Chiropractors in Multidisciplinary Teams: Enablers of Colocation Integration in GP-Led Primary Healthcare.

The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor's scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction.

Lesson of the month 1: Autoinflammatory syndromes - an unusual cause of pyrexia of unknown origin.

Autoinflammatory diseases are disorders of innate immunity and are characterised by recurring and unprovoked episodes of inflammation. We present a case of episodic pyrexia, associated with a significant inflammatory response, in a young man in whom the cause had remained unexplained since infancy. He was eventually diagnosed with hyperimmunoglobulinaemia D syndrome (HIDS); one of the autoinflammatory syndromes.

Mineralization of the transverse ligament of the atlas causing compressive radiculopathy. Resolution following odontoidectomy and atlantoaxial arthrodesis.

OBJECTIVE: To describe a case of a Boxer dog with radiculopathy due to mineralization of the transverse ligament of the atlas and subsequent resorption and resolution of clinical signs after atlantoaxial arthrodesis and odontoidectomy. CASE REPORT: A five-year-old neutered female Boxer dog was presented with a four-month history of cervical hyperaesthesia refractory to medical management. Neurological examination and magnetic resonance imaging indicated a diagnosis of radiculopathy due to cervical nerve root impingement by dystrophic mineralization of the transverse ligament of the atlas. Odontoidectomy was performed by a ventral approach and atlantoaxial arthrodesis was achieved with a ventral composite polymethylmethacrylate and pin fixation. RESULTS: Atlantoaxial arthrodesis and progressive resorption of the mineralization following stabilization facilitated indirect decompression. The radioclinical diagnosis and response to arthrodesis was considered analogous to retro-odontoid pannus in the human. CLINICAL RELEVANCE: A clinical condition similar to retro-odontoid pannus may exist in the canine and may be amenable to atlantoaxial arthrodesis.

Successful restoration of arteriovenous dialysis access patency after late intervention.

BACKGROUND: Arteriovenous dialysis access may be lost due to stenosis and thrombosis. Patency may be restored by thrombectomy or thrombolysis, but this is often not undertaken when the presentation is delayed. The success rate of delayed intervention is largely unknown. METHODS: In this single-centre study, we identified all instances of arteriovenous vascular access (VA) failure treated with angioplasty, thrombectomy or thrombolysis between August 2010 and July 2013. Patency rates immediately after intervention, and after 3 months, were assessed using multilevel mixed effects logistic regression. RESULTS: Sixty failures occurred in 41 accesses (38 patients). The access age at failure was 495 (316-888) days. Intervention was carried out after >48 h in 19 failures (32%). Immediate patency was achieved in 46 failures, of which 32 remained patent after 3 months. Delaying intervention increased the likelihood of achieving immediate patency (OR 0.55, 95% CI 0.31-1.0, P = 0.05). Having lost arteriovenous accesses previously increased the risk of immediate failure (OR 4.0, 95% CI 1.07-14.95, P = 0.04). There was no association between failure-to-intervention-time and 3-month patency rates (P = 0.23). Effect estimates did not differ between arteriovenous fistulae and synthetic arteriovenous grafts. CONCLUSION: Delayed intervention for failed arteriovenous VA may result in superior early patency rates and yields equivalent 3-month patency rates.

A case report: radiological findings in an unusual case of calciphylaxis 16 years after renal transplantation.

Calciphylaxis is a serious and potentially life-threatening disorder characterized by medial calcification of arterioles leading to subcutaneous ischemia and skin necrosis. It is most commonly seen in patients with end-stage renal disease or shortly after renal transplantation. We report an unusual case of calciphylaxis occurring 16 years after renal transplantation in a 48-year-old female with a failing graft, along with histological and striking radiological findings.

The Heart Center of Indiana: changing the way hearts are treated.

The owners of The Heart Center of Indiana are continuing their long history of pioneering efforts. As a 50/50 joint venture between physicians and a large health system, The Heart Center is one of a new breed of "hospitals of the future" and the first of its kind in Indiana. Early indications of outstanding clinical and financial outcomes and guest satisfaction point to long-term success for The Heart Center of Indiana.