For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Jul 2007
Issue 6
21/07/07 11:39
Willingness of emergency department patients with musculoskeletal complaints to participate in complementary and alternative medicine research.
CJEM. 2002 Nov;4(6):401-7.
Abu-Laban RB, van Beek CA, Quon JA, Wu J.
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
BACKGROUND: The emergency department (ED) is a unique potential location for recruitment into studies of complementary and alternative medicine (CAM) therapies. We sought to determine the stated willingness of ED patients with musculoskeletal complaints to participate in CAM research for their presenting problem, and to determine the characteristics of this population.
METHODS: The study was carried out in the ED of Vancouver General Hospital weekdays between 10 am and 6 pm from Oct. 16, 2000, to Nov. 21, 2000. All adults who presented with musculoskeletal complaints involving the spine, upper extremity or lower extremity, unless they had pain severe enough to impair their ability to answer questions or unless there was a language or other communication barrier, were approached by a research nurse. If it was learned that they had already been assessed by an emergency physician, they were eliminated as potential study participants. After being presented background information by the research nurse, consenting patients were asked a series of standardized questions during a 15-minute private interview prior to their assessment by an emergency physician.
RESULTS: Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). The mean age of those studied was 38 years, and 56% were male. Most presenting problems involved the ankle/foot (29%), multiple sites (19%), the lumbosacral region (14%) or the wrist/hand (14%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74% (69/93: 95% confidence interval [CI] 64.1%-82.7%); chiropractic 70% (65/93: 95%CI 59.5%-79.0%); and other CAM therapies 92% (86/93: 95%CI 85.1%-96.9%). Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study. Logistic regression modeling, performed for secondary purposes, indicated that willingness to participate in traditional Chinese medicine or chiropractic research was independent of age, sex, educational status, pain severity or prior exposure to the modality of interest.
CONCLUSIONS: ED patients with musculoskeletal complaints have a high stated willingness to participate in CAM research, even if this involves outpatient follow-up or a placebo-controlled design. ED-based CAM research appears feasible and should be pursued.
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SAFETY EXPERTS SAY TOO LITTLE IS BEING DONE TO STOP PATIENTS BEING HARMED OR EVEN KILLED BY AVOIDABLE ERRORS. HEALTH EDITOR ADAM CRESSWELL REPORTS
Health editor Adam Cresswell reports
July 14, 2007 Weekend Australian
PATRICIA Skinner has experienced the sharp end of medical mistakes. She spent 18 months with a pair of 15cm scissors in her abdomen.
Why? Because doctors forgot to take them out at the end of an operation.
"It was agony ... my husband would drive over a bump in the road, and I would scream,'' recalls Skinner. "My husband would say, `What's the matter with you?', and I thought I had cancer. I said to my doctor, `I feel like I've been knocked to the ground and someone's been kicking me with steel-capped boots'.''
In a way, of course, something had. But unfortunately for Skinner, now 79, for some time medical staff refused to believe anything was wrong. She had had major surgery, they told her; what did she expect?
The truth was only discovered after Skinner herself eventually insisted on an X-ray, which was performed at Sydney's St George Hospital in October 2002, 18 months after surgery at the same hospital to remove bowel polyps.
"They did the X-ray twice, because I don't think they could believe what they were seeing,'' Skinner says.
She went straight back to the hospital, and had surgery to remove the scissors the very next day. But after so long inside her, the scissors - which in the meantime had moved from her abdomen to near her coccyx, the tailbone at the base of the spine - had become partially overgrown by her own tissues. To get them out, doctors had to cut out a chunk of Skinner's bowel as well.
What she wanted then was an explanation of how it could have happened, but Skinner and husband Don had little joy here either. "They said at the time that scissors were `too big to lose', which was absolute nonsense,'' Skinner tells Weekend Health. "Was somebody off sick, or was somebody working for hours and gOt tired? I said there must have been a reason, but I wasn't allowed to talk to anybody. If you can understand what happened, you think, `OK, I can accept that'. But when you don't know, there's nothing to accept.''
The X-ray images and her story were reported around the world, and eventually Skinner, now 72, accepted compensation from the hospital, the size of which is confidential. The hospital also changed its counting procedures to make sure equipment is properly accounted for after operations.
Sadly, as Australia's first national report on serious mistakes shows, Skinner's experience is far from unique, either in terms of the mistake or the culture of secrecy and denial that surrounded it.
The report, published this week by the Australian Institute of Health and Welfare and the Australian Commission on Safety and Quality in Health Care, recorded 130 instances of "sentinel events'' reported by 759 public hospitals in 2004-05. These events fell into one of eight categories of serious events that were agreed by Australian Governments in 2004.
As The Australian reported this week, nearly half (41 per cent) of the 130 events were in the category of wrong site or wrong patient - where an operation or test was performed on the wrong part of the patient's body, or on the wrong patient altogether. Retained instruments - the category that Skinner would have fallen into - took second place, accounting for 27 cases.
The factors that contributed to these and other incidents were varied: staff ending their shift giving inadequate briefings to other staff starting a shift, or staff acting when they didn't know the full facts. For example, in one incident a patient was transfused wiTh blood intended for another patient with an incompatible blood type - a potentially fatal mistake - because the co-ordinating nurse only knew of one transfusion request, and when a courier delivered some blood she assumed - wrongly - that it was meant for that patient.
Other reasons included staff not following rules or guidelines, or not recording information on charts or other documents properly.
The report's authors say the reasons for doctors and nurses not reporting mistakes in the past include "fear of litigation and adverse publicity'', and admit that while low, the numbers of sentinel events in this week's report are likely to rise in future editions as doctors and nurses start to feel more comfortable about owning up after something has gone wrong. Even so, outgoing commission chief executive Diana Horvath rejected suggestions the numbers were merely the tip of the iceberg, claiming they were instead "a substantial part of it''.
But independent safety experts disagree, and it's not as if you have to look far to find other examples of medical mistakes every bit as horrifying as that which happened to Pat Skinner.
In a bulletin sent to its members earlier this year, doctors' insurance company MDA National revealed an unnamed 24-year-old patient suffered nightmares after a "throat pack'' - a wad of absorbent gauze or dressing to soak up blood and other fluids during surgery - was left in place after prolonged oral surgery.
"The patient coughed up the throat pack some hours later on the (recovery) ward,'' the bulletin said. "He was very distressed ... although the pharynx was sucked out under direct vision at the end of the procedure, the bloodstained pack was not seen until the patient coughed it up several hours post-operatively.
"Sporadic reports of this complication continue to occur, sometimes with disastrous consequences for the patient.''
MDA National said measures that might help avoid repeat occurrences included labelling patients' foreheads if throat packs were used, and recording the pack on the list of items that have to be accounted for at the end of the procedure.
In another case in the same bulletin, a 35-year-old patient went to an emergency department complaining of severe renal colic. He asked for a painkiller called hydromorphone, also known as Dilaudid, which he had previously found to be the most effective medication.
Instead the doctor ordered hydromorphine - a drug eight times more powerful - because she did not realise the difference.
The bulletin said this patient did not suffer any negative long-term effects from the overdose, although it added that some other previous mix-ups involving hydromorphone "have resulted in patient deaths''.
This week's report said the reporting culture was improving, and numbers of reported events will be higher in future reports.
But other safety experts think Horvath's suggestion that this week's figures already represent a significant proportion of the problem is little short of ridiculous.
Steve Bolsin, associate professor of patient safety at Victoria's Geelong Hospital, says the "notion that 130 adverse events is the majority of the iceberg is completely erroneous.
Previous work has shown that between 5 and 10 per cent of admissions have adverse events associated with them, and things may be worse in general practice. So there's a huge need to begin to improve in these areas.''
Bolsin points to the findings of the groundbreaking Quality in Australian Health Care Study (QAHCS), published in the Medical Journal of Australia 12 years ago (1995;163:458-71), which claimed that up to 16 per cent of hospitalised patients would suffer an adverse event, and that 50 per cent of these would be preventable. Of these preventable events, 10 per cent would lead to permanent disability or death.
Some doctors have been bitterly critical of the QAHCS findings, saying it was biased and found a much higher rate of adverse events than a similar US study. Had the same analysis applied in Australia as in the US, they say, the rate of adverse events reported in QAHCS would have been up to 25 per cent less.
With 4.3 million hospitalisations in public hospitals in 2004-05, the QAHCS suggests Australia's toll of serious adverse events should be closer to 35,000 than 130. But even a 25 per cent pullback from that figure still paints a worrying picture.
A follow-up editorial in the MJA two years ago (2005;182:260-1) asked if there was any evidence that health care had become any safer in the decade since the 1995 report, and promptly answered the question itself: "Unfortunately, the answer is no''.
Adverse events are also associated with significant costs.
Another study in the MJA last year (2006;184:551-5), conducted in 45 major Victorian hospitals, found each adverse event contributed an extra $6826 in costs, and the total cost for all the events in the participating hospitals in 2003-04 was $460 million - over 15 per cent of direct hospital costs.
Bolsin says there are "an incredible number of adverse events going on that are not being reported'' through the existing channels. However, a pioneering scheme already piloted at his own hospital in Geelong could hold the answer.
For the pilot, 14 anaesthetic registrars used personal digital assistants (PDAs) fitted with special software to report adverse events to a central database, identifying them in one of four categories - events causing death, serious outcomes such as extended hospital stay or permanent harm, transient or minor harm, and "near miss'' adverse events that had no bad effect on the patient. Researchers combed through the notes of cases where no incidents had been reported, to check how many incidents had been missed.
The findings, reported last year in the International Journal for Quality in Health Care (2006;18(6):452-7), found an adverse incident was reported for 156, or 3.5 per cent of the 4441 anaesthetic procedures reported, nearly half (46.2 per cent) of which were near misses.
Only one incident was identified in the case notes as having been missed, giving a reporting rate via PDAs of 99.5 per cent - far higher than has been achieved anywhere else in the world. Bolsin says PDAs can also be used to download appropriate clinical practice guidelines and other relevant information to help guide doctors, use of which he says has been proven to improve treatment outcomes.
So far, however, there has been limited enthusiasm from health bureaucrats for implementing a PDA-based system for adverse event reporting. "If we are really serious about safety in health care, we have to start using these technologies, and we have to start using them effectively and constructively,'' Bolsin says.
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Calls for tighter drug monitoring
Adam Cresswell | July 14, 2007 The Weekend Australian
DRUG safety experts have called on the federal Government to tighten monitoring procedures that can detect harmful drug side-effects.
The experts say existing methods remain relatively ineffectual.
More rigorous clinical studies and improved systems for picking up problems that only emerge after a new drug has appeared on the market should all be considered, they say amid claims that a recent controversy over a well-known brand of sleeping pill has exposed flaws in the current systems.
The criticism comes despite a move by the federal Government this week to intervene and save from closure a consumer medicines hotline which provides people with a means to report instances of suspected adverse events while taking drugs.
The Brisbane-based Adverse Medicine Events Line was to close at the end of this month when funding by its current sponsor, the pharmacy umbrella group the Pharmacy Guild, was to run out.
The hotline was mainly responsible for alerting Australia's medicines regulator, the Therapeutic Goods Administration, to the full extent of the disturbing reactions to the sleeping pill Stilnox.
The TGA's adverse events monitoring body, the Adverse Drug Reactions Advisory Committee, had put out a bulletin in 2002 saying it had received 72 reports of strange psychiatric effects in people taking the drug in the two years since its Australian release.
But it wasn't until February this year that ADRAC warned of "bizarre sleep-related effects'' linked to Stilnox, prompted by 24 reports of such cases, many of them through the hotline.
The cases reported in the February bulletin - which preceded similar warnings in the US - including cases of patients eating from the fridge or driving cars while asleep. One patient put on 23 kilograms over seven months, and her bemused family only discovered why when she was found eating in front of an open refrigerator while asleep. Another patient woke with a paintbrush in her hand after painting the front door while asleep.
In this week's announcement the Government said it had agreed to keep the service running for another 12 months, during which time longer-term funding options to keep it going indefinitely will be explored. The cost of the 12-month extension is not yet known.
In a statement, health minister Tony Abbott said the funding would "ensure that consumers are provided with a way to seek help with, or report, adverse reactions to medicines''.
Hotline manager and clinical pharmacist doctor Geraldine Moses said the hotline had probably received about 900 calls about Stilnox over a four-month period this year.
She said she was "very grateful and very excited'' at the extra funding. Although negotiations on the cost were still under way, the hotline had asked for $400,000 to fund the 12 months of operation, she said.
"It's a short-term solution,'' Moses said. "We are going to be entering negotiations with the National Prescribing Service and the Therapeutic Goods Administration to see if we can come up with some sort of long-term solution. This gives us some breathing-space.''
However, drug experts said Australia's systems for detecting problems with drugs would remain sadly lacking, even after the hotline's welcome reprieve.
Ken Harvey, Adjunct Senior Research Fellow in the School of Public Health at La Trobe University, said much more rigorous surveillance of drugs was required after they were put on sale, including measures to force drug giants to conduct effective large-scale studies. "It's good the Government's doing it (saving the hotline), but more needs to be done,'' Harvey said. "I certainly support what Geraldine Moses is doing. But you are still left with (a system of) spontaneous reporting, and we know that's not good enough.
"There's a move going on globally to get a much more rigorous post-marketing surveillance of drugs. Drug companies should be encouraged to do better studies, and to get good data, and you really need good population studies.''
The February bulletin reporting the bizarre effects of Stilnox attracted massive media publicity, and further reports to the hotline spiked as a result. The TGA says that up until May 25 ADRAC had received 727 reports about Stilnox, with 208 reports concerning "abnormal sleep-related event, sleep walking, and/or sleep talking'' - with all but 24 of the latter category coming in after the February bulletin.
"This rapid increase in reported side-effects following media attention on the issue of Stilnox is a phenomenon known as `stimulated reporting','' says a report on the TGA's website.
"Regulators must interpret the results of stimulated reporting with great care as the effect of media attention may be to overestimate the number of adverse reactions related to a medicine.
"This in turn may result in an overestimate of the risk side of any risk-benefit analysis conducted by the regulator.''
A spokesman for the drug industry umbrella group Medicines Australia said companies already had an obligation to report adverse efffects to the TGA.
"If the TGA had a concern they would work with the company to conduct post-marketing surveillance, and that process can be initiated by the company or by the TGA,'' he said.
"Before medicines are allowed to be sold in Australia they have to have been through rigorous clinical trials to make sure the benefit outweighs the risk. These trials won't necessarily pick up one-in-a-million side-effects, but that's why companies and the TGA continue to monitor medicines' safety once medicines are in general use.
"The TGA is certainly moving towards requiring companies to have risk-management plans for new medicines when they evaluate these new medicines, and that's being introduced now.''
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Quote:
Usefulness of sickness.
– "He who is often sick does not only have a much greater enjoyment of health on account of the frequency with which he gets well: he also has a greatly enhanced sense of what is healthy and what is sick in works and actions, his own and those of others: so that it is precisely the sickliest writers, for example – and almost all the great writers are, unfortunately, among them – who usually evidence in their writings a much steadier and more certain tone of health, because they understand the philosophy of psychical health and recovery better and are better acquainted with its teachers – morning, sunshine, forests and springs – than the physically robust.”
-- Human, All Too Human, 1886, Nietzsche
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Sciatica An archaic term
BMJ 2007;335:112 (21 July), doi:10.1136/bmj.39275.951343.BE
Letters
In their clinical review Koes et al use the entirely non-evidence-based term "sciatica."1 From the Greek, it literally means hip pain. In English, the Oxford English Dictionary gives precedent to a quote from Shakespeare's Timon of Athens (act IV, scene I), where sciatica is a curse placed on the senators. None of this is a good basis for current usage, which is supposed to describe nerve root or radicular pain, as the authors note but do not discuss.
The problem is that patients with back pain may also have referred pain, a phenomenon first pointed out by Kellgren over 60 years ago.2 Clinicians are not good at making this distinction, but they should at least try. This issue takes on greater importance when studying the evidence base where often this distinction is not made. Persistent use of the archaic word sciatica in the clinical setting is not in the best interests of people with a miserable and disabling condition. It remains an effective curse, but English terms such as nerve root pain or radicular pain better describe the clinical problem.
Jeremy C T Fairbank, consultant orthopaedic surgeon
Nuffield Orthopaedic Centre, Oxford OX3 7LD
jeremy.fairbank@ndos.ox.ac.uk
Competing interests: None declared.
References
1. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ 2007;334:1313-7. (23 June.)[Free Full Text]
2. Kellgren J. Sciatica. Lancet 1941;i:561-4.
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Review
Yoga as a Complement to Chiropractic Care
Sudhanva Char, Ph.D, Lee Carroll, Ph.D.
[July 19, 2007, pp 1-9]
Objective:To examine topical aspects of each of the two wellness modalities of chiropractic and yoga and consider the potential benefit yoga may have as a complement to chiropractic care.
Methods: A search of relevant research and other material included: The Yoga Institute of India; the Central Research Institute of Yoga; the Swami Vivekananda Yoga Research Foundation of Bangalore; the Mind-Body Medical Institute of MA; the team care plan of Bay Area Pain Program Los Gatos, California; a number of US Universities; The Union of the Swami Vivekananda Yoga Anusandhana Samsthana and the University of Texas MD Anderson Cancer Center.
Discussion: The authors examined relevant scientific papers that serve as evidence of measurable positive effects resulting from specific yogic interventions affecting the nervous system. This evidence includes such things as: mechanoreceptor and parasympathetic stimulation, head posture correction, erector spinae balance, enhanced cardiovascular and respiratory function, connective tissue stretch and headache relief to maximal athletic performance.
Conclusion: There is the beginning of valid scientific research demonstrating areas of overlap for practitioners to consider in creating a complementary-care plan; with future research hopefully focusing on an integrated wellness program of yoga practice and chiropractic care.
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Issue 5
09/07/07 12:15
Welcome
to Issue 5
Can fasting help prevent disease?
Alternate-day fasting and chronic disease prevention: a review of human and animal trials
Krista A Varady and Marc K Hellerstein
Calorie restriction (CR) and alternate-day fasting (ADF) represent 2 different forms of dietary restriction. Although the effects of CR on chronic disease prevention were reviewed previously, the effects of ADF on chronic disease risk have yet to be summarized.
Accordingly, we review here animal and human evidence concerning ADF and the risk of certain chronic diseases, such as type 2 diabetes, cardiovascular disease, and cancer. We also compare the magnitude of risk reduction resulting from ADF with that resulting from CR. In terms of diabetes risk, animal studies of ADF find lower diabetes incidence and lower fasting glucose and insulin concentrations, effects that are comparable to those of CR. Human trials to date have reported greater insulin-mediated glucose uptake but no effect on fasting glucose or insulin concentrations. In terms of cardiovascular disease risk, animal ADF data show lower total cholesterol and triacylglycerol concentrations, a lower heart rate, improved cardiac response to myocardial infarction, and lower blood pressure. The limited human evidence suggests higher HDL-cholesterol concentrations and lower triacylglycerol concentrations but no effect on blood pressure.
In terms of cancer risk, there is no human evidence to date, yet animal studies found decreases in lymphoma incidence, longer survival after tumor inoculation, and lower rates of proliferation of several cell types.
The findings in animals suggest that ADF may effectively modulate several risk factors, thereby preventing chronic disease, and that ADF may modulate disease risk to an extent similar to that of CR. More research is required to establish definitively the consequences of ADF.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 7-13, July 2007
© 2007 American Society for Nutrition
Australians live longer, says UN poll
July 9, 2007
Australia has one of the highest life expectancies in the world, according to a new United Nations report.
The State of the World Population 2007 report prepared by the United Nations Population Fund reveals Australian women live to 83.4 years on average and men to 78.4 years. This is higher than the average life expectancy of what the report terms "more developed regions",
which stands at 79.8 years for women and 72.5 years for men.
The average life expectancy across the globe is 68.6 years for women and 64.2 years for men.
Of the 153 countries listed, only two had higher life expectancies than Australia for both genders.
In Hong Kong, men can expect to live to 79.2 years and women to 85.1 years while in Japan women survive for 86.3 years and men for 79.1 years.
AAP
Copyright © 2007. The Sydney Morning Herald
There is good evidence that getting rid of that gut ("waist girth") will avoid some of the wonderful cardiac procedures out there
Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Chong-Do Lee, et al.
Background: Whether abdominal obesity is related to coronary artery calcification (CAC) is not known.
Objective: We investigated the relations of waist girth and waist-hip ratio (WHR) to CAC in 2951 African American and white young adults from the Coronary Artery Risk Development in Young Adults Study.
Design: The present study was a cross-sectional and observational cohort study. Using standardized protocols, we measured CAC in 2001–2002 by using computed tomography and measured waist and hip girths in 1985–1986 (baseline), 1995–1996 (year 10), and 2001–2002 (year 15, waist girth only). CAC was classified as present or absent, whereas waist girth and WHR were placed in sex-specific tertiles.
Results: After adjustment for age, sex, race, clinical center, physical activity, cigarette smoking, education, and alcohol intake, baseline waist girth and WHR were directly associated with a higher prevalence of CAC 15 y later (P for trend < 0.001 for both). The odds ratios (ORs) for CAC in the highest versus lowest tertiles of waist girth and WHR were 1.9 (95% CI: 1.36, 2.65) and 1.7 (1.23, 2.41), respectively. Waist girth and WHR at year 10 and waist girth at year 15 similarly predicted CAC. These associations persisted after additional adjustment for systolic blood pressure, fasting insulin concentrations, diabetes, and antihypertensive medication use but became nonsignificant after additional adjustment for blood lipids.
Conclusions: Abdominal obesity measured by waist girth or WHR is associated with early atherosclerosis as measured by the presence of CAC in African American and white young adults. This is consistent with an involvement of visceral fat in the occurrence of coronary artery calcium in young adults.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 48-54, July 2007
© 2007 American Society for Nutrition
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Hi Joe,
Ever seen a discectomy.
This would be good for the blog.
Donald
http://www.spine-health.com/dir/lumbarmicroendodiscectomy.html
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Joe,
All the hard work is done in these.
D
Check No 2, No 1, and 5.
Donald
http://www.chiroltd.com/FREESTUFF.htm
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Measles Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
News
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June)
EXERCISE: You need far less than you think in order to stay fit
How much exercise do you really need in order to be fit?
Apparently, it's far less than we've been told by government health agencies, who reckon on 20 minutes a day.
Researchers have discovered that people who walk or cycle for just half that amount – 72 minutes a week, or just over 10 minutes every day – improve their overall fitness by 4.2 per cent.
Double the exercise time and your fitness level will improve by 6 per cent, while those who walk or cycle for 27 minutes every day can see an 8 per cent improvement.
The other good news is that everyone – in all the exercise groups – saw a 2cm average reduction in their waist measurement, and that's without changing their diet.
However, none of the group – made up of post-menopausal women who lived mainly sedentary lives – lost weight, and their cardiovascular risk factors didn't reduce, either.
So some level of fitness is attainable for pretty much all of us, just as long as we're prepared to walk 10 minutes every day.
(Source: Journal of the American Medical Association, 2007; 297: 2081-91).
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Marginalization.
NB:This is a good word to describe how medicine tries to contain certain professions.
Piercing the veil: The marginalization of midwives in the United States
University of Colorado at Denver and Health Sciences Center, PO Box 6511, Campus Box 8309, 80045 Aurora, CO, USA
Social Science & Medicine. Volume 65, Issue 3, August 2007, Pages 610-621
Abstract
This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US.
This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care.
Currently midwives attend only 7% of births, compared to 50–75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing.
This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions.
These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
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hi joe,
Better patient care from the medical files.
Donald
Editorial
The Lancet 2007; 370:2
Evidence-based handshakes
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers.
Both papers consider patients' attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis' survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand.
The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication.
The Lancet
Measles
Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Every year about 20 million people worldwide, mainly children, contract measles. In 2005 there were 345 000 measles related deaths, but in developed countries that have taken eradication measures the disease is now rare. In 2004 the World Health Organization received reports of only 37 cases of measles in the United States.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June), doi:10.1136/bmj.39248.481701.DB
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Pain Guidelines, if you did not get them
Hi Joe,
Here is a link to the NHMRC Acute pain guidelines.
http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdf
It may be useful to have as a reference on the blog.
Donald
Can fasting help prevent disease?
Alternate-day fasting and chronic disease prevention: a review of human and animal trials
Krista A Varady and Marc K Hellerstein
Calorie restriction (CR) and alternate-day fasting (ADF) represent 2 different forms of dietary restriction. Although the effects of CR on chronic disease prevention were reviewed previously, the effects of ADF on chronic disease risk have yet to be summarized.
Accordingly, we review here animal and human evidence concerning ADF and the risk of certain chronic diseases, such as type 2 diabetes, cardiovascular disease, and cancer. We also compare the magnitude of risk reduction resulting from ADF with that resulting from CR. In terms of diabetes risk, animal studies of ADF find lower diabetes incidence and lower fasting glucose and insulin concentrations, effects that are comparable to those of CR. Human trials to date have reported greater insulin-mediated glucose uptake but no effect on fasting glucose or insulin concentrations. In terms of cardiovascular disease risk, animal ADF data show lower total cholesterol and triacylglycerol concentrations, a lower heart rate, improved cardiac response to myocardial infarction, and lower blood pressure. The limited human evidence suggests higher HDL-cholesterol concentrations and lower triacylglycerol concentrations but no effect on blood pressure.
In terms of cancer risk, there is no human evidence to date, yet animal studies found decreases in lymphoma incidence, longer survival after tumor inoculation, and lower rates of proliferation of several cell types.
The findings in animals suggest that ADF may effectively modulate several risk factors, thereby preventing chronic disease, and that ADF may modulate disease risk to an extent similar to that of CR. More research is required to establish definitively the consequences of ADF.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 7-13, July 2007
© 2007 American Society for Nutrition
Australians live longer, says UN poll
July 9, 2007
Australia has one of the highest life expectancies in the world, according to a new United Nations report.
The State of the World Population 2007 report prepared by the United Nations Population Fund reveals Australian women live to 83.4 years on average and men to 78.4 years. This is higher than the average life expectancy of what the report terms "more developed regions",
which stands at 79.8 years for women and 72.5 years for men.
The average life expectancy across the globe is 68.6 years for women and 64.2 years for men.
Of the 153 countries listed, only two had higher life expectancies than Australia for both genders.
In Hong Kong, men can expect to live to 79.2 years and women to 85.1 years while in Japan women survive for 86.3 years and men for 79.1 years.
AAP
Copyright © 2007. The Sydney Morning Herald
There is good evidence that getting rid of that gut ("waist girth") will avoid some of the wonderful cardiac procedures out there
Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Chong-Do Lee, et al.
Background: Whether abdominal obesity is related to coronary artery calcification (CAC) is not known.
Objective: We investigated the relations of waist girth and waist-hip ratio (WHR) to CAC in 2951 African American and white young adults from the Coronary Artery Risk Development in Young Adults Study.
Design: The present study was a cross-sectional and observational cohort study. Using standardized protocols, we measured CAC in 2001–2002 by using computed tomography and measured waist and hip girths in 1985–1986 (baseline), 1995–1996 (year 10), and 2001–2002 (year 15, waist girth only). CAC was classified as present or absent, whereas waist girth and WHR were placed in sex-specific tertiles.
Results: After adjustment for age, sex, race, clinical center, physical activity, cigarette smoking, education, and alcohol intake, baseline waist girth and WHR were directly associated with a higher prevalence of CAC 15 y later (P for trend < 0.001 for both). The odds ratios (ORs) for CAC in the highest versus lowest tertiles of waist girth and WHR were 1.9 (95% CI: 1.36, 2.65) and 1.7 (1.23, 2.41), respectively. Waist girth and WHR at year 10 and waist girth at year 15 similarly predicted CAC. These associations persisted after additional adjustment for systolic blood pressure, fasting insulin concentrations, diabetes, and antihypertensive medication use but became nonsignificant after additional adjustment for blood lipids.
Conclusions: Abdominal obesity measured by waist girth or WHR is associated with early atherosclerosis as measured by the presence of CAC in African American and white young adults. This is consistent with an involvement of visceral fat in the occurrence of coronary artery calcium in young adults.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 48-54, July 2007
© 2007 American Society for Nutrition
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Hi Joe,
Ever seen a discectomy.
This would be good for the blog.
Donald
http://www.spine-health.com/dir/lumbarmicroendodiscectomy.html
=-=-=-=-=--
Joe,
All the hard work is done in these.
D
Check No 2, No 1, and 5.
Donald
http://www.chiroltd.com/FREESTUFF.htm
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Measles Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
News
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June)
EXERCISE: You need far less than you think in order to stay fit
How much exercise do you really need in order to be fit?
Apparently, it's far less than we've been told by government health agencies, who reckon on 20 minutes a day.
Researchers have discovered that people who walk or cycle for just half that amount – 72 minutes a week, or just over 10 minutes every day – improve their overall fitness by 4.2 per cent.
Double the exercise time and your fitness level will improve by 6 per cent, while those who walk or cycle for 27 minutes every day can see an 8 per cent improvement.
The other good news is that everyone – in all the exercise groups – saw a 2cm average reduction in their waist measurement, and that's without changing their diet.
However, none of the group – made up of post-menopausal women who lived mainly sedentary lives – lost weight, and their cardiovascular risk factors didn't reduce, either.
So some level of fitness is attainable for pretty much all of us, just as long as we're prepared to walk 10 minutes every day.
(Source: Journal of the American Medical Association, 2007; 297: 2081-91).
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Marginalization.
NB:This is a good word to describe how medicine tries to contain certain professions.
Piercing the veil: The marginalization of midwives in the United States
University of Colorado at Denver and Health Sciences Center, PO Box 6511, Campus Box 8309, 80045 Aurora, CO, USA
Social Science & Medicine. Volume 65, Issue 3, August 2007, Pages 610-621
Abstract
This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US.
This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care.
Currently midwives attend only 7% of births, compared to 50–75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing.
This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions.
These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
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hi joe,
Better patient care from the medical files.
Donald
Editorial
The Lancet 2007; 370:2
Evidence-based handshakes
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers.
Both papers consider patients' attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis' survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand.
The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication.
The Lancet
Measles
Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Every year about 20 million people worldwide, mainly children, contract measles. In 2005 there were 345 000 measles related deaths, but in developed countries that have taken eradication measures the disease is now rare. In 2004 the World Health Organization received reports of only 37 cases of measles in the United States.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June), doi:10.1136/bmj.39248.481701.DB
-=-=-=-
Pain Guidelines, if you did not get them
Hi Joe,
Here is a link to the NHMRC Acute pain guidelines.
http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdf
It may be useful to have as a reference on the blog.
Donald
Issue 4
08/07/07 21:43
Welcome
to Issue 4
Direct Gaze
Seductive eyes: Attractiveness and direct gaze increase desire for associated objects
Madelijn Strick, Rob W. Hollanda and Ad van Knippenberga. Department of Social Psychology, Behavioural Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. Available online 28 June 2007.
Abstract
Recent research in neuroscience shows that observing attractive faces with direct gaze is more rewarding than observing attractive faces with averted gaze. On the basis of this research, it was hypothesized that object evaluations can be enhanced by associating them with attractive faces displaying direct gaze. In a conditioning paradigm, novel objects were associated with either attractive or unattractive female faces, either displaying direct or averted gaze. An affective priming task showed more positive automatic evaluations of objects that were paired with attractive faces with direct gaze than attractive faces with averted gaze and unattractive faces, irrespective of gaze direction. Participants’ self-reported desire for the objects matched the affective priming data. The results are discussed against the background of recent findings on affective consequences of gaze cueing.
This one may come as a surprise.
Are people with back pain really in need of exercise?
Curiously, how many times have you gotten a patient well, and they stated that they tried other therapy and all they got was exercises prescriptions?
Disuse and physical deconditioning in the first year after the onset of back pain
Pain; Volume 130, Issue 3, August 2007, Pages 279-286
Abstract
For years, physical deconditioning has been thought to be both a cause and a result of back pain. As a consequence physical reconditioning has been proposed as treatment-goal in patients with chronic low back pain (LBP). However, it is still unclear whether a patient’s physical fitness level really decreases after pain-onset.
The objectives of the present study were, firstly, to test the assumption that long-term non-specific LBP leads to a decrease of the level of physical activity (disuse), secondly, to evaluate any development of physical deconditioning as a result of disuse in CLBP, and thirdly, to evaluate predictors for disuse in CLBP. A longitudinal cohort study over one year including 124 patients with sub-acute LBP (i.e., 4–7 weeks after pain onset) was performed. Main outcome measures were change in physical activity level (PAL) and physical fitness (measured by changes in body weight, body fat and muscle strength) over one year.
Hypothesized predictors for disuse were: pain catastrophizing; fear of movement; depression; physical activity decline; the perceived level of disability and PAL prior to pain. Results showed that only in a subgroup of patients a PAL-decrease had occurred after the onset of pain, whereas no signs of physical deconditioning were found. Negative affect and the patients’ perceived physical activity decline in the subacute phase predicted a decreased level of PAL over one year.
Based on these results, we conclude that as to the assumption that patients with CLBP suffer from disuse and physical deconditioning empirical evidence is still lacking.
Surprise? Medicine not always using its own evidence?
Having recently had one of these, I was interested if what my cardiologist was doing was 'scientific'...apparently not...of course only chiropractors are unscientific, right?
Metoprolol Treatment to Prevent Restenosis following Percutaneous Transluminal Coronary Angioplasty
Damian Franzen, Nathalie Seifert, Angela Metha, Hans W. Höpp Klinik III für Innere Medizin, Universität zu Köln, Köln, Deutschland
Cardiology 2002;97:94-98 (DOI: 10.1159/000057679)
Abstract
This study tested the hypothesis that metoprolol reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) in native coronary arteries as compared to placebo. Apart from prognostic clinical effects in the treatment of patients with coronary heart disease, several in vivo and ex vivo studies have demonstrated antiproliferative and antiatherogenic effects of beta-blockers. In the present study, 192 male patients were randomized in a double-blind fashion to metoprolol sustained-release treatment or placebo starting at least 1 day before angioplasty. Lesion diameters and restenosis rates were evaluated using automatic edge detection systems. The study endpoint was the angiographic restenosis rate 4 months after PTCA. Ninety-seven randomized patients had a control angiography a mean of 4.5 months after PTCA. Dropouts were evenly distributed between the metoprolol and placebo groups. Lumen loss in the target lesion was 0.36 mm in the metoprolol group and 0.32 mm in the placebo group. Restenosis rates averaged 57.5% in the metoprolol group and 44.2% in the placebo group using conventional restenosis criteria. Taking metoprolol serum levels above 50 mmol/l as an indication of definite compliance with the metoprolol treatment, the restenosis rate was 58.3%. In conclusion, 95 mg of sustained-release metoprolol failed to reduce the restenosis rate following angioplasty in native coronary arteries.
Copyright © 2002 S. Karger AG, Basel
As the growing awareness in "natural medicine" escalates in proportion to drug reaction problems...
ECHINACEA MAY PREVENT COLDS, SAYS STUDY (News in Science, 26/6/07)
Echinacea may not only help reduce the symptoms of a cold but may help
prevent infection with some cold viruses, US researchers say.
http://www.abc.net.au/science/news/stories/2007/1962026.htm
Talking about yourself too much?
This article talks about Drs talking for the sake of self focus.
http://www.smh.com.au/news/world/doctors-talking-too-much-about-themselves-study/2007/06/27/1182623960915.html
PTs discover instrument assistance....
Of course, chiros discovered instrument assisted adjusting decades ago. I always marvel at the physiotherapy profession for never quite acknowledging the chiropractic profession for anything much at all. As in my comparison of various professions that specialise in musculo-skeletal care, one can see that this profession largely ignores facts in a historical context.
Manual Application of Controlled Forces to Thoracic and Lumbar Spine With a Device: Rated Comfort for the Receiver's Back and the Applier's Hands
Journal of Manipulative and Physiological Therapeutics
Volume 30, Issue 5, June 2007, Pages 365-373
Abstract
Purpose
High volumes of manual therapy work can lead to overuse hand and wrist injuries. This study evaluated hand and back comfort in asymptomatic volunteers during spinal mobilization carried out with an instrumented manual therapy tool.
Methods
This crossover design study examined 36 asymptomatic physiotherapy students that were tested in pairs. One participant assumed the role of the simulated therapist and the other the simulated patient, before reversing roles. Posteroanterior mobilization conditions formed by using 2 spinal segments (thoracic/lumbar), 2 force application methods (hands/device), and 3 grades of mobilization were applied in a random order. After each combination, both participants in each pair rated hand or back comfort, respectively, on a 100-mm visual analogue scale. Data were analyzed by analysis of variance.
Results
Rated back comfort was greater for hands than for the device and decreased with greater applied force. When the original hard rubber device tip was changed to one of soft molded rubber, both back and hand comfort improved significantly. Although tool mobilization was still rated as significantly less comfortable than mobilization with hands only, this difference was approximately half the discomfort experienced as the grade of mobilization increased from grade I to grade III. For hand comfort when using the softer device tip, the method of force application was no longer a significant determinant of comfort.
Conclusions
The mobilizing tool with a molded rubber tip was acceptably comfortable in use with asymptomatic backs and hands. Further research is indicated in manual therapy settings with therapists who have experienced hand pain.
Dramatic Drop in Cerebral Palsy Prevalence Among Very Premature Infants
Caroline Cassels
Medscape Medical News 2007. © 2007 Medscape
June 27, 2007 — A new study shows the prevalence of cerebral palsy (CP) among very premature infants has dropped dramatically over the past decade.
Led by Charlene T. Robertson, MD, investigators at the University of Alberta, in Edmonton, found that from 1974 to 1994 there was a steady increase in the prevalence of CP, which peaked at an all-time high of 131 per 1000 live births in 1994. However, a decade later (2001 to 2003) it dropped to 19 per 1000 live births.
"The prevalence of CP in 2001–2003 of 19 per 1000 live births for more than 3-year-old survivors of extreme prematurity is, to our knowledge, the lowest reported to date in the literature," the authors write.
The study is published in the June 27, 2007 issue of the Journal of the American Medical Association.
30-Year Study Period
According to the authors, determining true CP prevalence in this patient group has been challenging. In part, they write, this has been due to a lack of consistency in study criteria used by different research groups, including the use of different birth years, gestational ages, selection of study population by birth weight vs gestational age, and reporting rates among hospital survivors rather than gestation age–specific live births.
To examine changes in prevalence of CP in extremely premature infants over a 30-year period, the investigators conducted a population-based, longitudinal outcome study.
The study included all live-born infants with a gestational age of 20 to 27 weeks with birth weights of 500 to 1249 g born in Northern Alberta, Canada, from August 1 1974 to December 31, 2003.
During the study period 2318 very premature infants were born in this region. Of these, 1437 (62%) died by the age of 2 years and 23 (1%) were lost to follow-up. Of the 858 survivors, 122 (14.2%) were diagnosed with CP.
Increased CP Prevalence Parallels Survival Rates
Considered a source of major morbidity among preterm children, CP's steady 20-year increase paralleled an increase in population-based survival rates among very premature infants, with similar trends for gestational age groups of 20 to 25 weeks and 26 to 27 weeks.
For example, over the 30-year study period, population-based survival among infants 20 to 25 weeks increased from 4% to 31%, while CP prevalence per 1000 live births increased from 0 at study outset to 110 until 1992 to 1994, when it dropped to 22 in the years 2001 to 2003.
Neither preterm multiple birth or low birth weight for gestational age were associated with an increased prevalence of CP in this study. In addition, infants delivered by cesarean section did not have a lower rate of CP. While it is not clear why CP prevalence is dropping, the authors suggest it could be due to a number of factors, including a reduction in postnatal corticosteroid use.
JAMA. 2007;297:2733-2740.
Direct Gaze
Seductive eyes: Attractiveness and direct gaze increase desire for associated objects
Madelijn Strick, Rob W. Hollanda and Ad van Knippenberga. Department of Social Psychology, Behavioural Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. Available online 28 June 2007.
Abstract
Recent research in neuroscience shows that observing attractive faces with direct gaze is more rewarding than observing attractive faces with averted gaze. On the basis of this research, it was hypothesized that object evaluations can be enhanced by associating them with attractive faces displaying direct gaze. In a conditioning paradigm, novel objects were associated with either attractive or unattractive female faces, either displaying direct or averted gaze. An affective priming task showed more positive automatic evaluations of objects that were paired with attractive faces with direct gaze than attractive faces with averted gaze and unattractive faces, irrespective of gaze direction. Participants’ self-reported desire for the objects matched the affective priming data. The results are discussed against the background of recent findings on affective consequences of gaze cueing.
This one may come as a surprise.
Are people with back pain really in need of exercise?
Curiously, how many times have you gotten a patient well, and they stated that they tried other therapy and all they got was exercises prescriptions?
Disuse and physical deconditioning in the first year after the onset of back pain
Pain; Volume 130, Issue 3, August 2007, Pages 279-286
Abstract
For years, physical deconditioning has been thought to be both a cause and a result of back pain. As a consequence physical reconditioning has been proposed as treatment-goal in patients with chronic low back pain (LBP). However, it is still unclear whether a patient’s physical fitness level really decreases after pain-onset.
The objectives of the present study were, firstly, to test the assumption that long-term non-specific LBP leads to a decrease of the level of physical activity (disuse), secondly, to evaluate any development of physical deconditioning as a result of disuse in CLBP, and thirdly, to evaluate predictors for disuse in CLBP. A longitudinal cohort study over one year including 124 patients with sub-acute LBP (i.e., 4–7 weeks after pain onset) was performed. Main outcome measures were change in physical activity level (PAL) and physical fitness (measured by changes in body weight, body fat and muscle strength) over one year.
Hypothesized predictors for disuse were: pain catastrophizing; fear of movement; depression; physical activity decline; the perceived level of disability and PAL prior to pain. Results showed that only in a subgroup of patients a PAL-decrease had occurred after the onset of pain, whereas no signs of physical deconditioning were found. Negative affect and the patients’ perceived physical activity decline in the subacute phase predicted a decreased level of PAL over one year.
Based on these results, we conclude that as to the assumption that patients with CLBP suffer from disuse and physical deconditioning empirical evidence is still lacking.
Surprise? Medicine not always using its own evidence?
Having recently had one of these, I was interested if what my cardiologist was doing was 'scientific'...apparently not...of course only chiropractors are unscientific, right?
Metoprolol Treatment to Prevent Restenosis following Percutaneous Transluminal Coronary Angioplasty
Damian Franzen, Nathalie Seifert, Angela Metha, Hans W. Höpp Klinik III für Innere Medizin, Universität zu Köln, Köln, Deutschland
Cardiology 2002;97:94-98 (DOI: 10.1159/000057679)
Abstract
This study tested the hypothesis that metoprolol reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) in native coronary arteries as compared to placebo. Apart from prognostic clinical effects in the treatment of patients with coronary heart disease, several in vivo and ex vivo studies have demonstrated antiproliferative and antiatherogenic effects of beta-blockers. In the present study, 192 male patients were randomized in a double-blind fashion to metoprolol sustained-release treatment or placebo starting at least 1 day before angioplasty. Lesion diameters and restenosis rates were evaluated using automatic edge detection systems. The study endpoint was the angiographic restenosis rate 4 months after PTCA. Ninety-seven randomized patients had a control angiography a mean of 4.5 months after PTCA. Dropouts were evenly distributed between the metoprolol and placebo groups. Lumen loss in the target lesion was 0.36 mm in the metoprolol group and 0.32 mm in the placebo group. Restenosis rates averaged 57.5% in the metoprolol group and 44.2% in the placebo group using conventional restenosis criteria. Taking metoprolol serum levels above 50 mmol/l as an indication of definite compliance with the metoprolol treatment, the restenosis rate was 58.3%. In conclusion, 95 mg of sustained-release metoprolol failed to reduce the restenosis rate following angioplasty in native coronary arteries.
Copyright © 2002 S. Karger AG, Basel
As the growing awareness in "natural medicine" escalates in proportion to drug reaction problems...
ECHINACEA MAY PREVENT COLDS, SAYS STUDY (News in Science, 26/6/07)
Echinacea may not only help reduce the symptoms of a cold but may help
prevent infection with some cold viruses, US researchers say.
http://www.abc.net.au/science/news/stories/2007/1962026.htm
Talking about yourself too much?
This article talks about Drs talking for the sake of self focus.
http://www.smh.com.au/news/world/doctors-talking-too-much-about-themselves-study/2007/06/27/1182623960915.html
PTs discover instrument assistance....
Of course, chiros discovered instrument assisted adjusting decades ago. I always marvel at the physiotherapy profession for never quite acknowledging the chiropractic profession for anything much at all. As in my comparison of various professions that specialise in musculo-skeletal care, one can see that this profession largely ignores facts in a historical context.
Manual Application of Controlled Forces to Thoracic and Lumbar Spine With a Device: Rated Comfort for the Receiver's Back and the Applier's Hands
Journal of Manipulative and Physiological Therapeutics
Volume 30, Issue 5, June 2007, Pages 365-373
Abstract
Purpose
High volumes of manual therapy work can lead to overuse hand and wrist injuries. This study evaluated hand and back comfort in asymptomatic volunteers during spinal mobilization carried out with an instrumented manual therapy tool.
Methods
This crossover design study examined 36 asymptomatic physiotherapy students that were tested in pairs. One participant assumed the role of the simulated therapist and the other the simulated patient, before reversing roles. Posteroanterior mobilization conditions formed by using 2 spinal segments (thoracic/lumbar), 2 force application methods (hands/device), and 3 grades of mobilization were applied in a random order. After each combination, both participants in each pair rated hand or back comfort, respectively, on a 100-mm visual analogue scale. Data were analyzed by analysis of variance.
Results
Rated back comfort was greater for hands than for the device and decreased with greater applied force. When the original hard rubber device tip was changed to one of soft molded rubber, both back and hand comfort improved significantly. Although tool mobilization was still rated as significantly less comfortable than mobilization with hands only, this difference was approximately half the discomfort experienced as the grade of mobilization increased from grade I to grade III. For hand comfort when using the softer device tip, the method of force application was no longer a significant determinant of comfort.
Conclusions
The mobilizing tool with a molded rubber tip was acceptably comfortable in use with asymptomatic backs and hands. Further research is indicated in manual therapy settings with therapists who have experienced hand pain.
Dramatic Drop in Cerebral Palsy Prevalence Among Very Premature Infants
Caroline Cassels
Medscape Medical News 2007. © 2007 Medscape
June 27, 2007 — A new study shows the prevalence of cerebral palsy (CP) among very premature infants has dropped dramatically over the past decade.
Led by Charlene T. Robertson, MD, investigators at the University of Alberta, in Edmonton, found that from 1974 to 1994 there was a steady increase in the prevalence of CP, which peaked at an all-time high of 131 per 1000 live births in 1994. However, a decade later (2001 to 2003) it dropped to 19 per 1000 live births.
"The prevalence of CP in 2001–2003 of 19 per 1000 live births for more than 3-year-old survivors of extreme prematurity is, to our knowledge, the lowest reported to date in the literature," the authors write.
The study is published in the June 27, 2007 issue of the Journal of the American Medical Association.
30-Year Study Period
According to the authors, determining true CP prevalence in this patient group has been challenging. In part, they write, this has been due to a lack of consistency in study criteria used by different research groups, including the use of different birth years, gestational ages, selection of study population by birth weight vs gestational age, and reporting rates among hospital survivors rather than gestation age–specific live births.
To examine changes in prevalence of CP in extremely premature infants over a 30-year period, the investigators conducted a population-based, longitudinal outcome study.
The study included all live-born infants with a gestational age of 20 to 27 weeks with birth weights of 500 to 1249 g born in Northern Alberta, Canada, from August 1 1974 to December 31, 2003.
During the study period 2318 very premature infants were born in this region. Of these, 1437 (62%) died by the age of 2 years and 23 (1%) were lost to follow-up. Of the 858 survivors, 122 (14.2%) were diagnosed with CP.
Increased CP Prevalence Parallels Survival Rates
Considered a source of major morbidity among preterm children, CP's steady 20-year increase paralleled an increase in population-based survival rates among very premature infants, with similar trends for gestational age groups of 20 to 25 weeks and 26 to 27 weeks.
For example, over the 30-year study period, population-based survival among infants 20 to 25 weeks increased from 4% to 31%, while CP prevalence per 1000 live births increased from 0 at study outset to 110 until 1992 to 1994, when it dropped to 22 in the years 2001 to 2003.
Neither preterm multiple birth or low birth weight for gestational age were associated with an increased prevalence of CP in this study. In addition, infants delivered by cesarean section did not have a lower rate of CP. While it is not clear why CP prevalence is dropping, the authors suggest it could be due to a number of factors, including a reduction in postnatal corticosteroid use.
JAMA. 2007;297:2733-2740.