When we first put the idea of a launch together, I had no idea what kind of reaction it would receive.  And the response has been fantastic.  We’ve received hundreds of emails and a high level of participation in this launch.  CPD is obviously a topic of interest to people and is something that they’re prepared to take action on.  Our Clinical Handbook is now in the hands of professionals and students in many different countries with many of them also joining our members area and completing the online quiz for an hour of CPD.

And then we only gave about 4 days notice for the webinar with Professor Bogduk.  There are only 100 places available on the webinar, yet we’ve had many more than that register to attend.  This is going to put us in the situation on Tuesday night of having some people find that they can’t get onto the webinar – even though they’ve registered.  We’re now trying to figure out if we are able to accommodate more people.

Again, this response shows us that there are a lot of people who are interested in and motivated to attend online CPD activities.  Of course, this is very encouraging to us and we are enthused by the response.  When people can see what you’re trying to achieve and they align with it – well it just makes us all the more determined to provide the solution that best meets your needs.

We will be broadcasting it on twitter using the hashtag #hpcpd-bogduk

People who attend the webinar will be able to complete a short online quiz to redeem an hour of free CPD on us.

We’re also releasing another video later this week – with more surprises.  And then we will open enrollments for our CPD program on Monday the 2nd August.  We’ve put together a very special offer – and if you follow us on facebook, you might recall that we surveyed our facebook fans to find out what they wanted in an annual CPD program.  Well, we’ve been able to create that for you – and so we’re confident that when you see what we’ve got to offer next Monday, you’ll see that it answers your CPD needs for the next year – and more.

So, ‘see’ you on the webinar and if you can’t get on, then follow us on twitter using the hashtag #hpcpd-bogduk.

And remember, if you would like to claim CPD for attending this webinar then you’ll need a Free Basic Account with us.  If you haven’t created a basic account yet, you can do so by clicking on this link

Nikolai Bogduk Webinar: We’re over subscribed! is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

Not to mention, just like our kids, we both like having secrets and then revealing them.

And so it is with the complimentary webinar we’ve just announced today. A webinar with pain physician, Professor Nikolai Bogduk. You can read about it and register here. It’s time limited – since it’s being held at 7.30 pm on the 27th July 2010. It’s also limited to 100 attendees, so if you want in you’d better click on the link and sign up.

What’s the background story?

As a third year science student, studying in the osteopathy program at Victoria University, I attended a conference on evidence based medicine for low back pain.  It was the first scientific conference I had ever attended.  Nik Bogduk was a key note presenter and it was also the first time I had ever heard him speak.

I had read his book, Clinical Anatomy of the Lumbar Spine – we all had – it was a core text for our anatomy program – and it is a fantastic book.

He left a lasting impression on me.  A lot of the questions I had in my mind, but didn’t know how to articulate, Nik put into simple scientific terms that I could understand.  It was also my first introduction to the principles of evidence based medicine and clinical epidemiology.  That was back in 1997.  Since then I have been inspired to do two things:

1. Understand and apply the best available evidence for the diagnosis and treatment of pain conditions, and
2. Comprehensively understand the process by which this evidence is generated, so I can avoid being fooled by all the bad science out there.

Ten years later, it would turn out that Nik Bogduk would be one of the supervisors for my PhD (which is almost finished).  We’ve published two papers together and I get to attend intense professional development sessions at the Department of Clinical Research at the Royal Newcastle Centre, where we pull everything in pain medicine apart and then try and put it back together again.

Nik is without doubt one of the great researchers and educators in the field of pain medicine.  It really is my great pleasure to be able to use Web 2.0 technology to bring him into your computer on this Tuesday’s webinar.  Don’t miss it.  Tuesday, 27th July, 7.30 PM AEST (Sydney time) – Register Now.

Webinar with Professor Nikolai Bogduk is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

Can you relate to that?

In 1997 I mocked-up a word document to represent a scientific journal for osteopaths.  At the time I was an undergraduate student and didn’t own my own computer.  I remember staying late at the computer labs of Deakin University, with my wife who was studying at the Toorak Campus in Melbourne.  We would be the only ones left at 10.30 at night and as we’d made acquaintance with the security guard, he would let us stay until the very end.

I can remember the night that I mocked-up the journal and then took it into my University the next day.  I was studying for a science degree at Victoria University in Melbourne and I handed the mock-up to the head of school and he was supportive of the idea.  A journal was launched.

I had no idea how much time it would take.  How much effort it would involve.  How many people we would need.  To be precise – I had no idea at all.  And this was a good thing.

Years later, the journal is now an established scientific journal published by the worlds largest medical publisher, Elsevier.  And the success of the journal would not have been possible without the dedication of my great friend, Rob Moran.

I remember showing the mockup of the journal to a collection of students in a cafe  (we spent more time in cafes than in class if I recall).  The only student left at the table after it was time to ‘go to class’ was Rob.  Our partnership was sealed – but you’d have thought we’d learn our lesson.

Well – I’m happy to say that we didn’t learn our lesson.  Instead, we decided to start an online education service for health professionals.  Not because this hadn’t been thought of before, but because we thought we could do it better.  And here we are.

We are in the middle of a launch to Australian Osteopaths – although we’ve already had other people find out about it and join in from the UK, Italy, and Canada.  That’s the nature of the web and we love it.

We’ve had an incredible response to our first free CPD activity and as I sit here typing, my inbox keeps ‘peeping’ to let me know that another person has signed up to receive the book.  To have such a rapid response is very encouraging to me and it only fuels my desire to produce fantastic continuing education for health professionals that is useful, entertaining, and convenient.

If you haven’t checked out our launch site - you can see it here and download the book yourself.  We called the site Osteopathy20, for Osteopathy 2.0.  We have a range of other launches coming up and we are now working with some incredibly motivated and interesting people.

Taking on something like this is a big deal.  I wont hide it – there is a lot of work involved – a lot more than I expected.  We have learned so much during this period and we’re committed to making this thing work.  The main thing I’ve learned is this.  Online CPD is not about computers.  It’s not about regulations and compliance.  It’s not really even about patient care – although patient care is hopefully improved by  CPD.

CPD is actually about you.

It’s about your interests.  Your desires.  Your reasons for staying a health professional and wearing all the responsibility that comes with the territory.

So, that’s been our theme as we’ve developed this concept – this site that you’re reading this blog on right now – the launch – the facebook page – all of it is about the CPD that you want.

Thanks for your support – we need it.  We need as many people as possible taking hold of this and participating.  And so long as it’s about you – and not about us or them – then why wouldn’t you participate?  Help us spread the word.  Let’s make this a very positive experience all ’round.

Cheers

Nic

Some background info on the July launch of HPCPD is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

You’d think and hope that most health professionals follow a scientific approach to health care, except those, perhaps, who practice on the fringe of spirituality.  And of all the varieties of health professionals, you’d expect medical professionals to be the most likely to take a scientific approach.  I mean, after all, this is one of the unique characteristics they use to position themselves as authorities.

They’re not into woo-woo.  They’re not into airy-fairy.  They’re into hard science.

Aren’t they?

A recent study, published in 2010, found that GP’s were not so scientific in their approach to low back pain.  A survey of 3533 patient encounters found that:

1. over 25% of patients were referred for imaging, even though international guidelines discourage imaging
2. only 17% of patient were prescribed the recommended medication for low back pain (paracetamol / acetaminophen); whereas another 57% were prescribed medications that are not supported by the available evidence nor recommended by the international guidelines.

There’s no doubt, practicing scientific medicine is hard work – there is just so much information to keep up to date with.  We all find it hard to keep up with all the scientific studies that are published – and GP’s are included in this.

It makes you wonder though – if they’re not getting low back pain treatment right – what else are they getting wrong?  As a health professional, I have to ask myself, what am I getting wrong?  There’s bound to be something we’re messing up, and this mindset is a great start to continuing professional development and life long learning.  We operate in a pool of doubt and good practice is all about reducing the amount of doubt.

Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, et al. Low back pain and best practice care: A survey of general practice physicians. Arch Intern Med. 2010 Feb 8;170(3):271-7.

Scientific Evidence for Low Back Pain Treatment: Pah! is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

This case study got me thinking about two things.

First, case studies like this can really get you thinking about what goes on in your head during the diagnostic work up of a patient – and how easy it is to miss stuff or mis-interpret stuff.  Imagine, a patient walks into your practice with a fractured odontoid and no symptoms.  None of your tests reveal anything abnormal – so you just wouldn’t know that the fracture was there.  And on this basis, you may begin treatment.

Scientific isn’t it?

See, in this case, the history and the physical examination would both be giving you false negatives.  They would be telling you that there was nothing wrong with the patient, even though she had a fractured odontoid.  Fascinating.

I recall a case from my own training.  I was doing a radiology placement in a large teaching hospital and this guy comes in for a CT scan.  He’d had a car accident a few days prior and had already presented with a headache.  On his first visit, they’d taken a plain x-ray of the spine and found that it was normal.

He still had a headache though – and walked around with it for a few days before returning to the hospital.  He turns up at emergency and says he’s still got this headache and when he finally gets to see someone and shows them his x-rays, they think that maybe they can see something on the x-ray worth checking out – so they order a CT scan.

And this is where I come into the story, because I was watching CT scans that day and so I watched his.  They decided to do 3D imaging for him and it was the first time I’d seen that sort of technology – it was very detailed and they were amazing pictures.  Anyway, he was rolled into the scanner and we all huddled in the dark room waiting for the computer generated 3D images to appear on the screen.  Sure enough, the top of his skull started to appear on the screen and then as it progressed we all saw something – something that just wasn’t right.  The base of his skull was fractured into about three pieces and so was his first cervical vertebra.  It looked spectacular in 3D.

Well, you should have seen everyone jump into action.  All of a sudden they rush a serious looking neck brace into the room and fit it to him and he’s rushed off for a surgical consult.

Hmmm … that was a big lesson.  The history, the physical examination and the first x-ray were all false negative.  You never forget a lesson like that.

So, both of these stories are great examples of how medicine is not straightforward.  Just because you get a test, doesn’t mean that you should accept the results of that test.  In fact, the only way to practice scientific medicine is to be fully aware of the false negative and false positive rate of any diagnostic test and then to use this knowledge in the sensible interpretation of test results.

Every question you ask a patient is a test – and therefore has a false positive and false negative rate.

Every physical examination test, imaging test or laboratory test has a false positive and false negative rate.

This basic understanding of diagnosis is rarely discussed or explained adequately to patients – although there are no doubt certain practitioners who do explain these concepts to their patients.  Yet so often a test result is accepted on face value and interpreted as being 100% accurate.  I don’t propose a solution here – only that as health care practitioners it is good to be reminded every now and then that our tests are inherently noisy and will sometimes give incorrect results – we shouldn’t be surprised when this happens and we should be on the lookout for such things.

The issue about safety and HVLA

The second thing that got me thinking was the warning that the authors gave in the case study, specifically the warning that high velocity low amplitude (HVLA)  thrust techniques should not be used in cases where there is injury or instability in the cervical spine.  I got to thinking about why they picked this particular technique as the technique to emphasise as contraindicated in cervical instability.  Why HVLA?

Common sense tells you that when someones neck is unstable, you shouldn’t be applying high velocity movements to the neck – but that’s the problem with common sense – you might just see the obvious and miss the not-so-obvious.  While there is an emphasis in the paper on avoiding HVLA, there should also be an emphasis on avoiding any technique that causes extreme ranges of movement in the neck of someone with cervical instability.  The worry here is that someone thinks that muscle energy technique, mobilisation, or trigger point therapy is somehow safer than HVLA and therefore isn’t as cautious about providing these techniques.

Why might this happen?  Because over and over again in the literature HVLA, or manipulation, is targeted as the ‘un-safe’ procedure, whereas any number of other techniques may cause just as much trouble in someone with cervical instability.

So, for me, this case study has reminded me yet again that tests can be wrong and that we should frequently remind ourselves of this.   Ideally, health care practitioners should be aware of the reliability and validity of the tests they use, so that they can interpret them ina meaningful and scientific way.  The case study also let’s me know that the problem of highlighting HVLA as the ‘un-safe’ procedure is alive and well, and we would do well to be reminded that other techniques can be just as un-safe – or maybe more so – in certain cases.

Chakraverty J, Snelling N, Thomas G, Uzoigwe C. A delayed and innocuous presentation of odontoid peg fracture – Implications for osteopaths. Int J Osteopath Med; 13: 67-69.

One case study, two lessons. is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

I can ‘leak’ some information, however, and that is that the launch of HealthProfessionalCPD is imminent.  Rob Moran and I have a task list of things that simply MUST happen before we can launch and show you what we’ve been up to all this time.  It’s a long list – it’s a fiddly list – and it’s taking time to crush our way through it.  I thought I’d give you a small insight into what’s going on and where we’re up to.

First, we’ve been steadily growing a list of people who are interested in what we’re doing.

Second, we’ve developed an educational program that we’re going to include as part of our official launch.

Third, we’re tweaking the technology that we’ve invested so much time and money into over the last few years in order to give you a satisfying experience that is also highly secure and reliable.

Fourth, we’ve been building relationships with CPD providers to bring you high quality CPD

Fifth, we’ve surveyed our followers to find out what they want to cover in a CPD program – and we’re pleased to say that we can deliver what they want

Sixth – we’re preparing all the bits and pieces necessary for an online launch – and I can pretty much guarantee that the health professions haven’t seen anything like what we’re going to unleash during our launch period – it’s going to be a blast.  Seriously, we think our approach to providing CPD is going to be a game changer.  Just take a look at this photo I took tonight of the series of emails and web-pages I’ve created and that form part of our launch sequence.

It’s all going to be happening within the next month and this has special importance for Australian health professionals.  As of July 1st, CPD is going to be compulsory for many health professionals in Australia.  This literally means that without CPD, you can’t register to practice and  therefore you can’t earn money as a health professional.  So, CPD has just gone up a notch in terms of the priority that health professionals are going to have to give it.

We believe that we have the knowledge, skills, experience, technology and contacts to provide a highly engaging and useful CPD program that will fulfill registration requirements. So, as much as this isn’t an announcement of our launch – it’s a heads up that we’re getting very close.  If you want touch base and keep up to date with what’s happening, join us at our facebook page,

Stay tuned – it’s going to be a spectacle!

Preparing to launch a brand new CPD solution for Health Professionals is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

Therefore…

I’m very pleased to announce our first Survey of CPD Topics for Health Professionals where we ask you, the health professional, what CPD topics you’d like us to organise.

Earn CPD credit for attending a Webinar from your armchair – choose your topic

In this survey we’re trying to determine which topics you’d be interested in for a series of webinars.  A ‘webinar’ is a live online seminar of 1-2hrs that you “attend” from wherever you have a computer and an internet connection (home, work, cafe…beach anyone?). You login to the webinar at the scheduled time and “attend” the presentation.  You’ll see and hear whatever the presenter is showing on their computer screen. You can also ask questions of the presenter – just like an offline seminar. After the webinar, you’ll login to healthprofessionalcpd.com and have your certificate issued and your CPD will be automagically recorded in your MyCPD Record.  It’s a great way to collect CPD without the need to leave the comfort of your favourite armchair (best of all – nobody can see that you’re wearing slippers and sipping hot cocoa either).  If you can’t attend at the scheduled time then we’ll be recording most of the events for video streaming so that you can catch up later.

The survey is online NOW, and takes about 5-minutes (no, really – not the “just 5-minutes” those pesky telemarketers promise while you’re trying to eat your dinner…it really will take you about 5-minutes).  It’s just a list of topic ideas and all you need to do is  record your level of interest in each.  Simple enough.

Although we’ve listed a range of topics, we’re even more interested in your ideas…so please feel free to add a topic idea or two of your own in the space provided.

Why not complete it now?

We’ll announce the results down the track.

CPD Activities: What webinar topics do you want? is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

And argue we did.  For about a year.  All by email.

See, David had discovered that all of the so-called definitions of manipulation – quite a few of them used in legislation – weren’t definitions at all; they were descriptions.  They simply described what happened – or what people imagined happened – during a manipulation, rather than providing an accurate definition.

Think about the ramifications.  Policy. Legal documents and judgments.  Opinion.  Research.

All based on a description – not a definition.  And all different too.  No wonder there was confusion, misunderstanding, misrepresentation and conflict over the use of the term manipulation and what it means.

Based on research findings, rather than simple observations, David had come up with a list of ‘features’ that might be used to construct a definition of manipulation – and it was this list that we argued back and forth about.

• Does a manipulation have to have a “pop” or “crack” sound to be called a manipulation?
• Does it have to be a high velocity movement (thrust) to be called a manipulation?
• Does it have to be applied by someone to someone else – or are spontaneous cracks and pops that come from our joints every now and then ‘manipulations’?
• Does the ‘manipulator’ have to intend for a joint to ‘pop’ for it to be a manipulation?  What if a practitioner were just gently moving someones neck and the neck “popped” all by itself?

It was a very insightful list that David had come up with – and he argued fiercely for each point.  He also had a stack of literature to support his view, so his arguments were very well formed.  But with every argument, there is a potential loop-hole.  A problem with the wording, which make untenable implications.  And this is why David contacted me.  He needed someone as pedantic as I can be to try and find these things.

Now – I guess I should say I did it for the benefit of all the professions who use the term – and all those other peripheral groups who have to grapple with the term and are affected by it’s definition.  Really, I did it for the fun of it.  Arguing and debating something with someone who really knows their stuff can be great for the ol’ intellect.

The result?  We both lost and won on some counts.  It became very detailed.  The ‘track changes’ on the document became unmanageable, and after a few months it was quite possible to forget why we’d come to a certain conclusion and have to argue it out again.  Ha!

Finally, we agreed and the paper was submitted and accepted for publication in the journal Manual Therapy under the title of “What is a Manipulation? A reappraisal“.

Unfortunately, due to strict word limits, we were unable to publish some of the most enjoyable discussions explaining the arguments for our final choice of features that might define a manipulation.  This is a problem with publishers who publish hard copy paper journals – whereas the full content would be much more valuable to the readers, their paper prison places un-academic restrictions on content.  Anyhow, we did our best to get across the main points in as few words as possible and what we lost in clarity we gained in efficiency (maybe).

You can check out the article and have a read of the abstract at either ScienceDirect or the Journal Site

Here, I’m going to paste in an excerpt from the abstract to whet your appetite for the full article.

“A final definition is not offered. However, arguments for and against the inclusion of features are presented. Importantly, these features are explicitly divided into two categories: the ‘action’ (that which the practitioner does to the recipient) and the ‘mechanical response’ (that which occurs within the recipient). The proposed features are: 1) A force is applied to the recipient; 2) The line of action of this force is perpendicular to the articular surface of the affected joint; 3) The applied force creates motion at a joint; 4) This joint motion includes articular surface separation; 5) Cavitation occurs within the affected joint.”

I want you to read the full article.  I think it’s an important issue that affects all professions who use the term and all professionals who have an opinion about it.

Sorry – but what the heck is a ‘manipulation’? is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

What exactly is a webinar?

Basically, it’s just like a seminar, but it’s online. What happens is that you register to attend the seminar. You then get a confirmation that you are registered and a link you need to click on at the time of the scheduled webinar. So, you show up at the right time, click on the link and you will be taken to a webpage asking for details and then logging you into the webinar.  You’re computer will automatically download a small ‘client’ which will enable you to participate in the webinar.  Once you’re logged in, a new type of browser window will open and you’ll be able to see the presenters computer screen. You can also:

• raise your “hand” to ask a question
• type a question or comment into the instant messenger status bar
• participate in an online poll

The other major point about this webinar is that we’re making it freely available – so think of this as on opportunity to get some free CPD.  To go to the webinar, simply click on the following link.  See you there.

https://www1.gotomeeting.com/register/396544529

The first HealthProfessionalCPD webinar is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals

The brain is wired for pleasure

That the human brain has information-acquisition mechanisms which reward us for learning about our environment should not surprise us – such mechanisms would have an obvious evolutionary advantage. If ‘infovorous’ behaviour is advantageous it would follow that the brain has developed mechanisms which actually encourage information-seeking behaviour.

Beiderman and Vessel explain that mu-opioid receptors, which are involved in the modulation of pain and reward, are found in increasing density along the neural pathways responsible for visual and auditory processing, perceptual association and memory. Neural activity in these areas results in the release of endomorphins and subsequent stimulation of the mu-opioid receptors, which causes feelings of pleasure. Since the density of mu-opioid receptors increases along the processing pathway, information that contains lots of interpretable information will result in the greater stimulation of opioid receptors in the later stages of association processing and will therefore provide the greatest pleasure.

Understanding new information is key

Unless we are satisfying hunger or sexual drive, avoiding harm or are engaged in some other goal-directed behaviour our hunger for information is active, and boredom sets in pretty quickly when this drive is even moderately starved. We crave a constant supply of new and engaging information. When we are repeatedly exposed to the same stimulus pattern, like watching a movie for the fourth time, only a fraction of the same neurons active the first time will respond and the potential for pleasure diminishes.

Although humans have a preference for experiences that are both novel and richly interpretable, we can also derive increased pleasure with repeated exposure to the same information if we have not yet understood it. Beiderman and Vessel suggest that the pleasure derived from new information peaks at what they call the “click” of comprehension. According to the researchers, “the click corresponds to the release of endomorphins in the association areas as the brain makes rich connections with stored information”. Once we have understood the subject our preference for ongoing exposure declines, which reduces endomorphin release on the next exposure.

Maximise the pleasure of your addiction to learning

The brain’s craving for pleasure has ensured that the infovore system is designed to maximise the rate at which we absorb information. However, to maximise the pleasure derived from acquiring new information we need stimuli that are both novel and highly interpretable, and we need it as fast as we can comprehend it. This “preferred rate” of information exposure may correspond to the maximal release of endomorphins, explaining why information that is presented much more slowly than the rate of comprehension typically causes boredom or frustration instead of pleasure. Remember surfing the web with a dial-up modem? Information may also be presented faster than we can comprehend it, which is common when learning something complex, but anticipation of the rush when you ‘get it’ presents a powerful incentive to keep plugging away.

If Beiderman and Vessel’s work is accurate, then the human craving for information might compel the creation of a media that is immediately available, offers an endless variety of new and engaging information, provides ample opportunity for interpretive challenge, and can be delivered at rates according to individual preference.

Sounds a lot like the internet to me.

___

Ref: Biederman I, Vessel E. A. Perceptual pleasure and the brain. American Scientist. 2006;94:247-53.

Learning for pleasure is a post from: HealthProfessionalCPD | Continuing Professional Development for Health Professionals