Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia最新文献

Millions of women will be prescribed hormone replacement therapy (HRT) and be told that it will prevent osteoporosis occurring, despite the fact that there is doubt about its long term usefulness. Preventive measures outlined in this article are much more preferable, but need to be directed towards the whole population, not just menopausal women. The prevention of osteoporosis is an important public health issue which needs to be addressed now, not in the next century. This article explores the issues that surround the medicalisation of post-menopausal osteoporosis.

A literature review was conducted to determine significant factors for chiropractors progressing towards classification as an Occupational Health & Safety (OHS) consultant in Australia.A number of priority areas for investigation were identified as significant for OHS consultants. These included: work site assessment, risk control and prevention, spinal care awareness and injury prevention, OHS committee, training procedures and induction manuals, ergonomic improvements, stress management, first aid, forklift safety, accident records, job rotation and supervisor training. Several issues are important considerations where chiropractor's knowledge may be deficient. Lack of awareness of the issues may leave the chiropractor liable for prosecution due to misrepresentation as an OHS consultant.

Introduction: With the steady increase in public and professional concern regarding the biological effects of ionising radiation, there is a need for both the Chiropractic and Radiography professions to improve imaging techniques for the lowering of patient radiation doses. Lumbar radiographs are essential in chiropractic general practice for biomechanical diagnosis and postural analysis. Detailed anatomical measurements are taken from spinal radiographs for the determination of various biomechanical alterations for clinical purposes. The quality of spinal radiograph is dependent on a number of factors, including Focus Film Distance (FFD), magnification ratios, penumbra, contrast and density. Variation in FFD will vary magnification factor (MF) and Penumbra.

Objectives: The study aims to investigate the relationship between FFD and received radiation dose to patients, where the radiation dose to the testes may be significantly lowered whilst still maintaining acceptable image quality.

Methods: Radiographic images and dosimetry were obtained with a Seimans wall-mounted X-ray unit. All anterior/posterior (AP) and lateral lumbar-pelvic radiographs were taken of an anthromorphological phantom that resembles human tissues, at both 100cm and 200cm FFD. Five central beam air doses were measured for all parameters to demonstrate patient entrance doses.

Results: For AP lumbar-pelvic radiography, increasing FFD by a factor of two resulted in an approximately 30% decrease in entrance dose to the testes. For lateral lumbar-pelvic radiography a two fold increase in FFD resulted in a 70% reduction in entrance dose.

Conclusions: The study suggests for the first time that an FFD of 200 cm, which is largely utilised by the chiropractic profession, is an efficient method of minimising radiation dose to patient, during lumbar radiography.

Spondylolysis is a common nemesis of the professional cricket fast bowler. This case study demonstrates a series of clinical presentations beginning with spondylolysis in the same professional fast bowler over a one year period. The initial presentation of the injury received chiropractic evaluation and successful management. The second presentation of the patient eight months later was an aggravation of the first injury, but the second presentation did not respond to chiropractic management. Highlighted is the subsequent clinical presentation of the fast bowler two hours prior to sustaining a fracture of the opposite pedicle (left) and the presentation one hour post fracture. The goals of appropriate conservative management are discussed. The role of aberrant intersegmental spinal and sacroiliac joint mobility in the aetiology of spondylolysis is also discussed.

Objective: To review the available literature pertaining to the recording and analysis of the joint crack/cavitation sound produced as a result of spinal manipulative therapy. A critical appraisal of the recording and analysis techniques is presented.

Data source: A broad based search of the English language literature was conducted utilising the databases Medline (1966-1996) and Chirolars (1800-1996), using the key words cavitation, noise, sound, audible release, crack/s/ing, vibration, sound recording, acoustic recording and accelerometers, coupled with the terms facet joint, spinal joint and apophyseal joint and chiropractic, osteopathic and spinal manipulation. A manual search was also conducted of non-indexed journals and text books relating to manual therapy of the library at RMIT University, Bundoora, Victoria.

Results: There appears to be a paucity of this research relating to spinal manipulative therapy. Research to date has focused on recording the joint crack sounds via microphones or piezoelectric accelerometers both of which appear to have limited applications.

Conclusion: Some worthwhile information may be gained by conducting further research into the joint crack phenomenon, particularly with respect to spectral analysis. However, before this research is undertaken a more reliable and accurate means of capturing and processing the joint crack signal needs to be established.

Spinal pain of mechanical origin, with or without referred pain, is a serious health problem suffered by many Australians. In order to help patients with this ailment, and to investigate this costly and debilitating condition, the National Centre for Multidisciplinary Studies of Back Pain was established at Townsville General Hospital as a joint venture between James Cook University of North Queensland and the Northern Regional Health Authority. The Centre has a multidisciplinary clinical team including a chiropractor. The Centre functions successfully, contributes to the public health of the community and shows that a multidisciplinary clinical team which includes a chiropractor can work harmoniously in an Australian hospital setting. The need for such a centre is demonstrated by an ever increasing demand for its professional services in Townsville as indicated by a review of the number of new patients and overall patient visits. The Centre could act as a model for the inclusion of chiropractic into the Australian hospital setting.

A retrospective analysis of 500 patient radiographs was conducted to measure the clinical correlation of cervical lordosis measurements and incidence of motor vehicle accident (MVA). Five hundred lateral cervical radiographs were selected at random from the practice of one of the authors (DLM). The C1-7 angle of the cervical curve was then measured by two blinded examiners. Inter-examiner reliability had a confidence interval of 95%. Eighty-two percent of patients who have had a MVA had an abnormal lordosis. The mean lordosis of patients who had been involved in a MVA was 26.1 degrees (SD 11.4), compared with 36.4 (SD 8.4) for those who had not been involved in a MVA. The results suggest a correlation of reduced cervical lordosis measurements following motor vehicle accident (MVA).

Objective: To identify the main characteristics of classic migraine, with specific regard to diagnostic criteria for manual therapy practitioners, including chiropractors and osteopaths.

Method: Ten case studies on migraine were reviewed for the symptoms and clinical features.

Results: The majority of cases reviewed as classic migraines were in reality not correct diagnoses in accordance with standard classification systems. Some cases had classic signs which may have been misinterpreted, whilst other cases had possible inconsistent symptoms making diagnosis difficult.

Discussion: The various classification systems are presented with guidelines for diagnosis to assist practitioners making the accurate diagnosis.

Unlabelled: Patient satisfaction is a pre-requisite to successful clinical practice. While an efficacious treatment is an important consideration, other variables are recognized to contribute to clinical satisfaction. This case study of a South African teaching clinic identifies and compares variables perceived as essential, important and unnecessary by chiropractic students and their patients.

Method: A case study of the chiropractic student clinic at Technikon Natal was undertaken. A non-random sample of chiropractic patients and student clinicians were requested to respond to a questionnaire. Participants were requested to select 12 from a total of 27 closed questions and allocate 4 items to each of the three listed categories.

Results: Forty-three (43) patients and 17 student clinicians completed the questionnaire. Behaviours considered essential to chiropractic practice largely focused on listening carefully to the patient's description of their problem and explaining how the problem could be avoided in the future. Patients and student clinicians were also agreed about the relative importance of the duration of the clinical consultation, the necessity for patients to choose how they wish to be treated and the desirability of a narrow/broad focus on the patient's problem.

Conclusions: The importance of providing an understandable and comprehensive clinical discussion about the patient's problem emerged in both this and a similar Australian Study. It is suggested that competence in communication skills be considered as an integral component of the undergraduate chiropractic curriculum.