Volume 97, Issue 8

The authors studied the effects of caffeine withdrawal on 14 subjects at baseline and during a 4-day period of abstinence from caffeine. They studied the results from quantitative electroencephalograms performed on these subjects and gauged any changes that may have been evoked during this withdrawal period. The participants were also evaluated for the occurrence of somatic dysfunctions. Examinations for the presence of somatic dysfunctions were performed on the participants before caffeine cessation and on Days 1,2 and 4 of abstinence. Results showed that the number of somatic dysfunctions increased significantly during the process of caffeine withdrawal.

Skin-to-skin contact has been implemented recently to facilitate maternal-infant bonding of preterm infants. The technique allows the removal of fragile preterm infants from an incubator to the bare chest of a parent or caretaker. When specific guidelines are followed, thermal stability can be maintained, parent-infant bonding can be facilitated, and parental satisfaction can be enhanced. We illustrate a case in which a preterm infant has skin-to-skin contact while being monitored for physiologic parameters, including heart and respiratory rate, oxyhemoglobin saturation, and nasal airflow. Improvements in breathing patterns in this infant during skin-to-skin care and maintenance of a normal temperature suggest that this technique may not only be safe and psychologically beneficial, but it may also promote physiologic improvement.

Although the incidence of urethral diverticula in women of reproductive age ranges from 0.6% to 6%, urethral diverticulum calculi are rarely reported. This report describes excision and outpatient management of urethral diverticulum calculi in a symptomatic pregnant patient. The etiology, diagnosis, and recommended therapy of urethral diverticulum calculi are discussed. Historically, surgical therapy has been considered appropriate; however, recent technologic advancements-including ultrasound and lithotripsy-may change this widely accepted method of treatment.

Calls for medical education reform focus on four major criticisms directed at curricular content and context, infrastructure fragmentation, specialty mix, and the lack of integration with community and public health. In the previous article in this two-part series, authors from the osteopathic medical education community focused on uniquely osteopathic reforms for the curriculum and the fragmented educational system. That article documented the leadership position of osteopathic medical education in implementing reforms with respect to these two criticisms. The authors of this second article tackle the osteopathic contributions to workforce issues related to the generalist-to-specialist imbalance, the opportunities to move from a community-based profession to a profession accountable for community health, and the potential for technologic advances to aid in reform in all four areas under consideration in both articles. They conclude that the osteopathic medical profession can lead medical education reform in the United States with visionary leadership in place.