CJA Vol.38 Issue 2Editorial: Toward Cultural Authority - p41 Development of the 2006-2009 CAA Strategic Plan - p42 Traumatic Determinism: Tumours Misdiagnosed as
Sporting Injuries: A Report of Two Cases - p45 Critical Reflection in Work-Integrated Learning -
p49 Designing Core Clinical Bioethics Training for
Master’s Level Students in an American Chiropractic College -
p57 Chiropractic Care of a 3-Year-Old Male with Sleep
Disordered Breathing Syndrome - p69 General Health Status of a Sample of Chiropractic
Patients with Uncomplicated Biomechanical Neck or Low Back Pain -
p75 ABSTRACTS Traumatic Determinism: Tumours Misdiagnosed as Sporting Injuries. A Report of Two Cases LISA RIMMELZWAAN and PETER BULL Objective: To report two cases of patients presenting to chiropractic clinics with previously diagnosed activity-related conditions, in whom bone tumours were found on plain film radiography. Clinical Features: Case 1 presents a soccer player with a one-year history of left groin pain that had been non-responsive to treatment by a physiotherapist for suspected groin sprain. The physical examination findings reproduced pain over the left superior pubic ramus, but were otherwise unremarkable for the hip. Plain film radiographs demonstrated an expanded sclerotic lesion of the superior pubic ramus. The patient in Case 2 had a previous history of prostate and lung cancer. The 55-year-old presented with right elbow pain that had been previous diagnosed by his oncologist as “tennis elbow.” Physical examination of the elbow was unremarkable; cervical spine examination revealed restrictions and pain, predominantly within the early range of motion and upon right Kemps manoeuvre. Radiology demonstrated metastatic destruction of the C7 spinous process. Intervention and Outcome: Both cases were immediately referred to their general practitioner and then for advanced imaging. The diagnosis of the soccer player in Case 1 was fibrous dysplasia rather than a malignant lesion. The patient in Case 2 had surgical removal of bone metastasis, although outcomes were not known upon completion of this paper. Conclusions: Musculoskeletal tumours may mimic activity-related conditions from both local and referred sites. It is therefore important that a clinician consider imaging or referral to rule out a musculoskeletal tumour. This is particularly emphasised in the case where a suspected. INDEX TERMS: TUMOUR; SPORTS-RELATED CONDITION; MISDIAGNOSIS; CHIROPRACTIC. Chiropr J Aust 2008; 38:45-8. Critical Reflection in Work-Integrated Learning PHILLIP EBRALL, ADRIAN REPKA and BARRY DRAPER To report the outcomes of an approach to clinical learning that requires chiropractic students to critically reflect on directed activity that drives an engagement with work-integrated learning (WIL). Methods: A preview of learning objectives in RMIT University’s Bachelor of Applied Science, the degree that constitutes the first 3 years of the 5-year chiropractic program, led to implementation of a learning task that engaged students as a subject within a new patient assessment conducted by senior students in the University’s chiropractic teaching clinics, and then as an observer of a real-world chiropractic practitioner. A series of prompts were constructed to drive each task. The prompts reflected contemporary educational philosophy that required connection with the learning objectives of the course and utilised action verbs to drive a deeper learning engagement in the realm of the cognitive and qualitative dimensions. Results: A total of 105 completed Learning Journals were submitted by a class of 107 students. The reported comments represent the work of 22 individual students, a sample of 23.1% of the total class. Discussion: The themes that emerged included reinforcement of a student’s career choice and their approach to learning, reinforcement of classroom-based practical skills, and a connection between classroom learning and the workplace. The submitted work has power to inform teachers of current workplace practices and provide insight into the WIL practices in the teaching clinics. The authors see the outcomes as being supportive of the value of critical reflection to contribute strongly to a deepening of the student’s clinical learning. Conclusion: The authors are of the view that a thoughtful combination of structure and prompts will allow the development of an appropriate tool to engage students in the process of critical self-reflection in their senior years. INDEX TERMS: MeSH: CHIROPRACTIC; EDUCATION, HEALTH; CHIROPRACTIC EDUCATION; CHIROPRACTIC TRENDS. ICL: EDUCATION, CHIROPRACTIC; EDUCATION, CHIROPRACTIC/AUSTRALA. Chiropr J Aust 2008; 38:49-56. DANA J. LAWRENCE Objective: To develop a core curriculum for teaching biomedical ethics to master’s level students in a clinical research training program at a chiropractic institution and research centre and to provide a background and overview about bioethics curricula. Method: Qualitative research using interviews with semi-structured questions. Four leaders with experience in ethics teaching or administration were interviewed. Each was asked to consider a set of topics for bioethics, add to, alter or delete topics, and then to provide one key learning objective for each final topic. Answers were coded thematically, with responses used to develop a curriculum for a course in clinical bioethics. Results: Responses from participants provided guidance for the development of a course in clinical bioethics that relies upon the use of case scenarios and combined teaching and learning methodologies. It includes weekly “driving Scenarios” around which classroom discussion takes place. It also provides a list of learning objectives. Conclusion: A curriculum in clinical bioethics for master’s students was developed from information provided by interviewees. Early assessment indicates that students are successfully incorporating information from the bioethics class into research projects developed later in their course of study. INDEX TERMS: MeSH: BIOETHICS; CURRICULUM; EDUCATION, MEDICAL; (Other): QUALITATIVE RESEARCH. Chiropr J Aust 2008; 38:57-68. Chiropractic Care of a 3-Year-Old Male with Sleep Disordered Breathing Syndrome JOEL ALCANTARA, JULIE DESILETS, ROSEMARY E. OMAN Objective: To describe the chiropractic care of a patient with a chief complaint of “sleeping problems.” Clinical Features: A 3-yr-old boy with “sleeping problems” characterised as loud snoring, episodes of “breath-holding” and disturbed continuous sleep by awakening several times per night is cared for with chiropractic. His health history revealed recurrent sinusitis, one episode of bronchitis, episodes of otitis media and bronchitis. The child experienced no obvious injuries, according to his parents. Previous medical care seemed ineffective, a motivation for chiropractic intervention. Intervention andOutcome: The patient received chiropractic care based on the correction of the vertebral subluxation complex (VSC). Contact-specific, high-velocity, low-amplitude (HVLA) type thrusts were applied to sites of vertebral subluxations along with craniosacral therapy. Following 5 visits, the patient’s sleep was significantly improved. Conclusion: This case study may demonstrate a link between sleep disorders and its amelioration through chiropractic care. We advocate for more research in this field. INDEX TERMS: (MeSH) CHIROPRACTIC; SLEEP APNEA SYNDDROME. (Other): SLEEP DISORDERED BREATHING SYNDROMET. Chiropr J Aust 2008; 38:69-74. MAX J. WALSH, JOHN REECE and FRANK DONNOLI Objective: This study evaluates the general health status (as measured by the RAND-36 survey) of a sample of chiropractic patients with uncomplicated low back pain or neck pain and the impact that chiropractic treatment has on their health status. Design: Prospective case series. Setting: RMIT University chiropractic teaching clinics. Patients: Sixty-nine (69) patients of the RMIT chiropractic clinic diagnosed with either uncomplicated biomechanical neck pain (n=34) or low back pain (n=35). Intervention: Manual or instrument HVLA spinal adjustments plus soft tissue therapy as indicated. Main Outcome Measure: RAND-36 version 1.0 of the Medical Outcomes Trust short form 36 (SF-36) health questionnaire. Assessment was done pre-treatment and following an average of 7 treatments. Results: A case series of 69 patients with uncomplicated low back pain or neck pain found the patients to have a lower health status as measured by the RAND-36 v1 than comparable population norms prior to treatment. All scores in the RAND-36 improved following standard chiropractic treatment. A similar pattern was found for low back patients and neck pain patients separately. There were no significant differences between males or females or age groups. There were some significant treatment differential effects between acute compared with chronic cases. Conclusion: For the study sample, the presence of uncomplicated low back pain or neck pain was associated with a lowering of general health status as measured by the RAND-36 questionnaire, compared with the normal population. Chiropractic treatment for these patients would appear to lead to an increase in general health status for both low back and neck pain patients, however as there were no controls, the results cannot be directly related to the treatment regime. A randomised clinical trial is recommended to clarify the results. INDEX TERMS: (MeSH): CHIEROPRACTIC; HEALTH STATUS; (Other): SF-36. Chiropr J Aust 2008; 38:75-80. |
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