Volume 105, Issue 11

The author outlines current preparedness measures in the United States and overseas for containing and responding to the spread of influenza strain A, the avian influenza virus H5N1. Also noted are similarities between H5N1 and H1N1, the avian influenza virus responsible for the 1917–1918 influenza epidemic that killed 40 million people worldwide in approximately 6 months. The author concludes with a discussion of the particular successes of the osteopathic medical profession during the 1917–1918 crisis and indicates that current levels of preparedness among osteopathic physicians could be higher than those in the larger medical community–if the lessons of our osteopathic heritage are heeded and disseminated widely.

The West Virginia School of Osteopathic Medicine in Lewisburg instituted a free, community-based medical clinic in spring 1995 as part of an institution-wide Osteopathic Principles and Practices Integration Project. Under this initiative, osteopathic medical students are provided with 26 hours of supervised experience in osteopathic palpatory diagnosis and osteopathic manipulative treatment. The educational goal of the clinic is to increase the confidence of osteopathic medical students in their technical abilities in using osteopathic manipulative medicine to diagnose and treat community patients. Based on a variety of results from student-completed surveys, the authors conclude that the osteopathic manipulative medicine student clinic at West Virginia School of Osteopathic Medicine has met its goal of increasing student confidence in the application of these skills.

The authors outline the development of a form of nontraditional high-end, or luxury, healthcare known as concierge care—also often called boutique medicine or retainer practice. Physicians choosing to work within this new patient care model have provoked important medical, ethical, and legal questions in the medical community. Although some regulatory changes have taken place on the state and federal levels to address concerns about this trend, the authors argue for some of the perhaps lesser-known benefits of this model of care.

Injury to the lower urinary tract is a potential complication in all major vaginal and urogynecologic surgical procedures. Several authors have recommended the routine use of intraoperative cystoscopy during urogynecologic procedures. To evaluate possible injury to the lower urinary tract during intraoperative cystoscopy, the concomitant use of diuretics with indigo carmine dye has been advocated; efflux of dye is hypothesized to indicate functional patency of the urinary tract. This report describes a case in which a partial ureteral obstruction was present at the time of intraoperative cystoscopy—despite the observation of diuresis caused by furosemide. This case indicates that the efflux of indigo carmine-stained urine from both ureteral orifices is not conclusive evidence of the absence of ureteral insult during intraoperative cystoscopy.

Editor's note: This article was first published in the August 2005 issues of The DO magazine and JAOA and will be republished periodically, as space allows, as a public service announcement to AOA members.