Aspects of the resuscitation of the newborn with reference to caesarean section

No Abstrac

Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study

<p>Abstract</p> <p>Background</p> <p>Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.</p> <p>Methods</p> <p>Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1) Neck pain disability index (100-point scale), 2) Oswestry back pain index (100-point scale), 3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain, 4) treatment satisfaction, and 5) Symptomatic Reactions (SR). Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.</p> <p>Results</p> <p>A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (<it>p </it><0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.</p> <p>Conclusions</p> <p>Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.</p

Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature

<p>Abstract</p> <p>Background</p> <p>The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively.</p> <p>Methods</p> <p>A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable.</p> <p>Results</p> <p>Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality.</p> <p>Conclusions</p> <p>There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.</p

Integrated Assessment Systems for Chemical Warfare Material

The US Army must respond to a variety of situations involving suspect discovered, recovered, stored, and buried chemical warfare materiel (CWM). In some cases, the identity of the fill materiel and the status of the fusing and firing train cannot be visually determined due to aging of the container, or because the item is contained in an over-pack. In these cases, non-intrusive assessments are required to provide information to allow safe handling, storage, and disposal of the materiel. This paper will provide an overview of the integrated mobile and facility-based CWM assessment system prototypes that have been, and are being developed, at the Idaho National Engineering and Environmental Laboratory (INEEL) for the US Army Non-Stockpile Chemical Materiel Project. In addition, this paper will discuss advanced sensors being developed to enhance the capability of the existing and future assessment systems. The Phase I Mobile Munitions Assessment System (MMAS) is currently being used by the Army's Technical Escort Unit (TEU) at Dugway Proving Ground, Utah. This system includes equipment for non-intrusively identifying the munitions fill materiel and for assessing the condition and stability of the fuzes, firing trains, and other potential safety hazards. The system provides a self-contained, integrated command post including an on-board computer system, communications equipment, video and photographic equipment, weather monitoring equipment, and miscellaneous safety-related equipment. The Phase II MMAS is currently being tested and qualified for use by the INEEL and the US Army. The Phase II system contains several new assessment systems that significantly enhance the ability to assess CWM. A facility-based munitions assessment system prototype is being developed for the assessment of CWM stored in igloos at Pine Bluff Arsenal, Arkansas. This system is currently in the design and fabrication stages. Numerous CWM advanced sensors are being developed and tested, and pending successful test results, may be incorporated in the various munitions assessment systems in the future. These systems are intended to enhance CWM fill materiel identification, agent air monitoring, agent or agent degradation product detection by surface analysis, and real-time x-ray capabilities