Volume 109, Issue 2

Context: Descriptions of subtle palpatory perceptions in osteopathic cranial palpation can be misperceived by students. Thus, adequate dissemination and replication of cranial palpatory techniques is challenging for osteopathy students. Objective: To evaluate the effects of standardized protocol training on cranial palpation of the frontomalar suture. Methods: Fourth-year osteopathy students from the European Center for Osteopathic Higher Education in Paris, France, were recruited and randomly divided into three groups. Students in the study group received instruction in a standardized protocol for palpatory assessment of the frontomalar suture; students in the control group did not receive instruction; and the remaining students acted as subjects. A specialized force sensor was placed on the skin covering the left frontomalar suture of each subject. Student practitioners were instructed to palpate subjects' left frontomalar suture using the customary pressure described for evaluation and treatment of somatic dysfunction of the cranium. Pressure measurements were exported to a laptop computer. Results: Twelve students were in each group. Student practitioners' palpation pressures ranged from 0.19 to 1.12 N/cm 2 , while mean palpation pressures for each test ranged from 0.27 to 0.98 N/cm 2 . The mean (SD) palpation pressure in the study group and control group was 0.55 N/cm 2 (0.16 N/cm 2 ) and 0.53 N/cm 2 (0.15 N/cm 2 ), respectively. There was no statistically significant difference in mean palpation pressures used by the two groups. Substantial variation in test performance was noted in both groups. Conclusion: Palpatory training was ineffective in improving student practitioners' precision of cranial palpation performance. Quantitative feedback of palpation pressures during training may improve outcomes. To our knowledge, data on palpation pressures used during osteopathic cranial manipulation have not been reported previously in the medical literature.

Neonates and infants with brachial plexus injuries are typically treated using splinting, range-of-motion exercise, and, in more severe cases, nerve reconstruction. However, myofascial release—a common osteopathic manipulative treatment technique that has been used to manage thoracic outlet syndrome in adults—may provide effective, noninvasive management of brachial plexus injuries in neonates and infants. While emphasizing the importance of good communication with parents of affected patients, the authors review brachial plexus anatomy, describe diagnostic examinations, and outline a comprehensive treatment strategy.

Context : Progressively more osteopathic graduates are seeking training opportunities in programs accredited by the Accreditation Council on Graduate Medical Education (ACGME). Objective : To determine if family medicine residency training program choice (ie, allopathic [ACGME], osteopathic, or dually accredited) has an impact on professional satisfaction levels among recent osteopathic medical school graduates. Methods : The authors designed a survey instrument to gather data on professional satisfaction levels. Osteopathic family physicians who completed residency training from 1999-2003 were asked to participate in the study. Results : The survey was sent to 2284 individuals with an adjusted response rate of 37%. One hundred and one (15.8%) of the osteopathic family physicians who responded reported completing residency training programs approved by the American Osteopathic Association (AOA); 335 (52.3%), ACGME-accredited programs; 198 (30.9%), dually accredited programs. One hundred forty-three surveyed osteopathic physicians (22.3%) were less than happy with their career choice. In addition, 219 (34.2%) reported that they were “thinking of changing...specialty,” and 30 (4.7%) reported that they were not “currently practicing family medicine.” Individuals trained in ACGME programs reported slightly higher levels of professional satisfaction than individuals trained in AOA-approved or dually accredited programs—though these differences were deemed trivial (ie, low effect size, 0.01; P >.05). Conclusion : The authors found no statistically significant differences in professional satisfaction levels among osteopathic family physicians who were recent medical school graduates regardless of residency training program choice.

Artificial pacemakers and automatic implantable cardioverter-defibrillators are life-saving devices that generally improve patient quality of life. However, some patients report adverse effects such as anxiety, depression, and phantom shocks or, less often, phantom arrhythmia. The authors report the case of an 81-year-old woman who received a permanent artificial pacemaker and later described having rapid and irregular heartbeats and “pounding sounds,” which were suggestive of arrhythmia. However, a cardiac event monitor did not document any abnormalities. Although literature is limited regarding the phenomenon of phantom arrhythmia, the authors propose to define it as a cluster of symptoms suggestive of an arrhythmia perceived by a patient but not clinically verified.