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A 6‐year‐old, male, neutered, crossbreed dog was presented with a history of lethargy, chronic cough, right thoracic limb lameness, bilateral distal thoracic limb swelling and non‐healing skin wounds. Computed tomography showed bilateral forelimb irregular periosteal reaction and chronic right cranial lung lobe torsion, with secondary bronchiectasis. The affected lung lobe was surgically excised, the right radius was biopsied, and postoperative antimicrobial therapy was prescribed. Histopathology and bacterial culture confirmed chronic lung lobe torsion, associated bacterial bronchopneumonia, and right radial hypertrophic osteopathy. Two months after starting treatment, the respiratory signs resolved and the soft tissue swelling and lameness markedly improved. To the authors' knowledge, this is the first case report describing hypertrophic osteopathy suspected secondary to chronic lung lobe torsion in a dog. [ABSTRACT FROM AUTHOR]

Background: Traditional and complementary medicine (T&CM) is highly utilised and draws on traditional knowledge (TK) as evidence, raising a need to explore how TK is currently used. Objectives: Examine criteria used to select, evaluate and apply TK in contemporary health contexts. Methods: Systematic search utilising academic databases (AMED, CINAHL, MEDLINE, EMBASE, SSCI, ProQuest Dissertations Theses Global), Trip clinical database and Google search engine. Citations and reference lists of included articles were searched. Reported use of TK in contemporary settings was mapped against a modified 'Exploration‐Preparation‐Implementation‐Sustainment' (EPIS) implementation framework. Results: From the 54 included articles, EPIS mapping found TK is primarily used in the Exploration phase of implementation (n = 54), with little reporting on Preparation (n = 16), Implementation process (n = 6) or Sustainment (n = 4) of TK implementation. Criteria used in selection, evaluation and application of TK commonly involved validation with other scientific/traditional evidence sources, or assessment of factors influencing knowledge translation. Discussion: One of the difficulties in validation of TK (as a co‐opted treatment) against other evidence sources is comparing like with like as TK often takes a holistic approach. This complicates further planning and evaluation of implementation. Conclusion: This review identifies important criteria for evaluating current and potential contemporary use of TK, identifying gaps in research and practice for finding, appraising and applying relevant TK studies for clinical care. [ABSTRACT FROM AUTHOR]

Aim: Osteopathy and chiropractic techniques are used for babies for different reasons, but it is unclear how effective they are. The aim of this study was to evaluate their effectiveness in reducing crying time and increasing sleeping time in babies with infantile colic. Methods: A systematic review and meta‐analysis was conducted on infantile colic studies that used complementary and alternative medicine techniques as interventions. The outcome measures were hours spent crying and/or sleeping. We used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database and Google Scholar databases from inception to 11 November 2022. Results: The methodological quality of the randomised control trials ranged from fair to high. We focused on five studies with 422 babies. Complementary treatments failed to decrease the crying time (mean difference −1.08, 95% CI: −2.17 to 0.01, I2 = 92%) and to increase sleeping time (mean difference 1.11, 95% CI: −0.20 to 2.41; I2: 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures. Conclusion: Osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared with no additional intervention. [ABSTRACT FROM AUTHOR]

Objective: To describe the presenting signs, concurrent conditions, treatment and outcome of dogs with metaphyseal osteopathy. Materials and Methods: Multi‐centre retrospective review of medical records from January 2009 to September 2018 at four referral centres to identify dogs with a radiographic diagnosis of metaphyseal osteopathy. Results: Thirty‐nine dogs were identified. The median age at onset was 14 weeks old (range, 8 to 32 weeks old). There was a higher proportion of male dogs (29 of 39 male entire, nine of 39 female entire, one of 39 female neutered and no male neutered dogs). Where information was available, median time from the most recent vaccination was 20 days (range, 2 to 144 days). The most commonly recorded clinical signs were pyrexia (34 of 39), lethargy (32 of 39), pain (30 of 39), and being non‐ambulatory (17 of 39). Thirty‐five dogs required hospitalisation for analgesia and supportive care, 19 of 39 were discharged on prednisolone (median dose 2.0 mg/kg/day; range, 0.9 to 2.6 mg/kg/day), 18 of 39 were discharged on non‐steroidal anti‐inflammatories, two of 39 did not receive NSAIDs or prednisolone at any time point. The median duration of hospitalisation for those admitted was 5 days (range, 1 to 21 days). Where follow‐up was available, relapse occurred in eight of 25 cases before reaching skeletal maturity. At the time of metaphyseal osteopathy diagnosis, five of 39 cases had concurrent conditions. Where follow‐up was available, four of 25 developed future immune‐mediated conditions. Clinical Significance: Metaphyseal osteopathy should be considered in non‐ambulatory painful young dogs. Some dogs developed future immune‐mediated conditions, which may support the hypothesis that metaphyseal osteopathy is an autoinflammatory bone disorder. Further studies with a larger cohort are required to determine the clinical significance of this. [ABSTRACT FROM AUTHOR]

An 8‐year‐old, female, neutered cocker spaniel presented with progressive lethargy, inappetence and right pelvic limb lameness. Regional mastectomy and ovariohysterectomy had been performed 11 months prior. Mild neutrophilia and increased C‐reactive protein were present. Radiographs revealed mild periosteal reaction of distal long bone diaphyses of all limbs, consistent with hypertrophic osteopathy. Abdominal imaging revealed a mesenteric mass with a central woven radiopaque foreign body diagnosed as a gossypiboma following surgical excision and histopathology. Postoperatively the patient developed acute decompensation of suspected chronic subclinical disseminated intravascular coagulation and suffered cardiac arrest. Hypertrophic osteopathy was confirmed with multifocal periosteal hyperostosis and concurrent myelofibrosis within the medulla of the long bones. Hypertrophic osteopathy occurs secondary to chronic inflammatory or neoplastic intrathoracic lesions and rarely due to abdominal pathology. To the authors' knowledge, this is the first description of hypertrophic osteopathy associated with an abdominal gossypiboma with sequential disseminated intravascular coagulation. [ABSTRACT FROM AUTHOR]

An 8‐year‐old female‐spayed Great Dane was referred for further investigation of a 1‐month history of stiff gait, pain on palpation of the limbs, weight loss and pyrexia. Investigations revealed a generalized soft tissue swelling along the long axis of the forelimbs and to a smaller extent on the hindlimbs. CT identified a mixed osteolytic and osteoproliferative mass originating from the second right rib. CT also showed characteristic features of hypertrophic osteopathy along the forelimbs and proximal hindlimbs. Cytology of the rib mass was consistent with an aggressive sarcoma. To the authors' knowledge, this is only the second documented case of hypertrophic osteopathy associated with rib sarcoma without evidence of lung metastasis. [ABSTRACT FROM AUTHOR]

Background: Nephrology offers the unique opportunity to directly link patients to providers, allowing the study of patient outcomes at the provider level. The purpose of this analysis was to determine whether nephrologist experience, defined as years in nephrology practice, was associated with clinical outcomes. Design: Physician data contained within the American Medical Association (AMA) Physician Masterfile was combined with patient and Medicare claims data from the United States Renal Data System (USRDS) for the calendar year 2012, with follow up extending through June 30, 2014. Associations with important healthcare outcomes including mortality in patients receiving maintenance renal replacement therapy (RRT), waitlisting for kidney transplantation, and receipt of a kidney transplant were determined with broad adjustment for both patient and provider level variables, with attention on tertile of provider time in practice. Results: We identified 256,324 patients on maintenance RRT cared for by 6193 nephrologists. Nephrologists with the least experience were more likely to be female, reside in a region with ≥1,000,000 people, have a Doctor of Osteopathic Medicine degree, and have a listed maintenance of certification status as "yes." Overall, 30.2% of the cohort died at a mean follow up of 1.99 years. Compared to those with the 0–10 years of experience, receipt of care from nephrologists with more experience was associated with lower mortality (AHR 0.97 CI 0.94–0.99 for nephrologists with 11–20 years) and increased listing for kidney transplantation (AHR 1.10; CI 1.01–1.21 for nephrologists with >21 years experience). Experience level did not result in a difference in kidney transplantation rates. Conclusions: Receipt of maintenance RRT from nephrologists with greater experience was associated with decreased mortality and increased listing for kidney transplantation, an effect that remained significant after multiple adjustments for important patient and nephrologist variables. [ABSTRACT FROM AUTHOR]

Objective: To investigate the current headache medicine education paradigm in allopathic and osteopathic medical schools in the United States and Canada. Background: There is a disparity in the number of clinicians specially trained to treat patients with headache disorders and the number of people who have them. Early education and exposure to headache medicine is crucial to address this disparity. However, the current state of headache education within medical schools across the United States and Canada is unknown. Methods: The authors created a medical student headache education survey, which is a 20‐question REDCap survey that was distributed via email to the neurology clerkship director, curriculum dean, or similar role at each US and Canadian MD or DO conferring medical school. The email listserv was created using the American Academy of Neurology Clerkship Directory, the Association of American Medical Colleges Organization Directory, the American Association of College of Osteopathic Medicine Organization Directory, manual searches of the institutions' websites, and phone calls and emails to administrators as needed. Results: Of the 249 individuals contacted, 78 completed the survey, yielding a response rate of 31.3%. Of those responses, 84.6% of respondents (66/78) reported that their institution has at least one mandatory session on headache disorders. Many of these sessions (72.7% (48/78)) occurred during preclinical training, and 74.2% (49/78) occurred as part of the clinical curricula. Of respondents, 44.9% (39/78) reported that their institutions coordinate headache education across training levels (i.e., from preclinical to clinical), and only 17.9% (14/78) coordinate across clinical rotations. The most common topics covered were headache red flags, migraine, pharmacologic management, and differentiating primary versus secondary headache. 65.4% of respondents (51/78) felt that the preclinical headache curriculum prepares their students for the clinical experience, and 55.1% (43/78) felt that medical students were learning enough about headache medicine at their institution. Barriers to educating medical students about headache included insufficient time during courses, lack of administrative support in curricula development, lack of available resources, and lack of student interest. Case‐based learning modules and online lectures were the most desired educational materials to improve medical student headache education at their institution. Conclusions: The majority of medical schools report incorporating headache medicine education into preclinical or clinical curricula and cover a range of topics in headache medicine. Yet there remains a lack of consistency, with some reporting limited headache education, citing barriers such as lack of administrative support and available educational resources. There is also variation in what is being taught at the medical student level. Future projects should aim to address said barriers, with the goal of providing a standardized headache medicine curriculum for use across medical schools. [ABSTRACT FROM AUTHOR]

Pulmonary actinomycosis is described in 17 South Australian koalas necropsied between 2016 and 2019. From these cases, four koalas had secondary hypertrophic osteopathy. Plain radiographical and computed tomography images demonstrated periosteal reaction on multiple appendicular skeletal bones in all cases, including scapula, humerus, ulna, radius, ilium, femur, tibia, fibula, metacarpus, metatarsus and phalanx. Grossly, periosteal surfaces of the metaphyses and diaphyses of long bones were thickened and roughened; microscopically, this was characterised by bi‐layered proliferation of well‐differentiated trabecular bony spicules oriented perpendicular to the cortex (pseudocortices) and separated by vascular connective tissue, typical for hypertrophic osteopathy. Well characterised in domestic species and rarely reported in marsupials, this is the first radiographical and pathological characterisation of hypertrophic osteopathy in koalas, associated with pulmonary actinomycosis in all cases. [ABSTRACT FROM AUTHOR]

The article responds to a study on the effectivity of a manipulable digital pelvic bone in anatomy education. Topics discussed include the greater effectivity of virtual reality (VR)-based anatomy education than two-dimensional methods for the same, and the greater educational effectiveness of manipulable VR temporal bone models compared with cross-sectional views. Also noted is the considerable role played by manipulation of digital anatomical models in anatomy education.

We appreciate all the comments made regarding our study 'Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic'.[1] Concerning the first paragraph, despite of that our study is written in terms of complementary and alternative medicine, the forest plots are divided in subgroups because both interventions are not comparable. REFERENCES 1 Cabanillas-Barea S, Jiménez-del-Barrio S, Carrasco-Uribarren A, Ortega-Martínez A, Pérez-Guillén S, Ceballos-Laita L. Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic. On the other hand, the authors should not make subjective judgements ('the widespread use of osteopathic and chiropractic treatment indicate an interest by patients' or "osteopathic treatment is inexpensive"). [Extracted from the article]

The widespread use of osteopathic and chiropractic treatment for infantile colic indicates a widespread interest among patients. Clearly, Statement 2 prohibits a strong recommendation, but statements 1, 3 and 4 all support a weak recommendation for osteopathic and chiropractic manipulation in the treatment of infantile colic for the outcome of crying time. Abbreviation GRADE Grading of Recommendations Assessment, Development and Evaluation We would like to compliment Cabanillas-Barea et al.[1] for conducting a timely systematic review and meta-analysis to evaluate the effectiveness of osteopathy and chiropractic techniques for babies with infantile colic. [Extracted from the article]

Context: Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi‐institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. Methods: Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first‐year, 2764 second‐year, 2413 third‐year and 1958 fourth‐year students who completed a web‐based survey at the end of the 2017‐2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman‐Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. Results: Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African‐American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People‐Oriented' and 'Psychiatry' specialties). Conclusions: Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation. Using four nationwide samples of medical students in the US the authors explore correlates of empathy to explore strategies for career counselling and empathy development. [ABSTRACT FROM AUTHOR]

I study two important aspects of the Australian private ancillaries health insurance (PAHI) market—moral hazard and self‐selection. PAHI covers out‐of‐hospital health services including dental, optometry, physiotherapy, and chiropractic. Using instrumental variables methods, I find evidence that PAHI increases utilization, particularly for dental, physiotherapy, chiropractic, osteopathy, and acupuncture. I also find evidence of selection effects—both adverse and favorable. Several variables jointly predict a person's propensity to insure and to utilize health services. There is little evidence of self‐selection based on the joint probability of different health services, which has important implications for understanding the commercial success of PAHI. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population. In this study, we examined health care providers' knowledge of those recommendations and their application of them, as well as factors associated with guideline use. Methods: This study used a cross‐sectional, descriptive correlational design with a convenience sample. All data were collected with a 20‐question online survey sent to advanced practice nurses (APNs), medical doctors/doctor of osteopathic medicines (MDs/DOs), and physician assistants (PAs) in Central Texas. Results: One‐hundred eighty‐one health care providers responded. Participants most frequently said they were "moderately familiar" with guidelines for cognitive impairment screening (60.9%). Twenty‐three per cent of physicians, 37.4% of APNs, and 8.3% of PAs indicated that they incorporated routine screening into daily practice. However, 64% did not use standardized tools to assess cognitive function. The most common clinical tasks related to cognitive screening were referral for more in‐depth cognitive screening (44%) and education of families regarding cognitive problems (29%). Lack of time was the most common barrier to screening (57.7%). Conclusions: Most respondents believed that there was a good rationale for assessing cognitive function in people with diabetes. However, despite some familiarity with guidelines for cognitive function screening, most respondents did not use standardized assessment tools. The results indicate variability in clinical practice regarding assessment and practices, such that there may be some variability in outcomes for patients. [ABSTRACT FROM AUTHOR]

Anatomy faculties are integral to basic science instruction in medical schools, particularly given the preponderance of anatomic instruction in the preclinical curriculum. Recent years have witnessed major curricular restructuring and other emerging national trends that pose significant challenges to anatomists. An examination of anatomy faculty perceptions at two philosophically distinct medical schools within this shifting climate provides an indicator of how different institutional characteristics may impact anatomy instruction and other faculty responsibilities. Semistructured interviews of anatomy faculty from a large, well-established allopathic medical school (Indiana University School of Medicine) and a small, new osteopathic medical school (Marian University College of Osteopathic Medicine) were explored using qualitative thematic analysis. Four overarching themes were identified: (1) Institutional philosophies, such as affiliation with osteopathic versus allopathic medicine, have minimal impact on how the anatomical sciences are taught. (2) Differences in anatomy faculty experiences at these two institutions are largely driven by the institution's size and history. There is a disparity between institutions in the relative importance of teaching and research, but an ability to do research is important for both faculties. (3) Anatomy instruction and research agendas are driven by personal philosophies and interests rather than institutional philosophy. (4) Autonomy is highly valued by anatomists at both institutions. All the participants share a devotion to educating future physicians. In fact, this study identified more similarities than differences in these two faculties. Finally, we argue that shared educational resources and research collaborations can improve anatomy education and faculty development at both institutions. Anat Sci Educ 9: 255-264. © 2015 American Association of Anatomists. [ABSTRACT FROM AUTHOR]

The article presents the study that explores on the views and expectations of patients about osteopathic care in the private sector care in Great Britain. The topics discussed include ways of how their views impact their health care outcomes, the attributes of osteopathic medicine, and the qualitative method used in articulating patients' expectations on private osteopathic practice.

Background Prior studies reveal that bone mineral density ( BMD) in congenital adrenal hyperplasia ( CAH) is mostly in the osteopaenic range and is associated with lifetime glucocorticoid dose. The forearm, a measure of cortical bone density, has not been evaluated. Objective We aimed to evaluate BMD at various sites, including the forearm, and the factors associated with low BMD in CAH patients. Methods Eighty CAH adults (47 classic, 33 nonclassic) underwent dual-energy-x-ray absorptiometry and laboratory and clinical evaluation. BMD Z-scores at the AP spine, total hip, femoral neck, forearm and whole body were examined in relation to phenotype, body mass index, current glucocorticoid dose, average 5-year glucocorticoid dose, vitamin D, 17-hydroxyprogesterone, androstenedione, testosterone, dehydroepiandrosterone and dehydroepiandrosterone sulphate ( DHEAS). Results Reduced BMD (T-score <−1 at hip, spine, or forearm) was present in 52% and was more common in classic than nonclassic patients ( P = 0·005), with the greatest difference observed at the forearm ( P = 0·01). Patients with classic compared to nonclassic CAH, had higher 17-hydroxyprogesterone ( P = 0·005), lower DHEAS ( P = 0·0002) and higher non-traumatic fracture rate ( P = 0·0005). In a multivariate analysis after adjusting for age, gender, height standard deviation, phenotype and cumulative glucocorticoid exposure, higher DHEAS was independently associated with higher BMD at the spine, radius and whole body. Conclusion Classic CAH patients have lower BMD than nonclassic patients, with the most affected area being the forearm. This first study of forearm BMD in CAH patients suggests that low DHEAS may be associated with weak cortical bone independent of glucocorticoid exposure. [ABSTRACT FROM AUTHOR]

The article presents a pilot study on the advancement of safe drug use through interprofessional learning (IPL), with a focus on how interprofessional and collaborative patient-centered care (IPCPC) improves healthcare quality and cost. Topics include a case study on rational drug choice and prescription, the development of interprofessional education (IPE) for rational drug use curricula, and the feedback of nursing students on the IPE class.

Case report Metaphyseal osteopathy ( MO) was diagnosed in three Australian Kelpie puppies that were presented for veterinary assessment of lameness. The three puppies were siblings. Each was from a different litter by the same breeding pair. The puppy in case one was seen by the authors, and the puppies in cases two and three were patients at other veterinary hospitals. However, the medical records and radiographs were examined and reviewed for this report. Radiographic investigation of the lameness revealed pathognomonic appearance of MO affecting the metaphyseal region of the long bones in all three puppies. The diagnosis was confirmed on histopathology in one patient. Conclusion MO is considered a disease of large and giant-breed dogs, being rarely reported in non-large-breed dogs, and has not been reported in the Australian Kelpie, which is considered a medium-breed dog. This case series suggests a previously unreported breed predisposition to MO in the Australian Kelpie. [ABSTRACT FROM AUTHOR]

While background music is often used during osteopathic treatment, it remains unclear whether it facilitates treatment, and, if it does, whether it is listening to music or jointly listening to a common stimulus that is most important. We created three experimental situations for a standard osteopathic procedure in which patients and practitioner listened either to silence, to the same music in synchrony, or (unknowingly) to different desynchronized montages of the same material. Music had no effect on heart rate and arterial pressure pre- and posttreatment compared to silence, but EEG measures revealed a clear effect of synchronized versus desynchronized listening: listening to desynchronized music was associated with larger amounts of mu-rhythm event-related desynchronization ( ERD), indicating decreased sensorimotor fluency compared to what was gained in the synchronized music listening condition. This result suggests that, if any effect can be attributed to music for osteopathy, it is related to its capacity to modulate empathy between patient and therapist and, further, that music does not systematically create better conditions for empathy than silence. [ABSTRACT FROM AUTHOR]

Objective In light of the low efficiency of available drugs in treating irritable bowel syndrome (IBS), there has been a growing interest in its alternative therapies. The aim of this study was to evaluate the effectiveness of visceral osteopathy for IBS. Methods In total, 31 consecutive refractory IBS patients were prospectively included in a randomized, crossover placebo-controlled study. Qualitative evaluation of depression and four symptoms including constipation, diarrhea, abdominal distension and abdominal pain before and after each phase of the study were conducted using visual analog scales, measures of rectal sensitivity and colonic transit time. One year after the study, the assessment of symptoms was performed again in all patients. Results Visceral osteopathy was associated with a significant amelioration of self-reported diarrhea, abdominal distension and abdominal pain, while constipation did not change significantly after this therapy. It was also associated with decreased rectal sensitivity, presenting as an increase in threshold volume, constant sensation volume and maximum tolerable volume ( P < 0.001). However, no significant evolution of rectal sensitivity was observed when patients underwent placebo manipulations. Modifications of depression and total or segmental colonic transit time were not observed. One year after the end of this trial, symptom scores of diarrhea, abdominal distension and abdominal pain were significantly lower than those at enrollment ( P < 0.05). Conclusion This study suggests that visceral osteopathy improves short-term and long-term abdominal distension and pain, and also decreases rectal sensitivity in IBS patients. [ABSTRACT FROM AUTHOR]

Hypertrophic osteopathy (HO) is a rare condition in the horse characterised by symmetrical proliferation of connective tissue and subperiosteal bone, along the diaphyses of limb bones. In this case, a 10-year-old Irish Draught cross Thoroughbred mare was presented for investigation of weight loss, lethargy and firm swelling of all 4 distal limbs. Radiographs of the distal limbs revealed palisade-like periosteal new bone formation perpendicular to the cortex of the distal third metacarpal and metatarsal bones, proximal (P1) and mid (P2) phalanges. Rectal examination revealed a mass of approximately 20 x 30 cm in the right caudoventral abdomen. The mare was diagnosed with HO due to a granulosa thecal cell (GTC) tumour. The GTC tumour was removed and the diagnosis confirmed on histological examination. Clinical examination and radiographs of the distal limbs after surgery demonstrated reduction in size of the limb swellings and new bone formation. To the authors' knowledge this is the first report of HO due to a GTC tumour in a mare. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) has been defined as a disorder affecting body movement, motor skills and postural control. It is caused by damage to the developing fetal or infant brain during pregnancy, at birth or during the first 3-5 years of life. Patients with CP often seek out CAM treatments, such as acupuncture. The objective of this study was to examine the evidence for the safety and effectiveness of acupuncture for CP. Four databases (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE and MEDLINE) were searched for RCTs and systematic reviews (SRs) of acupuncture and CP. Titles and abstracts were screened; articles meeting the selection criteria were retrieved in full. Studies were included if they were SRs or RCTs and evaluated the effectiveness of an acupoint stimulation technique in children with CP. Only English and Chinese language papers were included. The search identified seven studies; six RCTs and one quasi-RCT that included acupuncture in at least one group. Three of the RCTs compared different types of acupuncture, while four compared acupuncture to another active intervention, including osteopathy, massage, music and play. The evidence of safety and effectiveness for acupuncture and cerebral palsy is difficult to interpret due to poor reporting. When the effectiveness of a treatment is unknown, data about its safety are paramount. With regards to paediatric needle acupuncture, there is reasonable evidence to suggest that it is safe in trained hands. However, the safety of acupoint injection is unknown, particularly when foreign proteins are being injected. [ABSTRACT FROM AUTHOR]

Background Although the UK Department of Health has advocated the involvement of service users and carers in health research for several years, there is little evidence about their contribution to the design of randomized controlled trials (RCTs). Objective To demonstrate how consulting parents about the design of a study, including which outcomes to use, led to the design and successful delivery of a RCT of osteopathy for children with cerebral palsy (CP). Design Semi-structured interviews were carried out with 20 parents of children with CP and other neurological conditions, asking them to choose between four different trial designs, to talk about noticeable changes in their child's condition and their views about payment for trial treatment. Setting and participants The parents interviewed were all members of Cerebra, a charity for 'brain-injured' children and young people. All interviews were carried out at the parents' homes. Results Parents had mixed views about possible trial designs; however, a waitlist design which allowed all children eventually to receive the treatment emerged as a clear favourite. Parents did not focus on isolated outcomes, but suggested a range of factors relevant to their child's quality of life. They expressed a clear preference for the costs of treatment to be funded by the trial. Conclusions Involvement of parents helped design a trial which was acceptable to families and addressed outcomes that mattered to them. By consulting parents about the design of the research, the subsequent trial achieved excellent recruitment and retention rates. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety and feasibility of studying osteopathic manipulative treatment and its potential effectiveness for patients with vertigo. Design: A nonrandomized pilot study. Setting: Outpatient clinic affiliated with a teaching hospital and osteopathic medical school. Patients: The subjects were older than 18 years of age, with the diagnosis of vertigo for longer than 3 months. Intervention: The patients were treated with osteopathic manipulative treatment (OMT). Main Outcome Measurements: Treatment effectiveness was measured with the use of the Dizziness Handicap Inventory (DHI), a validated symptom inventory. Intensity and duration of adverse effects after OMT were used to measure study safety. Results: Of the 18 patients who were recruited all 18 (100%) met the inclusion criteria and were enrolled in the study. Sixteen patients (88.9%) completed the treatment course with OMT, and data with respect to the DHI were obtained from all 16 (100%). Significant improvement (P < .001) in total and subcomponent DHI scores was observed after completion of treatment. Of the 8 patients with moderate pretest scores, 7 (87.5%) had mild post-test scores after undergoing OMT, and of the 8 patients with severe pretest scores, 4 (50%) had mild post-test scores. Of the 18 enrolled patients, 3 (16.7%) experienced an exacerbation of their vertigo, and 5 (27.8%) experienced muscle soreness after OMT. These adverse effects were mild and transient, not lasting longer than 24 hours. Conclusions: This study showed that OMT is generally well tolerated in patients with vertigo. It also demonstrated that it is feasible to recruit a population of patients with vertigo who can complete a course of OMT and collect data by using the DHI. A randomized control trial that examines the efficacy of OMT in patients with vertigo is warranted, given that OMT may be a reasonable treatment for vertigo and the functional impairment associated with it. [Copyright &y& Elsevier]

Background and Aim: Effective treatment for irritable bowel syndrome (IBS) is not yet available. Osteopathy is a manual treatment which relies on mobilizing and manipulating procedures in order to relieve complaints. In the present study, a randomized controlled trial was carried out to evaluate the effects of osteopathic treatment for IBS. Methods: Eligible IBS patients were randomized between osteopathy and standard care. Follow-up was 6 months and validated means of follow-up were used. After 1, 3 and 6 months an overall assessment of symptoms was noted and a symptom score was obtained on a 5-point Likert scale. Quality of life (QOL) was scored with the standardized IBSQOL 2000 questionnaire and the Functional Bowel Disorder Severity Index was used. Results: Twenty patients were randomized into the osteopathy group (OG) and 19 patients were included in the standard care group (SCG). Sixty-eight percent of patients in the OG noted definite overall improvement in symptoms and 27% showed slight improvement. One patient (5%) was free of symptoms at the end of the study. In the SCG, 18% noted definite improvement, 59% showed slight improvement, and in 17% worsening of symptoms was present. The difference in change in overall symptomatic improvement was statistically significant in favor of the osteopathic treatment ( P < 0.006). Mean Functional Bowel Disorder Severity Index (FBDSI) score in the OG decreased from 174 to 74 at 6 months ( P < 0.0001). Also, a significant decrease was noted in the SCG from 171 to 119 ( P < 0.0001). However, the decrease in the OG was significantly higher compared with the standard treatment ( P = 0.02). Mean symptom score in the OG decreased from 9.1 to 6.8 but this did not reach statistical significance. In the SCG, no change in symptom score occurred (8.7 vs 10). At 6 months, the score in the OG was significantly lower (6.8 vs 10; P = 0.02). The QOL score increased in the OG at 111 versus 129 ( P < 0.009). In the SCG an increase was also noted, but this was not statistically significant (109 vs 121). Conclusion: Osteopathic therapy is a promising alternative in the treatment of patients with IBS. Patients treated with osteopathy overall did better, with respect to symptom score and QOL. [ABSTRACT FROM AUTHOR]

Objective.—The objective of this study was to compare the effects of osteopathic treatment and progressive muscular relaxation (PMR) exercises on patients with tension-type headache (TTH). Background.—Relaxation is generally accepted as a treatment for TTH. Osteopathy is considered by some practitioners to be useful for headache management but there is limited scientific evidence regarding the effectiveness. This study compares relaxation and relaxation plus selected osteopathic techniques in the treatment of people with TTH. Design.—This was a single-blind, randomized, clinical study using an experimental design. Twenty-nine patients with TTH according to the International Headache Classification Subcommittee, 2004, were recruited for this study and randomly placed in either a control or experimental group. Both groups practiced PMR exercises at home while the experimental group also received 3 osteopathic treatments. Method.—All participants recorded headache frequency and intensity in a headache diary (HD) for 2 weeks pretreatment, and continued recording during the treatment period until reassessment for a total of 6 to 7 weeks. All tests of significance were set at P≤ .05. Results.—Twenty-six people completed the study. Results indicated that the number of Headache Free Days Per Week was significantly improved ( P= .016) in the experimental group. Two other measures, the Headache Degree of Improvement ( P= .075) and the HD rating ( P= .059), which combine headache frequency and intensity, did not meet our criteria for statistical significance but both scores are <.10 indicating a trend toward improvement in the experimental group that is clinically significant. The HD Rating also showed that the experimental group improved 57.5%, while the control group improved 15.6%. The intensity of headache did not show a significant improvement ( P= .264). Conclusion.—The people in this study who did relaxation exercises and received 3 osteopathy treatments had significantly more days per week without headache than those who did only relaxation exercises. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the therapeutic efficacy of osteopathic treatment in infants with postural asymmetry. A randomized clinical trial of efficacy with blinded videoscoring was performed. Sixty-one infants with postural asymmetry aged 6 to 12 weeks (mean 9wks) were recruited. Thirty-two infants (18 males, 14 females) with a gestational age of at least 36 weeks were found to be eligible and randomly assigned to the intervention groups, 16 receiving osteopathic treatment and 16 sham therapy. After a treatment period of 4 weeks the outcome was measured using a standardized scale (4–24 points). With sham therapy, five infants improved (at least 3 points), eight infants were unchanged (within 3 points), and three infants deteriorated (not more than –3 points); the mean improvement was 1.2 points (SD 3.5). In the osteopathic group, 13 infants improved and three remained unchanged; the mean improvement was 5.9 points (SD 3.8). The difference was significant (p=0.001). We conclude that osteopathic treatment in the first months of life improves the degree of asymmetry in infants with postural asymmetry. [ABSTRACT FROM AUTHOR]

Abstract: Aims: (a) To investigate how widespread is the use of long term treatment without improvement amongst clinicians treating individuals with low back pain. (b) To study the beliefs behind the reasons why chiropractors, osteopaths and physiotherapists continue to treat people whose low back pain appears not to be improving. Methods: A mixed methods study, including a questionnaire survey and qualitative analysis of semi-structured interviews. Questionnaire survey; 354/600 (59%) clinicians equally distributed between chiropractic, osteopathy and physiotherapy professions. Interview study; a purposive sample of fourteen clinicians from each profession identified from the survey responses. Methodological techniques ranged from grounded theory analysis to sorting of categories by both the research team and the subjects themselves. Results: At least 10% of each of the professions reported that they continued to treat patients with low back pain who showed almost no improvement for over three months. There is some indication that this is an underestimate. reasons for continuing unsuccessful management of low back pain were not found to be primarily monetary in nature; rather it appears to have much more to do with the scope of care that extends beyond issues addressed in the current physical therapy guidelines. The interview data showed that clinicians viewed their role as including health education and counselling rather than a ‘cure or refer’ approach. Additionally, participants raised concerns that discharging patients from their care meant sending them to into a therapeutic void. Conclusion: Long-term treatment of patients with low back pain without objective signs of improvement is an established practice in a minority of clinicians studied. This approach contrasts with clinical guidelines that encourage self-management, reassurance, re-activation, and involvement of multidisciplinary teams for patients who do not recover. Some of the rationale provided makes a strong case for ongoing contact. However, the practice is also maintained through poor communication with other professions and mistrust of the healthcare system. [Copyright &y& Elsevier]

This single case study of a ballet dancer incorporates essentially osteopathy, self-hypnosis and neurolinguistic programming (NLP) in the management of exhaustion, stress, anxiety and pain symptoms of the right thigh, calf and ankle combined with confidence strengthening techniques. Physical and mental burnout symptoms had reached the point of constant pain and overstrain of the muscles of the right leg and hip, spine and neck. In parallel with these were symptoms of exhaustion, unhappiness and a tendency to over-focus on other dancers at the expense of self-focus and motivation. The osteo/physical therapy entailed the rebalancing of overused, strained and hyper-tense muscular tissues using myofascial-release techniques, together with the deactivation of trigger points and postural integration. The mental attitude was supported through refraining techniques during self-hypnosis directed at general feelings of being blocked, imprisoned, cramped, exhausted and weakened in the right leg. Psychophysiological assessment post therapy was compatible with self-regulation training. [ABSTRACT FROM AUTHOR]

A case of hypertrophic osteopathy secondary to a pulmonary spindle cell sarcoma is described. The 9-year-old male cat presented with a 1-month history of decreased appetite, decreased activity and progressive lameness with swelling and pain of all four limbs. Thoracic radiographs showed a soft tissue opaque mass in the left caudal lung lobe. Radiographs of all limbs showed extensive periosteal new bone formation of uniform opacity demonstrating a ‘palisading’ pattern. The lung mass was removed at exploratory thoracotomy; histopathological examination diagnosed a low-grade spindle cell sarcoma. Prior to surgery, the cat had a non-specific conjunctivitis that resolved spontaneously following lobectomy raising the possibility of a paraneoplastic association. The lameness also resolved; six months after surgery, the periosteal palisading of new bone on the long bones had remodelled, and there was no evidence of pulmonary metastases. [ABSTRACT FROM AUTHOR]

Thirty-eight, first year osteopathic medical students provided a morning and afternoon urine sample (analyzed for norepinephrine and dopamine) on a school day. Change from morning baseline served as a measure of naturally induced arousal (i.e., ‘stress’) to a routine school day. They were also asked to fill out questionnaires assessing mood state during the morning session and, during the afternoon session, Type A Behavior, the frequency of 61 signs/symptoms of emotional arousal since the morning session and control data. One hundred and twenty-two Emotional Dyscognizance Indices (cross-sample t-scores for the two urinary amine measures minus t-scores for the 61 emotional frequency scores) were calculated. Each was then correlated with the Type A measure and 21 (17.2%) proved positive and statistically significant (p < .05). None were negative and statistically significant. The probability of such a finding is less than .001. Current results are consistent with the hypothesis of a heightened sympathoadrenomedullary arousal threshold for experiencing a given intensity of negative emotion in the Type A person. Such emotional dyscognizance would cause problems for both diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We report a case of hyperparathyroidism with hypercalcemia caused by a giant parathyroid adenoma. We use a technetium sestamibi scan to locate parathyroid mass. Bone emission computed tomography revealed the classic signs of metabolic osteopathy. She was recovered after parathyroidectomy. We report a case of hyperparathyroidism with hypercalcemia caused by a giant parathyroid adenoma. We use a technetium sestamibi scan to locate parathyroid mass. Bone emission computed tomography revealed the classic signs of metabolic osteopathy. She was recovered after parathyroidectomy. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2010; 17:1–3 © 2010 by the Society for Academic Emergency Medicine Objectives: Osteopathic medical students must take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)–USA series of examinations, but not the United States Medical Licensing Examination (USMLE-1) series. Few data are available describing the comparability of the two tests. This study sought to determine if COMLEX-1 scores could predict USMLE-1 scores among osteopathic medical students applying to an emergency medicine (EM) residency and to determine if the scores are interchangeable. Methods: This was a retrospective analysis of osteopathic medical students applying to an EM residency program in the 2005–2006 and 2006–2007 application seasons. Students were included if they took both the COMLEX-1 and the USMLE-1 examinations. Linear regression was performed and a Bland-Altman plot of the standardized mean scores of each test was created. Results: Ninety students were included. The mean (± standard deviation [SD]) COMLEX-1 score was 559.5 (±68.6), and the mean (±SD) USMLE-1 score was 207.6 (±15.5). The correlation was 0.79, with an R2 of 62.3%. The Bland-Altman plot showed a mean difference between the standardized scores of 0, with 95% confidence intervals (CIs) of −1.28 to +1.28 standard normal units. Limitations include that this was a single center study, and only students who took both tests could be studied. Conclusions: COMLEX-1 scores predict only 62.3% of the variance in USMLE-1 scores, and the scores are not interchangeable. [ABSTRACT FROM AUTHOR]

Diastasis recti abdominis is a condition in which the rectus abdominus muscle separates in the midline at the linea alba producing a ventral herniation. We have observed the occurrence of this condition in HIV-infected men attending an osteopathic clinic. Two such cases are described in detail. An apparent association with HIV-associated lipodystrophy syndrome and implications for management are explored. [ABSTRACT FROM AUTHOR]

The article suggests several courses and conferences including Tennessee Osteopathic Medical Association Convention & Scientific Seminar on April 5-8th, 2018 in Nashville, Tennessee; Sleep and Circadian Rhythms in Aging Symposium on April 13-14th, 2018 in Hoboken, New Jersey, and American Geriatrics Society 2018 Annual Scientific Meeting on May 3-5th, 2018 in Orlando, Florida.

The articles presents information on conferences and online educational opportunities in the field of elder care.

The article presents a speech by Richard W. Valachovic, President of the American Dental Education Association (ADEA) at the 94th ADEA Annual Session & Exhibition in Long Beach, California. Topics discussed include impact of the changing healthcare system on dental care, focus on improving oral health and patient care, and role of ADEA in supporting various health professions including schools of osteopathic medicine, social work and nursing.