CPR Standards

As a former EMT and a proponent for everyone in the world being CPR certified, this recent article caught my attention. You may have even become certified in CPR or First Aid but the standards are beginning to shift more focus on the chest compression:

As described by Bobrow et al, MICR calls for an initial 200 uninterrupted chest compressions over two minutes, followed by a rhythm analysis and, if necessary, a single defibrillator shock, "immediately followed by 200 postshock chest compressions before any pulse check or rhythm reanalysis." Three sequences of 200 chest compressions are required before the victim can be intubated.

Learn CPR in 3 easy steps (the website on this link is not enough instruction, you should take the class to experience and practice the technique with trained professionals). It really is simple and should not be something you are overwhelmed with, and should be worth the investment to learn it as you can save the lives of your loved ones. Don't forget the AED certification too.

There are a number of organizations that offer this life saving instruction, but these 2 are the most reputable:

• American Red Cross
• Together We Prepare
  

• American Heart Association

Addendum article

Drugs, Surgery, PT

In the continued debate between these three options for numerous diagnoses, here's a real basic article about drugs with some startling numbers, especially the amount of deaths caused by acetaminophen (1393 from 1998-2005). More and more keeps coming out, so keep on reading.

Physician shortage? Turn to PT's

Recently there has been much talk in the health blogosphere about the shortage of primary care physicians.

Is there a primary care crisis?

The trends from recent years largely held true in different specialties. Highly competitive programs such as plastic surgery and dermatology filled all of their slots, mostly with U.S. medical grads. Less competitive programs — largely those oriented toward primary care — relied more heavily on graduates of foreign programs and had some unfilled slots.

Unless the best and brightest physicians can master all possible diagnoses, and there are enough of them to cover all patients, you will always need to have some system of filtering and referral.

So if you want a guaranteed job go ahead and try to get into primary care... another option to help alleviate this problem in American health care is to start recognizing Physical Therapy as a qualified first line defense (direct access) for musculoskeletal issues, and recognizing the specialists within the field in their respective areas:

• neurology
  
• geriatrics
  
• pediatrics
  
• sports
• orthopedics
• cardiovascular/pulmonary
• clinical electrophysiology
  
• women's health

That referral system that will always need to be in place can (and is taught as such) that when red flags and yellow flags (precautions) are spotted, we as PT's will refer out to the appropriate specialty. PT's are now trained at a doctoral level, there are studies showing the cost-effectiveness of PT (read the comments too, well-summed up), and with the current healthcare crisis (and who knows what will happen in this election year), PT needs to be utilized to help improve the state of healthcare. That's where I stand.

And maybe even with the reduced load on physicians perhaps medical errors can be reduced.

Reimbursement 2

As a follow up to my recent post on reimbursement, there is a new story of insurance companies providing reimbursement for online consultations... interesting that we still have all these battles in PT even with Medicare enforcing a cap on therapy... here's a quote that captures the situation and frustrations pretty well from this interesting conversation:

"Here in New Jersey our state chapter of APTA has over a number of years attempted to reason with the insurance industry which has only resulted in further diminishment in reimbursement and loss of coverage as evidenced by arbitrary caps, sky rocketing co-pays and unreasonable and capricious visit limitations based solely on the need of insurers and their intermediaries to bolster their bottom lines."

When will health care and insurance companies come to their senses on what they should spend their money on. Hint hint: Skilled PT services :-D

Another Wii Bites The Dust

Dang it, another Wii article... problem is worth repeating: This is going to become attached to us...

Random person: oh, you are a PT, you have people play Wii to rehabilitate them, that's wonderful...

Not so much... why is it moments like this don't make news... PT is so much more than Wii, I should know based on the ridiculous amount of content I have to study for the licensure exam.

The new APTA marketing campaign can't come soon enough...

John Iams/CAM

I wanted to publicly respond to an e-mail I received inquiring about my opinion of John Iams.

Here is YouTube video of Mr. Iams discussing the changing times. Other than the circles in which he talks, the most befuddling part of the video starts at about 4 minutes and 22 seconds when he begins discussing evidence-based practice. The problem with guru's such as Mr. Iams and their theoretical models that are not based on any true scientific basis is they want to write off EBP or ignore it. Upon reviewing his website (PRRT) I can only say I was less impressed the more I saw. While we do live in a capitalistic society, the whole money-back guarantee on your magical product.
Here on his "blog", he addresses the EBP issue and claims that this technique is too new to have evidence and "it has been clinically proven to frequently reduce pain by 50% or more, even on the first visit."

While I am in this profession for the patient, and believe any form of pain relief that can be long lasting is worth going through all sorts of unusual treatments, I ultimately have to share in the opinions of the EIM team. Here is another post and comments on the issue worth taking a look at. The idea of CAM will certainly be one of interest in the years to come, which is why EBP is that much more important to continue to improve upon.

In other news:
More support for exercise... as if we really needed it...

Another Wii Story

The Wii story is in the last 3 or so minutes of this video. The most interesting part of that news piece for me was actually the USC PT introducing herself as Dr. (a whole 'nother bag of worms in PT). The Wii part of it is just another log on the fire that is the debate over "Wii-hab". The PT (and other health related) blogging community has a lot to say about it:

PT Rover

NPA Think Tank

MyPTSpace - EIM

Science to Life

Physio Info-blog - here is the journal article he is referring to.

Other Wii Articles:

Virtual gaming no replacement for real exercise!

Kevin MD - interesting comment on that one as to the OT vs. PT debate... I think we can certainly work together to be more productive, and I will leave it at that for now...

Speaking of OT - this OT student blog post has a Wii mention

A research team was able to extract rich information about a person's reaching movements while they performed a learning task using the Wii. Here is the actual journal article.

Use of Virtual Reality for burn victims.

Surgeons hone skills with Wii.

As a reminder I work with a Spinal Cord Injury population and we do in fact have a virtual reality room with Wii and an upper body ergometer that can be used to propel a virtual car and steer it left and right (although we had more problems with that one than actual play time). We also have recreational therapists on staff and most patients receive 2-30 minute sessions a week of recreational therapy, the TR's (because RT is reserved for respiratory therapist) also go on community outings along with the PT or OT. Through my observations the Wii along with dominoes, connect four and numerous other games are a large part of what the TR's work on.

Anyway, we have group activities every day as one of the three hours of therapy that all patients receive. I work with the action group which consists of patients that have a little more function than others, in particular almost all of our members can stand. We have a different topic every day and once every few Friday's we have "Fun Friday's" where we play some games (including the Wii). While we were playing we had the patients stand supported with a walker and a PT as needed. One particularly quiet patient was having a groggy day and in his complaints added: "he research has shown that the Wii helps people lose weight, I'm skinny, why am I doing this?"

There is a general image problem for PT in the public... how many people really know what we do? Now they start seeing news pieces with PT and the Wii... thats not why I spent 6 figures on 3 extra years of grad school and plan on doing an extra year long residency... PT is the neuromusculoskeletal specialists... we can do SOOOOO much to help peoples bodies feel better from SOOOOO many ailments, but the way PR has been working to date we are known for blackberry thumb, gardening tips, the Wii-hab craze and so much other niche areas that it is starting to get a little upsetting for someone like myself who has gone to schools to promote PT and physical activity to children. Oh brother...

Overall, I completely appreciate the psychological distraction the Wii can provide and the "break from the mundane" that some of the articles refer to (although, a better PT will never allow for a mundane routine). However, the Wii is very limiting in how much physical activity it allows and rarely is going to work on an area of weakness that translates into functional outcomes that are meaningful to a patient/client's activities of daily living. Speaking of which I am going for a run outside :-D

Wii Injury.com

Wii Have A Problem

Wii Injury Report

Reimbursement

I haven't gotten too much into the entire headache that is reimbursement. I got into PT to treat patients. I chose this profession over most other medical professions because we get to really be one on one. So when we have trouble getting paid by insurance companies for our hard work, it seems a little ridiculous that the latest CPT (insurance) codes for:
"The addition of codes for telephone and online evaluations reflect a reality anticipated in the Future of Family Medicine report - one in which "interactions will not be limited to traditional, individual, face-to-face encounters between the patient and the family physician."

Don't physicians spend too little time with their patients already?
Five minute consultation?

While I love technology and I can see some (albeit minimal) value of this type of "evaluation", face to face treatment is irreplaceable as is the laying on of hands.

Sidenote: Does drinking make for better academia? (Say it ain't so)

Quick Post - No PT...

Interesting article about HGH... good to see Evidence-Based Medicine getting out there.

Video of me playing paintball this weekend, fun stuff, amazing editing:

Prevention of Diabetes

"Diabetes care is a poster child for much of what’s wrong with our health-care system, which is good at handling acute crises but bad at preventing them." This is the opening quote of an article about employers in 10 U.S. cities agreeing to waive copays for employees’ diabetes meds, and to fund regular meetings between pharmacists and diabetic employees.

"A similar project in Asheville, N.C., a few years back suggested that employers save money in the long run, because improving diabetics’ health on the front end cuts the rate of expensive hospital procedures that are more common when diabetes is poorly controlled."

Maybe this is just a smart business move by pharamcists in response to recent slowdown of drug sales:
plenty of familiar reasons for the slowdown:

• “loss of exclusivity of branded medicines,
• fewer new product approvals,
• the leveling of year-over-year growth from the Medicare Part D program,
• and the impact of safety issues.”

I am thrilled anytime there is a move toward preventive (as opposed to preventative) care . However, in these studies funded by BigPharma, there is clearly no mention of another preventive measure that could be more cost-effective and more efficient in helping fight and control diabetes... a little thing we call exercise... and who is good at dealing with disease and exercise... a little group of people we call physical therapists...

In fact the American Diabetes Association webpage on how to prevent or delay diabetes mentions nutrition and exercise and yet nothing about drugs...

For the record: This is not intended to bash the pharmaceutical profession by any means, just sharing some candor on some interesting articles from today.

Here's another possibly positive story about health care with this great quote at the end:
“It begins with the assumptions that prescribing is one of the most useful and challenging things we doctors do, and that we doctors crave accessible, unbiased data about the drugs we prescribe. If war is too important to be left to the generals, then drug information is too important to be left primarily to the pharmaceutical industry.”

Speaking of exercise I am off to get a late night run in at my 24 hour gym... catch you cats on the flip side... go prevent something bad from happening to you!

More Train Thoughts

The ideal posture for reading would have your head in an upright position with your eyes aimed straight ahead. Our society has so many situations that almost encourage poor posture, getting into that hunched over look. Over time this is going to cause some musculoskeletal problems. Changing the length-tension relationships of a lot of muscles to a point where they become inefficient should not be ignored. Low back pain - a multi billion dollar problem annually - can be correlated to these poor postures (in theory - no links to any evidence as I'm phone blogging again). Speaking of phone blogging, I'm about to go underground and lose this post, so the message here is SIT UP STRAIGHT!!!

Where I Am

Currently on the Amtrak train, taking a nice 3 hour trip back home for the first time since I started my last affiliation (It's been 3 full weeks and 2 days). My class is going back to school tomorrow for a board review and to take care of some graduation stuff (exciting).
I have to keep my post shorter (than usual) as I have lost many a deep thought when blogging on my phone.
I don't think that I have shared much about my current setting. I am treating an average of 5 patients per day (each for an hour) plus being involved in one group activity with numerous patients. The rest of the day goes to learning and documenting in as much detail as possible. This is quite a change from my last affiliation where it seemed like I was seeing 5 an hour. I would like to link to a recent post by the 'PT Rover' - another student PT blogger apparently in a very similar setting - who recently posted on a great experience he had with a spinal cord injured patient. I too get very empassioned hearing and now seeing these stories on a daily basis. Before my treo cuts me off I bid you all adieu.

"It's not work if you are having fun."

More links

There has been an interesting discussion in PT with the move to a Doctorate degree. What should we call ourselves... Dr. Bo, PT... just Bo, PT... Bo, DPT... just Bo... that guy
Next time you are in Germany make sure you are careful doctor of PT.

Fascinating discussion on PT education.

Side note: everyone who cooks potatoes or eats them should read this.

I am leaning on doing my in-service on neural regeneration potential and how physical activity can affect that... physiological basis... should be fun researching. Gonna go catch up on some sleep. Ciao.

Yay OARSI

Latest blog entry from the CAM Report: referral to a PT is one of the recommended strategies to treat OA of the hip and knee. Check out the press release from OARSI... there was no statistical difference between pharmacological and non-pharm. treatments.

Also, I want to agree with red rover's post on cigarettes... I try and step on all the lit buds I see people throw on the ground... here in Philadelphia almost everyone I see on the street is smoking... it's sad to see really with all the EVIDENCE of the horrors for your health.

Right now I am debating on an in-service topic for my last clinical affiliation. I am on a floor where we treat patients with Spinal Cord Injury. I am currently debating on doing an Evidence Based Review on SCI, a look into acute/emergency care and long-term effects (but this has low PT treatment implications), weaning off of a respiratory vent, or just about anything else that is SCI-PT treatment related. Let me know if you have any ideas. Thanks in advance!

Have a great day people...

PT Online

Just wanted to do a quick roundup of all the useful PT sites I visit (along with some other good stuff)...

About PT
Physical Therapy site provides links, student information, exercises, and general information about physical therapy. It is updated very often with a lot of great general info.
APTA Message Board
A great way to communicate with other PT students around the country. This is way
underutilized so get on there and start chatting.

Blog.Evidence In Motion

Could be the best PT related site out there... Some great PT's talking about everything PT...

Evidence Based Rehab

Posts on physical therapy, health care, rehabilitation, health care politics, and any other subject that strikes me as interesting that day! He seems to have a few links to other PT blogs that I need to get to sooner or later...

MyPTSpace.coy

My Physical Therapy Space - from the Evidence In Motion guys - a great way to network and I recommend utilizing the message boards for great topics on your area of interest.

Myspace.com

Check out the "groups" section for more great networking opportunities. Unfortunately, these get a lot more traffic than the APTA message boards.

http://groups.myspace.com/physicaltherapy

http://groups.myspace.com/physicaltherapystudents

http://groups.myspace.com/PTnerds

Great thoughts, another site that does not get much traffic though...

NPA Think Tank

NPA Think Tank is a blog dedicated to critical observations of health, wellness, and the physical therapy profession.

NYPTA Student Resources

Many states have special interest groups for students that serve as yet another great networking opportunity along with many other potential benefits.

Orthopedic Physical Therapy

This blog is dedicated to the practice of orthopedic physical therapy. It is intended for licensed health care providers only. This blog is not intended for patients or consumers as a substitute for medical advice from a licensed health care provider.

Physical Therapy - Health/Fitness - AllExperts.com

I haven't spent much time on this site but it seems to generally be a way for people to ask questions and have them answered by a group of PT's.

Physical Therapy - The Web Space (Physiotherapy)

Another site I don't spend much time on but seems to offer general PT related article links.

They had a link on this site to a new social network for PT's: http://physicaltherapy.ning.com/

Rehab News

The latest rehabilitation news headlines published daily

Sports Medicine News

The latest sports medicine, fitness news headlines published daily

Sports Physical Therapy Section

One of the many APTA sections that offers a ton of great resources from evidence based links to open discussions on focused topics or even special interest groups.

Training and Conditioning Magazine

Updates on some of the topics regarding well...training and conditioning.

UBC Physio Info-blog.

Unfortunately, the main author has just recently announced he will not be continuing his great work with this blog, but hopefully someone will pick up where he left off.

Physical Therapist Rover

Another student PT that has had a lot of very insightful posts in his short time as a blogger.

Physiospot Musculoskeletal

Assisting health practitioners with evidence based practice and continued professional development

PT Diagnosis

Use simple measurements to make better clinical decisions and demonstrate medical necessity for physical therapy.

Overwhelmed? Seem like a lot of information out there? There certainly is a lot... so whats a great way to keep up with it? RSS feed readers allow you to subscribe to many different sites and keep it all in one convenient location, plus they automatically update. I just started using Google Reader recently and have been enjoying the time it saves. There are a ton of different ways to organize all these sites, do what works best for you...

Here's some other cool stuff I check a little less often:

American Sports Medicine Institute

ASMI'S MISSION: To improve the understanding, prevention, and treatment of sports-related injuries through research and education

Daily Healthbeat Tip

Launched on July 11, 2005, this service provides health promotion and disease prevention tips 5 days a week in audio and text formats.

FIMDM Health News Review

FIMDM Health News Review is a website dedicated to improving the accuracy of media reports.

Healthfinder - Daily

Daily news stories about health.

HowStuffWorks

HowStuffWorks explains hundreds of subjects, from car engines to lock-picking to ESP, using clear language and tons of illustrations. We do the research so you don't have to.

Medscape Today

Features medical journal articles, Free CME, MEDLINE, case reports, medical news, major conference coverage, and comrehensive drug information. You can subscribe to their newsletter to get a great abridged version of articles/links once a week.

The C.A.M. Report

Complimentary and Alternative Medicine Blog

The View from Sports Center

Sports related injuries blog...

They Call Me Galvez

He was diagnosed with a Brain Tumor. He is a physical therapist that became a patient. He became someone he’s always tried to help.
There are 96 posts and 104 comments so far.

Gothamist..

Great way to keep up with happenings in NYC... there is a link to other cities at the top if NYC isn't your biggest interest.

NeuroPT : Neurology Section - APTA

NeuroPT Message Board, many other message boards out there through yahoo among other sites.

Plaxo 3.0 Beta

A decent networking site, convenient way to keep your contacts updated.