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Biomedical subjects

A H Adams

Publications and source records attributed to A H Adams.

15 recordsLinked to original sources
PubMed1992

Spinal manipulation for low-back pain.

PURPOSE: To review the use, complications, and efficacy of spinal manipulation as a treatment for low-back pain. DATA IDENTIFICATION: Articles were identified through a MEDLINE search, review of articles' bibliographies, and advice from expert orthopedists and chiropractors. STUDY SELECTION: All studies reporting use and complications of spinal manipulation and all controlled trials of the efficacy of spinal manipulation were analyzed. Fifty-eight articles, including 25 controlled trials, were retrieved. DATA ANALYSIS: Data on the use and complications of spinal manipulation were summarized. Controlled trials of efficacy were critically appraised for study quality. Data from nine studies were combined using the confidence profile method of meta-analysis to estimate the effect of spinal manipulation on patients' pain and functional outcomes. RESULTS OF DATA SYNTHESIS: Chiropractors provide most of the manipulative therapy used in the United States for patients with low-back pain. Serious complications of lumbar manipulation, including paraplegia and death, have been reported. Although the occurrence rate of these complications is unknown, it is probably low. For patients with uncomplicated, acute low-back pain, the difference in probability of recovery at 3 weeks favoring treatment with spinal manipulation is 0.17 (for example, increase in recovery from 50% to 67%; 95% probability limits of estimate, 0.07 to 0.28). For patients with low-back pain and sciatic nerve irritation, the difference in probabilities of recovery at 4 weeks is 0.098 (probability limits, -0.016 to 0.209). CONCLUSIONS: Spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute low-back pain. Data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain.

Back Pain↗
PubMed1992

Proposal for establishing structure and process in the development of implicit chiropractic standards of care and practice guidelines.

With the advent of health care's "era of accountability", the chiropractic profession is now faced with generating implicit standards and guidelines for care or having it done for us by outside agencies. Already we see chiropractic groups in individual states and provinces being pressured into naive efforts of guideline development. Current knowledge and experience are available through recent health care literature that clearly defines the structure and process of guideline development and offers suggestions on how to measure outcomes of those processes. In addition, the United States Congress has directed a new federal agency to oversee this activity and monitor outcomes of quality improvement programs. The time has come for the chiropractic profession to define its exact role in health care delivery and develop implicit standards of care and practice guidelines. This sentinel effort should be managed by a commissioned body of empaneled experts that generally represent the academic and clinical chiropractic profession. A protocol for selection of these panelists and the panel chairperson needs to be developed and memorialized. Appropriate methodology (with definitions) needs to be developed for the process of standards/guideline development. Adherence to the accepted structure and process of guideline development will ensure the continuity of this dynamic process in the coming generations. This proposal offers a preliminary definition of the structure and process, including a "seed" policy statement and decision flow chart, specific to guideline development. Once the structure and process of guideline development for chiropractic are defined, the profession can then present this product to federal and state agencies, private sector health care purchasers, patient advocacy groups and other stakeholders of chiropractic care.(ABSTRACT TRUNCATED AT 250 WORDS)

Chiropractic↗
PubMed1992

Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial.

The revised Oswestry Low Back Pain Questionnaire (ROLBPQ) and Roland-Morris Activity Scale (RMAS) were compared in a randomized controlled trial of chiropractic manipulation, stroking massage, corset and transcutaneous muscular stimulation (TMS). This trial employed specific inclusion and exclusion criteria, including nonspecific low back pain for a duration of 3 wk to 6 months and ages between 18 and 55. We had the opportunity to ask 85 patients to answer the questionnaires. Sixty-three patients, who completed the initial and final evaluations, were used for data analysis. Both ROLBPQ and RMAS showed good internal consistency with alpha coefficients ranging from .77 to .93. Both instruments showed a significant difference between the chiropractic manipulation and massage groups (p less than .05). RMAS was able to further show significant differences between the chiropractic manipulation and TMS groups, and between the corset and massage groups, but the ROLBPQ failed to do so. RMAS also showed that chiropractic manipulation had a better but nonsignificant result than corset, possibly due to insufficient sample size and/or duration of treatment. We conclude that both instruments are reliable for measuring low back pain disability, and chiropractic manipulation has a superior short-term benefit when compared to stroking massage and TMS in subacute low back pain patients. In addition, it appears that RMAS is preferable in a clinical trial situation for subacute low back pain because it is more sensitive than ROLBPQ to detect changes.

Adolescent↗
PubMed1981

Adult onset absence status: a report of six cases.

The six cases which we report show the range of confusional states which may be seen in absence status. They also illustrate the importance of electroencephalography in the diagnosis of acute confusional states. In all cases the absence status began in adult life and in one of these it was the first manifestation of epilepsy. Two patients became schizophrenic concurrently with the onset of absence status. The preventive treatment of absence status remains problematic. In particular, clonazepam and valproic acid were ineffective in our series. The attack of absence status may respond to intravenous diazepam or oral clonazepam. In our experience, if the patient is able to take oral medication during absence status, oral clonazepam stops the status within one to two hours. This avoids the potential complications of intravenous diazepam.

Adult↗
PubMed1977

Paroxysmal atrial tachycardia and frontal lobe tumor.

We describe a patient who experienced repeated episodes of paroxysmal atrial tachycardia. He was found to have an epileptogenic focus within the right frontal lobe adjacent to a frontal lobe glioma. Subsequent to excision of the tumor, no further attacks have occurred.

Brain Neoplasms↗
PubMed1975

Painful ophthalmoplegia: report of a case with cerebral involvement and psychiatric complications.

The diagnosis of Tolosa-Hunt syndrome should be suspected in the presence of recurrent "painful ophthalmoplegia." The most useful tests are the rapid (within 48 hours) response to steroids and positive findings on orbital venography. It should be emphasized that Tolosa-Hunt's syndrome may not be a "pure syndrome." Perhaps it is only an occasional presentation of another rather poorly understood syndrome, that of "recurrent cranial neuropathies." The present patient had at least three episodes of painful ophthalmoplegia prior to this hospitalization. During the last hospitalization, he presented with painful ophthalmoplegia, showed a rapid response to steroids, had narrowing of the carotid artery on arteriogram and an abnormal orbital venogram. However, during his hospitalization he developed involvement of cranial nerves II, III, V, VI and VII, papilledema, pyramidal tract signs and severe psychiatric disturbances, all of which remitted. This, coupled with the abnormal pneumoencephalogram and electroencephalogram and organicity on psychological testing, suggests cerebral involvement in our case.

Adult↗
PubMed1975

Four cases of "locked-in" syndrome and review of the literature.

The clinical features, pathology, the autopsy studies, EEG correlation, and the cause of death were discussed. The difference between the locked-in syndrome and classical akinetic mutism was discussed. The importance of reaching a correct diagnosis was stressed to allow a different nursing care program for the conscious "locked-in" patient. Two of our cases were short-term survival, two were long-term survival, one of whom (Case 4) is still living and is the longest survival reported in the literature.

Adult↗
PubMedDate not supplied

Breast lesion discrimination using statistical analysis and shape measures on magnetic resonance imagery.

Magnetic resonance images of intact human breast tissue are evaluated using statistical measures and shape analysis. In this paper, the Mahalanobis distance measurement and a related F-statistical value demonstrate that breast lesions are statistically separable from normal breast tissue. The minimum set of parameters to provide first order statistical separability between fibroadenomas, cysts, and carcinomas are T1-weighted, T2-weighted, and Dixon opposed pulse sequences. Tumor shape is quantified by development of a compactness measure and a spatial frequency analysis of the lesion boundary. Malignant lesions are shown to be separable from benign lesions based on quantitative shape measures.

Adenofibroma↗