health information concerning contraindications remained in a secured flash drive. Players were then assigned an anonymous number for their lacrosse shot performance for the collection of statistics. In total, 13 players participated in the study.

★Poster No. *C-28

Abstract No. 2023-097

Category: Clinical

Research Topic: Impact of OMM & OMT

Quantifying the Effect of Thoracic Myofascial Release on Muscle Tone, Stiffness, and Elasticity

¹Seth J. Spicer, OMS-II; ¹Nicholas Averell; ¹Ahmed Gawash; ¹Brandon Goodwin; ¹Rahyan Mahmud; ¹Ryan St. John; ¹David Lo; ²Alexander King

¹Department of Medicine, Rowan-Virtua School of Osteopathic Medicine; ²Department of Osteopathic Manupulative Medicine, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Myofascial release is a core technique of osteopathic manipulative medicine used by osteopathic physicians. While there is plenty of evidence supporting the efficacy of this treatment in relieving pain and increasing mobility, there is no research quantifying the effect of myofascial release on the properties of skeletal muscle tissue using treatment from American osteopathic physicians. Showing an objective difference in tissue parameters pre-post OMT would greatly substantiate the field.

Primary: To determine if myofascial release to the thoracic spine alters the physiology of muscle tissue including muscle tone, stiffness, and elasticity in a statistically significant way. Secondary: To determine how much of an impact myofascial release has on the aforementioned tissue parameters as expressed by effect size.

Research Methods: 60 participants were placed into the control or treatment group. The control group received 1 minute of silent hands on traps placebo while the control group received 30 seconds of indirect myofascial release followed by 30 seconds of direct myofascial release. Measurements of muscle tone, stiffness, and elasticity were taken immediately pre and post treatment using the MyotonPro device. Measurements were taken at a marked site 2 inches laterally to the T3 vertebra on all participants to assess the perpendicular fibers of the trapezius muscle. Inclusion criteria: Our study population consists of first through fourth-year medical students aged 18+ at Rowan-Virtua School of Osteopathic Medicine It includes all gender and ethnic backgrounds. Exclusion Criteria: Subjects who have a history of musculoskeletal or neurologic conditions who take medications that affect muscle tone or have a body mass index >30 kg/m2 will be excluded. Alterations in muscle tone or excess adipose tissue will skew the measurements of MyotonPRO. Subjects younger than 21 will be excluded.

Data Analysis: Data was analyzed in JASP using a paired T test to compare each dependent variable pre-post intervention in the control and treatment groups. There was a statistically significant difference pre-post for all treatment groups including for muscle tone (p=<0.001) with a large effect size (d=0.810), a muscle stiffness (p=0.002) with a moderate effect size (d=0.557), and muscle viscoelasticity (p=<0.001) with a large effect size (d=-0.812). In the control group, there were no statistically significant differences pre-post.

Conclusion: Conclusion: 1 minute of myofascial release is very effective in changing the tissue properties of the thoracic musculature, while 1 minute of hands on sham placebo is an effective control resulting in no tissue changes. Limitations: Due to device limitations, this study was not able to assess deep muscles or participants with greater than 20mm of adipose tissue over the target muscle. The demographic of this study was limited to students which may not be representative of different populations. Future Directions: Study of tissue parameters with myotometry to objectively measure the efficacy of other OMM techniques should be taken up to provide more objective evidence to inform practice.

References

1. “Musculoskeletal Health.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions.

2. Geri T, Viceconti A, Minacci M, Testa M, Rossettini G. Manual therapy: Exploiting the role of human touch. Musculoskelet Sci Pract 2019;44:102044 doi: 10.1016/j.msksp.2019.07.008 [published Online First: 20190725].

3. Lunghi C, Tozzi P, Fusco G. The biomechanical model in manual therapy: Is there an ongoing crisis or just the need to revise the underlying concept and application? J Bodyw Mov Ther 2016;20(4):784-99 doi: 10.1016/j.jbmt.2016.01.004 [published Online First: 20160123].

4. Bohlen L, Schwarze J, Richter J, et al. Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial. Sci Rep 2022;12(1):16953 doi: 10.1038/s41598-022-20452-9 [published Online First: 20221010].

5. Gajdosik RL. . Clinical Biomechanics 2001;16:87-101.

6. Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins (Basel) 2021;13(4) doi: 10.3390/toxins13040282 [published Online First: 20210416].

7. Davidson MJ, Bryant AL, Bower WF, Frawley HC. Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles. Physiother Can 2017;69(2):104-12 doi: 10.3138/ptc.2015-85.

8. Lee Y, Kim M, Lee H. The Measurement of Stiffness for Major Muscles with Shear Wave Elastography and Myoton: A Quantitative Analysis Study. Diagnostics (Basel) 2021;11(3) doi: 10.3390/diagnostics11030524 [published Online First: 20210315].

Financial Disclosures: None reported.

Support: Funding for the device was internally supported through APSEA (American Prevention Screening and Education Association).

Ethical Approval: Study was fully reviewed and approved by the Rowan-Virtua SOM IRB (study #PRO2022-348) on 3/20/2023.

Informed Consent: Participants reviewed the details of the study with a study so-investigator. This conversation took place in one of the exam rooms of the Rowan Medicine Building. The Co-Investigator reviewed the consent form and described: (1) the goals of the research, (2) a description of the osteopathic manipulative techniques that will be used during the project, (3) a description of the types of measurements that were to be performed, and (4) the need to obtain demographic and health-related information. The Co-Investigator answered any questions the participants had about the study and what they would be asked to do as a participant. All participants were reminded that participation is entirely voluntary and if they chose not to take part in the study that this choice would not affect their relationship with RowanSOM. If after this process, the participant agreed to take part in the study, the consent form was signed.

Poster No. C-29

Abstract No. 2023-104

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Utilizing Biomarkers for Prognostic Evaluation, Disease Severity Assessment, and Treatment Effectiveness in Coronary Artery Disease

Armand Yazdani, OMS-III; Michaela Pletsch; Abraham Chorbajian; David Zitser; Vikrant Rai; Devendra K. Agrawal

Department of Translational Research, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Statement of Significance: The global burden of CAD has increased significantly over the years, resulting in millions of deaths annually and making it the leading healthcare expenditure and cause of mortality in developed countries. The lack of cost-effective strategies for monitoring the prognosis of CAD warrants a pressing need for accurate and efficient markers to assess disease severity and progression, both for reducing healthcare costs and improving patient outcomes.

To identify the key markers of substantial utility for monitoring coronary artery disease progression and the efficacy of therapeutic intervention among various markers of interest.

Research Methods: A literature search was conducted using PubMed and Google Scholar to identify the background, mechanism, and treatment usage of markers for coronary intervention. Articles were selected for inclusion based on keywords, alone or in combination, such as coronary artery disease, inflammatory markers, biomarkers, clinical findings, adverse effects, and acute complications. A total of 247 articles were retrieved. The article selection to include in this review article was based on the article title and abstract, following which the full-text articles were reviewed and included in the bibliography. The search was limited to peer-reviewed articles in the English language only. The duplicate articles, only abstracts, and non-English articles were excluded during the literature search following PRISMA guidelines. In this review, our focus was to include articles reporting or reviewing human studies, and studies in animal models were included only if the clinical study was done along with the animal model.

Data Analysis: Various biomarkers have shown promise in predicting cardiac outcomes and assessing disease progression in CAD. Studies have indicated the potential benefits of amyloid A, troponin, cytokines, MMPs, BNP and NT-proBNP, PAPP-A, and RDW as biomarkers for CAD prognosis and severity. Elevated levels of these biomarkers have been associated with increased morbidity and mortality, higher risk of cardiovascular events, symptomatic heart failure, and nonfatal myocardial infarction in patients with CAD. Furthermore, lower heart rate variability (HRV) has been linked to a higher risk of fatal or non-fatal cardiovascular disease, and reduced HRV is associated with an increased risk of sudden cardiac arrest, non-sudden cardiac death, and death from non-cardiac causes in patients with coronary artery disease. HRV serves as a valuable marker for assessing autonomic nervous system function, cardiovascular disease risk, and the effectiveness of interventions like beta-blocker medications and percutaneous coronary intervention in improving patient outcomes. Elevated HbA1c levels are also associated with an increased risk of CAD and CHD, while LP-PLA2 levels correlate with CAD severity and adverse cardiovascular events. Elevated VEGF-A levels in patients with atherosclerosis contribute to plaque growth, chronic inflammation, and neovascularization in unstable plaque areas, while decreased angiopoietin-1 and angiopoietin-2 levels are observed in coronary artery disease patients; furthermore, increased plasma VEGF and LDL-cholesterol levels are associated with coronary occlusions. Coronary Artery Calcium (CAC) was found to be most consistent in its ability to predict ischemic events and identify high-risk patient subgroups. CAC is recommended for patients at borderline or intermediate risk (10-year atherosclerotic CVD event risk, 5% to < 20%) by the American College of Cardiology but can also be useful in young patients (30–49 years) and patients with a family history and at low-risk.

Conclusion: In conclusion, accurate measurements of CAD disease prognosis and severity are crucial for risk stratification and monitoring of patients with coronary artery disease. Various biomarkers have shown promise in predicting cardiac outcomes and assessing disease progression in CAD. Overall, these findings highlight the importance of utilizing biomarkers in accurately assessing CAD prognosis, optimizing treatment strategies, and ultimately improving health outcomes for individuals with coronary artery disease. Further research and validation are needed to fully establish the clinical utility of these biomarkers in routine practice.

References

1. Abhinand, C. S., Raju, R., Soumya, S. J., Arya, P. S., & Sudhakaran, P. R. (2016). VEGF-A/VEGFR2 signaling network in endothelial cells relevant to angiogenesis. J Cell Commun Signal, 10(4), 347-354. https://doi.org/10.1007/s12079-016-0352-8

2. Erben, R. G. (2018). Physiological actions of fibroblast growth factor-23. Frontiers in Endocrinology, 9. https://doi.org/10.3389/fendo.2018.00267

3. Fichtlscherer, S., De Rosa, S., Fox, H., Schwietz, T., Fischer, A., Liebetrau, C., Weber, M., Hamm, C. W., Röxe, T., Müller-Ardogan, M., Bonauer, A., Zeiher, A. M., & Dimmeler, S. (2010). Circulating micrornas in patients with coronary artery disease. Circulation Research, 107(5), 677–684. https://doi.org/10.1161/circresaha.109.215566

4. Ganta, V. C., Choi, M., Farber, C. R., & Annex, B. H. (2019). Antiangiogenic VEGF(165)b Regulates Macrophage Polarization via S100A8/S100A9 in Peripheral Artery Disease. Circulation, 139(2), 226-242. https://doi.org/10.1161/CIRCULATIONAHA.118.034165

5. Hillis, G. S., Terregino, C., Taggart, P., Killian, A., Zhao, N., Dalsey, W. C., & Mangione, A. (2002). Elevated soluble P-selectin levels are associated with an increased risk of early adverse events in patients with presumed myocardial ischemia. American Heart Journal, 143(2), 235–241. https://doi.org/10.1067/mhj.2002.120303

6. Koenig, W., & Khuseyinova, N. (2007). Biomarkers of atherosclerotic plaque instability and rupture. Arteriosclerosis, Thrombosis, and Vascular Biology, 27(1), 15–26. https://doi.org/10.1161/01.atv.0000251503.35795.4f

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable.

Informed Consent: Not applicable.

Poster No. *C-30

Abstract No. 2023-110

Category: Clinical

Research Topic: Impact of OMM & OMT

The Effects of Osteopathic Manipulative Treatment on Cardiac Arrhythmias in Patients with Cardiovascular Implantable Electronic Devices: A Randomized Controlled Trial

¹Denis Malkov, MD, OMS-IV; ¹Jacqueline Nikakis; ¹Ermin Tale; ²Jordan Keys; ²To S. Li; ² Sheldon Yao, DO; ¹Todd J. Cohen

¹Department of Clinical Specialties, New York Institute of Technology; ²Department of Osteopathic Manupulative Medicine, New York Institute of Technology

Statement of Significance: Osteopathic manipulative treatment (OMT) techniques can affect the autonomic nervous system. Previously, we reported on the effects of OMT in patients with cardiovascular implantable electronic devices (CIEDs) as assessed by a quality-of-life survey and demonstrated statistically significant improvement in activities of daily living.(1)

To assess the effects of OMT on arrhythmias as recorded by CIEDs via a randomized controlled trial (RCT).

Research Methods: Cardiac patients with CIEDs were recruited to participate in a double-blind randomized controlled trial approved by an osteopathic medical school’s institutional review board (ClinicalTrials.gov ID: NCT0400474). Patients who consented to the trial were prospectively randomized to either OMT or light-touch (control) groups. All interventions were performed by board-certified OMM faculty. All patients were diagnosed for somatic dysfunctions in the following regions: cervical, thoracic and lumbar spine, cranium, rib cage, sacrum, and pelvis. The OMT protocol utilized cranial osteopathy, myofascial release, rib raising, and facilitated positional release. Significant arrhythmias included atrial fibrillation (AF), atrial flutter, atrial tachycardia (AT), supraventricular tachycardia (SVT), ventricular tachycardia (VT), and ventricular fibrillation (VF). The primary outcome was a change in the number of arrhythmias within the 30-days post intervention compared to 30-days prior to intervention. Statistical analysis included a Student t-test; p < 0.05 was statistically significant.

Data Analysis: 41 subjects were enrolled in the study; one was lost to follow-up (22 OMT/18 control). There were no adverse effects from either OMT or light touch during the trial. Effects of OMT on arrhythmias were as follows: 5 increased, 5 decreased, and 12 had no change from prior to intervention. Effects of light touch on arrhythmias were as follows: 5 decreased and 13 had no change. The data for specific arrhythmias were as follows (number of events pre/post intervention): SVT OMT 2/1, SVT control 1/0, AT OMT 0/0, AT control 1/1, atrial flutter OMT 0/1, atrial flutter control 0/0, AF OMT 1/2, AF control 1/1, VT OMT 3/3, VT control 1/1, VF OMT 0/0, VF control 1/1. There was no significant change in the overall number of arrhythmias between the two groups (P = 0.14).

Conclusion: This is the first RCT to assess the effects of OMT on cardiac arrhythmias in CIED patients. There were no significant pro- or antiarrhythmic effects of either OMT or light-touch OMT were observed within 30 days of intervention. This study provides additional data supporting the safety of OMT with respect to cardiac arrhythmias in patients with CIEDs. Additional RCTs in a larger population are necessary to determine any cause-and-effect relationship between OMT and arrhythmias in patients with CIEDs.

References

1. Nikakis J, Tale E, Malkov D, Singh-Arora U, Auerbach A, Young A, Keys J, Shan Li T, Yao S, Cohen TJ. The Effect of Osteopathic Manipulative Treatment on Quality of Life in Cardiac Arrhythmia Patients. SOMA. 2022

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Reviewed and approved by the IRB - BHS-1464

Informed Consent: Informed consent obtained upon enrollment

Poster No. C-32

Abstract No. 2023-116

Category: Clinical

Research Topic: Osteopathic Philosophy

Reaching a Wider Audience: Assessing Opinions of Osteopathic Medicine on a Popular Media Platform

Ruth L. Milanaik, DO; Emily Pochtar, BS, Kyle Han, BA

Department Pediatrics, Teen Trends Research Initiative at Cohen Children’s Medical Center of New York

Statement of Significance: Osteopathic Medicine was developed in 1874 by Dr. AT Still. Doctors of Osteopathic medicine (DO) receive conventional medical training and learn osteopathic manipulation techniques. In 1973, DOs became fully recognized physicians in all states. However, public opinions about the differences between Allopathic and Osteopathic Medicine remain varied indicating a fair amount of confusion persists. As the media has evolved, young users are turning to different sources to answer medical questions.

Tiktok is a widely used video-sharing media platform with > a billion users. Previous research has shown that Tiktok consumers utilize this platform to gather medical information. The hashtag #medicine has 26.7 billion views. In contrast, the hashtag #osteopathicmedicine has 55.8 million views. The objective of this study is to analyze publicly posted videos that discuss osteopathic medicine, in order to evaluate information and opinions circulated by this widely used communication platform.

Research Methods: The top 400 videos under the hashtags of “#osteopathicmedicine”, “#osteopathicdoctor”, and “#mdvsdo” were analyzed. The Apify webscraper platform was used to scrape the data from each video, including “like count”, number of shares, number of comments, and number of times viewed. Content from each video was collected by researchers including the content creator’s gender, ethnicity, qualifications, their opinions, and the type of comments left under the video. Videos were excluded if video creator (VC) comments were not audible or creator comments were not shared. Results were analyzed in R Studio. Negative comments were analyzed for themes

Data Analysis: Four hundred videos were analyzed, with 76 videos meeting inclusion criteria.; number of views (n=2,126,337), like count (n=101,755), number of shares (n=1,947), number of comments (n=4,809). The perceived gender of content creators were 83% (n=63) female. The perceived ethnicity of the creators were 55% (n=42) white and 45% (n=34) non-white. Of these videos, 53% (n=40) of VC self-identified as DOs, 4% (n=3) self-identified as MD and 43% (n=33) were laypeople. Of the laypeople, a total of 61% of all videos (n=20) did not view MDs and DOs differently. Within the comments under each video, 60% (n=46) videos had positive comments towards DOs (e.g.“I loved my DO doctor!”, “My DO gave me great medical advice”) and 40% (n=30) videos had negative comments (eg. “DO has a lesser undergrad GPA”, “MDs are better”, “Students who don’t get accepted into MD do DO”). Themes of negative comments were analyzed with three overarching concepts that DOs were considered 1)“less competitive” (58%) and 2) “less competent” (30%) or 3) the commenter displayed a “lack of awareness” (12%) ​

Conclusion: Tiktok is used by video creators to widely and quickly spread information regarding a variety of topics. While the hashtag #Osteopathicmedicine, with related hashtags, did receive a large amount of views (55.8 million), a concerning 40% of comments were perceived to be negative by researchers. Themes of particular concern were DOs were considered “less competitive” (58%) “less competent” (30%) or the commenter displayed a “lack of awareness” (12%). Videos that did not meet inclusion criteria, but were of interest, often showed manipulations being performed but without any commentary or confirmation that the clinician was an actual osteopathic doctor. These videos amassed millions of views indicating that viewers seemed interested in the practice of OMM. Tiktok and other similar platforms are very popular amongst youth of today. Encouraging organizations such as the AOA to expand media outreach movements to include new platforms will help Osteopathic physicians to reach a young, diverse and interested audience. The AOA should consider creating official content for new platforms that explains the details of the profession and training of Osteopathic physicians and works to present Osteopathic Medicine in a positive and exciting way. Reaching out to the youth of tomorrow is imperative to the continued growth of the Osteopathic profession.

References

1. Comp G, Dyer S, Gottlieb M. Is TikTok The Next Social Media Frontier for Medicine?. AEM Educ Train. 2020;5(3):10.1002/aet2.10532. Published 2020 Oct 21. doi:10.1002/aet2.10532

2. Mandzufas J, Ayalde J, Ta D, Munro E, Paciente R, Pranoto EP, King K, How K, Sincovich A, Brushe M, et al. The Investigation of Health-Related Topics on TikTok: A Descriptive Study Protocol. Digital. 2023; 3(1):97-108. https://doi.org/10.3390/digital3010007

3. Orenstein, R. History of Osteopathic Medicine: Still Relevant?. Journal of Osteopathic Medicine, 2017;117(3), 148-148. https://doi.org/10.7556/jaoa.2017.027

4. Reeves, R. & Burke, R. Perception of Osteopathic Medicine Among Allopathic Physicians in the Deep Central Southern United States. Journal of Osteopathic Medicine, 2009;109(6), 318-323. https://doi.org/10.7556/jaoa.2009.109.6.318

5. Zhao, Y. and Zhang, J. (2017), Consumer health information seeking in social media: a literature review. Health Info Libr J, 34: 268-283. https://doi.org/10.1111/hir.12192

6. Zheng, D.X., Ning, A.Y., Levoska, M.A., Xiang, L., Wong, C. and Scott, J.F. (2021), Acne and social media: A cross-sectional study of content quality on TikTok. Pediatr Dermatol, 38: 336-338. https://doi.org/10.1111/pde.14471

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The IRB deemed this study exempt as it was deemed to not contain human research subjects.

Informed Consent: There were no human research subjects.

★Poster No. *C-33

Abstract No. 2023-121

Category: Clinical

Research Topic: Musculoskeletal Injuries and Prevention

The Army Combat Fitness Test’s (ACFT) Ability to Screen and Predict Musculoskeletal Injury: A Retrospective Chart Review

¹Artiom Daniel Efimenko, OMS-IV, 2LT; ¹Sidharth Sahni, DO, DPT; ¹Christian Scouarnec, DO; ²Peter Pace, MS, RD, CSCS; ³Michael Groskranz, BSN; ³James Cahill, MD

¹ Department of Neuromusculoskeletal Institute, Rowan-Virtua School of Osteopathic Medicine; ²United States Army; ³Army National Guard

Statement of Significance: The United States Army recently introduced the Army Combat Fitness Test (ACFT), featuring an expanded repertoire of six events compared to the previous three events. Little is known about the long-term effectiveness of the ACFT in reducing musculoskeletal (MSK) injuries and its ability to predict future medical profile status. Previous studies have shown that soldiers who perform poorly in aerobic-related exercises are at an increased risk of MSK injuries.

Utilizing Osteopathic philosophies, we set out to determine whether the ACFT is a holistic, long-term predictor of receiving a medical profile in the United States Army.

Research Methods: A literature review was initially conducted utilizing PubMed, NCBI, and JAMA as primary databases. A broad spectrum of search terms were used, including ACFT, Army, training, injury, and profiles. Preliminary results demonstrated insufficient data to infer any significant correlation between ACFT and medical profile status. Thus, we conducted a retrospective chart review using ACFT data from a medical detachment unit associated with the New Jersey Army National Guard. The data included 46 service members who conducted the ACFT in November 2022.

Data Analysis: Of the 46 participants, 18 were female and 28 were male. The age range was between 19-60, with a mean age of 35. Scoring is based on a summative value of 0-100 possible points for each event, with a total possible score of 600. The minimum passing score for each event is 60 points, requiring the participant to achieve a total score of 360 to pass the minimum overall threshold. Of all the members who participated in the ACFT, 35 individuals passed (76%), and 11 individuals failed (24%). Further analysis revealed a significant difference in the average ACFT scores between individuals who passed (M = 441, SD = 43.049) and those who failed (M = 392, SD = 46.297), p < 0.05. Among the 11 individuals that failed, 2 did not pass because they received a total score below 360, whereas the remaining 9 of those who did not pass failed at least one individual event. Of those that failed a single event, 7 individuals failed either the 2-mile run or sprint-drag-carry event, both of which required a high degree of aerobic endurance. Furthermore, 4 individuals with medical profiles, that excused them from the 2-mile run, ended up passing the aerobic component of the test. These individuals were allowed to substitute a 2-mile run with an alternative form of testing, either a 5 KM row or a 2.5-mile walk.

Conclusion: To summarize, our results showed that a lack of aerobic fitness was most consistent with predicting failure of the ACFT, which research has shown to correlate with an increased risk of MSK injury. However, since data was utilized in a resource-constrained setting with soldiers from an Army National Guard unit, it is more challenging to track injuries and their mechanisms due to multiple external factors. Hence, additional data and further long-term follow-up are required to analyze significant trends and understand whether the ACFT is a truly beneficial predictor of medical profile status. Comparing data from active duty to National Guard and Reserve components may also provide helpful insight into identifying any fundamental differences, as both vary in total length of training and combat experience.

References

1. Army Combat Fitness Test. Army Combat Fitness Test. https://www.army.mil/acft/.

2. Lisman PJ, de la Motte SJ, Gribbin TC, Jaffin DP, Murphy K, Deuster PA. A Systematic Review of the Association Between Physical Fitness and Musculoskeletal Injury Risk: Part 1-Cardiorespiratory Endurance. J Strength Cond Res. 2017;31(6):1744-1757. doi:10.1519/JSC.0000000000001855

3. U.S. Army Reserve. Army health experts offer tips to prevent ACFT injuries. U.S. Army Reserve. https://www.usar.army.mil/News/News-Display/Article/2068388/army-health-experts-offer-tips-to-prevent-acft-injuries/.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable.

Informed Consent: Not applicable.

Poster No. *C-34

Abstract No. 2023-124

Category: Clinical

Research Topic: Acute and Chronic Pain Management

AOA Grant Award: 22018857

Inter- and Intra-Observer Reliability in Measuring Quantitative Ultrasound Biomarkers of the Upper Trapezius Muscles

¹Christopher Hannum, Jr., OMS-IV; ²Chris Edwards, DO; ³Ben Wilde, DO; ³David Park, DO; ³Jing Gao, MD

¹Rocky Vista University College of Osteopathic Medicine-Colorado; ²Department of Medicine, Rocky Vista University College of Osteopathic Medicine-Southern Utah; ³ Department of Medicine, Rocky Vista University College of Osteopathic Medicine-Montana

Statement of Significance: Given that preliminary studies demonstrate that ultrasound biomarkers associated with muscle tissue structure significantly differ between muscles in low back pain, neuromuscular disorders, and normal muscles, we aimed to assess these ultrasound biomarkers in assessing neck muscles. This study will evaluate which biomarkers are best suited to differentiate abnormal muscles in chronic neck pain (CNP) from healthy muscles and develop a quantitative objective program for CNP management.

To test the reliability of performing ultrasound shear wave elastography (SWE) to determine the prognostic performance of multiparametric quantitative ultrasound imaging biomarkers for assessing upper trapezius muscle (UTM) in participants with and without chronic neck pain and variable neck disability scores. Establishing fidelity in measured outcomes between the operators in a training session to demonstrate repeatability and reproducibility in performing SWE to support future pilot studies.

Research Methods: Prior to data collection, our clinical trial received Institutional Review Board approval and was registered with ClinicalTrials.gov. We collected written informed consent and a patient survey from all 33 participants for the preliminary observation portion of the study. Individuals underwent ultrasound shear wave velocity imaging of the upper trapezius muscles performed by two operators independently. Operator 1 has 30 years of experience in musculoskeletal ultrasound and 10 years of ultrasound elastography; Operator 2 has 2 years of study in musculoskeletal ultrasound and 1 year of ultrasound elastography. Intraclass correlation coefficient (ICC) was performed to analyze intra-observer repeatability and inter-observer reproducibility in measuring ultrasound parameters. Based on the 95% confidence interval (95% CI) of the ICC estimate. Bland-Altman analysis was also utilized to test the difference in the two sets of measured values performed by a single operator and the differences between the two operators. 95% lower and upper limits of agreement (95% LOA) were calculated using the mean and standard deviation (SD) of the difference between the two sets of measurements. Bland-Altman plots were created to demonstrate the difference versus the average of shear wave velocity (SWV, m/s) measurements between the junior and senior operators with 95% limits of agreement. A p-value < 0.05 indicates a significant difference. The difference in SWV between participants with neck disability scores ≤5 and >5 was examined using a two-tailed t-test.

Data Analysis: SWE was successfully performed on 33 participants (14 men and 19 women, mean age 45 years, age range 24 to 79yrs). One subject was excluded from the analysis for not meeting the inclusion criteria. The intra-observer repeatability and inter-observer reproducibility in performing SWE of UTM were excellent (ICC >0.96, 95% CI 0.96-0.99). The difference in SWV of UTM between participants with neck disability score 5 (SWV 8.23±3.29, n=12) and those with >5 (SWV 10.67±5.43, n=20) was significant (p=0.034).

Conclusion: The repeatability and reproducibility in performing ultrasound shear wave elastography of muscles are excellent. SWE is feasible to quantifiably assess the difference in UTM muscle stiffness between participants with neck disability scores ≤5 and >5. Further study in testing multiple QUS biomarkers in assessing UTM correlated with osteopathic findings is warranted.

References

1. Gao J, Caldwell J, McLin K, Zhang M, Park D. Ultrasound shear wave elastography to assess osteopathic manipulative treatment on the iliocostalis lumborum muscle: A feasibility study. Journal of Ultrasound in Medicine. 2020;39(1):157-164. doi: 10.1002/jum.15092

Financial Disclosures: Disclosure: The study is supported by AOA research fund (2022). Dr. Jing Gao received Research fund from AOA, received clinical research fund and cosigned equipment from SiemensHealthineers.

Support: Acknowledgment: Authors thank Siemens Healthineers for providing equipment to support the study

Ethical Approval: IRB Approved. IRB #2022-095.

ClinicalTrials.gov Identifier: NCT05497622

Informed Consent: Informed Consent was collected from all subjects prior to participation in the study. The risks and benefits of OMT and ultrasound imaging were explained to participants, and all subjects were screened for the inclusion and exclusionary criteria of study.

Exclusion criteria for the healthy participants include:

Under 18 years of age; Having a medical history of musculoskeletal conditions, joint and/or spine surgery, trauma; Employee of the study investigators; Being unable to competently consent or assent to participation (e.g., mentally disabled, demented, delusional, or a prisoner); Not tolerant to the osteopathic exam, ultrasound. Exclusion criteria for patients with chronic neck pain include:

Age < 18 years, Unable or unqualified to sign an informed consent, Unstable and/or late-stage diseases, Not tolerant to the osteopathic exam, ultrasound, OMT. There is no specific racial/ethnic background limitation in this study.

Poster No. C-35

Abstract No. 2023-126

Category: Clinical

Research Topic: Chronic Diseases & Conditions

AOA Grant Award: #23151879

Post-Stroke Disability, Somatic Dysfunction, and Association with Quality-of-Life in Patients with Cerebrovascular Disease

¹Navneet Bassi, DO; ¹Corinna Fazzio, DO; ¹William Brooks, DO; ²Guillermo Palchik, PhD; ¹Alan Yee, DO

¹Department of Neurology, University of California, Davis, School of Medicine; Department of Neurology, Sutter Health California Pacific Medical Center

Statement of Significance: Stroke is the leading cause of severe disability (1) and survivors frequently have incomplete recovery (2). Somatic dysfunction (SD) is identified by physical examination and defined as impaired function of related components of the body framework. While SD has been described in common musculoskeletal (3) and medical conditions (4), no study has rigorously quantified SD among stroke survivors.

We sought to examine the association between neurologic disability and hospital disposition following acute cerebrovascular disease, burden of SD among survivors with chronic physical disability, and relationship between disability type and quality-of-life (QoL) after stroke.

Research Methods: Retrospective analysis was performed to investigate all three aims: (1) We examined consecutive patients with (ischemic and hemorrhagic) stroke from the University of California Davis Comprehensive Stroke Service (December 2019-May 2022). Clinical characteristics (i.e., neurologic disability type, stroke subtype, demographics) and hospital disposition were collected. Chi-square was used to assess the relationship between disability and discharge disposition, and logistic regression assessed variables that independently predicted the need for ongoing rehabilitative institutionalization. (2) SD quantity, distribution, and severity were quantified using a novel diagnostic paradigm (Functional Pathology of the Musculoskeletal System; FPMSS) among patients with chronic stroke related motor disability. (3) QoL was examined among those with neurologic disability after incident stroke during outpatient clinical follow-up. Patient reported responses on executive function, physical ability, and socialization were recorded based on documented clinical encounters (January 2020-June 2021). Symptom quality frequencies and differences among variable neurologic disabilities were examined (chi-square).

Data Analysis: 1018 patients were analyzed, 601 (59%) with ischemic stroke (IS) and 417 (41%) with cerebral hemorrhage. The mean age was 68, 55% were male, and 54% were from non-white ethnicities. 7% of patients either died or discharged to hospice. 45% of the 560 survivors required skilled nursing facility/inpatient rehab. Mean NIHSS and modified Rankin Scale (mRS) were 4.7 (SD=5.9) and 2.3 (SD=1.6), respectively. Weakness (43%), aphasia (29%), sensation loss (20%), and visual impairment (18%) were commonest disabilities. Motor disability tripled the likelihood of requiring ongoing inpatient rehabilitation [X2 (143.2, 1), p ≤ 0.0001] as did greater mRS (3.3 vs 1.5, p ≤ 0.0001). Persistent motor impairment (OR=4; 95% CI 0.12, 0.39; p=.0001) and a mRS ≥2 (range 0-5, OR =5.6; 95% CI 0.09, 0.26; p≤0.0001) independently predicted discharge to rehabilitation. The severity, distribution, and quantity of somatic dysfunction (SD) was determined among six (4 men, 2 women; 38-67 years of age) patients with chronic hemiparesis after stroke. All but one had moderate to severe spasticity [mean NIHSS= 3.5 (range 2-6)]. The average SD burden among all patients was 105 (range 56-184, SD=42). Dysfunction of the axial spine, hip girdle and limbs opposite to paralysis side frequently exhibited moderate to severe SD (range 33-89, SD=23). QoL was examined among 44 IS survivors. 55% were men, 48% were Caucasian, and the mean age was 63 years. Average clinic follow-up time, mRS, and NIHSS were 60 days (SD=18), 1.2, and 4.3, respectively. Physicians discussed cognitive function, physical function, and social activities participation in 93%, 75%, and 11% of the encounters, respectively. 33 of 44 encounters addressed executive function of which 73% reported ongoing executive dysfunction. 41 of the 44 encounters addressed physical ability of which 69% endorsed ongoing impairment. The difference between patients reporting executive versus physical functioning was not significant [X2 (1,N=74)=1.6, p=0.20].

Conclusion: Our preliminary data suggests that: (1) motor impairment remains the most neurologic disability after IS and predicts rehabilitation disposition, (2) SD can be reliably quantified in patients with complex neuromotor disability using the FPMSS diagnostic model. Quantifying the location and severity of SD allows for profiling where dysfunction is greatest and allows for treatment prioritization. (3) Impaired physical and cognitive function remain common concerns voiced by patients, and physicians seldom inquire about patient satisfaction with social roles after stroke. Further studies are needed to better understand the ongoing recovery needs in order to develop novel therapeutic interventions (e.g., OMTx) that may impact QoL among stroke survivors with chronic physical disability. Moreover, future investigations to systematically examine for the presence of musculoskeletal dysfunction across physically disabled stroke survivors is warranted.

References

1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Circulation. 2022;145(8). doi:10.1161/CIR.0000000000001052

2. Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016;47(6). doi:10.1161/str.0000000000000098

3. Licciardone JC, Kearns CM. Somatic dysfunction and its association with chronic low back pain, back-specific functioning, and general health: Results from the osteopathic trial. J Am Osteopath Assoc. 2012;112(7).

4. Cox JM, Gorbis S, Dick LM, Rogers JC, Rogers FJ. Palpable musculoskeletal findings in coronary artery disease: Results of a double-blind study. J Am Osteopath Assoc. 1983;82(11). doi:10.1515/jom-1983-830710

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB approval was obtained for the study (UC Davis IRB#: 1194768-1). Data presented for this abstract was not based on pending funds from recent AOA Grant (#23151879).

Informed Consent: retrospective analysis on iRB approved protocol.

Poster No. *C-36

Abstract No. 2023-127

Category: Clinical

Research Topic: Osteopathic Philosophy

Student Utilization of Osteopathic Manipulative Treatments on Clinical Rotations

Claudia Nelson, OMS-IV; Gabrielle Dean, OMS-IV; Dayton Dean, OMS-IV; Eric Martinez; Edward Goering, DO, DVM

Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine Department, Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Oregon

Statement of Significance: WesternU provides approximately 220 hours of hands-on training in osteopathic manipulative treatments (OMT) to first and second-year osteopathic medical students. One way to quantify student success is through assessment scores during these pre-clinical years, but the ultimate goal is for students to take the concepts and principles learned and apply them during their clinical years.

To determine whether osteopathic medical students are utilizing OMT while on clinical rotations, and which modalities they are using most commonly.

Research Methods: An investigative survey was distributed via WesternU email addresses to the osteopathic medical students in the classes of 2023 and 2024 (DO2023 and DO2024, respectively) on both the Pomona, CA, and Lebanon, OR, campuses. These classes were included as they were the only two classes on clinical rotations at the time of survey disbursement. The survey results were analyzed using IBM SPSS Statistics 28.0.1.1 (14). Frequency tables were created examining student responses to whether they utilized OMT on clinical rotations outside of the required osteopathic manipulative medicine (OMM) rotation, which rotations students chose to utilize OMT, and which modalities they utilized the most and the least. The frequencies were then stratified by class (DO2023 versus DO2024) and campus (Lebanon versus Pomona), with each of these groupings being compared via a chi-squared analysis. Graphical representations were made to illustrate the findings more clearly. Gaining a clear understanding of the use of OMT outside of OMM rotations and what specific modalities are being utilized the most will better inform pre-clinical instructors of what needs to be emphasized more in pre-clinical curriculum and what modalities are actually being utilized outside of the classroom.

Data Analysis: Approximately 600 students were sent the investigative survey and 50 responses were received for a final survey response rate of 8.3% (n=50). Of the 50 respondents, 42% were in the DO2023 class, 58% were in the DO2024 class, 76% were enrolled at the Lebanon campus, and 24% were enrolled at the Pomona campus. Of the total 50 respondents, 72% indicated they utilized OMT outside of the required OMM rotation with the most common rotations being family medicine (71.4%), internal medicine (48.6%), and pediatrics (31.4%). When analyzing student utilization of OMT on clinical rotations outside of the required OMM rotation, there was no significant association to be found between the classes (Pearson Chi-Square = 0.315) or between the campuses (Pearson Chi-Square = 0.070). During the pre-clinical OMM curriculum, students are taught soft tissue, articulatory, muscle energy, high velocity-low amplitude (HVLA), counterstrain, lymphatics, myofascial release, balanced ligamentous tension, Still’s, cranial, and visceral techniques. Of these various modalities, counterstrain and soft tissue techniques were used the most (48.8% and 43.9%, respectively), and HVLA and cranial techniques were used the least (58.5% and 53.7%, respectively).

Conclusion: The fact that 72% of respondents are utilizing OMT outside of the required OMM rotation is indicative that students are finding ways to incorporate OMT when embarking on clinical rotations. However, given the poor response rate it is possible that these numbers are skewed and the results inherently biased. Interestingly, there was no significant association between classes or campuses. This could be an indication that the pre-clinical curriculum is maintained well across years and campuses, however more research is needed to further investigate this. Regarding the OMT modalities that were used the most and the least by the respondents, HVLA and cranial techniques are the least used. This poses the question of whether the pre-clinical curriculum could be improved to better educate on appropriate and efficacious clinical applications of these modalities. More investigation is needed into why certain modalities are utilized while others are not as it could help to better inform instructors on how to design future pre-clinical curriculum.

WesternU provides approximately 220 hours of hands-on training in osteopathic manipulative treatments (OMT) to first and second-year osteopathic medical students. One way to quantify student success is through assessment scores during these pre-clinical years, but the ultimate goal is for students to take the concepts and principles learned and apply them during their clinical years. Previous studies have evaluated student use of OMT on specific rotations, with Internal Medicine, Pediatrics, and Surgical rotations citing the lowest utilization of OMT(1). Other studies have investigated how often students were likely to suggest using OMT based on their physical examination and documentation(2), and Vazzana et al.(3), investigated whether early clinical exposure to OMT in first and second-year students led to student perceptions and attitudes towards the utilization of OMT on clinical rotations. While these studies have investigated the use of OMT in various settings and the perceptions towards the use of OMT in practice, they have failed to identify what specific OMT modalities were used most and within which particular rotation.

References

1. Gamber RG, Gish EE, Herron KM. Student perceptions of osteopathic manipulative treatment after completing a manipulative medicine rotation. J Am Osteopath Assoc. 2001 Jul;101(7):395-400. doi: 10.7556/jaoa.2001.101.7.395. PMID: 11476030.

2. Chamberlain NR, Yates HA. A prospective study of osteopathic medical students’ attitudes toward use of osteopathic manipulative treatment in caring for patients. J Am Osteopath Assoc. 2003 Oct;103(10):470-8. PMID: 14620081.

3. Vazzana KM, Yao SC, Jung MK, Terzella MJ. Perception-based effects of clinical exposure to osteopathic manipulative treatment on first- and second-year osteopathic medical students. J Am Osteopath Assoc. 2014 Jul;114(7):572-80. doi: 10.7556/jaoa.2014.111. PMID: 25002450.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Approved with Exempt Review (IRB# X22/IRB/085).

Informed Consent: The first question of the research survey described the nature of the research, explained that the respondent could withdraw from the submission process at any time, and by "clicking the next button" were consenting to begin the survey response process.

Poster No. C-37

Abstract No. 2023-131

Category: Clinical

Research Topic: Osteopathic Philosophy

Residency Bootcamp: Is It an Effective Tool to Help Transition Graduating Medical Students?

¹Chaya J. Prasad, MD; ²Jesus Sanchez, DO; ³Fanglong Dong

¹ Department of Clinical Sciences, Western University of Health Sciences College of Osteopathic Medicine of the Pacific; ² Department of Osteopathic Manipulative Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific; ³ Department of Basic Sciences, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Statement of Significance: Medical school curriculum emphasizes knowledge base rather than basic clinical skills, such as writing admission/discharge orders, prescription orders, phone consults, handoffs, responding to pages, etc. Research has demonstrated a gap between what residency program directors expect and what newly graduated physicians can do. Incoming residents also struggle with soft skills, such as time management, teamwork, resiliency and wellness, professionalism, etc.

To determine the efficacy of a residency bootcamp for graduating OMS 4 students, a pilot project was created. We wished to identify students’ strengths and assess where they needed improvement. We also wanted to assess the students’ competency and confidence levels after the attending the Residency Boot Camp. For these reasons we created a pilot project, the Residency Boot Camp, to assess graduating students’ competency in clinical and soft skills.

Research Methods: A Residency Boot Camp committee was established consisting of members of all core specialties, with support from the vice dean, associate dean of clinical education and assistant dean of academic affairs. Topics and speakers were determined by the committee members with input from residency program directors. A 1-day Residency Boot Camp was offered to all OMS 4 students, as a requirement for graduation. A hybrid model was used with pre-recorded videos and live virtual panel discussions with PGY 1 and 2 residents. Speakers included both faculty and residents. Specialty specific breakout sessions were also offered. On completion of the sessions, students voluntarily completed a survey. Survey questions assessed levels of confidence in basic clinical skills and handling of commonly encountered clinical scenarios.

Data Analysis: The survey was completed by 186/347 participants. On completion of the Residency Boot Camp, participants agreed that they were comfortable/confident with: developing their own clinical questions (81.7%), triaging sick/not sick patients (80.7%), presentation of patients (79.0%), recognizing abnormal vital signs (88.7%), recognizing changes that require immediate attention (81.8%), requesting specialty consultations (78.5%), handling specialty consultations (70.4%), communicating effectively with patients/family (88.2%), incorporating feedback into daily practice (87.1%), clinical documentation (83.9%), patient sign-out (78.0%), managing common clinical scenarios (83.3%), caring for patients in the clinic (79.0%) and hospital (77.4%), when to seek senior help (76.3%), their own resiliency skills (79.6%) and about sources of help when feeling overwhelmed (78.5%). The Residency Boot Camp had both faculty and resident speakers. 75.3% of the students wanted to see more resident presentations and 67.2% of the students were satisfied with the pilot and recommended the Residency Boot Camp to the next graduating class.

Conclusion: Residency is an intense experience for most incoming residents. Research has shown that there is a gap between what residency program directors expect and what an incoming resident/intern can do. This is particularly true with several EPAs such as writing prescription orders, admission/discharge/consult notes, addressing handoffs, pages, etc. Soft skills such as resiliency/wellness, time management, communication skills are also needed before starting residency programs. The pilot was informative to both students and faculty. Faculty were able to identify clinical skills that they could help students develop in the 3rd and 4th year of medical school training. We were also able to identify areas to build on in the upcoming years. Graduating g students were better prepared in many of the clinical skills and soft skills arena after attending the Residency Boot Camp. A Residency Bootcamp Camp serves to reinforce learned skills and teach those that may not have been addressed. It helps shape the transition from medical school to residency. It helps increase competency and confidence of graduating students. It is most effective when the presentations are offered in consultation with residency program directors and when they are offered by PGY 1 or 2 residents. A Residency Boot Camp helps identify areas of deficiency that can be addressed for future graduating class of students.

References

1. Farr DE, Zeh HJ, Abdelfattah KR. Virtual Boot Camps—An Emerging Solution to the Undergraduate Medical Education–Graduate Medical Education Transition. JAMA Surg. 2021;156(3):282–283. doi:10.1001/jamasurg.2020.6162

2. Mims D, Porter M, Simpson KN, Carek PJ. The “July Effect”: A Look at July Medical Admissions in Teaching Hospitals. The Journal of the American Board of Family Medicine. 2017; 30(2): 189–195. https://doi.org/10.3122/jabfm.2017.02.160214

3. Lypson ML, Frohna JG, Gruppen LD, Woolliscroft JO. Assessing Residents’ Competencies at Baseline: Identifying the Gaps. Academic Medicine. 2004; 79(6): 564–5703. https://doi.org/10.1097/00001888-200406000-00013

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Full IRB approval was obtained from Western University of Health Sciences IRB committee 1895603-1.

Informed Consent: Subjects were informed via email that participation was voluntary and completion and submission of the survey indicated informed consent.

Poster No. *C-38

Abstract No. 2023-135

Category: Clinical

Research Topic: Impact of OMM & OMT

Assessing Correlation Between Manual Dexterity, Specialty Choice and Desire to Practice OMT in Newly Admitted Osteopathic Medical Students

Valerie Rome, OMS-III; Nils Brolis, DO

Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Is there any relationship between manual dexterity, specialty choice, and the use of osteopathic manipulative treatment (OMT) in newly-admitted osteopathic medical students? Hand dexterity has previously been associated with surgical skill development in medical residents.1-5 There is currently a gap in the scientific literature in regards to the use of one’s hands and the career choice they ultimately pursue, in addition to interest in performing OMT in their respective fields.1-5

To help elucidate the answer to this question, this SMRF project aimed to evaluate the relationship between manual dexterity, specialty choice, and use of osteopathic manipulative treatment (OMT) in newly-admitted osteopathic medical students. Therefore, this project explored whether inherent hand dexterity has any influence on medical career path or incorporation of osteopathic skills.

Research Methods: 30 newly admitted RowanSOM students were assessed on their ability to “use one’s hands,” as represented by hand dexterity, with a timed-Purdue pegboard assessment.6,7 Time taken to complete the dexterity test was recorded, with shorter times correlating to better scores. 6,7 These students then took a survey to gauge their specialty interest and desire to perform OMT as future physicians. For the surveys, the “desire to practice OMT” and “the desire to pursue a surgical specialty” were quantified via a score on a scale from -2 to 2. The relationship between specialty/OMT interest and hand testing was thus explored. Furthermore, this project explored whether inherent hand dexterity has any influence on medical career path or incorporation of osteopathic skills. Statistical analysis of the data collected was conducted under the guidance of Dr.Steer using SPSS software.

Data Analysis: The data collected qualified for analysis via non-parametric statistics. The sample size consisted of 30 newly admitted RowanSOM prematriculation program students. 17 of the subjects were women and 13 were men. The average age of the subjects was 24.37 ± 2.798 years old. Hand dexterity was measured via time to complete the Perdue Pegboard exercise. Interest in a surgical specialty and interest in OMT were measured with a scored survey on a scale from -2 to 2. The following key was used: Strongly Disagree = -2, Disagree = -1, Neither Agree nor Disagree = 0, Agree = 1, Strongly Agree = 2. Dominant hand proficiency in the assembly task was positively correlated with an interest in performing OMT. This was evidenced by a positive Pearson correlation between better scores on the assembly task and being interested in OMT. The Pearson Correlation value was 0.371 and the p-value was 0.044. Therefore, a statistically significant correlation was found between better times to complete the Perdue Pegboard hand dexterity test and interest in OMT.

Conclusion: This project explored whether inherent hand dexterity has any influence on medical career path or incorporation of osteopathic skills. A statistically significant correlation was found between better times to complete the Perdue Pegboard hand dexterity test and interest in OMT. The collected data supports the claim that there is a positive correlation between hand dexterity and interest in performing OMT. This project can be repeated on a larger scale to see if these results are reproducible. If this correlation is supported by subsequent trials, this has the potential to influence the type of candidate medical school’s hope to recruit and the skills which are developed in both undergraduate pipeline programs and in the preclinical years.

References

1. JardineD,HoaglandB,PerezA,GesslerE.EvaluationofSurgicalDexterityDuringtheInterview Day: Another Factor for Consideration. J Grad Med Educ. 2015;7(2):234-237. doi:10.4300/JGME-D- 14-00546.1

2. GoldbergAE,NeifeldJP,WolfeLG,GoldbergSR.CorrelationofmanualdexteritywithUSMLE scores and medical student class rank. J Surg Res. 2008;147(2):212-215. doi:10.1016/j.jss.2008.02.050

3. Lugassy D,Levanon Y,Pilo R, etal. Predictingtheclinical performance of dentalstudentswitha manual dexterity test. PLoS One. 2018;13(3):e0193980. Published 2018 Mar 8. doi:10.1371/journal.pone.0193980

4. Constansia RDN, Hentzen JEKR, Buis CI, Klaase JM, deMeijer VE, Meerdink M. Issurgical subspecialization associated with hand grip strength and manual dexterity? A cross-sectional study. Ann Med Surg (Lond). 2021;73:103159. Published 2021 Dec 7. doi:10.1016/j.amsu.2021.103159

5. Causby R, Reed L, McDonnell M, Hillier S. Use of objective psychomotortests in health professionals. Percept Mot Skills. 2014;118(3):765-804. doi:10.2466/25.27.PMS.118k27w2

6. Proud EL, Bilney B, Miller KJ, Morris ME, McGinley JL. MeasuringH and Dexterityin People With Parkinson’s Disease: Reliability of Pegboard Tests. Am J Occup Ther. 2019;73(4):7304205050p1- 7304205050p8. doi:10.5014/ajot.2019.031112

7. Rule K, FerroJ, Hoffman A, etal. Purdue manual dexterity testing: Acohort study of community- dwelling elderly. J Hand Ther. 2021;34(1):116-120. doi:10.1016/j.jht.2019.12.006

Financial Disclosures: None reported.

Support: Internally funded through the Rowan Family Medicine Department and SMRF (Summer Medical Research Fellowship) program.

Ethical Approval: IRB #: PRO-2022-165, Title: Assessing Correlation between Manual Dexterity, Specialty Choice and Desire to Practice OMT in Newly Admitted Osteopathic Medical Students, was reviewed and approved by the RowanSOM IRB.

Informed Consent: All subjects signed an informed consent form: You are being asked to take part in a research study. The purpose of items 1-10 is to provide clear key information about the purpose of the study, study specific information about what will happen in the course of the study, what are the anticipated risks and benefits, and what alternatives are available to you if you do not wish to participate in this research study. The study team will explain the study to you and will answer any questions you might have before volunteering to take part in this study. If you have questions at any time during the research study, you should feel free to ask the study team and should expect to be given answers that you completely understand. After all of your questions have been answered, if you still wish to take part in the study, you will be asked to sign this informed consent form. You are not giving up any of your legal rights by volunteering for this research study or by signing this consent form.

Poster No. *C-40

Abstract No. 2023-141

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Vitamin D Status among US Adults with Psoriasis: An Analysis of NHANES 2009-2014 Data

¹Charles Liam Pillus, OMS-I; ²Aurel S. Apple, DO; ²Cindy Hoffman, DO

¹New York Institute of Technology; ²Department of Dermatology, St. Barnabas Hospital, Bronx, NY

Statement of Significance: Psoriasis is a chronic skin disease caused by immune system dysfunction and affects an estimated 3% of adults in the United States [1]. Treatment of psoriasis includes topical vitamin D, ultraviolet light, and systemic medications. However, current dietary recommendations for adults with psoriasis do not recommend vitamin D supplementation for the prevention or treatment of psoriasis in adults with normal vitamin D levels [2].

To describe the vitamin D status of US adults with psoriasis both overall and based on their use of a dietary supplement containing Vitamin D. Published literature suggests a large percentage of patients with psoriasis take vitamin D-containing dietary supplements but to our knowledge, there is limited research describing serum vitamin D levels among a nationally representative sample of US adults with psoriasis by their use of a dietary supplement containing vitamin D [3,4].

Research Methods: This cross-sectional analysis used public data from the National Center for Health Statistics’ 2009-2014 National Health and Nutrition Examination Survey (NHANES), nationally representative samples of noninstitutionalized US adults. Participants who self-reported their psoriasis diagnosis and who had complete dietary supplement recall and serum vitamin D data (n=463) were included. Vitamin D supplement users were identified as individuals whose mean daily Vitamin D supplement intake over the preceding 30 days was greater than 0 micrograms. Ultra-high performance liquid chromatography-tandem mass spectrometry was used to quantify the serum concentration of total 25-hydroxyvitamin D (25(OH)D), which is considered the best indicator of vitamin D status from dietary, supplemental, and cutaneous sources [5]. For this analysis, the 25(OH)D cut-points of 30 nmol/L (consistent with at-risk of deficiency), 50 nmol/L (consistent with at-risk of insufficiency), and 125 nmol/L (associated with adverse Vitamin D effects) were selected based on the National Academies of Science, Engineering, and Medicine recommendations [6]. Weighted analyses were performed using R statistical software (R Core Team, 2023), and the Survey package (4.1) to account for NHANES’ complex design. Logistic regression analysis was used to examine adjusted associations between 25(OH)D≲50 nmol/L and age, race/ethnicity, income, gender, time of year, and use of a vitamin D-containing dietary supplement. The NHANES study design and sampling methodology has been reported elsewhere [7].

Data Analysis: Overall, 41.0% (95% Confidence Interval (CI): 35.1 - 47.2) of adults in the US with psoriasis reported the use of a dietary supplement containing Vitamin D (Table 1). Adults with psoriasis who did not use supplements containing Vitamin D had significantly lower serum 25(OH)D levels (mean: 64.1 nmol/L, 95% CI: 60.4 - 67.9) compared to those using vitamin D supplements (mean: 85.1 nmol/L, 95% CI: 80.2 - 90.0) (p<0.001, Table 2). Overall, the prevalence of Vitamin D levels ≤30 nmol/L and ≤50 nmol/L was 4.4% (95% CI: 3.2 - 6.0) and 23.1% ( 95% CI: 18.4 - 28.5), respectively. Among those who did not report the use of a supplement containing vitamin D, over one-third had a vitamin D level ≤50 nmol/L (35.7%, 95% CI: 28.0 - 44.2). Moreover, 5.2% (95% CI: 3.0 - 9.0) of participants had vitamin D levels ≥ 125 nmol/L, with no significant difference between those who reported using or not using Vitamin D-containing supplements (p>0.6).

After controlling for age, income, gender, time of year, and vitamin D supplementation in a logistic regression model, Mexican American (adjusted odds ratio (aOR): 4.01, 95% CI: 1.98 - 8.11) and Non-Hispanic Black (aOR 2.64, 95% CI: 1.13 - 6.19) participants had significantly higher aOR of a vitamin D serum level ≤ 50 nmol/L than Non-Hispanic White participants (Table 3.2). Compared to participants reporting no use, those who reported use of a supplement containing Vitamin D had significantly lower aOR of a vitamin D serum level ≤ 50 nmol/L (aOR=0.08, 95% CI: 0.03-0.27).

Conclusion: The results of our study highlight the importance for clinicians to consider the assessment of vitamin D levels in adults with psoriasis. Among US adults with psoriasis, almost half reported the use of vitamin D-containing dietary supplements, and approximately one-quarter had a vitamin D serum concentration consistent with being at-risk for Vitamin D deficiency or insufficiency. Limitations of our study include the self-reported nature of both supplementation behaviors and psoriasis diagnosis. Additional research is needed to better understand the impact of vitamin D supplementation on psoriasis severity and treatment outcomes. Nonetheless, our study provides insights into the dietary supplementation behaviors of adults with psoriasis and highlights the need for clinicians to consider this intervention in the care of their patients with psoriasis.

References

1. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatology. 2021;157(8):940. https://doi.org/10.1001/jamadermatol.2021.2007

2. Ford AR, Siegel M, Bagel J, et al. Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatology. 2018;154(8):934-950. https://doi.org/10.1001/jamadermatol.2018.1412

3. Afifi L, Danesh MJ, Lee KM, et al. Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatology and Therapy. 2017;7(2):227-242. https://doi.org/10.1007/s13555-017-0183-4

4. Wilson PB. Serum 25-hydroxyvitamin D status in individuals with psoriasis in the general population. Endocrine. 2013;44(2):537-539. https://doi.org/10.1007/s12020-013-9989-8

5. Calcium I of M (US) C to RDRI for VD and, Ross AC, Taylor CL, Yaktine AL, Valle HBD. Overview of Vitamin D. www.ncbi.nlm.nih.gov. Published 2011. Accessed June 19, 2023. https://www.ncbi.nlm.nih.gov/books/NBK56061

6. National Institute of Health. Office of Dietary Supplements - Vitamin D. Nih.gov. Published 2017. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en1

7. Curtin LR, Mohadjer LK, Dohrmann SM, et al. National Health and Nutrition Examination Survey: sample design, 2007-2010. Vital Health Stat 2. 2013;(160):1-23.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Approved by the National Center for Health Statistics (NCHS) Ethics Review Board; no additional approvals obtained since data is publicly available and de-identified.

Informed Consent: Obtained by NCHS.

Poster No. *C-41

Abstract No. 2023-145

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Altering IBS Symptoms

Zuka Al-Safarjalani, OMS-I

Edward Via College of Osteopathic Medicine-Auburn Branch Campus

Statement of Significance: The lack of time that healthcare systems allocate to each patient means insufficient research resources allocated for many conditions. Irritable Bowel Syndrome (IBS) affects 200,000 Americans yearly in the form of abdominal pain due to a malfunction between the nervous and digestive systems which triggers flareups. Monitoring a patient’s lifestyle, diet, and stressors can aid in achieving better control over one’s symptoms and long-term health.

To single out the trigger food in each participant’s diet as well as to see if a change in that diet may aid in decreasing their symptoms and finding a clear correlation between stress, age, and IBS.

Research Methods: Participants are surveyed daily and asked to log foods they consumed, if they experienced a stressful situation, and flare-ups occurrences. Participants were chosen through social media and can be considered a random selection given it is a random pool of participants who responded to the post. While 23 patients had originally participate, only 10 committed to all three phases properly. All participant information remained anonymous except age, gender, and other medical conditions. Over the course of nine weeks, participants entered three phases (P1-P3), each three weeks in length. P1 involved a normal logging of diet and stressful situations to determine any trends between these factors and IBS symptoms. P2 deprived them of foods that led to IBS flareups in P1. P3 consisted of returning to the original state to observe the benefits of removing trigger foods in P2. By using hypothesis testing, observing patterns between these factors allows for a personalized treatment plan for each patient and their individual needs. The osteopathic approach targets not only the digestive system and treating flareups, but also the mental health of a patient and preventing the triggering of such symptoms. Expanding the field of observation allows for more effective treatment of aggressive symptoms that are harder to treat but easier to prevent. While some flareup symptoms may last months at a time, preventing it only takes careful planning once proper adjustments are made to diet and lifestyle choices.

Data Analysis: Participants ranged from ages 19-51 and all ten participants were previously diagnosed with IBS. From the participants, 60% were female and 40% were male which also proves that IBS is more prevalent amongst females with a survey response rate of 43.48%. Results showed a high positive correlation between foods high in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) and IBS symptoms. Low FODMAP foods did not cause as much pain except when stressful conditions present themselves. While cutting out trigger foods in P2 allowed for a temporary decrease in symptoms, the reintroduction of these items back into diet did not have the full effect in P3 as they did in P1. This showed that the digestive system’s sensitivity changes from time to time and even with careful monitoring and preventative measures, one cannot always control the symptoms that come with IBS. However, this study provided a better explanation and more personalized treatment plan for every individual who participated which allowed them to hold more control over their illness and the negative ways it affects their life. As each participant responded differently to changes in diet and stressors, no clear conclusion could be made of what specific foods/levels of stress ignites flareups. While some learned to manage stress better, others learned what foods to avoid or portions of it they could handle. Age seemed to play a role as some who had the illness for longer periods of time had more experience with careful lifestyle choices and understanding how to manage their symptoms better, especially during periods of flareups.

Conclusion: This study was created to examine the impact that food and stress had on symptoms of Irritable Bowel Syndrome and if careful monitoring could produce a personalized treatment plan for patients to use as a preventative osteopathic remedy. Ten participants were chosen through a social media call to action and of those were 6 females and 4 males. The three phases consisted of survey-based analysis in which participants were asked to log their diet, stressful times, and pain levels daily for nine weeks. While P1&3 were normal states, P2 removed trigger foods which correlated with symptoms of IBS. After the completion of the study, a positive correlation was found between high FODMAP foods, stress, and pain levels of IBS symptoms. Each individual who participated received a more clear understanding of what they should avoid, in terms of food and stressors, to improve their lifestyle and not allow IBS to overwhelm them. Due to the reliance on pain receptors, it is difficult to assess how IBS is affecting patients since a constant study of the intestinal tract cannot be done alongside daily activities. In the future, it one may consider better options to find the specific factors that inflame each patient’s intestinal tissue such as liquifying foods and testing it against intestinal tissue to see if it provides a response.

References

1. Huebner E. Irritable bowel syndrome. American College of Gastroenterology. January 1 2022. Accessed June 26, 2023. https://gi.org/topics/irritable-bowel-syndrome/#tabs1.

Financial Disclosures: None reported.

Support: Research grant of $3,000 was awarded to complete this research. The faculty member who advised me took $500 to their department as compensation for their time. The rest of the $2,500 was used as compensation for the author’s time.

Ethical Approval: IRB Completion ID- 36555617 (Biomedical) & 36321668 (Social & behavioral)This study was deemed exempt after proper IRB training courses were completed and certified by the IRB and reviewed by my advisor.

Informed Consent: Each participant was emailed a consent form to sign, however this was done anonymously through the collection of Google forms. Participants were asked to consent to release their daily information over the course of nine weeks about their diet, stressors, and pain levels. No patients were forced to consume food or be put in a situation that may bring them harm.

Poster No. *C-42

Abstract No. 2023-146

Category: Clinical

Research Topic: Osteopathic Philosophy

AOA Grant Award: 2861807728

The Impact of a Novel Physical Activity Integration Program on Body Composition and Blood Lipids among Overweight Medical Students: Results from a Randomized Cross-over Trial

¹Robert Steinberg, OMS-III; ²Min-Kyung Jung, PhD; ¹Joanne Donoghue, PhD

¹Department of Osteopathic Manupulative Medicine, New York Institute of Technology; ²Department of Research, New York Institute of Technology

Statement of Significance: A major challenge medical students face is maintaining healthy dietary/lifestyle habits while in school. Although initiatives have been put in place to increase physicians’ activity counseling, there are no guidelines for integrating wellness education into medical school curriculums. Literature suggests that schools should incorporate programs to increase physical activity and wellness education, but how these programs are incorporated into osteopathic medical schools is still of question [1].

To examine the effectiveness of activity trackers alone vs combined with online educational modules in an attempt to improve physical activity levels and body composition in overweight medical students over the course of an academic year.

Research Methods: This mixed-model randomized crossover trial was funded by the American Osteopathic Association (AOA), approved by the NYIT IRB, and registered (NCT02778009). Forty subjects (20 men, 20 women) signed written consent. Inclusion criteria was 1st/2nd year medical students ages 18-35 with a Body Mass Index (BMI) of ≥ 25.0 and body fat >19% for men, >33% for women. Exclusion criteria included pregnancy, gastrointestinal disorders, and those taking weight loss medication. Subjects were randomly divided into 2 groups of 20. Group 1 received the intervention within the first 4 months of the academic year, and Group 2 received the intervention the following 4 months. This asked subjects to: 1.Record diet into MyFitnessPal™ app at least 3x a week trying to attain the calorie goal set by their resting metabolic rate (RMR) 2.Try to attain 8,000 steps/day 3.Try to attain Target Heart Rate for a minimum 20 minutes 3x/week 4.Complete online modules on lifestyle management 5.Receive weekly email reminders. Outcomes included: Step count (monitored with a FitbitⓇ Blaze smart watch), Fasting RMR (using oxygen consumption), blood lipids (cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), total cholesterol/HDL ratio, hemoglobin A1C), and body composition using dual x-ray absorptiometry(weight, body fat mass, body fat %, lean body mass (LBM),visceral fat, BMI). All outcome measures were tested in August, December, and May. Exit surveys were given regarding study perceptions. The primary outcome was physical activity based on step count, and secondary outcomes were body composition and blood biomarkers. A repeated measures ANOVA was used to analyze outcome measures with a Bonferroni post hoc analysis when significance was found (p<0.05). Analyzing trends in activity and metabolic data throughout the preclinical years of medical school can help assess the need for interventions to improve the wellbeing of future osteopathic physicians.

Data Analysis: Forty participants consisting of 20 men and 20 women (average age 25.0 +/- 4.9) completed the study and were analyzed. Group 1 had a significantly higher step count in the intervention period vs non-intervention period (5935.5 steps(CI 95% - 4645.5, 7583.6) to 4368.4 steps(CI - 3222.2, 5922.3), p<0.001). Group 2 had no significant change in step count during the intervention period (4454.7 steps(CI - 3687.0, 5382.1) to 4257.2 steps(CI - 3372.7, 5373.8), p=0.45). Group 1 had no change in LBM during the intervention, but showed a significant increase following the non-intervention period (pre- 51.3 +/- 2.0 kg, end of fall semester- 51.3 +/- 1.9 kg, end of spring semester- 52.2 +/- 2.0 kg), p=0.001). Group 2 experienced no change in LBM throughout the duration of the study (p=0.35). Group 2 showed a significant increase in TG following their intervention period (pre- 84.1 +/- 13.4, end of fall semester- 83.0 +/- 9.4, end of spring semester- 102.51 +/- 4.9, p= 0.001). Group 1 had no change in TG throughout the duration of the study, p=0.42. There was no significant change in any other blood lipids, A1C, or RMR in both groups for the duration of the study. The results of the exit survey revealed that 46% of participants felt school commitments prevented full participation in the study, and 40% found it difficult to eat within the recommended calorie range. However, 71% of participants found that logging their diets helped them understand their diet better, and 87% of participants felt the smartwatch had a positive impact on their motivation to stay active. Unfortunately, the self-reported impact of the exit interviews was not reflected in the outcome results.

Conclusion: Medical students find it difficult to remain active due to their rigorous schedules, putting them at risk for future health problems[2-3]. It’s widely accepted that medical schools need to incorporate programs to promote student wellness, but we are still unsure how this can be done most effectively. Our data revealed that only group 1, who received the intervention at the start of the study, experienced a significant increase in step count. Group 1 also experienced an increase in LBM during the second half of this study, whereas group 2 had no change. This may be attributed to the fact that medical students have difficulty altering their routines to include more activity once they are established at the beginning of the year. Even though group 1 experienced the increase in LBM after the intervention, it’s likely that these students were able to maintain higher levels of activity since it was already habitual due to the intervention. The largest limitation of this study was compliance. There was only 35% compliance with the online modules for the fall semester, and 28% compliance in the spring semester. Being this study was conducted in New York, the climate of this region is an additional limitation. Group 1 began the intervention in August, and group 2 began the intervention in January. Average temperatures in New York are up to 50 degrees warmer in August, which is more conducive for outdoor activities. Future studies should look to control for variation in weather as a potential confound. Our overall findings suggest that medical students will likely struggle to: 1. Adhere to any program that is outside of their curriculum 2. Change their habitual routines once the academic year is underway. In conclusion, implementing interventions at the start of the medical school year demonstrated a favorable effect on activity levels among medical students. However, there was no observed change in activity when interventions were introduced midway through the year.

References

1. Frank E, Tong E, Lobelo F, Carrera J, Duperly J. Physical activity levels and counseling practices of U.S. medical students. Med Sci Sports Exerc. 2008;40(3):413-421. doi:10.1249/MSS.0b013e31815ff399

2. Stephens MB, Cochran C, Hall JM, Olsen C. Physical fitness during medical school: a 4-year study at the Uniformed Services University. Fam Med. 2012;44(10):694-697.

3. Dacey, Marie & Kennedy, Mary & Polak, Rani & Phillips, Edward. (2014). Physical activity counseling in medical school education: A systematic review. Medical Education Online. 19. 24325. 10.3402/meo.v19.24325.

Financial Disclosures: None reported.

Support: This study was conducted on behalf of a grant from the American Osteopathic Association (AOA); Grant #2861807728. Grant funding was used to purchase Fitbit activity trackers and fund faculty/staff support. Subjects were also compensated for completion of the study.

Ethical Approval: This study was reviewed and fully approved by NYIT’s IRB (BHS-1333). This study was also registered as a clinical trial (#NCT02778009)

Informed Consent: All subjects signed written consent prior to participation. Subjects received copies of their signed consent forms.

Poster No. *C-43

Abstract No. 2023-150

Category: Clinical

Research Topic: Musculoskeletal Injuries and Prevention

The Relationship Between Fitness and Injury Among ROTC Cadets

¹Swetha Sundaram, OMS-II; ¹Arpun Shah, MPH; ¹Usman Yaqoob, MS; ²Scott Dankel, PhD; ¹Altamash Raja, DO; ²Jennifer Longo, PhD

¹Neuromusculoskeletal Institute, Rowan-Virtua School of Osteopathic Medicine; ²Department of Exercise Science, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Existing research demonstrates an association between physical fitness and injury incidence using the Army Physical Fitness Test (APFT) to measure fitness. However, the Army has recently transitioned to the Army Combat Fitness Test (ACFT), which is designed to replicate the physical demands of soldiers. The APFT lacked measures of strength and power, and thus did not evaluate aspects of functional fitness.

(Context Cntd): Additionally, there are inconsistencies when comparing performance data between the APFT and ACFT, therefore it cannot be concluded that the fitness and injury relationships established by the APFT translate to the ACFT.

Objective: The purpose of the study was to evaluate ACFT performance differences based on injury incidence in Army Reserve Officers’ Training Corps (ROTC) cadets. A secondary purpose was to document injury locations and their impact on athletic performance.

Research Methods: Army ROTC cadets (n=30) were recruited to participate in this study. The modified version of the Oslo Sports Trauma Research Center Overuse Injury Questionnaire was administered monthly throughout the study period (5 months). The ACFT was conducted and scores for participating cadets were collected.

Data Analysis: The majority of reported injuries involved the lower extremity and spine, with few involving the upper extremities. Independent t-tests were conducted using presence of pain as the independent variable and performance on the ACFT as the dependent variables. No statistically significant differences were found in performance between those with pain and those without pain (p>.05 for all components of the ACFT).

Conclusion: While the results of this study did not reveal significant differences in injury risk based on presence of pain, it is important to note the relatively short duration of surveillance. There is a need for additional research over a longer study window as identifying injury risk factors early in the military career may be useful for mitigating injury risk later.

References

References can be provided upon request.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was approved by the Institutional Review Board. IRB #: PRO-2023-4.

Informed Consent: Study information was typed out on a document, and all participants granted their consent to take part in the study after reading the document.

Poster No. C-44

Abstract No. 2023-153

Category: Clinical

Research Topic: Osteopathic Philosophy

Medical Students’ Attitudes on Practicing Intravenous Insertion on Each Other

Risa Nicole Kiernan, DO, MS; Michael Gindi; Shannon Smith

Department of Clinical Sciences, New York Institute of Technology

Statement of Significance: Recently, there has been a shift in medical education from learning procedures on live subjects to learning procedures on simulation manikins (1-7).

Our study investigated students’ attitudes regarding IV insertion training with focus on anxiety, empathy, and learning preferences.

Research Methods: A 24-question IRB exempt survey was emailed to 1,174 1st – 4th year New York Institute of Technology College of Osteopathic Medicine (NYITCOM) students from the New York and Arkansas campuses. Spearman’s rank correlation coefficient was determined to identify relationships between questions. The following were addressed: safety of IV insertion, willingness to place an IV on a fellow student, willingness to have an IV placed on themselves by a fellow student, attitudes about IV insertions on manikins versus people, and levels of confidence and anxiety regarding inserting IVs on manikins and people. The practice of hands on simulation has osteopathic significance because the science of osteopathy is also taught through a hands-on approach.

Data Analysis: There was a high negative correlation between students feeling anxious having a medical student practice IV placement on themselves and willingness to have an IV inserted on themselves by another student (-0.70). There was a moderate negative correlation (-0.56) between students feeling anxious having an IV placed on themselves and willingness to have an IV inserted on them. There was a moderate positive correlation (0.51) between students feeling anxious having a student practice IV placement on themselves and students who would rather all practice be done on manikins. There was a moderate positive correlation (0.65) between students who believe they can learn empathy by having a classmate practice IV insertion on themselves and willingness to have an IV inserted in them. There was a moderate positive correlation between students who believe they can learn empathy by practicing IV insertion on a classmate and willingness to have an IV inserted on them (0.50).

Conclusion: For learning a painful procedure such as IV insertion, students prefer a combination of simulation and person-based learning. This strategy reportedly mitigates anxiety while enhancing empathy skills.

References

1. The Core Entrustable Professional Activities (EPAs) for entering residency. AAMC. Accessed June 27, 2023. http://www.aamc.org/what-we-do/mission-areas/medical-education/cbme/core-epas

2. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86(6):706-711. doi:10.1097/ACM.0b013e318217e119

3. Weersink K, Hall AK, Rich J, Szulewski A, Dagnone JD. Simulation versus real-world performance: a direct comparison of emergency medicine resident resuscitation entrustment scoring. Adv Simul. 2019;4(1):9. doi:10.1186/s41077-019-0099-4

4. Bowyer MW, Pimentel EA, Fellows JB, et al. Teaching intravenous cannulation to medical students: comparative analysis of two simulators and two traditional educational approaches. Stud Health Technol Inform. 2005;111:57-63.

5. Jung EY, Park DK, Lee YH, Jo HS, Lim YS, Park RW. Evaluation of practical exercises using an intravenous simulator incorporating virtual reality and haptics device technologies. Nurse Educ Today. 2012;32(4):458-463. doi:10.1016/j.nedt.2011.05.012

6. Kneebone R, Nestel D, Wetzel C, et al. The human face of simulation: patient-focused simulation training. Acad Med. 2006;81(10):919-924. doi:10.1097/01.ACM.0000238323.73623.c2

7. Woelfel IA, Takabe K. Successful intravenous catheterization by medical students. J Surg Res. 2016;204(2):351-360. doi:10.1016/j.jss.2016.05.004

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was approved by the New York Institute of Technology Institutional Review Board as an exempted study.

Informed Consent: Subjects were recruited through the NYITCOM Student Database. The survey was administered electronically on the secure web application Red Cap (Nashville, TN). Participation was voluntary and responses were kept anonymous and confidential.

Poster No. *C-45

Abstract No. 2023-154

Category: Clinical

Research Topic: Acute and Chronic Pain Management

Chronic Myofascial Pain Elimination through Trauma-Informed Autonomic Recalibration

¹Rishika Pandey, OMS-III; ²Drew Logullo; ²Robert J. Sexton; ²Natalie Saliba; ²William G. Pearson, Jr. PhD

¹Department of Anatomy, Edward Via College of Osteopathic Medicine-Auburn Branch Campus; ²Edward Via College of Osteopathic Medicine-Auburn Branch Campus

Statement of Significance: The autonomic nervous system has a well-known, integral role in both acute and chronic pain modulation^1–4. Autonomic Recalibration is a treatment paradigm that aims to eliminate chronic myofascial pain by using manual manipulation techniques that target patterns of sympathetic dominance identified by palpation and trauma history. This study aims to evaluate changes in pain and autonomic measurements in subjects after two days of treatment with the Autonomic Recalibration technique.

To determine if the Autonomic Recalibration treatment can effectively reduce myofascial pain by manipulating the autonomic nervous system.

Research Methods: Eighteen adult respondents who reported experiencing persistent dysfunctional myofascial pain in the neck or upper back were recruited for a two-day study. Volunteers with myofascial pain that is deemed functional (normal response to acute injury or ongoing pathology) were excluded from the study. This study required obtaining a detailed trauma history from each subject on Day 1, and a palpatory exam was conducted at the beginning of each day to identify areas of sympathetic dominance using nociceptive points. Then, multiple manual techniques were employed in the manipulation of the autonomic system to mitigate patterns of sympathetic dominance and ultimately reduce myofascial pain. For this study, three variables were compared: pain scale ratings, number of nociceptive points, and galvanic skin response (GSR). Pain ratings were recorded on a verbal analog scale from 1-10 before treatment on both days. Nociceptive points were identified using a comprehensive head-to-toe palpatory exam at the start of each treatment on both days. GSR served as a marker of autonomic change using wearable sensors on subjects during treatment on both days. These domains were chosen to obtain an evaluation of both subjective interpretations of pain and physiologic measurements of autonomic changes.

Data Analysis: Reported pain scale ratings from all subjects decreased from a pre-treatment average of 3.72 to post-treatment average of 0.33. Notably, only one subject reported any pain following treatment. The number of nociceptive points identified also dropped significantly over the course of treatment. We found that the average number of identified points from Day 1 was 12.83 per subject, and the average from Day 2 was 6.22 per subject; chi-square analysis shows p <0.0001 in reduction of nociceptive points from Day 1 to Day 2. Finally, to assess changes in sympathetic dominance, we compared two variables related to GSR: number of peak responses during treatment and the mean amplitude of peaks per day. There was a significant decrease in the number of peaks from 202 peaks on Day 1 to 133 peaks on Day 2 (p <0.0001 using chi square analysis). Similarly, mean amplitudes showed a significant decrease from 0.103 µS on Day 1 to 0.065 µS on Day 2 (p = 0.003 using 2-tailed t-test).

Conclusion: Autonomic Recalibration effectively mitigated chronic myofascial pain by reducing sympathetic dominance in a small sample of eighteen subjects. All three measurements of pain and sympathetic dominance that were measured in this study, including pain scale ratings, nociceptive points, and GSR, were shown to significantly decrease over the course of a two-day treatment. Notably, seventeen subjects reported no pain on Day 2 after receiving initial treatment. This technique offers a novel method of addressing chronic myofascial pain resulting from patterns of sympathetic hypervigilance created in response to prior trauma.

References

1. Schlereth, T., Birklein, F. The Sympathetic Nervous System and Pain. Neuromol Med 10, 141–147 (2008). https://doi.org/10.1007/s12017-007-8018-6

2. Hallman, D., & Lyskov, E. (2012). Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring. International Journal of Psychophysiology, 86(3), 276–282. https://doi.org/10.1016/j.ijpsycho.2012.09.017

3. Tracy, L. M., Ioannou, L., Baker, K. K., Gibson, S., Georgiou-Karistianis, N., & Giummarra, M. J. (2016). Meta-analytic evidence for decreased heart rate variability in chronic pain implicating parasympathetic nervous system dysregulation. Pain, 157(1), 7–29. https://doi.org/10.1097/j.pain.0000000000000360

4. Singh, K., García-Gomar, M. G., Cauzzo, S., Staab, J. P., Indovina, I., & Bianciardi, M. (2022). Structural connectivity of autonomic, pain, limbic, and sensory brainstem nuclei in living humans based on 7 Tesla and 3 Tesla MRI. Human Brain Mapping, 43(10), 3086–3112. https://doi.org/10.1002/hbm.25836

Financial Disclosures: None reported.

Support: "Autonomic Recalibration Approach to Myofascial Pain Elimination" was funded by VCOM REAP Grant AY2023.

Ethical Approval: This project was reviewed and approved by the Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA (Board Ref # 2022-058). The IRB number is 1952163 with the title "Autonomic Realignment Approach to Myofascial Pain Elimination", and it was approved on 03/06/2023.

Informed Consent: Potential subjects responded to an ad and went through prescreening with the research coordinator. Subjects who met criteria met with the PI for informed consent at VCOM Auburn. Once the informed consent process was complete and questions were answered, subjects signed a consent form for up to a week following the consent meeting. Once a signed consent form was provided, it was kept in a locked filing cabinet in the office of the PI. Then the subject was scheduled by the research coordinator for one session of data collection on two consecutive days. Subjects were not scheduled for the study until the consent form was signed. Subjects could opt out of the study at any time.

Poster No. C-46

Abstract No. 2023-156

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Neuromodulation as a Supplemental Therapy for Plaque Psoriasis to Augment the Body’s Self-Healing Mechanisms

Ilana Pyatetsky, OMS-IV; Ayana McLaren; Harald Martin Stauss MD, PhD; Kathryn Hall

Department of Research, Burrell College of Osteopathic Medicine

Statement of Significance: Plaque psoriasis patients often suffer from stigma, adversely affecting mental health and quality of life(1). Even with biologic drugs, skin lesions often do not fully resolve(2). Our long-term goal is to establish additional treatment options to assist the body’s self-healing mechanism and improve patients’ quality of life. Transcutaneous auricular vagus nerve stimulation (taVNS) has been suggested to elicit anti-inflammatory actions(3) and may constitute such a complementary treatment option.

To assess the clinical efficacy of non-invasive taVNS when added to standard of care treatment in patients with plaque psoriasis. To achieve this objective, we tested the hypothesis that taVNS added to standard of care therapy improves skin lesions in psoriasis patients via activation of endogenous anti-inflammatory pathways, such as the cholinergic anti-inflammatory pathway (4,5) and/or the hypothalamic-pituitary-adrenal (HPA) axis (6).

Research Methods: The study was IRB approved and registered with ClinicalTrials.gov. The inclusion criteria for the study consisted of patients aged 18 years or older who had been diagnosed with plaque psoriasis. Exclusion criteria included patients who were pregnant or planned to become pregnant, had a history of vestibulocochlear neuronitis, tinnitus, cardiac arrhythmia, epilepsy or had anticipated any changes in their psoriatic medication regimen during the 3-month study period. Patients with plaque psoriasis diagnosed by their dermatologists (n=4) self-administered taVNS (ear clip electrode, 10 Hz, 300 µs pulse width, 1-2 mA current) daily for 30 minutes for three months. At the beginning of the study before the start of the taVNS intervention the Psoriasis Area and Severity Index (PASI) was assessed, and photo documentation of a representative skin lesion was obtained. This assessment served as the baseline to which subsequent assessments following initiation of taVNS were compared. After 1 week, 1 month, 2 months, and 3 months following initiation of daily taVNS, the PASI score together with photo documentation of representative skin lesions were assessed again. Patients also reported perceived effects of taVNS in a diary.

Data Analysis: After one month of taVNS, PASI had significantly decreased compared to before taVNS (4.5±0.5 vs. 7.4±1.3, means±SEM, p<0.05) and remained reduced for the remainder of the study. This finding is reflected in the photo documentation and is consistent with diary reports, suggesting that skin lesions worsened if patients missed a few days of taVNS (e.g., during vacation or holidays), but improved upon resuming taVNS.

Conclusion: Neuromodulation through taVNS added to standard of care therapy enables the body’s natural self-healing mechanism to improve psoriatic skin lesions. Follow-up studies are underway to investigate the role of the cholinergic anti-inflammatory reflex (4,5) and the HPA-axis (6) for this augmentation of self-healing mechanisms by taVNS. In conclusion, taVNS appears to be a viable complementary treatment option to improve skin lesions and, therefore, improve the overall quality of life of patients with plaque psoriasis.

References

1. Wan MT, Pearl RL, Chiesa Fuxench ZC, Takeshita J, Gelfand JM. Anticipated and Perceived Stigma Among Patients With Psoriasis. J Psoriasis Psoriatic Arthritis. Jul 2020;5(3):93-99. doi:10.1177/2475530320924009

2. Haque EK, Azhar A, Corbett J, Frieder J, Wang X, Menter A. A Real-World Evaluation of the Long-Term Safety and Efficacy of Infliximab in the Treatment Moderate-to-Severe Psoriasis. Dermatol Ther (Heidelb). Oct 2020;10(5):1121-1135. doi:10.1007/s13555-020-00436-1

3. Kania AM, Weiler KN, Kurian AP, Opena ML, Orellana JN, Stauss HM. Activation of the cholinergic antiinflammatory reflex by occipitoatlantal decompression and transcutaneous auricular vagus nerve stimulation. J Osteopath Med. Feb 24 2021;121(4):401-415. doi:10.1515/jom-2020-0071

4. Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest. Feb 2007;117(2):289-96. doi:10.1172/jci30555

5. Tracey KJ. The inflammatory reflex. Nature. Dec 19-26 2002;420(6917):853-9. doi:10.1038/nature01321

6. Guo ZP, Sörös P, Zhang ZQ, Yang MH, Liao D, Liu CH. Use of Transcutaneous Auricular Vagus Nerve Stimulation as an Adjuvant Therapy for the Depressive Symptoms of COVID-19: A Literature Review. Front Psychiatry. 2021;12:765106. doi:10.3389/fpsyt.2021.765106

Financial Disclosures: None reported.

Support: This study is supported by a grant from the National Psoriasis Foundation and the Office of Research and Sponsored Programs of Burrell College.

Ethical Approval: This study was approved by the Burrell College Institutional Review Board (BURRELL IRB 0090_2021) and is registered with ClinicalTrials.gov (NCT05243303).

Informed Consent: All study participants provided written informed consent.

Poster No. *C-47

Abstract No. 2023-157

Category: Clinical

Research Topic: Health Disparities-Social Determinants of Health

Eclampsia and Preeclampsia as a Risk for Readmission in Postpartum Mothers and its Correlation With Income Status of the Household

¹Samaa Hassanien, OMS-IV; Allan Jacobs

¹New York Institute of Technology; ²Department of Obstetrics Gynecology, Coney Island Hospital. Brooklyn, NY

Statement of Significance: Preeclampsia contributes to 2% to 8% of pregnancy-related complications worldwide. It results in 9% to 26% of maternal deaths in low-income countries and 16% in high-income countries (Karrar 2023). Recent reports from the World Health Organization estimate that preeclampsia is directly responsible for 70,000 maternal deaths annually worldwide (Sibai 2005). There are different relevant risk factors. One of them that has not been well studied and emphasized is the household income status

Poor income could impact a mother’s ability to get good antenatal care, and the lower the income, the more the mother could face constraints in accessing healthcare services. Significant efforts have been to overcome social disparities in women’s health in the last decades. Still, more efforts need to be made in the US. Our question is, do all women get equal antenatal care? We took an example to study, which is preeclampsia and eclampsia odds in lower versus higher income communities.

Research Methods: We utilized the years 2016-202 Healthcare Cost and Utilization Project’s (HCUP) Nationwide Readmissions Database (NRD) was used with the index admission will be delivery of mothers ages 15 to 54 to analyze the risk for readmission for a hypertension-related preeclampsia and eclampsia diagnoses within 30 days from delivery hospitalization either full term vaginal or cesarean section. The NRD is one of the largest databases in the United States. Full-term birth was included, excluding Preterm labor, stillbirth, and abortion. The primary outcome is 30 days readmission, and the secondary outcome includes Eclampsia, Preeclampsia. Confounding factors were considered while processing the data, including gestational diabetes, postpartum hemorrhage, asthma, chronic kidney disease, and systemic lupus. Other variables were included in the data tables, including hospital bed size, rural versus urban hospital, and insurance carrier. The methodology was a retrospective chart review using a national database. NRD National Readmission Database is part of a family of online databases. It shows a full calendar year of data with diagnosis and procedure codes reported using the ICD-10-CM Variables were identified using International Classification of Diseases, Tenth revision codes. We included years (2019). The primary outcome was 30-day readmission, while secondary outcomes were trends in complications, mortality rate, healthcare cost, and length of stay of mothers who suffered from preeclampsia and eclampsia while comparing between groups of different household income using home address zip code median income. Multivariate analyses and descriptive bivariate analyses were performed. A p-value <0.05 was considered statistically significant. There were four groups based on household income (0-25 percentile, the lowest income, 26-50 percentile, 51-75 percentile, and 76-100 percentile, the highest income).

Data Analysis: 1678 readmissions were identified to happen within 30 days after index delivery Readmission was statistically significantly lower in higher-income families, with P value of 0.003 for the 51-75 group and 0.002 for the 76-100 group

Early Readmission Cox Regression overall

1. Median household income national quartile for patient ZIP Code

0-25th percentile 1.00 (reference group)

26th to 50th percentile (median) 0.930.407[0.78 - 1.11]

51st to 75th percentile0.730.003[0.59 - 0.90]

76th to 100th percentile0.680.002[0.54 - 0.86]

1. Length of stay was statistically significant P value less than 0.001 with lower LOS in higher income group and vice versa.

Secondary endpoint

Length of stay 556,608.30 1.89 0.73 0.01

0-25th percentile 196,260.81 1.94 0.71 0.01

26th to 50th percentile (median) 151,751.33 1.88 0.66 0.01

51st to 75th percentile 122,360.57 1.85 0.69 0.01

76th to 100th percentile 82,492.03 1.87 0.89 0.01

Adjusted Wald test (difference of means) for Length of stay: p<0.001

1. Same result regarding readmission cost with the highest cost in the lowest household income group and vice versa, with p-value <00.1 using the adjusted Wald test.

Total Cost 1,030,555,354.66 3,510.96 2,093.62 27.54

0-25th percentile 338,527,916.52 3,345.13 1,750.10 33.65

26th to 50th percentile (median) 277,734,405.53 3,444.43 1,844.21 34.75

51st to 75th percentile 235,979,161.02 3,577.80 1,834.58 33.44

76th to 100th percentile 171,110,870.44 3,917.65 3,312.26 47.27

Conclusion: Postpartum complications include pregnancy-induced hypertension, with eclampsia preeclampsia the most critical ones. Preeclampsia is responsible for over 70 000 maternal deaths and 500 000 fetal deaths worldwide yearly (Rana 2020). There is a higher prevalence of postpartum complications in low-income households, like anemia (Bodnar 2001) and depression (Gress-Smith 2012). Lower-income families suffer a more stressful life with less access to healthcare benefits, which might include the inability to pay for expensive medications. Mothers might have no time to visit the doctor as scheduled, and the mothers might still be working different jobs to increase their income desperately. Mothers with lower incomes will have less efficient prenatal care and less access to the healthcare system. That reflects in more poor outcomes as mothers suffer from complications like preeclampsia and eclampsia. That is noticed with a lower risk of readmission in higher-income groups, as seen in our study. The lower income group had a longer stay on readmission with higher costs. If we think realistically, offering better antenatal care to disadvantaged groups would save the healthcare system more in the long run and through more straightforward approaches by closely following mothers’ blood pressure and offering the right treatment at the right time

References

1. Karrar SA, Hong PL. Preeclampsia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 13, 2023. PMID: 34033373

2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-799. doi:10.1016/S0140-6736(0517987-2)

3. Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives [published correction appears in Circ Res. 2020 Jan 3;126(1):e8]. Circ Res. 2019;124(7):1094-1112. doi:10.1161/CIRCRESAHA.118.313276

4. Bodnar LM, Scanlon KS, Freedman DS, Siega-Riz AM, Cogswell ME. High prevalence of postpartum anemia among low-income women in the United States. Am J Obstet Gynecol. 2001;185(2):438-443. doi:10.1067/mob.2001.115996

5. Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, Howe R. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern Child Health J. 2012;16(4):887-893. doi:10.1007/s10995-011-0812-y

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The study was deemed exempt as we used a national database with de-identified patient information from online database website.

Informed Consent: Not applicable.

Poster No. *C-48

Abstract No. 2023-160

Category: Clinical

Research Topic: Health Disparities-Social Determinants of Health

COVID-Influenza Coinfection and Emergency Department Disposition Trends

¹Yehuda Azerrad, OMS-III; ²Stephanie Chain, MS-IV; ³Yisroel Grabie, DO; ⁴Sudeep Acharya, MD; ³Allison Glaser, MD

¹New York Institute of Technology; ²City University of New York School of Medicine, New York, NY; ³Department of Internal Medicine, SIU Hospital, New York, NY; ⁴Department of Pulmonary and Critical, SIU Hospital, New York, NY

Statement of Significance: There is a lack of literature on the statistics of coinfection with COVID-19 and Influenza. Our study was undertaken to offer guidance for optimizing resources and patient management strategies during the concurrent COVID-19 and Influenza epidemics.

To determine the incidence and emergency department disposition trends of COVID-Influenza coinfection.

Research Methods: This study was done via a retrospective chart review.

Data: Patient data from 10/1/22 to 3/1/23 were collected from the Northwell Health Sunrise Electronic Medical Record (EMR) System. ED visits were sorted into three groups: coinfection with COVID-19 and influenza, COVID-19 infection only, and influenza infection only. These groups were further subdivided into subsets of admitted vs. discharged. The trends of the groups and subsets were compared in various ways.

Incidence of Coinfection: The incidence of coinfectionwas calculated by taking the number of patients in the coinfection group and dividing that into the total number of patients in all 3 groups.

Admitted Patients: We calculated the frequency of ED admissions by calculating the percentage of patients who were admitted from each group.

Infected Groups: Data of coinfected, COVID-19, and Influenza patients who were admitted to the hospital were compared to that of patients who were discharged. This was done by calculating the mean (± standard deviation [SD]) age, BMI, first WBC count, first lactate, first procalcitonin, and first creatinine. The means were then separated by group and compared between the subsets. They were subsequently tested for significance via a two-sample t-test.

Mean ED Length of Stay (LOS) in Hours: The mean (± SD) LOS was calculated for each group and subset. These values were then compared to each other.

Demographics of Admitted Patients: Patients in each group were divided based on gender and race/ethnicity, and the frequency of hospital admissions was calculated for each category by using the percentage of patients who were admitted out of the total number presenting to the ED.

Data Analysis: Incidence of Coinfection 260 patients presented in the coinfection group, 13,614 patients presented in the COVID-19-only group, and 8,966 patients presented in the influenza-only group. The incidence of coinfection among all patients was 1.1%.

Admitted Patients A total of 260 patients presented in the coinfected group. Of those, 55 patients were admitted (21%). A total of 13,614 patients presented in the COVID-19-only group. Of those, 6,204 patients were admitted (46%). A total of 8,966 patients presented in the influenza-only group. Of those, 1,519 patients were admitted (17%). This figure shows that of the three groups, patients with COVID-19 infection had the highest rate of admission, followed by coinfection and influenza respectively.

Infected Groups The data show that there is a significantly higher value (p<0.05) in age, first WBC count, first lactate, first procalcitonin, and first creatinine in admitted patients when compared to discharged patients of the same group. There was no significant positive correlation between increased BMI and hospital admission.

Mean ED Length of Stay (LOS) in Hours Patients in the coinfection group had the highest LOS if they were admitted and the second lowest LOS if they were discharged. Patients in the COVID-19 group had the shortest LOS if they were admitted, and the longest LOS if they were discharged.

Demographics of Admitted Patients African American patients had the highest chance of being admitted in the coinfected group (59%), while patients of other races had the highest chance of being admitted in the COVID-19 group and influenza group.

Conclusion: COVID-influenza coinfection presents a significant challenge for emergency departments worldwide. The potential for severe illness necessitates close monitoring and effective management strategies. This retrospective chart review involving more than 20,000 patients presenting to the emergency department at a large hospital network in the Northeast discussed the trends in ED admission versus discharge for patients with COVID-influenza coinfection.

Our findings suggest that the incidence of COVID-Influenza coinfection is rare and does not inherently increase the risk of hospital admission when compared to singular COVID-19 or Influenza infections. Consistent admission trends were observed, with factors such as age, procalcitonin, lactate, WBC, and creatinine emerging as significant predictors of hospital admission (p<0.05). Contrary to expectations, we did not find a significant positive correlation between a higher BMI and hospital admissions in any of the groups. By understanding these trends and implementing appropriate strategies, we can mitigate the ED burden of COVID-influenza coinfection and optimize patient outcomes in a more efficient manner.

References

1. Cox FM, Cobb MM, Chua WQ, McLaughlin TP, Okamoto LJ. Cost of treating influenza in emergency department and hospital settings. American Journal of Managed Care. 2000. Available from: https://pubmed.ncbi.nlm.nih.gov/10977420/

2. Lee TC, Morris AM, Grover SA, Murthy S, McDonald EG. Outpatient Therapies for COVID-19: How Do We Choose? Clinical Infectious Diseases. Published 2022. doi:10.1093/ofid/ofac008

3. Ohsfeldt RL, Choong CK, McCollam PL, Abedtash H, Kelton KA, Burge R. Inpatient Hospital Costs for COVID-19 Patients in the United States. Advances in Therapy. 2021. doi:10.1007/s12325-021-01887-4

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: 23-0128

Informed Consent: N/A

★Poster No. *C-49

Abstract No. 2023-163

Category: Clinical

Research Topic: Osteopathic Philosophy

Exploring the Impact of Osteopathic Medical School on Body Composition: A 4-Year Longitudinal Study

Robert Steinberg, OMS-III; Joanne Donoghue, PhD

Department of Osteopathic Manupulative Medicine, New York Institute of Technology

Statement of Significance: Medical school poses various obstacles, most notably being the extensive time spent studying. A 4-year study done on medical students found that muscular endurance and aerobic capacity decreased significantly from 1st to 4th year [1]. Although fitness and metabolic data has been studied, literature is scarce regarding body composition. Addressing this gap in the literature can initiate discussions on interventions to enhance the physical health of future osteopathic physicians.

To analyze changes in body composition in osteopathic medical students over 4 years of medical school

Research Methods: This prospective longitudinal study was IRB approved, and all subjects signed written consent prior to participating. Dual x-ray absorptiometry (GE Lunar iDXA) was used to assess body fat percentage (BF%), Body Fat Mass (BFM), lean body mass (LBM), visceral fat, and Body Mass Index (BMI). Inclusion criteria was incoming first year medical students with no contraindication to a DXA scan. Exclusion criteria utilized contraindications to DXA scans based on the American College of Radiology (ACR) guidelines. Participants were scanned in August prior to their first year, and then in May prior to graduation in their 4th year. 120 students (60 men and 60 women, age 23.4±3.8) signed consent and were scanned prior to their first year. A paired t-test was used to analyze all outcome measures and assess for statistical significance. Significance was accepted at p< 0.05. Being the osteopathic (DO) philosophy promotes the unity and wellbeing of an individual’s mind, body, and spirit, DO schools should ensure that the physical health of their students does not decline while in school. By examining this overlooked aspect of osteopathic medical education, we hope to promote the implementation of interventions that encourage the wellness of our future osteopathic physicians. This may better prepare students to incorporate the principles of mind, body, and spirit into the treatment of their future patients.

Data Analysis: Out of the 120 subjects that were initially enrolled, 37 completed the study. Follow-up data was not able to be collected from all subjects due to the COVID-19 lockdown of 2020. These 37 subjects consisted of 19 men and 18 women (age 22.71±3.0). Although the study was open to all individuals, it is important to note that all of the subjects in this study identified as their biological sex. Of the 37 subjects that completed the study, 40.5% were Caucasian, 35.1% were Asian, 21.6% were Indian, and 2.7% were African American. The results found that there was a significant increase in body weight (66.11±13.22 kg to 68.21±14.80 kg, p<.001), LBM (46.58±11.50 kg to 48.04±11.92 kg, p<.001), BMI (23.00±2.79 to 23.60±3.30, p=.009), and visceral fat (.23±21 kg to .29±.30 kg, p=.018). There was no significant difference in BFM (p=.220) or BF% (p=.839). By gender, biological males were noted to have a significant increase in body weight (73.66±12.87 kg to 76.99±14.20 kg, p<.001), BFM (15.92±6.68 kg to 17.50±8.06 kg, p=.024), LBM (54.71±8.95 kg to 56.45±9.57 kg, p=.004), and BMI (23.9±2.84 to 24.70±2.48, p= .002). Males had no significant difference in BF% (p=.176) or visceral fat (p=.065). In biological women, there was a significant increase in LBM (37.99±6.58 kg to 39.16±6.41 kg, p= .011) and a significant increase in visceral fat (.09±.12 kg to .14±.13 kg, p= .032). There was no significant difference in body weight (p=.314), BF% (p=.154), BFM (p=.533), or BMI (p=.514).

Conclusion: Due to the academic demands placed on medical students, it is hypothesized that they would endure negative changes in body composition over their 4 years of school. However, our data revealed that students at our institution had a significant increase in LBM, and no significant change in BFM or BF%. Body weight and BMI did increase significantly, but this can be attributed to the noted increase in LBM. The only negative finding in our data was the significant increase in visceral fat, but this may be representative of age-related bias. Even by gender, neither men nor women had a significant increase in BF%, and both gained LBM. Although the data was generally positive, the limitation of selection bias must be acknowledged. Recruiting subjects for a body composition study will typically attract individuals who are active and discourage those who are not. Future research should collect similar data with the entirety of a medical school class to address this limitation. The institution where this data was collected has programs in place such as “Fit Physicians”, which aims to encourage movement in medical students. Being previous studies have noted negative changes in fitness data in medical schools without such initiatives, it is evident that osteopathic medical schools should be advocating for the implementation of similar programs. In addition to the physical health benefits they provide, these programs may better prepare students to embrace the osteopathic philosophy by effectively incorporating physical activity counseling into their future practice. Studies have shown that physicians who are physically active themselves are more likely to integrate physical activity counseling into treatment plans[2]. In conclusion, 4 years of osteopathic medical school did not lead to negative changes in body composition in our study. Future studies should aim to examine body composition within a more expansive cohort encompassing multiple geographic medical schools.

References

1. Stephens MB, Cochran C, Hall JM, Olsen C. Physical fitness during medical school: a 4-year study at the Uniformed Services University. Fam Med. 2012;44(10):694-697

2. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43(2):89-92. doi:10.1136/bjsm.2008.055426

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Study was reviewed and received full approval from IRB (BHS-1508).

Informed Consent: All subjects signed written consent prior to participation. Subjects received copies of their consent forms.

Poster No. *C-50

Abstract No. 2023-164

Category: Clinical

Research Topic: Chronic Diseases & Conditions

Evaluating the Accuracy of Machine Learning for Multiple Sclerosis Lesion Detection on Brain MRI Images

¹Alec Toufexis, OMS-III; Robert Steinberg, OMS-III; Rejath Jose, OMS-III; Nicholas Lewis, OMS-III; Zain Sattim, OMS-IV; Adriel Abraham, OMS-IV; Milan Toma, PhD

Department of Osteopathic Manpulitive Medicine, New York Institute of Technology

Statement of Significance: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS).¹ Early initiation of treatment has been shown to improve prognosis and prevent complications.² Recent advances in artificial intelligence have shown promise as an adjunctive tool to increase diagnostic efficiency. There is limited literature comparing the efficacy of various ML models in MS diagnosis. By addressing this gap in the literature, we aim to improve the prognosis of those diagnosed with MS.

To assess and compare the diagnostic accuracy of a Google Teachable Machine (GTM) model, trained with an online open-source MRI image database, for diagnosing Multiple Sclerosis (MS) using axial and sagittal brain MRI images.

Research Methods: An online open-source MS MRI image database was used to train the machine-learning model.³ The database was curated by Macin et al. and sourced from Kaggle. The dataset consists of axial and sagittal brain MRI images of patients with MS and from control patients. A total of 3,027 images were used to train the Google Teachable Machine (GTM) image classification model, 902 images were normal axial brain MRIs, 914 were normal sagittal brain MRIs, 550 images were axial brain MRI of MS patients, 661 images were sagittal brain MRI of MS patients. GTM is an online platform enabling users to train machine learning models without extensive coding knowledge.⁴ GTM is a user-friendly software that trains and deploys image classification models. GTM provides built-in data augmentation to increase the diversity and variability of the training data. The data was trained for 100 epochs with a batch size of 16. Epoch refers to the number of times each image is fed through the training model. Batch size refers to the number of images used in one training iteration. With 3,027 images and 16 images per batch, there are 190 batches. Once all batches go through the dataset, one epoch is complete. Google’s Teachable Machine generates its evaluation metrics by splitting 85% of the data into training samples (2,573 images) and 15% into test samples (454 images). 50 additional images per class were separated to assess for external validity. GTM calculated the accuracy as (true positive + true negative)/ (true positive + false positive + false negative + true negative). The mean and standard deviation of the accuracy will also be reported along with ANOVA to analyze for any statistically significant difference between the accuracy from different classes. By improving diagnostic accuracy and saving time, osteopathic physicians can dedicate more attention to comprehensive treatment plans that address the unity of the patient’s mind, body, and spirit.

Data Analysis: The overall accuracy of the model is 89%. The axial and sagittal control MRI classes had an accuracy of 88%. The sagittal MS MRI class also had an accuracy of 88%; however, the axial MS MRI class had an accuracy of 92%. While training the model, the accuracy of the training dataset increased as the number of epochs increased; likewise, the accuracy of the testing dataset also increased as the number of epochs increased. To analyze the external validity of the model, an extra 200 images (50 images per class), on top of the 454 images partitioned by GTM, was used to test the accuracy of the model. GTM was never exposed to these 200 images. The mean accuracy for the control axial MRI class was 0.95 +/- 0.20. The mean accuracy for control sagittal MRI class was 0.71 +/- 0.44. The mean accuracy for axial MS MRI class was 0.94 +/- 0.24, and the mean accuracy for sagittal MS MRI class was 0.82 +/- 0.38. The coefficient of variation for control axial MRI class was 0.21. The coefficient of variation for control sagittal MRI class was 0.62. The coefficient of variation for axial MS MRI class was 0.25, and the coefficient of variation for sagittal MS MRI class was 0.47. ANOVA showed a statistically significant difference between the four different classes (axial-control, sagittal-control, axial-MS, sagittal-MS) (p < 0.001). Tukey’s post-hoc analysis showed a mean difference of 0.238 between the axial-control and sagittal-control classes (p = 0.002), with axial-control having a higher accuracy than sagittal-control. Tukey’s post-hoc test also showed a mean difference of 0.116 between axial-MS and sagittal-MS classes (p = 0.30), with axial-MS having a higher accuracy than sagittal-MS.

Conclusion: Our data suggests that the GTM model demonstrated superior accuracy in detecting MS lesions in axial brain MRIs compared to sagittal brain MRIs. The external validity tests showed that the sagittal MRI model had a lower accuracy compared to the axial MRI model which correlates with the internal accuracy statistics that GTM provided. Subsequent ANOVA showed a statistically significant difference between the accuracies of the different imaging modalities. This is evidence to primarily use axial MRI images in the detection of MS lesions with AI. This finding aligns with prior research that suggested axial MRIs provide superior detection of MS lesions of CNS when compared to sagittal MRIs.5 The inherent qualities of MS lesions may allow for more visibility in axial planes, but the reduced accuracy in the sagittal MRI model may also be attributed to suboptimal image quality compared to axial images which is a limitation of the study. Another limitation is the use of just one dataset; more images from other databases can further elucidate the use of machine learning in MS diagnosis and treatment. Our data suggests that our model may be subject to “overfitting,” which is an additional limitation of our study. This means that the models are likely memorizing certain aspects of the dataset and are failing to extrapolate features specific to a certain class. To alleviate this issue, stopping training early can limit learning to critical components of the images. Another method to address this limitation is to omit images that do not represent the desired characteristics of the classes tested in the models being they may contain superfluous information that the model may learn from. In conclusion, the overall accuracy of this model further warrants the use of axial MRI images when using GTM to detect MS. Machine learning models can accurately be used as an adjunctive tool to improve the efficiency of MS diagnosis, ultimately contributing to improved prognosis.

References

1. Dighriri IM, Aldalbahi AA, Albeladi F, et al. An overview of the history, pathophysiology, and pharmacological interventions of multiple sclerosis. Cureus. Published online 2023. doi:10.7759/cureus.33242

2. Noyes K, Weinstock-Guttman B. Impact of diagnosis and early treatment on the course of multiple sclerosis. Am J Manag Care. 2013;19(17 Suppl):s321-s331.

3. Macin G, Tasci B, Tasci I, et al. An accurate multiple sclerosis detection model based on exemplar multiple parameters local phase quantization: Exmplpq. Applied Sciences. 2022;12(10):4920. doi:10.3390/app12104920

4. Teachable Machine: Train a Computer to Recognize Your Own Images, Sounds, Poses. https://teachablemachine.withgoogle.com

5. Galler S, Stellmann JP, Young KL, et al. Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis. AJNR Am J Neuroradiol. 2016;37(5):963-969. doi:10.3174/ajnr.A4638

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was deemed exempt under Institutional Review Board, with IRB number BHS-1902. Clinical trial registry number not applicable.

Informed Consent: Informed consent process not relevant to the study.

Poster No. *C-51

Abstract No. 2023-165

Category: Clinical

Research Topic: Osteopathic Philosophy

Examining Medical Students’ Perceptions of the Opioid Crisis

¹Nicholas Durstock, OMS-I; ¹Samuel Borgemenke, OMS-II; ²Elizabeth Beverly, PhD

¹Ohio University-Heritage College of Osteopathic Medicine; ²Department of Primary Care, Ohio University-Heritage College of Osteopathic Medicine

Statement of Significance: From 2000 to 2019, overdose was the number one killer of Americans under 50, and the number of overdoses increased every year. As of 2012, near 85% of all opioid drug users get their opioids from prescriptions from a healthcare provider, often a physician. Having a heightened perception on severity may better allow physicians to integrate alternative forms of care such as cognitive behavioral approaches, nonopioid therapies, and nonpharmacologic therapies into treatment plans for chronic pain.

To investigate medical students’ beliefs, experiences, and perceived impact of opioids at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) and the University of Toledo College of Medicine and Health Sciences (UT).

Research Methods: The descriptive and cross-sectional study involved surveying 377 medical students from Ohio University Heritage College of Osteopathic Medicine and the University of Toledo College of Medicine and Health Sciences on their beliefs, experiences, and perceived impact of opioids. To complete the survey, participants used Qualtrics, an electronic questionnaire service. The responses on experiences involving opioids were evaluated using a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The responses to questions to assess the perceived severity was rated on a scale of 0 (Not at All Severe) to 100 (Extremely Severe). Multiple t-tests were conducted to compare the difference in perceived severity and stigma between students who were impacted by the epidemic and those who were not. A Kendall rank test was performed to analyze the relationship between the county drug overdose rate and perceived severity for medical students. P < 0.05 defined statistical significance for all statistical tests performed in this study.

Data Analysis: In comparing medical student’s personal experiences with the opioid crisis, it was found that many more participants had experiences with an affected classmate or patient, as opposed to direct experiences within their family or group of friends. The average level of agreement for opioids impacting participants’ immediate family was 1.87 (95% CI, 1.75-1.99), and for impacting their circle of friends, it was 2.33 (95% CI, 2.19-2.47). This group of participants who were immediately impacted by opioids (stating that opioids impacted their nuclear family or circle of friends) were found to be more likely to view the crisis as more severe on Ohio’s adult population than those without that immediate experience (P=0.029, α=0.05). The difference in experience and severity outlook did not make one group of participants more likely to hold a stigma towards those struggling with opioid addiction (P=0.25, α=0.05). The study did not find a significant relationship between the drug overdose rate and perceived severity among participants when grouped by county (P>0.05, α=0.05).

Conclusion: Investigating the beliefs, experiences, and perceived impacts of the opioid crisis on the future physician could improve the training and curriculum design for medical students. This empowers medical students to learn how to provide holistic care for individuals battling addiction and explore alternative treatment options to mitigate the risk of opioid dependency. The findings of this study revealed a diverse range of backgrounds among the students, with some having direct exposure to the crisis while others had minimal experience. However, a significant majority of students had greater exposure to the crisis through classmates or patients rather than family or friends. Notably, those who had direct personal encounters with the crisis, such as through family or friends, tended to perceive the crisis as more severe than those without immediate impact. In general, differences in perceived severity did not correspond to differences in stigma towards individuals struggling with opioids.

References

1. Volkow ND, Blanco C. The changing opioid crisis: development, challenges and opportunities. Molecular Psychiatry. 2021; 26(1): 218–233. doi: 10.1038/s41380-020-0661-4

2. Humphreys K, et al. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford–Lancet Commission. The Lancet. 2022; 399(10324): 555-604. doi: 10.1016/S0140-6736(2102252-2)

3. Gleber R, et al. Trends in emergency physician opioid prescribing practices during the United States opioid crisis. The American Journal of Emergency Medicine. 2020; 38(4): 735-740. doi: 10.1016/j.ajem.2019.06.011

4. CDC. Prescription Painkiller overdoses in the US. Centers for Disease Control and Prevention. https://www.cdc.gov/Vitalsigns/PainkillerOverdoses/?s%5C_cid=tw%5C_cdc995. Published November 1, 2011. Accessed April 2, 2023.

5. NIH. Ohio: Opioid-Involved Deaths and Related Harms. National Institute on Drug Abuse. Published April 3, 2020. Accessed January 9, 2022. https://nida.nih.gov/drug-topics/opioids/opioid-summaries-by-state/ohio-opioid-involved-deaths-related-harms.

6. Jerome J. An Osteopathic Approach to Chronic Pain Management. Journal of Osteopathic Medicine. doi: 10.7556/jaoa.2017.056. Published May 1, 2017. Accessed April 2, 2023.

7. Mort SC, Díaz SR, Miller C, Bowlby M, Henderson D, Beverly EA. Influence of future prescribers’ personal and clinical experiences with opioids on plans to treat patients with opioid use disorder. Journal of Osteopathic Medicine. 2019;119(12):780-792. doi:10.7556/jaoa.2019.131

8. CDC. CDC WONDER. cdc.gov. https://wonder.cdc.gov/. Published 2022. Accessed February 28, 2022.

9. Dumenco L, Monteiro K, Collins S, Stewart C, Berkowitz L, Flanigan T, Rich J, George P. A qualitative analysis of interprofessional students’ perceptions toward patients with opioid use disorder after a patient panel experience. Substance Abuse. 2019;40(2): 125-131. doi: 10.1080/08897077.2018.1546262.

10. Corrigan C, Desnick L, Marshall S, Bentov N, Rosenblatt R. What Can We Learn from First-Year Medical Students’ Perceptions of Pain in the Primary Care Setting. Pain Medicine. 2011;12(8):1216–1222. doi: 10.1111/j.1526-4637.2011.01150.x.

11. Monnat SM, Khary KR. Examining rural/urban differences in prescription opioid misuse among US adolescents. The Journal of Rural Health. 2016; 32(2): 204-218. doi: 10.1111/jrh.12141

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Deemed exempt.

Informed Consent: Not applicable.

Poster No. *H-1

Abstract No. 2023-005

Category: Health Services

Research Topic: Osteopathic Philosophy

Orthopaedic Match Characteristics in Residents: Profile 2.0

¹Jessica Devi Ng, OMS-IV; ²Julieanne P. Sees, DO; ³Brian Handal, DO; ³Madison Messmer, DO

¹Philadelphia College of Osteopathic Medicine-Moultrie-Moultrie; ²American Osteopathic Academy of Orthopedics; ³Department of Orthopedic Surgery, Kettering Health, Dayton, OH

Statement of Significance: Matching with orthopaedic surgery residency is highly competitive.1 In order to select the most holistic residents, many facets of a medical student’s application are commonly examined by orthopaedic residency programs. Data are limited regarding characteristics in applicant’s profile who successfully matched in the selection process

To investigate the characteristics of a successfully matched osteopathic orthopaedic surgery resident’s profile under the previous American Osteopathic Associate accreditation system and quantify trends within American Osteopathic Academy of Orthopaedics (AOAO) distinctive workforce regarding their experiences before residency.

Research Methods: A confidential optional online survey was distributed with questions aimed at identifying trends in characteristics of osteopathic orthopaedic residents. Responses of current PGY (n=22), defined as PGY 4-5’s in-training across 39 osteopathic orthopedic residency programs, were compared to prior PGY’s (n=36), defined as active AOAO members for a total of 58 participants. Results were analyzed, such as clinical experiences and/or gap year(s) prior to medical school; publications prior to residency; whether USMLE was taken, which step(s) and what motivation; number of audition rotations/programs applied/interviews; and whether auditioned at matched residency. Statistical analysis was performed with Google Sheets to include mean values, interquartile ranges, correlation coefficients, and T-tests, when appropriate, to evaluate categorical values. Exploration of past and present resident characteristics provides advantageous data for future residency applicants and fostering a new generation of holistic osteopathic orthopaedic surgeons.

Data Analysis: Overall, 58 participants completed the survey, 87.9% males, 12.1% female, 93.1% White, 3.4% Black, 1.7% American Indian/Alaskan Native, and 1.7% two or more/mixed ethnicity. 22 participants were current PGY’s, average age 32.8 years, 36 were prior PGY’s, average age 50 years, at time of survey. Of 38 responses, the most common clinical experience prior to medical school was medical technician/PT at 31.6%. Of 30 responses, current PGY’s averaged 1.2 gap years (12, range: 0-5 years) while prior PGY’s averaged 1.3 years (18, range: 0-7 years). Prior to residency, average number of publications for current PGY’s was 3-4, whereas prior PGY’s was 0-1. Between the groups, the majority elected not to take USMLE Step 1, and those who did, majority elected not to take Step 2. Reason for taking USMLE was 50% for own personal interest or satisfaction, and 50% responded residency motivated. Between prior and current PGY’s, the average number of orthopedic auditions increased by 1.5. Interestingly, 95.5% of current PGY’s rotated at their matched orthopedics program, whereas 77.8% of prior PGY’s rotated at their matched program. Prior PGY’s submitted average of 11 residency applications (range: 1-30); current PGY’s submitted 29 applications (range: 10-120). The average number of residency programs at which a participant interviewed only increased by 2, with current PGY’s averaging 5 interviews (range: 2-10) and prior PGYs averaging 3 (range: 1-11) with significant positive correlation between number of applications vs. interviews for both Prior PGY’s (r=.428, p=.000003) and current PGY’s (r= .349, p=.0002).

Conclusion: Profile 2.0 osteopathic orthopedic resident includes a trend towards a more complex applicant, with a slight increase in publications, and, most significantly, an increase in match success with an audition and interview at the ultimate residency program. Out of a total of 58 participants completing this confidential, optional online survey, 22 were current PGY’s and 36 were prior PGY’s. Statistical analysis included mean values, interquartile ranges, correlation coefficients, and T-tests. Our survey study does recognize limitations. Our analysis captured anonymous, self-reported data. The sample size of the population was limited based on feedback and the validity of responses was not examined. Future consideration should be given to investigation of larger sample size, characteristics of PGY’s after the transition to a single GME accrediation system, and the transition of boards from numeric score to Pass/Fail will help characterize a new osteopathic student Profile 3.0 to match into an orthopaedic residency. Despite the limitations of the study, this novel data is one of the only available at capturing the distinguishing characteristics in osteopathic orthopaedic residents over the past 40 years. With such knowledge, the osteopathic philosophy continues to shape the growing AOAO membership while enhancing the future of the holistic orthopaedic workforce.

References

1. National Resident Matching Program, Results and Data: 2022 Main Residency Match®. National Resident Matching Program, Washington, DC. 2022.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB Exempt. IRB #:00001338

Informed Consent: Informed consent was not needed for this project.

Poster No. *H-2

Abstract No. 2023-007

Category: Health Services

Research Topic: Osteopathic Philosophy

Impact of the COVID-19 Pandemic on First Year Medical Students at the West Virginia School of Osteopathic Medicine

¹Devin Towne, OMS-III; James Easler; Courtney Eleazar, PhD

Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine

Statement of Significance: While mental health outcomes amongst medical students prior to the COVID-19 pandemic are documented, research on the experiences of first-year medical students starting their education in the fall of 2020 is limited. With a focus on the connection between mind, body, and spirit, osteopathic medical schools are in a unique position to holistically assess their students’ needs and strategically implement changes to student affairs and/or curricular delivery accordingly.

To assess the potential impact of the COVID-19 pandemic on the mental and overall wellness of first year medical students at the West Virginia School of Osteopathic Medicine (WVSOM) and longitudinally examine the effects of decreased pandemic restrictions, both nationally and at our institution.

Research Methods: A voluntary, anonymous survey was delivered via email to the WVSOM Class of 2024 and Class of 2026 in the spring semester of their first year of medical school (2021 and 2023, respectively). The only inclusion criterion was being currently enrolled in the class. Questions were designed to subjectively assess student mental health status and coping mechanisms over the course of their first year. In addition, respondents completed the Depression, Anxiety, and Stress Scale (DASS-21), a 21-question screening tool that yields a severity score (e.g., mild, moderate, severe, extremely severe) for each mental health category relative to the population mean.

Survey responses were compared between WVSOM academic years and with a pre-pandemic medical student population using t-tests, Chi-square, and Mann-Whitney U tests where appropriate. All data were de-identified. Aggregate results were disseminated in 2021 and 2023 to the WVSOM counseling center, administration, employees, and students to help facilitate discussion about potential areas of improvement to better support the mental and overall wellness of students.

Data Analysis: A total of 135 students participated in the survey; 82 from the Class of 2024 and 53 from the Class of 2026 (response rate= 40% and 27%, respectively). Compared to a pre-pandemic population, the Class of 2024 exhibited elevated mean severity scores for depression, anxiety, and stress on the DASS-21. COVID-19 restrictions severely limited social interactions, with 68% of respondents from the Class of 2024 reporting regularly engaging with less than ten WVSOM classmates during their first year of medical school. Compared to the Class of 2024, the Class of 2026 reported similar levels of anxiety and stress but significantly lower depression scores. Social interactions with classmates were not significantly different between the two classes; students in both classes interacted with a very limited number of classmates. Students in the Class of 2026 were more likely to report an increase in passion for medicine since attending medical school than students from the Class of 2024. Post-pandemic students report significantly higher rates of exercise and less frequent alcohol use as stress-relieving activities.

Conclusion: As hypothesized, the COVID-19 pandemic had a negative effect on depression, anxiety, and stress scores compared to pre-pandemic populations. Reduction in pandemic restrictions yielded some improvements in mental health outcomes among first-year students at WVSOM. Similar levels of stress, anxiety, and social interactions between classes might be explained by residual social anxiety post- pandemic and/or newly established preferences for at-home learning. Continued monitoring of future first-year students with DASS-21 surveys will provide increased insight into the longitudinal impact of COVID-19 on student wellness at WVSOM.

References

1. Nikolis L, Wakim A, Adams W, DO PB. Medical Student Wellness in the United States during the COVID-19 pandemic: A nationwide survey. BMC Medical Education. 2021;21(1). doi:10.1186/s12909-021-02837-y

2. Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey. Acad Med. 2019;94(11):1781-1791. doi:10.1097/ACM.0000000000002958

3. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334-341. doi:10.7326/0003-4819-149-5-200809020-00008

4. Covid-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. World Health Organization. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide. Published March 2, 2022. Accessed March 29, 2023.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was approved by the WVSOM IRB as an exempt research project (IRB #: 2021-4). Survey questions were designed to provide adequate information to researchers while minimizing risks to participants. The survey was anonymous. No data could be tied to any particular individual.

Informed Consent: Participants were informed of their right to consent or not consent to participating in the study with no associated repercussions. This information was provided in the recruitment email as well as the cover letter at the beginning of the survey requesting confirmation of consent to participate. Foreseeable risks of participation (including emotional risks and implications of taking a depression, anxiety, and stress screening test) were also outlined in this cover letter/consent form. A disclaimer was provided to inform participants that test results were not a medical diagnosis, and participants were encouraged to reach out to a healthcare professional with any questions or concerns about their test results.

★Poster No. *H-3

Abstract No. 2023-010

Category: Health Services

Research Topic: Osteopathic Philosophy

Trends in Contributions to the Osteopathic Political Action Committee: A Twenty-Two-Year Analysis

¹Thomas Scully, OMS-III; ²Reagan Loria, MAA-HCA, BA; ²Alexander Golden, MS; ²Victor H. Martinez BS; ³Julieanne Sees, DO, FAOA

¹Department of Research and Innovation, University of the Incarnate Word School of Osteopathic Medicine;²University of the Incarnate Word School of Osteopathic Medicine;³American Osteopathic Academy of Orthopedics

Statement of Significance: Healthcare policies significantly impact medical practitioners’ daily operations. Physician participation in politics is crucial to protecting their interests in healthcare legislation. With 11% of osteopathic physicians in the U.S[1], little is known about the political engagement of osteopathic physicians through the Osteopathic PAC (OPAC). OPAC is the sole political action committee representing the interests of osteopathic physicians at the federal level and is the political arm of AOIA[2].

This study aims to report on the regional distribution, historical trend, and general form of contributions made to the OPAC since the year 2000 to provide insight into the donation habits of osteopathic physicians. This information will allow for more accurate targeting of potential donors to increase the total funds available to OPAC for improved health policy advocacy.

Research Methods: Using the search term “American Osteopathic Association," the public Federal Election Commission database[3-4] was searched for political contributions made by osteopathic physicians from 2000 to 2022 toward the Osteopathic Political Action Committee (OPAC). The data was then divided and analyzed further based on the contribution year and the geography of the contributing physician. Since all the data came from public sources, this study did not involve human subjects and did not require approval from an institutional review board or informed consent.

Data Analysis: Between 2000 and 2022, osteopathic physicians contributed $5,944,999.36 to the Osteopathic Political Action Committee (OPAC). The average individual contribution by osteopathic physicians was $431.33. The highest amount of contributions were reported in 2012, with $326,068.10. There was no significant trend through the years in the total contribution amount. The states with the most contributions were Texas, Ohio, Michigan, and Florida, while Nebraska and Wyoming reported zero contributions toward OPAC. An average of 39.7% of OPAC funds were contributed to Democratic organizations. In comparison, an average of 60.3% of funds were contributed to Republican organizations.

Conclusion: The political contributions of osteopathic physicians in the United States have remained constant throughout the last twenty-two years, with no changes over time. During the study period, contributions made by OPAC overall favored the Republican organizations. Our findings identify opportunities for growth in engagement with AOIA-OPAC within the osteopathic community. More research is necessary to determine how this participation leads to health policies representative of the osteopathic profession.

References

1. American Osteopathic Association . (2022). Osteopathic Medical Profession Report 2022. Chicago.

2. AOIA-OPAC. Accessed March 26, 2023. https://www.osteopathicpac.org/Webpublish/controller.aspx?SiteName=OPACNew&Definition=AboutLevels&SV_Section=About

3. American Osteopathic Information Association - Osteopathic Political Action Committee. 2023. https://www.fec.gov/data/committee/C00113803/?tab=raising. Accessed 2023.

4. PAC profile: American Osteopathic Assn. OpenSecrets. https://www.opensecrets.org/political-action-committees-pacs/american-osteopathic-assn/C00113803/summary/2022. Published 2023. Accessed March 26, 2023.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Exempt from Institutional Review Board approval.

Informed Consent: Not Applicable

Poster No. *H-4

Abstract No. 2023-012

Category: Health Services

Research Topic: Health Disparities-Social Determinants of Health

Empathy Fatigue in Osteopathic Medical Students

¹Elizabeth Gernert, OMS-III; ¹Peter Malaker, OMS-III; ¹Troy Nguyen, OMS-III; ¹Logan Uptegrove, OMS-III; ²Supriya Nagireddi, DO

¹Department of Research, Lake Erie College of Osteopathic Medicine-Erie; ²Department of Research, University Hospitals, Shaker Heights, OH

Statement of Significance: Empathy is considered a major element of medical professionalism[1, 2]. Statistically significant positive associations have been reported between empathy scores and clinical competence or clinical outcomes among medical students and physicians [3, 4]. There have been a limited number of studies of empathy conducted among osteopathic medical students in comparison to their allopathic counterparts.

As osteopathic medical students progress through training from year 1 to year 3, there is a decrease in self-reported empathy via the Jefferson Scale of Empathy (JSE).

Research Methods: Data was gathered through a Google Scholar search of the key words “empathy fatigue in osteopathic medical students.” Four studies were found that compare empathy in osteopathic students from several osteopathic schools during their first and third years of medical school[2, 5-7]. In all of these studies, empathy was measured using the Jefferson Scale of Empathy. The aggregate data was analyzed using the random-effects model. The studies in the analysis are assumed to be a random sample from a universe of potential studies, and this analysis will be used to make an inference to that universe. The data in these studies was compared by analyzing the difference in means. Effect size was measured by using Cohen’s D score (standard difference in means). Heterogeneity was measured using an I2 score. The difference in means, as well as their confidence intervals, was visualized in a forest plot (Figure 1). All data was analyzed using the Comprehensive Meta analysis v4 program.

Data Analysis: The I2 value for the pooled data is 41%, which puts the data in the category of low variance. The values for standard difference in means, standard error, variance, lower/upper limits, z-value, p-value, and N data can be seen in Table 1. A comparison of the data, as well as the pooled data, is shown as a forest plot in Figure 1. With a P-value of 0.123, we fail to reject the null hypothesis that by the third year of osteopathic medical school, students do not experience empathy fatigue.

Conclusion: The current meta-analysis provides evidence that osteopathic medical education does not cause a significant loss of empathy throughout the first three years of medical education. Future research should consider longitudinal studies that examine the progression of empathy in individuals over the 4 years of medical school and may consider further study during residency. Additionally, it would be worth examining the impact of geographic location, core site of rotations, and osteopathic medical school attended which may account for the variation in previous studies. Examining the relationship between empathy and physician education is essential to improving physician education and developing caring and compassionate physicians.

References

1. Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M: Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum. Journal of General Internal Medicine 2012, 27(10):1280-1286.

2. McTighe AJ, DiTomasso RA, Felgoise S, Hojat M: Effect of Medical Education on Empathy in Osteopathic Medical Students. Journal of Osteopathic Medicine 2016, 116(10):668-674.

3. Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS: The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic medicine : journal of the Association of American Medical Colleges 2012, 87(9):1243-1249.

4. Chaitoff A, Rothberg MB, Windover AK, Calabrese L, Misra-Hebert AD, Martinez KA: Physician Empathy Is Not Associated with Laboratory Outcomes in Diabetes: a Cross-sectional Study. J Gen Intern Med 2019, 34(1):75-81.

5. Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH: Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE). Journal of Osteopathic Medicine 2019, 119(8):520-532.

6. Calabrese LH, Bianco JA, Mann D, Massello D, Hojat M: Correlates and Changes in Empathy and Attitudes Toward Interprofessional Collaboration in Osteopathic Medical Students. Journal of Osteopathic Medicine 2013, 113(12):898-907.

7. Kimmelman M, Giacobbe J, Faden J, Kumar G, Pinckney CC, Steer R: Empathy in Osteopathic Medical Students: A Cross-Sectional Analysis. Journal of Osteopathic Medicine 2012, 112(6):347-355.

8. Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, Veloski J, Magee M: The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educational and Psychological Measurement 2001, 61(2):349-365.

9. Hojat M: Empathy in patient care: antecedents, development, measurement, and outcomes, vol. 77: Springer; 2007.

10. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P: Patient complaints and malpractice risk. JAMA 2002, 287(22):2951-2957.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Deemed exempt as it was a meta-analysis.

Informed Consent: No informed consent is required.

Poster No. *H-5

Abstract No. 2023-020

Category: Health Services

Research Topic: Impact of OMM & OMT

Implementing Enhanced Disinfection Protocols in Medical School OMM Labs

¹Harrison A. Patrizio, OMS-III; ¹Riley Phyu; ²Thomas Boyle; ³Todd Schachter

¹Department of Medical Education, Rowan-Virtua School of Osteopathic Medicine; ²Department of Employee Health, Rowan-Virtua School of Osteopathic Medicine; ³Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Disinfection in healthcare facilities has gained heightened attention due to COVID-19.(1) Our previous research found several limitations in existing Osteopathic Manipulative Medicine (OMM) lab protocols, particularly focusing on high contact areas.(2) Given the high interaction in these labs, optimal disinfection is crucial for the safety of students and faculty. This follow-up study aimed to evaluate the efficacy of an enhanced disinfection protocol to address the identified limitations.

To measure the effectiveness of a newly introduced enhanced disinfection protocol by comparing student disinfection results with baseline data. Additionally, we sought to evaluate the retention and consistent implementation of this protocol by the students over a two-week period.

Research Methods: This longitudinal, nonrandomized study, tracked the implementation and effectiveness of an enhanced disinfection protocol on 20 Osteopathic Manipulative Medicine (OMM) examination tables. Tables were chosen based on their proximity to the podium and usage by students, maintaining consistency with our previous study.(2) Swab samples were collected from two high-touch areas (Location A: face cradle, Location B: mid-torso region) before and after applying the disinfection protocol. The enhanced disinfection protocol, detailed in five steps, involved thorough cleaning of the face cradle, flat surfaces, perimeter, creases, and adjustment handles of the examination tables. To assess the internal validity of our protocol, samples were collected before and after disinfection, with a 10-minute interval post-disinfection to avoid skewing results due to residual disinfectant. Two rounds of data collection were carried out. Day 1 involved disseminating the protocol among students through a short instructional video and flyers, followed by sample collection. Day 2 data collection, conducted two weeks later, served to assess the organic retention of the protocol by students, who were not informed about the post-class swabbing this time. ATP bioluminescence assays were performed using the AccuPoint Advanced HC Reader (3), which quantifies ATP content from organic matter in the form of relative light units (RLUs). The threshold for interpretation was set at ATP level of 500 RLU/100cm2. Statistical tests involved setting ATP values of less than 500 RLUs as a pass, and those of 500 or more as a failure. Shapiro-Wilks test was used for normality, while a nonparametric Wilcoxon signed rank test compared initial and terminal sample RLUs. Significance was set at p < 0.05. Cohen’s d test helped determine the magnitude of differences in RLUs, with a large effect size classified as d > 0.80.

Data Analysis: In the disinfection protocol validity trial, significant reductions in pathogen levels post-disinfection were seen in both locations. For Location A, the initial levels (Median=2673.5 RLU, Range=855-5012 RLU, N=20) reduced post-disinfection to Median=127 RLU, Range=0-315 RLU, N=20, with z=5.40, p<0.00001. Similar reductions were seen in Location B, from initial levels (Median=2038 RLU, Range=612-6020 RLU, N=20) to post-disinfection levels (Median=101.5 RLU, Range=0-312 RLU, N=20), with z=5.40, p<0.00001. Location A’s Day 1 post-disinfection sampling indicated a 95.0% success rate (19 out of 20 samples < 500 RLUs), while Day 2 showed a marked decrease to a 40.0% success rate (8 out of 20 samples < 500 RLUs). Wilcoxon signed rank test revealed significantly higher estimated pathogen levels on Day 2 (Median=703 RLU, Range=23-1345 RLU, N=20) than baseline (Median=127 RLU, Range=0-315 RLU, N=20), with z=-4.18, p<0.00001 and a large effect size, d=1.71. Location B yielded a 100% success rate on Day 1 (20 out of 20 samples < 500 RLUs), reducing to 55.0% on Day 2 (11 out of 20 samples < 500 RLUs). Here, the Wilcoxon signed rank test showed significant increase in estimated pathogen levels on Day 2 (Median=376.5 RLU, Range=15-1467 RLU, N=20) compared to baseline (Median=101.5 RLU, Range=0-312 RLU, N=20), with z=-3.12, p=0.0018 and a large effect size, d=1.24.

Conclusion: This study not only validates an enhanced disinfection protocol, significantly reducing potential pathogen levels in OMM labs, but also prompted an institution-wide reform in disinfection practices. The results led to the immediate implementation of the enhanced protocol across all medical education settings in our institution. However, the noticeable decline in adherence over two weeks underscores the necessity for sustained training, monitoring, and reinforcement of these practices. As a result, our institution has committed to ongoing education and adherence assessments. This research reaffirms the critical importance of consistent hygiene practices in medical education, demonstrating that the true effectiveness of a disinfection protocol lies in its regular and meticulous application. The institutional impact of this study highlights the broader implications for maintaining safe learning environments, prompting the continuous refinement of hygiene protocols based on emerging research findings.

References

1. Lima de Miranda K, Detlefsen L, Stolpe M. Overconfidence and Hygiene Non-Compliance in Hospitals. Kiel Working Paper; 2020.

2. Patrizio HA, Phyu R, Boyle T, Schachter T. The effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs. J Osteopath Med. Published online June 14, 2023. doi:10.1515/jom-2022-0213

3. Neogen Corporation AccuPoint advanced HC user manual. manualzz. https://manualzz.com/doc/54734086/neogen-

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study is exempt from the IRB review process.

Informed Consent: None reported.

Poster No. H-6

Abstract No. 2023-021

Category: Health Services

Research Topic: Health Disparities-Social Determinants of Health

COVID-19 Vaccine Distribution: A Healthcare Disparity?

¹Melanie Hyte, PharmaD, BCIDP; ²Mayra Rodriguez; ³David Redden

¹Department of Pharmacology, Edward Via College of Osteopathic Medicine-Auburn Branch Campus; ²Department of Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine-Auburn Branch Campus; ³Department of Biostatistics, Edward Via College of Osteopathic Medicine-Auburn Branch Campus

Statement of Significance: The purpose of this study is to determine whether the distribution of the COVID-19 vaccine in Alabama adhered to the COVID-19 vaccine rollout plan, which prioritized healthcare and essential workers, those with high risk medical conditions, and adults > 65 years of age.(1)

1. To determine disparities in COVID-19 vaccine distribution in Alabama.

2. To determine COVID-19 distribution based on county and type of facility.

Research Methods: This is a retrospective study of the COVID-19 vaccine distribution data as supplied by the Alabama Department of Public Health from December 15, 2020, to March 25, 2022. We examined the association among county levels variables such as population size, number of hospitals, number of nursing homes, and social vulnerability index (SVI) with the longitudinal distribution of COVID-19 vaccine doses using Pearson correlation statistics and linear mixed models. A division of the CDC developed the social vulnerability index that uses 16 U.S. census variables that helps emergency response planners and public health officials identify, map, and plan support for communities that will most likely need support before, during, and after a public health emergency. State and local health departments and non-profits use the SVI to guide community-based health promotion initiatives. (2)

All 67 counties in Alabama were studied. Data was divided into five quarters: Q1-4 for 2021 and Q1 for 2022.To test the association among doses distributed by quarter with county size, number of hospitals within the county, number of nursing homes per county, and social vulnerability index, Spearman correlations were calculated per quarter. We also constructed multiple linear regressions by quarter to determine the total amount of variability in dose distribution that could be explained by these factors as well as to determine which factors explained the variation the most.

Data Analysis: Across all five quarters investigated, the single factor most associated with the number of doses distributed to the county was county population size. Across all quarters, the Spearman correlation between population size and number of doses distributed was statistically significant (p < 0.0001) with correlations of 0.90 or greater. Also significantly associated (p< 0.0001) with the number of doses distributed per quarter were the number of hospitals in the county and the number of nursing homes within the county ranging consistently with Spearman correlations around 0.70. The only factor not significantly associated with the number of doses distributed per quarter was Social Vulnerability Index. Taken collectively, the two factors that significantly predicted total number of doses distributed per quarter were county population size and number of nursing homes within the county.

Conclusion: The COVID-19 vaccine rollout plan prioritized healthcare personnel, other essential workers, adults with high-risk medical conditions and adults aged > 65 years.(2) As a result of supply and demand principles, healthcare providers and facilities are more concentrated in areas of higher populations. Given patients in nursing homes are > 65 years of age, our results show a statically significant correlation of the number of COVID-19 vaccine doses with population, number of hospitals and the number of nursing homes. Given the reasonable association of more hospitals, (resulting in more healthcare personnel) and nursing home residents being > 65 years of age, we conclude that the COVID-19 vaccine was distributed as intended in the rollout plan.

To address the question of whether there was a disparity based on socioeconomic status, we used the Social Vulnerability Index (SVI). The distribution of doses was not associated with SVI.

These findings support the Alabama Department of Public Health’s efforts to successfully tackle COVID-19 vaccine distribution based on population, number of hospitals and number of nursing homes during unprecedented times.

References

1. McClung N, Chamberland M, Kinlaw K, et al. The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine-United States, 2020. Am J Transplant. Jan 2021;21(1):420-425. doi:10.1111/ajt.16437

2. Centers for Disease Control Agency for Toxic Substances and Diseases Registry. CDC/ATSDR Social Vulnerability Index . https://www.atsdr.cdc.gov/placeandhealth/project_snapshots/svitool_covid.htmlA. Accessed June 26, 2023.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Edward Via College of Osteopathic Medicine Institutional Review Board

1. Project Title: [2067847-1] COVID-19 Vaccine Distribution: A Healthcare Disparity?

VCOM IRB Record #: 2023-049

1. Action: Determination of not Human Subject Research

2. Decision Date: June 13, 2023

Informed Consent: Not applicable.

★Poster No. *H-7

Abstract No. 2023-027

Category: Health Services

Research Topic: Chronic Diseases & Conditions

Are Physicians Capturing Enough Data to Make Infant Growth Charts Useful Diagnostic Tools?

Joshua Clayton Ranta, OMS-II; Steven Enkemann; Andrew Walker; JuliSu DiMucci-Ward

Department of Cell Biology & Physiology, Edward Via College of Osteopathic Medicine-South Carolina Branch Campus

Statement of Significance: Growth monitoring is considered a fundamental component of routine pediatric care. Tracking the anthropometric measures of height, weight, and head circumference can be used to detect malnutrition, genetic and endocrine disorders, and even viral diseases. In the era of electronic health monitoring, what once was done with pencil and paper is now digital. The fundamental question is whether it is better. Are growth monitoring tools being used effectively?

To determine whether enough data was collected from infants to allow physicians to plot growth curves. Current pediatric recommendations indicate that a newborn infant should be measured shortly after birth, 1, 2, 4, 6, and 9 months of life in the first year and 4 more times in the second year of life. We investigated the electronic health data of more than 9000 individuals to determine if this objective was being met for infants in South Carolina.

Research Methods: The data utilized in this study was derived from electronic health records collected in hospital systems within South Carolina. The medical records from pediatric offices, outpatient clinics, hospitals, and emergency departments located throughout the state were collected by a unified collaboration defined as Health Sciences South Carolina (HSSC), which was created to provide data for the purpose of investigations into health trends within the state. We obtained from this organization growth measurements collected for infants over the pre-COVID period between February 18, 2008 to April 29, 2019. The primary variables of interest in this study were weight (measured in kg) and height measurements (measured in cm). Inclusion criteria included that the children had reached the age of 6 months at the time data was retrieved and that at least 3 measures existed in the database. A total of 186,849 patient visits were collected over this period from 9513 patients. Exclusion criteria consisted of removing visits where both a weight and a height were not recorded and removing individuals with lengthy hospital stays which was defined as anyone with over 30 visits recorded before reaching 5 years of age. After removing all visits that occurred after the 24th month we had 9,449 patients with a combined 74,353 visits. For some analyses we further reduced this cohort to include only those visits recorded as well-check visits. This reduced the numbers to 38,947 visits among 7806 infants.Cohorts of children that had aged at least 2, 4, 6, 12, and 24 months by the end of the collection period were analyzed. At these timepoints the expected number of well-check visits would be 3,4,5,7, and 10 respectively (including an initial visit within 1 week of birth). The cohorts were evaluated for the number of measurement events that had been recorded in the EHR during their life up to these time points and when these measurements occurred.

Data Analysis: Current world and USA recommendations are that infants should be measured 10 times in the first two years of life. The infants in the HSSC data were measured an average of 7 times. Our results indicate that approximately half of all infants missed a measurement within the first two months of life and that this trend continued to increase with age. If only well-child visits were considered, more than half of all infants had missed 2 measurements within the first 6 months of life and averaged only 5 well check visits in two years. Parents and healthcare providers seem to be making efforts to meet the prescribed well care visits as the majority of measurements occurred on the recommended milestones. At the beginning of life, the majority of infants were measured predominantly on the planned dates but as the infant ages the likelihood that a measurement occurs on a birth anniversary was lower and lower. Parents may miss the target date by weeks or skip the visit altogether leading to a reduced number of data points to plot for growth curves. This makes it more difficult to develop a picture of growth progression effectively rendering growth curves meaningless. A critical period of growth is from 2 to 6 months with only three recommended measurement dates within this timeframe. Our data suggests that 74.9% of infants were missing at least one of these measurements. This is where trends can be set that follow a child throughout life. The HSSC data showed that during this critical period nearly half of the infants had fewer than the advised number of measures making it difficult to use growth measures to spot growth trends.

Conclusion: The major health concern for infants in America is the early trend towards obesity. Research has suggested that unhealthy growth trends can be set in the first 1000 days of life setting a child on a path of lifetime obesity. For this reason, many have suggested that infants, as early as two months of age, should be assessed for unhealthy growth trajectories to allow time to put a child on a healthier path. The data presented here shows that even though electronic record keeping should be conveniently capturing and storing anthropometric data, most infants are missing key data. Approximately three quarters of infants had fewer than the recommended number of recorded growth measurements and a majority of infants were missing at least one measurement during the key ages of 2 to 6 months. It is not possible to visually observe growth trajectories with the low number of recorded measurements at this time.

As far as limitations go, there were many people gathering this data in a variety of clinical settings. This sets up the possibility of measurement error as well as miskeys into the electronic system. Similarly, children had measures from well-check visits, sick visits, and other reasons which could alter the short-term metabolism of each child. It is impossible to reasonably control for these differences, however, the large sample size should help mitigate some of these errors.

This study serves as a pilot for later projects to analyze why these anthropometric discrepancies occur and what can be done to solve these problems. In the future, more efforts will be taken to explain infants’ lack of doctor visits in the first 1000 days of life and develop new strategies to use measurements taken in the first 1000 days to correlate with the growing pediatric metabolic concerns nationwide.

References

1. Kuczmarski R, Ogden C. 2000 CDC Growth Charts for the United States: Methods and Development. Center for Disease Control and Prevention. 2002. Accessed June 6, 2023. https://www.cdc.gov/growthcharts/2000GrowthChart-US.pdf.

2. Cole TJ, Singhal A, Fewtrell MS, Wells JC. Weight centile crossing in infancy: correlations between successive months show evidence of growth feedback and an infant-child growth transition. The American Journal of Clinical Nutrition. 2016;104(4):1101-1109. https://doi.org/10.3945/ajcn.116.139774

3. Wolf ER, O’Neil J. Caregiver and Clinician Perspectives on Missed Well-Child Visits. Annals of Family Medicine. 2020;18(1). doi:10.1370/afm.2466

4. Scherdel P, Dunkel L, van Dommelen P, et al. Growth monitoring as an early detection tool: a systematic review. The Lancet Diabetes & Endocrinology. 2016;4(5):447-456. https://doi.org/10.1016/s2213-8587(15)00392-7

5. Marchand V. The toddler who is falling off the growth chart. Paediatrics & Child Health. 2012;17(8):447-450. https://doi.org/10.1093/pch/17.8.447

6. Gittner LS, Ludington-Hoe SM, Haller HS. Utilising infant growth to predict obesity status at 5 years. Journal of Paediatrics and Child Health. 2013;49(7):564-574. https://doi.org/10.1111/jpc.12283

7. Berkey CS, Reed RA, I Valadian. Longitudinal growth standards for preschool children. 1983;10(1):57-67. https://doi.org/10.1080/03014468300006181

8. Lioret S, Harrar F, Boccia D, et al. The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review. Obesity Reviews. 2022;24(1). https://doi.org/10.1111/obr.13524

9. Amirabdollahian F, Haghighatdoost F. Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio. Journal of Obesity. 2018;2018:1-15. https://doi.org/10.1155/2018/8370304

10. Schwarzenberg SJ, Georgieff MK. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018;141(2):e20173716. https://doi.org/10.1542/peds.2017-3716

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Study design submitted to VCOM Carolinas and received IRB approval. This study was deemed exempt by the IRB.

Informed Consent: Informed consent was not required because the study is exempt due to the use of de-identified data.

Poster No. *H-8

Abstract No. 2023-067

Category: Health Services

Research Topic: Impact of OMM & OMT

Attitudes and Practice Patterns In The Use Of OMM In Patients With Serious Illness

Corey Nick Brisseau, OMS-IV; Brenda Hoffman; Nicol Joseph; Lauren Noto-Bell; Stephanie Felgoise; Michael Srulevich, DO

Department of Geriatric Medicine, Philadelphia College of Osteopathic Medicine

Statement of Significance: In addition to evidence-based medicine, the osteopathic approach to person-centered care consists of the osteopathic philosophy of integrated structure and function and applying manual techniques to treat somatic dysfunction. Known collectively as Osteopathic Manipulative Medicine (OMM), this approach can be utilized when treating patients with both chronic and acute conditions. There is limited data on how often OMM is used to treat pain in patients facing serious illnesses.

To quantify the frequency with which osteopathic physicians are utilizing OMM and describe what symptoms are being treated, and in what settings. To understand attitudes towards utilizing OMM in seriously ill patients. To investigate if there are any associations between use of OMM and type of physician training, age, number of years in practice, or primary site of physician practice. To gauge osteopathic physicians’ attitudes towards their training in OMM.

Research Methods: A voluntary, anonymous survey was created to capture the practice patterns and attitudes of osteopathic physicians, regardless of specialty, in the uses and benefits of OMM in treating patients with serious illness. The survey was approved by the IRB and designed using a Likert-scale, multiple choice format using Redcap software and permission to distribute the survey electronically was granted from various national and local professional organizations including the American Osteopathic Association (AOA), Pennsylvania Osteopathic Medical Association (POMA) and the PCOM alumni association. Among key data analyzed were the frequency of OMM use in serious or life-limiting illness (Cancer, CHF, and COPD), attitudes about OMM, beliefs about OMM, and use of OMM in older adults. All data was entered into Redcap for analysis.

Data Analysis: Majority of osteopathic physicians (OPs) are comfortable utilizing OMM (79.8%), primarily for musculoskeletal pain (81%). Most OPs thought utilizing OMM in serious illness was "somewhat to "often" beneficial and was utilized “sometimes” or “frequently” in constipation (49%), neuropathic or visceral pain (67.2%), and dyspnea (58.7%) but it’s use in nausea (60.1%), older patients or in those with limited life expectancy was "rare" or "sometimes” utilized. Alongside evidence-based treatments, OPs utilize OMM in patients with cancer, but less so with congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). (57.5%) OP stated they have used OMM techniques to treat symptoms for my patients who had a terminal diagnosis. Overwhelmingly, respondents thought osteopathic training enables them to approach patients with empathy (84%) and view the patient-family-environment as part of an interconnected unit (83%).

Conclusion: Osteopathic Manipulative Medicine (OMM) is used by many osteopathic physicians when treating pain and other symptoms of patients who have serious illness. OMM is perceived to be beneficial when treating conditions related to CHF, COPD, and Cancer. Osteopathic Physicians who do utilize Osteopathic Manipulative Medicine believe that their training has allowed them to engage and treat patients with compassion, empathy, and view the patient-family-environment as an interconnected unit. These findings support the ongoing need for randomized controlled trials that could quantify potential benefits of OMM and the osteopathic approach for patients facing serious and life-limiting illness.

References

1. Snider KT et al. 2013. Retrospective medical record review of an osteopathic manipulative medicine hospital consultation service. JAOA.

2. Noll DR, et al. 2016. Multicenter Osteopathic Pneumonia Study in the Elderly: Subgroup Analysis on Hospital Length of Stay, Ventilator-Dependent Respiratory Failure Rate, and In-hospital Mortality Rate. JAOA. 2016 Sep 1; 116(9):574-587.

3. Licciardone, JC, Gatchel RJ 2020. Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry-Based Study.JAOA., 120(2), 64-73.)

4. RK Howell, TW Allen, RE Kappler. The influence of osteopathic manipulative therapy in the management of patients with chronic obstructive lung disease.J Am Osteopath Assoc, 74 (April) (1974), pp. 757-760.

5. Licciardone JC et al. 2019. Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of their Patients: A Pain Registry-Based Study. JAOA.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The study was approved by the IRB Committee on September 26, 2022 (Protocol #H22-028X).

Informed Consent: Not applicable.

Poster No. *H-9

Abstract No. 2023-070

Category: Health Services

Research Topic: Chronic Diseases & Conditions

Gestational Diabetes Among the South Asian Diaspora in the United States of America: A Scoping Review

Anudeep Deevi, OMS-II; Mariam Sharobeem, BS; Gabrianna Andrews, BS; Rahul Ubrani, BS Venkat Venkataraman, PhD

Division of Research, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Gestational diabetes mellitus (GDM) is defined as glucose intolerance in the second or third trimester of pregnancy in women who have not been diagnosed with diabetes prior to gestation. GDM has been identified as a major pregnancy complication, yielding a 7-fold increased risk of maternal development of type 2 diabetes1 as well as lower neonatal insulin sensitivity². South Asian women living in the United States have a three to four-fold increase in developing GDM compared to Caucasian women¹.

To review the current knowledge base regarding GDM among South Asians living in the United States. In addition, the review was meant to identify any gaps in knowledge, specifically as it pertains to the adverse health outcomes associated with GDM as well as the current prenatal care received by South Asians with GDM.

Research Methods: Search Methods: A systematic search of PubMed, Web of Science, EMBASE, and Scopus was conducted. The key phrase "gestational diabetes South Asians in the United States" was used as search terms. The search was restricted to U.S. articles published on or after 01/01/2013. Articles from database searches were then uploaded to Rayyan for inclusion and exclusion screening. Selection Criteria: Included articles were restricted to original research conducted in the United States that focused on South Asians as a distinct population and where GDM was the primary disease of the study. Articles were screened by 3 reviewers (AD, MS, and GA) at both the title/abstract level and the full-text level. One reviewer (RU) acted as a tiebreaker at the full-text level. Data Collection and Analysis: Data from included articles were then mapped to one of the following three categories: prevalence, risk factors, or outcomes. The data was condensed and explicated into a narrative review of the findings from the included articles.

Data Analysis: Prevalence: South Asian women were found to have a significantly higher risk of having GDM compared to Non-Hispanic Caucasian women in the United States (p<0.0001)³. South Asian women living in ethnic enclaves also have an increased likelihood of GDM compared to those living in other neighborhoods (95% CI)⁴. Risk Factors: Among the risk factors associated with GDM, inadequate health insurance and late initiation of prenatal care were highest among Pakistani and Bangladeshi women (p <0.001)³. Outcomes: South Asian women with a previous history of GDM were found to have a three-fold increase in the risk of developing Type 2 Diabetes compared to South Asians who did not have GDM (95% CI)1. Pakistani women with GDM were implicated to have significantly higher odds of having infants that were Smaller for Gestational Age within the 10th percentile compared to Non-Hispanic Caucasian women, whereas Indian and Bangladeshi women had two times the odds of having a child Small for Gestational Age in the 5th percentile compared to Non-Hispanic Caucasian women³.

Conclusion: Primary findings from the included articles are that South Asians are more likely to develop GDM and more likely to have live births resulting in low for gestational age birth weights than non-Hispanic Caucasians¹. In addition, South Asians living in ethnic enclaves were more likely to develop GDM than those who lived in more multicultural regions4. Finally, South Asians with GDM were found to be more likely to develop Type 2 diabetes postnatally than South Asians who did not have GDM¹. The limitations of the included studies were that they were particularly localized and did not provide a generalizable trend of South Asians with GDM nationwide. Furthermore, the included studies were retrospective studies that utilized databases that may not have been created for the purposes of studying GDM in South Asians. The current base of literature includes gaps in knowledge that are necessary to address in order to effectively provide care for this population. Such gaps include the exact risk factors that make South Asians more prone to developing GDM, additional neonatal and maternal adverse health outcomes that are more significantly prevalent among South Asians with GDM, and the integration of specific culturally relevant prenatal care for South Asian patients. As osteopathic physicians and medical students, it is quintessential to take into account ethnic predispositions for chronic conditions and culturally relevant constructs when providing holistic health care for patients. Further directions from this review include evaluating the nationwide prevalence of GDM-associated adverse health outcomes that are significantly higher among South Asians, understanding the current lived experiences of South Asian patients living in the United States regarding both their diagnosis and subsequent treatment of GDM5, and identifying deficiencies in providing culturally relevant prenatal care, especially as it pertains to dietary recommendations and familial support strategies⁶.

References

1. Gadgil MD, Oza-Frank R, Kandula NR, Kanaya AM. Type 2 diabetes after gestational diabetes mellitus in South Asian women in the United States. Diabetes Metab Res Rev. Jul 2017;33(5)doi:10.1002/dmrr.2891

2. Anand SS, Gupta M, Teo KK, et al. Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study. CMAJ Open. 2017;5(3):E604-E611. doi:10.9778/cmajo.201700275.

3. Sanchalika A, Teresa J. Risk of Gestational Diabetes Among South Asian Immigrants Living in New Jersey--a Retrospective Data Review. J Racial Ethn Health Disparities. Dec 2015;2(4):510-6. doi:10.1007/s40615-015-0099-64.

4. Janevic T, Borrell LN, Savitz DA, Echeverria SE, Rundle A. Ethnic enclaves and gestational diabetes among immigrant women in New York City. Soc Sci Med. Nov 2014;120:180-9. doi:10.1016/j.socscimed.2014.09.0263.

5. Bandyopadhyay M. Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia. BMC Pregnancy and Childbirth. 2021/07/09 2021;21(1):500. doi:10.1186/s12884-021-03981-56.

6. de Sequeira S, Halperin I, Lipscombe LL. Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What’s Missing? A Qualitative Study. Can J Diabetes. Dec 2019;43(8):573-579. doi:10.1016/j.jcjd.2019.09.007

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The study was exempt from IRB approval as the research conducted was a scoping review of the available literature.

Informed Consent: N/A.

Poster No. *H-10

Abstract No. 2023-077

Category: Health Services

Research Topic: Health Disparities-Social Determinants of Health

Does Self-Perceived Student Competency in Family Planning Counseling Differ Between Faith-Based Versus Non-Faith-Based OB/GYN Clerkship Sites?

¹Rachel Feltman, OMS-III; ²Steven R. Lewis; ³Nathan E. Thompson

¹Department of Academic Medicine Scholar, New York Institute of Technology; ²Department of Clinical Medicine, New York Institute of Technology; ³Department of Anatomy, New York Institute of Technology

Statement of Significance: Family planning healthcare needs (contraception and abortion) are utilized by thousands of patients each year [1,2]. Yet, an overall lack of family planning training has been shown at both the medical school and residency level [3-5]. A likely barrier to high-quality training is training at faith-based institutions [5-7]. However, research evaluating family planning education and training for medical students at faith-based institutions is limited, in particular for osteopathic medical students.

This study has two specific goals: 1) to assess the self-perceived competency of osteopathic medical students regarding contraception and abortion counseling confidence, ability, and knowledge, and 2) to evaluate if there is a difference in contraception and abortion training, or a difference in student experience and exposure to these topics, between faith-based or non-faith-based clerkship sites.

Research Methods: A confidential survey was created through Redcap and distributed to the 845 students at New York Institute of Technology College of Osteopathic Medicine (NYIT COM) who had completed their core third-year Ob/Gyn clerkship (i.e., all current end-of-3rd and 4th-year students). The survey queried students about demographic information as well as introductory questions including intended field of practice and the experiences they witnessed or participated in while on their Ob/Gyn clerkship. The next sections asked students to use a Likert-scale to rate their self-perceived competency on contraception and abortion counseling confidence, ability, and knowledge following the clerkship. The abortion-based questions are adapted from Gardner et al. [8] and have been extended here to also gauge contraceptive competence. Finally, students were asked to report their clerkship site and the religious affiliation (if known) of the site. Prior to data analysis each survey was reviewed, and the religious affiliation of the clerkship sites was verified. Student responses were tabulated among all respondents, as well as by verified religious affiliation of the Ob/Gyn clerkship site (Catholic, Protestant, Judiac, or secular). Differences among religious affiliations were tested using a Kruskal-Wallis one-way analysis of variance with a post-hoc Dunn’s test for pair-wise comparisons.

Data Analysis: Of the 82 participants, 40 students performed their rotation at a faith-based site (21 Catholic, 6 Protestant, 13 Judaic) and 42 students rotated at secular sites. Self-perceived competency in contraception counseling confidence was significantly lower for students that performed their rotation at Catholic (2.5±1.2) and Judiac (2.3±1.2) sites than for students at secular sites (3.6±1.0; p<0.01). Additionally, students at Catholic affiliated sites had significantly lower self-perceived competency in contraception counseling ability and knowledge compared to secular sites (p<0.05). Self-perceived competency in abortion counseling confidence, ability, and knowledge did not significantly differ among religious affiliations and/or secular sites, however, competency in these areas were absolutely low for all students (2.2±1.2–2.4±1.2). Students who completed their Ob/Gyn clerkship at secular sites also felt they were better able to adequately explain all options to a patient who has an unintended pregnancy (3.1±1.3) compared to students at Catholic (2.2±1.0), Judaic (2.2±1.4), or Protestant (1.8±1.6) sites. An overwhelming majority of students, regardless of clerkship site, felt that NYIT COM should include more education about contraception (87%), and abortion (83%) in their curriculum. The majority of students (80%) also said they would participate in additional lectures or learning opportunities in family planning if provided.

Conclusion: Our survey results indicated that competency in family planning following Ob/Gyn clerkships is moderate to low in contraception and abortion topics, respectively. Religious affiliation of the Ob/Gyn site does have an effect on contraception training. Specifically, students at Catholic clerkship sites report significantly lower competency in contraception counseling confidence, ability, and knowledge. There was no effect of religious affiliation on abortion competency, though abortion competency was low overall. One limitation to this study is the relatively small sample size at a single institution, but this can be resolved through expansion of the study to a nationwide audience of medical students. This will provide a more complete picture of medical student education and training in family planning topics at faith-based and secular hospitals and practices. Osteopathic medical education seeks to create well-rounded physicians who consider a holistic approach when treating patients. Our study suggests additional opportunities may be needed for, and would likely be well-attended by, osteopathic medical students to better prepare them to educate and counsel their future patients regarding family planning topics.

References

1. Daniels K, Abma JC. Current contraceptive status among women aged 15–49: United States, 2015–2017. NCHS Data Brief, no 327. Published online December 2018. https://www.cdc.gov/nchs/products/index.htm.

2. Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. Perspect Sex Reprod Health. 2022;54(4):128-141. doi:10.1363/psrh.12215

3. Duane M, Carson G, Vanderkolk K, Adams E, Gordon L. An Evaluation of US Medical Schools’ Reproductive Health and Family Planning Curricula. Issues Law Med. 2022;37(2):117-128.

4. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: A national survey. Am J Obstet Gynecol. 2005;192(2):640-643. doi:10.1016/j.ajog.2004.09.013

5. Guiahi M, Teal S, Kenton K, DeCesare J, Steinauer J. Family planning training at Catholic and other religious hospitals: a national survey. Am J Obstet Gynecol. 2020;222(3). doi:10.1016/j.ajog.2019.09.012

6. Bringley J, Zu V, Javlekar A, Daoud Yilmaz F, Flink-Bochacki R. Effects of rotating at a Catholic hospital on medical student contraceptive objective structured clinical exam scores. Contraception. 2022;106:64-67. doi:10.1016/j.contraception.2021.09.002

7. Guiahi M, Maguire K, Ripp ZT, Goodman RW, Kenton K. Perceptions of family planning and abortion education at a faith-based medical school. Contraception. 2011;84(5):520-524. doi:10.1016/j.contraception.2011.03.003

8. Gardner H, Zimmerman M, Flanigan M, Baldwin M. A comparison of medical student competency, attitudes and knowledge of abortion care after a structured clinical curriculum. Res Sq. 2020;PREPRINT (Version 3). doi:10.21203/rs.2.22383/v3

Financial Disclosures: None reported.

Support: Participants in this project were entered into a raffle for one of 40 gift cards ($25 each). The funding for participant incentives was provided by the NYIT Academic Medical Scholars Program.

Ethical Approval: This project was reviewed by the NYIT IRB and determined to be exempt (NYIT IRB BHS-1839).

Informed Consent: This survey was distributed through Redcap, and respondents were consented before proceeding to the survey. The consent stated the survey is voluntary and anonymous, and participants are free to leave at any time.

Poster No. *H-11

Abstract No. 2023-091

Category: Health Services

Research Topic: Osteopathic Philosophy

The Effectiveness of Disinfecting Protocols in Osteopathic Family Medicine Offices

¹Riley Phyu, OMS-III; ¹Harrison A. Patrizio; ²Thomas Boyle; ³Todd Schachter

¹Department of Medical Education, Rowan-Virtua School of Osteopathic Medicine; ²Department of Environmental Services, Rowan-Virtua School of Osteopathic Medicine; ³Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Healthcare-associated infections (HAIs) are a public health threat.(1) Despite efforts to curb HAIs in hospital environments, outpatient settings, notably in osteopathic family medicine, have not received the same degree of attention.(2-5) Osteopathic family medicine offices, as centers for holistic care, highlight the crucial role of simple disinfection protocols like thorough cleaning between patient appointments in reducing disease transmission and enhancing overall patient health.

To assess the effectiveness of the current disinfection protocols in osteopathic family medicine offices

Research Methods: A cross-sectional study evaluating disinfection practices on 18 active examination tables in an Osteopathic family medicine office was conducted. Two high-touch surfaces, namely the mid-torso region (Location A) and table edge (Location B), were the focal points of the study. Initial samples were collected post-morning disinfection by Environmental Services, and terminal samples gathered post-day’s end disinfection by the medical staff. ATP bioluminescence assays were performed using AccuPoint Advanced HC Reader, which quantified ATP, indicating contamination levels in the samples. All samplers were handled and tested as per manufacturer’s instructions, with ATP level of 500 RLU/100cm2 deemed the benchmark threshold for interpretation. A preliminary trial was conducted to confirm the internal validity of ATP bioluminescence measurements. The statistical analysis involved Shapiro-Wilks and Wilicoxin signed rank tests, with significance set at p < 0.05. Cohen’s d test was used to calculate the effect size, identifying meaningful differences in initial and terminal sample RLUs.

Data Analysis: In our disinfection protocol validity trial, significant reductions in pathogen levels were observed in both selected locations following the disinfection procedure. For Location A (Mid-torso), the pre-disinfection pathogen levels (Median=2250 RLU, Range=551-5900 RLU, N=18) were significantly reduced post-disinfection to Median=175.5 RLU, Range=3-391 RLU, N=18, with z=5.40, p<0.00001. Despite this reduction, the terminal sample showed a decrease in pass rate from an initial 94.4% (17 out of 18 samples < 500 RLUs) to 83.3% (15 out of 18 samples < 500 RLUs). The Wilcoxon signed rank test revealed no significant difference in estimated pathogen levels between initial (Median=134 RLU, Range=4-946 RLU, N=18) and terminal samples (Median=193 RLU, Range=1-690 RLU, N=18), with z=0.11, p=0.9124 and a small effect size, d=0.04. Similarly, Location B (Edge) saw a significant reduction in pathogen levels from pre-disinfection (Median=2225 RLU, Range=701-7201 RLU, N=18) to post-disinfection (Median=221 RLU, Range=5-530 RLU, N=18), with z=5.40, p<0.00001. Unlike Location A, however, Location B had no successful disinfection (0 out of 18 samples < 500 RLUs) in both initial and terminal samples. The Wilcoxon signed rank test indicated no significant difference in pathogen levels between the initial (Median=2257 RLUs, Range=932-5825 RLUs, N=18) and terminal samples (Median=2095 RLUs, Range=891-5540 RLUs, N=18), with z=-0.57, p=0.61 and a small effect size, d=0.12.

Conclusion: The findings from this study reveal a significant disparity in outcomes between the two sample locations, Location A (Mid-torso) and Location B (Edge). Location A demonstrated a relatively low failure rate in both initial and terminal samples, indicating successful outcomes. In contrast, Location B consistently displayed a 100% failure rate, emphasizing the need for more care and attention when cleaning the edge of the examination to ensure better outcomes. By prioritizing adequate disinfection protocols, including thorough cleaning between patients, osteopathic family medicine offices can effectively prevent disease transmission, promote patient safety, and align with the principles of holistic and patient-centered care.

References

1. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801

2. National Center for Emerging and Zoonotic Infectious Diseases (U.S.). Division of Healthcare Quality Promotion. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion; 2011. https://play.google.com/store/books/details?id=pg44twAACAAJ

3. Maki DG, Crnich CJ. History forgotten is history relived: nosocomial infection control is also essential in the outpatient setting. Arch Intern Med. 2005;165(22):2565-2567. doi:10.1001/archinte.165.22.2565

4. Jarvis WR. Infection control and changing health-care delivery systems. Emerg Infect Dis. 2001;7(2):170-173. doi:10.3201/eid0702.010202

5. Halpern MT, Yabroff KR. Prevalence of outpatient cancer treatment in the United States: estimates from the Medical Panel Expenditures Survey (MEPS). Cancer Invest. 2008;26(6):647-651. doi:10.1080/07357900801905519

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable.

Informed Consent: Not applicable.

Poster No. *H-12

Abstract No. 2023-093

Category: Health Services

Research Topic: Osteopathic Philosophy

A Systematic Review of the Efficacy of Personal Protective Equipment in Reducing Radiation Exposure in Urologists

¹Camryn Daidone, OMS-III; ¹Erika Lytle, OMS-III; ²Virgil DeMario, OMS-III; ¹Naved Salim, OMS-III; ³Cheyanne Izon, OMS-II; ²Kimberly Lince, OMS-III; ⁴Young Son, DO; ⁴Thomas Mueller, MD

¹Edward Via College of Osteopathic Medicine -Louisiana Branch Campus; ²University of the Incarnate Word School of Osteopathic Medicine; ³Kansas Health Sciences Center Kansas College of Osteopathic Medicine; ⁴Department of Urology, Jefferson Health

Statement of Significance: As the use of ionizing radiation in urological procedures increases, the lack of standardized guidelines to reduce exposure may cause harm to providers. The current literature lacks data on the impact of long-term radiation exposure that urologists will receive throughout the career and efficacy of personalized protective equipment and techniques to reduce exposure. The establishment of guidelines to reduce radiation exposure is essential in the protection of urologists and surgical staff.

To evaluate the literature to summarize the use of personal protective equipment (PPE), radiation safety, knowledge, education, and procedural modification to reduce radiation to urologists and surgical staff

Research Methods: The review protocol was registered in the PROSPERO (International Prospective Register of Systematic Review). A systematic review was performed in accordance with Preferred Reporting items for Systematic Reviews (PRISMA) guideline. We searched PubMed, Embase, Scopus, and Web of Science for systematic reviews evaluating articles for urological associated radiation knowledge, education, guidelines, safety, PPE, and procedural modification. Articles containing aforementioned criterias for practicing urologists or training urologists were included. Exclusion criteria included articles that were not written in English, case reviews, case reports, articles >10 years, and abstracts. Titles and abstracts of identified articles were reviewed by a methodologist with two independent reviewers screened for study eligibility. If there was a conflict between the two independent reviewers, a clinician adjudicator finalized the included studies. Risk-of-bias (RoB) assessment was performed independently by two authors using the cochrane RoB tool or validated Joanna Briggs Institute Critical Appraisal Checklist for non-randomized studies.

Data Analysis: The literature search yielded 209 unique articles regarding radiation association in urologists of which 45 articles were excluded as they were published greater than 10 years ago. Another 97 were excluded during abstract and title screening that did not meet the inclusion criteria. Through full manuscript review, additional 17 studies were excluded leaving a total of 50 studies meeting the inclusion criteria. Of the 50 studies, 19 articles reported radiation risks to practicing urologist/residents, 10 articles reported radiation knowledge and compliance, 9 articles reported percutaneous nephrolithotomy (PCNL) specific safety measures, 2 articles reported retrograde intrarenal surgery (RIRS) specific safety measures, and 4 articles reported general radiation safety practices. The annual dose of lens radiation exposure averaged from 1.41- 3.73 mSV for high volume RIRS and PCNL surgeons. Thyroid exposure deepdose equivalent (DDE) was 335 mrems while the trunk doses averaged 3.63 mSV. Hand ring dosimeter in urological trainees total DDE was 2,250 mrems. An average of 10% of respondents was not familiar with the ALARA principle, 63%-66% had not received any type of radiation training, and >50% of participants did not have any information about harmful effects of radiation or preventive measures. Furthermore, the compliance of PPE was noted to be lowest for lead lined glasses worn by 3-5%-9% worn during surgery. Thyroid shields were worn by 40%-99% of practicing urologists and trainees. Almost all of the respondents (99%) wore lead aprons during endourological surgeries that required radiation. Lastly, the consistent use of dosimeters was documented at 10%-30%.

Conclusion: This systematic review highlights the importance of PPE and education in reducing radiation exposure in urologists and surgical staff. Proper training is essential in promoting the use of PPE and procedural techniques that reduce radiation exposure. While some forms of PPE have been deemed highly effective, future research is necessary to evaluate the effectiveness of various types of PPE, procedural modifications, and education to ensure optimal protection for urologists and minimize long-term adverse health outcomes. As the use of fluoroscopy is increasing to provide better outcomes for patients, ultimately, the health and safety of healthcare providers should always be prioritized in this field.

References

1. Ketner, S et al., Evaluation of radiation exposure to urologists during percutaneous Nephro Lithotomy procedures and ways to minimize it. Italy. 2002.

2. Onk, K et al., Radiation Safety Knowledge and Practice in Urology Theaters: A Collaborative Multicenter Survey. Journal of Endourology. Jul 2021. 1084-1089. DOI: 10.1089/end.2020.0955

3. Bhanot, R et al., ALARA in Urology: Steps to Minimise Radiation Exposure During All Parts of the Endourological Journey. Curr Urol Rep 23, 255–259, 2022.Taylor, E et al., Ocular radiation exposure in modern urological practice. Journal of Urology 190(1), 2013. DOI: 10.1007/s11934-022-01102-z

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Systematic review exempt from IRB Approval. The review is registered through PROSPERO (International Prospective Register of Systematic Review)

Informed Consent: N/A.

Poster No. *H-13

Abstract No. 2023-100

Category: Health Services

Research Topic: Health Disparities-Social Determinants of Health.

Outcomes in Type II Diabetes Patients Through the COVID-19 Pandemic: A Retrospective Chart Review

¹Zurwa Nishat, OMS-III; ²Tara Pellegrino, DO; ³Robert A. Steer, EdD;

¹Rowan-Virtua School of Osteopathic Medicine; ²Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine; ³Department of Psychiatry, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: The COVID-19 pandemic provided a unique opportunity for urgent expansion of telemedicine services as providers continued to supply longitudinal care to patients. Patients with type II diabetes were vulnerable to serious infection with COVID-19 as well as disruption in management of their chronic disease. This study aimed to close gaps in existing literature pertaining to the effects of telemedicine in different patient populations that could aid in individuation of care in the U.S.

To delineate the outcomes in type II diabetes patients through the COVID-19 pandemic by a retrospective chart review in which disease management was evaluated through HbA1c and BMI.

Research Methods: Design: A retrospective chart review included type II diabetes patients from five university family medicine outpatient offices in New Jersey. All patients were receiving healthcare for their diagnosis from these clinics.

Procedure: The time frame of the study included a one-year pre-pandemic period from February 2019 to February 2020 and data from the pandemic beginning in March 2020 through May 2022. De-identified data was obtained from chart review of patients. Basic demographic information extracted included age, gender, and race. Moreover, the number of telehealth and in-person office visits, weight, BMI, HbA1c values, and information regarding insulin and diabetic medication prescriptions was collected. Abstracted data included 1098 patients and was narrowed down to 217 patients based on less than 31 days of difference between pre-pandemic HbA1c and pre-pandemic weight measurements as well as latest HbA1c and latest weight measurements for the time frame indicated.

Data Analysis: De-identified data was entered, coded, and analyzed descriptively using IBM SPSS software.

Osteopathic significance: Osteopathic principles highlight a holistic view of health and patient care, paying close attention to the interconnectedness of the body, mind, and spirit. This principle is especially important in the context of primary care and when managing multifactorial chronic diseases, such as diabetes. In the context of rapid structural change during the pandemic, rational treatment was geared towards balancing patient safety with adjustments needed to boost autonomy and realign patients’ self-healing capacity.

Data Analysis: The participants in this study were aged 31 to 89 years. Of the 217 patients included in the study, 58.5% were male and 41.5% were female. Ethnicity data was available for 196 patients, of which 65.9% were white, 26.5% were black/African American, and 7.7% were a race other than the former two. A paired t-test showed no significant difference in HbA1c levels from before the COVID-19 pandemic (M=38, SD=1.75) compared to during the pandemic (M=7.45, SD=1.72); t(216)=.645, p=.519. Contrastingly, there was a significant decrease in BMI observed before the pandemic (M=33.06, SD=6.69) compared to BMI during the pandemic (M=32.48, SD=6.93); t(216)=-3.35, p=<.001. The number of in-person and telemedicine visits were found to be moderately positively correlated, r=.367, p=<.001. A weak positive correlation was found in the following: HbA1c levels and BMI values measured during the pandemic period, r=.197, p=.004, the number of in-person office visits and BMI, r=.189, p=.005, and between age and number of in-person office visits, r=.164, p=.016. An independent samples t-test showed that outcomes between sex were not significantly different, despite females exhibiting a higher number of visits. A one-way ANOVA was conducted to compare healthcare visits, BMI, and HbA1c values. Post hoc testing showed significant differences between HbA1c levels of black/African American patients (M=8.052, SD=2.27) compared with patients with an undetermined race (M=7.005, SD=0.85), [F(3, 213)=3.09, p=.028]. Apart from this, there was a more dramatic change seen in oral medication usage in patients over time compared to insulin. Out of the 217 patients, 15 required insulin treatment compared to during the pandemic, in which 40 patients were utilizing insulin. Moreover, during the pre-pandemic period, 163 patients did not have any oral diabetes listed in their charts. compared to during the pandemic, wherein 76 patients were prescribed monotherapy and 103 patients were undergoing multitherapy.

Conclusion: This retrospective chart review demonstrated that despite the dramatic shift in healthcare delivery during the COVID-19 pandemic, type II diabetes patients did not experience worsening of health outcomes. A potential contributing factor is the continuation of provider-patient communication, allowing for interventions such as changes in oral medication regimen as disease progression occurred. The study showed that patients receiving in-person care more frequently resorted to using telemedicine in a similar manner. Older patients tended to have a higher number of in-office visits overall, which may be due to technological gaps in obtaining telemedicine care, while patients with a higher BMI exhibited greater healthcare utilization to maintain their health. Interestingly, African American patients had the highest number of both telemedicine and in-office visits, yet they exhibited the highest HbA1c values. Although the health of many type II diabetes patients was maintained or improved through the pandemic, the long-term goal for patients remains to continue improving the HbA1c and BMI levels to within recommended levels. The success of telemedicine in chronic disease care, especially diabetes, is due to reliance on lab results, A1c values, and other data accessed through the medical record. The rapid adjustment to these services points to the endless potential for improvements that can be made as both providers and patients become more accustomed to virtual care. Telemedicine can be the means to transforming diabetes care and making it personalized based on patients’ needs in achieving optimal glycemic control and overall health. Telemedicine could be used to address inequalities and psychosocial barriers that may make patients miss in-person appointments. Limitations of this study include the use of convenience sampling and reliance on existing records. Future work is required to assess the long-term impact of telemedicine and improve its accessibility and efficacy.

References

1. DeFronzo RA, Ferrannini E, Groop L, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015;1:15019. Published 2015 Jul 23. doi:10.1038/nrdp.2015.19

2. Wu Y, Ding Y, Tanaka Y, Zhang W. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. Int J Med Sci. 2014;11(11):1185-1200. Published 2014 Sep 6. doi:10.7150/ijms.10001

3. Hörnquist JO, Wikby A, Stenström U, Andersson PO, Akerlind I. Type II diabetes and quality of life: a review of the literature. Pharmacoeconomics. 1995;8 Suppl 1:12-16. doi:10.2165/00019053-199500081-00004

4. Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility and long-term consequences. Brain Behav Immun. 2020;87:53-54. doi:10.1016/j.bbi.2020.04.040

5. Hartmann-Boyce J, Morris E, Goyder C, et al. Diabetes and COVID-19: Risks, Management, and Learnings From Other National Disasters. Diabetes Care. 2020;43(8):1695-1703. doi:10.2337/dc20-1192

6. Aubert CE, Henderson JB, Kerr EA, Holleman R, Klamerus ML, Hofer TP. Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: an Observational Study. J Gen Intern Med. 2022;37(4):870-877. doi:10.1007/s11606-021-07301-7

7. Onishi Y, Yoshida Y, Takao T, et al. Diabetes management by either telemedicine or clinic visit improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan. J Diabetes Investig. 2022;13(2):386-390. doi:10.1111/jdi.13546

8. Bennett G, Young E, Butler I, Coe S. The Impact of Lockdown During the COVID-19 Outbreak on Dietary Habits in Various Population Groups: A Scoping Review. Front Nutr. 2021;8:626432. Published 2021 Mar 4. doi:10.3389/fnut.2021.626432

9. Khunti K, Valabhji J, Misra S. Diabetes and the COVID-19 pandemic. Diabetologia. 2023;66(2):255-266. doi:10.1007/s00125-022-05833-z

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Project approval and classification as exempt from review was determined by the Rowan University

1. Institutional Review Board (IRB): IRB #: PRO-2022-143

Informed Consent: A waiver of HIPAA authorization was requested for this study on the basis that the data collected was regulated by a covered entity under the HIPAA Privacy Rule and participant authorization was not to be obtained. Individual consent was not likely practicable since the study involved a large number of patients seen at multiple locations of Rowan Family Medicine offices. Since this is a retrospective chart review, there was minimal risk to subjects. There were no physical dangers to respondents or potential for participants to be identified since the information accessible to researchers was de-identified from the EMR. A RPR form was submitted to obtain approval from the Privacy Officer to receive the data.

Poster No. *H-14

Abstract No. 2023-101

Category: Health Services

Research Topic: Osteopathic Philosophy

Transition from Pediatric Care: A Comparison of Trends Nationwide and in New York State for Patients with Mental, Emotional, Developmental and Behavioral (MEDB) Problems

¹Alisha Tiwari, OMS-II; ¹Kavya Srinivasan, OMS-II; ²Arthur A. Klein, MD¹Joerg R. Leheste, PhD, MS

¹Department of Biomedical Sciences, New York Institute of Technology; ²Office of the Dean, New York Institute of Technology

Statement of Significance: Maintaining and enhancing patients’ general health requires a smooth transition from pediatric to adult care. The transition from pediatric to adult care takes place between the ages of 16 and 18, when adolescents are most vulnerable and mental health disorders typically arise (1). Both nationally and locally, anxiety, depression, and behavioral or conduct issues have significantly increased, requiring thorough analysis and a fresh approach (2,3).

The objective of this health policy project is to identify general trends and potential areas for improvement in the transition of healthcare for children, utilizing data from the National Survey of Children’s Health (NSCH). Additionally, we aim to review previous public health initiatives and their effectiveness to inform and enhance current practices. Ultimately, the project seeks to improve the transition from pediatric to adult care.

Research Methods: Transition of care policies are currently neither mandated federally nor in New York State (4). We have examined data on transitions of care from the NSCH as well as literary sources with the same focus on a needs assessment, particularly in the context of mental, emotional, developmental, and behavioral (MEDB) problems. Since NSCH data is intended for public use, the work did not require review by the NYIT IRB. The NSCH classifies children as belonging to the MEDB subgroup (5) if they meet the criteria of the "Children with Special Health Care Needs (CSHCN) Screener" or if they display one or more of the 10 qualifying conditions. The NSCH uses previously validated questions and scales and chooses participants using an address-based sampling technique (6). The descriptive statistics used in this study are divided into two phases: the first compares point estimates (M), and the second compares confidence intervals (CI) at the 95th percentile confidence level. First, NSCH data was examined to look for improvements in MEDB prevalence from 2018 to 2021, both for New York and on a national scale. In this case, M represents the percentage of respondents who belonged to the MEDB subgroup. Next, NSCH data was examined to determine the number of patients who reported receiving appropriate transitional care services between 2018 and 2021 in New York and Nationwide. In this case, M represents the percentage of respondents who indicated they had received adequate transitional care services in the survey. Children both with and without MEDB were included in the sample population. Establishing efficient transition of care policies is in line with the holistic values, patient-centered methodology, and preventive emphasis of osteopathic medicine. The quality and results of patients’ healthcare transitions are ultimately improved by supporting continuity of care, addressing the particular needs of patients, preventing gaps in care, and encouraging professional collaboration.

Data Analysis: The national data indicates a significant increase in MEDB prevalence between the years of 2018 [M = 22.1, CI (21.1, 23.1)] and 2021 [M=23.4, CI (22.6, 24.3)] without a significant year-to-year trend for the years in between. In New York, the MEDB prevalence increased overall between 2018 [M=23.0, CI (17.8, 29.1)] and 2021 [M= 23.4, CI (19.1, 28.3)], but at a statistically insignificant level. Nationwide, the percentage of survey participants with 1 or more MEDB problems receiving necessary transition of care services decreased between 2018 [M= 20.2, CI (18.0, 22.6)] and 2021 [M= 19.5, CI (17.7, 21.5)]. However, this decrease was not statistically significant. The same trend was observed in New York between 2018 [M= 24.4, CI (13.0, 40.9)] and 2021 [M = 15.4, CI (7.9, 27.8)] (5). The survey data implies that the majority of participants in the MEDB subgroup are not meeting the criteria for adequate transition of care, indicates that protocols are not improving, and identifies potential areas for reform. Some healthcare facilities across the nation have adopted a set of guidelines provided by Got Transition, a federal resource for care transition. The incorporation of Got Transition’s Six Core Elements into transition of care protocols has been shown to enhance transitions to adult care (4). Additionally, a study conducted in DC involved the implementation of a transition learning collaborative in various primary care practices to assess improvements in the transition process. The success of the learning collaborative was measured by analyzing the average scores of a transition index ranging from 1 to 8 at various points over 22 months. Before the collaboration, the facilities had an average score of 2.7 for transition preparation and 1.7 for transition planning, which increased to 5.7 and 4.2, respectively, at the second time of measurement (7). Outcomes favor programs that assist with both medical care coordination and non-medical activities (4).

Conclusion: According to this study, there are some general shortcomings in the current system of transitioning care that should be addressed more assertively in order to improve patient outcomes. Significant factors that call for the resolution of this problem include the rising prevalence of MEDB disorders and the absence of appropriate transition policies, both nationally and in New York State. A potential limitation of this study is the small sample size available in the NSCH data for New York State, which may have influenced significance levels. It may be possible to improve the areas where care transition is lacking by developing a number of amendments and program additions. For instance, the implementation of learning collaboratives in various primary care settings, the Got Transition protocol, and care coordination initiatives would all greatly aid in the transition process. The best way to address problems in the transition from pediatric to adult care would be to take a methodical, organized approach to care transition that is supported by science and carried out via health policy mechanisms.

References

1. Hendrickx G, De Roeck V, Maras A, et al., Challenges during the transition from child and adolescent mental health services to adult mental health services. BJPsych Bull. 2020;44(4):163-168. doi:10.1192/bjb.2019.85

2. Lebrun-Harris LA, Ghandour RM, Kogan MD, Warren MD. Five-Year Trends in US Children’s Health and Well-being, 2016-2020. JAMA Pediatr. 2022;176(7):e220056. doi:10.1001/jamapediatrics.2022.0056

3. Rao AR, Rao S, Chhabra R. Rising Mental Health Incidence Among Adolescents in Westchester, NY. Community Ment Health J. 2022;58(1):41-51. doi:10.1007/s10597-021-00788-8

4. Parsons H, Abdi HI, Nelson VA, et al. Transitions of Care From Pediatric to Adult Services for Children With Special Healthcare Needs. Published online May 31, 2022. https://doi.org/10.23970/ahrqepccer255

5. NSCH Interactive Data Query (2016 – present) - Data Resource Center for Child and Adolescent Health. www.nschdata.org. Accessed June 25, 2023. https://www.nschdata.org/browse/survey

6. NSCH Survey Methodology - Data Resource Center for Child and Adolescent Health. www.childhealthdata.org. https://www.childhealthdata.org/learn-about-the-nsch/methods

7. McManus M, White P, Barbour A, et al. Pediatric to Adult Transition: A Quality Improvement Model for Primary Care. Journal of Adolescent Health. 2015;56(1):73-78. https://doi.org/10.1016/j.jadohealth.2014.08.006

Financial Disclosures: None reported.

Support: None reported/

Ethical Approval: IRB exempt.

Informed Consent: Not applicable.

Poster No. *H-15

Abstract No. 2023-109

Category: Health Services

Research Topic: Acute and Chronic Pain Management

Analyzing Medicare Part D Opioid Prescriptions and Drug Overdose Rates in Ohio from 2017-2019

Samuel Borgemenke, OMS-II; Elizabeth Beverly, PhD

Department of Primary Care, Ohio University-Heritage College of Osteopathic Medicine

Statement of Significance: The drug overdose epidemic has had a drastic impact on public health nationally and locally. In Ohio, prescription opioids were involved in 571 of the 3,237 drug overdose deaths for 2018, 17.6% of all drug overdose deaths. The percentage of overdose deaths attributed to opioids indicates the possible relationship between prescription rates and opioid availability on the rate of overdose deaths.

To quantify the opioid prescription rate among older populations enrolled in Medicare Part D, as well as the relationship between the prescription rate of opioids for Medicare Part D and the drug overdose rate for counties in Ohio from 2017 to 2019.

Research Methods: This cross-sectional study utilized records on the drug overdose rate and opioid prescription rate for each Ohio county. The data for the drug overdose rate was obtained from the CDC’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality file. The opioid prescription rate for patients on Medicare Part D was calculated by the Centers for Medicare & Medicaid Services (CMS). A Pearson correlation test was performed to analyze the relationship between the prescription rate of opioids for Medicare Part D and the drug overdose rate in Ohio. Physicians should strive to have a holistic approach that treats the entire person. Addressing underlying issues that may impede patients’ ability to reach their optimal health, as well as pursuing alternative forms of treatment when appropriate, such as OMT, should be explored.

Data Analysis: From 2017 to 2019, the average prescription rate of opioids for Ohio was 4.3% (95% CI, 3.4-5.1) of all Medicare Part D claims. The opioid prescription rate decreased for each age group during this time. Moreover, the opioid prescription rate decreased as each patient population got older until the average age was 80 and older, where the prescription rate increased to 4.02% (95% CI, 2.6-5.4). The Pearson correlation test between the prescription rate of opioids for Medicare Part D and the drug overdose rate was significantly related (P < 0.001).

Conclusion: Reducing the number of prescribed opioids was associated with a significant decrease in the drug overdose rate in Ohio counties from 2017 to 2019. Thus, minimizing the number of prescriptions written for opioids may help lower the number of drug overdose deaths. An enhanced awareness of the correlation between the prescription rate of opioids and the drug overdose rate encourages public health officials to implement policies that lower the rate of non-essential opioid prescriptions. Moreover, the data indicate the importance of pursuing holistic, alternative forms of treatment for patients with chronic pain.

References

1. NSC Injury Facts. Drug overdoses. Published March 1, 2023. Accessed March 6, 2023. https://injuryfacts.nsc.org/home-and-community/safety-topics/drugoverdoses/#:∼:text=The%20number%20of%20preventable%20deaths,also%20an%20all%2Dtime%20high.

2. Ohio Department of Health. 2019 Ohio Drug Overdose Data: General Findings. Ohio Drug Overdose Report. Published January 6, 2020. Accessed January 15, 2022. https://odh.ohio.gov/wps/wcm/connect/gov/0a7bdcd9-b8d5-4193-a1af-e711be4ef541/2019_OhioDrugOverdoseReport_Final_11.06.20.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-0a7bdcd9-b8d5-4193-a1af-e711be4ef541-nmv3qSt.

3. NIH. Ohio: Opioid-Involved Deaths and Related Harms. National Institute on Drug Abuse. Published April 3, 2020. Accessed January 9, 2022. https://nida.nih.gov/drug-topics/opioids/opioid-summaries-by-state/ohio-opioid-involved-deaths-related-harms.

4. Inouye SK, Ganguli I, Jacobs EA. Enhancing Aging and Ending Ageism: JAMA Network Open Call for Papers. JAMA Netw Open. 2021; 4(6): e2117621. doi:10.1001/jamanetworkopen.2021.17621

5. CDC. CDC WONDER. cdc.gov. Published 2022. Accessed December 28, 2021. https://wonder.cdc.gov/.

6. CMS. Medicare Part D Prescribers - by Provider and Drug. Centers for Medicare & Medicaid Services Data. Published August 21, 2021. Accessed January 24, 2022. https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/medicare-part-d-prescribers-by-provider-and-drug.

7. CMS. Medicare Part D Prescribers - by Provider. Centers for Medicare & Medicaid Services Data. Published August 31, 2021. Accessed March 19, 2022. https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/medicare-part-d-prescribers-by-provider.

8. Schieber LZ, Guy GP Jr, Seth P, Losby JL. Variation in Adult Outpatient Opioid Prescription Dispensing by Age and Sex - United States, 2008-2018. MMWR Morb Mortal Wkly Rep 2020; 69:298-302. https://doi.org/10.15585/mmwr.mm6911a5.

9. CDC. CDC Guideline for Prescribing Opioids for Chronic Pain. Published 2022. Accessed March 6, 2023. https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-508.pdf.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Exempt.

Informed Consent: N/A.

★Poster No. *H-16

Abstract No. 2023-112

Category: Health Services

Research Topic: Osteopathic Philosophy

Analyzing ChatGPT’s Proficiency In Multiple Choice Osteopathic Manipulative Medicine Questions: Insights and Implications

¹Ashley Sundin, OMS-IV; ²Ahmed Gawash; ³Hasan Zia; ²David F. Lo; ²Nicholas Averell; ⁴Alexander King, DO; ⁴Leonard Powell, DO

¹Department of Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine; ²Department of Medicine, ²Rowan-Virtua School of Osteopathic Medicine; ³Department of Biology, ³Ruckers University; ⁴Department of Osteopathic Manipulative Medicine, ⁴Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Chat Generative Pretrained Transformer (ChatGPT) is a new language model developed to learn and converse interactively with users. Current medical research using ChatGPT has been done through the allopathic lens. Our research project shifts this viewpoint to focus on the Osteopathic holistic beliefs by asking ChatGPT questions about Osteopathic Manipulative Medicine (OMM). This research project will add to ChatGPT’s knowledge base and provide physicians with more insight into ChatGPTs abilities.

To assess ChatGPT abilities in multiple-choice osteopathic manipulative medicine questions.

Research Methods: The ChatGPT-3 model was utilized for this study. ChatGPT was asked 5 multiple-choice OMM questions in each of the following regions: Cervical, Thoracic, Cranial, Sacral/Innominate, Upper extremities, and lower extremities. The questions for these body regions included questions regarding diagnosis, treatment positioning, application of treatment, and more. Questions were marked either right or wrong and an explanation was provided to ChatGPT regarding the answer to each question afterward. These OMM questions were written and provided by the Principal investigators of this study, who serve as part of the OMM teaching faculty at Rowan Virtua School of Osteopathic Medicine. Due to the nature of the study, the study was exempt from IRB approval.

Data Analysis: OMM questions were provided in multiple-choice format to ChatGPT in the following regions: Cranial, Cervical, Thoracic, Sacral/Innominate/Pelvis, Lower Extremity, and Upper Extremity. In questioning, ChatGPT got 60% correct in the Cranial OMM section, 0% in the Cervical OMM section, 0% in the Thoracic OMM section, 40% in the Sacral/Innominate/Pelvis OMM section, 40% in the Lower Extremity OMM section, and 0% in the Upper Extremity OMM section.

Conclusion: In conclusion, while the initial results indicate a limited understanding of OMM by ChatGPT, this research project represents a valuable step toward expanding the system’s knowledge in this area. As AI continues to advance, it has the potential to complement healthcare practices and provide valuable insights. By focusing on OMM and addressing the unique aspects of osteopathic medicine, AI language models such as ChatGPT can contribute to the integration of holistic beliefs and practices into clinical decision-making processes, benefiting both patients and healthcare providers.

References

1. Cheng, K., Li, Z., Li, C., Xie, R., Guo, Q., He, Y., & Wu, H. (2023). The potential of GPT-4 as an AI-powered virtual assistant for surgeons specialized in joint arthroplasty. Annals of Biomedical Engineering, 51(7), 1366–1370. https://doi.org/10.1007/s10439-023-03207-z

2. Nori, H., King, N., McKinney, S. M., Carignan, D., & Horvitz, E. (2023). Capabilities of GPT-4 on Medical Challenge Problems. Cornell University. https://arxiv.org/abs/2303.13375

3. Li, J., Dada, A., Kleesiek, J., & Egger, J. (2023). Chatgpt in Healthcare: A taxonomy and systematic review. ScienceDirect. https://doi.org/10.1101/2023.03.30.23287899

4. Javaid, M., Haleem, A., & Singh, R. P. (2023). Chatgpt for healthcare services: An emerging stage for an innovative perspective. BenchCouncil Transactions on Benchmarks, Standards and Evaluations, 3(1), 100105. https://doi.org/10.1016/j.tbench.2023.100105

5. Galido, P. V., Butala, S., Chakerian, M., & Agustines, D. (2023). A case study demonstrating applications of chatgpt in the clinical management of treatment-resistant schizophrenia; Cureus. https://doi.org/10.7759/cureus.38166

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study is exempt from IRB approval.

Informed Consent: Informed consent was not necessary for this research project.

Poster No. *H-17

Abstract No. 2023-130

Category: Health Services

Research Topic: Musculoskeletal Injuries and Prevention

Quality Analysis of Patient Educational TikTok Videos For Knee Instability

¹Brandon D Rust, OMS-II; ¹Elie Christoforides, BS; ¹Vijay Patel, BS; ¹Jashkumar Choudhari, BS; ¹Santiago Ortiz, BS; ¹Aidan Kaspari, MS; ²Jackson Copper, BS; ²Desiree E. Ojo, MPH, MPA

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine; ²University of the Incarnate Word School of Osteopathic Medicine

Statement of Significance: Social media has provided opportunity for wide-scale public health education with popular platforms such as Facebook, Instagram, and TikTok. Educators can use these platforms to reach massive audiences. There are few barriers to sharing information on social media which leads to both health professionals and the general public sharing their expertise. However, the quality and accuracy of these videos relating to knee instability-related pathophysiology have yet to be systematically evaluated.

To characterize the quality of TikTok knee instability videos as a source of patient information using the DISCERN instrument.

Research Methods: TikTok was searched on June 20, 2023, using the phrase “knee stability exercises.” The search yielded 448 relevant videos. An initial screen for exclusion was performed to eliminate videos that (1) had no relevance to knee stability, pain, mobility, strengthening, or “bulletproofing” (n=232), (2) exercises not directly related to knee stability/mobility exercises (n=20), (3) videos with no educational component (n=7), and (4) reposted content (n=2). The remaining 187 hits were classified according to their source. A trained team of graders utilized a DISCERN scale to assess content quality. Score variations based on video sources were analyzed using Statistical Package for Social Sciences (SPSS).

Data Analysis: A total of 187 videos met the inclusion criteria. 69.84% (n=132) were produced by general users and 29.1% (n=55) were produced by healthcare professionals. DISCERN scores of videos uploaded by general users had significantly lower scores in all four categories than those uploaded by healthcare professionals (P = < 0.001, P = 0.282, P = 0.131, and P = 0.010). The overall total DISCERN score was inversely correlated with the total number of views, likes, comments, favorites, and shares. General users’ videos were graded as very poor (27.2%), poor (39.2%), fair (23.5%), good (9.7%), and excellent (0.0%). In comparison, the number of videos uploaded by healthcare professionals deemed very poor (20%) poor (40.9%), fair (28.2%), good (9.1%), and excellent (1.8%).

Conclusion: The current most popular knee instability videos on Tik Tok are of low quality. These videos provide information on how to perform the exercise, very few content creators will provide sources for their information, risks of treatment, and how the treatment works. Furthermore, our study found an inverse correlation between video popularity, as measured by the number of views and the respective DISCERN score. Low-quality videos were more popular compared to their higher-scoring counterparts. Future studies should be done to examine the impact of this trend.

References

1. Szeto, M. D., Mamo, A., Afrin, A., Militello, M., & Barber, C. (2021). Social media in dermatology and an overview of popular social media platforms. Current dermatology reports, 1-8.

2. Iqbal, M. (2021). TikTok revenue and usage statistics (2021). Business of apps, 1(1).

3. Jang CW, Kim M, Kang S-W, Cho HE. Reliability, Quality, and Educational Suitability of TikTok Videos as a Source of Information about Scoliosis Exercises: A Cross-Sectional Study. Healthcare. 2022; 10(9):1622. https://doi.org/10.3390/healthcare10091622

4. Bethell, Mikhail A. MS; Anastasio, Albert T. MD; Taylor, Joshua R. BS; Tabarestani, Troy Q. BA; Klifto, Christopher S. MD; Anakwenze, Oke MD, MBA. Evaluating the Distribution, Quality, and Educational Value of Videos Related to Shoulder Instability Exercises on the Social Media Platform TikTok. JAAOS: Global Research and Reviews 7(6):e23.00034, June 2023. | DOI: 10.5435/JAAOSGlobal-D-23-00034

5. Tabarestani, T. Q., Anastasio, A. T., Duruewuru, A., Taylor, J. R., Bethell, M. A., & Adams, S. B. (2023). Analyzing the quality and educational value of Achilles tendinopathy-related videos on TikTok. Foot and Ankle Surgery, 29(4), 350-354.

6. Charnock, D., Shepperd, S., Needham, G., & Gann, R. (1999). DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. Journal of Epidemiology & Community Health, 53(2), 105-111.

7. Aydin, M. F., & Aydin, M. A. (2020). Quality and reliability of information available on YouTube and Google pertaining gastroesophageal reflux disease. International journal of medical informatics, 137, 104107.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study did not include animal or human participation; no ethics committee approval was required.

Informed Consent: None reported.

Poster No. H-18

Abstract No. 2023-137

Category: Health Services

Research Topic: Osteopathic Philosophy

Understanding Barriers and Beliefs of Mental Wellbeing Amongst Health Professional Learners

¹Stephanie Elizabeth Rathjen, PhD, OMS-IV; Sara Worrill , OMS IV; Benjamin Skinner, OMS IV; Thomas Embry, OMS IV; Erin Lim, OMS IV; ²Edward Magalhaes, PhD, LPC

¹Edward Via College of Osteopathic Medicine-Virginia

²Department of Psychiatry, Edward Via College of Osteopathic Medicine-Virginia

Statement of Significance: There has been a significant rise in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) in America. ADHD and ADD are characterized by difficulty focusing, excessive physicality, and impulsivity. While these disorders are commonly diagnosed in school aged children and adolescents, there has also been an increase in the diagnosis of young adults attending college and graduate health programs. It is unclear why there is a rise in delayed diagnoses.

To serve as a pilot study to investigate factors that contribute to this increase in delayed diagnosis and stimulant-based treatment in students attending health education programs: allopathic/osteopathic medicine, veterinary medicine, physician assistant, nursing, pharmacy, physical therapy, occupational therapy, dentistry, orthodontia, optometry, and audiology. Additionally, this project looks to quantify the stigma many individuals face when seeking mental health treatment.

Research Methods: This study utilized a cross-sectional, anonymous survey distributed via various social media platforms (Facebook, Instagram, Twitter, Snapchat, Discord). The goal was to achieve a sample size of 100 health care professional students. The survey was a total of 36 questions with 33 multiple choice questions and 3 optional open-ended questions. The questions asked basic demographic information, age of ADHD/ADD diagnosis, religious views, barriers to seeking diagnosis and treatment, ADHD management strategies, and views on stimulant medications and ADHD diagnoses. Demographic information included age, gender, ethnicity, sexual orientation, marital status, religion. Participants were also asked if they were enrolled in a health education program and what year and state they are currently in. The survey used skip logic to guide participants to follow-up questions based on specific answers.

Quantitative data was run through basic descriptive statistical measures and used to analyze the prevalence of ADHD/ADD in student populations within health profession programs. Categorical measures of factors contributing to delayed diagnosis of ADHD/ADD will be compared to age of diagnosis of respondent. For the statistical analysis we looked at the trends of men and women, different religions, participants with or without a diagnosis of ADHD, participants who knew someone taking stimulants and compared each groups comfortability seeking physical and mental health medical care, their views on stimulant use, and the barriers to seeking mental health care.

Data Analysis: A total of 102 participants completed the survey. All those polled were between the ages of 22-35, identified as female (60.82%), and white/non-Hispanic (75.26%). Most of the respondents were enrolled in a Doctor of Osteopathic Medicine program (68.04%), are attending school in the Commonwealth of Virginia (72.16%), and have obtained a bachelor’s degree (75.41%). More male participants were diagnosed prior to undergraduate school (33.33% of males with ADHD) compared to 27.27% of females with ADHD.

Overall, students reported they felt overall more comfortable seeking care for physical illness over mental illness. Men and women had the same amount of comfortability seeking medical care for physical health, 42% and 44% respectably were very comfortable. However, women were more comfortable seeking medical care for mental health than men.

When looking at barriers to seeking a diagnosis or treatment for ADHD, there was a statistically significant difference between the cost barriers of those with confirmed/suspected ADHD diagnosis and those without (p = 0.04). Participants with the diagnosis of ADHD or suspected diagnosis responded that cost was more of a barrier compared to those without the diagnosis. All other barriers were not statistically significant between the two groups. Between the two groups, religion was more of a barrier for those without the diagnosis compared to those with or suspected ADHD diagnosis. There was also a statistically significant difference between the cost barriers of those with confirmed/suspected ADHD diagnosis and those without (p = 0.04). Participants with the diagnosis of ADHD or suspected diagnosis responded that cost was more of a barrier compared to those without the diagnosis.

There was a statistically significant difference between responses of those who were diagnosed with ADHD and those who have not been diagnosed (p=0.011). Those who have been diagnosed with ADHD had more positive views on taking stimulants.

Conclusion: From our pilot study, we have identified barriers that either contributed to delayed diagnosis or prevented the diagnosis of ADHD. Prior research, discussed in the background, has shown that women and minority groups are particularly at risk of this delay in treatment. We feel that our study displays that this area will require further evaluation in future studies.

Future research could involve working alongside more health professional programs to diversify the sample population and improve generalizability. As this was a pilot study, we were limited to sampling within our own social media networks. With minimal recruitment we were able to obtain 102 responses from students, which will be further analyzed with the support of a biostatistician. We want to expand to allopathic/osteopathic medicine, veterinary medicine, physician assistant, nursing, pharmacy, physical therapy, occupational therapy, dentistry, orthodontia, optometry, and audiology programs and contact them directly to distribute this survey to students. A larger sample size would help diversify the sampled population and reduce any biases that stem from limited polled population. Other future research could explore deeper into the relationship between religious importance in students and mental health care as well as the possible relationships between more negative views on stimulant use in osteopathic students and those who know someone with ADHD/ADD.

References

1. Wilens TE, Spencer TJ. Understanding Attention-Deficit/Hyperactivity Disorder From Childhood to Adulthood. Postgraduate Medicine. 2010 Sep;122(5):97–109.

2. Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents. J Clin Child Adolesc Psychol. 2018;47(2):199-212.

3. Plumber N, Majeed M, Ziff S, Thomas SE, Bolla SR, Gorantla VR. Stimulant Usage by Medical Students for Cognitive Enhancement: A Systematic Review. Cureus. 2021;13(5):e15163.

4. Taber JM, Leyva B, Persoskie A. Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med. 2015;30(3):290-297.

5. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5™). Washington: American Psychiatric Association, 103–106.

6. Schneider H, Eisenberg D. Who receives a diagnosis of attention-deficit/hyperactivity disorder in the United States elementary school population. Pediatrics. 2006;117(4).

7. Pastor PN, Reuben CA. Racial and ethnic differences in ADHD and LD in young school-age children: parental reports in the National Health Interview Survey. Public Health Rep. 2005;120(4):383–392.

8. Flores G, Tomany-Korman SC. Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children. Pediatrics. 2008;121(2).

9. Fadus MC, Ginsburg KR, Sobowale K, Halliday-Boykins CA, Bryant BE, Gray KM, Squeglia LM. Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. Academic Psychiatry. 2020; 44: 95-102.

10. Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry. 2019;28(4):481-489.

11. Angold A, Erkanli A, Egger HL, Costello EJ. Stimulant treatment for children: a community perspective. J Am Acad Child Adolesc Psychiatry. 2000; 39:975–984.

12. Thomas M, Rostain A, Corso R, Babcock T, Madhoo M. ADHD in the College Setting: Current Perceptions and Future Vision. Journal of Attention Disorders. 2015;19(8):643-654.

13. Bussing R, Koro-Ljungberg M, Noguchi K, Mason D, Mayerson G, Garvan CW. Willingness to use ADHD treatments: A mixed methods study of perceptions by adolescents, parents, health professionals and teachers. Social Science & Medicine. 2012; 74:92-100.

14. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry. 2010; 10:113.

15. San Miguel S, Forness S, Kavale K. Social skills in learning disabilities: the psychiatric comorbidity hypothesis. Learning Disability Quarterly. 1996; 19:252– 261.

Financial Disclosures: None reported.

Support: None provided.

Ethical Approval: The Edward Via College of Osteopathic Medicine Institutional Review Board deemed our project as exempt and approved on November 7th, 2022. The IRB reference number is 2022-065.

Informed Consent: A general statement of implied consent will be included at the beginning of the survey specifying that the responses of the survey will be used for research purposes. Participants have the option of not completing the survey.

Poster No. *H-19

Abstract No. 2023-159

Category: Health Services

Research Topic: Impact of OMM & OMT

The Need for Increased Research on the Use of MFR and Soft Tissue OMT in the Pediatric ASD Population

Tanvi Shah, OMS-II; Pooja Patel

School of Medicine, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Children with Autism Spectrum Disorders (ASD) often have difficulty in self-regulating their behaviors and actions which leads to decreased function and ability to focus. Occupational therapists (OT) utilize techniques that apply deep pressure to the child’s body to improve self-regulation and, therefore, function; a beneficial effect has been anecdotally asserted but not heavily researched. However, whether Osteopathic techniques have been used and/or beneficial remains to be determined.

The goal of this scoping review is to determine if any research exists on the use and/or effectiveness of osteopathic manipulative techniques (OMT), specifically myofascial release (MFR) and soft tissue techniques, in improving the self-regulation and function of children with ASD. Thus, this review aims to fill the gap on indication for the use of OMT in the ASD population to improve outcomes. The conclusions would be significant for the ASD population and the Osteopathic community.

Research Methods: An organized review of current literature was conducted to evaluate the potential benefits of OMT for children with ASD. The search was performed on the database PubMed as well as two journals: The American Association of Osteopathy Journal, and The Journal of Osteopathic Medicine. The following search strings were used: “osteopathic manipulative medicine and autism spectrum disorder”, “autism”, autism osteopathic, “osteopathic manipulative medicine and special needs”, “autism spectrum disorder and occupational therapy or physical therapy”, “osteopathic in autism population”, “osteopathic manipulation in autism”, “soft tissue technique in autism patients”. We included systematic reviews, case reports, clinical trials, and review trials in our analysis. Studies that did not focus on either ASD or the use of OMT/OT were excluded.

Data Analysis: There were three articles that specifically focused on the use of OMT in the ASD population, however two of the three articles focused on the use of visceral or cranial OMT. The first study was a longitudinal study utilizing the Autism Research Institute Secretin Outcomes Survey Form to measure the results of visceral osteopathic technique (VOT) on behavior and gastrointestinal symptoms in children with autism (1). There was a significant symptomatic improvement in social behavior and communication, digestive signs, vomiting, poor appetite, and eye contact post VOT application (1). The second article was a randomized controlled trial utilizing the Autism Treatment Evaluation Checklist to compare the efficacies between Upper Cervical Cranial Manipulative Therapy (CMT) and Full Spine CMT in children with autism (2). It was concluded that Upper Cervical CMT had better improvement in autism related behaviors than Full Spine CMT (2). Significant to note was that there did exist a single case report that stated the use of MFR on a pediatric participant with ASD showed global improvement in all symptoms (3).

Conclusion: While there has been promise shown in the use of CMT and VOT in people with ASD, there is only one case report that reports on the benefits of physical OMT techniques, specifically the use of MFR. Additionally, this case report was on a singular pediatric participant indicating that these results may not be generalizable. Further research needs to be done on the use and effectiveness of MFR and soft tissue OMT in the ASD population. Furthermore, it will be clinically useful to determine if the use of such treatments does improve self-regulation and function.

References

1. Bramati-Castellarin I, Patel VB, Drysdale IP. Repeat-measures longitudinal study evaluating behavioural and gastrointestinal symptoms in children with autism before, during and after visceral osteopathic technique (VOT). J Bodyw Mov Ther. 2016;20(3):461-470. doi:10.1016/j.jbmt.2016.01.001

2. Parnell Prevost C, Gleberzon B, Carleo B, Anderson K, Cark M, Pohlman KA. Manual therapy for the Pediatric Population: A Systematic Review. BMC complementary and alternative medicine. March 13, 2019. Accessed June 22, 2023. doi: 10.1186/s12906-019-2447-2.

3. Jungade S. Manual physical therapy as a novel treatment modality for Autism spectrum disorder - A pilot study. J Complement Integr Med. 2020;17(2):/j/jcim.2020.17.issue-2/jcim-2018-0243/jcim-2018-0243.xml. Published 2020 Mar 31. doi:10.1515/jcim-2018-0243

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Not applicable for IRB or IACUC. Our study was a scoping literature review.

Informed Consent: Not applicable.

Poster No. *PH-1

Abstract No. 2023-024

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Breastfeeding, the Workplace, and the Law: Understanding the Relationship with Racial Disparities in Breastfeeding Practices

¹Samantha Mindlin, OMS-IV; ²Elizabeth Dalianis; ²Nicole Vaughn

¹Department of Osteopathic Medicine, Rowan-Virtua School of Osteopathic Medicine; ²Department of Public Health, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Background: Breastfeeding poses great benefits for both maternal and child health. Despite efforts to increase breastfeeding rates in the US, there continues to be disparity in rates among different racial/ethnic groups. Both returning to work and factors in the work environment are well-established barriers to initiating and maintaining breastfeeding.

Purpose: This review aims to analyze the literature and policy addressing the relationship between the workplace, employment, and breastfeeding practices. Specifically, the authors will explore the relationship between employment, the workplace environment, and U.S. federal and state policies that support breastfeeding in the workplace with a focus on how these factors contribute to racial/ethnic disparities.

Research Methods: Methods: The researchers conducted a review of policy, analyzing the current federal and state laws that promote breastfeeding in the workplace. They investigated the current gaps in coverage and identified proposed legislation that aims to fill those gaps

Data Analysis: Results: The Affordable Care Act (ACA) Break Time for Nursing Mothers Act provision amended section 7 of the Fair Labor Standards Act (FLSA). This section outlines the right to overtime for employees that work for wages. There are several professions that are considered “exempt” from the FLSA. Due to the placement of this provision, employees in these professions are considered exempt from the Break Time for Nursing Mothers Act as well. The PUMP Act (2021) was proposed to provide Break Time and Space for breastfeeding employees for those who are exempt from existing legislation. The PUMP Act will expand coverage to approximately 9 million employees.

Conclusion: Although the PUMP Act is an important step in expanding coverage for breastfeeding employees, it should be noted that many of these women are white and earn salaries/higher hourly wages. There is still a need for federal and state policy that addresses disparity specifically. To reduce racial/ethnic disparities it is imperative to increase support for breastfeeding in all types of workplaces, ensure that policies are enforced amongst all segments of the population, and implement legislation that uses language pertaining to equity.

References

1. Maternal, Infant, and Child Health | Healthy People 2020. Accessed July 8, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives

2. Increase the proportion of infants who are breastfed exclusively through age 6 months — MICH-15 - Healthy People 2030 | health.gov. Accessed July 14, 2021. https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age-6-months-mich-15

3. Increase the proportion of infants who are breastfed at 1 year — MICH-16 - Healthy People 2030 | health.gov. Accessed July 14, 2021. https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-1-year-mich-16

4. CDC. Facts About Nationwide Breastfeeding Goals. Centers for Disease Control and Prevention. Published September 28, 2020. Accessed June 15, 2021. https://www.cdc.gov/breastfeeding/data/facts.html

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: N/A.

Informed Consent: N/A.

Poster No. *PH-2

Abstract No. 2023-025

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Attitudes of Osteopathic Medical Students on the Future of Medical Education and Clinical Practice following the Dobbs v. Jackson Women’s Health Organization Decision

Patricia Zielinski, MPH, OMS-III; Emily Krzykwa, MPH, OMS3; Nicole Vilar, OMS-III; Tara Lewandowski, OMS-III; Gabriela Llerena, OMS-III; Sepideh Nadery MS, OMS-III; Robin J Jacobs PhD MSW MS

Nova Southeastern University Kiran C Patel College of Osteopathic Medicine

Statement of Significance: The 1973 decision that affirmed the constitutional right to abortion was overturned in Dobbs v Jackson Women’s Health Organization [1]. As a result, states have implemented new jurisdiction over access to abortion which has the potential to impact medical education [2-4]. As abortion education is already limited in pre-clinical years, we aim to assess if Dobbs will limit medical students’ training further and/or discourage them from pursuing a career involving the care of pregnant women [5-8].

To investigate the attitudes of osteopathic medical students regarding abortion restrictions following the Dobbs decision and its effect on future medical education and clinical practice.

Research Methods: This cross-sectional, observational study collected data from 158 medical students at an osteopathic medical school in Florida, United States between February and March 2023. The participants completed an online questionnaire consisting of 35 anonymous items. The questionnaire assessed their opinions about future abortion education and practice, religiosity, and the acceptability of abortion at later stages of gestation. Descriptive statistics were used to analyze the sample characteristics and responses regarding concerns about future medical training and practice after the Dobbs decision. Hypothesis testing was performed using Speakman’s rank correlation and multivariate linear regression to explore the relationship between the dependent variables and the students’ attitudes towards abortion. The data analysis was conducted using SPSS v.29 statistical software.

Data Analysis: In total, 158 participants completed the questionnaire; 91 (57.6%) were women. The mean age was 25.8 (range 21-37 years). A significant regression equation was found, F(3,134) = 205.750, p < 0.001, R2 = 0.822, R2 adjusted = 0.818). The percentage of variance in the scores accounted for by the model was 60%. Feeling that the abortion ban would impact their training and future practice, lower levels of religiosity, and acceptability of abortion at later weeks significantly contributed to more positive attitudes toward abortion overall in this sample of osteopathic medical students.

Conclusion: The results suggest that attitudes towards abortion are influenced by several factors, extending beyond personal religiosity. For instance, acceptance of abortions in later weeks of gestation emerged as a factor that may conflict with new state laws restricting access to such procedures. Additionally, the findings shed light on participants’ concerns regarding their medical training in abortion procedures and the potential implications of the restrictive laws on their future medical practice. These findings hold significance in guiding osteopathic medical education initiatives to ensure that abortion practices and procedures are included in the curriculum, particularly for aspiring physicians interested in women’s health. By addressing these concerns, medical education can better equip future healthcare professionals to meet the holistic, whole-person needs of pregnant patients and provide comprehensive care.

References

1. Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson Women’s Health Organization et al. Updated June 24, 2022. Accessed April 28, 2023. https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf.

2. Nelson J. SB No 8 2021-2022 87th Legislature, 87(3). Texas Legislature Online. Published 2021. Accessed January 4, 2023. https://capitol.texas.gov/BillLookup/History.aspx?LegSess=873&Bill=SB8

3. Capriglione G. HB 1280 2021 87th Legislature, 87(R). Texas Legislature Online. Updated 2021. Accessed January 4, 2023. https://capitol.texas.gov/billlookup/History.aspx?LegSess=87R&Bill=HB1280.

4. The New York Times. Tracking the States Where Abortion is now Banned. The New York Times. Updated April 14, 2023. Accessed April 22, 2023. https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html

5. Committee on Health Care for Underserved Women. Abortion training and education. Updated November 2014. Accessed January 12, 2023. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/11/abortion-training-and-education.

6. Aksel S, Fein L, Ketterer E, Young E, Backus L. Unintended consequences: abortion training in the years after Roe v Wade. Am J Public Health. 2013;103(3):404-407. doi:10.2105/AJPH.2012.301152

7. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: a national survey. Am J Obstet Gynecol. 2005;192(2):640-643. doi:10.1016/j.ajog.2004.09.013

8. Guiahi M, Maguire K, Ripp ZT, Goodman RW, Kenton K. Perceptions of family planning and abortion education at a faith-based medical school. Contraception. 2011;84(5):520-524. doi:10.1016/j.contraception.2011.03.003

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was approved by Nova Southeastern University International Review Board (protocol #2023-37).

Informed Consent: All participants in this study provided informed consent prior to participation.

Poster No. *PH-3

Abstract No. 2023-038

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Healthcare Camp for High School Students Enhances the Understanding of Foundations of Osteopathic Medicine, Identifying Implicit Bias, and Recognizing Social Determinants of Health

Mary K. Flanagan, OMS-II; Elijah L. Liu; Alexa R. Neff; Alexis M. Klink, MS; Kasey M .Kruse, MS; Joseph M. Vroegop; Ashley L. Orr, MS; Brian W. Skinner PharmD; Julia M Hum PhD

Department of Biomedical Science, Marian University College of Osteopathic Medicine

Statement of Significance: Efforts to reduce health disparities and increase access to underserved populations may be outpaced as populations diversify further. An understanding of diversity that addresses social determinants of health can influence health outcomes. Early exposure of Diversity, Equity, Inclusion, Accessibility, and Belonging (DEIAB) initiatives within healthcare to high school students may improve perceptions of attainability as well as an understanding of equitable representation in healthcare.

To develop a more diverse population in healthcare, Marian University hosted a 5-day camp at the College of Osteopathic Medicine (MU-COM) for high school students to learn about a spectrum of health professions, with emphases on osteopathic principles and DEIAB-related health topics. The objective was to expose students to the importance of defining implicit bias and understanding social determinants of health, and the role these play in patient care and health outcomes.

Research Methods: The objectives for this project were assessed using two voluntary, anonymous and confidential surveys, one given at the beginning of camp and the second given at the end. Of the 73 total campers, 67 completed the pre-survey and 63 of those responses were matched to post-survey responses. Matching was completed using a specific code created by each camper. The pre-survey collected demographic information, as well as an identification of the presence of a healthcare worker within their immediate family. Participants were given opportunities to elaborate on their race and/or gender identity to acknowledge self-reported identities. On both the pre- and post-surveys, participants were asked to list as many healthcare careers as they could. They were also asked to complete a Likert-scale question that included statements about desire for and attainability of a career in healthcare, understanding of osteopathic philosophy and differences/similarities between MD/DO physicians, knowledge of specific conditions covered during the camp, and comfort level with the idea of implicit bias and the conversations surrounding biases in a healthcare setting. During camp, campers rotated through activities that encompassed the topics surveyed, including exposure to Anatomage and virtual reality, skills lab and simulated patient encounter activities, Osteopathic Manipulative Medicine techniques, social determinants of health and implicit bias training, as well as small groups about disparities in health and the importance of a healthcare team. Following completion of the camp, age-matched control data was collected from a group of high school students that attended Marian University’s engineering camp using the same pre-survey as the healthcare campers. After all data was collected, pre- and post-responses were matched, and statistical analyses were performed including a Wilcoxan Signed-Rank test to compare pre-survey and post-survey responses for the Likert-scale statements.

Data Analysis: In total, 86.3% of survey responses were able to be matched and were further separated by age, gender and race. Twenty-two campers identified as cisgender males (34.9%), thirty-seven as cisgender females (58.7%), one as non-binary/third gender (1.6%), and three preferred not to answer (4.8%). In August 2023, 1.6% of participants will be entering 9th grade, 17.5% will be entering 10th grade, 34.9% will be entering 11th grade, 44.4% will be entering 12th grade, and 1.6% will be starting college. Of these participants, 12.7% identify themselves as Black or African American, 41.3% as White or Caucasian, 11.1% as of Hispanic, Latin or Spanish origin, 22.2% as Asian, Native Hawaiian, or Pacific Islander, 9.52% as Bi-/Multi-Racial, and 3.17% who preferred not to say. In the pre-survey, campers listed an average of 6.67 careers in healthcare whereas in the post-survey following completion of camp, an average of 14.48 careers were listed (p<0.0001). It was also noted that the careers listed in the post-survey were more specific than the careers listed in the pre-survey. There were statistically significant (p<0.0001) increases in responses to the following Likert scale statements, “I feel comfortable explaining what osteopathic medicine is.” (2.57 pre-average, 4.17 post-average), “I understand the SIMILARITIES/DIFFERENCES between osteopathic (DO) and allopathic (MD) medicine/philosophy.” (2.42/4.08 for similarities, 2.46/4.10 for differences), “I know what implicit bias is.” (3.17/4.46), and “I feel comfortable having conversations about implicit bias with people who identify differently than I do.” (3.42/4.25). All of the averages for the control data of engineering students were lower than for the healthcare camp students in the pre-survey (1.69, 1.23/1.23, 2.92, 3.00, respectively). Overall, students demonstrated a comprehensive understanding of osteopathic philosophy, implicit bias and social determinants of health that will serve them throughout their careers.

Conclusion: Overall, campers at the healthcare camp demonstrated an enhanced understanding of osteopathic philosophy, implicit bias and social determinants of health compared to age-matched control campers. Bolstering opportunities for high school students to be exposed to the diverse range of careers in healthcare and fostering DEIAB values along the way will serve the future of our healthcare system well.

References

1. Francis, C. L., & Villwock, J. A. (2020). Diversity and Inclusion-Why Does It Matter. Otolaryngologic clinics of North America, 53(5), 927–934. https://doi.org/10.1016/j.otc.2020.05.021

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The study described herein was reviewed by the Marian University Institutional Review Board (IRB). Since our work involved surveying minors a full IRB review was conducted and approved. This study’s IRB number is CR-S22.139.

Informed Consent: A brief disclaimer of informed consent was provided as the first question on the pre and post survey administered. Students had the ability to opt in in or out of participation after reading the informed consent summary.

Poster No. *PH-4

Abstract No. 2023-041

Category: Public Health

Research Topic: Osteopathic Philosophy

A Student-Driven Mindfulness Curriculum for First-Year Osteopathic Medical Students: A Pilot Study

¹Christina Nielsen, OMS-III; ¹Sabrina Katz; ¹Meriah Parker; ¹Janelle Trefsgar; ¹Hend Bcharah; ¹Jacob Kalin; ¹Desiree Delavary; ²Mark Brunk-Grady; ³Dr. Breanne Jaqua, DO

¹A.T. Still University School of Osteopathic Medicine in Arizona; ²Department of Research, A.T. Still University School of Osteopathic Medicine in Arizona; ³Department of Research Clinical Education, A.T. Still University School of Osteopathic Medicine in Arizona

Statement of Significance: Medical education is stressful and can adversely affect the health and well-being of students. ^1-4 Although mindfulness-based interventions have been successfully used in other settings, little is known about the use of student-led interventions in undergraduate medical education.

To assess student satisfaction with 4 student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions.

Research Methods: First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation, and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A χ2 test was used to analyze student responses from each week about decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were used to determine associations between outcomes, and a logistic regression model was used to determine relationships between change in stress levels and other outcomes.

Data Analysis: Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1%) to 94 (61.0%) actively participated in the weekly mindfulness activities. Students indicated the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3%, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8%, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7%, 90/94 for week 1; 92.1%, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all P<.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in stress level were 16.6 times (95% CI, 6.8-47.2, P<.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95% CI, 3.3-13.9, P<.001).

Conclusion: Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.

References

1. Hope V, Henderson M. Medical student depression, anxiety and distress outside North America: a systematic review. Med Educ. 2014;48(10):963-979. doi:10.1111/medu.12512

2. Lapinski J, Yost M, Sexton P, LaBaere RJ, 2nd. Factors modifying burnout in osteopathic medical students. Acad Psychiatry. 2016;40(1):55-62. doi:10.1007/s40596-015-0375-0

3. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324

4. Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, burnout and coping strategies in preclinical medical students. N Am J Med Sci. 2016;8(2):75-81. doi:10.4103/1947-2714.177299

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: The current study was deemed exempt by the A.T. Still University-Arizona Institutional Review Board on March 17, 2022 (IRB no. 2022-064).

Informed Consent: Because the study was exempt, written informed consent was not required. Each survey contained the following statement: “By answering the survey questions you consent for your responses to be used in data collection and curriculum improvement. You may choose not to answer any of the following questions.”

Poster No. *PH-5

Abstract No. 2023-051

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Systematic review of SLE and Air Quality Levels

¹Dat Le, OMS-IV; ²Gary Oh; ³Nevena Barjaktarovic; ⁴Annie Le; ⁵Kelly Chan

¹A.T. Still University School of Osteopathic Medicine in Arizona; ²Department of Family Medicine^, Wright Center, Scranton, PA; ³Department of Rheumatology, Wright Center, Scranton, PA; ⁴Departmet of Family Medicine^, Permanente Medical Group, San Francisco, CA; ⁵Department of Pharmacy^, AbbVie, Chicago, IL

Statement of Significance: Evaluate the difference in SLE rates in developed vs developing countries following the quality of air.

Give future professionals a broader perspective on optimum disease management and treatment.

Provide a better picture of air pollutants that might lead to the development of autoimmune conditions like SLE.

Systemic lupus erythematosus, an autoimmune rheumatic illness characterized by complex immunological development, poor immunological regulation, and prolonged inflammation. Air quality has been linked to SLE progression. Underdeveloped countries are more susceptible to poor air quality & increased air pollutants since they cannot dispose of biodegradable contaminants. We aimed to determine the rate of SLE following air quality and compare the contaminants and their effect on incidence rates

Research Methods: Search strategy/ search criteria

The literature-based systematic review for the most recent research employed the PRISMA strategy. The search method developed suggested including publications on air quality and SLE. The prevalence of SLE in the set and developing countries was compared. The terms SLE, autoimmune disorders, air quality, developing nations, developed countries, SLE, SLE prevalence, environment and SLE, and air and SLE were used in an electronic search on PubMed Online and Scopus. It was scrutinized and examined to ascertain whether each piece matched the requirements for inclusion. It was analyzed and evaluated. The study only included them if they met all the inclusion parameters.

Data Extraction/ Identification of Studies

We identified 119 research papers from electronic searches of databases, i.e. Scopus, PubMed and BMC. We started screening studies by removing the duplicate research, which left us with 87 articles. We further filtered the articles on the absence of desired components in research, availability of full text of articles and year of publication. After the screening process, we were left with 18 researches which were narrowed down to 6 after a thorough research study. The total number of participants, their mean age, and the quality of air particulate and the prevalence of SLE concerning air quality was noted.

Data Analysis: We conducted a literature-based analysis of research to identify the rate of SLE among developed and developing countries while keeping in view the quality of their air and its pollutants. Our review comprised six articles, three from developing countries China, Chile and Brazil and three from developed countries Taiwan, Canada and the USA. All the studies are elaborated on in Table 1. We studied articles with 6259 SLE patients, with 89% females (n=5541) and 11% (n=718) males in the study participants. Both developed, and developing countries revealed similar results in terms of gender percentage in the research data. The mean age of participants in the research was 31.96± 10.88 years (CI: 95%, 45.4-18.44). The occurrence of SLE following the air quality was estimated to be 3.57 ± 3.28% (CI: 95%, 0.12- 7.02). The presence of nitrogen dioxide (NO2) and other substances in the air indicates whether air quality is good or harmful to health. Our review revealed the mean of NO2 in the air of 4 countries (China, Brazil, Taiwan & Chile) as 59.91 ±24.6 µg/m3 (CI: 95%, 99.20- 20.61). Similarly, the mean amount of ozone O3 in the air was 73.20 ±32.66 µg/m3 (CI: 95%, 113.76- 32.64). The mean carbon monoxide (CO) concentration among developing countries was 0.79 ±0.71 ppm (CI: 95%, 0.99- 2.57) and 0.74 ±0.59 ppm (CI: 95%, 0.20- 1.68) for the total CO observed in studies. Fine particles are transported to the blood and might trigger a systemic inflammatory response. Particulate matter (PM10) damages the walls of the upper airways that result in pulmonary inflammation [10]. PM2.5 was present in 4 studies, only two from developing states and the rest from developed ones. The mean of PM2.5 was found to be 33.58 ±20.95 µg/m3 (CI: 95%, 0.24- 66.92). Developing countries showed PM2.5 almost double in concentration compared to the developed countries. The mean was 44.96 ±22.39 µg/m3 and 22.2 ±17.25 µg/m3 in developing and developed countries respectively.

Conclusion: A total of 6259 participants of research studies selected from developing and developed countries concerning the significance of air quality and its relation to SLE rates were included in this review. Being informed of no bias in our study at the personal level for selection or conduction of review is imperative. The study consists of the majority of female participants, 89% female and 11% male, depicting that SLE incidence is more prevalent in females of both developed and underdeveloped regions. Fig.2 represents the pictorial presentation of the number of study participants in every research study and their respective countries. The survey by Chakmak et al. in Chile included 4062 patients of SLE when they studied the association of air pollution to SLE hospitalization, which resulted in a positive relationship between air pollutants such as particulate matter and the development of SLE [15].

We studied the incidence rate of SLE among developed and underdeveloped countries, which demonstrated that concentrated PM and pollutants in the air increase the risk of SLE development in both locales. A higher incidence of SLE would likely lead to increased rates of hospitalization for SLE patients along with increased complication rates. Developed countries showed a decreased incidence or impact of SLE due to better air quality compared to developing states with far more polluted air with concentrated pollutants leading to hazardous consequences such as increased mortality rates of SLE patients. A possible solution to lowering the incidence rate of SLE within the poor air quality locations could be the reduction of air pollutants via filtering devices. However, there are no current studies examining this.

References

1. Tang KT, Ben-Jei Tsuang, Kai Chen Ku, Chen YP, Lin CH, Chen DY. Relationship between exposure to air pollutants and development of systemic autoimmune rheumatic diseases: a nationwide population-based case–control study. 2019; 78(9):1288-1291. https://doi.org/10.1136/annrheumdis-2019-215230

2. Fernandes EC, Silva CA, Braga ALF, Sallum AME, Campos LMA, Farhat SCL. Exposure to Air Pollutants and Disease Activity in Juvenile-Onset Systemic Lupus Erythematosus Patients. Arthritis Care & Research. 2015;67(11):1609-1614. https://doi.org/10.1002/acr.22603

3. Vidotto J, Pereira L, Braga A, et al. Atmospheric pollution: influence on hospital admissions in paediatric rheumatic diseases. Lupus. 2012;21 (5):526-533. https://doi.org/10.1177/0961203312437806

4. Zhao C, Mei Y, Wu G, et al. Effect of air pollution on hospital admissions for systemic lupus erythematosus in Bengbu, China: a time series study. 2019;28 (13):1541-1548. https://doi.org/10.1177/0961203319882503

5. Bernatsky S, Fournier M, Pineau CA, Clarke AE, Vinet E, Smargiassi A. Associations between Ambient Fine Particulate Levels and Disease Activity in Patients with Systemic Lupus Erythematosus (SLE). Environmental Health Perspectives. 2011;119 (1):45-49. https://doi.org/10.1289/ehp.1002123

6. Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet (London, England). 2019;393 (10188):2332-2343. https://doi.org/10.1016/S0140-6736(19)30237-5

7. Moher D, Shamseer L, Clarke M, et al. Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) 2015 Statement. Systematic Reviews. 2015;4 (1). https://doi.org/10.1186/2046-4053-4-1

8. Schiavo JH. PROSPERO: An International Register of Systematic Reviews Protocols. Medical Reference Services Quarterly. 2019;38(2):171-180. https://doi.org/10.1080/02763869.2019.1588072

9. Nemmar A, Hoet PHM, Vanquickenborne B, et al. Passage of Inhaled Particles Into the Blood Circulation in Humans. Circulation. 2002;105(4):411-414. https://doi.org/10.1161/hc0402.104118

10. Sellner J, Kraus J, Awad A, Milo R, Hemmer B, Stüve O. The increasing incidence and prevalence of female multiple sclerosis--a critical analysis of potential environmental factors. Autoimmunity reviews. 2011;10(8):495-502. https://doi.org/10.1016/j.autrev.2011.02.006

11. Valavanidis A, Fiotakis K, Vlachogianni T. Airborne particulate matter and human health: toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. Journal of environmental science and Health Part C, Environmental Carcinogenesis & ecotoxicology reviews. 2008;26(4):339-362. https://doi.org/10.1080/10590500802494538

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Submitted to the The Wright Center for Graduate Medical Education Institutional Review Board

They have determined this project does not meet the definition of human subject research under the purview of the IRB according to federal regulations. They will retain a copy of this correspondence within their records. If you have any questions, please contact Nathan Cardona at (570) 591-5105 orcardonan@thewrightcenter.org. IRB PROJECT Number: [2072242-1].

Informed Consent: N/A.

Poster No. PH-6

Abstract No. 2023-052

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Using AACOM’s Academic Recognition Program to Educate Future Physicians on Health Disparities and Health Equity

¹Erik Guercio, MA; ²Emily Young, MD; ³Clint Whitson, EdD; ⁴Jeff Tjiputra, DSc, MLS; ⁵Anthony Martin, DO; ⁶Alyssa Land, OMS-II

¹Research Department, American Association of Colleges of Osteopathic Medicine; ²Department of Pediatrics, American Association of Colleges of Osteopathic Medicine; ³Office of Student Affairs, American Association of Colleges of Osteopathic Medicine; ⁴Department of IT and Operations, American Association of Colleges of Osteopathic Medicine; ⁵Department Internal Med, American Association of Colleges of Osteopathic Medicine

Statement of Significance: Patients suffer disparate health outcomes in the United States based on their identification within marginalized social groups. Improving health outcomes requires educating current and future healthcare professionals on the presence of and historical reasons for these disparities as well as mitigation measures. The American Association of Colleges of Osteopathic Medicine (AACOM) released an academic program to help its member colleges educate students on Health Disparities and Health Equity.

To present an overview of the Health Disparities and Health Equity ARP, provide data on the course evaluation students submitted upon completing the program, share learning experiences from the perspective of AACOM, provide a deep dive into Marian University College of Osteopathic Medicine (MU-COM) experience with the program and discuss future plans for this program. The expertise gained helps students identify disparities and implement solutions to address health inequity.

Research Methods: AACOM’s Academic Recognition Program (ARP) was designed as a supplemental offering for students to better understand disparities and where they exist across marginalized populations. It consists of ten modules delivered asynchronously online using AACOM’s Moodle Learning Management System (LMS). Each module is a one-hour lecture and assigned readings. Learners apply the readings to formulate questions and a final exam.

AACOM collected data on the Health Disparities and Health Equity ARP via a program evaluation survey. Students who complete the course must submit an evaluation survey to receive course credit. The survey asks students to rate their agreement with various aspects of the ARP (e.g., the content supported its stated intent/purpose, the program achieved its purpose/outcome, etc.) on a Likert scale across eight sections: 1) registration/access, 2) need for the program, 3) program design, 4) assigned readings, 5) implementation, 6) program efficiency, 7) program LMS and 8) program impact. In addition to the Likert scale question, students were asked which presentations were the most/least effective, whether AACOM should release more ARPs and to respond to open-ended questions on the program’s strengths/weaknesses. As of June 16, 2023, 208 students have submitted an evaluation.

Data were evaluated using both quantitative and qualitative methods: descriptive statistics for Likert scale and categorical questions and grounded theory/thematic analysis for the open-ended comments. Researchers will also provide a use-case scenario to demonstrate how MU-COM used the ARP to educate DO and health professions students on health disparities and health equity. The significance to osteopathic medicine is the ARP will create future physicians who are better educated on the impact of health disparities and health equity, foster the skills needed to provide effective care to underserved patient populations and ensure they are able to provide equitable care.

Data Analysis: Descriptive statistical analysis revealed the average ranking across all evaluation questions was 3.91 (1 – strongly disagree to 5 – strongly agree Likert scale), indicating an overall positive response to the ARP. Students ranked the following aspects of the program highest: the asynchronous format provided an optimal individualized learning rhythm (avg. 4.20), the content of the course supported its stated intent/purpose (4.20) and the program addresses a specific need/problem (4.20). Conversely the following aspects of the program were ranked lowest: I would be willing to join in a virtual, real-time focus group discussion about the value of this program (3.30), the exercise in writing questions enhanced my learning of the content (3.50), the amount/length of the assigned readings supported the learning process (3.70) and the program provided reinforcement of learning while avoiding redundancies/unnecessary repetition (3.70). Respondents reported that the most effective module was Lesbian, Gay, Bisexual and Transgender (Sexual Gender Minorities) Health Disparities (21.7%) and the least effective modules was The Ethics of Health Equity and Health Inequities and Health Policies (30.6%). Approximately 70 percent of students passed the exam on their first attempt and 98 percent of students passed the exam after the three attempts. Over 90 percent of respondents believe that AACOM should release more ARPs.

Qualitative analysis revealed several key themes from students’ responses to open ended questions. The program’s strengths are its asynchronous format, value added to students’ educational learning and clinical effectiveness and ability to engage with materials and expertise of the lecturers. Possible improvements to the ARP include providing a summary at the end of each module, making the program/videos shorter and asking the exam questions at the end of each module instead of as a final exam.

Conclusion: The nation’s colleges of osteopathic medicine (COM) are committed to increasing medical student diversity, ensuring medical education is accessible to all and educating students on the impact health disparities and inequity have on patient outcomes. AACOM’s ARP on Health Disparities and Health Equities is used by COMs to educate students on health disparities and where disparities exist across marginalized populations. Quantitative and qualitative analysis of students’ responses to the ARP course evaluation survey revealed the following: 1) an overall positive response to the program, with most students agreeing to strongly agreeing with the evaluation metrics, 2) the most/least effective modules, 3) the importance of the programs’ content, the quality of the lecture/materials and positive impact on students’ ability to deliver care and 4) several opportunities to improve the program, including shortening the length of the video lectures, having a summary at the end of each module and asking the exam questions at the end of each module instead of as a final exam. AACOM plans to implement improvements to address several of these concerns. MU-COM’s deep dive demonstrates that the ARP is valuable addition to curriculum, can be used to meet NBOME/COCA standards and is valuable for DOs and other health profession students, leading to a physician workforce equipped to improve health outcomes for underserved populations and provide equitable care.

References: None reported.

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This project was deemed exempt from review by Marian University’s IRB (#S23.178).

Informed Consent: N/A.

Poster No. *PH-7

Abstract No. 2023-053

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Preliminary Analysis of Health-Related Quality of Life among American Asian Indians in the National Health Interview Survey

¹Priyanka Taneja, OMS III; ¹Shreya Kumar; ¹Amanpreet Kaur; ²Steven Day; ³Kathaleen Briggs Early

¹Pacific Northwest University of Health Sciences College of Osteopathic Medicine; ²Department of Statistics, Pacific Northwest University of Health Sciences College of Osteopathic Medicine; ³Department of Nutrition, Pacific Northwest University of Health Sciences College of Osteopathic Medicine

Statement of Significance: Health-related quality of life (HRQOL), a psychosocial construct, is defined as a person’s physical and mental health, and is linked to health outcomes. There is a dearth of literature evaluating HRQOL of Asian Indians despite this being a growing ethnic group with higher rates of chronic health conditions, like diabetes.

The purpose of this study was to evaluate HRQOL across age and sex categories in a nationally representative sample.

Research Methods: We examined HRQOL as measured via the Health and Activity Limitation Index (HALex; scores can range from 0-1, with 1 being the highest score) from the National Health Interview Survey (NHIS) using data collected from 2003 to 2018. NHIS collects information on health status, health care access, and behaviors as a cross-sectional, stratified, and weighted household interview survey. We examined adults over age 18 and considered the weighted and stratified nature of the data to compare HRQOL among Asian Indians to non-Hispanic Whites.

Data Analysis: This study represents 245 million adults, among whom 2.67 million were Asian Indian. Across all ages below 85 years, Asian Indians had a mean age-and-sex-adjusted HALex score similar to but lower than that of Whites with a mean of [95% CIs] 0.857 (0.855, 0.859) and 0.837 (0.836, 0.837), respectively. However, among adults aged 85+, a significant disparity develops, as HALex scores for Asian Indians dropped to 0.392 (0.272, 0.511), with Whites at 0.630 (0.623, 0.638). In the 65–85-year age group, women had lower HALex scores (mean 0.731 (0.681, 0.782) than males 0.822 (0.784, 0.860).

Conclusion: Lower HALex scores among Asian Indians at ages 85+ could be attributed to increased likelihood of multiple comorbidities, limited access to resources, inadequate healthcare education, immigration status, and communication barriers. Asian Indian women having lower average HALex scores than males in ages 65-85 years could be due a variety of factors like childbearing and gender roles. Lack of HRQOL data among Asian Indians shows that ethnic subgroups should be studied to promote health equity in research. Sex and age differences observed herein warrant further evaluation to clearly determine causes and mitigating factors.

References

1. Alvi S, Zaidi AU. Invisible Voices: An Intersectional Exploration of Quality of Life for Elderly South Asian Immigrant Women in a Canadian Sample. J Cross Cult Gerontol. 2017 Jun;32(2):147-170. doi: 10.1007/s10823-017-9315-7. PMID: 28497244. (https://pubmed.ncbi.nlm.nih.gov/28497244/)

2. Dey KC, Zakrzewski-Fruer JK, Smith LR, Jones RL, Bailey DP. The Prevalence of Daily Sedentary Time in South Asian Adults: A Systematic Review. Int J Environ Res Public Health. 2021 Sep 2;18(17):9275. doi: 10.3390/ijerph18179275. PMID: 34501864; PMCID: PMC8431135. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431135/)

3. Jang Y, Yoon J, Park NS. Source of Health Information and Unmet Healthcare Needs in Asian Americans. J Health Commun. 2018;23(7):652-660. doi: 10.1080/10810730.2018.1500660. Epub 2018 Aug 10. PMID: 30095372; PMCID: PMC6419743. (https://pubmed.ncbi.nlm.nih.gov/30095372/)

4. Kachan D, Tannenbaum SL, Olano HA, LeBlanc WG, McClure LA, Lee DJ. Geographical variation in health-related quality of life among older US adults, 1997-2010. Prev Chronic Dis. 2014 Jul 3;11:E110. doi: 10.5888/pcd11.140023. PMID: 24995652; PMCID: PMC4082433. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082433/)

5. Livingston, E.H. and Ko, C.Y. (2002), Use of the Health and Activities Limitation Index as a Measure of Quality of Life in Obesity. Obesity Research, 10: 824-832. https://doi.org/10.1038/oby.2002.111 (https://onlinelibrary.wiley.com/doi/10.1038/oby.2002.111)

6. Mehrotra N, Gaur S, Petrova A. Health care practices of the Foreign-Born Asian Indians in the United States. A Community Based Survey. J Community Health. 2012 Apr;37(2):328-34. doi: 10.1007/s10900-011-9449-4. PMID: 21811880. (https://pubmed.ncbi.nlm.nih.gov/21811880/)

7. NCHS. Technical Notes for Summary Health Statistics Tables: National Health Interview Survey. Available from: https://www.cdc.gov/nchs/nhis/SHS/tables.htm.

8. Paudel S, Owen AJ, Owusu-Addo E, Smith BJ. Physical activity participation and the risk of chronic diseases among South Asian adults: a systematic review and meta-analysis. Sci Rep. 2019 Jul 5;9(1):9771. doi: 10.1038/s41598-019-46154-3. PMID: 31278314; PMCID: PMC6611898. (https://pubmed.ncbi.nlm.nih.gov/31278314/)

9. Singh K, Patel SA, Biswas S, Shivashankar R, Kondal D, Ajay VS, Anjana RM, Fatmi Z, Ali MK, Kadir MM, Mohan V, Tandon N, Narayan KMV, Prabhakaran D. Multimorbidity in South Asian adults: prevalence, risk factors and mortality. J Public Health (Oxf). 2019 Mar 1;41(1):80-89. doi: 10.1093/pubmed/fdy017. PMID: 29425313; PMCID: PMC7304513. (https://pubmed.ncbi.nlm.nih.gov/29425313/)

10. Tang, JW, Mason, M, Kushner, RF, Tirodkar, MA, Khurana, N, Kandula, NR. South Asian American Perspectives on Overweight, Obesity, and the Relationship Between Weight and Health. Prev Chronic Dis. 2012;9:110284. doi: 10.5888/pcd9.110284. Epub 2012 May 31. PMID: 22652125; PMCID: PMC3457742. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457742/)

Financial Disclosures: None.

Support: None

Ethical Approval: Our study did not need IRB approval.

Informed Consent: N/A.

Poster No. *PH-8

Abstract No. 2023-060

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Assessing the Anxiolytic Properties of Native Appalachian Herbals Passiflora incarnata and Hypericum Perforatum in Danio Rerio

¹Hannah Olivia Sherrod, OMS-II; ¹Annie Le, OMS-II; ²Lori McGrew, PhD

¹Lincoln Memorial University-DeBusk College of Osteopathic Medicine; ²Department of Pharmacy, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

Statement of Significance: Plant-based treatments can be more accessible and affordable compared to conventional pharmaceuticals. This can be especially beneficial for populations like the Appalachian region facing financial constraints or limited access to healthcare services, providing them with alternative options for managing anxiety and depression. Native Appalachian herbals Passiflora incarnata and Hypericum perforatum have shown to be effective treatments in reducing anxiety and depression, respectively.

To determine whether commercially available supplements of Passiflora incarnata and Hypericum perforatum can provide a reproducible improvement in anxiety in the zebrafish species Danio rerio.

Research Methods: A behavioral assay utilizing the model organism Danio rerio in a novel dive tank setting following treatment with specified supplements.

35 adult, wildtype members of the zebrafish species, Danio rerio, were housed in a flow-through system and utilized for this study.

12 fish were assigned to the control group while the other 23 fish were utilized for testing increasing doses of supplements.

Fish were treated by immersion in solutions of the supplement for 10 minutes and then transferred to a resting beaker for an additional 10 minutes prior to testing. All solutions were prepared in fish system water. After immersion in solution, the fish had a 10-minute resting period and then were transferred to a novel dive tank for observation of anxious behavior.

The Ethovision XT software was employed to analyze video recordings of the fish swimming in the novel dive tank setting. Decreased activity, erratic swimming, or avoidance behaviors suggest higher anxiety levels. The analysis focused on examining the movement patterns of the fish, including their vertical location (upper and lower zone of tank), average distance traveled, average speed, mobility, and meander To compare the results between control fish and treated fish, a student’s t-test was used. Additionally, dose-response data was analyzed by employing regression curve-fitting techniques.

Ethnobotany and osteopathic medicine are related in the sense that both approaches emphasize a holistic approach to healthcare and consider the body’s natural healing abilities. By recognizing the cultural significance of plants and the knowledge passed down through generations, osteopathic physicians can appreciate the diverse perspectives on healing and incorporate that understanding into patient care. Ethnobotany can contribute to a broader understanding of the relationship between plants and human health, enhancing the practice of osteopathic medicine with a deeper appreciation for traditional healing wisdom.

Data Analysis: The average time the fish spent in the upper zone of the novel dive tank was used as the most accurate measure of the anxiolytic properties of the supplements. Compared to the control fish spending an average time of 21.21 s in the upper zone, the fish treated with Passiflora incarnata supplements at varying concentrations of 250 mg/L, 125 mg/L, 67.5 mg/L and 33.25 mg/L spent at average time of 16.80 s, 42.61 s, 163.29 s, and 122.21 s, respectively. The concentrations of 67.5 mg/L and 33.5 mg/L showed significant difference relative to the control with calculated p-values of 0.0035 and 0.0106, respectively. The fish treated chronically over the time course of two weeks with 0.1 mg/L Hypericum perforatum spent an average time of 39.44 s in the upper zone. Since this treatment did not show significant difference between the control with the p-value of 0.0999, but it is trending toward significance; the chronic treatment will be continued for an additional 2 weeks to determine if a significant difference occurs.

Conclusion: Acute Passiflora incarnata treatment reduced anxiety as measured by the novel dive tank in the zebrafish species Danio rerio. The most effective dose was 67.5 mg/L. Chronic Hypericum perforatumtreatment was also demonstrated to reduce anxiety. The effective dose was 0.1mg/L over the time course of 2 weeks.

Passiflora incarnata supplements or tea may be beneficial to those who have mild anxiety. This knowledge may benefit patients with limited access or aversion to prescription anxiolytics. This is also consistent with the ethnobotanical usage of Passiflora incarnata.

Hypericum perforatum ethnobotanical usage for depression is well-documented. The current study validates use of the zebrafish novel dive tank model in addition to supporting the use of Hypericum perforatum for mild depression. Future studies will utilize locally growing Hypericum perforatum plants to confirm their effectiveness since these are accessible to local Appalachian residents.

Limitations to this study include the fact that the supplements were tested on Danio rerio fish models instead of human patients.

References

1. Hege A, Ball L, Christiana RW, et al. Social Determinants of Health and the Effects on Quality of Life and Well-being in 2 Rural Appalachia Communities: The Community Members’ Perspective and Implications for Health Disparities. Fam Community Health. 2018;41(4):244-254. doi:10.1097/FCH.000000000000020

2. Snell-Rood C, Carpenter-Song E. Depression in a depressed area: Deservingness, mental illness, and treatment in the contemporary rural U.S. Soc Sci Med. 2018;219:78-86. doi:10.1016/j.socscimed.2018.10.012

3. Willsky GR, Bussmann RW, Ganoza-Yupanqui ML, Malca-Garcia G, Castro I, Sharon D. Integrating Traditional and Modern Medicine: Perspectives from Ethnobotany, Medical Anthropology, Microbiology, and Pharmacy. Transforming Global Health. Published online 2020:301-314. https://doi.org/10.1007/978-3-030-32112-3_19

4. Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26(5):363-367. doi:10.1046/j.1365-2710.2001.00367.x

5. Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. J Affect Disord. 2017;210:211-221. doi:10.1016/j.jad.2016.12.048

6. Cavender A, Beck S. Generational Change, Folk Medicine, and Medical Self-Care in a Rural Appalachian Community. Human Organization. 1995;54(2):129-142. https://doi.org/10.17730/humo.54.2.10nv346252n6m3v3

7. Zebrafish and learning paradigms. Nodulus Informational Technology.

8. Fontana BD, Alnassar N, Parker MO. The zebrafish (Danio rerio) anxiety test battery: comparison of behavioral responses in the novel tank diving and light-dark tasks following exposure to anxiogenic and anxiolytic compounds. Psychopharmacology (Berl). 2022;239(1):287-296. doi:10.1007/s00213-021-05990-w

Financial Disclosures: None reported.

Support: Hannah Sherrod, OMSII and Annie Le, OMSII received the Debusk Summer Research Scholar Award of $2,000. The funds were used to help pay for living expenses while conducting summer research.

Ethical Approval: The LMU Institutional Animal Care and Use Committee deemed the research project reviewed and accepted. The protocol number 2203 RES-A3.

Informed Consent: N/A-working with danio rerio zebrafish species.

★Poster No. *PH-9

Abstract No. 2023-062

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

National Prevalence and Quality of Medical Spanish Education in US Osteopathic Medical Schools: An Approach to Improve Health Equity

¹Kally Ann Dey, OMS-IV; ²Sinibaldo Arocha, BS; ³Yoon Soo Park, PhD; ³Pilar Ortega, MD, MDM

¹Midwestern University/Chicago College of Osteopathic Medicine; ²University of Minnesota Medical School, Minneapolis, MN; ³Department of Medical Education, University of Illinois, Chicago, IL

Statement of Significance: Spanish is the language in the US with the most significant language-concordant physician deficit (1). Language-concordant healthcare, when clinicians and patients communicate directly in the same language, improves patient outcomes and embodies osteopathic philosophy. Medical Spanish education aims to improve health equity for the growing Spanish-speaking population. However, the national prevalence of medical Spanish education at osteopathic medical schools has not been measured and evaluated.

To describe the medical Spanish landscape at US osteopathic schools and evaluate program adherence to previously established basic standards: having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit (2).

Research Methods: In 2022 (between March and October,) online surveys were sent to all 44 schools belonging to the American Association of Colleges of Osteopathic Medicine. For nonrespondents, data was obtained from publicly available websites. Primary surveys were sent to medical school deans or diversity, equity, and inclusion officers at each school to determine the presence of medical Spanish curricula and to identify a medical Spanish liaison. If liaisons were identified, they received the secondary online survey.

Data Analysis: We gathered information from 91% (40/44) of osteopathic medical schools. Fifty-seven percent (25/44) responded to the surveys, and four schools (9%) neither responded to surveys nor had available online information regarding medical Spanish. Overall, 89% (39/44) offered medical Spanish, of whom 67% (26/39) had formal curricula, 44% (17/39) had faculty educators, 18% (7/39) assessed learner skills, and 28% (11/39) provided course credit. Only 13% (5/39) of schools with medical Spanish programs met all basic standards. Urban/suburban schools were more likely to offer medical Spanish than rural schools (p=0.020). Osteopathic medical schools in states with the highest Spanish-speaking populations were more likely to offer student-run initiatives (p=0.027).

Conclusion: Most osteopathic schools provide medical Spanish curricula. However, further efforts are warranted to improve their consistency, quality, and sustainability. Limitations to this study include possible respondent bias, an average (57%) response rate that may affect generalizability, potential for publicly available information to be outdated or inaccurate, and high degrees of individual course variation. Future research should focus on osteopathic student language proficiency assessment, improved medical Spanish accessibility for students at rural programs, and exploration of the unique content areas of osteopathic medical Spanish education.

References

1. Garcia ME, Bindman AB, Coffman J. Language-Concordant Primary Care Physicians for a Diverse Population: The View from California. Health Equity. 2019;3(1):343-349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626968/

2. Ortega P, Francone NO, Santos MP, et al. Medical Spanish in US Medical Schools: a National Survey to Examine Existing Programs. J Gen Intern Med. 2021;36(9):2724-2730. https://link.springer.com/article/10.1007/s11606-021-06735-3.

Financial Disclosures: Dr. Ortega receives textbook author royalties from Elsevier.

Support: None reported.

Ethical Approval: The University of Illinois Institutional Review Board determined that this study met exemption criteria on October 28, 2017 (Protocol# 2017-1157).

Informed Consent: Invited participants first reviewed the study purpose and procedures and could then voluntarily participate or decline to participate in the survey.

Poster No. *PH-10

Abstract No. 2023-076

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Investigating the Relationship of Tobacco and Alcohol Utilization on Attempted Suicide Among American High School Students During the COVID-19 Pandemic

Caleb Edwin Clemons, OMS-II; Theresa J. McCann, PhD

Department of Preventive Medicine, Edward Via College of Osteopathic Medicine

Statement of Significance: The COVID-19 pandemic disrupted the lives of young people in the United States. As a result, this pandemic’s impact on U.S. youth has been the target of much research. One prominent study, the Adolescent Behaviors and Experiences Survey (ABES) was done by the Centers for Disease Control and Prevention (CDC) in 2021.¹ Thus, the ABES study was viewed as a data source that could examine potential relationships between behaviors and adverse outcomes among U.S. adolescents during the era of COVID-19.

To determine whether tobacco or alcohol use were associated with attempting suicide among American high school students during the COVID-19 pandemic.

Research Methods: The data utilized were obtained from the ABES study which was conducted by the CDC. The 7,998 students who submitted surveys were selected for participation using a “three-stage cluster probability-based sampling approach” from January-June 2021 to yield a one-time, voluntary “representative sample of students in grades 9-12 attending public and private schools” in the United States.¹ After obtaining consent for involvement, participants watched a video detailing instructions and then completed a 110-question survey to identify their various health behaviors and experiences during the COVID-19 pandemic.¹ After the ABES survey results were made publicly available, the data were imported to IBM SPSS Statistics Version 29. Descriptive statistics were first obtained for variables of interest. Several variables were recoded as needed for analyses. Following recoding, the survey participants’ responses regarding current cigarette, electronic vapor product, smokeless tobacco, and alcohol use were cross tabulated with reported suicide attempt within the past 12 months to perform Pearson’s Chi-Square Tests. Prior to final analysis, confounding variables were identified using the 10% rule for confounding.² Under this method, it was determined that participants’ sex confounded the relationship between current cigarette use and attempted suicide. Furthermore, participants’ sex and sexual identity were found to confound the relationship between current smokeless tobacco use and attempted suicide. To adjust for these confounding variables, the Cochran-Mantel-Haenszel method was used. Overall, it was believed that this methodology was osteopathically meaningful, for it would allow important relationships, regarding the impact of COVID-19 on the body, mind, and spirit of adolescents, to be obtained.

Data Analysis: The ABES survey had a sample size of n = 7,705 useable questionnaires and an overall response rate of 18%.¹ Males and females comprised 47.9% and 52.1% of respondents, respectively. Additionally, 44.9% of participants were white and 55.1% of participants were non-white; 71.9% of respondents identified as heterosexual while 28.1% of respondents identified as non-heterosexual. After adjusting for confounding variables as needed, the following significant results were obtained by Pearson’s Chi-square tests between each of the following and suicide attempt: current cigarette use (χ² = 232.9, p<0.001), electronic vapor product use (χ² = 301.2, p<0.001), smokeless tobacco use (χ² = 103.2, p<0.001), and alcohol use (χ² = 255.6, p<0.001).

Conclusion: Based upon these findings, it is apparent that American high school students who reported current use of cigarettes, electronic vapor products, smokeless tobacco products, and alcohol had a significantly higher association of reporting suicide in the previous 12 months, during the COVID-19 pandemic, relative to those who did not. These results are interesting given that a 2020 study found tobacco, caffeine, and alcohol consumption, in 7th-12th grade South Korean students, to be associated with attempted suicide.³

Finally, it is necessary to address limitations of this work. Due to the cross-sectional design of this research, the temporality of the assessed variables cannot be determined. Future research will explore levels, or duration of use, of cigarettes, electronic vapor products, smokeless tobacco products, or alcohol and their relationship with attempted suicide. Other substances will also be assessed for an association with suicide attempt. Additional indicators of poor mental health, like anxiety or depression, will also be assessed to better understand experiences during the COVID-19 era in this age group.

References

1. Rico A, Brener ND, Thornton J, et al. Overview and Methodology of the Adolescent Behaviors and Experiences Survey - United States, January-June 2021. MMWR Suppl. 2022;71(3):1-7.

2. Lamorte W. Adjusting for Confounding in the Analysis. 2021. PH717 module 11 - confounding and effect measure modification. https://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH717-QuantCore/PH717-Module11-Confounding-EMM/PH717-Module11-Confounding-EMM5.html#headingtaglink_5

3. Cho MS. Use of Alcohol, Tobacco, and Caffeine and Suicide Attempts: Findings From a Nationally Representative Cross-sectional Study. J Prim Care Community Health. 2020;11:2150132720913720.

Financial Disclosures: None reported.

Support: The data utilized in this research was obtained from the Adolescent Behaviors and Experiences Survey (ABES) that was made publicly available by the Centers for Disease Control and Prevention (CDC).

Ethical Approval: According to our Institutional Review Board, this project did "not meet the definition of human subject research under the purview of the IRB according to federal regulations." This project’s IRB number is 2023-039.

Informed Consent: This project utilized publicly available data that was collected from the 2021 Adolescent Behaviors and Experiences Survey (ABES). The ABES project was conducted by the Centers for Disease Control and Prevention (CDC). According to the published methodology for this online survey, local consent procedures were utilized. This involved return of both parental and student permission forms. On top of this, students were given a randomly generated login code, prior to beginning the online survey, that allowed for each student’s responses to remain anonymous.

Poster No. *PH-11

Abstract No. 2023-078

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Efficacy of a Real-Time Machine Learning American Sign Language Translation Model for Clinical Use

Anvin Dominic Thomas, OMS-III; ¹Rejath Jose; ¹Nicholas Lewis; ¹Kaitlin Unser; ¹Adriel Abraham; ¹Faiz Syed; ¹Thomas Jacob; ²Milan Toma, PhD

¹Department of Osteopathic Manipulative Medicine, New York Institute of Technology; ²Department of Clinical Sciences, New York Institute of Technology

Statement of Significance: Communication barriers exist in the deaf/hard of hearing (HOH) population [1,2] - medical personnel struggle to understand symptom expression, and patients do not understand provider instructions in about half of appointments [1,3]. Video remote interpreting technology is common but faces technical limitations and leads to patient dissatisfaction [4]. Machine learning presents an opportunity to make a real-time sign language recognition tool to ease interpretation and address health disparities.

To create and test the accuracy and reliability of a machine learning model for sign language recognition and outline potential implementation in clinical settings, addressing previous limitations in American Sign Language (ASL) users and assisting in effective interpretation as deaf/HOH patients face worse health outcomes and unproductive appointments in part to miscommunication.

Research Methods: The current study will use Google’s Teachable Machine (GTM), an online tool for pose detection. The model will be trained on a sequence of images that correspond to ASL translations of five commonly used clinical terms (blood pressure, cough, dizziness, fever, and pain/hurt). The sequence of images corresponding to each pose was collected from one author to control for variations. There were 228 images for blood pressure and cough, and 227 images for dizziness, fever, and pain/hurt. There were also 220 images for a start position where the user is at the starting position before performing the correct pose. Once the dataset was processed and uploaded onto the GTM, the pose detection tool was employed to develop a pose classification model for each of the different ASL translations. The data was trained for 1,341 images, 100 epochs (number of times each image is fed through the training model) with a batch size (number of images used in one iteration of training) of 16, and a learning rate of 0.001. Once all batches go through the dataset, one epoch is complete. GTM generates its own evaluation metrics by splitting 85% of the data into training samples (1,140 images) and 15% into testing samples (201 images). The pose detection model has no access to the testing sample imageset. GTM analyzes the efficacy of the model by pushing the testing images into the trained model and seeing if the model can accurately predict the images from the testing samples from its corresponding category. To assess external validity of the model, four of the authors (N=4) who did not train the model tested its accuracy by performing the sign language action at least five times. ANOVA was used to assess differences in accuracy between different students and different words. This approach uses the behavioral and psychological models of the osteopathic principles, as communication between patient and physician is vital for holistic care which this methodology seeks to improve.

Data Analysis: There were 33 images each for the start position, blood pressure, and cough, and there were 34 images each for dizziness, fever, and pain/hurt for a total of 201 images in the testing splits. The GTM metrics showed that the model was able to correctly predict which word corresponded to each of the 33-34 samples, yielding a 100% accuracy for all six categories. Accuracy and loss per epoch plots were also generated, and both plots show that as accuracy of the training set increases, the accuracy of the testing set also increases; likewise, as the loss of the training set decreases, the loss of the testing set also decreases. The mean accuracy for blood pressure was 0.63 +/- 0.39, cough was 0.40 +/- 0.49, dizziness was 0.950 +/- 0.1, fever was 1.00 +/- 0 and pain/hurt was 0.60 +/- 0.37 (N=4). ANOVA showed trends but no statistically significant differences in accuracy for different words (F = 2.41, p = 0.095) and different testers (F = 1.25, p = 0.33).

Conclusion: Our model demonstrates a proof-of-concept idea and framework for a real-time machine learning model that can interpret ASL for use in a clinical setting. The 100% internal accuracy of the model indicates that there is some degree of overfitting of the data, meaning that the model is memorizing image sequences rather than extrapolating features [5]. The increase in accuracy and decrease in loss of the testing and training set as the number of epochs increases indicates that there should be no overfitting, but adjusting for external validity shows otherwise. This model still shows promise as it was able to detect several terms (fever and dizziness) with great accuracy across all testers. There was a mean difference in accuracy between different words and testers but it was not statistically significant; ideally the accuracy should be similar across testers. This indicates that more work is needed to make the model more robust, as more data will decrease the risk of overfitting. One limitation of the model was its inability to make correct predictions at different depths; this can be fixed by training the model on samples that are different lengths away from the camera. Other limitations include physical differences between the training author and testing authors and camera quality differences between testers and trainers. To further improve accuracy, multiple individuals should train the model at different distances from the camera with different variations of ASL words. The findings of the current model can contribute to future research opportunities that can help build future models with words and more image sequences per word. This model shows a starting point in addressing several barriers to medical care for deaf/HOH patients, mainly miscommunication and interpreter availability, and it can increase accessibility and active participation for their future healthcare encounters.

References

1. Hommes RE, Borash AI, Hartwig K, DeGracia D. American Sign Language Interpreters Perceptions of Barriers to Healthcare Communication in Deaf and Hard of Hearing Patients. J Community Health. 2018;43(5):956-961. doi:10.1007/s10900-018-0511-3

2. McKee MM, Paasche-Orlow MK, Winters PC, et al. Assessing Health Literacy in Deaf American Sign Language Users. Journal of Health Communication. 2015;20(sup2):92-100. doi:10.1080/10810730.2015.1066468

3. Xia K, Lu W, Fan H, Zhao Q. A Sign Language Recognition System Applied to Deaf-Mute Medical Consultation. Sensors. 2022;22(23):9107. doi:10.3390/s22239107

4. Kushalnagar P, Paludneviciene R, Kushalnagar R. Video Remote Interpreting Technology in Health Care: Cross-Sectional Study of Deaf Patients’ Experiences. JMIR Rehabil Assist Technol. 2019;6(1):e13233. doi:10.2196/13233

5. Takahashi Y, Ueki M, Tamiya G, et al. Machine learning for effectively avoiding overfitting is a crucial strategy for the genetic prediction of polygenic psychiatric phenotypes. Transl Psychiatry. 2020;10(1):294. doi:10.1038/s41398-020-00957-5

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB Exempt (IRB # BHS-1902)

Informed Consent: N/A.

Poster No. *PH-12

Abstract No. 2023-086

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Medical Terminology for Mixtec Languages

¹Eunae Parkman, OMS-IV; ¹Bao-Minh Nguyen-Phuc; ¹Daniel Slaton; ¹Ashley Chang; ²Salustia Ávila; ²Javier García; ²Abigail Hernández; ²José Luis Mendoza; ²Jeremías Salazar; ³Guillem Belmar; ³Eric Campbell;

¹A.T. Still University School of Osteopathic Medicine in Arizona; ²Department of Interpretation, JSILO, Santa Maria, CA; ³Department of Linguistics, UCSB, Santa Barbara, CA

Statement of Significance: There are many Mixtec speaking patients in the county of Santa Barbara. Many were observed to have difficulty navigating the healthcare system as well as receiving appropriate care due to language barrier. The difficulty stems from the lack of a standardized written language as well as many variations of Mixtec spoken from different regions. There is a shortage of Mixtec interpreters as well as a lack of quality in translation due to difficulty conveying modern medical terms and concepts. ​

To create a glossary of medical terminology that can be distributed among health care providers and interpreters for the purpose of translating Mixtec. This glossary will aid to translate the medical conditions as well as their significance. The goal is to increase patient education, compliance and nourish provider and patient relationship.

Research Methods: Survey of Mixtec language variations and create a glossary that accurately conveys medical terms and concepts. Surveys are conducted in two hour workshops with eight Mixtec speaking interpreters. Medical terms are selected before the workshops and distributed to the interpreters during the workshop.The interpreters are then divided into three groups containing one medical student. During the first hour, medical students describe medical terms and concepts in each group. Interpreters are encouraged to ask questions for clarification and discuss amongst each other for words they believe are more accurate in their variation of Mixtec. During the second hour, a translation of the terms as well as the description of why these terms are important are phonetically written down. The interpreters are also encouraged to trial these phrases with their family members as well as members of the community to further refine them. Interpreters are then asked to submit these phrases using voice recordings or in a written format. These interpretations are collected and ​used to create a glossary.

Data Analysis: Currently, our results include documentation of Mixtec translations from the regions of Yucunani San Juan and San Agustin Atenango. However we are working towards including other regional variants with upcoming workshops. Terms, their translations, and the interpreters’ location of origin which reflects their spoken variant was documented. As seen below, there are important similarities as well as differences in translation.

1. Mixtec from Yucunani, San Juan Mixtepec

Hypertension: tá nìǐ nchuà’a tsíka nìǐ, ntakuè’è tùchi

Chickenpox: nti’i yá’áMeasles: nti’i chá’ì

Tetanus: kuè’è ntasiá’a kàaGallbladder: kàvà

Kidney: ntuchǐ (inì)Anemia: kǒo nchèě nìǐ-nà

Dialysis: ntúntoo nìǐ-nàLiver: stàà tsǎa

1. Mixtec from San Agustín Atenango

Hypertension: Kontita tuchi, ti tùu nií

Mammogram: Nana ntojo / Kuaxina ntojo

Blood sample: Kana nií

Chickenpox: nti’i va’a

Measles: nti’i kusi

Tenatus: jai ka’a

Kidney: nduchi ini

Gallbladder: kaù ini títsiAnemia: na ntukui nií

Heart attack: na sukui anima

Stroke: na teenti ti tùu ini xintiki

Dialysis: ntoò nií ini / nakatina nií ini

Conclusion: There are many variations of Mixtec that are spoken here in Santa Barbara county. Not only is there a shortage of qualified Mixtec interpreters, oftentimes many do not speak the variation that is in need of translating. There is a lack of resources to aid in providing appropriate translation for these patients which impact their quality of healthcare. A group of interpreters from Justicia Social de Intérpretes de Lenguas Originarias and community members from the Central Coast, linguists from University of California, Santa Barbara Linguistics Department, and medical students from Andrew Taylor Still University - School of Medicine Arizona have been collaborated to conduct workshops where ​medical terms are discussed and ​phonetically transcribed. Terms to be interpreted were selected in a joint effort by the medical students as well as the interpreters. Terms that were commonly used in patient encounters as well as terms that elicited confusion based on interpreters’ experiences were ultimately chosen.

One interpretational workshop has taken place thus far which included eight interpreters. Ongoing efforts are being made to arrange more workshops. The goal is to gather increased variations of Mixtec as well as increase the number of terms. These terms will be distributed to health care providers and interpreters where it will serve as a resource to ​modify words as needed ​depending on the patient’s origin.

References

1. Ávila, S., García, J., Hernández, A., Mendoza, J., Salazar, J., Pachezo Guzmán, N., Belmar, G., & Campbell, E. W. (2023). Glosario Indígena: Justicia lingüística y documentación para proveer el apoyo para un cambio. Workshop on American Indigenous Languages (WAIL), Santa Barbara, CA

Financial Disclosures: None reported.

Support: Grant giver: Physicians for a Health California, Medstudentserve Grant Funding was used to support the funding of interpretation workshops. This includes, compensating hourly for interpreters as well as staff who helped to organize the workshop. Medical students were not compensated.

Ethical Approval: Study was IRB exempt.

Informed Consent: Not relevant.

Poster No. *PH-13

Abstract No. 2023-096

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

A Predictive Social Determinant Calculator for Successful Same Day Discharge Following Total Knee and Hip Arthroplasty

¹Harrison A. Patrizio, OMS-III; ²Rex W. Lutz; ³Danielle Y. Ponzio; ²Hope S. Thalody; ¹Miranda M. Czymek; ⁴Michael Ast; ³Zachary D. Post; ³Alvin C. Ong;

¹Rowan-Virtua School of Osteopathic Medicine; ²Department of Orthopedics, Jefferson Health, Stratford, NJ; ³Department of Orthopedics, Rothman Institute, Egg Harbor, NJ; ⁴Department of Orthopedics, HSS Orthopedics, New York, NY

Statement of Significance: Current models predicting same calendar day discharge (SCDD) after total joint arthroplasty (TJA) mostly rely on clinical variables, overlooking the influence of social determinants of health (SDOH). (1,2) This study addresses this gap, developing a novel predictive calculator that integrates SDOH into discharge decision-making following TJA for a more holistic, patient-centered approach.

To construct and validate a model predicting successful SCDD after TJA by integrating various SDOH and clinical variables, thereby enhancing personalized patient care and improving patient selection strategies.

Research Methods: A retrospective review of 2,159 TJA patients was included in the final analysis. Twenty-eight SDOH were analyzed, including demographics, social history, and living situation. Patients were randomly divided into training (80%, n= 1,726) and testing (20%, n= 433) datasets. Logistic regression was applied to create the model, and its performance was evaluated using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC).

Data Analysis: This comprehensive, multifaceted patient analysis suggests that increased age, higher ASA and CCI scores were adverse predictors of successful SCDD. In contrast, being male and undergoing THA emerged as positive predictors. Interestingly, in terms of social history, regular exercise stood alone as a significant influencer towards a successful SCDD. For living situation predictors, variables such as a fewer number of stories in the home, the existence of a first-floor bedroom, and readily accessible transportation considerably boosted the odds of success. However, a history of hospital or ER visits within the past year negatively influenced successful SCDD. The model exhibited superior performance characteristics at a 0.8 cutoff score, particularly a high specificity and fair sensitivity in both training and testing datasets. Specifically, the model exhibited a specificity of 98.3% ± 0.6% in the training dataset, with a sensitivity of 27.5% ± 2.1%. Similarly, in the testing dataset, the specificity remained high at 98.1% ± 1.3%, although the sensitivity was somewhat lower at 20.7% ± 3.8%. This corroborates the model’s excellent ability to correctly predict successful SCDD while minimizing instances of false positives, an attribute essential for patient safety.

Conclusion: This study introduces a new predictive calculator that synergistically merges clinical variables and SDOH, offering an expanded, patient-centered perspective to determine SCDD eligibility following TJA. By incorporating an individual’s life circumstances, this predictive model provides clinicians with deeper context to inform their decisions and improve patient-centered care. The very high specificity of the model significantly reduces the likelihood of false-positive predictions, thus preventing premature discharges that could result in poor patient outcomes, underscoring its clinical utility. Future work should focus on refining this novel tool and expanding its validation, enhancing its accuracy, robustness, and practical application.

References

1. Hoogeboom TJ, Dronkers JJ, Hulzebos EHJ, van Meeteren NLU. Merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol. 2014;27(2):161-166.

2. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168-173.

Financial Disclosures: “Rex Lutz, Hope Thalody, Harrison Patrizio, Miranda Czymek, declare that there is no conflict of interest. Zachary Post receives royalties from Orthodevelopment and is a consultant for Orthodevelopment and Depuy. Danielle Ponzio is a consultant for Depuy. Alvin Ong receives royalties from Smith and Nephew and is a consultant for Smith and Nephew and Stryker. Michael Ast is a consultant for BD, Bioventus, Conformis, Convatec, Orthoalign, Smith and Nephew, Stryker, and Surgical Care Affiliates, and he receives royalties from Orthoalign. He has stock options in Convey Med, HS2, Ospitek, Osso VR, and Parvizi Surgical Innovations.”

Support: None reported.

Ethical Approval: N/A.

Informed Consent: N/A.

Poster No. *PH-14

Abstract No. 2023-114

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Preventive Women’s Healthcare in the United States: The Influence of Race, Education Level, and Insurance Status on the Frequency of Preventive Health Screening Between 2017 and 2019

¹Elise Quartucio, OMS-IV; ¹Sarah Klein, BS; ²Angeline Sanders, MS; ³Keila T.Campos, DO, MS

¹Nova Southeastern University Kiran C Patel College of Osteopathic Medicine; ²Department of Biostatics, The University of North Carolina at Chapel Hill, Chapel Hill, NC; ³Department of OB/GYN, St. David’s Healthcare, Austin, TX

Statement of Significance: Preventative healthcare screening is an integral part of women’s healthcare; it ensures timely and potentially life-saving screening for diseases of the female reproductive organs. The role that differing demographics and health disparities may play in the reception of preventive care necessitates proper analysis in order to delineate which groups may be more at-risk and can guide practitioners to ensure delivery of proper preventive care and screening.

The purpose of this study is to analyze the impact that race, education level, and insurance status may have on the frequency of Papanicolaou (Pap) tests (PT), pelvic exams (PE), and human papillomavirus (HPV) testing in women between the ages of 21-49 years old as reported in the Center for Disease Control and Prevention’s (CDC) 2017-2019 National Survey of Family Growth (NSFG) [1].

Research Methods: This project analyzed data derived from the CDC’s 2017-2019 NSFG. Multivariable logistic regression models were created for each outcome to evaluate the effect of race (Black or African American, White, Hispanic, or other race groups), insurance (Medicaid, Medicare or other government health insurance, military health care, private health insurance, state-sponsored health plan, Indian Health Service or single service plan, inapplicable, or don’t know), and education level (some high school, completed high school, some college, completed college, beyond college) for women aged 21-49 years. Outcomes analyzed are Pap tests (n=5,022), pelvic exams (n=5,025), and ever receiving HPV testing (n=4,588). Women under 21 years of age were excluded because they do not meet the recommended age for cervical cancer screening guidelines.

Data Analysis: Race, education, and insurance status are associated with receiving a PT, PE, and HPV testing.

Black or African American (AA) women were more likely to receive a PT than their White, Hispanic, and other race groups counterparts, with black or AA women being almost 3 times more likely than other race groups (OR=2.712, CI: 2.019, 3.642).Women who “don’t know” insurance were less likely to receive a PT than those with private insurance. Women who completed college or beyond were more likely to receive a PT than those who had some or complete high school education.

Black or AA women were more likely to receive a PE than White, Hispanic, and women of other race groups, with the greatest difference being between Black or AA and other race groups (OR=2.893, CI: 2.155, 3.884). Women with an “inapplicable” insurance status were less likely to receive a PE than those with Medicaid, Medicare or other government health care, military health care, private health insurance, or state-sponsored health plan. Women with an education status of at least some college and beyond were more likely to receive a PE than those who had completed some highschool.

Black or AA women were more likely to receive HPV testing than White women and women of other race groups. White women were more likely to receive testing than Hispanic women and women of other race groups. Those who replied “don’t know” to insurance were less likely to receive HPV testing than those with Medicaid, private insurance, inapplicable, military health care, and state-sponsored health plans. Those with state-sponsored health plans were almost 4 times more likely to receive HPV testing than women with private health insurance (OR=3.637, CI: 1.229, 10.760).Women with an education level of at least some college were significantly more likely to receive an HPV test than women who completed some high school.

Conclusion: Analysis of the CDC’s 2017-2019 NSFG for female respondents aged 21-49 points to disparities amongst different races, education levels, and insurance statuses with regard to screening exams and testing. Outlining where disparities exist can help guide physicians in understanding which of their patients may be at risk for not receiving proper screening. Examination of the insurance status of women emphasizes the importance of affordable healthcare, as those who replied “inapplicable” or “don’t know” were often less likely to receive important screening. The differences that exist between women of different education levels emphasizes the importance of early education regarding women’s health. Disparities among races provide insight as to which demographics may require better follow-up or more appointments. This study has potential limitations. Analysis was limited to women who answered questions regarding race, insurance, and education. The 2017-2019 NSFG does not include women beyond age 49 and, therefore, our results do not encompass or reflect women beyond the age group examined. Additionally, women who responded “inapplicable” or “don’t know” to insurance status limit the generalizability of our results.

References

1. National Center for Health Statistics. 2017-2019 NSFG: Public-Use Data Files, Codebooks, and Documentation. Updated March 30, 2021. Accessed June 26, 2023. https://www.cdc.gov/nchs/nsfg/nsfg_2017_2019_puf.htm

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: N/A.

Informed Consent: N/A.

Poster No. *PH-15

Abstract No. 2023-117

Category: Public Health

Research Topic: Acute and Chronic Pain Management

The Association of ACE Scores on the Efficacy of Pain Management Therapies Among Patients With Chronic Pain

Nisha Puri, MPH, OMS-III; Ricardo Reyes, OMS-III, MS; Wesley Force, OMS-III; Lana Abusamra, OMS-3, MS; Kin Luu, OMS-III; Michael Cao, OMS-III; Vanessa Mackey, OMS-III; Tatyana Minafee; Sarah Miller, OMS-III, BSN; Joseph Rivera, OMS-III; Ada Florescu, OMS-III

Department of Public Health, A.T. Still University School of Osteopathic Medicine in Arizona

Statement of Significance: Adverse childhood experiences (ACEs) are traumatic events occurring in a patient’s childhood that have potentially severe lasting effects on their overall wellbeing (1). ACEs are associated with complications in a patient’s health; notably, they are associated with increased pain complications. The aim of this project is to examine the efficacy of behavioral health interventions in decreasing chronic pain levels among patients with recorded ACE scores.

Our study objectives are as follows:

1. Provide evidence supporting Buena Vida’s Pain Program approach to treating chronic pain

2. Encourage the use of behavioral health interventions to improve outcomes in patients with chronic pain

3. Demonstrate the importance of ACE scores to be used as part of an informed approach to treating patients with chronic pain

Research Methods: The study is a cross sectional analysis of EHR data. Our exposure is Behavioral Health (BH) intervention completed at Buena Vida (defined as any BH intervention including group therapy, speaking to BH team, or individual therapy). Our outcome is the difference between pre and post-BH intervention PROMIS-21 score (where pre-BH is defined as PROMIS-21 score on enrollment in the program). Secondary outcomes include: pre-BH and post-BH blood pressure, hbA1C, and BMI. We created the cohort by applying the inclusion and exclusion criteria to all of Buena Vida’s patients over the course of 3 years. The population was stratified based on their ACE score (ACE score=0 (no risk), ACE score=1-3 (intermediate risk), ACE score=4+ (high risk)). Once the dataset was created, we completed a paired t-test on the cohort to determine change in the mean pain levels experienced, mean blood pressure, mean BMI, and mean hbA1C before and after a behavioral health intervention. Then, we stratified the study population into groups with an ACE score of 0, ACE score of 1-3 (intermediate risk) and ACE score of 4+ (high risk). Among the strata, a cross tabluation was completed to compare counts of pre and post BH PROMIS-21 scores across strata. Inclusion criteria include: patient has been seen at Buena Vida or is currently being seen at Buena Vida, patient has completed an ACE screening questionnaire, patient has completed at least 1 BH intervention during their time in the program, patient has all health information available through Epic at El Rio. Exclusion criteria include: patients who are pregnant, patients below the age of 18, patient did not complete the Buena Vida program or they are not being seen at Buena Vida, patient has not completed an ACE questionnaire, patient does not have all information in their EHR through Epic at El Rio.

Data Analysis: After applying inclusion and exclusion criteria to the cohort, the cohort size (n) included 94 patients. Of the total, 50 were in the high risk ACE category, 31 were in the moderate risk category, and 13 were in the no risk category. The results of the paired t-test on the entire cohort did not demonstrate a statistically significant difference in pre and post BH intervention PROMIS-21 score, hbA1C, BMI, or blood pressure. Among the ACE score strata, the cross tabulation demonstrated a statistically significant difference in pre and post-BH intervention PROMIS-21 scores (p<0.05). Among the high risk strata, 22 patients demonstrated a decrease in PROMIS-21 scores after at least 1 behavioral health intervention. Among the intermediate risk strata, 10 patients demonstrated a decrease in PROMIS-21 scores after at least 1 behavioral health intervention. Among the no risk strata, 8 patients demonstrated a decrease in PROMIS-21 scores after at least 1 behavioral health intervention.

Conclusion: Our results did not demonstrate a statistically significant difference between the pre-treatment and post-treatment PROMIS-21 scores in patients that participated in at least one behavioral health encounter. While the data is not statistically significant, patients did appear to have decreased PROMIS-21 scores after at least one behavioral health session indicating the potential value behavioral health interventions may play in improving patient’s chronic health conditions. Considering the strong connection between behavioral health and pain demonstrated in the existing literature, we believe there is more to learn from interrogating data from the Buena Vida program. Additionally, our data does show a significant difference between high and low risk groups in terms of their response to behavioral health interventions, indicating another potential direction for future research with this study population. A limitation in our study included inability to utilize data from many patients enrolled in the Buena Vida program as they had incomplete data sets. Our sample size was also decreased due to the fact that we were unable to access records prior to 2022. Additionally, while we did consider co-variants such as medication use (antidepressants, opiates, gabapentaoids, antipsychotics) during enrollment in Buena Vida, we were unable to determine when medication was started or how long it was used. Lastly, we were unable to measure the effect behavioral health interventions had on pre-treatment and post-treatment pain levels due to conflicting timelines in the patient’s pre-behavioral health pain level, last behavioral health appointment, and post-behavioral health meeting. This can confound a patient’s pain level given the amount of time that had passed between the measurement and the last meeting. Follow up studies could consider adding a post-treatment PROMIS-21 score at a fixed time after graduating the Buena Vida program.

References

1. Waters RC, Gould E. Early Life Adversity and Neuropsychiatric Disease: Differential Outcomes and Translational Relevance of Rodent Models. Front Syst Neurosci. 2022;16:860847. doi:10.3389/fnsys.2022.8608472.

Other references on our poster (not included in the abstract due to lack of space):

1. Tidmarsh LV, Harrison R, Ravindran D, Matthews SL, Finlay KA. The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care. Front Pain Res (Lausanne). 2022;3:923866. doi:10.3389/fpain.2022.923866

2. Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Family Practice. 2001;18(3):292-299. doi:10.1093/fampra/18.3.292

3. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Our team applied for and received exemption status from ATSU SOMA’s IRB. After receiving IRB exemption, we submitted our research to El Rio’s Research Committee to receive approval to begin our study. Our IRB study number is: #2023-010.

Informed Consent: N/A.

Poster No. PH-16

Abstract No. 2023-119

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Enhancing First Responders: Combatting the Opioid Crisis Through Community Training

Stephen Loggia, MS; Kenneth Stagliano, PhD; Richard Jermyn, DO; Patrick Dugan, BA, EMT

NeuroMusculoskeletal Institute, Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: At the start of this project in 2020, Atlantic County had the highest drug mortality rate of all New Jersey’s 21 counties, at 36 deaths per 100,000.[1] In 2017, there were 2,685 confirmed overdose deaths in NJ—the ninth largest in the nation.[2] 190 of these deaths occurred in Atlantic County. [3] The Atlantic County medical examiner listed fentanyl/fentanyl analog as the major cause of death in over 69% of overdose cases. From 2015-2017, fentanyl deaths in Atlantic County increased 250%.

To train First Responders and provide naloxone training and mobile outreach to at-risk communities to determine the impact of social programs and community training on drug safety.

Research Methods: This project is being conducted through a unique multidisciplinary team of first responders and healthcare workers through a partnership between Rowan SOM and the Atlantic County Sheriff’s Office (ACSO). This team includes, law enforcement, EMT, physicians, medical students, and social workers.

This project has been in operation since early 2020 during the beginning of the COVID-19 pandemic. Hope One, the team of addiction service social workers which works with the medical workers at Rowan SOM, has trained 1375 members of the community in overdose recognition, Naloxone administration, and Fentanyl/Carfentanil safety. These 1375 community members, most of whom were affected by opioid addiction or were socially affiliated with somebody struggling with opioid addiction, also received distributions of Narcan from the first responders or Hope One outreach workers.

Since the training launch in September 2020, 1881 First Responders have been trained through the FR-CARA Train-the-Trainer/SAVE-A-LIFE program, which trains First Responders on the use of Narcan and how to train community members on the use of Narcan.

The New Jersey State Police Drug Management Initiative (DMI) provides our team with real-time overdose information from Atlantic County, which is given to the Hope One team to provide mobile outreach within 72 hours of the overdose event. Since August 2020, Hope One has been given the contact information of 1142 overdose survivors to provide outreach to in an effort to connect the individual to treatment.

Information on the individuals served through Hope One was gathered through the use of Qualtrics data collection platform. Information for the First Responders trained through the Train-the-Trainer program was gathered through Rowan University’s encrypted online Market portal, which was the platform that held the training. Survivors’ information is encrypted by NJ state police DMI.

Data Analysis: Atlantic County saw an overall drop in suspected overdose deaths from 2020 to 2021 (216 to 188, respectively), against the trend of the state of NJ at large and surrounding counties. However, in Calendar Year 2022, the number of suspected overdose deaths increased again (255), in line with the trend of the state of NJ and surrounding counties. Calendar Year 2023 is on track to see a slight decrease relative to the previous year.

The Hope One team has connected 620 of the 1142 overdose victims to treatment after contacting them within 72 hours of the overdose survival.

In total, Hope One has linked 4268 individuals struggling with addiction to treatment services, housing services, and other necessary living services. These 4268 individuals were connected ​by combinations of DMI outreach, street outreach, pop-up recovery events, and First Responder interface/dispatch.

Conclusion: While data is still being collected, the unique program that is being done through the interface between Rowan University SOM and ACSO shows great progress in enhancing the community’s ability to combat against the opioid crisis. Hope One’s efforts in the community have impacted and potentially saved hundreds of lives. Through the Train-the-Trainer program, Atlantic County has also seen an increase in opioid safety-informed first responders across several sectors (EMT, Police, Private Security, and Firefighters). In addition, there is promise in the 72-hour outreach to overdose survivors in the likelihood of these individuals avoiding future overdose incidents and other addiction struggles. More work must be done to better know the impact that such proactive outreach programs may have in the community.

References

1. New Jersey Division of Mental Health and Addiction Services (n.d.). New Jersey substance abuse monitoring system: state summary report. Retrieved May 3, 2019 from https://njsams.rutgers.edu/njsams/

2. Barnes, G.M., Welte, J.W., Tidwell, M.O. and Hoffman, J.H. (2015). Gambling and substance use: co-occurrence among adults in a recent general population study in the United States. Int. Gambl. Stud. 15, 55-71. doi: 10.1080/14459795.2014.990396

3. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2017 on CDC WONDER Online Database, released 2018.

4. US Census Retrieved May 3, 2019 from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml?src=bkmk

5. New Jersey Prevention Network (2014). Health disparities report with county profiles.

6. Castaneda, S., Rosenbaum, R.P., Holscher, J.T. and Talavea, G.A. (2015). Cardiovasculars disease risk factors among Latino migrant and seasonal farmworkers. J. Agromedicine 20, 95-104. DOI: 10.1080/1059924X.2015.1010060

7. University of Wisconsin Population Health Institute (2019).

8. Centers for Disease Control and Prevention (2018). Drug overdose mortality by State: 2017. Retrieved May 3, 2019 from https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm.

9. Department of Law and Public Safety, Office of the Attorney General (n.d) .NJ Cares: a real-time dashboard of opioid-related data and information. Retrieved May 3, 2019 from https://www.njcares.gov/.

10. Department of Law and Public Safety, Office of the Attorney General (n.d) .NJ Cares: a real-time dashboard of opioid-related data and information. Retrieved May 3, 2019 from https://www.njcares.gov/.

11. New Jersey Division of Mental Health and Addiction Services (n.d.). New Jersey substance abuse monitoring system: Atlantic County summary report. Retrieved May 3, 2019 from https://njsams.rutgers.edu/njsams/

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Rowan University’s IRB subjected this project to Expedited Review and approved the study initially in 2020, and this approval was renewed two more times to date (most recent approval ends on 2-21-2024). IRB #: PRO-2020-126

Informed Consent: Individuals who are connected to services through our program give informed consent during intake with the Atlantic County Sheriff’s Office (ACSO) social worker team. First Responders give informed consent to us before beginning their training through the online portal.

Poster No. *PH-17

Abstract No. 2023-122

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Is Bystander Intervention Training Effective in Mitigating Sexual Misconduct?

¹Keziah Jara Hidalgo, OMS-IV; ¹Elizabeth Kim, OMS-IV; ²Jenny Silberger, MD; ³Fanglong Dong, PhD; ¹Chaya Prasad, MD, MBA

¹Department of Clinical Sciences, Western University of Health Sciences College of Osteopathic Medicine of the Pacific; ²Department of Internal Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific; ³Department of Basic Sciences, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Statement of Significance: Bystander Intervention Training (BIT) programs in healthcare institutions aim to prevent sexual harassment and abuse. Positive changes in attitude from participation in these programs suggest a benefit in implementing BIT programs1. BIT helps specifically identify a situation warranting intervention2. The medical community has been lagging in investigating sexual misconduct within its profession. Hence more research is required to determine the effectiveness of BIT in healthcare institutions.

To determine the baseline exposure of BIT that healthcare professionals have received and evaluate optimal strategies and timing needed for effective BIT. We also wished to evaluate the participants’ perceptions of an effective BIT.

Research Methods: In the spring of 2023, two of the authors (CP and JS) conducted a four-part webinar series on sexual harassment in the medical profession and offered the cross-sectional online survey to registrants from select chapters of the American College of Physicians. A link to the Qualtrics survey was sent to the registrants. Survey topics included the standard demographics, years of training, recipient of formal training versus none, level of confidence in intervening as a bystander, training effectiveness, and methods, timing, and topics of effective training. Given that this was a sensitive topic, participants were made aware of the nature of the survey and informed that the participants could opt out of the survey at any given time. Local and national resources for help were also provided in the event of triggering effects. Consent was determined through the submission of surveys. A total of 65 participants responded to the questionnaire. Chi-square tests were conducted to assess the difference in the responses between various categorical variables. Fisher’s exact tests were conducted as the expected cell count <5. Sexual misconduct in the medical profession is often a taboo subject, with up to 70% of female healthcare professionals being subjected to sexual misconduct3. BIT aligns with the holistic perspective of osteopathic medicine by addressing the physical safety of individuals, their psychological well-being, and the broader social dynamics involved.

Data Analysis: A total of 65 participants responded to the questionnaire. Among these respondents, 24 (41.4%) subjects had received formal sexual assault and harassment BIT (9 subjects did not respond). Within those who had received formal training, 87.5% agreed/strongly agreed that they felt confident to intervene in the event of witnessing a sexual assault, as compared to 56.3% of those who did not receive formal training (p=0.0286). There was a statistically significant difference in the perception of the BIT in the Caucasian versus non-Caucasian groups, as evident in the following questions: BIT addressed common barriers to intervention (100% versus 60%, P=0.0237), BIT was effective in making them feel confident to intervene (84.6% versus 30%, P=0.0253), they could safely intervene as a bystander (91.2% versus 63.6%, P=0.0127). Furthermore, participants in the age 40+ group had a statistically significant higher percentage than those <40 years old in confidence levels to intervene (78.4% vs. 52.6%, P=0.0439), and the ability of BIT to adequately address incidents involving faculty or persons of authority (84.6% versus 40%, P=0.0303). With reference to strategies and timing of effective BIT, the most preferred methods included small group sessions using vignettes and information on how to intervene safely. Participants considered BIT training at high school and undergraduate education to be most effective, while graduate level and internship/residency were least effective.

Conclusion: This study highlights the importance and potential benefits of BIT programs in healthcare institutions. Our results indicate that BIT can be an effective tool in increasing the confidence levels and ability to intervene safely in incidents of sexual misconduct. Effective BIT can include various modalities with clinical vignettes being the most effective. The responses from our study highlight the need for the development of informed policies and proactive education programs in healthcare institutions, to ultimately promote a safe and supportive environment for addressing sexual misconduct. Future research opportunities should include the differences in training among specific populations or the cultural factors that influence bystander behaviors and attitudes. Possible limitations of our study include the population consisting of a small sample of the American College of Physicians, and the fact that healthcare professions trainees were not included.

References

1. Jouriles EN, Krauss A, Vu NL, Banyard VL, McDonald R. Bystander programs addressing sexual violence on college campuses: A systematic review and meta-analysis of program outcomes and delivery methods. J Am Coll Health. 2018;66(6):457-466. doi:10.1080/07448481.2018.1431906

2. Kettrey HH, Marx RA. The Effects of Bystander Programs on the Prevention of Sexual Assault across the College Years: A Systematic Review and Meta-analysis. J Youth Adolesc. 2019;48(2):212-227. doi:10.1007/s10964-018-0927-1

3. Notaro E, Pascoe V, Shinohara MM, DeNiro K. Sexual harassment from patient to provider. Int J Womens Dermatol. 2019;6(1):30-31. Published 2019 Sep 10. doi:10.1016/j.ijwd.2019.09.001

Financial Disclosures: None reported.

Support: Heatherington Foundation. Students will be provided with travel funds to participate and present their findings in the 2023 OMED conference.

Ethical Approval: Review outcome: Fully approved by WCG IRB. IRB tracking ID: 20226877

Informed Consent: It was explained to the potential participants that submitting the survey constituted their informed consent to participate. Therefore, receipt of a completed survey served as informed consent.

Poster No. *PH-18

Abstract No. 2023-125

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Diversity Champion Initiative Exploration and Evaluation

Ramanan Ramesh, OMS-IV; Safia Ansari; Brianna Holmes

Department of Professional Development, Campbell University-Jerry M. Wallace School of Osteopathic Medicine

Statement of Significance: Minority patients are disproportionately impacted by health conditions such as diabetes and heart disease. As a medical school training the next generation of physicians, it is vital that diversity education is incorporated into both the clinical and pre-clinal programs. Culturally competency trained physicians have been shown to significantly improve overall patient trust and adherence to medical decisions and therapies compared to their untrained counterparts.

To determine if the creation and development of a certificate program in diversity, equity, and inclusion can address a gap in the medical education curriculum regarding topics related to cultural competency and sensitivity.

Research Methods: The program was piloted by three (n=3) students at CUSOM to test the reproducibility and identify any pitfalls. These students who had an interest in evolving their cultural competency volunteered for the initial pilot of the program. Students had the liberty to choose projects that interested them. Potential areas included but were not limited to racial disparities in healthcare, LGBTQ+ healthcare, identifying structural racism in the healthcare system, and cultural sensitivity. The primary goal of the pilot was to assess for successful completion. Additionally, to adequately measure the efficacy of the program, pre-evaluation and post-evaluation surveys were implemented throughout the medical school curriculum. These surveys included qualifying and quantifying questions on students’ knowledge of healthcare disparities and cultural competency. A quantitative scale was used from 1 to 5, which denoted “strongly disagree, disagree, neutral, agree, and strongly agree”, respectively. Examples of questions included are “I feel comfortable counseling a transgender patient on medication and lifestyle recommendations” and “Native American herbal remedies are dangerous and should be discouraged.” Surveys were conducted twice a year, for a total of 8 surveys to gauge and plot students’ progression in understanding cultural competency values.

Data Analysis: By the end of the pilot, all participants were able to meet the predetermined criteria (100% completion rate). Examples of the original research that was conducted include “Misinformation and Other Barriers to Vaccination in American Indian/Alaskan Native Populations.” Examples of oral presentations given include “Implicit Bias in Maternal Mortality in North Carolina.” All of the students who participated in the program demonstrated greater than 50% improvement in knowledge and application of the measured competencies. During the pilot, students expressed that they were able to develop a stronger grasp on cultural sensitivity and were trained to be better equipped to tackle disparities in their future practices. Additionally, these projects significantly increased exposure to healthcare disparities for the remainder of the class.

Conclusion: The first phase of the Diversity Certificate program was a success. Students will be working closely with leadership to implement the next phase of the program, utilizing lessons learned from the pilot. By creating and developing this program, CUSOM will play an active role in creating and training the next generation of culturally competent physicians. Ideally, this initiative should be encouraged and developed into a deeper program in which other medical schools can adapt to their own curriculum.

References

1. Graham G. Disparities in cardiovascular disease risk in the United States. Curr Cardiol Rev. 2015;11(3):238-245. doi:10.2174/1573403x11666141122220003

2. Tucker CM, Marsiske M, Rice KG, Nielson JJ, Herman K. Patient-centered culturally sensitive health care: model testing and refinement. Health Psychol. 2011;30(3):342-350. doi:10.1037/a0022967

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: N/A.

Informed Consent: Not relevant

Poster No. *PH-19

Abstract No. 2023-136

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Mobile Telemedicine Hotspot to Engage Homeless Inviduals Without Internet Access in Telemedicine Services

Justin Stout, MBA, OMS-III; Justin Stout; Colton Spencer; Greg Salzberg; Emily Forester; Mahhum Naqvi; Emily Tran; Matt Kains

Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: According to the CDC, there were over 81,000 drug overdoses between May 2019 and May 2020 in the United States [1]. Southern New Jersey has been particularly affected by the opioid crisis. Atlantic County has the highest overdose mortality rate, and the 4th largest number of overdose deaths in New Jersey [2,3]. To address this concern, a pilot program using the Hope One Mobile Response Unit was created to connect homeless populations to medical care providers via videoconferencing.

To determine whether a Mobile Telemedicine Hotspot is effective in enrolling homeless individuals in Atlantic County, NJ into telemedicine services and improving health outcomes during the COVID-19 pandemic.

Research Methods: This pilot study collected survey data from homeless individuals within Atlantic County, New Jersey. Inclusion criteria were predominantly homeless adults ages 18-84, without internet access diagnosed with an opiate use disorder or a chronic medical condition, with sufficient cognitive status to undergo the consent process. Exclusion criteria were individuals living outside of Atlantic County, subjects who had insufficient cognitive status, and subjects under the age of 18, or over the age of 84. A mobile van provided by Hope One was utilized in this study to conduct the telemedicine visits. Direct recruitment of participants was conducted based on convenience via outreach events and homeless shelter visits within Atlantic City. Verbal screenings were conducted to assess subject eligibility prior to enrollment. If subjects were deemed cognitively sufficient, consent was collected, and eligible participants were enrolled in the program. Intake forms were collected after enrollment to assess medical history. An SF-12 form was completed to assess physical and mental health of each participant. Each subsequent appointment was conducted on the Hope One Mobile Van where participants were connected to health care providers via telemedicine. At the completion of each visit, participants completed an SF-12 form and a patient satisfaction survey. Patients were considered to have fully completed participation in the study once the 90-day appointment was reached. Independent samples and one sample t-tests were performed to analyze the data collected from the SF-12 forms. Descriptive analysis of the patient satisfaction surveys was used to determine the percentage of responses for each rating. This study is significant to the philosophy of Osteopathic Medicine as it aims to find a solution to the disruption of total body homeostasis that occurs as a result of substance use disorder, specifically within the vulnerable population of homeless individuals in Atlantic County.

Data Analysis: In total, this study enrolled 22 patients. Two patients were lost to attrition. Among the 20 remaining patients, 12 patients participated in psychiatry telemedicine, four patients participated in Medication for Addiction Treatment (MAT) telemedicine, and 4 patients participated in both psychiatry and MAT telemedicine appointments. At the conclusion of the study, seven out of the 20 participants completed the full 90 days in the program. Among the 13 participants who did not complete the full 90 days in the program, an average of 1.77 telemedicine appointments were attended by each patient. One patient who did not complete the full 90 days in the program was transferred to a permanent provider. Among the SF-12 forms completed by all patients at each respective appointment, the mean physical component score (PCS-12) was 41.1101 and the mean mental component score (MCS-12) was 37.5178. Among the general US population, the average PCS-12 and MCS-12 is 50. Compared to the general US population, there is a significantly lower PCS-12 and MCS-12 score among the Hope One patient population (p < 0.001). Among the initial SF-12 scores in the Hope One patient population, we found no significant difference in PCS-12 based on primary care physician status (p=0.712), insurance status (p=0.563), or gender (p=0.445). Regarding the MCS-12, there was also no significant difference in score based on primary care physician status (p = 0.591), insurance status (p = 0.093), or gender (p=0.059). Among the patient satisfaction survey responses, 89.6% of respondents ranked their overall treatment experience at the telemedicine hotspot as “Good” or “Excellent.”

Conclusion: Data analysis of results collected from patients’ SF-12 survey forms indicated significantly lower Physical Component Scores (PCS-12) and Mental Component Scores (MCS-12) in program participants compared to the general US population. These results indicate that there may be a higher need to improve access to quality healthcare in this patient population. Based on patient satisfaction surveys, most of the patients enrolled in the program were highly satisfied with the healthcare they received through the program. Almost 90% of patients rated their experience with the program as “good” or “excellent.” These results indicate that the target population is likely satisfied with the intervention, and continued involvement and expansion of the program within the community is likely to be welcomed by participants. One limitation in this pilot study was loss of participants to follow-up. Nine out of twenty participants only came for one appointment. Limitations also include a small sample size, which can be attributed to the limited bi-weekly appointment schedule and limited number of available providers. This small sample size makes it difficult to compare the sample PCS-12 and MCS-12 with that of the US population at large. Future iterations of this program should include expansion of services provided by the program, expansion of appointment slots and number of providers to increase sample size, and improved collaboration with community partners.

References

1. Overdose Deaths Accelerating During COVID-19. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html#print.

2. Atlantic, New Jersey. County Health Rankings & Roadmaps. Accessed June 26, 2023. https://www.countyhealthrankings.org/explore-health-rankings/new-jersey/atlantic?year=2023.

3. NJ Cares Data by County. New Jersey Office of Attorney General. February 21, 2023. Accessed June 26, 2023. https://www.njoag.gov/programs/nj-cares/nj-cares-data-by-county

Financial Disclosures: None reported.

Support: This study was funded with the support of the New Jersey Health Foundation. Funding was used for study equipment (laptop, internet, etc.), professional services, and gift cards for participant compensation.

Ethical Approval: This study was approved by the IRB until May 1, 2024. The study ID is “PRO-2023-91.”

Informed Consent: Informed consent was obtained prior to enrolling any subject in the study. Subjects were provided with documentation explaining study purpose, expectations of the course of the study, anticipated risks and benefits, and alternatives to participation. An outreach worker or investigator was present during the consent process to explain the study and answer any questions. Informed consent was obtained prior to enrolling any subject in the study. Subjects were provided with documentation explaining study purpose, expectations of the course of the study, anticipated risks and benefits, and alternatives to participation. An outreach worker or investigator was present during the consent process to explain the study and answer any questions.

Poster No. *PH-20

Abstract No. 2023-140

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Follow-up Survey for Twelve-Week Dance Intervention Demonstrates Need for Precision-Medicine Community Public Health Service Programs in Rural Appalachia

Cambri LuAnn Fox, OMS-III; Meaghan Kuzmich, OMS-IV; Kaitlyn Gates, OMS-III; Hannah Campbell, OMS-III; Lori McGrew, PhD

Lincoln Memorial University-DeBusk College of Osteopathic Medicine

Statement of Significance: Following the promising results from the Dance for Parkinson’s Disease® class (DfPD®) held via Zoom at the Harrogate Senior Center in Tennessee in the Spring of 2022, a longitudinal study was conducted using pre-recorded classes from the DfPD® website for twelve weeks during the Fall of 2022. However, this study showed a discrepancy between the participants’ subjective perceived benefit of the classes and the results from the quality of life survey utilized.

This study aims to further elucidate the discrepancy noted in the prior longitudinal study. This study will assess whether the type of dance exercise modality impacts the benefits of the class.

Research Methods: In the pilot study, the dance teacher was live on Zoom, whereas the longitudinal study utilized recordings of previous DfPD® classes available on the DfPD® website. This study utilized a new modality for the classes, which consisted of an in-person instructor who conducted a live dance class at the Harrogate and Tazewell Tennessee senior centers. Similarly to the pilot study, a voluntary, anonymous paper survey was utilized with fewer questions and tailored to the literacy level of the local community. Potential research subjects met the inclusion criteria if they had attended the live class and were at least 50 years of age. Questions were included in the survey that would allow for the stratification of participants into the following groups: previously participated in a DfPD® pre-recorded dance class, previously participated in a DfPD® live Zoom class, or no prior participation in a DfPD® class. Analysis was conducted utilizing the One-sample t-test (t) to test for significant differences between groups.

Data Analysis: Fifteen participants completed the survey post-dance class, with eleven having previously participated in a DfPD® live Zoom class and a DfPD® pre-recorded dance class at the respective senior centers. 93.33% of participants preferred dance over other forms of exercise, such as swimming, yoga, walking, and biking (n=15). According to participants who had experienced all the variations of dance class, 9.10% preferred the DfPD® pre-recorded dance class, 45.45% preferred a live dance class, and 45.45% had no preference between modalities (n=11). Analysis revealed no significant difference in how the dance classes are received compared to the varying modalities (t=2.750, df=2; p>0.1107). However, there was a statistically significant difference when asked which online modality they preferred, with 36.36% preferring the DfPD® pre-recorded dance class, 36.36% preferring a live Zoom class, and 27.27 % having no preference between modalities (t=11.00, df=2; p=0.0082).

Conclusion: This follow-up survey demonstrated that, although participation and outcomes from the longitudinal study were conflicting, the seniors of rural Appalachia continue to desire increased access to any formalized group dance class when compared to other forms of health service programs. The aforementioned findings could demonstrate the want for online dance classes, even when live/in-person dance classes are unavailable, which aligns with previous literature detailing the benefits of online dance classes.¹

Providing senior rural Appalachian community members with healthy and meaningful activities they want to participate in can increase the overall health of a community experiencing such significant health disparities.² ³ ⁴ Future studies and health initiatives should focus on implementing precision-medicine community-based public health programs to better serve this rural Appalachian community.

Some limitations of this study include the small sample size and brevity of the survey. The process of engaging with rural communities is often made difficult by the resistance to outside help. However, the continued progression of interacting within the community, such as in senior centers, is one of the multitudes of ways that medical professionals can break down the barriers of medical mistrust, which have historically been prominent in the community.⁵ Osteopathic students can further facilitate the utilization of the tenets of osteopathic medicine by interacting and collaborating with their local communities to create classes that engage the mind, body, and soul of health and well-being. This may be done through the increased number of public health programs or research projects led by osteopathic medical students. The prominent health disparity gap between rural Appalachia and the rest of the nation can potentially be reduced through the continued outreach efforts of the osteopathic community.

References

1. Morris ME, Slade SC, Wittwer JE, et al. Online dance therapy for people with Parkinson’s disease: Feasibility and impact on consumer engagement. Neurorehabilitation and Neural Repair. 2021;35(12):1076-1087. doi:10.1177/15459683211046254

2. Marshall AJL, PDA AO. Health Disparities in Appalachia. Appalachian Regional Commission. February 3, 2021. Accessed June 26, 2023. https://www.arc.gov/report/health-disparities-in-appalachia/.

3. van Dis J. Where we live: Health Care in Rural vs Urban America. JAMA. 2002;287(1):108. doi:10.1001/jama.287.1.108-jms0102-2-1

4. Savla J, Bivens LR, Roberto KA, Blieszner R. Where you age matters: Individual- and county-level predictors of formal and informal care in rural Appalachia. Journal of Aging and Health. 2018;31(5):837-860. doi:10.1177/0898264318761907

5. Zanjani F, Rowles GD. “We Don’t Want to Talk About That”: Overcoming barriers to rural aging research and interventions on sensitive topics. Journal of Rural Studies. 2012;28(4):398-405. doi:10.1016/j.jrurstud.2012.03.005

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was reviewed and received initial approval by the Lincoln Memorial University Institutional Review Board on March 16, 2022. The project was deemed to be minimal risk and reviewed as expedited as described in HHS 45 CFR 46.110(7). A request to amend the IRB protocol in relation to this study was also reviewed and received approval from the Lincoln Memorial University Institutional Review Board on March 20, 2023. IRB number 1089 V.2.

Informed Consent: Informed consent was obtained utilizing a prepared oral script and an informational sheet regarding the details of the voluntary study and any risks associated with participation. No identifying or sensitive information was collected on the survey, and as a result, the completion of the survey indicated the subjects’ consent to participate.

Poster No. *PH-21

Abstract No. 2023-142

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Cultural and Health Literacy Factors that May Contribute to Medication Noncompliance in Adult Asian Patients with Chronic or Preventable Conditions, and Ways to Combat Them

Emily Tran, OMS-III; Mahhum Naqvi

Rowan-Virtua School of Osteopathic Medicine

Statement of Significance: Patients of Asian descent tend to make up high proportions of medically noncompliant patients on a global and national scale. Physicians are generally aware of socioeconomic factors such as financial stability that influence medication compliance, however there is a literature gap on cultural belief in Eastern Medicine and patient perception that also highly influence medication compliance. This study aims to explore those factors to further help reduce preventable deaths in disease management.

To explore cultural and health literacy factors that may contribute to medication noncompliance in adult Asian patients with chronic or preventable conditions, and ways to combat them.

Research Methods: A systematic review was conducted on current literate to assess relationships between cultural beliefs, heritage, and patient perspectives on medication noncompliance and poor disease management. The specific databases used were: NIH (National Institute of Health) and PubMed. The search terms and keywords used in this review were as follows: “Asian patients medication compliance” AND “Medication noncompliance relationship with race”. These terms were the key words in determining the theme of literature results. This review included literature that were largely based on South-Asian, or Asian descent as a whole (which included but are not limited to populations from Southeast or Far East Asia, and the Indian subcontinent). Included in the review were literature that examined relationships between medication adherence and race, and literature that studied [asian] patient perception and understanding of their disease management. Several studies were selected for their focus on how Asian patients experience medication nonadherence in adjustment to Western medicine. Studies based from the United States, United Kingdom, and Asia were considered if information was pertinent to behaviors and factors linked to Asian patient medication noncompliance. Risk factors, beliefs, sociological impacts, and patient perspective in relation to chronic disease medication adherence were qualitatively assessed. There were no limitations on the type of chronic condition of the patients as any case of disease management and medication compliance were considered in this review. The data included the type of demographic and chronic disease assessed, proportion of the participants impacted by medication noncompliance, and improvement models made to combat the issue. The data extracted was assessed and analyzed descriptively. Data analyzed includes risk factors, sociocultural factors, socioeconomic factors, and improvement models.

Data Analysis: Across several studies, patients agreed that having familial support with their disease management was crucial, as it provided a means for transportation to important appointments, assistance with calculation and keeping track of doses, and a translator in case of language barriers. Diabetic patients without these forms of familial support experienced higher frequency of A1c level increases. Patients with chronic heart disease without familial support were shown to have left over doses of their prescribed medication. In Asian patients that expressed close international relationships from non-western countries, it was indicated that family and friends from those different countries often expressed their own view towards patient medication regimen that affected adherence. Poor compliance results were more pronounced in patients who had extended stays in those countries. Among this demographic of patients, studies showed that international travel for family, cultural, and religious reasons were common causes of potential disturbances in daily chronic condition management. These disturbances in daily routine are strongly linked with ‘forgetfulness’, which was a major factor seen across the board for medication nonadherence in Asian patients. If physicians do not make effort to establish rapport with their patients, it may lead to patients feeling neglected by their healthcare providers, which in turn can make them less likely to attend appointments and discuss their medications. In some countries with less developed pharmaceutical manufacturing industries and healthcare systems, there is a certain level of established distrust in using medication, which may indicate high preference for Eastern Medicine perspective. Some patients may believe that due to the less developed nature of those industries in their respective country, harmful additives and poor manufacturing practices may lead to taking these daily medications being harmful for one’s health overall.

Conclusion: Gaining insight on one’s insight, mindset, and subjective obstacles in the behavior of medication nonadherence has proven to be relevant in regards to the presence of high proportions of noncompliance. It may be the key to producing models to combat this issue in Asian patient populations. A limitation encountered in this review was that many studies have different ‘cutoff’ definitions of ‘medication nonadherence’, it did not allow for this review to directly compare numerical and statistical results among each other to extrapolate overarching statistical relationships across all the studies. The study revealed a strong relationship between familial support and medication adherence, due to increased access to translators, verbal reminders, and transportation to appointments. For this reason, it is likely that programs that allow for increased access to these resources in the Eastern and South Asian patient populations can decrease prevalence of nonadherence. Study results also indicated gaps in patient health literacy. This reveals an avenue for improving medication adherence through community educational models which are culturally competent and sensitive. Data collected during this review which pertain to sociocultural aspects of the patient experience provide insight into potential solutions to medication nonadherence in Asian patient populations, which include context of Eastern or Alternative medicine approach and the preferences that Asian patients strongly hold for it. By improving health literacy and allowing for increased access to resources that reduce barriers to health, it is possible that Asian patients can improve adherence to medication. This review provides insight into the potential to overcome international stigma, cultural beliefs, unsupportive relationships, and misconceptions or reservations about western medicine that can help reduce the prevalence of medication noncompliance in these demographics.

References

1. Kleinsinger F. (2018). The Unmet Challenge of Medication Nonadherence. The Permanente journal, 22, 18–033. https://doi.org/10.7812/TPP/18-033

2. Jamil, A, Jonkman, LJ, Miller, M, Jennings, L, Connor, SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. J Am Coll Clin Pharm. 2022; 5(8): 829-836. doi:10.1002/jac5.1668

3. Chong E, Wang H, King-Shier KM, Quan H, Rabi DM, Khan NA. Prescribing patterns and adherence to medication among South-Asian, Chinese and white people with type 2 diabetes mellitus: a population-based cohort study. Diabet Med. 2014;31(12):1586-1593. doi:10.1111/dme.12559

4. Ens TA, Seneviratne CC, Jones C, Green TL, King-Shier KM. South Asians’ cardiac medication adherence. Eur J Cardiovasc Nurs. 2014;13(4):357-368. doi:10.1177/1474515113498187

5. Ens TA, Seneviratne CC, Jones C, King-Shier KM. Factors influencing medication adherence in South Asian people with cardiac disorders: an ethnographic study. Int J Nurs Stud. 2014;51(11):1472-1481. doi: 10.1016/j.ijnurstu.2014.02.015

6. Jamil, A, Jonkman, LJ, Miller, M, Jennings, L, Connor, SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. J Am Coll Clin Pharm. 2022; 5(8): 829-836. doi:10.1002/jac5.1668

7. Farrukh F, Abbasi A, Jawed M, et al. Hypertension in Women: A South-Asian Perspective. Front Cardiovasc Med. 2022;9:880374. Published 2022 Aug 10. doi:10.3389/fcvm.2022.880374

8. Huang, Z., Tan, E., Lum, E., Sloot, P., Boehm, B. O., & Car, J. (2019). A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial. JMIR mHealth and uHealth, 7(9), e14914. https://doi.org/10.2196/14914

9. Huo X, Krumholz HM, Bai X, et al. Effects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus: A Randomized Clinical Trial. Circ Cardiovasc Qual Outcomes. 2019;12(9):e005805. doi:10.1161/CIRCOUTCOMES.119.005805

10. Jamil, A, Jonkman, LJ, Miller, M, Jennings, L, Connor, SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. J Am Coll Clin Pharm. 2022; 5(8): 829-836. doi:10.1002/jac5.1668

11. Kleinsinger F. (2018). The Unmet Challenge of Medication Nonadherence. The Permanente journal, 22, 18–033. https://doi.org/10.7812/TPP/18-033

12. Kroll J, Linde P, Habenicht M, et al. Medication compliance, antidepressant blood levels, and side effects in Southeast Asian patients. J Clin Psychopharmacol. 1990;10(4):279-283.

13. Li WW, Stotts NA, Froelicher ES. Compliance with antihypertensive medication in Chinese immigrants: cultural specific issues and theoretical application. Res Theory Nurs Pract. 2007;21(4):236-254. doi:10.1891/088971807782427967

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: This study was deemed exempt from requiring an IRB approval.

Informed Consent: Informed consent process was not relevant in this study as it is meta-analysis of current literature.

Poster No. *PH-22

Abstract No. 2023-158

Category: Public Health

Research Topic: Health Disparities-Social Determinants of Health

Efficacy of Cardiovascular Health Seminars on Improving Health Literacy in Rehabilitation Program Residents

¹Hadia Tariq, OMS-III; ¹Pruthvi Patel; ¹Ali Abbas Raza; ²Gregory Jacobs, DO

¹Department of Research, Alabama College of Osteopathic Medicine; ² Department of Clinical Skills, Alabama College of Osteopathic Medicine

Statement of Significance: Health literacy continues to be an ongoing issue in many parts of the country and across a variety of patient populations (1). The ARK House is a community-based organization in Dothan, Alabama that seeks to house and rehabilitate men and women who are struggling with addiction, houselessness, as well as previously incarcerated individuals. Medical students at the Alabama College of Osteopathic Medicine formed a partnership with the ARK to provide health education to its residents.

Our objective was to improve ARK residents’ health literacy through the presentation of health seminars so they may effectively take control of their cardiovascular health and efficiently communicate their needs with their healthcare providers.

Research Methods: The inclusion criteria for this study was residents who were actively enrolled in the ARK House rehabilitation program, which consisted of 9 female and 10 male residents. Exclusion criteria consisted of anyone who was affiliated with the ARK such as staff, but was not a part of the rehabilitation program. We approached this study by first polling the residents about what topics they thought they were the most unfamiliar with and would benefit the most from; a majority of whom requested a seminar on cardiovascular health. We then created a presentation that touched on the many different factors that comprise an individual’s cardiovascular status such as at-risk behaviors, signs and symptoms of heart attacks, as well as various diet and lifestyle modifications to improve one’s heart health. We created a survey that was administered both before and after the seminar that asked residents to rate on a scale of 1-10 the level of competency they felt they had regarding the 6 objectives that were covered. Survey answers were analyzed to assess trends in self-reported health literacy.

Data Analysis: Overall, both the male and female participant groups showed a significant increase in perceived competency across all objectives. The female participant group showed the largest improvement which ranged from a 2.56% to 64% increase while the male population also had an overall trend of improvement that ranged from 7.32% to 20.51%. Interestingly, both subject groups showed the highest level of increased competence in the same objective, which was “I know what a heart attack looks like for men and women”. Although there was a wide variety in the level of improvement observed across the 6 objectives, we still observed an overall increase in each one.

Conclusion: Conducting this study, we saw that the Heart Health Seminar was beneficial to the residents of the Dothan ARK House as the results showed increased awareness and knowledge on factors that influence cardiovascular health. The overall positive trend that was observed in health literacy can also be applied to the resident’s ability to take control of their overall health and better communicate their health goals to healthcare providers. The success and improvement illustrated by the results advocates for future health seminars on other topics that are of importance to such at-risk populations. Through the utilization of more seminars, we can improve the health literacy in at-risk and underserved populations in Dothan.

References

1. Rolova G, Gavurova B, Petruzelka B. Health Literacy, Self-Perceived Health, and Substance Use Behavior among Young People with Alcohol and Substance Use Disorders. International Journal of Environmental Research and Public Health. 2021;18(8):4337. https://doi.org/10.3390/ijerph18084337

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: IRB Approval was obtained prior to the survey delivery. IRB forms were completed and sent to approval body. Once approved, Health Seminars and Surveys were conducted. IRB#HS230223-E-2.

Informed Consent: Consent was obtained by explaining to residents that the surveys will be used in an ongoing research project. Participants had the option to participate or not. An informed consent statement was placed at the top of each survey.

Poster No. *PH-23

Abstract No. 2023-162

Category: Public Health

Research Topic: Impact of OMM & OMT

Retrospective Study of Osteopathic Manipulative Treatment Use for Pain in Patients with Ehlers Danlos Syndromes and Hypermobility Spectrum Disorder (EDS/HSD)

Mike Jinwoo Chung, OMS-IV; Jayme Mancini PhD, DO; Sheldon Yao, DO

Department of Osteopathic Manupulative Treatment, New York Institute of Technology

Statement of Significance: EDS/HSD are a diverse group of connective tissue disorders that are generally characterized by joint hypermobility, skin hyper-extensibility, and poor wound healing. 1, 2 Most EDS/HSD patients experience varying musculoskeletal pain in terms of location, intensity, and frequency. 2, 3 The pain includes arthralgia, neuralgia, headaches, and visceral pain.4 While there are treatment options like painkillers, physical therapy, and surgery, their long-term effectiveness lacks clear evidence.

Novel pain-reduction interventions for patients with EDS/HSD are much needed.4 Previous case reports suggested that applying Osteopathic Manipulative Treatment (OMT) was safe and improved pain and/or function in patients with EDS/HSD. However, the use of OMT to care for patients with EDS/ HSD has not been well-investigated. Therefore, the aim of this retrospective study is to determine if OMT provided during patient care significantly improved pain from EDS/HSD patients.

Research Methods: A retrospective cohort study, approved by NYIT-IRB (BHS1565), was performed on patient charts in the EDS and HSD Treatment Center at the outpatient Academic Health Care Center from 2015 to the present. The data from de-identified patients with EDS/HSD were then analyzed. Patients 10-73 years old were selected by ICD-9/10 codes for hypermobile EDS (hEDS), vascular EDS (vEDS), classical EDS (cEDS), HSD, join hypermobility syndrome (JHS), and Hypermobility and CPT codes for OMT. Patients were excluded if they had autoimmunity, neurodegeneration, and/or cancer present. The no-OMM group included physical, occupational, or psychological therapy. A qualitative assessment of pain was used to determine if pain had improved after treatment.

Data Analysis: Preliminary data have been collected from the total of 154 de-identified patients with EDS/HSD. The mean age for patients was 37 (±13.6; n=154) years old. They were 94% (145) female; 6% (9) male. Joint hypermobility was present in 99% while 4% (6) had vascular EDS. There was a strong positive correlation (r=0.0143) of arthralgias and myalgias with age among those with a Beighton Score of at least 4. Genetic testing was performed for 27% (42), and 30% (8) of those tested had a genetic variant linked to connective tissue. The most commonly used genetic test was GeneDx Heritable Disorders of Connective Tissue Panel tissue-sequencing and del/dup panel. At least 92% (142) of the patients presented with pain at their initial OMT visit. Analgesics or herbs were concurrently taken by 10% (15) of the patients. Although 54% (83) patients had OMT, 5% (4) had trigger-point and/or prolotherapy injections with OMT. 30% (25) of the patients had other rehabilitative therapies without OMT, and 10% (15) had a Geneticist or Family Practice consult only. The mean number of regions treated with OMT was 4 (±2; ranged 1-8). Cranial (63.0%) and myofascial release (63.0%) were the most frequently provided OMT techniques. There was a significant improvement of pain after OMT in approximately 74% (114) of the patients.

Conclusion: The preliminary analysis from the extensive retrospective chart review of the patients with EDS/HSD confirmed that most patients reported some levels of pain. Of those with joint hypermobility, pain in the joints and muscles increased with age. The results of this initial chart review suggested that most patients in the EDS and HSD Center who underwent OMT treatment reported improvement in their initial assessment of pain. Further analysis also demonstrated a significant improvement of the pain after OMT treatment. However, the extent of the effects or long-term effects of OMT on the pain management remains unclear. Therefore, future prospective studies of OMT in the treatment of pain in individuals with EDS/HSD are necessary to determine the best osteopathic approach.

References

1. Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26. doi:10.1002/ajmg.c.31552

2. Tinkle B, Castori M, Berglund B, et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017;175(1):48-69. doi:10.1002/ajmg.c.31538

3. Zhou Z, Rewari A, Shanthanna H. Management of chronic pain in Ehlers-Danlos syndrome: Two case reports and a review of literature. Medicine (Baltimore). 2018;97(45):e13115. doi:10.1097/MD.0000000000013115

4. Castori M. Pain in Ehlers-Danlos Syndromes: Manifestations, therapeutic strategies and future perspectives. Expert Opinion on Orphan Drugs. 2016;4(11):1145-1158. doi:10.1080/21678707.2016.1238302

Financial Disclosures: None reported.

Support: None reported.

Ethical Approval: Approved by NYIT-IRB (BHS1565). No clinical trial to register

Informed Consent: N/A.