Volume 116, Issue 2

Surgical fixation of maxillofacial fractures can be associated with a myriad of surgical complications. Specific complications correlate with the type of fracture. The authors present a case of multiple maxillofacial fractures, briefly review various types of fractures, and discuss the operative decision-making process. This case report serves as an important reminder that the operative decision-making process should take into account a patient’s entire clinical condition.

Context: In 11 counties in Appalachian Ohio, the self-reported prevalence of diabetes mellitus (11.3%) is higher than the state (7.8%) or national (7.2%) average. Direct medical costs for diabetes in the United States are estimated at $176 billion annually. Indirect costs from disability, work loss, and premature death add up to another $69 billion. Objective: To determine the effectiveness of the Complete Health Improvement Program (CHIP) in reducing cardiovascular disease (CVD) risk factors in a sample of Appalachian participants with elevated fasting blood glucose (FBG) levels or a diagnosis of type 2 diabetes mellitus (T2DM). Methods: In a retrospective study, data from 6 CHIP cohorts conducted in Appalachian Ohio from 2011 to 2012 were combined and analyzed for short-term changes in CVD risk factors from baseline. This study focused on a subsample of the overall CHIP, whose participants had elevated FBG levels or T2DM. Statistical analysis was completed by calculating means and SDs and using paired t tests to compare differences in variables. Results: After the CHIP intervention, 110 participants with baseline elevated FBG levels showed notable reductions in FBG levels, total cholesterol, low-density lipoprotein cholesterol, body mass index, and systolic blood pressure (all P values <.001). Likewise, participants in the subsample with T2DM experienced reductions in all CVD risk factors (all P values <.05). Conclusion: The CHIP lifestyle intervention was effective in reducing CVD risk factors in this Appalachian population with elevated FBG levels or with T2DM.

Context: With the recent merger of the American Osteopathic Association and the Accreditation Council for Graduate Medical Education, new standards may be established for scholarly activity criteria and designation for each specialty. Objective: To determine the percentage of osteopathic physicians on editorial boards in general and specialty medical journals and to compare the participation of osteopathic vs allopathic physicians and other health care researchers in editorial activities. Methods: The number of osteopathic and allopathic physicians and other health care professionals serving as editor in chief, associate editor, editorial board member, emeritus editor, or in other editorial positions was examined in 8 major medical journals ( New England Journal of Medicine, JAMA, Annals of Internal Medicine, Annals of Surgery, Annals of Emergency Medicine, Annals of Family Medicine, Obstetrics and Gynecology , and Pediatrics ) published during the past 30 years. Results: The number of editorial board positions increased during the past 30 years, with Annals of Surgery adding the most positions (64). When compared with allopathic physicians in all fields of medicine, the number of osteopathic physicians serving on an editorial board of a medical journal was significantly less ( P <.001). When all editorial positions were combined, osteopathic physicians occupied 0.15% of all positions. Conclusion: A disparity exists between the numbers of osteopathic vs allopathic physicians in editorial positions in the core disciplines of medicine. Further investigation into the reasons why few osteopathic physicians serve in editorial roles is needed.

Context: Burnout is a known problem among physicians in training but has not been extensively studied in osteopathic residents. Objective: To evaluate the relationship of burnout to sex, age, marital status, and residency program type (surgical vs nonsurgical) and length (3, 4, 5, or 6 years) across 12 residency programs at Doctors Hospital in Columbus, Ohio. Methods: An anonymous, voluntary questionnaire was given to residents in their 10th month of residency. Thirty questions were provided, including general background questions and the Maslach Burnout Inventory Human Services Survey to assess burnout. Results: A total of 131 of 180 residents (72.8%) returned the questionnaire, and 129 provided complete responses in most categories. Of the 129 respondents, 89 (69.0%) reported emotional exhaustion and 96 (74.4%) reported depersonalization at a moderate or high level. In addition, 70 respondents (54.4%) experienced a moderate or high level of burnout in relation to personal accomplishment. No statistically significant association was found between the burnout factors (emotional exhaustion, depersonalization, and personal accomplishment) and sex, age, marital status, and residency program type and length. Conclusions: The majority of the osteopathic residents surveyed reported experiencing burnout. More data on burnout among osteopathic residents and associated factors are needed.

As osteopathic medical education shifts to competency-based learning, course curriculums must adapt to measure behavioral milestones in addition to traditional knowledge and technical skills. Of the core competencies, medical professionalism or lack thereof has been shown to correlate with future state disciplinary board action; therefore, early identification of poor professionalism and intervention is imperative. However, performance indicators, such as humanistic behavior and primacy of patient need, are difficult to measure in most first- and second-year medical school courses. Therefore, A.T. Still University–Kirksville College of Osteopathic Medicine developed a rubric to objectively measure professionalism within the first- and second-year osteopathic manipulative medicine curriculum. The rubric assesses such measures as timeliness and professional appearance. In the present article, the author describes the grading rubric and the methods for implementing a professionalism score within an osteopathic manipulative medicine curriculum.

Myofascial trigger points (TPs) are a poorly understood phenomenon involving the myofascial system and its related neural, lymphatic, and circulatory elements. Compression or massage of a TP causes localized pain and may cause referred pain and autonomic phenomena. The authors describe a 58-year-old woman who experienced precipitation of substantial psychological symptoms directly related to her treatment for a lower abdominal TP. Her symptoms resolved after 2 weeks of receiving high-velocity, low-amplitude manipulation and soft tissue massage. Particularly in the abdomen, TPs may be associated with psychological reactions as well as physical aspects of bodily function.