Masa Sasagawa

Background: The Emerald City Volleyball Classic is an annual tournament involving over 1,000 amateur female youth athletes. Since 2010, a medical team composed of licensed naturopathic physicians and student clinicians from Integrative Medicine Group and Bastyr University has provided onsite sports medicine support. Purpose: To retrospectively analyze the injury types and treatment modalities delivered during the 2024 tournament and to evaluate how this data can inform future medical planning and healthcare provider readiness for similar athletic events. Methods: Over three days (May 25–27, 2024), medical care was administered to athletes at a central treatment station. Interventions included athletic and elastic taping guided by the Manual Tissue Direction Test, soft tissue release, joint manipulation, concussion assessments (Sport Concussion Assessment Tool-6), and first aid. Treatment data were collected and categorized by body region, treatment type, and day. Results: A total of 664 injury-related treatments were provided to more than 300 athletes. The most common interventions were elastic taping of the lower extremities and athletic taping of the ankles and knees. The left ankle, right shoulder, and lumbar spine were the most frequently treated areas. Ten concussions were assessed using Sport Concussion Assessment Tool-6, and two athletes were referred for suspected fractures. A trend of cumulative fatigue was observed, with increased spinal and shoulder complaints by Day 3. Discussion: This report highlights key injury trends and treatment demands observed in amateur female youth volleyball athletes. The findings support the importance of lower extremity support, early fatigue recognition, and concussion management readiness. Integrating naturopathic providers into event coverage may enhance preventative and functional care. Limitations include lack of diagnostic coding and stratification by age or player position. Recommendations include expanding future data collection and strengthening provider preparation for recurrent treatment patterns. Conclusion: This retrospective observational report provides clinically relevant insights for improving athlete care, training protocols, and medical preparedness at youth tournaments. It supports the role of structured, evidence-informed naturopathic care in multidisciplinary sports medicine delivery.

Purpose: Concussions are a form of traumatic brain injury frequently observed in youth sports, with variable recovery patterns. Integrative medicine, including naturopathic care, has gained interest as a supportive approach, though limited research exists on compliance with such protocols. To evaluate compliance with a naturopathic concussion protocol and assess its relationship to return-to-play timelines among youth female volleyball athletes.Methods: This observational pilot study was conducted at the 2023 Emerald City Classic volleyball tournament. Athletes aged 14–18 diagnosed with concussion by licensed naturopathic physicians were enrolled. Participants received a naturopathic concussion protocol including supplements (e.g., vitamin D, N-acetylcysteine), lifestyle and dietary modifications, and structured return-to-play guidelines. Follow-up spanned up to six weeks. Assessment tools included Sport Concussion Assessment Tool-5, symptom severity scoring, and physical/cognitive exams.Results: Six concussions were evaluated; three athletes met inclusion criteria and were enrolled. All three were diagnosed with mild concussion and demonstrated improvement in acute symptoms after initial naturopathic care. Symptom severity scores ranged from 37 to 51 out of 132. However, none of the participants completed follow-up after the event.Conclusion: The naturopathic concussion protocol was feasible in an acute sports setting and demonstrated short-term benefit. However, loss to follow-up hindered evaluation of long-term compliance and outcomes. Future studies should incorporate improved follow-up strategies to assess sustained adherence and clinical efficacy.

Background: Although growing numbers of patients seek acupuncture for pain management, few acupuncturists with insurance credentialing work in the conventional medical settings. This has resulted in increasing frustration among patients wishing to receive acupuncture in primary care settings as part of their insurance benefits. Methods: A course of eight weekly sessions of group auricular acupuncture (AA) for chronic musculoskeletal pain was implemented in a US primary care clinic and billed to insurance. The process of implementing group AA is described, including patients and researchers’ perceptions of their experience. We also examined various hypothetical scenarios for reimbursement based on relative value units (RVUs) based on Centers for Medicare and Medicaid (CMS) billing/coding. Results: Recruitment was greatly limited by COVID-19 requirements for social distancing and administrative hurdles, such that only four patients participated, three of whom attended all eight sessions. Seven additional Medicare patients were excluded due to concerns that acupuncture would not be covered. Participants reported mostly positive experiences with both AA and the group model of care. Based on our hypothetical reimbursement scenarios, in the fee-for-service model, group sessions appear to be economically more viable when staffed by non-physician acupuncturists credentialed for insurance reimbursement. For example, for a group of six patients each receiving acupuncture would be anticipated to generate 3.60 RVUs, whereas a physician seeing three individual patients consecutively for return office visits at CMS Evaluation and Management (E/M) level 3 could generate at least 4.11 RVUs. Conclusions: Offering group AA services in primary care clinics might increase access to acupuncture for patients with chronic pain. Although patients appreciated quicker access to acupuncture through group visits, and the group visit experience itself, logistical and economic barriers remain a challenge for sustainable group-based acupuncture visits.

We report the effects of mixed omega-7 fatty acid supplementation on changes in serum hsCRP, TNFα, and IL-6 levels and self-reported outcomes in people with non-specific chronic musculoskeletal discomfort. Design: A double-blind, placebo-controlled, 1:1 randomized single crossover trial composed of 688 mg/day palmiteolate for the verum and an equivalent amount of medium-chain triglycerides for the placebo. Method: Data were analyzed in two independent groups and as a crossover group. Results: From 211 screened participants in 2017–2019, 56 were randomized. Six participants dropped out and fifty completers contributed to the statistical analyses. At baseline, none of the investigated biomarkers were significantly correlated to subjectively assessed musculoskeletal discomfort levels. For the two-group analysis (n = 26 and n = 24), none of the serum biomarkers reached statistical significance; however, a statistically significant placebo effect was found in the subjective outcomes. Conclusion: For the crossover analysis (n = 50), three weeks of supplementation with n7FA containing 688 mg per day of palmiteolate did not reduce serum inflammatory biomarkers nor did it improve subjectively measured quality of life (QoL) compared to placebo. Future studies should explore appropriate biomarkers, sufficient power, length of dosing, inclusion criteria for volunteers with higher BMI, and the verification of cis-palmiteolate versus trans-palmiteolate.

Background: Supplementation with dietary palmitoleate was reported to lower serum high-sensitivity C-reactive protein (hsCRP) for those with elevated hsCRP. The objective of the study was to evaluate subjectively and objectively measured outcomes of an omega-7 fatty acid (n7FA) dietary supplement on people with non-specific chronic musculoskeletal discomfort. Methods: A double-blind, placebo-controlled, 1:1 randomized single crossover trial was composed of Group “A” which was given placebo first and verum second while group “B” was given verum first and placebo second. Volunteers with uncomplicated chronic musculoskeletal discomfort or a baseline serum hsCRP >1.0 mg/L were recruited from 2017 – 2019. Verum capsules contained palmitoleate and the placebo contained medium chain fatty acids (MCT). Participants took two capsules per day from the first bottle for three weeks followed by two capsules per day from the second bottle without washout for an additional three weeks. Subjects were instructed to maintain their current diet and lifestyle.Results: From 211 volunteers consented and screened, 56 subjects were randomized. Six subjects dropped out, and fifty subjects contributed to the statistical analyses. At baseline, none of the investigated biomarkers were significantly correlated to subjectively assessed musculoskeletal discomfort levels, and Group B showed higher HDL and lower triglyceride than Group A. Main Outcomes of crossover analysis found no statistical significance in all measurements. The mean difference of subjectively measured PROMIS® scores between the first and second visits showed improvement for both placebo and verum groups. Conclusions: Supplementation for three weeks with 688mg per day of a palmiteolate dietary supplement did not reduce serum inflammatory biomarkers nor did it improve subjectively measured quality of life (QoL) for those with chronic non-specific musculoskeletal discomfort. Future studies should explore time, dosing and verification of cis-palmiteolate versus trans-palmiteolate. Future studies should also consider selection of patients with chronic inflammation, for example individuals with higher body-mass index (BMI).Trial registration: NCT03669575. Registered 13 September 2018 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03669575.

Objectives: Dispositional humility in professionals is a character trait that allows one to monitor self-centered occupational drive and to pay attention to the needs of other professionals. The aim of this study is to test whether or not clinicians working in interprofessional team care environments identify the character trait of humility as an important factor for successful collaborative relationships. This study aimed to revise a concept map of dispositional humility created through literature review. Design: An explanatory sequential mixed-methods study was composed of the HEXACO personality test and the Integrative Medicine Attitude Questionnaire, followed by summative and directed content analyses of one-on-one interview data in order to identify the element of dispositional humility. Setting: In the State of Washington, USA, where physicians (MD/DO), nurse practitioners (NP) and naturopathic clinicians (ND) serve Medicaid patients in community clinics. Participants: 6 MDs, 4 NPs, and 11 NDs. Results: Twenty-one primary care clinicians were enrolled. Fifteen clinicians completed the interview. It was observed that the: 1) honesty-humility trait (pConclusion: To maintain high-quality patient care while working as a team, limiting self-interest while focusing on the needs of others may be necessary and in the best interest of patients. An attitude of accepting the principles of integrative medicine has permeated this sample of primary healthcare workers. Both quantitative and qualitative analyses revealed that humility was viewed as an important character trait for successful interprofessional collaboration. A revised concept map of dispositional humility to enhance collaborative relationships was created.

Background: US healthcare consumers increasingly demand more integrative medical care. Collaboration among clinicians trained in different professional disciplines and specialties may require particular character traits and/or training that focus on factors that facilitate effective collaborative work. Dispositional humility may be a factor that balances self-focused desire for recognition with other-focused professional collaboration to serve patients. The objective of this paper is to create a concept map of dispositional humility in healthcare professionals as a factor to enhance collaboration. Methods: Articles published between 1997 and 2017 were searched using the term “dispositional humility” or titles containing “humility” AND either “leadership,” “cultural,” “religious,” “relational,” or “personality.” The abstracts were screened for relevance and full articles were located. To strengthen the scientific rigor of qualitative work by systematizing a method of concept analysis, the Walker and Avant’s eight-step concept analysis was used. Results: Ninety-five articles were reviewed in the qualitative synthesis, including 82 full-text articles from the original search and 13 full-text articles containing the concepts “empathy,” “professionalism” or “openness” identified from references found in the 82 articles. A concept map was created after interpreting the contents of these articles. Conclusions: Collaboration requires not only professional competency but also positive dispositional factors. Dispositional humility allows clinicians to have an accurate self-assessment, to be open to new ideas, to appreciate the contribution of others, and to develop generosity. Dispositional humility in leaders can facilitate character development of team members and create an environment characterized by fairness and equality, transparency, non-punitive consequences for reporting errors and near-misses, and a safe and encouraging environment. Nonetheless, dispositional humility must be nurtured and developed through professional training because high educational attainment, career and financial success, and busy schedules may lead to a sense of self-importance and entitlement that promotes separation of team members into hierarchies based on professional disciplines and specialties.