Tuesday, October 19, 2010

Another Term’s End- the Fun Entry

Here we are again, at the end of another term, at least here in Davenport, and so it is time to take a short break and head out for a chance to catch our collective breaths. To that end, I offer up a few fun and interesting youtube clips for your entertainment.

1. Big Bang Big Boom:
This is evolution as seen on a wall painting. I can only imagine how hard it must have been to film this using stop and go techniques over long periods of time.

2. The Passenger:
A film clip in animation about a bookwork stuck on a bus that he might not wish to be on.

3. The Cat Piano:
You know what? There really were cat pianos!

4. Rango: http://www.youtube.com/watch?v=SKi2KzKbjVY&feature=player_embedded
Because you know you want to see a movie in which a chameleon plays a role in helping rid a town of bad guys.

5. The Fall: http://www.youtube.com/watch?v=QhARR-zmTCE&feature=player_embedded
Simply gorgeous, produced by Tarsem, a former video producer who also wrote and filmed the Jennifer Lopez movie “The Cell.”

6. Let Me In: http://www.youtube.com/watch?v=qjavOLdPk1c
I previously sang the praises of “Let the Right One In,” and this is the American remake. While not the same as the original, which I consider a perfect movie, this is also quite good in its own way.

7. Harry Potter and the Deathly Hallows:
Because you know it’s coming soon to a theater near you, and you’ll go see it.

Have a great break, even if it is a short one!

Monday, October 11, 2010

An Introduction to Evidence-Based Clinical Practice

Evidence-based medicine developed out of a movement started by a group of medical educators at McMaster’s University during the 1980s (1). These physicians observed that a gap had developed between what occurred in clinical practice and what was obtainable in reports of clinical research. Essentially, clinicians could not stay abreast with new research because it was being produced so fast; consequently they were not putting into practice the most current information. Evidence-based methods were designed to bridge this gap. This concept has been embraced by the chiropractic profession as well, leading to what we now call evidence-based chiropractic (EBC), or evidence-based chiropractic practice (EBCP).

EBCP is unique in several ways:

• For example, chiropractic interventions are difficult to investigate by experimental methods, because it is hard, if not impossible, to design an effective placebo, and it is impossible to blind either the doctor or the patient to the interventions being studied. As a result, there are fewer chiropractic articles that use placebo group controls than in other scientific or medical disciplines.

• Chiropractors commonly use a number of treatment modalities in addition to adjustment, while clinical trials may focus on a single intervention in order to isolate its effects.

• Traditionally, it was hard for chiropractors to obtain funding for rigorous research, though this has certainly changed, all the more so here at PCC.

But these challenges have also meant that we have a uniqueness to our profession. While we might not always have the most rigorous of studies, and for understandable reasons, we have developed an impressive body of evidence to support what we do.

Sackett has stated that EBP is “ … the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (1) This is an important statement, because in it we see that the practitioner’s clinical expertise is an important component; the goal is to integrate clinical expertise with best evidence on behalf of the patient. EBCP is therefore not in any way cookbook medicine or practice, it is the integration of best evidence with the past training and expertise of the clinician, resulting in better care for the patient. And new evidence is replacing old all the time.

Patient preferences also play an important role. This includes the personal values, concerns and expectations that patients have about their care. Considering these are critical steps in the EBCP process.

• Personal values: These are the beliefs patients have about the care being offered to them, which may be based on personal, religious or philosophical reasons.

• Patient concerns: Such as financial concerns, time constraints, office location, ease of parking, etc.

• Patient expectations: This relates to the degree that patients will accept a doctor’s recommendations. Compliance is an ongoing problem in patient care, as well as in clinical trials and other forms of research.

1. Evidence-Based Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-2425
2. Sackett DL. Evidence-based medicine. Lancet 1995;346:1171

Monday, October 4, 2010

Effective Workshops, Part 2

Picking up from last week’s entry, let me bring this to a close by adding in these additional tips, based on the work of Dr. Yvonne Steinert (1).

7. Encourage active participation and allow for problem solving and/or skill acquisition. Steinart notes that active participation is a key ingredient of a successful workshop; therefore, you should plan to have people and groups involved in all aspects of the workshop you are leading. Invite questions, lead debate and engage attendees. In order to allow this to happen, you should work to limit the size of the small groups, so that everyone can have an opportunity to be heard and to be involved. In fact, the actual lay-out of the room can help or hinder this process; lecture rooms are not conducive to small-group activity.

8. Provide relevant and practical information. We know this from the general problem facing continuing education that often people attend programs or conferences and when they return it has changed nothing on what they do. You need to ensure that your participants have learned something new which they can apply when they return to their work setting. Your workshop can contain mini-lectures around which the small-group activities revolve, but a long lecture is not a good way to provide skills and knowledge which will be applied upon return to work. People need to interact with both you and others to reinforce learning.

9. Remember principles of adult learning. This means that we each will bring to the sessions we attend our past experiences and training, and our own personal motivations and expectations about the workshop. We need to remind ourselves that as adults, we are often re-learning, rather than learning, so we need to be careful in how we present information so that we do not create resentment among those who are in attendance. The incentive for learning is self-motivated, not externally motivated, and feedback is therefore critically important.

10. Vary your activities and your style. Consider the pacing of your presentation, and ensure that it meets with participant needs and attention. I find that I am resistant to certain kinds of group work; I tend to work best alone, but I also know that I will learn better when I have people to play ideas and thoughts against. Consider this as well.

11. Summarize your session and request feedback from the group. Always restate your goals and objectives in running the workshop in order to summarize and synthesize the points you have made. You may wish to ask the group to also summarize what they have learned, and you can ask as well for them to give you thoughts on what you might do to improve this session in the future.

12. Enjoy yourself- and have fun. There was a time when I because quite fearful before I ran sessions for professionals. It took time for me to realize that the people attending would not know whether or not I presented all I meant to present, nor would they know if I had made a flub somewhere along the line. This was liberating; I could now go and just do the session and enjoy myself and I now look forward to running workshop sessions. If you have a good time, chances are so will the people taking the session with you.

1. Steinert Y. Twelve tips for conducting effective workshops. Med Teacher 1992;14:127-131