The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Apr 2004
Review Case ReportsCommon scenarios to clarify the interpretation of cardiac markers.
The authors present a practical approach for physicians in clinical practice to use cardiac troponins in the interpretation of heart disease and myocardial damage. Laboratory results that fall within the intermediate area of facility-specific cutoff reference values for elevated troponin levels confer lower risks to patients than do higher levels of cardiac troponin. Perhaps not surprisingly, the actual anatomy of the vessels at cardiac catheterization does not correlate well with the troponin level. ⋯ Elevated levels of cardiac troponin provide a very sensitive measure for clinicians diagnosing patients with myocardial necrosis, but such measures are also useful in defining a broad spectrum of disease. Whenever the troponin levels are elevated (barring laboratory error), the patient has a poorer prognosis. The greatest challenge for physicians is in determining which patients with cardiac troponin elevation will best benefit from heart catheterization and percutaneous intervention.
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J Am Osteopath Assoc · Mar 2004
Randomized Controlled Trial Clinical TrialEffect of inhaled corticosteroids on markers of pulmonary inflammation and lung maturation in preterm infants with evolving chronic lung disease.
Chronic lung disease (CLD) is one of the most severely disabling conditions of extremely low-birth-weight infants. Systemic corticosteroids are effective but cause many adverse effects. Targeted therapy with inhaled corticosteroids may be an effective and less toxic alternative. ⋯ The addition of inhaled corticosteroids to a 7-day systemic course of corticosteroids did not alter cytokine response or improve pulmonary function.
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J Am Osteopath Assoc · Mar 2004
Status of complementary and alternative medicine in the osteopathic medical school curriculum.
Reflecting society's interest in complementary and alternative medicine (CAM), most allopathic medical schools in the United States offer instruction in CAM. Pertinent information about the teaching of CAM at osteopathic medical schools is lacking. The authors therefore sought to document the form and content of CAM instruction at osteopathic medical schools and compare their findings with those reported for allopathic medical schools in a recently published survey. ⋯ Most (72%) CAM instructors were also practitioners of CAM modes of therapy. Few (12%) of the instructors taught CAM from an evidence-based perspective. The authors conclude that the form and content of CAM instruction at osteopathic medical schools is similar to that offered at allopathic medical schools and that both osteopathic and allopathic medical schools should strive to teach CAM with less advocacy and more reliance on evidence-based medicine.
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J Am Osteopath Assoc · Feb 2004
Case ReportsJ-tip spring guidewire entrapment by an inferior vena cava filter.
The number of complications between guidewires and inferior vena cava filters is unknown and most likely underreported. Since 1993, at least 17 cases of central venous catheter guidewires entangled in inferior vena cava filters have been reported. ⋯ The authors report a case in which entrapment of a guidewire occurred without causing displacement of the filter. In addition, a review of simple but useful recommendations to prevent and manage these complications is presented.
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J Am Osteopath Assoc · Jan 2004
Comparative StudyOsteopathic emergency physician training and use of osteopathic manipulative treatment.
Previous studies of osteopathic manipulative treatment (OMT) have examined its use in several clinical settings, but no study to date has been specific to emergency medicine. This article examines the use of OMT in the practice of emergency medicine by osteopathic physicians. Osteopathic physicians who identified their practice as emergency medicine were surveyed to determine OMT use, including techniques used, graduate medical education, and factors affecting usage. ⋯ Techniques most often used include soft tissue treatment, high velocity/low amplitude treatment, and muscle energy treatment. Factors affecting usage include residency training, undergraduate medical experiences, and practice environment. These findings indicate that further investigation into the indications and efficacy of OMT in emergency medicine is warranted.