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The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Managed Care Subverts Chiropractic
A study published in the American Journal of Managed Care underscores why so many chiropractic patients go out of network in order to get the care they need: Managed care may be effectively locking them out.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Thinking About Cohen's Kappa
Let's think about some notions of reliability and validity, and about what it means for diagnostic examiners to agree in meaningful ways. Diagnostic tests must obviously be both reliable and valid.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Dietary Fat and Prostate Cancer: An Important Update and Review of Mechanisms
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
A Tribute to a True Chiropractic Leader
President of Texas Chiropractic College (alumnus, class of 1950) and the American Chiropractic Association (ACA) Board of Governors. President of the Texas Chiropractic Association and twice-appointed member of the Texas Board of Chiropractic Examiners.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Why More Patients Don't Come to Your Office
Every so often, something turns out to be much easier than anticipated. It's like ordering a piece of furniture or a child's toy that comes in 167 pieces.
Troubleshooting: Billing Multiple Fees for the Same Service
I am afraid I may doing something illegal. I have heard I cannot bill different fees for the same service.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
When Patients Lie (Bribe or Flatter)
Recently, a new patient told me about what I thought was a novel twist on the doctor-patient relationship. She felt she had to lie to her DC to discontinue her treatment.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Active Care for Ankle Sprains
An ankle sprain is a common injury, since this joint is required to perform complex movements under high forces during normal walking. In fact, 10 percent of all emergency-room visits are ankle-sprain related and an estimated 25,000 ankle sprains occur in the United States daily.
We Get Letters & Email
It was with great interest that I read "Trouble in the Wellness Waters?" in the May 1, 2015 issue of Dynamic Chiropractic. I heartily applaud Dr. Hayes for his insightful and informative article.
Do You Have a Post-ICD-10 Strategy?
Post-ICD-10 planning is critically important to the health of a practice, in part because ICD-10 is brand new to providers, payers and related affiliates alike.
April, 2014, Vol. 14, Issue 04
What Does an Evidence-Based Practice Look Like?
By Ann Catlin, LMT, NCTMB, OTR
We hear a lot these days about evidence-based practice (EBP). As massage therapy becomes more accepted as an allied health profession, I think it's important that we continue to build an evidence-based case for why massage works.So, what makes a practice evidenced-based? I hope to give you a basic understanding of EBP and offer examples from my own work elders in long-term care facilities.
Definitions of EBP vary somewhat but they all seem to agree that EBP is a combination of:
The desired outcome of EBP is optimal service to each client/patient on a case-by-case basis. I've paraphrased the steps presented by Duke University Medical School to determine if an approach, modality or method is indeed evidence-based. What we are really trying to find out is whether the methods or techniques we use really are effective to meet the client's need and why or why not? Then we can be confident in the actions we take in caring for our client and also when we articulate the benefits of our services.
Start with the client's clinical problem or a question which arises from the care of the client. Identify the need or problem of the individual client. What's the reason you are seeing this client? Generally, the reason for referral or the client's stated goal is a good place to start.
For example, I have a client who has Alzheimer's disease who is cared for in a memory support unit of an assisted living facility. She becomes increasingly physically agitated (rummaging through other elder's things and grabbing people's arms as they walk by her) and disoriented (going into other people's rooms) in the afternoons, disturbing those who also live there. She has been referred in hopes of calming her and easing the agitated, restless behavior.
Construct a well-built clinical question derived from this client's problem. The question must be phrased in such a way as to facilitate finding an answer when you look for relevant research. The question should include: 1. The key problem of the patient; 2. What treatment, method or modalities are you are considering using; and 3. The desired outcome.
In the case of my client, I might ask this question: "In people with Alzheimer's disease, is hand massage and/or back massage effective in reducing physical agitation or restlessness?"
Select the appropriate resource(s) and conduct a search. The type of question we ask can help lead us to the best type of study or research to look for. Massage therapy questions often center on how to select treatments that do more good than harm and that are worth the efforts and costs of using them. We're told by the Duke team that randomized controlled trials are best to look for when asking a therapy or treatment question. They offer this explanation of this kind of study: "Randomized controlled clinical trials are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect."
It's important to understand that just searching the internet for articles isn't enough. We must be careful about the source. The quip, "if it's written on the Web, it must be so," does not apply here! So, where should we look? One recommended source is PubMed/MEDLINE, a respected database of literature. It's beyond the scope of this article to explain how to go about a search in PubMed, however there are tutorials on that website. Since my question is a therapy question, I set out to find studies that used randomized controlled trials about hand and/or back massage to decrease agitation in people with dementia. I found a number of studies exploring massage in dementia care. Several abstracts of the articles report that hand or slow-stroke back massage reduced anxiety, restlessness and other forms of agitation. My next task is to review the articles to see if the methods used for the study meet criteria for valid research.
Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice). Fortunately, there are guides to help with this process. We are looking to answer three basic questions:
In the end, we want to have confidence in the research we cite. One example from my search is a 2008 study, Favorite Music and Hand Massage: Two Interventions to Decrease Agitation in Residents with Dementia. In my best judgment, this study holds up to the criteria for validity. It compares the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Researchers found that following ten minute sessions of FM and HM individually and combined significantly decreased agitation for up to an hour following the session.
Apply the results to your client. Integrate that evidence with clinical expertise, patient preferences and apply it to practice. So, back to my client. Because the afternoon is the time when she becomes more restless, I schedule sessions for mid-afternoon twice a week. Sessions consists of hand massage, slow-stroke back massage and focused one-to-one attention. I also do staff education, teaching them how to do a simple five minute hand massage and focused touch.
Evaluate client's response to treatment. What result do you see in the individual client? Were they similar or different from results you found in the research? Do you need to make adjustments to your approach? In the case of my client, she was receptive to receiving hand and back massage and she tolerated a thirty minute session without distraction when the session was carried out in a quiet room. She was talkative during the hand massage and often fell asleep during the back massage. At the end of the session, she remained in a calm, quiet state from thirty minutes to an hour. The care staff reported that they noticed a decrease in the restless behaviors, especially her tendency to grab people's arms. The staff used the simple hand massage protocol in the late afternoon and reported it seemed to also help relax her and that she enjoyed the interaction and smiled.
Where does my clinical experience fit in to all this? I've had hundreds of sessions with elders living with Alzheimer's disease and related dementia, many of whom have some degree of agitated behavior, anxiety and restlessness. It's been my experience that human touch, massage and compassionate presence ease these issues and have a profound effect on enhancing quality of life. I've also witnessed the effect of shared human touch on the ability of a person with advanced dementia to engage in relationship.
And last, but certainly not least, what about my client's needs, preferences, expectations? It's a little tricky sometimes to determine what my client might want or need when she can't state them clearly because of dementia. It falls to me to tune in to the non-verbal cues. People with dementia tell us a lot about their inner world and needs through behavior. My client's restless behaviors that annoyed others are her way of communicating a need in the moment. Perhaps she's lonely or is disoriented and thinks she needs to get home to take care of her kids. I also always know that one universal expectation of each client is to have basic human needs met and to be treated with respect.
Taking all this into account, can I state with confidence that my approach is evidence-based? I believe that, yes, I can. I hope this has helped you understand what evidence-based practice is all about so you can perhaps apply it to your own work.
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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