journal: Journal of Osteopathic Medicine

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Zeitschrift Open Access

Journal of Osteopathic Medicine

Sprache: Englisch

Erstveröffentlichung: 1. Januar 1900

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Über diese Zeitschrift

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

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

Open Access
A crisis within the physician shortage in the United States: the need for consistent 12-week paid parental leave

5. Mai 2026

Kali Chiriboga

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Parental leave policies for physicians in the United States remain inconsistent and inadequate, despite growing recognition of their critical role in supporting families’ well-being and retention in the workplace. While federal efforts such as the Family and Medical Leave Act (FMLA) and the Federal Employee Paid Leave Act (FEPLA) provide some relief, their limitations – especially regarding wage replacement and eligibility – leave many physicians without sufficient support. State-level paid parental leave (PPL) programs offer uneven coverage, with only 13 states offering such programs and wide variability in duration and compensation. Physicians, as a unique professional group, experience higher levels of burnout compared to other professions, with female physicians facing even greater risk. This is compounded by later childbearing ages and increased risk of pregnancy-related complications. Surveys reveal that most female physicians feel that their parental leave benefits are insufficient and often rely on short-term disability, paid time off (PTO), or unpaid leave to recover from childbirth and care for their newborns. This lack of comprehensive support can contribute to burnout, depression, and increased attrition from the medical workforce. The United States faces a projected shortage of up to 86,000 physicians by 2036, with burnout and family obligations driving some physicians to reduce hours or leave the profession entirely. Evidence from other industries and the military demonstrates that robust PPL policies improve retention, reduce gender-based attrition, and offer substantial cost savings with a significant return on investment for every dollar spent. This review and policy proposal highlights the unique challenges faced by physicians and the urgent need for targeted federal and state-level policy interventions to advance PPL and improve the physician workforce sustainability in the United States.
Open Access
Correlational analysis of COMAT FBS and COMLEX-USA Level 1 scores

29. April 2026

Jinghua Liu, Stuart Barnum, Robert Dukat, Min Liang

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Context The National Board of Osteopathic Medical Examiners (NBOME) provides the Foundational Biomedical Sciences (FBS) examinations – FBS-Comprehensive and FBS-Targeted – to support the evaluation of osteopathic medical knowledge. These assessments were launched in 2018 and 2020, respectively. However, the relationship between FBS performance and performance on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 has not been fully explored. Objectives The purpose of this study is to investigate the relationship between performance on Comprehensive Osteopathic Medical Achievement Test (COMAT) FBS assessments and COMLEX-USA Level 1 scores. Methods This study analyzed the examination performance of first-time COMLEX-USA Level 1 test-takers who completed an FBS assessment between 2021 and 2024. Pearson pairwise correlation analyses were conducted to evaluate the relationship between FBS scores and Level 1 performance. Results The Pearson correlation coefficient between the FBS-Comprehensive and COMLEX-USA Level 1 was r =0.63. Correlations between the FBS-Targeted assessments and COMLEX-USA Level 1 ranged from r =0.50 to r =0.64. These indicate strong positive linear relationships between the two assessments. Conclusions This study demonstrates a strong correlation between FBS performance and COMLEX-USA Level 1 outcomes. These findings provide empirical support for the use of COMAT FBS assessments as valuable tools for gauging students’ readiness for COMLEX-USA Level 1.
Open Access
Pain: a century-old approach to treatment with objective documentation

29. April 2026

Precious L. Barnes, Frank J. Casella, Hilda Lai, Olavi Airaksinen, Michael L. Kuchera

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Context While medications have their place in the treatment of pain, incorporating the century-old practice of osteopathic manipulative treatment (OMT) into pain treatment protocols may be beneficial. OMT has been administered with positive results in the reduction of pain, but it has been difficult to quantify palpable somatic changes, post-OMT. However, with technological advancement, adding objective documentation could potentially support the many published subjective studies demonstrating OMT effectiveness, reproducibility of OMT techniques, and the effect of OMT in pain reduction. Objectives This study documented objective changes in cervical hysteresis, consistent reproducible palpatory diagnosis, and treatment pressures with associated pain levels. Methods A total of 213 subjects were enrolled and randomized into two treatment groups. Subjects reported their cervical pain via pre- and posttreatment questionnaires. One physician measured somatic tissue hysteresis pre- and posttreatment in all cervical segments utilizing the ULTRAlign SA201 ® . A second physician independently diagnosed for significant somatic dysfunction and treated with cervical OMT (while wearing the IsoTouch ® palpation monitoring system). Results Statistically significant or suggestive overall cervical changes were observed in all four ULTRAlign SA201 ® hysteresis measurement components. Consistent diagnostic and treatment IsoTouch ® pressure measures were documented in the cervical region. Neck pain subjects reported pain reduction posttreatment, with no subjects remaining in the severe pain subgroup. Conclusions Statistically significant or suggestive objective cervical hysteresis changes were noted after direct method OMT, along with a reduction in pain scores in this subject population. Consistent palpatory pressures for cervical diagnosis and treatment were measured, supporting the reproducibility of these techniques.
Open Access
Manual therapy modalities and depression: a systematic review

27. April 2026

Paulyna Schulz, Teodor Huzij

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Context Depression and other mood disorders have a significant impact on patients, affecting their daily functioning, physical health, and emotional well-being. While psychopharmacological medications and psychotherapy are the most common evidence-based treatments (supported by a significant amount of scientific research), there is growing research that supports the use of complementary therapies (nonmainstream approaches utilized together with conventional medicine), including manipulative or manual therapies. Objectives This systematic review contributes to the existing literature by evaluating published studies on the effectiveness of various manual-therapy modalities in reducing depression symptoms, and it provides a comparative examination of these modalities as complementary treatment options for depression and related mood disorders. Methods A comprehensive literature search was conducted from January to April 2025 utilizing PubMed, Embase, and Google Scholar. Search results were uploaded to DistillerSR to assist with the screening phase. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required studies to be to be peer-reviewed, published in English, assessed mood disorder symptoms as a primary variable, utilized validated depression measures pre- and postintervention, and involved manual therapies administered by qualified professionals. Selected articles were independently evaluated by authors with two metrics: a level of evidence (LOE) table and a screening criterion incorporating specific elements from the search process. The Strength of Recommendation Taxonomy (SORT) was utilized to assess the quality of the studies. Results The literature search gathered 6,661 articles that were uploaded to DistillerSR. Then 717 duplicates were removed, so 5,944 articles were screened. Ultimately, 5,810 articles were excluded during title and abstract screening. Full-text analysis was conducted on 132 articles, of which 97 met the inclusion criteria. The following modalities were studied: acupressure, acupoint massage, bone setting, chiropractic manipulation, craniosacral therapy, energetic and light touch therapies, manual therapy, osteopathic manipulative treatment/therapy (OMT/OMTh), foot reflexology, massage therapy, and other soft tissue therapies. Each modality was assigned a “B” rating based on SORT. Seventeen studies in the review included patients with specific psychiatric diagnoses, such as major depressive disorder (MDD), depression, adjustment disorder, and seasonal affective disorder, in which manipulative therapies were evaluated for their impact on managing depressive symptoms. Out of these 17 studies, 15 (88.2 %) reported that manipulative therapy led to a significant reduction in depression symptoms. The results of each modality demonstrating beneficial effects in treating depression symptoms are as follows: 6/6 (100 %) acupressure; 5/6 (83.3 %) chiropractic manipulation; 3/3 (100 %) craniosacral therapy; 8/9 (88.9 %) energetic therapies and light-touch therapies; 9/14 (64 %) manual therapy; 5/10 (50 %) OMT/OMTh; 2/3 (66.7 %) foot reflexology; 32/45 (71.1 %) massage therapy; and 2/5 (40 %) other soft tissue therapies. Conclusions This systematic review evaluates the current literature indicating that manual therapy may be effective in reducing symptoms of depression as a complementary treatment. Research demonstrates that acupressure, craniosacral therapy, and massage therapy are consistently associated with improvements in depressive symptoms; however, further investigation into other modalities, particularly within psychiatric populations, is necessary. Ultimately, additional research is needed to substantiate the efficacy of manual therapies for individuals with psychiatric disorders.
Open Access
Demographics of physicians in family medicine residencies during the transition to single GME accreditation

27. April 2026

Jeremy A. Ginoza, Jennifer M. Weaver, Daniel L. Meyer, Russell G. Maier

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Context In 2020, the Accreditation Council on Graduate Medical Education (ACGME) became the sole accrediting body for osteopathic and allopathic residency programs. Programs were given the option to apply for Osteopathic Recognition (OR) to emphasize their training in osteopathic principles and practices. This study, protocol 19–366 A5 (Council of Academic Family Medicine Educational Research Alliance [CERA] Survey), was ethically approved by the American Academy of Family Physicians Institutional Review Board (IRB). The study was exempt from clinical trial registration due to its noninterventional online survey methodology. Participants electronically confirmed consent prior to survey initiation. Objectives Our objective was to examine the demographic changes in osteopathic residents, faculty, and program directors (PDs) in ACGME family medicine (FM) programs over the 5-year period of transition to single accreditation. Methods Utilizing demographic data from the 2015 and 2020 CERA omnibus PD surveys, we conducted analyses to examine the changes in number and gender distribution of osteopathic residents, faculty, and PDs. Results Between 2015 and 2020, there were statistically significant increases in Doctor of Osteopathic Medicine (DO) PDs, faculty, and residents in FM residency programs. There is also a nonstatistically significant trend toward a higher proportion of female PDs, from  38.1 % in 2015 to 43.5 % in 2020. Conclusions The number of DOs in ACGME-accredited FM residency programs increased during the transition to single accreditation. Further research is needed to determine the role of Osteopathic PDs and faculty in OR status.
Open Access
Unopposed alpha-1 constriction: a critical review of beta blocker use in cocaine-associated cardiovascular events

24. April 2026

Jeremy Jong, Clipper F. Young, Jennifer M. Abueg, Christina Kinnevey Greig

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Context Cocaine-associated cardiovascular events pose significant challenges in primary care settings, where outpatient physicians often serve as the first point of contact for patients with both acute and chronic cardiovascular complications. Current guidelines discourage the use of beta blockers in cocaine-related acute coronary syndrome (ACS) due to concerns of unopposed alpha-1 constriction, but emerging evidence questions the validity of this caution. Primary care physicians frequently manage patients with heart failure and comorbid substance use disorders, highlighting the need for clarity on beta blocker safety and efficacy in this population. Objectives This review aimed to systematically evaluate the evidence of unopposed alpha stimulation when prescribing beta blockers in people who utilize cocaine, as well as the safety and efficacy of beta blockers in managing heart failure in this population. Methods PubMed was searched from April 1968 through August 2024 utilizing the search terms “cocaine”, “beta blocker”, and several commonly prescribed beta blockers. The screening process was performed by two authors (CKG and JJ), with discrepancies resolved by a third reviewer (CY). The inclusion criteria encompassed original human studies examining the outcomes of patients utilizing cocaine who were treated with beta blockers. The exclusion criteria consisted of studies lacking beta blocker intervention and articles not written in English. The extracted data from each article included the study type, purpose, design, time period, data source, sample size, follow-up duration, clinical intervention, outcomes, and mortality. Critical appraisal skills programme (CASP) checklists for bias analysis were completed for each non–case study article. Different artificial intelligence (AI) bots (Gemini, Microsoft CoPilot, and ChatGPT) were utilized in helping with the completion of the checklists with comparison across the three different platforms and then cross-referenced with the article text itself. The reviewers completed the final risk-of-bias determination without the use of AI. Results The search identified 156 articles, with two duplicates being removed. The remaining 154 articles were screened for relevance, and 116 were excluded based on the inclusion and exclusion criteria outlined in the methods. Of the 38 potentially relevant articles, full-text review led to the exclusion of 12 articles, which ultimately led to 26 articles being included in this review. Conclusions Current evidence suggests that the risk of unopposed alpha-1 constriction with beta blockers in cocaine-associated cardiovascular events may be overstated. Mixed alpha/beta blockers and beta-1 selective agents were associated with favorable hemodynamic control with minimal reported adverse events. For outpatient physicians, these findings support a more nuanced approach to beta blocker use in patients with a history of cocaine use, emphasizing the need for further randomized controlled trials to refine guidelines and optimize patient care in primary care settings.
Open Access
Osteopathic manipulative treatment and cervicogenic headache: a randomized controlled trial

23. April 2026

Stephan T. Klemm, Walter Klemm, Regina Semmler-Ludwig, Maren Witt

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Context Cervicogenic headache (CeH) is a common secondary headache type arising from a disorder or lesion of the cervical spine and its soft tissues. Objectives This study aimed to evaluate the effect of osteopathic manipulative treatment (OMT) in patients with CeH. Methods A total of 413 patients with CeH were treated by 30 osteopaths and allocated by block randomization to an OMT group (n=226) or a placebo group (n=187). The primary outcome was the Neck Disability Index (NDI) score; the secondary outcome was upper cervical rotation measured with the Flexion-Rotation Test (FRT) utilizing a cervical range of motion (CROM) device. Patients received two treatments over 4 weeks (standardized sham vs. findings-based OMT). Two-factor analyses of variance (ANOVAs) were utilized for the NDI score and CROM_FRT_sum, and Cohen’s d was calculated for all clinical outcomes. A severity-based subgroup analysis of the NDI was performed. Results The NDI improved by 5.9 points (11.8 %) in the OMT group and by 2.5 points (5.1 %) in the placebo group from baseline to final follow-up. Only the OMT group reached the established minimal clinically important difference (MCID) of 5.5 points. Effect sizes in the OMT group were large (Cohen’s d =0.74 short-term and 0.87 at follow-up). Conclusions OMT reduces pain and improves functional disability in patients with CeH in a clinically meaningful way. Patients with higher initial NDI scores benefit more from OMT than others.
Open Access
21st century osteopathic medicine: a modern perspective

21. April 2026

MarkAlain Dery

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Open Access
Gas gangrene of the great toe identified on radiograph

17. April 2026

Cody A. Sprague, David S. Pryluck, Bryan G. Kane

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Open Access
Investigating the efficacy of osteopathic manipulative treatment for intractable hiccups: a pilot study

17. April 2026

Derek E. Bowman, Emily C. Jamo, Rosalyn R. Bloch, Zachary Tepper, Ethan M. Poland, Megan Kempa, Canyon O’Brien, Kayla Fong, Ahmed Shahbain, Makenzie A. Kamm, Jack R. O’Hara, Angela S. Lee, J’Aimee Lippert

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Context Intractable hiccups is a rare medical condition defined as daily hiccups continuing for more than 30 days and is recognized by the National Organization for Rare Disorders (NORD) and NIH Genetic and Rare Diseases (GARD) Information Center. Hiccups are spasmodic contractions of the respiratory muscles, triggered by activation of the hiccup reflex arc. Intractable hiccups can occur if this arc is chronically or aberrantly activated. The hiccup reflex arc has three components: (1) afferent pathways involving the phrenic, sympathetic, and vagal nerves; (2) central processing centers within the central nervous system; and (3) efferent fibers, including the phrenic nerve, vagal branches, and intercostal nerves. Previously published case reports have reported robust improvements to intractable hiccup disease severity after osteopathic manipulative treatment (OMT) for related areas of somatic dysfunction, with one achieving complete remission. However, no structured studies have evaluated this approach to date. Objectives The objective of this case series is to determine whether one session of OMT can reduce the severity of intractable hiccups. Methods Five participants aged 18 and older with intractable hiccups were recruited through physician offices, online postings, and flyers placed on and around the Michigan State University (MSU) campus over a 2-year study period. Following eligibility screening, participants recorded their daily hiccup frequency and associated symptoms for 7 days before and after OMT. Each participant received one OMT session after a comprehensive medical history and osteopathic musculoskeletal examination. Identified somatic dysfunctions were treated utilizing appropriate OMT techniques. Muscle energy, counterstrain, and Still Techniques were utilized most frequently. High-velocity, low-amplitude (HVLA) methods were not employed in this study. All treatments were performed by an experienced osteopathic physician at the university-associated osteopathic manipulative medicine (OMM) clinic. Results Across the participants, we observed common patterns of somatic dysfunction in the cervical spine (C1 and C5), thoracic regions, and the abdominal diaphragm. After OMT, patients experienced clinically meaningful and statistically significant reductions in hiccup frequency. The average number of daily hiccups decreased from 16.37 to 5.66, representing a 65.4 % reduction after intervention (paired t -test, p=0.018). In addition, three out of the five participants experienced statistically significant reductions in their mean number of daily hiccups after treatment ( t -test, p<0.05). Conclusions This case series is the first structured investigation into the use of OMT for intractable hiccups. The findings strongly suggest that OMT can be an effective option for reducing the disease burden of intractable hiccups through the treatment of related areas of somatic dysfunction. Our results also support a plausible mechanistic basis for OMT’s effectiveness, because somatic dysfunctions were consistently found along the hiccup reflex arc. Finally, the study raises the possibility that the prevalence of intractable hiccups is underrecognized and may represent a clinical domain in which osteopathic care provides distinct advantages.
Open Access
A diffuse presentation of urticarial bullous pemphigoid

16. April 2026

Ahmed Farid, Mark Saad, Daniel Albatarseh, Natalie Prena, Robert Dazé

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Open Access
Evaluating median nerve stiffness in patients with mild to moderate-severe idiopathic carpal tunnel syndrome receiving OMT and conservative therapy: a pilot study

16. April 2026

Roland Gazaille, Cole Knox, Michelle Pershing, K. Doug Pugar, H. Brent Bamberger, James Schoen, Nicklaus Hess, Chelsea Nickolson, Taylor Vickery, Don Flowers, Antipas Marati, Kortney LaCombe, Sharal Mall

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Context Osteopathic manipulative treatment (OMT) has been recognized as a conservative management option for patients with carpal tunnel syndrome (CTS), although limited research exists to validate its ability to effect posttreatment changes in the median nerve or the surrounding soft tissues. Objectives The objectives of this study are to evaluate and quantify changes in the elasticity of the median nerve, transverse carpal ligament (TCL), and intracarpal tunnel soft tissues in patients treated for CTS with traditional conservative therapy (e.g., steroid injection and splinting), OMT, or OMT plus conservative therapy. Methods This single-blinded, randomized controlled pilot study included patients with a definitive diagnosis of mild to moderate-severe CTS. Participants were assigned to one of the three treatment groups utilizing a random number generator. Analysis of variance (ANOVA) was conducted to compare the following outcome measures from baseline through 6 weeks of treatment across the three groups of interest: the CTS-6 assessment tool and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire, electromyography (EMG) of the median nerve, grayscale ultrasound evaluation of the cross-sectional area (CSA) of the median nerve, and shear wave elastography (SWE) of the median nerve, TCL, and the intracarpal tunnel contents (ICTC). Associations between EMG severity scores, CTS-6 assessments, and Quick-DASH scores were also explored through correlation analyses. Results Among the 15 wrists randomized to the study, 5 withdrew, primarily due to the inability to complete all follow-up visits. 10 wrists completed the study: 3 in the conservative group, 4 in the OMT group, and 3 in the OMT plus conservative group. Ultrasound and SWE were effective in measuring median-nerve CSA and stiffness, although changes through 6 weeks were generally limited. There was no significant difference in the CSA measurements of the median nerve throughout the study (p=0.22, 0.11, 0.18, and 0.71 at weekly visits 1, 3, 5, and 7, respectively). Only the conservative therapy group showed notable reductions in CSA and stiffness over time, which corresponded to statistically nonsignificant reductions in CTS-6 survey scores (ANOVA analysis at visit 6 producing p=0.35) and Quick-DASH scores (p=0.12). One ANOVA analysis of the TCL average shear velocity did produce significant results at visit 7 (OMT mean=4.1, combination mean=3.5, conservative mean=3.7, p=0.01). Changes in EMG parameters (amplitude, latency, and conduction velocity of the median nerve) from baseline through 6 weeks were variable, with no clear pattern of change in any group. Similarly, there was weak association between EMG severity scores and CTS-6 (R 2 =0.1463) and Quick-DASH scores (R 2 =0.4676). Conclusions History and clinical examination are the primary means of establishing the diagnosis of CTS, with EMG and imaging playing supportive roles. The use of grayscale ultrasound and SWE as alternative, noninvasive diagnostic means in establishing a diagnosis of CTS continues to be explored. Given that SWE can serve as a reproducible, noninvasive, and objective means of evaluating the stiffness of soft tissues prior to and following various forms of treatment, further studies should be undertaken to investigate its utility and value in providing objective evidence of the efficacy of OMT.
Open Access
Osteopathic manipulative medicine lymphatic drainage techniques for venous insufficiency and peripheral arterial disease: a review

16. April 2026

Iya Agha, Lyudmyla Susla, Elizabeth Ryder, Gursimran Nanki Udhwani, Sheldon C. Yao

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Context Chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) are associated with significant morbidity, often manifesting as edema, pain, and nonhealing ulcers. Despite standard therapies such as compression, pharmacologic management, and surgical interventions, recurrence rates remain high, and outcomes are limited. Osteopathic manipulative medicine (OMM) lymphatic drainage techniques, including pedal pump maneuvers, aim to enhance venous return, reduce interstitial stasis, and improve overall vascular and lymphatic function. Such approaches may complement conventional therapies by addressing physiologic barriers to healing. Literature addressing OMM lymphatic drainage techniques in this population is sparse, creating a gap in evidence-based options for improving vascular and wound-healing outcomes. Objectives The objective of this study is to systematically evaluate the evidence regarding the effectiveness of OMM lymphatic drainage techniques on wound healing, symptoms, and quality of life in patients with CVI and PAD. Methods A systematic literature search was conducted to cover all available literature from database inception through January 20, 2024, with searches performed from February 26, 2023, to January 20, 2024, by four authors (IA, LS, ER, GNU). The databases searched included PubMed, World Health Organization (WHO) Global Health Library, Google Scholar, and ResearchGate. The keywords and Medical Subject Headings (MeSH terms) utilized were “lymphatic drainage,” “pedal pump,” “thoracic outlet,” “pelvic inlet,” “venous insufficiency,” “peripheral arterial disease,” “lower-leg ulcers,” and “osteopathic manipulative medicine,” combined with Boolean operators. Articles were included if they assessed OMM lymphatic drainage interventions in patients with CVI or PAD. Exclusion criteria were noninterventional design, lack of OMM focus, or irrelevance to PAD/CVI. Screening followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: duplicates were removed, titles and abstracts were screened, and disagreements among reviewers were resolved collectively. Results A total of 65 records were identified (PubMed=41, Google Scholar=12, ResearchGate=9, WHO=3). After removing duplicates, 32 remained; 27 were excluded following abstract screening, therefore five full-text articles were included. These consisted of one pilot case-control trial (n=30, PAD), one randomized controlled trial (n=20, immobile nursing home residents), one nonrandomized before-after community trial (n=8, lower-extremity ulcers), and two healthy-volunteer trials (n=17 and n=30). The reported outcomes included improvements in endothelial function, ankle–brachial index, treadmill performance, wound surface area, leg volume, blood lactate clearance, and platelet count. Collectively, these studies suggest the physiologic and clinical benefits of OMM lymphatic drainage, although the small sample sizes and heterogeneous methodologies limit generalizability. Conclusions Emerging evidence indicates that OMM lymphatic drainage techniques may provide meaningful physiologic and clinical benefits for patients with CVI and PAD. However, current studies are limited by small sample sizes, heterogeneity, and variable treatment protocols. Larger randomized controlled trials are needed to confirm the efficacy, establish standardized approaches, and clarify the role of lymphatic OMM in multidisciplinary vascular care.
Open Access
Disparities in endocrinologist distribution and diabetes outcomes in Appalachian and non-Appalachian counties of Ohio

20. März 2026

Samuel Borgemenke, Anja Eshbaugh, Katherine Kulp, Isaiah Comnick, Elizabeth A. Beverly

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Context Shortages in medical subspecialty care, particularly endocrinology, present a growing challenge in the United States. In Ohio, structural inequities in the rural and Appalachian regions, including fewer healthcare providers, limited facilities, and barriers to transportation and broadband connectivity, contribute to delayed diabetes diagnoses, increased complications, and a higher mortality rate. Objectives This study aimed to examine the distribution of endocrinology subspecialists in Ohio and the corresponding prevalence of diabetes. Methods This cross-sectional study utilized public data gathered in 2022 from the Centers for Medicare & Medicaid Services (CMS) and the United States Diabetes Surveillance System (USDSS) to compare the mean prevalence and incidence of diabetes, the mean costs, and the Prevention Quality Indicator (PQI) scores for both short-term and long-term diabetes complications by Appalachian and non-Appalachian counties in Ohio. Results Of the 263 endocrinologists analyzed in this study, 21 (7.9 %) practiced in counties classified as Appalachian and 242 (92.1 %) practiced in counties classified as non-Appalachian (p<0.001). Moreover, only 9 of 32 (28.1 %) Appalachian counties had at least one practicing endocrinologist compared with 26 (46.4 %) of the non-Appalachian counties (p<0.1). The mean prevalence of diabetes was also significantly higher in Appalachian counties than in non-Appalachian counties (12.3±0.6 % vs. 11.2±0.9 %; p<0.01). In contrast, no statistically significant differences were observed in diabetes-related costs (p=0.4), short-term complications (p=0.2), or long-term complications (p=0.7) between Appalachian and non-Appalachian counties. The regression models found that although a higher density of endocrinologists per 100,000 persons was negatively associated with diabetes prevalence and incidence, none of these relationships reached statistical significance, with diabetes prevalence being the strongest predictor of endocrinologist concentration (Akaike Information Criterion [AIC]=258). Conclusions This study revealed a dual disparity in Appalachian Ohio, where these counties not only had fewer endocrinologists, but also had a higher prevalence and incidence of diabetes compared to non-Appalachian counties. Targeted strategies are needed to address this critical gap in subspecialty care in these Appalachian communities.
Open Access
Conceptualizing osteopathic medical professionalism: an institutional self-assessment rubric for colleges of osteopathic medicine

19. März 2026

Regina K. Fleming, Anne C. Jones, Matthew Shelnutt, Tony A. Slieman, Stephanie White, Bruce R. Williams

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Context Professionalism in medicine has been historically difficult to define, teach, assess, and remediate. While professionalism is vital to the practice of medicine, the lack of consistency across training and disciplines, combined with the often generalized nature of its description, has caused challenges in academic medicine and has led to the weaponization of its use. It is clear that change in this essential competency in medicine is needed, and change has to begin with an honest self-assessment. Objectives The purpose of this report is to present an evidence-based rubric for the assessment of professionalism at the institutional level. The literature on professionalism emphasizes the importance of creating and maintaining a culture of professionalism within an educational community that guides expected behaviors and ensures accountability. This rubric presents expected behaviors within the major areas of the academic enterprise through an osteopathic lens, emphasizing the distinctive wisdom of osteopathic philosophy and the guidance it provides for a new landscape of medical professionalism. Methods Through the Senior Leadership Development Program (SLDP) of the American Association of Colleges of Osteopathic Medicine (AACOM), the authors identified six key areas in which to define osteopathic medical professionalism at the institutional level. These are: Definition and Culture; Prematriculation and Matriculation; Preclinical Curriculum; Clinical Curriculum; Student Affairs, Disciplinary Procedure, and Code of Conduct; Patient Care; and Research. Within each area, five clusters of professionalism were utilized to capture the multi-dimensional nature of cultivating a culture of professionalism within a community: Ethics and Integrity, Respect, Teamwork, Accountability, and Self-Management. A four-tier scale was developed to evaluate participants’ performance in these areas. Results The result of this report is a multi-dimensional and comprehensive rubric that can be utilized by colleges of osteopathic medicine (COMs) to perform self-assessments of how professionalism is conceptualized at their institution. In addition, the rubric can be utilized by segments of the academic enterprise in focused self-assessment and for change efforts at the programmatic level. Conclusions Osteopathic medical professionalism has the potential to carve a new pathway for the future of professionalism in academic medicine. This institutional self-assessment rubric for COMs is the first step in a change process that can clarify and specify how professionalism is defined, so that appropriate and meaningful teaching, assessment, and remediation can follow. Future research on this rubric will be to conduct formal validation analysis in order to standardize its application in an effort to broaden its use and potential impact.
Open Access
Epidemiology of pediatric abuse- and neglect-associated emergency department visits in the United States: an analysis of the 2019–2022 National Hospital Ambulatory Medical Care Survey

12. März 2026

Elizabeth Oberlander, Nam Nguyen, Micah Hartwell, Amy D. Hendrix-Dicken, Christine Beeson

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Context Child maltreatment impacts an estimated 7.4 per 1,000 children in the United States. Given the severity of some abusive injuries, children may present to emergency departments (EDs). As such, EDs are primary screening locations for early identification of maltreatment. Objectives Our objective was to assess rates of maltreatment among pediatric patients presenting to the ED. Methods We performed a cross-sectional analysis of pediatric ED visits utilizing data from the Center for Disease Control’s (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS, 2019–2022). Child maltreatment was identified by International Classification of Diseases (ICD) diagnosis codes of confirmed and suspected maltreatment, examinations performed after sexual assault, problems related to upbringing, malnutrition, and chief complaint codes for ‘child abuse,’ ‘sexual abuse,’ or ‘rape.’ Design-based chi-squared tests and regression models were utilized to determine associations between sociodemographic factors, comorbidities, wait time, and length of stay for these patients. Results Our sample included 13,896 pediatric visits. After applying sampling weights, 1.4 % of pediatric ED visits (422,755 visits annually) were related to maltreatment. Of these visits, 62.7 % were for examinations after sexual assault, 31.2 % included maltreatment, and 6.1 % were for problems related to upbringing or malnourishment. No significant associations were observed by race, age, insurance, sex, or rurality. When evaluating associations between comorbidities and child maltreatment–related visits, associations of asthma, substance use, and developmental disorders were statistically significant (p<0.05). Additionally, visits for these encounters were 28.0 minutes longer compared to other visits (p=0.040). Conclusions Our findings show maltreatment-affected children across sociodemographics between 2019 and 2022, with more than 420,000 cases presenting to the ED annually. Our results showed that higher rates of maltreatment were found among children with substance use and developmental disorders. At the hospital level, maltreatment visits were often longer than usual visits, but with shorter boarded time – more arriving via ambulance compared to other visits. This underscores the urgent need for comprehensive education and training for all ED staff on how to recognize and respond to child maltreatment across diverse populations. Taking a comprehensive history as well as implementing evidence-based protocols can help increase sensitivity to child maltreatment in EDs across the United States.
Open Access
Response to: Regarding “Where are the Black men in osteopathic medical schools?”

9. März 2026

Michael Megafu

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Open Access
Regarding “Where are the Black men in osteopathic medical schools?”

9. März 2026

Forrest Bohler, Allison R. Garden

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Open Access
Addressing physician shortage in medically underserved rural and tribal communities through residency program collaboration

6. März 2026

Natasha N. Bray, Michael Raischel, Derek McGuire, Ryan Newhardt, Douglas Nolan, Tyler Snyder, Mousumi Som, Lesley VanVolkinburg, Chad Landgraf, Denna Wheeler

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Context The United States is facing a persistent physician shortage, particularly in rural and tribal regions. Oklahoma ranks 43rd nationally for primary care provider (PCP) availability, with rural and tribal communities experiencing some of the most severe health workforce shortages. The Indian Health Service (IHS) Oklahoma City service area reports a 16 % physician vacancy rate, with national IHS vacancy rates reaching 38 %. Rural and tribal healthcare systems are especially impacted by recruitment and retention challenges. Evidence suggests that physicians are more likely to practice near their residency training site, highlighting the importance of location-specific training programs to alleviate workforce disparities. Objectives This study aimed to evaluate the geographic distribution and practice outcomes of graduates from three family medicine residency programs located in tribal healthcare systems in Oklahoma and to assess their contributions to addressing physician shortages in rural and underserved areas. Methods A retrospective cohort analysis was conducted on 87 graduates (2013–2024) from three Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs: Cherokee Nation, Choctaw Nation, and Chickasaw Nation. Program rosters were utilized to identify participants and reported initial practice location. Practice locations were verified utilizing National Provider Identification (NPI) data and cross-checked against the Federation of State Medical Boards (FSMB) Licensure database. Practice sites were classified by Medically Underserved Area/Population (MUA/P) status, Primary Care Health Professional Shortage Area (HPSA) score, and Rural Location utilizing the Federal Office of Rural Health Policy (FORHP) designation, IHS, or Tribal Healthcare Setting. Statistical analysis examined associations between medical school location and postresidency practice location. Results Among 87 graduates included in the final analysis, 64.4 % completed medical school at Oklahoma State University College of Osteopathic Medicine (OSU-COM) in Tulsa, Oklahoma. A total of 66.7 % of graduates remained in Oklahoma, 79.3 % practiced in Primary Care HPSAs, 65.5 % practiced in rural areas, and 57.5 % had initial practice locations in MUAs. OSU-COM graduates were significantly more likely to remain in Oklahoma postresidency (78.6 % vs. 45.2 %, p<0.01). Additionally, 55.4 % of OSU-COM alumni continued to work within tribal healthcare systems, compared to 41.9 % of graduates from other schools. Graduates represented 23 different medical schools with 9 graduates pursuing fellowships, most commonly sports medicine and emergency medicine. Conclusions Residency programs located in rural tribal healthcare systems in Oklahoma are effective in producing physicians who remain in rural and medical shortage areas. These programs support balanced physician distribution, particularly within tribal healthcare systems, and represent a replicable model for addressing national workforce shortages through location-targeted graduate medical education (GME). Further research is needed to evaluate long-term retention.
Open Access
Estimating ejection fraction and heart failure severity using cardiac apex angles: a multiphase pilot study

5. März 2026

Schafer Paladichuk, Graydon Dietrich, Austin Evanovich, Dane Warp, Ronald F. Walser, Dan Selski, Jesse Cone

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Context Heart failure (HF) affects 6.7 million American adults. The gold standard for HF assessment is echocardiography (echo) to determine the ejection fraction (EF). Evaluating the cardiac apex angle may be a possible way to estimate EF; however, there is a lack of investigation into this relationship. Objectives This study aimed to evaluate whether a correlation exists between the cardiac apex angle and EF. Methods A new, standardized method was developed to measure the cardiac apex angle, with the apex as the vertex, the inferior ray extending from the vertex to the right heart border, and a superior ray extending to the intersection of the left atrial appendage and ventricle. Cadaveric hearts were assessed and patient data from the Medical Information Mart for Intensive Care (MIMIC-IV) database were retrospectively analyzed. Chest X-rays (CXR) provided the cardiac apex angles, and echocardiogram reports contained matched EF values. Results In 15 cadaveric hearts, the average apex angle was 47.2°, and the average EF was 48.5 %. Linear regression analysis revealed an R 2 value of 0.6543. In the MIMIC-IV cohort of 583 unique patients with matched echocardiograms and CXRs, the average EF was 52.7 %, and the average apex angle was 47.2°, with linear regression analysis revealing an R 2 value of 0.7018. This was further broken down by sex and CXR direction. Conclusions Access to echo may be limited in resource-constrained settings. Utilizing CXRs to estimate EF offers a practical alternative, potentially enabling early diagnosis and standardized treatment. This approach leverages common imaging modalities to bridge diagnostic gaps and improve HF management.
Open Access
Clinical evolution of atypical pyoderma gangrenosum in a patient with hemochromatosis

2. März 2026

Nicholas Lo, Robert Dazé

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Open Access
Identifying risk factors for burnout and self-harm thoughts among medical students: a multi-institutional survey study

26. Februar 2026

Alexander J. Eddy, Natasha N. Bray, Aaron J. Place

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Context Burnout is a critical issue, with prevalence as high as 76 % among medical students. Associated with decreased empathy, cheating, withdrawal from medical school, and suboptimal patient care, burnout correlates with work hours (WH) and self-harm thoughts (SHT). Objectives This study analyzes the correlations of burnout, WH, SHT, and various socioeconomic, demographic, experiential, and behavioral factors among medical students. Methods A cross-sectional analysis was conducted utilizing a 60-question survey distributed to 12 osteopathic and 23 allopathic medical schools in six states (AR, KS, LA, MO, OK, and TX). Data from 137 medical students was analyzed utilizing the Copenhagen Burnout Inventory (CBI). Average burnout scores, weekly WH, and frequency of SHT were calculated for different demographic groups, with multiple linear regression analysis identifying significant predictors of burnout. Results Key findings include: (1) burnout and SHT rates increased from medical school year 1 (MS1) to MS3 years despite varying workloads; (2) female students reported higher burnout while male students had higher SHT rates; (3) married students showed significantly lower SHT rates (2.6 vs. 16.3 %); (4) students experiencing mistreatment had substantially higher burnout scores (48.8 vs. 38.0) and doubled SHT rates (19.3 vs. 7.8 %); (5) self-funded students reported higher burnout and SHT; and (6) religious affiliation was associated with lower SHT prevalence. Regression analysis identified male gender as protective against burnout, while depression/hopelessness, self-funded education, increased WH, and mistreatment were significant risk factors. Conclusions Medical student burnout varies significantly based on multiple factors, with concerning relationships between burnout, WH, and SHT. Medical schools should prioritize creating supportive learning environments and eliminating student mistreatment, with targeted interventions for vulnerable groups including female students, those with financial strain, and caregivers. Addressing these factors early in medical training may help mitigate burnout throughout physicians’ careers, ultimately improving healthcare delivery.
Open Access
Osteopathic manipulative treatment vs. standard therapy in the management of acute neck and low back pain in the emergency department

25. Februar 2026

Steven M. Hochman, Katherine Vlasica, Alexis LaPietra, Bhargavi K. Patel, Christine Ju, Nicholas J. Mota, Scott Wilder

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Context Acute neck and low back pain are common emergency department (ED) presentations, generally treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Osteopathic manipulative treatment (OMT) is a hands-on treatment modality utilized to treat a variety of musculoskeletal conditions. Objectives We sought to evaluate the relative efficacies and side effects of hands-on OMT vs. one dose of oral ibuprofen, in the treatment of adult patients presenting with acute neck or back pain. Methods We conducted a prospective randomized controlled trial at a high-volume urban ED. Adult patients with acute neck or low back pain were randomized to 5 min of OMT or oral ibuprofen 400 mg. Primary endpoint was the reduction in pain. Secondary outcomes included patient satisfaction and the rate of adverse events. Results Thirty-eight patients were enrolled; 35 were included in the final analysis. Twenty patients were randomized to OMT, 15 to ibuprofen. Median pain reduction on the Numeric Rating Scale 11 (NRS-11) scale was 2.0 points for OMT and 1.0 point for ibuprofen (p=0.11) at 30 min; 2.5 points for OMT and 2.0 points for ibuprofen (p=0.22) at 60 min. There was no significant difference between groups. Nor were there any significant differences on the 5-point Pain Relief Scale (PRS-5) scale (p=0.36), or in any of the secondary outcomes. Conclusions In this small, unblinded, single-center randomized trial, we found no significant difference in utilizing OMT compared to 400 mg of oral ibuprofen for patients with acute neck or low back pain, regarding pain control, patient satisfaction, or side effects.
Open Access
The effectiveness of osteopathic treatment in cervical whiplash: a randomized controlled trial

9. Februar 2026

José Larios-Ortega, Antonio M. Díaz-Acuña, María T. Colón-Fraile, Adriana Rivera-Sequeiros, Manuel Albornoz-Cabello, María V. Ruiz-Romero

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Context Whiplash is common after road traffic accidents and affects millions of people worldwide. The incidence of whiplash-associated disorders (WADs) has risen to at least 300 per 100,000 in Western countries, with global emergency room visits estimated at 235–300 per 100,000 annually. Objectives The aim of this study was to evaluate an osteopathic intervention for whiplash and determine whether pain, mobility, and quality of life improve with respect to conventional treatment. Methods A randomized, controlled clinical trial (from January 13, 2021 to August 10, 2022) conducted at Hospital San Juan de Dios del Aljarafe, Bormujos (Seville), Spain. The inclusion criteria were patients with WADs grade II, aged 18–55. The exclusion criteria were previous WAD, previous osteopathic treatment, pregnancy, or neurological/rheumatic conditions. Measures included initial and final evaluations at 21 days (Visual Analog Scale [VAS], Neck Disability Index [NDI], Whiplash Disability Questionnaire [WDQ]) and WDQ re-administered at 4 weeks. The control group followed the hospital’s protocol, and the experimental group also received an osteopathic intervention (n=52, 26 in each group). Statistical analysis was performed utilizing Statistical Package for the Social Sciences (SPSS) version 27.0. An intra-subject comparison was conducted with student’s t -test for dependent samples and Wilcoxon’s test, and inter-group comparisonswere performed utilizing student’s t -test for independent samples as well as Mann–Whitney U, and chi-squared tests. Results Significant improvements were obtained in the intervention group at 7, 14, and 21 days for pain (decrease of two units at each time point; p<0.001), number of pain sites (decrease of one additional unit; p<0.001), and number of medications taken (decrease of one additional unit; p=0.004; p=0.002; p=0.051). The WDQ administered at 4 weeks showed a greater improvement in the intervention group (−62.5 [IR: −73.0 to −47.5] vs. −43.5 [−56.3 to −34.0]; p=0.004) and at 21 days in the control group (−88.0 [−99.5 to −53.5] vs. −62.0 [−76.3 to −37.8]; p=0.035). The algometer for the left trapezius was better for the intervention group (0.7 [(0.12–1.0] vs. 1.0 [0.5–1.5]; p=0.029). Conclusions A significant improvement was observed for the intervention group in terms of pain, number of sites, medications taken, and at 4 weeks posttreatment in the WDQ. These findings emphasize the significance of a personalized and comprehensive osteopathic approach in the treatment of WADs.
Open Access
Different letters, same results: a comparison of milestones among US allopathic and osteopathic residents

9. Februar 2026

Melissa L. Langhan, Thuy L. Ngo, Kenji Yamazaki, Jo-Ann O. Nesiama, Lorenzo Pence, Sean O. Hogan

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Context Allopathic physicians, those with a Doctor of Medicine (MD) degree, may be unfamiliar with training distinctions with a Doctor of Osteopathic Medicine (DO) degree. Concerns about differences in medical training between DO and MD students may lead to biases against DOs as applicants for entry into residency or fellowship programs. This bias may be associated with lower acceptance rates into certain programs, with several competitive specialties matching <1 % of DO applicants. The potential for disparate treatment could lead to shortages in certain specialties. There is a lack of evidence that competency assessments of DO residents differ from those of MDs when it comes to patient care and outcomes. Objectives This study aimed to compare Milestone assessments across Accreditation Council for Graduate Medical Education (ACGME) competencies (Patient Care [PC], Medical Knowledge [MK], Practice-based Learning and Improvement [PBLI], Interpersonal and Communication Skills [ICS], Professionalism [PROF], and Systems-based Practice [SBP]) of residents who attended US allopathic (MD) vs. osteopathic (DO) medical schools, hypothesizing that there would be no differences throughout residency. Methods We analyzed Milestone achievements of residents in 3-year programs from the four largest medical specialties in the 2016 and 2017 Match: Family Medicine, Internal Medicine, Pediatrics, and Emergency Medicine. We excluded residents who graduated from international medical schools and programs that exclusively had either osteopathic- or allopathic-trained residents to control for potentially confounding effects. We extracted Milestone data for two cohorts of categorical residents who entered training in July 2016 and July 2017. These cohorts were chosen to avoid the effects of the COVID-19 pandemic and to utilize a single assessment instrument, Milestones 1.0. Milestone scores were compared at the initial and penultimate assessment periods. For each competency domain, by specialty separately, we applied a generalized estimating equations model to account for the correlation among Milestone ratings repeated over time for each resident nested within a training program. Results Among 13,544 eligible residents, 31 % were DO graduates. At the initial assessment in the 2016 cohort, DOs had lower Milestone means than MDs in eight areas: Family Medicine MK; Internal Medicine MK, SBP, PBLI, and ICS; and Pediatrics PC, SBP, and PROF. DOs had higher Milestone means than MDs in two areas: Emergency Medicine PC and SBP. By the penultimate assessment, DOs had lower Milestone means than MDs in only three areas (Pediatrics PC, MK, and SBP), and higher Milestone means in all 6 areas for Emergency Medicine. On initial assessment in the 2017 cohort, DOs had lower Milestone means than MDs in seven areas: Family Medicine MK; Internal Medicine PC, MK, SBP, PBLI, PROF, and ICS. DOs had higher Milestone means than MDs in one area: Emergency Medicine MK. By the penultimate assessment, the only significant differences were lower Milestone scores for DOs in Family Medicine MK and PBLI. The absolute value of the differences ranged from 0.05 to 0.12. Conclusions Osteopathic- and allopathic-trained residents in four medical specialties demonstrate similar Milestone assessments throughout their training. Small, statistically significant differences found in Milestone assessments favored either MDs or DOs; however, no consistent trends were seen by year or specialty.
Open Access
Challenging hierarchies and fostering collaboration: a critical discourse analysis of interprofessional education in healthcare training

6. Februar 2026

Emma M. Zorda, Mikayla A. Sargent, Cara E. Gose, Mitchell T. Becker, Sarah S. Garber, Adam DePrimo, Tamzin Batteson

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Context Interprofessional education (IPE) in health professions training strives to create a future collaborative healthcare workforce for the betterment of patient care. One of the aims of IPE experiences is to challenge healthcare hierarchies, with a focus on fluid leadership among healthcare team members. This promotes improved patient-care experience, as well as addressing patient well-being in a more holistic manner. Objectives This study aimed to critically analyze the discourse of an interprofessional team of healthcare students following a simulated patient encounter to assess the power dynamic among the professions present. Methods Researchers critically analyzed the discourse from student Interprofessional Team Immersion (IPTI) simulation debrief sessions. Sessions were transcribed and the discourse was coded utilizing Interprofessional Education Collaborative (IPEC) core competencies. A critical discourse analysis (CDA) was employed as a methodology to identify the prevalence of utilitarian and emancipatory discourse among students in diverse health professions and how collaborative interprofessional teamwork and patient health outcomes are impacted. Results Student teams modeled emancipatory and utilitarian discourses to structure team debriefs. The first debrief session operated through utilitarian discursivity, demonstrating instances of individual insecurity, slow team growth, and less coordinated patient care. Analysis of the second debrief session demonstrated the use of emancipatory discourse through the presence of greater team cohesiveness, less focus on self, and greater collaborative focus on patient care. Furthermore, analysis suggests the presence of fluid leadership with no dominant, healthcare profession (HCP)-specific hierarchy. Conclusions Employing a critical discursive lens in healthcare education can help students challenge power imbalances and shift toward fluid leadership and increase team cohesion between HCPs. These findings highlight how IPE can lead to greater collaboration between interprofessional student team members, challenge hierarchy, and empower the healthcare team to provide improved patient care.
Open Access
The effect of kinesiology tape on pain reduction in patellofemoral pain syndrome: a systematic review and meta-analysis of randomized controlled trials

5. Februar 2026

Jessica R. Mitchell, Seth Spicer, Christopher Jones, Matthew Anfuso, Alexa Simonetti, Taylor Carmichael, Brandon Goodwin, Morgan Blusewicz, Ian Maitin

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Context This systematic review and meta-analysis is the first of its kind to analyze the effectiveness of kinesiology tape (KT) on reducing pain in individuals with patellofemoral pain syndrome (PFPS). KT demonstrates significant reductions in pain outcomes, thus, its incorporation into osteopathic treatment for PFPS is supported. Objectives The objectives of this study were to systematically evaluate the evidence documenting the effectiveness of KT on pain reduction for patients with PFPS utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and to evaluate the pain reduction efficacy of KT in patients with PFPS through a meta-analysis of pooled data from previous studies. Methods A systematic review and random-effects meta-analysis was conducted utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Included were randomized controlled trials (RCTs) from any publication time until March 2024 that assessed pain outcomes of KT before and immediately after application. Key terms were initially identified utilizing Medical Subject Headings (MeSH), and then Boolean operators were applied. Five databases (PubMed, MEDLINE, Cochrane, Embase, and Web of Science) were searched utilizing the search string (“Patellofemoral pain syndrome” OR “Patellofemoral pain” OR “Patellofemoral syndrome” OR “Anterior Knee Pain Syndrome” OR “PFPS” OR “Runner’s knee”) AND (“kinesiology tape” OR “kinesio tape” OR “elastic therapeutic tape” OR “kinesiology therapeutic tape” OR “k-tape” OR “kinetic tape”) AND (“pain” OR “discomfort” OR “stability”). Six authors participated in the initial search and screen utilizing Rayyan.ai software to reach a two-person consensus on inclusion. Disagreements among authors were discussed and agreed upon by a third author. Included were RCTs that utilized pain intensity to assess the effectiveness of KT pre- and immediately post-application. Studies with a delayed follow-up time or no pain data were excluded from our analysis. Results Ninety-four articles were found in the search, of which 37 duplicates were subsequently removed, leaving 57 papers for analysis of titles and abstracts based on the inclusion and exclusion criteria. After title and abstract screening, 10 papers were left for full-text review. Full text studies with a delayed follow-up time (n=2) or those that did not report pain data means pre-post intervention (n=3) were excluded. Five articles were included in the study consisting of a total of n=105 participants in the control group and n=120 participants in the KT group. The overall pooled estimate demonstrated a significant reduction in pain intensity pre-post KT application (p≤0.001, Cohen’s d = −1.18 [−1.89, −0.48]) with substantial heterogeneity (I 2 =81.1). No difference was found in the control group (p=0.07, Cohen’s d = −0.71, [−1.48, 0.07]) with substantial heterogeneity (I 2 =79.0). Subgroup analysis found no significant differences between groups (p=0.38). Conclusions This meta-analysis found a significant benefit in utilizing KT for PFPS. The high I 2 values of both subgroups suggest substantial variability, which likely contributed to the insignificant differences between subgroups. Overall, the data suggest that the utilization of KT may be effective in acutely reducing pain perception in patients with PFPS, but more high-quality research is required.
Open Access
Bridging the gaps: a holistic approach to strengthening the pediatric medical and surgical workforce

5. Februar 2026

Adaeze OkoroAjuzie, Rajvarun S. Grewal, Matinder K. Dhillon, Julieanne P. Sees

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Context The pediatric surgical workforce in the United States faces increasing strain due to a limited supply of specialists, geographic maldistribution, and rising complexity in pediatric cases. Rural and underserved communities experience the greatest gaps in access to timely, specialized care. Additionally, existing literature lacks integration of osteopathic perspectives in workforce development discussions, despite the holistic and preventive contributions of osteopathic medicine to patient care and physician well-being. Objectives This review analyzes current gaps in the pediatric surgical workforce and propose actionable solutions through an osteopathic lens, including the integration of osteopathic principles such as whole-person care, preventive health, and osteopathic manipulative treatment (OMT). Methods A narrative literature review was conducted utilizing peer-reviewed publications, workforce data, policy reports, and the 2023 National Academies of Sciences, Engineering, and Medicine (NASEM) report on the pediatric subspecialty workforce. The review considered sources published between 2003 and 2024. Search terms included combinations of “pediatrics,” “pediatric surgical workforce,” “osteopathic medicine,” “OMT,” “healthcare disparities,” and “surgical access,” and they were applied to PubMed, Google Scholar, and gray literature databases. Inclusion criteria prioritized national US data on workforce distribution, diversity, burnout, and training. Then the studies were selected. No formal meta-analysis was conducted. Results Approximately 1,150 board-certified pediatric surgeons practice in the United States, equating to approximately 18.2 surgeons per one million children. Access remains concentrated in urban academic centers, leaving rural regions dependent on general surgeons or patient transfers. Minority and uninsured children experience significantly lower rates of surgical intervention. Workforce burnout and limited training pipelines exacerbate shortages. Although no formal outcomes synthesis was performed, osteopathic contributions such as OMT for postoperative care and holistic, team-based education models were identified as underutilized assets in existing workforce strategies. Conclusions The pediatric surgical workforce must be expanded and diversified to meet growing and unevenly distributed care needs. Integrating osteopathic principles – including whole-person care, OMT, and provider wellness – into training, recruitment, and care delivery offers a holistic framework for sustainable improvement. Future workforce strategies should incorporate these perspectives to enhance both patient outcomes and provider resilience.
Open Access
Osteopathic manipulative treatment for enhanced pitch performance in collegiate baseball players: a feasibility study on shoulder and hip interventions

28. Januar 2026

Carissa Rosten, Sidney Brown, Tanaya Nandedkar, Alex Pearson, Ethan Worthington, Danielle Fastring

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Context Previous studies have sought to improve pitch performance and shoulder function utilizing the Muscle Energy Technique (MET) or Spencer’s technique. The results of these studies have been mixed. Some found immediate, but short-lived, improvement to different planes of the range of motion (ROM) of the throwing shoulder. None found improved velocity or investigated further pitch metrics, such as spin rate. Objectives This study is the first to measure the effects of osteopathic manipulative treatment (OMT) among key points of the kinetic chain, measuring ROM of the shoulder and the hip, as well as pitch metrics beyond release velocity. Methods Baseball pitchers from a local collegiate baseball team were offered participation in this study. Pitchers had to be medically cleared for participation as members of the team and had to be given permission by the coach to join the study. Sixteen pitchers were assessed for inclusion, and 13 of the 16 were randomized into OMT and control groups for a prospective cohort study. One dropped out of the control group upon randomization, and one member of the control broke baseline protocol, leaving six members in the experimental group, and five members in the control group. Data, including pitch metrics, active ROM, and demographics were collected at three time points with statistical analyses comparing data between groups. Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) was collected twice. After the third time point, the control group was crossed over to receive the OMT protocol also. Data were analyzed utilizing paired t -tests and Fisher’s exact test. Results Six pitchers received intervention (OMT), and five pitchers received no intervention (control). Overuse injuries developed in the control group only, preventing two of the five members of the control group from throwing further pitches for data collection at 5 weeks. When analyzed by Fisher’s exact test, those in the control group were 9.29 times more likely to develop an injury than those receiving a single application of OMT. The only significant difference in pitch performance was an immediate 0.74 mph reduction in effective velocity in the OMT group (p=0.048), not sustained at the 5-week follow-up. Immediately posttreatment, the intervention group appreciated a 7.16° advantage in shoulder internal rotation over the control group (p=0.017). Five weeks posttreatment, the intervention group appreciated a 9.44° advantage in shoulder external rotation (p=0.047). Bilateral hip extension was immediately significantly improved in the treatment group (p<0.001). Left hip flexion was significantly improved in the treatment group when compared against the control group both immediately by 6.76° (p<0.011) and at 5-week follow-up by 12.87° (p<0.001). An advantage in right hip flexion was significant only at 5 weeks by 5.89° (p<0.02). Conclusions A single application of OMT is a low-risk intervention to prevent overuse injuries in the elite overhead athlete. While this study found differences in velocity, ROM, and injury risk, this study was limited by the sample size (n=11). A larger sample group is needed both for reproducibility and for assessment of other pitch parameters such as horizontal break, vertical break, and pitch extension.
Open Access
Early osteopathic treatment delivered to patients with an acute lateral ankle sprain improves recovery: an investigative study

22. Januar 2026

Claire Bournon, Dominique Prin-Conti, Jimmy Douay, Pierre-Alexandre Montfajon, Lukshe Kanagaratnam, Stéphane Gennai

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Context Acute lateral ankle sprain (ALAS) is responsible for short-term disability, increased risk for future acute ankle sprain, and chronic ankle instability. Several studies highlighted that manipulative therapy may reduce pain and increase the range of motion (ROM) of the injured ankle, but not all of them targeted acute injuries. Some studies focused their interest on a specific manipulative technique or utilized either physiotherapy or chiropractic techniques. Objectives The objectives of this study were to evaluate the effectiveness of osteopathic care in ALAS, to assess pain, edema, and functional stability of the injured ankle, and to assess and comparing mobility between the injured and noninjured ankle. Methods We conducted an interventional randomized controlled trial (RCT) in the emergency department (ED) of a French University Hospital. Fifty patients were enrolled in this study. They had to be ≥18 years old, consulting in the ED for a single ALAS (<72 h) stage 1 or 2, and must have had preliminary consultation with an emergency physician. Patients with an ALAS stage 3 or fractured, or with history of homolateral ankle surgery, were excluded. Patients were randomized either in the medical treatment (MT) group or in the medical and osteopathic treatment (MOT) group and had a 3-week follow-up. In the MOT group, the intervention consisted of a single osteopathic treatment (manual intervention) at Day 0, depending on the tissue affected and on the intensity of the tissular tension found, and individualized advice provided at Days 0, 7, and 21. Comparisons between groups were investigated utilizing the chi-square or Fisher’s exact test, or Student’s t -test or Mann Whitney U-test, as appropriate. Results Forty-five patients completed the study. The patients’ median age was 29.5 years old (23–40 years). At Day 21, 95.7 % of patients in the MOT group had equivalent capacity of unloaded dorsal flexion between the injured and noninjured ankle, vs. 50.0 % of patients in the MT group (p=0.0005). Between Day 0 and Day 21, the pain with the injured ankle loaded and unloaded decreased more significantly in the MOT group (p=0.001 and p=0.0007, respectively), while the loaded and unloaded dorsal flexion, and the unloaded plantar flexion, increased (p=0.003, p<0.0001 and p=0.02, respectively). Between Day 0 and Day 0 postosteopathic treatment, all judgment criteria showed improvement in the MOT group. At Day 7, all the functional stability tests were performed better by patients in the MOT group. Conclusions Early osteopathic treatment associated with usual MT, delivered to patients with an ALAS, may improve mobility and functional stability, and may reduce pain and edema, in the 3 weeks postintervention. These promising findings require confirmation in a larger controlled trial.
Open Access
Osteopathic manipulative medicine among injured emergency department patients: a nationwide study

19. Januar 2026

Hanna Harris, Aviya DiStefano, Kaitlin M. Bowers, Dhimitri A. Nikolla

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Context Osteopathic manipulative treatment (OMT) encompasses a wide range of diagnostic and treatment techniques for many conditions, but few studies have evaluated OMT use on injured patients. Objectives We aimed to describe the use of OMT on injured patients from a nationwide sample of emergency department (ED) encounters. Methods We performed a retrospective analysis of the 2018–2022 Nationwide Emergency Department Sample (NEDS) datasets. We included all ED encounters with an injury diagnosis as well as an osteopathic diagnosis or treatment, including International Classification of Diseases – Tenth Revision (ICD-10) Clinical Modification (CM) codes M9900-M9909, ICD-10 Procedure Coding System (PCS) codes 7W00X07-7W09X9Z, and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes 98925-98929. We calculated the Injury Severity Score (ISS) and the predicted probability of injury-related in-hospital mortality for each encounter utilizing the ROCmax method. Except for counts, all statistics at the encounter level are weighted to account for the complex survey design. Results Among 29,966,447 ED encounters with an injury diagnosis within the study period, we identified 1,686 with at least one osteopathic diagnosis or treatment code, 6.0 per 100k injury encounters (95 % confidence interval [CI] 4.2 to 8.2). A minority of encounters (574 [35.5 %]) were at level 1 or 2 trauma centers. Although 677 (39.7 %) were admitted, the median ISS was only 1 (interquartile range [IQR 1, 4]), and only 62 (2.9 %) had computed tomography (CT) orders. The predicted probability of injury-related mortality was low, 1.5 % (IQR 1.3, 2.0). Most encounters had a somatic dysfunction diagnosis without an osteopathic treatment code, 1,239 (75.9 %). The most common site of injury, as well as the body area with somatic dysfunction diagnosis and osteopathic treatment, was the thorax. Conclusions In this nationwide sample, few injured ED patients received OMT, the majority only received a somatic dysfunction diagnosis without osteopathic treatment, and most had minor injuries. These results offer real-world insights into the use of OMT among injured ED patients and may inform efforts to promote its adoption.
Open Access
Evaluation of the association between history of open chest or abdominal surgery and cardiovascular risks: an NHANES study, January 2007 – March 2020

13. Januar 2026

Alexander Olson, David L. Coffman, Clipper F. Young

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Context The clinical relationship between cardiovascular disease and deleterious surgical outcomes has been extensively examined; however, the relationship between cardiovascular risk and the association with major surgical interventions has yet to be examined at the population level. Previous use of National Health and Nutrition Examination Survey (NHANES) data has investigated the relationship between cardiometabolic risk and a history of bariatric surgery, suggesting that NHANES population data may be a useful tool to uncover a primary association and provide insight into subgroup effects. Objectives This study attempts to quantify the relationships between cardiovascular risk factors and the history of open-chest or abdominal surgery. Methods We analyzed de-identified NHANES data from January 2007 through March 2020 for US adults ≥20 years of age selected via stratified multistage sampling (participants with missing data were excluded; Institutional Review Board [IRB] not required). We extracted self-reported history of open-chest/abdominal surgery (binary), seven metabolic/cardiovascular biomarkers (hemoglobin A 1c [HbA 1c ], low-density lipoprotein [LDL], triglycerides, total cholesterol, systolic/diastolic blood pressure [SBP/DBP], high-density lipoprotein [HDL]), and covariates (race/ethnicity, gender, education, insurance, income-to-poverty ratio). Associations were estimated as odds ratios (ORs) utilizing survey-weighted logistic regression in STATA 16 adjusted for all covariates (two-sided α=0.05), with subpopulation logistic models for subgroup analyses by HbA 1c . Results The elevated HbA 1c level was the only variable that was statistically significant, with an OR of 1.14 (95 % confidence interval [CI], 1.06–1.23). Secondary subgroup analyses demonstrated differential impacts: Non-Hispanic White, individuals without insurance, those with a lower income-to-poverty ratio, females, and individuals with less than a ninth-grade education or a high school/General Education Development (GED) equivalent were more likely to have a surgical history as HbA 1c levels increased. Conclusions A significant association exists between elevated HbA 1c levels and a history of open-chest or abdominal surgery. Specific subgroups are at greater risk and may be disproportionately affected by the downstream consequences of higher HbA 1c levels.
Open Access
Allopathic resident prevalence in orthopedic residency programs formerly accredited by the American Osteopathic Association during single accreditation

9. Januar 2026

Jett B. Murray, George C. Balazs, Mark R. Speicher, Aaron A. Olsen

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Context The finalization of the Single Accreditation System (SAS) in 2020 resulted in the combined residency training of both allopathic (MD) and osteopathic (DO) graduates and has raised concerns about residency position availability for DO applicants in competitive specialties. Objectives The purpose of this study was to evaluate formerly American Osteopathic Association (AOA) - accredited orthopaedic surgery programs to identify the prevalence of DO degrees among program directors and residents, and stratify the association of program geography, program director degree, and osteopathic recognition status on resident composition. Methods A retrospective review of formerly AOA orthopaedic surgery programs was performed. Database information, program websites, and social medial profiles were used to determine program director degree and degree of all residents during academic year 2023–2024. Osteopathic Recognition status and program location were recorded. Associations were analyzed using chi-square and Fisher’s Exact Test. Results Of the 36 identified formerly AOA programs, 12 (33.3 %) had an MD program director. Among 561 residents in these programs, there were 43 MD residents. MD residents were more likely to train under an MD program director (p < 0.01). Programs with a DO program director were significantly more likely to train zero MD residents (p < 0.01). Programs located in the Midwest trained the highest proportion of DOs (97.2 %, p < 0.01). All 5 programs with Osteopathic Recognition were training zero MD residents during the study period. Conclusions The increase in MD leadership in formerly AOA-accredited programs and the associated increase of MD residents in those programs that has occurred since the advent of the Single Accreditation System should be of concern to osteopathic leadership, who are dedicated to matching well qualified DO graduates into increasingly competitive residency positions such as those in orthopaedic surgery.
Open Access
Investigating biomarkers associated with mortality in patients receiving VA-ECMO for cardiogenic shock: a systematic review

9. Januar 2026

James Ramsarran, Thomas Albertson, Tyler Hoops, Darsh Patel, Andreas N. Christy, Robert Joyner

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Context Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-sustaining therapy for severe refractory cardiogenic shock. Although VA-ECMO provides various degrees of cardiopulmonary support, mortality rates remain high. Serum biomarkers have potential to identify the rising risk of mortality in patients receiving ECMO, but evidence supporting their prognostic value is inconsistent. Objectives This study aims to systematically investigate existing evidence on the relationship between biomarkers and mortality in adult patients with refractory cardiogenic shock undergoing VA-ECMO support. Methods A systematic review was conducted conforming to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines. Analogous search strings were developed to complete a comprehensive literature search across multiple databases that included Embase, Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search limits include studies published in the last 5 years (>2018) and in the English language. The inclusion criteria were: all genders aged 18 and older being treated for cardiogenic shock with VA-ECMO and intra-ECMO biomarker data with corresponding mortality data. Biomarkers included in the criteria were: lactate, creatinine, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), troponin, C-reactive protein (CRP), and white blood cell (WBC) count. Identified articles were included within the main findings after unanimous approval by all authors. The quality of the evidence was assessed systematically utilizing a standardized and validated checklist. Results Our search yielded 1,033 studies, with 650 studies remaining after the removal of duplicates, leaving 538 studies to be screened for title and abstract study relevance. Subsequently, 112 studies remained for full-text review. Reasons for exclusion during full-text review include conference abstract, no mention of specific biomarkers, and wrong comparison of treatment modalities. Five studies remained for data extraction. Data gathered from five retrospective cohort studies reported a total of 589 patients supported by VA-ECMO following a diagnosis of cardiogenic shock, with the most common inciting factor being postcardiac surgery. Most patients were male. The age range for all participants was between 45 and 77 years. Common comorbidities include diabetes mellitus, hypertension, and vascular disease. Overall mortality was 59.9 % (353/589) based on survival to 30-day post-ECMO initiation or hospital discharge. In three of the studies, the patients in the survivor cohort had statistically significant lower intra-ECMO lactate levels compared to the non-survivors (p<0.01). One of the studies found statistically significant differences between survivors and non-survivors in the intra-ECMO values for serum lactate (p<0.001), creatinine (p<0.023), bilirubin (p<0.001), AST (p<0.05), and ALT (p<0.05). Another study reported statistically significant differences in nadir lactate levels through 24 and 48 h of ECMO initiation in survivors vs. non-survivors (p=0.001 and p=0.001 respectively). Conclusions Serum lactate was the biomarker most utilized to assess the risk of mortality. Serum creatinine (Scr), bilirubin, AST, and ALT also demonstrated significance in predicting mortality, although not as widely studied as serum lactate. Future research is needed to further investigate the usage of Scr, bilirubin, AST, and ALT to better assess their significance, regarding VA-ECMO mortality in patients diagnosed with cardiogenic shock. Further research is also warranted to investigate the minimal concentration of these biomarkers and their association with mortality to allow clinicians a better predictor of a patient’s mortality risk while receiving VA-ECMO.
Open Access
Effect of COMLEX-USA Level 1 pass/fail score reporting on student stress, test preparation, and performance

8. Januar 2026

Rong Jin, Jeanne M. Sandella, Gretta A. Gross, Mark Dawley, John Boulet, Xia Mao, Yi Wang

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Context The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three-level national standardized licensure examination designed for the practice of osteopathic medicine. Following several years of analysis and considering input from across the continuum of osteopathic medical education, training, and licensure, the National Board of Osteopathic Medical Examiners (NBOME) transitioned COMLEX-USA Level 1 (Level 1) score reporting from a numeric score with a pass/fail result to a pass/fail result only beginning with the 2022–2023 testing cycle in May 2022. Objectives The purpose of this study is to investigate the differences in student Level 1 self-reported stress levels, test preparation, and performance following the transition to pass/fail score reporting. Methods The study utilized data from Level 1, including end-of-examination survey responses from first-time test takers in the 2023–2024 administration and examination performance data from first-time test takers across the 2021–2022, 2022–2023, and 2023–2024 administrations. The analysis examined changes in three key outcomes: self-reported stress during examination preparation, perceived examination preparation, and performance on Level 1 examination. Results After Level 1 transitioned to pass/fail score reporting, 60 % of students responding to the 2023–2024 end-of-examination survey reported reduced stress in Level 1 examination preparation, and 75 % of respondents reported no change in preparation time. In the first testing cycle after the transition, declines were observed in several performance indicators, including pass rate and the mean, standard deviation, and maximum of z-scores (converted from Level 1 numeric scores). In the subsequent cycle, the pass rate rebounded and the mean z-score stabilized, while both the standard deviation and maximum z-score continued to decline. Conclusions The COMLEX-USA series is designed as a licensure examination to assess competencies essential for the practice of osteopathic medicine. Passage of Level 1 indicates that a student has demonstrated competence in the foundational biomedical sciences, osteopathic principles, and related physician competency domains to enter supervised patient care settings. The transition in score reporting for Level 1 preserves that purpose. This study provides preliminary insights into the perceived differences in students’ stress level, examination preparation, and examination performance patterns following the change of score reporting. Further study will be conducted as these students transition through their osteopathic education.
Open Access
Associations of comorbidities, opioid use, and intimate partner violence, with urinary tract infections in pregnancy: implications for prevention and screening

22. Dezember 2025

Kathryn Donatucci, Sachi Pathak, Kristen McPherson, Jameca Price, Micah Hartwell

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Context Urinary tract infections (UTIs) in pregnant women may present as asymptomatic bacteriuria (ASB) to symptomatic bladder or kidney infections (cystitis and pyelonephritis, respectively). Identifying risk factors for a UTI may allow for improved screening techniques and help facilitate preventative medicine in at-risk populations from dangerous UTI-related sequelae. Objectives The objective of this study is to identify conditions associated with the increased risk of symptomatic UTIs in pregnancy. Methods We utilized the pregnancy risk assessment monitoring system (PRAMS) Phase 8, which surveyed postpartum women from 2016 to 2021 to assess factors related to the occurrence of UTIs during pregnancy. PRAMS has respondents self-identifying ethnoracial groups, socioeconomic status (SES), and comorbidities, which we utilized to identify the associated risk of developing a UTI during pregnancy. Data within PRAMS’ automated research file (ARF) regarding UTIs were only available from three states: Delaware, Michigan, and Mississippi. Results The overall prevalence of symptomatic UTIs among pregnant individuals within these states was 14.8 %. From 2016 to 2021, we found significant differences in the rates of UTI occurrence from 2016 at 12.7 %, to highs of 16.4 % in 2018 and then 16.1 % in 2019. Rates from 2020 through 2021 were not significantly different than 2016 through 2021. Results also showed significant associations between depression (odds ratio [OR] = 2.18, 95 % confidence interval [CI]), intimate partner violence (IPV) (OR = 2.18, 95 % CI), and prescription pain relievers (OR = 2.65, 95 % CI) in the development of UTI during pregnancy. Maternal race affects the risk of occurrence. Compared to UTIs in White women, UTIs in Black (OR = 1.22, 95 % CI), American Indian (OR = 2.24, 95 % CI), and multiracial (OR = 1.17, 95 % CI) women occur more frequently in pregnancy. In contrast, Asian women are less likely to experience a UTI in pregnancy (OR = 0.45, 95 % CI) than white women. Conclusions Compared to reported UTIs rates from 2000 to 2002 of 17 %, our findings show that the occurrence of UTIs during pregnancy has decreased to 13 %. Given the relevant significant findings, increased screening for depression and IPV may be warranted for those presenting with UTI. In addition, increased screening for UTIs in Black, American Indian, and multiracial women can help prevent the development of serious sequelae of pregnancy-associated UTIs.
Open Access
Analysis of hepatitis B immunity in vaccinated medical students

12. Dezember 2025

Nicole Gentile, Chandni Aghera, Haylie Smith, Sena Mazzoleni, David Redden, Lindsay Tjiattas-Saleski

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Context Hepatitis B virus (HBV) is a vaccine-preventable hepatic infection causing transient and chronic infections, ultimately leading to liver failure with cirrhosis and hepatocellular carcinoma (HCC). Because healthcare workers and medical students are at higher exposure risk to this virus, immunity status is important to assess and maintain. Previous studies have shown a decrease in those classified as immune by antibody titer within the medical student and healthcare worker populations. Objectives The objective of this study is to evaluate whether various factors, including the interval between vaccination and antibody titer measurement and the timing of first vaccination, contribute to a reduction in HBV immunity among medical students with a history of HBV vaccination. Methods This retrospective cohort study utilized previously collected vaccination data from students who have attended or currently attend Edward Via College of Osteopathic Medicine’s – Carolinas Campus (VCOM-Carolinas) from the years 2011 to 2023. The deidentified data include subjects’ age, sex, original vaccination dates, HBV titer date, repeat vaccination dates and titer dates (if applicable), and final immunity status. Of the 2050 students, 1878 subjects met the study’s criteria. Students are required to obtain the hepatitis B surface antibody titer prior to matriculation. A student was considered immune if his or her titers were over the lab-provided threshold or if otherwise nonimmune. Statistical analyze included sample mean, standard deviation (SD), and the Wilcoxon rank-sum test for continuous measures such as age at first vaccination, time since last dose, time between doses, and subject’s age. Pearson’s chi-square test compared the differences in nonimmunity rates by year, gender, and number of vaccine doses. A multivariable logistic regression model was utilized to determine which variables associated with nonimmunity remained statistically significant in the presence of each other. Results The results show a significant decrease (p<0.001) in the population of students considered nonimmune to HBV, from 16.0 to 61.3 % in the classes from 2011 to 2023. There also was a statistically nonsignificant difference in nonimmunity rate by sex (females=39.9 %, males=38.3 %, p=0.50). There was a significant difference between the percentage of students who were nonimmune based upon the age at which they were first vaccinated. Although only 47.8 % of students who received their first vaccination at 5 years old or younger were nonimmune, only 11.3 % of students who received their first vaccination after 5 years of age were nonimmune (p<0.001). The odds of being nonimmune multiplied by 1.11 for each year postimmunization (p<0.001). Conclusions Overall, the longer duration after immunization increases the odds that a person will have decreased immunity to HBV. This study shows that those who have a higher risk of contracting HBV may need to be more regularly screened for their HBV titers and potentially obtain booster vaccinations as needed.
Open Access
The impact of discontinuation and non-publishing of osteoporosis clinical trials

10. Dezember 2025

Daxton Kennington, Andrew Simonsen, Whitney Shae, Catherine Satterwhite

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Context Osteoporosis is a prevalent chronic disease associated with fractures, reduced quality of life, and substantial healthcare costs. Randomized controlled trials (RCTs) are essential for developing effective treatments, but when trials are discontinued or unpublished, valuable data are lost. This results in unnecessary costs and exposes thousands of participants to interventions without contributing to clinical care. Objectives This study aims to evaluate the rates and characteristics of discontinuation and nonpublication among US-registered phase 3 and 4 RCTs investigating osteoporosis therapies from 2000 to 2022. Methods Phase 3 and 4 osteoporosis-related RCTs were identified through ClinicalTrials.gov. Trial completion and publication status were determined utilizing multiple databases and researcher contact. Chi-square and Fisher’s exact tests assessed the associations between trial characteristics and outcomes. Results Of 303 trials, 29 (9.6 %) were discontinued, and 274 (90.4 %) completed. Among completed trials, 124 (45.3 %) remained unpublished. Discontinuation was significantly more common in nonindustry-funded and single-center trials (p<0.01, p=0.04). Nonpublication was more frequent among industry-funded and internationally recruited trials (p<0.01, p=0.01). Conclusions Nearly half of osteoporosis RCTs were either discontinued or unpublished, representing a substantial loss of clinical data, financial inefficiency, and ethical concerns. These findings mirror patterns observed in other therapeutic areas, underscoring systemic challenges in clinical research transparency. Strengthening feasibility assessments, enforcing reporting mandates, and addressing structural barriers to trial completion and publication are essential to safeguard research integrity and ensure that patient contributions meaningfully inform medical knowledge.
Open Access
Clinically significant lung function improvement for collegiate soccer players after OMT with restrictive ribcage motion correlated with Expanded Zink screen

8. Dezember 2025

Daniel Y. Leung, Edward G. Stiles

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Context This study was undertaken to build upon the work of J. Gordon Zink, DO, FAAO, by developing a novel screening examination (Expanded Zink screen) that can correlate with proper identification of somatic dysfunction, the area of greatest restriction (AGR), and effective treatment in soccer players, which would elevate the osteopathic profession and advance the field of medicine. Objectives The objectives of this study are to determine whether the Expanded Zink screen can accurately correlate with the somatic dysfunctions found in soccer players, with what ended up being treated, and with effectiveness of treatment as measured by spirometry. Methods We performed a correlational study that involves female collegiate soccer players during the season who signed up to receive osteopathic manipulative treatment (OMT) after providing written informed consent. We screened 8 University of Pikeville (UPIKE) women’s soccer players; exclusion criteria included any pre-existing health problems, such as bleeding disorders, congenital malformations, and spinal cord injuries. Each soccer player underwent pre-OMT spirometry measurements. Next, each soccer player received a screening examination (“Traditional Zink” screen or “Expanded Zink screen”) from Operator 1. The soccer player then received the same screening examination from Operator 2. Operator 2 then found somatic dysfunctions and performed OMT. Finally, Operator 1 completed a re-screen of the soccer player utilizing the initial screen and noted any changes in findings. The soccer player then completed post-OMT spirometry measurements. Results We find that all players in both groups after receiving OMT have a normal lung function pattern or one that improved from an obstructive pattern to a normal pattern as measured by spirometry. All eight soccer players had lumbar somatic dysfunction, innominate somatic dysfunction, and lower extremity somatic dysfunction. All players had all four junctions equalized post-OMT. Seven out of the eight players had cranial somatic dysfunction, and five of them had their cranial somatic dysfunction treated first, including Player 5, who showed clinically significant improvement in lung function post-OMT. Player 5’s ribs were treated second in the treatment sequence. A novel Expanded Zink screen accurately correlated OMT of exhaled ribs to lateral asymmetry in rotation at the cervicothoracic junction in Player 5. Spirometry measurement post-OMT in Player 5 revealed clinically significant improvement in lung function showing 32 % change from obstruction to a normal pattern, which we attribute to correction of restrictive ribcage motion/dysfunction utilizing OMT. Both cranium and rib treatments accurately correlate with Expanded Zink screen findings of cranial and rib somatic dysfunctions in Player 5. Conclusions The Expanded Zink screen can be utilized as a screening model for the hypothesized correlating body regions to identify significant somatic dysfunction and to augment the physician’s ability to detect key body regions that need OMT. Through the use of the Expanded Zink screen, we discovered an out-of-pattern rib somatic dysfunction, which may have led to what we call a “restrictive ribcage motion/dysfunction.” This type of rib motion may have been the cause of the obstructive pattern on pre-OMT spirometry seen in Player 5. Once the rib was treated, the restrictive ribcage motion resolved, which allowed lung function to be restored to normal.
Open Access
Osteopathic manipulative treatment for management of feeding dysfunction in breastfed newborns

8. Dezember 2025

Dominique Fons, Kari Beth Watts, Holly Vannitamby, Shane Rainey, Jessica Ford-Davis, Yanzhi Wang, Seth Van Heukelom, Amanda Wright

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Context The benefits of breastfeeding are well established, from reduced incidence of common childhood infections to decreased incidence of sudden infant death syndrome and infant mortality. Offering support to breastfeeding mothers should be a key aspect of care in the perinatal period. Objectives The purpose of this study was to evaluate whether utilization of a standardized osteopathic manipulative treatment (OMT) protocol as an adjunct to lactation support improves feeding dysfunction in breastfed newborns. Methods This was a single-blinded, randomized, controlled, prospective pilot study of healthy, full-term neonates identified by an International Board Certified Lactation Consultant (IBCLC) as having feeding dysfunction. Neonates were subsequently randomized in an alternating fashion into an OMT protocol treatment vs. sham treatment. Infant LATCH ( L atch, A udible swallowing, T ype of nipple, C omfort of birth person, and H elp birthing person needs holding infant to breast) scores were assessed by nurses and IBCLCs during hospitalization assessed with mean and median score improvement between groups. Results Forty infants were included in the study, divided into a sham group (n=21) and OMT group (n=19). The groups had similar characteristics. The change between pre- and postintervention LATCH scores were calculated for each group, respectively. The mean LATCH score change in the OMT group was 2.0±1.8. The mean LATCH score change in the sham group was 0.9±1.2. The mean LATCH score change in the OMT group is statistically significantly greater than the mean LATCH score change in the sham group (p=0.030), indicating that the OMT group had greater improvement in their LATCH score compared to the sham group. Conclusions Healthy newborns with feeding dysfunction who were randomized to receive two OMT treatments during their hospitalization demonstrated a statistically significant moderate improvement in the changes in the median modified LATCH score compared with newborns randomized to the sham group. However, the effect size was moderate, at best. The LATCH score changes between groups cannot be highly attributed to the OMT interventions. However, there were no adverse effects of treatment. These findings suggest that OMT may be a safe adjunct to traditional lactation support in the care of healthy breastfed newborns with feeding dysfunction. Future studies could investigate other factors, such as the length of time that mothers breastfeed their infants after the two initial treatment sessions or potentially including a separate arm for neonates with ankyloglossia.
Open Access
Examiner reliability of a systematic osteopathic musculoskeletal examination model in patients with stroke: results from the SOMADC-AC study

4. Dezember 2025

Alan H. Yee, William J. Brooks, Guillermo A. Palchik, Beatrice Akers, Yueju Li, Michelle L. Dossett

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Context No study has systematically measured somatic dysfunction (SD) in patients with acute cerebral ischemia or tested the reliability of a new osteopathic diagnostic construct, called the Functional Pathology of the Musculoskeletal System (FPMSS) model. The methodology assesses the musculoskeletal system (MSS) as an integrated organ system, shifting emphasis of examination away from structural/postural malalignment to whole systemic motion and allows quantification, prioritization, and profiling of disproportionate motion imbalances as compared to traditional diagnostic criteria. Objectives This study aims to assess the reliability of a novel, systematic musculoskeletal examination model to identify SD after stroke or transient ischemic attack (TIA) and in healthy participants. Methods Asymptomatic participants and patients admitted with acute brain ischemia were recruited from an academic tertiary referral center to undergo standardized examinations. Participants were anticipated to undergo paired, blinded ratings by two independent raters on the same day. Paired ratings were performed twice in healthy participants (2 weeks apart), once in those with transient cerebral ischemia, and up to three paired instances, 48-72 hours apart, for patients admitted with acute stroke. Each musculoskeletal assessment consisted of 80 unique physical examination tests performed on each participant focusing on specified body regions: innominate, leg, cephalic extremities, spine, hip, and ankles/feet. Diagnostic assessments were performed by passive, specified linkage testing for available motion, and all examiners were required to participate in standardized consensus training of the FPMSS model. The methodology provides a quantifiable scale to measure grades of restricted motion. Inter-rater reliability was estimated by intraclass correlation coefficient (ICC) analysis. Results A total of 120 participants were enrolled (20 healthy controls, 20 with TIA [disease controls], and 80 with ischemic stroke). A total of 246 examinations were performed by seven examiners with 80 unique paired assessments across the three participant groups. Nearly two-thirds of stroke participants had hemiparesis with, on average, moderate degrees of neurologic disability. By the end of the study, acceptable inter-rater reliability was attained with: moderate agreement testing the innominate and leg; good agreement of the cephalic extremities, spine, and hip; as well as excellent agreement among raters with examination of the ankles/feet. Conclusions Examiners achieved acceptable levels of inter-rater reliability applying the FPMSS diagnostic construct in asymptomatic participants and in those with acute cerebral ischemia following standardized consensus training.
Open Access
The role of osteopathic manipulative medicine in cerebral palsy: bridging treatment gaps and enhancing care

10. November 2025

Ambrose Loc Ngo, Niki Gharavi Alkhansari, Rachana Tadakamalla, Mercede Hess, Uyen Tam Nguyen, John Yazji, Robert S. Rogers

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Osteopathic manipulative medicine (OMM) is a hands-on approach utilized by physicians to diagnose, treat, and prevent various conditions through the application of muscle manipulation techniques. It has been applied in managing chronic musculoskeletal (MSK) pain, headaches, migraines, Parkinsonian gait, and psychological conditions such as stress, anxiety, and depression. In our narrative review, we aim to integrate both direct clinical studies of OMM in cerebral palsy (CP) and supportive literature on mechanisms and related conditions. A comprehensive literature search was conducted utilizing PubMed and Google Scholar to identify relevant studies on OMM in CP management. Search strategies were intentionally broad to capture mechanistic, supportive, and clinical evidence. Representative terms included “osteopathic manipulative medicine and cerebral palsy,” “osteopathic treatment and neurological disorders,” and “manual therapy and cerebral palsy.” Additionally, reference lists of relevant articles were manually reviewed to identify additional studies. Overall, we found that integrating OMM into CP management may offer a noninvasive approach to improving MSK function and neuromuscular control while alleviating the emotional and physical challenges, as well as increasing movement to reduce joint contractures associated with the condition. OMM techniques may also help reduce stress, anxiety, and constipation, which are prevalent among CP patients due to the psychological and physiological burdens of the disorder. OMM’s holistic approach has the potential to enhance outcomes for individuals with CP by addressing their multifaceted needs. While further research and advocacy are necessary to fully integrate OMM into mainstream CP management, existing evidence suggests that OMM may improve patient outcomes and quality of life. However, the current evidence has remained somewhat limited.
Open Access
Identifying somatic and social concerns that may suggest an underlying mental health condition in pediatric primary care

6. November 2025

Casey Shubrook, Kimberly Breneisen, Maxine Pottenger

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Most adult mental health conditions begin in early childhood and adolescence, the most common being anxiety and behavioral disorders. Early intervention can improve outcomes and may reduce the risk of developing a clinical disorder in the future. However, children may not have the communication or understanding to share their symptoms with those around them, leaving pediatric primary care providers responsible for identifying concerning signs. This paper reviews both general symptoms that suggest possible mental health conditions as well as specific correlations between symptoms and psychiatric diagnoses. A literature search utilizing PubMed identified nine relevant articles that were supplemented with additional sources. The findings found that impaired coordination or balance, weakness, paralysis or loss of sensation, seizure-like activity, blindness, double vision, deafness, or one severe symptom, typically pain, were general signs that may indicate a psychiatric illness. More specific associations were also identified. For instance, children who report somatic complaints and school refusal have been linked to anxiety; in addition, reported stress, anger, and worries about family alcohol and drug use have been linked to depression, among many others. Awareness of the somatic and social concerns presented by children to primary care can reduce the delay from the onset of symptoms to diagnosis, leading to earlier identification, treatment, and improved outcomes. Early intervention may delay or prevent symptoms from developing into a diagnosable psychiatric disorder and/or may reduce the severity of symptoms in a child who already has a psychiatric condition.
Open Access
A quantitative analysis comparing pre-clinical volunteering hours with third-year medical students’ preceptor evaluations

5. November 2025

Emily K. Ranta, Joshua C. Ranta, David Redden, Alexis M. Stoner

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Context Many studies have suggested that participation in pre-clerkship volunteering opportunities is associated with higher confidence in clinical skills, improved perspectives on social barriers, and greater soft skills and empathy. While these studies have described a positive impact on subjective qualities, few studies have investigated the impact on objective standards such as third-year evaluations. Objectives The aim of this study was to explore the relationship between volunteer hours and third-year evaluations, with the hypothesis being that these previously studied, perceived benefits of volunteerism would translate to better evaluations. Methods This retrospective cohort study stratified a class of 161 medical students by volunteer hours completed during pre-clerkship years and self-recorded into the Translating Osteopathic Understanding into Community Health (TOUCH) reporting system. Preceptor evaluations were gathered utilizing the school’s report system and were analyzed in categories that included communication, problem solving, clinical skills, osteopathic manipulative medicine (OMM), medical knowledge, and professional/ethical standards. The statistical analyses utilized included Pearson and Spearman correlations. Results At the time of data accruement, only 127 of the 161 students had completed all required rotations and had completed evaluations. Therefore, the final sample size analyzed was 127 students and 1,321 evaluations. The average overall score on evaluations was 4.47, and the average number of logged TOUCH hours was 65.63. After Pearson and Spearman correlational analyses, no statically significant results were found (p>0.05). Conclusions Although previous studies suggest the positive impact of volunteering on confidence in clinical abilities, this study suggests no statistically significant correlation between TOUCH hours and preceptor evaluations. Current literature suggests that this may be due to preceptor subjectivity, evaluator and clinical engagement, and grade inflation. Given that evaluations are an important factor in residency interview selection, this study raises the question on how to adapt volunteerism and evaluation standards to better prepare osteopathic medical students for residency and beyond.
Open Access
Predictability of cranial base strains as related to birth presentation: a review of literature

4. November 2025

Summer K. McElwain, Deborah Schmidt

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Context The etiology of cranial base strains (CBS) in newborns is poorly elucidated in historical and current literature. There have only been a handful of studies examining the prevalence of CBS in newborns or vaginal birth presentation prevalence individually, let alone their relationship. Defining this link could help to further the applications of osteopathic manipulative medicine in neonates. Objectives The objective of this review was to consolidate all historical and current research on the potential link between vaginal birth presentation and CBS in infants. Methods A review of historical and current literature was completed in October 2023 by all authors utilizing the PubMed database and Google Scholar with the following search terms: cranial strain, osteopathy, fetal, molding, pediatric, birth presentation, delivery, and labor. These terms were utilized in various combinations and individually. Inclusion criteria included description of infant skull morphology, CBS patterns, and vaginal birth presentation. Exclusion criteria included studies with noninfant populations that did not address cranial morphology and/or discussed plagiocephaly unrelated to birth. There was no date range in the exclusion criteria due to the scarcity of research. Texts that included an evaluation and treatment of children at various ages were selected for partial reviews, only including the sections relevant to infancy. The best judgment of the authors was utilized to recognize reliable articles and texts. Extensive research returned very few recorded associations of CBS caused by vaginal birth and their accompanying mechanisms; thus, a review of citations in articles sought for retrieval was also completed. Most of the information procured was found in academic and historical texts rather than research articles. Results The results of this review are inconclusive and can only align with the theory that physiological CBS are the most common and that pathological CBS are uncommon; no relationship to vaginal birth presentation can be concluded with the available research. However, the literature reviewed illustrates a statistically significant increase in somatic dysfunction/cranial asymmetry in infants after prolonged labor, an increase in the rates of plagiocephaly in infants born to nulliparous women and/or the use of assistive devices, improvement of symmetry with the administration of osteopathic manipulative treatment (OMT), and the improvement of symptomatology after OMT. Conclusions More research needs to be completed on this topic to increase knowledge in the field of infantile CBS. A better understanding of the effect of vaginal birth presentation on infant CBS and occipital flattening could optimize infant development and the prevention of common diagnoses such as plagiocephaly, developmental delay, torticollis, colic, and feeding difficulties.
Open Access
Osteopathic manipulative treatment for refractory chronic traumatic pain and mobility restrictions at a level 1 trauma center

29. Oktober 2025

Gerard A. Baltazar, Michelle Cao, Jared Van Vleet, Sky Hart, Andrea Jakubowski, Nathan Suree, Patrizio Petrone, Shahidul Islam, Francisco Machado, Jerry Rubano

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Context Traumatic musculoskeletal injuries may result in chronic pain and mobility limitations, decreasing quality of life, and increasing predisposition to comorbid disorders. Osteopathic manipulative treatment (OMT) utilizes palpatory assessment and application of manual forces as an adjunct intervention for musculoskeletal disease. Multiple studies have demonstrated OMT’s potential benefits for a range of disease states, but data on osteopathic OMT are limited. Objectives The objective of our study was to understand the potential benefits of a novel OMT for trauma outpatient program for the care of injured patients suffering chronic pain and mobility limitations. Methods In 2021, the New York University (NYU) Langone Hospital – Long Island Level 1 Trauma Center established a novel outpatient OMT for Trauma Program (OTP). We performed a retrospective analysis of OTP patients seen from January 1, 2021 to December 31, 2022 with the chief complaint of refractory chronic (persistent ≥3 months since inciting injury) postinjury pain and mobility limitations (inclusion criterion). We excluded patients missing follow-up, then extracted and analyzed patient demographic, injury-specific, and OMT data. Data are presented as frequencies (percentages) or medians (interquartile range [IQR]). Results Forty-three patients (75.4 % of patients treated at the outpatient OTP) reported a mechanism of injury (MOI). Of these, 30 (69.8 %) met the inclusion criteria, and seven met the exclusion criterion, yielding 23 total patients for the analysis (40.3 % of the total OTP population). 73.9 % were female aged 46 (39–59) years old. Patients presented 3.00 (0.58–20) years since etiologic injury. MOIs included 56.5 % motor vehicle collisions (MVC), 21.7 % falls, 8.7 % penetrating, and 13.0 % sports-related or lifting injuries. Patients reported 3 (2–4) treatment modalities tried and 2 (1–3) medications attempted prior to the OTP. After the first OMT session, 95.7 % of patients reported subjective improvement in pain with a decrease in pain score 3 (3–7) out of 10. After OMT, patients also self-reported ease of activities of daily living (ADLs, 82.6 %), improved sleep hygiene (26.1 %), improved anxiety/mood (65.2 %), and decreased use of analgesic medication (13.0 %). Four (17.4 %) reported post-OMT complication of 2–3 days of self-limited, mild musculoskeletal pain. Univariate logistic regression models demonstrate that OMT benefited patients regardless of time since inciting injury. Conclusions OMT may benefit refractory chronic traumatic pain and mobility limitations regardless of the time since inciting the injury. This is the first major publication from the OTP and bolsters proof-of-concept for an organized OMT program at a level 1 trauma center. Further study, including comparative analysis with more formalized pain assessments utilizing validated tools as well as standardized OMT session surveys, is warranted.
Open Access
Painful and exophytic tumor on the thigh

24. Oktober 2025

Milie M. Fang, Kevin P. White, Alex G. Ortega-Loayza

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Open Access
Do patients with renal calculi exhibit viscerosomatic reflexes as evident on CT imaging?

10. Oktober 2025

Dillon R. Haughton, Akhil K. Gupta, Bader R. Nasir, Adrienne M. Kania

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Context Experimental evidence supporting the existence of the viscerosomatic reflex highlights an involvement of multiple vertebral levels when renal pathology is present. Further exploration of this reflex, particularly in the context of nephrolithiasis, could offer valuable insights for osteopathic treatments related to this pathology. Open-sourced machine learning datasets provide a valuable source of imaging data for investigating osteopathic phenomena including the viscerosomatic reflex. Objectives This study aimed to compare the rotation of vertebrae at levels associated with the viscerosomatic reflex in renal pathology in patients with nephrolithiasis vs. those without kidney stones. Methods A total of 210 unenhanced computed tomography (CT) scans were examined from an open-sourced dataset designed for kidney and kidney stone segmentation. Among these, 166 scans were excluded due to pathologies that could affect analysis (osteophytes, renal masses, etc.). The 44 scans included in the analysis encompassed 292 relevant vertebrae. Of those, 15 scans were of patients with kidney stones in the right kidney, 13 in the left kidney, 7 bilaterally, and 11 without kidney stones. These scans included vertebral levels from T5-L5, with the majority falling within T10-L5. An open-sourced algorithm was employed to segment individual vertebrae, generating models that maintained their orientation in three-dimensional (3D) space. A self-coded 3D slicer module utilizing vertebral symmetry for rotation detection was then applied. Two-way analysis of variance (ANOVA) testing was conducted to assess differences in vertebral rotation between the four possible combinations of kidney stone location (left-sided, right-sided, bilateral, or none) and vertebral levels (T10-L4). Subsequently, the two-way ANOVA analysis was narrowed down to include various combinations of three vertebral levels (T10-L4) to identify the most significant levels. Results We observed a statistically significant difference in average vertebral rotation (p=0.0038) dependent on kidney stone location. Post-hoc analysis showed an average difference in rotation of −1.38° leftward between scans that contained left kidney stones compared to no kidney stones (p=0.027), as well as an average difference of −1.72° leftward in the scans containing right kidney stones compared to no kidney stone (p=0.0037). The average differences in rotation between the remaining stone location combinations were not statistically significant. Narrowed analysis of three vertebral level combinations showed a single statistically significant combination (T10, T12, and L4) out of a total of 35 combinations (p=0.028). A subsequent post-hoc procedure showed that angular rotation at these levels had the only statistically significant contribution to the difference between scans containing right kidney stones and no kidney stones (p=0.046). Conclusions This study observed a statistically significant difference in the rotation of vertebrae at the levels associated with the viscerosomatic reflex between patients with unilateral kidney stones and those without kidney stones. The vertebral levels with the highest significance of association with this finding, particularly in right kidney stones, were T10, T12, and L4.
Open Access
Necrobiosis lipoidica arising in a port wine stain treated with topical ruxolitinib

1. Oktober 2025

Neena Edupuganti, Jay Nguyen, Fahad Siddiqui, Victoria Dukharan, Rajiv Nathoo

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We present a unique case of necrobiosis lipoidica (NL) arising within a port-wine stain (PWS), which, to our knowledge, has not been previously reported. NL is a rare granulomatous disorder often associated with diabetes mellitus, characterized by chronic inflammation and microvascular dysfunction. PWS, a congenital vascular malformation, results from defective endothelial differentiation and capillary malformation. The coexistence of these conditions suggests a potential link in their pathophysiological mechanisms, including inflammation, endothelial dysfunction, and shared signaling pathways such as mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K), and tumor necrosis factor (TNF)-alpha. Our patient’s NL lesions demonstrated improvement with topical ruxolitinib, a Janus kinase (JAK) inhibitor, after failing conventional therapies, including clobetasol, tacrolimus, and pulsed dye laser. To our knowledge, this is the first reported case of NL successfully treated with topical ruxolitinib monotherapy. This case highlights the emerging role of JAK inhibitors in managing granulomatous disorders and raises intriguing questions about the shared pathophysiologic mechanisms between inflammatory and vascular processes. Further investigation into cytokine dysregulation, immune responses, and targeted therapies for these overlapping pathologies could inform more effective treatment strategies and improve patient outcomes.

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Journal Impact Factor	1.1	2024, Journal Citation Reports (Clarivate, 2025)
5-year Journal Impact Factor	1.4	2024, Journal Citation Reports (Clarivate, 2025)
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CiteScore	2.6	2024, Scopus (Elsevier B.V., 2025)
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Source Normalized Impact per Paper	0.667	2024, CWTS Journal Indicators (CWTS B.V., 2025; Data Source: Scopus)

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AOA EDITOR IN CHIEF

Ross D. Zafonte, DO
Spaulding Rehabilitation Hospital Harvard Medical School
Boston, Massachusetts

EDITORIAL BOARD

BEHAVIORAL HEALTH
Section Editor:
Eileen Ryan, DO
The Ohio State University Wexner Medical Center
Columbus, Ohio

Associate Editors:
Justin Faden, DO (Philadelphia, Pennsylvania)
R. Gregory Lande, DO (Silver Spring, Maryland)
Jed Magen, DO, MS (East Lansing, Michigan)
Stephen M. Scheinthal, DO, CS (Mount Laurel, New Jersey)

CARDIOPULMONARY MEDICINE
Section Editor:
Kenneth J. Steier, DO, MBA, MPH
Touro College of Osteopathic Medicine
Middletown, New York

Associate Editors:
Olalekan Ogunsakin, MD, PhD, MBA, MPH (New York, New York)
Tanchun Wang, PhD (Middletown, New York)

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Section Editor:
Nadege Dady, EdD
Touro College of Osteopathic Medicine
New York, New York

Associate Editor:
Albert H. O-Yurvati, DO, PhD (Fort Worth, Texas)

MUSCULOSKELETAL MEDICINE AND PAIN

Section Editor: Gene Tekmyster, DO (Los Angeles, California)

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Jonathan W. Lowery, PhD (Indianapolis, Indiana)
R. Dallin Thomas, DO, MPH, CAQSM (Bethesda, Maryland)

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Touro University California College of Osteopathic Medicine
Vallejo, California

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Section Editor:
Meaghan Nelsen, DO
The University of North Texas Health Science Center
Fort Worth, Texas

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Daniel J.S. Martingano, DO, PhD (Rockaway, New York)
DeEtte Vasques, DO (Fort Worth, Texas)

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Oklahoma State University
Tulsa, Oklahoma

Associate Editors:
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Alissa Craft, DO, MBA (Scottsdale, Arizona)
Colony S. Fugate, DO (Tulsa, Oklahoma)
Tami Hendriksz, DO (Vallejo, California)
Muhammad Waseem, MD, MS, CHSE-A (Bronx, New York)

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Section Editor:
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Ohio University Heritage College of Osteopathic Medicine Athens, Ohio

Section Editor:
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Cleveland Clinic
Twinsburg, Ohio

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Craig S. Boisvert, DO (Lewisburg, West Virginia)
John J. Dougherty, DO (Provo, UT)
Lisa M. Hodge, PhD (Fort Worth, Texas)
Kim Pfotenhauer, DO (Vallejo, California)

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Cleofás Rodríguez Blanco, PhD, DO (Madrid, Spain)
Loic Tref fel, DO, PhD (Toulouse, France)

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Emily Chin, OMS IV, MBA, MHA (Auburn, Alabama)
Jantzen J. Faulkner, OMS II (Tulsa, Oklahoma)
Divakara Gouda, OMS I (Stratford, New Jersey)
Matthew Mayeda, OMS IV, MPH (East Lansing, Michigan)

REPRESENTATIVE FROM THE AOA BOARD OF TRUSTEES
Geraldine T. O'Shea, DO (Jackson, California)

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President:
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President-elect:
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Robert Orenstein, DO
Mayo Clinic
Phoenix, Arizona

Thomas Wesley Allen, DO, MPH^†Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
Tulsa, Oklahoma
University of Oklahoma College of M edicine
Oklahoma City, Oklahoma

† Deceased

Gilbert E. D'Alonzo Jr, DO
Temple University School of Medicine
Philadelphia, Pennsylvania

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eISSN: 2702-3648

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