Biomedical subjects

Mikel Aickin

Publications and source records attributed to Mikel Aickin.

7 recordsLinked to original sources

PubMed2003

Efficacy of cervical endplay assessment as an indicator for spinal manipulation.

STUDY DESIGN: Double-blind, randomized, placebo-controlled trial. OBJECTIVES: To evaluate the effect of manual endplay assessment on neck pain and stiffness outcomes in neck pain patients receiving spinal manipulation. SUMMARY OF THE BACKGROUND DATA: There have been no studies on the efficacy of palpation used as an indicator for manipulation in the management of back and neck pain. METHODS: Neck pain patients (n = 104) were randomly assigned to two groups. The study group received manipulation targeted to individual cervical vertebrae according to endplay restriction noted by the examining clinician. The control group received manipulation determined by sham, computer-generated examination findings; endplay examination was ignored and served as a placebo assessment. Treatment was rendered on a single occasion by a chiropractor. Outcomes were neck pain and stiffness assessed before and after manipulation and at least 5 hours following treatment. RESULTS: The study and control groups showed clinically important improvement in neck pain and stiffness. However, there were no clinically important or statistically significant differences between the study and control groups in terms of pain or stiffness outcomes. Findings were robust across patient, complaint, and treatment characteristics. CONCLUSIONS: Endplay assessment in and of itself did not contribute to the same-day pain and stiffness relief observed in neck pain patients receiving spinal manipulation. The impact on a longer course of treatment remains to be investigated. The data suggest that pain modulation may not be limited to mechanisms associated with manipulation of putative motion restrictions.

Adult↗

PubMed2003

Does methodology affect the ability to monitor tobacco control activities? implications for HEDIS and other performance measures.

BACKGROUND: It is unclear whether methodological differences in sample size, survey methods, and analysis approach significantly affect the ability to accurately monitor tobacco control activities and to make rate comparisons. METHODS: Questionnaires were sent to 64,764 members of nine health plans in diverse settings soon after their visit to a primary care clinician. Of these 41,677 completed responses were received. We compared responses received by mail and by telephone follow-up for the percentage of smokers, characteristics of smokers, and their rates of reporting physician cessation counseling. RESULTS: Overall, 10.2% were current cigarette smokers, but the proportion was 8.6% for mail responders and 17.2% for phone follow-up responders. Smokers identified by phone follow-up were different from mail responders in most demographic and smoking characteristics and their reports of clinical smoking cessation activities differed for six of nine clinician smoking cessation actions. Calculating advice rates as a proportion of visits produced lower rates with more dispersion among plan rates than doing so without accounting for visit variation. CONCLUSIONS: Smoking surveys using only mailed questionnaires dramatically undersample smokers, especially in some demographic groups. Comparisons of tobacco counseling among health plans can be improved by ensuring an adequate sample size and response rate and by analyzing by frequency of quit advice.

Adult↗

PubMed2003

Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics.

PURPOSE: To describe PREMIER, a randomized trial to determine the effects of multi-component lifestyle interventions on blood pressure (BP). METHODS: Participants with above optimal BP through stage 1 hypertension were randomized to: 1) a behavioral lifestyle (BLS) intervention that implements established recommendations, 2) a BLS intervention that implements established recommendations plus the DASH diet, or 3) an advice only standard of care group. The two BLS interventions consist of group and individual counseling sessions for 18 months. The primary outcome is systolic BP at 6 months. Additional outcomes include diastolic BP and homocysteine at 6 months; systolic and diastolic BP at 18 months; fasting lipids, glucose and insulin at 6 and 18 months; and effects in subgroup. CONCLUSION: Results from the PREMIER trial will provide scientific rationale for implementing multi-component behavioral lifestyle intervention programs to control BP and prevent CVD.

Blood Pressure↗

PubMed2003

Food group sources of nutrients in the dietary patterns of the DASH-Sodium trial.

The aim of this paper is to identify major food group sources of several essential nutrients in the two dietary patterns used in the DASH-Sodium trial: a control diet and the DASH dietary pattern. The DASH-Sodium trial was a multicenter, randomized, controlled-feeding trial comparing the effects of three levels of sodium and two dietary patterns on blood pressure. Nutrient contents of all the menus for both the control and the DASH diets were analyzed and examined for their dietary sources from 13 food groups. Contributions of all foods within each food group to each nutrient were averaged then weighted to reflect the actual distribution of energy levels in the study. Nutrient contents across the three sodium levels are very similar within each diet. Refined grains and whole grains are the major energy sources for the control and the DASH diet, providing 35% and 23% to the total intake, respectively. Nutrient-dense whole grains contributed greatly, ranging from 11% to 46%, to the higher intakes of protein, fiber, calcium, magnesium, potassium, zinc, and folate in the DASH diet. Vegetables, in addition to being a good source for fiber, vitamins A, C, E, and folate, also contributed an average of 15% to the intakes of magnesium, potassium, and calcium in the DASH diet. Differences in nutrient contents between the control and the DASH diets were accomplished by varying the selection of food items (eg, refined grains vs whole grains) and quantities of certain food groups (eg, less red meats and higher amounts of fruits and vegetables). The DASH dietary pattern recommends four to five servings of fruits; four to five servings of vegetables; two to three servings of low-fat dairy products; seven to eight servings of grain products (preferably whole grains); two or less servings of meats, poultry, and fish per day; and four to five servings of nuts, seeds, and legumes per week for a 2,000 kcal diet. Each of these food groups contributes critical nutrients across various sodium levels. It is important to emphasize all food groups when trying to follow this proven dietary pattern.

Blood Pressure↗

PubMed2002

One-year trend in pain and disability relief recall in acute and chronic ambulatory low back pain patients.

Clinicians use patients' recall of pain and disability relief as indicators of therapeutic effectiveness. Recall can change over time, however, and is influenced by factors other than true relief, including current health status. We have determined the trend in the relative contribution of current pain/disability and actual relief (current-baseline score) to relief recall over the course of 1 year. Self-referred patients (n=1182) seeking treatment from primary-care medical doctors and chiropractors in community-based clinics were asked to record present pain and disability, as well as perceived relief at five follow-up time points from 2 weeks to 12 months after initial consultation for acute and chronic low back pain (LBP). Multiple regression analysis was performed at each time point and over the five follow-up time points. We found a clear logarithmic time trend of increasing dependence of pain relief recall on present pain (P<0.0001) and a concomitant pattern of decreasing dependence on actual pain relief (P<0.0001). The patterns are fairly consistent for acute and chronic patients. The principal independent predictor of perceived pain/disability relief appears to be present pain/disability with actual relief playing a smaller role at all time points (P<0.0001) except for disability relief recall at 2 weeks (P=0.103). The findings are robust in LBP sufferers. Complaint characteristics including LBP chronicity, sciatica, LBP history, and comorbidity; psychosocial variables including stress, depression, and well being; sociodemographics; and treating provider type are not important independent predictors of pain and disability relief recall in ambulatory LBP patients. Perceived relief is too weakly related to present pain and disability to be accurate enough for use as a clinical assessment tool for individual patients. Physicians may need to use objective relief data to give the patient a realistic idea of actual improvement.

Acute Disease↗

PubMed2002

Beyond randomization.

Conventional opinion states that randomization is the appropriate way to allocate participants to treatments in biomedical studies. The most frequently cited justification is that it is the only method that guarantees balance between treatment groups with respect to all prognostic factors, whether measured or not. Here it is shown by simple arguments that this justification is false and misleading. Design-adaptive allocations are an alternative to randomization that are easy to implement, and virtually guarantee better balance than randomization, for both measured and unmeasured factors. The fraction of studies that will exhibit severe imbalance under randomization is not always trivial. For this reason, in small studies or studies with subgroup analyses or many prognostic factors, design-adaptive allocation is an attractive alternative to randomization. These considerations are particularly relevant to complementary and alternative medicine studies, where resources are relatively scarce, and otherwise underpowered studies might lead to premature termination of promising research paths.

Bias↗

PubMedDate not supplied

Oral disorders in institution-dwelling elderly adults: a graphic representation.

This study was conducted to assess the oral health status and dental care needs of elderly adults living in long-term care facilities. Dentists examined 601 elderly adults, living in one of six extended-or intermediate-care facilities, between September 1999 and May 2000. Data from 532 of the subjects were analyzed with descriptive statistics and zero-order inverse polynomials. Using a computer program, the authors compiled summaries of oral health data on individuals and institutional levels. This study suggests that there are numerous unmet dental needs among elderly adults who live in institutions. The CODE index used to assess the oral health of these residents offers a systematic portrayal of oral disorders in terms of severity. As the authors demonstrated, this index can be readily analyzed using zero-order inverse polynomials to summarize collected data into a graphic description, which can be helpful in managing and administrating oral health care interventions in long-term care facilities.

Age Factors↗