Volume 95, Issue 5

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 longterm 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.

Experimental and clinical studies of nerve compression syndromes show that ischemia or edema, singly or combined, causes responses in nerves that lead to alterations in impulse conduction and to commonly observed clinical signs. Because osteopathic manipulative treatment (OMT) is thought to affect microcirculation and anatomic positioning of structures, nerve compression syndromes appear ideal as models for studying how OMT accomplishes results. We recommend that researchers develop experimental protocols or clinical studies of nerve compression syndromes that will use anatomic, histologic, and physiologic criteria to monitor the effects of OMT. Techniques such as soft tissue, muscle energy, counterstrain, or myofascial release are appropriate for study in nerve compression syndromes. Such studies are necessary to understand the biologic basis of OMT.

Physician workforce issues in the healthcare reform debate have led to considerable agreement on the need to reform graduate medical education (GME) in order to control the cost, mix and supply of physician manpower. The osteopathic medical profession's infrastructure is ill-prepared to respond to many of the changes that policymakers are suggesting. In last month's issue, the author reviewed the Gephardt and Mitchell bills, which emerged during the last Congress, identified the reforms recommended for GME, and examined the elements of agreement between the bills. The position of osteopathic medicine vis-a-vis healthcare reform was explored and distinctions between the two bills were drawn. In this article, the author recommends comprehensive secondary reforms in the osteopathic medical profession's three institutions-its colleges, its hospitals, and its political organization, the American Osteopathic Association.

Physicians are often called on to address interpersonal conflicts among office staff and colleagues. Because such strife can interfere with patient care, physicians should learn to diffuse these situations as adeptly and quickly as possible. The authors outline one approach, which they developed while working at the Oklahoma Department of Mental Health. Designated by the mnemonic LIFT (Listen, Inquire, ask for Feedback, Test), this approach has been used successfully to resolve interpersonal conflict in small groups.