bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performances of candidates with osteopathic compared with allopathic subspecialty training on the American Osteopathic Board of Internal Medicine subspecialty certifying examinations 1984 to 1992
Authors: Slick Gary L. , Dolan Sandra 
Published: October 2018

Abstract
The American Osteopathic Board of Internal Medicine has been examining various factors that may affect candidate performance on subspecialty certifying examinations. To see whether taking subspecialty training in an osteopathic compared with an allopathic institution could predict better performance on the certifying examinations, the authors analyzed examination performance for all candidates from 1984 through 1992. There was no significant difference between the mean scores for the two groups for any of the nine subspecialty certifying examinations. When the results from all nine examinations were pooled, the mean first-time examination takers' score for candidates in allopathic subspecialty programs (n=201) was 78.3 and for those in osteopathic subspecialty programs (n= 153), 77.4 (P> O.2). On the basis of these results, we cannot conclude that osteopathic subspecialty training is a factor that predicts better performance on the subspecialty certifying examination.
Planning a medical relief mission
Authors: Lesho CPT Emil P. 
Published: October 2018

Abstract
Surveillance of drug consumption and disease incidence from medical relief missions in two locations (southeast Asia and eastern Africa) revealed close similarities. Analgesics, antibiotics, antimalarials, antihistamine or decongestant preparations (or both), bronchodilators, and scabicides were the 10 most commonly used drugs. Orthopedic, respiratory, gastrointestinal, dermatologic, and ophthalmic conditions, malaria, sexually transmitted diseases, and parasitic infestations were encountered most frequently. Recognition and early treatment of xerophthalmia, trachoma, and onchocerciasis, which are rare in more developed countries but common at tropical latitudes, can prevent the blindness that results from untreated disease progression. Pulsetemperature relationships and fever patterns may offer diagnostic clues to physicians deprived of laboratory support. Important logistic considerations, disease incidences, and selected topics and idiosyncrasies of humanitarian aid missions to tropical communities are discussed in hopes of aiding providers who are planning future relief missions.
Bicarbonate therapy in the treatment of lactic acidosis: Medicine or toxin?
Authors: Sing Ronald F. , Branas Charles A. , Sing Robert F. 
Published: October 2018

Abstract
The metabolic acidosis resulting from poor tissue perfusion is considered to have several significant hemodynamic effects. Correction of the acidosis with sodium bicarbonate seems to be a rational approach to this problem. However, the current medical literature shows little clinical benefit to this tactic. In fact, indiscriminate bicarbonate administration may, itself, have deleterious effects. Concurring with the absence of a consistent therapeutic advantage to the use of sodium bicarbonate in the treatment of lactic acidosis due to inadequate tissue perfusion, the American Heart Association removed the routine use of sodium bicarbonate from the treatment of cardiac arrest in the algorithms of the Advanced Cardiac Life Support course. Although the debate continues, a detailed review of the medical literature does not support the use of sodium bicarbonate in this setting.
Female enrollment in colleges of osteopathic medicine: Five years and five percentage points behind
Authors: Baker Helen H. 
Published: October 2018

Abstract
An estimated one fifth of graduates of the colleges of osteopathic medicine (COMs) before 1910 were women. However, the proportion of women declined after 1900, so that by 1969, less than 3% of osteopathic medical students were women. Dramatic gains have been made in the past 25 years: for the 1993-1994 academic year, women made up 35% of all osteopathic medical students. Although these gains seem impressive, allopathic medical school enrollment comprised 400/0 women during the same academic year (5 percentage points higher than in osteopathic medical schools). Allopathic medical schools have had significantly more women enrolled every year between academic years 1969-1970 and 1993-1994. In. academic year 1985-1989, allopathic medical schools already had an enrollment that consisted of 35% female students, a percentage that COMs would first reach 5 years later. Based on these findings, enrollment of women in COMs is 5 years and 5 percentage points behind that of allopathic medical schools.
Twenty-year experience with the Mentor bladder pacemaker
Authors: Finkelstein Leonard H. , Coffman Leland M. 
Published: October 2018

Abstract
Twenty years after placement of a Mentor bladder pacemaker, a 38-year-old woman with spina bifida cystica still has controlled detrusor contraction and complete bladder emptying. The varied treatment modalities for this difficult group of patients has included electronic bladder stimulation. Although no longer commonly used, electronic bladder stimulation has shown long-term efficiency in this patient.
Reexamination of the paradigm of HIV risk reduction in adolescents
Authors: Karl Daniel Thad 
Published: October 2018

Abstract
Infection with the human immunodeficiency virus (HIV) in the adolescent/young adult population of the United States is a serious, growing problem. The current HIV risk reduction strategies for adolescents have been less than effective in stemming the tide of infection. This ineffectiveness can be linked to failure of making developmentally appropriate risk-reduction informational material and reliance on condom-based interventions, which have an unacceptably high failure rate. A critical analysis of current models of HIV-risk reduction should be undertaken to create more developmentally appropriate and effective methods.
Challenges and opportunities in occupational medicine
Authors: McCunney Robert J. 
Published: October 2018

Abstract
Recent position papers of the American College of Physicians and the Institute of Medicine have emphasized the role of primary care physicians in occupational medicine. Although opportunities for physicians to become certified in occupational medicine have expanded, shortages in the specialty are likely to persist throughout the 1990s. To help acquaint osteopathic physicians with some of the challenges facing the specialty of occupational medicine, this article addresses the extent of occupational illnesses, health-related policies in the workplace, the delivery of occupational medical services, and graduate medical education.
Does Sjogren's syndrome predispose surgical patients to acquired hemophilia?
Authors: Dachman Adam F. , Margolis Harold , Aboulafia Elie 
Published: October 2018

Abstract
The authors report the first American case of a factor VIII inhibitor found in a patient with Sjogren's syndrome. The inhibitor was isolated from a patient with no known hematologic disorder who was seen with a compartment syndrome of the left thigh after sustaining a fall from bed. The Sjogren's syndrome had been previously diagnosed via lower lip biopsy. After fasciotomy, signs and symptoms of intra-abdominal hemorrhage developed, and the patient was taken to laparotomy, where no hemorrhage was found. A coagulopathy developed, and the patient's hemoglobin continued to fall. A complete factor analysis revealed a factor VIII inhibitor that was quantified at 40 Bethesda units. After vigorous therapy-which included factor concentrates, immunoglobulins, steroids, antifibrinolytic agents, and blood replacement-the patient's bleeding stopped and she continued to convalesce under hospital care until her ultimate death from respiratory problems. Acquired hemophilia with a factor VIII inhibitor may be associated with Sjogren's syndrome.
The amobarbital sodium interview in conversion disorders: Use of video feedback in therapy
Authors: Bradley Ronald H. , Zonia Carolynn L. , Caputo Sam J. 
Published: October 2018

Abstract
The prognosis in treating acute conversion disorder is good, but it demands considerable time in the form of an intensive, and often extensive, hospital stay. With the increasing trend to limiting hospital stays, the family practitioner working with a psychiatrist in the hospital setting is pressured to find new approaches in order to limit the use of inpatient units. The authors describe a case of classic conversion disorder and outline a successful approach that uses a video recording of the interview, during which the patient is under the influence of amobarbital sodium. The videotape then provides valuable feedback during future therapy sessions in the treatment of this persistent disorder.
Interexaminer agreement on palpatory diagnosis and patient self-assessment of disability: A pilot study
Authors: Patriquin David A. , Beal Myron C. 
Published: October 2018

Abstract
To evaluate interexaminer agreement on palpatory diagnostic findings, we compared interexaminer results, patient disability self-evaluations, and assessment of patients' progress by referring physicians. Three examiners (two clinicians and a third-year osteopathic medical student fellow) monitored patients' progress using negotiated examination procedures. The patients were examined independently by each examiner at each of eight weekly visits. Patients completed a disability assessment form at each visit, and the referring physicians recorded changes in their patients' condition. The patients' disability self-rating and examiner test results did not show clear correlation. There was a 62.2% agreement between the two physician examiners when the general descriptors ''improvement,'' ''no change," or "aggravation" were used. The student examiner's agreement with the clinician examiners was 60.2% and 51.8%. Interexaminer agreement of findings from osteopathic testing procedures appears to depend on general clinical experience and specific experience with the testing procedures.
Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome.
Authors: Greenman Philip E. , McPartland John M. 
Published: October 2018

Abstract
Craniosacral findings were recorded for all patients with traumatic brain injury entering an outpatient rehabilitation program between 1978 and 1992. The average cranial rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral findings were similar to those in patients with low back pain. Although craniosacral manipulation has been found empirically useful in patients with traumatic brain injury, three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner must be prepared to deal with the possibility of adverse reactions.
Topical metronidazole for arterial insufficiency ulcers
Authors: PharmD Barbara Kaplan, , Gibson Leo B. 
Published: October 2018

Abstract
The use of topical metronidazole has been limited to the treatment of acne rosacea, infected foot ulcers associated with diabetes mellitus, varicose veins, postirradiation ulcers, and dental conditions since the Food and Drug Administration approved the drug in 1988. Because of this agent's apparent effectiveness in treating anaerobic bacterial infections in such ulcers, the authors believed that treatment of arterial insufficiency ulcers with a solution of topical metronidazole would be a rational approach. They describe a 30-year-old man in whom bilateral lower extremity cellulitis developed as a result of arterial insufficiency. The patient's ulcers were unresponsive to intravenously administered antibiotics and whirlpool therapy. However, when a topical solution of metronidazole was administered, the ulcers began to heal and epithelialization at the ulcer sites occurred. The authors review others' studies concerning clinical use of topical metronidazole and suggest that further study is warranted. To the authors' knowledge, topical metronidazole solution for the treatment of arterial insufficiency and venous stasis ulcers has not been previously reported.
Fatal venous air embolism after removal of a central venous catheter
Authors: Sing Ronald F. , Steffe Thomas J. , Branas Charles C. 
Published: October 2018

Abstract
Venous air embolism is an infrequent, but potentially disastrous, occurrence after the insertion or removal of central venous catheters. The authors describe fatal venous air embolism after removal of a central venous catheter in a 43-year old man recovering from coronary artery bypass surgery. They discuss the pathophysiology, diagnosis, treatment, and prevention. Several practical considerations are necessary to prevent this complication of central venous catheterization, a procedure commonly delegated to junior house officers.
Changes in presence of a segmental dysfunction pattern associated with hypertension: Part 1: A short-term longitudinal study
Authors: Johnston William L. , Kelso Albert F. , Babock Howard B. 
Published: October 2018

Abstract
A statistically significant pattern of segmental components of somatic dysfunction associated with a history of high blood pressure was investigated for change after an interval of 4 to 8 months. The volunteer subjects, from an inner-city ambulatory clinic, included normotensive, borderline hypertensive, and hypertensive persons. A standardized palpatory examination determined whether there were specific motion asymmetries centered at spinal segments C6, T2, and T6 and confirmed by mirror-image motion asymmetries in adjacent segments. Blood pressure measurements and diagnosis of hypertension followed American Heart Association standards. The repeated presence of the pattern in subjects with a history of hypertension was statistically significant. Presence of the pattern in normotensive subjects, however, appeared to be random. The subjects' histories during the study period revealed no influence of antihypertensive medications, major accidents, or illness on the patterns' continuing presence in subjects requiring medical control of their hypertension.
Making sense of federal GME reforms: The impact on osteopathic medicine
Authors: Meyer Christopher T. 
Published: October 2018

Abstract
Physician workforce issues, particularly the generalist/specialist mix, surfaced as a major component of the healthcare reform debate in the last Congress. Both of the major bills before the Congress at the end of the session would have legislated reforms in graduate medical education designed to control the cost, mix, and supply of physician manpower. This article examines the graduate medical education reform measures proposed in the Gephardt (House) and Mitchell (Senate) bills and identifies elements of agreement. Discussion focuses on the potential for reforms that could be enacted in the new Congress, with a look at the implications for the osteopathic medical profession. A second article, to appear in next month's issue, will focus on recommendations for secondary reforms to prepare osteopathic medical institutions for the changing graduate medical education environment. Such a changing environment requires comprehensive reevaluation in all of the institutions of osteopathic medicine-the colleges, the hospitals, and the American Osteopathic Association.
Emphasizing a preventive medicine orientation during primary care/family practice residency training
Authors: Winters Frank D. , Inwald Samson A. 
Published: October 2018

Abstract
In the wake of managed care, primary care physicians are expected to be gatekeepers in the overall healthcare system. As such, preventive medicine, rather than disease-oriented medicine, will play a key role in keeping medical costs in line. To that end, the authors review the current preventive medicine practices and guidelines and suggest ways in which these practices can be implemented in the training of primary care/family practice residents.
'But doctor, someone has to do something': Resolving interpersonal conflicts in the workplace
Authors: Robinett Jane , Cruser des Anges , Podawiltz Alan Lee 
Published: October 2018

Abstract
Physicians are often called on to address interpersonal conflicts among office staff and colleagues. Because such strife can interfere with patient care, physicians should learn to diffuse these situations as adeptly and quickly as possible. The authors outline one approach, which they developed while working at the Oklahoma Department of Mental Health. Designated by the mnemonic LIFT (Listen, Inquire, ask for Feedback, Test), this approach has been used successfully to resolve interpersonal conflict in small groups.
Systemic Malassezia furfur infection in an adult receiving total parenteral nutrition
Authors: Shparago CPT Neal I. , Bruno LTC Philip P. 
Published: October 2018

Abstract
Malassezia furfur sepsis developed in a woman with hyperemesis gravidarum while she was receiving total parenteral nutrition supplemented with lipids. Fever, chills, dyspnea, pleuritic chest pain, and multiple bilateral pulmonary nodular infiltrates were the primary clinical manifestations. Lysis-centrifugation fungal blood cultures supplemented with olive oil grew M furfur. Treatment included removal of the central venous catheter line, discontinuation of the lipid emulsion, and antifungal chemotherapy. Malassezia furfur sepsis complicating total parenteral nutrition may be more common in adults than once suspected. A high index of suspicion is required to diagnose this infection, and the addition of olive oil to the fungal culture medium will provide the necessary growth factors to isolate this fungus.
Accidental epinephrine auto-injector-induced digital ischemia reversed by phentolamine digital block
Authors: Hardy Stephen J. , Agostini Dennis E. 
Published: October 2018

Abstract
The use of epinephrine-containing auto-injectors as a prescription medication for treating routine to severe anaphylactic reactions is now widely accepted. Associated with this trend is an increasing number of accidental injections of epinephrine into digits, causing severe vasoconstriction and the risk of ischemic necrosis. When epinephrine is accidentally discharged into a digit, ischemic skin necrosis resulting from the aadrenergic blocking effects of this agent can lead to the need for multiple operations, wound infection, and even loss of the digit. The a-adrenergic blocking characteristics of phentolamine administered by a variety of methods have proved effective in reversing the effects of epinephrine in these cases. The authors urge that the described treatment protocol become more widely disseminated 'among primary care and emergency physicians.
A standardized form for DSM-IV review of symptoms and mental status examination for students and residents
Authors: Reeves Roy R. , Bullen John A. 
Published: October 2018

Abstract
A common error by medical students and residents is the inadvertent omission of some part of the mental status examination or failure to screen for a psychiatric diagnosis that is not evident on the patient's presentation. The authors introduce a structured questionnaire and standardized form to guide psychiatric and generalist medical trainees through the mental status examination. Based on criteria from the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), the questionnaire and form are intended to facilitate a psychiatric review of patients without missing key points.
First-pass radionuclide cineangiography in diagnosis of coronary artery disease in patients older than 75 years: Evaluation of sensitivity
Authors: Sacher Howard L. , Sacher Michael L. , Landau Stuart W. , Kersten Roger S. , Dooley Frances , Cnmt Allen Chien, , Dietrich Kathleen A. , Sacher Amy , Sacher Mandy 
Published: October 2018

Abstract
The sensitivity of first-pass radionuclide cineangiography in the detection of coronary artery disease was evaluated in 60 patients subdivided equally according to age younger than or older than 75 years. The mean age of group 1 (age > 75 years) was 80.2 years ±5.3, and the mean age in group 2 (age < 75 years) was 62.0 years ±6.4. Disease prevalence in group 1 was 87% versus 80% in group 2. Group 1 had higher prevalence of hypertension (67% vs 33%) and lower prevalence of typical angina pectoris (23% vs 55%). Overall sensitivity of first-pass radionuclide cineangiography in group 1 was 93% versus 97% in group 2. Older patients had significantly lower maximal heart rates, workloads, and exercise durations, and age correlations were significant for exercise heart rate, workload, and exercise duration. Failure to achieve an adequate exercise endpoint had significant effect on testing sensitivity only in the younger subjects (98% vs 60%), indicating that sensitivity of first-pass radionuclide cineangiography is age independent.
Phenobarbital-induced fibromyalgia as the cause of bilateral shoulder pain
Authors: Goldman Stephen J. , ATC Michelle S. Krings 
Published: October 2018

Abstract
A female swimming instructor was seen with chronic bilateral shoulder pain and loss of range of motion. Intensive physical therapy significantly improved the range of motion but did not alleviate the pain. Osteopathic manipulative treatment produced no further improvement in pain or function. Results of laboratory tests were all within normal limits. Four months after the initial consultation, the patient, who was taking medication for tonic/clonic seizures, recalled that her symptoms began after her anticonvulsant medication was switched from hydantoin sodium to phenobarbital. Therefore, phenobarbital-induced fibromyalgia was diagnosed. In 4 months, pain had completely disappeared. The authors discuss several theories regarding the cause of fibromyalgia and the mechanism of action of phenobarbital, including its relationship to sleep disturbance, a probable contributor to pain and dysfunction in the patient described.
Hospital guidelines for diagnosis-related groups/osteopathic manipulative treatment
Authors: Feely Richard A. 
Published: October 2018

Abstract
The DRG/OMT [Diagnosis-Related Groups/Osteopathic Manipulative Treatment] Master Matrix is a tabulated guideline for helping osteopathic physicians and hospitals document their unique form of healthcare. The DRG/OMT Master Matrix is a quality management tool designed for osteopathic physician care of hospitalized patients. It furnishes a mechanism for relating various diagnostic entities to probable areas of somatic dysfunction. This matrix and the accompanying patient record aid the physician in recording diagnosis and treatment, thus providing the hospital with documentation of osteopathic patient care's competitive advantage. In a hospital record review, OMT use increased from 5% to 15% of patients after the DRG/OMT Master Matrix was introduced.
Cluster headache: A review
Authors: Connors Marilyn J. 
Published: October 2018

Abstract
Cluster headache is a debilitating neuronal headache with secondary vascular changes and is often accompanied by other characteristic signs and symptoms, such as unilateral rhinorrhea, lacrimation, and conjunctival injection. It primarily affects men, and in many cases, patients have distinguishing facial, body, and psychologic features. Several factors may precipitate cluster headaches, including histamine, nitroglycerin, alcohol, transition from rapid eye movement (REM) to non-REM sleep, circadian periodicity, environmental alterations, and change in the level of physical, emotional, or mental activity. The pathophysiologic features have not been completely elucidated, but the realms of neurobiology, intracranial hemodynamics, endocrinology, and immunology are included. Therapy is prophylactic or abortive (or both). Treatment, possibly with combination regimens, should be tailored to the needs of the individual patient.