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Clinical Skills

The Language We Use

This is a bit of a departure of my usual blog, but I think you may find it useful. In the November edition of The Spine Journal and simultaneously in the American Journal of Neuroradiology an article is being published on lumbar disc nomenclature.(1) This has long been recognized as a potential issue. In...
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Evidence, Science and Belief, Writ Small

A long time ago I read a book called “The Hot Zone,” by Richard Preston. It was a book about the discovery of Ebola virus in a primate laboratory located in Reston, Virginia, and it detailed the history of the emergence of Ebola virus in Zaire in 1976, and in Sudan shortly thereafter. The...
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A better way to measure and interpret pain severity?

Have you ever been challenged with interpreting pain that a patient rates with a number from 0-10? To my knowledge, there is no formula to conveniently and accurately convert a sensation to a number. For example, how do we really know what the number 6 means? I for one, have great difficulty interpreting a...
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More Words on Diagnostic Testing: Likelihood Ratios and Test Probabilities

Over the past three blog entries that I have presented, I looked at measures related to diagnostic testing. I started with this question: how do we know a diagnostic test measures what we think it is measuring, since we all know of cases where someone has a condition yet tests negative when we use...
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More satisfied patient when I sit or stand?

Several years ago, a patient thanked me for making them feel like the only person in my office, no matter how busy the practice seemed. To me, the comment was both rewarding and troubling. Though I had been in practice for several years, it was the first time I recalled a patient making that...
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Patients and Study Participants

Applying research findings to clinical decisions with patients always involves critical appraisal and reflection. If an intervention was shown to be effective for the participants in a study you have to decide if that translates to likely being helpful for the patient in front of you. You need to determine if the participants in...
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Some Not-So-Final Words on Diagnostic Testing

  In my past two columns, I provided you with information related to sensitivity and specificity, as well as both positive and negative predictive values. These are measures of the effectiveness of a diagnostic test; that is, they provide you information about whether the test can identify people with and without the condition the...
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Pain education, how can it benefit patients?

A recent article published in the journal Spine describes a 30 minute educational program for patients undergoing surgery for lumbar radiculopathy.1 The education focused on giving patients a basic understanding of the physiology of pain. Of the 67 patients in the study, ½ received the educational session. One year post surgery, both patient groups...
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Efficacy evidence for manual therapies

The Journal of Manual and Manipulative Therapy recently published a systematic review of evidence for the efficacy of spinal manipulation, mobilization and soft tissue techniques, exercise, and usual medical care for patients with acute and chronic low back pain (1). The authors found moderate – strong evidence for spinal manipulation for acute and chronic...
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Shining a light on blind, double –blind and triple-blind

I was recently looking at an article on the short term effects of manipulation on pain perception that classified itself as a “randomized, double-blind controlled clinical trial.” (1) Well, I know what “randomized” means and in general I know what a controlled clinical trial is but I realized that I could not really say...
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