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Public Health and Primary Care

Adverse childhood experiences and trauma informed care: treating the whole patient with a more complete osteopathic approach

T. Brian Marcoux, DO
In this Commentary, the author proposes an expansion of the Tenets of Osteopathic Medicine with a fifth principle—considering the implications of a patient’s past formative experiences, their present life circumstances, and their future prospects—as a vehicle for instilling trauma informed care principles ubiquitously throughout osteopathic medical training to develop physicians who treat the whole person more completely and are better equipped to manage this public health crisis.
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General

Knowledge of osteopathic manipulative medicine and osteopathic physicians in a New York South Asian community

Jasmine Lee, OMS III; Chun Maung, OMS III; Jenzel Espares, OMS III; Justin Chen, OMS III; Frenda Yip, OMS III; Willis Lin, OMS II; Lauren Zhao, MS, OMS II; and To Shan Li, DO
Research regarding patient awareness of osteopathic manipulative medicine (OMM) can help identify barriers and factors limiting patient knowledge. Levels of knowledge about OMM and osteopathic physicians have been studied in New York’s Chinese and Korean populations, but have not previously been investigated in the South Asian population. In this study, the authors assess the knowledge of OMM and osteopathic physicians within a South Asian community of New York.
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Public Health and Primary Care

Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio

Elizabeth A. Beverly, PhD, and Francis Osowik, OMS IV
The authors assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life.
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Clinical Image

Epiglottic squamous cell carcinoma

John Carter, DO; Jessica Ball, DO, MPH; George McKean, DO; and Samir Patel, MD, DPM
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Clinical Image

Kaposi varicelliform eruption in a patient with atopic dermatitis

Robert Dazé, DO; Jorge Canales, DO; and Risa Ross, DO, FAOCD
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Medical Education

U.S. medical school admissions and enrollment practices: status of LGBTQ inclusivity

Reid M. Gamble, BS; Andrew M. Pregnall, MS; Angie Deng, MSN; Jesse M. Ehrenfeld, MD, MPH; and Jan Talley, PhD, MA, MSW
The failure to collect information on lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity in healthcare and medical education is a part of a systemic problem that limits academic medical institutions’ ability to address LGBTQ health disparities. In this paper, the authors determine whether accurate sexual and gender minority demographic data is being consistently collected for all US medical schools during admissions and enrollment, and whether differences exist between collection practices at osteopathic and allopathic schools.
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Obstetrics/Gynecology

Osteopathic considerations for breastfeeding women

Eileen M. Conaway, DO, IBCLC, and Arlene E. O’Donnell, DO
Extensive benefits of breastfeeding have been identified and although many women initiate breastfeeding, discontinuation is common when problems arise. In this article, the authors review the pertinent anatomy of the breast with osteopathic considerations to help osteopathic physicians identify myofascial, vascular, lymphatic, or innervation somatic dysfunctions to support the breastfeeding mothers’ long term breastfeeding goals, optimize breastmilk supply, and potentially prevent or treat problems that could interfere with lactation.
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Public Health and Primary Care

The role of tocilizumab therapy in critically ill patients with severe acute respiratory syndrome coronavirus 2

Zaid Saffo, DO; Weixia Guo, MD, MSc; Kylie Springer, MS; Kathleen Maksimowicz-McKinnon, DO; Vivek Kak, MD; John E. McKinnon, MD, MSc; and Pallavi Bhargava, MD
Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor antagonist, has been approved for use in rheumatoid arthritis and cytokine storm syndrome (CSS) associated with chimeric antigen receptor T cells treatment. Although TCZ is currently utilized in the treatment of critically ill coronavirus 2019 (COVID-19) patients, data on survival impact is minimal. The authors assess the mortality rate of patients presenting with COVID-19 who received TCZ for suspected CSS.
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Medical Education

Analyzing the cost of medical student virtual conference registration by specialty during the COVID-19 pandemic

Daniel Veyg, BS, OMS III, and Robert Gurevich, BBA, MS III
The authors investigate the cost incurred by medical students to attend the premier annual scientific meeting of each major medical specialty in 2020, during the novel coronavirus 2019 (COVID-19) pandemic, and evaluate whether “research intensive” specialties carried greater conference registration costs.
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Letters to the Editor

Response to “COMSAE phase 1: value added”

Jeanne M. Sandella, DO; Brandon Craig, PhD; Tsung-Hsun Tsai, PhD; Marie Fleury, DO, MBA; and Andrea Clem, DO
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Cardiopulmonary Medicine

Spin in the abstracts of systematic reviews and metaanalyses focused on percutaneous coronary intervention

Wesley Tanner Cole, BS; Peter Wittl, BS; Wade Arthur, BS; Ryan Ottwell, BS; Benjamin Greiner, DO, MPH; Gershon Koshy, DO; Justin Chronister, DO; Micah Hartwell, PhD; Jonathan Staheli, BS; Drew N. Wright, MLS; Meghan Sealey, MS; Lan Zhu, PhD; and Matt Vassar, PhD
“Spin” is a form of bias that involves highlighting study results in a way that presents the conclusions about benefit or efficacy beyond the scope of the data. Spin in the abstract of published studies has the potential to affect patient care, making investigations about its presence and prevalence important for readers. The authors evaluate the most severe types of spin in the abstracts of systematic reviews and metaanalyses focused on percutaneous coronary intervention.
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Medical Education

Effect of a standardized patient encounter on first year medical student confidence and satisfaction with telemedicine

Emily L. Unrue, OMS II; Grayson White, OMS II; Ning Cheng, PhD; and Tom Lindsey, DO, FACOS
One hundred and sixty two first year medical students recruited from Edward Via College of Osteopathic Medicine-Carolinas campus were surveyed to evaluate the role of a standardized patient encounter on first year medical student confidence and satisfaction in using telemedicine.
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Public Health and Primary Care

Resident opinions of diabetes management in training: a survey

Amber M. Healy, DO; Jarrod L. Uhrig, DO; Jay H. Shubrook, DO, FACOFP, FAAFP; Nay Linn Aung, MD, BC-ADM; and Archana R. Sadhu, MD, F.A.C.E.
Using an 18-item cross sectional survey sent via email to program directors and chief residents of 16 different training programs located in seven different health systems and four different states, the authors quantify osteopathic and allopathic family medicine residents’ amount of exposure to diabetes in residency training, investigate referral patterns related to diabetes management, and assess comfort levels with various diabetes treatment modalities.
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Clinical Image

Scimitar syndrome

William Dennehy, OMS IV, and Eric M. Neverman, DO, MHA
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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.
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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.
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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).
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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.
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Clinical Image

Multiple thrombotic events in a patient with coronavirus 2019

Vraj Shah, MD; Sarah Meng, DO; and Michael Vest, DO
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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.
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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.
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