Volume 107, Issue 11

Context : Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years. Objectives : To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999. Methods : Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases. Results : Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years. Conclusions : The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once “critical mass” for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.

In the United States, the number of intercountry adoptions has steadily increased in the past 15 years. Healthcare providers should understand the medical aspects of such adoptions in order to better advise families and aid them in making an informed decision when adopting a foreign-born child. Pretravel consultation is addressed, including immunizations, safety issues, and how to create a personalized prophylactic medical travel kit. Review of pictures, videos, and the medical history of the potential adoptive child is also discussed, as is air travel with children. Postemigration medical examinations—including developmental and psychosocial evaluations, general work-up with laboratory studies, and immunizations—are outlined. This article reviews the medical aspects of intercountry adoption for adoptive parents in the United States. The osteopathic approach of caring for the whole family lends itself to advising families on intercountry adoptions.

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Osteopathic principles and practice (OPP) are considered the core, distinguishing elements of the osteopathic medical profession. As such, the American Osteopathic Association introduced Osteopathic Postdoctoral Training Institutions (OPTIs) in 1995 to further incorporate OPP into osteopathic graduate medical education. The current study describes the evolution of the OPP teaching programs at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg in conjunction with its OPTI consortium, the Mountain State OPTI. Developments in distance-learning technology, lecture and workshop curricula for graduate and undergraduate students, and faculty training are described. In addition, elements of “telehealth” technology, including administrative support, and trainee and student evaluations of the programs are examined. It is hoped that the description of WVSOM's curricular evolution and the emphasis on meeting the needs of OPP program attendees will assist other osteopathic medical schools in developing their own unique OPP programs.

At the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg, an electronic rating form was created to assist preceptors in evaluating student performance for third- and fourth-year clinical rotations. Multiple preceptors, often in rural locations, rated the clinical performance of 70 students in the WVSOM graduating class of 2005. The current study analyzes these ratings. Using Cronbach α, subscore reliability coefficients were obtained for all rotations: clinical knowledge, 0.80; data collection, 0.59; application of knowledge, 0.65; and professionalism, 0.78. For the three required family medicine rotations, which were almost always supervised by osteopathic physicians, reliability of the rating for osteopathic principles and practice (OPP) was 0.44. Intercorrelations among these five subscores ranged from 0.46 to 0.94, all statistically significant at the .01 level. Ratings for the five subscores were compared with 19 measures of student performance in other parts of the WVSOM curriculum, many correlations were significant at the .01 level. Clinical knowledge correlated 0.59 with year 2 grade point average (GPA), 0.51 with years 1 and 2 OPP GPA, 0.50 with Comprehensive Osteopathic Medical Licensing Examination USA Level 2 Cognitive Evaluation, and 0.45 with years 1 and 2 physical diagnosis GPA. Application of knowledge correlated 0.55 with year 2 GPA and 0.50 with the organization score on the college's year 3 objective structured clinical evaluation. Professionalism correlated 0.51 with year 2 GPA and 0.49 with OPP years 1 and 2 written examination score. The average preceptor rating using the new electronic form was 92.6, compared with 96.8 when the previous paper-based form was used for the WVSOM class of 1998 (change significant at .05 level). These moderate correlations provide some support for the validity of the Clinical Education Grade Form.