Tuesday, February 21, 2012

End of Term Youtube Frenzy

Yes, we are at the end of the term and it is time to have a fun blog entry once again, so here in particular order are some interesting and novel youtube clips.

1. Ariel Tweto and Flying Wild Alaska- this is a guilty pleasure TV show for me, and Ariel is part of the reason why. Sassy, funny and outspoken , she makes the show. http://www.youtube.com/watch?v=0gCIRDaFmio&feature=relmfu

2. Laughing baby- everyone loves laughing babies! http://www.youtube.com/watch?v=RP4abiHdQpc

3. OK Go- these guys do the most incredible music videos and this is no exception: http://www.youtube.com/watch?v=qybUFnY7Y8w

4. Downhill mountain biking- this one scares me each time I see it: http://www.youtube.com/watch?v=56kJ99AvfoI

5. RAGBRAI- yes, I ride it each year, and this is a great introduction as to why (note: there is one profanity in this clip): http://www.youtube.com/watch?v=Pwf-B0mi_4I

6. Big Bang Theory- okay, I am now in love with this show, because I am a geek nerd: http://www.youtube.com/watch?v=4RCZamyEo4A&feature=related

7. BBT 2- well, here we are again… : http://www.youtube.com/watch?v=Bv4LBuJTyJ4&feature=related

8. Adele: she’s good! http://www.youtube.com/watch?v=0ckIulg1DfQ

9. Maggie Vessey winning the Prefontaine 800m race- this one moves every time I see it, since Maggie Vessey is last at both 400m and 200m to go and still pulls off the win: http://www.youtube.com/watch?v=okY5FaRt62c

10. The Bloodhound SSC- a car designed to go 1000 mph! It outs out 135,000 horsepower! http://www.youtube.com/watch?v=lM8jIwpOpZI&feature=related

Monday, February 13, 2012

EBCP Basics

Evidence-based medicine developed out of a movement started by a group of medical educators at McMaster’s University during the 1980s. 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 have the most rigorous of studies, 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.” 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 asin clinical trials and other forms of research.

Monday, February 6, 2012

A Few New Articles for Your Pleasure

Schlegal C, Woermann U, Rethans JJ, van der Vleuten C. Validity evidence and reliability of a Simulated Patient Feedback Instrument. BMC Medical Education 2012, 12:6 doi:10.1186/1472-6920-12-6


Background: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF).

Methods: Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings.

Results: All but two items of the mQSF received importance ratings of >2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter.

Conclusions: The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

Praestegaard J, Gard G. The perceptions of danish physiotherapists on the ethical issues related to the physiotherapist-patient relationship during the first session: a phenomenological approach. BMC Medical Ethics 2011, 12:21 doi:10.1186/1472-6939-12-21


Background: In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice.

Methods: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework.

Results: Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective.

Conclusions: Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well.

Scheermesser M, Bachmann S, Schamann A, Oesch P, Kool J. A qualitative study on the role of cultural background in patients' perspectives on rehabilitation. BMC Musculoskeletal Disorders 2012, 13:5 doi:10.1186/1471-2474-13-5


Background: Low back pain (LBP) is one of the major concerns in health care. In Switzerland, musculoskeletal problems represent the third largest illness group with 9.4 million consultations per year. The return to work rate is increased by an active treatment program and saves societal costs. However, results after rehabilitation are generally poorer in patients with a Southeast European cultural background than in other patients. This qualitative research about the rehabilitation of patients with LBP and a Southeast European cultural background, therefore, explores possible barriers to successful rehabilitation.

Methods: We used a triangulation of methods combining three qualitative methods of data collection: 13 semi-structured in-depth interviews with patients who have a Southeast European cultural background and live in Switzerland, five semi-structured in-depth interviews and two focus groups with health professionals, and a literature review. Between June and December 2008, we recruited participants at a Rehabilitation Centre in the German-speaking part of Switzerland.

Results: To cope with pain, many patients prefer passive strategies, which are not in line with recommended coping strategies. Moreover, the families of patients tend to support passive behaviour and reduce the autonomy of patients. Health professionals and researchers propagate active strategies including activity in the presence of pain, yet several patients do not consider psychological factors contributing to LBP. The views of health professionals are in line with research evidence demonstrating the importance of psychosocial factors for LBP. Treatment goals focusing on increasing daily activities and return to work are not well understood by patients partly due to communication problems, which is something that patients and health professionals are aware of. Additional barriers to returning to work are caused by poor job satisfaction and other work-related factors.

Conclusions: LBP rehabilitation can be improved by addressing the following points. Early management of LBP should be activity-centred instead of pain-centred. It is mandatory to implement return to work management early, including return to adapted work, to improve rehabilitation for patients. Rehabilitation has to start when patients have been off work for three months. Using interpreters more frequently would improve communication between health professionals and patients, and reduce misunderstandings about treatment procedures. Special emphasis must be put on the process of goal-formulation by spending more time with patients in order to identify barriers to goal attainment. Information on the return to work process should also include the financial aspects of unemployment and disability.