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CHIR892 Clinical Chiropractic Questions  Preamble In the past few years, a consensus document1 based on themes from the World Federation of Chiropractic (WFC) Education meeting in 2014 was adopted by the majority of Chiropractic teaching institutions worldwide. This statement outlined goals for chiropractic education relating to clinical and professional practice. Specifically, the chiropractic graduate should be equipped with the tools to: Providean evidence based approach to care, Understandwhat constitutes professional practice, Deliverprimary prevention strategies, Developa chiropractic identity that does not include the vitalistic construct, Becognisant of practice styles that contribute to inappropriate patient  The Chiropractic Board of Australia has developed a Code of Conduct for Chiropractors in Australia. The Code outlines the expected standards of care to be provided by registered chiropractors in Australia. Your Tasks:  Elaborate on each of the points numbered 2a, 2b, 2c, 5, and 7 from the positionstatement in context of what this will mean for the management of patients under your care. Provide examples/scenarios to support your elaboration. Make brief comments on how the practice style outlined in the position statement complies or does not comply with the Chiropractors Code of Conduct document produced by the Chiropractic Board of Australia March 2014. Whatwill be the impact on Chiropractic identity (if at all) as the profession transitions from more traditional models of care (e.g. vitalism) towards evidence informed models of care (e.g. biopsychosocial models of care)? Inyour response, you may consider a selection of articles relating to Chiropractic identity. Answers 1. 2a. As described in 2a of Clinical and Professional Chiropractic Education: a Position Statement, an evidence-based approach to the rational clinical interventions for the patient is important. The case study, physical examination, diagnosis, report’s findings is important to plan the treatment and management of the patient. The case study and medical history is important, as it is the core of patient care. It provides the information about what happened to them, personality, unique circumstances, current medications and past illness. The entering into patient data is important that provide information about the patient health history and a chiropractic assistant gather the information like first appearance of symptoms, existence of disorder, previous treatments. This is helpful for the case evaluation to determine the type of examination procedures that would be best suited or the patient and related contradictions. For example, in a severe chronic condition, the chiropractic assistant meets the patient and studies the patient case to discuss his recommendations for treatment plan or referral. In chiropractic, the physical examination is important to rule out specific conditions. After the physical examination, the chiropractor can focus and pay attention to the areas of complaint. For example, a patient with spine pain has to go through x-rays to focus on the area of complaint. It also decides variety of assessments by chiropractor like palpitation, range of motion, reflex testing, orthopaedic and neurological tests that require adequate focus. Accurate Diagnosis and diagnostic imaging is also important for the comprehensive and specific care plan. The discovery of the patient’s problems is crucial to provide problem-oriented therapy and in the specific area of complaint. Report findings and management plan in chiropractic is important as high-quality imaging and digital access to radiology imaging aid in the professional interpretation by specialists. Diagnostics is important to fully understand the musculoskeletal system and provide proper treatment intervention for positive patient outcomes. The evidence-based approach to these above clinical interventions is to penetrate and transform this profession to a level where they can strengthen their practice curricula. 2b. In the healthcare system, patient handoffs and numerous interfaces takes place that require accurate communication and collaborative care. Without it, patient safety is at risk due to misinterpretation of information, lack of critical information, poor clinical handoffs and overlooking of vital parameters of the patient. Medication errors can also happen due to lack of effective communication, as there is failure to communicate about the patient’s condition.. For this, effective communication is crucial to overcome faulty and incomplete information exchange that might lead to errors and ignore the clinical discrepancies and red flags. Structured communication can serve the purpose of assisting chiropractors to make effective clinical decisions and take required actions. It provides openness and trust that enable chiropractors to work in partnership with the patients under their care. 2c. The public health focus is to improve the quality of life and health of the population through prevention measures and treatment of the disease. For this, it is important to take into consideration the knowledge of the population regarding the preventive measures about a particular infection and how these measures are being practiced in daily life. For example, the knowledge of possible preventive measures can be helpful in preventing the infectious diseases and promote healthy lifestyle practices. The knowledge of preventive measures among the population is important to assess the incidence of a disease, physical and mental health conditions and provide tailored health promotion programs to take preventive initiatives. 5. The teaching of vertebral subluxation complex (VSC) is a matter of issue in terms of evidence-based practice in chiropractic care and subluxation. Moreover, there is also need for the clinical evidence for supporting the VSC in diagnosis and intervention.The call for VSC evidence is not yet recognized in the chiropractic curriculum due to lack of clinical evidence. According to Discipline of Chiropractic Position Statement on VSC, there is lack of clinical evidence in supporting its diagnosis and treatment. There is only documentation of kinetic, neural, muscle, connective and vascular change. There is no possibility of clinical experience where the patient can face every VSC levels and by utilizing this Chiropractic Statement, it is a concept that all students need to read and understand in identifying the VSC in patient healthcare.   7. In the chiropractic practice, the practice styles like breaching of confidentiality inappropriate patient dependence and repeated exposure to ionising radiation are not included in the undergraduate program. The reason behind this is that chiropractic students should recognize that these approaches are inappropriate and should not be practiced in chiropractic profession. Under the Ethics of Chiropractic care, maintenance of patient confidentiality is crucial, as it is one of the main ethical cornerstones in chiropractic practice. The patient’s best interests are of paramount importance and there should not be inappropriate patient dependency. There should be healthy patient-healthcare provider relationship within the boundaries of professionalism and no scope for inappropriate dependency. Although, there is efficient cell repair mechanism, however, it depends on the duration and amount of radiation exposure along with exposed organs. Continuous exposure to radiations makes the cell abnormal and prone to mutation that damages the natural cell repair system of the body and alters DNA leading to temporary or permanent cell abnormality. 2. The practice styles outlined above in the position statement does not comply with the Chiropractors Code of Conduct and Chiropractic Board of Australia March 2014. According to Professional Behavior point 9, there should be standards behavior by chiropractors that warrants respect and trust in the community. According to point 9, there should be professional boundaries and clear separation between the chiropractor’s profession to meet the patient health needs and his or her personal views and feelings. This promotes appropriate patient dependency and working under professional boundaries. According to point 3.4-confidentiality and privacy, under Chiropractors Code of Conduct, Australia, it is stated that chiropractors have the legal and ethical obligation to protect the confidentiality and privacy of the patients by withholding their personal information and releasing only when required in law or public considerations. To ensure standards of care, it is important to maintain patent’s privacy, confidentiality in their practice setting. Under the point 7.2 in the code of conduct, chiropractors should perform good practice to risk management that ensures patient safety. Therefore, it is important for the chiropractors to avoid continuous exposure to radiations that might have harmful and long-term health effects like mutation. 3. As the chiropractic profession is transforming from transitional models of care to evidence-based, it will have a huge impact on the chiropractic identity.For example, the biopsychosocial model of health for acute and chronic pain in spine and bones is important to assess the warning signs of psychological conditions like fatigue, back pain, headaches, mood changes and stress (9). The chiropractic identity is influenced in a way where they have to consider the psychological parameters to understand the spine pain with a biopsychosocial approach. There would be changing in the screening tools and collaborative healthcare encompassing the social factors that affect health. In the broader context, there will be a change in the chiropractic practice where pain was considered an elusive condition and traditional model of care, however, now chiropractors have to consider variables in pain including physiological, biological and psychological parameters. There would be a huge impact on chiropractic identity as it provide a holistic care approach in the pain management like patient-centred care through biopsychosocial model of health. Concisely, due to shifting of model of care from traditional to evidence-based, there would be inclusion of mind and body by chiropractors to fully manage pain and address the disease in the chiropractic service delivery. References and Professional Chiropractic Education: a Position Statement. 2017 [cited 21 August 2017]. Available from: Statements-june-2015.pdf   Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. European Journal of Pain. 2012 Jan 1;16(1):3-17.   Green BN, Johnson CD. Interprofessional collaboration in research, education, and clinical practice: working together for a better future. Journal of Chiropractic Education. 2015 Mar;29(1):1-0.   Erwin WM, Korpela AP, Jones RC. Chiropractors as primary spine care providers: precedents and essential measures. The Journal of the Canadian Chiropractic Association. 2013 Dec;57(4):285.   McGregor M, Giuliano D. Manikin-based clinical simulation in chiropractic education. Journal of Chiropractic Education. 2012 Apr;26(1):14-23.   Walker BF, Stomski NJ, Hebert JJ, French SD. Evidence-based practice in chiropractic practice: A survey of chiropractors’ knowledge, skills, use of research literature and barriers to the use of research evidence. Complementary therapies in medicine. 2014 Apr 30;22(2):286-95.   Chang M. The chiropractic scope of practice in the United States: a cross-sectional survey. Journal of manipulative and physiological therapeutics. 2014 Aug 31;37(6):363-76.   Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals of internal medicine. 2002 Feb 5;136(3):216-27.   Reggars JW. Chiropractic at the crossroads or are we just going around in circles?. Chiropractic & manual therapies. 2011 May 21;19(1):11.   Straub RO. Health psychology: A biopsychosocial approach. Macmillan; 2006 Dec 22.

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