Safety

Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety

By Frank M. Painter|March 24, 2017|Chiropractic Care, Pediatrics, Safety|

Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety: A Cross-sectional Survey

SOURCE: J Manipulative Physiol Ther. 2016 (Sep); 39 (7): 487–493

Katherine A. Pohlman, DC, MS, Linda Carroll, PhD,
Lisa Hartling, PhD, MSc, Ross Tsuyuki, PharmD, MSc,
Sunita Vohra, MD, MSc

Research Institute,
Parker University,
Dallas, TX.

OBJECTIVE: The purpose of this cross-sectional survey was to evaluate attitudes and opinions of doctors of chiropractic (DCs) specializing in pediatric care toward patient safety.

METHODS: The Medical Office Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality was adapted for providers who use spinal manipulation therapy and sent out to 2 US chiropractic organizations’ pediatric council members (n = 400) between February and April 2014. The survey measured 12 patient safety dimensions and included questions on patient safety items and quality issues, information exchange, and overall clinic ratings. Data analyses included a percent composite average and a nonrespondent analysis.

RESULTS: The response rate was 29.5% (n = 118). Almost one- third of respondents’ patients were pediatric (≤17 years of age). DCs with a pediatric certification were 3 times more likely to respond (P < .001), but little qualitative differences were found in responses. The patient safety dimensions with the highest positive composite percentages were Organizational Learning (both administration and clinical) and Teamwork (>90%). Patient Care Tracking/Follow-up and Work Pressure and Pace were patient safety dimensions that had the lowest positive composite scores (<85%). The responses also indicated that there was concern regarding information exchange with insurance/third-party payors. Two quality issues identified for improvement were (1) updating a patient’s medication list and (2) following up on critically abnormal results from a laboratory or imaging test within 1 day. The average overall patient safety rating score indicated that 83% of respondents rated themselves as “very good” or “excellent.”

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Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects

By Frank M. Painter|January 29, 2015|Safety, Spinal Manipulation|

Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects: A Preliminary Report of a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: Dis Markers. 2014; 2014 :815379

A. Achalandabaso, G. Plaza-Manzano, R. Lomas-Vega, A. Martínez-Amat,
M. V. Camacho, M. Gassó, F. Hita-Contreras, and F. Molina

Centro de Fisioterapia y Psicología Soluciona,
18002 Granada, Spain.

Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention.

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FDA’s NSAID Panel Nixes Naproxen Safety Claim

By Frank M. Painter|February 11, 2014|Iatrogenic Injury, NSAIDs, Safety|

FDA’s NSAID Panel Nixes Naproxen Safety Claim

The Chiro.Org Blog

SOURCE: MedPage Today ~ 2-11-2014

By John Gever, Deputy Managing Editor, MedPage Today

In 16-9 vote, the FDA advisory committee assessing NSAID safety said the warning label on naproxen should not be changed to suggest it has a better cardiovascular risk profile than other drugs in this class.

Those voting “No” on the question indicated that the current evidence on naproxen’s safety — much of which was indirect, coming from studies in which it served as a comparator to a coxib drug — did not meet the standards necessary to support label statements.

The panel — comprising members of FDA’s arthritis and risk management committees — split more closely on a question about label information on the duration of NSAID treatment that raises cardiovascular safety risks.

Currently, labels for these drugs say that short-term treatment is relatively safe; however, some recent studies have sown doubt. A total of 14 panel members said the current statement should be reconsidered, while 11 voted No.

However, most of those in the latter camp indicated in post-vote discussion that they believed there is no completely safe dosing period.

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The Treatment Experience of Patients With Low Back Pain During Pregnancy

By Frank M. Painter|October 10, 2012|Chiropractic Care, Pregnancy, Safety|

The Treatment Experience of Patients With Low Back Pain During Pregnancy

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Oct 9)

Shabnam Sadr, Neda Pourkiani-Allah-Abad and Kent Jason Stuber

Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3 J1, Canada

Background Chiropractors regularly treat pregnant patients for low back pain during their pregnancy. An increasing amount of literature on this topic supports this form of treatment; however the experience of the pregnant patient with low back pain and their chiropractor has not yet been explored. The objective of this study is to explore the experience of chiropractic treatment for pregnant women with low back pain, and their chiropractors.

Methods This qualitative study employed semi-structured interviews of pregnant patients in their second or third trimester, with low back pain during their pregnancy, and their treating chiropractors in separate interviews. Participants consisted of 11 patients and 12 chiropractors. The interviews consisted of 10 open-ended questions for patients, and eight open-ended questions for chiropractors, asking about their treatment experience or impressions of treating pregnant patients with LBP, respectively. All interviews were audio-recorded, transcribed verbatim, and reviewed independently by the investigators to develop codes, super-codes and themes. Thematic saturation was reached after the eleventh chiropractor and ninth patient interviews. All interviews were analyzed using the qualitative analysis software N-Vivo 9.

Results Five themes emerged out of the chiropractor and patient interviews. The themes consisted of Treatment and Effectiveness; Chiropractor-Patient Communication; Pregnant Patient Presentation and the Chiropractic Approach to Pregnancy Care; Safety Considerations; and Self-Care.

Conclusions Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.

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From the Full-Text Article:

Background:

Low back pain (LBP) during pregnancy is reported by approximately 50% to 80% of pregnant women [1-3]. The structural, postural, or hormonal changes that occur during pregnancy, or any combination thereof, may lead to LBP during pregnancy [3]. Treatment options include a range of therapies, such as exercise programs, massage therapy, acupuncture, and chiropractic [4, 5]. Chiropractic care may include spinal manipulative therapy (SMT), mobilizations and soft tissue therapy, as well as exercise prescription. [3] Previous studies and systematic reviews of the literature have indicated the relative safety and effectiveness of chiropractic treatment for LBP during pregnancy. [3, 5, 7]

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Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction

By Frank M. Painter|August 16, 2012|Patient Satisfaction, Safety, Upper Cervical Adjusting|

Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction Associated with Upper Cervical Chiropractic Care: A Prospective, Multicenter, Cohort Study

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2011 (Oct 5); 12: 219

Kirk Eriksen, Roderic P Rochester, and Eric L Hurwitz

Chiropractic Health Institute, PC, Clinic Director, 2500 Flowers Chapel Road, Dothan, AL 36305, USA. drkirke@graceba.net

BACKGROUND: Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.

METHODS: Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included:

Neck pain disability index (100-point scale),
Oswestry back pain index (100-point scale),
11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain,
treatment satisfaction, and
Symptomatic Reactions (SR).

Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.

RESULTS: A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.

CONCLUSIONS: Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.

From the FULL TEXT Article:

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Newer antimicrobial therapies proposed may lead to resistance of human innate immune response.

By stevev|February 23, 2012|Ethics, Fever Management, General Health, Health Care, Immune Function, Immune System, Medicine, Public Health, Research, Safety|

One current trend into fighting antibiotic resistant bacteria is developing a new class refered to as antimicrobial peptides (AMP’s). However a newly published study published¹ a proof of concept that bacteria will develop not only resistance to these new drugs but to our own innate immune response peptides as well.

A very nice summary of the findings was published in the latest issue of The Scientist online magazine.²

1. G. J. L. Habets, Michelle, and Michael Brockhurst. “Therapeutic
antimicrobial peptides may compromise natural immunity .” Biology Letters. N.p., n.d. Web. 23 Feb. 2012. <http://rsbl.royalsocietypublishing.org/content/early/2012/01/20/rsbl.2011.1203

2. Richards, Sabrina. “Antimicrobial Cross-Resistance Risk | The Scientist.” The Scientist. N.p., 24 Jan. 2012. Web. 23 Feb. 2012. <http://the-scientist.com/2012/01/24/antimicrobial-cross-resistance-risk/

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