Volume 112, Issue 11

Osteoarthritis (OA) of the knee, one of the most common causes of disability, continues to increase in prevalence as the older adult and obese populations grow. Often, the general practitioner is the first to evaluate a patient with a painful knee that has arthritis. Evidence-based evaluation and treatment guidelines recommend the use of nonoperative treatments before surgical treatment options such as total knee arthroplasty (TKA) are considered. Understanding available nonoperative treatment options is critical for physicians who first encounter patients with OA of the knee. The authors provide an overview of nonoperative treatment options for patients with OA, including weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. The authors also discuss operative treatment options to be considered before TKA and review indications for TKA when other treatment options have been exhausted.

Context: During the past 20 years, colleges of osteopathic medicine (COMs) have made several advances in research that have substantially improved the osteopathic medical profession and the health of the US population. Furthering the understanding of research at COMs, particularly the factors influencing the attainment of extramural funds, is highly warranted and coincides with the missions of most COMs and national osteopathic organizations. Objectives: To describe bibliometric measures (numbers of peer-reviewed publications [ie, published articles] and citations of these publications, impact indices) at COMs from 2006 through 2010 and to examine statistical associations between these measures and the amount of National Institutes of Health (NIH) research funds awarded to COMs in 2006 and 2010. Methods: A customized, systematic search of the Web of Science database was used to obtain bibliometric measures for 28 COMs. For the analyses, the bibliometric measures were summed or averaged over a 5-year period (2006 through 2010). The NIH database was used to obtain the amount of NIH funds for research grants and contracts received by the 28 COMs. Bivariate and multivariate statistical procedures were used to explore relationships between bibliometric measures and NIH funding amounts. Results: The COMs with 2010 NIH funding, compared with COMs without NIH funding, had greater numbers of publications and citations and higher yearly average impact indices. Funding from the NIH in 2006 and 2010 was positively and significantly correlated with the numbers of publications, citations, and citations per publication and impact indices. The regression analysis indicated that 63.2% and 38.5% of the total variance in 2010 NIH funding explained by the model (adjusted R 2 =0.74) was accounted for by 2006 NIH funding and the combined bibliometric (ie, publications plus citations), respectively. Conclusion: Greater scholarly output leads to the procurement of more NIH funds for research at COMs.

Context: Physicians often encounter patients with functional pain disorders such as irritable bowel syndrome (IBS), fibromyalgia (FM), and their co-occurrence. Although these diseases are diagnosed exclusively by patients' report of symptoms, there are few comparative studies about patients' perceptions of these diseases. Objective: To compare perceptions of these conditions among 4 groups—3 clinical groups of older women with IBS, FM, or both disorders (IBS plus FM) and 1 similarly aged control group of women with no IBS or FM—using their responses to survey questions about stressful life events, general physical and mental health, and general medical, pain, and psychiatric comorbidities. Method: Using data from the Biopsychosocial Religion and Health Study survey, responses from women were compared regarding a number of variables. To compare stress-related and physical-mental health profiles across the 4 groups, 1-way analyses of variance and χ 2 tests (with Tukey-Kramer and Tukey post hoc tests, respectively) were used, with α set to .05. Results: The present study comprised 3811 women. Participants in the control group, the IBS group, the FM group, and the IBS plus FM group numbered 3213 (84.3%), 366 (9.6%), 161 (4.2%), and 71 (1.9%), respectively, with a mean (standard deviation) age of 62.4 (13.6), 64.9 (13.7), 63.2 (10.8), and 61.1 (10.9) years, respectively. In general, participants in the control group reported fewer lifetime traumatic and major life stressors, better physical and mental health, and fewer comorbidities than respondents in the 3 clinical groups, and these differences were both statistically significant and substantial. Respondents with IBS reported fewer traumatic and major life stressors and better health (ratings and comorbidity data) than respondents with FM or respondents with IBS plus FM. Overall, respondents with both diseases reported the worst stressors and physical-mental health profiles and reported more diagnosed medical, pain, and psychiatric comorbidities. Conclusion: The results revealed statistically significant, relatively large differences in perceptions of quality of life measures and health profiles among the respondents in the control group and the 3 clinical groups.

This article transcribes the A.T. Still Memorial Lecture, delivered by the author on July 21, 2012, to the House of Delegates during the 2012 Annual Business Meeting of the American Osteopathic Association.

Stress-induced cardiomyopathy is becoming a more commonly recognized diagnosis, accounting for 2% to 3% of patients presenting with signs and symptoms of acute anterior myocardial infarction. We present the case of a 68-year-old man with dyspnea 9 days after an unrelated operation. After hospital admission, he complained of chest pain, and an electrocardiogram demonstrated ST-segment elevation in the anterolateral and inferior leads, ST-segment depression in lead aVR, and an absence of ST-segment changes in lead V 1 . Cardiac biomarker levels were elevated. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 30% to 40%, basilar hyperactivity, apical dyskinesia, and distal inferior and anterior akinesia. Cardiac catheterization did not reveal any culprit obstructive lesion. He received a diagnosis of stress-induced cardiomyopathy and was treated according to established recommendations for systolic heart failure. His cardiac biomarkers returned to normal, and a repeated transthoracic echocardiogram 3 days later revealed nearly complete resolution of myocardial wall–motion abnormalities.