Neuroelectrophysiological approaches in heroin addiction research: A review of literatures.

Neuroelectrophysiological properties have been used in human heroin addiction studies. These studies vary in their approach, experimental conditions, paradigms, and outcomes. However, it is essential to integrate previous findings and experimental methods for a better demonstration of current issues and challenges in designing such studies. This Review examines methodologies and experimental conditions of neuroelectrophysiological research among heroin addicts during withdrawal, abstinence, and methadone maintenance treatment and presents the findings. The results show decrements in attentional processing and dysfunctions in brain response inhibition as well as brain activity abnormalities induced by chronic heroin abuse. Chronic heroin addiction causes increased ß and α2 power activity, latency of P300 and P600, and diminished P300 and P600 amplitude. Findings confirm that electroencephalography (EEG) band power and coherence are associated with craving indices and heroin abuse history. First symptoms of withdrawal can be seen in high-frequency EEG bands, and the severity of these symptoms is associated with brain functional connectivity. EEG spectral changes and event-related potential (ERP) properties have been shown to be associated with abstinence length and tend to normalize within 3-6 months of abstinence. From the conflicting criteria and confounding effects in neuroelectrophysiological studies, the authors suggest a comprehensive longitudinal study with a multimethod approach for monitoring EEG and ERP attributes of heroin addicts from early stages of withdrawal until long-term abstinence to control the confounding effects, such as nicotine abuse and other comorbid and premorbid conditions.

Functional Rating Index: literature review.

UNLABELLED: In 1999, a new self-report outcome measure, the Functional Rating Index (FRI), was developed and tested. This measure demonstrated reasonable reliability, validity and responsiveness. Since the publication of the original testing, numerous independent research teams have examined the psychometric qualities of the FRI and published their findings. The aim of this study is to review the psychometric properties of the FRI as reported by published studies. Researchers independently searched the literature for relevant studies using MEDLINE and Index to Chiropractic Literature from January 2001 to August 2009. Descriptive and outcome data was extracted using standardized forms. The psychometric properties of the FRI were analyzed with established criteria and compared head-to-head with other outcome measures. The search yielded ten studies that provided psychometric data. Reliability: Test-retest: Intraclass correlation coefficient and Cronbach's alpha were good, and FRI is equivalent to the other measures. VALIDITY: the FRI has good convergent validity with pain and function self-report scales and a weaker correlation with items that measure different constructs. Responsiveness: FRI was similar to the comparative measures for standardized response mean, effect size and receiver operating curve statistics. Patient acceptability: time required by the patient and staff averaged 78 seconds per administration, and there were few missing responses. The FRI demonstrates favorable measurement properties of reliability, validity and responsiveness. It provides an alternative to other self-report measures, because it is quicker for a patient to complete and can be used for patients with neck and back pain.

Cost minimization analysis of low back pain claims data for chiropractic vs medicine in a managed care organization.

OBJECTIVE: A managed care organization (MCO) examined differences in allowed cost for managing low back pain by medical providers vs chiropractors in an integrated care environment. The purpose of this study is to provide a retrospective cost analysis of administrative data of chiropractic vs medical management of low back pain in a managed care setting. METHODS: All patients with a low back pain-related diagnosis presenting for health care from January 2004 to June 2004 who were insured by an MCO in northeast Wisconsin were tracked. The cumulative health care costs incurred by this MCO during the 2-year period from January 2004 to December 2005 related to these back pain diagnoses were collected. RESULTS: Allowed costs of chiropractic treatment were 12% greater than medical primary care and 60% less per case than other types of medical care combined, on a per-case basis: median cost of medical primary care was $365.00, chiropractic care was $417.00, and medical nonprimary care was $669.00. CONCLUSION: This study of an MCO's low back pain allowed costs may be better redirected to primary care or chiropractic, given equivalent levels of case complexity. This study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.

Awareness and implementation of tobacco dependence treatment guidelines in Arizona: Healthcare Systems Survey 2000.

BACKGROUND: This paper presents findings from the Tobacco Control in Arizona Healthcare Systems Survey, conducted in 2000. The purpose of the survey was to assess the status of Arizona healthcare systems' awareness and implementation of tobacco cessation and prevention measures. METHODS: The 20-item survey was developed by The University of Arizona HealthCare Partnership in collaboration with the Arizona Department of Health Services Bureau of Tobacco Education and Prevention. It was mailed to representatives of Arizona's 40 healthcare systems, including commercial and Medicare managed care organizations, "managed Medicaid" organizations, Veterans Affairs Health Care Systems, and Indian Health Service Medical Centers. Thirty-three healthcare systems (83%) completed the survey. RESULTS: The majority of healthcare systems reported awareness of at least one tobacco cessation and prevention clinical practice guideline, but only one third reported full guideline implementation. While a majority covered some form of behavioral therapy, less than half reported covering tobacco treatment medications. "Managed Medicaid" organizations administered through the Arizona Health Care Cost Containment System were significantly less likely to offer coverage for behavioral therapy and less likely to cover pharmacotherapy than were their non-Medicaid counterparts in managed care, Veterans Affairs Health Care Systems and Indian Health Service Medical Centers. CONCLUSION: Arizona healthcare system coverage for tobacco cessation in the year 2000 was comparable to national survey findings of the same year. The findings that only 10% of "Managed Medicaid" organizations covered tobacco treatment medication and were significantly less likely to cover behavioral therapy were important given the nearly double smoking prevalence among Medicaid patients. Throughout the years of the program, the strategic plan of the Arizona Department of Health Services Bureau of Tobacco Education and Prevention has included the goal of identifying and eliminating tobacco related disparities for special populations, including low-income groups. Of importance, in 2008 the Arizona Health Care Cost Containment System was authorized to provide tobacco cessation pharmacotherapy as a covered benefit for its members.

The K-SF-42.

The purpose of the present article is to propose an alternative short form for the 199-item Arizona Life History Battery (ALHB), which we are calling the K-SF-42, as it contains 42 items as compared with the 20 items of the Mini-K, the short form that has been in greatest use for the past decade. These 42 items were selected from the ALHB, unlike those of the Mini-K, making direct comparisons of the relative psychometric performance of the two alternative short forms a valid and instructive exercise. A series of secondary data analyses were performed upon a recently completed five-nation cross-cultural survey, which was originally designed to assess the role of life history strategy in the etiology of interpersonal aggression. Only data from the ALHB that were collected in all five cross-cultural replications were used for the present analyses. The single immediate objective of this secondary data analysis was producing the K-SF-42 such that it would perform optimally across all five cultures sampled, and perhaps even generalize well to other modern industrial societies not currently sampled as a result of the geographic breadth of those included in the present study. A novel method, based on the use of the Cross-Sample Geometric Mean as a criterion for item selection, was used for generating such a cross-culturally valid short form.

Chiropractic manipulation in adolescent idiopathic scoliosis: a pilot study.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns. The scientific evidence supporting the use chiropractic intervention is inadequate. The purpose of this study was to conduct a pilot study and explore issues of safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, inter-professional cooperation, quality assurance, and outcome measure selection. METHODS: Six patients participated in this 6-month study, 5 of whom were female. One female was braced. The mean age of these patients was 14 years, and the mean Cobb angle was 22.2 degrees. The study design was a randomized controlled clinical trial with two independent and blinded observers. Three patients were treated by standard medical care (observation or brace treatment), two were treated with standard medical care plus chiropractic manipulation, and one was treated with standard medical care plus sham manipulation. The primary outcome measure was Cobb, and the psychosocial measure was Scoliosis Quality of Life Index. RESULTS: Orthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial. Patient recruitment and compliance was good. Chiropractic treatments were safely employed, and research protocols were successful. CONCLUSION: Overall, our pilot study showed the viability for a larger randomized trial. This pilot confirms the strength of existing protocols with amendments for use in a full randomized controlled trial. TRIAL REGISTRATION: This trial has been assigned an international standard randomized controlled trial number by Current Controlled Trials, Ltd. http://www.controlled-trials.com/isrctn/. The number is ISRCTN41221647.

Status of activator methods chiropractic technique, theory, and practice.

OBJECTIVE: To provide an historical overview, description, synthesis, and critique of the Activator Adjusting Instrument (AAI) and Activator Methods Chiropractic Technique of clinical assessment. METHODS: Online resources were searched including Index to Chiropractic Literature, EBSCO Online, MANTIS, CHIROLARS, CINAHL, eJournals, Ovid, MDConsult, Lane Catalog, SU Catalog, and Pubmed. Relevant peer-reviewed studies, commentaries, and reviews were selected. Studies fell into 2 major content areas: instrument adjusting and the analysis system for therapy application. Studies were categorized by research content type: biomechanical, neurophysiological, and clinical. Each study was reviewed in terms of contribution to knowledge and critiqued with regard to quality. DISCUSSION: More than 100 studies related to the AAI and the technique were found, including studies on the instrument's mechanical effects, and a few studies on clinical efficacy. With regard to the analysis, there is evidence for good reliability on prone leg-length assessment, but to date, there is only 1 study evaluating the Activator Methods Chiropractic Technique analysis. CONCLUSION: A body of basic science and clinical research has been generated on the AAI since its first peer-reviewed publication in 1986. The Activator analysis may be a clinically useful tool, but its ultimate scientific validation requires testing using sophisticated research models in the areas of neurophysiology, biomechanics, and statistical analysis.

Do manual therapies help low back pain? A comparative effectiveness meta-analysis.

STUDY DESIGN: Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain. OBJECTIVE: Determine relative effectiveness of spinal manipulation therapies (SMTs), medical management, physical therapies, and exercise for acute and chronic nonsurgical low back pain. SUMMARY OF BACKGROUND DATA: Results of spinal manipulation treatments of nonsurgical low back pain are equivocal. Nearly 40 years of SMT studies were not informative. METHODS: Studies were chosen on the basis of inclusion in prior evidence syntheses. Effect sizes were converted to standardized mean effect sizes and probabilities of recovery. Nested model comparisons isolated nonspecific from treatment effects. Aggregate data were tested for evidential support as compared with shams. RESULTS: Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham's effectiveness. Most acute results were within 95% confidence bands of that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not. CONCLUSION: Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations--features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.

Level and determinants of knowledge of symptomatic knee osteoarthritis among railway workers in Malaysia.

BACKGROUND: Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. PURPOSE: This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. METHODS: A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. RESULTS: Mean (± SD) age of the respondents was 41.4 (± 10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥ 50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. CONCLUSION: The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care.

A drug-drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence.

BACKGROUND: It is essential that current and future health professionals be able to evaluate for possible clinically significant drug-drug interactions (DDIs) and when detected, determine appropriate management strategies to prevent patient harm. OBJECTIVE: Assess the validity of a DDI knowledge assessment instrument in a health professional student population. METHODS: This study recruited health professional students (medical, nurse practitioner, and pharmacy) beginning experiential training at the University of Arizona. Students were given a knowledge assessment instrument that included 15 medication pairings selected on the basis of clinical importance and were asked to select the most appropriate DDI management strategy for each pair by selecting "avoid combination," "usually avoid combination," "take precautions," or "no special precautions." Data were analyzed in 2 ways because of the subjective nature of classifying DDIs into specific management categories. In the first analysis, respondents were given credit for a correct item only if they selected the management strategy deemed appropriate (management strategy analysis). In another analysis, students were given credit for an item only if they correctly identified specific DDIs (DDI recognition analysis). Rasch analysis was used to assess the validity of the knowledge instrument. RESULTS: A total of 165 of the 226 eligible health professional students completed the DDI knowledge assessment (73% response rate). The mean score for management strategy analysis was 3.82 out of 15, whereas DDI recognition analysis produced a higher average (mean=6.55). Good reliability was demonstrated in both strategies, and no ceiling or floor effects were observed. Some construct underrepresentation occurred with both scoring strategies, and some mistargeting was identified when analyzing the management strategy. CONCLUSIONS: Although improvements in construct representation may be beneficial, the instrument used demonstrated good reliability and validity and could be used by educators to assess and improve DDI knowledge. The ability of the participants to identify DDIs and select an appropriate management strategy was low. These results support the need for additional DDI education in this institution's health curricula.

Medical, nursing, and pharmacy students' ability to recognize potential drug-drug interactions: a comparison of healthcare professional students.

PURPOSE: To evaluate and compare the drug-drug interaction (DDI) knowledge of pharmacy, medical, and nurse practitioner (NP) students who are beginning supervised clinical practice. DATA SOURCES: This study utilized a prospective evaluation of DDI knowledge among healthcare professional students who were currently enrolled in their final didactic year at the University of Arizona Colleges of Medicine, Pharmacy, or Nursing's NP program. Students were asked to assess 15 drug pairs and to select an appropriate management strategy for each pair. The primary outcome measure was the ability to correctly categorize each drug pair into one of the five management responses. The secondary outcome measure was the number of clinically significant DDIs recognized. CONCLUSIONS: Pharmacy students demonstrated significantly better knowledge than medical and NP students with respect to identifying and selecting management strategies for possible DDIs. However, there is much room for improvement for all groups. IMPLICATIONS FOR PRACTICE: An increase in curricular content that focuses on DDIs has the potential to better prepare medical, pharmacy, and NP students for practice situations involving DDI alerts, and to increase the quality of patient care.

Construction and validation of the scoliosis quality of life index in adolescent idiopathic scoliosis.

STUDY DESIGN: A prospective cross-sectional design was used to evaluate the Scoliosis Quality of Life Index (SQLI). SQLI is a 22-item self-reporting health-related quality-of-life questionnaire for idiopathic scoliosis patients. OBJECTIVE: The goal of this study was to evaluate the psychometric qualities of SQLI. SUMMARY OF BACKGROUND DATA: SQLI, a modification of the Scoliosis Research Society-22 (SRS-22) questionnaire, is intended to be more applicable to patients with adolescent idiopathic scoliosis (AIS) between 10 and 18 years of age. METHODS: Eighty-four subjects with a mean age of 14.9 years participated. We determined reliability, validity, distribution of scores, and clinical utility of SQLI in a hospital setting. Seventy patients were AIS patients (16 postsurgical, 30 braced, 24 unbraced) with a mean Cobb angle of 30.7 degrees, and 14 patients were sibling controls. RESULTS: Reliability: Intraclass correlation coefficient for test-retest reliability of the global index was very good (ICC 2,1 = 0.80); Spearman's rho correlations between items and domains was 0.39 to 0.89 and between domains and global index was 0.55 to 0.78; Cronbach's alpha scores were more than 0.80 (0.82-0.89). VALIDITY: construct validity was established by correlations between SQLI's global index and Quality of Life Profile for Spine Deformities (QLPSD) global index (Spearman's rho, 0.79) and between SQLI domains and QLPSD domains (0.46-0.81); discriminate validity was established by SQLI's global index successfully partitioned controls and AIS subjects (Kruskal-Wallis test, P = 0.0013). Time required by the patient averaged 2.5 minutes per administration. CONCLUSIONS: SQLI is reliable and valid and demonstrates satisfactory distribution of scores. SQLI is a promising instrument in the assessment of AIS patients.

Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study.

OBJECTIVE: To determine the feasibility of conducting a randomized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage, as well as a nontreatment control group. DESIGN: Randomized controlled-comparison trial with 3 parallel groups. SETTING: Private practice outpatient chiropractic clinic. PATIENTS: Twenty-three subjects, aged 24 to 50 years with systolic or diastolic essential hypertension. INTERVENTIONS: Two months of full-spine chiropractic care (ie, Gonstead) consisting primarily of specific-contact, short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation. The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation. The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room. MAIN OUTCOME MEASURES: Cost per enrolled subject, as well as systolic and diastolic blood pressure (BP) measured with a random-0 sphygmomanometer and patient reported health status (SF-36). Pilot study outcome measures also included an assessment of cooperation of subjects to randomization procedures and drop-out rates, recruitment effectiveness, analysis of temporal stability of BPs at the beginning of care, and the effects of inclusion/exclusion criteria on the subject pool. RESULTS: Thirty subjects enrolled, yielding a cost of $161 per enrolled subject. One subject was later determined to be ineligible, and 6 others dropped out. In both the chiropractic and massage therapy groups, all subjects were classified as either overweight or obese; in the control group there were only 2 classified as such. SF-36 profiles for the groups were similar to that of a normal population. The mean change in diastolic BP was -4 (95% confidence interval [CI]: -8.6, 0.5) in the chiropractic care group, 0.5 (95% CI: -3.5, 4.5) in the brief massage treatment group, and -4.9 (95% CI: -9.7, -0.1) in the no treatment control group. At the end of the study period, this change was -6.3 (95% CI: 13.1, 0.4), -1.0 (95% CI: -7.5, 15.6), -7.2 (95% CI: -13.3, -1.1) in the 3 study groups. The mean improvements in the chiropractic care and no treatment control groups remained consistent over the follow-up period. CONCLUSIONS: This pilot study elucidated several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension. A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control. Measures need to be used to assure comparable groups regarding prognostic variables such as weight. Studies such as these demonstrate the feasibility of conducting a full-scale 3-group randomized clinical trial in the private practice setting.