Volume 116, Issue 12

Context: Research has shown that osteopathic manipulative treatment (OMT) in hospitalized patients can shorten hospital length of stay. However, hospital staff may be unfamiliar with OMT and its use in this setting. Objective: To assess a hospital staff’s knowledge of osteopathic manipulative medicine (OMM) and investigate whether there is a correlation between job category and knowledge of OMM. Methods: The study used a 13-item survey that was developed using SurveyMonkey. A brief description stating the purpose of the survey with a hyperlink to the survey was sent in an e-mail to the employee LISTSERV at Good Samaritan Regional Medical Center. This LISTSERV included all 1933 employees at the medical center. After 10 days the survey was closed and the responses were collected and interpreted by a statistician and the primary investigator. Incomplete surveys were included. Results: A total of 474 employees (24.5%) returned the survey. Of these respondents, 267 (66.9%) responded that OMM could be done in the hospital. Only 97 respondents (24.6%) reported seeing OMM performed in the hospital. Physicians had the highest awareness of OMM (53.7%), compared with all other employees (7%). Conclusion: An overall lack of knowledge exists regarding OMM among hospital staff, especially nonphysician employees, at a medical clinic.

Context: Existing literature suggests participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the prenatal and postnatal periods is associated with lower rates of breastfeeding among WIC-eligible mothers. However, minimal research has been published on the association between WIC enrollment and exclusive breastfeeding. Objective: To examine the association between WIC exposure and exclusive breastfeeding at 3 months postpartum. Methods: We conducted a secondary data analysis using information on 784 low-income women who participated in the longitudinal population-based Infant Feeding Practices Study II between May 2005 and June 2007. The main outcome of interest was exclusive breastfeeding at 3 months postpartum. Logistic regression analysis was used to estimate OR and 95% CI for exclusive breastfeeding relative to WIC enrollment status, controlling for the confounding effects of other maternal characteristics. We further conducted a subgroup analysis among those participating in WIC prenatally to examine the association between receipt of information about infant feeding from WIC and exclusive breastfeeding at 3 months postpartum. Results: The crude prevalence of exclusive breastfeeding at 3 months postpartum was 18.1% of women enrolled in WIC and 41.1% of WIC-eligible nonparticipants ( P <.0001). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding at 3 months were lower for women enrolled in WIC (OR, 0.57; 95% CI, 0.37-0.88) when compared with women not enrolled in WIC. In the subgroup analysis, receipt of information from WIC about feeding infants during the prenatal period was not significantly associated with exclusive breastfeeding at 3 months (OR, 0.86; 95% CI, 0.39-1.89). Conclusion: Women who were enrolled in WIC and who received information about feeding infants were less likely to exclusively breastfeed than women not in WIC. Continued improvement and adjustment to the existing WIC breastfeeding program could potentially improve these rates. Additional studies that examine the quality of WIC services provided, especially those pertaining to breastfeeding programs, are warranted.

Background: Obesity and diabetes are epidemic in the United States, with many treatment options having limited long-term efficacy. A possible effective medical management tool is the shared medical appointment (SMA), which offers an efficient and cost-effective approach to behavior change and aligns with the Triple Aim (reduce costs, improve population health, and improve patient care experience) set forth by the Institute for Healthcare Improvement. Objectives: To assess the effectiveness of SMAs to achieve the Triple Aim and to improve the management of overweight/obesity or diabetes. Methods: Peer-reviewed literature from PubMed was searched by the keywords shared medical appointments , group medical appointment , and group medical visit , with no date restrictions and limited to English publications with sample sizes greater than or equal to 20. Results: Eight articles met inclusion criteria. The Triple Aim was not referenced in the studies, but most reported some combination of reduced costs, improved care, and improved outcomes or patient satisfaction. Conclusions: Potential benefits of SMAs include improved patient outcomes and satisfaction. Osteopathic and, in particular, primary care medicine could likely benefit from moving toward greater adoption of SMAs; however, more randomized controlled trials are needed to assess their effectiveness with regard to the Triple Aim.

An association has been consistently made about continuity of care with improved quality of care and improved medical outcomes. However, resident ambulatory block scheduling prevents the optimization of continuity of care in ambulatory clinical education. The author performed a PubMed search for studies examining continuity of care and curriculum scheduling in US primary care residency clinics. These studies indicate the success of an X + Y scheduling model in resident ambulatory training. Additional benefits have also been noted, including improved clinical teaching and learning, increased sense of teamwork, increased resident satisfaction, improved recruitment and retention, improved patient satisfaction, and elimination of year-end patient care issues after graduation. Many allopathic institutions have begun to implement such curricular changes with demonstrated success. The author argues that osteopathic graduate medical education should embrace the X + Y scheduling model.

Kratom ( Mitragyna speciosa ) is a plant indigenous to Southeast Asia. Its leaves and the teas brewed from them have long been used by people in that region to stave off fatigue and to manage pain and opioid withdrawal. In a comprehensive review published in 2012, Prozialeck et al presented evidence that kratom had been increasingly used for the self-management of opioid withdrawal and pain in the United States. At the time, kratom was classified as a legal herbal product by the US Drug Enforcement Administration. Recent studies have confirmed that kratom and its chemical constituents do have useful pharmacologic actions. However, there have also been increasing numbers of reports of adverse effects resulting from use of kratom products. In August 2016, the US Drug Enforcement Administration announced plans to classify kratom and its mitragynine constituents as Schedule 1 controlled substances, a move that triggered a massive response from kratom advocates. The purpose of this report is to highlight the current scientific and legal controversies regarding kratom.

Somatic dysfunction caused by traumatic brain injury (TBI) may be managed by osteopathic manipulative treatment (OMT). In this case report, the authors describe 2 patients with severe TBI who were each treated with OMT in a level-1 regional trauma center. Both patients received OMT beginning in the acute care phase of injury. Somatic dysfunction improved during the course of treatment, and no adverse effects of OMT were noted. More comprehensive research may clarify the efficacy and adverse effects of OMT as part of multimodal acute care of patients with severe TBI.