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Neck Manipulation & Stroke Risk

Neck Manipulation & Stroke Risk

Cervical dissections (CD) of the arteries—small tears in the layers of the arterial walls in the neck—are an important cause of stroke in young and middle-aged patients. CD can result in ischemic stroke if blood clots form after a trivial or major trauma in the neck and later cause blockages to the blood vessels in the brain. “CD accounts for just 2% of all ischemic strokes but 8% to 25% of strokes in patients younger than age 45,” says José Biller, MD, FAAN, FACP, FAHA. “The annual incidence, however, is likely underestimated because asymptomatic CD often goes undiagnosed.” Currently, the underlying pathology for spontaneous CD is unknown, but several factors have been linked to CD (Table 1). Dissections can be either spontaneous or traumatic, and their severity can vary. Research has shown that mechanical forces often play a role in a considerable number of CDs. “Most dissections involve some form of trauma, stretching, or mechanical stress,” says Ralph L. Sacco, MD, MS, FAHA, FAAN. These dissections can also occur with cervical manipulative therapy (CMT), various sporting activities, whiplash injuries, sudden neck movements, and violent vomiting or coughing, even if these events are deemed inconsequential by patients. Although CMT techniques vary, maneuvers often extend and rotate the neck, and some involve a forceful thrust. New Recommendations In 2014, the American Heart Association (AHA) released a scientific statement on CD and its association with CMT. “The statement reviews the current state of evidence on diagnosing and managing CDs and their statistical association with CMT,” says Dr. Sacco, who co-chaired the AHA writing committee that developed the scientific statement. “The association between...
Making the Case for Meningococcal Disease Prevention

Making the Case for Meningococcal Disease Prevention

While relatively rare, meningococcal disease is a serious cause of morbidity and mortality, even when it is managed with state-of-the-art therapy. Meningococcal disease is often hard to diagnose in its early stages because it typically presents with only fever and malaise. However, the disease can progress very rapidly, with death occurring within 24 hours of symptom onset in some cases. In an outbreak of disease, emergency room physicians or family practice specialists often find themselves on the front lines of caring for meningococcal disease. Unfortunately, they may not have any prior hands-on experience in identifying or treating it. The Development of Vaccines Because of the pattern of insidious onset and a high risk of severe sequelae and mortality, prevention of meningococcal disease is viewed as the best option. Vaccines have been developed to address this critical public health need and protect those at risk. Vaccines that offer protection against four of the five serogroups of meningococcal disease—A, C, W, and Y—are currently available in the United States and are recommended for routine use in adolescents as well as other vulnerable populations. While these established vaccination programs have reduced the incidence of meningococcal disease in the U.S., serogroup B still causes approximately one-third of all cases overall. Currently, there is no licensed vaccine for serogroup B meningococcal disease, and vaccine development for this serogroup has been challenging. Examining Recent Efforts Meningococcal disease tends to occur in outbreaks. For example, in 2013, outbreaks of serogroup B disease occurred at both Princeton University and the University of California, Santa Barbara. To help thwart the spread of disease, the FDA allowed a broad...
Transformative Leadership Begins with Self-Development

Transformative Leadership Begins with Self-Development

If healthcare leaders want to transform our healthcare system so it is truly patient-centered and cost-effective and if we are serious about creating a culture of health in which we are preventing diseases long before they result in sickness, the place to start is with ourselves. All healthcare leaders—no matter whether you practice in a small office or a large hospital—because more often than not, physicians set the tone. But what you may not realize is that your mental and emotional state has a significant effect on the people around you. In his book Primal Leadership: Unleashing the Power of Emotional Intelligence, psychologist Daniel Goleman revealed: “The actions of the leader account for up to 70 percent of employees’ perception of the climate of their organization.”[1] Leading Means Showing the Way Unhappy, dysfunctional leaders cannot create high-functioning, compassionate practice environments, and a stressed out, unhealthy organization cannot take care of the health of others. So as physicians, we need to ensure that the effect we have on others is positive and beneficial. As leaders: ♦ If, when facing a problem, we display thoughtful intelligence rather than anger or frustration, we will inspire that behavior in others and promote creative solutions. ♦ If we are trustworthy and nurture a culture of trust, our colleagues will feel safe enough to communicate honestly, therein creating an environment in which real change is possible. ♦ If our words and actions demonstrate a deep commitment to cost effective, patient care, others will follow our lead, resulting in an improved practice environment. ♦ If we hold ourselves accountable for the vision and if we foster...
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