Band 101, Heft 7

A national telephone survey was conducted in 1998 using random-digit dialing and the first Osteopathic Survey of Healthcare in America (OSTEOSURV-I) instrument to determine patients' satisfaction with their healthcare, as well as their perceptions of osteopathic medicine. Of the 1106 respondents, 243 (22.0%) had received medical care from an osteopathic physician, and another 307 (27.8%) claimed to be aware of osteopathic physicians. Patients of osteopathic physicians reported the highest levels of satisfaction in 8 of the 11 elements studied when compared with patients of allopathic physicians, chiropractors, and nonphysician clinicians other than chiropractors. Respondents perceived osteopathic manipulative treatment (OMT) to be beneficial for musculoskeletal disorders (P < .001). In addition, respondents perceived that healthcare services provided by osteopathic physicians were similar to those provided by allopathic physicians (P < .001), but not to those provided by chiropractors (P = .01). A total of 97.9% of current patients of osteopathic physicians agreed with the statement that osteopathic physicians practiced in their local community, compared with 80.6% of former patients of osteopathic physicians and 67.8% of patients who had never visited osteopathic physicians (P lt; .001). In general, the most favorable perceptions of osteopathic medicine were reported by current patients of osteopathic physicians, followed by former patients of such physicians. The least favorable perceptions came from patients who had never been patients of osteopathic physicians. The perception that OMT should be covered by health insurance was significantly associated with the use of osteopathic physicians (odds ratio, 3.2; 95% confidence interval, 1.5 to 6.7, among patients who had ever been to an osteopathic physician). The results of our survey suggest that greater access to osteopathic services, including OMT, is desirable and that promotional efforts aimed at encouraging the use of osteopathic medical services among the general population are warranted.

Many patients admitted to the intensive care unit have respiratory failure and thus require mechanical ventilation. Weaning patients from mechanical ventilation after their primary disease process has been treated can be difficult in approximately 30% of patients. Inadequacies in pulmonary gas exchange and in the performance of the respiratory muscle pump are the most common causes for failure to wean. Assessing whether a patient can be weaned from mechanical ventilation involves two major factors: (1) examining the patient for evidence of an increase in the work of breathing, and (2) measuring spontaneous breathing variables. Although different modalities have been used in weaning patients from mechanical ventilation, none has been shown to be more successful than repeated trials of spontaneous breathing.

The use of anabolic steroids among competitive athletes, particularly bodybuilders, is widespread. Numerous reports have noted "hepatic" dysfunction secondary to anabolic steroid use based on elevated serum aminotransferase levels. The authors' objective was to assess whether primary care physicians accurately distinguish between anabolic steroid-induced hepatotoxicity and serum aminotransferase elevations that are secondary to acute rhabdomyolysis resulting from intense resistance training. Surveys were sent to physicians listed as practicing family medicine or sports medicine in the yellow pages of seven metropolitan areas. Physicians were asked to provide a differential diagnosis for a 28-year-old, anabolic steroid-using male bodybuilder with an abnormal serum chemistry profile. The blood chemistries showed elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) levels, and normal gamma-glutamyltransferase (GGT) levels. In the physician survey (n = 84 responses), 56% failed to mention muscle damage or muscle disease as a potential diagnosis, despite the markedly elevated CK level of the patient. Sixty-three percent indicated liver disease as their primary diagnosis despite normal GGT levels. Prior reports of anabolic steroid-induced hepatotoxicity that were based on aminotransferase elevations may have overstated the role of anabolic steroids. Correspondingly, the medical community may have been led to emphasize anabolic steroid-induced hepatotoxicity and disregard muscle damage when interpreting elevated aminotransferase levels. Therefore, when evaluating enzyme elevations in patients who use anabolic steroids, physicians should consider the CK and GGT levels as essential elements in distinguishing muscle damage from liver damage.

Recent studies have demonstrated a decline in the use of osteopathic manipulative treatment (OMT) by osteopathic physicians, reflecting a trend that may begin in medical school. The authors used a questionnaire to examine the teaching and use of OMT in five rotations and the perceptions of 86 graduating osteopathic medical students of their experiences following their core manipulative medicine rotation. Most students indicated that they applied osteopathic principles sometimes (39.5%) or often (29.1%) during rotations. Forty-three percent of students rated their ability to apply osteopathic principles as average. The number of students who indicated that they rarely used OMT during their rotations was 31 (36.0%) for internal medicine, 21 (24.4%) for surgery, 23 (26.7%) for pediatrics, and 24 (27.9%) for obstetrics/gynecology. When asked why OMT was not used during a rotation, 47.2% of respondents cited time constraints, and 21.7% stated that their attending physicians discouraged the use of OMT. These results demonstrate a distinction between students' perceived level of osteopathic principles and skills and their application during clinical rotations.