Volume 122, Issue 5

Context Osteopathic medicine in the United States continues to produce a substantial number of physicians and medical educators. However, recently popularized misconceptions about osteopathic medical practice, education, and manual therapy suggest an unsettling prevalence of inaccurate beliefs held by the public. The public often searches the internet to find out information about osteopathic medicine, but the content of questions and the transparency of the resulting information is unknown. Objectives We sought to explore frequently asked questions (FAQs) generated by Google to assess commonly searched questions about the osteopathic profession and to determine the level of information transparency associated with resulting sources. Methods On June 16, 2021, we searched Google for three terms: “osteopathic medicine,” “doctor of osteopathic medicine,” and “DO,” until a minimum of 100 FAQs and their answer links were extracted from each search. After excluding irrelevant FAQs, we used Rothwell’s Classification of Questions to categorize the FAQs. We then used the Journal of the American Medical Association’s Benchmark Criteria to assess information transparency for each corresponding answer source provided by Google. The answer sources were screened for the inappropriate use of “osteopathy” in place of “osteopathic medicine” and for “osteopath” in place of “DO,” “Doctor of Osteopathic Medicine,” or “Osteopathic Physician.” We performed statistical tests to ascertain the differences in information transparency between osteopathic and nonosteopathic information sources. Results Our Google search revealed 110 unique FAQs about osteopathic medicine. The majority of FAQs were classified as fact-based (82/110; 74.55%), nearly half of which (45.12%) were related to the medical practicing privileges of DOs. The FAQs were most commonly answered by academic institutions (44/110, 40.0%). Nearly half (49.09%) of the linked answer sources were deemed inadequate by JAMA benchmark criteria. Of the 110 linked answer sources, 19 (17.27%) misused either osteopathy, osteopath, or both to describe osteopathic physicians. Only 30 sources were linked to US-based osteopathic organizations. Osteopathic organizations were statistically less likely to meet high-transparency criteria than nonosteopathic organizations (p=0.002). Conclusions Our study shows that the US public may be unsure about the physician status of DOs, which may prevent securing the professional identity of osteopathic physicians in the eyes of the public. Osteopathic organizations should tailor awareness campaigns toward addressing the common misconceptions revealed by our study. Osteopathic organizations should use transparency criteria as a rubric when publishing information to enhance transparency.

Context The overlap between medical school, residency, and childbearing potential increases the likelihood a woman will pursue parenthood within her, or her partner’s, medical training. Parental leave benefits mothers, fathers, and infants. Adequate parental leave promotes physical recovery, mental health, infant bonding, improved breastfeeding, appropriate childhood immunization, and familial engagement. Despite the risks and benefits, the United States does not have national paid maternity, paternity, or parental leave requirements. Complicating matters for medical trainees, parental leave policies are not well-defined within the undergraduate (UME) and graduate medical education (GME) realms. Significant policy advancements are on the horizon for GME; however, medical schools are left without evidence to support policy formation. Objectives This study aims to identify the presence and nature of maternal/paternal leave policies and procedures within UME. Given the authors’ close association with osteopathic medical education, only osteopathic medical schools were considered to lay the framework for future study in UME. Methods Investigators searched university websites for student handbooks outlining rules and policies surrounding parental leave. The following terms were utilized to investigate these documents: “parental,” “maternity,” “paternity,” “pregnant,” “pregnancy,” and “leave of absence” (LOA). Administrative personnel were contacted, and subjective data were documented. A parental leave policy was defined as explicitly dedicated to expectant parents or those parents planning on adoption. Medical leave or other short- and long-term LOA policies were not considered a parental leave policy. Results A total of 42 osteopathic medical schools were identified. Investigators established email communication with 17 schools (40.5%). Neither a student handbook nor email contact could be made with one institution. Two (4.9%) osteopathic medical schools overtly described parental leave in their policies. The majority of schools recommended students seeking parental leave follow short- or long-term LOA policies. Conclusions Without protected leave time, students must decide whether to begin a family or delay medical education. As GME begins prioritizing policy change, the authors call on UME to follow suit. Parenthood and medicine must be intertwined.

This paper aims to provide a comprehensive review of the management of sacroiliac (SI) joint pain in pregnant patients. Although SI joint pain is highly prevalent among pregnant patients, the unique anatomy of the joint is rarely discussed in a clinical setting. This paper provides comprehensive review of the epidemiology, anatomy, alarm findings, standard treatment, osteopathic assessment, and osteopathic manipulative treatment (OMT) of the SI joint, and it provides a general and in-depth understanding of the SI joint pain in pregnant patients and its management.

Context Sixty thousand people are diagnosed with Parkinson’s disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances, including muscular rigidity and decreased range of motion (ROM), that increase the fall risk of those afflicted. Osteopathic manipulative treatment (OMT) emphasizes the central role of the musculoskeletal system, which could be ideal for addressing the somatic dysfunction associated with neurodegeneration in PD. The close anatomical relationship of structures implicated in PD within the skull and the increased frequency of strain patterns raise the question of whether osteopathic cranial manipulative medicine (OCMM) can improve gait performance by improving circulation to the affected nervous tissue. However, there have been few studies in recent years that explore the effects of a standardized OMT protocol on Parkinsonian gait characteristics, and there have been few studies that include OCMM techniques. Objectives This study aims to determine whether a single session of OMT or OMT + OCMM can improve the gait of individuals with PD by addressing joint restrictions in the sagittal plane and by increasing ROM in the lower limb. Methods The following study is a two-group, randomized controlled trial in which individuals with PD (n=45) and age-matched healthy control participants (n=45) were recruited from the community. PD participants were included if they were otherwise healthy, able to stand and walk independently, had not received OMT or physical therapy (PT) within 30 days of data collection, and had idiopathic PD in Hoehn and Yahr stages 1.0–3.0. PD participants were randomly assigned to one of three experimental treatment protocols: a ‘whole-body’ OMT protocol (OMT-WB), which included OMT and OCMM techniques; a ‘neck-down’ OMT protocol (OMT-ND), including only OMT techniques; and a sham treatment protocol. Control participants were age-matched to a PD participant and were provided the same OMT experimental protocol. An 18-camera motion analysis system was utilized to capture 3-dimensional (3D) position data in a treadmill walking trial before and after the assigned treatment protocol. Pretreatment and posttreatment hip, knee, and ankle ROM were compared with paired t-tests, and joint angle waveforms during the gait cycle were analyzed with statistical parametric mapping (SPM), which is a type of waveform analysis. Results Individuals with PD had significantly reduced hip and knee extension in the stance phase compared to controls (32.9–71.2% and 32.4–56.0% of the gait cycle, respectively). Individuals with PD experienced a significant increase in total sagittal hip ROM (p=0.038) following a single session of the standardized OMT-WB treatment protocol. However, waveform analysis found no significant differences in sagittal hip, knee, or ankle angles at individual points of the gait cycle following OMT-WB, OMT-ND, or sham treatment protocols. Conclusions The increase in hip ROM observed following a single session of OMT-WB suggests that OCMM in conjunction with OMT may be useful for improving gait kinematics in individuals with PD. Longitudinal studies over multiple visits are needed to determine the long-term effect of regular OMT and OMT+OCMM treatments on Parkinsonian gait characteristics.

Context Management remains controversial due to the risk of upgrade for malignancy from flat epithelial atypia (FEA). Data about the frequency and malignancy upgrade rates are scant. Namely, observational follow-up is advised by many studies in cases of pure FEA on core biopsy and in the absence of an additional surgical excision. For cases of pure FEA, the American College of Surgeons no longer recommends surgical excision but rather recommends observation with clinical and imaging follow-up. Objectives The aim of this study is to perform a systematic review and meta-analysis to calculate the pooled upgrade of pure FEA following core needle biopsies. Methods A search of MEDLINE and Embase databases were conducted in December 2020. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A fixed- or random-effects model was utilized. Heterogeneity among studies was estimated by utilizing the I2 statistic and considered high if the I2 was greater than 50%. The random-effects model with the DerSimonian and Laird method was utilized to calculate the pooled upgrade rate and its 95% confidence interval. Results A total of 1924 pure FEA were analyzed among 59 included studies. The overall pooled upgrade rate to malignancy was 8.8%. The pooled upgrade rate for mammography only was 8.9%. The pooled upgrade rate for ultrasound was 14%. The pooled upgrade rate for mammography and ultrasound combined was 8.8%. The pooled upgrade rate for MRI-only cases was 27.3%. Conclusions Although the guidelines for the management of pure FEA are variable, our data support that pure FEA diagnosed at core needle biopsy should undergo surgical excision since the upgrade rate >2%.

Context Our original work addresses the biological sex impact on low back pain (LBP) management and prognosis in primary care settings. To our knowledge, our study is the first in the United States to evaluate the differences in clinicians’ approaches to LBP in the ambulatory setting specifically based on patient gender. Our findings suggest that there is a knowledge gap among primary care providers (PCPs) toward the potential impact of biological sex on LBP and a bias toward gender roles when counseling patients for home chores or occupational tasks. Further evaluation of this knowledge gap and its impact on LBP management and prognosis is recommended in US healthcare settings. Objectives This study aims to explore PCP experiences and practice patterns regarding LBP in females compared to males in US healthcare settings. Methods We utilized a cross-sectional study design and convenience sampling. Data were collected anonymously utilizing a 27-item online survey sent periodically via email to PCPs working in Ohio. We had 58 responses for analysis; data were analyzed utilizing bivariate and multivariate analyses. Results On average, approximately 9 out of 10 responding clinicians reported experiencing LBP. PCPs were not in agreement that LBP is different in women than men. Clinicians with a women’s health, osteopathic, or sport’s medicine background were more likely to agree that LBP is different in women than in men. PCPs were more likely to counsel female patients about pelvic floor exercises; however, their intake of present pelvic symptoms in LBP female patients is suboptimal. PCPs were more likely to counsel females for home chores than males, which is aligned with the perceived traditional gender roles among PCPs. Conclusions There may be a knowledge gap among PCPs toward the potential impact of biological sex on LBP and a bias toward gender roles when counseling patients for home chores or occupational tasks. Further investigation of this knowledge gap and counseling approaches is recommended to better bridge the gender disparity.