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Doylestown Chiropractor, Botox for headaches?!?

FDA Approves Botox for Elbow Spasms. Are Migraines Next?
By MELLY ALAZRAKI
03/10/10 Company News, Healthcare

The Food and Drug Administration on Tuesday approved Allergan’s (AGN) wrinkle-smoothing drug Botox to treat elbow, wrist and finger spasms. Spasticity in the flexor muscles, common after stroke, traumatic brain injury or the progression of multiple sclerosis, afflicts 1 million Americans, many in their upper limbs, according to Allergan, based in Irvine, Calif. (Botox does not affect darkened elbow skin and folds.)

“Muscles affected by spasticity have increased stiffness and tightness, which may lead to pain, difficulties with hygiene and other activities of daily living, and may affect how a patient looks,” says Dr. Russell Katz, director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. Botox, injected into the affected muscles, blocks the connections between nerves and muscles, paralyzing the spastic muscle for an average of up to three months in clinical trials.

Sweating, Spasm…and Migraines?

Because the active ingredient in Botox is the highly poisonous botulinum toxin, the FDA last year required Allergan to warn that the effect of Botox could spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism, including potentially life-threatening difficulty with swallowing and breathing.

The FDA further stressed that Botox has not been proved a safe, effective treatment for larger muscles such as those in the legs and others in the upper limbs. Nor is it safe for treatment of fixed contracture, a condition that affects range of motion. The most common adverse reactions were nausea, fatigue, bronchitis, muscle weakness and pain in the arms.

Although better known for its cosmetic applications, Botox is approved to treat such therapeutic conditions as underarm sweating, neck spasms, and eye-muscle disorders. Therapeutic sales of Botox accounted for approximately 52% of Allergan sales last year and increased about 4% over 2008. Cosmetic sales accounted for approximately 48% and decreased approximately 4%. Allergan is testing Botox for other medical uses, including migraines, which may be the most significant area for the drug’s future sales growth.

‘Off-Label’ Treatments

While Botox’s FDA-approved uses may be limited, doctors are allowed to prescribe it in unapproved (“off-label”) treatments for muscle spasms. But pharmaceutical companies are prohibited from promoting off-label uses. Last year, Eli Lilly (LLY) paid a $1.42 billion fine, and Pfizer (PFE) paid a record $2.3 billion fine, to settle charges of off-label promotions.

Allergan has sued the FDA, arguing that these rules violate its First Amendment right to free speech. It wants to be allowed to “share relevant information with the medical community on the safe use” of Botox for off-label uses. Tuesday’s approval, demonstrating that the FDA doesn’t hold a grudge, eases investors’ concerns on that front. Botox sales rose 5.6% last quarter, to $347.7 million, and Allergan forecasts full-year 2010 net sales of $1.33 billion to $1.37 billion. Allergan shares rose some 1.8% in morning trading.

While therapeutic uses may continue to fuel increases, cosmetic uses may too: Despite the recession, plastic surgeries declined only 2% in 2009 — nearly 10 million procedures in the U.S. included 2.5 million procedures involving botulinum toxin type A (whether Botox or rival Ipsen Group’s Tercica’s Dysport).

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Doylestown Chiropractor, Weight Watchers says eat at McDonald’s to lose weight?!?

Weight Watchers says eat at McDonald’s to lose weight (opinion)
by Mike Adams, the Health Ranger, NaturalNews Editor

Weight Watchers has now officially endorsed Chicken McNuggets as a “healthy meal” in New Zealand, where McDonald’s restaurants will begin carrying the Weight Watchers logo on several menu items. This bizarre and inexplicable decision has now made Weight Watchers the laughing stock of the health world where nutrition and weight loss experts normally don’t use “McDonald’s fast food” and “weight loss” in the same sentence.
As The Guardian reports, “As part of the deal, which the company says is the first of its kind in the world, McDonald’s will use the Weight Watchers logo on its menu boards and Weight Watchers will promote McDonald’s to dieters.”
Nutritionists, not surprisingly, were shocked at the announcement. The idea of eating at McDonald’s to lose weight seems a bit ridiculous, and anyone who believes that eating Chicken McNuggets will cause you to lose weight is arguably one nugget short of a Happy Meal. Sometimes you just have to point out the stupidity of these things, even at the risk of offending someone who has convinced themselves that eating more Chicken McNuggets is their ticket to a slim, fit and sexy body.
Watch your weight balloon!
Weight Watchers, by the way, never actually claims that eating the foods they endorse will cause you to lose weight. If you examine it carefully, even their name isn’t really about weight loss. It’s about weight watching… as in, watch your weight grow larger by the day…
A “weight watch” is sort of like a “tornado watch” or a “tsunami watch.” You keep your eyes peeled and wait for something disastrous to happen — such as ballooning to 300 pounds while engaging in unhealthy eating McHabits based on snarfing down meat parts from factory-farmed cows raised in bovine concentration camps that might more accurately be called “Cowschwitz.”
If Weight Watchers is going to endorse McNuggets, then why not just endorse the entire McDonald’s menu and throw the logo behind Big Macs and ice cream shakes, too? It’s not like Weight Watchers is trying to “protect its reputation” by not crossing a line, you know. Once you’ve endorsed McDonald’s as “healthy” food, that line is no longer anywhere in sight.
Of course, McDonald’s products merely join a long list of questionable foods marketed under the “Weight Watchers” brand name — a brand that in my opinion has discovered great commercial success in selling the false hope of weight loss to clueless consumers who are unwilling to read ingredients lists on food labels.
Not coincidentally, Weight Watchers has now become the “McDonald’s” of the weight loss industry — and industry filled with so many scams and shams that the idea of eating Chicken McNuggets to lose weight doesn’t even seem that strange to many people.
We live in a world where corporate promotional lies are disgusting at best, and criminal at worst. We’re told that psychiatric drugs will make you happy, that chemotherapy will make you healthy and that eating at McDonald’s will make you lose weight. We’re told that sugary junk drinks will give you “energy”, that toxic vaccines are necessary for your immune system to work correctly and that buying silly pink-ribbon products will somehow cure cancer.
At the same time, we’re told that vitamins are dangerous, that sunlight causes cancer and that there’s no such thing as a cure for type-2 diabetes. Everything that’s good for you is discredited as bad while everything that’s toxic is hyped up as “healthy.”
I suppose in light of the corporate-sponsored sick-care insanity that passes for medical advice these days, the idea that eating at McDonald’s will make you lose weight doesn’t seem as insane as it really should.
But that doesn’t make it any more true.
In a world gone mad with dietary misinformation touting fictional foods, insanity can now be marketed to the intoxicated mainstream as if it somehow made sense.
… and people swallow it.

Sources for this story include:
http://www.guardian.co.uk/business/…

Doylestown Chiropractor Says Don’t Let Slouch Lead to ‘Ouch’

Doctors, chiropractors and ergonomics experts say poor posture while sitting is something of an epidemic.
Sam McManis
McClatchy Newspapers

So what is it now, you medical experts?
We need to learn how to sit?
Oh, puhleeze. We’ve been doing it all our lives. For many, sitting for eight hours straight is pivotal to the job, not to mention that post-work leisure time plopped on the La-Z-Boy watching TV or playing video games. Oh, occasionally we’ll get up to go sit in our cars in order to sit in restaurants and eat.
You’d think, therefore, we’d have this sitting thing down by now, that we’d be no slouches when it comes to taking a load off.
Right?
Not so.
Turns out, we literally are slouches. Doctors, chiropractors and ergonomics experts, who make a nice living off our backs, say poor posture while sitting is something of an epidemic.
Eighty percent of Americans will cringe with back pain at some point in their lives, and back injuries prove the top reason for missed work, according to the National Institutes of Health.
This is something San Francisco chiropractor Gregg Carb, for one, just won’t stand for.
Carb has written a self- published book, “The Science of Sitting Made Easy” (Posture Press, $14.95, 176 pages), to address the problem. Boiled to its essence, Carb’s message is the same as Mom hectored you with for years: Sit up straight, will ya?
Our spines are strong and resilient, Carb says, but not impervious to the deleterious effects of slouching, craned necks, twisted trunks.
“When you hold any body position for long periods of time, your spine is gradually reshaped into that very position through an adaptation of the connective soft tissues,” Carb says.
“Everyone has their own style of sitting, so to speak. But no one’s immune to gravity and, therefore, you will experience (back pain) as a result.”
This is not some breakthrough discovery, back experts concede. But, just as a dentist reminds people to floss, a spinal specialist will preach posture and body alignment, especially when we’re on our duffs.
“It’s a huge issue,” says Dr. George D. Picetti III, spine surgeon at the Sutter Neuroscience Medical Group in Sacramento, Calif. “Sitting is very hard on the spine, mostly in the lumbar (lower back) region. The longer you sit, the more you compress the discs. Throughout the day, the water content of each disc declines. You’re very vulnerable to lifting or something like that.”
Years of improper sitting can lead to disc degeneration, which is permanent. But, Carb says, mobility and comfort can be restored through rigid adherence to, well, sitting rigidly.
“You will get some actual form changes over time if you improve your posture,” Carb says. “It’s almost like having braces (on your teeth). But we’ve found we can loosen people up in a matter of weeks.”
What not to do while sitting: Roll your shoulders inward, jut your head forward, round out your lower back, sink your chest.
What to do to avoid those bad habits: Set your seat back to a nearly upright position and sit as far back into the seatback as you can, keeping your rib cage and trunk upright and your head aligned directly above your shoulders.
Picetti recommends lumbar support – usually a molded foam pad – to promote the natural forward arch of the lower back, called lordosis. The support should be placed around the belt line, “but some people have more swayback, so you’ve got to fit yourself for it.”
The other option is to spring for a high-end, ergonomically designed office chair, such as the Herman Miller Embody at $1,600. Picetti, though, says he just uses “a regular chair with a lumbar support.”
Paying close attention to your breathing – deep breaths that expand the rib cage – is another key, Carb says.
“Patients are always worried about their head and shoulders being in the wrong position,” Carb says. “But if you keep your rib cage up, the other parts will follow. That’s how to do it without overwhelming yourself doing too many things at once.”
Indeed, trying to remember to keep proper alignment and breathing while concentrating on work tasks – or gaining another level on the hand-held video game – is hard but not impossible.
The only proven alternative, says Scottish researcher Dr. Waseem Amir Bashir, is to go into full La-Z-Boy recline on the job. Bashir’s study at a hospital in Aberdeen, Scotland, compared magnetic resonance imaging results of people reclining vs. sitting upright. It showed reclining puts less strain on lumbar disc than does sitting up straight.
“The study is correct,” Picetti says. “But how are you going to work reclining without craning your neck forward?”
Two other alternatives are sitting on a Swiss exercise ball in lieu of a chair, or standing at a specially aligned chest-level desk. Neither is practical, Carb says.
“I wouldn’t want to stand all the time, because there’s the issue of blood pooling in the lower extremities,” Carb says. “If you do it, you need to shift your weight around, get some contraction in the muscles.”
Picetti says the exercise ball is beneficial only if you’re an athlete with a strong core muscle group and that “the average person is going to end up with more back pain.”
No, the only upright thing to do is sit down and straighten up, just like Mom scolded.
Copyright © 2010, HealthKey

Lifestyle Changes That Will Keep You Alive

Lifestyle Changes That Will Keep You Alive
Written by Dr. Mercola | January 23 2010 |

Americans spend billions every year on a dizzying array of health schemes. But some of the best approaches to health care are cheap and within your grasp, if only you can find the will to make some lifestyle changes.
1. Experience the benefits of sex
Sex has many apparent health benefits. Studies suggest sex can boost your immune system and reduce stress.
2. Keep your teeth clean
Diabetes, low birth weight babies and heart disease have all been linked to gum and bone disease in your mouth. Even heart attacks have been linked to bad dental hygiene.
3. Use the sun
A little sunshine is good for your mood and allows your body to produce necessary vitamin D, which is lacking in some 70 percent of American kids these days.
4. Drink less
After years of hearing that moderate drinking is good for your health, a study in November, 2009 found that having a drink or two each day might be something that healthy people do, rather than the drinks being the cause of their good health. And if you’re having more than a couple drinks a day, then you’re at higher risk for liver damage and diabetes.
5. Wash your hands
Hand washing remains the best prevention against the flu and many other diseases.
6. Get some rest
Serious lack of sleep — less than six or seven hours a night — has been associated with increased risks of high blood pressure, hypertension, obesity, diabetes and cancer. Lack of sleep can also contribute to auto accidents and on-the-job injuries.
7. Stop smoking
About half of all smokers die from smoking, and of these, about half die around age 50 or sooner.
8. Don’t stress
Stress kills. It causes deterioration in everything from your gums to yourheart and can make you more susceptible to a range of ills, from colds to cancer.
9. Exercise
Over and over, studies find a host of exercise benefits, not just for your body: It can raise kids’ academic performance and stimulate adult brains. Exercise makes bones stronger and alleviates many types of chronic pain. Regular exercise has even been associated with a lower risk of cancer.
10. Eat better
Choose real food instead of sugar laced with traces of real food. Cook at home rather than eating fast food, and use spices, rather than gobs and gobs of oil or sugar, to spice up your meals.
Sources:
Live Science December 30, 2009

This is an excellent, empowering list for the New Year, one you can use to improve your health by leaps and bounds. The reality is that more than any pill or medical “treatment,” your lifestyle is what will determine your level of health now and in the years to come.
It was the ancient Roman poet Martial, wise beyond his time, who first said:
“Life’s not just being alive, but being well.”
This is still true today, many centuries later. Your health is a gift that cannot be bought, and once it’s lost it may be impossible to get back.
So I urge you to do some serious contemplating on what really matters in your life, and then make a commitment to doing all you can to support and nourish your health. Whether you realize it yet or not, you have at your disposal numerous methods to influence your physical and mental well-being, and ultimately take control of your health.
You are Not a Victim to Your Genes
Before I delve into more detail about exactly how you can change your lifestyle for the better, I first want to dispel the myth that you are a captive to your genes.
For some of you reading this, this may be a weight lifted off your shoulders. If your mother suffered from breast cancer, or you have a family history of diabetes or obesity, for instance, it does not mean that you are destined to have that same fate.
As proven through the massive genetic study, the Genome Project, each one of your genes can create up to 30,000 proteins, any and all of which can create a different outcome. So the fact that you may have a genetic “predisposition” for a certain illness does not mean that you are doomed to develop it.
Rather, there is something that either activates or suppresses your genes, and that “something” is usually lifestyle-related. If you are constantly stressed you will likely have a different genetic expression than if you focus your thoughts in a positive direction.
Likewise, if you eat healthy, fresh, whole foods you will have a different genetic expression than if you rely on sugar and fast foods.
Ultimately, this is great news, as it means you can make the choice to help your genes express themselves in a positive, disease-fighting way.
Which Diseases Can Your Lifestyle Help Prevent?
A far more appropriate question would be, “What can’t it?” — because the choices you make on a daily basis truly influence just about every disease known to man, and probably more than handful of those yet to be discovered!
Here is just a short list of some of the major diseases your decision to eat well, exercise, reduce stress, and so on will help to ward off:
• Cancer
• Heart disease
• Diabetes
• Alzheimer’s and Parkinson’s diseases
• High blood pressure
• Hormonal imbalances
Again, this is by no means an exhaustive list. If you name a disease or illness, there’s a good chance your lifestyle can help prevent it or influence it in a positive way.
My Top Lifestyle Recommendations for a Healthy 2010
The start of a new year is always a good time to evaluate your past mistakes and make a fresh start. So if you haven’t been leading the type of lifestyle you’d like to be, I give you permission to wipe the slate clean right now.
Today is a new day, and today can be the day you start leading a lifestyle of health and wellness. With that in mind, here are my top recommendations to make 2010 your healthiest year yet.
1. Learn How to Effectively Cope With Stress
In my past experience treating patients with serious chronic illnesses, the vast majority have previous emotional stress that contributed to their problem. And for most of the serious illnesses, the trauma stems back to their childhood.
But according to at least one recent study, it doesn’t take serious trauma to cause these changes. Even normal “everyday” emotional experiences can have a detrimental impact on your future health.
Meditation, prayer, physical activity and exercise are all viable options that can help you maintain emotional and mental equilibrium. I also strongly believe in using tools such as the Meridian Tapping Technique (MTT) to address deeper, oftentimes hidden emotional problems.
2. Get Optimal Exposure to Sunlight
Vitamin D, often referred to as “the sunshine vitamin,” is different from other vitamins in that it influences your entire body. Vitamin D receptors have been found in almost every type of human cell, from your brain to your bones, so its power to optimize your health is truly great.
Please remember that vitamin D will optimize over 2,000-3,000 genes in your body or 10 percent of your total genes!
Studies have shown you can decrease your risk of cancer by MORE THAN HALF and lower your risk of many other common diseases simply by optimizing your vitamin D levels with sun exposure.
3. Eat a Healthy Diet That’s Right for Your Nutritional Type
My nutrition plan, based on natural whole foods, is your first step toward increasing your chances of living a longer, healthier life. The heart of my program is the elimination, or at the very least, drastic reduction of grains and sugar in your diet, while focusing on the foods that are right for your unique biochemistry.
4. Eat Plenty of Raw Food
One of the most important aspects of a healthy diet that is most frequently overlooked is the issue of eating your food uncooked, in its natural raw state.
Unfortunately, as you may be aware, over 90 percent of the food purchased by Americans is processed. And when you’re consuming these kinds of denatured and chemically altered foods, it’s no surprise we have an epidemic of chronic and degenerative diseases.
Ideally you’ll want to eat as many foods as possible in their unprocessed state; typically organic, biodynamic foods that have been grown locally, and are therefore in season.
But even when you choose the best foods available you can destroy most of the nutrition if you cook them. I believe it’s really wise to strive to get as much raw food in your diet as possible. I personally try to eat about 80 percent of my food raw, including raw eggs and meats.
5. Optimize Your Insulin and Leptin Levels
Eating sugar and grains will increase your insulin level, which is one of the fastest ways to premature aging. Leptin is another heavyweight hormone associated with the aging process.
Like your insulin levels, if your leptin levels become elevated, your body systems will develop a resistance to this hormone, which will wreak havoc in your body.
Ron Rosedale, MD, who is one of the leading experts on leptin, does an excellent job of explaining the links between insulin, leptin, your weight and your overall health, and has done so in numerous articles posted on my site.
Your diet, as discussed in steps three and four above, is the key to maintaining the balance of these two hormones.
6. Exercise
The benefits of exercise are staggering, and if you think you can achieve or maintain optimal health without it, you’re deceiving yourself. For example, it helps you to:
• Sleep better
• Lose weight, gain weight or maintain weight, depending on your needs
• Improve your resistance to fight infections
• Lower your risk of cancer, heart disease and diabetes
• Help your brain work better, making you smarter
If you’ve fallen off the exercise wagon, watch my Primary Principles of Exercise video to get back on track.
7. Consume Healthy Fat
The science is loud and clear on this point: omega-3 fats are essential for optimal health.
The omega-3 found naturally in fish and seafood is high in two fatty acids crucial to human health, DHA and EPA. These two fatty acids are pivotal in preventing heart disease, cancer, and many other diseases. Your brain is also highly dependent on DHA — low DHA levels have been linked to depression, schizophrenia, memory loss, and a higher risk of developing Alzheimer’s.
Unfortunately most fish commercially available today (even wild-caught varieties) are polluted with mercury, PCBs and other toxic substances, which is why I recommend you take a supplement like krill oil instead of getting it from your food.
8. Limit Your Exposure to Toxins
The number of toxic chemicals and their sources is so large, addressing them all could easily require an entire library, but I believe you can help you keep your toxic load as low as possible by becoming an informed and vigilant consumer.
This includes tossing out your toxic household cleaners, soaps, personal hygiene products, air fresheners, bug sprays, lawn pesticides, and insecticides, just to name a few, and replacing them with non-toxic alternatives.
For a review of some of the most common sources of household dangers, I suggest you review this previous article, or search my site for any number of different toxins by name.
9. Make Pure Water Your Primary Beverage
Every day your body loses water through urine and sweat, and needs to be replenished. You can actually survive without food for months, but without water you’d die after a few days, so needless to say, water is absolutely essential to life.
You can easily tell what your water requirement is by using your thirst and the color of your urine as guides. Your urine should be a very light-colored yellow. If it is a deep, dark yellow then you are likely not drinking enough water.
Further, if you are healthy, then drinking whenever you feel thirsty should be an adequate guide of how much water you need. You can confirm that you are drinking enough water by looking at the color of your urine, as mentioned above.
As for obtaining clean, pure water, installing a water filter in your home is your best bet. For the latest recommendations on the methods that work best to remove impurities and toxic byproducts caused by water chlorination from your tap water, please review this previous article, Tap Water Toxins—Discover Your Three Best Solutions, Straight From the Experts.
10. Get Plenty of Quality Sleep
Scientists have discovered that your circadian rhythms regulate the energy levels in your cells. In addition, the proteins involved with your circadian rhythm and metabolism are intrinsically linked and dependent upon each other.
Therefore, when your circadian rhythm is disrupted, it can have a profound influence on your physical health. For example, research has also linked disrupted sleep cycles to serious health problems like depression, coronary heart diseases, and even cancer.
Dr. Mercola is the founder of the world’s most visited natural health web site, Mercola.com.

From Harvard Medical School in the U.S. to medical schools in Europe, medical education related to musculoskeletal conditions is inadequate.

Medical Training Related to Musculoskeletal Conditions is Inadequate
ChiroACCESS Editorial Staff
Published on January 6, 2010

From Harvard Medical School in the U.S. to medical schools in Europe, medical education related to musculoskeletal conditions is inadequate. A 2009 survey tested physician’s knowledge related to simple low back pain management. The average survey score of family practitioners was 69.7 and the average score of orthopedists was far less at 44.3. Orthopedists were less likely to make the proper radiological referral and appropriate pharmacological prescription based upon the literature.
Another 2009 study from the U.K. found that only 13% of the junior doctors felt they had adequate musculoskeletal medical training. Research from the University of Washington found that less than 50% for the fourth-year student interns were competent in the area of musculoskeletal medicine. A 2007 study of Harvard medical students found that they were not confident in management of musculoskeletal cases and failed to demonstrate cognitive mastery. The study concluded that “These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field.”
The current failure of modern medicine worldwide to adequately train physicians and the continually growing problems like low back pain creates a window of opportunity for the chiropractic profession.
Orthopedists’ and family practitioners’ knowledge of simple low back pain management.
Spine (Phila Pa 1976). 2009 Jul 1;34(15):1600-3.
Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C.
Department of Orthopaedics, Assaf HaRofeh Medical Center, Zeriffin, Israel. asff@inter.net.il

STUDY DESIGN: Comparative knowledge survey.

OBJECTIVE: This study compared the knowledge of orthopedic surgeons and family practitioners in managing simple low back pain (LBP) with reference to currently published guidelines.

SUMMARY OF BACKGROUND DATA: LBP is the most prevalent of musculoskeletal conditions. It affects nearly everyone at some point in time and about 4% to 33% of the population at any given point. Treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians’ knowledge of the guidelines.
METHODS: Orthopedic surgeons and family practitioners participating in their annual professional meetings were requested to answer a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain.
RESULTS: One hundred forty family practitioners and 253 orthopedists responded to the questionnaire. The mean family practitioners’ score (69.7) was significantly higher than the orthopedists’ score (44.3) (P < 0.0001). No relation was found between the results and physician demographic factors, including seniority. Most orthopedists incorrectly responded that they would send their patients for radiologic evaluations. They would also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs, despite the guidelines recommendations to use paracetamol or nonspecific nonsteroidal anti-inflammatory drugs. Significantly less importance was attributed to patient encouragement and reassurance by the orthopedists as compared with family physicians.
CONCLUSION: Both orthopedic surgeons’ and family physicians’ knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.

The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.
J Bone Joint Surg Br. 2009 Nov;91(11):1413-8.
Al-Nammari SS, James BK, Ramachandran M.
Department of Trauma & Orthopaedics, 2nd Floor, John Harrison House, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.

The aim of this study was to determine whether the foundation programme for junior doctors, implemented across the United Kingdom in 2005, provides adequate training in musculoskeletal medicine. We recruited 112 doctors on completion of their foundation programme and assessed them using the Freedman and Bernstein musculoskeletal examination tool. Only 8.9% passed the assessment. Those with exposure to orthopedics, with a career interest in orthopedics, and who felt that they had gained adequate exposure to musculoskeletal medicine obtained significantly higher scores. Those interested in general practice as a career obtained significantly lower scores. Only 15% had any exposure to orthopedics during the foundation programme and only 13% felt they had adequate exposure to musculoskeletal medicine. The foundation programme currently provides inadequate training in musculoskeletal medicine. The quality and quantity of exposure to musculoskeletal medicine during the foundation programme must be improved.

Competence in evidence-based medicine of senior medical students following a clinically integrated training programme.
Hong Kong Med J. 2009 Oct;15(5):332-8.
Lai NM, Teng CL.
Department of Pediatrics, School of Medicine and Health Sciences, Monash University Malaysia, JKR 1235, Bukit Azah, 80100, Johor Bahru, Johor Darul Takzim, Malaysia. lainm123@yahoo.co.uk

OBJECTIVE: To assess the impact of a structured, clinically integrated evidence-based undergraduate medicine training programme using a validated tool.

DESIGN: Before and after study with no control group.
SETTING: A medical school in Malaysia with an affiliated district clinical training hospital.
PARTICIPANTS: Seventy-two medical students in their final 6 months of training (senior clerkship) encountered between March and August 2006.
INTERVENTION: Our educational intervention included two plenary lectures at the beginning of the clerkship, small-group bedside question-generating sessions, and a journal club in the pediatric posting.
MAIN OUTCOME MEASURES: Our primary outcome was evidence-based medicine knowledge, measured using the adapted Fresno test (score range, 0-212) administered before and after the intervention. We evaluated the performance of the whole cohort, as well as the scores of different subgroups that received separate small-group interventions in their pediatric posting. We also measured the correlation between the students’ evidence-based medicine test scores and overall academic performances in the senior clerkship.
RESULTS: Fifty-five paired scripts were analyzed. Evidence-based medicine knowledge improved significantly post-intervention (means: pre-test, 84 [standard deviation, 24]; post-test, 122 [22]; P<0.001). Post-test scores were significantly correlated with overall senior clerkship performance (r=0.329, P=0.014). Lower post-test scores were observed in subgroups that received their small-group training earlier as opposed to later in the clerkship.
CONCLUSIONS: Clinically integrated undergraduate evidence-based medicine training produced an educationally important improvement in evidence-based medicine knowledge. Student performance in the adapted Fresno test to some extent reflected their overall academic performance in the senior clerkship. Loss of evidence-based medicine knowledge, which might have occurred soon after small-group training, is a concern that warrants future assessment.

More evidence of educational inadequacies in musculoskeletal medicine.
Clin Orthop Relat Res. 2005 Aug;(437):251-9.
Schmale GA.
Children’s Hospital and Regional Medical Center, University of Washington, Seattle, 98105, USA. gschmale@u.washington.edu

In their study, Freedman and Bernstein suggested that 80% of a group of graduates from many of the best medical schools in the United States were deficient in their knowledge of basic facts and concepts in musculoskeletal medicine. How do these results compare with results from students attending a medical school with a long-standing dedicated program to musculoskeletal education? Does additional clinical experience in musculoskeletal medicine improve understanding of the basic facts and concepts introduced in a second-year course? A modified version of an exam used to assess the competency of incoming interns at the University of Pennsylvania was used to assess the competency of medical students during various stages of their training at the University of Washington. Despite generally improved levels of competency with each year at medical school, less than 50% of fourth-year students showed competency. Students who completed a musculoskeletal clinical elective scored higher and were more competent (78%) than students who did not take an elective. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient and that competency increased when learning was reinforced during the clinical years.

Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School.
Acad Med. 2007 May;82(5):452-7.
Day CS, Yeh AC, Franko O, Ramirez M, Krupat E.
Musculoskeletal Curriculum, Harvard Medical School, Orthopedic Hand Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. cday1@bidmc.harvard.edu

PURPOSE: To assess medical students’ knowledge and clinical confidence in musculoskeletal medicine as well as their attitudes toward the education they receive in this specialty.
METHOD: A cross-sectional survey of students in all four years of Harvard Medical School was conducted during the 2005-2006 academic year. Participants were asked to fill out a 30-question survey and a nationally validated basic competency exam in musculoskeletal medicine.
RESULTS: The response rate was 74% (449/608). Medical students rated musculoskeletal education to be of major importance (3.8/5) but rated the amount of curriculum time spent on musculoskeletal medicine as poor (2.1/5). Third-year students felt a low to adequate level of confidence in performing a musculoskeletal physical examination (2.7/5) and failed to demonstrate cognitive mastery in musculoskeletal medicine (passing rate on competency exam: 7%), whereas fourth-year students reported a similar level of confidence (2.7/5) and exhibited a higher passing rate (26%). Increasing exposure to the subject by taking clinical electives resulted in greater clinical confidence and enhanced performance on the exam (P < .001). Students’ feedback suggested that musculoskeletal education can be better integrated into the preclinical curriculum, more time should be spent in the field, and more focus should be placed on common clinical conditions.
CONCLUSIONS: These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field. Implementing a four-year integrated musculoskeletal curriculum is one way that medical schools can address this concern.


Categories: Uncategorized

You’re No Dummy! Auto Accident’s Hurt!

Auto Accidents
Thousands of Americans are injured in auto accidents every year. Many of those people do not know where to turn after an auto accident and do not understand their rights after being injured in an auto accident. At Azzatori Chiropractic of Doylestown, we know that it can take up to several weeks to feel the full effects of an auto accident injury. Spinal conditions due to auto accident injuries are not only a “pain in the neck” they can interfere with your life. At Azzatori Chiropractic of Doylestown we strive to help you regain your health and independence after an auto accident. We are here to help auto accident victims understand their rights and guide them on the right path to recovery. First, you must understand your rights after you have been injured in an auto accident. Your auto insurance carrier is responsible for repairing your vehicle, paying for any lost wages, paying your medical bills, medical mileage, attendant care, and paying for help around the house if necessary. It is important to understand that your own auto insurance company is obligated to pay all reasonable and necessary medical bills and expenses associated with the injuries you suffered in your auto accident for the rest of your life. Also, if you are referred to a neurologist, orthopedic surgeon, neurosurgeon, or other doctor for a second opinion, treatment, or testing the auto insurance carrier will be required to pay those additional medical bills, with no referral needed. You should never have to pay a medical bill out of your own pocket as long as the treatment was medically necessary and related to injuries sustained in your auto accident. The most important point to understand is that you will need to see a chiropractor after an auto accident. Though you may have been to the hospital and a medical doctor you still need to see a chiropractor. Why? Because you need a doctor that focuses on the treatment and diagnosis of auto accident injuries. Usually, hospitals will check vital signs, make sure there are no life-threatening conditions and release the patient with a prescription for addictive pain-relief medication. They do not treat the underlying improper musculoskeletal bio-mechanics that can and often do lead to future pain. Dr. Jeff McQuaite specializes in treating and correcting the many symptoms associated with auto accident injuries such as: neck pain, headaches, back pain, numbness in arms & legs, sciatica, disc bulge, hip pain, shoulder pain, dizziness, anxiety/tension, and many more.
At Azzatori Chiropractic of Doylestown, we specialize in auto accident injuries. Our comprehensive rehabilitation services focus on structural correction of the spine and posture, not just pain relief. In addition to chiropractic spinal adjustments we also provide other therapies like heat, ice, traction, massage, neuro-muscular therapy and postural exercises. Once a spinal injury due to an auto accident is corrected, or is as near normal as possible, we will help you to maintain the correction in order to prevent the condition or injury from returning. Dr. McQuaite and his staff understands the pain, difficulty, and discomfort that an auto accident causes, which is why we treat each patient like a member of our own family, offering an exceptional level of comfort. Dr. McQuaite utilizes a natural and gentle method in order to work one-on-one with his patients to assist in the restoration and maintenance of health after an auto accident. It is our goal to help you regain your health and independence. Whether it’s missing work, inability to spend time with loved ones, putting off the yard work and house cleaning, or not being able to enjoy the fun things in life, spinal conditions caused by auto accident injury can affect everything.   See if Dr. McQuaite at Azzatori Chiropractic of Doylestown can help you regain your health and your life. Visit our website at www.mcquaitechiropractic.com. Check out the new patient special and see patient testimonials on how Dr. McQuaite has helped Doylestown and Central Bucks residents achieve pain relief and begin living their lives as they did before the accident.
For more information find us on:
LinkedIn-http://www.linkedin.com/in/jeffmcquaite
Facebook-http://www.facebook.com/home.php?#!/pages/Doylestown-PA/McQuaite-Chiropractic-Center/61797319643?ref=ts