CJA Vol.35 Issue 3Editorial: E Pluribus Unum - p85 Untangling Complementary Medicine, Alternative
Medicine, etc. in Australia - p86 Chiropractic Registration—Queensland Style -
p93 The Relevance of Magnetic Resonance Imaging to
Chiropractic Practice - p101 Fostering Critical Appraisal Skills as a Prelude to
Clinical Practice - p107 Spondylolisthesis and Associated Clinical Features:
A Retrospective Study from a Chiropractic Student Outpatient Clinic -
p112 Book Review - p100 In Memoriam - p116 Books - p117 ABSTRACTS Untangling Complementary Medicine, Alternative Medicine, etc. in Australia NLEY P. BOLTON The phrase complementary and alternative medicine (CAM) is used by the United Nations Health Organization (WHO) to describe non-medical health services and substances in developed countries, including Australia. This paper explores the meaning and implications of the phrases complementary medicine, alternative medicine, integrative medicine and allied health professionals in the Australian context and draws attention to risks from indiscriminate use of complementary medicines and substances by both registered and unregistered healthcare providers in the private sector of the Australian healthcare system. Integrative medicine, a new, definitive style of medical practice, has introduced chiropractic care into the public sector of the healthcare system. New government-initiated healthcare provisions that now include limited chiropractic care within the public sector of the healthcare system are identified and their medical control questioned. INDEX TERMS: AUSTRALIA; ALTERNATIVE MEDICINE; COMPLEMENTARY MEDICINE Chiropr J Aust 2005; 35:86-92. Chiropractic Registration-Queensland Style J. KEITH SIMPSON Using documentary evidence, this historical paper examines the failed attempt at registration of chiropractors in 1967 and the successful introduction of registration in Queensland in 1979. The paper also examines chiropractic coverage under Workers’ Compensation in Queensland and the difficulties presented by the requirement for an injured worker to be referred by a general medical practitioner. INDEX TERMS: MeSH: AUSTRALIA; HISTORY OF CHIROPRACTIC; WORKERS’ COMPENSATION; REFERRAL AND CONSULTATION. OTHER: REGISTRATION; PROFESSIONAL MISCONDUCT. Chiropr J Aust 2005; 35:93-100. The Relevance of Magnetic Imaging to Chiropractic Practice GAVIN B. LUCAS and PETER W. BULL Objectives: This study was undertaken 1) to establish how chiropractors currently use magnetic resonance imaging (MRI) and the extent to which they do so, 2) to determine the use of MRI in determining diagnosis and/or treatment of a patient, 3) to examine the role chiropractors see MRI playing within their profession in the future, and 4) to determine the importance of MRI-related material in chiropractic education. Design: Electronic questionnaire. Setting: Non-randomised, voluntary electronic mail. Subjects: Members of the Chiropractors’ Association of Australia (CAA National) who have provided their association with an electronic mail address. Intervention: None. Questions Asked: Participants were asked 13 questions relating to their use of MRI, its usefulness, their training, and their demographics. Results: Seventy-six (76) usable responses were received, with most chiropractors viewing magnetic resonance images 1 to 5 times per month, generally when the patient already has such images. MRI was reported to be useful in determining a patient’s diagnosis and treatment plan. Poor availability of referring by chiropractors for MRI was the main factor felt to restrict MRI use. The majority of chiropractors feel that they were not trained adequately in interpreting images produced using MRI. Conclusions: MRI is not used to a large extent within the chiropractic profession, and most practitioners do not actively seek such images. Results amongst respondents suggesting inadequate training may indicate chiropractic education may benefit from integrating more MRI-related material, as most chiropractors believe this modality should be employed to a greater extent in the future. A main limitation of this study is that it relied on the computer literacy skills of the respondents. Having these skills may also indicate a bias towards practitioners with a greater understanding of technology who may be more inclined to use new technology such as MRI. INDEX TERMS: CHIROPRACTIC; MAGNETIC RESONANCE IMAGING. MRI. Chiropr J Aust 2005; 35:101-6. Fostering Critical Appraisal Skills as a Prelude to Clinical Practice JENNIFER R. JAMISON Competent diagnosis and treatment depend on proficient critical appraisal. This paper reports on how students are provided with learning opportunities to develop and enhance critical appraisal skills. Methods: A case study of a 4th year diagnosis unit at Murdoch University, which offered 6 discrete critical appraisal opportunities, is described. Student evaluation of the learning experiences by means of questionnaire completion is reported, as are the results of formal assessment of student work demonstrating the use of critical appraisal skills. Results: Student evaluation of the learning experience was largely positive. Case-study-type learning opportunities, particularly when presented in a group differential diagnosis format, were particularly popular. While case analysis may have been directly responsible for the confidence students expressed regarding their future competence as diagnosticians, other opportunities to develop critical appraisal skills such as those created to facilitate active learning, reorganise previous knowledge and appraise current learning were also well received. After 4 weeks, formal assessment found all students capable of implementing diagnostic thinking strategies—to varying degrees. Conclusion: Refined critical analysis skills are fundamental to successful clinical practice. While case studies provide an ideal learning format for acquiring these skills, other scenarios can also provide valuable learning experiences. Most students appeared to value the diverse learning opportunities offered. INDEX TERMS: MeSH: CHIROPRACTIC; DIAGNOSTIC DECISION MAKING; CRITICAL APPRAISAL. Chiropr J Aust 2005; 35:107-11. STACY L. TREBLE, BEATA A. NIEZABITOWSKI and PETER W. BULL
Objective: To report on the relationship between an isthmic spondylolisthesis and a number of radiographic and clinical findings of patients who attended the Macquarie University student outpatient clinics at Eastwood, Epping and Summer Hill. Design and Outcome Variables: Retrospective study based on radiological and clinical analysis of cases with isthmic spondylolisthesis. A total of 1,978 radiographic reports were reviewed from 3 student outpatient clinics, and only those with an isthmic spondylolisthesis were selected for further analysis. Corresponding patient files were examined, and information sought included sex, age, reported visceral conditions, transitional vertebrae and spina bifida occulta. Results: Of the 1,978 radiographic reports, 109 contained an isthmic spondylolisthesis. Of the 109 reports, there was a gender ratio of 2.2 males to every female; 34 had spina bifida occulta; and 10 had a transitional segment. Ninety-four (94) corresponding patient records were found, and 67.02% of patients presented with a history of low back pain. Conclusion: Prevalence of spondylolisthesis, gender relationship, lifetime prevalence of low back pain, and prevalence of spina bifida occulta are all consistent with current literature. Of note is that 79.37% of patients who have experienced low back pain and have an isthmic spondylolisthesis indicated on a pain diagram that they felt their low back pain in the low lumbar spine, sacroiliac joints and buttocks area, and that pain referral into one or both legs is not a common finding. INDEX TERMS: MeSH: SPONDYLOLISTHESIS; CHIROPRACTIC; RADIOGRAPHY; LOW BACK PAIN. Chiropr J Aust 2005; 35:112-6. |
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