Wednesday, June 10, 2015

End of Term Youtube Extravaganza: Binge Watching Edition

What with a longer break than normal coming up, I thought I would provide you with a list of shows to binge watch, starting with the obvious one…

Buffy the Vampire Slayer:  Yep, my foavorite program, of which there were 144 episodes over 7 seasons. The entire first episode is on youtube, as seen here. This is the best show ever put on TV and it is about far more than a young girl fighting vampires.

Firefly:  Another show from Joss Whedon, who created Buffy. This one centers on a group of misfits who live in the future, where science fiction blends with westerns. Weird, funny and brilliant, and it only had one season.

Lost Girl:   Yet another fantasy program, about Bo, a succubus (look it up). This is about the Fae and their world, and it introduces you to perhaps the funniest sidekick in the history of television, the irrepressible Kenzi (played by Ksenia Solo).

House, MD:  Gregory House is a misanthrope. He hates everyone and trusts no one. But he always gets it right, in the end, usually at a cost…

The Bridge:  Dark and twisted, but with great acting, it is a story about a murder investigation involving both US and Mexican police. Stand-out is Diane Kruger as Sonia, who is a woman without empathy- she is literal and does not understand subtext, facial expressions, or other cues to behavior.

Continuum:  A great science fiction program about a woman sent back in time to prevent a terrorist attack. It twists and turns and goes places you do not expect.

Lie to Me:  Tim Roth plays a man who is an expert in reading microexpressions, making it harder for them to get away with lying. But he lacks social skills himself and is protected by his co-workers.

A little light watching for you! Enjoy the break.


Monday, June 1, 2015

New From Biomed Central

Svavarsdóttir NH, Sigurðardóttir AK, Sigurðardóttir A. How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education. BMC Med Educ 2015, 15:87  doi:10.1186/s12909-015-0370-x

Background: Health professionals with the level of competency necessary to provide high-quality patient education are central to meeting patients’ needs. However, research on how competencies in patient education should be developed and health professionals trained in them, is lacking. The aim of this study was to investigate the characteristics of an expert educator according to health professionals experienced in patient education for patients with coronary heart disease, and their views on how to become an expert educator. Methods This descriptive qualitative study was conducted through individual interviews with health professionals experienced in patient education in cardiac care. Participants were recruited from cardiac care units and by using a snowball sampling technique. The interviews were audiotaped and transcribed verbatim. The data were analyzed with thematic approaches, using systematic text condensation. Results Nineteen Icelandic and Norwegian registered nurses, physiotherapists, and cardiologists, who had worked in cardiac care for 12 years on average, participated in the study. Being sensitive to the patient’s interests and learning needs, and possessing the ability to tailor the education to each patient’s needs and context of the situation was described as the hallmarks of an expert educator. To become an expert educator, motivation and active participation of the novice educator and a supportive learning environment were considered prerequisites. Supportive educational resources, observation and experiential training, and guidance from experienced educators were given as examples of resources that enhance competence development. Experienced educators expressed the need for peer support, inter-professional cooperation, and mentoring to further develop their competency. Conclusions Expert patient educators were described as those demonstrating sensitivity toward the patient’s learning needs and an ability to individualize the patient’s education. A supportive learning environment, inner motivation, and an awareness of the value of patient education were considered the main factors required to become an expert educator. The experienced educators expressed a need for continuing education and peer support.

Davis R, Ives J, Dunn M. A systematic review of empirical bioethics methodologies. BMC Med Ethics 2015, 16:15  doi:10.1186/s12910-015-0010-3

Background: Despite the increased prevalence of bioethics research that seeks to use empirical data to answer normative research questions, there is no consensus as to what an appropriate methodology for this would be. This review aims to search the literature, present and critically discuss published Empirical Bioethics methodologies.
Methods: MedLine, Web of Science and Google Scholar were searched between 15/02/12 and 16/06/13 to find relevant papers. These were abstract reviewed independently by two reviewers with papers meeting the inclusion criteria subjected to data extraction.

Results: 33 publications (32 papers and one book chapter) were included which contained 32 distinct methodologies. The majority of these methodologies (n = 22) can be classed as either dialogical or consultative, and these represent two extreme ‘poles’ of methodological orientation. Consideration of these results provoked three central questions that are central to the planning of an empirical bioethics study, and revolve around how a normative conclusion can be justified, the analytic process through which that conclusion is reached, and the kind of conclusion that is sought.
Conclusion: When considering which methodology or research methods to adopt in any particular study, researchers need to think carefully about the nature of the claims they wish to generate through their analyses, and how these claims align with the aims of the research. Whilst there are superficial similarities in the ways that identical research methods are made use of, the different meta-ethical and epistemological commitments that undergird the range of methodological approaches adopted rehearse many of the central foundational disagreements that play out within moral philosophy and bioethical analysis more broadly. There is little common ground that transcends these disagreements, and we argue that this is likely to present a challenge for the legitimacy of the bioethical enterprise. We conclude, however, that this heterogeneity ought to be welcomed, but urge those involved in the field to engage meaningfully and explicitly with questions concerning what kinds of moral claim they want to be able to make, about normative justification and the methodological process, and about the coherence of these components within their work

Schneider M, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L. US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey. Chiropr ManTher 2015, 23:16  doi:10.1186/s12998-015-0060-0

Background: Evidence based practice (EBP) is being increasingly utilized by health care professionals as a means of improving the quality of health care. The introduction of EBP principles into the chiropractic profession is a relatively recent phenomenon. There is currently a lack of information about the EBP literacy level of US chiropractors and the barriers/facilitators to the use of EBP in the chiropractic profession.
Methods: A nationwide EBP survey of US chiropractors was administered online (Nov 2012-Mar 2013) utilizing a validated self-report instrument (EBASE) in which three sub-scores are reported: attitudes, skills and use. Means, medians, and frequency distributions for each of the sub-scores were generated. Descriptive statistics were used to analyze the demographic characteristics of the sample. Means and proportions were calculated for all of the responses to each of the questions in the survey.

Results: A total of 1,314 US chiropractors completed the EBASE survey; the sample appeared to be representative of the US chiropractic profession. Respondents were predominantly white (94.3%), male (75%), 47 (+/− 11.6) years of age, and in practice for more than 10 years (60%). EBASE sub-score means (possible ranges) were: attitudes, 31.4 (8–40); skills, 44.3 (13–65); and use, 10.3 (0–24). Survey participants generally held favorable attitudes toward EBP, but reported less use of EBP. A minority of participants indicated that EBP coursework (17%) and critical thinking (29%) were a major part of their chiropractic education. The most commonly reported barrier to the use of EBP was “lack of time”. Almost 90% of the sample indicated that they were interested in improving their EBP skills.
Conclusion: American chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains.

Tuesday, May 26, 2015

Resources for Desire2Learn

Because this is a short week following a holiday weekend, this will be a very brief entry. Desire2Learn provides its users a significant amount of support and resources. Here are just a few:  This is a link to the latest updates and news related to the learning management platform.  This is a link to a large number of video clips which can walk you thorugh all the different functions and options you can use in the D2L environment. From start-up to advanced user, there is material here for you.  This is the company's dedicated youtube channel. On this site, you will find a plethora of youtube clips also showing you how to use the product. I find so much information among these clips.  This is Brightspace Training Videos on Demand, even more clips for your use.  This is the Brightspace community, where you can post questions and receive answers from other users.

Monday, May 18, 2015

David Sackett, RIP

On May 13, David Sackett died. He was inarguably the Father of evidence-based medicine, and his work has transformed the practice of healthcare in incalculable ways. He began his work by establishing the first Department of Clinical Epidemiology and Biostatistics in Canada, at McMaster University. McMaster is now renowned as the epicenter of evidence-based care, and we have sent many of our faculty there to take their week-long course in how to teach evidence-based care.

According to the website devoted to the Sackett Symposium, Dr. Sackett was best known for work in three areas: research methods for applied testing of healthcare innovations; use of those methods to evaluate the scientific validity and clinical utility of medical interventions; and education of healthcare clinicians in the use and application of best evidence in practice.
The work at our college has been transformed by his work. We use his approach in what we do- we ask questions, acquire information, appraise that information, apply it, and assess it to determine whether it is working. That cycle repeats itself as time goes on and as our patient either does or does not respond to what we do. What he did, more than anyone before or after, was show how to use research literature and combine it with clinical expertise to benefit the patient, always respecting the patient’s own values. We say this as a mantra now, but it was a seismic shift in how medicine was practiced.

And he acknowledged the evidence-based medicine was not static; it needed to evolve, and it has. He was funny, bold, and at times profane, not afraid to use a select swear word where it was appropriate to make his point. The Users’ Guide to the Medical Literature is based on the series of papers Sackett and others wrote in the 1980s; that book is now in its 3rd edition, and it helps inform Dr. Mike Haneline’s excellent text “Evidence-Based Chiropractic Practice.”
And he was much of the opinion that once you become seen as an expert, you need to stop and do something else. He did, regularly; He shifted from epidemiology, to compliance and then to writing about clinical trials. Once he became good at something, he stopped and moved to a new area.

We owe him a huge debt, which we repay every day when we use the tools he brought to our attention. He will be missed.

Monday, May 11, 2015

The Point of a Professor: NY Times Article

As I was reading the New York Times this morning, I came across this article: The article is entitled “What’s the point of a professor?” It makes the biting point that there is one part of higher education that falls low on the ladder of “meaningful contacts: the professors.” I tend to agree with this article, and I note that this has been an evolutionary change since the days when I entered the chiropractic profession as an instructor at what was then National College of Chiropractic.

The article points out that while students are generally content with their teachers, they are also not very much interested in them as thinkers and mentors. In general, students are enrolled in our courses, but then they rarely have much contact with us outside of class. They show up, they may even engage in the classroom (though that is certainly not always the case), but they do not seek our counsel once class ends. There are many reasons for this, in my opinion. One is that we do not give them reason to seek us outside of class. This is a bit of “hidden curriculum,” in fact, where we may not send welcoming messages. And students view us as means to an end, the end being getting their degree. Thus, we are something to put up with, rather than to truly engage with. There is a bit of a service attitude; students are consumers and we need to make consumers happy. And there is a need to have good reviews in order to receive promotion. Sometimes good reviews can be had by making life easy for students, rather than challenging them.
Beyond that is the wild world of the internet. I have never gone to- and never will- the website What good would come of it? The only reason I can think of to visit that site as a student would be to berate an instructor. In chiroprac6tic education, that could be fore reasons having nothing to do with teaching skills. It could be because of differences in philosophy, for example. But places such as yikyak are growing in size and influence. They place professors into difficult situations- you cannot respond since the system is designed to be anonymous.

In this new world, we need to find ways to reach students. I do not see students myself as a teacher until 9th trimester. By the time I see them, they are nearly gone, so there is little time to develop long-term relationships. I cannot act as a moral exemplar for them save for the 15 weeks I have them in class before they leave the college. We need to find ways to provide such interactions very early in their time at the college. Work for us all.

Monday, May 4, 2015

Some of the Highlights of Palmer Homecoming 2015, San Jose Campus

Validating our Traditional Chiropractic Philosophy with Contemporary Science
Christopher Colloca, D.C.
Deep-seated in our roots and central to the chiropractic profession has been the concept of vertebral subluxation.  Although controversy exists over the various definitions of subluxation, our history has provided numerous vertebral subluxation models that science has begun to investigate. In this session, we will explore some of the contemporary models of vertebral subluxation and research into the neuromechanical advances in biomechanics and neurophysiology of chiropractic adjustments. Dr. Colloca will present an overview of his award-winning in vivo research, conducted in both humans and large-animal models, to form a basis to begin to explore our traditional chiropractic philosophy with contemporary science.

Integrated Chiropractic Technique: Primary and Secondary Subluxations of Sacrum
Robert Cooperstein, D.C.
This chiropractic technique seminar compares and contrasts primary and secondary subluxations of the sacrum, with respect to the innominate bones. It proceeds from the pathomechanics of the sacroiliac joint, to typical history and physical examination findings, to adjustive strategies.

Strengthening Palmer’s Core
Dennis Marchiori, D.C.
Chiropractic organizations, whether colleges, support organizations or individual practices, are facing increasingly difficult challenges. The business literature identifies tactics for meeting these challenges. Assessments of an organization’s strengths, desires and environmental compatibility are important to strategically moving forward for success. This opening session to the Homecoming program will focus on several key strategies to continue the College’s heritage.

"Understanding and Preparing for Integrated Onsite Clinic Chiropractic Opportunities"
Bill Updyke, D.C.
This session will provide an overview of the onsite clinic landscape and how chiropractic has and continues to make inroads; how you can position yourself for an onsite clinic job and preparing for work in an integrated medical practice environment.

The Current Concepts in Motion Palpation
Brett Winchester, D.C.
Throughout the last century, we have learned how all bodily systems respond to the chiropractic adjustment. Although much has focused on biomechanical events, there also is a significant neurologic effect. This section will focus on how to assess for joint dysfunction from a biomechanical and a neurologic standpoint and how to perform adjustments pertaining to these joint dysfunctions. Dr. Winchester is an instructor and board member for the Motion Palpation Institute and will share current, evidence-informed concepts and techniques. He believes that the ability to palpate accurately is an absolute prerequisite to performing effective adjustments. The participant will learn current concepts in neurology and adjustments, followed by a hands-on demonstration focusing on assessment and adjustments.

The Spine as the Foundation for Health and Disease: A Contemporary Chiropractic BioPhysics® (CBP®) Technique Presentation
Deed Harrison, D.C
Chiropractic is changing. Research, patient management, objective clinical results, treatment techniques, philosophies, and principles all advance over time. The mission of CBP Technique is to provide a research-based response to these changing times that is clinically, technically and philosophically sound. Understanding the relationship of upright human posture and spinal displacements to various pain, functional, and health disturbances is a key concept of this presentation. Secondly, the attendee will gain an appreciation of and for CBP's chiropractic corrective care procedures for structural rehabilitation of the spine and posture using mirror image® adjusting, exercise and spinal remodeling procedures.

Chiropractic Quality, Cost and Risks: What the Evidence Says and Why You Should Care
Christine Goertz, D.C., Ph.D.
Never has the saying “in God we trust all others bring data” been truer. As the U.S. health care system continues to evolve towards the “Triple Aim” of improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost, it becomes increasingly critical that the chiropractic profession is able to talk the evidence-based talk. Learn what you can and cannot say to your patients, payers, other clinicians and policy makers based on the data. Presentation highlights include the latest information on:
           the outcomes of chiropractic care for low back pain, neck pain and other conditions,
           the costs of chiropractic care delivery, and
           the relative risks associated with spinal manipulation.

The Chiropractic Adjustment and the Science of Core Stability
William Morgan, D.C.
The philosophy of chiropractic is wed to the adjustment’s value in restoring and preserving normal nerve function.   In this lecture Dr. William Morgan will present new evidence validating the chiropractic adjustment’s role in normalizing neural function in regard to core stability.  He will uncover the neurophysiology and clinical competencies needed to meld core stability programs into a busy chiropractic practice.  This course is a bridge between philosophy-based practices and science-based practices.

Cox Flexion Distraction Spinal Manipulation: Biomechanics and Clinical Outcomes
Dean Greenwood, D.C.
In this session, we will present information related to changes in intradiscal pressure and the foraminal area, along with discussions related to facet joint motion, disc changes under distraction manipulation, and the biomechanics of the intervertebral disc and spine. Video depictions of the spine during spinal manipulation will be shown. Clinical research related to the use of long-axis distraction of the spine will be presented, and there will be demonstrations of manipulation to various regions of the spine. Demonstration of spinal manipulation of the cervical, thoracic, and lumbar spine and pelvis will be in this program.

Chiropractors in Cancer Hospitals
Jeff Sklar, D.C.
This course will provide indications and contra-indications for administering chiropractic care to cancer patients. Dr. Sklar will discuss understanding side effects of cancer treatment on the musculoskeletal and nervous systems and understanding the role of chiropractic in quality of life at any stage of the disease, as well as the criteria of patient-centered care.

Chiropractic and the Future of Spine Care
Scott Haldeman, M.D., D.C., Ph.D.
Spinal disorders in the form or low back pain and neck pain have been determined by a formal WHO study to be the number 1 and number 4 causes of disability in the world. In the USA and much of the developed world the current model of care has resulted in increased cost and, at the same time, increased disability. This unacceptable situation is resulting in a rethinking of the manner in which care is offered people with spinal disorders. The new model of care that is receiving the most attention is the identification of a primary spine care provider or clinician who follows evidence based approach to spine care. Chiropractors are uniquely positioned so that, with minor modification of their training and acceptance of this position, they could assume this position in the health care system.

An Evidence-Based Guide for Patient Management: The Lower Quarter
Nate Hinkeldey, D.C., and Michael Tunning, D.C., ATC
In the past, chiropractic treatment and spinal adjustment have been used as synonyms. However, time has passed and chiropractors have added different treatment methods to their skill set. Manual therapy modalities to include trigger point therapy, instrument assisted myofascial release, exercise/ rehabilitation, stretching techniques, and mobilization.  As a result, it is important that chiropractors have systems in place to determine where and when to each modality. Philosophies and rationale for time of implementation may differ, but all treatment plans should have some evidence-based rationale.’ This class offers one evidence-based perspective for implementation of the different modalities.

Chiropractors - Providers of Lifelong Dynamic Functional Health and Performance
Austin McMillin, D.C.
Chiropractic patients are accustomed to great pain relief from the care they receive.  Yet chiropractic care is about much more. Chiropractors can, should, and do provide much more.  This presentation will provide an overview of areas that chiropractors can dramatically increase their value in patient care as well as in the health care marketplace — with a focus on improving functional health, performance, and quality of life.  By viewing care from the patient perspective, using emerging research to drive forward thinking strategies and understanding how providing better technical expertise is good for patients and good for business, chiropractors can thrive in a challenging health care delivery world.  This program will show you how and send you back to practice with new ideas to improve your expertise and competitive edge.   

Recognizing Food Allergies: Challenges and Opportunities
Lia Nightingale, Ph.D.
Food allergies are a major health concern in developed countries, causing serious physical, social and financial burdens. The epidemiology and pathogenesis of food allergies will be reviewed, while clinical diagnosis, prevention strategies and treatment will be discussed in detail.

Imaging of Conditions Common to Chiropractic Practice.
Ian McLean, D.C., DACBR
Image interpretation is a skill combining diagnostic imaging findings with clinical presentations.  This program for the chiropractic physician is designed to reinforce those skills necessary to differentiate critical radiographic findings from those less important.  Emphasis is placed on recognizing conditions common to chiropractic practice along with recognizing diagnostic pitfalls.  Clinical management will also be discussed. A regional approach will be utilized with emphasis on spinal and musculoskeletal system.


Monday, April 27, 2015

Three New Papers from the Biomed Central Family of Journals

Joosen MCW, van Beurden KM, Terluin B, van Weeghel J, Brouwers EPM, van der Kilnk JJL. Improving occupational physicians’ adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. BMC Medical Education 2015, 15:82  doi:10.1186/s12909-015-0364-8

Background: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs’ barriers were evaluated. Methods OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs’ experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. Results The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). Conclusions The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs’ knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

Jafree SR, Zakar R, Fischer F, Zakar MZ. Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses. BMC Medical Ethics 2015, 16:16  doi:10.1186/s12910-015-0011-2

Background: The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.

Methods: The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety.

Results: Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors.

Conclusion: Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.

Ahn K, Jhun HJ. New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion. BMC Musculoskeletal Disorders 2015, 16:97  doi:10.1186/s12891-015-0551-0

Background: Lumbar spondylolisthesis (LS) and lumbar instability (LI) are common disorders in patients with low back or lumbar radicular pain. However, few physical examination tests for LS and LI have been reported. In the study described herein, new physical examination tests for LS and LI were devised and evaluated for their validity. The test for LS was designated “low midline sill sign”, and that for LI was designated “interspinous gap change” during lumbar flexion-extension motion. Methods The validity of the low midline sill sign was evaluated in 96 patients with low back or lumbar radicular pain. Validity of the interspinous gap change during lumbar flexion-extension motion was evaluated in 73 patients with low back or lumbar radicular pain. The sensitivity, specificity, and positive and negative predictive values of the two tests were also investigated. Results The sensitivity and specificity of the low midline sill sign for LS were 81.3% and 89.1%, respectively. Positive and negative predictive values of the test were 78.8% and 90.5%, respectively. The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively. Positive and negative predictive values of the test were 77.1% and 68.0%, respectively. Conclusions The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.