Advance Articles

Medical Education

The pandemic silver lining: preparing osteopathic learners to address healthcare needs using telehealth

Jennifer Taylor, DHEd, MPH; Amanda Wright, DO; and Michael Summers, MD
During the COVID-19 pandemic, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visits while simultaneously having to minimize direct patient care. The shift in direct clinical learning opportunities provided to third- and fourth-year medical students required a shift in the educational curriculum to develop learner skills around the appropriate use of telehealth in patient care. The aim of this project was to provide exposure to students so they could learn the telemedicine equipment and best practices, and how to identify infectious diseases to improve access to care and meet the needs of the patient.
Advance Article
General

Utilizing the Four Tenets of Osteopathic Medicine as an intersectional framework for approaching sexual orientation and gender identity disclosure as a provider

Timothy L. Counce, Jr, OMS III; Amy Ko, OMS III; Anthony D. Martinez, OMS III; Jenna M. Rivera, OMS III; Carol Browne, DO; and Linda Solis, PhD
The Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and other (LGBTQI+) community continues to experience health inequity and unmet needs. This manuscript examines the application of the Four Tenets of Osteopathic Medicine during a patient’s self-disclosure of their sexual orientation and/or gender identity to the provider, also known as coming out.
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Medical Education

Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students

Abraham Abdulrazzak, OMS III; Andrew Chandler, OMS IV; Rosemary Lu, OMS IV; Olivia Mobarakai, OMS IV; Bryan Lebron, OMS IV; Nicholas Ingram, DO; Avni Sheth, DO; Neel Patel, DO; Shreel Parikh, DO; Rita Kumar, OMS III; Jessica Bedi, OMS III; Ndeye Kane Diaw, OMS III; Adal Abonamah, OMS III; Christine Lomiguen, MD; and Stacey L. Fanning, PhD
The percent of underrepresented minority (URM) students who apply to medical school has changed minimally in the past 40 years. Due to the lack of URM applicants, the consequent matriculation of URMs is grossly disproportionate from their percent representation of the US population. Increasing diversity among medical students and physicians has previously been identified as essential to decreasing healthcare disparities among US minorities. The objective of this study was to recognize the barriers of applying to medical school among URMs in high school.
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Public Health and Primary Care

A pilot of a modified diabetes prevention program in Quito, Ecuador

Susana Alvear Durán, MD, MPH; Galo Sanchez-del-Hierro, MD, PhD; Diego Gomez-Correa, MD; Andrés Enriquez, MD; Enver Sanchez, MD; Melissa Belec, DO, MPH; Sharon Casapulla, EdD, MPH; Mario J. Grijlava, PhD; and Jay H. Shubrook, DO
Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community. This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention Diabetes Prevention Program would be feasible in an Ecuadorian population.
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Public Health and Primary Care

A renaissance in the treatment of diabetic kidney disease, hypertension in chronic kidney disease, and beyond

Jordana Yahr, DO; Juan Calle, MD; and Jonathan J. Taliercio, DO
Chronic kidney disease (CKD) affects approximately 15% of the US population and is associated with significant cardiovascular morbidity and mortality. In this article, the authors define CKD staging, review new hypertension and diabetic guidelines for CKD patients, and discuss major trials for new potential therapies in CKD, particularly diabetic kidney disease. They also provide practical guidance for primary care physicians to diagnose CKD and implement these agents early in the disease course to prevent the progression of disease and reduce the morbidity and mortality of this vulnerable population.
Advance Article
NMM/OMT

Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry

Shirley Chang, OMS IV; Jason Maddox, OMS IV; Erich Berg, OMS IV; Karen Kim, OMS III; Scott Messier, OMS IV; Loren Swanson, OMS IV; Richard Dobrusin, DO; Amy B. Stein, PhD; G. Nathan Nakken, DO; Jeannine Noble, PT; and Randall Nydam, PhD
The thoracic spine is a common area of focus in osteopathic manipulative medicine for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by palpating for asymmetry at the tips of the transverse processes. This authors examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation.
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Pediatrics

Analysis of the effects of isotretinoin on the premature epiphyseal closure in pediatric populations: a literature review

Sama Alazawi, DO; and Tami Hendriksz, DO
Oral isotretinoin, a systemic retinoid and a vitamin A derivative, has been widely utilized to treat acne in both adult and pediatric populations. It is important to raise awareness of the potential side effects of isotretinoin to enable informed treatment decisions before beginning an isotretinoin regimen. This article aims to describe that isotretinoin, given at various doses and durations, has been associated with growth plate abnormalities, which can lead to premature epiphyseal closure.
Advance Article
NMM/OMT

Efficacy of osteopathic manipulative treatment in patients with Parkinson’s disease: a narrative review

Raymond Li, OMS IV; Ann Jose, OMS IV; Jessica Poon, OMS IV; Cindy Zou, OMS IV; Maria Istafanos, OMS IV; and Sheldon C. Yao, DO
Parkinson’s disease (PD) is a neurodegenerative disease that leads to impaired motor and non-motor function in patients. PD is non-curative and gradually reduces quality of life, leading patients to seek treatment for symptom management. Osteopathic manipulative treatment (OMT) applies the biomechanical, neurologic, circulatory, metabolic, and psychosocial models in approaching and treating the major symptomatology of PD patients. This article evaluates the literature published in the past 10 years analyzing evidence on OMT and its functional application on gait, balance, motor function, bradykinesia, and autonomic dysfunctions, and to identify promising avenues for further investigation.
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NMM/OMT

Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT)

Rafael P. Ribeiro, MSc; Filipe G. Guerrero, DO; Eduardo N. Camargo; Luiza R. Pivotto, MSc; Mateus A. Aimi; Jefferson F. Loss, PhD; and Cláudia T. Candotti, PhD
Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint and its dysfunctions lack validity and reliability values. This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test and the sitting flexion test.
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Cardiopulmonary Medicine

C-reactive protein levels associated with COVID-19 outcomes in the United States

Jacob Lentner, OMS III; Taylor Adams, OMS IV; Valene Knutson, OMS III; Sarah Zeien, OMS IV; Hassan Abbas, OMS III; Ryan Moosavi, OMS III; Chris Manuel, OMS III; Thomas Wallace, MD; Adam Harmon, MD; Richard Waters, MD; Samuel Ledford, MD; Rajakrishnan Vijayakrishnan, MD; Nikhil Jagan, MD; Nezar Falluji, MD; Michael DelCore, MD; Curt Bay, PhD; and Sunny Jhamnani, MD
COVID-19 caused a worldwide pandemic and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay.
Advance Article
Public Health and Primary Care

Masqueraders: how to identify atypical diabetes in primary care

Sumera Ahmed, MD; Sana Saeed, MS; and Jay H. Shubrook, DO
While type 1 diabetes, type 2 diabetes, and gestational diabetes are most frequently encountered, there are many other types of diabetes with which healthcare providers are less familiar. These atypical forms of diabetes make up nearly 10% of diabetes cases and can masquerade as type 1 or 2 diabetes mellitus (T1DM or T2DM), and the treatment may not be optimized if the diagnosis is not accurate. This paper will detail the defining characteristics of each atypical form and demonstrate how they can masquerade as T1DM or T2DM.
Advance Article
Letters to the Editor

Influence of an osteopathic manipulative intervention on cerebral blood velocity changes: do we have the whole story to appropriately interpret the data?

Audrey Drapeau, MSc; Sarah Imhoff, MSc; and Patrice Brassard, PhD
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Clinical Image

Disseminated peritoneal coccidioidomycosis

David B. Villafuerte, DO
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Cardiopulmonary Medicine

Functional evaluation of the diaphragm with a noninvasive test

Bruno Bordoni, DO, PhD; and Allan R. Escher, DO
Cardiac surgery with median sternotomy causes iatrogenic damage to the function of the diaphragm muscle that is both temporary and permanent. Myocardial infarction itself causes diaphragmatic genetic alterations, which lead the muscle to nonphysiological adaptation. This article reviews the neurophysiological relationships of the diaphragm muscle and the symptoms of diaphragmatic contractile dysfunction, and the authors discuss a scientific basis for the use of a new noninstrumental diaphragmatic test in the hope of stimulating research.
Advance Article
Letters to the Editor

Red reflex variations in black patients

Chinwe Abaraoha, OMS I; and Athina Giovanis, DO
Advance Article
Letters to the Editor

Response to “Tocilizumab therapy and COVID-19”

Pallavi Bhargava, MD
Advance Article
Letters to the Editor

Embracing industry sponsored research to expand osteopathic medical student research experiences

Zachary P. Morehouse, OMS IV, MS; and Rodney J. Nash, PhD
Advance Article
Behavioral Health

The use of person-first language in scientific literature focused on drug-seeking behavior: a cross-sectional analysis

Patrick Sharp, DO; Jaclyn Slattery, DO; Austin Johnson, BS; Trevor Torgerson, BS; Ryan Ottwell, DO; Matt Vassar, PhD; and Micah Hartwell, PhD
Person first language (PFL) – a way of referring to individuals with medical conditions or disability that emphasizes the person over their condition or disability – is important in reducing the stigma surrounding individuals who exhibit drug-seeking behavior. Drug-seeking behavior is generally associated with a negative connotation by healthcare professionals, which may create poor provider perceptions of these individuals and potentially impact patient care. Therefore, to reduce stigmatization surrounding drug-seeking behavior and to improve patient care in these individuals, the use of PFL should be promoted. The primary objective of this study is to investigate how frequently research articles focused on drug-seeking behavior adhere to PFL.
Advance Article
Pediatrics

Osteopathic interventions via telehealth in a pediatric population: a retrospective case series

Joanna L. Kramer, DO, MPH; and Kathleen De Asis, DO, MS
Healthcare delivery was dramatically affected during the COVID-19 pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment, via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician’s experience in delivering osteopathic interventions to pediatric patients via telehealth.
Advance Article
Letters to the Editor

Tocilizumab therapy and COVID-19

Rujittika Mungmunpuntipantip, PhD; and Viroj Wiwanitkit, MD
Advance Article
Clinical Image

Epiglottic squamous cell carcinoma

John Carter, DO; Jessica Ball, DO, MPH; George McKean, DO; and Samir Patel, MD, DPM
Advance Article
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.
Advance Article