Jessica J. Wong

Back to the Debate: Sternalis Muscle

El musculo esternal (ME) es una variante anatomica en la pared toracica anterior. Mientras que los sitios de fijacion del ME estan acordados, la inervacion y la funcion de este musculo no estan bien establecida. Exploraciones cadavericas y quirurgicas han informado que el ME esta inervado por los nervios pectorales o ramos anteriores de los nervios intercostales, o una combinacion de ambos. El conocimiento del SE es relevante para los proveedores de atencion de salud especializada de imagenes y / o cirugia de la pared toracica anterior. Este documento tiene como objetivo crear conciencia en la comunidad medica de la relevancia clinica de ME a traves de dos reportes de caso y una breve revision bibliografica.

Student-led interprofessional education revolution: Developing the “Diamond Approach”

With chronic diseases on the rise, patients and their families are expecting to receive more timely services, while playing an active role in the decision making process (Conference Board of Canada, 2004). Interprofessional approaches to health services may help ease the demands on the health care system and improve the quality of patient care. However, health professionals must be mentally and technically prepared to collaborate using teamwork principles. As such, the purpose of the student-led Interprofessional Education (IPE) Council at the Canadian Memorial Chiropractic College (CMCC) is to use the leadership, enthusiasm and unique learning styles of students to advance IPE among Chiropractic and other health care professions. Research shows that student engagement enhances students’ willingness to collaborate and facilitates long term sustainability of IPE efforts (Hoffman et al., 2007). It is also suggested that the teaching methods match the learning needs of the student, as a mismatch can have negative results (Rassool & Rawaf, 2007). The IPE Council used a multi-faceted method, called the ‘‘Diamond Approach’’, to incorporate a multitude of learning environments for students to learn with, from and about each other through IPE. The purpose of the Diamond Approach is to incorporate learning theories into IPE initiatives. Interprofessional education is, by definition, a multidisciplinary domain. The literature now suggests that there needs to be a model to incorporate the wide range of ideas about and approaches to its evaluation (Stone, 2006). This innovative model was developed to meet the needs of health care students and their different characteristics, strengths and learning styles, while maintaining a diverse forum for IPE. The approach may be adopted by other student groups and organizations to facilitate collaboration. As shown in Figure 1, the Diamond Approach to IPE integrates three learning environments that are each based on a learning style, as often described in the literature (Slack & Norwich, 2007). The first area is the Auditory Facet, which utilizes lectures,

A Descriptive Study of Departmental Policies Regarding Patients' Use of Complementary and Alternative Medicine in Ontario Radiation Therapy Centres

W hile patient use of complementary and alternative medicine (CAM) during cancer treatment is popular, its research is limited. It is anticipated that practices differ considerably amongst practitioners and cancer centres. This study explored current variability in Ontario cancer centres regarding departmental policies and patient education literature for CAM. A semi-structured telephone survey was used to gather data from nine radiation therapy departments across Ontario. One representa- tive was purposefully selected from each centre. Analysis of quantitative data was mainly descriptive and representa- tional, while qualitative data was evaluated using thematic analysis. While six of nine centres had policies on CAM, only two centres considered their policies as sufficient. For patient education litera- ture, five of nine centres had literature on CAM, but only one centre deemed it sufficient. The results demonstrated considerable differences regarding CAM policies and patient education literature in Ontario cancer centres. A common theme was that policies and literature were either too general or absent altogether. A standardized approach would ensure consistent patient teaching on this topic. RESUME

Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic

The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women’s, children’s, and adolescents’ health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.

Leading change in healthcare

Written in a model collaborative manner among editors and contributors from the UK, Ireland and USA, Leading Change in Healthcare speaks to a novel approach of healthcare reform that focuses on relationship-centered administration. Its target audience is executives, managers, team leaders and administrators in all types of healthcare organizations. In light of an era where health systems are seeking change and more effective organizational structure, the purpose of the text is to offer a different perspective on change management that is grounded in relational theories. The text is well organized into twomain sections, followed by appendices, which combine theory and practical applications. Part I introduces theories around complexity, positive psychology and relationship-centered care, acting as a conceptual framework for the book. Part II describes eight case studies that illustrate existing models of relationshipcentered care in diverse settings, including a community hospital in the USA, a regional system of treatment/care for HIV/AIDS in Kenya and a new academic science center in Ireland. The case studies are described in a narrative fashion, woven with anecdotal experiences from the members of the healthcare team. The appendices provide practical examples of management strategies for building professional relationships, such as interview questions, proposed dialog for effective discussions and tips for facilitating meetings. Key points are highlighted throughout the text for ease of reading. The distinct strength of this book is its motivating and interesting concept of relationship-centered partnerships in healthcare, which involves fostering positive conversations, interactions, ideas and feedback. This is important with every healthcare team member at the grassroot level, serving as the primary goal of the health system. The authors describe how seemingly trivial pertubations to the system, such as conversations, can grow into significant effects over time. This is often different from more conventional approaches to health management, which may utilize top-down hierarchical structures to run the institution with macro-level goals. The theory’s effectiveness is demonstrated with real-life examples in the case studies, though the cases would be richer with more quantitative outcomes data, particularly in schematics and tables containing data over time. The main limitation is the difficulty in translating knowledge to practice. Although appendices provide useful tips, and the theories and examples are inspiring, it leaves the reader, particularly a healthcare administrator, unsure of how to immediately implement change in this new direction, and sustain it over time. Instead, the book would benefit from a follow-up text that centers on practical solutions and applicability. Leading Change in Healthcare serves as a useful and easyto-read resource for healthcare administrators in need of different approaches to managing teams and promoting positive organizational culture. Its theories and strategies may be particularly useful for interprofessional teams, where collaboration and communication may be challenging among the different disciplines/professions working together in new environments. Overall, this is a refreshing and innovative text that imparts promising insights and relationship-based approaches to transforming our perspective on healthcare systems.

Multimodal Therapy Combining Spinal Manipulation, Transcutaneous Electrical Nerve Stimulation, and Heat for Primary Dysmenorrhea: A Prospective Case Study

Objective The purpose of this case study was to report the effects of multimodal therapy as an adjunct to oral contraceptives on pain and menstrual symptoms in a patient with primary dysmenorrhea. Clinical Features A 27‐year old nulligravid and nulliparous woman presented with low back pain, thigh pain, and menstrual symptoms associated with primary dysmenorrhea. Multimodal therapies (spinal manipulation, clinic‐based transcutaneous electrical nerve stimulation, and heat applied at home) were delivered over 3 menstrual cycles. Outcome measures included pain (visual analogue scale) and menstrual symptoms (Menstrual Distress Questionnaire) from baseline to follow‐up. She continued to take her oral contraceptives throughout the study period. Intervention and Outcome For both low back and thigh pain, the patient reported clinically important differences in average pain and worst pain after 2 and 3 months from baseline. There were no clinically important differences in current pain, best pain, or menstrual symptoms at follow‐up. No adverse events were reported. Conclusion Some of this patient’s dysmenorrhea symptoms responded favorably to multimodal therapy over 5 months. The authors observed important short‐term reductions in low back and thigh pain (average and worst pain intensity) during care.

Education for Future Practice

Written for educators, scholars, practitioners and those concerned with preparing future professionals for the workplace, Education for Future Practice aims to underscore the importance of envisioning the future and its complexities during education. This is one of four texts in a series focused on university education, professional practice, work and society, which is a joint effort by a number of editors and contributing authors predominantly from universities in Australia and the UK. The text centers on the need for active participation, reflection and collective partnerships toward creating communities of practice in light of ever-changing social contexts. The text comprises 26 peer-reviewed chapters that are organized into four sections, with each chapter written by select authors in a narrative fashion. The first two sections focus on contextualizing practice, by highlighting concepts around the formation of adaptive workplace communities with critical reflection and transformative dialogs. The next two sections focus on practice-based education, including topics on enhanced clinical teaching, adult learning theory, interprofessional education and work-integrated learning. A few existing examples of innovative practice-based learning models are given throughout the text, and helpful references are given at the end of the chapters. The strength of this book is that each section delves into the views, experiences and expertise of the author(s) who wrote the chapter, and collectively creates a broad lens that views the future of university education in evolving and multi-layered environments. However, this format lacks depth in the proposed concepts and is unable to form an overarching theoretical framework for university education. Instead, if the reader is interested in specific theories, the reference lists allow further research in those topic areas. Another limitation to this format is that it decreases the overall flow of the text and leads to content repetition between chapters. For future books in the series, the use of schematics, charts and key-point summaries may help organize the information in a spatial manner. Although it is intended for a broad audience, this text is better suited for educators and scholars interested in the dialog around theories and administration of higher education. It serves as a good overview and starting point for asking the questions needed to improve learning environments that have not yet embraced critical and practice-based learning approaches. For deeper understanding of specific educational models, I would recommend consulting other books to supplement this text. Most notably, Education for Future Practice highlights the need for future professionals who are flexible, collaborative, and skilled in communication and education to utilize critical modes of practice within complex work environments.