Machine Learning-Augmented Propensity Score-Adjusted Multilevel Mixed Effects Panel Analysis of Hands-On Cooking and Nutrition Education versus Traditional Curriculum for Medical Students as Preventive Cardiology: Multisite Cohort Study of 3,248 Trainees over 5 Years.

BACKGROUND: Cardiovascular disease (CVD) annually claims more lives and costs more dollars than any other disease globally amid widening health disparities, despite the known significant reductions in this burden by low cost dietary changes. The world's first medical school-based teaching kitchen therefore launched CHOP-Medical Students as the largest known multisite cohort study of hands-on cooking and nutrition education versus traditional curriculum for medical students. METHODS: This analysis provides a novel integration of artificial intelligence-based machine learning (ML) with causal inference statistics. 43 ML automated algorithms were tested, with the top performer compared to triply robust propensity score-adjusted multilevel mixed effects regression panel analysis of longitudinal data. Inverse-variance weighted fixed effects meta-analysis pooled the individual estimates for competencies. RESULTS: 3,248 unique medical trainees met study criteria from 20 medical schools nationally from August 1, 2012, to June 26, 2017, generating 4,026 completed validated surveys. ML analysis produced similar results to the causal inference statistics based on root mean squared error and accuracy. Hands-on cooking and nutrition education compared to traditional medical school curriculum significantly improved student competencies (OR 2.14, 95% CI 2.00-2.28, p < 0.001) and MedDiet adherence (OR 1.40, 95% CI 1.07-1.84, p = 0.015), while reducing trainees' soft drink consumption (OR 0.56, 95% CI 0.37-0.85, p = 0.007). Overall improved competencies were demonstrated from the initial study site through the scale-up of the intervention to 10 sites nationally (p < 0.001). DISCUSSION: This study provides the first machine learning-augmented causal inference analysis of a multisite cohort showing hands-on cooking and nutrition education for medical trainees improves their competencies counseling patients on nutrition, while improving students' own diets. This study suggests that the public health and medical sectors can unite population health management and precision medicine for a sustainable model of next-generation health systems providing effective, equitable, accessible care beginning with reversing the CVD epidemic.

PROMOTE Study: Safety of Osteopathic Manipulative Treatment During the Third Trimester by Labor and Delivery Outcomes.

BACKGROUND: Few quality data exist on the safety of osteopathic manipulative treatment (OMT) during pregnancy. The Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study was a randomized controlled clinical trial that studied the application of an OMT protocol to manage pain and dysfunction in pregnant patients during their third trimester. OBJECTIVE: To evaluate the safety of an OMT protocol applied during the third trimester of pregnancy by analyzing incidence of high-risk status and labor and delivery outcomes. METHODS: In the PROMOTE study, 400 pregnant patients were randomly assigned to 1 of 3 study groups: usual care plus OMT (OMT), usual care plus placebo ultrasound treatment (PUT), or usual care only (UCO). The incidence of high-risk status of participants and outcomes of labor and delivery, including length of labor, fever in mother during labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, meconium-stained amniotic fluid, and infants' Apgar scores, were analyzed. RESULTS: Data from 380 participants were studied. High-risk status was less likely to develop in participants who received OMT (95% CI, 0.16-0.91; P=.03). The OMT protocol also did not increase risk of precipitous labor, operative vaginal delivery, conversion to cesarean delivery, need for forceps or vacuum device, need for episiotomy, incidence of perineal laceration, or meconium-stained amniotic fluid when compared with participants in the other 2 groups (P>.05). Of all other maternal outcomes examined, no difference was reported among the 3 treatment groups with the exception of incidence of prolonged labor in the OMT group. Participants receiving OMT had longer durations of labor than participants in the other groups (P=.002). CONCLUSION: These results suggest that the OMT protocol given during the third trimester of pregnancy as applied in the PROMOTE study is safe with regard to labor and delivery outcomes. The increased duration in labor in the OMT group needs further study. (ClinicalTrials.gov number NCT00426244).

Programmatic Approach to Increasing Osteopathic Medical Student Participation in Research: The TCOM Experience.

Providing medical students with a meaningful research-based educational experience will help them become exemplary physicians and informed consumers of medical research outcomes in the practice of evidence-based medicine. By participating in research projects during medical school, students have the opportunity to study specific fields that interest them in greater depth and develop their written and oral presentation skills. Studies indicate that students who have participated in research and scholarly activities during medical school are at an advantage when matching to their preferred residency. In this article, the authors outline programs and projects that provide opportunities for osteopathic medical students at the University of North Texas Health Science Center Texas College of Osteopathic Medicine to research concepts and conduct hypothesis-driven, hands-on research projects.

Research funding at colleges of osteopathic medicine: 15 years of growth.

CONTEXT: Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years. OBJECTIVES: To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999. METHODS: Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases. RESULTS: Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years. CONCLUSIONS: The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once "critical mass" for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.

A practical method for increasing scholarly activity in an academic family medicine department.

BACKGROUND: Providing a stimulating environment designed to increase scholarly activity is becoming increasingly difficult in today's academic medicine departments. This article was written to communicate methods and results of a practical program designed to increase scholarly activities in an academic medicine department. DESCRIPTION: A straightforward program was developed and implemented with the objective of increasing scholarly activity in an academic medicine department. Concomitant departmental changes in scholarly activities including publications, lecturing, and research were determined over a 3-year period. EVALUATION: At Year 3 post program initiative, there was a significant increase in the number of faculty members publishing (from 15.8%-73.7%). The number of articles submitted to peer-reviewed journals increased from 5 to 44, and the number accepted increased from 8 to 10. The number of national lectures given by faculty increased from 1 to 17, whereas the number of local lectures did not increase. CONCLUSION: A straightforward program can be effectively used to increase scholastic endeavors such as writing and lecturing in an academic setting.

A divisional approach to enhancing research among osteopathic family practice residents.

There is an increasing demand to expose osteopathic family practice residents to research. Within the Department of Family Medicine at the University of North Texas Health Science Center at Fort Worth-Texas College of Osteopathic Medicine, the Division of Education and Research (DEAR) was developed in 1999. The primary focus of DEAR is to provide the necessary resources and knowledge for faculty members and residents to conduct research and accomplish scholarly activities. Guidelines are implemented to ensure the timeliness, efficiency, and completion of each resident's paper. The efficacy of DEAR's policies is evaluated annually through surveying the residents, tracking paper submissions to the resident director, and tracking publications and presentations. The expectation of DEAR's resident research component is full completion of a resident paper suitable for publication in a peer-reviewed journal before graduation. Initial evaluation suggests positive strides toward reaching this goal. Future successes will be determined by monitoring the next few years.