Band 118, Heft 8

Context Duty hours were enacted in 2003 with the intent to improve patient safety and resident well-being. However, limited data exist regarding improvements in residents’ well-being since the implementation of these restrictions. Objective To examine osteopathic emergency medicine (EM) resident characteristics regarding sleep and lifestyle habits and duty hour reporting. Method A convenience sample of osteopathic EM residents was surveyed at a statewide conference in May 2014. The conference included 177 residents from 15 osteopathic EM residencies. Data regarding demographics, sleep and lifestyle habits (including work-related motor vehicle incidents [MVIs] and chemical aid use for sleep/wakefulness), and duty hour reporting were collected. The Epworth Sleepiness Scale (ESS) score was calculated, with a score greater than 10 indicating sleep disturbance. Results Of the 128 residents (72%) who returned the survey, approximately two-thirds were female, were currently on an EM rotation, and were training in suburban emergency departments with more than 60,000 annual visits. Only 35% of respondents slept 8 or more hours per night during an EM rotation, and 63% admitted to weight change during residency. Forty-two percent of respondents had a work-related MVI, which was more likely to occur if their ESS score was greater than 11 ( P <.03). Mean (SD) ESS score was 9.9 (4.8; range, 0-24). Respondents reported using chemical aids for staying awake or going to sleep on a mean (SD) of 6.9 (9.3) days per month (range, 0-30). The majority of respondents (84%) reported strict duty hour enforcement policies, few (17%) had ever been asked to falsify reports, and more than half (56%) had ever voluntarily reported false hours. Conclusion Most residents surveyed slept fewer than 8 hours per night and had a weight change during EM residency training. The majority of residents used a chemical aid for sleep or wakefulness. Nearly half of residents surveyed met criteria for disordered sleep, which was associated with a higher occurrence of MVIs.

Common sexually transmitted infections (STIs) in the United States include genital herpes, HIV, and human papilloma virus. In 2017, the Centers for Disease Control and Prevention released a report detailing a surge in chlamydia, gonorrhea, and syphilis infections in the United States. The authors summarize current trends and discuss epidemiologic factors, disease burden, and patient care. It is important to be aware of the recent increases in these 3 STIs and to be prepared to screen for, diagnose, and manage these infections and their complications.

Educating Leaders is the annual conference of the American Association of Colleges Educating Leaders is the annual conference of the American Association of Colleges of Osteopathic Medicine (AACOM). In preparation for this event, the Call for Presentations receives hundreds of high-quality abstract submissions. Presentation submissions for Educating Leaders 2018 were based on seven focus areas: Advocacy and Policy, Graduate Medical Education, Humanism and Mentoring, Learner Affairs, Osteopathic Medical Education, Professional Development, and Research Support and Technology. Following Educating Leaders 2018, session presenters were provided the opportunity to submit their sessions for publication. These sessions were reviewed by fellows (listed below) of the National Academy of Osteopathic Medical Educators—we thank them for their service. The following abstracts comprise the research and scholarly work of faculty, administrators, students, and physicians from across the osteopathic medical education continuum and were accepted by AACOM and the American Osteopathic Association for publication in The Journal of the American Osteopathic Association .

Context Consuming a diet rich in fruits and vegetables offers numerous health benefits. However, many college students do not consume the recommended amount of fruits and vegetables daily. Objective To predict change in fruit and vegetable consumption behavior among college students who were not eating the recommended amount of fruits and vegetables using the multitheory model (MTM) of behavior change. Methods In this cross-sectional study, a 38-item face-, content-, and construct-valid survey was sent to college students at a large university in the southeastern United States. Students were included in the analysis if they were aged at least 18 years and ate less than 5 cups of fruits and vegetables per day. The survey was broken into sections based on the MTM constructs of initiation of behavior change (participatory dialogue, behavioral confidence, and changes in physical environment) and sustenance of behavior change (emotional transformation, practice for change, and changes in social environment). Stepwise multiple regression was conducted to predict behavior change regarding fruit and vegetable consumption. Results Of the 5000 potential respondents, 175 completed the survey and were included in the analysis. Behavioral confidence and changes in physical environment were statistically significant predictors of the intention to initiate fruit and vegetable consumption ( F 2,173 =59.700; P <.001) and accounted for 40.2% of the variance. Emotional transformation, practice for change, and changes in social environment were statistically significant predictors for the intention to sustain fruit and vegetable consumption ( F 3,171 =26.374; P <.001) and accounted for 30.4% of the variance. Conclusion Survey results showed that the MTM is a useful framework for designing behavior change interventions to promote fruit and vegetable consumption among college students.

Context Binge drinking is a salient problem on college campuses, with estimates as high as 40% of students engaging in it. Binge drinking is associated with numerous negative consequences among college students, such as suicide attempts, unsafe sex practices, property damage, and driving under the influence. Several behavioral approaches in this regard have had modest impact and only short-term effects, however. Objective To use the multitheory model (MTM) of health behavior change to predict initiation and sustenance of responsible drinking or abstinence among binge-drinking college students in a sample drawn from a large southern public university. Methods This cross-sectional survey study included a sample of college students who binge drank in the past 30 days. A 39-item face- and content-valid instrument was used. In addition, construct validity using confirmatory factor analysis and internal consistency reliability using the Cronbach α were established. Hierarchical regression modeling was used to build models. Results A total of 289 students participated. The Cronbach α for the scale and all subscales ranged from 0.81 to 0.94 and demonstrated acceptable internal consistency reliability. Construct validity using confirmatory factor analysis yielded 1-factor solutions for each of the subscales. On hierarchical regression modeling, gender ( P= .05), race/ethnicity ( P= .004), behavioral confidence ( P= .029), and changes in physical environment ( P =.001) were associated with intended initiation for drinking responsibly/abstinence behavior change. The addition of MTM constructs led to a significant increase in R 2 of 0.20 ( F 3,194 =18.1; P< .001). The sustenance constructs yielded a significant increase in R 2 of 0.20 ( F 3,193 =19.4; P< .001). Conclusion This study provides empirical justification for MTM constructs that can be used to inculcate the intention to drink responsibly or abstain among college students who binge drink. This predictive model may prove valuable in the design of interventions aiming to improve responsible drinking behavior in this population.

Context Research on the effect of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) on chronic symptoms of multiple sclerosis (MS) is lacking. Objective To evaluate the effect of OMTh on chronic symptoms of MS. Methods Patients with MS who were evaluated at the neurology clinic at Genoa University in Italy were recruited for this study. Participants received 5 forty-minute MS health education sessions (control group) or 5 OMTh sessions (OMTh group). All participants completed a questionnaire that assessed their level of clinical disability, fatigue, depression, anxiety, and quality of life before the first session, 1 week after the final session, and 6 months after the final session. The Extended Disability Status Scale, a modified Fatigue Impact Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the 12-item Short Form Health Survey were used to assess clinical disability, fatigue, depression, anxiety, and quality of life, respectively. Results Twenty-two participants were included in the study (10 in the control group and 12 in the OMTh group). In the OMTh group, statistically significant improvements in fatigue and depression were found 1 week after the final session ( P =.002 and P <.001, respectively). An increase in quality of life was also found in the OMTh group 1 week after the final session ( P =.36). Conclusion Results demonstrate that OMTh should be considered in the treatment of patients with chronic symptoms of MS.

Context The diabetes pandemic has outpaced the US supply of diabetes specialists and has overwhelmed primary care providers (physicians, physician assistants, and nurse practitioners). Primary care diabetes fellowships can be used to address this workforce shortage. Objectives To determine the skills obtained during 2 diabetes fellowship programs, the barriers encountered in practice, the impact of the programs on career paths, and perceived acceptance by patients and colleagues. Methods A Qualtrics link to a 26-item survey was sent via email to all graduates of the Ohio University Heritage College of Osteopathic Medicine and East Carolina University Brody School of Medicine diabetes fellowship programs. Items included demographic information, comfort level with different clinical diabetes skills, and current system barriers encountered in their practices. Results Of 39 graduates, 36 completed the survey. The most beneficial skills acquired during the fellowship were insulin pump management (13 [36%]), insulin management (10 [29%]), and diabetes pharmacology (6 [17%]). The most common barrier was the lack of board certification as a diabetologist, which affected time with patients and insurance reimbursement. The perceived acceptance by patients was high (25 [69%]), and the perceived receptiveness by colleagues was mostly neutral (7 [19%]) or positive (10 [29%]). The most common postfellowship career path was primary care medicine (15) followed by hospitalist (7) and diabetologist (5). Conclusion Physicians who completed the diabetes fellowship training reported high comfort levels with treating patients with diabetes, but they also reported the barriers faced in an unrecognized specialty.

Medical education technology initiatives can be used to prepare osteopathic medical students for modern primary care practice and to provide students with training to serve vulnerable populations. Over academic years 2014 through 2017, the authors designed and implemented 26 case studies using patient simulations through a virtual community health center (CHC). First-year students, who were preparing for clinical training in CHCs, and second-year students, who were training in CHCs, completed the simulation case studies, gaining practice in clinical reasoning, Health Systems Science, and applied osteopathic principles and practice. This article explains the project, illustrates an alignment with Health Systems Science and osteopathic competencies, and highlights findings from previous research studies.

Soft palate penetrating injuries have been reported among children, particularly in children falling with objects in their mouth. The authors present a case of a healthy 14-month-old child who fell onto a blunt-ended chopstick, the subsequent cerebrovascular accident, and the role of the osteopathic tenets thereafter. The child had an acute infarction to the region of his right middle cerebral artery secondary to right internal carotid artery occlusion. Physicians should consider the neurologic sequelae of lateral soft palate injuries and damage to the surrounding anatomical structures. A thorough, whole-patient approach to physical examination is critical.