Volume 114, Issue 2

Context: Sleep problems among active-duty service members are pervasive and complicate the recovery from comorbid posttraumatic stress and mood disorders. Objective: To better understand chronic sleep problems among active-duty service members. Methods: Medical records for active-duty service members who completed enhanced sleep assessments during an 18-month period beginning in October 2010 at the Walter Reed National Military Medical Centers' Psychiatry Continuity Service were retrospectively reviewed. Sleep assessment measures included the Pittsburgh Insomnia Rating Scale, the Alcohol Use Disorders Identification Test, the Zung Self-Rating Depression Scale, the Zung Self-Rating Anxiety Scale, the Posttraumatic Stress Disorder Checklist – Military Version, the Epworth Sleepiness Scale, the Pre-Sleep Arousal Scale, and a home sleep study. Results: A total of 76 records met the study criteria. Twenty-two participants (29%) had an apnea/hypopnea index that suggested mild to moderate sleep apnea. Service members with higher self-reported posttraumatic stress scores also reported a higher degree of both somatic and cognitive factors interfering with sleep initiation. Compared with those who had low self-reported posttraumatic stress scores, service members with high posttraumatic stress scores also had less total sleep time (mean difference, 38 minutes) and higher scores on the apnea/hypopnea index, the respiratory disturbance index, and the oxygen saturation index. Conclusion: Enhanced sleep assessments that include traditional self-report tests and a home sleep study can help identify previously undiscovered behavioral and respiratory problems among service members, particularly those with higher posttraumatic stress scores.

Context: Randomized controlled trials (RCTs) are considered the standard for establishing practice guidelines; however, they are expensive and time-consuming, and often the generalizability of the results is limited. Objectives: To conduct an observational study using the findings of the American Osteopathic Association's Clinical Assessment Program (AOA-CAP) low back pain module, and to compare these findings with those of a major back pain–related RCT to determine the validity and generalizability of this pseudoexperimental model. Methods: Data were abstracted from the AOA-CAP for Residencies platform from April 1, 2006, through October 5, 2007, with a diagnosis code consistent with low back pain. Process and outcome measures were compared after segregating a similar patient population to an RCT that compared “osteopathic spinal manipulation” with standard care. Results: A total of 1013 medical records were abstracted and entered into the AOA-CAP low back pain module. Mean (standard deviation [SD]) age was 44.7 (15.9) years, and body mass index was 29.6 (8.1). The eligible patients comprised 415 men (41.0%) and 598 women (59.0%), and common comorbid disease was found in 69 patients (6.8%). Activities of daily living were limited in 402 patients (42.4%), whereas 546 (57.6%) had no limitations. Previous exacerbations of low back pain occurred in 653 patients (65.9%). Most patients had no sensory or proprioception deficit (729 [87.7%]), and motor function was normal in 636 patients (74.5%). Normal ankle and knee reflexes were found in 744 of 814 (91.4%) and 755 of 829 (89.0%) patients, respectively. Osteopathic manipulative treatment (OMT) was performed on the lumbar spine (576 patients [56.9%]), thoracic spine (411 [40.6%]), sacrum/pelvis (440 [43.4%]), rib (261 [25.8%]), and lower extremity (256 [25.3%]). A segregated patient cohort (n=539) showed statistically significant differences between patients who received OMT and those who did not with the use of analgesics, steroids, spinal injections, straight-leg raising, and days off or limited work duties. Conclusion: The observational findings of the present study, which suggest that analgesic medication use is lower in patients who receive OMT, align with previous findings of RCTs and support the generalizability of these findings.

Familial hypercholesterolemia (FH) is an autosomal dominant disorder resulting in severe elevation of total and low-density lipoprotein cholesterol levels. There are more than 600,000 individuals in the United States with FH. Individuals with FH tend to experience premature cardiovascular disease and often die from sudden cardiac death at a young age. Statins alone or in combination with other lipid-lowering medications are effective in managing FH and preventing cardiovascular events. For patients who do not respond to or are intolerant of pharmacotherapy, low-density lipoprotein apheresis is available as a nonpharmacologic treatment option. Despite the prevalence of FH, it is undiagnosed and untreated in the majority of patients. Screening, combined with appropriate drug therapy, can save lives. The authors review the screening, diagnosis, and management of FH.

Context: Mini–medical school programs are designed to give participants, usually high school students, a more realistic perception of medicine and to leave students with a stronger desire to pursue a career in medicine. Objective: To determine if the annual High School Mini–Medical School program hosted by the West Virginia School of Osteopathic Medicine increased interest in osteopathic medicine among high school students. Design: A survey was conducted before and after the program to test the program's effectiveness. Setting: West Virginia School of Osteopathic Medicine's Clinical Education Center. Participants: High school students from Charleston, Fairmont, and the Greenbrier Valley in West Virginia. Interventions: The participants attended an outreach program designed to interest them in a career in medicine and specifically osteopathic medicine. Results: Sixty-nine participants came away with an improved understanding of a physician's life and medical school after the program. There was a mean increase in positive responses for the survey items “I understand what medical school life is truly like” ( P =.0066) and “I understand what life as a doctor is really like” ( P =.0004). Participants left the program with a stronger desire to pursue a career in medicine ( P <.0001). Conclusion: Mini–medical school programs are an effective tool to inspire high school students to pursue careers in medicine, including osteopathic medicine.

This article is the second installment in a series of 6 articles on the history of and controversies related to the DO degree. This article examines how Andrew Taylor Still made the transition from informally training apprentices to launching a formal chartered institution—the American School of Osteopathy. In its first decade of existence, Still expanded both the length and breadth of the curriculum and transformed his college from what he called a “school of bones” to a “school of medicine.” As this shift was occurring, J. Martin Littlejohn, then the dean of the American School of Osteopathy, questioned whether the DO degree was the appropriate degree to award its graduates.

The authors describe the case of a patient with ankylosing spondylitis who was treated with orthotic devices for postural unleveling. The patient described specific pre-existing postural problems, both static and dynamic, that had been present for many years. A unilateral 9-mm gel heel lift was used, followed by custom-molded orthotic devices that incorporated the heel lift. The patient reported immediate resolution of these symptoms after orthotic treatment, as well as increased functionality and satisfaction in activities of daily living, which coincided with the leveling of his posture. The orthotic devices were used until the patient underwent total hip arthroplasty, at which point the orthotic treatment was discontinued.

Biliary dyskinesia is a functional gastrointestinal disorder of the gallbladder and sphincter of Oddi. Diagnosis is made on the basis of symptoms of biliary colic in the absence of cholelithiasis and gallbladder inflammation. Palpatory findings of tissue texture changes at midthoracic levels (T6-T9) may correspond to visceral dysfunction related to the biliary system. Osteopathic manipulative treatment (OMT) of the T6-T9 segments can remove the feedback related to the somatic component, thereby affecting nociceptive facilitation at the spinal level and allowing the body to restore autonomic balance. Few reports in the current literature provide examples of treatment for patients with biliary dyskinesia using OMT. The author describes the case of a 51-year-old woman who presented with symptoms consistent with biliary dyskinesia. Her biliary colic completely resolved after OMT. Osteopathic evaluation and OMT should be considered a safe and effective option for conservative management of biliary dyskinesia.