Volume 113, Issue 7

Context: Lymphatic pump techniques have the potential to alter blood cell counts and thus enhance immune function in elderly adults with diminished mobility. Objective: To test whether an osteopathic manipulative treatment (OMT) protocol designed to enhance immune function will have an effect on lymphocyte and lymphocyte subset counts compared with a sham control group. Design: The study design was a single-session, randomized, controlled clinical trial comparing a standardized lymphatic pump protocol with a light-touch protocol. Participants were assigned to 1 of 2 groups by using a 1:1 allocation ratio. Setting: The study was conducted in 2 rural long-term care facilities in Missouri. Participants: Residents in the long-term care facilities who were aged 60 years or older and who were confined to a bed or wheelchair for most of their waking hours. Twenty residents were recruited to participate in the study, and 10 were randomly assigned to each group. Interventions: Baseline blood samples were obtained. Then each patient received a 6-minute study protocol treatment. Thirty minutes after completion, posttreatment blood samples were obtained. The OMT protocol consisted of 3 osteopathic techniques: myofascial release to the thoracic inlet, the splenic pump, and the pedal lymphatic pump. The light touch protocol was applied to the same body areas as the OMT protocol for 6 minutes. Outcome Measures: A pretreatment and posttreatment lymphocyte subset panel, complete blood cell count, and automated white blood cell count differential was obtained from each participant. Results: There was a statistically significant between-group difference in mean change for platelet counts: counts in the OMT group decreased by a mean (standard deviation) of 15,400 (7947) platelets per microliter and the light touch group increased by 4,700 (17,857) platelets per microliter ( P =.004). The between-group differences for the mean (standard deviation) absolute lymphocyte cell count, red blood cell count, hemoglobin level, and hematocrit measures all decreased, but the changes were not statistically significant relative to the control group. Conclusion: The OMT protocol used in this pilot study modestly reduced platelet counts in nursing home residents with limited mobility.

Context: Depression and low back problems are common issues in primary care. Objective: To compare 6-month depression outcomes (specifically, clinical results and number of outpatient visits) in patients with or without comorbid low back conditions (LBCs). The authors hypothesized that the presence of an LBC within 3 months of the diagnosis of depression would negatively affect clinical outcomes of depression treatment after 6 months. Design: Retrospective record review. Setting: Collaborative care management program in a large primary care practice. Participants: Patients with a diagnosis of depression enrolled in collaborative care management (N=1326), including 172 with and 1154 without evidence of an LBC within 3 months of enrollment. Main Outcome Measures: Clinical depression outcomes (remission and persistent depressive symptoms) and number of outpatient visits at 6 months. Results: Regression modeling for clinical remission and persistent depressive symptoms at 6 months demonstrated that LBCs were not an independent factor affecting clinical remission ( P =.24) but were associated with persistent depressive symptoms (odds ratio, 1.559; 95% confidence interval, 1.065-2.282; P =.02); LBCs remained an independent predictor of outlier status for outpatient visits (≥8 clinical visits after 6 months of enrollment), with an odds ratio of 1.581 (95% confidence interval, 1.086-2.30; P =.02). Conclusion: Increased odds of persistent depressive symptoms and increased number of outpatient visits were found in patients with depression and concomitant LBCs 6 months after enrollment into collaborative care management, compared with those in patients with depression and without LBCs. The data suggest that temporally related LBCs could lead to worse outcomes in primary care patients being treated for depression, encouraging closer observation and possible therapeutic changes in this cohort.

Context: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly. Objective: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR. Design: Quasi-experimental study with enrollment between January and December 2008. Setting: Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania. Participants: Mothers at least 18 years old who had given birth within the previous 24 hours. Intervention: The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD and practiced on a manikin. The control group included mothers with prior conventional CPR training. Main Outcome Measures: In both groups, knowledge and proficiency were assessed with written and practical examinations developed by certified CPR instructors. Participant surveys were conducted at 3 times: immediately before dissemination of course materials, within 24 hours after the mother agreed to participate in the study, and 6 months after initial evaluation. Results: A total of 126 mothers were enrolled in the study: 79 in the experimental group, 25 in the control group, and 22 who withdrew from the study. Written and practical examinations were used to determine proficiency, and composite scores were generated, with a maximum composite score of 12. The composite scores were statistically significantly higher in the experimental group than in the control group, with median scores of 10 and 7, respectively ( P <.001). Twenty-two mothers (21%) had been previously offered CPR training. In the experimental group, 76 mothers (96%) felt more confident as caregivers after learning CPR. Before training in both groups, 84 mothers (81%) stated that learning CPR was extremely important, compared with 100 mothers (96%) after training ( P =.001). Conclusion: Use of an instructional kit is an effective method of teaching CPR to new mothers. Mothers reported that learning CPR is extremely important and that it increases their confidence as caregivers.

Hereditary angioedema (HAE) is a rare genetic condition that manifests as painful and potentially life-threatening episodic attacks of cutaneous and submucosal swelling. It results from functional deficiency of C1 inhibitor (C1 INH), which is a regulator of the complement, fibrinolytic, kinin (contact), and coagulation systems. In patients with HAE, the low plasma concentration of functional C1 INH leads to overactivation of the kinin cascade and local release of bradykinin. Bradykinin is responsible for the pain, vascular permeability changes, and edema associated with HAE. Until recently, therapeutic options for HAE have been very limited. Many new therapies have emerged, however, such as C1 INH replacement drugs and medications aimed at components of the contact system (eg, plasma kallikrein inhibitor and bradykinin B 2 receptor antagonist). The authors review current and novel treatments for patients with HAE.

Research can achieve many objectives, primarily by establishing a supportable, verifiable basis for clinical decisions. An evidence-based practice can streamline patient care, improving safety through consistency of care and making health care more affordable for patients. By cultivating research skills, osteopathic physicians and trainees can begin to forge a reciprocal relationship with medical literature and current findings, approaching research as active contributors as well as consumers. Many challenges, however, potentially hinder osteopathic physicians, residents, or medical students who wish to develop research skills. In the present article, the authors summarize research concepts and terminology that will enable novice researchers to interact effectively with more experienced researchers, statisticians, and methodologists.

Whiplash injury is often caused by rear-end motor vehicle collisions. Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. Osteopathic manipulative treatment techniques applied at the level of the cervical spine, suboccipital region, and cranial region alleviated the patient's facial symptoms by treating the right-sided strain of the trigeminal nerve. The strain on the trigeminal nerve likely occurred at the upper cervical spine, at the nerve's cauda, and at the brainstem, the nerve's point of origin. The temporal portion of the cranium played a major role in the strain on the maxillary.