Are chiropractors in the uk primary healthcare or primary contact practitioners?: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>One of the debates regarding the role of chiropractors is whether or not they should be considered as primary healthcare practitioners. Primary care is often used to describe chiropractic but without any definition of what is meant by the term. Primary healthcare itself has many definitions and this adds to the problem. Existing research literature, based mostly in the USA, suggests that the use of the title "primary healthcare professional" by chiropractors is central to the identity of the profession. It has also been suggested that the concept of primary care is misused by chiropractors because they have not examined the concept in detail and thus do not understand it. For the sake of quality of patient care and for the legitimacy of the profession, chiropractors in the UK need to agree on their healthcare role. This study aimed to examine the opinions of chiropractors towards the use of the term primary healthcare when applied to chiropractic practice within the UK.</p> <p>Methods</p> <p>A sequential study of exploratory design was used; this model is characterised by an initial phase of qualitative data collection and analysis that precedes and informs the quantitative phase of data collection and analysis. In this study, interviews with members of chiropractic teaching faculty were used to inform the development of a questionnaire used to survey the opinions of chiropractors in the UK.</p> <p>Results</p> <p>There was a general consensus of opinion that chiropractors are primary contact practitioners, who work in a primary healthcare setting and that to be able to fulfil this healthcare role, chiropractors must be able to diagnose patients and refer when required. Participants did not feel that chiropractors are able to treat all of the most common medical conditions that present in a primary healthcare setting.</p> <p>Conclusions</p> <p>The findings of this study suggest that chiropractors in the UK view their role as one of a primary contact healthcare practitioner and that this view is held irrespective of the country in which they were educated or the length of time in practice.</p> <p>Further research needs to be developed to evaluate the findings of the current study within a wider healthcare context. In particular the opinions of other healthcare professionals towards the role of chiropractors in healthcare, need to be examined in more detail.</p

Biomarker and Clinical Trial Design Support for Disease-Modifying Therapies: Report of a Survey of the EU/US: Alzheimer's Disease Task Force

BACKGROUND: Disease-modifying therapies are urgently needed for the treatment of Alzheimer’s disease (AD). The European Union/United States (EU/US) Task Force represents a broad range of stakeholders including biopharma industry personnel, academicians, and regulatory authorities. OBJECTIVES: The EU/US Task Force represents a community of knowledgeable individuals who can inform views of evidence supporting disease modification and the development of disease-modifying therapies (DMTs). We queried their attitudes toward clinical trial design and biomarkers in support of DMTs. DESIGN/SETTING/PARTICIANTS: A survey of members of the EU/US Alzheimer’s Disease Task Force was conducted. Ninety-three members (87%) responded. The details were analyzed to understand what clinical trial design and biomarker data support disease modification. MEASUREMENTS/RESULTS/CONCLUSIONS: Task Force members favored the parallel group design compared to delayed start or staggered withdrawal clinical trial designs to support disease modification. Amyloid biomarkers were regarded as providing mild support for disease modification while tau biomarkers were regarded as providing moderate support. Combinations of biomarkers, particularly combinations of tau and neurodegeneration, were regarded as providing moderate to marked support for disease modification and combinations of all three classes of biomarkers were regarded by a majority as providing marked support for disease modification. Task Force members considered that evidence derived from clinical trials and biomarkers supports clinical meaningfulness of an intervention, and when combined with a single clinical trial outcome, nearly all regarded the clinical trial design or biomarker evidence as supportive of disease modification. A minority considered biomarker evidence by itself as indicative of disease modification in prevention trials. Levels of evidence (A,B,C) were constructed based on these observations. CONCLUSION: The survey indicates the view of knowledgeable stakeholders regarding evidence derived from clinical trial design and biomarkers in support of disease modification. Results of this survey can assist in designing clinical trials of DMTs

Preliminary validation of MERIS water products for Belgian coastal waters

This paper describes the methods used to acquire sea-level data for validation of MERIS water products in Belgian coastal waters and comparison of such measurements with MERIS level 2 data as available in November 2002. Results are presented for two Reduced Resolution level 2 images for which sea-level match-up data exists. One image was acquired during partially cloudy skies - while not appropriate for quantitative validation of the water products themselves, this image is useful for validation of the various quality and confidence flags supplied with the MERIS products. The second image was acquired during clear sky conditions and is optimal for quantitative validation of water-leaving reflectance, algal pigment index (chlorophyll concentration) and total suspended matter concentration. Firstly, a qualitative assessment is made of the images based on knowledge of the region and of inconsistencies between the products themselves. This assessment suggests that many pixels which are partially or wholly cloudy are not identified as such, giving an unreliable impression of product quality to users. Furthermore, unrealistic spatial discontinuities are observed in products because of switching of the case 2S flag. It is recommended that more attention be paid to validation of the MERIS L2 flags and especially cloud pixel identification and the impact of spatial variability of the case 2S flag. Secondly a quantitative assessment is made of products using the sea-level match-up data. For the image with clear sky conditions water-leaving reflectance in the blue is severely overestimated by MERIS because of underestimation of aerosol optical thickness and epsilon factor. It is recommended that the performance of the turbid water atmospheric correction be investigated in more detail and with more imagery for this and other regions