Standardization of the hospital record for osteopathic structural examination: Part 2. Effects of an educational intervention on documentation of palpatory and structural findings and diagnosis.

The purpose of this two-part study was to develop and test an instructional videotape for use in the osteopathic hospital setting; to standardize a procedure for documentation of palpatory and structural findings and diagnoses; and to examine the program's influence on the correlation of palpable and structural findings with a diagnostic impression of somatic dysfunction. To that end, the authors analyzed results of a survey of the medical records of 20 osteopathic training hospitals. Patients' charts were randomly pulled before and after house staff who performed admitting hospital examinations viewed an educational videotape. The videotape emphasized that the structural and palpatory screening examination should simply answer the question, "Is there a problem in the musculoskeletal system?" Chi-square analysis was used to evaluate the frequency of documentation of altered structural findings (structure, motion, tissue changes) and the diagnostic impression of somatic dysfunction and their correlation. Based on more than 300 reviewed charts, the authors found that the frequency of documentation of structural and palpatory examination was not significantly altered after house staff viewed the videotape. A sequence of hospital-based instruction in osteopathic principles and practices has been initiated at more than 50 osteopathic medical institutions, and the problems related to continuing medical education and clinical research in osteopathic medicine are discussed.

Changes in presence of a segmental dysfunction pattern associated with hypertension: Part 2. A long-term longitudinal study.

The short-term portion of this study (part 1) showed an association between somatic dysfunction and the regulation of blood pressure. To study long-term relationships, follow-up examinations were made of 61 subjects studied 3 to 10 years earlier. They were heterogeneous Family Practice Clinic patients with a mean age of 45 years. By methods used in part 1 and in our previous studies of systemic interactions, palpatory examination was done to support presence or absence of a C6T2T6 pattern of segmental motion dysfunctions, and blood pressure status was established by the medical history. The C6T2T6 pattern persisted in 16 of 16 subjects with grade 2 or greater hypertension and 4 of 9 normotensive subjects who had shown the pattern initially. At follow-up, the pattern first appeared in 7 subjects who had hypertension previously diagnosed and who remained hypertensive; the pattern disappeared in 5 normotensive subjects who remained normotensive. The C6T2T6 pattern's long-term persistence in hypertensive subjects and changes in its presence corresponding to the subjects' hypertensive status indicate an important relationship between this pattern of segmental motion dysfunctions and disturbances in regulation of blood pressure.

Changes in presence of a segmental dysfunction pattern associated with hypertension: Part 1. A short-term longitudinal study.

A statistically significant pattern of segmental components of somatic dysfunction associated with a history of high blood pressure was investigated for change after an interval of 4 to 8 months. The volunteer subjects, from an inner-city ambulatory clinic, included normotensive, borderline hypertensive, and hypertensive persons. A standardized palpatory examination determined whether there were specific motion asymmetries centered at spinal segments C6, T2, and T6 and confirmed by mirror-image motion asymmetries in adjacent segments. Blood pressure measurements and diagnosis of hypertension followed American Heart Association standards. The repeated presence of the pattern in subjects with a history of hypertension was statistically significant. Presence of the pattern in normotensive subjects, however, appeared to be random. The subjects' histories during the study period revealed no influence of antihypertensive medications, major accidents, or illness on the patterns' continuing presence in subjects requiring medical control of their hypertension.

Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis.

Atelectasis is a preventable complication that often occurs after upper abdominal surgery. In our 1-year randomized, researcher-blinded trial, low-risk cholecystectomy patients were subjected to either the thoracic lymphatic pump (n = 21) or incentive spirometry (n = 21) to prevent atelectasis. The treatment groups were equal with respect to risk factors for atelectasis and deviation of preoperative respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) from the predicted values. Atelectasis occurred in 2 (5%) of 21 patients regardless of whether incentive spirometry or thoracic lymphatic pump treatment was used. Study patients treated with the thoracic lymphatic pump technique had an earlier recovery and quicker return toward preoperative values for FVC and FEV1 than patients treated with incentive spirometry.