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Volume 14
J Chiropr Humanit 2007; 14
Table of Contents
The Mechanistic/Vitalistic
Dualism of Chiropractic and General Systems Theory: Daniel D. Palmer and Ludwig
von Bertalanffy
Alana K. Callender, MSLS
Objective: The purpose of this paper is to investigate similarities and
differences between the mechanistic/vitalistic dualism of chiropractic and
general systems theory.
Discussion: Early chiropractic philosophy is compared with the progression of
general systems theory from its roots in vitalistic thinking to quantum theory.
The writings of D.D. Palmer predate those of Ludwig von Bertalanffy (1901-1972),
the acknowledged founder of general systems theory. The mechanistic/vitalistic
dualism of chiropractic is explored against theories.
Conclusion: Early and contemporary general systems theories parallel some of the
writings of chiropractic authors and share some common vitalistic ground.
When Demand Exceeds
Supply: Allocating Chiropractic Services at VA Medical Facilities
Andrew S. Dunn, DC, MEd, MS and
Steven R. Passmore DC, MS
Objective: With limited Veterans Affairs (VA) doctors of chiropractic (DCs) in
geographically disparate VA medical facilities of varying capacities, the
potential of demand for care exceeding supply can be realized. The purpose of
this paper is two-fold. First the authors propose a model for VA chiropractic
clinic operation to maximize appropriate access to care and utility of services
provided. Second the authors suggest an ethical basis for making potentially
difficult administrative decisions regarding the distribution of chiropractic
services within VA medical facilities.
Discussion: The authors suggest practices to maximize clinic efficiency and
effectiveness under conditions of demand for chiropractic services in excess of
available supply. In terms of access, the service agreement and gatekeeper
instructions for ordering a consultation should help shape demand and avoid
inappropriate consultation requests. Consultation requests should also be
screened by VA DCs. Scheduling should work to minimize no-shows through a
patient reminder system. With regard to utilization, the delivery of
chiropractic services should be made more efficient through the use of templates
within the electronic medical record. Lastly, evidence-based outcome measures
should be applied to objectify clinical progress and help to identify clinical
end points in care. Utilitarian theory serves as a possible ethical framework to
guide VA DCs in maximizing the benefits of chiropractic care to our veteran
patient population
Conclusions: VA doctors of chiropractic must balance the demand for patient care
with the limited availability of resources. Suggested practices may enhance
appropriate access to and efficient utilization of chiropractic care within the
VHA.
Chiropractic Research in
the Postmodern World: A Discussion of the Need to Use a Greater Variety of
Research Methods
Kent J Stuber, DC
Objective: This paper aims to provide a discussion of postmodern research ideas
that could be implemented in the chiropractic profession.
Discussion: Many studies on chiropractic care are really more evaluations of one
or two modalities alone (such as spinal manipulative therapy / chiropractic
adjustments) and do not consider the entire chiropractic clinical encounter. The
results of chiropractic care in randomized controlled trials for example have
not necessarily shown the results that one might anticipate and the evidence is
conflicting. Postmodern research encourages looking at problems from multiple
perspectives and requires consideration of local context first and foremost.
Qualitative and practice-based / action research methods are postmodern
techniques that have been employed sparingly in chiropractic research. These
methods could be of benefit as they could reduce the gap between practice and
research and provide a more patient-centered means of studying the profession.
Several chiropractic researchers have indicated the need to use such techniques
to improve the profession and our understanding of it.
Conclusion: Implementing research methods that have postmodern perspective could
be beneficial for the profession. This is not to say that randomized controlled
trials should be abandoned, they are still an extremely necessary part of the
health care research landscape, but tempering them with some studies that employ
unique postmodern methodologies could be useful in helping expand our
understanding of the profession, particularly at a local and clinical level.
The Four Principles of
Biomedical Ethics: A Foundation for Current Bioethical Debate
Dana J. Lawrence, DC, MMedEd
Objective: To provide an overview of the four principles originally developed by
Thomas Beauchamp and James Childress are now used in modern bioethical
decision-making and debate and to describe several challenges to their premier
status in bioethics.
Discussion: The four principles that form the core of modern bioethics
discussion include autonomy, beneficence, nonmaleficence and justice. The
originators of these principles claim that none is more important than another,
yet challenges have been laid against these principles on that basis as well as
on other areas of disagreement. This paper looks at the nature of the most
significant of those challenges.
Conclusion: The four principles have withstood challenge now for nearly 30 years
and still form the basis for most decision making in both the research setting
and in clinical practice within the chiropractic profession. However,
professional understanding of the principles is not known and may provide a
fertile area for further investigation.
Philosophy of
Chiropractic: Its Origin and Its Future
Gerard Clum, DC
This paper, addressed to the World Federation of Chiropractic 9th Biennial
Congress 2007 meeting, held in Vilamoura, Portugal, briefly overviews the
history of philosophical underpinnings of the chiropractic profession. This
paper further identifies future areas of thought and inquiry for the profession.
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