Journal of Osteopathic Medicine最新文献

{"title":"Evaluating median nerve stiffness in patients with mild to moderate-severe idiopathic carpal tunnel syndrome receiving OMT and conservative therapy: a pilot study.","authors":"Roland Gazaille, Cole Knox, Michelle Pershing, K Doug Pugar, H Brent Bamberger, James Schoen, Nicklaus Hess, Chelsea Nickolson, Taylor Vickery, Don Flowers, Antipas Marati, Kortney LaCombe, Sharal Mall","doi":"10.1515/jom-2025-0177","DOIUrl":"https://doi.org/10.1515/jom-2025-0177","url":null,"abstract":"<p><strong>Context: </strong>Osteopathic manipulative treatment (OMT) has been recognized as a conservative management option for patients with carpal tunnel syndrome (CTS), although limited research exists to validate its ability to effect posttreatment changes in the median nerve or the surrounding soft tissues.</p><p><strong>Objectives: </strong>The objectives of this study are to evaluate and quantify changes in the elasticity of the median nerve, transverse carpal ligament (TCL), and intracarpal tunnel soft tissues in patients treated for CTS with traditional conservative therapy (e.g., steroid injection and splinting), OMT, or OMT plus conservative therapy.</p><p><strong>Methods: </strong>This single-blinded, randomized controlled pilot study included patients with a definitive diagnosis of mild to moderate-severe CTS. Participants were assigned to one of the three treatment groups utilizing a random number generator. Analysis of variance (ANOVA) was conducted to compare the following outcome measures from baseline through 6 weeks of treatment across the three groups of interest: the CTS-6 assessment tool and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire, electromyography (EMG) of the median nerve, grayscale ultrasound evaluation of the cross-sectional area (CSA) of the median nerve, and shear wave elastography (SWE) of the median nerve, TCL, and the intracarpal tunnel contents (ICTC). Associations between EMG severity scores, CTS-6 assessments, and Quick-DASH scores were also explored through correlation analyses.</p><p><strong>Results: </strong>Among the 15 wrists randomized to the study, 5 withdrew, primarily due to the inability to complete all follow-up visits. 10 wrists completed the study: 3 in the conservative group, 4 in the OMT group, and 3 in the OMT plus conservative group. Ultrasound and SWE were effective in measuring median-nerve CSA and stiffness, although changes through 6 weeks were generally limited. There was no significant difference in the CSA measurements of the median nerve throughout the study (p=0.22, 0.11, 0.18, and 0.71 at weekly visits 1, 3, 5, and 7, respectively). Only the conservative therapy group showed notable reductions in CSA and stiffness over time, which corresponded to statistically nonsignificant reductions in CTS-6 survey scores (ANOVA analysis at visit 6 producing p=0.35) and Quick-DASH scores (p=0.12). One ANOVA analysis of the TCL average shear velocity did produce significant results at visit 7 (OMT mean=4.1, combination mean=3.5, conservative mean=3.7, p=0.01). Changes in EMG parameters (amplitude, latency, and conduction velocity of the median nerve) from baseline through 6 weeks were variable, with no clear pattern of change in any group. Similarly, there was weak association between EMG severity scores and CTS-6 (R<sup>2</sup>=0.1463) and Quick-DASH scores (R<sup>2</sup>=0.4676).</p><p><strong>Conclusions: </strong>History and clinical ex","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A diffuse presentation of urticarial bullous pemphigoid.","authors":"Ahmed Farid, Mark Saad, Daniel Albatarseh, Natalie Prena, Robert Dazé","doi":"10.1515/jom-2026-0007","DOIUrl":"https://doi.org/10.1515/jom-2026-0007","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteopathic manipulative medicine lymphatic drainage techniques for venous insufficiency and peripheral arterial disease: a review.","authors":"Iya Agha, Lyudmyla Susla, Elizabeth Ryder, Gursimran Nanki Udhwani, Sheldon C Yao","doi":"10.1515/jom-2025-0210","DOIUrl":"https://doi.org/10.1515/jom-2025-0210","url":null,"abstract":"<p><strong>Context: </strong>Chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) are associated with significant morbidity, often manifesting as edema, pain, and nonhealing ulcers. Despite standard therapies such as compression, pharmacologic management, and surgical interventions, recurrence rates remain high, and outcomes are limited. Osteopathic manipulative medicine (OMM) lymphatic drainage techniques, including pedal pump maneuvers, aim to enhance venous return, reduce interstitial stasis, and improve overall vascular and lymphatic function. Such approaches may complement conventional therapies by addressing physiologic barriers to healing. Literature addressing OMM lymphatic drainage techniques in this population is sparse, creating a gap in evidence-based options for improving vascular and wound-healing outcomes.</p><p><strong>Objectives: </strong>The objective of this study is to systematically evaluate the evidence regarding the effectiveness of OMM lymphatic drainage techniques on wound healing, symptoms, and quality of life in patients with CVI and PAD.</p><p><strong>Methods: </strong>A systematic literature search was conducted to cover all available literature from database inception through January 20, 2024, with searches performed from February 26, 2023, to January 20, 2024, by four authors (IA, LS, ER, GNU). The databases searched included PubMed, World Health Organization (WHO) Global Health Library, Google Scholar, and ResearchGate. The keywords and Medical Subject Headings (MeSH terms) utilized were \"lymphatic drainage,\" \"pedal pump,\" \"thoracic outlet,\" \"pelvic inlet,\" \"venous insufficiency,\" \"peripheral arterial disease,\" \"lower-leg ulcers,\" and \"osteopathic manipulative medicine,\" combined with Boolean operators. Articles were included if they assessed OMM lymphatic drainage interventions in patients with CVI or PAD. Exclusion criteria were noninterventional design, lack of OMM focus, or irrelevance to PAD/CVI. Screening followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: duplicates were removed, titles and abstracts were screened, and disagreements among reviewers were resolved collectively.</p><p><strong>Results: </strong>A total of 65 records were identified (PubMed=41, Google Scholar=12, ResearchGate=9, WHO=3). After removing duplicates, 32 remained; 27 were excluded following abstract screening, therefore five full-text articles were included. These consisted of one pilot case-control trial (n=30, PAD), one randomized controlled trial (n=20, immobile nursing home residents), one nonrandomized before-after community trial (n=8, lower-extremity ulcers), and two healthy-volunteer trials (n=17 and n=30). The reported outcomes included improvements in endothelial function, ankle-brachial index, treadmill performance, wound surface area, leg volume, blood lactate clearance, and platelet count. Collectively, these studies suggest the physiologic and clinical bene","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in endocrinologist distribution and diabetes outcomes in Appalachian and non-Appalachian counties of Ohio.","authors":"Samuel Borgemenke, Anja Eshbaugh, Katherine Kulp, Isaiah Comnick, Elizabeth A Beverly","doi":"10.1515/jom-2025-0182","DOIUrl":"https://doi.org/10.1515/jom-2025-0182","url":null,"abstract":"<p><strong>Context: </strong>Shortages in medical subspecialty care, particularly endocrinology, present a growing challenge in the United States. In Ohio, structural inequities in the rural and Appalachian regions, including fewer healthcare providers, limited facilities, and barriers to transportation and broadband connectivity, contribute to delayed diabetes diagnoses, increased complications, and a higher mortality rate.</p><p><strong>Objectives: </strong>This study aimed to examine the distribution of endocrinology subspecialists in Ohio and the corresponding prevalence of diabetes.</p><p><strong>Methods: </strong>This cross-sectional study utilized public data gathered in 2022 from the Centers for Medicare & Medicaid Services (CMS) and the United States Diabetes Surveillance System (USDSS) to compare the mean prevalence and incidence of diabetes, the mean costs, and the Prevention Quality Indicator (PQI) scores for both short-term and long-term diabetes complications by Appalachian and non-Appalachian counties in Ohio.</p><p><strong>Results: </strong>Of the 263 endocrinologists analyzed in this study, 21 (7.9 %) practiced in counties classified as Appalachian and 242 (92.1 %) practiced in counties classified as non-Appalachian (p<0.001). Moreover, only 9 of 32 (28.1 %) Appalachian counties had at least one practicing endocrinologist compared with 26 (46.4 %) of the non-Appalachian counties (p<0.1). The mean prevalence of diabetes was also significantly higher in Appalachian counties than in non-Appalachian counties (12.3±0.6 % vs. 11.2±0.9 %; p<0.01). In contrast, no statistically significant differences were observed in diabetes-related costs (p=0.4), short-term complications (p=0.2), or long-term complications (p=0.7) between Appalachian and non-Appalachian counties. The regression models found that although a higher density of endocrinologists per 100,000 persons was negatively associated with diabetes prevalence and incidence, none of these relationships reached statistical significance, with diabetes prevalence being the strongest predictor of endocrinologist concentration (Akaike Information Criterion [AIC]=258).</p><p><strong>Conclusions: </strong>This study revealed a dual disparity in Appalachian Ohio, where these counties not only had fewer endocrinologists, but also had a higher prevalence and incidence of diabetes compared to non-Appalachian counties. Targeted strategies are needed to address this critical gap in subspecialty care in these Appalachian communities.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualizing osteopathic medical professionalism: an institutional self-assessment rubric for colleges of osteopathic medicine.","authors":"Regina K Fleming, Anne C Jones, Matthew Shelnutt, Tony A Slieman, Stephanie White, Bruce R Williams","doi":"10.1515/jom-2025-0082","DOIUrl":"https://doi.org/10.1515/jom-2025-0082","url":null,"abstract":"<p><strong>Context: </strong>Professionalism in medicine has been historically difficult to define, teach, assess, and remediate. While professionalism is vital to the practice of medicine, the lack of consistency across training and disciplines, combined with the often generalized nature of its description, has caused challenges in academic medicine and has led to the weaponization of its use. It is clear that change in this essential competency in medicine is needed, and change has to begin with an honest self-assessment.</p><p><strong>Objectives: </strong>The purpose of this report is to present an evidence-based rubric for the assessment of professionalism at the institutional level. The literature on professionalism emphasizes the importance of creating and maintaining a culture of professionalism within an educational community that guides expected behaviors and ensures accountability. This rubric presents expected behaviors within the major areas of the academic enterprise through an osteopathic lens, emphasizing the distinctive wisdom of osteopathic philosophy and the guidance it provides for a new landscape of medical professionalism.</p><p><strong>Methods: </strong>Through the Senior Leadership Development Program (SLDP) of the American Association of Colleges of Osteopathic Medicine (AACOM), the authors identified six key areas in which to define osteopathic medical professionalism at the institutional level. These are: Definition and Culture; Prematriculation and Matriculation; Preclinical Curriculum; Clinical Curriculum; Student Affairs, Disciplinary Procedure, and Code of Conduct; Patient Care; and Research. Within each area, five clusters of professionalism were utilized to capture the multi-dimensional nature of cultivating a culture of professionalism within a community: Ethics and Integrity, Respect, Teamwork, Accountability, and Self-Management. A four-tier scale was developed to evaluate participants' performance in these areas.</p><p><strong>Results: </strong>The result of this report is a multi-dimensional and comprehensive rubric that can be utilized by colleges of osteopathic medicine (COMs) to perform self-assessments of how professionalism is conceptualized at their institution. In addition, the rubric can be utilized by segments of the academic enterprise in focused self-assessment and for change efforts at the programmatic level.</p><p><strong>Conclusions: </strong>Osteopathic medical professionalism has the potential to carve a new pathway for the future of professionalism in academic medicine. This institutional self-assessment rubric for COMs is the first step in a change process that can clarify and specify how professionalism is defined, so that appropriate and meaningful teaching, assessment, and remediation can follow. Future research on this rubric will be to conduct formal validation analysis in order to standardize its application in an effort to broaden its use and potential impact.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of pediatric abuse- and neglect-associated emergency department visits in the United States: an analysis of the 2019-2022 National Hospital Ambulatory Medical Care Survey.","authors":"Elizabeth Oberlander, Nam Nguyen, Micah Hartwell, Amy D Hendrix-Dicken, Christine Beeson","doi":"10.1515/jom-2025-0231","DOIUrl":"https://doi.org/10.1515/jom-2025-0231","url":null,"abstract":"<p><strong>Context: </strong>Child maltreatment impacts an estimated 7.4 per 1,000 children in the United States. Given the severity of some abusive injuries, children may present to emergency departments (EDs). As such, EDs are primary screening locations for early identification of maltreatment.</p><p><strong>Objectives: </strong>Our objective was to assess rates of maltreatment among pediatric patients presenting to the ED.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of pediatric ED visits utilizing data from the Center for Disease Control's (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS, 2019-2022). Child maltreatment was identified by International Classification of Diseases (ICD) diagnosis codes of confirmed and suspected maltreatment, examinations performed after sexual assault, problems related to upbringing, malnutrition, and chief complaint codes for 'child abuse,' 'sexual abuse,' or 'rape.' Design-based chi-squared tests and regression models were utilized to determine associations between sociodemographic factors, comorbidities, wait time, and length of stay for these patients.</p><p><strong>Results: </strong>Our sample included 13,896 pediatric visits. After applying sampling weights, 1.4 % of pediatric ED visits (422,755 visits annually) were related to maltreatment. Of these visits, 62.7 % were for examinations after sexual assault, 31.2 % included maltreatment, and 6.1 % were for problems related to upbringing or malnourishment. No significant associations were observed by race, age, insurance, sex, or rurality. When evaluating associations between comorbidities and child maltreatment-related visits, associations of asthma, substance use, and developmental disorders were statistically significant (p<0.05). Additionally, visits for these encounters were 28.0 minutes longer compared to other visits (p=0.040).</p><p><strong>Conclusions: </strong>Our findings show maltreatment-affected children across sociodemographics between 2019 and 2022, with more than 420,000 cases presenting to the ED annually. Our results showed that higher rates of maltreatment were found among children with substance use and developmental disorders. At the hospital level, maltreatment visits were often longer than usual visits, but with shorter boarded time - more arriving via ambulance compared to other visits. This underscores the urgent need for comprehensive education and training for all ED staff on how to recognize and respond to child maltreatment across diverse populations. Taking a comprehensive history as well as implementing evidence-based protocols can help increase sensitivity to child maltreatment in EDs across the United States.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"Where are the Black men in osteopathic medical schools?\"","authors":"Forrest Bohler, Allison R Garden","doi":"10.1515/jom-2024-0150","DOIUrl":"https://doi.org/10.1515/jom-2024-0150","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Regarding \"Where are the Black men in osteopathic medical schools?\"","authors":"Michael Megafu","doi":"10.1515/jom-2026-0036","DOIUrl":"https://doi.org/10.1515/jom-2026-0036","url":null,"abstract":"","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing physician shortage in medically underserved rural and tribal communities through residency program collaboration.","authors":"Natasha N Bray, Michael Raischel, Derek McGuire, Ryan Newhardt, Douglas Nolan, Tyler Snyder, Mousumi Som, Lesley VanVolkinburg, Chad Landgraf, Denna Wheeler","doi":"10.1515/jom-2025-0086","DOIUrl":"https://doi.org/10.1515/jom-2025-0086","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;The United States is facing a persistent physician shortage, particularly in rural and tribal regions. Oklahoma ranks 43rd nationally for primary care provider (PCP) availability, with rural and tribal communities experiencing some of the most severe health workforce shortages. The Indian Health Service (IHS) Oklahoma City service area reports a 16 % physician vacancy rate, with national IHS vacancy rates reaching 38 %. Rural and tribal healthcare systems are especially impacted by recruitment and retention challenges. Evidence suggests that physicians are more likely to practice near their residency training site, highlighting the importance of location-specific training programs to alleviate workforce disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to evaluate the geographic distribution and practice outcomes of graduates from three family medicine residency programs located in tribal healthcare systems in Oklahoma and to assess their contributions to addressing physician shortages in rural and underserved areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort analysis was conducted on 87 graduates (2013-2024) from three Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs: Cherokee Nation, Choctaw Nation, and Chickasaw Nation. Program rosters were utilized to identify participants and reported initial practice location. Practice locations were verified utilizing National Provider Identification (NPI) data and cross-checked against the Federation of State Medical Boards (FSMB) Licensure database. Practice sites were classified by Medically Underserved Area/Population (MUA/P) status, Primary Care Health Professional Shortage Area (HPSA) score, and Rural Location utilizing the Federal Office of Rural Health Policy (FORHP) designation, IHS, or Tribal Healthcare Setting. Statistical analysis examined associations between medical school location and postresidency practice location.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 87 graduates included in the final analysis, 64.4 % completed medical school at Oklahoma State University College of Osteopathic Medicine (OSU-COM) in Tulsa, Oklahoma. A total of 66.7 % of graduates remained in Oklahoma, 79.3 % practiced in Primary Care HPSAs, 65.5 % practiced in rural areas, and 57.5 % had initial practice locations in MUAs. OSU-COM graduates were significantly more likely to remain in Oklahoma postresidency (78.6 % vs. 45.2 %, p&lt;0.01). Additionally, 55.4 % of OSU-COM alumni continued to work within tribal healthcare systems, compared to 41.9 % of graduates from other schools. Graduates represented 23 different medical schools with 9 graduates pursuing fellowships, most commonly sports medicine and emergency medicine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Residency programs located in rural tribal healthcare systems in Oklahoma are effective in producing physicians who remain in rural and medical shortage areas. T","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating ejection fraction and heart failure severity using cardiac apex angles: a multiphase pilot study.","authors":"Schafer Paladichuk, Graydon Dietrich, Austin Evanovich, Dane Warp, Ronald F Walser, Dan Selski, Jesse Cone","doi":"10.1515/jom-2025-0118","DOIUrl":"https://doi.org/10.1515/jom-2025-0118","url":null,"abstract":"<p><strong>Context: </strong>Heart failure (HF) affects 6.7 million American adults. The gold standard for HF assessment is echocardiography (echo) to determine the ejection fraction (EF). Evaluating the cardiac apex angle may be a possible way to estimate EF; however, there is a lack of investigation into this relationship.</p><p><strong>Objectives: </strong>This study aimed to evaluate whether a correlation exists between the cardiac apex angle and EF.</p><p><strong>Methods: </strong>A new, standardized method was developed to measure the cardiac apex angle, with the apex as the vertex, the inferior ray extending from the vertex to the right heart border, and a superior ray extending to the intersection of the left atrial appendage and ventricle. Cadaveric hearts were assessed and patient data from the Medical Information Mart for Intensive Care (MIMIC-IV) database were retrospectively analyzed. Chest X-rays (CXR) provided the cardiac apex angles, and echocardiogram reports contained matched EF values.</p><p><strong>Results: </strong>In 15 cadaveric hearts, the average apex angle was 47.2°, and the average EF was 48.5 %. Linear regression analysis revealed an R² value of 0.6543. In the MIMIC-IV cohort of 583 unique patients with matched echocardiograms and CXRs, the average EF was 52.7 %, and the average apex angle was 47.2°, with linear regression analysis revealing an R² value of 0.7018. This was further broken down by sex and CXR direction.</p><p><strong>Conclusions: </strong>Access to echo may be limited in resource-constrained settings. Utilizing CXRs to estimate EF offers a practical alternative, potentially enabling early diagnosis and standardized treatment. This approach leverages common imaging modalities to bridge diagnostic gaps and improve HF management.</p>","PeriodicalId":36050,"journal":{"name":"Journal of Osteopathic Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}