Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review.

Low back pain (LBP) is a well-recognized public health problem with no clear gold standard medical approach to treatment. Thus, those with LBP frequently turn to treatments such as spinal manipulation (SM). Many clinical trials have been conducted to evaluate the efficacy or effectiveness of SM for LBP. The primary objective of this paper was to describe the current literature on patient-centered outcomes following a specific type of commonly used SM, high-velocity low-amplitude (HVLA), in patients with LBP. A systematic search strategy was used to capture all LBP clinical trials of HVLA using our predefined patient-centered outcomes: visual analogue scale, numerical pain rating scale, Roland-Morris Disability Questionnaire, and the Oswestry Low Back Pain Disability Index. Of the 1294 articles identified by our search, 38 met our eligibility criteria. Like previous SM for LBP systematic reviews, this review shows a small but consistent treatment effect at least as large as that seen in other conservative methods of care. The heterogeneity and inconsistency in reporting within the studies reviewed makes it difficult to draw definitive conclusions. Future SM studies for LBP would benefit if some of these issues were addressed by the scientific community before further research in this area is conducted.

Professional liability insurance.

The American Association of Nurse Attorneys recommends that all nurses engaged in the practice of nursing insure themselves against liability to third parties arising out of that practice. To make an informed decision whether to purchase individual insurance and how much to purchase, each school nurse must personally evaluate a multitude of factors. Each school nurse should also understand the various types of insurance policies available and how an individual policy is affected by coverage provided through the school district policy or self-insurance program. In certain states, school nurses also may be protected by the legal doctrine of sovereign immunity. This article provides answers to some of the questions frequently posed by school nurses about individual professional liability insurance.

Consent and release.

Because school nursing practice by definition involves delivering services to minors, school nurses often find themselves with questions about consent. Because school districts, much like other health care providers, occasionally face liability for the undesired health care outcomes of their clients (i.e., students), another question that surfaces frequently deals with release from liability. Each question must be answered based on analysis of the specific facts and applicable laws. This article provides an overview of the principles that provide school nurses with general guidance on consent issues and release of liability and, by way of example, applies them in the answers to four specific questions forwarded by practicing school nurses.

Managing risks in professional and clinical performance dilemmas: Part II.

The primary purpose of the second article in this 2-part series is to describe and illustrate the use of an analytical framework that may assist school nurses to approach and resolve the dilemmas they may face in practice. Part I of the article was published in the April issue of this journal. It defined the terms "professional performance issue" and "clinical performance issue" and described a 5-step framework for analyzing practice dilemmas related to clinical and performance issues. In this article, the framework will be applied to a specific case scenario involving unsafe staffing and delegation.