Volume 108, Issue 7

Context: Previous studies suggest that the use of osteopathic structural examinations and osteopathic manipulative treatment (OMT) have declined dramatically in the hospital setting. Objectives: To determine frequency of use for osteopathic medicine's traditional manual diagnostic and treatment model and to evaluate the possible effects of required documentation. Design: A retrospective review of patients' medical records at nine Midwestern osteopathic hospitals. Methods: Medical records for patients admitted to participating hospitals during February 2006 were examined for documented use of osteopathic structural examinations and OMT. Analysis evaluated the effects of using standardized forms to meet criteria established by the American Osteopathic Association (AOA). Subanalysis compared records from hospitals that used such forms with those that did not. Results: A total of 1047 patient medical records were evaluated, 418 (40%) of which met AOA criteria. Two-hundred twenty (35%) of the 629 non–AOA-compliant records showed that detailed osteopathic structural examinations were conducted. The use of standardized forms correlated with an increased use of OMT and an increased likelihood that examinations met AOA criteria (P<.001). However, standardized forms also led to fewer narrative descriptions of clinical findings. Conclusion: Although many records documented the use of these examinations, this paperwork often failed to meet AOA criteria. To ensure high-quality, personalized patient care, expectations for hospital osteopathic structural examinations—including the importance of physician narratives in patient records—should be emphasized for osteopathic physicians-in-training.

Benign prostatic hyperplasia (BPH) is highly prevalent in men older than 50 years and is associated with a range of lower urinary tract symptoms that may have a negative impact on patient quality of life. Alpha 1 -adrenergic receptor antagonists are the first-line of pharmacologic management for lower urinary tract symptoms associated with BPH. However, many patients take multiple medications that may exacerbate age-related orthostatic hypotension. Thus, clinicians should evaluate the treatment of these patients within the context of comorbidities. The present article discusses the role of non–subtype-selective and subtype-selective α 1 -adrenergic receptor antagonists in the clinical management of BPH. Safety and tolerability for both non–subtype-selective and subtype-selective α 1 -adrenergic receptor antagonists for patients with BPH are also reviewed.

There are no uniform protocols in the United States for safe, environmentally acceptable disposal of controlled substances by patients. In addition, there are conflicting protocols used by various institutions for the disposal of narcotic medications. Although the US Drug Enforcement Administration oversees the prescribing, acquisition, and distribution of controlled substances and works to prevent the illegal diversion of these products, it stops short of recommending specific mechanisms for consumers to dispose of unused medications. The lack of specific regulations in this area increases the risk of illegal diversion of prescription medications and other controlled substances. The authors review and examine the dilemma posed by an ill-defined set of guidelines for disposal of controlled substances by patients and institutions not registered with the US Drug Enforcement Administration. The authors encourage public officials to update and reform ambiguous policies regarding opioid disposal by consumers and allied healthcare workers.

Pulmonary embolism (PE) is a potentially lethal condition that presents in patients with chest pain or shortness of breath. Although electrocardiograms (ECGs) typically demonstrate abnormalities associated with PE, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), has—on rare occasions—been noted on ECGs of patients with acute PE. The current report documents the case of a 57-year-old man who presented to the emergency department with chest pain. Findings from an ECG suggested anteroseptal AMI; however, cardiac catheterization indicated that the patient did not have critical ischemic heart disease. On further examination, the patient was found to have a massive bilateral PE. The present report emphasizes that physicians must investigate PE in all patients presenting with chest pain, dyspnea, or both, even in the face of ECG changes that are suggestive of a cardiac etiology. A brief discussion of the current theories of ST-segment elevation in the setting of PE is also included.