Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its intersection with cancer has emerged as a significant clinical concern. Recent large-scale cohort studies reveal a bidirectional association, with new-onset-particularly idiopathic-AF linked to an elevated risk of subsequent cancer diagnosis. This risk peaks within the first 3months after AF onset, most notably for thoracic, abdominal, and hematologic malignancies, and diminishes thereafter. Proposed mechanisms include shared risk factors, systemic inflammation, prothrombotic states, oxidative stress, paraneoplastic phenomena, and detection bias from increased medical surveillance. While patients with secondary AF and multiple comorbidities bear the highest cancer risk, those with idiopathic AF also demonstrate a nonnegligible risk, albeit lower in magnitude. Cancer diagnosed shortly after AF onset is associated with poorer prognosis, heightened cardiovascular complications, and increased bleeding risk. Current guidelines do not recommend routine cancer screening for idiopathic AF but advocate individualized evaluation when clinical suspicion exists. Significant research gaps remain, particularly in differentiating idiopathic from secondary AF, elucidating biological pathways, and defining evidence-based screening strategies. Addressing these gaps will require coordinated, multidisciplinary research to clarify causality, refine risk stratification, and guide early detection approaches.

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

This article examines the sentiments of a Phoenix-area hospitalist who feels underpaid despite earning an objectively high salary. While physician compensation in the UnitedStates, including that of hospitalists (around $365,000 in Phoenix), ranks among the highest globally and places them in the top income percentiles domestically, the perception of being "underpaid" persists. The piece argues this feeling is a complex value judgment, influenced by the immense effort, sacrifice, and societal contribution inherent in the profession, often perceived as inadequately reflected by market-driven compensation. Cognitive biases, such as the Intrinsic Worth Fallacy and Social Comparison Bias, further shape this perception. Systemic healthcare issues, including administrative burdens and professional disempowerment, also contribute, leading to dissatisfaction where salary becomes a primary, yet seemingly insufficient, metric of worth. The article concludes that true professional value transcends monetary figures, calling for systemic changes to better acknowledge and support physicians, ensuring their profound contributions are recognized beyond financial metrics.

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. 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. 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 theseareas. 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 programmaticlevel. 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.

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

This systematic review and meta-analysis is the first of its kind to analyze the effectiveness of kinesiology tape (KT) on reducing pain in individuals with patellofemoral pain syndrome (PFPS). KT demonstrates significant reductions in pain outcomes, thus, its incorporation into osteopathic treatment for PFPS is supported. The objectives of this study were to systematically evaluate the evidence documenting the effectiveness of KT on pain reduction for patients with PFPS utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and to evaluate the pain reduction efficacy of KT in patients with PFPS through a meta-analysis of pooled data from previous studies. A systematic review and random-effects meta-analysis was conducted utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Included were randomized controlled trials (RCTs) from any publication time until March 2024 that assessed pain outcomes of KT before and immediately after application. Key terms were initially identified utilizing Medical Subject Headings (MeSH), and then Boolean operators were applied. Five databases (PubMed, MEDLINE, Cochrane, Embase, and Web of Science) were searched utilizing the search string ("Patellofemoral pain syndrome" OR "Patellofemoral pain" OR "Patellofemoral syndrome" OR "Anterior Knee Pain Syndrome" OR "PFPS" OR "Runner's knee") AND ("kinesiology tape" OR "kinesio tape" OR "elastic therapeutic tape" OR "kinesiology therapeutic tape" OR "k-tape" OR "kinetic tape") AND ("pain" OR "discomfort" OR "stability"). Six authors participated in the initial search and screen utilizing Rayyan.ai software to reach a two-person consensus on inclusion. Disagreements among authors were discussed and agreed upon by a third author. Included were RCTs that utilized pain intensity to assess the effectiveness of KT pre- and immediately post-application. Studies with a delayed follow-up time or no pain data were excluded from our analysis. Ninety-four articles were found in the search, of which 37 duplicates were subsequently removed, leaving 57 papers for analysis of titles and abstracts based on the inclusion and exclusion criteria. After title and abstract screening, 10 papers were left for full-text review. Full text studies with a delayed follow-up time (n=2) or those that did not report pain data means pre-post intervention (n=3) were excluded. Five articles were included in the study consisting of a total of n=105 participants in the control group and n=120 participants in the KT group. The overall pooled estimate demonstrated a significant reduction in pain intensity pre-post KT application (p≤0.001, Cohen's d=-1.18 [-1.89,-0.48]) with substantial heterogeneity (I2=81.1). No difference was found in the control group (p=0.07, Cohen's d=-0.71, [-1.48, 0.07]) with substantial heterogeneity (I2=79.0). Subgroup analysis found no significant differences between groups (p=0.38). This meta-analysis found a significant benefit in utilizing KT for PFPS. The high I2 values of both subgroups suggest substantial variability, which likely contributed to the insignificant differences between subgroups. Overall, the data suggest that the utilization of KT may be effective in acutely reducing pain perception in patients with PFPS, but more high-quality research is required.

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

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

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

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