Advance Articles

Letters to the Editor

COMSAE Phase 1: value added

Donald Sefcik, DO, MBA, and Elizabeth M. Petsche, JD
Advance Article
Musculoskeletal Medicine and Pain

Assessment of potential strain injury to rectus capitis posterior minor muscles during whiplash type distortions of the cervical spine

Richard C. Hallgren, PhD, and Jacob J. Rowan, DO
Whiplash type injuries resulting from a rear end motor vehicle accident are thought to be caused by excessive loading and displacement of structural components of the cervical spine. On impact, the seat propels the driver’s torso forward relative to the head, resulting in forced flexion of the occipitoatlantal (OA) joint, accompanied by forced stretching of the rectus capitis posterior minor (RCPm) muscles. To quantify the relationships among flexion of the OA joint, RCPm muscle stretch, and backset - and to quantify the biomechanical response of RCPm muscles to increasing levels of axial load due to stretching - the authors assessed the results of hydrauclic stretching of RCPm muscles from unembalmed head and neck specimens from three elderly White female cadavers.
Advance Article
Medical Education

Establishing osteopathic assessments to fulfill osteopathic recognition standards: a model for dermatology and other subspecialties

Scott J. Mahlberg, DO; Yujie Linda Liou, DO; and Jenifer Lloyd, DO
In this Commentary, based on the results of a literature review, the authors propose a model to provide a focused osteopathic assessment for the purposes of maintaining Osteopathic Recognition within residency training programs based on the Accreditation Council for Graduate Medical Education’s six core competencies. Examples of multiple choice and essay questions are provided, as is a rubric for grading. The model is applied to the field of dermatology in this article but proposed as a blueprint for other subspecialties.
Advance Article
Medical Education

Effect of a required online graded curriculum in the clerkship years on medical student national standardized examination performance

Kelli Glaser, DO; Vanessa Pazdernik, MS; Denise Sackett, DO; and Valerie Sheridan, DO
To determine whether third year and fourth year students receiving a new online curricula during core clerkship at A.T. Still University’s School of Osteopathic Medicine in Arizona performed better overall on national standardized examinations than students from previous years who had not received the curricula, the authors conducted a retrospective cohort study of 713 students from the classes of 2017-2020 (curriculum group) and 2014-2016 (precurriculum group).
Advance Article
Editorial

Physician wellbeing – what do physicians want?

Eileen P. Ryan, DO
In this Editorial, Journal of Osteopathic Medicine’s Section Editor for Behavioral Health discusses the “thorny questions” around what contributes to and helps sustain medical student and physician wellbeing, and conversely, what contributes to physicians’ dissatisfaction and unhappiness with their work.
Advance Article
Musculoskeletal Medicine and Pain

Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome

Musa S. Danazumi, PT, MScPT; Abdulsalam M. Yakasai, PT, PhD; Aminu A. Ibrahim, PT, PhD; Usman T. Shehu, PT, MPH; and Shehu U. Ibrahim, PT, MScPT
Previous studies have indicated that the muscle energy technique (MET) and the positional release technique (PRT) are effective in the management of piriformis syndrome (PS); however, evidence is scarce regarding the combination of these techniques in the form of an integrated neuromuscular inhibition technique (INIT) in the management of individuals with PS. The authors conducted a single blind, randomized clinical trial of 48 patients to examine the effects of INIT with integrated RRAF compared with PRT in the management of patients diagnosed with PS.
Advance Article
Clinical Image

Multiple thrombotic events in a patient with coronavirus 2019

Vraj Shah, MD; Sarah Meng, DO; and Michael Vest, DO
Advance Article
General

Are randomized controlled trials in urology being conducted with justification?

Samuel Shepard, OMS II; Audrey Wise, OMS II; Bradley S. Johnson, OMS III; Nicholas B. Sajjadi, OMS II; Micah Hartwell, PhD; and Matt Vassar, PhD
The authors assessed 256 articles published in the “top 5” urology journals according to h5 index, appraising how often previous systematic reviews were appropriately used as justification for conducting a new randomized controlled trial.
Advance Article
Medical Education

Examining concurrent validity between COMLEX-USA Level 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation

Brandon Craig, PhD; Xiaolin Wang, PhD; Jeanne Sandella, DO; Tsung-Hsun Tsai, PhD; David Kuo, DO; and Charles Finch, DO
The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs; COMLEX-USA Level 2 includes a written assessment (Level 2-Cognitive Evaluation [L2-CE]) and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. To assess concurrent validity between the two parts, the authors compared first attempt test scores from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched them to the students’ L2-PE scores.
Advance Article
Public Health and Primary Care

National disparities in colorectal cancer screening in patients with comorbid conditions: an analysis of the Behavioral Risk Factor Surveillance System

Benjamin Greiner, DO, MPH; Ronak Gandhi, DO; Robinder Abrol, DO; Milee Patel, DO; and Micah Hartwell, PhD
Each year, approximately 53,200 people die in the U.S. from colorectal cancer (CRC), indicating a need to increase screening efforts. To analyze CRC screening rates in patients with comorbidities compared with healthy patients, and to assess whether the number of comorbid diagnoses impacted screening rates, the authors performed cross sectional analysis of 279,784 patients who received CRC screening using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS).
Advance Article
Medical Education

The role of extracurricular activities and lectures in mitigating medical student burnout

Jennifer C. Sepede, DO; Joanna Petrides, MBS, PsyD; Philip B. Collins, DO; Meredith C. Jones, PhD; Nicole Cantor, MA; and Linda Boyd, DO
To examine how involvement in extracurricular activities and attendance at burnout lectures can impact burnout among medical students, the authors assessed the anonymous responses of 597 students at Rowan School of Osteopathic Medicine to a survey that included the Maslach Burnout Inventory alongside questions regarding the number of burnout/wellness lectures respondents had attended, the number of clubs in which the respondents participated, the number of hours spent in these clubs, and any leadership positions held by the respondents.
Advance Article
Clinical Image

Orange palpebral spots

Stacey Blannett, MS, OMS III; Shane M. Swink, DO, MS; and Stephen M. Purcell, DO
Advance Article
NMM/OMT

Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain

Danielle Cooley, DO; James Bailey, DO; and Richard Jermyn, DO
Chronic low back pain (cLBP) is the second leading cause of disability in the United States, with significant physical and financial implications. Development of a multifaceted treatment plan that is cost effective and optimizes patients’ ability to function on a daily basis requires data; among the needed data points is a cost comparison of osteopathic manipulative treatment vs standard care for patients with cLBP. To that end, the authors conducted a prospective, observational study of 146 patients over 4 months with either standard care or standard care plus osteopathic manipulative treatment, quantifying patients’ pain scale responses as well as cost data for all associated interventions during the study period.
Advance Article
Medical Education

Meaningful use of COMSAE Phase 1 in preparation for COMLEX-USA Level 1

Xiaolin Wang, PhD; Hotaka Maeda, PhD; Brandon Craig, PhD; Tsung-Hsun Tsai, PhD; Jeanne M. Sandella, DO; and Marie Fleury, DO, MBA
To investigate how the COMSAE Phase 1 examination was used by candidates and how completing Phase 1 impacted their performance on the COMLEX-USA Level 1 examination, the authors assessed Level 1 data from 7,120 first time candidates who took the 2018-2019 COMSAE administration between May 2018 and April 2019, counting the frequency of the unique Phase 1 forms taken by the candidates and calculating the correlations between first attempt Phase 1 scores and the number of Phase 1 forms taken as well as Level 1 scores and Phase 1 scores.
Advance Article
NMM/OMT

Osteopathic manipulative medicine in the management of headaches associated with postconcussion syndrome

Dmitry Esterov, DO; Alphonsa Thomas, DO; and Kyle Weiss, DO
Previous studies have demonstrated the effectiveness of osteopathic manipulative treatment (OMT) for various headache types, with limited evidence of its use for headaches related to mild traumatic brain injury (MTBI). To evaluate the efficacy of OMT for headaches in patients with postconcussion syndrome (PCS) - defined as symptom persistence for longer than 3 months after MTBI – the authors performed a pilot study of 26 patients (13 in an OMT group and 13 in a control group), comparing headache scores on a Visual Analog Scale or Headache Impact Test (HIT-6) at baseline, posttreatment, and 4 to 6 week follow up.
Advance Article
NMM/OMT

Perceptions of nonopioid treatment for pain in a homeless population

Kristina A. Fraser, OMS IV; Harvard Nguyen, OMS IV; Suhhyun Kim, OMS III; Flora Park, OMS III; Joshua Bernal, OMS IV; Alexa D. Westberg, OMS IV; and Alan Podawiltz, DO
The authors collected voluntary responses from 200 residents at the True Worth Place Homeless Shelter in Fort Worth, Texas – where the University of North Texas Health Science Center (UNTHSC) offers a Homeless Outreach through Medical Education (HOME) Clinic – to assess the past and current use of complementary and alternative treatments for chronic pain among people experiencing homelessness, as well as their awareness and perception of osteopathic manipulative treatment (OMT) as a complementary treatment.
Advance Article
Musculoskeletal Medicine and Pain

Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes

John C. Licciardone, DO, MS, MBA
In this pre-post study of 476 participants enrolled in a pain registry, the author measured changes in utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic to help quantify how the pandemic has impacted the delivery of health care services throughout the United States.
Advance Article