Volume 114, Issue 1

Context: Clinically meaningful somatic dysfunction, if left untreated, should persist over time and be associated with objective measurable findings. Objective: To investigate the persistence of lumbar somatic dysfunction over 8 weeks and the association of that persistence with lumbar bone mineral density (BMD) T scores. Methods: Individuals were assessed at 0, 4, and 8 weeks for the presence and severity of paraspinal tissue texture abnormalities (TTA), vertebral rotational asymmetry, anterior motion restriction, and tenderness from L1 to L4. Participants underwent dual-energy x-ray absorptiometry of the lumbar spine at 0 and 8 weeks. Persistent somatic dysfunction findings from all 3 examinations were compared with BMD T scores obtained at 8 weeks and to changes in the BMD T scores from 0 to 8 weeks. Results: Forty-eight individuals (38 women [79%] and 10 men [21%]) participated in the study. The mean (standard deviation [SD]) age was 30.1 (6.4) years (range, 20.0-40.8 years), and the mean (SD) body mass index was 26.3 (5.2). The percentage of vertebrae with persistent somatic dysfunction varied by vertebral level and ranged from 44% to 83% for TTA, 63% to 79% for rotational asymmetry, 10% to 56% for motion restriction, and 2% to 10% for tenderness. Vertebral segments with persistent motion restriction had higher mean BMD T scores (95% confidence interval [CI]) than those without persistent motion restriction (0.6 [0.4 to 0.8] vs 0.2 [0.1 to 0.4], respectively; P =.02). There was a significant increase in the vertebral BMD T scores for those vertebrae that demonstrated persistent TTA ( P =.02) and for those vertebrae that demonstrated persistent moderate/severe TTA ( P =.02). A significant difference was found in the initial to final vertebral BMD T-score change between vertebrae that demonstrated persistent tenderness and those that did not (mean [95% CI] change, −0.2 [−0.4 to 0.1] vs 0.1 [0.0 to 0.1], respectively; P =.04). Conclusion: A persistence of predominantly left lumbar rotation was observed. Persistent vertebral motion restriction was shown to have an association with final lumbar BMD T scores, and persistent TTA and tenderness were associated with changes in the BMD T scores over 8 weeks.

Context: A health care team depends on the accurate documentation of the patient-physician encounter, be it written or electronic. If documentation is inaccurate or incomplete, patient care may be adversely affected. Previous studies have identified factors that influence documentation errors, such as fatigue, carelessness, and being overworked. More research, however, is needed into the patterns of errors and, by extension, these patterns' potential effect on patient care. Insights about these areas would be valuable to practicing physicians, as well as to medical educators, who could incorporate such insights into the training of medical students. Objective: To identify potential patterns of commissive documentation errors on SOAP notes during the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE); specifically, to calculate the frequency with which specific items are misrepresented in SOAP (subjective, objective, assessment, plan) notes and to explore patterns of misrepresentation in relation to the documentation of history taking and physical examination. Methods: Among the 12,510 candidates tested between July 2007 and June 2010, there were 24 candidates who failed the COMLEX-USA Level 2-PE because they misrepresented clinical findings on SOAP notes. These errors of commission (over-documentation) were categorized as errors in either history-taking or physical examination, and then subcategorized and analyzed to determine if meaningful patterns in the documentation of these errors occurred. Results: A total of 662 errors were recorded among the 24 candidates. History-taking items were more often misrepresented (n=378) than physical examination items (n=284). Patient history—a subcategory that included past medical, surgical, medication, allergy, and family histories—was more likely to be misrepresented than other subcategories under history taking (eg, “history of present illness” and ”associated symptoms”) and many physical examination subcategories. Results of the analysis indicated that the misrepresentations were not evenly distributed (χ102=323.1; P <.01): candidates whose SOAP notes contained misrepresentations were statistically more likely to misrepresent in some categories rather than in others. Conclusion: Physicians and medical students should pay particular attention to patient history, lifestyle history, and neurologic examination to minimize the risk of documentation errors.

This article is the first installment in a series of 6 articles on the history of and controversies related to the DO degree. Four questions about the origins of osteopathy and the initial use of the DO designation will be addressed in this particular article. First, did Andrew Taylor Still earn an MD diploma?—he being invariably described as an MD in current osteopathic periodical literature. Second, what was the importance of “magnetic healing” in the evolution of Still's thought? Third, how did the principles and practice of “bonesetting” complete his new system? Finally, when did he originate the term osteopathy and first devise and employ the DO designation? Future articles will examine episodically the history of the DO degree from Still's establishment of the American School of Osteopathy in 1892 up through to the present debate over its significance and value.

In this article, the second in a series on the basic concepts of research, the authors review aspects of research design including participant considerations, randomization, reliability and validity of measurements, and data collection and management. The authors also discuss considerations for research using questionnaires and tests. The goal of this article is to assist the novice researcher in identifying potential problems that must be addressed during the design of a research project.

Myopericarditis occurs in 15% of patients with pericarditis. Recurrent myopericarditis occurs in 15% to 30% of patients after partial or complete recovery from acute myopericarditis. Relapse often occurs within 1 month of an initial episode. The standard of care for pericarditis or myopericarditis is initial treatment with nonsteroidal anti-inflammatory drugs for 10 to 14 days. Colchicine is often administered for 3 to 6 months for residual chest pain due to myopericarditis. The authors present a case of seasonal recurrent myopericarditis in a 32-year-old man who presented with severe chest pain in nearly the same month for 4 consecutive years. The authors conducted an extensive review of the literature but found no other case reports of seasonal recurrent myopericarditis. If a patient presents with severe chest pain requiring hospitalization, physicians should consider prescribing nonsteroidal anti-inflammatory drugs or colchicine before seasonal symptom recurrence.

Colonic varices, usually detected by means of colonoscopy, are extremely rare and typically indicative of portal hypertension or chronic hepatopathology. Even more rare are those cases with no underlying disease, or idiopathic colonic varices. The authors report a case of these unexplained varices found during colonoscopy of a 30-year-old man with a 10-year history of diarrhea and occasional bloody stool. A thorough workup was performed, revealing no underlying abnormalities for his varices. Additionally, the authors review the literature of this rare diagnosis. Physicians must rule out hepatic, vascular, and cardiac causes before classifying a case of varices as idiopathic.