Open Access Published by De Gruyter

Volume 108 Issue 9

Issue of Journal of Osteopathic Medicine

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LETTERS

Open Access September 1, 2008

Osteopathic Manipulation: Promise for Infantile Colic

Stuart Jeffrey Friedman

Page range: 483-483

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Open Access September 1, 2008

One Hundred Thousand Cases of Influenza With a Death Rate of One-Fortieth of That Officially Reported Under Conventional Medical Treatment

MarkAlain Déry

Page range: 484-530

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SPECIAL COMMUNICATIONS

Open Access September 1, 2008

Statins and Sepsis: Good Bullet, Disappearing Target

Richard H. Woerndle, Daniel L. Maxwell

Page range: 486-490

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Abstract

Despite several decades of research and phenomenal advances in technology and therapeutics, sepsis remains a catastrophic enigma. As a frequent cause of death, sepsis now rivals acute myocardial infarction. The longstanding therapeutic principles of early antibiotics use and supportive care have been difficult to improve upon. The authors conducted a concise review of pertinent literature on the pathophysiologic mechanisms of sepsis and the pharmacologic effects of statins. They conclude that, though statins possess anti-inflammatory and lipid-lowering properties, these effects may not be advantageous throughout the changing immunoresponse that can occur in sepsis syndrome. Based on the available information, statin therapy seems advantageous before the onset of sepsis and during sepsis resolution—but not during the compensatory anti-inflammatory response that may occur. Thus, the authors recommend that, until the status of a patient's changing immune response can be clearly determined, the uninterrupted use of statin therapy throughout the full spectrum of sepsis should be avoided.

ORIGINAL CONTRIBUTIONS

Open Access September 1, 2008

Intraobserver Reliability of Cranial Strain Patterns as Evaluated by Osteopathic Physicians: A Pilot Study

Kelly D. Halma, Brian F. Degenhardt, Karen T. Snider, Jane C. Johnson, M. Schaun Flaim, Danielle Bradshaw

Page range: 493-502

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Abstract

Context : Few studies of inter- or intraobserver reliability have focused on evaluations of cranial strain patterns. Objective : To determine whether substantial intraobserver reliability can be achieved by osteopathic physicians (DOs) using common palpatory tests to diagnose cranial dysfunction. Methods : Forty-eight subjects were divided into three diagnostic groups, categorized as those with asthma, headaches, or neither asthma nor headaches (ie, healthy control group). Two blinded DO examiners separately evaluated approximately 8 subjects from each group (4 subjects per session), conducting diagnostic tests for cranial rhythmic impulse (CRI) rate, cranial strain patterns, and quadrants of restriction. Results : Overall, among the three diagnostic procedures, cranial strain patterns showed the highest intraobserver reliability (κ=0.67). The highest intraobserver reliability was achieved in cranial strain patterns for the control group (κ=0.82), followed by the headache (κ=0.67) and asthma (κ=0.52) groups. Diagnoses of the left anterior quadrant of restriction also showed substantial intraobserver reliability for the headache and control groups (κ=0.60 and 0.61, respectively). Diagnoses of three quadrants of restriction showed moderate overall intraobserver reliability (κ=0.44-0.52), while the left posterior quadrant had only fair overall intraobserver reliability (κ=0.33). Conclusion : Osteopathic physicians can obtain substantial intraobserver reliability when diagnosing cranial strain patterns in healthy subjects as well as those with asthma or headache. However, results are less promising for diagnoses of CRI and quadrants of restriction.

Open Access September 1, 2008

Postpartum Thyroid Measures and Depressive Symptomology: A Pilot Study

Sarah J. Breese McCoy, J. Martin Beal, Mark E. Payton, Audra L. Stewart, Ariana M. DeMers, Gary H. Watson

Page range: 503-507

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Abstract

Context : While correlations have been demonstrated between postpartum depression and psychosocial and circumstantial risk factors, some evidence exists for a similar relationship between postpartum depression and thyroid measures. Objective : To search at 4 weeks postpartum for correlations of numerical scores on a postnatal depression screening tool and thyroid measures. Methods : Subjects took the Edinburgh Postnatal Depression Scale (EPDS) prenatally and at 4 weeks postpartum. Participants were also given blood tests for thyroid-stimulating hormone (TSH), free thyroxine 4 , thyroid peroxidase, and thyroglobulin at the same testing intervals. Results : Fifty-one subjects aged 18 years or older were recruited. Subjects with higher serum TSH at 4 weeks postpartum tended to have higher EPDS scores. Similarly, the 7 subjects (13.7%) with positive postnatal thyroid antibody tests were more likely than their counterparts to have higher EPDS scores. Conclusions : Presence of thyroid autoantibodies or higher TSH levels during the postpartum period may be related to depressive symptoms or dysphoric mood, even when clinical depression is not present. Either or both of these associations may contribute, along with other physiologic and psychosocial risk factors, to postpartum depression. (ClinicalTrials.gov number NCT00565032)

BRIEF REPORTS

Open Access September 1, 2008

Clinical and Research Protocol for Osteopathic Manipulative Treatment of Elderly Patients With Pneumonia

Donald R. Noll, Brian F. Degenhardt, Christian Fossum, Kendi Hensel

Page range: 508-516

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Abstract

Pneumonia in elderly patients is a major public health concern because of greater morbidity and mortality and longer hospital stays relative to younger populations. Based on the premise that osteopathic manipulative treatment (OMT) is beneficial in the management of pulmonary infections, the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) was designed as a prospective randomized controlled trial to evaluate the efficacy of OMT as an adjunct to the current pharmacologic treatment of elderly patients hospitalized for pneumonia. The protocol developed for MOPSE has its origins in early osteopathic medical literature at a time when effective antibiotic therapy was unavailable and osteopathic physicians relied on physical examination and empiric reasoning to develop treatment strategies and OMT techniques to improve host defenses against pneumonia. The present paper reviews the early osteopathic medical literature to identify the reasoning behind the OMT techniques that are the basis for the design of the MOPSE protocol. Likewise, the contemporary medical literature relevant to the protocol is reviewed. Finally, a description of the study design and the OMT and light touch (sham) protocols used in MOPSE are provided.

REVIEW ARTICLES

Open Access September 1, 2008

Type 2 Diabetes Mellitus in Childhood: Obesity and Insulin Resistance

Malcolm S. Schwartz, Anila Chadha

Page range: 518-524

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Abstract

As rates of childhood obesity climb, type 2 diabetes mellitus has increasingly been diagnosed in children and adolescents, with the highest incidence occurring among youth from racial and ethnic minority backgrounds. The serious complications associated with type 2 diabetes mellitus make it essential for physicians to be aware of risk factors and screening guidelines, allowing for earlier patient diagnosis and treatment. It is also important for physicians to be aware of the treatment options available, including weight control through diet and exercise as well as common pharmacotherapeutic options.

CASE REPORTS

Open Access September 1, 2008

Incidental Pleural-Based Pulmonary Lymphangioma

Michael G. Benninghoff, William U. Todd, Rebecca Bascom

Page range: 525-528

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Abstract

Adult benign thoracic lymphangiomas typically present as incidental mediastinal lesions, or, more rarely, as solitary pulmonary nodules. Symptomatic compression of vital structures may require lesion resection or sclerotherapy. In the present report, we describe the incidental finding of a solitary pleural-based pulmonary lymphangioma in a 38-year-old woman with chronic arm and shoulder pain. Positron emission tomography revealed that the lesion was highly fluorodeoxyglucose-avid. Biopsy exposed benign tissue consistent with lymphangioma. After continued radiographic tests, the lesion was determined to be an unlikely source of the patient's chronic pain. The present report is, to our knowledge, the first published case of solitary pleural-based pulmonary lymphangioma in the medical literature.

LETTERS

Open Access September 1, 2008

Osteopathic Certification Evolving Into a Continuous Certification Model

Jack S. Moskowitz

Page range: 530-530

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Open Access September 1, 2008

Responses

Diane Burkhart

Page range: 531-531

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CORRECTIONS

Open Access September 1, 2008

Corrections

Page range: 533-533

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About this journal

The Journal of Osteopathic Medicine, founded in 1901 and known for 119 years as the Journal of the American Osteopathic Association, is the premier scholarly, peer-reviewed publication of the osteopathic medical profession. The mission of JOM is to serve as an international forum for the dissemination of scientific literature that incorporates an integrative, comprehensive, patient-centered approach to clinical care and improving health. JOM conducts double-blind peer review of academic research manuscripts from a wide variety of medical specialties, covering the full spectrum of clinical settings in which osteopathic physicians practice. All submissions are vetted by a distinguished group of Section Editors led by Editor-in-Chief Ross Zafonte, DO, and supported by a full Editorial Board.

JOM publishes original research, narrative and systematic review articles (including meta-analyses), clinical practice descriptions, and a very limited number of case reports, all of which are described fully in our Instructions for Authors. JOM is particularly interested in original scientific research that provides quantitative analysis of and contributes significantly to the evidence base underpinning current practices in osteopathic medicine, including but not limited to neuromusculoskeletal medicine. We also accept research submissions documenting trends and changes in education for osteopathic medical students. The ultimate focus of all material published in JOM is to support, enhance, and advance patient care through evidence.