#evidence based practices

[beyondbasicteaching]

Back to School is Upon Us

School starts in a few weeks, and instagram has been reminding me of some things that I feel the need to share, in no particular order:

1. How you decorate and design your classroom can affect how well (or poorly) students can focus. Neon rainbow everything with every square inch of wall covered in 14,000 “cute” but illegible fonts will likely be overstimulating for your students and will definitely be more of a distraction than a help.

2. Rewards, points systems, prizes, and other extrinsic motivators are bandaid methods of managing behavior. They are not classroom management. They will not last. They will undermine your students’ motivation to do the right thing because it’s the right thing. And when one system stops working, it becomes an endless cycle of trying to find the next shiny thing that will keep some semblance of order and productivity in the room.

3. BEHAVIOR MANAGEMENT IS NOT CLASSROOM MANAGEMENT. Behavior management is not classroom management. Behavior management is. not. classroom. management.

But classroom management IS behavior management.

Classroom management means having a plan for ordering the classroom and how students will accomplish various procedures throughout the day. Classroom management means knowing how you want things done: how do you want students to enter the room in the morning? Where do they put their things? Where do they sit? What will they do when they get there? How will they get materials? How will they turn in work? What are the expectations for behavior in the room? What happens when expectations are not met?

The more structured and clear your expectations and procedures are, the more consistently you teach and practice and follow through on them, the easier they are for students to accomplish. Students NEED structure. Anything you want students to do must be explicitly taught.

Points and rewards and punishments undermine student ownership and motivation. Rewards are fun every once in a while, but let’s be honest, do you really want to have to manage all of that every day?

The best classroom and behavior management is to a) know what you want students to do and how you want them to do it; b) explicitly TEACH them what and how, and then practice until it’s automatic; and c) be consistent.

Consistent, clear expectations and follow-through will trump every other behavior management involving prizes and bribes and punishments.

4. Just because something is on Instagram, Pinterest, or TikTok, just because something looks cute or fun, doesn’t mean it’s effective, good for kids, or best practice. There are evidence-based practices that are both effective AND engaging. Be judicious.

[heroesriseandfall]

Kind of funny when fanfic writers have Tim figure out Dick’s identity by seeing Robin do a quadruple flip in person, because DC writers didn’t even think of that back when they were trying to make it a rule that Robin couldn’t be seen on TV so the Batfam could be urban legends. They just still had Tim see Robin do a flip on TV and never tried to explain how Robin could be an urban legend and still have his exploits broadcasted on TV by professional news media.

[rudjedet]

medical history protip: if an article claims that the Ebers papyrus "contains evidence of [whatever medical treatment the article is about]", don't take it at face value because a solid 50% of the time, if not more, it's bull.

[jcsmicasereports]

A contemporary clinical reasoning and multi-dimensional approach of Lower back pain management by Dr. Sarma S.T in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

The incidence rate of low back pain (LBP) is expanding in every clinical context as it is a common musculoskeletal illness affecting the overall population although the frequency of back pain and functional impairment increasing with age. This leads to tremendous strain as it represents one of the leading causes for growing disability and major socioeconomic burden in almost every healthcare system globally thus an efficient back pain management strategy is an urgent priority. This review is to outline the common causes, associated risk factors, clinical presentation and contemporary clinical reasoning including multi-dimensions of pain aspects to assess the patients with low back pain for achieving the precise clinical decision making as it would be a provision to implement potential tactics to lower the socioeconomic burden of this musculoskeletal disorder on the healthcare service providers.

Keywords: Biopsychosocial model, Clinical decision making, Diagnostic triage, Evidence-based practice, Lower back pain

INTRODUCTION

Lower back pain is a collective musculoskeletal illness affecting the overall population although frequency of back pain and dysfunction take place with aging. The previous research advocates that LBP occurrence increasingly takes place with aging and incidence may be recognized to work-related physical activities too. Population-based studies have indicated that LBP remains global concern thus it challenges every nation. The occurrence of LBP is 84%[1] as this common condition affecting individual at some point in their live consequently seen in both primary and tertiary care clinical settings. Moreover, the 1-year prevalence of LBP in aging people range from 13 to 50% similarly, up to 80%[2] experience this substantial musculoskeletal pain and follow long-term healthcare facility. If the LBP continues more than three months, this is considered to be as chronic lower back pain but there are number of studies advocate that chronic pain is lasting beyond the expected natural healing time period and neglecting the timeline-based classification. The differential diagnosis is crucial as it provides the underlying pathological causes because LBP is a disease not a symptom. The back pain represents one of the leading causes globally for growing number of disability and major socioeconomic burden in almost every healthcare system. According to the Global Burden of Disease Study evaluation revealed that LBP accountable for many years patient lived with disability[3]. Another study estimated that approximately 97% of people experience back pain at some time in their life while around 62% is mechanical nature or non-specific but between 5 and 10% of cases [4] develops chronic LBP then it seems to be the primary focus on seeking health care services. This eventually leads to a wider-range of negative consequences not only individual suffering from LBP but also causing negative impact on national levels. It minimizes the person’s quality of life due to personal suffering and subsequent economic impact on health care system. In the long run, LBP leads to disability in the working population and severely impacts on their productivity subsequently loss their working days. The resultant cost and absenteeism from work along with LBP is a serious social concern.[5] The LBP has a wider-range of potential etiologies and the LBP symptomatology can be overlapped each other also depend on the patient population but among the mechanical nature and non-specific causes are most common. However, successful outcomes of LBP are dependent on precise differential diagnosis. It can be reached by detailed clinical history taking, knowledge of the regional anatomy, precise understanding of the pathology comprehensive physical examination and diagnostic studies.[6] A number of clinical guidelines show that potential success of conservative management for LBP approximately 70% [7] although in certain cases are required surgical intervention. Thus, the efficient LBP management strategy is an urgent priority as the alarming rate of socioeconomic burden of this musculoskeletal disorder for nearly all healthcare service providers in every nation in worldwide.

ETIOLOGY

There is a wider-range of potential causative factors for developing LBP in every population although these etiologies depend on the patient’s medical history, examination and investigation. However, it is advocated that commonly mechanical or non-specific nature of LBP and among a large incidence of mechanical back pain due to lumbago, paraspinal hypertonicity, degenerative disease, facet joint and sacroiliac joint dysfunction while disc prolapse, inflammatory diseases, osteoporosis, malignancy, nerve root compression, canal stenosis and infection are all part of the differential diagnostic procedure.[8] Even though the majority of back pain is mechanical or non-specific nature and somewhere 12-33% [9] of people experience back pain due to either a true red flag like caudaequina syndrome then it need to be the immediate focus on medical management. At present, a growing number of researches contend that the pain occurs because of other aspect like cognitive behavioral factors, thus this dimension must be taken into the back pain diagnostic procedures. Differentiating the nociceptive pain from neuropathic pain and psychogenic pain is an essential step to make precise differential diagnosis as it is a high priority before initiating any therapeutic approaches.[10] The important trait of LBP management is identification of red flags to avoid delay of appropriate intervention and ensure patient safety.[11] It is vital to have comprehensive understand on clinical presentation of individual back pain cases and identifying the typical red flags associated with back pain such as loss of neurological functions, bowel or bladder incontinence and sleep disturbance could help to establish optimistic therapeutic management. There are several interventional approaches are being applied to cure the lower back pain suffering though the recent research report reveals that the majority of back pain cases resolve naturally with certain time duration.[12]

RISK FACTORS

A greater number of studies claimed that varying evidence related to job demands such as lifting and twisting with weight, ethnicity, genetic predisposing factors and mental health issues are all associated with higher risk of back pain although there is a few evidence provided that women have a greater risk of lower back pain.[13] A recent cross-sectional study claimed that there is strong correlation between lower back pain and obesity have a strong relationship as obesity is one of the risk factor to develop back pain subsequent functional disability. However, it is contended that the incidence rate of lower back pain is high when there is high chance of psychological issues.[14] In addition to that this study postulated that there is high prevalence of lower back pain among people with sedentary lifestyle thus they conclude that physical activity help significantly to decrease lower back pain perception. The varying level literature evidence and the lack of a homogenous definition of back pain lead to challenge for clinicians to have definitive conclusion in related to back pain scenarios though the global survey testify that it is varied geographically.[15]

CLINICAL PRESENTATION

The type of pain can be classified easily in case of having clear picture of mechanism of injury like bruise of skin or broken bone unfortunately there are some type of pain mechanism seems to be vague particularly incase of chronic lower back pain. The lower back pain is classified as acute when it persists for up to six weeks period and it is considered as sub-acute when it is prolonged for up to three months. If the pain is persisted beyond three months is considered as chronic lower back pain because 3 months period is commonly required to natural healing.[16] The back pain is usually defined as local pain, spasmodic muscle tenderness between below the costal margin and above the inferior gluteal folds with or without having leg symptoms. The acute lower back pain is often occurred as the result of tissue injuries and patients suffer from acute back pain are unlikely to follow medical care because acute pain gets better on their own or with conservative treatment. The majority of cases are non-specific and this non-specific chronic lower back pain management needs a huge financial burden to every healthcare system globally. The diagnosis and treatment for patients with low back pain have variation within and between country’s clinical practice guidelines.[17]

CLINICAL DIAGNOSIS

The clinical history taking and comprehensive clinical examination are the most important tools for assessing lower back pain to narrow down the potential root causes of lower back pain subsequently arriving precise differential diagnosis.[18] The goal of diagnosis in lower back pain is to describe the root causative factor of anatomic pain unambiguously as possible also concentrating on wisely classified clinical subgroups with the understanding of pain nature. This is essential to organize the appropriate clinical questions, active listening and mapping out the location of the lower back pain. These are the key areas in the medical history taking helps to identify the present pain location and any changes since its onset.[11] Also it is needed to find out easing and aggravating of pain factors because these are important keys to arrive a precise differential diagnosis. Thus, it is essential for clinicians to have clear understanding on the difference between somatic and visceral pain nature. However, if pain does not fit to any known diagnostic profile there may be other factors like psycho-social issues need to be considered.[19]

INTERVENTIONS

The biopsychosocial model has pragmatic clinical care guide to achieve potential prognosis among the chronic musculoskeletal pain cases. Unfortunately, the majority of healthcare providers follow the biomedical focused clinical practice. This approach relies on the structural model as it is generally assumed that the cornerstone of musculoskeletal pain management is governed by the structural changes in the human body.[21] However, the biopsychosocial model focuses on both biomedical element and potential psychological and social effect to analysis individual patient’s back pain. This would help to achieve the optimistic clinical outcomes with shared-clinical decision making with patient ideas, expectations and concerns rather than solely on clinician’s decision. According to the Institute of Pain Medicine, chronic musculoskeletal pain has been acknowledged as association of nervous system instead of completely relies on structural changes.[22]

CONCLUSION

Biopsychosocial model is concentrated a lot of effects on pain related psychosocial factors because people thought, feeling somatosensory experience and social dimensions contribute to development of pain. However, it is an enormous energy paid out to understand structural chances that relates to pain over the decades indeed still chronic musculoskeletal disorders are magnifying an alarming rate consequently burden to almost every healthcare system. Therefore, identification of psychosocial factors involvement and interpretation related to chronic musculoskeletal painful scenarios can contribute to implementation of cost-effective successful pain management strategies and innovation of drugs that help us to cut down socio-economic burden regard to chronic musculoskeletal pain. Therefore, it is essential to shift from biomedical structural model treatment approaches to manage chronic musculoskeletal pain by considering the psychosocial component in every contact of low back pain scenario. Therefore, practicing efficient multimodality chronic lower back pain management pragmatic approaches based on biopsycosocial model is an urgent priority to reduce the socioeconomic burden to almost every healthcare provider as a result of pain reduction, avoid fear of movement and minimize pain catastrophizing would be achieved far better off quality of life in lower back cases.

AUTHOR’S CONTRIBUTION

The author has critically reviewed and approved the final draft and is responsible for the manuscript’s content and similarity index.

ETHICAL APPROVAL

The authors confirm that this review has been prepared in accordance with COPE roles and regulations. The Institutional Review Board review was not required because of the nature of this review.

Declaration of patient consent There is no patients participation in this study thus consent is not required.

Financial support and sponsorship This review has not received any funding or financial support from third party of the public and commercial sectors.

Conflict of interest There is no conflict of interest.

[transingthoseformers]

You can 100% argue for a late Aligned plot where Shockwave comes back with an army of predacons or otherwise creations and the now unified (they do unify at some point) autobots and decepticons have to defeat him together

[eqan]

breeder contract says i have to neuter dewey at 6 months of age or “at the discretion of the veterinarian” but the veterinarian i saw yesterday was like “neuter him asap or he’ll get aggressive and get cancer” and i know neither of those are true so 💀 i need to find a new vet

[weenie-wizard]

my kink is when the research article has a rabbit hole of well written citations that you can cite as well

[nerdgirlnarrates]

God I am so angry about the way my patient with sickle cell disease is being treated, it’s unreal

[sungtaro]

alright no idea what’s going on in dashville tonight clearly

[ramyeongif]

deeply in love with this

[hamdun888]

Artificial Intelligence (AI) in Healthcare - Findings from recent Studies

❓Question: Can AI answer medical questions better than your doctor?What did a study find?🖥️ Good or very good quality answers: ChatGPT received these ratings for 78% of responses, while physicians only did so on 22% of responses.❓Question: Can AI share more empathy than your doctor?What did a study find?🖥️ Empathetic or very empathetic answers: ChatGPT scored 45% and physicians 4.6%.READ MORE VIA…

[iridescentalchemyst]

Halloween 2024: Five Years of Pumpkins Part TWO

Five Years. It’s coming up on the five year anniversary since I said goodbye to my children. It’s hard to believe. It doesn’t seem right, and I’ve had to count the years out on my fingers several times. 2020. 2021. 2022. 2023… 2024. I have reflected on years past in previous posts, so if you are just tuning in, the links above will get you all caught up. This article will be long enough,…

[play-based-wellness]

ABA Therapy Services in Dallas, Texas | Play-Based Wellness

Looking for ABA therapy for children with autism across Dallas-Fort Worth, Texas? Play-Based Wellness offers personalized virtual and in-home ABA therapy sessions, including direct therapy, parent training, and assessments. Contact us today for professional support and guidance on your child's autism journey.

[dolivia]

What is the Difference Between Evidence-based Practice and Evidence-informed Practice?

Learn about the difference between evidence-based and evidence-informed methods. Discover how each one influences decision-making across different disciplines.

[gryffindorpsychologyandcoffee]

New planner. End of semester paper. Next up: Practicum!

[s0dium]

I need you

Synopsis: Choso needs to fuck you despite the fact that you are Yuuji's babysitter.

Warnings: Desperate sex, rough sex

Visual link: xxxxx

Choso thinks you are an angel.

Honestly.

He marvels at how you always help his family out by babysitting his little brother Yuji, even if it's late at night. Your kindness shines through in every action, and he can't help but notice how your eyes glow like an angel's, your skin seems so soft, and your voice carries a soothing, gentle tone. It's not just what you do; it's the way you do it, with such grace and beauty, that makes him believe you truly are a blessing to his family.

So that is why he must do this.

His touches are relentless, drawing you into his room the moment Yuuji is asleep. You can barely even get a word in before his bigger hands are under your shirt, exploring the warmth of your skin, a desperate longing evident in each caress. You want to tell him to slow down, to truly connect beyond the frantic urgency. But your words dissolve into breathless whispers as you meet his dark tired eyes that are practically begging for you, begging to be with you, begging to feel you.

"I like kissing you." He murmurs against your lips. "I like you. I like you so much, you are so pretty. I like and love you."

You let yourself fall into his touch and Choso captures your mouth with his, a deep, enveloping kiss that makes you moan and whine for more. As he gently removes your tank top and shorts, leaving you in your bra and underwear and he devotes attention to every inch of your skin, delivering tender nips, soft sucks, and gentle bites.

"Perfect." He mumbles under his breath, burying his nose into the crook of your neck to pepper the delicate skin with soft kisses. "Fuck, you are so perfect, baby."

Your mind grows fuzzy at his words and you let out a sharp gasp when you feel him pull the hem of your underwear down your legs.

"Jump," he commands softly, his voice a low rumble that reverberates through you. Without hesitation, you leap up and in one fluid motion, he lifts you up. Your legs instinctively wrap around his waist, securing you against him as he presses you against the wall. Your fingers find their way into his black hair tied up in buns long, tugging gently at the strands, anchoring yourself to him as his kisses deepen. You don't even notice that he has lowered his pants until you feel the hard pressure against your tight hole, making you instinctively squirm away.

"Stay still f'me ok baby?" Choso groans, peppering kisses along your jaw while he aligns himself with you. Without warning, he thrusts into you, the sudden friction and collision with your G-spot knocking the wind out of your lungs. It's as if every fiber of your being is tuned to this moment, each caress and sensation amplifying the pleasure that surges through you. You feel a soft shiver start at the base of your spine, traveling upward, making your skin tingle with exquisite delight. Ticklish pleasure courses through your veins and you immediately throw your head back against the wall as Choso thrusts into you.

"Hnghh, s-so good~~" You whine. It was dizzying, the grith of his dick digging itself against your g-spot, the euphoria of him fitting snuggly against walls with every thrust. The friction is incredible and it made pain quickly turn into pleasure. The tightness of your cunt has Choso gasping for breath, the grip on your hips almost bruising as he tries to keep himself from spilling inside of you right here and now.

"I can feel you baby, sh-shit, I can feel you doing it to me." Choso is not a whining man but here he is falling apart at the warmth of your cunt. God you were heaven, he thinks he would be eternally happy if he could just spend all his time inside of you, feeling you squeeze around him, smelling the intoxicating scent of your shampoo. He uses you like his personal cock sleeve, thrusting up into your warm cunt with such vigor that it shapes your insides and bruises your cervix until your entire body jolts with sensitivity.

For a moment, he slows down, leaning down to the space between you and letting a glob of thick spit drop onto your clit. He moves side to side, opening up your folds and rubbing your clit. You cry from the pleasure and Choso's Adam apple bobs as he groans as well.

He's close, and he knows you are too.

He is glaring at you with hooded eyes, watching the expressions of pleasure you make intently. Choso is caught in some sort of trance, like even though he is fucking you, he is powerless to you.

Your mind begins to drift, losing itself in the intensity of the experience of Choso fucking you. Time seems to blur, and the world around you fades, leaving only the profound connection between you and the pleasure you're immersed in. Each moment stretches and deepens, and you're carried away by the ebb and flow of sensations. Your body responds instinctively, arching off the wall and lifting your hips to meet Choso's thrusts, seeking more, craving the next wave of ecstasy. The pleasure builds and builds, a crescendo that fills you to the brim. It's a symphony of sensation, a dance of pure, unadulterated joy that leaves you breathless and yearning.

And then, in a glorious, breathtaking instant, it peaks. The world seems to explode in a kaleidoscope of bliss, and you are utterly consumed by it. Your heart races, your breath catches, and for a moment, you are weightless, suspended in a universe of pure pleasure.

Luckily for you, Choso is right there with you. His mind dips into a ocean of pleasure and before he can put a stop to it, he is spilling load upon loads of himself in you.

Damn it, he should've done this sooner.