The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Sep 2002
ReviewUse of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors: indications and complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications-both prescription and over the counter-in the United States. Gastrointestinal side effects from NSAIDs are responsible for significant patient morbidity and mortality as well as healthcare cost. With the development of cyclooxygenase-2 (COX-2) specific inhibitors, these serious adverse reactions have been significantly reduced without affecting therapeutic benefit; however, the need for careful monitoring of patients on therapy with traditional NSAIDs and COX-2 inhibitors continues. In this article, recent developments regarding COX-2 inhibitors and potential future uses of this class of drugs are also discussed.
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The Balanced Budget Act of 1997 and continuing changes put into place by the Educational Commission on Foreign Medical Graduates (ECFMG) are altering the environment for graduate medical education (GME) in ways that threaten osteopathic graduate medical education in particular. Hospital revenue is decreasing due to declines in Medicare GME and patient-care reimbursements. The new 3-year rolling average methodology for counting "house staff" makes it likely that unfilled positions will be eliminated. ⋯ Approximately 25% of all allopathic GME positions in the United States are filled by international medical graduates. If this applicant pool decreases, allopathic medical programs may turn to osteopathic medical graduates as the only other available pool of individuals to fill program positions. At a time when allopathic internship positions are already unfilled and 30% of osteopathic medical graduates enter allopathic first-year programs, further inroads by allopathic programs could severely impact osteopathic GME efforts.
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The authors analyzed mode of delivery and resuscitation rates in a group of 1410 newborns. Comparisons were made between vaginal and cesarean deliveries, and these were further stratified with regard to whether cesarean section was performed as a routine elective procedure or whether an indication existed that necessitated operative delivery of the child (nonelective). ⋯ The risk of resuscitation after repeat elective cesarean section was low, and this risk increased significantly in the nonelective cesarean delivery group. As the risk of resuscitation after elective repeat cesarean sections is not significantly increased, it may not be necessary that a pediatrician be present at these deliveries.
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Although prehospital trauma guidelines call for spine immobilization for many trauma victims, there is a lack of clarity in medical institutions as to how trauma or emergency medicine physicians should proceed to remove cervical immobilization devices (CIDs) and "clear" the spine. Despite wide variations in physicians' approaches to such matters, however, certain specific aspects of vertebral assessment in such circumstances are well documented. The authors describe and explore several of these issues with respect to initial approach to the immobilized patient, clinical clearance of the spine, radiographic evaluation of the vertebrae in victims of blunt trauma, management of spine tenderness or pain, removal of CIDs, and indications for subspecialty consultation. Critical care physicians should be reminded that the responsibility lies with them for removing CIDs and halting other spine precautions--underlying the importance of careful consultation with radiologists and other specialists.