The Journal of the American Osteopathic Association
-
This section reviews some of the more prominent alternate causes of dementia that need to be excluded when pursuing a diagnosis of Alzheimer's disease. In practice, this exclusion cannot be done with 100% precision. ⋯ Brain biopsy, which is seldom performed in practice, is the only method of moving diagnostic accuracy to near 100%. There is yet no intervention that halts or reverses the underlying pathophysiology of Alzheimer's disease, so the invasive brain biopsy is rarely justified to confirm a diagnosis.
-
J Am Osteopath Assoc · May 1999
ReviewQuality medical management of the geriatric population using practice guidelines, physician-managed home health services, and continuous quality-improvement management strategies.
One challenge confronting physicians in the 1990s is the delivery of cost-effective quality healthcare to the elderly. Given current utilization, federal expenditures on Medicare and other federal healthcare programs are projected to increase to more than 6% of the gross national product by the year 2030. Physicians' practice habits will have an impact on the cost of caring for the nation's elderly. ⋯ Second, physicians should consider alternative approaches to present practice patterns such as physician-managed home health services. Finally, physicians need to take a proactive approach to quality by supporting continuous quality improvement. The purpose of this review is to present some of the existing established practice guidelines, data to support the use of physician-managed home care as an alternative practice approach, and suggestions to incorporate the principles of continuous quality improvement to serve as one practice model that can be used by physicians to improve the quality of medical care given to America's elderly.
-
Sedentary lifestyle is associated with obesity and obesity-related chronic diseases. Increased physical activity can produce clinically significant changes in body composition and a reduction in risk of obesity-related chronic diseases in obese people. ⋯ This article summarizes significant research conclusions about the relationship between physical activity, obesity, and health. It also provides practical strategies for helping obese patients integrate physical activity into their lives.
-
J Am Osteopath Assoc · Mar 1999
Case ReportsHeadache in Chiari malformation: a distinct clinical entity?
A relatively common group of developmental anomalies of the posterior fossa and its contents make up the Chiari malformations. The most common of these anomalies are the Chiari malformations type I and type II. Many patients with these defects are asymptomatic, but many of them suffer from headaches. ⋯ Both had Chiari malformation type I diagnosed. Chiari malformation should be considered in the differential diagnosis of patients who complain of exertional headache. Exertional headaches or worsening of pain during Valsalva's maneuver should prompt clinical suspicion of an underlying intracranial lesion and warrants further evaluation by appropriate neuroimaging studies.
-
J Am Osteopath Assoc · Jan 1999
Method of preparing emergency medicine residents for giving legal depositions.
This study was performed to determine if a simulated legal deposition increases emergency medicine (EM) residents' knowledge, self-confidence, and understanding of a legal deposition. This prospective study included a convenience sample of EM 1-3 residents. A knowledge and a self-assessment pretest were given, followed by a didactic session moderated by local attorneys, followed by knowledge and a self-assessment posttest. ⋯ Using a paired t-test, the authors found this difference to be statistically significant. (P < 0.01) Using Hotelling's T2 test, the authors compared presimulation and postsimulation self-assessment questions. The results revealed that there was a difference between these scores (P < 0.001). Participants in the deposition significantly improved their self-assessment ranking and knowledge inventory test scores by participating in a simulated legal deposition.