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  By John in Health on May 21st, 2013 at 4:44 pm
Source NY Times
Fiscal Policy can be a Matter of Life or Death
In their new book, “The Body Economic: Why Austerity Kills,” economist David Stuckler and physician Sanjay Basu examine the health impacts of austerity across the globe. The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis. For example, in Greece, where spending on public health has been slashed by 40 percent, HIV rates have jumped 200 percent, and the country has seen its first malaria outbreak since the 1970s. An economist and public health specialist, Stuckler is a senior research leader at Oxford University. Dr. Basu is a physician and epidemiologist who teaches at The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis.
If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity.
Continue reading …
By Frank M. Painter, D.C. in Documentation on May 17th, 2013 at 1:10 pm
SOAP Notes: Is It Time for a Cleaning?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic – May 15, 2013
By James Edwards, DC
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
But Dr. Ronald Short beat me to the punch with his outstanding article:
“SOAP: A Chiropractic Perspective” [March 1, 2013 issue], in which he masterfully illustrated the problem. Hopefully, claim reviewers and documentation gurus will finally realize the difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit.
As Dr. Short so ably pointed out, to require orthopedic and neurological testing on each chiropractic visit is the equivalent of requiring a medical doctor to perform blood tests after each antibiotic pill. I could not have said it better myself.
It is important to remember that doctors of chiropractic are unique because we wear two very different hats. First, we are physicians who examine and diagnose (assessment) the patient. Then, after doing so, we carry out our treatment plan by providing care (treatment) to the patient. Failing to realize the distinct difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit places undue, unfair and unnecessary examination and documentation requirements on doctors of chiropractic, and it is time for it to stop.
This problem has been known for years, yet no one has been successful in sensitizing the chiropractic “powers that be” about this unfairness. The American Chiropractic Association’s Clinical Documentation Committee, during the process of authoring the third edition of the ACA Clinical Documentation Manual, attempted to directly address the issue by approving and submitting the following provision:
It is important to understand that the chiropractic physician has two responsibilities to their patients.
Continue reading …
A Comprehensive Review of Chiropractic Research
The Chiro.Org Blog
SOURCE: Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC
By Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC
Former Director of Research and Education for the Foundation for Chiropractic Education and Research (FCER) until its demise (1992-2007), and is now the current Director of Research at International College of Applied Kinesiology (USA).
I. Introduction
A. Perspectives:
In the space of just 115 years from its inception, chiropractic has emerged as the third largest healthcare profession in the United States offering diagnostic as well as therapeutic services to patients. It has reached this lofty height driven by research which has made particularly dramatic strides over the past 30 years, supported by a budget which represents merely an infinitesimal fraction of that applied to medical and pharmaceutical research.
Like all health professions, chiropractic regularly tests the effectiveness, safety, and costs of its approaching health care. Studies continue to show that chiropractors offer the public a viable alternative to invasive healthcare (drugs, surgery) especially in the treatment of musculoskeletal problems such as back, neck, and headache pain. But chiropractic treatments are likewise effective in the treatment of non-musculoskeletal health issues, including infantile colic, enuresis, asthma, dysmenorrheal, otitis media, hypertension, and heart rate variability. And few medical professions outside of chiropractic can offer such healthcare solutions with equal safety and cost records.
Having been historically been placed in the category of “alternative and complementary” medicine, chiropractic because of its rapid growth in its research has now been deemed to have reached the crossroads of mainstream and alternative medicine. [1] As a hybrid, it appears to have successfully incorporated many of the research methodologies of orthodox medicine while striving to maintain its distinct healthcare paradigm. Indeed, when the practitioner’s primary means of patient care and published randomized clinical trials supporting that intervention are matched, chiropractic can be shown to enjoy a higher percentage of interventions thus supported when compared to such other medical disciplines as general practice, inpatient general surgery, dermatology, or hematology-oncology. [2] In other words, chiropractic can now claim to have attained at least as much of a scientific grounding as other medical interventions based upon its research.
So what is it that one means by chiropractic research? The research related to the practice of chiropractic, to be reviewed in this chapter, has been presented in multiple dimensions, including:
1. Published clinical articles;
2. Literature reviews;
3. Surveys and public opinion research;
4. Analyses of insurance claims [actuarial research];
5. Guidelines
B. First major interdisciplinary cohort study:
One of the first lines of evidence in support of chiropractic intervention that could be considered to be more robust came in 1985 from a prospective observational study of 283 patients suffering from chronic low back and leg pain, drawn from a university back pain clinic reserved for patients who had not responded to previous conservative or operative treatment. Given a 2-3 week regimen of daily spinal manipulation by an experienced chiropractor, 81% of these patients with referred pain and 48% of those with nerve compression displayed improvements in pain grades after their assessments at 1 month followed by 3-month intervals. The research was noteworthy in that it represented a collaboration between chiropractic [David Cassidy] and medical providers [William Kirkaldy-Willis] and was published in a leading medical journal. [3]
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Get the Lead Out!
The Chiro.Org Blog
SOURCE: MedPage Today ~ May 13, 2013
By Nancy Walsh, Staff Writer, MedPage Today
When the FDA finally got around to testing 324 multivitamin-mineral products that target children and pregnant women, they found that only 4 of them were lead-free.[1]
Well, new research now suggests that even low levels of lead in a supplement can have adverse effects on your children. Why not use a supplement made correctly, so you can protect your family?
Here’s the Bad news from MedPage Today:
Even Low Lead Exposure Hinders Kids’ Reading
Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.
On tests of reading readiness, children with blood lead levels between 5 and 9 µg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 µg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.
And those with lead levels of 10 µg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics.
Continue reading …
By Frank M. Painter, D.C. in Announcement on May 12th, 2013 at 12:11 pm
Happy Mother’s Day to all our Lady Friends!
The Chiro.Org Blog
Women are the backbone of Civilization. We honor you!
By Frank M. Painter, D.C. in Announcement on May 11th, 2013 at 12:00 am
Chiro.Org is now 18 years old! Whooo-eee!
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Clinical Biomechanics: Scoliosis
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 13 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 13: Scoliosis
In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.
GENERAL CONSIDERATIONS
The Spinal Curves [1-9]
A curved column has increased resistance to compression forces. This is just as true in the spine, as for a rib or long bone. Most authorities consider the spine to have four major curves: anteriorly convex curves at the cervical and lumbar areas and, anteriorly concave curves at the thoracic and sacral levels. Cailliet considers the coccyx a curve, but this curve is usually considered an extension of the sacral curve. A few authorities consider the atlanto-occipital junction as a separate anteriorly convex curve. Regardless, the spinal curves offer the vertebral column increased inflexibility and shock-absorbing capability while still maintaining an adequate degree of stiffness and stability between vertebral segments (Fig. 13.1).
Structural vs Functional Curves
The adult thoracic and sacral anteriorly concave curves are firm structural arcs as the result of their vertebral bodies being shorter anteriorly than posteriorly. The normal kyphosis of the adult thoracic and sacral curves is quite similar to that of the fetal spine. This is not true for the anteriorly convex cervical and lumbar regions where the curves are essentially the result of their soft tissue wedge-shaped IVDs. It is for this reason that the cervical and lumbar curves readily flatten in the supine position, while the thoracic kyphosis reduces only a slight amount.
There is a clinical correlation of disc wedging to disc disease. Most disc lesions are found in the cervical and lumbar regions where the greatest degree of physiologic wedging occurs. This appears to be true in both hyperlordosis and an exceptionally flat cervical or lumbar curve.
Effect of Bipedism
An adult discless spine would resemble that of the newborn. Since animals that walk on four legs and infants prior to assuming the erect position do not have the physiologic curves of the erect adult, it can be assumed that these curves are the result of bipedism. In the erect position, the lower lumbar area is especially subjected to considerable shearing stress. [10, 11]
Overall Balance
Although the spine is often considered as the central pillar of the body, this is only true when the spine is viewed from the anterior or posterior aspect. When viewed laterally, the spine lies distinctly posterior to the thoracic body mass essentially because of the space-occupying heart (Fig. 13.2), It lies much more centrally in the cervical and lumbar regions. An abundance of body mass also lies anterior to the midline in the head, which must be held by erector and check ligament strength if a thoracic “hump” or a flattened cervical curve are to be avoided.
You may also enjoy our
Scoliosis and Chiropractic Page
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By John in News on May 7th, 2013 at 5:07 pm
Source The Guardian
Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize. Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.
The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114. One of the UK’s most eminent spinal surgeons said the discovery was the greatest he had witnessed in his professional life, and that its impact on medicine was worthy of a Nobel prize.
“This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics,” said Peter Hamlyn, a consultant neurological and spinal surgeon at University College London hospital.
Specialists who deal with back pain have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark who found that 20% to 40% of chronic lower back pain was caused by bacterial infections.
“This will not help people with normal back pain, those with acute, or sub-acute pain – only those with chronic lower back pain,” Dr Hanne Albert, of the Danish research team, told the Guardian. “These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected.”
The Danish team describe their work in two papers published in the European Spine Journal. In the first report, they explain how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae.
In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a randomised trial, the drugs reduced pain in 80% of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.
By Frank M. Painter, D.C. in Chiropractic Care on April 24th, 2013 at 11:36 am
Spinal Manipulation: The Right Choice
for Relieving Low Back Pain
The Chiro.Org Blog
Spinal High-velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo
Spine 2013 (Apr 1); 38 (7): 540–548
von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med
Competence Center for Clinical Studies; and †Institute for Biometrics, University of Bremen, Bremen, Germany
Thanks to Dynamic Chiropractic for access to these Key Findings from the study
- “There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” (compared to subjects receiving diclofenac therapy).
- “Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”
- “The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation arm. While the authors note that these results were not significant due to large between-individual variations (meaning a few patients could have taken many tablets, throwing off the overall totals), it still suggests that value of spinal manipulation vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the diclofenac group).
The Abstract
Continue reading …
By John in Research on April 24th, 2013 at 11:12 am
Source The Vancouver Sun
by Dr Don Nixdorf
 Research is key to developing better treatments and care protocols to eliminate disease and stay healthy. The chiropractic profession is fortunate to have twelve Canadian Chiropractic Research Foundation (CCRF) research chairs in major universities across the country, each of which conducts and contributes to world class research. But the more significant benefits to weaving these research chairs into the fabric of academia are the interdisciplinary connections and collaborations that result. There is no other time in history where we have seen so many different health professions coming together with one common goal: improving healthcare.
When many different health professionals work together, patients routinely experience better care and are on average better prepared to care for themselves. There are several examples of this in practice already. St. Michael’s Hospital in Toronto uses a multi-disciplinary approach to treat and manage back pain. Community health clinics with nurse practitioners, dentists, nutritionists and several other health care providers are peppered throughout Canada and experience tremendous success in the amount of patients they can treat and the quality of the care that is delivered. Let’s also not forget our amazing Canadian athletes who benefit from a team healthcare approach. It makes perfect sense that patients benefit from having multiple perspectives of expertise that work together to treat the whole person, not just the corner of their body with a problem.
In an effort to gain further momentum to this type of approach and increase collaboration in the academic community, several chiropractic doctors out of McMaster University came together to form the McMaster Chiropractic Working Group in 2009. Dr. Steven Passmore DC, PhD, a researcher from the University of Manitoba is one of the founding members of this group that aims to raise the profile of chiropractic in the university setting through credible research and collaborative efforts. With the exception of the CCRF researchers in universities, chiropractic education and advancement is primarily through chiropractic schools and funded almost entirely by chiropractic doctors. Even after earning his PhD from McMaster in 2012, Dr. Passmore continues to be a part of this initiative that is setting an example for others across the country. BC is already investigating the potential of a local working group based on the McMaster model.
Continue reading …
By John in Chiropractic Education on April 24th, 2013 at 10:47 am
Source The Australian
Macquarie University has announced plans to offload its chiropractic teaching by 2015.
It said it would begin discussions with other “interested” higher education providers about taking over its chiropractic units and degrees, including academic staff and teaching facilities. Executive science dean Clive Baldock said his faculty wanted to concentrate on developing “recent major strategic investments” in research-intensive disciplines including biomedical science and engineering.
“Macquarie University has recently invested significantly in a postgraduate medical school and a state-of-the-art private hospital,” he said. “We naturally want to focus our efforts on supporting these initiatives with our teaching and research.” Professor Baldock issued a sales pitch to possible tenderers while acknowledging that the discipline didn’t meet Macquarie’s requirements “from a research-intensive perspective”.
“We believe our chiropractic degrees to be of the highest teaching quality, and they remain extremely popular with students,” he said.“We therefore believe the responsible thing to do is to begin discussions with other higher education providers who are keen to grow in this area.”
By Frank M. Painter, D.C. in Chiropractic Care on April 23rd, 2013 at 11:55 am
Sports Management:
Leg, Ankle, and Foot Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 27 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 27: Leg, Ankle, and Foot Injuries
The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body.
Injuries of the Leg
The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.
A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.
Bruises and Contusions
The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.
Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.
GASTROCNEMIUS CONTUSION
This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.
Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.
TRAUMATIC PHLEBITIS
Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.
Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.
NERVE CONTUSIONS
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By Frank M. Painter, D.C. in Chiropractic Care on April 20th, 2013 at 12:50 pm
Sports Management:
Shoulder Girdle Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 22 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 22: Shoulder Girdle Injuries
This chapter concerns injuries of and about the scapula, clavicle, and shoulder. In sports, the shoulder girdle is a common site of minor injury and a not infrequent site of serious disability. It is second only to the knee as a chronic site of prolonged disability. Upper limb injuries amount to about 20% of sport-related injuries. They can be highly debilitating, require considerable lost field time, and can easily ruin a promising sports career.
Introduction
The versatile shoulder girdle consists of the sternoclavicular, acromioclavicular, and glenohumeral joints, and the scapulothoracic articulation. These allow, as a whole, universal mobility by way of a shallow glenoid fossa, the joint capsule, and the suspension muscles and ligaments. The shoulder, a ball-and-socket joint, is freely movable and lacks a close connection between its articular surfaces.
The regional anatomy offers little to resist violent shoulder depression, and the shoulder tip itself has little protection from trauma. The length of the arm presents a long lever with a large head within a relatively small joint. This allows a great range of motion with little stability. The stability of the shoulder is derived entirely from its surrounding soft tissues.
History and Initial Care
A careful history recording the mechanism of trauma and the position of the limb during injury, careful inspection and palpation of the entire region, muscle and range-of-motion tests, and other standard neurologic-orthopedic tests will often arrive at an accurate diagnosis without the necessity of x-ray exposure. Forceful manipulations should always be reserved for late in the examination to evaluate contraindications.
Contusions, strains, sprains, bursitis, and neurologic deficits must be alertly recognized and treated. Fractures and dislocations, obviously, take precedence over soft-tissue injuries with the exception of severe bleeding. Always check for bony crepitus, fracture line tenderness and swelling, angulation and deformity. Because the shoulder readily “freezes” after injury, treatment must strive to maintain motion as soon as possible without encouraging recurring problems. The key to avoiding prolonged disability is early recognition and early mobilization.
There are more materials like this @ our:
Shoulder Girdle Page
Posttraumatic Assessment
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By Frank M. Painter, D.C. in Earth Day on April 19th, 2013 at 2:57 pm
How Do YOU Celebrate Earth Day?
The Chiro.Org Blog
Chiropractic Care is the most holistic and natural form(s) of treatment available.
As Stewards of Health, we can also be positive examples for our communities regarding the health challenges faced by our Planet.
If you are not already involved in activities, the Earth Day Network can connect you to local Organizations you can work with or contribute to.
Our Earth is in for a bumpy ride, and every little decision we make take can contribute to or reduce the stress on our Planet.
By Frank M. Painter, D.C. in Announcement on April 18th, 2013 at 4:19 pm
Participate in a Wellness Care/
Maintenance Care Research Project
The Chiro.Org Blog
Wellness care, or “maintenance care,” is widely accepted by the profession as an integral part of chiropractic practice. However, to date, a cause-and-effect relationship between wellness care and improved long-term health outcomes has yet to be clearly demonstrated. This proposed study is designed to add to the evidence base about this important topic.
Purpose of this Study
The purpose of this study is to assess changes in Health-Related Quality of Life over a 12 month period for chiropractic patients who do, or do not participate in wellness care. It is being conducted in the offices of U.S. chiropractors who are members of the Integrated Chiropractic Outcomes Network (ICON).
For this study, we define chiropractic wellness care as a course of long-term care provided to a patient who is either asymptomatic or whose original presenting complaint has been resolved or stabilized, and is provided for the purpose of preventing disease, optimizing function, and supporting the patient’s wellness-related activities and/or minimizing recurrences of previous complaints.
Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD, Marion Willard Evans Jr., DC, PhD, MCHES, Daniel Redwood, DC
Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 556-567
Study Design
Baseline data are collected in practitioners’ offices; follow-up is conducted by the central office at Logan, by phone and email. Each doctor enrolls 5 consecutive new patients. New patients of any age are eligible! Data are collected at 4 points: first visit and 1, 6 and 12 months later. Outcomes are assessed primarily via questions from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Patients are entered in a drawing for a $100 gift card when they complete the follow-up.
Would You Like to Join Our Study?
We have rolling enrollment so you can still join!
Simply email or call Program Coordinator
Michelle Anderson:
michelle.anderson@logan.edu or call her at: (636) 230-1946 |
Principal Investigator: Cheryl Hawk, DC, PhD
Coinvestigators: Katherine Pohlman, DC, MS, U of Alberta
Jay Greenstein, DC, CCSP, private practice
Program Coordinator: Michelle Anderson
You may also want to review our:
Maintenance Care, Wellness and Chiropractic Page
More on Chiropractic Cost Effectiveness
The Chiro.Org Blog
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655-662
Spinal Manipulation Epidemiology:
Systematic Review of Cost Effectiveness Studies
Michaleff ZA, Lin CW, Maher CG, van Tulder MW.
The George Institute for Global Health, The University of Sydney, Missenden Road, Sydney, NSW 2050, Australia. zmichaleff@georgeinstitute.org.au
BACKGROUND: Spinal manipulative therapy (SMT) is frequently used by health professionals to manage spinal pain. With many treatments having comparable outcomes to SMT, determining the cost-effectiveness of these treatments has been identified as a high research priority.
OBJECTIVE: To investigate the cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration.
METHODS: We searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Full economic evaluations conducted alongside randomised controlled trials with at least one SMT arm were eligible for inclusion. Two authors independently screened search results, extracted data and assessed risk of bias using the CHEC-list.
RESULTS: Six cost-effectiveness and cost-utility analysis were included. All included studies had a low risk of bias scoring ≥16/19 on the CHEC-List. SMT was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to GP care, exercise and physiotherapy.
There are many more articles like this @ our:
Cost-Effectiveness of Chiropractic Page
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By Frank M. Painter, D.C. in Bone Injury on April 15th, 2013 at 8:35 am
Sports Management:
Bone and Joint Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 15 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 15: Bone and Joint Injuries
In traditional general medical practice, the musculoskeletal system is the most overlooked system in the body, yet it comprises over half the body mass. The relationship between structure and function, and the interrelationship between all body systems, cannot be denied. Muscles, bones, and connective tissues are involved in both local and systemic pathology, and in a wide assortment of functional and referred disturbances. Thus, great care must be taken in eliciting the details of a complaint when any musculoskeletal disorder is suspected. This section reviews the basis of alert management of bone and joint injuries within the health care of athletic and recreational injuries.
Bone Injuries
Correlation of the history of the present complaint with musculoskeletal dysfunction must be done in detail and with care. Maintain accurate initial and progress records with repeated monitoring. Few patients can appreciate the relationship of dysfunction in one somatic part with a distant somatic part, let alone the relationship between a somatic dysfunction and a visceral dysfunction.
Background
Musculoskeletal symptoms may be the first clues toward poor structural adaptation or stress adaptation. The most common musculoskeletal symptoms are joint stiffness, joint swelling, and joint pain. Bones, being essentially nonyielding structures, are damaged when excessive force is applied directly or indirectly. The nature of the damage depends on the direction of the applied force on the bones and the manner in which these bones are attached to other structures. The principal acute skeletal injuries are sprains, strains, subluxations, fractures, and dislocations.
Normal bone has an excellent blood supply with some exception in the metaphyseal area; but tendons, ligaments, discs, and cartilage are poorly vascularized. Yet both bone and joints challenge the host’s defensive mechanisms. The pressure of pus under hard bone blocks circulation, and emboli and thrombosis can cause additional devascularization. When circulation is deficient, local phagocytic function and nutrition are deficient, and cure is stymied.
The most accurate diagnosis can be made immediately after injury, before swelling clouds the picture. Many fracture and dislocation complications such as nerve and vessel injury occur not from the trauma itself but from poor first aid which does not provide adequate splinting prior to movement. Traumatic bone injury rarely occurs without significant soft-tissue damage. The physical examination must be gentle but thorough because soft-tissue trauma is poorly visible on roentgenograms for several days after injury. For example, a working diagnosis of stress fracture may have to be made in the absence of classic symptoms by bony tenderness alone as the fracture may not be demonstrable on x-ray films for 10-14 days or longer.
Probing the History
Symptoms of a musculoskeletal nature that cannot be linked to trauma are suspect of a chronic organic process. Unfortunately, a history of stress or strain may not be remembered. Even severe trauma is easily put out of the mind uring a game when emotions are high or forgotten once the pain and swelling have left. Whether pain is present or not, the history must be probed to determine if the dysfunction is the result of bone, the joint, or the motor apparatus involved in the joint motion.
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By Frank M. Painter, D.C. in Documentation on April 13th, 2013 at 11:23 am
Medical Documentation Falls Short of ICD-10 Coding Demands
The Chiro.Org Blog
SOURCE: MedPage Today ~ April 12, 2013
By David Pittman, Washington Correspondent
Nearly 65% of clinical documentation doesn’t contain enough information for coders to use for billing under the upcoming ICD-10 coding system, a coding expert said here at the American College of Physicians annual meeting.
The switch to the new coding system will greatly increase the specificity of diagnostic codes, and most doctors don’t provide enough detail for office coders to translate that to ICD-10, said Rhonda Buckholtz, vice-president of ICD-10 education and training at AAPC, a medical coding society based in Salt Lake City, Utah. Her estimate of the percentage of charts that were inadequately documented came from a survey of patient charts done by the AAPC, but further detail on the survey was not provided.
Complicating the switch for physicians, most payers said they won’t reimburse for unspecified codes, which are commonly used by doctors who may not know how to exactly diagnose a patient when they see them, she said. “Under ICD-10, if we’re not ready, we’re not going to get paid.”
Doctors have bemoaned the switch to ICD-10 — short for International Classification of Diseases, version 10 — because of the tremendous increase in complexity from the current ICD-9. The number of diagnostic codes will increase from nearly 14,000 to around 69,000. The number of procedure codes will jump from around 3,000 to roughly 87,000.
ICD-10 requires much greater detail on location of ailments, cause and type, and complications or manifestations compared with ICD-9. For example, diabetes will require complications to be incorporated within a single code. And asthma is listed as “mild,” “mild intermittent,” “mild persistent,” “moderate persistent,” or “severe.”
Therefore, Buckholtz said physicians need to start work now to ensure they will provide enough information for billers to properly code.
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By Frank M. Painter, D.C. in Autoimmune on April 12th, 2013 at 11:26 am
Multiple Sclerosis Puzzle: Vitamin D and the Month of May
The Chiro.Org Blog
SOURCE: MedPage ~ 4-11-2013
By Nancy Walsh, Staff Writer, MedPage Today
Fetal defects in thymic function and inadequate circulating levels of vitamin D may explain the well recognized influence of birth month on risk for multiple sclerosis, British researchers suggested.
Tests for a surrogate marker for thymic output of T cells found about twice the levels in cord blood of autoreactive T cells among individuals born in May compared with those born in November (P=5.5 × 10−5 versus P=1.2 × 10−6), according to Sreeram V. Ramagopalan, DPhil, of the University of Oxford, and colleagues.
Editor’s Note: If you are born in May, you would have been conceived the previous August or September, so the baby would have been carried to term during the low sunlight period of winter.
Mounting evidence has linked MS with vitamin D deficiency, and individuals born in May had lower levels of circulating 25-hydroxyvitamin D, at a mean of 38.4 nmol/L compared with 50.9 nmol/L, P=0.02), Ramagopalan’s group reported in a research letter in the April JAMA Neurology.
The association of birth month with later MS has been observed in many populations, although the phenomenon remains unexplained.
“We hypothesized that birth month influences T-cell production and may impair T-cell central tolerance and/or T-regulatory/T-effector cell balance, predisposing to MS,” the researchers wrote. To test this hypothesis, they examined cord blood from 100 healthy infants, half born in May and the other half in November.
Not only were the numbers of T-cells higher and the vitamin D levels lower in the May cohort, but an inverse correlation also was found between cord blood 25-hydroxyvitamin D and autoreactive CD4+ cells (ρ=−0.37, P=0.009) and CD8+ cells (ρ=−0.04, P=0.004).
These findings, in conjunction with recent observations that genes associated with MS have been found activated in cord blood, support the hypothesis that autoimmune conditions may represent a complex interplay of genetic and environmental factors, according to the researchers.
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Clinical Disorders and the Sensory System
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 8: Clinical Disorders and the Sensory System
This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.
THE ANALYSIS OF PAIN IN THE CLINICAL SETTING
Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.
Common Causes of Pain and Paresthesia
The common causes of pain and paresthesia are:
(1) obvious direct trauma or injury;
(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;
(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;
(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions;
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The Horizontal Neurologic Levels
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 4: The Horizontal Neurologic Levels
and Related Clinical Concerns
This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.
OVERVIEW
The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.
Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.
It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.
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The Longitudinal Neurologic Systems
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 3 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 3: The Longitudinal Neurologic Systems
This chapter succinctly describes the basic structure and function of the six major longitudinal systems; viz, the sensory, motor, visceral, vascular, consciousness, and cerebrospinal fluid systems.
As we begin this chapter, it might be well for the reader to subjectively grasp the significance of the motor and sensory systems as far as possible. One exercise in this is to imagine that you had become unconscious and someone has placed you in a remote dark empty cellar, far beyond any source of environmental sound. The first thing you realize is that you are a total sensory and motor paralytic from the neck caudad. You are unable to move even a fingertip because your motor system is not functioning. Because there is no feeling, you do not know whether you are recumbent or tied in a chair. Your vision is normal, but there is no light. Your hearing is normal, but there is no sound. Your taste buds are functional, but there is nothing to eat or drink. Your olfactory organs are functional, but there are no detectable odors. There is little left except thought and memory.
After a time in this predicament, thoughts undoubtedly arise such as, “I wish I had really looked at the beauty of the world when I had a chance. I wish I had listened to the music of the masters and even the birds in my backyard when I had a chance. I gulped down so many delicious meals. I had a beautiful garden, but I rarely took time to appreciate its design and fragrance. I even failed to take time to appreciate the texture of my own clothes. I was in such a hurry to go nowhere that was more important. I missed so much.”
OVERVIEW
The human nervous system is a marvel in organizing and adapting to internal and external environmental changes:
(1) The receptors and afferent neurons of the visceral and somatic input systems are necessary to detect internal and external environmental changes.
(2) The visceral efferent neurons and the muscles of the motor output system must be stimulated if action is to be taken.
(3) The integrative system serves as intermediary stations via a complex arrangement of interneurons whose synapses control impulse strength and signal direction from the sensory system to the motor system.
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By Frank M. Painter, D.C. in Acupuncture on April 2nd, 2013 at 8:09 pm
Updated Reference Guide to Dr. Richard C. Schafer’s Articles
The Chiro.Org Blog
There are now 62 different Chapters from Dr. Schafer’s various best-selling textbooks for your review, available exclusively at Chiro.Org
These learned articles by Dr. Schafer can also be found again easily by selecting the EDUCATION Category, on the right-hand side of this page, just below Recent Comments. We hope you will find them of interest.
Our thanks to ACAPress for access to these materials!
Sports Management:
Introduction to Sports-related Health Care
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 1 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 1: Introduction to Sports-related Health Care
If you were to ask the average coach about the responsibilities of an athlete, he would most likely reply that he or she was to conduct one’s self to the credit of the team, play fair, obey the officials, keep in training, be a credit to the sport, follow the rules, and enjoy the game: win or lose. This is the rhetoric commonly spooned to the naively inclined. If it were true, fewer sports injuries would be suffered.
With rare exception, even the Little Leaguer is commonly taught to WIN, drilled to disguise foul play from the eyes of the referees and umpires. Even in so-called noncontact sports, emphasis is often placed on getting the other team’s stars out of the game without causing injury to your own team. While conditioning is emphasized, the motivation is frequently on the preservation of a potential winning season rather than on prevention of a personal injury to a human being.
These words are harsh, but realistic. Yet, doctors handling athletic injuries must have a realistic appraisal of sports today if they are in good conscience to properly evaluate disability and offer professional counsel.
The Art of Evaluation
All people participating in vigorous sports should have a complete examination at the beginning of the season; and re-evaluation is often necessary at seasonal intervals. Re-evaluation is always necessary with cases where the candidate has suffered a severe injury, illness, or had surgery.
Evaluation begins with questioning. Because of drilled routine, any doctor is well schooled in the taking of a proper case history. But with an athletic injury, both obvious and subtle questions often appear. How extensive was the preseason conditioning? How much time for warm up is allowed before each game or event? What precautions are taken for heat exhaustion, heat stroke, concussion, and so forth? Does the coach make substitution immediately upon the first sign of disability for proper evaluation? How adequate is the protective gear? How many others on the team have suffered this particular injury this season?
Who, what, when, where, how, and WHY? These are the questions which must be answered before any positive course of health care can be extended. A detailed history of past illness and injury is vital. In organized sports, an outline of the regimen of training should be a part of the history, as well as a record of performance. Most sports will require a detailed locomotor evaluation of the player. Special care must be made in evaluating the preadolescent competitor because of the wide range of height, weight, conditioning, and stages of maturation. A defect may bar a candidate from one sport but not another, or it may be only a deterrent until it is corrected or compensated. Many famous athletes have become great in spite of a severe handicap.
The Physician’s Responsibilities
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For CAs: The Language of the Health-Care Professions
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“The Chiropractic Assistant”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 4: The Language of the Health-Care Professions
When more than one person is involved in any task, good communication is basic for success. Thus, a sound foundation in chiropractic terminology is an important functional skill to be possessed by any chiropractic assistant. It is a requisite to becoming an important asset to the office.
If a CA’s duties include taking dictation of case histories, examination findings, or narrative reports, she must know how to record scientific terms in shorthand and know how to spell them accurately. A good medical dictionary will be an important reference. Even if dictation is not required, she still must know what the doctor means when certain terms are used. He will expect his assistants to have a fundamental grasp of commonly used medical terms, abbreviations, and acronyms.
Do not enter this study lightly. On the other hand, do not let yourself be appalled by the formidable and specialized vocabulary used in health care. The learning of professional terms will not come overnight. It will extend the entire length of your career as new and unfamiliar words are confronted.
THE UNIVERSAL LANGUAGE OF HEALTH CARE:
WHY IT IS NECESSARY
It would not be unusual if you found many words used in the first three chapters of this program strange or at least unknown. When you undertake the transposition from lay person to chiropractic assistant, you are faced with an entirely new language that must be mastered so the transition be successful. The most efficient method to accomplish this is by securing an understanding of basic word roots, prefixes, and suffixes used in the formation of technical words and gaining an understanding of the meaning of commonly used abbreviations and acronyms. Study and repetitive use is the way to mastery.
A fundamental knowledge of anatomy (structure) and physiology (function) will be of great assistance in learning terminology. A basic understanding of human anatomy and physiology is offered in the following chapter. This chapter will prepare you for the terminology of those and other clinical subjects. While professional terms may at first seem strange, you will see their purpose in this and following chapters.
PHONETICS: THE QUICK WAY TO GRASP MEANINGS
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