Volume 125, Issue 5

Context This is a follow-up to the original published article, Effects of the Strong Hearts Program after a Major Cardiovascular Event in Patients with Cardiovascular Disease. Objectives This study evaluated the long-term efficacy of the Strong Hearts program up to 2 years after program completion. Methods All study participants who initially completed the Strong Hearts program between 2020 and 2021 (n=128) were contacted at 12 months and 24 months following the date of program completion. A phone survey was conducted to see if any significant post-cardiovascular events or readmissions to the hospital occurred, and self-reported dates of any occurrences were recorded. Hospital readmissions and cardiac-related procedures were cross-referenced with the hospital’s electronic medical record. A chi-square goodness-of-fit analysis was utilized to compare the observed rates of categorical outcomes vs. expected rates yielded from the empirical literature. Results The rate of all-cause readmission at 6 months post-program completion was 2/120 (1.7 %), compared to the expected rate of 50 %, χ 2 (1) = 112.13, p<0.001. The readmission rate at 1 year post-program completion was 17/120 (14.2 %), vs. the expected rate of 45 %, χ 2 (1) = 46.09, p<0.001, and at 2 years post-program completion, the readmission rate was 24/120 (20.0 %) compared to the expected rate of 53.8 %, χ 2 (1) = 56.43, p<0.001. Ten participants (8.3 %) had a subsequent cardiac procedure within 2 years of completing the program, including two requiring percutaneous coronary intervention (1.7 %) and eight requiring coronary artery bypass grafting (CABG, 6.7 %), compared to the expected rates of 13.4 and 57.74 %, χ 2 (1)=153.08, p<0.001, respectively. Mortality at 2 years post-program completion was 2/128 (1.6 %), compared to 23.4 %, χ 2 (1)=34.13, p<0.001. Conclusions Efficacy of the Strong Hearts program continued at 6 months, 1 year, and 2 years post-program completion in terms of all-cause readmission, subsequent cardiac event, and all-cause mortality.

Context The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges. Objectives This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors. Methods A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15–30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher’s exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different. Results Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission. Conclusions Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

Context Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field. Objectives The main objective of this study aimed to investigate recent match rate trends in orthopedic surgery within the past 5 years and to forecast match trends for both allopathic and osteopathic students to further analyze the future projection of the orthopedic surgery match. Methods This study utilized publicly available data from the National Residency Match Program (NRMP) Main Residency Match data. Data were collected retrospectively from 2020 to 2024 regarding students applying for orthopedic surgery residency. The number of matched Doctor of Osteopathic Medicine (DO) applicants, Doctor of Medicine (MD) applicants, overall applicants, and the proportion of matched applicants being DOs were forecasted over the next 10 years utilizing an Autoregressive Integrated Moving Average (ARIMA) model in SPSS 29.0. This model harvests data from previous instances (number of matched applicants from 2008 to 2024) to develop a close-fit model to predict future values and their respective confidence intervals (CIs). This study incorporated all applicants applying to orthopedic surgery, including international medical graduates (IMGs). Results There was an increase in the total applicants applying to orthopedic surgery residency positions for both allopathic and osteopathic students. The largest increase in applicants occurred between the 2021 and 2022 application cycles. There was a statistically significant difference in the total number of applicants overall over the 2020–2024 match cycle. The percentage of DOs to match into an orthopedic surgery residency position decreased from 63.28 % in 2020 to 45.70 % in 2024, and there was a statistically significant decline in the match percentage of DOs in orthopedic surgery residency over the 2020–2024 match cycle. Based on the ARIMA model projection utilizing data from 2008 to 2024, there is expected to be an average increase of 14.1 % in the total number of positions offered by 2034, to 1,045 positions total. There is expected to be a moderate increase in the number of matched DO applicants, from 128 in 2024 to 161 in 2034. Utilizing data from 2016 to 2024, there is expected to be an average increase of 10.7 % in the total number of positions offered by 2034, leading to a decreased proportion of positions filled by DO applicants by 2034, from 14.0 % in 2024 to 12.2 % by 2034. Conclusions Osteopathic students continue to face challenges despite progress in DO representation within orthopedic surgery. We hope to provide insight into the growing competitiveness of orthopedic surgery programs and to describe future trends in DO match rates to aid students pursuing this field.

Injury to the elbow is very common in the throwing athlete and can potentially lead to long absences from play and, in the most severe scenarios, medical retirement. The throwing motion is a highly complex series of movements through the entire kinetic chain that results in very high angular velocities and valgus forces at the elbow joint. The repetitive nature of overhead throwing in combination with the high levels of accumulated force at the elbow puts both pediatric and adult athletes at risk of both acute and chronic overuse injuries of the elbow. This review provides an update on common injuries in the throwing athlete and covers clinical presentation, diagnosis, and treatment of these injuries.

Context Medical students report high levels of perceived stress and burnout, especially during the preclinical years. The combination of physical stressors from poor posture, poor sleep quality, and mental stressors from the rigorous curriculum stimulates the sympathetic nervous system (SNS) to secrete cortisol. Previous studies have shown that persistent elevated cortisol levels are associated with negative health outcomes. Objectives We conducted an Institutional Review Board (IRB)-approved study to determine if regular osteopathic manipulative treatments (OMTs) could impact the stress levels of first-year osteopathic medical students (OMSs) at Touro College of Osteopathic Medicine (TouroCOM) Harlem campus by measuring physiologic stress through changes in weekly salivary cortisol levels, perceived emotional and psychological stress levels, and cognitive function. Methods We recruited 10 first-year OMSs who were not currently receiving external OMT outside of weekly coursework; other forms of external stress management, such as yoga or meditation, were not controlled for in this study. Utilizing a random number generator, the 10 student respondents were split into a control group that received no treatment and a treatment group that received 15 min of weekly OMT for 6 weeks. The treatment consisted of condylar decompression, paraspinal inhibition, and supine rib raising, which are techniques that are known to balance the SNS and parasympathetic nervous system (PNS). Cortisol levels were quantified by enzyme-linked immunosorbent assay (ELISA) cortisol immunoassay via salivary samples collected at the beginning of each weekly session, prior to treatment for the treatment group, at the same time of day each week. We also measured participants’ weekly subjective perception of stress utilizing the College Student Stress Scale (CSSS) and cognitive function utilizing the Lumosity Performance Index (LPI). We conducted a two-tailed, unpaired t -test as well as a U test for the cortisol levels, given the smaller sample size and potential for a nonnormal distribution. Results A lower cortisol level was correlated to a higher optical density (OD), the logarithmic measure of percent transmission of light through a sample; analysis of our data from the ELISA cortisol immunoassay showed an average weekly change in OD (∆OD) for the treatment group of 0.0215 and an average weekly ∆OD of −0.0044 in the control group. The t -test showed p=0.0497, and our U test showed a p=0.0317. Both tests indicated a statistically significant decrease across the weekly salivary cortisol levels in the treatment group utilizing a p<0.05. An additional effect-size analysis supported our finding of a significant decrease in weekly cortisol levels in the treatment group, Cohen’s d =1.460. Based on the CSSS responses, there was no significant difference in perceived stress between the control and treatment groups (p=0.8655, two-tailed). Analysis of the LPI revealed no statistically significant difference in cognitive performance (p=0.9265, two-tailed). Conclusions Our study supports the claim that OMT that targets the SNS and PNS has a significant impact on cortisol levels. While the reduction in cortisol levels was statistically significant, the broader physiological impact remains unclear. Further research is necessary to determine whether this reduction translates to meaningful clinical benefits.

Context Deep organ-space infection (OSI) following gynecologic surgery is a source of patient morbidity and mortality. There is currently conflicting evidence regarding the use of bowel preparation prior to gynecologic surgery to reduce the rates of infection. For the additional purpose of improving patient recovery at our own institution, a retrospective cohort study compared the rate of deep OSI in patients who received oral antibiotic bowel preparation per Nichols–Condon bowel preparation with metronidazole and neomycin. Objectives The primary aim of this study was to compare the rate of deep organ-space surgical site infection in gynecologic surgery before and after institution of an oral antibiotic bowel preparation, thus assessing whether the preparation is associated with decreased infection rate. The secondary objective was to identify other factors associated with deep organ-space site infection. Methods A retrospective cohort study was performed. Demographic and surgical data were collected via chart review of 1,017 intra-abdominal surgeries performed by gynecologic oncologists at a single institution from April 1, 2019 to December 1, 2021. Of these, 778 met the inclusion criteria; 444 did not receive preoperative oral antibiotic bowel preparation, and 334 did receive preoperative bowel preparation. Odds ratios (ORs) were calculated, and a logistic regression model was utilized for categorical variables. Multivariable regression analysis was performed. Results A total of 778 patients were included. Deep OSI rate in patients who did not receive oral antibiotic bowel preparation was 2.3 % compared to 0.3 % (OR 0.13, confidence interval [CI] 0.06–1.03, p=0.02) in patients who did. Receiving oral antibiotic bowel preparation predicted absence of deep OSI (OR 0.04, CI 0.00–0.87, p=0.04). Laparotomy (OR 20.1, CI 1.6–250.2, p=0.02) and Asian race (OR 60.8, CI 2.6–1,380.5, p=0.01) were related to increased rates of deep OSI. Conclusions Oral antibiotic bowel preparation predicts a reduced risk of deep OSI. This preparation is inexpensive and low-risk, and thus these clinically significant results support a promising regimen to improve surgical outcomes, and provide guidance for prospective larger studies.