Band 114, Heft 8

Context: Somatic dysfunctions of the pelvis, sacrum, and lumbar spine are common. Their association with leg length discrepancies has been observed; however, it is unclear which dysfunctions lead to mild changes in leg length or weight bearing distribution in asymptomatic individuals. Objectives: To determine which somatic dysfunctions of the pelvic, sacral, and lumbar spine lead to minor leg length discrepancies and weight-bearing differences and to determine which of these dysfunctions are most common in the asymptomatic population. Methods: Asymptomatic participants between the ages of 18 and 40 years without a recent history of trauma were enrolled. Participants were measured from the anterior superior iliac spine to the medial malleolus; only those with mild leg length discrepancies (less than a quarter inch) were included. Weight-bearing distribution through each lower extremity was measured on a quadruped scale. Participants were then evaluated for somatic dysfunctions of the pelvis, sacrum, and lower lumbar spine. Results: Ninety-eight participants completed the study. The most common somatic dysfunctions were superior innominate shears, left-on-left sacral torsions, and right rotated lower lumbar spine segments. Several statistically significant associations were found. Most participants with right anterior innominate dysfunctions exhibited an ipsilateral longer leg and a contralateral shorter leg when measured in the supine position ( P =.05). Participants with a left superior shear tended to exhibit a shorter left leg in the supine position ( P =.05). For sacral somatic dysfunctions, participants with a left-on-left sacral torsion tended to exhibit a shorter left leg while standing ( P =.02). In addition, a statistically significant association was found between right anterior innominate rotation dysfunctions and weight-bearing differences ( P =.02). A greater percentage of patients with a right anterior innominate dysfunction bore more weight through their left lower extremity (45%). Conclusion: Specific pelvic and sacral somatic dysfunctions have the potential to influence leg lengths, leading to mild disparities in length and in weight-bearing distribution through the lower extremities. (ClinicalTrials.gov number NCT01097109)

Context: Studies of burnout among allopathic physicians have shown many deleterious effects for both physicians and patients. To our knowledge, no studies have quantified burnout among osteopathic physicians. Objective: To determine the prevalence of burnout, mentoring, and resident training satisfaction among US osteopathic otolaryngology residents compared with previously published data for allopathic otolaryngology residents. Methods: A cross-sectional, questionnaire-based, electronic survey of US osteopathic otolaryngology residents was conducted. Residents were surveyed about demographic information, personal and professional life satisfaction, professional stressors, burnout (assessed with the Maslach Burnout Inventory–Human Services Survey), and mentor-resident interactions. Burnout was measured based on levels of emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). Results were compared with previously published data for allopathic otolaryngology residents. Results: Of the 102 osteopathic residents contacted, 48 (47%) responded and 47 provided complete responses in some categories. Burnout rates were low in 11 respondents (23%), moderate in 31 (66%), and high in 5 (11%), compared with published rates of 14%, 76%, and 10%, respectively, for allopathic residents ( P =.18). The rates of EE and DP did not differ significantly from published data, but levels of PA were higher in osteopathic residents ( P =.03). Sleep hours per night were significantly higher in osteopathic than in allopathic residents (mean, 6.6 vs 6.2; P =.04), and work hours per week were significantly lower (mean, 62 vs 71; P <.001). Increased EE scores were negatively associated with hours of sleep (ρ=−0.42, P =.003). Increased influence from a mentor was associated with decreased levels of burnout for all 3 components (EE: ρ=−0.54, P =.002; DP: ρ=−0.59, P <.001; PA: ρ=0.44, P =.02). Conclusion: To our knowledge, the current study is the first to quantify burnout among osteopathic residents, and our findings suggest that osteopathic residents have lower rates of burnout than allopathic residents. Osteopathic residents reported lower rates of low PA, increased hours of sleep, and decreased overall work hours. Further study of the relationship between mentoring and decreased burnout is needed.

Context: Proliferation of the use of psychopharmacologic drugs for the treatment of individuals with attention and behavior disorders has promoted discussion of the illicit use of such drugs to enhance academic performance. Previous research has focused on the use of such drugs by undergraduate students; however, inquiry into the nonmedical use of prescription stimulants by medical students is warranted because of the unique qualities of the medical school environment (including academic pressure, stress, and competition with peers) and the demographic characteristics common to many medical students. Objective: To examine the nonmedical use of prescription stimulants among osteopathic medical students, focusing on such key associated variables as academic stress, social network connections, and use of other substances. Methods: In 2012, first- and second-year students at a large osteopathic medical school were surveyed on the nonmedical use of prescription stimulants, stress, social networks, perceptions of drug use, and related topics. Data were compared with national data and assessed using analysis of variance and χ 2 statistical tests. Results: A total of 380 students completed the survey. Of those, 56 (15.2%) reported using prescription stimulants nonmedically to help them study in medical school. This percentage is significantly higher than the national estimated rate of diagnosis of attention-deficit/hyperactivity disorder in similar populations ( t =3.72, P <.001). Both positive perceptions of the nonmedical use of stimulants ( F =14.89, P <.001) and the use of other substances (χ 2 =18.00, P <.001) were positively associated with the nonmedical use of stimulants. Social network connections did not positively predict use by medical students, and certain types of social connectivity had a negative association with use. Conclusion: In contrast with research on undergraduate populations, addressing academic stress and feelings of competitiveness may not be viable strategies for mitigating nonmedical use of stimulants among medical students.

Context: To the authors' knowledge, few studies have investigated the relationship between electronic media multitasking by undergraduate and graduate students during lecture and their academic performance, and reports that have looked into this behavior have neglected to investigate factors that may influence students' multitasking during lecture. Objective: To determine the extent to which medical students multitask during lecture; the types of multitasking; the frequency of multitasking and factors that influence frequency; and the correlation between multitasking and knowledge acquisition as assessed by a postlecture quiz. Methods: A 1-page survey assessing students' multitasking behavior was administered to 125 second-year students at Edward Via College of Osteopathic Medicine and collected at the onset of a standard 50-minute lecture. On completion of the 50-minute lecture, an unannounced 10-question multiple-choice quiz was given to assess knowledge acquisition during those lectures. On a separate date, after a standard 50-minute lecture, a second quiz was administered. Results: The 1-page survey revealed that 98% of students check e-mail, 81% use social media, and 74% study for another class. Students spent the most time studying for another class (23 minutes) followed by using social media (13 minutes) and checking e-mail (7 minutes). The most influential factors behind multitasking were examination schedule (91%), lecturer (90%), and the number of lectures in the day (65%). The mean score for quiz 1 (the day after an examination) was 75%, and the mean score for quiz 2 (the day before an examination) was 60%. Conclusion: Multitasking during lecture is prominent among medical students, and examination schedule is the most influential factor. Although a robust drop in mean score on a lecture-based, unannounced quiz was identified 1 day before a scheduled examination, the effect from multitasking on this process remains unclear.

Singultus, or hiccups, are involuntary spasms of the diaphragm that in most cases are harmless and self-limited. Treatments are reserved for those cases that persist, and current options include pharmacotherapeutics, complementary methods (such as acupuncture), and osteopathic manipulative treatment. A 32-year-old woman with stiff person syndrome and concurrent aminoacidopathy in the setting of acute inpatient rehabilitation was experiencing daily bouts of singultus, ranging from 20-minute to 5-hour durations. Osteopathic manipulative treatment at the onset of spasm resulted in immediate cessation of and further suppression of singultus for approximately 12 to 24 hours. Overall, there was a noted reduction in singultus frequency, duration, and intensity, as well as better tolerance of physical and occupational therapy. The authors theorize that OMT could be a useful adjunct to, or replacement of, pharmacologic interventions for singultus, especially when pharmacologic therapies have failed.