Volume 117, Issue 2

Context : Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and document their medical history is an important step to improve the diagnostic process. Objective : To evaluate patients’ office experience before and after they authored their subjective medical history for the electronic health record. Methods : Patients were mailed a prehistory form and presurvey to be completed before their family medicine office visit. On arrival to the office, the prehistory form was scanned into the electronic health record while the content was transcribed by hospital staff into the appropriate fields in the history component of the encounter note. Postsurveys were given to patients to be completed after their visit. Pre- and postsurveys measured the patients’ perception of office visit quality as well as completeness and accuracy of their electronic health record documentation before and after their appointment. Medical staff surveys were collected weekly to measure the staff’s viewpoint of the federal law that allows patients to view and amend their medical records. Results : Of 405 patients who were asked to participate, 263 patients aged 14 to 94 years completed a presurvey and a prehistory form. Of those 263 patients, 134 completed a postsurvey. The pre- and postsurveys showed improved patient satisfaction with the office visit and high scores for documentation accuracy and completeness. Before filling out the prehistory form, 116 of 249 patients (46.6%) agreed or strongly agreed that they felt more empowered in their health care by completing the prehistory form compared with 110 of 131 (84.0%) who agreed or strongly agreed after the visit ( P <.001). Staff members agreed that patients should have the right to view and amend their medical records in accordance with federal law. Conclusion : Empowering patients to contribute subjective information to their electronic health record has the potential to improve the diagnostic process. When conducting a medical encounter, the authors recommend having patients complete a prehistory form beforehand to improve the patient experience while accommodating federal law.

Background : Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside the endometrial cavity. Such pregnancies occur in approximately 1.5% to 2.0% of all pregnancies and cause 6% of maternal deaths. Objectives : To evaluate osteopathic structural examination (OSE) findings in patients with ectopic pregnancies of uncommon locations and to establish the utility of these findings in the diagnosis of these ectopic pregnancies. Methods : In this prospective case series, a focused OSE was performed on each patient with an ectopic pregnancy at her initial presentation after the patient history but before other diagnostic or laboratory tests were performed and surgical treatment was initiated. Chapman reflex points (CRPs) were evaluated pre- and postoperatively. For comparison, patients who had otherwise normal first pregnancies, underwent elective postpartum bilateral tubal ligation, or had simple ovarian cysts were also included and received OSEs. Results : Seven cases with ectopic pregnancies outside the fallopian tube were included. Two primary ovarian pregnancies and 1 heterotopic pregnancy (uterine and ovarian) had somatic dysfunction at the T10-T11 spinal levels and CRPs posterior for the ovary, 1 primary omental pregnancy with somatic dysfunction at the T9-T12 spinal levels and CRPs anterior and posterior for the ileum and jejunum, and 1 tubal pregnancy with somatic dysfunction at the T10-L1 spinal levels and CRPs anterior and posterior for the fallopian tube. Two cornual ectopic pregnancies were not associated with unique findings. These somatic dysfunctions and CRP findings appear to be distinct from those of comparison cases, including first pregnancies at any trimester, simple ovarian cysts, and elective bilateral tubal ligation. Conclusion : The OSE findings demonstrated in these cases aided in the final diagnosis and thus can potentially prove helpful in cases of ovarian, tubal, and omental pregnancies to provide clues to abnormal ectopic pregnancy locations where diagnostic imaging results are insufficient or equivocal. Osteopathic structural examinations may allow osteopathic physicians to better prepare for treatment approaches, including surgery.

Injuries to the foot and ankle are commonly encountered, especially among athletes, and can lead to morbidity if not managed appropriately. Health care professionals must have a firm understanding of injury anatomy, diagnoses, and management. This article provides a review of lateral talus process fractures, os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures, and syndesmotic injuries.

Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum is depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and tachycardia. The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed.

Context : With the coming single accreditation system for graduate medical education, medical educators may wonder whether knowledge in basic sciences is equivalent for osteopathic and allopathic medical students. Objective : To examine whether medical students’ basic science knowledge is the same among osteopathic and allopathic medical students. Methods : A dataset of the Touro University College of Osteopathic Medicine-CA student records from the classes of 2013, 2014, and 2015 and the national cohort of National Board of Medical Examiners Comprehensive Basic Science Examination (NBME-CBSE) parameters for MD students were used. Models of the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores were fit using linear and logistic regression. The models included variables used in both osteopathic and allopathic medical professions to predict COMLEX-USA outcomes, such as Medical College Admission Test biology scores, preclinical grade point average, number of undergraduate science units, and scores on the NBME-CBSE. Regression statistics were studied to compare the effectiveness of models that included or excluded NBME-CBSE scores at predicting COMLEX-USA Level 1 scores. Variance inflation factor was used to investigate multicollinearity. Receiver operating characteristic curves were used to show the effectiveness of NBME-CBSE scores at predicting COMLEX-USA Level 1 pass/fail outcomes. A t test at 99% level was used to compare mean NBME-CBSE scores with the national cohort. Results : A total of 390 student records were analyzed. Scores on the NBME-CBSE were found to be an effective predictor of COMLEX-USA Level 1 scores ( P <.001). The pass/fail outcome on COMLEX-USA Level 1 was also well predicted by NBME-CBSE scores ( P <.001). No significant difference was found in performance on the NBME-CBSE between osteopathic and allopathic medical students ( P =.322). Conclusion : As an examination constructed to assess the basic science knowledge of allopathic medical students, the NBME-CBSE is effective at predicting performance on COMLEX-USA Level 1. In addition, osteopathic medical students performed the same as allopathic medical students on the NBME-CBSE. The results imply that the same basic science knowledge is expected for DO and MD students.

Leo Buerger, MD, was the first to describe dependent rubor associated with marked atherosclerosis. Historically, dependent rubor has been described as erythromelalgia (or erythromelia), and terms such as chronic rubor , reactionary rubor , induced rubor , and hyperemic response have also been used to describe this sign associated with peripheral vascular disease. This brief review will reacquaint physicians with the Buerger test, which is used to assess arterial sufficiency, as well as erythromelalgia, and the proposed mechanisms responsible for erythromelalgia. The Buerger test is an important consideration when examining patients for erythromelalgia, which remains distinct from erythema associated with skin and soft-tissue infections.

Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside of the endometrial cavity. The majority of ectopic pregnancies encountered in clinical practice are located within the fallopian tube. Abdominal pregnancies represent 1% of all ectopic pregnancies. Primary omental pregnancy, in which the extrauterine site of implantation is the greater omentum, is the least common form of abdominal pregnancy. The rarity of an ectopic pregnancy in the omentum and the absence of clinical symptoms often delays diagnosis and proper identification before rupture. The authors describe the case of a 23-year-old woman who had hemoperitoneum from a ruptured omental ectopic pregnancy that mimicked adnexal implantation. Her omental pregnancy was diagnosed through intraoperative exploration and osteopathic structural examination findings.

Scapular winging represents a rare phenomenon that most commonly results from nerve damage to either the long thoracic nerve, spinal accessory nerve, or, less commonly, the dorsal scapular nerve. This injury results in an abnormal scapulohumeral interaction during kinetic motion known as scapular dyskinesis . In this case report, the patient presented with scapular dyskinesis and medial scapular winging caused by overhead weight-lifting exercises, and a long thoracic nerve injury was diagnosed. Physicians are encouraged to consider long thoracic nerve damage in a patient with a history of repetitive overhead movements who presents with scapular dyskinesis and the corresponding restriction of overhead arm motions. Potential mechanisms of injury and treatment options are also discussed.