Volume 106, Issue 11

Untreated trichophagia secondary to trichotillomania is a potentially life-threatening condition. Taking a thorough family and social history, most notably with the aid of a genogram or family tree, can aid in including this disorder in the differential diagnosis. This case presentation describes a unique occurrence of untreated trichotillomania in a female adolescent that led to formation of a trichobezoar requiring emergent surgical intervention and follow-up psychiatric treatment. This case highlights osteopathic medicine's fundamental concept of treating the whole person rather than just symptoms by considering factors such as genetic influences in understanding disease.

Context: Glucocorticoids are used for a variety of medical conditions. This class of drugs is arguably the most common cause of iatrogenic osteoporosis, but studies have shown that physicians are not investigating and treating glucocorticoid-induced osteoporosis. Objective: To determine whether primary care physicians (osteopathic and allopathic) are evaluating and treating adult patients at risk for osteoporosis secondary to long-term prednisone use. Methods: Electronic medical records from three primary care practices (family medicine, geriatric medicine, and internal medicine) were retrospectively reviewed to identify patients who were taking at least 2.5 mg of prednisone per day for 8 weeks or longer. Records were then grouped according to whether patients had undergone bone mineral density screening and had been given therapy to prevent or treat bone loss. Whether patients had comorbid risk factors for secondary osteoporosis (according to the National Institutes of Health Consensus Development Conference Statement on Osteoporosis) was noted to determine whether treatment was given because of prednisone use or because of the comorbid risk factors. Statistical analysis was performed using a Pearson product moment correlation 2-tailed χ 2 test. Results: The medical records of 49 patients met inclusion criteria (19 men, 30 women; mean age, 61 years; age range, 21–89 years). A statistically significant difference was found in physician evaluation practices for patients with vs patients without comorbid risk factors (82.1% vs 38.1%; P =.002). Conclusion: Primary care physicians do not routinely evaluate patients for osteoporosis secondary to glucocorticoid treatment, especially when patients do not have comorbid risk factors for osteoporosis.

Context: Critical appraisal is an important skill for medical students. A proposed curriculum may be an effective teaching tool. Objective: To determine whether the teaching of critical appraisal can be successfully introduced into an osteopathic clinical clerkship in obstetrics and gynecology. Design: Osteopathic medical students (N=77) were assigned by lottery to one of eight rotation groups during their clinical clerkship in obstetrics and gynecology. Four of these rotation groups received instruction in critical appraisal (study group; received evidence-based medicine [EBM] curriculum; n=38); the other four rotation groups did not (control group; received non-EBM; n=39). The ability of the study EBM group to critically analyze the literature was compared with that of the control (non-EBM) group on the basis of results of a multiple-choice examination. Setting: The University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine clinical clerkship in obstetrics and gynecology. Results: The median scores for critical analysis were 41 for the control group and 64 for the study group. This difference was statistically significant ( P <.001). Conclusion: The teaching of critical appraisal can be successfully introduced into a clerkship in obstetrics and gynecology.

Aneurysms of aortocoronary saphenous vein bypass grafts are a rare complication of coronary artery bypass grafts. The authors report the incidental finding of four aneurysms in two aortocoronary saphenous vein bypass grafts in a 77-year-old man with progressive generalized weakness, left facial drooping, and digitalis toxicity. A brief review of the literature on this rare condition is also provided.

Context: The number of physician-researchers in the United States is in decline. Osteopathic medical schools must examine strategies for increasing the number of trained clinical researchers. Objectives: To assess the interest of first- and second-year osteopathic medical students in taking an elective research course during their third and fourth years of medical school; and to examine the relationship among students' personal characteristics, previous research experience, and elective research courses. Design: Fifteen-question, self-administered, cross-sectional survey. Setting: Edward Via Virginia College of Osteopathic Medicine in Blacksburg in September 2004. Participants: First- and second-year osteopathic medical students. Main Outcome Measures: Personal characteristics, previous research experience, and research elective interest (8-week vs 12-week course; and clinical/population vs basic science focus). Results: The response rate was 83.9% (N=255 [149 first-year students; 106 second-year students]), with 51% women responding. Approximately 72% of students had worked on a research project at some time during undergraduate or medical training, and 42% had completed an undergraduate, data-based thesis. Students reported greater interest in a 12-week elective (34%) than an 8-week elective (23%), and two thirds preferred a clinical and/or population to a basic science focus. Conclusions: Colleges of osteopathic medicine must develop research training and mentoring programs to foster such interests in their students, and innovative recruitment approaches need to be developed for DO/PhD degree programs. These strategies will help provide meaningful research education and experiences to osteopathic medical students.