Band 109, Heft 11

Context : In 1992, the West Virginia School of Osteopathic Medicine (WVSOM) created a task force as part of an institution-wide initiative to integrate osteopathic principles and practice (OPP) across its entire curriculum. The goals of the initiative, which was implemented with the graduating class of 1997, were to create a clearly distinct osteopathic curriculum and preserve the use of osteopathic manipulative treatment (OMT) by WVSOM alumni. Objective : To evaluate outcomes of the Osteopathic Principles and Practices Integration Project among WVSOM alumni. Methods : A survey was mailed on a staggered timeline to WVSOM alumni who had graduated at least 5 years earlier. Data from the graduating classes of 1995 and 1996 (preintervention) were compared with data from the graduating classes of 1997 through 2002 (postintervention). Results : After excluding responses from alumni still in residencies, responses from 52 (41.9%) of 124 alumni in the preintervention group and 155 (40.9%) of 379 alumni in the postintervention group were analyzed. Comparisons of preintervention group to postintervention group, based on the χ 2 test, revealed significant improvement in the proportion of alumni who agreed that basic sciences faculty at WVSOM provided exposure to osteopathic philosophy ( P =.020); that basic sciences faculty at WVSOM taught OMT ( P =.019); and that alumni were exposed to osteopathic philosophy during rotations with DOs ( P =.031). Approximately 53% of alumni in both groups reported daily OMT use in treating patients. Posthoc analysis using the McNemar test for correlated proportions revealed that the proportion of all alumni rating themselves as “prepared” in OMT and OPP at the end of the second year of the WVSOM curriculum was 92.7%, significantly higher than the 76.1% rating of preparation at graduation ( P <.001). Conclusion : Survey results indicate that WVSOM's Osteopathic Principles and Practices Integration Project has created a distinctly osteopathic curriculum and has helped alumni maintain use of OMT in clinical practice.

Context : The effect of a variety of preadmission variables, including the number of elective preadmission upper-level science courses, on academic achievement is not well established. Objective : To investigate the relationship between number of preadmission variables and overall student academic achievement in osteopathic medical school. Methods : Academic records of osteopathic medical students in the 2008 and 2009 graduating classes of Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, California, were analyzed. Multivariate linear regression analyses were performed to identify predictors of academic achievement based on Medical College Admission Test (MCAT) subscores, undergraduate grade point average (GPA), GPA in medical school basic science (preclinical GPA) and clinical clerkship (clinical GPA), and scores on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE). Results : Records of 358 osteopathic medical students were evaluated. Analysis of β coefficients suggested that undergraduate science GPA was the most important predictor of overall student academic achievement ( P <.01). Biological sciences MCAT subscore was a more modest but still statistically significant predictor of preclinical GPA and COMLEX-USA Level 1 score ( P <.01). Physical sciences MCAT subscore was also a statistically significant predictor of preclinical GPA, and verbal reasoning MCAT subscore was a statistically significant predictor of COMLEX-USA Level 2-CE score (both P <.01). Women had statistically significantly higher preclinical GPA and COMLEX-USA Level 2-CE scores than men ( P <.05). Differences in some outcome variables were also associated with racial-ethnic background and age. Number of preadmission elective upper-level science courses taken by students before matriculation was not significantly correlated with any academic achievement variable. Conclusion : Although undergraduate science GPA and MCAT biological sciences subscore were significant predictors of overall academic achievement for osteopathic medical students, the number of elective upper-level science courses taken preadmission had no predictive value.

Nutritional deficiencies are unrecognized in approximately 50% of patients who undergo gastric bypass surgery. The authors present some of the more common nutritional deficiencies and related complications that can occur in this patient population. Greater awareness of the potential effects of nutritional deficiency after gastric bypass surgery may help physicians better recognize and manage these challenging conditions.

Notalgia paresthetica is a chronic sensory neuropathy characterized by pruritus of the upper to middle back, typically below the left shoulder blade. Symptoms may include pain, hyperesthesia, paresthesia, and hyperpigmentation of the affected area. Although the etiologic process of this condition is poorly understood, recent correlations with degenerative spinal changes suggest that spinal nerve impingement may play a role. The authors report the case of a 59-year-old woman with notalgia paresthetica who received one 20-minute session of osteopathic manipulative treatment that focused primarily on thoracic spine and rib somatic dysfunctions. After treatment, the patient reported immediate improvement of symptoms. A discussion of this condition based on previously published literature is also provided.

Sarcoidosis is a multisystem inflammatory disease that characteristically involves the lungs and lymph nodes. Involvement of the genitourinary system is rare. We report the case of a 39-year-old African American man who presented with an asymptomatic right-sided epididymal mass and underwent partial epididymectomy. Pathologic analysis revealed numerous noncaseating granulomas. Results from computed tomography imaging of the chest and lung biopsy were consistent with sarcoidosis.