Cayman Islands Chiropractic Continuing Education

• Describe three basic legal concepts that led to the doctrine of informed consent.
• Describe three approaches to determining the disclosure standard for judging that a patient or client has been informed.
• Discuss three major aspects of the process of obtaining informed consent.
• Distinguish "general consent" from "special consent" documents.
• Differentiate between the never-competent and once-competent patient or client and the challenges posed by each in regard to informed consent.
• Compare informed consent as it is used in health care practice and in human studies research.
• Describe some considerations one must always take into account to be sure one is being culturally competent and honoring cultural difference when informed consent is the standard.

• Assess the current literature on outcomes assessment in chiropractic practice
• Describe the psychometric properties outcome measures
• Summarize the utility of patient related outcome measures
• Outline the various domains of outcome assessments
• Describe the clinical significance of common patient reported outcome measures
• Identify guidelines and recommendations for use of outcomes measures in daily practice
• Identify clinician driven outcome measures and discuss the strength of evidence supporting them along with their clinical significance and utility

• Define Evidence Based Practice (EBP)
• Identify problems/obstacles to EBP
• Outline the process of EBP
• Learn how to ask good clinical questions: PICO
• Describe how to search PubMed and learn how PubMed translates a search query
• Define MeSH terms and describe their use
• Illustrate how to limit or broaden your search to find the appropriate content
• Compare the results of boolean operators AND, OR and NOT

• Provide a rationale for the use of outcome assessments in practice
• Survey the recommended outcome assessment measures used by chiropractors and provide a copy or link to download them electronically
• Describe the recommended outcome measures and provide instruction on how to score them
• Detail the psychometric properties of the commonly used outcome measures to aid in determining clinically relevant change in patients
• Indicate which outcome measures to use and when to use them

• Evaluate the effectiveness of the influenza vaccine in healthy adults and children 
• Evaluate the effectiveness of the influenza vaccine in the elderly 
• Evaluate the importance of influenza vaccination in those with recent cardiac events 
• Explain the key elements in the "Tamiflu Controversy" 
• Discuss limitations to the Tamiflu research base 
• Discuss limitations to using zinc for the common cold 
• Evaluate strengths of study design for pragmatic trials 
• Discuss the effectiveness of using probiotics for the common cold 

• Recognize the initiation and growth of evidence-based  (EBP) or evidence informed practice (EIP)
• Interpret the need to utilize EBP
• Define EBP.
• Explain the levels of evidence and applications to practice
• Contrast EBP/EIP with what is not EBP/EIP and relate to your clinical expertise.
• Evaluate the research evidence for application to practice
• Locate the literature that applies to the doctor’s patient
• Integrate the literature research with their clinical expertise and the patient preferences
• Recognize patient preferences
• Distinguish your patients from the benchmarks of care
• Distinguish the different types of evidence
• Synthesize EBP/EIP into case studies
• Implement EBP/EIP procedures to your practice for increased patient compliance,
• Differentiate individual patient cases with similar diagnoses
• Identify actions contingent upon the level of evidence

• Hypothesize situations where being able to critically evaluate research on your own may be particularly important
• Recall the original definition of evidence-based medicine
• Identify point-of-care resources for high quality evidence
• Categorize the evidence-based resources into point-of-care, summaries, syntheses etc.
• Define “bias” in the context of research studies
• Discover risk of bias in randomized controlled trials as it relates to unmasking and blinding
• Paraphrase the meaning of a “straw man” in the context of study design
• Discover risk of bias in randomized controlled trials as it relates to industry sponsorship, specifically referencing spin, straw man design, selective outcome reporting
• Identify the aspects of ‘non-specific effects’
• Define minimal (clinically) important difference
•  Explain why minimal important differences may be more relevant than p values
• Apply research findings to the patient in front of you

• Explore contemporary healthcare issues from the perspective of Robert Lustig, MA and John Abramson, MD.
• Integrate the relevance of these issues to the chiropractic profession.
• Evaluate at the concept of evidence-based “medicine,” especially the “randomized controlled trial,” and describe how it applies to the chiropractic profession.
• Discriminate recent examples of “randomized controlled trials,” especially as related to pain syndromes and opioid drugs.Discusss the importance of the 2021 Nobel Prize for the chiropractic profession and mechanical-based care.
• Detail the physiology of the Piezo1 mechanical receptor.
• Introduce the concepts of mechanical function and mechanical neurology.
• Integrate the importance of the cerebellum to mechanical integrity and mechanical based care.
• Explain a randomized clinical trial that supports mechanical-based chiropractic care for visceral physiology.
• Distinguish the basic physiology of the neurotransmitter norepinephrine.
• State the basic physiology of the neurotransmitter dopamine.
• Outline the basic physiology of the neurotransmitter serotonin.
• Integrate the balance of the neurotransmitters dopamine and serotonin.
• Recite the relationship between the neurotransmitters dopamine, epinephrine and norepinephrine.
• Explore the concept of Heart Rate Variability (HRV).
• Integrate upper cervical chiropractic care, spinal chiropractic care, and HRV.

• Identify the relationship between an upper cervical - trigeminal cervical nucleus and headaches.
• Integrate headache, upper cervical spine, and the temporomandibular joint.
• Distinguish between the clinical management of compressive neuropathology v. supersensitivity nerve interference.
• Identify “red flags” associated with compressive neuropathology.
• Discuss the relationship between mechanoreceptors, the sympathetic nervous system, and neuroimmunology.
• Highlight the uniqueness of upper cervical spine mechanoreceptors and the vagus nerve.
• Describe mechanobiology and diseases of mechanotransduction.
• Explain connective tissue as a body-wide signaling network.
• Summarize some randomized controlled/clinical trials pertaining to chiropractic and/or manipulation care.
• Recall studies looking at the influence of chiropractic care on opioid use.
• Interpolate the importance of sagittal posture on pain and function.
• Examine the importance of sagittal posture on cognition.
• Integrate evolutionary biology, infection, and the existence of chiropractic subluxation.           
• Summarize studies showing the influence of joint adjusting on a variety of visceral syndromes.
• Detail the relationship between an infectious agent and host health.
• Recognize the basic details of neuroimmunology.

• Identify the differences between the deposition and trial
• Understand the fundamentals and subtleties of the discovery of evidence
• Distinguish between discovery and impeachment
• Describe the steps involved in a deposition and trial
• Discuss critical issues encountered in the deposition and trial

• Demonstrate how to get started in marketing new skill sets
• Recognize how to contract work
• Establish case preparation protocols
• Distinguish between oral and written reports
• Describe the steps involved in opinion forming

• Discuss demonstrative evidence and props
• Distinguish between discovery and impeachment
• Understand the steps involved in a deposition
• Recognize the worth of your knowledge as a forensic examiner
• Review the steps involved in civil and criminal cases

• Understand the steps involved in a trial
• Identify critical issues encountered in a trial
• Create a defensible curriculum vitae
• Explain the concept of work product
• Discuss critical issues encountered in discovery of work product

• Understand critical issues encountered in a forensic practice
• Recognize pertinent case law
• Explain the concept of absolute immunity
• Recognize risk management protocols for the forensic examiner
• Discuss the future challenges for the forensic examiner

• Develop a level of knowledge and understanding of the federal and state legal system
• Develop a level of knowledge, comprehension, and understanding of the deposition process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Integrate the Rules of Evidence
• Illustrate which Federal Rules of Evidence apply to the expert witness
• Explain discovery techniques
• Discuss that the expert witness may need to produce business records
• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Assess Daubert criteria
• Explain what each chiropractic expert should look for when preparing for the opposing attorney relating to hearsay
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to Daubert challenges

• Discuss trick question posed on cross examination
• Assist judges in implementing effective management of expert evidence involving scientific issues
• Identify judicial notice, aggregation, and compensation schedules for specific injuries
• Develop a level of knowledge, comprehension, and understanding of the cross examination process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Develop a level of knowledge and understanding of the federal and state court appointed expert process
• Discuss evidentiary framework
• Identify which Federal Rules of Evidence apply to the expert witness
• Critique the nature of the claims, the theories of general and specific causation, the defenses, and in particular the bases for disagreement among experts
• Explore the use of reference guides

• Integrate Scientific Reasoning vs. Methodology
• Critique questions relating to scientific validity
• Assess Frye criteria
• Discuss hearsay exceptions
• Explore statistical estimates
• Emphasize that judges will exclude certain evidence
• Identify scientific theories that are not testable
• Comment on forensic techniques that have fallen into disfavor
• Discuss implicit error

• Discuss the Reference Manual on Scientific Evidence
• Emphasize keeping junk science out of court
• Review and critique literature refuting whiplash syndrome
• Summarize the amended Rules of Evidence and their impact of Daubert
• Identify which Federal Rules of Evidence apply to the expert witness
• Demonstrate how to read a legal opinion
• Assess the concept of ipso facto as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Integrate case law as it relates to the practice of forensic chiropractic and testifying as an expert witness

• Develop a level of knowledge, comprehension, and understanding of the federal legal system as it relates to malpractice and testifying as an expert witness
• Explain punitive or exemplary damages
• Discuss the "but for" test
• Assess the concept of res ipsa loquitur
• Summarize battery and assault
• Emphasis adequate informed consent
• Contrast breach of contract or warranty to cure
• Detect the opposing attorney's intent
• Develop a level of knowledge, comprehension, and understanding of the ethical expert witness

• This includes all content from Functional Medicine 201 thorugh 205. Please see educational objectives for those courses

• Identify the risks and complications of long-term PPI (Proton Pump Inhibition) exposure, complicating factors increasing our risks and their correction, and “best practices” for prescribing this therapy.
• Demonstrate a hiatal hernia correction technique with a Chiropractic Adjustment
• Integrate and apply phytotherapy treatment of different causes of dysmotility (SIBO, SIFO, IBD, IBS, neuropathy) based upon identifying key colonocyte target receptors in both TH1 (autoimmune) VS TH2 (allergic) situations.
• Identify and summarize Metabolic Inflammation, explain its’ triggers, resultant diseases and prescribe treatment for it.
• Discuss inflammation in the Intestine-Lung axis, apply dietary and lifestyle preventative and corrective treatment.
• Develop the use of therapeutic “biotics” for asthma, airway inflammation, and atopic disorders,
• Associate GI and respiratory biodome imbalances with asthma and allergic disorders, and their relationship to allergic sensitization
• Critique the interaction of the hygiene hypothesis and our “window of opportunity” to prevent asthma and allergic diseases
• Apply home and office based environmental therapy to help limit daily allergic exposure, allergy and asthma reactions.

Hour 1:

• Discuss PNI and its relationship to musculoskeletal conditions
• Review the interaction of the Hippocampus-Pituitary-Adrenal axis with PNI and its effect on musculoskeletal conditions Discuss clinical approach to managing these syndromes

Hour 2:       

• Explain what factors affect the baby boomer population
• Establish Patient education and doctor patient relationship
• Establish protocols to improve treatment outcomes

Hour 3:

• Mind over matter- how the brain and neuropathways affect musculoskeletal conditions
• Describe cellular structure connections
• Evaluate patients with musculoskeletal conditions and consider the effect of the mind, body, cellular and neurological alterations manifesting of these conditions.

• Identify the Importance of the Microbiome in Leaky Gut Syndrome
• Examples of symptoms of Leaky Gut Syndrome
• Discuss the health conditions caused by Leaky Gut Syndrome
• Breakdown the causes of Leaky Gut Syndrome
• Explain Nutritional Therapies used to heal Leaky Gut Syndrome

• Explain the importance of Glutathione as a Nutritional Therapy.
• Demonstrate the Symptoms of Alzheimer’s, Liver dysfunction, Lung conditions and Eyes, Ears, Nose and Throat conditions and the benefits of Glutathione therapy in each case.
• Discuss abstracts that illustrate the benefits of Glutathione therapy in Alzheimer’s, Liver and lung dysfunction and conditions of the Eyes, Ears, Nose and Throat.
• Illustrate the primary benefit of Glutathione therapy for Alzheimer’s and conditions of the liver, lung and ears, eyes, nose, and throat.
• List the primary precursors for Glutathione in the body.

• Simplify the progressive cause-effect relationship of disease from biochemical imbalances to physiological disturbances to cellular/organ degeneration to disease manifestation
• Identify the five primary underlying etiologies of virtually all chronic degenerative disease
• Analyze the most common antecedents and triggers that predispose your patients to disease
• Devise an evaluation algorithm that efficiently guides your testing recommendations
• Discover novel in-office testing procedures that cost-effectively demonstrate patients’ nutrient insufficiencies; unmanaged stress; toxic burden; and sleep “debt”
• Evaluate Heart Rate Variability test results to easily measure and demonstrate patients’ stress adaptability as well as their response to treatment modalities
• Discriminate the meaningful information gleaned from Bio-Impedance Analysis (BIA) testing for monitoring your patients’ health restoration progress
• Interpret evaluation results to efficiently identify which primary factors are contributing to your patients’ health challenges
• Prioritize treatment plans that address both short-term goals (symptomatic relief) and long-term goals (correction, stabilization and prevention)
• Distinguish which nutraceuticals best support patient needs based on history, exam, testing and symptomatology
• Communicate the functional medicine model of health and disease with your patients with greater clarity and ease

• This contains all courses with the educational objectives listed from Functional Medicine 209 through 212.

• Design an efficient and cost-effective approach to evaluating your patients’ underlying health challenges
• Select key questions to ask your patients (consultation, history, questionnaires) to hone-in on their principal underlying imbalances
• Discover in-office, economical evaluation tools to efficiently reveal key diagnostic clues
• Create a systematic decision-making process that directs your testing recommendations
• Devise a practical and effective formula to skillfully evaluate gut health (dysbiosis), adrenal imbalance, blood sugar dysregulation (dysglycemia); oxidative stress; methylation defects; thyroid insufficiency; and sex hormone imbalances
• Generate a logical treatment sequence to competently treat the fundamental underlying conditions revealed in your evaluation
• Differentiate which nutraceuticals best support and rebalance underlying physiological imbalances.

• Identify the appropriate candidates (patients) for a detoxification program
• Effectively communicate the need for detoxification support
• Ensure a safe and comfortable detoxification experience
• Establish realistic expectations - for you and your patient
• Measure the outcome of your patient’s detoxification using novel, in-office, cost-effective evaluation procedures
• Generate 14 and 21 day detoxification programs
• Devise detoxification programs for various levels of patient commitment and participation
• Easily and readily respond to common patient questions and concerns about detoxification
• Address post-detoxification clinical considerations and directions

• Identify the most common pre-disposing factors for the initiation of cancer
• Design a screening protocol to evaluate cancer risk factors
• Discover specific evaluation procedures that identify biochemical imbalances indicative of cancer risk
• Interpret specialized laboratory test results that portray a physiological environment conducive to cancer promotion
• Devise treatment strategies shown to reverse cancer related imbalances
• Hone diagnostic skills by reviewing and analyzing a series of patient case studies, inclusive of history, exam findings, lab test results
• Develop safe and effective treatment recommendations for some of the more common chronic degenerative conditions, e.g., thyroid imbalances, chronic fatigue, inflammatory bowel disease

• Explain how beneficial commensal microbes support gastrointestinal health
• Describe the major components of the intestinal barrier
• Summarize the microbial composition of a typical stool sample
• Explain the role of comprehensive stool testing in assessing gastrointestinal health

• Recognize the three most common types of microbial dysbiosis
• Describe common factors that can reduce beneficial microbes and disrupt the intestinal barrier
• Assess pathogens and opportunistic microbes identified with comprehensive stool testing
• Discuss how the selection of microbial testing methodology may affect the identification of pathogens and opportunists
• Outline therapeutic approaches that address common dysbiosis types identified via comprehensive stool testing