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

jmmt.jpg 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

ecam.gif    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

jacm.gif   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 ChasmPubMed Record    Journal Record 

Chiropractor and MD Interaction

jacm.gif  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)

blackle.jpg  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 EngineEarthleGreygle; 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.)