A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes.

This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.

Population Pharmacokinetics and Pharmacodynamics of Burosumab in Adult and Pediatric Patients With X-linked Hypophosphatemia.

Burosumab is a fully human monoclonal antibody against fibroblast growth factor 23, which has been approved to treat X-linked hypophosphatemia (XLH) in adult and pediatric patients. The present work describes the pharmacokinetics (PK) of burosumab and the pharmacokinetic-pharmacodynamic (PK-PD) relationship between burosumab and serum phosphorus in adult and pediatric patients with XLH. A total of 2844 measurable serum concentrations of burosumab and 6047 measurable serum concentrations of phosphorus in 277 subjects from 9 clinical studies were included in the population PK and PK-PD modeling. The serum concentration of burosumab following a subcutaneous administration was well described by a population PK model comprising a first-order absorption, 1-compartmental distribution, and a linear elimination. The relationship between serum burosumab and serum phosphorus was adequately described by a sigmoid maximal efficacy model. Body weight was the only covariate associated with PK and PK-PD parameters. No other intrinsic factors affected PK or PK-PD relationship in adult and pediatric patients with XLH. Further simulations helped to guide the dosing regimen of burosumab in adult and pediatric patients with XLH including age groups with no clinical data.

A systematic review exploring palliative care for families who are forced migrants.

AIMS: To explore the palliative care experiences of forced migrant children, families, and healthcare professionals (HCPs) highlighting successes, challenges, and associated practice implications. DESIGN: Systematic literature review. DATA SOURCES: The following search engines were searched from 2008 - 2018: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, Embase, ProQuest, Scopus, Psycinfo, and Web of Science. Extensive reference and citation checking were also conducted. REVIEW METHODS: Systematic review followed PRISMA guidelines with prepared PROSPERO registered protocol #CRD42019129200. English language qualitative, quantitative, or mixed methods studies were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Eighteen studies (reported in 20 articles) met the final inclusion criteria. Most focused on challenges to care provision. Thematic analysis following methods proposed by Braun and Clarke was undertaken. Five themes were identified: (a) divergence of beliefs and expectations; (b) communication; (c) navigating healthcare systems; (d) burdens and coping strategies; and (e) training and knowledge. A compassionate, collaborative approach with mutual respect crossed themes and was linked to high-quality care. CONCLUSION: Forced migrant families have multiple needs including physical and emotional support and help in navigating complex systems. Professional interpreters can ease communication barriers when resourced appropriately. Individualized care is crucial to addressing the intricate mosaic of culture such families present. A cultural sensitivity/insensitivity framework is presented that may help guide future interactions and priorities for those working in children's palliative care. IMPACT: This systematic review explored the international experiences of palliative care for forced migrant families. The findings highlight the plight of families who experience multiple traumas and increased levels of grief and loss through their migration experiences and when caring for a child with a life-limiting condition. This research has potential to have an impact on professionals working with culturally diverse families in all palliative care settings.

Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT.

BACKGROUND AND OBJECTIVES: Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up. METHODS: Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time. RESULTS: Both groups improved during active treatment in all subdomains of parent stress (ß = -1.42, -1.25, -0.92; P < 0.001), depressive symptoms, and anxiety symptoms (ß = -0.62 and -0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (ß = -1.91 and -1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (ß = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems. CONCLUSIONS: Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.

Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks.

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.

Using community-engaged methods to adapt virtual reality job-interview training for transition-age youth on the autism spectrum.

BACKGROUND: Virtual Reality Job-Interview Training (VR-JIT) is an efficacious Internet-based intervention for adults with severe mental illness (SMI). Evaluations of VR-JIT have shown improved interview skill and access to employment in several cohorts of adults with SMI and with autism spectrum disorders (ASD). VR-JIT trains participants how to fill out job applications and handle job interviews through e-learning content and applied practice. Trainees receive feedback through in-the-moment nonverbal cues, critiques, and recommendations for improving performance. Our study sought to adapt VR-JIT for transition-age youth with ASD (TAY-ASD). METHODS: We recruited TAY-ASD and adult stakeholders from public and charter schools, transition programs, and community service providers. Participants provided feedback on VR-JIT to enhance its applicability to TAY-ASD. We used community-engaged methods to process and analyze data from TAY-ASD and stakeholders, presented their quantitative and qualitative responses to community and scientific advisory boards for review and recommendations, and adapted the intervention design and content. RESULTS: Our adaptations included adding diversity (gender; race/ethnicity) to the virtual hiring manager; shortening the interview by reducing response options; increasing social storytelling to enhance engagement with VR-JIT core components; adding employment opportunities more relevant to younger workers; reducing the reading level; and making the e-learning content more accessible by adding bullet points, voiceover, and imagery/video; and adding new learning goals. CONCLUSIONS: This study presents a rigorous and innovative community-engaged methodology for adapting VR-JIT to meet the needs of TAY-ASD. We review our engagement with TAY-ASD and stakeholders, and discuss the standardized coding scheme we used to adapt VR-JIT and the usefulness and limitations of employing this methodology in adapting other behavioral interventions.

The impact of assault by vitriolage on quality of life: Integrative review.

AIMS: To analyse quality of life post vitriolage and explore factors affecting an individual's everyday functioning after an acid attack. DESIGN: Integrative review. DATA SOURCES: Articles (N = 570) retrieved from Medline, CINAHL Embase and Psychinfo between 2004-2017. Reference chaining and hand-searching yielded 12 further articles. A total 12 articles were reviewed. REVIEW METHODS: Whittemore and Knalf (2005) Journal of Advanced Nursing, 52, 546-553. RESULTS: Five themes were identified; contextual factors, physical wounds, psychological wounds, social wounds, and legal factors, as demonstrated by a conceptual model exploring traumatic events experienced by survivors. CONCLUSION: The event, the burn injury itself, scarring and ocular damage are core factors that impair quality of life. Patients find it difficult to reintegrate into society following the assault and discrepancies between medico-legal and social services further prevent them from achieving their pre-morbid level of functioning. Nurses can use the biopsychosocial findings of this review to provide effective care for those assaulted by acid. It also provides a basis of discussion and application to other permanently disfiguring conditions and intentional injuries. IMPACT: This review has found survivors of acid assaults experience legal, physical, psychological, and social problems. Findings suggest that no single person will have the same experiences since the burden of injury is dependent on socio-cultural and contextual factors rather than the degree of injury alone. Inadequate coordination between multidisciplinary services hinders reintegration into society; causing permanent traumatization for some survivors. This review can assist nurses in understanding how acid assaults impact on quality of life to enable more holistic care provision.

Factors impacting employment for people with autism spectrum disorder: A scoping review.

The aim of this study is to holistically synthesise the extent and range of literature relating to the employment of individuals with autism spectrum disorder. Database searches of Medline, CINAHL, PsychINFO, Scopus, ERIC, Web of Science and EMBASE were conducted. Studies describing adults with autism spectrum disorder employed in competitive, supported or sheltered employment were included. Content analysis was used to identify the strengths and abilities in the workplace of employees with autism spectrum disorder. Finally, meaningful concepts relating to employment interventions were extracted and linked to the International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder. The search identified 134 studies for inclusion with methodological quality ranging from limited to strong. Of these studies, only 36 evaluated employment interventions that were coded and linked to the International Classification of Functioning, Disability and Health, primarily focusing on modifying autism spectrum disorder characteristics for improved job performance, with little consideration of the impact of contextual factors on work participation. The International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder are a useful tool in holistically examining the employment literature for individuals with autism spectrum disorder. This review highlighted the key role that environmental factors play as barriers and facilitators in the employment of people with autism spectrum disorder and the critical need for interventions which target contextual factors if employment outcomes are to be improved.

Children with albinism in African regions: their rights to 'being' and 'doing'.

BACKGROUND: Albinism is an inherited condition with a relatively high prevalence in populations throughout sub-Saharan Africa. People with oculocutaneous albinism have little or no pigment in their hair, skin and eyes; thus they are visually impaired and extremely sensitive to the damaging effect of the sun on their skin. Aside from the health implications of oculocutaneous albinism, there are also significant sociocultural risks. The impacts of albinism are particularly serious in areas that associate albinism with legend and folklore, leading to stigmatisation and discrimination. In regions of Africa those with albinism may be assaulted and sometimes killed for their body parts for use in witchcraft-related rites or to make 'lucky' charms. There is a dearth of research on the psychosocial aspects of albinism and particularly on how albinism impacts on the everyday lives of people with albinism. DISCUSSION: There is a growing recognition and acceptance in Africa that people with albinism should be considered disabled. Thomas's social-relational model of disability proposes it is essential to understand both the socio-structural barriers and restrictions that exclude disabled people (barriers to doing); and the social processes and practices which can negatively affect their psycho-emotional wellbeing (barriers to being). In this article, we combine a social model of disability with discussion on human rights to address the lacuna surrounding the psychosocial and daily experiences of people with albinism. CONCLUSION: Through using this combined framework we conclude that the rights of people with albinism in some regions of Africa are not being enacted. Our debate highlights the need to develop a holistic concept of rights for children and young people with albinism which sees human rights as indivisible. We illuminate some of the specific ways in which the lives of children with albinism could be improved by addressing 'barriers to being' and 'barriers to doing', at the heart of which requires a shift in attitude and action to address discrimination.

Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues.

Adverse childhood experiences have a strong negative impact on health and are a significant public health concern. Adverse childhood experiences, including various forms of child maltreatment, together with their mental health sequelae (eg, posttraumatic stress disorder, depression, dissociation) also contribute to adverse pregnancy outcomes (eg, preterm birth, low birth weight), poor postpartum mental health, and impaired or delayed bonding. Intergenerational patterns of maltreatment and mental health disorders have been reported that could be addressed in the childbearing year. Trauma-informed care is increasingly used in health care organizations and has the potential to assist in improving maternal and infant health. This article presents an overview of traumatic stress sequelae of childhood maltreatment and adversity, the impact of traumatic stress on childbearing, and technical assistance that is available from the National Center for Trauma-Informed Care (NCTIC) before articulating some steps to conceptualizing and implementing trauma-informed care into midwifery and other maternity care practices.

Single-Dose, Preoperative Vitamin-D Supplementation Decreases Infection in a Mouse Model of Periprosthetic Joint Infection.

BACKGROUND: Despite recent advances, infection remains the most common etiology of arthroplasty failure. Recent work suggests that 25-hydroxyvitamin D (25D) deficiency correlates with the frequency of periprosthetic joint infection (PJI). We endeavored to examine whether 25D3 deficiency leads to increased bacterial burden in vivo in an established mouse model of PJI and, if so, whether this effect can be reversed by preoperative 25D3 supplementation. METHODS: Mice (lys-EGFP) possessing fluorescent neutrophils were fed a vitamin D3-sufficient (n = 20) or deficient (n = 40) diet for 6 weeks. A group of 25D3-deficient mice (n = 20) were "rescued" with 1 intraperitoneal dose of 25D3 at 3 days before surgery. A stainless steel implant was inserted into the knee joint and the joint space was inoculated with bioluminescent Staphylococcus aureus (1 × 10 colony forming units [CFUs]). In vivo imaging was used to monitor bacterial burden and neutrophil infiltration. Blood was drawn to confirm 25D3 levels 3 days before surgery and on postoperative days (PODs) 0 and 14. Mice were killed at POD 21, and CFUs were quantified after culture. Myeloperoxidase (MPO) and ß-N-acetylglucosaminidase (NAG) were assayed to look at neutrophil infiltration and activated tissue macrophage recruitment, respectively. RESULTS: Serum values confirmed 25D3 deficiency and repletion of the 25D3-rescued group. Bacterial bioluminescence and neutrophil fluorescence were significantly greater (p < 0.05) in the 25D3-deficient group. CFU counts from the joint tissue and implant were also significantly greater in this group (p < 0.05). Rescue treatment significantly decreased bacterial burden and neutrophil infiltration (p < 0.05). Compared with the 25D3-sufficient and 25D3-rescued groups, MPO activity was higher (p < 0.02) and NAG activity was lower (p < 0.03) in the 25D3-deficient group. CONCLUSIONS: This study demonstrated in vivo in a mouse model of PJI that (1) 25D3 deficiency results in increased bacterial burden and neutrophil infiltration, and (2) this effect can be reversed with preoperative repletion of 25D3. CLINICAL RELEVANCE: Considering that >65% of patients undergoing arthroplasty have insufficient or low levels of total 25D and that 25D levels can be replenished with ease using a U.S. Food and Drug Administration (FDA)-approved, oral 25D3 product, 25D deficiency may be an important modifiable risk factor in humans undergoing joint replacement.

Murine pattern recognition receptor dectin-1 is essential in the development of experimental autoimmune uveoretinitis.

Mycobacteria in complete Freund's adjuvant (CFA) are an essential component of immunization protocols in a number of autoimmune disease animal models including experimental autoimmune encephalomyelitis and uveoretinitis (EAE and EAU, respectively). We determined the role in EAU of two C-type lectin receptors on myeloid cells that recognize and respond to mycobacteria. Using receptor-specific antibodies and knockout mice, we demonstrated for the first time that the macrophage mannose receptor delays disease development but does not affect severity. In contrast, dectin-1 is critically involved in the development of CFA-mediated EAU. Disease severity is reduced in dectin-1 knockout mice and antibody blockade of dectin-1 during the induction, but not the effector phase, prevents EAU development. Significantly, similar blockade of dectin-1 in vivo has no effect in non-CFA-mediated, spontaneously induced or adoptive transfer models of EAU. Thus dectin-1 plays a critical role in the ability of complete Freund's adjuvant to induce EAU in mice.

Reducing distress in mothers of children with autism and other disabilities: a randomized trial.

BACKGROUND: Compared with other parents, mothers of children with autism spectrum disorder or other neurodevelopmental disabilities experience more stress, illness, and psychiatric problems. Although the cumulative stress and disease burden of these mothers is exceptionally high, and associated with poorer outcomes in children, policies and practices primarily serve the identified child with disabilities. METHODS: A total of 243 mothers of children with disabilities were consented and randomized into either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice). Well-trained, supervised peer mentors led 6 weeks of group treatments in 1.5-hour weekly sessions, assessing mothers 6 times before, during, and up to 6 months after treatment. Mothers had children with autism (65%) or other disabilities (35%). At baseline, 85% of this community sample had significantly elevated stress, 48% were clinically depressed, and 41% had anxiety disorders. RESULTS: Using slopes-as-outcomes, mixed random effects models, both treatments led to significant reductions in stress, depression, and anxiety, and improved sleep and life satisfaction, with large effects in depression and anxiety. Mothers in Mindfulness-Based Stress Reduction versus Positive Adult Development had greater improvements in anxiety, depression, sleep, and well-being. Mothers of children with autism spectrum disorder improved less in anxiety, but did not otherwise differ from their counterparts. CONCLUSIONS: Future studies are warranted on how trained mentors and professionals can address the unmet mental health needs of mothers of children with developmental disabilities. Doing so improves maternal well-being and furthers their long-term caregiving of children with complex developmental, physical, and behavioral needs.

The effects of relaxing music for anxiety control on competitive sport anxiety.

This investigation examined the effects of relaxing music for anxiety control on measures of competitive state anxiety and the performance of a simple motor skill. Seventy-two undergraduate students volunteered to participate in the study. Participants were informed that they would be required to partake in a sport competition, possibly with an audience present, and possibly whilst being filmed. Participants were randomly allocated to one of three intervention conditions, listening to relaxing music for anxiety control, listening to non-relaxing music or a no music control. During the 10-minute intervention period, measures of anxiety (CSAI-2R, subjective relaxation and HR) were taken on three occasions (baseline, pre-intervention and post-intervention). Repeated measures MANOVA showed that all three interventions provoked significant reductions in competitive state anxiety. Condition had no impact upon any of the DVs. These results suggest that listening to relaxing music for anxiety control was no more effective at reducing competitive state anxiety than non-relaxing music or a period of silence. ES, mean difference and 90% CI data did however provide some support for the application of relaxing music for anxiety control. There were no between-condition differences in motor task performance.

A review of treatment and management modalities for premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) affects 5 to 8 percent of women and can significantly decrease their quality of life. Symptoms generally present during the late luteal phase of the menstrual cycle and can affect women emotionally, behaviorally, cognitively and physiologically. This article reviews the clinical literature on PMDD and the evidence behind various methods of symptom management. Evidence suggests that a holistic approach, including lifestyle modifications, pharmacotherapy and cognitive behavioral therapy, is most beneficial for symptom reduction and improvement in daily functioning and quality of life.

'It's not me, it's them': How lesbian women make sense of negative experiences of maternity care: a hermeneutic study.

AIM: The paper is a report of one aspect of a hermeneutic study of lesbian women's experiences of maternity care, specifically interpretations of negative experiences. BACKGROUND: There is a growing body of literature in relation to lesbian women's experiences of maternity care. Although most commentators discuss the negative experiences encountered by lesbian mothers, there has been no contextual analysis of these expressions of negativity in an increasingly positive environment. METHODS: The study was undertaken using a qualitative approach using an adapted Gadamerian hermeneutic phenomenology using unstructured interviews with eight women. The interviews took place between November 2007 and March 2008. All of the participants had disclosed their sexual orientation in pregnancy. Snowball sampling was used. The data were then analysed using an iterative hermeneutic framework. FINDINGS: The participants not only described their experiences of maternity care as being positive but also offered examples of negative experiences. These were analysed separately to explore the ways in which the women made sense of them in the context of an otherwise positive experience. These experiences were expressed in ways that distanced the negative and that seemed to rationalize behaviour or ascribe it to the health professional. CONCLUSIONS: Negative encounters with health professionals are processed by women in a way that protects their overall experience. Health professionals in maternity care should consider the impact of negative responses to lesbian mothers and the effect that it has in reducing the overall quality of this significant life event.

A healthy settings framework: an evaluation and comparison of midwives' responses to addressing domestic violence.

OBJECTIVES: to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy. DESIGN: a postal survey questionnaire. SETTING: Northern Ireland. STUDY POPULATION: 983 hospital and community midwives. FINDINGS: overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence. KEY CONCLUSIONS: the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence. IMPLICATIONS FOR PRACTICE: healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

Children, health and gender: recognition in nursing research?

AIM: This paper examines the hitherto mostly unrecognised relationship between gender, health and children; its significance for nursing practice and how it has been considered in nursing research. BACKGROUND: Holistic nursing practice with children requires adequate assessment and consideration of all potential influences on children's lives. Socioeconomic disparities have received widespread attention and gender inequalities in adult health have been studied in some depth. The links between gender, health and children, however, have received little consideration. The paper first considers this context in depth; it then applies the context to research in practice. DESIGN: Systematic review. METHODS: A systematic literature search was undertaken on four mainstream nursing research journals over 38 months up to February 2007. A total of 567 articles met the key word searches. Duplicates, opinion pieces and articles not focusing on children were removed. The remaining 23 nursing studies relevant to child health were examined for their gender sensitivity. RESULTS: Full consideration of gender issues was found largely to be absent in nursing research on children. Eight studies gave specific consideration to gender relevance, where boys and girls may have responded differently to care. Only six studies specifically addressed gender sensitivity. Allowing children a voice, however, was a strength in these studies, with 18 reflecting children's views directly. CONCLUSIONS: Major gaps still exist in research and theorisation relating to children, health and gender. These need to be acknowledged and investigated, particularly in relation to how they might impact on nursing care. RELEVANCE TO CLINICAL PRACTICE: Nursing practice and research needs to account for all potential health issues, of which gender may often be important.

Introducing osteopathic medical education in an allopathic residency.

BACKGROUND: Osteopathic medical school graduates, who are entering allopathic residencies in increasing numbers, want to maintain their osteopathic manipulative medicine (OMM) skills, but such residency programs do not include osteopathic curricula. OBJECTIVES: To describe the development and implementation of an osteopathic curriculum within an allopathic family medicine residency, and to evaluate the program's success. METHODS: Osteopathic residents, with the assistance of their allopathic faculty, generated the goals, objectives, and implementation strategies for an osteopathic curriculum that consisted of an osteopathic clinic and educational activities. The modified nominal group technique was used to determine the success of the clinic, highlighting its strengths and weaknesses. Success of the educational activities was measured by the American Osteopathic Association's approval of the residents' first year of postgraduate training. RESULTS: Osteopathic residents, who staffed the clinic, reported maintenance of their OMM skills to be the greatest strength of the clinic and lack of structured didactics to be its greatest weakness. Since the curriculum was introduced in 2004, 3 residents have applied for and received the American Osteopathic Association's approval for training. CONCLUSION: In the present study, an osteopathic curriculum was successfully implemented in an allopathic family medicine residency, enabling osteopathic residents to maintain their OMM skills. In addition to exploring the curriculum's impact on allopathic colleagues, further research should investigate whether osteopathic graduates who participate in such a curriculum are more likely to practice OMM after their residency ends.