Volume 125, Issue 6

Context Following the transition to a single graduate medical education (GME) accreditation system in 2020, leaders at American Association of Colleges of Osteopathic Medicine (AACOM) were interested in learning more about the research being done about osteopathic medical education leading up to that point in time. Objectives The objective of this scoping review was to identify trends in undergraduate and graduate osteopathic medical education and to determine where this information was being disseminated and the institutions who were creating the content. Methods Searches were conducted in eight databases: PubMed (National Center for Biotechnology Information [NCBI]), MEDLINE (Ovid), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature ([CINAHL], EBSCO), Education Research Complete (EBSCO) OSTMED.DR, Education Resources Information Center ([ERIC], Ovid), and Scopus (Elsevier). Gray literature sources were also identified. All 10 authors were involved in the search. Search terms were identified by utilizing Medical Subject Headings (MeSH), the Yale MeSH Analyzer, and through consultation with an expert searcher. Sources were excluded if they were not in English, were based outside of the United States, did not fit in the date range of being published between 2010 and 2020, and included information on COVID-19. The research team conducted title/abstract screening based on the inclusion and exclusion criteria. Results A total of 8,083 articles were identified and included through searches, ending in a total of 1,203 articles after full-text screening. Most sources for this osteopathic medical education review were journal articles (n=505) and conference proceedings (n=482). A total of 23 trends were identified, with the top three being residency (n=318), curriculum (n=235), and pedagogy (n=178). None of the other 23 primary trends were above 6.9 %. Conclusions Osteopathic medical education trends from 2010 to 2020 were primarily focused on residency, curriculum, and pedagogy. This information was disseminated evenly between published journal articles and conference presentations, and osteopathic institutions that have existed longer and have established research track records were more likely to publish and share information in this area.

Overhead sports place a significant amount of stress on the shoulder. There are a variety of activities and sports with overhead athletes including both throwing (baseball, softball, football, cricket) and nonthrowing (tennis, swimming, volleyball) sports. Although all of these overhead motions can lead to pathology, a large focus has been on the consequences of overhead throwing. Overhead-throwing sports place forces on the joints, muscles, tendons, and ligaments that vary through the spectrum of athletes, as does the potential injuries that may be caused by these forces. The primary joints that are commonly injured in overhead sports are the shoulder and the elbow. The goal of this article is to discuss the impact of overhead motions on the shoulder, with a primary focus on throwing, as well as to highlight the osteopathic approach to assessment, treatment, management, and prevention.

Context Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the paranasal sinuses that may significantly impair quality of life. CRS may also benefit from the application of manual techniques through osteopathic manipulative treatment (OMT), which aims to improve venous and lymphatic circulation, sympathetic and parasympathetic outflow, and cervicothoracic somatic dysfunction. Objectives This study aimed to assess whether OMT focused on lymphatic drainage of cranial structures can provide immediate, as well as sustained, relief of CRS symptoms. Methods This prospective, single-blinded study (WCG IRB study number: 1359444) was conducted at an allergy/immunology practice. Study participants included 43 adult patients, with a diagnosis of CRS, refractory to conventional medical therapy, with prior exposure to OMT. Patients consented to the study and were assigned by the provider to the OMT group or the control group 50/50. A four-question, 5-point Likert scale survey inquiring about the severity of nasal congestion, postnasal drainage, and facial or sinus pain/pressure, as well as the appreciation of the opportunity for an alternative therapy, was administered prior to the intervention. An OMT sequence was applied by the same osteopathic physician to each OMT group participant in the following order: thoracicinlet release, venous sinus drainage, occipital-atlantal decompression, thoracic paraspinal inhibition, facial sinus pressure, and Galbreath technique. A structural examination involving light touch was applied to the control group participants. The same 5-point Likert scale survey was administered immediately after the intervention. Participants were provided a blank copy of the survey to save and complete 10 days after the intervention. A paired t -test was applied for statistical comparison between the pre- and postsurveys. Results A total of 43 patients, including 22 patients in the treatment group (51.1 %) and 21 (48.8 %) patients in the control group, consented to and participated in the study, from May 1 to 30, 2024. Study demographics included 76.7 % females (n=33), 23.3 % males (n=10), 97.7 % White (n=42), and they patients had an average age of 54.4 years. Surveys administered before and immediately after the intervention were completed by 100 % of the study participants. All three surveys, including the presurvey and postsurvey completed immediately after and 10 days after the intervention, were completed by 60.5 % of the study participants. The OMT group pre-vs. immediate postsurvey results scored a statistically significant decrease in the severity of nasal congestion (p=0.001), postnasal drainage (p=0.002), and facial or sinus pain or pressure (p=0.0004). Conclusions Our single-blinded, prospective survey findings suggested that there was a benefit of OMT application for the immediate relief of CRS symptoms, predominantly in alleviating the severity of sinus pain or pressure. This study is the first large study (n=43) with a control group that shows that OMT techniques improve immediate CRS symptom relief of nasal congestion, postnasal drainage, and facial or sinus pain/pressure when compared to the pretreatment survey. Our study also demonstrated that the symptomatic relief by OMT of rhinosinusitis was not sustained in 10 days. OMT offers a safe, nonpharmacological complementary therapy to relieve lymphatic congestion and improve mucociliary clearance in CRS.

Endometriosis is defined as the presence of endometrial-like glands and stroma outside of the uterus. There are three types of endometriotic lesions: superficial or peritoneal endometriosis, ovarian endometrioma, and deep infiltrating disease. Endometriosis not only occurs in the pelvis but also can be found in extrapelvic sites such as the gastrointestinal tract, upper abdominal viscera, genitourinary tract, abdominal wall, diaphragm, and thoracic cavity. After thorough history and physical examination is performed, imaging, such as ultrasound or magnetic resonance imaging (MRI), should be obtained if there is high suspicion for deep-infiltrating endometriosis to better assess visceral involvement. Endometriosis can be suspected based on symptoms, physical examination findings, and imaging. However, a definitive diagnosis requires histopathologic confirmation. Treatment options include expectant, medical, and surgical management. Endometriosis is largely a quality-of-life issue, and treatment should be tailored accordingly with empiric medical therapy frequently utilized. Medical management focuses on symptom improvement. Surgical management with excision of endometriosis is preferred over ablation or fulguration of endometriotic lesions. In the case of deep or extrapelvic endometriosis, treatment with a multidisciplinary team with experience in the treatment of advanced-stage endometriosis is essential to minimizing morbidity and increasing long-term success.

This case report details the presentation, diagnosis, and management of a newborn Native American male with non-Herlitz junctional epidermolysis bullosa (JEB), a rare diagnosis specifically in the Native American population. Genetic analysis revealed a homozygous mutation in the COL17A1 gene. The management involved multidisciplinary care and highlighted the challenges in treatment, including pain management, wound care, and ethical considerations surrounding adoption within Indigenous communities. This case highlights the importance of tailored interventions and the need for further research into the genetic diversity and prevalence of epidermolysis bullosa (EB) among the Native American population.

Context Vascular access malfunction and failure contribute to morbidity and hospitalization in hemodialysis populations. Although controversy still exists over the identification and appropriate management of access malfunction, recognition of sentinel signs during physical examination remains an efficient way to screen for access malfunction. Dialysis staff are on the front line of providing quality care to dialysis patients, often being the first ones who could detect early physical signs of access malfunction. Objectives The study’s purpose is to determine the effect of an advanced vascular access educational module presented to hemodialysis nurses and technicians, focusing on physical examination findings to identify a dialysis access at risk for malfunction. Methods Utilizing a quasi-experimental pretest and posttest group design with a nonequivalent comparison control group, the effect of an advanced vascular access education module to improve vascular access knowledge and skill in recognition of sentinel signs of access malfunction was studied in a group of hemodialysis nurses (registered nurses [RNs]) and certified patient care technicians (PCTs). Results Knowledge post-test scores (RN, M=94.44, SD=7.05; PCT, M=90.83, SD=7.93) were significantly higher than pretest scores (RN, M = 79.54, SD = 12.47; PCT M=80.67, SD = 7.99) in the intervention group (p<0.001) but not in the comparison group. There were no statistically significant differences in mean skill scores between dialysis nurses (p=0.38) and PCTs (p=0.826) or between intervention and comparison groups (p=0.332). Conclusions This study exposes a critical gap in the transition of vascular access knowledge to the practical skill of access assessment. The findings suggest the need for restructuring the clinical training of dialysis nurses and PCTs in vascular access management and care. Newer active learning educational strategies in physical assessment of hemodialysis vascular access should be explored to further support dialysis nurses and PCTs in providing optimal patient care.