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Volume 120 Issue 11

Issue of Journal of Osteopathic Medicine

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ORIGINAL CONTRIBUTION

Publicly Available October 8, 2020

Associations Between Social Support and Diabetes-Related Distress in People With Type 2 Diabetes Mellitus

Clipper F. Young, Jay H. Shubrook, Elyssa Valencerina, Shirley Wong, Sze Ngong Henry Lo, Joy A. Dugan

Page range: 721-731

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Abstract

Context Diabetes is a complex, chronic condition and managing it can have psychosocial implications for patients, including an impact on relationships with their loved ones and physical wellness. The necessary modifications to daily behaviors can be very overwhelming, thus leading to diabetes-related distress. Objective To investigate the association between diabetes-related distress and perceived social support among people with type 2 diabetes. Methods This cross-sectional study surveyed a population with a lower socioeconomic status (Medi-Cal recipients, which are only given to low-income individuals) in Solano County, California. Patients who had type 2 diabetes mellitus, who were between 40 and 80 years old, and who had a medical appointment in the clinic(s) at least once between December 2015 and December 2016 were included. Patients who could not understand or speak English and patients whose primary care clinicians declined their participation in the study were excluded from the study. Each study participant was recruited at the end of their medical appointment, and the survey instrument in paper form was administered. The Problem Areas in Diabetes (PAID) scale, which indicates diabetes-related distress, and Multidimensional Scale of Perceived Social Support (MSPSS) with 3 subscales (family, friends, and significant others) were used in this study. Multiple linear regression models were used to analyze the associations between PAID and MSPSS surveys. Results For the 101 participants included in our study, multiple linear regression models showed statistically significant association between total MSPSS scores and total PAID scores (β = −.318; 95% CI, .577, −.0581; P =.017) as well as between MSPSS family subscale scores and total PAID scores (β= −.761; 95% CI, −1.35, −.168; P =.012). Among the 3 MSPSS subscales, higher perceived support from family members was found to be significantly associated with lower total PAID scores (β= −.761; 95% CI, −1.35, −.168; P =.012). Conclusion Our findings suggest that a higher level of perceived social support experienced was associated with lower diabetes-related distress among patients with type 2 diabetes. Osteopathic physicians have a central role in providing comprehensive, patient-centered, holistic care, and the attention to social support in chronic disease management can help remove barriers in providing optimal care.

Publicly Available September 22, 2020

Evaluation of “Spin” in the Abstracts of Randomized Controlled Trial Reports in Cardiology

William B. Roberts, Craig M. Cooper, Mahmood Khattab, Patrick Neff, Dan Wildes, Cole Wayant, Matt Vassar

Page range: 732-739

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Abstract

Context The misrepresentation and distortion of research findings, known as “spin,” has been shown to affect clinical decision making. Spin has been found in randomized controlled trials (RCTs) published in various fields of medicine. Objective To evaluate the abstracts of RCTs found in the cardiology literature for spin. Methods The authors searched PubMed using a specific string of keywords to identify previously published articles documenting RCTs of cardiovascular treatments in humans. To be included, a cardiology trial had to randomize humans to an intervention, statistically compare 2 or more groups, and have a nonsignificant primary endpoint. Records were excluded if they did not meet these criteria. Data extraction was double-blinded and done using a pilot-tested Google Form. Items extracted from each trial included the title, journal, funding source, comparator arm, primary endpoint, statistical analysis of the primary endpoint, secondary endpoints, statistical analysis of secondary endpoints, and trial registration number (if reported). The 2 authors who screened records for inclusion were then asked whether spin was present in the abstract of the randomized trial. Spin in the title, abstract results, abstract conclusions, and selection of reported endpoints were considered. Results Of the 651 PubMed citations retrieved by our search string, 194 RCTs with a clearly defined primary endpoint were identified. Of these 194 RCTs, 66 trials contained nonsignificant primary endpoints and were evaluated for spin. Of these trials, spin was identified in 18 of the 66 abstracts (27.3%). Conclusions Spin was present in our sample of cardiology RCTs. Spin may influence clinical decision making by creating false impressions of the true validity of a drug or intervention.

REVIEW

Publicly Available August 27, 2020

DERMS DO 5: A Proposed Curriculum for Dermatologic Training in 5 Osteopathic Competencies

Rachel Giesey, Joseph Kamel, Gregory Delost, Jenifer Lloyd

Page range: 740-748

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Abstract

Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, “DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5,” to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.

MEDICAL EDUCATION

Publicly Available September 17, 2020

Status of Entrustable Professional Activities (EPA) Implementation at Colleges of Osteopathic Medicine in the United States and Future Considerations

Machelle Linsenmeyer, Leslie Wimsatt, Mark Speicher, Pamela Basehore, Patricia S. Sexton

Page range: 749-760

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Abstract

Context Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entrustable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country. Objective To review the status of EPA implementation at COMs nationally. Methods An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from “moderate implementation with reporting” to “full implementation with reporting.” Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings. Results Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above “somewhat knowledgeable” toward “expert” regarding knowledge of EPAs, but 23 (64%) also indicated “no confidence” or “somewhat confident” regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the “foundational implementation” (10; 28%), “slight implementation” (11; 31%), and “moderate implementation” (11, 31%) categories, with a few schools indicating “no implementation” (2; 5%) or “progressive implementation” (2; 5%). Conclusion The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.

ORIGINAL ARTICLE

Publicly Available October 6, 2020

Ultrasonography to Assess the Efficacy of Osteopathic Manipulative Treatment for Lumbar Spine Asymmetry

Jeffrey Winter, Andrew Kimber, Stuart Montenegro, Jing Gao

Page range: 761-769

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Abstract

Context The effectiveness of osteopathic manipulative treatment (OMT) on the lumbar spine has been studied qualitatively, but quantitative measurement of the effects of OMT has not been thoroughly investigated. Objective To quantitatively measure the palpated improvements of OMT on the lumbar spine using ultrasonography (US) and correlate palpatory diagnosis with US measurements of lumbar asymmetry. Methods From September to November 2018, we recruited 20 adult participants 18 years of age or older. Lumbar somatic dysfunction (SD) was identified via osteopathic palpation. US was then performed on all participants with standard machine settings (frequency, 7 MHz; depth, 7 cm; dynamic range, 60; tissue harmonic imaging; and single-image focus). Longitudinal images of each lumbar transverse process were recorded and saved bilaterally by an experienced radiologist and a medical student. The participant's SD was then managed using OMT, including Still technique, myofascial release, muscle energy technique, high-velocity low-amplitude technique, functional positional release, balanced ligamentous tension, and counterstrain. Following OMT, US was performed again in the same method. Measurements of the saved US images were reviewed using a Digital Imaging and Communications in Medicine viewer. These measurements were obtained by 3 separate observers (J.W., A.K., S.M.), using the same computer software. Statistical analysis included a 2-tailed paired t -test to analyze rotational asymmetry pre- and posttreatment, an intraclass correlation coefficient (ICC) to test intra- and interobserver reliability, and a Pearson correlation coefficient (PCC) to analyze the correlation between US findings and OMT. Results The difference in soft tissue thickness before and after OMT was significant ( P =.014), indicating improvements in rotational asymmetry. Side-bending asymmetry did not demonstrate statistically significant improvement. US findings correlated with the physician's palpatory rotational diagnosis (PCC=0.62, P =.004). ICC was greater than 0.9 for intra- and interobserver reliability tests of both US operation and offline image processing. Conclusion The results of this study demonstrate that US is a feasible method of evaluating the efficacy of OMT. These results show good intra- and interobserver reliability of US acquisition and landmark measurement. Our study suggests that US assessment correlated closely with palpatory diagnosis. Our results also suggest that OMT can significantly improve lumbar rotational asymmetry, but did not improve side-bending asymmetry.

CASE REPORT

Publicly Available October 5, 2020

Opioid-Induced Sickle Cell Crisis With Multiple, Life-threatening Complications

Ashley Griswold Haggerty, Andrew Koons, Gillian Beauchamp, Matthew D. Cook, Robert D. Cannon, Kenneth D. Katz

Page range: 770-773

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Abstract

The risk of opioid use disorder among patients with sickle cell disease who are treated with chronic opioids remains unclear, but the complications associated with opioid use and overdose can be accentuated in those with sickle cell disease. In this case report, we describe a 13-year-old girl with sickle cell disease who presented to the emergency department after a morphine overdose causing renal infarction, acute kidney injury, acute respiratory distress syndrome, and posterior reversible encephalopathy syndrome.

REVIEW

Publicly Available September 22, 2020

An Osteopathic Modular Approach to Asthma: A Narrative Review

Jason Schend, Marija Rowane, Neha Sanan, Sir Robert Hostoffer

Page range: 774-782

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Abstract

Asthma is among of the first ailments documented in the existing academic literature as being successfully managed with osteopathic manipulative treatment (OMT) techniques. Time-efficient and well-tolerated OMT techniques have been gradually added to the literature to manage this increasingly prevalent disease. In this narrative review, the authors discuss previously-published literature describing the history, diagnosis, and management of asthma related to osteopathic principles and practices and OMT application. They also present current and newly-approved medical managements, including biologics and inhaled corticosteroids. This article also includes supplemental videos showcasing OMT techniques for asthma management, which were developed by the authors based on recommendations indicated in the literature.

OMT MINUTE

Publicly Available November 1, 2020

Osteopathic Approach to Treatment of Carpal Dysfunction: The Carpal Mobilization Technique

Thomas R. Mehner, Drew D. Lewis

Page range: 783-784

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REVIEW

Publicly Available August 7, 2020

Osteopathic Considerations for the Pregnant Patient With COVID-19

Kendra M. Gray, Lauren Murphy, Brian Buckner

Page range: 785-791

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Abstract

In any given year, approximately 130 million babies are born worldwide. Previous research has shown that pregnant women may be more severely affected and vulnerable to contracting emerging infections, making them a particularly high-risk population. Therefore, special considerations should be given to treatment methods for pregnant women with COVID-19. In this narrative review, the authors evaluate scholarly journal articles and electronic databases to determine what is known about the pathophysiology of COVID-19 in pregnancy and the associated mortality rate. Osteopathic manipulative treatment techniques to mitigate the underlying pathology were identified, and modifications for use in pregnancy and the critical care setting are described.

CASE REPORT

Publicly Available October 6, 2020

Somatic Dysfunctions of Hip and Pelvis Overlooked in a Case of Vulvodynia

Athina Giovanis, Stephanie Zeszutek

Page range: 792-795

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Abstract

Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dysfunctions. If left untreated, these somatic dysfunctions can directly alter ligamentous tension on the pelvic floor and surrounding regions, resulting in perineal pain. Management of vulvodynia must be individualized due to the multifactorial etiology and complicated structure and function of the pelvic floor muscles . The authors present a case of vulvodynia in which osteopathic manipulative treatment was an effective management technique.

ORIGINAL CONTRIBUTION

Publicly Available October 8, 2020

Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency

Jen-Tzer Gau, Charles Ebersbacher, Tzu-Cheg Kao

Page range: 796-805

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Abstract

Context Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied. Objective To estimate the prevalence of low serum zinc concentrations among community-dwelling adults, and to characterize clinical features and risk factors associated with zinc deficiency. Methods This retrospective pilot prevalence study took place from 2014 to 2017 at an outpatient clinic in southeast Ohio. Patients aged 50 years or older with a stable health status were categorized into a case group with zinc deficiency (serum zinc concentration, <0.66 µg/mL) and a control group (serum zinc concentration, ≥0.66 µg/mL). Measurements included serum zinc concentration, nutritional biomarkers (ie, magnesium, calcium, albumin, and total 25-hydroxy vitamin D levels), patient history of fractures and events such as hospitalization, antibiotic use, and self-reported falls that occurred within 1 year prior to the date serum zinc concentration was measured (index date). Patients were excluded if they had a serum zinc measurement within 2 months after a hospitalization, severe renal insufficiency (3 patients with serum creatinine concentration above 2.5 mg/dL), or serum zinc concentration above 1.20 µg/mL. Results This study included 157 patients, consisting of a case group of 41 (26%) patients with zinc deficiency and a control group of 116 (74%) without zinc deficiency. Mean (SD) zinc concentrations of the case and control groups were 0.58 (0.05) µg/mL and 0.803 (0.13) µg/mL, respectively ( P <.01). Patients in the case group were more likely to have had a history of hospitalization, antibiotic use, a fall within 1 year before the index date, and a history of fractures and hip fracture ( P <.01 in each case). Patients taking gastric acid suppressants had increased odds of lower zinc concentrations (odds ratio, 2.24; 95% CI, 1.08-4.63). Both logistic and multivariate linear regression models revealed that past fractures, hip fractures, and hypoalbuminemia (albumin <3.5 g/dL) were associated with zinc deficiency or lower zinc concentrations. Conclusion This study revealed that 26% of patients in an outpatient adult clinic had zinc deficiency based on serum concentrations. Patients with fracture history and low serum albumin were at higher risk for zinc deficiency.

COMMENTARY

Publicly Available October 7, 2020

The Battle Between Politics and Science Is Costing Us a Timely Victory Over the COVID-19 Pandemic

Marc B. Hahn

Page range: 806-807

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Abstract

Against the backdrop of the COVID-19 pandemic, the author discusses what he views as a persistent tension between the nature and aims of politics vs science. He outlines a call to action for osteopathic physicians to stand with science, advocate for best practices, undertake dialogue with local and state health authorities, and act as role models for colleagues and patients alike.

CLINICAL IMAGES

Publicly Available November 1, 2020

Primary Familial Brain Calcification

Melvin Parasram, J. Levi Chazen, Harini Sarva

Page range: 808-808

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Publicly Available November 1, 2020

Acute Suppurative Thyroiditis

Parth Desai, Chimezie Mbachi, Anshu Singh

Page range: 809-810

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About this journal

The Journal of Osteopathic Medicine, founded in 1901 and known for 119 years as the Journal of the American Osteopathic Association, is the premier scholarly, peer-reviewed publication of the osteopathic medical profession. The mission of JOM is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health. JOM conducts double-blind peer review of academic research manuscripts from a wide variety of medical specialties, covering the full spectrum of clinical settings in which osteopathic physicians practice. All submissions are vetted by a distinguished group of Section Editors led by Editor-in-Chief Ross Zafonte, DO, and supported by a full Editorial Board.

JOM publishes original research, narrative and systematic review articles (including meta-analyses), clinical practice descriptions, and a very limited number of case reports, all of which are described fully in our Instructions for Authors. JOM is particularly interested in original scientific research that provides quantitative analysis of and contributes significantly to the evidence base underpinning current practices in osteopathic medicine, including but not limited to neuromusculoskeletal medicine. We also accept research submissions documenting trends and changes in education for osteopathic medical students. The ultimate focus of all material published in JOM is to support, enhance, and advance patient care through evidence.