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A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain

ABSTRACT Background: The adult lifetime incidence for low back pain is 75% to 85% in the United States. Investigating appropriate care has proven difficult, since, in general, acute pain subsides spontaneously and chronic pain is resistant to intervention. Subacute back pain has been rarely studied. Objective: To compare the relative efficacy of chiropractic adjustments with muscle relaxants and placebo/sham for subacute low back pain. Design: A randomized, double-blind clinical trial. Methods: Subjects (N = 192) experiencing low back pain of 2 to 6 weeks' duration were randomly allocated to 3 groups with interventions applied over 2 weeks. Interventions were either chiropractic adjustments with placebo medicine, muscle relaxants with sham adjustments, or placebo medicine with sham adjustments. Visual Analog Scale for Pain, Oswestry Disability Questionnaire, and Modified Zung Depression Scale were assessed at baseline, 2 weeks, and 4 weeks. Schober's flexibility test, acetaminophen usage, and Global Impression of Severity Scale (GIS), a physician's clinical impression used as a secondary outcome, were assessed at baseline and 2 weeks. Results: Baseline values, except GIS, were similar for all groups. When all subjects completing the protocol were combined (N = 146), the data revealed pain, disability, depression, and GIS decreased significantly (P < .0001); lumbar flexibility did not change. Statistical differences across groups were seen for pain, a primary outcome, (chiropractic group improved more than control group) and GIS (chiropractic group improved more than other groups). No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups. Conclusion: Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS. Hoiriis KT, et al. Journal of Manipulative and Physiological Therapeutics. July/August 2004; Vol. 27, No. 6. Read the complete study by clicking on the JMPT Online link in the "Members' Only" section. Not a member? Than join NYSCA today to access this and other regularly updated information.

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Lighten the Load: Backpack Strategies for Parents From the American Chiropractic Association

ARLINGTON, Va. -- As students savor the last precious days of summer vacation, parents are out making the final run for school supplies. So, parents, take note -- when back to school shopping this year there is one essential item that requires very special attention: your child's backpack. Backpack weight is becoming an increasing problem, and studies show that heavy backpacks can lead to both back pain and poor posture, noted the American Chiropractic Association (ACA). In fact, in 2001 backpacks were the cause of 7,000 emergency room visits and countless complaints of muscle spasms, neck and shoulder pain. "In my own practice, I have noticed a marked increase in the number of young children who are complaining about back, neck and shoulder pain," said Dr. Scott Bautch, a chiropractor from Wausau, Wis., and noted ergonomics expert. "The first question I ask these patients is, 'Do you carry a backpack to school?' Almost always, the answer is 'yes.'" This painful trend among youngsters isn't surprising when you consider the disproportionate amounts of weight they carry in their backpacks -- often slung over just one shoulder. According to Dr. Bautch, "Many of these kids are carrying a quarter of their body weight over their shoulders for a large portion of the day. That's equivalent to a 180-pound man carrying around a 45- pound load." Thankfully, backpacks have undergone a radical evolution in recent years and now many are designed to be ergonomic while remaining fashionable. Not to mention, the backpack of today has adapted to keep up with our changing lives. Children not only pack heavy schoolbooks, band instruments and running shoes into their backpacks, many of them also tuck away popular electronics -- such as laptops, cellular phones, MP3 players, CD players and personal digital assistants (PDA) -- into specially designed compartments inside their backpacks. Bulging backpacks offer a significant risk to children, but parents can help limit the strain on young necks, backs and shoulders. The ACA offers the following tips to help prevent the pain caused by backpack misuse. --- Make sure your child's backpack weighs no more than 10 percent of his or her body weight. A heavier backpack will cause your child to stoop forward in an attempt to support the additional weight. --- The backpack should never hang more than 4 inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking. --- A backpack with individualized compartments helps position the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child's back, and try to place the heaviest items closet to the body. --- Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry and the heavier the backpack will be. --- Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause a disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain. --- Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child's shoulders. --- The shoulder straps should be adjustable so the backpack can be fitted to your child's body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain. --- If the backpack is still too heavy, talk to your child's teacher. Ask if your child could leave the heaviest books at school, and bring home only lighter handout materials or workbooks. Ask the teacher for a set oftext books to keep at home. Chiropractic has been practiced in the United States for more than 100 years, and each year, millions of Americans trust their health to one of the nation's 60,000 doctors of chiropractic. To read research studies about the effectiveness of chiropractic care, visit ACA's website at:

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NYSCA Comments Helps Prod Insurance Department Into Dropping Offending No-Fault Provisions

In response to comments the State Insurance Department (SID) received from the New York State Chiropractic Association (NYSCA) and other professional groups, individuals and organizations, on August 18, the Department published a “revised” regulatory proposal floated earlier this year that, among other things, would have pegged the fees for durable medical equipment (DME) at Medicaid levels, and, in one of the other more controversial amendments referred to as the "Concurrent Care Rule," would have required the “sharing of fees among licensed health providers or the payment of a fee only to the provider whose specialty was most relevant to the diagnosis, if more than one licensed health provider treated the patient at the same time, and the treatment involved overlapping or common services.” Read more in "Members' Only" section. Not a member? Consider joining NYSCA today to access this and other regularly updated information.

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Survey: Chronic Back Pain Sufferers Prefer Drug Free Pain Management

ARLINGTON, Va. -- More than 80 percent of chronic back pain sufferers surveyed would prefer to avoid the use of medication to treat their ailments, yet ironically, a majority are taking either narcotics, muscle relaxants or over-the-counter medications to deal with their pain, according to a study conducted for the American Chiropractic Association (ACA) by a national market research firm. In addition, more than 64 percent of survey respondents reported that they would consider seeking the professional health care services of a doctor of chiropractic (DC), health care providers who offer a drugless approach to pain relief. The omnibus survey, conducted in the spring of 2004 for ACA by I/H/R Research Group, a full service market research firm that includes experienced health care managers, interviewed 800 adults nationwide. The survey was conducted to gain insight into the treatment methods used by those with chronic back pain and to better understand the amount of relief experienced from various treatment options. Survey results did indicate that while millions of Americans trust their health care to one of the nation's 60,000 doctors of chiropractic, only 13.8 percent of respondents were currently seeking health care from a DC. However, when survey participants were asked if they felt their pain was under control as a result of their current treatment, 30 percent indicated their pain was not, and an additional 39.3 percent said their pain was only moderately under control. Furthermore, more than 27 percent of respondents reported that they were taking a form of analgesic or narcotic for their chronic back pain; 25 percent indicated they relied on over-the-counter medications; and 19.6 percent used muscle relaxants. "The survey results reiterate that chiropractic care offers the treatment options desired by patients -- compassionate health care that works safely without drugs or surgery," said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. "However, the information provided also shows that more needs to be done to educate patients, physicians and the health community about the benefits of chiropractic care and its ability to manage pain effectively." Other survey highlights include: * 18 percent of all chronic back pain was reported as the result of an accident or injury * Almost 40 percent reported their pain as very severe or severe at the time of the survey * 71 percent of respondents said they had suffered from chronic back pain for five or more years Eighty percent of Americans suffer from back pain at some point in their lives, and back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. "Given the physical and mental demands of the fast-paced, active lifestyles that many Americans lead, it is essential that we keep ourselves in good physical condition without overusing medications that can negatively affect our health. Some medications can induce drowsiness and impair judgment," Dr. Krippendorf said. "You can achieve an improved level of medication-free wellness with the help of your doctor of chiropractic." Recent evidence supporting the efficacy of chiropractic care comes from a study published in the July 15, 2003, edition of the journal Spine, which found that manual manipulation -- the primary form of treatment performed by doctors of chiropractic -- provides better relief of chronic spinal pain than does acupuncture or even a variety of medications. Additional research The ACA offers the following tips for choosing a doctor of chiropractic. * Be sure the chiropractor has attended an accredited chiropractic college. A list can be found on ACA's Web site: http://www.acatoday.com/media/whatis/careers/cce_accredited.shtml * Be sure the chiropractor is licensed to practice in your state. After graduating from an accredited chiropractic college, chiropractors must pass rigorous state and national board exams before they can practice. * The chiropractor should be willing to answer your questions and should talk freely with you about your concerns and your course of treatment. * Talk to your friends, family and co-workers. The best referrals often come from satisfied patients.

Vitamin E may help upper respiratory track infection

ABSTRACT Vitamin E and Respiratory Tract Infections in Elderly Nursing Home Residents A Randomized Controlled Trial Simin Nikbin Meydani, DVM; Lynette S. Leka, BS; Basil C. Fine, MD; Gerard E. Dallal, PhD; Gerald T. Keusch, MD; Maria Fiatarone Singh, MD; Davidson H. Hamer, MD Context -- Respiratory tract infections are prevalent in elderly individuals, resulting in increased morbidity, mortality, and use of health care services. Vitamin E supplementation has been shown to improve immune response in elderly persons. However, the clinical importance of these findings has not been determined. Objective -- To determine the effect of 1 year of vitamin E supplementation on respiratory tract infections in elderly nursing home residents. Design, Setting, and Participants -- A randomized, double-blind, placebo-controlled trial was conducted from April 1998 to August 2001 at 33 long-term care facilities in the Boston, Mass, area. A total of 617 persons aged at least 65 years and who met the study's eligibility criteria were enrolled; 451 (73%) completed the study. Intervention -- Vitamin E (200 IU) or placebo capsule administered daily; all participants received a capsule containing half the recommended daily allowance of essential vitamins and minerals. Main Outcome Measures -- Incidence of respiratory tract infections, number of persons and number of days with respiratory tract infections (upper and lower), and number of new antibiotic prescriptions for respiratory tract infections among all participants randomized and those who completed the study. Results -- Vitamin E had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, fewer participants receiving vitamin E acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.00; P = .048 for all participants; and 65% vs 74%; RR, 0.88; 95% CI, 0.75-0.99; P = .04 for completing participants), or upper respiratory tract infections (44% vs 52%; RR, 0.84; 95% CI, 0.69-1.00; P = .05 for all participants; and 50% vs 62%; RR, 0.81; 95% CI, 0.66-0.96; P = .01 for completing participants). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83; 95% CI, 0.68-1.01; P = .06 for all participants; and 0.66 vs 0.83 per person-year; RR, 0.80; 95% CI, 0.64-0.98; P = .04 for completing participants) and fewer participants in the vitamin E group acquired 1 or more colds (40% vs 48%; RR, 0.83; 95% CI, 0.67-1.00; P = .05 for all participants; and 46% vs 57%; RR, 0.80; 95% CI, 0.64-0.96; P = .02 for completing participants). Vitamin E had no significant effect on antibiotic use. Conclusions -- Supplementation with 200 IU per day of vitamin E did not have a statistically significant effect on lower respiratory tract infections in elderly nursing home residents. However, we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold, that merits further investigation. JAMA. 2004;292:828-836. Read the full text at:

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CRIME RING IN QUEENS INDICTED FOR NO-FAULT AUTO INSURANCE FRAUD

10 People, 5 Corporations Indicted For Operating Fraud Ring in Hollis, Queens Superintendent of Insurance Gregory V. Serio and Attorney General Eliot Spitzer today announced the indictment of 10 individuals and five corporations accused of operating an insurance fraud ring out of SZ Medical, a clinic in Hollis, Queens. The defendants include nine health care providers and are alleged to have fraudulently billed an insurance carrier for months of treatment and extensive testing, including medical evaluations, diagnostics tests, physical therapy, chiropractic treatment and acupuncture. Gregory V. Serio, Superintendent of Insurance, said, "It’s particularly disturbing that this fraud ring was comprised of doctors and health care providers, professionals who are here to protect us and not betray the public’s trust by defrauding our insurance system. Thanks to our strong partnership with Attorney General Spitzer, these people have been exposed and this case will help us build more momentum in the fight against fraud." "This case demonstrates the sustained and coordinated effort required to combat the pervasive nature of auto insurance fraud," Attorney General Spitzer said. "My office will continue to work with the State Insurance Department, law enforcement, and industry officials to bring these cases. While we are making progress, there is still an extraordinary amount of work yet to do." Under the State's no-fault auto insurance law, insurance carriers reimburse medical facilities for services provided to persons injured in motor vehicle accidents. It is alleged that the defendants submitted fraudulent claims to a no-fault insurance carrier for services never provided or for services that were not medically necessary. The charges stem from a long-term investigation of SZ Medical which began in Spring, 2003. According to the indictment, the defendants fraudulently billed an insurance carrier for months of treatment and extensive testing, including medical evaluations, diagnostics tests, physical therapy, chiropractic treatment and acupuncture. The indictment charges that fraudulent claims were submitted by three medical doctors, Sergey Zavilyansky, 48, of Brooklyn; Gary Friedman, 51, of Manhattan; and Lee Craig Nagourney, 52, of Brooklyn. Zavilyansky is the owner of SZ Medical. All three are charged with fabricating medical diagnoses and submitting claims for services not provided or not medically warranted. The indictment additionally charges the following defendants with fraudulent claim submissions: Stanley Frankel, 69, of Manhattan, a dentist; Michael Ferrato, 56, of Suffolk County, a psychologist; Juby Uralil, 26, of Queens County, a physical therapist; Joel Santos, 34, of Queens County, a physical therapist; Peter Pramberger, 51, of Suffolk County, a chiropractor; and Ji Yong Kim, 39, an acupuncturist. The indictment also charges that defendant Nelson Bloom, 57, of Brooklyn, a paralegal, held himself out as a licensed attorney and directed a no-fault patient to undergo medical tests and attend the clinic for several months, without regard to medical need, in an effort to increase the potential settlement of a bodily injury claim. Five corporations are also charged in the indictment: SZ Medical, P.C.; Almaz Medical Services, P.C., owned by physician-defendant Lee Craig Nagourney; Ferrato Psychological Services, P.C., owned by psychologist-defendant Michael Ferrato; Life Chiropractic P.C., owned by defendant Peter Pramberger; and Somun Acupuncture, P.C., owned by acupuncturist-defendant Ji Yong Kim. The defendants are facing charges of Insurance Fraud in the Third Degree, a D felony; Insurance Fraud in the Fourth Degree, an E felony; Falsifying Business Records in the First Degree, an E felony; Insurance Fraud in the Fifth Degree, an A misdemeanor, Attempted Grand Larceny in the Fourth Degree, an A misdemeanor; Practicing or Appearing as an Attorney-At-Law Without Being Admitted and Registered, an A misdemeanor; Conspiracy to Commit Grand Larceny in the Fourth Degree, an A misdemeanor; and Attempted Petit Larceny, a B misdemeanor. New York is aggressive in its fight against insurance fraud. To report suspected incidents of insurance fraud call 1-888-FRAUD-NY (1-888-372-8369). It should be noted that an arrest is merely an accusation and that a defendant is presumed innocent until proven guilty.

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Two Doctors of Chiropractic Join Elite Team of Olympic Health Care Providers

ARLINGTON, Va., Aug. 12 -- For the first time in the history of the Olympic Games two doctors of chiropractic will serve on the official U.S. Olympic Team medical staff, an elite group of health care providers selected by the U.S. Olympic Committee (USOC) to treat U.S. Olympiads. Drs. Marc Jaffe of Summit, N.J., and Ira Shapiro of Old Bridge, N.J., will join 44 other medical professionals serving the U.S. Olympic Team at the Summer Games in Athens, Greece. Since 1980, there has been only one doctor of chiropractic (DC) included on the medical staff of each U.S. Summer Olympic Team, and 2002 was the first year that a DC served on the U.S. Winter Olympic Team's medical staff. However, increasing athlete demand for chiropractic care has persuaded the USOC to boost the amount of available care at the 2004 Summer Games. "It is a true testament to the value of chiropractic care to be recognized by the U.S. Olympic Committee. It is with great pleasure that ACA's members have served athletes in past Olympics, and with two doctors of chiropractic on staff for this summer's games, we can be assured that our athletes have the best health care available," said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. During the games, medical staff will be available to the athletes at practice and during competition. Some of the staff will also work with athletes at the USOC's medical clinic in the Athlete's Village. "It's the athlete who realizes the benefit [of chiropractic care]. That's why we're in the Olympic movement," explained Dr. Shapiro. "We fit in perfectly with everything that goes on there." Athletes have long understood the value of chiropractic care as a means to maintain their health and improve their competitiveness. In the past, U.S. athletes sought out chiropractic care on the side because they strongly believed in its effectiveness to alleviate pain at the source and to condition their bodies for peak performance. Additionally, with increased scrutiny surrounding the use of performance-enhancing drugs, athletes are turning to safe, drug-free health care whenever possible. Athletes outside of the Olympics rely on chiropractic care, too. Both Drs. Jaffe and Shapiro have dedicated much of their professional lives to treating the nation's finest athletes. Dr. Jaffe has served as an attending chiropractor for events such as the U.S. Track and Field Championships, the U.S. Weightlifting Championships, the U.S. Triathlon Championships and the New York City Marathon. Furthermore, he is a consultant to the Rutgers University football team and is listed as a treating chiropractor in a manual distributed by the NFL to players for the New York Giants and New York Jets. Dr. Shapiro has an equally illustrious list of credentials that include service as an attending physician at the Gatorade Ironman Triathlon World Championship, the U.S. Figure Skating Championships and the World Championship of Freestyle Wrestling. However, previous experience does not ensure a berth on the U.S. Olympic medical staff. Both doctors were required to complete a rigorous evaluation of their clinical skills and of their abilities to work as a team with Olympic athletes and other medical staff. With the growing popularity of complementary and alternative medicine, chiropractic care has become increasingly integrated with other, more traditional medical treatments. The USOC medical team uses a similar approach by creating a group of providers who work cooperatively to maximize the athletes' health and well-being. "We have a tremendous collaborative working relationship with the other health care professionals," observed Dr. Shapiro -- who adds that there is a saying that the chiropractor is the busiest person around at USOC medical facilities. Chiropractic has been practiced in the United States for more than 100 years, and each year, millions of Americans trust their health to one of the nation's 60,000 doctors of chiropractic. To read research studies about the effectiveness of chiropractic care, visit ACA's website at:

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Palmer College of Chiropractic Florida accredited by CCE

(Issued by Palmer Marketing Department on Friday, July 30, 2004. At its July 2004 semi-annual meeting, the Commission on Accreditation (COA) of the Council on Chiropractic Education (CCE), the chiropractic colleges' specialized accrediting body, met with representatives of the Palmer College of Chiropractic (PCC) Doctor of Chiropractic degree program in a progress review meeting to discuss PCC's requests for substantive change to include Palmer Florida as a branch campus of PCC and the implementation of the Mastery Curriculum at the Florida campus. Following that meeting, the COA met in executive session and reached a consensus decision to extend accreditation to include the Palmer College of Chiropractic Florida (PCCF) site. As of this notice, PCCF will be included in (but not limited to) the regular accreditation cycle for PCC. As such, the Doctor of Chiropractic degree program of Palmer College of Chiropractic Florida is accredited by the Commission on Accreditation of the Council on Chiropractic Education (8049 North 85th Way, Scottsdale, Arizona 85258-4321. Tel: 480-443-8877). In discussing the accreditation, Douglas E. Hoyle, Ph.D., who oversees all accreditation, planning and institutional effectiveness activities, said, "The administration at Palmer has worked diligently for close to the past three years to have this event happen, which is a once in a lifetime event in the history of this college. We are very proud of the effort that has gone into this project, the patience of the students at PCCF while we obtained it, and the belief the faculty had in us while we pursued accreditation." In addition to the actions of the Commission on Accreditation of the Council on Chiropractic Education, Palmer Florida is licensed in the state of Florida by the Florida Commission on Independent Education (License number 2648), and is recognized as an accredited branch campus of Palmer College of Chiropractic by the Higher Learning Commission of Palmer's regional accrediting agency, the North Central Association of Colleges and Schools (30 North LaSalle Street, Suite 2400, Chicago, Illinois 60602-2504 Tel: 800-621-7440).

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MEDICARE UPDATES GUIDELINES FOR REFERRAL OF PATIENTS FOR X-RAYS BY CHIROPRACTORS

A chiropractor, licensed or legally authorized by the state or jurisdiction of service, may provide treatment only in the form of manual spinal manipulation to correct a subluxation (provided such treatment is legal in the state where it is performed). Specifically, Medicare defines chiropractors, based on §18601(r) of the Act, as physicians with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the state or jurisdiction in which treatment is provided. The following article addresses the ordering of X-rays for chiropractic patients. Read more in the Member's Only News Section. If you are not a member, join the NYSCA today and obtain access to the full story above.

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In-Hospital Deaths from Medical Errors at 195,000 per Year, HealthGrades' Study Finds

Little Progress Seen Since 1999 IOM Report on Medical Errors Lakewood, CO – An average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company. The HealthGrades Patient Safety in American Hospitals study is the first to look at the mortality and economic impact of medical errors and injuries that occurred during Medicare hospital admissions nationwide from 2000 to 2002. The HealthGrades study applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a research study published in the Journal of the American Medical Association (JAMA) in October of 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. The HealthGrades study finds nearly double the number of deaths from medical errors found by the 1999 IOM report “To Err is Human,” with an associated cost of more than $6 billion per year. Whereas the IOM study extrapolated national findings based on data from three states, and the Zhan and Miller study looked at 7.5 million patient records from 28 states over one year, HealthGrades looked at three years of Medicare data in all 50 states and D.C. This Medicare population represented approximately 45 percent of all hospital admissions (excluding obstetric patients) in the U.S. from 2000 to 2002. “The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years,” said Dr. Samantha Collier, HealthGrades’ vice president of medical affairs. “The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S.” HealthGrades examined 16 of the 20 patient-safety indicators defined by the Agency for Healthcare Research and Quality (AHRQ) – from bedsores to post-operative sepsis – omitting four obstetrics-related incidents not represented in the Medicare data used in the study. Of these sixteen, the mortality associated with two, failure to rescue and death in low risk hospital admissions, accounted for the majority of deaths that were associated with these patient safety incidents. These two categories of patients were not evaluated in the IOM or JAMA analyses, accounting for the variation in the number of annual deaths attributable to medical errors. However, the magnitude of the problem is evident in all three studies. “If we could focus our efforts on just four key areas – failure to rescue, bed sores, postoperative sepsis, and postoperative pulmonary embolism – and reduce these incidents by just 20 percent, we could save 39,000 people from dying every year,” said Dr. Collier. The HealthGrades study was released in conjunction with the company’s first annual Distinguished Hospital Award for Patient SafetyTM, which honors hospitals with the best records of patient safety. Eighty-eight hospitals in 23 states were given the award for having the nation’s lowest patient-safety incidence rates. A list of winners can be found at http://www.healthgrades.com. Study Highlights

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Dietary niacin may protect against Alzheimer’s disease

ABSTRACT Dietary niacin and the risk of incident Alzheimer’s disease and of cognitive decline M C Morris, D A Evans, J L Bienias, P A Scherr, C C Tangney, L E Hebert, D A Bennett, R S Wilson and N Aggarwal Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neurodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer’s disease (AD) and cognitive decline in a large, prospective study. Methods: This study was conducted in 1993–2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were administered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria. Results: Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p = 0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (ß = 0.028 SU/year; p = 0.008), those with low baseline cognitive scores (ß = 0.023 SU/year; p = 0.02), or those with fewer than 12 years’ education (ß = 0.035 SU/year; p = 0.002) Conclusion: Dietary niacin may protect against AD and age related cognitive decline. SOURCE: Morris, M.C. Journal of Neurology, Neurosurgery, and Psychiatry, August 2004; vol 75: pp 1093-1099.

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INDEPENDENT MEDICAL EXAMINATIONS (IME) AUTHORIZATION RELOCATIONS

The New York State Court of Appeals’ June 10, 2004 decision in Belmonte v. Snashall affirmed the New York State Workers’ Compensation Board regulations regarding independent medical examinations, specifically the definition of “board certified” contained in the regulations. The regulations define the term “board certified” as a “physician or surgeon who is certified by a specialty board that is recognized by the American Board of Medical Specialties or the American Osteopathic Association.” Please be advised that because the physicians listed below do not currently satisfy the “board certified” requirement in the regulations as they are not certified by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), their temporary authorizations to perform independent medical exams have been revoked, effective July 1, 2004. Reports of examination conducted through June 30, 2004 are permitted and the physicians entitled to payment. In addition, testimony and/or depositions concerning independent medical examinations conducted through June 30, 2004 may be provided. Revoked Independent Medical Examinations Authorizations Dominic John Belmonte, MD Donald J. Cally, MD Barry Constantine, MD Arthur Dinoff, MD Harvey Fishman, MD William J. Kilgus, MD Jose R. Lopez-Reymundi, MD Lawrence E. Miller, DO James W. Nelson, MD Jay Alan Rosenblum, MD Librada M. Santos, MD Any questions regarding this matter should be referred to the Office of General Counsel at 518-486-7676. David P. Wehner Chairman

HUDEC BECOMES FIRST DOCTOR OF CHIROPRACTIC EVER TO GRADUATE FROM MILITARY RESIDENCY PROGRAM

Arlington, VA – For the first time in history, a doctor of chiropractic graduated from a military hospital residency program -- when Joanna Hudec, DC, completed a fellowship in integrative medicine at the National Naval Medical Center (NNMC) in Bethesda, MD on June 18, 2004. Hudec’s history-making graduation is seen by many as one of the clearest signs to date that the chiropractic profession works well with the medical community. Known as “the President’s hospital” because it is the site at which sitting U.S. presidents and other dignitaries receive care, NNMC is considered the “flagship of naval medicine.” The hospital also is the National Capital Region Resource for homeland defense. Most importantly, NNMC keeps the uniformed services mission ready and provides care to their families. “For chiropractic care to be integrated into a program within the most hallowed halls of medicine is an unparalleled step for this profession,” said American Chiropractic Association (ACA) President Donald J. Krippendorf, DC. “The ACA sincerely thanks Dr. Hudec for the shining example she has set for chiropractic.” U.S. Surgeon General Dr. Richard Carmona not only attended the graduation ceremony -- which included about 355 medical interns, residents and fellows -- but also congratulated Dr. Hudec for her efforts and thanked NNMC attending physician William Morgan, DC for the time he spent as the program director of this residency. Additionally, the commanding officers of both NNMC and Walter Reed Army Medical Center thanked Dr. Hudec for her outstanding work. At a dinner following the ceremony, Texas Chiropractic College (TCC) President Richard Brassard, DC, presented Dr. Hudec with a diploma certifying her completion of TCC’s Postdoctoral Fellowship in Integrative Medicine. Dr. Hudec began her 12-month fellowship at NNMC in April of 2003. Recognizing the need for doctors of chiropractic to be trained to work in an integrative hospital environment, TCC Director of Research James Giordano, PhD, and Dr. Morgan envisioned and then implemented the fellowship program, which is expected to become an ongoing, annual program. Dr. Hudec, an ACA member, called the founding of the fellowship program “just the beginning of the advancement of chiropractic into the military.” “In establishing this fellowship program, Texas Chiropractic College has made a very real contribution to our profession’s ongoing efforts toward integration into both the military health care system and our nation’s hospital system,” said Dr. Krippendorf. During her fellowship program, Dr. Hudec established a chiropractic clinic for the medical students at the Uniformed Services University of the Health Sciences (USUHS), also located in Bethesda, MD. That clinic is believed to be the only chiropractic clinic ever established within a medical school. A major goal of the military hospital chiropractic fellowship program is to provide a qualified pool of doctors of chiropractic to serve the needs of civilian, Department of Veterans Affairs (DVA) and Department of Defense (DOD) hospital-based chiropractic clinics.

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'

Abstract Background: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. Methods: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2– 3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. Results: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). Conclusion: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine. BMC Musculoskeletal Disorders 2004, 5:19 - Published: 15 June 2004

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For a child’s cough, sugar water no better then cough syrup

ABSTRACT Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents Objectives. To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo. Methods. Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights. Results. For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine. Conclusions. Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families. Ian M. Paul, MD, MSc, Katharine E. Yoder, Kathryn R. Crowell, MD, Michele L. Shaffer, PhD, Heidi S. McMillan, MD, Lisa C. Carlson, MD, Deborah A. Dilworth, RN and Cheston M. Berlin, Jr., MD Pediatrics 2004; 114: e85-e90.

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New Facts About Alternative Health Use In US Revealed In CDC Study

Centers for Disease Control and Prevention (CDC) released study on the use of complementary and alternative medicine (CAM) in U.S. The study involved more then 31,000 U.S. adults and appears to be one of the most comprehensive to date. To view the study click on the link below:

Clinical and Cost Outcomes of an Integrative Medicine IPA

ABSTRACT Objective: We hypothesized that primary care physicians (PCPs) specializing in a nonpharmaceutical/nonsurgical approach as their primary modality and utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine would have superior clinical and cost outcomes compared with PCPs utilizing conventional medicine alone. Design: Incurred claims and stratified randomized patient surveys were analyzed for clinical outcomes, cost offsets, and member satisfaction compared with normative values. Comparative blinded data, using nonrandomized matched comparison groups, was analyzed for age/sex demographics and disease profiles to examine sample bias. Setting: An integrative medicine independent provider association (IPA) contracted with a National Committee for Quality Assurance (NCQA)-accredited health maintenance organization (HMO) in metropolitan Chicago. Subjects: All members enrolled with the integrative medicine IPA from January 1, 1999 through December 31, 2002. Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. Conclusion: In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population. Sarnat RL, Winterstein J. Journal of Manipulative and Physiological Therapeutics. June 2004; Vol. 27, No. 5.

VA to Begin Chiropractic Care

WASHINGTON -- Veterans can receive chiropractic care at 26 selected Department of Veterans Affairs (VA) facilities beginning this fall, Secretary of Veterans Affairs Anthony J. Principi announced today. VA will hire or contract with doctors of chiropractic to provide the care. In consultation with VA primary care providers, doctors of chiropractic will offer patient evaluations and chiropractic care for neuromusculoskeletal conditions. "Today, VA makes another significant improvement to the world-class health care we provide for eligible veterans," said Principi. "Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health." Locations where chiropractic care will be provided include Togus, Maine; West Haven and Newington, Conn.; Buffalo and the Bronx, N.Y.; Butler, Pa.; Martinsburg, W.Va.; Columbia, S.C.; Augusta, Ga.; Tampa and Miami, Fla.; Mountain Home, Tenn.; Columbus, Ohio; Danville, Ill.; Iron Mountain, Mich.; Kansas City, Kan.; Jackson, Miss.; San Antonio, Temple, and Dallas, Texas; Albuquerque, N.M.; Fort Harrison, Mont.; Seattle, Wash.; Sacramento and Los Angeles, Calif.; and Sioux Falls, S.D. Eligible veterans in areas distant from these locations will also be able to receive chiropractic care through VA's outpatient fee-basis program after a referral by their primary care provider, and prior authorization by the department. VA was authorized to offer chiropractic care and services under the provisions of section 204 of Public Law 107-135, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. Chiropractors seeking employment or to provide contract services to veterans should call the Human Resources office of any of the above facilities. Some VA positions may be advertised at:

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NOTICE OF RESCISSION OF REGISTRATION OF IME ENTITY: NORTHEAST MEDICAL EVALUATION & DIAGNOSTIC SERVICES

Effective June 26, 2004, the New York State Workers’ Compensation Board is rescinding the designation of Northeast Medical Evaluation and Diagnostic Services, P.C. as an entity registered to derive income from independent medical examinations in workers’ compensation cases. This rescission is made pursuant to Section 13-n of the Workers’ Compensation Law and 12 NYCRR 300.2 (e). This rescission is permanent. The entity’s address is: Northeast Medical Evaluation and Diagnostic Services, P.C. 900 Merchants Concourse Westbury, New York 11590 On the effective date of this rescission, the entity named above is permanently prohibited from deriving income from independent medical examinations in workers’ compensation cases. Examinations conducted prior to June 26, 2004 are valid. Any questions regarding this matter should be referred to the Office of General Counsel at 518-486-7676. David P. Wehner Chairman

The Natural Treatment of Hypertension

ABSTRACT The goal of this review is to evaluate the efficacy of commonly available dietary supplements in the treatment of hypertension, using the average blood pressure reduction achieved with the implementation of lifestyle modifications as a standard. For this reason, the authors focus on the antihypertensive potential of these agents rather than pharmacology, pharmacokinetics, adverse effects, or supplement ñ drug interactions. For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine. J Clin Hypertens (2004) 6;5:242-248