The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Sep 2007
Case ReportsTrauma-induced pneumothorax after "bear-hug back crack" home remedy: attempted spinal manipulation by a layperson.
Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement--often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.
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J Am Osteopath Assoc · Jul 2007
Randomized Controlled Trial Multicenter StudyAnalysis of pooled data from two pivotal controlled trials on the efficacy of topiramate in the prevention of migraine.
A substantial proportion of the patient population with migraine headache should be considered for preventive treatment based on the frequency and disability associated with this disorder. Use of the anticonvulsant topiramate was previously examined in two large, double-blind, randomized, placebo-controlled clinical trials of a subset of patients who have 3 to 12 migraine episodes per month. ⋯ Pooled efficacy data from two large, similarly designed, placebo-controlled migraine-prevention trials demonstrated that a statistically significant proportion of patients using topiramate met or exceeded two main outcome guidelines recommended by the International Headache Society (>/=50% and >/=75% reduction in frequency of monthly attacks). Based on efficacy and tolerability, topiramate at a dosage of 100 mg per day (50 mg twice daily) should be the target dosage for most patients with migraine.
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J Am Osteopath Assoc · Jul 2007
Getting "beyond the barriers" in reforming osteopathic medical education.
As the healthcare needs of the United States change, some leaders at colleges of osteopathic medicine and osteopathic graduate medical education programs have embraced one very important and timeless goal: to prepare future physicians to meet society's health needs. These medical educators have made significant strides toward moving "beyond the barriers" to effect curricular reform and quality improvement at their institutions. Some of the barriers to osteopathic medical education reform are addressed in this article, which recommends allowing curricular evolution and faculty development; expanding clinical learning and teaching; breaking down departmental walls; integrating osteopathic principles and practice; reevaluating admission requirements of colleges of osteopathic medicine; and eradicating the unspoken and, ironically, often detrimental culture of medicine, which can be contrary to compassionate patient care and healing.
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J Am Osteopath Assoc · Apr 2007
Full face mask for noninvasive positive-pressure ventilation in patients with acute respiratory failure.
Noninvasive positive-pressure ventilation (NPPV) is commonly used to improve ventilation and oxygenation in patients with acute respiratory failure (ARF). Mask leak and intolerance due to facial discomfort or claustrophobia often occur with NPPV and are frequently cited reasons for treatment failure. ⋯ For individuals with hypercapnic respiratory failure who cannot tolerate NPPV using nasal or oronasal masks, use of full face masks may improve outcomes, allowing physicians to avoid ordering endotracheal intubation and mechanical ventilation.
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J Am Osteopath Assoc · Mar 2007
ReviewHerpes zoster vaccine: clinical trial evidence and implications for medical practice.
This review of the data from the Shingles Prevention Study (SPS) highlights the efficacy and safety of a high-titer live attenuated herpes zoster virus vaccine in preventing herpes zoster and postherpetic neuralgia (PHN) in adults aged 60 years or older. In the SPS, the vaccine reduced the burden of illness due to herpes zoster disease by 61.1% and the incidence of its most common and debilitating sequela, PHN, by 66.5%. ⋯ The vaccine was safe in the SPS population, with little differentiation from the safety profile of placebo other than an increased risk for reactions at the injection site. Rates of serious adverse events, systemic adverse events, hospitalization, and death were low and similar to those observed in the group that received placebo.