The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Dec 1994
Comparative StudyPerformances of candidates with osteopathic compared with allopathic subspecialty training on the American Osteopathic Board of Internal Medicine subspecialty certifying examinations 1984 to 1992.
The American Osteopathic Board of Internal Medicine has been examining various factors that may affect candidate performance on subspecialty certifying examinations. To see whether taking subspecialty training in an osteopathic compared with an allopathic institution could predict better performance on the certifying examinations, the authors analyzed examination performance for all candidates from 1984 through 1992. ⋯ When the results from all nine examinations were pooled, the mean first-time examination takers' score for candidates in allopathic subspecialty programs (n = 201) was 78.3 and for those in osteopathic subspecialty programs (n = 153), 77.4 (P > 0.2). On the basis of these results, we cannot conclude that osteopathic subspecialty training is a factor that predicts better performance on the subspecialty certifying examination.
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J Am Osteopath Assoc · Dec 1994
Medical liability, product liability, and the question of tort reform.
Physicians have identified malpractice reform as their first priority during the recent flurry of national reform initiatives. Their focus on malpractice, however, tends to obscure the relationship between malpractice and the systemic problems wracking our healthcare delivery system. ⋯ The authors define the areas of physician liability under tort law (both malpractice and product liability), point out the misperceptions that inform physician behavior, and review the individual reforms proposed. They identify the stakeholders and their positions on each proposal, while imploring a cooperative, systemwide approach to tort reform.
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The recruitment and retention of osteopathic medical students by osteopathic medical institutions is arguably the most important priority facing the profession today. Residencies accredited by the Accreditation Council on Graduate Medical Education are now the major competitors for osteopathic medical students; osteopathic residency graduates are readily accepted at most hospitals; and osteopathic medical faculty are regularly appointed to university and government positions. ⋯ Osteopathic GME must sell academic quality by developing a university-like environment in the hospitals conducting training programs. Osteopathic training hospitals should consider requiring their directors of medical education to develop strategic plans for GME which result in the development of competitive programs.
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J Am Osteopath Assoc · Jun 1994
Intraspinal delivery of opiates by an implantable, programmable pump in patients with chronic, intractable pain of nonmalignant origin.
The use of intraspinal therapy for the management of intractable pain from nonmalignant causes has not been widely discussed. An implantable, externally programmable infusion pump was used for intraspinal delivery of morphine sulfate to 15 patients with intractable pain from reflex sympathetic dystrophy, arachnoiditis after spinal surgery, or an unknown cause. Dosage patterns were individualized. ⋯ Two patients chose to terminate therapy. Few complications occurred, but most patients needed increasingly larger doses over time to maintain pain relief. Intraspinal infusion of morphine sulfate by use of an implanted, externally programmable pump is safe and effective in selected patients with intractable pain of nonmalignant origin.
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Telangiectasia macularis eruptiva perstans (TMEP) is a rare form of mastocytosis. It appears most frequently in adults and only occasionally will affect young children or infants. In this disease, multiple brownish-red confluent macules and telangiectasias develop, primarily on the trunk. ⋯ A simple workup can help to differentiate between these two conditions. The authors describe a 48-year old woman who was seen with cutaneous features of TMEP and with multiple symptoms suggesting systemic mastocytosis. They discuss the clinical features, diagnostic workup, and therapeutic options in the management of this relatively rare condition.