RESEARCH Chimpanzees may hold answers to back pain: study RESEARCHERS from Simon Fraser University (SFU) in British Columbia believe they may have found a link between human evolution and back pain. SFU post-doctoral fellow Kimberly Plomp, a biological anthropologist, has been studying ancient bones for disease and injury that provide insight about our ancestors’ health and how they lived, according to a SFU news report written by Diane Luckow. Plomp has been working with professor Mark Collard in the Human Evolutionary Studies Program, and other researchers from the University of B.C., University of Iceland and University of Aberdeen. The research has been examining the relationship between vertebral shape, upright locomotion and human spinal health, using two-dimensional shape analyses of chimpanzee, orangutan and archaeological human vertebrae, the SFU news report explained. Plomp’s team found that some characteristics of the human vertebrae differ in shape between individuals who have Schmorl’s node – a small hernia that can occur in the cartilaginous disc between the vertebrae. “The humans that have Schmorl’s nodes tend to have vertebral elements with a shape that is statistically indistinguishable from chimpanzee vertebrae. “Humans and chimpanzees split from a common ancestor about eight to nine million years ago, and at some point after that split it is thought the human lineage evolved to be bipedal, moving on two rear legs, while the chimpanzees evolved to be knuckle-walkers,” Plomp explained. According to the findings, the vertebrae of people with disc disorders more closely resemble those of the chimpanzees’ – human’s closest ape relatives – than the vertebrae of humans without disc problems. “As evolution occurred, our vertebrae would have changed as we evolved from using some form of quadrupedal locomotion, using four legs, to bipedalism, using two legs,” Plomp said. “However evolution is not perfect and some vertebral characteristics, such as the ones we identified as being similar to chimpanzees, may have remained within the human ‘blueprint’ and result in some people having vertebrae that are less able to withstand the pressures of bipedal walking.” The study suggests the pathological vertebrae of some people may be less well-adapted for walking upright. Plomp calls it the “ancestral shape hypothesis.” Plomp and Collard plan to investigate further using 3D shape studies of ancient and modern human and primate spine, and explore other spinal diseases such as osteoarthritis. Plomp’s findings were published in the journal, BMC Evolutionary Biology. RESEARCH Stem cell study brings hope for people with spinal cord injury A SMALL NUMBER of paraplegics are now able to feel some sensation after having neural stem cells transplanted into their damaged spinal cords as part of a study, raising hope that the therapy may help restore movement in some paralyzed patients. Researchers in Zurich, Toronto and Calgary used the experimental treatment in 12 people with injuries to the thoracic region of their spinal cords. The thoracic segments of the spine run roughly in line with the armpits to an area just below the waist. Within months of having the injections of 20 million human neural stem cells, more than half the patients reported they had areas of restored sensation when tested with light touch, pin pricks or heat. While the transplants did not bring back the ability for patients to move their legs or control other muscles below the site of their injury, seven of the 12 had “significant improvement in sensation,” said Dr. Michael Fehlings, Krembil chair in Neural Repair and Regeneration at the University Health Network, who led the Toronto arm of the study. That recovery of feeling means the stem cells may have partially repaired damage to the spinal cord, suggested Fehlings. “The implications of what we’re doing now is really quite profound because we have now legitimately entered into the era of regenerative neuroscience,” he said. “And this isn’t occurring in shady overseas clinics that are selling things to vulnerable people. This is occurring under the auspices of the most rigorous federal agencies in the world. So the science is real and I feel very hopeful for the future.” Stem cells are the body’s building blocks, giving rise to different kinds of cell types. Neural stem cells spawn various types of central nervous system cells, such as those found in the brain and spinal cord. The transplants were performed at least three months following the injuries – most of which were caused by motor vehicle accidents – but before permanent scarring of the lesion had set in. Cells were injected both above and below the area of injury. “The cells have the property where they migrate toward the injury site, they home in on the injury site and they track along the nerve fibres in the spinal cord,” Fehlings said. Patients ranged in age from 19 to 53, with a mean age of 33. Eleven males and one female took part in the research, which was presented recently in Montreal at a joint meeting of the International Spinal Cord Society and the American Spinal Injury Association. Dr. Armin Curt, head of the Spinal Cord Injury Centre at Balgrist University Hospital who led the Zurich team, said thoracic spinal cord injuries have “historically defied responses to experimental therapies.” The measurable gains found in some patients “strongly argue for a biological result of the transplanted cells,” Curt said in a release. “Such gains are unlikely to have occurred spontaneously given the average time from injury.” Cells for the research came from California-based StemCells Inc., which organized the study. Because the cells are purified and grown from donated tissue, recipients took a medication to prevent an immune-system reaction for about nine months. The neural stem cells, or HuCNS-SCs, did not cause adverse effects in patients and are considered to be safe, the researchers concluded. “Our primary focus in this study... was to evaluate safety and also to look for even small signs of an effect that went beyond the possibility of spontaneous recovery,” said StemCells chief medical officer Dr. Stephen Huhn. “We found evidence of sensory gains in multiple segments of the injured thoracic spinal cord across multiple patients.” The company is now turning its sights on the next phase of its research – transplanting the stem cells into patients with more common cervical spinal cord injuries, which occur in the upper back and neck and typically cause loss of movement in the arms and hands. Fehlings said because the cervical spine is “exquisitely enervated,” stem cells might potentially have an effect on motor function that was not seen in treatment of the thoracic region. “So if someone were to recover motor function – a segment or two or three or four – depending on the level of injury, it might mean that they could recover upper arm function or even possibly hand function,” he said. “And that could have a big impact in terms of people’s quality of life.” - Sheryl Ubelacker, The Canadian Press EDUCATION Canadian Chiropractor hosts business forum in Vancouver World Federation Chiropractic president Dr. Greg Stewart was the keynote speaker at the recent Canadian Chiropractor Business Forum in Vancouver. In his presentation, Stewart talked about opportunities for expanding the business of chiropractic. He cited the World Health Organization report identifying spinal pain as the number one cause of disability worldwide. This presents a great opportunity for chiropractic to promote the identity of the profession as spinal health care professionals – but there is work to be done by the profession to fully attain such global recognition, he noted. For one thing, Stewart says the profession needs to work at increasing the evidence that support chiropractic care for spinal health, especially when the profession continually endures fierce competition from other health-care profession. “Trust matters more when you have competition,” he said. Currently, “we lack the evidence that our care could substantially decrease the impact of spinal pain on global health and disability,” he said. Stewart, however, acknowledged some in the profession who have dedicated their careers to research and increasing the evidence that support chiropractic, such as Dr. Pierre Cote, who is the Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and many others. “Once we are identified as a solution, our credibility will be enhanced. We will then have a voice for other issues and burdens related to population health,” Stewart outlined in his presentation. This credibility will lead to increase in public demand for chiropractic care, which will ultimately “relieve practice survival pressures” and provide increased and varied opportunities for new practitioners. The alternative to all this potential is to do nothing, Stewart cautioned. “We will continue to compete for the limited demand with increasing internal and external competition.” Also speaking at the Canadian Chiropractor Business Forum in Vancouver was Dr. Dean Greenwood, co-founder of the Vancouver Spine Care Centre. Greenwood talked about interprofessional collaboration for patient centred care. “Integrative health care is a practice of medicine that reaffirms the relationship between practitioner and patient… The end goal is improved patient care and improved professional authority,” he said. He urged chiropractors to do better in “getting patients under our care,” and outlined some of the things chiropractors can do to achieve this: conduct workshops for patients and allied health providers; participate in health forums; engage in lifelong learning; get published. “Building relationships does not happen overnight; you need to work at it,” Greenwood stressed. The business forum, which was held April 25 at Simon Fraser University’s Morris J Wosk Centre for Dialogue, also featured Dr. Don Nixdorf, a member of the board of the College of Chiropractors of B.C. Nixdorf discussed professional ethics and responsibilities in the use of social media and other new technologies. “You have an opportunity to raise the profession to a higher standard of public awareness through social media,” Nixdorf told business forum participants. However, he cautioned, the use of social media must be “incredibly well thought out” and should always meet the standards of professional ethics. Risk management through proper record keeping was the topic of Don Lebans’ presentation. Lebans, a partner at Vancouver-based law firm Branch McMaster LLP, said good clinical records that can stand legal scrutiny must be complete, contemporaneous, accurate and legible. Internet marketing experts Matt Astifan and Rob Green, meanwhile, gave forum attendees a crash course on social media marketing, providing an overview of how to utilize Google a dwords as a low-cost business promotion tool, search engine optimization techniques, as well as social media platforms and how to use them to promote the practice. - Mari-Len De Guzman HEALTH CARE Proposed law lets patients pay for MRI scans SASKATCHEWAN’S HEALTH MINISTER said proposed legislation aimed at reducing wait times would allow patients to pay out-of-pocket for MRI scans. Dustin Duncan said the regulations could make MRI scans available at private clinics as soon as next spring. For every scan paid for privately, clinics would be required to provide a scan at no charge to a patient on the public wait list. Private clinics would have to develop a business model and Duncan does not know how much scans would cost. “What we want to see is whether or not this concept of two-for-one... can demonstrate that a business case actually could support this type of alternative arrangement.” Duncan said between 4,000 and 5,000 people are waiting for MRIs in Saskatchewan. The recommended wait time for an urgent case is up to a week compared to three months for a non-urgent scan. NDP health critic Danielle Chartier said the proposed legislation is problematic because it could result in delayed treatment for those on the public wait list. “This government needs to build capacity in our public system to ensure your health card gets you medicare, not your credit card,” she said. MRI scans can cost up to $3,000 and introducing a private system is a “slippery slope,” Chartier suggested. “There are people who can’t afford private MRIs.” - Clare Clancy The Canadian Press HEALTH CARE Ontarians experience better health care than in other provinces: report A NEW REPORT released by Health Quality Ontario (HQO) indicates older patients in Ontario have better health-care experience compared to people in other provinces and in other countries. Ontarians aged 55 and older often experience top-rated coordination of their health care, as well as communication with their health-care providers, according to Experiencing Integrated Care, the latest report from HQO, the provincial advisor on healthcare quality. The report is based on the 2014 Commonwealth Fund International Health Policy Survey of Older Adults. It found 82 per cent of Ontario respondents said their regular care provider helps coordinate their health care by making appointments with other providers. This result ranks Ontario among the best in Canada and on par with other top-performing countries. The report also uncovered areas where Ontario could improve. For example, 75 per cent of respondents in Ontario who had been hospitalized said they received written information about what to do and what symptoms to watch for when they got home, compared to 89 per cent in the U.S. and 87 per cent in New Zealand – the top-performing countries. Experiencing Integrated Care offers patients’ perspectives on key touchpoints where patients are in transition from one healthcare provider to another and therefore, where care coordination and communication is needed, such as during a health-care visit, between appointments or after a stay in hospital. These aspects of integrated care are important measures of how well our health system is performing, HQO stated in a release. Other report highlights on how Ontarians experience well-coordinated care include: • 81 per cent of respondents in Ontario said that after a hospital stay, the hospital made sure they had follow-up care when they got home – on par with other provinces and top-performing countries. • 90 per cent of Ontario respondents knew whom to contact when they left hospital if they had a question about their treatment, a result that ranked the province on par with most other provinces on this measure, and better than four countries in the survey and on par with the rest. The HQO repor t cited other areas that Ontario could improve upon. Ten per cent of respondents in Ontario said there was a time in the past two years when a specialist doctor did not have basic medical information or test results at an appointment. In France, three per cent of respondents said that was the case and in the Netherlands five per cent reported that challenge. Among Ontario respondents aged 55 and older with chronic conditions, 63 per cent said they have access to someone who can help with medical questions between visits. In the United States and the Netherlands, 79 per cent said there is a health-care professional they can easily contact for information or advice between visits to the doctor. “Some of the highest risks to quality care occur during the hand-offs as patients move from one care provider to another,” said Dr. Joshua Tepper, president and CEO of HQO. “When the various parts of the health system work well together, patients and their care providers have the information they need to make informed decisions. Better transitions lead to a higher quality of care.” To access the full report, visit hqontario.ca. CAREERS Key questions in a job interview According to a new OfficeTeam survey, more than six in 10 recruiting managers admitted they have misjudged a candidate’s fit with their work environment, while two-thirds said they have lost an employee because he or she was not suited to the work environment. “Employers often focus on ensuring a skills fit when recruiting, but a corporate culture fit is equally important and more challenging to gauge,” said Robert Hosking, executive director of OfficeTeam. Whether you are a new chiropractor looking for an associate position or a clinic owner in search of an associate, OfficeTeam highlighted seven questions to consider when assessing a candidate’s fit with an employer’s corporate culture. What values are important to you? It’s challenging to work at a company if its principles are at odds with yours. Ask the hiring manager about characteristics the employer values. Are you a team player? Someone who enjoys collaboration would thrive at a company that emphasizes teamwork over autonomy. How much of a risk-taker are you? If you’re keen to try new ideas, a conservative organization may not be the best match. What type of work environment do you thrive in? You may prefer a quiet, closed office over one that’s open and lively. Take a look at the setup when you’re on-site for an interview. Do you like hanging out with coworkers? Socializing with colleagues outside and inside the office can be common. Find out if there are any fun company traditions and how milestones are celebrated. What are your long-term goals? It’s important to make sure a company is a good fit for your career objectives. Ask about advancement opportunities, and determine what professional development and training options are available. RESEARCH Alberta researchers offer insight on mystery of knuckle cracking IN A STUDY PUBLISHED recently, University of Alberta scientists describe how modern imaging technology has shed new light on the age-old riddle of why some joints crack when you pull them. “It’s something that every culture, every society is interested in,” said Dr. Greg Kawchuk, chiropractor and lead author of the paper published in the online journal Plos One. “We all do it. People love it or are repulsed by it.” But nobody had actually looked at how the noise beloved by annoying uncles is created. With the help of fellow chiropractor Dr. Jerome Fryer, Kawchuk decided to bring MRI technology to bear. No one had ever before looked inside a knuckle as it cracked. “When we saw that, we said, ‘Wow! There’s a real opportunity here.’ It’s been sitting there waiting for someone to do (it).” The team designed a carefully calibrated knuckle-puller that resembles the kind of woven finger-trap on offer in novelty stores. The subject digit was placed under a magnetic resonance imager and the requisite tug applied. Video of the event – which lasted about 310 milliseconds – was carefully analyzed. At first, the surface tension of the fluid in the joints kept the bones together. “As we increased the pull, suddenly you reach the point where you overcome that surface tension and the two joint surfaces suddenly fly apart,” said Kawchuk. “In that moment, we saw the creation of an air cavity that happens at the same time the sound is produced.” A similar effect can be created by pressing two hands together at the palm, then quickly separating them. The imager wasn’t able to determine what’s in the cavity, air or a gas released by surrounding tissues. Nor can Kawchuk be completely sure the cavity is what creates the sound. “We’re only imaging a very small slice of what’s happening inside the joint. There’s things that are happening to the left and right and in between our images that may be causing the sound, but we don’t see them.” The research does have real importance. Fingers aren’t the only joints in the body that crack. “By using this technique to look into people’s joints, we have a little bit of a window to better understand joint health.” - Bob Weber The Canadian Press