Blog 15: Entrepreneurship

The item that impacted me most from the entrepreneurship discussion in class was having time for your family.  That is something that I value greatly.  One of the sites presented to us in class said that entrepreneurs have more time for themselves and for their families; in my experience I don't think this is true.  All of the entrepreneurs I have worked with appear to be so consumed in their work that they don't have much free time to be with their families.  They may be able to make their own schedules and make time for certain family events, but aside from that they work the longest hours out of any employee and often bring their work home with them.  Typically entrepreneurs do things that they love, but that lifestyle seems more stressful to me; it would be nearly impossible to escape work.  I know this from first hand experience too.  My mom is a small business owner, and my family hardly takes vacations because of it; but when we have she is often to worried about her business to be able to really relax on vacation.  


My career goals are to be a physical therapist, and at least for my first 10 years I know that I don't want to have my own clinic.  My passion is helping people and working with the human body.  So, I'm not saying that I want to be a business person, I just want to do what I love.  I want to help people move and teach them how to maintain their physical health.  I don't want to deal with hiring, firing, bills, insurance companies and other managerial duties.  I hope to find a job that would be flexible with my children's schedules so that I don't miss out on their events.


I think I fall in a different category from the classic "business person" or "entrepreneur"; I do want to be innovative in my treatments, so in that sense I will be a type of an entrepreneur.  There are new modalities, techniques, and areas of expertise being developed constantly in physical therapy; I aspire to be on the cutting edge of that technology.  I just don't want the responsibilities of running a clinic, I would rather focus all of my attention on the patients.  

Blog 14: Lean Process

To implement a lean process in my work space, I decided to focus on motion.  By decreasing the motions necessary to function in my work space, I can save time and work more efficiently.  To do this, I put the most commonly used objects:  pen, pencil, lap top and charger, and biology book in close reach.  The lap top charger is run underneath the desk to reduce clutter.  Other items that are used less frequently:  highlighter, post-it notes, calculator and physics books, are stored near by in drawers.  And items that are only used occasionally, like my accounting book, and printer are stored in a closet.
By having the items that I use most frequently easily accessible I can spend less time moving around and searching for them.  This will allow me to focus on my work more, which in turn will lead to a more productive study session.

Blog 13: Criteria for Evaluation

Quality: Evaluate group members by ranking in numerical order; do not include yourself in this evaluation.

1.      Participation:

a.       researching topics

b.      adding to the conversation

c.       asking questions

d.      attendance in group meeting and class

2.      contributions

a.       quality effort

3.      Tasks accomplished

a.       follow the timeline established by the group

4.      professionalism

5.      communication 

Blog 12: 5S

For my 5S project, I organized a messy work area.  While doing so I assessed the 8S's discussed in class.  The first S is for Sorting:  I disposed of unneeded papers and materials, and stored tools that weren't frequently used to reduce clutter.
The second S stands for Straightening:  To exercise straightening, I grouped together writing utensils by type, and found a home for all of the materials that are used on a regular basis.  This will make materials easily accessible when needed.
For the third S, Sweeping:  I dusted, and vacuumed the work area.  I placed a garbage can under the desk to make cleaning easier and I put an air freshener in the room to provide a fresh aroma.
The next S is for  Standardizing.  This S will be practiced in daily and weekly cleaning routines.  When things are reorganized, they will go back in their places so that they can be easily found.
To go along with standardizing, the next S, Sustaining the discipline, allows for change where it is fit.  Over time, the materials used at this work place may vary, therefore it's important to periodically reassess the needs of the work place.
Safety is the next S that is sometimes included in the 5S process. For this work space, I stored sharp objects out of immediate reach, so that they are not accidentally grabbed.  I also made sure that proper power strips were used so that circuits were not blown.
For Security, I made sure that window fixtures had proper locks and that the server being used was password protected.
The final S, Satisfaction, can be assessed after the re-organized work space is used.  The worker can make suggestions and describe features that they would change.  The work space can then be re-adjusted to accommodate for the the workers needs and preferences.

Before

After

Blog 11: Quality Management

Identify and describe a quality management process that is utilized in your field of interest. Typically this process is in response or guided by a professional organization in that field. Identify that organization.


In the Physical Therapy profession, PTs utilize surveys to measure and evaluate patients' progress throughout therapy.  One company that has a series of surveys for PTs to use is Focus On Therapeutic Outcomes, Inc.  (FOTO).  On their website, they describe how their system works:  "Patients complete our survey on their first visit, or at intake. Surveys are tailored to the specific care type, body part or impairment requiring treatment. The survey is retaken one or more times during the patient's course of treatment, and again at discharge. The outcome is the difference between the FS Score at intake and the FS Score at discharge."
This ensures quality in care by proving that a patient is improving or has improved upon discharge from therapy.  FOTO is recognized by other organizations as being a legitimate and accurate measure of quality.  This system of managing quality is approved by the Physician Quality Reporting Initiative.  The information gathered from these surveys can also be directly delivered to the Centers for Medicare and Medicaid Services.  


Sources:


http://www.fotoinc.com/assets/pdf/UnderstandingNeuro.pdf

Blog 9: Project Plan

Curing COPD


Issue:  The two main diseases categorized as chronic obstructive pulmonary diseases are asthma and emphysema.  Currently there is no cure for COPD, the only options to control the disease are a variety of drugs and therapy, and surgery in some severe cases.  However, drugs and therapy don't provide lasting relief and they can't undue damage caused by emphysema.  


Action Plan:  
1)  research COPD:  causes, current treatments, hypothesized cures
2)  meet with a physician to discuss possible cures
3)  formulate a cure or treatment or device
4)  investigate costs, longevity of cure, and sustainability of cure

Blog 10: Specific Ethical Question

I am a pre-physical therapy student, at my internship this past summer I was introduced to a new physical therapy modality:  trigger point dry needling.  According to Kinetachore, this treatment technique "uses small filament needles to release tight muscles with the goal of permanently reducing pain and dysfunction."  The pain that this treatment is attempting to cure is pain caused by a trigger point: an irritated contraction knot found in tight bands of muscles. The needles used for dry needling are solid, and they do not cut the skin or muscle; they function by deactivating and desensitizing myofascial pain.  At first this seems like a good approach to overcome pain caused by trigger points.  However, after collaborating with other physical therapists, I found that physical therapists are not in agreement on the technique.  

One physical therapist that I recently shadowed is against trigger point dry needling because in his experience injections are more effective and provide long-lasting relief faster.

According to Progressive Physical Therapy, after a dry needling session, you will likely be sore for about 2 days, and a day or 2 of relief will follow.  A patient will likely need multiple dry needling sessions to obtain permanent relief.  This does not seem like a good approach to treat a trigger point, as a patient I would want lasting relief as soon as possible.  

The Department of Physical Medicine & Rehabilitation at the University of California Irvine did a study to compare the outcomes of patients treated with trigger point dry needling as opposed to patients treated with injections that contained 0.5% lidocaine. After receiving treatment, 100% of the patients who were dry needled experienced soreness different from their previous trigger point pain, while only 42% of patients who received lidocaine injections experienced soreness.   The author states that, "Patients treated with dry needling had postinjection soreness of significantly greater intensity and longer duration than those treated with lidocaine injection."  Through this study, it is apparent that lidocaine injections are a better option in treating trigger points than dry needling.  The two main reasons are that patients don't become as sore and that relief lasts longer.  

After observing how effective lidocaine injections can be, I began to wonder why a physical therapist would use dry needling as a technique.  The only reason I can conclude is that physical therapists aren't licensed to administer injections; they are only allowed to perform dry needling.  I don't think it's ethical for a physical therapist to perform a certain treatment if there is a better treatment option available; even if they have to give up patients.  In health care, it's all about the patients; a physical therapist should recognize which patients would better benefit from lidocaine injections and refer them to a doctor who will give the patient the injections.  Patients with trigger point pain should receive injections as a faster and more pleasant treatment. 

Sources

1)  Hong, CZ. "Lidocaine Injection versus Dry Needling to Myofascial Trigger Point. The Importance of the Local Twitch Response." Pubmed.gov. Department of Physical Medicine & Rehabilitation, University of California Irvine, Orange. Web. 24 Oct. 2011. <http://www.ncbi.nlm.nih.gov/pubmed/8043247>.

2)  "TDN Overview." Intramuscular Manual Therapy, Aka Trigger Point Dry Needling, Training Physical Therapists. Web. 24 Oct. 2011. <http://www.kinetacore.com/physical-therapy/TDN-Overview/page34.html>.

3)   "Trigger Point Dry Needling." Progressive Physical Therapy. 1 May 2011. Web. 24 Oct. 2011. <http://pptaccess.dot3tech.net/?p=35>.