NSC Mobilie Recap

It was an amazing conference, a great way to finish up my career as a student and unfortunately the end of my role on the nominating committee. There were over 1300 students from around the country and over 600 of them voted in the elections for new Student Assembly officers. The election process was a huge success with a great new board coming in and hopefully the highly qualified candidates who were not elected will not be discouraged and find their way to make a difference because they all had so much potential. Through gathering feedback, apparently communication between the apta and the students out there needs some improvement, and I am confident it will. The future looks very bright. There were so many positive things going on at the conclave from programming (including the one the board members from this year and I presented), to mock interviews, resume critiques, great vendors in the exhibit hall, making connections from all across the country and so much more. I cut this short because I am about to go underground, so as my nom com buddy ms. crawford so eloquently put it: 'I am going to make like a joint and mobilize.' Have a phenomenol day!

SO Much Info Out There

Here is another great website for keeping up to date with Rehab News:
http://www.medicalnewstoday.com/sections/rehabilitation/

Here are two recent articles from there that are of interest to this Student PT:

1.

Soreness After Exercise Not Prevented By Stretching Out

Studies show that stretching before or after exercise has little or no effect on muscle soreness between half a day and three days later, a team of Cochrane Researchers has found.
...
"The data were remarkably consistent," says lead researcher Robert Herbert from the School of Physiotherapy at the University of Sydney, Australia, "The available evidence suggests that stretching before or after exercise does not prevent muscle soreness in young healthy adults."

The researchers do, however, believe that there is a need to see whether stretching can have an effect on people in the community who have reduced levels of flexibility.

2.

Sports Concussion Education Campaign Being Developed By National Athletic Trainers' Asociation And National Academy Of Neuropsychology

"Often, brain injuries initially go unrecognized," said NATA president Chuck Kimmel, ATC. "The goal of this program is to educate individuals on the importance of rapid recognition and treatment of concussions and to ensure the athlete is ready to return to play."
--
This program is going to be vital in helping many athletes out there. In recent weeks I have unfortunately seen a number of concussions occur in sport and felt that everyone involved could use a little more education on the subject.

On another note, part of the reason I sometimes neglect to post for a few days has to do with the overwhelming amount of knowledge I get exposed to on a consistent basis. Just in the last few days I have been exposed to Tai Chi, Business Planning, a CAPTE accreditation review board, people e-mailing me about various topics in PT in response to previous blog posts, getting stuck in 3 hours of traffic trying to get to a continuing education course in Long Island, a NYPTA Board of Directors meeting where a number of bylaw changes for the NYSSIG I proposed were accepted, preparation for the National Student Conclave, an aerobic capacity/metabolic test on a treadmill (which was very cool and I will be a subject for later today...possibly) the list goes on and on... I stay fairly busy. This often leads to a lot of blog ideas but I am never sure which ones to include, which to filter out, so often times I just choose sleeping, studying, or working out instead of posting :-D sorry...

But I hope the content I do add is a benefit to someone in some way... if we can just change one person for the better... insert additional cliché here

And now it is raining outside so I must start my long wet commute, hope you have a great day and thanks for letting me get a little bit of PT off my chest...

Two Stolen Articles

I had to post these two for the respective reasons:
1. To help me study for an upcoming exam dealing with health care delivery.
2. To spread the word about this great idea by Google Inc. They seem to be at it again with great ideas that make sense and will seemingly help society all the while making them much richer I am sure.

Thank you APTA Bulletin for being so useful (hopefully they don't accuse me of theft :)

United States Continues to Have Highest Level of Health Spending

The United States continues to spend the most on health care when compared with other Organization for Economic Cooperation and Development (OECD) countries. Health care prices and higher per capita incomes are major factors for higher US spending, according to a study by Johns Hopkins Bloomberg School of Public Health and Princeton University.

Compared with the average OECD country in 2004, the United States has fewer health resources -- physicians, nurses, and hospital beds -- and lower utilization of these resources. Health care spending for chronic health issues, such as obesity, alcohol consumption, and smoking, also contributes to high health care spending in the United States, says a Johns Hopkins news release.

Key study results, based on 2004 data, show the following about US health care spending:

• Per capita expenditures were 2.5 times greater than those of the median OECD country.

• The United States spent 15.3% of its gross domestic product on health care, which is substantially higher than any other OECD country.

• US growth in health care spending per capita from 1994 to 2004 was similar to the OECD median.

• The United States has promoted policies to reduce the number of hospital days as a way to contain costs. It is now ranked fourth highest among OECD countries for hospital spending per capita.

• The United States spent 3.6 times what the median OECD country spent in 2004 for outpatient care. Most of the difference is attributable to higher spending on physician services.

Results were published in the September/October issue of Health Affairs (Vol 26, No 5).

Google Announces Plans for Health Initiative at Web Summit

Google Inc plans to launch a health initiative in 2008 that will include improved search experiences, data storage, and organization of patient records, the company announced this week at the Web 2.0 Summit in San Francisco.

Marissa Mayer, Google's vice president of Search Products and User Experience, told Internet industry leaders that "…people are already using Google more than any other tool on the Web to find health information. And the health care industry generates a huge amount of information every year. It's a natural core competency for us, to understand how to organize all that data."

The company has developed a prototype online platform for its health offering that incorporates personal medical records, health care-related search features, diet and exercise regimens, a localized "find a doctor" application, and other elements.

Microsoft Corp introduced its electronic health record service called Microsoft Health Vault earlier this month.

Update on Low Back Pain (LBP)

In case you did not know this, LBP is big. A large percentage of the population will experience it sooner or later; "Low back pain is the fifth most common reason for all physician visits in the United States." Close to 85% of it is non-specific, meaning no one can really figure out what is causing the pain. Thus, there are many efforts to try to bring the positive outcomes associated with LBP into a much higher percentage bracket.

The latest issue of Annals of Internal Medicine has a few articles looking at LBP (open access is great). Very quick guide to interpreting this literature is that: it comes from a journal with a great reputation and is highly peer-reviewed and these studies use a review of current evidence making them higher up on the hierarchy of evidence than most other research.

The first (Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society) attempts to establish guidelines for clinicians who deal with the issue. They are even nice enough to have a summary for patients of the information contained in the article which is an excellent strategy in patient education.

The next article in the issue is looking at nonpharmacologic approaches to treating LBP and finds the following: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.

The last one is looking at pharmacological treatments and finds NSAIDs amongst the "useful" group. Startling statistics show that use of these medications leads to more than 100,000 hospitalizations and 16,000 deaths each year in the United States—equaling more deaths than from AIDS and more than four times as many deaths as those from cervical cancer.
The study authors conclude that: "Evidence is insufficient to identify one medication with a clear overall net advantage because of complex tradeoffs between benefits and harms."

The American Pain Society will publish the comprehensive guideline including invasive procedures for low back pain in 2008.

Acupuncture

This past Tuesday we had a class that covered Acupuncture. The lecturer was both a PT and Acupuncturist. The experience of having needles pierce my skin to alleviate something in my body was something I had been curious about moreso for possible referral purposes in the future.

I was used as a subject for my 'tight' (some call it 'short') hamstrings. The needles going into the skin di not hurt, well some felt a little sharper than others as they probably went into much 'tighter' areas. She also used me to demonstrate 'cupping' - which involves taking clear plastic cups and creating a vaccum between the cup and my skin. This serves (in theory) to clear the meridians further. It reminded my of previous myofascial releases that I had received. Also, when I was younger my mother had taken me to a 'european' doctor to use cupping to treat my bronchitis and asthma. Back then they used oil and matches to create the vaccum. Back then a mixture of therapies seemed to help me clear my lungs up.

To review, acupuncture involves placing needles into points along the bodies meridians (which are likened to veins and arteries except are filled with chi aka life energy). At times these meridians can have blockages so the insertion of these needles helps clear the flow.

Case Reports

We are in "mid-term" week. One part of one exam deals with case reports. In the hierarchy of evidence based practice (EBP) the case report as pretty much at the bottom - aka it is a very basic form of evidence (it is amazing how hard it was to find a link to this hierarchy, perhaps it is not as widely accepted as I thought - perhaps just the specifics are not as generalizable?). But it's place in the pecking order is no reason to look down on these very important studies.

The following info comes from my interpretation of Writing Case Reports (I have decided not to cite anything, but just to link to it, I believe that is acceptable, you let me know...):

Case reports...

• ..."illustrate EBP" through the therapeutic alliance as described by Sackett and colleagues. They integrate clinical experience as the author describes their decision making process, the qualitative aspect that patient choice exemplifies and lastly with the use of the best available research evidence through the citations used throughout the study.
• ..."help develop hypotheses for future research" by providing a unique clinical question or observation that may not otherwise have been brought up. Because the case report cannot test cause and effect relationships it can discuss the current thinking about a possible relationship between research variables and hypotheses that may be carried out in randomized controlled trials (the higher level of studies, trumped mainly by systematic reviews). There are numerous instances where case reports are written in response to a lack of current literature on the topic of interest.
  
• ..."build problem-solving skills" as a reader or as an author. As a reader it is valuable to follow a colleagues process of problem-solving and possibly pick-up a skill or two. To write a successful case report requires that your problem-solving skills be at a high level. From researching the literature on your topic to reflecting on your process of problem-solving to lastly accepting and utilizing the feedback that the peer-review process provides you will in fact build tremendously on your skills.
• ..."support, enhance, or cast doubt on theory underlying practice" by describing the application of theory thus shedding light on how the theory holds up in a clinical situation. In relation to this, the case report can then challenge the existing theory and hopefully spark a respectful debate on the topic to ideally lead to optimized patient/client outcomes.
• ..."help develop guidelines and pathways" by providing examples of specific patient populations with greater accuracy and a time frame of reference. The practice variation is vital for a profession to be aware of as there may be techniques available that may be more efficient. Furthermore, an accumulation of case reports can be a stronger level of evidence than a single case report as trends begin to emerge and informal conclusions can begin to formulate and thus lead to new thinking.
  

"Unrelated to the rest of the post" quote:
"Indecision may or may not be my problem" - Jimmy Buffet

Yoga Patanjali's Eight Fold Path

My abridged study version of Patanjali's Eight Fold Path, an integral part of therapeutic yoga...

1. Yama - moral precepts
2. Niyama - qualities to nourish
3. Asana - postures/movements
4. Pranayama - breathing exercises
5. Pratyahara - withdrawal of the senses, such as in meditation
6. Dharana - concentration
7. Dhyana - uninterrupted meditation
8. Samadhi - "in the zone"

The three postures we learned to focus on (I may not spell these correctly):

• Tadasana - helps extension and standing posture
• Buddha Konasana
• Sukasana - one I had a lot of trouble doing

Just a quick FYI... sort of not really... sorry, had a lot of coffee... off to take this exam now

Frustration

I am probably more frustrated than I have ever been in my life right about now... and not just because the yankees blew it today, or the jets are in line for a great draft pick... but along these lines, people (in so many facets of life) seem to be letting me down as of late... I do not want to make this too personal a blog but I just wanted to vent right there... all done

Life is too short for the negativity, so trying to stay positive (although yoda says: "do, or do not. there is no 'try'.")

Speaking of doing... A lot to do, part of the reason for my lack of blog contributions. So now I must 'do' more blogging...

• Doing a presentation next week on the use of the Nintendo Wii for Rehab aka wii-hab and a video analysis of a power clean.

• Another presentation on an article about the lack of mental health services provided to college students that uses the Virginia Tech incident as an example. I just found an audio interview in relation to this article, good supplement to use.

• "A cohort is worth defining here as a group of people who share a common characteristic or experience within a defined time period (e.g., are born, leave school, lose their job, are exposed to a drug or a vaccine, etc.). Thus a group of people who were born on a day or in a particular time period, say 1948, form a birth cohort." This is all from wikipedia which is a questionable source to use more often than not, but there are times when it provides information in such a great way that other sources do not, so be cautious in using this site.

• Have an exam tomorrow on psychoneuroimmunology, complementary and alternative medicine in general, and yoga therapeutics.

• Will be doing a presentation about Evidence Based Practice as part of VISION 2020 at the end of the month at the National Student Conclave.

• Will be presenting different ways to get involved in the profession of PT at the NYPTA Downstate Student Conclave.
  

• Have to present a lot of case studies, plan of cares, interventions, etc.

• Have to present a 10 year professional plan.

• Must fill out my last generic abilities assessment (it's more complex than the linked version).

• A few more exams along with finding a place to live in Philadelphia for February-May 2008... I am certainly forgetting a few assignments... overall, it's all manageable... I certainly am not complaining but it could all be so much simpler - and just to clarify it is not any of these bullets that frustrates me at all... could be a lot worse too so for all those canadians... Today I give thanks for what I DO have!
  

Just Another Tuesday

Hi... seems like forever since I have posted... blogger withdrawal.

I have been busy looking for a place in Philly for when do my clinical there, or alternative locations or... just a mess. Every day I get home and want to blog but I either am so ready to go to sleep or just can't decide which of the multitude of possible topics that I covered throughout the day I should post about. Sometimes I think about too many things and am left with nothing. Jack of all trades and master of none? I hope not, have to try to avoid that scenario.

Tomorrow I am going to do a presentation to the 1st years about evidence-based practice that I will also be presenting in Valley Forge, PA at the National Student Conclave, you should come by! It is a very interesting presentation if I do say so myself...