Volume 102, Issue 9

Neurologic disorders are often described in terms that relate to symptoms rather than specific etiologic factors. Such descriptive terms are confusing to healthcare professionals and to the parents of children in whom these disorders are diagnosed. Cerebral palsy is one example of a descriptive term that is applied to a disorder that is heterogeneous in its etiology, morbidity, and mortality. A random sampling of 100 adults selected from the waiting room of a suburban ambulatory pediatrics office associated with the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine (Stratford, NJ) was surveyed with a 20-item questionnaire on their perceptions of the term cerebral palsy and its associated disability and prognosis. Subjects' responses suggest that a percentage of the general population holds several misconceptions about the disorder, including the belief that the disorder has a genetic etiology (40%) and that affected children cannot speak (20%), die earlier than unaffected children (57%), and cannot hold jobs as adults (20%) should they survive to adulthood. A small percentage of subjects believe that cerebral palsy is infectious (4%) and that parents should restrict their children from associating with those affected (3%). Our study population was somewhat homogenous in that most respondents were educated and most were middle to upper-middle class. Yet, even in this population, the term cerebral palsy is ambiguous to many and may have negative connotations. Further studies are needed to address whether a higher frequency of negative perceptions are present in more socioeconomically diverse populations.

The purpose of this study was to examine student performance on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) level 2 examination following a clinical evaluation, feedback, and intervention program. Students who completed their core clinical training (year 3) at the Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania, returned to the campus for a weeklong series of clinical science testing. Their performance in this program was compared to their performance on COMLEX-USA level 2 administered by the National Board of Osteopathic Medical Examiners approximately 3 months later. The authors analyzed other student data (Medical College Admission Test scores, grade point averages, and COMLEX-USA level 1 scores) to identify the relationship between these variables and the students' success (or failure) on COMLEX-USA level 2. Using a correlation approach, the authors found a relationship between COMLEX-USA levels 1 and 2 as well as between the preparation week and COMLEX-USA level 2, and that the significant difference in the results of the "at-risk" students continues in the COMLEX-USA level 2 performance. Further, the intervention used with students performing at less-than-satisfactory levels in the preparation program was successful in improving the performance of this group to a level equal to that of the second decile, thus increasing the likelihood that these students will pass the COMLEX-USA level 2 examination.

Pain in the elderly is often unrecognized and undertreated. Ineffective pain management can have a significant impact on the quality of life of older adults, leading to depression, social isolation, and a loss of function. Proper assessment of older adults requires the physician to regularly ask about the presence of pain and be skillful in assessment strategies to evaluate the frequency and intensity of pain. Assessment of pain in older adults with dementia and communication disorders is especially challenging. Effective pain management in elderly patients should include both pharmacologic and nonpharmacologic strategies. Pharmacologic strategies call for administration of nonopioid analgesics, opioid analgesics, and adjuvant medication. Polypharmacy, drug-drug and drug-disease interactions, age-associated changes in drug metabolism, and the high frequency of adverse drug reactions need to be carefully considered in using medications in this population. Nonpharmacologic approaches such as cognitive-behavioral therapy, education, osteopathic manipulative treatment, and exercise should be applied in addition to pharmacologic therapy. Using a team approach and incorporating principles of pain management can effectively provide good analgesia for older adults.

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.

Delayed closure of the anterior fontanelle is often associated with significant disease entities. Range of normal closure of the anterior fontanelle is 4 to 26 months. Increased intracranial pressure, hypothyroidism, and skeletal anomalies are common etiologic factors. History, physical examination, and diagnostic testing rule out most disorders. Once these disorders have been ruled out, it is important for the physician to realize that a persistent open anterior fontanelle beyond the accepted ranges of closure can be a normal outlier.