Latest Reading List

Slow goings, but going to pick up soon now that I dedicated myself NOT to write code for work outside of work hours.  

On the bookshelf: 

• Structure of Scientific Revolutions - Kuhn 
• Still Alice - Lisa Genova 
• A First Rate Madness: Uncovering the Links between Leadership and Mental Illness - Ghaemi 

On the Docket: 

• All The Strange Hours - Loren Eiseley
• Start with WHY - Sinek 
• Left Neglected - Lisa Genova
• Phantoms in the Brain - Ramachandran
• Battle Royale - Rowaiaru
• Doctors: The Biography of Medicine - Nuland 
• An Unquiet Mind: a Memoir of Moods and Madness - Kay Redfield
• The Drunkard's Walk: How Randomness Rules Our Lives - Mlodinow 
• Ready Player One - Cline 
• How Doctors Think - Groopmman 
• Look Me in the Eye: My Life with Aspergers - Robinson 
• Second Opinions - Groopman 
• One for the Money - Evanovich
• Every Patient Tells a Story - Sanders 
• The Center Cannot Hold: My Journey Through Madness - Elyn Saks
• The Fifth Discipline - Senge
• Only What They Could Carry - ??
• Under the Banner of Heaven - Krakauer
• Hippocrates Shadow - Newman 
• Consciousness Explained - Dennett 
• Death of the Guilds - Krause 
• Painful Yarns - Lorimer Moseley
• The Best Practice - Kenney 
• The Black Swan: Impact of Highly Improbable - Taleb 
• Dan Brown Books -  The Da Vinci Code
• Checklist Manifesto - Gawande 
• Blink - Gladwell (re-read) 
• One Step at a Time - Bliell 
• Courage to Teach - Palmer
• The Seven Laws of Magical Thinking.. - Hutson
• Blindness - Jose Saramago
• The Road - McCarthy
• The Postman - David Brin
• Oryx and Crake - Margaret Atwood
• A Canticle for Leibowitz - Miller
• Alas, Babylon - Frank
• Z for Zachariah - O'Brien
• Answer to the Question: What is Enlightenment? - Kant

Readings and Musings 8.31.12

Another collection of random things that have caught my attention.  In the future, I will try to put out this list of things a little more frequently.

The Best Argument in Favor of Open Access Science is All Of Them @Kevbonham  I shouldn't have to explain why this matters.  More information here: Open Access Publishing

Develop a Web Presence - tips and ideas for boosting your web presence, from social networking to blogging.  I'm still on google.  Maybe I should make a switch to boost my street cred. @adachis

Ridgeway & Silvernail 2012.  Innominate 3d Modeling: Biomechanically interesting, but clinically irrelevent.  @Dr_Ridge_DPT

Dr. Ridgeway was kind enough to supply with the full unedited prior to submission full text here.  Thanks!! 

Patients understand that they are in pain. Health care professionals like to try to explain why patients are in pain. But it's a spinning plate trick - to tell them what we know about pain without invalidating what they KNOW about how they feel, and how they believe it impacts them. I like the article What predicts outcome in non-operative treatments of chronic low back pain? A systematic review (Wessels et al. 2006) for this reason. Changes in cognitive and behavioral measures may be more predictive for treatment outcomes of chronic low back pain than physical measures. But more research needs to be done (click me). What I like about this review, and it ties back into other articles (like Mannion 2001), is that we shoud do more to address patients' beliefs about pain, fear avoidance, coping, and mood. I don't think these questions can be addressed without LISTENING to how patients feel, and what they understand about their pain. 

These info graphics are so cool:  Mobile Healthcare or validation for my interest in developing software.
More digital information: HIPAA Devices: 2 Myths Debunked, 1 Proven True from @WebPT.  Ipads are HIPAA compliant.  Cloud storage is safer than hiding money in your mattress.  Digital storatge is safer than paper storage. 

Forward Thinking PT Posts by @joebrence9.  The latest post is about the neuromatrix model of pain developed by Dr. Ronald Melzack.  The brain uses a vast integrative network of systems to interpet threats to the system contextually as pain. Cool stuff.  One of my major interests as a #physicaltherapist (when I get a license).

Rec Fem Causes Hip...

EXTENSION!

But that isn't what this post is about...  Our models for understanding pathology are too primitive to be meaningful.  The background of what I'm thinking:

This article is a perfect example of how remarkably complex human motion really is.  And all I can help taking from it is that after explaining the mechanism to 3 people now, all have fired back with "So, how is that functional?"  Without even giving a minute or two to try to think about a circumstance when something like that might actually be functional.

"This is what I've observed."  "It has to be this way because of the origin and insertion."

 Electrical stimulation of the rectus femoris during pre-swing diminishes hip and knee flexion during the swing phase of normal gait.

Besides the actual function and clinical relevance discussed in the article, I like to think more about how many other parts of everything I've learned act as functional oversimplifications.

These over-simplifications are the basis, for instance, for much of how we model and explain very complex evaluative tools.  I wrote this post a couple weeks ago, and have been thinking about it since then, with a little feedback from a mentor.  At the same time, not too soon after, a friend of mine (@RGWooderson) forwards a blogpost to me called "A Few Tests To Toss".  It is a great post that actually offered ANSWERS to some of the questions and things I've been thinking about.  A recommended read, for sure.

Now my purpose: 

The Low Back.  We try to model the mechanics of it, in all the spine's complexities.  And evaluate the "motion" people perform by merely touching and observing.  I'm not bashing touching and observing.  I think touch and observation are our greatest tools - just extremely inaccurate, or inconsistent at best.  And seem to fail to achieve proposed/described biomechanical influences. And in the end we are frustrated or confused - as a freaking profession! - about why we can't cure back pain.  Or why our outcomes for certain sub-populations aren't better than surgery. 

I'm not satisfied.  Not with the methods of evaluation I was taught in school - like SI movement, low back quadrant testing, and evaluating based on assumptions of biomechanics that don't hold true.  When I was learning it in school, and disagreed, I felt like I was out of the loop.  Like there was another lecture that I didn't get to hear. So WTF? Am I an idiot?  Arrogant?  Hopeless? 

Pain I understand - and trying to create a more meaningful picture with provocation testing (see "A Few Tests to Toss") makes sense to me, especially if it can be linked to treatments that are effective at reducing pain (are they?).  BUT trying to explain the mechanism of pain by assessing 1 - 2 mm of movement through centimeters of soft tissue doesn't just seem useless, it seems irresponsible.

One answer, as I was hoping to hear (homework: revisit hindsight bias) was outcomes.  We have got to critically analyze our treatments and their outcomes as a GROUP, and hastily discontinue treatments that don't yeild meaningful results - or as a practice we should be left behind.  Stop trying to explain the mechanism because it is very poorly understood.  Focus on what works, and be certain you are truly quantifying it. 

I started reading Doctors: A Biography of Medicine.  I haven't finished (thanks, self, for sucking at modalities and cardio/pulm).  There were two main schools of thought regarding medicine.  Both wanted to help patients.  One school of thought was Hippocrates, who, as the father of medicine, and, as I understand it from the book, discusses change in patient condition and patients getting better as the focus of his practice.  The other school of thought in Pergamon focused on pathology, and, ultimately, did not produce a father of medicine.  Galen was more like an uncle of medicine.  Brilliant, to be certain, but wrong frequently about anatomy and physiology.  Understanding of pathology, cell models, etc... was too primitive to be meaningful then, and in many cases today, too primitive to be meaningful now.   I like the clinical prediction rules as a starting point for treatment because, while ignoring the ever elusive question of "why are you in pain?"  it still offers solutions which have documented improvements compared to older methods of treatment. 

Rant over.

Jumping back on the cardiovascular/pulmonary and modalities studying for the NPTE bandwagon.  Thanks for reading. 

-d