Volume 125, Issue 11

Context Clinicians face a difficult challenge in identifying vertebrobasilar insufficiency (VBI) resulting from atherosclerosis. VBI is a term utilized to describe a reduction in blood flow to the vertebral and basilar arteries that supply the posterior cerebral system. For musculoskeletal clinicians, diagnostic differentiation of VBI is essential, because its presence directly impacts the clinical use of manual treatment interventions. Clinical guidelines provide a set of cardinal symptoms (inclusive of Coman’s 5D’s) in which VBI may manifest, the accuracy of which is under contestation because literature provides evidence suggesting a wider set of symptoms. Objectives The objectives of this study were to gather all relevant literature reporting features of VBI pertaining to atherosclerosis, with the aim to help provide evidence that may guide clinical practice in the use of manual therapy interventions and to raise awareness of the manifestations that VBI may present. Methods Six databases were searched from inception to September 2024 (Allied and Alternative Medicine Database [AMED], AgeLine, SPORTDiscus, Medical Literature Analysis and Retrieval System Online [MEDLINE], Cochrane, and Cumulative Index of Nursing and Allied Health (CINAHL Plus). Articles were screened in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, The included articles required a diagnosis of VBI through clinical examination with radiological evidence of atherosclerotic lesions, without evidence of existing or previous neurological infarcts, concomitant arterial pathology, or any other form of pathological mechanism. Primary data were extracted utilizing a template, and the methodological quality was assessed utilizing the Joanna Briggs Institute critical appraisal tool. Findings were summarized utilizing a narrative synthesis and a table of descriptive statistics. Results Two hundred and eighty-three papers were identified, and 15 were included (93 cases, 50M/43F, age 64 years old ± 9 standard deviation [SD] yrs). Vertigo was the most common reported symptom, within a total of 37 different symptoms reported either in isolation or combination. Symptoms inclusive to Coman’s 5D’s accounted for 22 % of reported features. Conclusions Vertigo is the most common symptom (27.7 %) of VBI induced by atherosclerosis. However, there is not sufficient data to make concrete conclusions, although results do instill doubt over the sole use of Coman’s 5D’s in clinical practice. Prospective observational studies with standardized data extraction for VBI symptoms and their pattern of behavior are warranted.

Context Applying into urology residency is highly competitive. Disparities in osteopathic (Doctor of Osteopathic Medicine [DO]) representation exist within the current urology workforce. Objectives This study aimed to examine the number of DO graduates in urology residency programs over time and map their current distribution throughout the United States. Methods All US urology residency programs for the 2023–2024 academic year were identified, and residents’ postgraduate year and degrees, and the program’s states, were collected from each program’s websites. DO residents were stratified by their postgraduate years to observe the trends in the number of urology residents over the past 5 years. Their geographical distribution was evaluated. The number of DO urology residents per state and their ratio among all urology residents per state were examined. Results Among 135 urology residency programs analyzed, 1753 urology residents were identified. Ninety-nine residents hold a DO degree from a total of 39 urology programs (28.9 %). The number of DOs that matched into urology has been steadily increasing from 15 in 2019 to 26 in 2023 ( R 2 =0.8556, p=0.0244). Michigan had the greatest number of DO urology residents (n=35). Pennsylvania (n=10, 7.81 %) and South Carolina (n=10, 40 %) had the second highest. Illinois (n=7, 7.14 %) had the third highest. More than half of the states with urology residency programs had no DO residents (n=27, 62.8 %). Conclusions Osteopathic medical training plays an important role in the urology workforce, and there is an increased recognition of DOs within urology residency programs in the United States. In the era of urologist shortages, efforts to support the contributions of DOs in underserved and rural communities may have a profound impact in this field.

Context The coronavirus disease 2019 (COVID-19) pandemic necessitated a rapid transformation in medical education and research. Online learning became the standard to supplement in-person training and maintain accreditation requirements. Scholar 12 was constructed from the Scholar Series foundational lectures and a Master of Science in Medical Education thesis into a comprehensive research development platform accessible to all learners and institutions (https://scholar12.org). Objectives The objectives of this study were to involve students and faculty in a free, interactive virtual platform to address osteopathic literature deficits and scholarly activity criteria, promote new generational learning of research skills, build scholarly culture, and to employ Scholar 12 in a group-mentor research poster project to encourage osteopathic medical student participation in osteopathic-focused research. Methods A blinded, multi-campus, optional presurvey was digitally administered to third-year osteopathic medical students, prior to completing the Scholar 12 program, in collaboration with junior faculty mentors, during their Geriatrics/Osteopathic Principles and Practices (OPP) core rotation. Students self-reported their research skill competency relevant to each learning unit, on a 5-point Likert scale, before and after completing Scholar 12. Additional survey questions assessed the efficacy of the group mentor model and the quantity of further research presentations. Results Students’ self-reported research skill competency scores significantly improved (p=4.53 × 10e −8 ) after completion of Scholar 12, in comparison of the composite presurvey (n=1,800, 75.0 % response rate) vs. postsurvey responses (n=1,200, 50.0 % response rate), over four academic years (2020–24). Poster presentations for institutional research day grew an average of 166 % per academic year, after the introduction of Scholar 12, from 40 posters in 2019–2020 to 278 posters in 2023–2024. Conclusions The successful Scholar 12 implementation into a medical school curriculum demonstrated sustainable institutional scholarly activity growth through four consecutive academic years. Scholar 12 offers an accessible research learning platform relevant to undergraduate and graduate medical education objectives.

Context There is currently no clinical research investigating the effect of osteopathic manipulation on the milk supply of lactating patients. Herbal and prescription galactagogues are limited and have the potential for serious side effects. Objectives The objective of this study was to determine whether osteopathic manipulative treatment (OMT) can increase milk supply in lactating people with low milk supply (hypogalactia). Methods The patients presented in this series participated in an Institutional Review Board (IRB)-approved prospective pilot study. All participants were aged 18–40 years old and 2–28 weeks postpartum with the desire to exclusively breastfeed with infants who weighed at least 2,500 g at birth. At 1 h, the measured milk production was <1 oz expressed through a hospital-grade pump. Participants were ineligible if they were utilizing prescription galactagogues or had a contraindication to OMT. They were treated with an OMT protocol plus ad lib OMT once a week for 4 weeks. The study was suspended and ultimately closed due to the SARS-CoV-2 pandemic. Results All three participants demonstrated an increase in milk production from baseline at each visit. Given the small number of participants, these results are not statistically significant. Power analysis calculated a need for 10 subjects. Therefore, these patients are presented as a case series. Conclusions These results show promise for the use of osteopathic manipulation to increase human milk production. A study with a larger number of participants is needed.

Context In the United States, nearly 80 % of the adult population reported lifetime alcohol use, with 50 % of those reporting alcohol consumption within the past 30 days in 2019. The expense of excess alcohol intake was estimated to have an annual associated healthcare cost of $28 billion, and there was greater than $221 billion in additional costs due to the detrimental effects of excess alcohol intake on productivity and societal setbacks over the last year. Alcohol use disorder (AUD) provides a major barrier for patients seeking medical treatment, because AUD is consistently regarded as one of the most stigmatized disorders globally. Provider-based discrimination toward patients with AUD may lead to providing a lower quality of care. Objectives Our objective was to assess whether patients with a history of AUD and/or positive blood alcohol content (BAC+) affect emergency department (ED) wait times. We hypothesized that patients presenting to the ED with AUD+/BAC+ would have longer wait times. Secondarily, we investigated the impacts of sociodemographics within these analyses. Methods We conducted a cross-sectional analysis of the 2019–2021 National Hospital Ambulatory Medical Care Survey (NHAMCS). Individuals’ primary diagnosis had to be of musculoskeletal origin based on ICD-10 codes starting with ‘S’ for skeletal or bodily injuries or ‘M’ for diagnoses related to musculoskeletal or connective tissue conditions. Wait time was quantified from time of entry into the triage system to the time patients were seen by the first provider. We included data points with or without a recorded history of alcohol misuse or dependence (AUD +/− ) in their chart and those with a positive or negative blood alcohol content (BAC +/− ). Results ED wait times among individuals presenting with musculoskeletal injuries with a current history of AUD presenting with BAC- at the time of triage were not significantly different from those without a history of AUD. Individuals who were BAC+ at the time of triage had shorter wait times regardless of AUD history – and only AUD-/BAC+ had shorter wait times. Our binary regression and adjusted models showed that individuals who were AUD-/BAC+ had a significantly shorter wait time (minimum −18.43, standard error [SE]=1.92, t =−9.59, p<0.001; SE=2.97; t =−5.62, p<0.001) compared to individuals who were AUD-/BAC- respectively. Those who were AUD+/BAC+ also had shorter wait times compared to AUD-/BAC− (min=−11.11, SE=4.05; t=−2.75, p=0.006). Conclusions Overall, our study showed no significant difference in ED wait times between individuals with and without a history of AUD – indicating that AUD history does not delay being seen. Shorter wait times for those entering the ED BAC+ may be due to their immediate need for treatment due to toxicity or alcohol withdrawal syndrome, having more severe injuries, or harm prevention.