Volume 121, Issue 11

Context Person first language (PFL) – a way of referring to individuals with medical conditions or disability that emphasizes the person over their condition or disability – is important in reducing the stigma surrounding individuals who exhibit drug-seeking behavior. Drug-seeking behavior is generally associated with a negative connotation by healthcare professionals, which may create poor provider perceptions of these individuals and potentially impact patient care. Therefore, to reduce stigmatization surrounding drug-seeking behavior and to improve patient care in these individuals, the use of PFL should be promoted. Objectives The primary objective of this study is to investigate how frequently research articles focused on drug-seeking behavior adhere to PFL. Methods We performed a cross-sectional analysis systematically searching PubMed for articles published between May 1, 2011, and April 30, 2020, focused on drug-seeking behavior. To be included, the article must have met the following criteria: (1) published in a peer-reviewed journal; (2) relevant to drug-seeking behavior; and (3) must include human subjects and be retrievable in English. All articles were screened and data were extracted independently in a masked, duplicate fashion. Each article was reviewed for 19 predefined non-PFL terms with certain terms adopted from the American Medical Association Manual of Style. Results Our search returned 699 articles related to drug-seeking behavior, of which 390 articles met inclusion criteria and were analyzed for non-PFL. Our analysis found only 13.6% (53/390) of articles adhered to PFL while 86.4% (337/390) of articles contained at least some form of non-PFL. There was no association between PFL adherence and extracted study characteristics. Conclusions PFL adherence is uncommon among research literature focused on drug-seeking behavior. The power of language can be profound, and should be understood by researchers, health care providers, and educators alike, specifically when dealing with known and exhibited characteristics of substance use disorders. This is relevant because of the high prevalence of substance use disorders, limited amount of prior research, and the impact stigma has on patients and healthcare providers.

Cardiac surgery with median sternotomy causes iatrogenic damage to the function of the diaphragm muscle that is both temporary and permanent. Myocardial infarction itself causes diaphragmatic genetic alterations, which lead the muscle to nonphysiological adaptation. The respiratory muscle area plays several roles in maintaining both physical and mental health, as well as in maximizing recovery after a cardiac event. The evaluation of the diaphragm is a fundamental step in the therapeutic process, including the use of instruments such as ultrasound, magnetic resonance imaging (MRI), and computed axial tomography (CT). This article reviews the neurophysiological relationships of the diaphragm muscle and the symptoms of diaphragmatic contractile dysfunction. The authors discuss a scientific basis for the use of a new noninstrumental diaphragmatic test in the hope of stimulating research.

Context Medical student involvement in research is an important metric used by residency programs across most specialties to better assess the candidates’ commitment to advancing medicine as well as their specialty of interest. One strategy is presentation of research work at national conferences in the specialty of interest; another is simply attending these events for networking purposes with program directors. However, attending these conferences carries cost. Objectives To investigate the cost incurred by medical students to attend the premier annual scientific meeting of each major medical specialty in 2020, during the novel coronavirus 2019 (COVID-19) pandemic, and to evaluate whether “research intensive” specialties carried greater conference registration costs. Methods Potential medical specialties to which students can apply upon graduation were identified in the National Residency Match Program (NRMP). “Research intensive” specialties were defined as those with a mean number of abstracts, presentations, or publications ≥10 per matched applicant in the 2020 NRMP. The premier conference for each specialty was determined by membership in the American Medical Association House of Delegates in the NRMP. The cost to be a member of each conference’s parent organization and attend the annual meeting were determined by internet search. Subgroup analysis was conducted to compare cost between research intensive and non research intensive specialties. Results The registration cost of 19 virtual conferences held in 2020 were analyzed in this study. The average cost to attend as a medical student member of the hosting organization for all conferences was $49.82 (range, $0–$331; SD±$92.18), while the average cost to attend as a nonmember across all conferences was $188.16 (range, $0–$595; SD±$176.35; p<0.001). Seven of 19 (36.8%) meetings had free registration for medical students who are members of the hosting organization. The premier meetings affiliated with the seven research intensive specialties had a significantly higher mean cost for medical students who were members of the parent organization than the meetings of the other specialties ($125.60 vs. $49.20; p=0.031). There was no significant difference in mean registration cost between research intensive and non research intensive specialty conference registration for nonmember medical students (p=0.85). Vascular surgery, radiation oncology, and emergency medicine were the three specialties with the most expensive medical student member registration fees overall ($331, $200, and $195, respectively). Conclusions Medical student attendance and presentation at national scientific meetings was found to be significantly more costly for research intensive specialties, although all meetings were held in an online format due to the COVID-19 pandemic. Overall, this reflects an increased financial burden to an already indebted medical student population and compounds the stresses brought on by the pandemic. More national medical societies might consider free meeting registration to reflect support for medical students and encourage their continued participation in research to advance their specialty of interest.

Context Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. Objectives This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). Methods In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic ( K ) were utilized. Results The construct validity was determined for STFT (70% agreement; K =0.49; p<0.01) and SIFT (56.7% agreement; K =0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K =0.43; p<0.01) and SIFT (56.7% agreement; K =0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K =−0.02; p=0.825) and SIFT (13.3% agreement; K =0.01; p=0.836). Conclusions The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.

Context Healthcare delivery was dramatically affected during the coronavirus disease 2019 (COVID-19) pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment (OMT), via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician’s experience in delivering osteopathic interventions to pediatric patients via telehealth. To our knowledge, these techniques have not previously been described in the literature. Objectives To detail the experience of one osteopathic pediatrician’s experience in delivering osteopathic interventions via telehealth. Methods Patients were offered the option of converting their existing OMT appointment to a telehealth visit. Prior to the appointment, instructions were emailed to the patient’s parent or guardian along with a voluntary survey to provide feedback. Thirty-minute telehealth visits were conducted during which the provider gave verbal and visual instructions to a parent or guardian over a video platform to guide them in providing treatment to the patient based on osteopathic principles. Patients aged 3 and older rated their pain before and after the appointment using the Wong-Baker FACES scale. Deidentified patient demographics, chief complaints, treatments, anatomic locations, and pain scores were recorded in a REDcap database. Descriptive statistics were analyzed and paired samples t-tests were used with a p-value of <0.05 used to determine significance. Results Eighteen patients ranging from 6 months to 19 years of age were treated utilizing osteopathic interventions via telehealth during 54 distinct visits. The most common chief complaints treated were back (n=31; 26.3%) and neck (n=28; 23.7%) pain. The most common osteopathic techniques upon which instruction was based were inhibition (n=131; 29.7%) soft tissue (n=127; 28.8%) and counterstrain (n=78; 17.7%). The average post-treatment pain score (2.57) was significantly lower than the average pre-treatment pain score (6.77) p<0.01. No serious complications were observed. Conclusions In our small retrospective case series, osteopathic interventions via telehealth resulted in decreased average pain scores following treatment while minimizing risk of viral exposure and transmission. Further study is needed to determine if such treatment methods could be effective on a larger scale when distance or illness preclude an in-person OMT visit.