Thursday, November 29, 2007

Patient-practitioner perceptions: Can chiropractors assume congruence?

*1 Jennifer R. Jamison MB, BCh, PhD, EdD aProfessor of Diagnostic Sciences, Department of Chiropractic, Osteopathy & Complementary Medicine, Faculty of Biomedical & Health Sciences, Bundoora, Victoria, Australia. Journal of Manipulative and Physiological Therapeutics Volume 23, Issue 6, July 2000, Pages 409-413

Abstract Background: Advances in mind-body medicine have resulted in the realization that beliefs can modulate pathophysiologic processes. Because symbolic interaction affects health status, perceptions and the congruence between the perceptions of chiropractors and their patients become a relevant clinical consideration.

Objective: A case study to explore the congruence of health-relevant perceptions of chiropractors and their patients was undertaken.

Method: This Australian case study was undertaken to explore the concurrence of patient-practitioner perceptions with respect to the patient's stress levels, the importance of injury as a causative factor in the presenting symptom and the responsibility the patient should take “in getting themselves well.” Purposive sampling of practitioners and convenience sampling of patients was undertaken. Data were collected by means of a patient questionnaire and a practitioner questionnaire and interview. Data were analyzed to determine the congruence of patient-practitioner perceptions within each of 173 consultations. Results: A total of 9 practitioners and 173 patients participated. Within each patient-practitioner dyad, congruence of perceptions was <50% in each of 3 dimensions examined. Most patients believed they should take a high level of responsibility for “getting well.”

Discussion: Although the results of a case study cannot be extrapolated to the chiropractic patient population, this study does suggest that it may be prudent for chiropractors to ascertain the extent to which their patients share their perceptions of the presenting clinical problem. “Thinking hats” are proposed as a helpful perception management tool.

Conclusion: This exploratory study suggests that practitioners should not assume that their patients share their perceptions. Given that each patient-practitioner encounter is unique, it may be prudent for chiropractors to actively ascertain the patient's opinions. A patient's perception of his or her responsibility for “getting well” should be harnessed in developing management plans with high compliance.
*1 This study was supported by the Australian Spinal Research Foundation.

Editors notes: Once again CEO has been ahead of the curve! The CEO procedures with our Quality of Life goals have been doing exactly this for the last 8 years! If you don’t understand what we are doing just call us or visit the web site. Every procedure in the CEO practice system supports patient “Participaction” (that isn’t a spelling error). New concepts on Chiropractic, new systems, new outcome - how does it get better than that!

Antibiotic Overuse and Microbial Resistance

CDC: Antibiotic resistance"Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. After their discovery in the 1940's they transformed medical care and dramatically reduced illness and death from infectious diseases. However, over the decades the bacteria that antibiotics control have developed resistance to these drugs. Today, virtually all important bacterial infections in the United States and throughout the world are becoming resistant. For this reason, antibiotic resistance is among CDC's top concerns."
CDC: Campaign to Prevent Antimicrobial Resistance in Healthcare Settings- Each year nearly 2 million patients in the United States get an infection in a hospital.- Of those patients, about 90,000 die as a result of their infection.- More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them.
More than 50 million unnecessary antibiotic prescriptions are written each year in the United States for patients outside of hospitals, according the Centers for Disease Control and Prevention
It is striking how reticent the CDC is to place blame on physicians, who are primarily responsible for the mass overuse of antibiotics, and totally responsible for their over prescription. The medical director for CDC's National Campaign for Appropriate Antibiotic Use, Richard Besser, M.D., is quoted thusly on the CDC site: "The biggest problem is inappropriate prescribing of antibiotics. Up to 40% of antibiotics prescribed in doctor's offices are for viral infections, which are not treatable with antibiotics. There are many reason's for this, including demand from patients, time pressure on physicians, and diagnostic uncertainty." Dr. Besser deftly avoids citing the major reason for the overuse of antibiotics, that physicians irresponsibly prescribe them when they are neither needed nor effective. Can we expect the CDC's campaign to be effective if it neglects the main cause of antibiotic resistance? The claim that "demand from patients" is a major reason for "inappropriate prescribing of antibiotics," is nonsensense. A physician who prescribes a drug which he knows to be inappropriate is behaving irresponsibly and unethically. He should cease the practice of medicine. Physicians have demanded and received complete control over the dispensing of most drugs, but they seek to avoid responsibility for the consequences of this paternalism.

Editor’s notes: Wow, you need to visit the site. They lay the blame for the overuse of antibiotics on the Medical profession with a very large stick. This should be headlines in the news! About time someone started telling the truth!!!

Wednesday, November 14, 2007


We’ve known for many years about the physiological benefits of exercise. Certainly it’s good for our hearts, lungs and muscles. Recently, studies have shown the remarkable effect regular exercise has on our brains and mental wellness.
I’ve referred to it as “medicine’s dirty little secret”. In head to head studies, regular aerobic exercise has been shown to be just about as effective as certain popular anti-depression medications for treating clinical depression.
Here’s a recent study reported in USA Today that suggests regular exercise has a significant impact on helping children focus on schoolwork, impulse control and organization. Here’s the story…
By Nanci Hellmich, USA TODAY
Kids who play hard every day may be making their brains, as well as their bodies, stronger. A new study reports that children who play vigorously for 20 to 40 minutes a day may be better able to organize schoolwork, do class projects and learn mathematics.
"Children who are not active may be at a disadvantage academically," says Catherine Davis, an associate professor of pediatrics at the Medical College of Georgia in Augusta. She presented the research last week at the annual meeting of the Obesity Society, a group of weight-loss professionals.
Davis and colleagues worked with 163 sedentary, overweight children, ages 7 to 11, for three months. The children were divided into three groups: a control group that did no physical activity after school; a group that did 20 minutes of vigorous physical activity five days a week after school; and a group that did 40 minutes of such activity on those same days.
The activity groups played intermittent, high-energy running games, such as flag tag, relays, jump rope and modified basketball. They wore heart-rate monitors and were given rewards for maintaining a high average heart rate. Students also were given cognitive-function tests at the beginning and end of the study. They were tested for their math and reading achievement and "executive function."
Executive function includes skills important for planning and organizing, focusing on schoolwork, resisting impulses, self-monitoring and using strategies to achieve goals. Children who have attention deficit disorder have difficulty with those tasks.
Among the findings from the National Institutes of Health-financed study:
The children in the 40-minute activity group had significant improvement on an executive-function test compared with the control group. They increased about 4 points on a cognitive-performance scale. Those in the 20-minute group showed about half that improvement.
There was a small improvement in math achievement for both exercise groups but no signs of improvement in reading.
Those in the exercise groups lost about 1% to 2% of body fat.
The researchers also performed brain scans and found that the children who were exercising appeared to have more neural activity in the frontal areas of their brains, an important area for executive function, Davis says. "The animal literature tells us that exercise, particularly regular exercise, stimulates the growth of blood vessels and neurons in the brain, so we think the same may be happening in the children."
Other studies have shown that executive function improves in older adults who become more physically active, she says. "School systems need to know that to reach their achievement targets, they need to add physical activity to the school day rather than reduce it."
Phillip Tomporowski, a study co-author and exercise psychologist at the University of Georgia in Athens, says exercise "may well improve the underlying mental processes that are involved in a lot of behaviors and academic tasks."
Says Darla Castelli, assistant professor in the department of kinesiology and community health at the University of Illinois at Urbana-Champaign: "This research corroborates several of our studies, which have also examined executive function in kids. We found strong associations between math performance and aerobic fitness among elementary-school-age children."
Howell Wechsler, director of the Division of Adolescent and School Health for the Centers for Disease Control and Prevention, says some children don't have as many opportunities outside school to be as active as children in previous generations.
"Today there is so much more competition for their time with all the attractive options to be sedentary, from hundreds of cable stations to video games and computer games," Wechsler says. "This makes it even more important to have physical education programs and other opportunities for physical activity at school."
So, if your kids aren’t exercising in school (many schools have cut P.E. from their curriculum) it will help them physically and mentally to be involved in some structured aerobic activity. I promise you, a half hour of vigorous activity will reap far more benefit than a half hour staring at a video screen playing the latest game!
And, we adults get a similar benefit from exercise – what a great reason to get the whole family together. Go for a jog or walk, kick a soccer ball around, smack a table tennis ball … you, your family and your brain will be glad you did!
To Your Brain Health,
Daniel Amen, M.D.CEO, Amen Clinics, Inc.Distinguished Fellow, American Psychiatric Association

Thursday, November 8, 2007

The Folly of Multitasking

The Folly of Multitasking – The Week, October 26. 2007

Our cell phones and computers, says novelist Walter Kirn, had us convinced we could do five things at once. But neuroscience^ is now finding that the mental gymnastics required actually dumbs us down.

In the Midwestern town where I grew up (a town so small that the phone line on our block was a "party line" well into the 1960s), there were two skinny brothers in their 30s who built a car that could drive into the river and become a fishing boat.

My pals and I thought the car-boat was a wonder. A thing that did one thing but also did another thing—especially the opposite thing, but at least an unrelated thing—was our idea of a great invention and a bold stride toward the future. Where we got this idea, I'll never know, but it caused us to envision a world-to-come teeming with crossbred, hyphenated machines. Refrigerator-TV sets. Dishwasher-air conditioners, Table saw-popcorn poppers, Camera-radios.
With that last dumb idea, we were getting close to something, as I’ve noted every time I’ve dropped or fumbled my cell phone and snapped a picture of a wall or the middle button of my shirt. Impressive. Ingenious. Yet juvenile. Arbitrary. And why a substan­dard camera, anyway? Why not an excellent electric razor?

Because (I told myself at the cell phone store in the winter of 2003, as I handled a feature-laden upgrade that my new contract entitled me to purchase at a deep discount that also included a rebate) there may come a moment on a plane or in a subway station or at a mall when I and the other able-bod­ied males will be forced to subdue a Terror­ist, and my color snapshot of his trussed-up body will make the front page of USA Today and appear at the left shoulder of all the superstars of cable news.

While I waited for my date with citizen-journalist destiny, I took a lot of self-por­traits in my Toyota and forwarded them to a girlfriend in Colorado, who reciprocated from her Jeep. Neither one of us almost died. For months. But then, one night on a snowy two-lane highway- while I was crossing Wyoming to see my girl's real face, my phone made its chirpy you-have-a-picture noise, and I glanced down in its direction while also, apparently, swerving off the pavement and sailing over a steep embank­ment toward a barbed-wire fence.

It was interesting to me—in retrospect, after having done some reading about the frenzied activity of the multitasking brain—how late in the process my prefrontal cortex, where our cognitive switchboards hide, changed its focus from the silly phone (Where did it go? Did it slip between the seats? I wonder if this new photo is a nude shot or if its another one from the topless series that seemed like such a breakthrough a month ago but now I'm getting sick of) to the important matter of a steel fence post sliding spear-like across my hood.
The laminated windshield glass must have been high quality; the point of the post bounced off it, leaving only a star-shaped surface crack. But I was still barrel­ing toward sagebrush, and who knew what rocks and boulders lay in wait.
Five minutes later, I'd driven out of the field and gunned it back up the embank­ment onto the highway and was proceeding south, heart slowing some, satellite radio tuned to a soft-rock channel called the Heart, which was playing lots of soothing Celine Dion.
"I just had an accident trying to see your picture."
"Will you get here in time to take me out to dinner?"
"I almost died."
"Well, you sound fine."
"Fine's not a sound."
I never forgave her for that detachment-I never forgave myself for buying a camera phone.

We all remember the promises. The slo­gans. They were all about freedom, libera­tion. Supposedly we were in handcuffs and wanted out of them. The key that dangled in front of us was a microchip.
"Where do you want to go today?" asked Microsoft in a mid-1990s ad campaign. The suggestion was that there were endless destinations—some geographic, some social, some intellectual—that you could reach in milliseconds by load­ing the right devices with the right software. It was further insinuated that where you went was purely up to you, not your spouse, your boss, your kids, or your government. Autonomy through automation.
This was the embryonic fallacy that grew up into the monster of multitasking.

Human Freedom, as clas­sically defined (to think and act and choose with minimal interference by outside pow­ers), was not a product that firms like Microsoft could offer, but they recast it as something they could provide. A product for which they could raise the demand by refining its features, upping its speed, restyling its appearance, and linking it up with all the other products that prom­ised freedom, too, but had replaced it with three inferior substitutes that they could market in its name:Efficiency, convenience- and mobility. For proof that these bundled minor virtues don't amount to freedom but are, instead, a formula for a period of mounting frenzy climaxing with a lapse into fatigue, consider that “Where do you want to go today?" was really manipulative advice, not an open question. "Go somewhere now," it strongly recommended, then go somewhere else tomorrow, but always go, go, go—and with our help- But did any rebel reply, ”Nowhere, I like it fine right here"? Did anyone boldly ask, "What business is it of yours?" Was anyone brave enough to say, "Frankly, I want to go back to bed"?

Maybe a few of us. Not enough of us. Everyone else was going places, it seemed, and either we started going places, too— especially to those places that weren't places (another word they'd redefined) but were just pictures or documents or videos or boxes on screens where strangers conversed by typing—or else we'd be nowhere (a loca­tion once known as "here") doing nothing (an activity formerly labeled "living"), What a waste this would be. What a waste of our new freedom.
Our freedom to stay busy at all hours, at the task—and then the many tasks, and ulti­mately the multitask—of trying to be free. It isn't working it never has worked.

The scientists know this too, and they think they know why. Through a variety of experiments, many using functional mag­netic resonance imaging to measure brain activity, they've torn the mask off multi­tasking and revealed its true face, which is blank and pale and drawn.
Multitasking messes with the brain in several ways. At the most basic level, the mental balancing acts that it requires—the constant switching and pivoting—ener­gize regions of the brain that specialize in visual processing and physical coordina­tion and simultaneously appear to short­change some of the higher areas related to memory and learning. We concentrate on the act of concentration at the expense of whatever it is that we're supposed to be concentrating on.
What does this mean in practice? Consider a recent experiment at UCLA, where researchers asked a group of 20-somethings to sort index cards in two trials, once in silence and once while simul­taneously listening for specific tones in a series of randomly presented sounds- The subjects' brains coped with the additional task by shifting responsibility from the hippocampus—which scores and recalls information—to the striatum, which takes care of rote, repetitive activities. Thanks to this switch, the subjects managed to sort the cards just as well with the musical dis­traction—but they had a much harder time remembering what, exactly, they'd been sorting once the experiment was over.
Even worse, certain studies find that multitasking boosts the level of stress-related hormones such as cortisol and adrenaline and wears down our systems through biochemical friction, prematurely aging us. In the short term, the confusion, fatigue, and chaos merely hamper our abil­ity to focus and analyze, but in the long term, they may cause it to atrophy.
The next generation, presumably, is the hardest-hit. They're the ones way out there on the cutting edge of the multitasking revolution, texting and instant messaging each other while they download music to their iPod and update their Facebook page and complete a homework assignment and keep an eye on the episode of The Hills flickering on a nearby television. (A recent study from the Kaiser Family Foundation found that 53 percent of students in grades seven through 12 report consuming some other form of media while watch­ing television, 50 percent multitask while reading; 62 percent while using the com­puter; and 63 percent while listening to music, "I get bored if it's not all going at once," said a 17-year-old quoted in the study.) They’re the ones whose still-matur­ing brains are being shaped to process information rather than understand or even remember it.
This is the great irony of multitasking—that its overall goal, getting more done in less time, turns out to be chimeri­cal. In reality, multitasking slows our think­ing. It forces us to chop competing tasks into pieces, set them in different piles, then hunt for the pile we're interested in, pick up its pieces, review the rules for pulling the pieces back together, and then attempt to do so, often quite awkwardly- (Fact: A brain attempting to perform two tasks simultaneously will, because of all the back-and-forth stress, exhibit a substantial lag in information processing.)

Productive? Efficient"? More like running up and down a beach repairing a row of sand castles as the tide comes rolling in and the rain comes pouring down. Multitasking, a definition; "The attempt by human beings to operate like computers, often done with the assistance of computers." It begins by giving us more tasks to do, making each task harder to do, and dimming the mental powers required to do them. It finishes by making us forget exactly how on earth we did them (assuming we didn't give up, or "multiquit"), which makes them harder to do again.
After the near-fatal consequences of my 2003 decision to buy a phone with a fea­ture I didn't need, life went on—and rather rapidly, since multitasking eats up time in the name of saving time, rushing you through your two-year contract cycle and returning you to the company store with a suspicion that you didn’t accomplish all you hoped to after your last optimistic, euphoric visit.

The Busy Brain - Lights on, nobody home

"Which of the ones that offer rebates don't have cameras in them?"
"The decent models all do. The best ones now have video capabilities. You can shoot little movies.”
I wanted to ask, Of what? Oncoming barbed wire?
I shook my head. I was turning down whiz-bang features for the first time.
'I’ll take the fat little free one”, I told the salesman.
"The thing’s inert, It does nothing. It's a pet rock."
I informed him that I was old enough to have actually owned a pet rock once and that I missed it
From a longer essay that appears in
November's The Atlantic Monthly,
© 2007 by The Atlantic Monthly Group.
Distributed bv Tribune Media Services.