Publications

Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States and changes in lifestyle can minimize the likelihood of succumbing to heart disease. Anti-inflammatory agents are commonly used to reduce the chronic inflammatory state behind the pathogenesis of CVD. Multiple studies have been published correlating nut consumption with a reduction in both heart attacks and strokes. The goal of this study is to determine to what extent the consumption of almonds, hazelnuts, and walnuts have on the blood markers associated with cardiac disease and inflammation.

METHODS: This was a six-week study in which subject's baseline values act as controls. Fasting blood draws occurred at week 0, week 2, and after four weeks of intervention (week 6). All participants had undesirable lipid profiles and no medications related to heart disease.

RESULTS: Total cholesterol (TC): high-density lipoprotein (HDL-C) ratio was lowered a statistically significant amount at the six-week time point (3.89 ± 0.74) compared to both the zero-week (4.93 ± 1.16, p < 0.01) and two-week (4.63 ± 1.20, p < 0.5) timepoints. Low-density lipoprotein (LDL) measurements were lowered a statistically significant amount at the six-week time point (135.6 ± 15.0 mg/dL) compared to the zero-week (159.7 ± 12.3 mg/dL, p < 0.01). Erythrocyte sedimentation rate (ESR) was lowered a statistically significant amount at six-week time point (10.44 ± 5.05 mm/h) compared to the zero-week (14.44 ± 5.12 mm/h, p < 0.01).

CONCLUSIONS: Blood markers associated with CVD specifically and the general marker for inflammation associated with many chronic diseases can be favorably modified with the consumption of specific nuts as demonstrated by this study.

When the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a global health emergency, Colleges of Osteopathic Medicine (COMs) debated the role of medical students during this developing pandemic. Initially, the discussion included whether medical students were essential personnel contributing to meaningful patient care. Many questions arose regarding how COVID-19 would affect medical education and if the changes would be temporary or continue for a significant period of time. Due to the lack of availability of personal protective equipment (PPE) and a decreased focus on clinical education within many healthcare settings, in March the American Association of Colleges of Osteopathic Medicine (AACOM) declared that medical students were not essential personnel and recommended that COMs take a 'pause' and remove students from the clinical environment. This 'pause' would allow COMs time to assess where medical education could continue, to define the critical pieces of clinical education that required a clinical environment and to address how medical students could contribute during the pandemic. The AACOM Clinical Educators group began to meet on a weekly basis during this time so that Clinical Deans from Osteopathic medical schools across the country could collaborate, share ideas, discuss current challenges, and co-create a system to deliver medical education realizing the limitations of in-person clinical training.

Anxiety disorders are one of the most common psychiatric disorders presenting to the family physician. Anxiety disorders are both biologic and psychologic in origin. Anxiety is a signal alerting the individual of ‘danger.’ This danger can be unknown, internal, conflictual and vague. The anxiety signal allows the individual to respond to, and resolve the ‘danger.’ This is to be differentiated from fear which is the emotional response to a real or perceived imminent threat. These two states overlap but differ in that fear more often triggers the physiologic response of fight or flight. Anxiety disorders result when one or both of these systems are in a chronic ‘hyper reactive’ state for either biologic or psychologic reasons. This article reviews the criteria for anxiety disorders and the range of therapeutic interventions, pharmacologic and non-pharmacologic.

CONTEXT: Assessment of the anterior superior iliac spine (ASIS) is a key component in generating the pelvic diagnosis of somatic dysfunction, but studies have shown poor reliability between examiners.

OBJECTIVE: To assess the influence of homogeneous training, years of experience, and eye dominance on the percentage of correctness, sensitivity, and specificity of ASIS evaluation.

METHODS: Osteopathic physicians, predoctoral teaching fellows, and first- and second-year osteopathic medical students from a single teaching institute assessed 3 plastic pelvic models with ASIS anatomic landmarks set at different levels: even and 5- and 10-mm descrepancies. Dominant and nondominant eyes were used independently to assess ASIS levels.

RESULTS: A total of 147 examiners (participants) participated in this study (66 first-year and 61 second-year medical students, 15 fellows, and 5 osteopathic physicians). The overall percentages of correct results were 31.0% (even levels), 82.8% (5-mm discrepancy), and 91.7% (10-mm discrepancy). Differences by level of training were statistically significant only for the 5-mm ASIS discrepancy, where participants with more experience performed better. The overall sensitivity was 82.8% (5-mm discrepancy) and 91.7% (10-mm discrepancy), and the specificity was 31.0%. No statistically significant differences were found in the percentage of correct results by eye dominance.

CONCLUSION: Assessment of ASIS is sensitive but not specific at discrepancies of 5 mm or greater. Length of experience positively influences the percentage of correct results, and eye dominance does not significantly change this outcome. This form of assessment can be used to screen for ASIS asymmetry.

Multidisciplinary fragmentation contributes to myriad medical errors and as many as 98,000 patient deaths per year. The Institute of Medicine has proposed steps to improve healthcare delivery, including providing more opportunities for interdisciplinary training. The authors describe the interprofessional education (IPE) program at Western University of Health Sciences (WesternU) in Pomona, California. In 2007, 9 colleges at WesternU-including the College of Osteopathic Medicine of the Pacific-undertook an IPE initiative that resulted in creation of a 3-phase program. Part of the IPE development process involved identifying core competencies that were nontechnical and nonclinical and common to all healthcare professions. The IPE development and implementation process and the identified competencies were analyzed for their relationship to the tenets of osteopathic medicine and the core competencies of osteopathic medical education. Although these tenets and core competencies were not intentionally used in the development process of the WesternU IPE program, the analysis revealed that the major components of the program are congruent with the framework of osteopathic principles and practice. The osteopathic medical profession's founding principles, broad-based perspective, and health-promoting tenets put the profession in a position to emerge as one of the leading forces in IPE.