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Center for the Future of the Health Professions June 2022 digest

This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion around the past, present, and future of osteopathic manipulative medicine. This update is presented by Karen Snider, DO, FAAO, FNAOME, professor and assistant dean for osteopathic principles & practice integration, neuromusculoskeletal medicine/osteopathic manipulative medicine at A.T. Still University’s Kirksville College of Osteopathic Medicine (ATSU-KCOM). Osteopathic manipulative medicine (OMM) is a systematic approach to patient care that acknowledges the body’s ability to heal itself and optimizes the health of the patient’s body, mind, and spirit. We look forward to your comments.

Randy Danielsen, PhD, PA-C Emeritus, DFAAPA

Professor & Director

The Center for the Future of the Health Professions

A.T. Still University

Osteopathic Manipulative Medicine: Past, Present, and Future

Past

Osteopathic medicine, developed by Dr. Andrew Taylor Still, is a systematic approach to patient care that acknowledges the body’s ability to heal itself and optimizes the health of the patient’s body, mind, and spirit.1,2 Hands-on diagnosis and manual treatment, known as osteopathic manipulative medicine (OMM), are used to address development and progression of disease. OMM has always been a component of holistic patient management in the osteopathic educational curriculum.

Although all osteopathic physicians initially used OMM in patient care, its use has since declined. Reasons for this decline are multifactorial and include clinical time constraints, lack of skill mastery, and difficulties with reimbursement.3 Some suggest osteopathic medicine may now be considered indistinct from allopathic medicine.3 In the U.S., OMM is provided by a minority of osteopathic physicians.3-5 Internationally, the use of OMM is expanding, but is primarily provided by non-physician osteopaths and other manual medicine practitioners.6-8

OMM is beneficial for patients with various clinical problems, and our understanding of underlying physiological mechanisms of OMM is evolving.7,9,10 Like all procedural-based studies, OMM studies are criticized for having fewer participants than pharmacological studies, but meta-analysis can combine results from smaller studies for greater statistical power. Unfortunately, OMM studies will never meet “gold standard” double blinding of both patients and clinicians.

Present

Although clinical use has declined, OMM is still taught at every college of osteopathic medicine (COM), and research suggests hands-on learning of OMM influences empathy of students.11-13 Osteopathic medical students receive a well-rounded education in OMM during their first and second years, guided by the core OMM curriculum of the Education Council on Osteopathic Principles.14 Recommended as the minimum foundation for OMM, this curriculum is reflected on all National Board of Osteopathic Medical Examiners Comprehensive Osteopathic Medical Licensing Examination of the United States exams.15

The Commission on Osteopathic College Accreditation standards also require OMM training,16 but ensuring clinical training and mentorship of OMM during third-year and fourth-year clerkships are challenging.17,18 A.T. Still University’s Kirksville College of Osteopathic Medicine (ATSU-KCOM) addresses this challenge with the Advanced Osteopathic Principles and Practice (OPP) curriculum, now used at 15 COMs. This curriculum teaches students to integrate OMM for comprehensive management of 38 common clinical conditions.19

ATSU-KCOM also supports OPP integration in residency training through the National Center for Osteopathic Principles and Practice Education (NCOPPE),20 which provides scholarly activity support and education through live and on-demand video lectures and workshops. Currently, NCOPPE provides education in 31 residency programs, including surgery, family medicine, and internal medicine (IM).

Future

The future of OMM embodies hope and caution. The Accreditation Council for Graduate Medical Education (ACGME) Osteopathic Recognition program accredits residency programs integrating OPP.21 These programs are reviewed annually to ensure meaningful OPP integration. Thus, osteopathic and allopathic physicians who want to integrate OMM into patient care are mentored and trained during residency.

Although ACGME accepts American Osteopathic Association board certification for IM program directors,22 in 2024, residents under such directors will be ineligible to certify through the American Board of Internal Medicine (ABIM).23 Currently, ABIM is the only specialty board that excludes residents trained under osteopathically boarded physicians from eligibility. In future, IM physicians may avoid osteopathic board certification, reducing IM residency programs providing OPP training. Overcoming this barrier will require ABIM to grant eligibility to all residents completing ACGME-accredited IM residencies.

Ultimately, the future of OMM in the United States rests with those using it to care for patients. Although challenges to mentorship and training persist, they can be overcome by confronting professional biases and ensuring everyone has access to education and hands-on training. ATSU will continue to help the osteopathic profession meet these challenges with quality resources for OMM mentorship and training.

References

1. Seffinger MA, ed. Foundations of Osteopathic Medicine: Philosophy, Science, Clinical Applications, and Research. 4th ed. Wolters Kluwer; 2018.

2. Haxton J. Andrew Taylor Still: Father of Osteopathic Medicine. Truman State University Press; 2016.

3. Healy CJ, Brockway MD, Wilde BB. Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States. J Osteopath Med. 2021;121(1):57-62. doi:

10.1515/jom-2020-0013

4. Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76(8):821-828.

doi:10.1097/00001888-200108000-00016

5. Spaeth DG, Pheley AM. Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties. J Am Osteopath Assoc. 2003;103(1):16-26.

6. Ellwood J, Carnes D. An international profile of the practice of osteopaths: a systematic review of surveys. Int J Osteopath Med. 2021;40:14-21. doi:10.1016/j.ijosm.2021.03.007

7. Osteopathic medicine and osteopathy: defining the profession. Osteopathic International Alliance. Accessed April 6, 2022. https://oialliance.org/about-us/osteopathic-medicine-and-osteopathy/.

8. The OIA global report: global review of osteopathic medicine and osteopathy 2020. Osteopathic International Alliance. Accessed April 6, 2022.

9. Nelson KE, Glonek T, eds. Somatic Dysfunction in Osteopathic Family Medicine. 2nd ed. Wolter Kluwer Health; 2015.

10. Hruby RJ, Tozzi P, Lunghi C, Fusco G, eds. The Five Osteopathic Models: Rationale, Application, Integration—From an Evidence-Based to a Person-Centered Osteopathy. Handspring Publishing; 2017.

11. Licciardone JC, Schmitt ME, Aryal S. Empathy in medicine osteopathic and allopathic physician interpersonal manner, empathy, and communication style and clinical status of their patients: a pain registry-based study. J Am Osteopath Assoc. 2019;119(8):499-510. doi:10.7556/jaoa.2019.092

12. Rizkalla MN, Henderson KK. Empathy and osteopathic manipulative medicine: is it all in the hands? J Am Osteopath Assoc. 2018;118(9):573-585. doi:10.7556/jaoa.2018.131

13. Kimmelman M, Giacobbe J, Faden J, Kumar G, Pinckney CC, Steer R. Empathy in osteopathic medical students: a cross-sectional analysis. J Am Osteopath Assoc. 2012;112(6):347-355.

14. Hensel K, Cymet T. A Teaching Guide for Osteopathic Manipulative Medicine. 2nd ed. American Association of Colleges of Osteopathic Medicine; 2018.

15. COMLEX-USA master blueprint: osteopathic principles, practice, and manipulative treatment. National Board of Osteopathic Medical Examiners. Accessed April 6, 2022.

https://www.nbome.org/assessments/comlex-usa/master-blueprint/competency-domains/principle s/.

16. Accreditation of colleges of osteopathic medicine: COM continuing education standards. Commission on Osteopathic College Accreditation. Updated July 1, 2019. Accessed April 6, 2022.

https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf.

17. Shubrook JH Jr, Dooley J. Effects of a structured curriculum in osteopathic manipulative treatment

(OMT) on osteopathic structural examinations and use of OMT for hospitalized patients. J Am Osteopath Assoc. 2000;100(9):554-558.

18. Teng AY, Terry RR, Blue RJ. Incorporating a mandatory osteopathic manipulative medicine (OMM) curriculum in clinical clerkships: impact on student attitudes toward using OMM. J Am Osteopath Assoc. 2011;111(4):219-224.

19. A.T. Still University (ATSU) catalog: 2021-22 university catalog. A.T. Still University. Accessed April 6, 2022. https://catalog.atsu.edu/mime/media/16/286/2021-22+University+Catalog.pdf.

20. National Center for Osteopathic Principles and Practice Education. A.T. Still University. Accessed April 6, 2022. https://www.atsu.edu/ncoppe/.

21. Osteopathic recognition requirements. Accreditation Council for Graduate Medical Education. Updated July 1, 2021. Accessed April 6, 2022.

https://www.acgme.org/globalassets/pfassets/programrequirements/801_osteopathicrecognition_2 021v2.pdf.

22. ACGME program requirements for graduate medical education in internal medicine. Accreditation Council for Graduate Medical Education. Updated February 7, 2021. Accessed April 6, 2022. https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/140_InternalMedicine_2022_ TCC.pdf?ver=2021-02-19-152901-957&ver=2021-02-19-152901-957.

23. AOA staff. Announcement regarding ABIM program director policy. American Osteopathic Association. Published February 9, 2022. Accessed April 6, 2022.

https://osteopathic.org/2022/02/09/announcement-regarding-abim-program-director-policy/#:~:tex t=ABIM%20will%20continue%20to%20accept,by%20ABIM%20in%20their%20discipline.

One of the highlights of our conversation with Dr. Mathieson on the latest TLC podcast episode was discussing what is up and coming in education. The Horizon Report, published each year by EDUCAUSE was referenced as a resource that lists the latest trends, technologies, and practices which are predicted to shape the future of teaching and learning. Over the next few months, the TLC Hot Take will focus on the most notable topics and will summarize their implications for health science education. At the same time, we encourage you to connect with the TLC and share which resources you turn to regarding the future of health science education.

This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.

This month features a follow up to last June’s article entitled “Confessions of a recovering sage on the stage performer” by Dr. Gevitz. This month features further discussion surrounding the traditional classroom lectures for health professions students in another tongue-in-cheek presentation by Norman Gevitz, PhD, professor of history and sociology of health professions and senior vice president-academic affairs at A.T. Still University (ATSU). We look forward to your response.

I received a mixed reaction to my essay following my previous piece in the Digest. Some readers defended “the lecture” as the most time-efficient means by which students can organize their studying for an exam given by a professor. Actually, I agree, but with this caveat. There is no necessary correlation between passing an internal examination on a delimited amount of subject matter and preparing for and doing well on an externally administered assessment on a broader and deeper set of learning objectives on the same subject.

When I was at the Ohio University College of Osteopathic Medicine, faculty members worked in teams to put together the Calgary-style curriculum. We had approximately 12 teams, and each team—usually five members—were composed of at least one basic scientist, one clinician, and one social scientist. During the first meeting of the “respiratory block” meeting, I left the room briefly, and upon my return, I found that I was elected the block leader in my absence. For 10 years, I led the block and benefitted by having and retaining three other core members who took the task seriously of organizing the curriculum, deciding on learning objectives, scheduling, preventing the presentation of duplicative material, and writing and selecting test questions. Individual faculty members owned the curriculum they were responsible for but not the assessment, which was a block committee’s responsibility. All questions, whether written by the given presenter or by members of the block committee, were tied to stated learning objectives, and the presenter could not give hints on what would be on the test as she/he did not know. This meant that the student studied a broad set of learning objectives rather than just a PowerPoint which we concluded better-prepared students for taking an externally administered exam.   

In my last piece for the Digest, I argued that a lecture is warranted when it brings together a synthesis of material not to be found in a textbook or another single source. Some readers challenged me with giving an example. Such is the purpose of the rest of this essay, based on a lecture I gave at Ohio University and how I would now hopefully improve it.

The lecture was entitled “Feces happens: A brief history of constipation and diarrhea.” I was asked by members of the gastrointestinal block to provide either an ethical or social science presentation as our college goal was to ensure that all blocks integrated the social dimension of medicine. I responded with the aforementioned title explaining to the block members my familiarity with the history of unorthodox and over-the-counter remedies to treating constipation as well as the differing perceptions of physicians and patients over the significance of constipation and diarrhea, where patients—particularly older patients—believed that a daily bowel evacuation was a vital key to their health. In contrast, physicians regarded diarrhea as a more concerning symptom of an underlying problem. The block members agreed with my reasoning, and I began to create my presentation.

Indeed, it was a novel subject—not something one would ordinarily find in a gastroenterology text. Two history of medicine colleagues, James Whorton and Micaela Fowler-Sullivan, had written seminal pieces on earlier physicians’—both orthodox and orthodox—fascination with the colon and the interesting and unusual means employed to keep defecation regular. They also explored theories of autointoxication, whereby scientists and others postulated that gases and bacteria escaped the colon and these agents were responsible for a plethora of systemic ills of humankind. In addition, I recovered advertisements for various prescribed and over-the-counter remedies and examined studies that estimated the number or percentage of patients whose presenting complaint was missing their daily bowel movement. Finally, I read articles that included discussions of delayed care for dehydrated patients who did not think their diarrhea was symptomatic of anything serious. I had great fun putting this presentation together. The slides were colorful and somewhat startling. I had time at various points during the presentation to engage the students in discussion.

Based on the student evaluations, I believe I accomplished my overriding goal, which was to get students to recognize that patient and physician perceptions of the seriousness of symptoms or maladies may differ, and part of the responsibility of physicians is to educate patients. For example, taking over-the-counter remedies for constipation, particularly in large doses, can be harmful, as well as ignoring persistent diarrhea. Nevertheless, the student evaluations also revealed a serious failure on my part. While certainly, I included a social science element into the gastrointestinal block curriculum, I had not sufficiently melded a basic science or clinical dimension into my presentation. In the words of one student’s stinging rebuke, “Dr. Gevitz gave a fascinating presentation, but how does any of the material he presented help me prepare me for the board exams? What a waste!” My first reaction was to dismiss the comment. Indeed, not everything presented in the medical school curriculum needs to be tested on the national boards. However, the more I thought about it, the more I became convinced I had missed an opportunity to be more integrative.

To do so, I would now extend the one-hour session to a two-hour presentation and team-teach “Feces happens” with a basic scientist and a clinician. The basic scientist would discuss the process by which fecal matter is ultimately formed and how the elimination of waste material in a solid, semi-solid, or liquid state occurs. The basic scientist and the clinician would discuss the underlying pathology associated with constipation and diarrhea. The clinician would also discuss the clinical manifestations of the underlying pathology and the medical or surgical treatment or recommended change of diet and lifestyle. Also, extending the session to two hours would allow more time for class discussion and interaction. This organization of the session would better accomplish greater integration of basic science, clinical science, and social science materials.

As faculty members, we tend to forget the good student reviews and remember the stinging ones. Sometimes the stinging ones are a reminder that we are not the only or ultimate arbiter of the quality or usefulness of a presentation. These reviews may, on occasion, push us to make our presentations better. Hopefully, it all comes out better in the end. 

Room reservations

Beginning May 1, 2022, study room requests on the Missouri campus library are now being considered on a first come, first served basis. 

If you need to reserve a study room for a group or special meeting, please contact the library at 660.626.2345, libmo@atsu.edu, or in person at the circulation desk. 

Please contact the circulation desk to reschedule or cancel reservations.

Food policy

Keeping with updated mask policies on campus, the library’s food policies have been updated as follows, effective immediately:

  • Snacks, including fruit and covered beverages are allowed
  • Complete meals and messy food are not allowed (including popcorn)
  • If you need a spoon, fork, or knife to eat the item, it is not allowed
  • If you have it delivered from an outside source (e.g. pizza), it is not allowed

A.T. Still Memorial Library is pleased to welcome a new assistant librarian in Santa Maria, California, and a temporary library assistant in Mesa, Arizona.

Dot Winslow

Dot Winslow, MFA

Dot Winslow (she/her) is the new assistant librarian at the Santa Maria campus. She lives in Santa Maria, California, with her husband, stepdaughter, two rabbits, and a snake. Winslow is a poet and holds her MFA in creative writing from Antioch University, and is training to become a certified applied poetry facilitator. In her down time, she likes to craft, catch up on anime, rewatch her favorite shows, and read a wide variety of books. She also enjoys fantasy football and hockey, and cheers on the Saint Mary’s College Gaels men’s basketball team and the San Francisco Giants. 

Mari Murillo

Mari Murillo

Mari Murillo is an undergrad biology major at Arizona State University. Murillo recently joined as the temporary library assistant in Mesa, Arizona. Murillo enjoy hiking, trying new foods, and spending time at the movies.

New streaming videos from SAGE Video Nursing Collection and Films on Demand were recently added to the library catalog. 

SAGE Video Nursing has added new content on nursing & diversity, nursing & mental health, nursing & leadership, and nursing in times of crisis. New videos in this collection include a presentation on the assessment of intimate partner violence in rural areas and a BBC Horizon documentary on end-of-life care. New Films on Demand content includes a PBS documentary about Helen Keller’s life and a video on best practices for rehabilitation via telehealth.

The library has a wide variety of streaming videos available to users; we invite you to check them out.

Exam prep resources

In addition to our robust collection of Exam Prep Resource LibGuide, the A.T. Still Memorial Library is happy to announce four new trial databases for exam prep. To serve the needs of all stakeholders, we are on a database trial, and welcome any feedback regarding ease of access, applicability to curriculum, and advancement of research you may have on these resources to determine their on going value to the University.

LWW Health Library: Board Review Series covers all the core basic sciences and affords an efficient method of studying by providing content in an easy-to-digest outline format containing review questions with accompanying answers and detailed explanations—chapter exams and a comprehensive exam for each text—clinical information, full-color illustrations, photographs, and tables.

Lippincott Board Prep for MD/DO students offers USMLE-style questions for USMLE Steps 1 and 2 and COMLEX levels 1 and 2. It also offers board-style clinical vignettes with complete answer explanations. 

LWW Health Library: Orthopedic Surgery offers a comprehensive selection of procedure-focused texts and videos designed to guide residents, surgeons and rehabilitation professionals. 

Lippincott Board Prep for PA students has 14 major content areas of the PANCE, board-style clinical vignettes with complete answer explanations and End of Rotation exams. 

All LWW and Lippincott resources require (free) personal account to be registered with your ATSU email for access. 

You can find these resources through the Databases link on the library home page. New databases are listed on the bottom right hand corner of the page under “trial databases.” 

Please send your feedback and comments regarding these resources to libmo@atsu.edu or libaz@atsu.edu.

New LibGuide

Check out our new LibGuide on how to identify a good research topic and narrowing down or broadening your research topic.

Updated Sage Research Methods database

Sage Research Methods, a cross-disciplinary research methods tool which provides full access to books, journals, case studies, videos about designing and conducting a research project, specific research methods, performing literature review, and writing about research results. It also includes full text Little Green Books and Little Blue Books.

It’s warming up in Kirksville, and starting to sizzle in Arizona, it’s always perfect in Santa Maria, and the final stretch of the year is upon us. Congratulations to our almost-graduates of A.T. Still University’s (ATSU) classes of 2022. In addition to the undergraduates of these colleges, congratulations to the inaugural Central Coast Physician Assistant program class for a successfully completing their first academic year.

In my last newsletter, I announced our newly negotiated, transformative agreement with the Wiley publisher journals where ATSU faculty/staff can have their open-source APC fees waived in the hybrid journals of that company. In addition, I am pleased to announce that a similar agreement has been reached with the Cambridge publishing house hybrid journals.

Finally, I hope you took advantage of the plethora of educational offerings that have been available this spring. Maud Mundava, MLS, MBA, co-taught a plagiarism class with the University Writing Center. Laura Lipke, MLIS, MOT, has taught several sessions of “How to Research 101 for the Student” course; I will be talking about open science/open access achievements within academia and how our library supports this endeavor which our faculty to disseminate their research on a more equitable scale.

Enjoy the spring: it is warm and full of hope. Look for new database announcements in the next few weeks.

This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion around hearing loss and comorbidities: considerations for healthcare education and patient care in the U.S. This month’s feature is authored by Tabitha Parent-Buck, AuD, professor and chair of audiology and speech-language pathology, program director, entry-level doctor of audiology program at A.T. Still University. Dr. Parent Buck has published in the areas of hearing aid technology, otoacoustic emissions, vestibular evaluations, and pharmacology. In addition, she has conducted numerous presentations on the AuD movement, otoacoustic emissions, pharmacology for audiologists, web-based educational tools, frequency compression hearing aids, neuroanatomy, genetics, and embryology. Dr. Parent Buck is a past-president of the Academy of Doctors of Audiology.

Hearing loss and comorbidities: Considerations for healthcare education and patient care

The relationship between hearing and balance disorders and other medical conditions is not new. Audiology education has emphasized the importance of understanding a patient’s overall health, communication needs, fall risk, and factors impacting the quality of life. The term comorbidities is common in audiology literature, and there is a realization that hearing loss is not an isolated sensory disorder. Statistics from the National Institute on Deafness and Other Communication Disorders highlight that 30 million people in the U.S. aged 12 years or older have bilateral hearing loss. In addition, approximately 25% of individuals aged 65-74 and 50% of those over 75 years of age have disabling hearing loss.8  Research studies and meta-analyses from across the globe have linked the following conditions to hearing loss: social isolation, depression, falls, cardiovascular disease, diabetes, cognitive impairment and dementia, anemia, psoriasis, rheumatoid arthritis, kidney disease, and others.1-2, 5-7, 9 In the last decade, increased focus has been placed on the interrelationship of hearing loss and cognitive decline and on balance disorders, falls, and hospitalizations. The COVID-19 pandemic has added yet another layer of attention to the negative impact of hearing on the ease of communication and positive interpersonal interactions. With the use of masks during the pandemic, communicating with any level of existing hearing loss, and even with normal hearing, has been challenging. As we look toward the future, it is critical to consider hearing and balance function for patients of all ages, with various healthcare team members making referrals to audiologists and audiologists making referrals to other healthcare providers for evaluation and management of comorbid conditions.

The education of future doctors of audiology finds a highly appropriate home within A.T. Still University (ATSU), with its vital mission focused on “a commitment to continue its osteopathic heritage and focus on whole-person healthcare.” Whole person healthcare across the professions, including audiology, is more critical than ever. The doctor of audiology programs at ATSU provide students with the breadth of knowledge to work collaboratively with other healthcare team members to assess and manage patients with hearing loss and comorbid conditions. In addition, there are interprofessional opportunities for students across disciplines to learn with and from one another regarding hearing loss and various health conditions. Healthcare education must continue to promote the knowledge and confidence of future graduates to engage in the multidisciplinary care of patients.

It is not feasible to delve into all of the comorbidities in this article, but looking at just a couple will show a great deal of interplay between the conditions. For example, let us begin by considering hearing loss and falls. The Centers for Disease Control and Prevention reports that one out of four older adults falls each year, and one out of five falls leads to serious injury (e.g., hip fractures, traumatic brain injury).3 Individuals who have fallen or are afraid of falling may reduce their activities. This reduction in daily activities can correspond with increased weakness, increased chances of falling, and other social isolation and depression issues. Falls and mobility restrictions are also among the conditions associated with hearing loss. So now we have links between hearing loss and falls, and both hearing loss and falls can increase social isolation and depression. 

Now let us add cognitive decline to the picture. A 2011 study by Frank Lin and colleagues spotlight the relationship between hearing loss and dementia. The prospective study of 639 individuals over approximately 12 years concluded that “hearing loss is independently associated with incident all-cause dementia”.6 Research evidence linking hearing loss and cognitive decline has continued to grow. In 2020, an update from the Lancet Commission on Dementia Prevention, Intervention and Care described 12 potentially modifiable risk factors accounting for approximately 40% of worldwide dementia, and hearing loss is at the top of the list for midlife factors. Depression, social isolation, and physical inactivity make the list of later life factors.7 So, once again, the interrelationship of hearing loss with several comorbid conditions is evident. Hearing loss is a modifiable risk factor for dementia and other problems. More work needs to be done to identify hearing loss, counsel patients, and modify the risk factor.

The interactions between comorbid conditions can be a bit convoluted, and there is not always direct evidence of which conditions came first or which ones are modifiable. The evolving big picture is the importance of increased awareness by patients, audiologists, and all healthcare providers, regarding the comorbidities and the benefits of patients receiving hearing and balance assessment and management in conjunction with other care. Understanding the hearing and balance status and providing amplification or other management strategies may mitigate some of the impacts. Management of hearing loss can also improve the communication between patients and other healthcare providers during office visits. It is becoming quite common for patient intake processes in hospitals or medical offices to gather information about patients’ falls or fear of falling. A recent 2022 article in the AMA Journal of Ethics describes why primary care clinicians should routinely examine the mouth.4 It is excellent to see falls and oral disease receiving attention. With substantial evidence about hearing loss and comorbid conditions, it is also time for healthcare providers to ask about ears routinely. This can be done with a simple question or short hearing loss questionnaire and also by recommending an annual hearing evaluation.

References

  1. Abrams H. (2017) Hearing loss and associated comorbidities: What do we know? Hear

Rev 24 (12):32–35.

  • Besser J, Stropahl M, Urry E, Launer S. (2018) Comorbidities of hearing loss and

the implications of multimorbidity for audiological care. Hear Res 369:3–14.

  • Centers for Disease Control and Prevention. (2021). Facts about Falls. Retrieved from

https://www.cdc.gov/falls/facts.html

  • Feierabend-Peters, J., & Silk, H. (2022). Why Should Primary Care Clinicians Learn to

Routinely Examine the Mouth? AMA Journal of Ethics, 24(1), 19–26.

  • Hall III, J. W. (2019). Comorbid Conditions Associated with Hearing Loss: Another

Challenge in Educating AuD Students. Audiology Today31(3), 74–75.

  1. Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L.

(2011). Hearing loss and incident dementia. Archives of neurology68(2), 214–

220. https://doi.org/10.1001/archneurol.2010.362

  1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and

care: 2020 report of the Lancet Commission. The Lancet 2020.

  • National Institute on Deafness and Other Communication Disorders. (2021). Quick

Statistics About Hearing. Retrieved from https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

  • Tsimpida, D., Kontopantelis, E., Ashcroft, D. M., & Panagioti, M. (2021). The dynamic

relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA). Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-021-02155-0

A.T. Still Memorial Library in Kirksville, Missouri, has been awarded $6,100 from the Kirksville Osteopathic Alumni Association (KOAA) and A.T. Still University-Kirksville College of Osteopathic Medicine’s (ATSU-KCOM) Education Program Fund to purchase anatomical models for the library’s Missouri location.

The library will purchase nine new anatomical teaching and study tools, including:

  • 3D-printed right thoracic wall, axilla, and root of the neck model
  • functional knee joint and elbow models
  • 3D-printed superficial dissection of the upper limb

These models will be available to faculty and students on the Missouri campus to be utilized as teaching tools and study aids for medical and dental students.

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