Volume 123, Issue 9

Context Obesity has been a national epidemic throughout the United States due to the increasingly sedentary western lifestyle, paired with calorically dense abundant low-nutritional food options. Discussing weight necessitates the conversation of not only the numerical value (body mass index [BMI]) associated with obesity but also the perceived weight or how an individual categorizes their weight, irrespective of their calculated BMI classification. Perceived weight can influence food relationships, overall health, and lifestyle habits. Objectives The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes among three groups: those correctly identifying as “obese” with a BMI >30 (BMI Corrects [BCs]), those incorrectly identifying as “obese” with a BMI <30 (BMI Low Incorrect [BLI]), and those incorrectly identifying as “nonobese” with a BMI >30 (BMI High Incorrect [BHI]). Methods An online cross-sectional study was conducted from May 2021 to July 2021. Participants (n=104) responded to a 58-item questionnaire regarding demographics (n=9), health information (n=8), lifestyle habits (n=7), dietary habits (n=28), and food attitudes (n=6). Frequency counts and percentages were tabulated, and analysis of variance (ANOVA) testing was conducted to examine the associations utilizing SPSS V28 at a statistical significance level of p<0.05. Results Participants incorrectly identifying as “obese” with a BMI <30 (BLI) had higher food attitude scores, indicating worse food attitudes, behaviors, and relationships with food compared to participants correctly identifying as “obese” with a BMI >30 (BC) and incorrectly identifying as “non-obese” with a BMI >30 (BHI). When comparing BC, BLI, and BHI participants, no statistically significant differences were found in dietary habit scores, lifestyle habit scores, weight change, or nutritional supplement or diet started. However, overall, BLI participants had worse food attitude scores and consumption habits when compared to BC and BHI participants. Even though dietary habit scores were not significant, an examination of specific food items revealed significant findings, in which BLI participants had higher consumption of potato chips/snacks, milk, and olive oil/sunflower oil, compared to BHI participants. BLI participants had higher beer and wine consumption compared to BC participants. Additionally, BLI participants had higher carbonated beverages, low-calorie beverages, and margarine and butter consumption compared to BHI and BC participants. BHI participants had the lowest hard liquor consumption, BC had the second lowest hard liquor consumption, and BLI participants had the highest consumption of hard liquor products. Conclusions The findings of this study have shed light on the intricate relationship that exists between perceived weight status from a “nonobese/obese” perspective and attitudes toward food and the overconsumption of particular food items. Participants who perceived their weight status as “obese” despite having a calculated BMI below the CDC threshold and classification for “obesity” had poorer relationships with food, consumption behaviors, and on average consumed food items that were detrimental to overall health. Comprehending a patient’s weight status perception and conducting a thorough history of their food intake could play a crucial role in addressing the patient’s overall health and medically managing this population.

Context The COVID-19 pandemic caused the largest disruption to graduate medical education in modern history. The danger associated with SARS-CoV-2 necessitated a paradigm shift regarding the fundamental approach to the education of medical residents and fellows. Whereas prior work has examined the effect of the pandemic on residents’ experiences during training, the effect of the pandemic on academic performance of critical care medicine (CCM) fellows is not well understood. Objectives This study examined the relationship between CCM fellow’s lived experiences during the COVID-19 pandemic and performance on in-training examinations. Methods This mixed-methods study consisted of a quantitative retrospective analysis of critical care fellows’ in-training examination scores and a qualitative, interview-based phenomenological examination of fellows’ experiences during the pandemic while training in a single large academic hospital in the American Midwest. Quantitative : Prepandemic (2019 and 2020) and intrapandemic (2021 and 2022) in-training examination scores were analyzed utilizing an independent samples t test to determine whether a significant change occurred during the pandemic. Qualitative: Individual semi-structured interviews were conducted with CCM fellows exploring their lived experiences during the pandemic and their perception of the effect on their academic performance. Transcribed interviews were analyzed for thematic patterns. These themes were coded and categorized, and subcategories were developed as indicated during the analysis. The identified codes were then analyzed for thematic connections and apparent patterns. Relationships between themes and categories were analyzed. This process was continued until a coherent picture could be assembled from the data to answer the research questions. Analysis was performed from a phenomenological perspective with an emphasis on interpretation of the data from the participants’ perspectives. Results Quantitative : Fifty-one in-training examination scores from 2019 to 2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the final analysis. A significant difference was found between mean total prepandemic and intrapandemic in-service examination scores ( t 49 =2.64, p=0.01), with mean intrapandemic scores being 4.5 points lower than prepandemic scores (95 % CI, 1.08–7.92). Qualitative: Interviews were conducted with eight CCM fellows. Thematic analysis of the qualitative interviews revealed three main themes: psychosocial/emotional effects, effects on training, and effects on health. The factors that most effected participants’ perceptions of their training were burnout, isolation, increased workload, decreased bedside teaching, decreased formal academic training opportunities, decreased procedural experience, a lack of an external reference point for normal training in CCM, fear of spreading COVID-19, and neglect of personal health during the pandemic. Conclusions In-training examination scores decreased significantly during the COVID-19 pandemic for CCM fellows in this study. The fellows in this study reported perceived effects of the pandemic on their psychosocial/emotional well-being, medical training, and health.

Context In light of the COVID-19 pandemic, healthcare-associated infections have taken center stage. Healthcare has adjusted workflows to accommodate for more robust disinfecting regiments to help protect the community. This has resulted in the need for medical institutions to reevaluate the current disinfection protocols down to the student level. The osteopathic manipulative medicine (OMM) laboratory provides an optimal avenue for assessing the effectiveness of medical students’ ability to clean examination tables. With OMM laboratories having a high level of interaction, adequate disinfection is important for the health and safety of students and teaching faculties. Objectives This study will evaluate the effectiveness of the current disinfection protocols in the medical school OMM labs. Methods A cross-sectional, nonrandomized study was performed on 20 OMM examination tables utilized for osteopathic training. Tables were chosen based on their close proximity to the podium. Close proximity was utilized as a criteria to increase the probability of utilization by students. The sampled tables were observed to ensure their use by students during class. Initial samples were collected in the morning after disinfection by Environmental Services. Terminal samples were collected after Osteopathic medical students utilized and disinfected the OMM examination tables. Samples were collected from the face-cradle and midtorso regions and analyzed utilizing adenosine triphosphate (ATP) bioluminescence assays with an AccuPoint Advanced HC Reader. This reader provides a digital readout of the quantity of light measured in relative light units (RLUs), which is directly correlated to the amount of ATP present in the sample, providing an estimated pathogen count. For statistical analysis, a Wilcoxon signed-rank test was utilized to find statistical differences in RLUs in samples after initial and terminal disinfection. Results The face cradle showed a 40 % increase in failure rate in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed an estimated pathogen level for face cradle that was significantly higher after terminal disinfection (median, 4,295 RLUs; range, 2,269–12919 RLUs; n=20) compared to initial disinfection (median, 769 RLUs; range, 29–2,422 RLUs; n=20), z =−3.8, p=0.00008, with a large effect size, d =2.2. The midtorso region showed a 75 % increase in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed that the estimated pathogen levels for midtorso were significantly higher after terminal disinfecting (median, 656 RLUs; range, 112–1,922 RLUs; n=20) compared to initial disinfecting (median, 128 RLUs; range, 1–335 RLUs; n=20), z =−3.9, p=0.00012, with a large effect size, d =1.8. Conclusions This study suggests that medical students frequently failed to disinfect high-touch regions on examination tables, such as the midtorso and the face cradle. It is recommended that the current OMM lab disinfection protocol be modified to include the disinfection of high-touch regions in order to reduce the possibility of pathogen transmission. Further research should explore the effectiveness of disinfection protocols in clinical settings such as outpatient offices.

Context Neck pain is a common complaint in healthcare clinics. Although the pathogenesis of neck pain is often multifactorial, trapezius muscle dysfunction has been commonly linked to neck pain. Osteopathic manipulative treatment (OMT) has been demonstrated to be an effective treatment modality in treating trapezius muscle dysfunction and neck pain. However, there is a current lack of objective, quantitative measures to assess the effectiveness of OMT. Through previous research, ultrasound technology has been shown to be promising in its ability to quantify tissue changes both pre- and post-OMT. Objectives The objectives of this study are to evaluate the feasibility of shear wave elastography (SWE) in assessing upper trapezius muscles with pain and hypertonicity, as well as the changes in these muscles post-OMT for cervical somatic dysfunctions. Methods After obtaining approval from the Rocky Vista University Institutional Review Board and written informed consent from participants, SWE and osteopathic assessments were performed on 22 adult participants with and without cervical spine somatic dysfunction. Participants with positive osteopathic assessments of tissue texture, asymmetry, restricted motion, and/or tenderness (TART) were treated utilizing OMT. Shear wave velocity (SWV, m/s) and shear wave velocity rate [SWVR = (SWV contraction  – SWV relaxation )/ SWV relaxation ] of the upper trapezius muscles with and without pain and hypertonicity, and before and after OMT, were examined utilizing a two-tailed t -test. Results SWV in muscle contraction and SWVR were significantly lower in muscles with pain compared to muscles without pain (p≤0.01). SWV in muscle contraction was also significantly lower in hypertonic muscles compared to normotonic muscles (p<0.01). Following OMT, SWV in muscle contraction and SWVR in muscles with pain and hypertonic increased significantly (p≤0.01). Overall TART score of all muscles with somatic dysfunction (SD) after OMT significantly decreased (p<0.01). SWV in muscle contraction and SWVR in hypertonic muscles were also significantly increased (p≤0.03), with an improvement index of 0.11 and 0.20. Conclusions This study’s results demonstrate the feasibility of utilizing SWE to evaluate somatic dysfunctions of the upper trapezius musculature and the efficacy of OMT for neck somatic dysfunctions.

Context Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. Objectives This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician’s age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). Methods We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. Results Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06–2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28–2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36–3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44–0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33–0.92; p=0.02). Conclusions Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.