Band 102, Heft 1

A patient survey was used to measure and explain patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment (OMT). Participating in the survey were 459 people who attended an ambulatory OMT specialty clinic from March 1998 through September 1998 and who had received OMT there at least twice previously. Standardized patient satisfaction scores were greatest for overall performance (0.61 +/- 0.29) and interpersonal manner (0.61 +/- 0.24). Satisfaction with finances (0.11 +/- 0.31) was significantly lower than for all other global dimensions of care (P < .001). Subjects perceived OMT to be highly efficacious (0.74 +/- 0.34) and reported significant relief from pain or discomfort (P < .001) and improvement in mobility (P < .001). Of all the respondents, 8.6% attributed an adverse reaction to OMT. Perception of OMT efficacy was significantly associated with all dimensions of patient satisfaction (P values ranged from less than .001 to .003). Relief from pain or discomfort was significantly associated with overall satisfaction (P < .001). Females had greater reduction in pain or discomfort than males (P = .001). Respondents perceived significant community shortages of OMT services through primary care (-0.45 +/- 0.50; P < .001) and specialty (-0.35 +/- 0.54; P < .001) physicians, and reported significant dissatisfaction with insurance coverage for OMT services (-0.09 +/- 0.57; P = .001). These findings suggest the need for greater access to OMT services.

The use of physician-assisted suicide (PAS) in the care of terminally ill patients is controversial. While there are published surveys assessing the attitudes and views of physicians in certain specialties, both nationally and in targeted geographic areas, no such data are available specifically pertaining to osteopathic physicians, who deliver 9% of the primary care in the United States. This article describes a study whose purpose was to identify the views and perspectives of osteopathic physicians on PAS through a national survey. Questionnaires were forwarded to all board-certified internists who are members of the American College of Osteopathic Internists and all surgeons and a random sample of family physicians who are members of the American Osteopathic Association. Physicians were surveyed with initial and follow-up mailings. The 49-item questionnaire was a modified version of the Physician Survey, Center for Ethics in Health Care: Oregon Health Sciences University. Of the 2910 questionnaires that were mailed, 1028 were returned in a usable form, for a 35% response rate. Respondents were predominantly (81%) male and from all parts of the country. Most (58%) would not be willing to prescribe a medication for a competent, terminally ill patient to use with the primary intention of ending his or her own life, and most (55%) would oppose the legalization of PAS. Thirty-three percent of osteopathic physicians admit to receiving requests by terminally ill patients for PAS. Most (53%) osteopathic physicians indicate that the osteopathic principle of holistic care has influenced their decision-making on this issue, and a significant minority (44%) responded that the osteopathic oath influenced their view on PAS. Religion and the degree of prayer frequency were important predictors of the decisions to support or oppose PAS. When compared to other physician surveys, this survey of osteopathic physicians demonstrates some similarities in response but also significant differences. These data suggest that osteopathic education and training may result in a perspective on PAS that reflects the distinctiveness of the osteopathic profession.

Anthrax is a disease caused by Bacillus anthracis, a gram-positive, aerobic, spore-forming rod. It is also used as a biological weapon. The primary care physician will be the public's first line of defense in the event of a widespread anthrax exposure and will play a crucial role providing postexposure prophylaxis. Understanding the disease process will allow the primary care physician to play an essential role in protecting and educating the public. Accurate diagnosis and quick treatment will save many lives and help calm the panic following a biological attack.

Anthrax is a naturally occurring organism with a low incidence of infection. There are no known cases of human-to-human transmission. Bioterrorism-related anthrax in the United States has been seen in three high-risk groups: (1) postal workers, (2) politicians and their staffs, and (3) the press. It appears as though the bioterrorism-related anthrax cases of fall 2001 have been transmitted through the US Postal Service. The authors present a case in which a person at high risk for anthrax exposure was inadequately treated and had symptoms that do not fall into any specific category of disease. It emphasizes the need for someone who has been started on prophylaxis for anthrax to complete a full 60-day course of treatment. It also shows the effectiveness of antibiotic therapy, even in those with high exposure to weaponized anthrax. Further, we would like to suggest that there may exist a new clinical entity of "aborted anthrax infection."

Pruritic urticarial papules and plaques of pregnancy is considered the most common pruritic skin condition seen in pregnancy, and its classic presentation and treatment options have been well described. However, the exact etiologic factor of this condition remains obscure. This article presents an unusual case to demonstrate a variation in presentation of this disease as well as a unique course of treatment. The unusual progression of this case may render new insight regarding the etiologic factor of this disease.