Search PubMed⌕ Search

Biomedical subjects

N M Hadler

Publications and source records attributed to N M Hadler.

At least 73 records · Page 4Linked to original sources
PubMed1987

A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial.

Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints. All suffered from regional low-back pain for less than 1 month, were ages 18-40, had never previously undergone any form of spinal manipulation, and denied a prior episode of backache within the previous 6 months. Randomization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2-4 weeks. Outcome was monitored by a questionnaire assessing functional impairment. A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry. In the first week following manipulation, these patients improved to a greater degree (P = .009, t test) and more rapidly (P less than .025, Wilcoxon rank-sum test).

Acute Disease↗
PubMed1986

A critical reappraisal of the fibrositis concept.

Physicians could use such terms as "fibrositis" and "the myofascial pain syndrome" simply to describe an easily recognized quality of illness. But the terms are chosen as part of a privileged vocabulary designed to assert a pathophysiologic insight(s). On careful consideration, these insights are tenuous at best. Furthermore, the terms, with their pathophysiologic insights, become labels that may perturb the patient's experience of disease in a fashion that is counterproductive.

Fibromyalgia↗
PubMed1986

Criteria for screening workers for the establishment of disability.

Disability determination in the US is traditionally based on the classical medical disease-illness paradigm: if one defines the quantity of disease (pathoanatomical abnormality), one can predict the magnitude of illness (symptoms), including how the illness will operate in the workplace. This inference underlies the Handbook of Social Security Disability Insurance (SSDI) and the early attempts at "schedules" in workers' compensation. The reliability and validity of this inference, however, leave much to be desired. The alternatives currently used include the "expert opinion," even when based on direct examination, which is heavily used in both programs. The opinion of the worker's personal physician is relied upon only before the administrative law judge in the SSDI program. These administrative alternatives color the doctor-patient relationship and the worker's perceptions of his illness.

Disability Evaluation↗
PubMed1986

The role of the primary physician in disability determination for Social Security insurance and workers' compensation.

Primary care physicians frequently are asked to serve as advisors, objective third-party examiners, patient advocates, or adjudicators in different work disability programs, or serve at various functions within the same program. The two largest disability programs are Social Security Disability Insurance and Workers' Compensation. Social Security programs are nationally uniform, based on set criteria, and do not require the applicant to show the cause of his or her impairment. Workers' compensation programs differ from state to state and require that the injury or illness occurred as a result of employment. Physicians are often asked to assess impairment or causality on the basis of incomplete information. Improved awareness of the limitations of our scientific knowledge regarding work disability, and the roles physicians play in the disability process, may reduce frustration for physician and patient.

Disability Evaluation↗
PubMed1984

The argument for aspirin as the NSAID of choice in the management of rheumatoid arthritis.

In view of their costliness, the use of newer NSAIDs is justified if they are demonstrably more effective, less toxic, or better tolerated than aspirin (ASA). However, there is no evidence that any is more effective than ASA, and their widely assumed comparable effectiveness has not been demonstrated convincingly. In terms of clinically meaningful overt and even occult gastrointestinal blood loss, ASA is indistinguishable from the newer NSAIDs. Most NSAIDs evoke fewer unpleasant gastrointestinal symptoms than ASA does, although current recording of such symptoms has magnified the ASA experience. Prescribing a new NSAID before ASA requires a heuristic assertion of comparable effectiveness, misconception of overt toxicities, and belief in the meaningfulness of data demonstrating differential tolerance. The trade-off is increased expense and unknown long-term toxicity.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1984

Occupational illness. The issue of causality.

Following European precedents, workers' compensation statutes and the Social Security Disability Insurance program were developed in the United States to deal with the problem of work incapacity. The former was designed to insure for loss of wages consequent to workplace injury, the latter to insure against poverty consequent to work incapacity. Issues such as employer or product culpability, quantification of the magnitude of work incapacity, and insurance for partially restricted work capacity have greatly distorted the intent of these programs; both now provide financial awards based more on damage and disease rather than on the illness of work incapacity. Understanding this evolution will allow physicians to offer more appropriate guidance to their patients, to contribute their voices and perspective to the sociopolitical ethos, and to distinguish the legal issue of culpability from the clinical issues of pathogenesis of disease and of the role of human and work-place factors in causing the disease to be manifest as the illness of work capacity.

Accidents, Occupational↗
PubMed1984

De morte medicinae.

Explore the source record for details and available documents.

Education, Medical↗
PubMed1983

Sounding Board. The illness as the focus of geriatric medicine.

Understanding the difference between illness and disease is a prerequisite to the care of patients affected by incurable disorders. Educated palliation in the absence of substantive information regarding this discrepancy is the art of medicine. Because elderly patients often present with several chronic diseases, many of which are irreversible, cure-oriented physicians caring for the elderly are especially vulnerable to frequent disappointments. Multiple influences, such as psychological, social, environmental, and iatrogenous factors, may also substantially limit the possibilities for "total cure." More important, even though many chronic conditions are incurable, the discomfort or disability they produce may be substantially modified. If this concept is not realized and addressed, patients (many of them elderly) with irreversible chronic diseases may receive less than optimal care from physicians seeking cures. Studies need to be directed at defining and quantifying specific interactions between illness and disease and discovering risk factors for chronic disability in the elderly. The degree to which we as physicians can assist the chronically ill may reflect our understanding of human discomfort and our sensitivity to personal distress. If we maintain a purely disease-specific focus, we may have difficulty thinking about strategies to serve the patient. Defining pathologic entities may be less complicated than intervening in the illness of the patient, but the latter constitutes healing.

Activities of Daily Living↗
PubMed1983

On the design of the Phase III drug trial. The example of rheumatoid arthritis.

No new drug can be marketed in the United States unless a favorable risk-benefit ratio has been demonstrated to the satisfaction of the Food and Drug Administration. Inspection of the fashion in which this is accomplished with reference to rheumatoid arthritis reveals shortcomings in form and substance. Ten issues of design are isolated and options discussed. One design suggested, as a compromise, is 2 20-center trials to supplant late Phase II and Phase III trials. At each center a single investigator evaluates at least a 10-subject, highly selected cohort over 6 months in a 2-drug or a 2-drug plus placebo double-blind format. The active drug versus active drug component of the program will be pivotal in analysis. Advantages include expedience, lower cost, effective detection of short-term stratum-specific toxicity and of investigator bias, and absence of compromise in beta error. With such data and with emphasis on the beta error, the risk-benefit judgment will be more meaningful. Formalized Phase IV monitoring is proposed to detect infrequent or delayed toxicities.

Arthritis, Rheumatoid↗