Chiropractic legal challenges to the physical therapy scope of practice: Anybody else taking the ethical high ground?

 Here is an editorial by Peter A. Huijbregts, PT, MSc, MHSc, DPT, OCS, FAAOMPT, FCAMT, published in v. 15 (2) of the Journal of Manual and Manipulative Therapy.

He ends his editorial with the questions, Are there any chiropractors out there willing to join the only ethically defensible position and help end these skirmishes about scope of practice? Isn’t it time we concentrated on matters more important, like caring for the patients who seek our help?

Huijbregts P. Chiropractic legal challenges to the physical therapy scope of practice: Anybody else taking the ethical high ground? [editorial]. J Man Manipulat Ther 2007; 15(2):69-80.

Sections: Chiropractic: A profession in crisis; Chiropractors: Not subluxation correctors or primary care physicians; Chiropractors: Neuromusculoskeletal specialists?; Solely economic motives for scope of practice challenges; Physical therapy: History; Physical Therapy: Education and Licensing Requirements; Physical Therapy: Concept and Technique Development and Description; Physical Therapy: Research; Semantics: Lessons in Obfuscation; Physical Therapy and Chiropractic: Distinct Central Concepts; Physical Therapy and Chiropractic: Comparative Safety Records; Chiropractors: Truly Capable of Differential Diagnosis?; Physical Therapy: Safe and Effective in a Direct-Access Role; Ethical versus Economic Motives; References (80)

Computer prediction: 1999 A.D.

Take a look at a prediction made in a 1967 film entitled 1999 A.D., by the Philco-Ford Corporation. Features include online banking (done by the husband, of course), online shopping, flat screens, networked computers, sophisticated communications and domestic surveillance.  Check out the facial expressions on the husband and wife, and the catchy music!
Here is a clip from the same film, about the kitchen of the future. And here is a vision of the year 2000 from 1957.

Evaluating complex healthcare systems: A critique of four approaches

    From the latest issue of Evidence-based Complementary & Alternative Medicine (eCAM), an Open Access journal:

Boon H, MacPherson H, Fleishman S, Grimsgaard S, Koithan M, Norheim AJ et al. Evaluating complex healthcare systems: A critique of four approaches. eCAM 2007; 4(3):279-285.

Abstract: The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or whole’ systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK), whole systems research, whole medical systems research described by NCCAM (USA) and a model from NAFKAM (Norway). Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced); the necessity of using mixed methods including randomized clinical trials (RCTs) (explanatory and pragmatic) and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM) as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first) especially with respect to how the definitive’ RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems. Full Text

Reinventing CME: The role of the care pilot in the medical group practice

   Here is an interesting article from the October/December 2007 issue of the Journal of Ambulatory Care Management:

Greene BR, Filerman GL. Reinventing CME: The role of the care pilot in the medical group practice. J Ambul Care Manage 2007; 30(4):283-290.

Abstract: This article recommends that the content of traditional continuing medical education be changed significantly to include the concepts and skills necessary to enable practice teams to feedback information into the practice, which would result in the creation of a learning organization with the ability to plan for and anticipate future activities. The primary role in this new organization would be called a care pilot who would have as a primary responsibility, the successful navigation and improvement of the 6 aims as spelled out in the Institute of Medicine report Crossing the Quality Chasm.  PubMed Record    Journal Record 

Chiropractor and MD Interaction

  From the October/December 2007 issue of the Journal of Ambulatory Care Management:

Allareddy V, Greene BR, Smith M, Haas M, Liao J. Facilitators and barriers to improving interprofessional referral relationships between primary care physicians and chiropractors. J Ambul Care Manage 2007; 30(4):347-354.
OBJECTIVE: Findings from recent studies suggest that there are poor interprofessional referral relationships between primary care physicians (MDs) and chiropractors (DCs) and this can lead to fragmentation of care. The objective of this study is to identify potential facilitators and barriers to developing positive interprofessional referrals relationships between MDs and DCs.
METHODS: We conducted 2 rounds of focus group interviews on a convenience sample of MDs and DCs. The focus groups were audiotaped, and transcripts were prepared for each focus group interaction. These data were analyzed through content analysis by 2 independent evaluators to determine the key themes and concepts provided by the focus groups.
RESULTS: Both MDs and DCs suggested that good communication, openness to discussion by providers, and patient interest are key factors for developing positive interprofessional referral relationships and implementing interprofessional practice-based research networks. Barriers to interprofessional relationships include lack of good communication between the 2 provider types, bias toward alternative medicine, lack of knowledge or understanding of chiropractic care, geographic constraints, and economic considerations.
CONCLUSIONS: This study identified several facilitators and barriers for developing positive referral relationships between primary care physicians and chiropractors. Future studies must focus on demonstrating the role of these factors on developing positive interprofessional relationships.  PubMed Record

Greene BR, Smith M, Haas M, Allareddy V. How often are physicians and chiropractors provided with patient information when accepting referrals? J Ambul Care Manage 2007; 30(4):344-346.
Abstract: The objective of our study is to document how often MD/DOs and doctors of chiropractic (DCs) receive patient information from referring MD/DOs and DCs and highlight to what extent there is a lack of formal intraprofessional and interprofessional referral relationships between MD/DOs and DCs. A total of 517 MD/DOs and 452 DCs participated in this study. The study results suggest that patient information is not regularly provided by either MD/DOs or DCs, even when making formal referrals to a provider of the same type. This was more pronounced when MDs made formal referrals to DCs.  PubMed Record

By the same authors: Referral patterns and attitudes of primary care physicians towards chiropractors

Search with Blackle and save energy (maybe)

  Are you looking for ways to save energy? Did you ever think that you could save energy when you search with Google? Well, neither did I, until I came across Blackle. Here is some background:

Blackle was created by Heap Media to remind us all of the need to take small steps in our everyday lives to save energy. Blackle searches are powered by Google Custom Search.  Blackle saves energy because the screen is predominantly black. “Image displayed is primarily a function of the user’s color settings and desktop graphics, as well as the color and size of open application windows; a given monitor requires more power to display a white (or light) screen than a black (or dark) screen.” Roberson et al, 2002 

I tried it, and got the same results as searching the white Google. There is no Advanced Search, but you can use the advanced search features that I wrote about a while ago in A Google Primer. For example, to find Web sites (in Blackle) with Blackle in the title, simply type allintitle: Blackle. Or search a phrase like “Anne T-V’s Blog”.

I don’t know if I will bother to use Blackle, but I am endlessly fascinated by how people play with Google. (I still like Google Fight and Google World.)

After I wrote the above, I looked for critiques of Blackle’s claims and I found this video on YouTube: Watts Up Meter Demonstration, in which a man shows that the white Google actually uses less energy than Blackle.  Then there are the bloggers …

Here are some other attempts to make a greener Google: GreenerGLE; Energy Efficient Search Engine;  Earthle;  Greygle; Ninja. These all deliver the same search results, but in different colours, so really, Blackle’s claim does look like it may be a bit of a scam or hoax.

You be the judge.

Really, really bad slide presentations

We have all endured these. Have a look at comedian Don McMillan’s take on slide presentations. (Thanks to Sue Pelletier for this.)

• Read this blog entry entitled Short scientific talks for dummies, from Respectful Insolence, who also wrote A field guide to biomedical meeting creatures, part 2: Poster time! Hilarious!
• And if you still haven’t had enough, read PowerPoint Is Evil: Power Corrupts. PowerPoint Corrupts Absolutely, by Edward Tufte, Wired Magazine, September 2003

10 Simple Rules (for research scientists) Collection (PLoS)

  From Philip E. Bourne, Editor-in-Chief of PLoS Computational Biology, here is a collection of editorials intended to provide a quick, concentrated guide for mastering some of the professional challenges research scientists face in their careers. All PLoS (Public Library of Science) journals are Open Access journals. This page updated December 10, 2007.

• Erren TC, Cullen P, Erren M, Bourne PE (2007) Ten Simple Rules for Doing Your Best Research, According to Hamming. PLoS Comput Biol 3(10): e21
• u J, Bourne PE (2007) Ten Simple Rules for Graduate Students. PLoS Comput Biol 3(11): e229
• Erren TC, Bourne PE.  Ten simple rules for a good poster presentation. PLoS Comput Biol. 2007 May 25;3(5):e102.  Related Articles in PubMed
  See also A field guide to biomedical meeting creatures, part 2: Poster time! Hilarious!
• Bourne PE. Ten simple rules for making good oral presentations. PLoS Comput Biol. 2007 Apr 27;3(4):e77.  Related Articles in PubMed
• Vicens Q, Bourne PE. Ten simple rules for a successful collaboration. PLoS Comput Biol. 2007 Mar 30;3(3):e44.  Related Articles in PubMed
• Bourne PE, Friedberg I. Ten simple rules for selecting a postdoctoral position. PLoS Comput Biol. 2006 Nov 24;2(11):e121.  Related Articles in PubMed
• Bourne PE, Korngreen A. Ten simple rules for reviewers. PLoS Comput Biol. 2006 Sep 29;2(9):e110.  Related Articles in PubMed
• Bourne PE, Chalupa LM. Ten simple rules for getting grants. PLoS Comput Biol. 2006 Feb;2(2):e12.  Related Articles in PubMed
• Bourne PE.  Ten simple rules for getting published. PLoS Comput Biol. 2005 Oct;1(5):e57. Related Articles in PubMed

Brand names make it to the OED!

It’s fascinating to peruse the new words added to the OED. (Here are the words added in June 2007; and added in September 2007.)  Brand names often enter the language as generic terms, and I’ve listed a few of them below. (I wonder who they have in mind with the word “flip-flopper”. And what on earth is a cotylosaur? I thought “chicklet” meant a little piece of gum, but I was disappointed to discover that it means a small chick or girl.)

Google
Goo·gle  – verb: to use the Google search engine to find information on the Internet.

Botox
bo·tox – noun or verb – A proprietary name for: a preparation of botulinum toxin which is injected into specific muscles to create temporary paralysis, as part of the treatment of various medical conditions and in the cosmetic treatment of wrinkles of the face (esp. frown lines and crow’s feet). Also: treatment by this means; a course of such treatment.

Popsicle
pop·sicle – noun – A proprietary name for: an ice lolly.

Hoover
hoo·ver – verb: to clean with a vacuum cleaner (Chiefly British)

Kleenex [see more ads]
klee·nex – noun: the proprietary name of an absorbent disposable cleansing paper tissue.

Xerox
xe·rox – noun or verb: a name for a copying machine or the act of reproducing printed, written, or pictorial matter by xerography.

Thermos
ther·mos  –noun: a vacuum bottle or similar container lined with an insulating material, such as polystyrene, to keep liquid hot or cold

Prozac
pro·zac  -noun: a brand of fluoxetine hydrochloride
Spandex
span·dex  –noun: a synthetic fiber composed of a long-chain polymer, used chiefly in the manufacture of garments to add elasticity

JELL-O
jell·o  -noun: brand of dessert made from a mixture of gelatin, sugar, and fruit flavoring, dissolved in hot water and chilled until firm

Band-Aid
band·aid  -noun: adhesive bandage with a gauze pad in the center, used to cover minor abrasions and cuts

Viagra
vi·ag·ra  -noun: sildenafil citrate, used to treat impotence

Frigidaire
frig·i·daire – noun: the proprietary name of a brand of refrigerator.

Should eponyms be abandoned?

   The September 1, 2007 issue of BMJ contains a feature entitled Should eponyms be abandoned? Alexander Woywodt and Eric Matteson wrote the Yes response, and Judith A Whitworth the No response.

Excerpt from Should eponyms be abandoned? Yes:
The Oxford English Dictionary defines an eponym as a person . . . after whom a discovery, invention, institution, etc is named or thought to be named. Eponyms are deeply rooted in tradition and their use has long been viewed as a matter of taste. However, it is time to abandon them in favour of a more descriptive nomenclature.

Eponyms often provide a less than truthful account of how diseases were discovered and reflect influence, politics, language, habit, or even sheer luck rather than scientific achievement. Moreover, the continued use of tainted eponyms is inappropriate and will not be accepted by patients, relatives, or the public.

Read the BMJ Rapid Responses to Yes

Excerpt from Should eponyms be abandoned? No:
Some years ago, filling in time between candidates in a clinical examination, I was chatting to a colleague about eponyms. His view was that eponyms were not particularly useful and he recalled an encounter with a young woman struggling in a similar examination. She couldn’t find the lymph nodes and seemed unfamiliar with pulmonary auscultation. To bolster her spirits, he asked her who discovered Koch’s bacillus. She became even more anxious and lost for words. My colleague helpfully asked, “Who wrote Mendelssohn’s Spring Song?” and she burst into tears. Similarly, I recall a friend coming out of a fine arts examination and asking who designed the Eiffel Tower.

I understand there was a long line of people happy to argue that eponyms be abolished, and few prepared to take the contrary view. This I can only ascribe to the well known human propensity to enjoy tilting at windmills.

Read the BMJ Rapid Responses to No

Join the debate and respond to the survey at the medpageTODAY site:

Should Medicine Abandon Eponyms for More Scientific Descriptions?
* Yes, Addison, Zollinger, Ellison and the others didn’t do anything that merits a permanent entry in Dorland’s
* No, eponyms are a convenient shorthand

Survey results (398 responses) as of Wednesday, September 5, 2007, 6:16pm in Ontario: Yes/No