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1.  Superior pulmonary sulcus tumor 
The patient who presents to the chiropractic physician complaining of long-standing upper extremity pain offers a most perplexing diagnostic challenge. Although pancoast tumor is rarely considered in the differential diagnosis, its ability to mimic more common, yet less ominous pathologies, warrants a careful and thorough clinical assessment. A case presentation and discussion are presented to illustrate the complexity of this entity and its relationship to diagnostic protocol.
Images
PMCID: PMC2484347
Pancoast tumor; chiropractic; manipulation
2.  Attitudes of non-practicing chiropractors: a pilot survey concerning factors related to attrition 
Background
Research into attitudes about chiropractors who are no longer engaged in active clinical practice is non-existent. Yet non-practicing chiropractors (NPCs) represent a valid sub-group worthy of study.
Aim
The purpose of this research was to assess attrition attitudes of NPCs about the chiropractic profession and develop a scale to assess such attitudes.
Methods
A 48 item survey was developed using the PsychData software. This survey included 35 Likert-style items assessing various aspects of the profession namely financial, educational, psychosocial and political. An internet discussion site where NPCs may be members was accessed for recruitment purposes.
Results
A total of 70 valid responses were received for analysis. A majority of respondents were male with 66% being in non-practice status for 3 to 5 years and less with 43% indicating that they had graduated since the year 2000. Most respondents were employed either in other healthcare professions and non-chiropractic education. A majority of NPCs believed that business ethics in chiropractic were questionable and that overhead expense and student loans were factors in practice success. A majority of NPCs were in associate practice at one time with many believing that associates were encouraged to prolong the care of patients and that associate salaries were not fair. Most NPCs surveyed believed that chiropractic was not a good career choice and would not recommend someone to become a chiropractor. From this survey, a 12 item scale was developed called the "chiropractor attrition attitude scale" for future research. Reliability analysis of this novel scale demonstrated a coefficient alpha of 0.90.
Conclusion
The low response rate indicates that findings cannot be generalized to the NPC population. This study nonetheless demonstrates that NPCs attrition attitudes can be assessed. The lack of a central database of NPCs is a challenge to future research. Appropriate investigation of attrition within the chiropractic profession would be helpful in the analysis of attitudes regarding both chiropractic education and practice. Further research is needed in this area.
doi:10.1186/1746-1340-18-29
PMCID: PMC2992535  PMID: 21050461
3.  An epidemiological examination of the subluxation construct using Hill's criteria of causation 
Background
Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
Aim
The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
Methods
The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
Results
The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
Conclusion
There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.
doi:10.1186/1746-1340-17-13
PMCID: PMC3238291  PMID: 19954544
4.  The appropriate use of radiography in clinical practice: a report of two cases of biomechanical versus malignant spine pain 
Background
To describe the evaluation, treatment, management and referral of two patients with back pain with an eventual malignant etiology, who were first thought to have a non-organic biomechanical disorder.
Clinical features
The study was a retrospective review of the clinical course of two patients seen by a chiropractor in a multi-disciplinary outpatient facility, who presented with what was thought to be non-organic biomechanical spine pain. Clinical examination by both medical and chiropractic physicians did not indicate the need for radiography in the early course of management of either patient. Upon subsequent re-evaluation, it was decided that certain clinical factors required investigation with advanced imaging.
In one instance, the patient responded to conservative care of low back pain for nine weeks, after which she developed severe pain in the pelvis. In the second case, the patient presented with signs and symptoms consistent with uncomplicated musculoskeletal pain that failed to respond to a course of conservative care. He was referred for medical therapy which also failed to relieve his pain. In both patients, malignancy was eventually discovered with magnetic resonance imaging and both patients are now deceased, resulting in an inability to obtain informed consent for the publication of this manuscript.
Conclusion
In these two cases, the prudent use of diagnostic plain film radiography did not significantly alter the appropriate long-term management of patients with neuromusculoskeletal signs and symptoms. The judicious use of magnetic resonance imaging was an effective procedure when investigating recalcitrant neuromusculoskeletal pain in these two patients.
doi:10.1186/1746-1340-14-8
PMCID: PMC1488857  PMID: 16734899
5.  The musculoskeletal effects of diabetes mellitus 
Diabetes mellitus (DM) is a multi-system disease characterized by persistent hyperglycemia that has both acute and chronic biochemical and anatomical sequelae, with Type-2 DM representing the most common form of the disease. Neuromusculoskeletal sequelae of DM are common and the practicing chiropractor should be alert to these conditions, as some are manageable in a chiropractic office, while others are life and/or limb threatening. This paper reviews the effects of DM on the musculoskeletal system so as assist the chiropractor in making appropriate clinical decisions regarding therapy, understanding contraindications to therapy, referring patients to medical physicians when appropriate and understanding the impact that DM may have on the prognosis for their patients suffering from the myriad musculoskeletal conditions associated with this disease.
PMCID: PMC1839979  PMID: 17549168
diabetes; musculoskeletal; chiropractic
6.  The necessary future of chiropractic education: a North American perspective 
The chiropractic educational system in North America is currently in a state of flux. The attempted conversion of some chiropractic schools into "universities" and the want of university affiliation for chiropractic schools suggests that we are searching for a better alternative to the present system. In the early 20th century, the Flexner Report helped transform modern medical education into a discipline that relies on scientific and clinical knowledge. Some have wondered if it is time for a Flexner-type report regarding the education of doctors of chiropractic. This article outlines the current challenges within the chiropractic educational system and proposes positive changes for that system.
doi:10.1186/1746-1340-13-10
PMCID: PMC1181629  PMID: 16001976
7.  Spine Cancer 
Background: Spine pain is a common presenting complaint of patients who visit physicians and although spine cancer accounts for a very small percentage of cases of back pain, metastasis is a relatively common cause of spine pain in the elderly. The presentation of patients with spine cancers is highly variable, and in many cases the clinical findings of benign and cancerous causes of spine pain can be similar, often confounding the clinical picture. This can create difficulties in interpreting the clinical data available to the physician, particularly with a disease with such a devastating prognosis.
Objective: This manuscript discusses the more common causes of malignant lesions of the spine, including an overview of the incidence/prevalence data and clinical features of both primary and secondary malignancies. It also provides the reader with a clinical overview of patients with spine cancer.
Discussion: It is important to appreciate the myriad epidemiologic and clinical features of primary and secondary spine cancers. Patients with malignant skeletal lesions may be asymptomatic in the area of cancerous bone disease and, as a consequence, these lesions can be overlooked. This may result in dismal consequences for the patient, given the generally poor prognosis associated with spine cancers. Knowledge of the features discussed in this paper will assist the clinician in appropriately raising his/her index of suspicion for spine cancer in suitable clinical circumstances.
PMCID: PMC2051311  PMID: 17987205
Spine; pain; cancer; review

Results 1-8 (8)