Evidence-based Medicine

For CAs: The Language of the Health-Care Professions

By Frank M. Painter|March 31, 2013|Chiropractic Care, Chiropractic Education, Education, Evidence-based Medicine|

For CAs: The Language of the Health-Care Professions

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 (more…)

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The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

By Frank M. Painter|March 27, 2013|Evidence-based Medicine, Spinal Manipulation, Stroke|

The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

The Chiro.Org Blog

SOURCE: PLoS ONE 2013 (Mar 20); 8 (3): e59170

Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk

Texas Chiropractic College,
Pasadena, Texas, United States of America.

Background Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

Purpose 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and
2) assess the quality of these reports.

Methods A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

Results Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

Conclusions This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Copyright: © 2013 Wynd et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Greg Kawchuk receives salary support from the Canada Research Chairs program. Sunita Vohra receives salary support from Alberta Innovates-Health Solutions. Training support for Shari Wynd was provided by the Alberta Canadian Institutes of Health Research (CIHR) Training Program in Bone and Joint Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

From the Full-Text Article:

Introduction

In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1, 2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2]. While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. More specifically, injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with cSMT [5-7]. Although this subset of adverse events appears to occur infrequently [1, 8, 9], understanding the relation between CADs, stroke and cSMT is important given the medical [7], societal [1], economic [9], and legal [8] implications of any event leading to cerebrovascular compromise.

Read the rest of this Full Text article now!

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Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain

By Frank M. Painter|March 26, 2013|Algorithm, Chiropractic Care, Chronic Pain, Evidence-based Medicine, Spinal Manipulation|

Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain

The Chiro.Org Blog

SOURCE: Top Integrative Health Care 2012 (Dec 31); 3 (4)

Gregory A. Baker, DC, Ronald J. Farabaugh, DC,
Thomas J. Augat, DC, MS, CCSP, FASA,
Cheryl Hawk, DC, PhD, CHES

The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3]

Introduction:

The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3] Their recommendations were based on a combination of consideration of the current evidence and their clinical judgment. In addition, another consensus document related to care rendered by doctors of chiropractic for the purpose of health promotion, disease prevention, and wellness, developed through a project funded by the NCMIC Foundation, was also referenced to clarify terminology used in the algorithms. [4] (See Table 1.)

There are more articles like this @ the:

Clinical Model for the Diagnosis and Management Page and the:

Chronic Neck Pain and Chiropractic Page and the:

Low Back Pain and Chiropractic Page

Table 1.
Definition of terms related to acute and chronic care

The terms “supportive care” and “maintenance care,” which are frequently used within the chiropractic health care arena, are not consistent with general healthcare industry lexicon. Instead of “supportive care,” we use the more descriptive term, “ongoing/recurrent” care.

Chronic pain management can be divided into three categories:

those who can home manage;
those who can be managed with episodic care; and
those who need “scheduled” ongoing care, which is a very small proportion of chronic pain sufferers. Those patients require proper documentation of responses to care and procedures, including therapeutic withdrawal response, multi-modal, multi-disciplinary consideration, patient education, etc.

(more…)

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There Will Never Be Enough Research To Satisfy Our Critics

By Frank M. Painter|January 24, 2013|Chiropractic Care, Evidence-based Medicine, Health Care Reform, Patient Satisfaction, Spinal Manipulation|

There Will Never Be Enough Research To Satisfy Our Critics

The Chiro.Org Blog

A Chiro.Org Editorial

For some, there will never be enough research to support the use of chiropractic. These people will forever hide behind the claim that they wish to protect patients from quackish practices.

For those who may have forgotten, or for those who never knew, organized medicine spent decades and tens of millions of dollars trying to discredit and destroy chiropractic. Today, the vestiges of that oppression is still found on fringe web sites that ignore the body of peer-reviewed research supporting chiropractic care.

The Wilk anti-trust case against the AMA and 20 other named medical groups revealed that the AMA Plan was to:

Undermine Chiropractic schools
Undercut insurance programs for Chiropractic patients
Conceal evidence of the effectiveness of Chiropractic care
Subvert government inquires into the effectiveness of Chiropractic, and
Promote other activities that would control the monopoly that the AMA had on health care
They even threatened their own ranks: any MD who taught in our schools, performed research with chiropractors, or accepted a referral from, or made a referral to a chiropractor, would lose their hospital privileges, leaving them unable to treat patients.

while, all along, they knew that:<

There also was some evidence before the Committee that chiropractic was effective – more effective than the medical profession in treating certain kinds of problems such as workmen’s back injuries.

The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.
(Opinion pp. 7)

(more…)

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Medical Students Take the Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ)

By Frank M. Painter|January 24, 2013|Evidence-based Medicine, Outcome Assessment|

Medical Students Take the Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ)

The Chiro.Org Blog

SOURCE: Evidence-based Complementary and Alternative Medicine (eCAM) 2011 (Apr 14)

Center for East-West Medicine,
Department of Medicine,
David Geffen School of Medicine,
University of California,
Los Angeles, CA, USA

While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students’ attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007.

Factor analysis of the CAIMAQ revealed five distinct attitudinal domains:

desirability of CAIM therapies,
progressive patient/physician health care roles,
mind-body-spirit connection,
principles of allostasis and
a holistic understanding of disease.

The students held the most positive attitude for the “mind-body-spirit connection” and the least positive for the “desirability of CAIM therapies”. This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable. (more…)

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When Research Challenges Our Assumptions

By Frank M. Painter|September 8, 2012|Chiropractic Care, Evidence-based Medicine, Guidelines, Health Care Reform, Health Promotion|

When Research Challenges Our Assumptions

The Chiro.Org Blog

SOURCE: ACA News ~ Sept 2012

By Daniel Redwood

When new research, research reviews or practice guidelines support our current beliefs and practices, enthusiasm comes easily. When the 2007 medical practice guidelines on low back pain (LBP) jointly prepared by the American Pain Society and the American College of Physicians recognized spinal manipulation as the only non-pharmacologic method providing “proven benefits” for acute LBP and as one of several methods (including exercise, rehabilitation, acupuncture and yoga) proven effective for chronic LBP, the American Chiropractic Association and doctors of chiropractic (DCs) everywhere welcomed this as a long-overdue recognition of the value of our primary treatment methods.

But when research challenges our assumptions, our responses are understandably mixed. Such findings, if confirmed in multiple studies, may create pressure to change our practice patterns or threaten reimbursement from insurance companies. Like members of other health professions, DCs do not find such developments pleasant. How we and members of other health professions respond to such research says a great deal about who we are, how fully we practice what we preach, and the depth of our commitment to providing the best possible care to our patients. (more…)

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