Orthotics to Improve Pain in a Patient With Multiple Internal Fixations and Multilevel Thoracic Fusion.

The authors present the case of a 24-year-old man who sustained multiple injuries during a hard landing following a parachute jump. These injuries included a right sacral fracture, bilateral femoral fractures, a separated pubic symphysis, and compression fractures of the fifth and sixth thoracic vertebrae. He was treated with a right sacroiliac joint fixation, pubic symphysis fixation, open reduction internal fixation of his bilateral femurs, and fusion of the third through seventh thoracic vertebrae. The patient experienced back pain, bilateral hip pain, and bilateral knee pain resistant to chiropractic and medical treatments. The patient presented 2 years after his aforementioned surgical procedures for treatment of persistent postoperative pain at the Physical Medicine and Rehabilitation service at the Veterans Affairs Medical Center in Hampton, Virginia. His treatment involved gait correction achieved using a left-sided heel lift and a transition to custom molded orthotics that incorporated the lift. This treatment leveled his sacral base and resulted in a simultaneous decrease in his self-reported pain scores.

Orthotic correction of postural unleveling in a patient with ankylosing spondylitis.

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.

An unexpectedly progressed lumbar herniated disk.

The authors describe a case of a 26-year-old female military veteran who presented with low back pain that she attributed to a recent foot injury. The patient reported a history of lumbar pain while in the military that had been treated successfully with high-velocity, low-amplitude osteopathic manipulative treatment. The patient's current pain was improved with osteopathic manipulative treatment and gait correction. Several weeks after her initial presentation, the patient reported that she had had a herniated disk diagnosed 2 years earlier by means of magnetic resonance imaging. Updated magnetic resonance imaging was performed, the results of which revealed a large herniated disk that had caused severe stenosis. The patient was immediately referred to a neurosurgeon for consultation and subsequently underwent surgical treatment.

Promoting the public's oral health: the Department of Health and Human Services, U.S. Public Health Service, and the U.S. Public Health Service Commissioned Corps.

The story of the Department of Health and Human Services (DHHS), its United States Public Health Service (US PHS), and the US PHS Commissioned Corps is comprised of people and programs aimed at protecting and promoting the nation's health, including oral health. The federal precursors of these organizations focused on clinical services for federal beneficiaries, and with time grew to include federal support for community and state programs for underserved and institutionalized populations; biomedical and behavioral research conduct: drug, device, and food regulatory activities; and, most recently, an enhanced response to biodefense and emergency readiness, among other activities. An essential component of the workforce addressing these activities is the US PHS Commissioned Corps, directed by the Surgeon General of the US PHS. This corps is a mobile, uniformed health service assigned to programs throughout the DHHS, as well as to other departments and agencies as needed. Dentistry has been a critical part of these programs and of the corps since their inception.

Capacity for training in clinical research: status and opportunities.

The ability to base patient care on scientific evidence depends in part on the results of translational and applied research. The shortage of trained clinical researchers identified by several sources limits the availability of clinical research studies upon which to base evidence-based therapeutics. This premise suggests that the dental profession needs to train more clinical researchers and faculty to conduct clinical research and to teach its applications to practice. Increasing opportunities for clinical research training in a variety of settings should eventually increase the numbers of clinical researchers, raise faculty involvement in clinical research, and promote science transfer. This paper reports on the current status of clinical research in dental schools, specifies the diverse groups involved in the clinical research enterprise, and identifies underutilized opportunities and partnerships for clinical research training. Data on federal and nonfederal funding of clinical research and training programs are presented. Existing and novel mechanisms for expanding clinical research training throughout and across traditional as well as unconventional environments are explored.