Can the ileocecal valve point predict low back pain using manual muscle testing?

Background: According to some technique groups in chiropractic the ileocecal valve may malfunction and be associated with a large array of health problems that can lead to common chronic health issues prevalent in our society. Many tests commonly used in chiropractic are presumed to identify painful and/or dysfunctional anatomical structures, yet many have undemonstrated reliability. Despite this lack of evidence, they form the basis of many clinical decisions. One cornerstone procedure that is frequently used by chiropractors involves the use of manual muscle testing for diagnostic purposes not considered orthopaedic in nature. A point of the body referred to as the ileocecal valve point is said to indicate the presence of low back pain. This procedure is widely used in Applied Kinesiology (AK) and Neuro-Emotional Technique (NET) chiropractic practice. Objective: To determine if correlation of tenderness of the "ileocecal valve point" can predict low back pain in sufferers with and without low back pain. It was the further aim to determine the sensitivity and specificity of the procedure. Methods: One hundred (100) subjects with and without low back pain were recruited. Subjects first completed information about their pain status, then the practitioner performed the muscle testing procedure in a separate room. The practitioner provided either a yes or no response to a research assistant as to whether he had determined if the subject had back pain based on the muscle test procedure. Results: Of 67 subjects who reported low back pain, 58 (86.6%) reported a positive test of both low back pain and ICV point test. Of 33 subjects, 32 (97.0%) with no back pain positively reported no response to ICV point test. Nine (9) subjects (13.4%) reported false negative ICV tests and low back pain, and 1 subject (3%) reported a false positive response for ICV test and no low back pain. Conclusion: The majority of subjects with low back pain reported positive ileocecal valve testing, and all but one of the subjects without low back pain reported negative ileocecal valve testing. The application of ileocecal valve testing as a diagnostic measure of low back pain was found to have excellent measures of sensitivity, specificity and diagnostic competency. This study confirms that the use of this test within the limitations of this study is reliably associated with the presence of low back pain. Further testing is required to investigate all aspects of the diagnostic milieu commonly used by proponents of this form of diagnostic testing

The use of traditional Chinese medicine principles in chiropractic technique

Objectives: The authors of this manuscript seek to define the role, and scientific backing for the inclusion of Traditional Chinese Medicine (TCM) principles in the chiropractic techniques know as Applied Kinesiology (AK) and Neuro-Emotional Technique (NET). A discussion of the suitability of TCM principles within the chiropractic profession is also presented. Data Sources: A search through the electronic databases Medline, Meditext, Pubmed, OVID, CINAHL, and the Cochrane Library was performed for the period of 1900 – 2007 using the key words Traditional Chinese Medicine, Meridian, five-element, five-phase, acupuncture, chiropractic, Applied Kinesiology, and Neuro-Emotional Technique. The results were limited to works published in English appearing in peer-reviewed journals. A hand search was then performed within the reference lists of the articles retrieved. Study Selection: Based on their relevance to the subject, 196 references were obtained. Data Extraction and Synthesis: Only those historical principles and current research findings that pertain specifically to the TCM concepts used in AK and NET have been included. Conclusions: Principles and philosophies from TCM are incorporated into the diagnostic and treatment of protocols of the chiropractic techniques AK and NET. The scientific backing for this inclusion is still evolving and it is clear that further research is required to support the placement of TCM principles and practices within these chiropractic techniques. The welcoming of TCM principles into chiropractic practice may broaden the scope of the chiropractic profession and allow chiropractors to more faithfully adhere to the biopsychosocial model of healthcare

A web-based survey of the motivations and challenges faced by emerging researchers in the chiropractic profession

OBJECTIVE: To investigate the motivations, challenges and perceptions of the educational environment of emerging researchers in chiropractic. METHODS: A descriptive web-based survey of higher-degree chiropractic research students was performed between October and November 2013. The survey consisted of open and closed questions and the Dundee Ready Education Environment Measure. RESULTS: Twenty-two students currently enrolled in a higher-degree research program participated. Students were most commonly enrolled in a doctor of philosophy program at a part-time rate. Motivations of research were desire to improve the clinical care aspects of chiropractic for the public and belief that chiropractic research is lacking. The greatest challenges were the negative attitudes towards chiropractic, finding enough time to do everything required, and feelings of isolation. The higher-degree research educational environment was perceived to be more positive than negative, with the stimulating nature of research a positive feature. A negative feature of the educational environment was poor undergraduate preparation for higher-degree research. CONCLUSION: This study is the first study to describe higher-degree chiropractic research students. Primary motivations included building research, while challenges included not only negative attitudes toward the chiropractic profession but also negative attitudes toward researchers from within the profession. The higher-degree research educational environment was perceived to be positive. By acknowledging the issues that surround emerging researchers in chiropractic, the profession is better placed to foster academics and build research capacity

Assessment and modelling of chiropractic and allied healthcare in Australia: Background and need for a formal investigation

There is need for a detailed investigation on the availability and impact of chiropractic and allied healthcare services, on healthcare choice and healthcare costs, as well as the delivery and spatial distribution of chiropractors in Australia. The goal of this paper is to discuss the background and to propose our intent to conduct an interdisciplinary assessment and modelling of the determinant factors of adoption of healthcare choices in Australia. Due to the highly complex nature of selecting a healthcare choice amongst available alternatives in today's world, it has been decided to design a research project using a new and innovative approach to the study of knowledge and knowledge systems in a social group. It was determined that the theory base of social interpretation of knowledge and knowledge implementation and change will drive this study. the study design will entail mixed methods including surveys, extensive document review, and a series of interviews of key stakeholders in the allied health professions within Australia. Studies such as this have potential to guide the planning process for federal and state governance bodies in chiropractic, in facilitating consumer choice between alternatives in healthcare. the knowledge gained through this study can drive healthcare change into the 21st century with chiropractic as a potential change agent

The influence of a biopsychosocial-based treatment approach to primary overt hypothyroidism: A protocol for a pilot study

Background Hypothyroidism is a prevalent endocrine condition. Individuals with this disease are commonly managed through supplementation with synthetic thyroid hormone, with the aim of alleviating symptoms and restoring normal thyroid stimulating hormone levels. Generally this management strategy is effective and well tolerated. However, there is research to suggest that a significant proportion of hypothyroid sufferers are being inadequately managed. Furthermore, hypothyroid patients are more likely to have a decreased sense of well-being and more commonly experience constitutional and neuropsychiatric complaints, even with pharmacological intervention. The current management of hypothyroidism follows a biomedical model. Little consideration has been given to a biopsychosocial approach to this condition. Within the chiropractic profession there is growing support for the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. Methods/Design A placebo-controlled, single-blinded, randomised clinical pilot-trial has been designed to assess the influence of Neuro-Emotional Technique on a population with primary overt hypothyroidism. A sample of 102 adults (≥18 years) who meet the inclusion criteria will be randomised to either a treatment group or a placebo group. Each group will receive ten treatments (NET or placebo) over a six week period, and will be monitored for six months. The primary outcome will involve the measurement of depression using the Depression, Anxiety and Stress Scale (DASS). The secondary outcome measures to be used are; serum thyroid stimulating hormone, serum free-thyroxine, serum free-triiodothyronine, serum thyroid peroxidase auto-antibodies, serum thyroglobulin auto-antibodies as well as the measurement of functional health and well-being using the Short-Form-36 Version 2. The emotional states of anxiety and stress will be measured using the DASS. Self-measurement of basal heart rate and basal temperature will also be included among the secondary outcome measures. The primary and secondary measures will be obtained at commencement, six weeks and six months. Measures of basal heart rate and basal temperature will be obtained daily for the six month trial period, with recording to commence one week prior to the intervention. Discussion The study will provide information on the influence of NET when added to existing management regimens in individuals with primary overt hypothyroidism

Therapeutic monoclonal antibodies and antibody products: Current practices and development in multiple myeloma

Immunotherapy is the latest innovation for the treatment of multiple myeloma (MM). Monoclonal antibodies (mAbs) entered the clinical practice and are under evaluation in clinical trials. MAbs can target highly selective and specific antigens on the cell surface of MM cells causing cell death (CD38 and CS1), convey specific cytotoxic drugs (antibody-drug conjugates), remove the breaks of the immune system (programmed death 1 (PD-1) and PD-ligand 1/2 (L1/L2) axis), or boost it against myeloma cells (bi-specific mAbs and T cell engagers). Two mAbs have been approved for the treatment of MM: the anti-CD38 daratumumab for newly-diagnosed and relapsed/refractory patients and the anti-CS1 elotuzumab in the relapse setting. These compounds are under investigation in clinical trials to explore their synergy with other anti-MM regimens, both in the front-line and relapse settings. Other antibodies targeting various antigens are under evaluation. B cell maturation antigens (BCMAs), selectively expressed on plasma cells, emerged as a promising target and several compounds targeting it have been developed. Encouraging results have been reported with antibody drug conjugates (e.g., GSK2857916) and bispecific T cell engagers (BiTEs®), including AMG420, which re-directs T cell-mediated cytotoxicity against MM cells. Here, we present an overview on mAbs currently approved for the treatment of MM and promising compounds under investigation

Requisites for becoming a trader

More often than not, traders devote their time and risk their money with the intention of deriving a profit therefrom; this is what is called 'inuomissio speculativa'. 'La figura del commerdante risulta pertanto da questi due elemenci: la interposizione nello scambio (di merci, denaro, servigi) e la speculazione, collegati fra essi dal rapporto di causa ad effetto: la interposizione e determinata dallo scopo del guadagno e ii guadagno e l'effetto della interposizione' (Bolaffio). Again, E commerciante quel fotografo il quale eserdsce uno stabilimento fotografico e, quindi, specula sia sull'altrui attivira, sia colla rivendita dellc materie prime. Ma non puo qualificarsi tale il fotografo che, esercicando la sua arte, non tiene alcuno stabilimento, ma loca meramente la sua opera.' (Emm. Darmanin no. vs. C. Giglio; Vol. XXVII, Pt. I, P. 958). Section 4 of the Commercial Code defines a trader as 'any person who, by profession, exercises acts of trade in his own name, and includes any commercial partnership'. It is of the utmost importance to distinguish between a trader and a non-trader, for a trader has certain rights and duties at law, which are not applicable to a non-trader. Yet a trader does not acquire a juridical status, but a social one.peer-reviewe

Chiropractic in Australia: A survey of the general public

Background: An increase in the use of complementary and alternative medicine was identified in several countries including Australia. There is a need to assess the current position of chiropractic within the Australian health system. Objectives: To estimate the lifetime prevalence of the use of chiropractic in Australia; to investigate the perceptions and attitudes of Australian general public about: their health status, the chiropractic profession, chiropractic and health services in general. Methods: A survey was carried out in which a novel 21-item questionnaire was utilised. To obtain a sample whose opinions would be representative of the Australian general population with a 95% level of significance and 4% margin of error, 600 respondents were required. Descriptive statistics, the chi-squared test and logistic regression were used to present and analyse the data. Results: 757 respondents completed the survey. A high prevalence of pain and discomfort relating to the musculoskeletal system were found, particularly in the lower back (71.1 % of the respondents) and neck (55.6%). The first contact with respect to therapy for the greatest proportion of respondents was general medicine (35.5%), followed by chiropractic (16%), physiotherapy (13.8%) and massage (10.2%). Physiotherapy was rated highest in its ability to relieve the symptoms (18%) followed by chiropractic (15.9%), massage (15.5%) and medicine (14%). In our sample 302 (39.9%) participants used chiropractic before and 75.9% of these consumers were satisfied or highly satisfied with the services provided. No significant differences in income, age and gender were found with regards to those individuals who reported a previous use of chiropractic services. The main reasons for not using chiropractic were: that there was no perceived need for a chiropractic intervention, associated cost, lack of information about chiropractic, lack of referral, being attended by another health professional, and concern about the safety and efficacy of the treatment. Most of the respondents considered that attending to general health and well-being was more important than simply alleviating symptoms and their personal philosophy was a major determinant when it came to the choice of health services. Conclusions: This study suggests that chiropractic is a thriving profession in Australia. It would appear that there is a need for chiropractic services in Australia, particularly in attending to the highly prevalent realm of musculoskeletal disorders. A considerable number of Australians already utilise chiropractic services. Encouragingly, the vast majority of these consumers are satisfied with the service provided. Chiropractic could play an even greater role within the Australian health if better integrated with the mainstream and allied medicine. A more active approach should be taken by chiropractic practitioners and institutions to improve the general public's knowledge about chiropractic