The Cost of Caring: How Medical School Debt Shapes Our Healthcare System - Pg.12
THE FUTURE D.O.
BREAKING BARRIERS: EMPOWERMENT & ADVOCACY IN MEDICINE
Volume 2, Issue 2 December 2024
Our Forgotten Colleagues - Pg. 34
STUDENT OSTEOPATHIC MEDICAL ASSOCIATION
Collaborating for Change: Addressing Challenges in Family Medicine - Pg. 30
Editorial Board '24-'25..........................................2-5 Poem: A Journey of Struggle and Strength........... 6 Greetings from Editor-In-Chief..............................7-8 Artwork: Indigenous Peoples in Medicine................ 9 Editors' Perspectives............................................ 10-13 Artwork: Belle Glade............................................ 14 Abstracts: Case Reports........................................ 15-21 Artwork: Feeding the Problem............................... 22 Abstracts: Original Research................................. 23-31 Poem: The Hands That Heal.................................. 32 Abstracts: Literature Reviews................................ 33-40 Artwork: Leaving Vienna...................................... 41 Student Perspectives............................................42-46 Poem: The Silent Weight...................................... 47 Updates from SOMA National Board of Directors..... 48-53 Food for Thought................................................ 54 Research Director............................................... 55
About the Cover Artist:
Artwork Statement:
Nidhi Patel, a third-year medical student at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, has been passionate about art since childhood, once dreaming of becoming a cartoonist. Her creative journey evolved during her undergraduate years at the University of Florida, where she was offered a graphic designer position for Victoria’s Secret’s Pink Campus program, inspiring her to teach herself graphic design. During the pandemic, she launched an online art business through social media, collaborating with clients worldwide from creating digital newsletters for health and wellness brands to designing podcast covers for young voices. At her medical school, she served as the President of the Pediatrics Club and took on creative roles in other organizations, showcasing her creativity and even producing end-of-year videos for her class annually. Nidhi now seeks to integrate her artistic talents with her medical career, using design to enhance patient education and healthcare communication.
CONTENTS
Behind every patient, there will always be a healthcare team guiding their every step, advocating for their rights, and cheering for their recovery. The role of a physician is to empower patients to understand their own health and become active participants in their care. This artwork symbolizes the continuous support that physicians provide for their patients in their healthcare journey.
Editor-In-Chief Ivy Nguyen Editorial Board Ahana Chakraborty Alexandra Steck Aishwarya Rajendran Amardeep Kaur Dana Simon Ismihan Uddin Shuangtao Ma Varsha Reddy Venu Peddibhotla Winnie Chijioke Research Director Mahi Basra On The Cover Behind You Every Step Digital design by Nidhi Patel The Future DO is a magazine for the advancement and education of the osteopathic medical student. It is published biannually by the Student Osteopathic Medical Association (SOMA). Funding for The Future DO is provided by the SOMA. Views expressed in The Future DO publications are solely those of the authors and do not necessarily reflect the opinions of the editorial board, The Future DO, or SOMA unless specified.
EDITORIAL BOARD
Aishwarya earned her bachelor’s degree from the University of Florida and her Master’s in Medical Sciences from Boston University. Her passion for working with underserved communities is deeply rooted in her experience as a first-generation immigrant. Before medical school, she worked in clinical research, dedicating her efforts to improving healthcare access and addressing health disparities in medically underserved communities in Virginia. Aishwarya is currently interested in Internal Medicine and plans to subspecialize in Endocrinology. She aims to empower her future patients through education, compassion, and personalized care to enhance their quality of life. In her free time, Aishwarya enjoys cooking, dancing, and spending time with her 7-year-old Pitbull, Kamal.
MEET THE EDITORIAL BOARD
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Ivy is a third-year medical student at TOUROCOM-NY, originally from Vietnam, and moved to the U.S. during middle school. She is currently completing rotations at Staten Island University Hospital and has a strong interest in primary care specialties. As the editor-in-chief, she aims to create a platform for osteopathic medical students to showcase their research, scholarly activities, and creative work to improve healthcare culture, advocate for patients, and enhance medical training. Through the magazine, she is committed to empowering students to have a voice in shaping the future of medicine. Outside of school and work, Ivy enjoys spending time with friends and family, cooking, dancing, doing art, and playing with her cat Krispy (and her roommate's cat, Mona).
Aishwarya Rajendran, OMS II WCU COM Editor
Ahana Chakraborty, OMS II CHSU COM Editor Magazine Design
IVY NGUYEN, OMS-III TOURO COM, harlem Editor-In-Chief
Ahana's journey through medicine is driven by a love of research and advocacy. Growing up in San Diego, CA, she was inspired by the city’s rich biomedical landscape and developed a curiosity for the science behind medicine, while her passion for advocacy stems from her family's experiences navigating healthcare disparities. As President of CHSU SOMA and the Pediatric Interest Group, Ahana creates spaces for peers to engage in discussions on healthcare and empowers them to pursue advocacy. She aspires to become a pediatric gastroenterologist or neurologist, continuing to champion vulnerable populations. In her free time, she enjoys baking, creating art, running, and all things spooky.
THE FUTURE DO • VOL 2 • ISSUE 2
Varsha Reddy, OMS IV MSUCOM Editor
Alexandra Steck, OMS III Touro COM, Harlem Editor
Alexandra’s academic journey has been marked by a passion for research and a commitment to making a difference in healthcare. As the President of AMWA at TouroCOM Harlem, she is interested in orchestrating events that not only empower aspiring women physicians but also emphasize the crucial significance of reproductive care. Her ultimate goal is to become a GYN oncologist, combining clinical practice with research to make a lasting impact on patients' lives. In her spare time, Alexandra enjoys traveling back home to Upstate NY, hanging with her two dogs, Reagan and Nori, and making her way through recipes by NY Times Cooking.
Shuangtao (Shaun) Ma, OMS III NYIT COM Editor
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Varsha grew up in Michigan and has been interested in medicine from a young age. Before her medical school journey at MSUCOM, she graduated from Michigan State University with a degree in Neuroscience and worked as an ophthalmic technician/scribe and EMT. Her passions include community service and improving access to health care, which are embodied in her involvement in volunteer work and research. She enjoys spending her free time exploring new coffee shops and restaurants, dancing, and swimming.
Shaun is an enthusiastic cardiovascular researcher. He continues his research project funded by the American Heart Association while in medical school. He and his team found that ingredients in chili peppers can lower blood pressure, peppermint can help control weight in a high-fat diet, cinnamon is good for the kidneys, and wasabi and mustard oil can slow heart aging. He enjoys spending time with his family, cooking, hiking, and skiing.
Amardeep is a first-generation Punjabi American medical student who grew up in Yuba City, California. With a passion for providing compassionate care, she was inspired to pursue medicine to serve communities in need. Currently, Amardeep is interested in pursuing a career in either internal medicine or anesthesiology. Outside of her studies, Amardeep enjoys spending time with her nieces, watching TV, traveling, and capturing moments through photography. Her dedication to both her personal and professional pursuits reflects her commitment to making a meaningful impact in the lives of others.
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Winifred Chijioke, a second-year medical student at Touro College of Osteopathic Medicine, is passionate about advancing healthcare equity and advocating for women of color. Growing up as a Nigerian immigrant in rural Indiana, she developed a deep commitment to helping underserved communities and improving maternal health as an aspiring OB/GYN. Her leadership roles include serving as President of the American Medical Women’s Association, National Liaison Officer for her school's SOMA chapter, and Medical Students for Choice Leader. She is a Primary Care Leadership Program Scholar and a Johnson & Johnson Alliance in Medicine Scholar, as well as a certified Medical Laboratory Scientist. In her free time, Winifred enjoys exercise, cooking, baking, mentorship, and volunteering.
Venu enjoys working with undeserved populations and has a passion for treating cardiac disease. He hopes to become a Cardiologist serving the areas of rural Virginia.
Amardeep Kaur OMS II Touro COM, California Editor
Winifred Chijioke OMS II Touro COM, Middletown Editor
Venu Peddibhotla OMS IV Virginia COM Editor
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Dana Simon OMS III MSU COM Editor
Dana's interest in medicine began during a trip to Cambodia in high school, where she quickly recognized her passion for working with under-served communities. She received her undergraduate degree from Michigan State University where she was able to build upon her medical experiences through research and community service. Since entering medical school, she has participated in two global health trips and hopes to be involved in international medicine as a physician as well. In her free time, she loves to play soccer, explore new restaurants, and hang out with friends.
Ismihan Uddin OMS II MWU Chicago COM Editor
I am a proud Bosnian woman with a deep passion for global healthcare. Growing up with a keen awareness of the disparities in medical access, I’ve always felt a strong desire to help bridge that gap. My goal as a physician is to provide quality care to underserved populations and advocate for those in need, both locally and globally. Whether through clinical practice, humanitarian work, or public health initiatives, I am committed to making a meaningful impact on health equity. My aspirations include working in international health settings, contributing to global health policy, and inspiring future generations of physicians to think beyond borders in their pursuit of healing.
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Leticia Perez - Alabama College of Osteopathic Medicine
A Journey of Struggle and Strength
I was born from humble roots, a Mexican daughter, First to finish high school, though my parents got no further. I helped them dream, translated their way, From loans to businesses, I led them each day. Selling food from our truck, clothes at the flea, Even funded the gas station—my family leaned on me. Financial hardships, emotional weight, But together we pushed, with dreams that wouldn’t wait. When med school called, guilt grew in my heart, I felt like I was tearing us apart. Leaving the business, leaving them behind, A duty to family versus my own climb. But then I saw—this dream was mine to chase, To serve, to heal, to find my place. In South Florida, where my roots run deep, A mission awakened I couldn’t keep. Families too afraid to seek out care, With medications too costly, hope was rare. A mother couldn’t pay for what she needed, Her stroke came because her warnings went unheeded. Yet from those hardships, a strength arose, A deeper drive, the path I chose. To be a symbol for those like me, To show that hard work sets us free. Now, I carry the lessons from my past, A physician determined, built to last. For my family, my people, I’ll always strive, A dream pursued, and now alive. I’ll teach my patients a better way, And make sure they’re heard, every word they say. For in their faces, I see my own— The struggle, the hope, the seeds we’ve grown.
Artwork by Ahana Chakraborty, OMS II CHSU COM
POETRY
This holiday season, on behalf of the National Student Osteopathic Medical Association (SOMA) and The Future D.O. Editorial Board, I wish you joyful moments with your family and friends.
Dear readers and contributors, My name is Ivy Nguyen, and it is my immense honor to greet you as the new Editor-in-Chief of The Future D.O. As we turn the page on another season, our magazine’s commitment to promoting osteopathic medicine and enhancing the culture of healthcare remains as strong as ever. With that said, we are excited to introduce this issue’s theme: Breaking Barriers: Empowerment and Advocacy in Medicine Before deciding on medicine, as a multi-passionate teenager and an avid reader, I used to read a great deal of self-development and career-guidance books. One, in particular, stands out for its interesting take on leadership—Start with Why: How Great Leaders Inspire Everyone to Take Action. The author, Simon Sinek, introduces the concept of the Golden Circle, a model for how successful individuals and organizations inspire action and drive innovation. The Golden Circle consists of three layers: the innermost layer, "Why," represents the core purpose or belief that drives one’s work; the middle layer, "How," reflects the approach or process taken; and the outermost layer, "What," represents what they do. Sinek argues that the most impactful leaders and organizations communicate from the inside out, starting with "Why." This framework made me wonder: Can the concept of the Golden Circle be applied to our efforts in transforming the current culture of healthcare? Why? To answer this question, let’s take a step back and reflect on the current healthcare landscape, which faces complex structural and societal pressures. Our healthcare system is tasked not only with keeping pace with rapid technological advancements but also with addressing the deeply rooted health disparities and social determinants that impact patient outcomes. These disparities are driven by a range of factors, such as inadequate healthcare coverage, rising costs, lack of access to care, bias within the medical community, gaps in cultural competency, staffing shortages, and increasing rates of burnout among physicians and nurses. As a result, a cycle of social issues is perpetuated, including poorer educational outcomes, higher rates of unemployment, and limited access to housing and financial stability. These inequities create barriers to upward mobility and contribute to broader systemic poverty, affecting the overall well-being of patients, especially those in underserved communities. Specifically, racial and ethnic health disparities alone impose a significant financial burden, costing the United States $451 billion in 2018—an increase of 41% from the previous estimate of $320 billion in 2014, according to the National Institute on Minority Health and Health Disparities (NIMHD). This underscores the urgent need to address these disparities and implement sustainable, long-term solutions. How? Recognizing the scale of these challenges, institutions across the country have made significant strides to combat this billion-dollar problem. As part of this collective commitment, this issue of The Future D.O. provides osteopathic medical students with a platform to share their perspectives on the ongoing fight against disparities, biases, and stigma, as well as the need to break through the barriers that persist within our healthcare system. Specifically, we believe that empowerment and advocacy are at the forefront of overcoming these challenges and driving meaningful change. While advocacy drives awareness and policy reforms, empowerment enables patients to make informed health decisions and provides healthcare workers with the autonomy and resources to perform their roles effectively. What? As you flip through the pages of this issue, you will discover the innovative projects our students have undertaken, ranging from addressing reporting errors in electronic medical records for specific patient populations, to showcasing the effectiveness of osteopathic treatments, to interviewing family medicine physicians about challenges in primary care. These projects not only shed light on understudied topics in medicine but also enhance the engagement of marginalized communities in research and academic activities. Additionally, you will find updates from the National Board of Directors on their committee's work, highlighting SOMA’s ongoing commitment to advancing advocacy and empowerment in healthcare. In Closing Before I send you off, I want to remind you that the journey of a medical student, while advocating to fight against health disparities, biases, and stigma, is not easy. It requires persistence and perseverance. There will be times when we may lose the clarity of our "Why." There will be moments when we are unsure about our roles and contributions. During those difficult times, I hope we trust and hold on to our "Why"—why we pursue medicine, why we stay, why we care, and why we want to continue to make a difference. As Sinek notes in his book, “Companies with a strong sense of ‘Why’ are able to inspire their employees,” I hope that one day, our “Why” will attract, amplify, and inspire others to take action. Happy reading!
Greetings from Editor-In-Chief
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EDITOR-IN-CHIEF
"During those difficult times, I hope we trust and hold on to our "Why" —why we pursue medicine, why we stay, why we care, and why we want to continue to make a difference."
In Erratum [Osteosarcoma of Scapula Found on an Adolescent Male] This note aims to correct an error in the authorship. An author name was unintentionally excluded in the above-stated article of the following issue: The Future D.O. 2024; 2(1):14. The correct author list is as follows: Sohil Gopal¹, Steven Li¹, Ryan Meng¹, Samira Perez¹, Jacob Wilson¹, Ruben Kenny Briceno, M.D.², Jill Cochran, Ph.D.¹ 1. West Virginia School of Osteopathic Medicine, Lewisburg, WV 2. Michigan State University College of Osteopathic Medicine, East Lansing, MI The other elements, including the article itself, remain correct and unchanged.
The Golden Circle By Simon Sinek
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Artist: Stephen Lu, OMS III, Kansas City University College of Osteopathic Medicine
ARTWORK
"To redefine the future we must look to the past. History provides insight on what works and what does not, on what is right and what is wrong. This art piece is a collage of prominent Native American physicians - historical and present. These figures serve as a bedrock on which healthcare has developed and reformed within Native American communities and elsewhere in the United States."
Indigenous Peoples in Medicine
EDITORS' PERSPECTIVE ARTICLES
Empowerment Meets Advocacy in Patient Centered Care
*SOMA Weekly is a weekly email circular for all SOMA-related news and events. You must be registered as a SOMA member to receive the newsletter. Register to join SOMA at studentdo.org!
"I left my very first rotation with one of the most profound lessons I had learned: the recognition of reciprocal empowerment in the patient-physician relationship. This dynamic not only encourages patients to take ownership of their health but also reinforces the physician's essential role in advocating for changes within the medical field."
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We go into medicine because we want to help people, right? So cliche, I know. Yet, that was exactly what I believed when I began this journey two and half years ago. Then came the endless cycle of textbooks, intense studying, and long exams, all of which made it easy to lose sight of my initial purpose. During my pre-clerkship years, there were moments when I found myself forgetting why my own life experiences had once led me to aspire to be a physician. This all changed when I started my clerkship rotation. For the first time in a long while, I found myself genuinely enjoying every single day. It felt as though a tremendous weight had been lifted off my shoulders. My passion and excitement for medicine was rekindled, and I felt a renewed sense of purpose and commitment to the lives of my patients. The first rotation site where I worked was unique because of the population it serves: individuals who are uninsured and underinsured, many of whom have faced significant obstacles throughout their lives, particularly in their pursuit of healthcare. It only took a few patient encounters for me to realize that the empowerment I had always hoped to portray to my patients is, in fact, a two-way street. While we, as providers, have much to contribute, the resilience and strength demonstrated by my patients gave me an immense sense of empowerment in return. Of course, I have many hard days and long hours, yet I often think back to one particular patient who empowers me to keep going. This patient had to adopt her granddaughter due to a series of family events related to substance use. To provide for her granddaughter, she took on a new job that required her to spend long hours on her feet and even sold her car for extra money. She said that although she had let her own health lapse, she always ensured that her granddaughter had access to all health and educational resources she could possibly need. By the end of the visit, after opening up about the depth of her struggles, I saw a glimmer of hope in her eyes, as if my listening had helped her reconnect with her own health. While my empathy may have empowered her to take steps towards better care for herself, her story, in return, empowered me in ways she will never realize. I left my very first rotation with one of the most profound lessons I had learned: the recognition of reciprocal empowerment in the patient-physician relationship. This dynamic not only encourages patients to take ownership of their health but also reinforces the physician's essential role in advocating for changes within the medical field. Advocacy is an integral part of medicine. It is defined as “activities relating to ensuring access to care, mobilizing resources, addressing health inequities, and creating system change.” As students, this may be a daunting task. Many of us may experience imposter syndrome, believing our reach is small, and questioning whether we are truly equipped to make a difference. However, this is far from the truth. We offer valuable insights that are unique to our experiences as osteopathic medical students. Years ago, I worked with Dr. S, a rural family physician, who served low-income communities. Some of the major challenges affecting the community’s well-being included lack of access to healthcare, inadequate food access, and low health literacy. From organizing free public health screenings and pushing for more resources like affordable transportation to healthcare services to working one on one with each patient to improve their lifestyle, Dr. S worked tirelessly to dismantle social and systemic barriers. What was her secret? It may seem simple, but it all started with listening. Each patient had a story, and by taking the time to listen, Dr. S was able to address each of her patients’ medical needs. When asked what motivates her drive to champion underserved communities, she replied, “if we don’t speak up for our patients, who will?” As osteopathic medical students, we are trained to treat the body holistically-mind, body, and spirit. This philosophy emphasizes that we not only consider the physical health of our future patients, but also the social, economic and environmental factors affecting their well-being. By truly listening to our future patients, we can recognize their unique challenges, amplify their voices, and advocate for solutions that address their concerns. Through advocacy, we empower others, and that empowerment drives us to continue advocating. Let us all commit to building a future where every patient has the resources and support they truly deserve.
DANA SIMON1, AISHWARYA RAJENDRAN2 1 MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE 2 WILLIAM CAREY UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
"Each patient had a story, and by taking the time to listen, Dr. S was able to address each of her patients’ medical needs. When asked what motivates her drive to champion underserved communities, she replied, “if we don’t speak up for our patients, who will?”"
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EDITOR'S PERSPECTIVE
This year, I applied for residency, a process that involved submitting ERAS applications, completing licensing examinations, and undertaking audition rotations. At one point, a friend casually made a comment to me about how expensive the journey had been, and I could not stop thinking about it, realizing how fortunate I was. As I looked around my medical school class, I began to notice a pattern: not only was I fortunate, but so were most of my classmates. To clarify, we were not rich, but we came from backgrounds that provided us with enough financial stability to pursue this profession. Although there is a promise of significant financial gain at the end, the path of becoming a physician is long and arduous, filled with numerous hardships and financial demands. It is extremely cost-prohibitive with increasing rates of tuition, applications, standardized exams, and living expenses which limits the current and prospective students and impacts healthcare at large. One of the most significant factors contributing to the prohibitive cost of medical school is the tuition. The Association of American Medical Colleges (AAMC) reports the average tuition for a private medical school is higher than $60,000, and $40,000 for in-state medical schools. When you factor in additional costs such as textbooks, lab fees, housing, applications for audition rotations, and other hidden costs, the total can exceed $250,000. These high costs often lead to substantial student loan debt, with the average medical school graduate owing nearly $200,000 in federal student loans alone, not including private loans or interest accrued over time. Students from lower-income backgrounds may face a significant barrier when traversing medical expenses at medical schools. Most of them have to take on financial debt, which often acts as a deterrent for those considering the medical route. This is especially true for students from economically disadvantaged communities, who may not have the same access to financial resources, scholarships, or family support that wealthier students do. The financial barrier of medical training affects the socio-economic makeup of the medical profession, creating a relatively monolithic culture amongst physicians in an incredibly diverse nation. Although there has been some progress, the cost of education remains a major hurdle. The financial burden of medical school also disproportionately impacts women, particularly those who may face additional challenges balancing career and family responsibilities. Moreover, students who take on large amounts of debt may be more likely to pursue higher-paying specialties or practice in geographic regions with greater financial return, rather than underserved or rural communities where the need for healthcare professionals is greatest. Higher-paying specialties are more competitive, requiring more applications for residency, more travel for away and audition rotations, and networking, all of which add to financial strain and lead to greater reliance on loans. The cost-prohibitive nature of medical education has broader implications for the healthcare system as a whole. It contributes to physician shortages, particularly in primary care and rural areas. Many medical students, burdened by the weight of their debt, choose specialties such as surgery, dermatology, anesthesiology, or radiology which offer higher salaries and more predictable work hours, rather than entering primary care fields that are lower paying and often involve long, unpredictable hours. This shift toward high-paying specialties exacerbates the already existing shortage of primary care physicians, which, in turn, affects patient access to healthcare services. Furthermore, the financial pressure placed on medical students may lead to burnout and a reduced quality of patient care. Students facing large amounts of debt may prioritize short-term financial gain over long-term professional satisfaction, leading to job dissatisfaction and stress later in their careers. This can contribute to a cycle of physician burnout, which is already a significant problem in the medical field. Addressing the cost-prohibitive nature of medical education is crucial for ensuring a more balanced and sustainable healthcare workforce, ultimately benefiting both providers and patients alike.
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The Cost of Caring: How Medical School Debt Shapes Our Healthcare System
VENU PEDDIBHOTLA1, ISMIHAN UDDIN2 1 VIRGINIA COLLEGE OF OSTEOPATHIC MEDICINE 2 CHICAGO COLLEGE OF OSTEOPATHIC MEDICINE
"The financial barrier of medical training affects the socio-economic makeup of the medical profession, creating a relatively monolithic culture amongst physicians in an incredibly diverse nation."
The SOMA Research Committee regularly provides opportunities for osteopathic medical students to engage in meaningful discussions and workshops. The monthly Journal Club serves as a forum for students, both SOMA members and non-members, to analyze and delve into current clinical research across various medical specialties, with a focus on topics such as asthma, diabetes, and surgical procedures. In addition, the committee hosts Research Workshops which offer education on a range of subjects including IRB approvals, writing abstracts, or case reports to aid students in gaining research experience and developing valuable skills to succeed in their careers. Join us at our next Journal Club and Research Workshop! Look for an announcement in either SOMA Weekly* or by following @national_soma on Instagram. *SOMA Weekly is a weekly email circular for all SOMA-related news and events. You must be registered as a SOMA member to receive the newsletter. Register to join SOMA at studentdo.com!
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"This shift toward high-paying specialties exacerbates the already existing shortage of primary care physicians, which, in turn, affects patient access to healthcare services."
My first clinical rotation was in Rural/Underserved Medicine in Belle Glade, Florida, a city known for its farmlands and extensive vegetation. Near the end of the rotation, I spent an afternoon painting with the residents as part of the hospital’s tradition to depict an artwork that represents something meaningful to us. I chose to paint the sugar cane fields I drove past every morning on my way to the hospital. To me, the stretching fields represent a different way of life that is more tranquil and isolated from busy city traffic. However, this distance also creates notable health disparities that need to be addressed. As future physicians, it is imperative that we reach out as a helping hand through these barriers to care for those who need it most.
Belle Glade Artist: Alexandra Lens, OMS III, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine - Fort Lauderdale
CASE REPORTS
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Longitudinal Extensive Transverse Myelitis: A Rare Initial Manifestation of Sarcoidosis
Clozapine Treatment for Refractory Impulse Control Disorder in a Patient with Traumatic Brain Injury
INTRODUCTION: Impulse control disorders (ICDs) are a group of psychiatric conditions characterized by difficulties controlling urges and behaviors that can be harmful to oneself or others. Patients with a history of TBI are at higher risk of developing impulse control issues. CASE PRESENTATION: This report details the history of a 45-year-old caucasian male living in a supportive care nursing facility. He was born with cerebral palsy that affected his motor control with no cognitive deficits. Eleven years ago he had a TBI after falling where he lost consciousness and had multiple episodes of seizures. FINDINGS: Two years after the TBI he had significant personality and behavioral changes, such as unwarranted anger, aggression, and impulsivity. TREATMENT/INTERVENTION: The patient’s behaviors had been refractory to several psychotropic medications. The patient started on clozapine and showed significant reduction in explosive episodes and impulsive behaviors . CONCLUSION: There is limited evidence on the efficacy of clozapine for ICD in TBI patients but suggests potential benefits due to its effects on multiple neurotransmitter systems. Clozapine should be considered a strategy of treatment for refractory ICD, with careful monitoring for side effects. Further iInvestigation is required to explore the mechanisms of clozapine and develop guidelines for managing ICD in TBI populations.
THE FUTURE DO • VOL 1 • ISSUE 2
INTRODUCTION: Longitudinally extensive transverse myelitis (LETM) involves inflammation of three or more segments of the spinal cord. When associated with sarcoidosis, it poses diagnostic and management challenges due to its rarity. This study highlights the importance of maintaining a broad differential diagnosis and recognizing sarcoidosis as a potential cause. CASE PRESENTATION: A 50-year-old African American female with a history of hypertension, transient ischemic attack (TIA), and tobacco use presented with three weeks of worsening bilateral leg pain, ascending numbness, and progressive paralysis. She reported no recent infections, trauma, or travel. Family history was non-contributory. FINDINGS: Physical exam revealed decreased strength and reflexes in the lower extremities with paresthesia over the dorsal feet and legs. MRI showed extensive spinal cord edema from T5 through the conus medullaris. Cerebrospinal fluid analysis indicated elevated protein, and lymph node biopsy confirmed non-necrotizing granulomas, consistent with sarcoidosis. TREATMENT/INTERVENTION:fHigh-dose corticosteroids and plasma exchange showed minimal improvement. Methotrexate was discontinued due to liver toxicity, and infliximab was initiated and continued outpatient. The patient remained paraplegic, demonstrating limited response to standard therapies. Additionally, outpatient supportive care was prioritized, incorporating physical and occupational therapy and assistive devices to optimize comfort and functionality. Psychological support and counseling were also provided to help the patient cope with the current medical condition. CONCLUSION: This case illustrates the diagnostic complexity of neurosarcoidosis presenting as LETM, a rare form of sarcoidosis. It emphasizes the need for comprehensive diagnostic strategies and raises awareness of atypical presentations. Further research is needed to develop standardized management guidelines for LETM in sarcoidosis.
SHAYNA CHEJFEC, PRASHANTH TAMRAGOURI, MD. SHANNON BARTOLUCCI, MSN, GNP, PMHNP1 MARIAN UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE schejfec051@marian.edu
Nikoloz Gvetadze, Kevin Tse, Camila Bejarano, md, Ethan Rosenblatt, md Touro College of Osteopathic Medicine, Middletown, NY ngvetadz@student.touro.edu
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ITP Exacerbates Preeclampsia: A Case Report
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INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is a rare autoimmune disorder of platelet destruction, frequently manifesting as a chronic condition in adults. While most patients remain asymptomatic, ITP may occasionally exacerbate preeclampsia during pregnancy. The interplay between ITP and preeclampsia presents unique challenges and requires tailored management to mitigate risks to both maternal and fetal health. CASE PRESENTATION: A 33-year-old G1P0000 female with a history of ITP presented to the labor unit at 35 weeks of gestation with decreased fetal movement. She reported headache and back pain but denied vision changes and right upper quadrant pain. Patient was hypertensive at 160/90 mmHg and promptly admitted for management of preeclampsia with severe features complicated by ITP. FINDINGS: The patient had low platelet counts ranging 27,000 to 36,000/µL, elevated transaminases (ALT 77 U/L and AST 55 U/L), and a normal creatinine level (0.8 µmol/L) on admission. Her urine protein levels were within normal limits. Sonography and biophysical profile with non-stress testing showed a single live intrauterine gestation in cephalic presentation, an anterior placenta without previa, and a fetal heart rate of 169 bpm. TREATMENT/INTERVENTION: The patient was treated with high-dose prednisone, intravenous immunoglobulin, labetalol, magnesium sulfate, and hydralazine. Her low platelet count initially prevented her from receiving epidural procedures. After her platelet count improved to 90,000/µL, she received an epidural analgesia and successfully delivered vaginally without complications. CONCLUSION: Chronic ITP increases platelet aggregation, which circulates as microthrombi. These preactivated microthrombi may damage the vascularization of the newly formed placenta, thereby increasing the risk for preeclampsia.
Leah katz, nidhi Chawla, adele el kareh MD, PhD, facog TOURO COLLEGE OF OSTEOPATHIC MEDICINE , HARLEM, NY lkatz12@student.touro.edu
INTRODUCTION: Inotuzumab ozogamicin (InO) has been successfully used as a bridge to definitive therapies such as chimeric antigen receptor T- cell (CAR-T) or hematopoietic stem cell transplant (HSCT) in cases of relapsed leukemia. Currently, there is a lack of literature on the long-term remission after InO as a monotherapy in a pediatric, multiply relapsed B cell acute lymphoblastic leukemia (BCP-ALL) patient that did not undergo further definitive treatment. CASE PRESENTATION: We present a case of a 16-year-old female who experienced her third relapse of BCP-ALL. FINDINGS: Approximately 10 months after her second relapse, she was admitted for pancreatitis. Further imaging showed lesions on her kidney and pancreas. A kidney biopsy confirmed recurrence of BCP-ALL. TREATMENT/INTERVENTION: Both the patient and family opted not to pursue aggressive therapy and wished to avoid hospitalization. A decision was made to place the patient on two cycles of dose-reduced inotuzumab. After the abdominal magnetic resonance imaging (MRI) and minimal residual disease (MRD) both showed negative results, InO was discontinued. A maintenance regimen consisting of one dose of vincristine and monthly steroid pulses for several months was started. Patient remained in her fourth remission for over four years after her last InO dose before experiencing a recurrence with isolated central nervous system leukemia. CONCLUSION: In this case, inotuzumab treatment led to a sustained remission without subsequent transplant or CAR-T cell therapy in a multiply relapsed patient, providing her with many years of great quality of life. The success of this treatment offers new pathways for managing BCP-ALLin the pediatric population.
Inotuzumab: More than Just a “Bridge”?
Caroline Kelly,1, Eleny Romanos-Sirakis, MD2,3 1Touro College of Osteopathic Medicine 2Northwell staten island university hospital 3Zucker school of medicine at Hofstra/Northwell ckelly@student.touro.edu
Daniel Kruglyak1, Dalton Schroeder1, Nathaniel Vance1, David Kufner1, Philip Myers DO2 1 William Carey University College of Osteopathic Medicine 2 Singing River Health System dkruglyak528262@student.wmcarey.edu
INTRODUCTION: Foot drop can present a significant diagnostic challenge, often necessitating extensive evaluations without a clear etiology. This case emphasizes the importance of osteopathic manipulative treatment (OMT) as a potential therapeutic option when traditional approaches fail, providing a unique perspective on the neuromusculoskeletal contributions to chronic foot drop. CASE PRESENTATION: A 42-year-old female with a history of kidney infections, migraine headaches, and irritable bowel syndrome presented with chronic foot drop following a gym-related injury. Her symptoms persisted despite multiple neurological evaluations, imaging, and conventional treatments. An extra navicular bone identified on imaging contributed to the complexity of her case. FINDINGS: Physical exam findings revealed posterior fibular head somatic dysfunction, correlating with impaired dorsiflexion. Despite prior medical and alternative therapies, no definitive neurological cause was identified. Diagnostic workup included X-ray, MRI, VEP, and EMG studies, which ruled out common causes of foot drop. TREATMENT/INTERVENTION: The patient received OMT to mobilize the fibular head to relieve pressure on the peroneal nerve. Techniques were employed to engage restrictive barriers, including high velocity low amplitude (HVLA) to posterior fibular head and talus, muscle energy for anterior tibialis muscle, direct myofascial release, and pedal pump, resulting in 75% relief of her symptoms after the first treatment. Over a period of four months, she experienced significant improvements in leg color, mobility, and overall function. CONCLUSION: This case highlights the diagnostic and therapeutic challenges associated with foot drop and underscores the potential value of OMT as a first-line treatment. Further research is warranted to explore OMT’s role in managing neuromusculoskeletal conditions, especially when traditional interventions are ineffective.
INTRODUCTION: This case report explores endogenous ochronosis, a rare pigmentation of tissues caused by alkaptonuria (AKU). Alkaptonuria is an autosomal recessive disorder with a prevalence of less than 1 in 100,000 in the United States. It is caused by a mutation in the enzyme homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid in cartilage and black pigmentation of tissue, which causes inflammation, degeneration, and osteoarthritis. CASE PRESENTATION: A 67-year-old female presented with achy pain at the base of her left thumb for 5-6 months, worsening at night and with gripping activities. FINDINGS: Physical exam demonstrated a positive basal grind test and laxity about the basal joint. Multiple radiographs of the left hand confirmed the diagnosis of end-stage left first carpometacarpal (CMC) joint arthritis. TREATMENT/INTERVENTION: The patient failed conservative treatment. The decision was made to proceed with basal joint arthroplasty with harvest and transfer of the left flexor carpi radialis tendon for ligamentous reconstruction and tendon interposition. Initial dissection revealed the presence of ochronotic pigmentation within the bony and tendinous structures. No immediate need to abort the procedure. Biopsy was sent to pathology for AKU evaluation. The patient tolerated the procedure well without complications. CONCLUSION: The accidental finding of AKU in this 67-year-old patient during the arthroplasty procedure is atypical, as nearly a quarter of AKU patients are diagnosed within the first year of life. However, if early signs are missed, patients typically present with joint pain in their thirties. Further research is needed to understand the factors behind this atypical AKU presentation and to develop appropriate treatment strategies.
An Osteopathic Approach to Foot Drop: A Case Report of Posterior Fibular Head
Mikhail Volokitin, MD, DO, Abraham Libman, MA, Siam Ayon, DO Touro College of Osteopathic Medicine - Harlem CAMPUS, NY alibman2@student.touro.edu
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Alkaptonuria Diagnosed At The Time Of Basal Joint Arthroplasty
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Alekya mallampallI, Ajith Castelino, MD Chicago College of Osteopathic MedicIne - Midwestern University alekya.mallampalli@midwestern.edu
A Case of Treatment-Resistant Catatonia Without Access to ECT
Fatima Mahmoodi1, Vanessa Lim1, Teresa Lonce1, Ayodeji Somefun, MD2 1 West Virginia School of Osteopathic Medicine 2 Frederick Health Hospital fmahmoodi@osteo.wvsom.edu
A Unique Case of Cervical Complex Regional Pain Syndrome: A Case Report and Review of the Literature
INTRODUCTION: Complex Regional Pain Syndrome is a rare neuropathic disorder consisting of long-lasting pain and inflammation following an injury, surgery, or trauma. CRPS most commonly occurs in the extremities. Those living with CRPS experience pain that is disproportionate to the preceding medical event. CASE PRESENTATION: A 73 year-old man was referred to our clinic with severe pain in the neck after multiple facet blocks and epidural injections due to degenerative joint disease and cervical and lumbar stenosis. FINDINGS: The patient’s MRI revealed cervical spondylosis at C5-C6. His range of motion was restricted due to hyperalgesia and allodynia. His extensive history, spinal procedures, and debilitating pain led to the diagnosis of CRPS based on the Budapest criteria. TREATMENT/INTERVENTION: The patient alternated between tramadol, cymbalta, and hydrocodone, which only minimally helped. The patient is currently doing physical therapy and is taking tramadol 50mg, gabapentin 600mg, tizanidine 4mg, diclofenac gel 1%, and lidocaine cream 4%. This combination is well-tolerated and may be altered based on changes in his disease and pain level. Our patient continues to have excruciating pain without any sign of remission. CONCLUSION: This patient’s unique presentation of CRPS in the cervical area, in contrast to more common presentations in the extremities, prompts use of a multidisciplinary approach to treat patients suffering with CRPS. Such an approach is crucial for addressing the complex, multifactorial nature of the condition and optimizing outcomes for patients with less conventional presentations.
INTRODUCTION: The first-line treatment for the psychomotor syndrome of catatonia is benzodiazepines, a GABA-A agonist that depresses the central nervous system (CNS) activity. This medication is typically followed by electroconvulsive therapy (ECT) for those who are treatment-resistant. We present a case of refractory catatonia in a patient with no identifiable organic cause or known psychiatric history. CASE PRESENTATION: 21-year-old Hispanic male, Spanish-speaking only, with no known psychiatric or medical history. FINDINGS: The patient was dysphoric, had a flat affect, and limited speech. He was immobile and maintained no eye contact. Lumbar puncture and CT scans were negative. TREATMENT/INTERVENTION: The patient displayed slight improvements with the initial treatment of a low dose of lorazepam and risperidone. Risperidone was discontinued, and aripiprazole 5 mg by mouth (PO) daily was started for psychotic causes of catatonia. To treat possible neurological causes, the patient received thiamine 200 mg PO daily. The patient was later started on memantine 5 mg PO twice a day (BID) that was eventually titrated to 10 mg PO BID with little response. A trial of IV ketamine 0.5mg/kg dosing was administered, which improved the patient’s Bush-Francis rating from 16 to 12. After the initial improvements from the benzodiazepines, the patient’s response throughout treatment did not significantly change.The patient was later transferred to another facility for ECT treatment. CONCLUSION: This case underscores unique barriers that clinicians face when treating first-episode catatonia with limited patient history. It highlights the need for more targeted research and resources to provide patient-centered care in resource-limiting circumstances.
Exploring Adolescent Psychosis: 14-Year-Old Male with Substance Abuse
INTRODUCTION: Atrial fibrillation (AF) is a common arrhythmia associated with increased perioperative risks in surgeries. Atrial fibrillation is closely linked to advanced age and various risk factors associated with aging. Preoperative assessment, pharmacological management, and perioperative vigilance are crucial for mitigating these risks. CASE PRESENTATION: A 67-year-old woman with pre-existing AF underwent an elective laparoscopic right hemicolectomy. TREATMENT/INTERVENTION: Despite preoperative optimization, she progressed to postoperative atrial fibrillation with rapid ventricular response (RVR) and ventricular tachycardia (VT), an exacerbation associated with the stress of surgery and electrolyte imbalances postoperative. Her course was affected by ileus and hypokalemia which prolonged her hospital stay. Multifactorial management, including strict rate and rhythm control with diltiazem 60 mg three times a day, followed by metoprolol 100 mg twice a day (BID), cardioversion, and amiodarone 200 mg BID, resulted in stable outcomes and a follow-up for cardiac ablation. CONCLUSION: This case highlights the obstacles in managing atrial fibrillation in perioperative noncardiac surgeries, especially in patients with pre-existing conditions. It highlights the importance of a multidisciplinary approach tailored to the patient's risk factors. Research supports beta-blockers, amiodarone, and statins for the prevention of atrial fibrillation. Colchicine as prophylaxis in perioperative management remains unclear. Emerging evidence supports that including atrial fibrillation as an independent risk factor in the Revised Cardiac Risk Index (RCRI) has the potential to finer-tune management to patients undergoing surgeries.
P. LeticIa1, H. MaoHao, MD2 1 Alabama College of osteopathic MedicINE 2 ADVANCED GASTROENTEROLOGY & SURGERY ASSOCIATES perezl@acom.edu
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Aging Population: In Search of New Atrial Fibrillation Approach
Ayana J. Mclaren, Love O. AfrifIa, Luisa M. Sanchez-Mendez,, Peter Sangra, MD Burrell College of Osteopathic MedicIne ayana.mclaren@burrell.edu
INTRODUCTION: Acute psychosis is a well-researched disease process in adults, described as a brief period of hallucinations, delusions, disorganized thoughts, behaviors, or speech. Its impact on adolescents, as well as risk factors, remain relatively understudied. Further investigation regarding the relationship between substance abuse and psychosis in adolescents would be advantageous for the medical community. CASE PRESENTATION: A 14-year-old male with a history of marijuana, spice, alcohol, and nicotine use who presented with aggressive behavior and disturbing actions. The patient was hospitalized at our inpatient psychiatric facility for seven days. FINDINGS: Patient appears disheveled and avoids eye contact. Affect was blunted and irritable. Speech was rapid, and his thought process was goal-directed. Patient was experiencing depersonalization. Insight and judgment were poor. TREATMENT/INTERVENTION: The patient received psychotherapy, group therapy sessions, family therapy sessions as well as antipsychotic medication and several doses of haloperidol. However, there were occasions when the haloperidol injections failed to curb his acute aggressive episodes. A multidimensional approach was implemented into the patient’s treatment plan to emphasize coping mechanisms to manage his negative emotions towards others. CONCLUSION: This case underscores the critical need for expanded research investigating the co-occurrence of first-episode psychosis and substance abuse in adolescents. Such studies should elucidate the underlying pathophysiological mechanisms and risk factors associated with this complex presentation. Additionally, the case highlights the imperative for interdisciplinary collaboration among healthcare professionals for optimizing treatment outcomes in this vulnerable population. Further research should refine evidence-based interventions and ensure optimal clinical care and support for adolescents experiencing these co-occurring mental health conditions.
Chenxi shi, Deep ParikIh, MD Kansas City University College of oSteopathic medicIne bm1865@mynsu.nova.edu
The Evolution of a Schizoaffective Disorder in an Adolescent Male
Luisa Sanchez-Mendez, Love O. Afrifa, Ayana McLaren, Peter Sangra, MD Burrell College of Osteopathic Medicine luisa.sanchez@burrell.edu
INTRODUCTION: Acute retinal necrosis (ARN) is an extremely rare eye condition commonly caused by infection of herpesviruses. A common clinical presentation is patients aged 50-70, with panuveitis and a characteristic triad of vasculitis, vitritis, and retinitis. CASE PRESENTATION: An 85-year-old female presents with a two-month history of progressive unilateral vision loss without pertinent past medical history. The patient was diagnosed with uveitis by a local ophthalmologist and was referred due to refractory to both oral and topical steroid therapy. FINDINGS: The slit-lamp exam of the right eye revealed 2+ cells in the anterior chamber and macular retinal hemorrhage. The indirect fundoscopic exam showed peripheral retinitis and 3+ vitritis, with limited visibility due to inflammation. Vision in the right eye was limited to light perception.The left eye exam demonstrated normal age-related changes. TREATMENT/INTERVENTION: A working diagnosis of ARN was established. The patient was prescribed intravitreal foscarnet along with oral valaciclovir, in addition to the ongoing steroid regime. A PCR testing result of the aqueous humor sample returned positive for varicella-zoster virus, thus confirming the diagnosis. The patient is being closely monitored for ongoing treatment. During a recent follow-up after 2.5 months of treatment, the patient’s vision improved to hand motion, and the anterior chamber inflammation had resolved. CONCLUSION: Early diagnosis and treatment of ARN are crucial for a favorable prognosis. This case highlights the importance for physicians to consider a broad range of differential diagnoses and address the underlying cause of uveitis.
A Case of Complicated Acute Retinal Necrosis
INTRODUCTION: Paranoid delusions are a common warning sign for early-stage psychosis in adolescents. It may be the sole symptom, as seen in delusional disorder, or precede other symptoms such as hallucinations or disorganized thoughts, as in schizophrenia or schizoaffective disorder. The presentation of these disorders in adolescents are less understood. Analyzing how these disorders develop during this crucial stage of growth could be key to improving intervention strategies. CASE PRESENTATION: A 15-year-old male with substance abuse disorder and immediate family history of schizophrenia, presented to an inpatient psychiatric facility during an acute psychotic episode. FINDINGS: During the patient’s hospitalization, stabilization of psychotic symptoms was achieved. However, his delusions and paranoia were difficult to treat. The patient experienced fluctuating progress, through various dosage trials and medications. Aripiprazole, a second-generation antipsychotic, was given to decrease his paranoia and valproate, a mood stabilizer, was added to improve his overall mood. TREATMENT/INTERVENTION: A holistic treatment approach, incorporating individual, group and art therapy, as well as daily physical activity. The patient continued his antipsychotic and mood stabilizer treatment indefinitely for long term management of his condition. His condition progressively deteriorated, with signs of a persistent psychotic disorder emerging. CONCLUSION: This case illuminates the contributing factors of acute psychosis in an adolescent male. By examining themes of delusions, substance abuse, and their potential influence on psychotic episodes, this case contributes to the existing knowledge on adolescent psychiatric conditions. It advocates for the prioritization of mental health awareness, as well as comprehensive intervention strategies which can be employed to promote adolescent patients’ well-being.
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"Neuroanatomy Atlas Composite" Artist: Anastasia Joy Harris Abbott, OMS-III University of the Incarnate Word School of Osteopathic Medicine
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SOMA Research Spotlight Award
QUALITY IMPROVEMENT (QI)
Let's bring academia in Osteopathic Medicine to the forefront! The SOMA Research Spotlight Award is a great way to highlight and bring attention to your current and past works. Students are chosen monthly for Spotlight recognition. Apply now and let's celebrate your accomplishments together!
Lecanemab Treatment for Alzheimer’s Disease in a 79 year-old with Mild Cognitive Impairment
Brittany Woody1, Sheri Swader, MD 2 1 Alabama College of Osteopathic Medicine 2 Marshall Medical Centers woodyb@acom.edu
Know a student researcher who deserves recognition? Encourage them to apply!
INTRODUCTION: Alzheimer’s Disease (AD), the leading cause of dementia in the United States, results from the accumulation of amyloid-beta in the brain. Lecanemab, recently approved by the FDA, is a monoclonal antibody that binds to and removes amyloid-beta. It is indicated for mild cognitive impairment with evidence of amyloid on PET scans or through cerebrospinal fluid testing. CASE PRESENTATION: Patient is a 79 year old female with a past medical history of hypertension presented to the neurologist for memory loss. FINDINGS: Patient scored 25/30 on her first Mini-Mental State Exam (MMSE). Laboratory results showed elevated phosphorylated-tau, total tau, and phosphorylated-tau to amyloid-beta ratio. Her APOE genotype is e3/e4, which is associated with an intermediate risk of developing AD. Head CT, brain MRI, and electroencephalogram findings were normal. TREATMENT/INTERVENTION: The patient was initially started on donepezil for her memory loss but was later changed to memantine due to side effects. Given her mild cognitive impairment, Lecanemab was added to her regimen. Ten months later, her MMSE score dropped by 2 points. The patient and her daughter also reported that her handwriting seemed to improve during the treatment period. CONCLUSION: The MMSE score of the average Alzheimer’s patient drops 3-4 points per year. Because this patient’s score dropped by only 2 points in about the same time period, it suggests that Lecanemab could have slowed the progression of her disease. Further research is needed to confirm the correlation and extent of Lecanemab’s impact.
https://forms.gle/Zxd83h57PTuSjVm97
Feeding The Problem: Medicine In A Culture of Excess
ORIGINAL RESEARCH
Kayla Leiber, OMS-II, Alabama College of Osteopathic Medicine: Heart disease remains the leading cause of death in the United States. Is our culture of excess feeding the problem? This piece represents the ongoing challenges physicians face in treating heart disease within the landscape of American diet culture.
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INTRODUCTION: First rib (FR) and acromioclavicular joint (ACJ) subluxation can present both symptomatically and asymptomatically. This project displays the effectiveness of treating ACJ-FR subluxation somaticdysfunction. METHODS: This project was a quasi-experimental pre-and-post experimental design with 20 students, 10 male and 10 female. A goniometer assessed range of motion (ROM). The shoulder was abducted 90 degrees (90D), flexed 15 degrees (15D), elbow stabilized in 90D flexion with internal rotation (IR) of the shoulder during hand pronation. Cervical region restriction is a lack of rotation, 15D or more, toward the side of the subluxed FR. Pressure was applied to the FR, depressing it downward towards the sterno-clavicular joint (SCJ). Medial-superior manual pressure was simultaneously applied to the ipsilateral ACJ while flexing the ipsilateral shoulder 90D, and raising the arm superiorly The patient's head was continuously positioned downward, rotated contralateral to the dysfunctional side. The researcher moved the flexed arm slightly above and behind the patient’s head as the patient concurrently exhaled, repeating the technique as needed. RESULTS: This technique alleviated the 15D pre-corrective restrictions with ipsilateral cervical rotation and restoration of the pre-corrective 15D loss of ROM with IR of the shoulder. Shoulder IR showed 11° mean improvement, P-value=0.00019. Cervical ROM showed 5.1° mean improvement, P-value=0.01. ɑ=0.05. CONCLUSION: Treatment re-establishes full ROM with ipsilateral cervical rotation and IR of the shoulder. Clinical findings remained consistent regardless of age or gender. FR subluxation appears ubiquitously and can be treated with OMM.
Enhancing Alzheimer's Dementia Knowledge and Utilization Through Trainings for Healthcare Professionals
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Meaghan Barros, Alexander Bennett, Taras Kochno, MD, and Thomas Fotopoulos, DO Alabama College of Osteopathic Medicine bennettaa@acom.edu
Winnie Chen, Michelle Ngo, Sweta Tewary, PhD, MS, MSW Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, wc578@mynsu.nova.edu
A Novel Osteopathic Manipulative Technique Directed Toward Treating Acromioclavicular Joint-First Rib Somatic Dysfunction
INTRODUCTION: Current healthcare professionals are unsatisfied with their care of Alzheimer's disease (AD) patients due to a lack of ongoing training. This study analyzes the impact of AD-related training to further enhance their knowledge on various AD topics. METHODS: A qualitative study on 213 participants from 5 healthcare professional groups at different levels of education was performed across five years (2020-2024) at Nova Southeastern University’s South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) in South Florida. Participants completed training sessions on AD-related topics and a post-training self-assessment survey related to their knowledge change and the likelihood of applying that knowledge. Responses from each survey were analyzed and a matched sample t-test was performed to determine the significance of knowledge change. RESULTS: Our participants were as follows: 35.7% students, 10.8% residents, 4.2% fellows, 33.3% faculty, 16% other. The results of their surveys demonstrated a 1.88% and 32.9% decrease in the “none” and “low” knowledge groups, respectively. The “moderate” and “high” knowledge groups increased by 5.16% and 29.11%, respectively. The t-test results showed significant improvement in knowledge (p<0.05). Most participants reported that they are very likely to apply the knowledge they gained from a training session to their future clinical practice. CONCLUSION: SGFWEP training sessions positively impact healthcare professionals by improving their understanding of AD-related topics. By strengthening their knowledge, healthcare professionals are more willing to incorporate their understanding into future practice. Additional studies should explore the effectiveness of such trainings in patient care settings.
ORIGINAL RESEARCH/QI
JENNIE DWORKIN1, AURELIE LAMBOY1, ZACHARY STEIER1, KRISTINA LEIDER1, ALIYAH STEPHENS1, CAMILLE KARREN1, POOJA PATEL1, PRAKHYAT SUNUWAR1, WESLEY MUSTAFALLARI1, HANNA WOLLOCKO MD, PHD2, NILANK SHAH MD, MS, CFN, CNC1 1 TOURO COLLEGE OF OSTEOPATHIC MEDICINE, MIDDLETOWN, NY 2 OXYVITA INC., MIDDLETOWN, NY jdworkin@student.touro.edu
LIAM BROWNING, MALAAK ELHAGE, NICOLE OSKA, GEORGE KIDESS, LIZA HINCHEY, PHD, ARWA SALEEM, SADIE KNILL, ARASH JAVANBAKHT, MD LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE melhage82730@med.lecom.edu
INTRODUCTION: Each year, approximately 436,000 Americans die from cardiac arrest (CA), with survival outcomes influenced by underlying causes, speed of intervention, and access to medical assistance. However, survival rates remain relatively low, between 10% and 20%. This study assessed the effectiveness of a hemoglobin-based oxygen carrier (HBOC) as an adjunct intravenous therapy to improve oxygen delivery to hypoxic cardiac tissue during the third phase of CA, where treatment options are limited. Additionally, we investigated the potential of ascorbic acid (AA) and N-acetylcysteine (NAC), given their antioxidant properties, to further enhance the efficacy of HBOC. METHODS: To improve oxygen transport and efficiency, we introduced AA and NAC at fixed doses across varied pH levels. We evaluated changes in the treatment's efficacy by measuring the oxidized-to-reduced iron ratio using an ultraviolet-visible spectrophotometer. This measurement provided a direct correlation with the treatment's potential for oxygen transportation and delivery. RESULTS: The addition of AA and NAC shifted the Hb ratio versus time graphs from linear to exponential models at pH 7.45 and 8.0. Furthermore, the slope of the NAC graph was steeper and plateaued earlier than that of AA. CONCLUSION: NAC demonstrated a greater potential for optimizing oxygen delivery via the HBOC. Looking ahead, our research will explore additional antioxidants to boost the effectiveness of the HBOC in preventing CA-induced tissue damage, aiming to improve outcomes for patients after traditional interventions have been exhausted. These findings can help reduce the likelihood of irreversible damage during CA, potentially improving survival rates and long-term recovery for patients.
Pioneering Hemoglobin-Based Solutions for Critical Cardiac Support
INTRODUCTION: Arab Americans represent one of the largest ethnic groups in the United States, yet their mental health and opinions on this topic remain understudied, despite higher rates of mental illness and lower rates of treatment. Unique cultural conceptualizations of mental illness may generate stigma, contributing to treatment disparities. This study aimed to assess the attitudes and perspectives of Arab Americans regarding mental illness to address barriers to treatment. METHODS: An anonymous bilingual Qualtrics survey on various mental health-related topics (e.g., beliefs in origin of mental illness, preferred treatment resources, etc.) was conducted with 218 Arab participants and 76 non-Arab participants, all aged 18 and older. Chi-square tests, independent T-square tests, and Analysis of Covariance (ANCOVAs) were used for analysis. Bivariate Pearson correlations were used to assess statistical significance. RESULTS: Compared to non-Arabs, Arabs reported higher average mental illness stigma and were more likely to rate psychiatric medications as addictive and unhelpful (t(292) = -3.42, p < 0.001). Among Arabs, being Christian, male, and 29 years or older were each associated with higher stigma (t(194) = 2.10, p = 0.037). Arabs were less likely than non-Arabs to believe in a biological explanation for mental illness (r(219) = -0.401, p < 0.001). CONCLUSION: Our results demonstrate higher levels of stigma towards mental illness among Arab Americans, especially among Christian, male, and older Arabs, which may be linked to a weaker belief in a biomedical model for mental illness. Understanding this stigma is a crucial first step toward informing future interventions to provide culturally competent care to Arab Americans.
Mental Health Attitudes and Perspectives of Arab Americans: Beliefs Associated with Stigma, Treatment, and the Origins of Pathology
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Ethnic Disparities in Alzheimer's Disease: A Machine Learning Approach to Neuroimaging Analysis
Anna Haymov, Cassie Girardin, Paula Bongiovanni, Shafayath, Chowdhury, Catie Carolla, Constantino Lambroussis, DO, MS Lake Erie College of Osteopathic Medicine, ElmirA cgirardin72065@med.lecom.edu
Daniel Gibbs1, Benjamin Black1, Fan Zhang, PhD2,3 1 Texas College of Osteopathic Medicine, Fort Worth, 2 Institute for Translational Research, University of North Texas Health Science Center, Fort Worth 3 Department of Family Medicine, University of North Texas Health Science Center, Fort Worth danielgibbs@my.unthsc.edu
INTRODUCTION: Historically, Doctor of Osteopathy (DO) students aimed to take the United States Medical Licensing Examination (USMLE) Step 1 in addition to their required Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 to enhance their competitiveness for residency. However, in 2022, USMLE Step 1 transitioned to a pass/fail grading system. This study examines how this change has influenced DO students' decisions to take the USMLE Step 1 and Step 2 exams. METHODS: This meta-analysis explores the rates of COMLEX Level 1 (required) and USMLE Step 1 (optional) participation before and after the 2022 shift to pass/fail, along with trends in Step 2 participation, using literature, survey, and official data from the USMLE website. The survey was collected in August of 2023 from 53 students from Lake Erie College of Osteopathic Medicine in Elmira. RESULTS: Before the grading transition, our findings revealed 45.9% of osteopathic students planned to take USMLE Step 1. However, participation in Step 1 dropped by 12% between 2021 and 2022, coinciding with the pass/fail shift. Conversely, Step 2 participation surged with an increase of 35% from 2020 to 2022, though a decline in Step 2 takers began in 2022, paralleling the trend seen in Step 1. CONCLUSION: With Step 1 and Level 1 now being pass/fail, the Step 2 exam holds greater weight, influencing osteopathic students' decisions regarding exam-taking. Future studies are needed to address the limitations of this study and to further investigate the impact of changes in exam-taking decisions on residency application patterns.
INTRODUCTION: Alzheimer's Disease (AD) affects millions in the United States, with neuroimaging playing a crucial role in diagnosis and research. This study employs machine learning, specifically Random Forest (RF) algorithms, to analyze neuroimaging data across diverse ethnic groups to identify key brain regions associated with AD progression. METHODS: Data from 2950 participants (657 African Americans, 1147 Mexican Americans, 1146 non-Hispanic Whites) were analyzed using MRI, DTI, and PET scans. RF models were employed to determine cognitive status (Cognitively Unimpaired versus Cognitively Impaired) based on neuroimaging variables. Feature importance and SHAP values were used to identify significant brain regions. RESULTS: RF model accuracy varied across ethnic groups: 69.30% (African Americans), 86.75% (Mexican Americans), and 82.46% (non-Hispanic Whites). PET-Tau Posterior Cingulate SUVr (Tau-PC) emerged as a consistently important feature across all ethnicities. Tau-PC and Tau-Lateral Parietal were more influential in Mexican American and non-Hispanic White groups compared to African Americans. CONCLUSION: The study highlights Tau-PC as a critical predictor of cognitive status across diverse ethnic groups, potentially serving as a valuable biomarker for early AD detection. The varying influence of neuroimaging features across ethnicities underscores the importance of considering ethnic disparities in AD research and diagnosis. Future studies should investigate longitudinal data and potential confounding factors to validate these findings.
A Shifting Landscape: Osteopathic Students’ Step 1 and Step 2 Trends in Response to Pass/Fail Scoring
Expression and Function of SARM1 in Peripheral Blood Mononuclear Cells in Type 1 Diabetes
Differential Modulation of Aquaporin-1 in Chronic Lung Toxicity Models
Gabrielle Groves1, Lila Dabill2 Ivana Shen2, Jennifer Brazill2, Aaron DiAntonio2, Yo Sasaki2, Erica L Scheller2, Phd, DDS 1 Kansas City University 2 Washington University School of Medicine, St. Louis, MO gabrielle.groves@kansascity.edu
INTRODUCTION: SARM1, an NADase protein, regulates axon degeneration and contributes to peripheral neuropathy in patients with type 1 diabetes (T1D). In rheumatoid arthritis (RA), SARM1 protein was found to have lower basal levels in RA monocytes versus in controls and inversely correlated with IL-1β secretion, identifying an anti-inflammatory role for SARM1.[2] SARM1 may also regulate macrophage proinflammatory immune response. Inflammation contributes to T1D-associated tissue damage, yet SARM1 in peripheral blood mononuclear cells (PBMCs) has not been examined. We hypothesize that SARM1 is expressed in PBMCS and is decreased in adolescents with T1D. METHODS: Bulk RNA sequencing and single cell RNA sequencing data sets were analyzed for SARM1 in PBMCs. TaqMan qPCR was conducted on cDNA from PBMCs from adolescent girls for analysis of SARM1 and IL-1β. SARM1 function was analyzed by using mass spectrometry. RESULTS: SARM1 expression levels in PBMCs did not significantly different between controls and patients with T1D in the RNA sequencing datasets. Additionally, both SARM1 and IL-1β expression did not show significant differences between control subjects and T1D patients, as assessed by TaqMan qPCR or in a functional assay for SARM1. We observed no correlation between expression of SARM1 and IL-1β at the gene level. CONCLUSION: SARM1 is expressed in PBMCs, but at low basal levels. We did not detect differences in SARM1 expression in PBMCs in patients with T1D. Future clinical trials of SARM1 inhibitors for prevention of neuropathy may benefit from the consideration of secondary effects on inflammation and immune cell function.
Ariel Hus, Ekta Yadav, Sukanta Bhattacharya, Brijesh Yadav, Ryan Akhavan, Niket Yadav, Jagjit S Yadav Kiran C. Patel Nova Southeastern University College of Osteopathic Medicine Ah3338@mynsu.nova.edu
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INTRODUCTION: Aquaporins, or water channels, in the lung respond to various stimuli, such as ventilation or infections, and thus play a crucial role in lung homeostasis and pathophysiology. However, little is known about the effect of environmental toxicant exposures and co-exposures that induce pulmonary injury (inflammation, edema, acute lung injury) or diseases (bronchitis, COPD). This study aims to uncover whether lung toxicants affect expression of aquaporin 1 (AQP1) equally. METHODS: Chronic toxicity mouse models were developed using particulate toxicant such as carbon nanotubes (CNTs), chemical toxicant such as cigarette smoke extract (CSE), or a combination of both. These models were assessed for the effects of these toxicants on the modulation of aquaporins in terms of mucosal defense, protein homeostasis, and pathological endpoints. RESULTS: Variable levels of alveolar cellular infiltration and other histopathological changes associated with the two types of toxicants were observed. The molecular targets showed either similar or differential regulation, depending on the toxicant type, with the effects of co-exposure being largely additive. CONCLUSION: Both toxicant types, nanoparticles and smoke chemicals, caused a similar trend of downregulation for mucosal defense targets (SP-A, Muc5b), indicating a disrupted homeostasis with an increased propensity to cause infections in the affected lungs. In contrast, the regulation of aquaporin 1 differed between the two toxicants:upregulation of AQP1 in nanoparticle-exposed and downregulation in smoke-exposed. This differential regulation corresponds to various impacts on vascular permeability and alveolar infiltration, suggesting AQP1 may serve as a specific biomarker for toxicant type-specific pulmonary injury.
INTRODUCTION: This study evaluates how medical students across all years cope with death during clinical training. Through an anonymous survey, we assess their experiences with death and identify areas for improvement, aiming to implement changes. We hypothesize that having seminars focused on handling death earlier in students' medical education can allow them to become better equipped when handling death and dying. METHODS: An online survey with 19 questions was distributed to medical and master students across TouroCOM campuses (Harlem, Middletown, Montana). The survey included multiple-choice, text responses, and rating scales to assess personal experiences with death and dying. A total of 117 responses have been reported thus far and data was analyzed using Qualtrics. RESULTS: Preliminary results suggest most medical students have prior clinical experiences and over half (56%) have encountered death, suggesting a critical need for emotional preparedness. Approximately 46% of participants desire a grief counseling course reflecting mixed results, although data collection is still ongoing. In addition, 73% of participants reported it was their first anatomy lab experience in medical school. Our study identifies gaps on grappling with death and dying during clinical rotations, which can be improved by expanding resources for students prior and during clinical rotations. CONCLUSION: Our study's results have the potential to advance medical education and student support during medical school. These results identify variables that impact students' preparedness for death and dying, and subsequent areas to improve upon when training for clinical rotations and their careers in medicine.
Evaluating Cervical and Lung Cancer Risk among Hispanic and Non-Hispanic Black Women in Three Urban Texas Counties
Irene Jayesh1, Megan Chu2, Marcela Nava, PhD2 1 Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth 2 The University of Texas, Arlington irenejayesh@my.unthsc.edu
INTRODUCTION: We assessed whether there were statistically significant differences in the incidence rate of cervical and lung cancer between these Hispanic and Non-Hispanic Black (NHB) women in Tarrant (TC), Dallas (DC), and Bexar Counties (BC). METHODS: Using data from the National Cancer Institute’s SEER Program from 2000 to 2020, trends in cancer diagnoses were assessed using age-adjusted annual percent change (APC). The data were ranked by county and race/ethnicity. Next, APC with 95% confidence intervals for Hispanic and NHB women were compared. RESULTS: In TC, the cervical cancer APC of Hispanic women was -1.8 [-3.4,0.1] and NHB women was -1.2 [-3.7, 1.3]. In DC, the cervical cancer APC of Hispanic women was -2.1 [-3.4, -0.8] and NHB women was -1.8 [-3, -0.5], suggesting a greater decrease for Hispanic women. Lung cancer APC of incidence rates saw a similar pattern. While the APC was lower for Hispanic women in both cities, the overlap of confidence intervals (CI) indicates no statistically significant difference. CONCLUSION: Although the overlapping CI suggests insignificance, the APC still offers insights into diagnostic trends in urban areas. Both populations showed changes in cervical and lung cancer incidence, indicating shared influencing factors during the study. Future research should explore variables such as socioeconomic status, healthcare access, culture, and healthcare utilization patterns to better understand cancer incidence among minority groups. Additionally, further studies should assess the impact of interventions aimed at reducing cancer health disparities across diverse populations.
Amanda Kaine, Shivani Padhi, Juliana Cialdella, Daniel Zona, Chienye Victoria Onukaougu, Micheal Foti, DO. Touro College of Osteopathic Medicine, Middletown, NY akaine@student.touro.edu
An Investigation Into Factors Affecting Response to Patient Death
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Effect of Cessation of Renin-Angiotensin System Inhibitors on Clinical Outcomes in AKI
INTRODUCTION: Aortic Stenosis (AS) is a prevalent valvular heart disease, disproportionately affecting elderly populations and underserved communities. African American and Hispanic patients in socioeconomically disadvantaged regions, such as rural and underserved metropolitan areas, face disparities in access to life-saving aortic valve replacement (AVR) treatments. Current echocardiographic methods for AS diagnosis require improvement in both accuracy and efficiency. Artificial Intelligence (AI) technologies, such as convolutional neural networks (CNN), offer a solution for improving diagnostic accuracy and reducing healthcare disparities. METHODS: A single-center retrospective cross-sectional study was conducted at the University of Illinois Chicago (UIC) analyzing transthoracic echocardiograms (TTEs) from 289 patients with mild-to-moderate AS after being selected from an expanded cohort of 774 patients via REDCap. Using the Us2.ai platform, CNN algorithms were applied to assess TTE parameters, aiming to enhance diagnostic precision and reduce analysis time. Patients were selected based on complete TTEs and native aortic valves, with AI performance compared against expert cardiologist evaluations. RESULTS: The AI model reduced analysis time by 95% (2-tailed P value of <.05), completing echo readings in 1-2 minutes, while maintaining accuracy closely aligned with expert evaluations. Higher incidences among Hispanic/Latinx and Black/African American populations were found, highlighting the need for more equitable diagnostic practices. Insurance analysis revealed reliance on Medicaid and Medicare among severe AS patients. Conclusion: This study demonstrates the potential of AI in improving diagnostic accuracy for AS, particularly in underserved populations, by reducing analysis time and increasing diagnostic precision. Ongoing research and implementation of AI-driven solutions are vital to achieving more equitable healthcare.
INTRODUCTION: The second Electronic Alerts for Acute Kidney Injury Amelioration (ELAIA-2) trial was conducted to evaluate the effectiveness of medication-targeted alerts for acute kidney injury (AKI) across multiple hospitals. We investigated whether an automated clinical decision support system could improve the discontinuation rates of potentially nephrotoxic medications and enhance clinical outcomes in patients with AKI. METHODS: A subgroup analysis using STATA, an instrumental variable regression, was performed to compare the clinical outcomes between patients who had their renin-angiotensin-aldosterone system inhibitors (RAASi) discontinued versus those who continued the treatment.. Next, the existence of a causal relationship between ACE/ARB inhibition and clinical outcomes was determined. In addition, the influence of patient characteristics on the effect of these medications is also evaluated. RESULTS: The group that had their ACE/ARB discontinued showed a significantly higher proportion of in-patient mortality, dialysis, AKI progression and composite outcomes at 14-days follow-up. However, instrumental variable regression analysis revealed no causal relationship between the cessation of RAASi and clinical outcomes. This lack of association was consistent across all examined subgroups, including congestive heart failure, chronic kidney disease, pulmonary disease, hypertension, depression, malignancy and liver disease. CONCLUSION: There is minimal causal relationship between RAASi cessation and outcomes among hospitalized patients with AKI. This leads us to conclude that stopping or continuing the medication in any of the given comorbidities had no impact on clinical outcomes.
Amrita Makhijani, Farah Yasmin, Dennis G. Moledina, Yu Yamamoto, Francis P. Wilson NEW YORK INSTITUTE OF TECHNOLOGY amakhija@nyit.edu
Enhancing Aortic Stenosis (AS) Diagnosis: Leveraging Artificial Intelligence (AI) for Improved Accuracy and Addressing Health Disparities
SOHail Khan1, Hema Krishna, MD2 1 Touro College of Osteopathic Medicine, Middletown, NY 2 University of Illinois Chicago (UIC) in Chicago, IL skhan49@student.touro.edu
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Investigating LVAD Thrombosis in Cadaveric Heart Model
Empowering Southern Communities: Addressing C-Section Disparities for Healthier Birth Outcomes
Bryan C. Hernandez, Anjali Saji, Mauricio Soto, Umer Khan, Peter Kotsiviras, Sebastian Egberts Philadelphia College of Osteopathic Medicine as3416@pcom.edu
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INTRODUCTION: Cesarean section (C-section) is a common surgical procedure for childbirth, with over 1 million performed annually in the United States (U.S). While lifesaving, C-sections carry risks and exhibit significant regional variability, particularly in the Southern region, where rates are disproportionately high. Prior research suggests that maternal clinical diagnoses alone do not account for these disparities. This study explores how patient demographics and hospital characteristics contribute to elevated C-section events in the Southern U.S. METHODS: This retrospective study analyzed data from the Healthcare Cost and Utilization Project (H-CUP). Variables included elective versus non-elective admission, race, income, hospital region, teaching status, and emergency services use. Patients who underwent C-sections were examined, excluding cases with missing key data. Descriptive statistics and logistic regression were used to assess associations between predictor variables and C-section rates. RESULTS: Preliminary findings show significant regional disparities in C-sections. When adjusted for income, race, and hospital types, patients in the Southern region face a 1.1 times higher likelihood of C-section events. Non-elective admissions, minority races, and low-income patients are 1.2 times more likely to undergo C-sections. Hospital teaching status and geographic region are also significant predictors of C-section likelihood (p < 0.05). DISCUSSION: This study highlights non-medical factors like socioeconomic status and hospital characteristics that influence C-section rates, particularly in underserved regions. Addressing these disparities through policy changes and further research is essential to optimize maternal healthcare and reduce unnecessary C-sections, especially in the Southern U.S.
INTRODUCTION: Heart failure is a devastating condition affecting millions globally, with limited treatment options for advanced stages. Left ventricular assist devices (LVADs) offer hope and extended survival for patients awaiting heart transplantation or as destination therapy. However, LVAD thrombosis presents significant challenges, leading to stroke, device malfunction, and mortality. This study explores the complex dynamics of LVAD thrombosis and the importance of optimizing patient care through a cadaveric heart model. METHODS: We analyzed a cadaveric heart with an LVAD and compared it to a healthy heart from a similar cadaver. Detailed anatomical evaluations included chamber dimensions and myocardial architecture. The LVAD heart underwent histological examination to characterize thrombus composition and tissue response, with findings compared to existing studies on living LVAD patients. RESULTS: The upper left ventricular wall thickness was 12.87 mm in the LVAD-implanted heart and 10.86 mm in the control (p < 0.05). In the lower region, the implanted heart measured 10.76 mm, while the control measured 9.47 mm (p < 0.05). Histological analysis revealed fibrosis, granulation tissue, and congested blood vessels in the LVAD heart, contrasting with normal myocardium of the control heart. The LVAD heart thrombus showed lines of Zahn, indicating pre-mortem formation, while material deposition near the inflow bearing suggested potential flow obstruction. CONCLUSION: The LVAD-implanted heart exhibited significant left ventricular thickness and fibrosis, diverging from typical LVAD findings. These anomalies indicate heart failure progression despite LVAD support, highlighting the need for vigilant monitoring of ventricular morphology and predictive markers like LDH levels to detect and mitigate thrombotic events.
Brittney Clarke, Bharani Gudla, Iannis Moshovitis, Naman Sahota, WILLIAM CAREY UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE nsahota597633@student.wmcarey.edu
INTRODUCTION: As part of a research team in the Brain, Executive Functioning, and Attention Research Lab at Boys Town National Research Hospital in Omaha, Nebraska, we recruited pediatric patients to investigate how young children learn, make executive decisions, and process information in their brains. METHODS: We utilized functional infrared spectroscopy (fNIRS), eye-tracking, and electroencephalography (EEG) to study how varying factors affect neurological developmental trajectories as well as long-term outcomes of executive functioning. We investigated the relationship between functional connectivity, ocular-motor control, behavior, and ADHD risk in children, as well as the implications of medication shortages, using randomized controlled trials. The findings were represented through 3-dimensional brain diagrams to map neural circuitry and visualize connections throughout the brain. RESULTS: Females on methylphenidates and nonstimulant medications had significantly less visible neural connections across hemispheres, as well as shared similar neural circuitry diagrams with females who were not on medication, as compared to females on amphetamines. Consequently, type 2 and 3 medications were ineffective in these patients. CONCLUSION: Amphetamine medication remains the superior prescribed option. Females are most affected by a shortage of or lack of amphetamines medication. Additional studies must be done to address more specific limitations of females as to one medication type.
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Dalia Shaaban1,2, June Pounder1, Andrea Grindeland1,2 1 McLaughlin Research Institute, Great Falls, MT USA 2 Touro College of Osteopathic Medicine Montana, Great Falls, MT dshaaban@student.touro.edu
Amphetamine Shortages may Disproportionately Affect Females: A Case Study of Neural Circuitry Differences by Medication Type in 6–8-year-olds
Assessing the Impact of Formic Acid Treatment on Brain Tissues for Prion Inactivation
Darius J. Shahbazi1, anastasia kerr-german, phd2 1 Kansas City University College of Osteopathic Medicine 2 Boys Town National Research Hospital, Omaha, NE darius.shahbazi@kansascity.edu
INTRODUCTION: Due to the difficult nature of inactivating prions with standard decontamination methods, there are significant risks for handling prion infected tissue samples and potential iatrogenic transmission in clinical, diagnostic, and research settings. Previous studies recommend formic acid for prion inactivation to avoid potential risks associated with handling infected tissues. However, an issue raised includes the effect this chemical has on the morphology of tissue samples. This study aims to evaluate the usability of formic acid as a prion inactivation method to maintain safer research practices without sacrificing the quality of research specimens. METHODS: We compared one hemisphere of a mouse model brain treated with 95% formic acid to the untreated hemisphere. Samples included both diseased and normal brain tissue. Following treatment, brains were embedded in paraffin, sectioned, and stained with hematoxylin and eosin. Tissue sections were visualized and imaged microscopically. Three areas of the brain, specifically the cortex, hippocampus, and cerebellum, were evaluated quantitatively using the program Fiji. RESULTS: Statistical data demonstrated a P value of 0.0001 showing reduction in cortical thickness with both diseased and normal brain tissue. Formic acid-treated tissue showed an average thickness of 0.75 mm compared to approximately 0.99 mm in non-treated tissue. CONCLUSION: The findings indicate that formic acid significantly compromises the morphology of both diseased and normal brain tissue samples. Prion diseases, like Creutzfeldt-Jakob disease, pose significant risks due to their transmissibility and resistance to standard decontamination methods. This study highlights the need for safer, more reliable inactivation techniques that maintain tissue quality.
SOMA Spring 2025 Research Symposium
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The National SOMA Research Committee holds two research symposiums annually, one in the spring and one in the fall. Our goal is to create a platform for osteopathic medical students to engage in scholarly activity. The Spring 2025 National SOMA Research Symposium will take place in March 2025 Keep an eye out for the Call for Abstracts announcement in either the SOMA Weekly newsletter or by following @national_soma on Instagram. If accepted, students will be invited to prepare a poster and oral presentation. This is a great opportunity for students to showcase and articulate their research. All students and faculty are welcome to attend the symposium to support their colleagues as well as learn about a variety of research topics. Winners will receive national recognition and a monetary prize. If you have any questions or concerns, please email the SOMA Research Symposium Committee at: somaresearchsymposium@ studentdo.com. For more information about the symposiums and for information on previous winners, please visit our research website: www.studentdoresearch.org.
Caleb Sooknanan, Lionel Chong, Shawn Geffken, Tint Tha Ra Wun, Anoushka Guha, Pooja Jaiswal, Tamayo Kobayashi, Satoru Kobayashi, PhD, Qiangrong Liang, MD, PhD New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY csooknan@nyit.edu
INTRODUCTION: P21-activated kinase 1 (PAK1) is a serine/threonine protein kinase that plays a crucial role in cardiomyocyte survival in response to various stresses. However, the underlying cardioprotective mechanisms of PAK1 remain unclear. Autophagy is a lysosome degradation pathway essential for cellular homeostasis. In the present study, we showed the ability of PAK1 to regulate autophagy in cardiomyocytes and identified p62 as a potential downstream mediator. METHODS: PAK1 is silenced in H9c2 cardiac myoblasts by siRNA or overexpressed by adenovirus. Autophagy flux was determined by LC3-II protein levels and a fluorescent autophagy reporter with and without Pepstatin A (pepA) and Aloxistatin (E64d). RT-qPCR was used to analyze p62 mRNA levels in relation to PAK1 knockdown or overexpression in vitro and in vivo. RESULTS: Downregulation of PAK1 reduced LC3-II levels in whole cell lysates, which was not affected by pepA and E64d, suggesting that PAK1 knockdown reduced autophagy flux. Conversely, PAK1 overexpression increased LC3-II levels, which were further elevated by pepA and E64d, suggesting that PAK1 is sufficient to promote autophagy. Protein expression of p62, a ubiquitin-binding autophagy adaptor, was increased by PAK1 overexpression and reduced by PAK1 knockdown. Overexpression of p62 rescued the defective autophagy flux in the absence of PAK1, suggesting that p62 may mediate PAK1-dependent autophagy. CONCLUSION: The results showed that p62 degradation was mitigated by PAK1 overexpression and accelerated by PAK1 knockdown. This suggests that PAK1 is sufficient and necessary to maintain autophagy in cardiomyocytes, which is likely mediated by its ability to affect p62 protein stability.
PAK1 Regulates Cardiomyocyte Autophagy Through p62
LITERATURE REVIEW
In the quiet space between breaths, A doctor’s hands rest on another’s skin, Not just to examine, but to connect. These hands carry stories— Of patients, of sleepless nights, Of lives that have passed through them. It’s not the textbooks that teach this touch, But the lives we encounter, The moments of fear and hope Held in the air, heavy but fragile. A mother cradles her child, Her eyes searching for more than answers. She seeks comfort, Not from words, but from presence, A presence that says, "I am here with you." Medicine isn’t in the pills, Or the machines that beep in sterile rooms, It’s in the quiet moments, Where we sit in the stillness of a shared humanity. We listen to heartbeats, But we hear stories. We do not heal alone. The patient heals us too, A reminder that we are all bound by the same flesh, The same fragility. We are more than our skills— We are companions on a journey, Walking alongside the pain, The fear, the hope, Holding each other, As human beings first.
The Hands That Heal
Grace Herrick Alabama College of Osteopathic Medicine
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Bethany Baumgartner Kansas City University College of Osteopathic Medicine bethany.baumgartner@kansascity.edu
The Role of Perioperative Anxiety and Stress in Postoperative Pain Evaluating Holistic Management Approaches
INTRODUCTION: The ability to seek healthcare is influenced by numerous factors. Previous research indicates that location and type of insurance impacts patient access to care and, consequently, overall health. However, few studies have investigated the relationship between types of insurance coverage and patients’ perceptions of their own health. This study hypothesizes that individuals with private health insurance will have more positive perceptions of their health compared to those with government coverage. METHODS: Data from the “Survey of Consumer Attitudes and Behavior, October 2014” found in the ICPSR database was used for analysis. A random sample of 485 households were interviewed nationally in a rotating panel design. Respondents rated their health in one of five categories ranging from “Excellent” to “Poor.” RESULTS: Findings indicate that those with government insurance (Medicare, medicaid, tricare) are more likely to view their health as “poor”, while those with private insurance (BCBS, Caremark) view their health as “Excellent” or “Very Good” (p value < 0.001). CONCLUSION: Types of insurance coverage are directly correlated with perceptions of health, and furthermore, could impact the likelihood one seeks medical care. Recognizing that individuals with government insurance have poorer perceptions of their health compared to those with private insurance, providers can enhance outreach and advocacy efforts, as well as engage in support programs, to bridge this disparity and ensure all patients have access to quality care.
INTRODUCTION: Postoperative pain significantly impacts surgical outcomes and patient recovery. While the physical aspects of pain are well understood, the roles of anxiety and physiological stress in pain modulation require further exploration. This review investigates the impact of perioperative anxiety and stress on postoperative pain, evaluating both non-pharmacological and pharmacological management strategies, as well as tools for assessing anxiety. METHODS: A PubMed search was conducted using terms related to perioperative anxiety, stress, cortisol, and pain. Only peer-reviewed articles involving human subjects were included with no restrictions on publication year. RESULTS: Several questionnaires, including the Brief Measure of Emotional Preoperative Stress, State-Trait Anxiety Inventory, and Amsterdam Preoperative Anxiety and Information Scale, can effectively assess preoperative anxiety, helping identify patients at greater risk for severe postoperative pain. Pharmacological interventions, e.g. preemptive analgesia, have been shown to significantly reduce postoperative pain intensity and opioid administration. Non-pharmacological approaches, including music therapy and aromatherapy, are promising in reducing preoperative anxiety and postoperative pain. In pediatric patients, perioperative dialogue techniques were found to lower cortisol levels and reduce morphine requirements post-surgery. CONCLUSION: While cortisol serves as a marker of physiological stress, routine preoperative cortisol measurement may be impractical. We recommend a holistic approach incorporating psychological assessments and, in select cases, cortisol measurements to inform preoperative care. Integrating both pharmacological and non-pharmacological interventions offers a pathway to optimize postoperative outcomes. Future research should prioritize standardized protocols for anxiety and stress management, as well as explore biological differences in stress and pain responses for personalized care strategies.
Peter S. Chindavong1, RAKA CHINDAVONG, DO2, AREN YARCAN1, PHILLIP COCHRAN1 NEBOJSA NICK KNEZEVIC, MD, PHD2 1 Alabama College of Osteopathic Medicine 2 ADVOCATE ILLINOIS MASONIC MEDICAL CENTER chindavongp@acom.edu
Health Disparities Between Government and Private Insurance Coverage on Patient Perceptions of Health
LITERATURE REVIEWS
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The Impact of Civil Commitment Laws for Substance Use Disorder on Opioid Overdose Deaths
INTRODUCTION: We analyzed the impact of civil commitment (CC) laws for substance use disorder (SUD) on opioid overdose death rates (OODR) in the U.S. from 2010–2021. METHODS: Our retrospective study used CDC WONDER data to analyze overdose death rates from any opioid during 2010–21 using ICD-10 codes for all 50 states and D.C. We compared OODR between states with and without CC SUD laws using t-tests and two-way ANOVA via GraphPad Prism 10.0. RESULTS: We found no significant difference in annual mean age-adjusted OODR from 2010–2021 between states with and without CC SUD laws. Pre-COVID (2010–19), neither the presence or absence of CC SUD law had a difference in age-adjusted OODR. Post-COVID (2020–2021), there was a significant increase in OODR in states with a CC SUD law compared to states without the law (p = 0.032). Furthermore, OODR increased at a faster rate post-COVID among both states with CC SUD laws (p < 0.001) and states without the law (p = 0.019). CONCLUSION: The higher age-adjusted OODR in states with CC SUD laws may reflect a response to the opioid crisis or may be due to potential resistance from physicians or unawareness of CC SUD laws. These barriers could lead to underutilization of CC. The recent enactment of CC SUD laws and the lack of a central database for relapse tracking may contribute to differences in overdose rates. Further investigation is needed to analyze factors influencing OODRs and long-term effects of the CC SUD laws.
The Effect of Patient-Provider Relationships on Compliance in Uncontrolled Diabetic Patients
INTRODUCTION: Patient compliance with treatment regimens is crucial for optimal health outcomes, yet compliance rates vary and can be influenced by factors such as patient-provider relationships. This study explores how patient attitudes toward their healthcare providers affect treatment compliance, with a focus on comparing compliance rates between individuals with poorly managed diabetes mellitus (PM DM) and those without (DM-). METHODS: Utilizing data from the All of Us Research database, this study analyzed survey responses measuring patients' perceptions about their interactions with physicians. After excluding non-respondents, the study included 94,218 non-diabetic (DM-) patients and 1,903 participants with PM DM. Bivariate analysis was used to identify survey responses that were independently associated with PM DM. Variables significant at p<0.10 were included in a multivariable model, and backwards stepwise binary logistic regression was used to determine the best-fit model. Variables with p<0.05 were retained. RESULTS: Patients who felt a lack of respect from their provider were significantly more likely to have uncontrolled diabetes (p=0.0005). However, in contrast to the original hypothesis, patients who do not feel nervous to see their provider (p<0.0001) and are able to express their opinion (p<0.0001) on their healthcare to their provider were significantly more likely to have poorly managed diabetes. CONCLUSION: These findings suggest that while positive patient-provider interactions are beneficial, they alone may not ensure proper disease management. This underscores the need for balanced communication and accountability in treatment compliance. Further research is necessary to better understand how various aspects of patient-provider relationships influence patient care and outcomes.
Victoria Comfort, Neely Burns, Alexis Grover, Lilla Reed Harrington William Carey University College of Osteopathic Medicine vcomfort584101@student.wmcarey.edu
Phillip Ross Cochran, Peter S. Chindavong, Jurian Edelenbos, Amy Chiou, JD, Haylee F. Trulson, Rahul Garg, PhD, Robert W. Parker, PharmD Alabama College of Osteopathic Medicine cochranp@acom.edu
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Potential for Medicare Savings on Men's Health Drugs through the Mark Cuban Cost Plus Drug Company Model
INTRODUCTION: This study evaluated data sharing statements (DSS) in manuscripts from the top five anesthesia journals between 2020 and 2023. DSS are crucial for research transparency. Given the growth in anesthesia and its research, it is important to assess how leading journals are adopting these practices. This analysis investigates DSS presence and quality in leading anesthesia journals publishing primary patient data. METHODS: We identified the top five anesthesia journals using Clarivate’s Journal Citation ReportsTM and searched MEDLINE (PubMed) for relevant studies from 2020 to 2023. Authors screened articles and extracted data using a standardized form. We focused on DSS presence, themes, and authors’ responsiveness to data sharing requests. RESULTS: DSS prevalence varied: Anesthesia, Critical Care & Pain Medicine increased from 15.4% in 2020 to 30% in 2023, while Anesthesia and Analgesia remained under 8%. Government-funded research was positively associated with DSS inclusion (estimate: 0.734, p = 0.047), whereas higher impact factor journals showed a negative association (estimate: -0.298, p = 0.008). The most common DSS theme was Conditional Data Availability (74.5%). Only 27.4% of authors responded to data sharing requests, and 13.7% agreed to share data for replication. CONCLUSION: The study reveals significant deficiencies in data sharing practices in leading anesthesia journals. Implementing robust data sharing policies could improve transparency and reproducibility, advancing open science in this field.
Data Sharing in Anesthesia Research: The Price Tag of Transparency and Compliance
INTRODUCTION: Patients requiring medications for men's health conditions often face challenges in accessing affordable treatments. The Mark Cuban Cost Plus Drug Company (MCCPDC) Model offers a solution by providing prescription medications at lower costs. This study aims to assess the effectiveness of the MCCPDC in reducing men's health drug costs compared to Medicare Part D. METHODS: A comprehensive comparison was conducted on all ‘Men's Health’ drugs available on the MCCPDC. Prices, including dispensing and shipping fees, were collected for the minimum quantity (30ct) and maximum quantity (90ct) from the MCCPDC. Unit costs and total savings were calculated, and standardized unit prices for 30-day and 90-day periods were compared between Medicare and MCCPDC. RESULTS: Of the 15 drugs in our sample, Medicare’s expenditure amounted to $1.8 billion, with MCCPDC displaying lower prices overall compared to Medicare Part D. Evaluating 30ct prescriptions, 11 of 15 (73.3%) men’s health drugs resulted in cost savings totaling $1.1 billion, with an overall cost reduction of $892 million. On average, 30ct prescriptions were 36.8% less expensive than Medicare. For 90ct prescriptions, all 15 drugs yielded savings totaling $1.3 billion. CONCLUSION: Our study findings highlight the substantial potential for cost savings, estimated at approximately $1.3 billion in 2021, if Medicare were to change their current contracted rates to those set by the MCCPDC. We recommend healthcare providers include MCCPDC in patient counseling sessions to educate patients about accessing medications at lower prices. Integrating MCCPDC as a resource can contribute to significant savings and improve medication affordability.
Adam Khan1, Eli Oldham1, Jacob Duncan1, Matthew Rashid1, Matt Vassar PhD1,2 1 Oklahoma State University Center for Health Sciences 2 Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences adam.khan@okstate,edu
Tag Harris1, BRYCE SANCHES1, ALEX HAGOOD1, ANNES ELFAR1, JACOB DUNCAN1, TAYLOR GARDNER1, ELI PAUL1, CHASE LADD, dO2, ALICIA ITO FORD, PHD1, MATT VASSAR, PHD1 1 Oklahoma State University College of Osteopathic Medicine 2 DEPARTMENT OF ANESTHESIOLOGY, DETROIT MEDICAL CENTER tagharr@okstate.edu
Soumya Malhotra1, Liza Rackley2, Mayur S. Parmar, PhD2 1 Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University 2 Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University sm4584@mynsu.nova.edu
INTRODUCTION: Rapid eye movement (REM) sleep disturbances have been implicated in accelerating cognitive decline in aging individuals and those with Alzheimer’s disease (AD). This review explores the relationship between REM sleep disruptions and the progression of AD. METHODS: A comprehensive literature review was conducted in June 2024 across PubMed, Embase, Scopus, and Google Scholar using terms, “Alzheimer’s,” “REM,” and “sleep disturbances.” Articles focused on REM sleep disturbances in AD patients, excluding those with underlying sleep disorders, comorbidities, or genetic predispositions, were selected. Key data on tau pathology, beta-amyloid accumulation, cognitive decline, and neuroimaging findings were independently extracted and analyzed. RESULTS: Initial screening identified 52 articles related to REM sleep disturbances in AD pathogenesis, of which 28 met the inclusion criteria. These studies encompassed 2,800 participants, with a mean age of 72 years (range 50-90). Of the participants, 1,200 were in the preclinical stages of AD, while 1,600 had clinical AD. REM sleep disturbances were associated with a 20-30% increase in tau pathology, driven by tau phosphorylation and misfolding, and a 30-40% increase in beta-amyloid accumulation in the medial temporal lobes and prefrontal cortex. These changes were linked to cognitive decline, executive function, and episodic memory. CONCLUSION: REM sleep disturbances lead to beta-amyloid plaque buildup affecting the pathogenesis and progression of AD. Given the variability and measured outcomes, further controlled trials are warranted to study specific alterations that directly correlate with REM sleep disturbance and AD.
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Impact of Rapid Eye Movement Sleep Disturbances in the Pathogenesis of Alzheimer's Disease: A Scoping Review
The Evolving Landscape of Migraine Treatment: Osteopathic Manipulative Treatment and Migraine Costs
Daniel Malak1, Paul Mikhail1, Joseph Mikhail2, Kimia Badakhshan1, Khavir Sharieff, D.O, MBA3 1 Philadelphia College of Osteopathic Medicine- Georgia Campus 2 University of South Florida Health Morsani College of Medicine 3 Department of Clinical Skills, Simulation and Surgery, Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine, Tampa Bay Campus dm3474@pcom.edu
INTRODUCTION: Migraine affects millions of people worldwide and causes significant disability due to its severe pain and unpredictable nature. Furthermore, the direct medical costs for migraine care exceed $34 billion annually. In this study, we highlight the efficacy of Osteopathic Manipulative Treatment (OMT) in migraine symptom improvement, prophylaxis, and cost reduction. METHODS: A systematic search was conducted through September 2024 across PubMed, EMBASE, Ovid MEDLINE following PRISMA guidelines. Keywords included “osteopathic manipulative treatment,” “migraine,” “migraine costs,” among others. Studies which were published in English and reported data on OMT use in migraine patients and their subsequent healthcare costs were included in the analysis. RESULTS: Six publications met the inclusion criteria (5 randomized controlled trials and 1 pilot study). Two studies utilized myofascial trigger points, three reported craniosacral treatment, and one used myofascial release, balanced ligamentous and membranous tension. A total of 205 patients were followed up from 2-6 months. In-depth analysis revealed a significant decrease in migraine severity, duration, and frequency, and improvement in health-related quality of life and functional disability in OMT interventional groups. Additional retrospective case studies revealed a significant decrease in the length of hospital stay, 50% fewer office visits, an overall decrease in medication prescriptions, radiographic costs, and referrals in patients treated with OMT. CONCLUSION: This study highlights the remarkable efficacy of OMT in migraine treatment with consequent reduction in healthcare-associated costs. However, better clinical study designs are needed to address challenges such as small sample sizes and lack of standardization to continue researching OMT in migraine management.
Marijuana and Anesthetic Practices: A Review of Effects on the Cardiovascular, Pulmonary, and Neurological Systems
Kenil D. Mehta, Rohan Wadhwa, Jacquelyn Waller, PharmD Rocky Vista University - Montana College of Osteopathic Medicine kenil.mehta@mt.rvu.edu
INTRODUCTION: Elder abuse is a growing public health issue and violation of human rights. Considering race and ethnicity when exploring elder abuse is important due to the increasing diversity of the older population. Elder abuse can lead to physical and psychological distress, the latter of which has not been thoroughly studied. This review aims to determine the impact of elder abuse on the mental health of racialized older adults in Canada and the United States. METHODS: A PRISMA-oriented systematic search was conducted across PubMed, APA PsycInfo, and Cumulative Index to Nursing and Allied Health (CINAHL). Inclusion criteria included publications after the year 2000, peer-reviewed journal articles, and publications in English. After deduplication, abstract screening, full-text review, and quality appraisal, 418 of 424 articles were excluded. RESULTS: Of the six studies examined, elder neglect was the most common type of elder abuse, followed by financial exploitation and psychological mistreatment. The review found that these three categories were consistently associated with negative mental health outcomes such as anxiety, depression, and suicidal ideation. These associations were particularly prevalent in Chinese, Korean, and Native American older adults in the United States. No relevant Canadian studies were identified. CONCLUSION: This review demonstrates the significant mental health impact of elder abuse on racialized older adults, particularly within the United States. It highlights the need for improved screening tools, community support, and cultural competency when addressing elder abuse. Overall, more research is needed to address the association of elder abuse on mental health in other racial groups, especially in Canadian communities.
INTRODUCTION: Understanding marijuana-anesthetic interactions in the perioperative setting is critical as more than 22% of Americans aged ≥ 12 years report ever using marijuana. A comprehensive analysis of marijuana effects on anesthetic efficacy and patient safety across cardiovascular, pulmonary, and neurological systems is lacking. This study aims to characterize these interactions and provide clinical recommendations. METHODS: A systematic search of PubMed, Science Direct, Clinical Key, and Access Medicine was conducted for studies from 2018 to 2024. The focus was on the perioperative effects of marijuana on anesthesia, emphasizing case reports, meta-analyses, and systematic reviews from the United States, while excluding postoperative pain management. RESULTS: Tetrahydrocannabinol (THC), a substance that is primarily responsible for the effects of marijuana by acting as a weak partial agonist on the cannabinoid-1 and cannabinoid-2 receptors, significantly affects cardiovascular function. Acute marijuana use is linked to tachycardia and hypertension, while chronic use is associated with bradycardia and an elevated risk of cardiovascular complications, including potential cardiac arrest. When combined with anesthetic substances like ketamine, marijuana can worsen cardiovascular strain and consequently, thereby increasing myocardial oxygen demand. Additionally, the presence of delta-9-THC, especially in chronic marijuana users, can alter the effectiveness of propofol and midazolam, requiring higher doses for adequate sedation and airway reflex depression, which can lead to neurological and pulmonary complications. CONCLUSION: Incorporating marijuana use history into anesthetic management is essential for enhancing patient safety and optimizing perioperative outcomes. Further research is needed to establish guidelines addressing marijuana's implications for anesthetic practices, ultimately contributing to safer patient care.
The Impact of Elder Abuse on the Mental Health of Racialized Older Adults: A Scoping Review
Viraj Padhiar NOVA SOUTHEASTERN UNIVERSITY - KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE vp746@mynsu.nova.edu
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Advancements and Challenges in Tissue Engineering Strategies for Bone Regeneration in Orthopedics: A Literature Review
Tyler D Perleberg1, Itai Bezherano2, Robert Ablove, MD2 1 Kansas City University College of Osteopathic Medicine 2 Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, tyler.perleberg@kansascity.edu
The Impact of Chronic Alcohol Consumption in the Intensive Care Unit
Cheyenne Chandler1,2, Meena Pattabiraman 1,2,3, Alex Williams1,2, Jamie Sturgill1,2 1Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky College of Medicine 2Kentucky Research Alliance for Lung Disease, Office of Research, University of Kentucky College of Medicine 3University of Pikeville-Kentucky College of Osteopathic Medicine meenakshipattabira@upike.edu
INTRODUCTION: Alcohol Use Disorder (AUD) affects 29.5 million people annually in the United States, with more than 2,200 deaths each year in Kentucky. Within the University of Kentucky Healthcare system (UK Healthcare), patients with AUD are expected to have accurate coding under the International Classification of Diseases, 10th Revision (ICD-10) . However, our initial review of patient charts revealed discrepancies and improper ICD-10 coding, leading us to hypothesize that chronic alcohol use is significantly underreported in our hospital system. This adequate report may contribute to complications related to AUD in the future. METHODS: A three-month sample of patients discharged from the Medical Intensive Care Unit (MICU) here at UK Healthcare was used to conduct a retrospective chart review to confirm the presence of AUD. From September 2022 to February 2023, discharged patients were categorized based on their underlying condition, AUD notation, prognosis, discharge, re-admission, and ICD-10 codes recorded. RESULTS: A significant discrepancy between reported alcohol abuse in the history and physical (H&P) and actual ICD-10 coded AUD was found. Of the five ICD-10 codes examined (F10, K70, K85, K86 and No Code), only about 20% of AUD patients, on average, had these respective codes correctly identified in their charts. 55.56% of charts with an indicated AUD in the H&P did not have an AUD ICD-10 code listed at all. DISCUSSION: Multiple gaps within the AUD-related reporting system at the University of Kentucky must be addressed to ensure accurate ICD-10 codes at the initial patient encounter, by enhancing patient outcomes.
INTRODUCTION: The regeneration of bone for critically sized fractures and defects is a frequent complication in orthopedics, often requiring complex surgical interventions. Bone tissue engineering (BTE) offers promising techniques, such as scaffolds and biomaterials, to guide bone tissue regeneration. BTE advancements have the potential to reduce healing times and minimize surgical interventions. This literature review explores ongoing advancements and challenges in BTE for bone regeneration. METHODS: A comprehensive literature search was conducted using PubMed, Embase, and OVID. Search terms included “orthopedics,” “tissue engineering,” “bone regeneration,” “challenges,” and “advancements.” Articles were screened by title and abstract, followed by full-text review using inclusion and exclusion criteria. RESULTS: The review revealed significant advancements in BTE. The gold-standard is composite rigid scaffolds, evolving to incorporate ceramics, metals, and biocompatible polymers. Incorporating mesenchymal stem cells (MSCs) and growth factors, specifically bone morphogenic proteins (BMPs), has enhanced bone regeneration, stabilized immune microenvironments, and increased scaffold colonization. Nanomedicine using electromagnetic fields is also advancing, enhancing osteogenic differentiation and strengthening mechanical properties of scaffolds. However, challenges including inadequate vascularization, clinical translation, and inflammatory environments remain. CONCLUSION: This review highlights advancements in BTE, including the development of scaffolds, stem cells, and nanotechnology. Challenges like inadequate vascularization underscore the need for scaffolds that enhance angiogenesis and clinical integration, which are critical to improving recovery and long-term outcomes. Addressing these challenges could expand effective treatment options and elevate standards of care for patients with critical-sized defects.
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INTRODUCTION: Congenital syphilis (CS) is an infection of syphilis that is passed from mother to baby during pregnancy. CS can lead to fetal death, and babies born with CS can have systemic abnormalities. The rate of congenital syphilis has increased every year in the United States. since 2013. Inadequate testing and treatment for pregnant women has contributed to the rise in CS. The purpose of this study is to explore current literature to evaluate the impact of universal screening for syphilis in the emergency room on the rate of congenital syphilis. METHODS: A literature review was conducted using the following electronic databases: PubMed, Embase, Medline Complete, and ProQuest Central. Keywords include “screening,” “testing,” “congenital syphilis,” “treponema,” “emergency room,” and “prevention.” Articles were limited to 2014 or later. Studies selected include quantitative, comparative, and systematic reviews. RESULTS: Fifteen studies have shown that implementation of universal screening for syphilis in the emergency department could decrease the rates of congenital syphilis. Increased testing resulted in improved diagnosis and treatment of syphilis. One study uncovered rates of syphilis double the national average, and another study averted nine cases of CS through universal screening. CONCLUSION: Syphilis is often asymptomatic, leading to missed diagnoses. Additionally, only half of pregnant women are positive for established risk factors. As less patients engage in primary care, the emergency department has a unique position in prevention of CS. The results from recent studies support that implementation of universal syphilis screening can increase the diagnosis and treatment of syphilis, and therefore prevent CS.
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Hemangi Patel, Alexandria Sobczak, Suzanne Riskin, MD Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine as5048@mynsu.nova.edu
INTRODUCTION: Stress fractures and medial tibial stress syndrome (MTSS) are common lower extremity injuries resulting from overuse in athletes and military recruits with various factors contributing to the incidence. Diagnosis involves clinical assessment and imaging. Treatment options include but are not limited to shoe orthoses and rest. This scoping review explores MTSS and stress fractures, discussing the prevalence, risk factors, diagnosis, treatment, and return-to-play protocol in athletes and military recruits. METHODS: A comprehensive literature search between January 1, 2000 and November 1, 2023 using PubMed, Embase and Medline databases was performed. Meta-analysis and literature reviews were excluded. The initial search identified 554 articles of which 24 articles were used for final analysis. RESULTS: There are multiple risk factors that lead to the development of these injuries including foot pronation, gait cycle changes, diet, race/ethnicity, variation in stiffness of the tibia bone, body mass index (BMI) and physical activity level. A diet with increased calcium and vitamin D levels was found to have the ability to help protect against MTSS and stress fractures. Magnetic resonance imaging (MRI) is the gold standard in diagnosis and helps to grade the severity of injury which will affect the amount of recovery time needed. On average, it takes 70 days to recover from MTSS. There is no specific time for stress fractures. CONCLUSION: MTSS and stress fractures are multifactorial with multiple risk factors leading to its development. Future studies should focus on determining better treatments and improving the return-to-play protocol.
Addressing the Impact of Systematic, Opt-Out Syphilis Testing in the Emergency Department on Rates of Congenital Syphilis
Alexis Van Pelt1, Amanda Brosnan PAC2 1 University of North Texas Health Science Center Texas College of Osteopathic Medicine 2 University of North Texas Health Science Center College of Health Professions alexisvanpelt@my.unthsc.edu
Overview of Medial Tibial Stress Syndrome and Stress Fractures in Athletes and Military Recruits: A Scoping Review
Introduction: Millions of surgical procedures yearly require general anesthesia, postoperative follow-up, and pain management. Remifentanil, a rapidly activating analgesic, is commonly used intraoperatively. However, it often causes increased pain sensitivity in the postoperative setting, which increases opioid use. This study aims to compare the efficacy of intraoperative use of dexmedetomidine, an opiate-free alpha-2 receptor agonist, with remifentanil in reducing postoperative pain and opioid use. Methods: This study conducted a systematic review of existing literature on the efficacy of dexmedetomidine compared to remifentanil. A literature search was performed using PubMed, following PRISMA guidelines. The primary outcome was the comparison of postoperative pain levels, opioid use, and the incidence of opioid-induced hyperalgesia (OIH) in patients undergoing various surgeries. Results: Our findings reveal significant benefits with the use of dexmedetomidine, including fewer rescue analgesics (p = 0.046, 0.038, 0.045, 0.038) and an 86% reduction in fentanyl use for anesthesia compared to when remifentanil is used (p<0.001). In addition, patients in the dexmedetomidine group experienced less pain. Two studies also showed dexmedetomidine reduced the likelihood of developing OIH compared to remifentanil, due to the reduction in opiate usage. The shortcomings of dexmedetomidine were seen with a significant delay in eye-opening after surgery (p<0.01). Conclusion: This review highlights the potential benefits of dexmedetomidine in minimizing the reliance on opioids and consequently, decreasing the risk of opioid abuse from medical prescriptions. However, the small sample size and variability in dexmedetomidine dosing warrant further research to bring this medication to mainstream anesthesia care.
INTERESTED IN HAVING YOUR WORK PUBLISHED IN THE FUTURE DO?
Comparative Efficacy of Dexmedetomidine and Remifentanil in Reducing Postoperative Pain and Opioid Use: A Systematic Review
Abbas Al-Hassan, Brandon Weissman, Varun Soti PhD Lake Erie College of Osteopathic medicine bweissman91883@med.lecom.edu
The Future DO (TFDO) publishes student abstract submissions and perspective articles bi-annually. We welcome students to submit their research abstracts and articles for consideration to be featured in our next issue. Students are not required to be SOMA members to submit an abstract. In addition, TFDO will be accepting student artwork for print either on the cover or within the body of the magazine! Stay tuned for email announcements from the SOMA Weekly or check out our research website at www.studentdoresearch.org for updates and announcements. We look forward to receiving your submissions!
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PERSPECTIVE ARTICLES
Leaving Vienna 1938 Artist: Abraham Libman, OMS II, Touro College of Osteopathic Medicine - Harlem, NY
"This painting is based on a photograph of my grandmother's family, who was forced to flee their home in Vienna, Austria because they were Jewish. The composition shows my Bubbie (grandmother), Eva, her sister Ada, and their parents in the window of the train car that they rode in to leave Vienna behind forever. They ultimately managed to survive and start a new life in Canada; however, their extended family (pictured in the foreground of the painting) was murdered during the Holocaust. I feel that the themes that I sought to express in this painting also embody this edition's theme, as my family's experience with overcoming some of the worst forms of discrimination imaginable drives me to work toward healing the divides that still exist between people of all different backgrounds."
Disclaimer: Views expressed in The Future DO publications are solely those of the authors and do not necessarily REPRESENT the opinions of the editorial board, The Future DO, or SOMA.
Redefining the Physician
ABIGAIL COLWELL Touro college of osteopathic medicine, Great falls, Montana
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Defining physicians as invincible results in them not being expected to be a biological machine in need of routine maintenance, like sick days and maternity leave. In a study done by Goranson et al., a sample of Americans was surveyed to gain understanding of their perception of doctors. This study demonstrated that Americans often typecast physicians as being God-like and easily shrugging off depressive feelings. These perceptions influence stigma within the medical community, leaving physicians feeling as though they are unable to ask for help. This stigma is dangerous and is likely related to the troubling fact that one physician commits suicide a day. In addition, defining physicians as intellectually superior exacerbates the power divide between the patient and physician that is already present due to factors such as race and socioeconomic status. This divide puts pressure on the physician to always have the answer and leaves the patient feeling as though they cannot ask questions. The redefining of physicians as humans who make mistakes and do not know everything, by both sociologists of medicine and patients, will be beneficial to both the physician’s mental health and patient-physician relationship. Through this redefining, the physician should become a resource instead of a gatekeeper. Just as physicians are a resource to the patient, other physicians should be seen as resources to each other, with whom they can consult about complex cases. This redefining will allow physicians to be comfortable telling patients when they do not yet know what the root of a particular illness may be. This redefining should not just improve the mental health of the physicians but should also increase patient satisfaction, as this new framework adjusts the micro level of medicalization to make the patient and physician partners in the treatment process. Female physicians face additional conflicting classifications, as they must pick between the societal role of “mother” or “doctor.” In the article Female Physicians and the Work-Family Conflict, Treister-Goltzman and Peleg discuss the findings of a comprehensive literature review about female physicians’ relationship with the work-life balance. The work-family conflict is a major theme and arises from the understanding that one cannot fully assimilate to their gender role within the family and the expectations of their career. Women physicians who are in their mid-career demonstrate the least satisfaction pertaining to their work life balance compared to male colleagues. Female physicians tend to be more family oriented and are more likely to take time off to raise their children. Many women stated that they chose their field of medicine due to “domestic circumstances.” Despite this prioritizing of family 41.3% of female physicians report that their career interferes with their ability to have children. Building on this, about 57.3% of female surgeons reported that raising children “slowed their career.” This internal struggle to balance both the role of mother and doctor has resulted in more than 43.3% of female surgeons reporting burnout, compared to 39% of their male counter parts. As the number of female physicians continue to grow, it is crucial that domestic roles continue to shift. Society’s classification system must be altered to allow for an individual to function sustainably as both physicians and mothers. Through this new definition of a female physician that encompasses the role of “mother,” Hacking’s theory of “making up people” can be applied.” Through this redefining of female physicians, a new category will develop in which women can fit into. Through this new category, a “new” type of person is added to society and can find where they fit in the new structure.
SLM 2024 AOA Speakers (left to right): Dr. Teresa Hubka, Dr. Ira Monka, Kathleen Creason, Dr. Robert Piccinini
SLM 2024 Suture Workshop
NATIONAL SOMA 2024 CONFERENCE RECAP
Abigail Colwell received her bachelor's in Neuroscience from Skidmore College in 2022. Following her graduation she attended Cornell University’s Masters of Public Health program, during which she wrote this piece. Following her graduation from Cornell University, Ms. Colwell continued on to TOUROCOM where she is currently pursuing her osteopathic medical degree. As the daughter of a physician Ms. Colwell witnessed her mother navigate through society as a female physician. Having experienced the impact of societal classifications as the child of a female physician and current medical student, Ms. Colwell has taken great interest in society’s expectations of both physicians and females.
SLM 2024 Community Outreach - Ronald McDonald House Care Package Delivery
OMED 2024 House of Delegates
PERSPECTIVES
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OMED 2024 Community Outreach
SLM 2024 Region Meeting
"Society’s classification system must be altered to allow for an individual to function sustainably as both physicians and mothers."
About The Author:
Family medicine is a cornerstone of healthcare, known for professionals with the ability to problem solve any presentation that walks through the door. Many of their patients face health literacy, socioeconomic, and chronic health challenges. As primary care providers strive to address these challenges, they fight against resource constraints and administrative burdens oftentimes leading to burnout. This article reflects on interviews I have had with physicians practicing in various fields of family medicine. I found these diverse perspectives to be very profound, and I hope that they can provide insight to my fellow, future DO’s as well as advocate for collaboration and change in family medicine. Lack of resources affects more than just patients. An Army medicine doctor noted that working in primary care is “like being in a never ending ‘mass-cal’ [or mass casualty event].” She described “mass-cals” as events where the medical needs greatly exceed the available medical resources. Many family physicians have to work with what they’ve got; which may not be a lot. They are often the front line of defense, and sometimes the only defense when resources are limited. One rural physician became a “local subject-matter-expert” due to lack of specialists in the area. Some of her wildest cases included “a patient with a suspected septic joint that could not be seen by Ortho for three days [and] a man who forgot to get his sutures removed and came to see [her] 40-days post-op for removal because he couldn’t get in with his surgeon who was three hours away.” A family physician working with Indian Health Services shared that he has “delivered babies, placed chest tubes, ran medical and trauma codes, reduced fractures, [and] performed paracentesis.” Dr. Marlin Christianson, who practiced Navy and civilian family medicine, discussed practicing “at the top of our license” and doing everything we can before sending a referral. Many of these experiences show that sometimes there isn’t time or availability for a referral. Christianson was able to pool resources by strengthening both local and virtual communities with other providers. Naval dive medicine officers use “dive phones” to consult their peers no matter where they may be. These ideas can be adopted by family physicians to overcome challenges of limited resources. Perhaps the most limited resource for family physicians is time. A recent study showed that PCP’s would need 27 hours a day to complete recommended guidelines for their patients. Many of the physicians I talked to are so passionate about providing thorough patient care, but face long, complex problem lists during increasingly short visits. Their time is also limited by the administrative burden of navigating insurance allowances, prior authorizations, and other paperwork. Dr. Lenthe, who practiced Air Force and civilian family medicine, reflected on this aspect of medicine saying, “Just allow us to practice medicine. If there were less ‘red tape’ [we] could either spend more time with patients or see more patients. Insurance companies have too much control.” Dr. Jaren Blake works in a Direct Primary Care (DPC) clinic where patients are forgoing insurance and paying a subscription fee to the practice instead. He states that getting insurance “out of the room” allows him to have more time with his patients. He spends “maybe five percent” of his time on paperwork where a typical family doctor will sometimes spend “2-3 hours of administrative work for every hour of patient care,” according to a physician in the North-West. DPC is an innovative idea that is challenging the idea of traditional insurance-based healthcare. Challenging these barriers can elevate the quality of patient care and improve provider job satisfaction. In an attempt to identify other ways to overcome barriers, I asked physicians what they would change about primary care. Dr. Matt Potter, who primarily sees Spanish-speaking patients in a community health center, said, “... compensation rates, not necessarily because I feel like I deserve more money, but [because] I feel it would attract more applicants… which would ultimately result in [increased] access to care for patients, more time… spent with patients, and better work-life balance as a provider.” Despite resource limitations and administrative burdens, family medicine remains a highly rewarding field. Regardless of background, I found that family doctors love the variety and the lifelong relationships they build with their patients. Our healthcare system needs improvement, however with increased collaboration and a commitment to breaking down barriers — whether in relation to resources, time restraints, or administrative hurdles — we can create an accessible, equitable, and sustainable system that empowers both patients and providers.
"Our healthcare system needs improvement, however with increased collaboration and a commitment to breaking down barriers — whether in relation to resources, time restraints, or administrative hurdles — we can create an accessible, equitable, and sustainable system that empowers both patients and providers"
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Isaac Parrish noorda College of Osteopathic Medicine
Collaborating for Change: Addressing Challenges in Family Medicine
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Isaac is a third-year osteopathic medical student at Noorda College of Osteopathic Medicine and a Navy HPSP recipient. He is passionate about serving rural and underserved communities and is pursuing a career in family medicine. When not studying or volunteering, he enjoys spending time with his wife and kids.
Our Forgotten Colleagues
I am writing this piece on September 28th, 2024, from the comfort of my apartment somewhere in California. I started my third clerkship this past week and have a night shift in the next four hours. I expect to see what is typical for one of the busiest emergency rooms in California. Patients in gurneys fill every corner of every hallway, leaving little to no space for hospital staff. Different zones of the emergency department are filled with elderly men and women groaning and screaming, while I, the third-year medical student, walk timidly through the halls wearing my freshly pressed short white coat, holding my clipboard and a sticky note with my patient’s bed information—information I will likely struggle to find amidst the chaos. Physically, I am present in the world I know. I am an osteopathic medical student in the United States, and these are the patients I serve, the community that raised me and that I so desperately want to support as a future physician. Then, suddenly, a thought that has occupied my mind for almost a year now surfaces in the back of my brain: What about our colleagues in Gaza? Each day, casualty numbers flash across the news. Individuals are reduced to numbers. Today, the Palestinian Ministry of Health reports: Killed: at least 41,534 people, including nearly 16,500 children Injured: more than 96,092 people Missing: over 100,000 I think about the hospitals in Gaza that no longer exist or are severely debilitated, like Al-Shifa Hospital, Indonesian Hospital, Al-Awda Hospital, and Beit Hanoun Hospital. Scores of physicians, nurses, and medical students have already died protecting their patients as bombs tore through the buildings they worked in. Images of men, women, and children lying on hospital floors, intravenous lines in their arms, taking their final breaths flood my mind. My brain cannot let go of the stark disparity that exists at this moment: how, across the world, a student just like me is no longer able to experience the momentous rite of passage of wearing their white coat to serve a patient, or feel secure knowing that, while the healthcare system may not be perfect, it still exists to serve the wounded, the ill, and the vulnerable. But, of course, what can I, a helpless medical student, do other than write this piece from the comfort of my apartment somewhere in California? Other than ask my peers reading this, what about our colleagues in Gaza?
Fatima yusuf California health sciences college of Osteopathic Medicine
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Doctors at al-Shifa hospital | Ashraf Amra | Al-Jazeera
Fatima Yusuf is a third-year osteopathic medical student at CHSU-COM with a strong commitment to global health, particularly in advocating for equitable healthcare access in Palestine and other communities facing systemic injustice worldwide. She serves as the Region Administrator for SOMA’s Overdose Prevention Committee, contributing to efforts addressing the overdose crisis. Guided by her faith, Fatima strives to use her medical training to address healthcare disparities and work toward meaningful change for populations affected by oppression and marginalization across the globe.
The Silent Weight
In halls where healing hands reside, Where hope and heartache coincide, A doctor stands with quiet grace, But hides the shadows on their face. The stethoscope around their neck, The scrubs worn thin, the life in check— They bear the weight of others' fears, While drowning in their silent tears. The nights grow long, the days grow cold, The stories told, the hands they hold. Yet in the quiet of their mind, No peace, no refuge can they find. For who will heal the healer’s pain, When every breath feels like a strain? The broken pieces go unseen, Behind the white coat’s polished sheen. They stitch up wounds, they mend the soul, But who will help them to feel whole? The burden grows, they feel alone, Until the silence turns to stone. We speak of life, of death, of care, But seldom see the despair there, In those who give, and give again, Till they are lost beneath the strain. So let us see the hands that shake, The smiles they wear, the hearts that break. For every life a doctor saves, They, too, deserve the strength they gave. No more lost voices, unseen cries— Let light shine through their weary eyes. For though they heal, they need it too, A hand, a word to see them through.
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Julienne Zhou and Andre Ho Touro University Nevada College of Osteopathic Medicine
Director: Matthew Boss Author: Matthew Boss, Nicholas Cristofari
The Alumni Task Force is dedicated to strengthening connections between SOMA members, alumni, residents, and attending physicians within the osteopathic medical community. By establishing and expanding alumni relations, we aim to create a supportive network that enhances the growth, mentorship, and professional development of SOMA members. This task force seeks to create a structured and accessible pathway for alumni to give back by fostering mentorship and engagement with our future osteopathic physicians. Goals of the Task Force: Enhance Mentorship Opportunities: Connect SOMA members with alumni who can offer insights, support, and guidance throughout their medical journey. Build a Stronger Community: Create opportunities for alumni, residents, and attending physicians to contribute to SOMA’s mission and nurture a sense of belonging within the osteopathic community. Facilitate Professional Growth: Empower SOMA members to develop skills, access resources, and benefit from the expertise and experiences of alumni. Importance of the Task Force: The Alumni Task Force plays a pivotal role in sustaining a connected osteopathic community, where relationships between SOMA members and alumni enrich the osteopathic profession as a whole. Alumni engagement fosters a cycle of support, helping SOMA members develop and alumni stay connected to the evolving needs of osteopathic education and practice. By supporting these relationships, the task force strengthens the osteopathic community’s collective knowledge, experience, and support network. Current Committee Initiatives: Encouraging Alumni Participation: We're actively reaching out to alumni, residents, and attendings through a Google sign-up link to express interest in mentoring SOMA members. By simplifying the engagement process, we’re steadily building a pool of alumni interested in making a difference. Laying the Foundation for the Future: Working to integrate an option into the AOA’s registration process for residents and attending physicians to indicate interest in SOMA alumni relations. This option would allow them to check a box signaling their willingness to participate as mentors or alumni contacts, streamlining how we identify and connect with engaged alumni. Future Vision for the Committee: We envision a streamlined and accessible alumni relations structure where residents and attending physicians can opt into SOMA alumni networks. By collaborating with the AOA to establish a check-box option in their registration, we aim to make alumni involvement simpler, visible, and structured. As our network grows, we will focus on organizing regional and specialty-specific workshops and networking events both in person at conferences and virtually over platforms like Zoom. These events will offer SOMA members opportunities for mentorship, collaboration, and networking, helping them to connect with alumni who understand their journey. The task force aims to establish a sustainable alumni relations model that ensures continuity, growth, and active engagement across the osteopathic profession. The goals of the OPP Education division include creating and highlighting resources that assist medical students and professionals practice and review Osteopathic Manipulative Treatments that may be applicable to daily practice and common chief complaints. We hope to help educate pre-medical students and non-medical community members about OMT and Osteopathic Medicine in general. It is our hope to highlight the many strengths of DO physicians and how our holistic training prepares us to assist our patients. We also hope to make OMT more accessible and understandable to pre-med students so it’s not something they’ve heard of but are unclear on what it entails when deciding on osteopathic medicine. The goals of the Wellness division include promoting and reinforcing the importance of Mental Health and Wellness for medical students and professionals. The current atmosphere of healthcare has caused a significant amount of stress to students and healthcare workers, so more than ever we aim to work to provide tools to help support and promote mental health. We hope to continue and build upon previous programming surrounding the wellness of students. We continue to focus on the 8 tenets of wellness and utilize these tenets to guide our programming. We will also build upon current programming by bringing in new ideas from each one of our task force members, which will ensure that voices from many schools/regions are represented. Seeing that we are pursuing the osteopathic profession, emphasizing the aspects of our training that separate us from our allopathic colleagues is of great importance. There are many unique aspects to osteopathic medicine that can be applied to every specialty. At the core of osteopathic philosophy, we take pride in a holistic approach. We as students, and future physicians, cannot adequately take care of others if we do not take care of ourselves first. Having both the OPP Education and Wellness Task Forces are vital in keeping these aspects as a priority for our members. We have a vast array of programming planned from now through the spring months! Some of the programming includes various wellness events emphasizing different routine building habits and tangible ways to incorporate wellness into your everyday life. We also hope to host a panel to discuss how to make the most of OMT and other parts of OPP while on clinical rotations. Professional development is essential in empowering osteopathic medical students to become confident, capable, and competitive applicants for residency and beyond. Our Professional Development Committee within SOMA focuses on building the skills that help students stand out in an increasingly competitive landscape—on paper and in person. Today, landing a residency means more than just having excellent academic credentials; it requires a professional presence, a well-curated CV, and the ability to communicate and connect effectively. This is where professional development becomes vital. A primary goal of the committee is to launch our SOMA Scholarly Excellence, Leadership Experience, Collaborative Training (SELECT) certification course; a program designed to enhance students’ leadership skills through structured training. SELECT provides a foundation in leadership by focusing on knowledge-building, mentorship, and reflection. As we prepare to enroll our first cohort of students, we’re enthusiastic about shaping the future leaders of osteopathic medicine. In addition to SELECT, our task force is working on numerous resources to support students at every stage of their journey. We are developing board preparation guides, curriculum vitae templates, and practical tools for residency interviews, including mock interviews and resources on professional communication. Recognizing that communication skills are often overlooked but critical, we provide guidance on writing emails, crafting letters of intent, personal statement writing, and delivering compelling presentations. To make our resources more engaging, we’re also offering hands-on and interactive learning experiences. Through our collaboration with ScholarRx, we’re integrating interactive Bricks modules, giving students a dynamic way to engage with content. Another innovative resource is our interactive escape room activity, which challenges students’ clinical knowledge and problem-solving skills in a collaborative environment. Additionally, our committee is actively researching the current state of leadership development within medical schools, aiming to align our initiatives with the broader needs and gaps within medical education. I’m grateful to be part of such a talented and dedicated team, whose hard work and commitment make all these efforts possible. Special thanks to Lu Wolff, John Buford, Emily Reimche, Michelle Adema, Christine Le, Anna Claire Brock, Carley Murphy, Bailey Harper, Otmar Borchard, Joshua Gadelsayed, Reagan Boyett, Sana Altaf, Henry Knox, and Raghavee Neupane. Their collaboration and dedication to supporting the next generation of DOs are invaluable, and together, we’re building something truly impactful. Looking to the future, our committee’s vision is to continually adapt and expand these resources to meet the evolving needs of osteopathic medical students. We aim to foster a professional skill set that prepares students for a successful transition into residency and equips them with the tools to become respected, compassionate, and confident leaders in healthcare. Professional development is more than just building a CV; it’s about building a career, a network, and a reputation. Our task force is here to ensure that osteopathic medical students are prepared to face every aspect of that journey with skill, confidence, and purpose. The Grassroots Advocacy Subcommittee is currently conducting an in-depth review of existing SOMA policies to identify resolutions that would be strong candidates for letter-writing campaigns. As a team, we will begin drafting tentative letters to advocate for positive change that are aligned with SOMA’s current policy positions. Our current goals include narrowing down the list of potential letter-writing topics and preparing draft letters to submit to the Board of Trustees for approval by the end of December. The importance of this subcommittee cannot be overstated. Each year, the AOA, practicing physicians, residents, and medical students convene in Washington, DC, to advocate for legislation critical to medical education and healthcare in this country. Similarly, this subcommittee works to create actionable letters for fellow students to sign and send to their legislators or one of our affiliate organizations, requesting change in line with standing SOMA policies. The Political Affairs Newsletter Task Force is currently preparing the November edition for release via email and the SOMA website. This task force enables SOMA to showcase our members’ advocacy efforts in action, provide relevant legislative updates, and highlight resolutions passed at the Fall and Spring House of Delegates. Our team is dedicated to producing a high-quality publication each month with fresh, engaging topics that we believe SOMA members will appreciate. One of my current goals is to increase reader engagement, encourage more submissions for our member spotlight pieces, and potentially incorporate user-submitted content into the newsletter. This task force is essential in keeping SOMA members informed of both external legislative and internal policy changes, ensuring they stay up-to-date in their advocacy efforts. Goals of the Task Force: To disseminate and educate medical students and the general public about health and food disparities, and how they are intertwined with healthcare access, quality, and outcomes. Importance of the Task Force: The DEHI (Diversity, Equity, Health, and Inclusion) Committee is committed to leveling the playing field and ensuring equal and fair health opportunities for all patients, especially those from marginalized communities. Addressing health and food disparities is a crucial step toward building a more equitable healthcare system. Initiatives: Infographics: We are developing various infographics to raise awareness and educate both students and healthcare professionals about health disparities and their impact on patient outcomes. These visuals will help distill complex issues into accessible, easy-to-understand content. ScholarRx Blocks: We are creating educational blocks in ScholarRx that focus on holistic and inclusive approaches to patient care, emphasizing cultural competence, addressing biases, and improving patient-provider relationships. Food Insecurity Task Force: On this front, we are organizing a social media takeover where we will demonstrate how to shop for healthy meals on a budget of $50. We plan to showcase how limited resources can still support nutritious and balanced meals, helping to highlight the intersection of food insecurity and healthcare. The future vision for our committee is to foster a healthcare environment where health equity is the standard, not the exception. We aim to expand our educational efforts, provide more resources to support students and healthcare professionals, and continue raising awareness about the systemic issues that contribute to health and food disparities. Long-term, we hope to integrate these lessons and practices into medical curricula and hospital settings, ultimately helping healthcare providers offer more equitable and culturally competent care to all patients, regardless of their socio-economic status or background. Additionally, we plan to partner with community organizations to address the root causes of food insecurity and other social determinants of health. Goals of the task force: The main goals of the Public Relations Committee is to promote our Student Osteopathic Medical Association members, celebrate their achievements, share resources to decrease barriers, and bring opportunities to the future of osteopathic medicine and the greater medical community. We are here to celebrate our SOMA members, Chapters, Chapter Leaders, National Leaders, alumni, and partnering organizations. We aim to collaborate and create intentional relationships in order to bring value and opportunities to our organizations. Through PR, we are responsible for representing osteopathic medical students through media, brand management, connecting to a wider audience, and ensuring the efforts of those who make up our organization and heard. Importance of the task force: National SOMA represents the nation’s largest network of osteopathic medical students. With that comes great responsibility, as much of our duties revolve around ensuring accurate representation of National SOMA and the student osteopathic medical community as a whole. We have frequent meetings and meet with various board members to do our best to accurately represent our organization. One of the most important elements of the PR Committee that many may not think of, is to create a community where students feel seen, heard, and celebrated. We believe in uplifting and empowering one another, which we believe helps the greater morale of the osteopathic student community. Current projects: We always have multiple projects in the works. Currently, we are working on meeting with (hopefully) every director on the National SOMA Board to help plan their marketing strategies for their programming for the next 6 months. Our goal is to create effective and creative campaigns to give students something to look forward to, have a sense of belonging, and have incredible learning opportunities. We have quite a few elections and applications back to back, and with the conference season behind us, we are on to our next series of projects (which will be shared when it is close to launch time!). We love celebrating our local SOMA chapters and helping students network to find leadership, networking, and community opportunities. We also prioritize our student wellness and use of media platforms as an avenue for students to feel a sense of community. We are very grateful for all of the students (and alumni and supporters) who have helped us grow our supportive community. We also have several longitudinal projects in the works that have never been done here before, but those will be announced in 2025… stay tuned! What is the future vision of your committee? We are hoping to expand our committee. The PR committee responsibilities has grown much larger than anticipated, which has been incredible! We now need more hands on deck, and our future vision is to have quite a large team of editors, business-savvy individuals, marketing/PR enthusiasts, creatives, and more. We can’t be too specific as we might give away a few surprises, but we envision our committee being the backbone of SOMA someday. Goals of the task force: The goals of this subcommittee are to create events to serve local communities, provide resources to schools across the nation on community outreach, and raise awareness for needs in local communities. Importance of the task force: The importance of this subcommittee is to serve our local communities. As future physicians, community health is one of the foundations of future practice. By getting involved in our local communities, we are able to understand how to best care for our patients. Currently, this subcommittee is working on a Nationwide blood drive with RedCross to stock the blood banks for the holidays and are running Charity Miles to fundraise for a charity of your choice. Additionally, we are putting together a seminar on Domestic Violence and how to recognize it as physicians. The vision for this subcommittee is to continue creating community events in our local communities across the nation to make a large impact. By each of our osteopathic students getting involved, we make small changes in communities that change lives. My goals are to ensure that our SOMA members are able to gain adjunctive benefits that are supplemental to their medical education! Additionally, I have aimed to develop and maintain relationships with strategic partners by promoting the SOMA name! I feel like my position is important in that I aim to provide some of the tangible benefits for SOMA members when they attain a membership. Allowing access to resources that our partners have for students is of utmost importance. I am currently working on creating a survey that allows SOMA members to give us feedback on what they like about our strategic partners as well as what improvements they think can be made in this space! I am totally open to future ideas from any SOMA member, whether they be a member at their chapter or a chapter leader! The Convention Committee plays a vital role in supporting the planning, logistics, and execution of SOMA's three national conferences each year: DO Day/Spring Convention, the Summer Leadership Meeting, and the Student Track of the Osteopathic Medical Education Conference (OMED). With such a large organization, this task force is essential to managing all the details that make our conventions successful. This winter, our committee's major goals include implementing the use of our committee email to give members more responsibility, increasing the variety of interactive programming at conventions, and ensuring our upcoming convention provides chapter leaders with the tools they need to succeed in their new roles! The goal of our committee is to plan events and programming for pre-medical students, grow our membership, and spread awareness about osteopathic medicine. Our committee plays a vital role in engaging members across the nation, planning conferences and events, managing our social media, and bringing diverse perspectives to make Pre-SOMA as inclusive and comprehensive as possible. Recently, we completed our new mentorship program, which pairs medical students with pre-medical mentees. Mentors also attend an online training session that provides them with resources to support their mentees effectively. Additionally, we have hosted Zoom events for pre-meds on topics such as MCAT preparation and application advice. Looking ahead, our vision is to continue collaborating with undergraduate and high school institutions to promote osteopathic medicine and increase our membership and engagement. The SOMA Research Committee aims to empower osteopathic students by providing them with opportunities to engage in meaningful research projects. Our primary goals are to enhance research literacy, encourage scholarly activity among SOMA members, and contribute to the broader osteopathic research community by supporting projects that advance knowledge in patient care, public health, and osteopathic principles. The SOMA Research project this year is being conducted on obesity education within osteopathic schools. We aim to assess the current state of obesity education in these institutions and identify areas for improvement. The SOMA Magazine, The Future D.O., is a biannual publication dedicated to empowering osteopathic medical students across the nation. It provides a unique platform for students to publish research abstracts, opinion pieces, and creative content, thereby showcasing their scientific, research, and personal achievements. Furthermore, the magazine serves as an opportunity for students to share their insights on pressing medical issues and stay updated on the latest developments in the field. With features that cover a range of topics including policy, political affairs, wellness, and professional development, The Future D.O. aims to highlight and support the academic pursuits of future osteopathic physicians. Its mission is to celebrate and amplify their contributions to human health, fostering a community of informed and engaged future medical professionals. The Spotlight Award Winners recognizes students who have conducted research. The students receive a $25 gift card, a certificate of recognition, will have their project promoted on the National SOMA website and social media platforms, and are encouraged to add this honor to their “Awards” section in their CV. The Student Osteopathic Medical Association hosts two Research Symposiums annually, unfolding in both the fall and spring. These symposiums offer an inclusive platform for SOMA members to present their research endeavors and potentially earn national recognition along with monetary rewards. Our emphasis is on fostering an environment that encourages collaboration, sharing insights, and celebrating the diverse contributions within osteopathic medicine. Articles are written by the SOMA Research Committee, reflecting their dedication to fostering a culture of inquiry and professional excellence. These articles on our website serve as a holistic guide for those engaged in the research field. The collection includes useful databases for manuscript submissions, details on symposiums, and information on relevant conferences, providing you with the tools needed to thrive in your research endeavors. Last, but certainly not least, we host a monthly Journal Club and Research Workshop for our members! Research is a critical component in advancing the medical field and improving patient care. Our task force serves as a resource for students interested in research, providing guidance, resources, and networking opportunities
UPDATES FROM SOMA NATIONAL BOARD OF DIRECTORS
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Promotion of Osteopathy and Wellness Task Force
Director: Raelynn Dorscheid Author: Raelynn Dorscheid
Alumni Task Force
NBD UPDATES
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Professional Development
Director: Tyson Hillock Author: Tyson Hillock
Grassroots Advocacy Subcommittee and Political Affairs Newsletter Task Force
Director: Dylan Bogle Author: Dylan Bogle
Director: pHuong Vo Author: Phuong Vo
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Diversity, Equity, Health, and Inclusion
Public Relations
Director: Momo Cote Author: Momo Cote
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Director: Caitlyn Simtion Author: Caitlyn Simtion
Community Outreach
Research Committee
Convention Committee
Director: MAHI BASRA Author: MAHI BASRA
Strategic Partnerships
Director: Raj Watson Author: RAJ WATSON
Director: Julia Beck Author: Julia Beck, Preston Capener
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Senior Director: Jennifer Wilson Junior Director: Ava DiGirolamo Author: Ava DiGirolamo
Pre-SOMA
Top image, NBD (left to right): Mahi Basra, Matt Boss, Ava diGirolamo, Caitlyn Simtion, Tyson Hillock, Raj Watson, Julia Beck, Nick Cristofari, Raelynn Dorscheid, Momo Cote, Jennier Wilson, Phuong Vo Middle image, BoT (left to right): Julia Moore, Kailey, Jacobsen, Nate Gentry, Monzer Alatrach, Josh Connor, Amy Chiou, Cassie Holub, Nick Cristofari, Grace Hwang, Sneha Pollam, Chethana Gallage Dona, Maria Rollinger. Bottom image (left to right): Dylan Bogle, NBD. Palmer Ford, BoT
2024-2025 NATIONAL SOMA BOARD OF TRUSTEES & NATIONAL BOARD OF DIRECTORS
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After the first time he fell, I held my father’s hand through seizures, sat with him during appointments, and saw how a person’s age, rather than the individual himself, can dictate the kind of care received. After the last time he fell, he never recovered. I wiped his mouth as he vomited what resembled coffee grounds, dried his tears and mine as I asked him what was most important if time became short, and said my last "I love you." I watched how a 97-year-old with early stages of a chronic illness was treated by some in the medical community. Despite being a medical school professor until he was 93, once he started showing signs of dementia, his date of birth dictated how he was perceived. After one trip to the hospital, he told me that he felt he was no longer a valid human being. It was upsetting to see him reduced to a demographic by the field he had dedicated his life to. There is curing, and there is healing. Inability to achieve the former should not affect accomplishing the latter. I never thought I would have to encourage my father to eat. I never thought I would have to hold his hand when, crying, he told me that he would rather be dead. I never thought I would have to tell the man who raised me that he was so physically weak that we could no longer care for him at home. What I did know was that someday I would have to say goodbye; I just never envisioned having the role I did. Before he lost consciousness, I insisted on allowing him to choose the medications he would be given. Our last lucid conversation consisted of discussing what he wanted. After years of not having control over his brain, his body, or his life, I wanted to make sure he could at least have a choice in his death. I am still grieving the loss of my father, but I am grateful for what my time with him has taught me. I have learned to be empathetic as a wounded healer. I was inspired by him to utilize my voice to advocate for patients whose voices are often silenced. The fight to have his autonomy respected and his dignity preserved was worth every heartbreaking minute. As future physicians, we are but a partner in patient care. Without the patient, we lose our purpose, so we must listen to and respect what our patients show and tell us. We must amplify their voices and ensure equitable care. I hope that my story, and my father’s, can inspire at least a few to take the time to be present with future patients and to advocate for them in the same way we hope someone will one day do for us.
FOOD FOR THOUGHT Voice and Choice: What My Father's Final Days Taught Me About Medicine SARAH GERARD NEW YORK INSTITUTE OF TECHNOLOGY COLLEGE OF OSTEOPATHIC MEDICINE - OLD WESTBURY, NY
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A Message From Our Research Director
MAHI BASRA (OMS-IV) Dr. Kiran C. Patel College of Osteopathic Medicine at Nova Southeastern University - tampa campus
Medicine is not just a professional career choice—it’s a calling that gathers individuals from various parts of life, each drawn to the field by their unique experiences and aspirations. While our individual journeys may differ, we are united by a shared purpose: breaking barriers to be the best for our patients. These barriers manifest in many ways: language, culture, socioeconomic challenges, systemic inequities, and even historical mistrust that some communities may feel toward the medical system. As future physicians, we are positioned to confront these challenges head on. As we enter our journey into becoming physicians, I encourage each of you to embrace your role in our communities as compassionate leaders within the healthcare system. By fostering inclusivity and understanding within our teams and with each patient we encounter, we can make a meaningful difference. Medical school is hard, none of us question that. On those late nights that we spend wondering why we chose this field, I implore you to remember your “Why?”. Combating these barriers begins with self-reflection. How can we continue to show up for our patients? Do our words validate their experiences, or unintentionally marginalize? Do we listen to truly understand, or are we quick to respond with assumptions? For patients navigating unstable housing, food insecurity, or limited healthcare access, our approach can mean the difference between hope and despair. It is our responsibility to use language that honors their dignity and meets their unique needs with empathy. As physicians, we hold the immense privilege of being present during some of the most vulnerable moments in our patients’ lives. They turn to us not just for medical expertise but for reassurance, connection, and hope. In these moments, our ability to connect—through a kind word, an attentive ear, or a comforting presence—becomes just as essential as our clinical knowledge. Let us carry forward the spirit of breaking barriers by showing up with compassion and humility in every patient interaction. And as we do, I leave you with the words of Albert Schweitzer: "The purpose of human life is to serve, and to show compassion and the will to help others." Let this quote be a reminder to lead with kindness, communicate with respect, and always strive to make a meaningful impact—not just as doctors, but as human beings. The barriers we break today will pave the way for a healthcare system that truly serves all.
1 MESSAGE FROM RESEARCH DIRECTOR
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"The good physician treats the disease; the great physician treats the patient who has the disease." - Sir William Osler
VOLUME 2 • ISSUE NO. 2