Band 97, Heft 7

The human low back is highly susceptible to dysfunction. Many diagnostic and treatment modalities for low back problems are used subjectively in clinical practice. Availability of a quantitative reference of back motion could improve practice efficiency. This article describes hysteresis and the hysteresis loop as an objective measurement model of low back motion. The authors constructed an instrument that quantifies force displacement responses of the lower back in passive subjects. Hysteresis loops generated by this instrument lay a scientific foundation on which to base diagnostic procedures and therapeutic measures.

Bicycle-related head trauma is a significant source of death, disability, and healthcare costs in the United States. Bicycle helmets are effective safety devices that can reduce most of this burden on society. Bicycle helmet laws and education programs are effective ways to increase helmet use rates. Osteopathic physicians can play a prominent role in bicycle-related injury prevention by actively supporting and participating in helmet legislation, research, and community-based education. This article provides a current summary of state bicycle helmet laws and highlights research that supports the effectiveness and necessity of these laws. The recent trend in safety standards for bicycle helmets is included to give a comprehensive view of bicycle helmet law in the United States.

Medical education has not kept pace with the evolving healthcare system. Criticism from industry and policy observers focuses on four major areas requiring reform: the curriculum, the fragmented educational infrastructure, the specialist-to-generalist mix, and the alienation from community and public health. The dominance of managed care organizations in the delivery and financing of healthcare is forcing a new set of physician competencies to the fore and changing projections of physician manpower and specialty needs. The authors address the four major criticisms from a uniquely osteopathic point-of-view. In this first of two articles, the authors describe the evolving osteopathic medical education model, and then employ a medical analogy to diagnose the causes of and propose treatments for curricular issues and infrastructure fragmentation. In the second article of the pair, they explore the causes of and propose strategies to address the generalist-to-specialist imbalance and the alienation of medicine from community and public health; the article also explores the role of technology in support of reform. In each article, the authors propose treatments to correct the problems in the osteopathic medical education model, and conclude that the profession is well-positioned to lead medical education reform.

Retrosternal thyroid accounts for a significant percentage of anterior mediastinal masses, but has been described very rarely as the cause of superior vena cava (SVC) syndrome. Most cases of SVC syndrome occur as a complication of malignancy. The authors report the case of a patient with few respiratory symptoms, mild upper airway obstruction, and SVC syndrome caused by a benign retrosternal multinodular goiter.

Gunshot wounds of the pelvis are not uncommon. Penetrating injuries of the bladder are usually documented by means of a cystogram. The patient reported here was shot with a small caliber bullet. No extravasation was demonstrated. The authors caution that not all penetrating injuries to the bladder will demonstrate extravasation on a properly performed cystogram.

The purpose of this study was to determine if internal medicine residency type or location was associated with differences in performance of candidates as measured by the internal medicine certifying examination. Included in the study were all first-time taker candidates for the 1986 to 1996 American Osteopathic Board of Internal Medicine certifying examinations in internal medicine. Group analysis was performed based on the type of residency track leading to board eligibility: (1) traditional internship plus 3 years of internal medicine residency; (2) traditional internship plus 2 years of internal medicine residency and 1 year of subspecialty training; (3) specialty track internship plus 2 years of internal medicine residency; and (4) traditional internship plus 3 years of allopathic internal medicine residency. Subgroup analysis of the subspecialty track group was performed to determine if any particular subspecialty-trained subgroup performed better than the others. Results indicate that all groups had similar scores and pass rates except for the allopathic-trained residents, whose scores and pass rates were lower. Subgroup analysis of the subspecialty-trained candidates revealed that procedure-oriented subspecialty candidates performed similar to nonprocedure-oriented candidates. No gender differences were noted in scores or pass , rates. It is concluded that the overall performance of candidates is equivalent for . each of the residency training tracks developed by the American College of Osteopathic Internists. Future performance on the recertification examination will need to be tracked to determine if these trends continue for practicing internists.