Volume 125, Issue 4

Peripheral artery disease (PAD) is an atherosclerotic disease that contributes to significant morbidity and mortality, including loss of limb, myocardial infarction (MI), stroke, and death. Treatment options are often underutilized. A major limiting factor in PAD care is the ability to efficiently identify and screen at-risk patients. A PAD patient screening and clinician decision support tool was created to improve access to high-quality, evidence-based care to drive improved clinical outcomes. The tool identifies known PAD risk factors and presenting symptoms, in combination with objective data obtained via the ankle-brachial index (ABI). The tool utilizes this data to drive PAD diagnosis, risk assessment, and treatment, and it is adaptable across multiple care settings, by varied health professions. The implementation of a PAD screening and treatment toolkit enhances anticoagulation and PAD stewardship, and it has been integrated into use across various care settings.

Context Public interest in sport-related medical conditions is known to be affected by social media and pop cultural coverage. The purpose of this project was to assess the relationship between popular culture concerning chronic traumatic encephalopathy (CTE) and analyze of how often this topic was searched on the internet. Objectives The objective of this study was to investigate deviations in public interest following player incidents of CTE and the effects that the media has had on public interest in CTE. Methods To determine our primary objective, we utilized Google Trends to extract the monthly relative search interest (RSI) in CTE between January 2002 and October 2022. To assess the increase in RSI following a major event, an autoregressive integrated moving average (ARIMA) to predict RSI from March 2012 was created through the end of the period, and calculated the differences between the actual and forecasted values. Results Data indicate that RSI increased over time, specifically following the release of the movie Concussion . The peak in RSI (100) over this timespan was following the release of Aaron Hernandez’s autopsy results in 2017, which was 87.8 (95 % CI: 8.7–15.7) higher than forecasted, showing a 720.3 % increase in RSI. While research was published regarding CTE in 2005, the first major spike in search interest occurred after Junior Seau died in 2012. Increasing public interest in CTE continued when media exposure conveyed autopsies of former NFL players, the movie Concussion , and the release of The Killer Inside: The Mind of Aaron Hernandez . Given this increased interest in CTE, we recommend that media broadcasters become more educated on brain injuries, as well as the movement of Brain Injury Awareness Month and Concussion Awareness Day. Conclusions There has been an increase in public interest in CTE from 2004 through 2022 with surges following media releases of events involving NFL players. Therefore, physicians and media broadcasters must create partnerships to better educate the public about head injuries and the effects of CTE.

Context With the advent of the Single Accreditation System (SAS) within the Accreditation Council for Graduate Medical Education (ACGME), few programs have achieved Osteopathic Recognition (OR) status to date. OR is an accreditation that graduate medical education (GME) programs can achieve to distinctly acknowledge the additional focus on osteopathic training. There is an effort by national osteopathic organizations to determine barriers for programs to achieve OR and what innovative methods might help overcome them. In identifying its own barriers, a central Ohio hospital created a unique Program Director for Osteopathic Medical Education (PDOME) role to assist its 10 programs in achieving OR. Objectives The objectives of this study were to determine the effect that a PDOME role has through measures of the numbers of programs achieving OR and standards met, as well as the perceived ‘helpfulness’ of the role based on surveys of program leadership. Methods Upon initiation of the PDOME in July 2021, the PDOME assessed applications, citations, and curriculums of the 10 hospital programs with varied OR status to help determine curricular goals. Additional osteopathic activities, evaluation tools and faculty development were subsequently offered based on this information and needs assessments of the programs. A survey was sent to all programs at intervals of 12 and 18 months after role inception to be utilized as process improvement. Comparisons were made between surveys, as well as between the total number of programs with continued OR status and the total OR requirements achieved before and after PDOME. A chi-square test (or Fisher’s exact test when the ‘n’ was too small) was utilized for significance, and the p value was set at 0.05. Results After the PDOME, there was a significant increase in the number of OR standards met across programs (p<0.001). Although not significant, the number of programs achieving continued OR increased from 4 to 8 (p=0.168). Due to many positive responses in both surveys, there was no significance between surveys in the “helpfulness” of PDOME; however, there was a significant increase in the number of respondents from 13/67 (or 19.4 %) to 32/67 (or 47.8 %) (p<0.001), indicating increased engagement among respondents. Conclusions This study suggests that a PDOME role in medical education may be well received and may assist GME programs in achieving OR. Implementation of a similar role elsewhere could help programs overcome barriers and stir growth in OR programs nationwide.

Context The healthcare industry faces a critical shortage of qualified physicians. To address this growing concern, medical schools nationwide are increasing their efforts to recruit and train premedical students to fill this gap. Those efforts include adequately preparing premedical students with the competencies and skills to meet the application requirements and gain acceptance to the medical school of their choosing. These requirements include a Medical College Admission Test (MCAT) score at or above the mean of 504, a grade point average (GPA) at or above the mean of 3.61 for the total GPA and 3.53 for the science GPA. The application also requires demonstrating specific core competencies, including patient care, communication, and problem-solving skills evidenced by activities and achievements. Unfortunately, many premedical students are unsure of what activities and experiences fulfill these competencies, the expectations of medical school and clinical practice, and the roles and responsibilities in various settings. Therefore, early exposure and guidance when selecting these experiences and activities are vital in helping premedical students to make informed decisions and select experiences that align with their career goals. While obtaining clinical experiences can be challenging, these requirements may provide invaluable insights into the profession and fulfill competencies required for medical school admission. Furthermore, these experiences familiarize students with clinical and interprofessional settings early in their careers. Because premedical students are better equipped to gain admission to medical school, universities can expand their pool of qualified and adequately prepared candidates matriculating into medical training. Objectives This review aims to determine how US premedical osteopathic and allopathic students gain clinical experiences and extracurricular activities that enhance their application and increase their chances of admission into a medical school of their choice. Methods The authors conducted a comprehensive search of Education Resources Information Center (ERIC), Scopus, Excerpta Medica dataBASE (EMBASE), and other databases for original peer-reviewed studies of undergraduate, premedical, and medical students in the United States utilizing the deconstruction technique. The authors utilized thematic analysis to unearth overarching themes from the results and outcomes of these studies. Results The authors reviewed 14 studies published between 2004 and 2022. The articles addressed two main themes: the types of clinical experiences and extracurricular activities that increase medical school admission and those that meet the critical competencies required for medical school and osteopathic practice. Activities such as shadowing, research, healthcare, and volunteering were identified repeatedly. Self-reporting, researcher bias, and low response rates were among the limitations. The six themes informed the tips: Shadowing, Health-related work experiences, Internships and achievements, Non-health-related work experiences, Extracurricular activities, and Community enrichment and Volunteering (SHINE-CV). The authors discuss acquiring these opportunities, navigating challenges, maximizing the skills and competencies gained, and demonstrating them in the medical school application. Conclusions This timely, systematic review provides an updated comprehensive summary of the clinical experiences and activities intended to help prepare premedical students for medical school, given the changing climate and increased competition in medical education. The study aims to fill a gap in the literature regarding best practices for premedical students in selecting and documenting these activities. Premedical students can utilize these tips to help prepare their medical school application and acquire the competencies required for medical school.

Context Dystonia is a movement disorder that causes involuntary muscle contractions leading to abnormal movements and postures, such as twisting. Dystonia is the third most common movement disorder in the United States, with as many as 250,000 people affected. Because of its complexity, dystonia presents a significant challenge in terms of management and treatment. Despite limited research, osteopathic manipulative treatment (OMT) has been considered as an adjunctive treatment due to its inexpensive and noninvasive nature, as opposed to other modalities such as botulinum toxin injections, deep brain stimulation (DBS), and transcranial magnetic stimulation, which are often expensive and inaccessible. OMT treatments performed in case studies and series such as balanced ligamentous tension/articular ligamentous strain (BLT/ALS), muscle energy (ME), high-velocity low-amplitude (HVLA), and myofascial release (MFR) have shown reduction of pain and muscle hypertonicity, including in patients with dystonia. Objectives The studies reviewed in this paper provide a snapshot of the literature regarding the current evidence of OMT’s role for dystonia. Methods A medical reference librarian conducted a thorough literature search across multiple databases including PubMed and Google Scholar to find articles relevant to the use of OMT for dystonia. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to osteopathic medicine and dystonia to ensure precise retrieval of relevant articles within the last 20 years. Despite limited research on the topic, all four relevant reports found in the literature were selected for review. Results Of the four relevant reports, case series and studies highlighted the potential benefits of OMT in managing dystonia, particularly cervical dystonia and foot dystonia. OMT has shown promising results addressing pain, stiffness, and impaired motor function. In cases of foot dystonia in Parkinson’s disease, OMT has helped improve gait and reduce pain by targeting somatic dysfunctions (SDs) associated with dystonia, such as abnormalities in foot progression angle (FPA) and musculoskeletal imbalances. Also, OMT has been found to alleviate symptoms of cervical dystonia, including tremors, muscle spasms, and neck stiffness. These interventions performed in case studies and series led to improvements in gait biomechanics in foot dystonia and overall symptom severity in patients with cervical dystonia. Conclusions Currently, botulinum toxin, oral medications, physical therapy, and rehabilitation are commonly utilized in managing dystonia. The studies reviewed in this paper suggest that these treatments may lead to improvements in pain and muscle hypertonicity in patients with dystonia. It is important to investigate whether factors such as the type of dystonia (eg, focal vs. segmental) and its underlying cause (eg, idiopathic, trauma, infection, autoimmune, medication side effects) influence treatment outcomes. Further research is recommended to explore the role of OMT in managing dystonia.

Context Underserved communities in southeastern Ohio and Appalachia face significant healthcare accessibility challenges, with the Midwest offering a lower density of healthcare providers compared to coastal regions. Specifically, underserved communities in southeastern Ohio and Appalachia are disadvantaged in otolaryngology care. Objectives This analysis aims to identify factors that lead otolaryngologists to a respective practice location, and if any of that influence comes from where otolaryngologists completed their medical education. Methods The proportion of otolaryngologists who performed medical school, residency, and/or fellowship in Ohio was analyzed utilizing a three-sample test for equality. Multivariate logistic regression and Pearson prediction models were produced to analyze the impact of performing medical training (medical school, residency, and fellowship) in Ohio. Results Going to medical school in Ohio significantly increases the odds of going to an otolaryngology residency in the state (p<0.001). Moreover, between medical school and residency, medical school was a significantly better predictor of otolaryngologists practicing in Appalachia (Δ Bayesian Information Criterion [BIC]>2) and southeast Ohio (ΔBIC>10). Medical school in state was also a better predictor of percent rural and median household income than residency (ΔBIC>10). The multivariate model of medical school and residency was significantly better than either predictor alone for the population (ΔBIC>2). All models predicting percent rural were significantly improved with the addition of a Doctor of Osteopathy (DO) degree (ΔBIC>10). Conclusions Where physicians complete their medical training (medical school, residency, and fellowship) in state has a significant impact on predicting their future place of practice. This study found that the location of such training has a positive predictive nature as to whether that physician will practice in a rural and underserved area in the future. Notably, the addition of being licensed as a DO also increased the probability of that physician practicing in a rural area.