Volume 116, Issue 5

Context: High blood pressure (BP) is a common chronic condition in the United States. For many people, BP control through pharmacologic intervention alone is not effective at maintaining a healthy BP. Team-based, patient-focused care and home-based BP monitoring in addition to pharmacologic interventions have been shown to be effective for controlling BP. Objective: To determine the effectiveness of the hypertension management program at the Heritage Community Clinic in Athens, Ohio. Methods: Medical records of 43 patients who took part in the hypertension management program were retrospectively reviewed and included clinical data such as age, sex, BP, body mass index, comorbidities, family history, and demographic information. In addition to standard pharmacologic interventions, the program provided equipment for at-home BP monitoring, education on behavior and lifestyle modification, and 5 follow-up visits. Data from the 5 follow-up visits were analyzed. Results: Linear mixed-effects regression models of BP suggested that the visit factor was significantly associated with BP ( P <.001). On average at each visit, patients showed a 6.8–mm Hg reduction in systolic BP and a 3.8–mm Hg reduction in diastolic BP after controlling for demographic variables. General stress level, marital status, and depression were all significantly associated with BP ( P <.05). In addition, 67.5% of the patients who took part in this program achieved the target treatment guidelines of the Eighth Joint National Committee for hypertension management. Conclusion: A clinic-based hypertension management program comprising patient education, support, medication, and home BP monitoring was effective at reducing BP.

Background: Expanded insurance coverage will likely increase the demand for primary care physicians in the United States. Despite this demand, the number of medical students planning to specialize in primary care is decreasing. Objective: To explore premedical students’ attitudes toward the primary care specialty. Methods: Students enrolled in premedicine at a large Midwestern university were invited to complete the Primary Care Attitudes Survey (Cronbach α=.76). This 25-item survey measures attitudes about primary care on a 5-point Likert scale, ranging from 1, “strongly disagree” to 5, “strongly agree.” Basic sociodemographic characteristics were assessed using descriptive statistics, and frequencies of individual survey responses were calculated using SPSS statistical software version 21.0. Results: A total of 100 premedical students (mean [SD] age, 19.8 [1.5] years; 59 female, 82 white non-Hispanic, and 33 freshman) completed the survey. Of 100 students, 33 planned to pursue primary care; 66 thought that primary care physicians would always have a job; 25 thought that primary care may become obsolete as medicine becomes more specialized; 48 thought that physician assistants and nurse practitioners would take over many primary care duties in the future; 91 thought that primary care physicians make important contributions to medicine; and 84 agreed that primary care focuses on the whole patient. Conclusions: Premedical students held positive views about the importance of primary care; however, many expressed uncertainty about the stability of primary care careers in the future. Further, a substantial number of students believed common misconceptions about the scope and practice of primary care, such as primary care doctors are gatekeepers and mostly diagnose colds and ear infections.

In general, physicians’ interest in research continues to be a challenge. The lack of research culture is more pronounced in the osteopathic medical profession, which is historically not research oriented. With increasing focus on evidence-based medicine and with the single accreditation system for graduate medical education in motion, growing research and scholarly activities among osteopathic physicians and students and residents becomes imperative. This article illustrates how an educational consortium, such as an osteopathic postdoctoral training institution, can play a pivotal role in creating a culture of research through broad-based training of medical students and residents.

Of ectopic pregnancies encountered in clinical practice, more than 95% are located within the fallopian tube, and 2% to 4% are cornual. A cornual ectopic pregnancy is a serious clinical condition and poses diagnostic and therapeutic challenges. Thus, understanding the clinical course and treatment options is essential. The authors describe the case of a 29-year-old woman who presented to the Department of Obstetrics and Gynecology. The patient was suspected of having a cornual pregnancy, and a dermoid cyst had been detected during routine ultrasonography. In the absence of maternal symptoms, the clinical scenario is potentially dangerous and must be treated promptly and efficiently to decrease morbidity and mortality.

Sclerotherapy is an increasingly popular treatment modality for patients with chronic venous insufficiency and varicose veins. Potential complications of foam sclerotherapy include cerebrovascular accidents and transient ischemic attacks (TIAs). We report the case of a 55-year-old woman who had a TIA shortly after undergoing foam sclerotherapy. She had presented for treatment with no confirmed risk factors for microemboli formation or thrombus. After the procedure, however, she had transient visual loss, dysarthria, confusion, and frontal headache, which resolved within 30 minutes of onset. A subsequent diagnosis of a patent foramen ovale was thought to have put her at risk for TIA in the setting of foam sclerotherapy. Osteopathic physicians should be aware of the potential for neurologic sequelae after foam sclerotherapy and inform patients prior to consent.