Volume 104, Issue 7

Study Objective: Determine prevalence of osteoporosis screening and prevention and modes of treatment in women older than 65 years at risk of osteoporosis. Methods: Retrospective chart review of older female patients seeking osteoporosis screening in the community setting. Results: 399 women at risk of low bone mineral density (BMD) underwent dual-energy x-ray absorptiometry scanning. Among participants younger than 65 years (n=52), low BMD was diagnosed in 44.2%; among participants older than 65 years (n=347), low BMD was diagnosed in 70.0%, a statistically significant difference (P=.001). Conclusion: From a community-level perspective, the authors have shown that osteoporosis screening at local senior centers, living facilities, and health fairs is an effective tool for identifying low BMD in women at high risk of osteopenia and osteoporosis.

Effective asthma control requires long-term (anti-inflammatory) controller medications for patients with mild-persistent to severe-persistent disease, and quick-relief bronchodilator medication for all patients with asthma to control intermittent symptoms of cough, wheeze, and bronchoconstriction, as well as acute exacerbations. For patients with chronic obstructive pulmonary disease, quick-relief and long-acting bronchodilators are primarily used in the maintenance and treatment of associated symptoms, including shortness of breath. For many years, the most widely used bronchodilator has been racemic (R, S)-albuterol, a short-acting β 2 -adrenergic agonist, commonly dispensed as an inhaled aerosol or solution. Until the introduction of levalbuterol inhalation solution (Xopenex) in 1999, all marketed forms of albuterol (including Ventolin and Proventil brands) were racemic mixtures composed of a 1:1 ratio of (R)- and (S)-stereoisomers. Administered as a proportionally equivalent nebulized dose, levalbuterol [(R)-albuterol] provides greater bronchodilation than racemic albuterol and, in the appropriate clinical setting, offers the possibility for improving clinical outcomes in patients with asthma and other obstructive airway diseases. Additionally, levalbuterol can be given at lower doses than racemic albuterol to provide comparable bronchodilation, with the potential for reduced β-mediated adverse effects in adults and children. Only since the past decade has the technology to separate stereoisomers become available, and thus the biologic activities of the albuterol stereoisomers had not been established. Binding studies have demonstrated that (R)-albuterol binds to the β 2 -adrenergic receptor with a high affinity, whereas (S)-albuterol binds with 100-fold less affinity than (R)-albuterol. Other evaluations have suggested that (R)-albuterol possesses the bronchodilatory, bronchoprotective, and ciliary-stimulatory properties of racemic albuterol, while (S)-albuterol does not contribute beneficially to the therapeutic effects of the racemate and was originally assumed to be inert. However, preclinical evaluations have shown that (S)-albuterol has effects that work in opposition to (R)-albuterol and may diminish the therapeutic effects of (R)-albuterol.

The authors report the performance levels and pass rates of various candidate demographic groups and the effect on performance of delaying taking the certifying examination. They also report on the effect American Osteopathic Association reentry resolutions have on allopathic-trained candidates entering the osteopathic certification process in internal medicine. Included in the study were all candidates for the American Osteopathic Board of Internal Medicine certifying examination for the period between 1986 and 2002. Investigators performed group analysis based on type of residency track leading to board eligibility, as well as on the number of retake candidates, candidates reestablishing board eligibility 6 or more years after completion of residency training, and allopathic-trained candidates. Results indicate that medicine-track candidates performed better than any other study demographic group, including allopathic-trained candidates. A delay in taking the certifying examination after completion of residency results in lower candidate performance and pass rates. Various AOA reentry resolutions have not been successful in the repatriating of allopathic internal medicine–trained candidates into the certification process. Candidates in larger training programs have similar mean performance levels and pass rates as candidates in smaller programs.