Band 103, Heft 4

The purpose of this study was to assess whether physicians in practice inadequately diagnose osteoporosis in a high-risk population of postmenopausal women who have sustained hip fractures. Using the Texas Hospital Discharge Data-Public Use Data File (PUDF) provided through the Texas Health Care Information Council, the authors conducted a review of all postmenopausal women older than 55 years with fractured hips discharged from Texas hospitals during 1999. A total of 13,628 patients meeting these criteria were found using the PUDF. In their diagnoses, physicians for 2233 (16.3%) of these 13,628 women also specified the code for osteoporosis (P < .001) from the ninth revision of the International Classification of Diseases. It is estimated that between 40% and 50% of postmenopausal women have osteoporosis. Therefore, women with fragility fractures form an even more at-risk subset of the population--so much so that one would expect a majority of these women to carry diagnoses of osteoporosis. The age distribution in each group was comparable, implying that receiving a coded diagnosis for osteoporosis was not related to the age of the patient when she was admitted to the hospital. Further, when data was analyzed by race or ethnicity, percentages for each group (ie, diagnosed with hip fracture only versus diagnosed with hip fracture and osteoporosis) were comparable. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high-risk population of postmenopausal women who were admitted to hospitals with fractured hips. Future analysis of subsequent annual databases will identify whether continuing medical education efforts cause physicians to diagnosis osteoporosis in this high-risk population more frequently.

Although research is a critical component of academic medicine, it has not been a significant component of osteopathic medicine. For years, leaders in the osteopathic medical profession have called for increased research in osteopathic medical schools. The need for cost-effective clinical practice leading to improved clinical outcomes creates a necessity for conducting well-designed clinical outcomes research related to osteopathic practice. The authors assess the growth in research at osteopathic academic medical centers from 1989-1999. The amounts of extramural funding at each school, sources of funding, types of research funded, departments funded, and investigators' degree types are also assessed. During the 10 years analyzed, total research funding increased 37%. Twenty-five percent of the grants and 55% of the funding to colleges of osteopathic medicine were from the National Institutes of Health. Most (63%) grants were awarded to PhD faculty. Most research was conducted in the basic biomedical sciences. Clinical research related to osteopathic practices appears to be a relatively minor component of research at osteopathic medical centers.

Given the need for multicenter clinical trials to support evidence-based treatments, the authors hypothesized that the process of gathering large amounts of data from disparate clinical sites could be facilitated through direct input of clinical and survey data through a Web interface. A series of data collection instruments was created and published as Web pages to support a clinical study performed at Des Moines University Osteopathic Medical Center. The most challenging tool to implement was the visual analog scale, which required special programming. Specific Web pages allowed research study participants to input their own data, while other Web pages were restricted to use by the investigator for inputting clinical and laboratory observations. Data from these sources were automatically combined in a single spreadsheet by the Web administrator in a manner that maintained the confidentiality of participants. Subsequently, the system was tested from a remote site (Chicago), and data were captured at Des Moines University Osteopathic Medical Center. This test involved a variety of data including the visual analog scale. Although this system provided a facile method for collecting and analyzing a large amount of data in almost real time, with a demonstrable savings of time and money, the authors believe the more important use for this data collection system is in large multicenter clinical trials. Hence, the authors commend its use for support of large outcomes studies for osteopathic researchers engaged in interinstitutional efficacy studies.

Osteopathic physicians may use regional diagnostic rotation tests of the spine during physical examinations for patient evaluations. Clinical judgments of these responses relate to symmetry as a criterion for mobility. This first part of a two-part study reports the authors' investigation of regional ipsilateral myoelectric activity during responses to active and passive shoulder and trunk rotations on the left- and right-side muscles with subjects seated. Results indicate symmetry existed in both active and passively induced regional rotation tests. Further, the distribution (profile) of ipsilateral myoelectric activity in the thorax reflected a bell-shaped activity curve that peaked at thoracic levels 6 and 7. This profile element demonstrates remarkable similarity between volitional and physician-induced rotation motions. These myoelectric data justify symmetry and profile as tangible standards for making clinical judgments of regional responses to spinal rotation diagnostic tests.