Legislative approaches to the regulation of the chiropractic profession

Traditional or complementary health care services have a growing and significant role in both developed and developing countries. In the United Kingdom there was new legislation to regulate the chiropractic and osteopathy professions in 1993 and 1994. This was supported by the British Medical Association. There is now legislation regulating chiropractic practice in many jurisdictions. In general chiropractic is regulated as a separate discipline, although chiropractic and osteopathy are jointly regulated in some Australian states and South Africa. Regulatory bodies generally have chiropractic and lay representation, and sometimes medical representation.In Canada and the United States there is an emphasis on a defined scope of practice. In the UK, Australia, New Zealand and Hong Kong there is no definition of scope of practice and an emphasis on protection of title. This paper reviews the different approaches to regulation of the chiropractic profession. Subjects discussed include the composition of regulatory boards, scope of practice including access to diagnostic services, educational requirements and protection of title.     

Knowledge and opinions of Downsview physicians regarding the chiropractic profession

This study was a preliminary investigation into the knowledge of and current attitudes towards the chiropractic profession by medical practitioners with varying years of clinical experience. A questionnaire was designed and mailed to seventy general practitioners in Downsview, Ontario who agreed to participate in the study. Twenty-six were returned for a response rate of 37%. The data were analyzed and responses from doctors with differing years of practice experience were compared using the chi square statistic. When comparing attitudes towards the chiropractic profession between medical practitioners with greater and less than 15 years of clinical experience a statistically significant difference was found (p = 0.0005). However, no significant differences were observed in terms of their interaction with or knowledge of the chiropractic profession. Further, 88% of respondents reported that they had referred a patient to a chiropractor. The limitations of the study and suggestions for improvement are discussed.     

Management of knee and hip osteoarthritis: an opportunity for the Canadian chiropractic profession

Knee and hip osteoarthritis (OA) place a significant burden on the Canadian health system and are a major public health challenge. This brief commentary discusses the recently published Osteoarthritis Research Society International guideline and the American College of Rheumatology guideline for the management of OA. Special attention has been given to the role of manual therapy, exercise, and patient education for the treatment of knee and hip OA. This article also reviews the Good Life with osteoArthritis in Denmark (GLA:D^®) treatment program for knee and hip OA and the implementation of this program in Canada. Lastly, the authors discuss the opportunity for the Canadian chiropractic profession to embrace treatment programs like GLA:D^® and take an active role in the strengthening of the Canadian health system from a musculoskeletal perspective.     

A comparison of quality and satisfaction experiences of patients attending chiropractic and physician offices in Ontario

Introduction:

Improving the quality of healthcare is a common goal of consumers, providers, payer groups, and governments. There is evidence that patient satisfaction influences the perceptions of the quality of care received.

Methods:

This exploratory, qualitative study described and analyzed, the similarities and differences in satisfaction and dissatisfaction experiences of patients attending physicians (social justice) and chiropractors (market justice) for healthcare services in Niagara Region, Ontario. Using inductive content analysis the satisfaction and dissatisfaction experiences were themed to develop groups, categories, and sub-categories of quality judgments of care experiences.

Results:

Study participants experienced both satisfying and dissatisfying critical incidents in the areas of standards of practice, professional and practice attributes, time management, and treatment outcomes. Cost was not a marked source of satisfaction or dissatisfaction.

Conclusion:

Patients may be more capable of generating quality judgments on the technical aspects of medical and chiropractic care, particularly treatment outcomes and standards of practice, than previously thought.     

Laboratory methods for the diagnosis of asthenozoospermia

Human sperm samples from 46 men were evaluated for standard semen parameters by two trained technicians, according to WHO criteria. A computer-aided semen analyzer (CASA, HTM-IVOS) was employed. The overall mean coefficient of variation for the 2 participants and the 46 samples studied was 17% for the percentage of progressive motile spermatozoa (r = 0.77). Twenty-nine (63%) samples were classified as asthenozoospermia by both methods. From the studied samples, 12 (26%) were classified as asthenozoospermia by the subjective method and 2 (4.3%) by CASA (p =.01). The two methods do not provide directly comparable data.     

Perceived effects of the delisting of chiropractic services from the Ontario Health Insurance Plan on practice activities: a survey of chiropractors in Toronto, Ontario

The purpose of this study was to survey a random sample of Toronto chiropractors and gather their perceptions of the effects that the delisting of chiropractic services from OHIP had on their practices profiles.

Methods:

A survey was mailed to 199 chiropractors who were asked to disclose demographic information, if they were in practice at the time when OHIP coverage was in effect, the perceived effect OHIP delisting had on their patient volumes, income, the profession’s credibility and if they would be in favor of having OHIP reinstated.

Results:

Among the 123 respondents in practice during OHIP coverage (n = 92), 48.9% indicated they perceived their practice income and 36.6% perceived their patient volume was negatively affected; 57.5% reported both had subsequently recovered. Almost 50% perceived OHIP delisting negatively affected the profession’s credibility and 46.1% of respondents were in favor of it being reinstated for chiropractic services; this percentage was much higher among chiropractors who were not in practice during the time of OHIP coverage.

Conclusion:

Most chiropractors reported that patient volumes and incomes have returned to pre-delisting levels and few chiropractors who were in practice during OHIP coverage expressed interest in having it reinstated.     

Atheroembolization in cardiac surgery. The need for preoperative diagnosis

BACKGROUND: Atheroembolization is a recognized complication of cardiac surgical procedures, and has been implicated in postoperative stroke, renal failure, multiorgan failure, and death. Preoperative identification of patients at risk for developing atheroemboli is essential. The aim of this study was to determine preoperative risk factors for atheroemboli and to assess the postoperative course of the patients who developed atheroembolic syndrome. METHODS: A retrospective record review was conducted. From 1/1990 to 12/1994 5486 patients underwent coronary artery bypass grafting (CABG), valve operations, or other cardiac surgical procedures at Massachusetts General Hospital. Of this population, 107 patients (1.9%) developed atheroembolic syndrome. RESULTS: Patients who develop atheroemboli were older, with an increased incidence (p < 0.01) of hypertension, cerebrovascular disease, and aortoiliac disease. Many had a complicated course after catheterization, with renal insufficiency (35%) and evidence of peripheral emboli (12%). Average Intensive Care Unit stay, hospital stay, and hospital cost of these patients were respectively 16.8 days, 48.4 days, and $88,000, compared to 1.5 days, 9.6 days and $23,000 for a concurrent population undergoing CABG surgery. Of these 107 patients only 2 were discharged home, the others either died (48 patients, or 25% of all cardiac surgical deaths during this period), or went to rehabilitation or chronic hospital facilities. Twenty-seven autopsies were performed and invariably showed a diffusely diseased aorta, with calcification, mural thrombus, and ulceration. CONCLUSIONS: Atheroembolization during cardiac surgical procedures has profound medical and economic consequences. Because of the diffuse nature of aortic disease, measures approaching the disease as a local process are likely to be unsuccessful. Appropriate evaluation would ideally identify patients with extensive aortic atheromatous disease, prior to rather than during surgery.     

Evaluation of ultrasonographic parameters in the diagnosis of pyloric stenosis relative to patient age and size

IntroductionPyloric thickness of 3 mm or higher and length of 15 mm or higher by ultrasonography (US) is widely accepted as diagnostic criteria for pyloric stensosis (PS). However, infants presenting at earlier ages are held to this same criteria, which may not be applicable.MethodsRetrospective review was conducted on patients evaluated with pyloric US to rule out PS from May 2010 through December 2010. Pearson correlation was used to detect an association between weight and age with pyloric thickness and length. Sensitivity and specificty for US parameters were determined.ResultsThree hundred four patients underwent 318 ultrasounds, of which 67 had PS. Of those with PS, age and weight had a positive correlation with thickness (P < .007), and age positively correlated with length (P < .001). In patients with and without PS, there was a negative correlation for both age and weight with thickness (P < .02). Those who did not have PS held a stronger negative correlation between age and thickness (P = .002). Overall, US had a 100% sensitivity and specificity for PS. Thickness of 3 mm or higher was 100% sensitive and 99% specific, and pyloric length of 15 mm or higher was 100% sensitive and 97% specific.ConclusionsAlthough significant associations between age and weight with pyloric thickness and length may exist, our data indicate that this does not have an impact on the diagnostic criteria for PS.     

前列腺癌实验室诊断方法研究进展

近年来前列腺癌的发病率呈上升趋势,是导致患恶性肿瘤男性死亡的主要原因之一,其早期症状不明显,20%的患者初诊时已发生转移。早期诊断率低是我国前列腺癌病死率高于欧美国家的主要原因。前列腺癌患者的血液、尿液、精液中存在着特异性和敏感性较高的诊断标志物,如早期前列腺癌抗原、ERG蛋白、基质金属蛋白酶9、GSTP1甲基化等,联合检测可以提高前列腺癌早期诊断率,做到早发现、早治疗,为患者的治疗提供机会,进一步延长患者的生存期。     

Laboratory diagnosis and antibacterial therapy in joint diseases

The indication for arthrocentesis is a difficult medical decision. Once obtained, however, puncture fluid is unique and important examination material which should always be thoroughly analyzed for diagnostic purposes, and also stored in a serum bank. In addition to the total protein and/or albumin fractions, the individual immunoglobulins in particular have proved to be a key parameter: they enable mechanical, hydro, inflammatory, and chronic-inflammatory processes to be distinguished. Especially in combination with the serum value, CRP is the best marker for acute inflammatory and traumatic changes. Determination of complement factors C1, C4, and C3, also of total complement activity, CH50 and of rheumatism factors, enables chronic-immunologic/rheumatic conditions to be diagnosed and their course evaluated. Bacteriologic study of punctates should always be included--not least as confirmation for the examiner--as also should cytologic and histologic examination of the sediment. Since, with bacterial etiology, the infections concerned are usually in their later stages, e.g., gonorrhea, yersinia, rubella, arthritis, antibody assays should always be performed in the serum and the joint in addition to these tests. Controversy still surrounds the question of local binding of immunoglobulin antibody complement components in the synovia itself; the present authors' findings hitherto also fail to furnish any definitive data on this issue.