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Theory: Servant Leadership
Description:
The briefing should be comprised of a presentation that is about
1 minute per person and has one slide per person outlining your
take on the theory of leadership (with the additional cover slide
and reference slides.
The slides should:
1) summarize the theory
2) explain how it adds to leadership studies
3) discuss criticisms of the theory
4) present some new material on the theory (last five years {the
more recent the better})
5) provide your group’s assessment of the approach with respect
to today's workforce and current global environment (e.g. is it
useful, practical, easy, dated).
Contact:
Slide: Theory Summary
Slide Information:
What is Servant Leadership Theory?
Servant leadership is often described as an approach to
leadership that does not follow common sense. Why do you
think that is? Well, when we think about leaders we don’t
necessarily think about leaders being a servant. Leaders lead
and servants follow.
In our textbook Northouse (2019) shares that much of what we
know about Servant Leadership originated in the writings of
author Robert K. Greenleaf in 1970,1972 and 1977.
According to Dirk Dierendonck, most of the academic and
nonacademic writing has been prescriptive and not focused on
what servant leadership actually is in practice.
Servant leadership emphasizes that leaders need to be attentive
to the concerns of their followers, they need to have the ability
to emphasize with them and nurture them.
Servant leaders are willing to put their followers first and see
ways for each of them to reach their full personal capacity.
According to Mário Franco and Augusto Antunes (2020),
servant leaders are ethical and are always looking to serve the
greater good of an organization.
Contact:
Slide: How It Adds to Leadership Studies
Slide Information:
Contact:
Slide: Discuss Criticisms of the Theory
Slide Information:
Contact:
Slide: New Material on the Theory
Slide Information:
Contact:
Slide: Group’s Assessment of the Approach with Respect to
Today’s Workforce and Current Global Environment
Slide Information:
Resources:
Franco, M., & Antunes, A. (2020). Understanding servant
leadership dimensions. Nankai Business Review
International,11(3), 345-369. doi:10.1108/nbri-08-2019-0038
Greenleaf, R. K. (1970). The servant as leader. Westfield, IN:
Greenleaf Center for Servant Leadership.
Greenleaf, R. K. (1972). The institution as servant. Westfield,
IN: Greenleaf Center for Servant Leadership.
Greenleaf, R. K. (1977). Servant leadership: A journey into the
nature of legitimate power and greatness. New York, NY:
Paulist Press.
Northouse, P. G. (2019). Leadership: theory and practice (8th
ed.) Los Angeles: Sage Publications.
EVERY MODERN HEALTH CARE
PRACTITIONER IS SURELY FAMILIAR WITH
DAVID SACKETT’S 1996 DESCRIPTION
OF EVIDENCE-BASED MEDICINE AS “THE
CONSCIENTIOUS, EXPLICIT, AND JUDICIOUS
USE OF CURRENT BEST EVIDENCE IN MAKING
DECISIONS ABOUT THE CARE OF INDIVIDUAL
PATIENTS. The practice of evidence-
based medicine means integrating
individual clinical expertise with
the best available external clinical
evidence from systematic research.”1
The intent of evidence-based practice
(EBP) was to marry the best and most
current quantitative scientific research
evidence with the clinical experience
of the practitioner, earned through
clinical practice with patients, to
create optimal decision-making for the
treatment of a problem.
Evidence-based rigidity
Over the years, however, critics of EBP
have argued that this approach turns
clinicians into technicians who follow
a recipe, with individual patient and
CHECKING THE EVIDENCE
Patient-centered chiropractic care and emerging
treatments call for your own evidence-informed inquiry
when evidence-based research falls short
B Y S T E V E A G O C S , D C
TIME TO READ: 10-12 MIN.
T H E T A K E A W A Y
Evidence-informed practice is gaining popularity among
chiropractors and health care
providers over evidence-based practice, especially when it
comes to newer procedures
with little existing peer-reviewed research. Evidence-informed
practice advocates using
conventional wisdom and common sense, and giving higher
value to qualitative studies,
case reports, scientific principles and expert opinions.
RESEARCH
RESULTS
40 C H I R O P R A C T I C E C O N O M I C S • M A R C H
1 1 , 2 0 1 9 C H I R O E C O . C O M
http://ChiroEco.com
RESEARCHRESULTS
practitioner values, as well as the circum-
stances of each patient, being lost in
the mix.2 The majority of providers, left
to their own devices, would probably
not express this tendency. However, the
adoption of evidence-based practice
guidelines such as the American College
of Occupational and Environmental
Medicine or Official Disability Guidelines
that dominate the third-party pay struc-
ture has certainly contributed to the
idea that the research component of
EBP is what really matters and the other
factors are less important. One could
make the argument that, over time, EBP
became research-focused rather than
patient-focused.
Any chiropractor who has been told
they have six visits to make significant
changes with a patient with low back pain
or else their care is the wrong option, for
example, understands the frustration
that can come with EBP guidelines. It is
easy to see how practitioners can have a
negative outlook on the evidence when it
is used to guide care (or the lack thereof)
for patients who depend on third-party
pay structures.
Also inherent to evidence-based
practice is the type of research that is
considered. Practice guidelines like the
ACOEM or ODG mentioned previously,
systematic reviews and meta-analyses
get the highest ranking. However, as with
any type of research these can have their
own inherent biases and are not without
problems, especially when being applied
to a patient whose circumstances may
not exactly match the research inquiry.
In practice, EBP tends to put the highest
value on these types of research,
assessment and diagnosis, and factors
like prevalence.2 Rarely, however, does a
patient’s presentation exactly match the
inquiries of EBP and the evidence, and
so, how does a provider use all of the
available research to better serve the
patient at hand?
Evidence-informed, patient-centered
In more recent years the term “evidence-
informed practice” (EIP) has found
One could make the
argument that, over
time, evidence-based
practice became
research-focused rather
than patient-focused.
C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R
O P R A C T I C E C O N O M I C S 41
http://www.mybreakthrough.com/mdp?utm_source=chiroeco&ut
m_medium=display&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
activator.com
1-602-224-0220
PASADENA
March 2, 2019
KANSAS CITY
March 16, 2019
COLUMBUS
March 23, 2019
DENVER
April 6, 2019
ATLANTA
April 13, 2019
CHICAGO
April 27, 2019
DALLAS
April 27, 2019
MINNEAPOLIS
May 4, 2019
CALGARY
May 18, 2019
TYSON’S CORNER
June 1, 2019
Students can attend for $99
and New Doctors* for $179!
REGISTER TODAY
at www.Activator.com
or call 1-602-224-0220
for more information
ACTIVATOR
METHODS
SPRING 2019
SEMINAR
SCHEDULE
*A “New Doctor” is a doctor that has not
attended a seminar in the last five years.
Spring2019-ChiroEcon-2.25x9.625-061918.indd 1 1/25/19
9:54 AM
its way into the lexicon of health care
providers. While it may seem like mincing
words, there is a significant difference
between what has become evidence-
based practice and this newer approach.
Proponents of EIP suggest that the goal
of collecting evidence to help inform a
provider on a particular case should go
further than the singular goal of reducing
bias and that a wider range of research
information should be used. Estabrooks
advocated that providers add “some
of our own conventional wisdom and
common sense” and give higher value to
qualitative studies, case reports, scientific
principles and expert opinions.3 Miles
and Loughlin have promoted the use
of evidence-informed practice to mean
the process is person-centered rather
than research and evidence-focused4
and this is, perhaps, the most important
distinction between evidence-informed
and evidence-based practice styles.
To better illustrate the differences in
evidence-based and evidence-informed
practices, let us consider two therapies
gaining popularity among manual
therapists and chiropractors: cupping
and compression “flossing.” Cupping
gained wide popularity in the United
States during the 2016 Olympics when
U.S. swimmer Michael Phelps was seen
with the now-familiar cupping marks
on his shoulder and back. The media
exploded with curiosity about cupping
therapy. Of course, the endless debates
about “if it works” or not came with it.
Cupping and
compression-band flossing
Cupping has been used for more than
3,000 years throughout Asia, Greece,
Egypt and the Saharan region, Iran, and
throughout the Muslim world. A medical
textbook published in Europe in 1694
shows an illustration of a man having
cupping performed on his buttocks.
Yet, a 2014 systematic review of cupping
concluded that, “because of the unrea-
sonable design and poor research quality,
the clinical evidence of cupping is very
low,” and a 2011 review found that, “the
effectiveness of cupping is currently not
well-documented for most conditions.”
Compression-band flossing, aka
“voodoo flossing,” has quite a fuzzy
An evidence-informed
approach would combine
anecdotal evidence, the
potential underlying
mechanisms, risk and
reward analysis, and
would balance these
against EBP guidelines
that suggest that an
intervention for low
back pain, for example,
should yield significant
objective changes within
a trial of six visits.
42 C H I R O P R A C T I C E C O N O M I C S • M A R C H
1 1 , 2 0 1 9 C H I R O E C O . C O M
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display&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
history; however, there is clear evidence
of it being utilized in powerlifting gyms
before gaining popularity in the CrossFit
community through the book and videos
of physical therapist Kelly Starrett. Today
it is rare to not see it being practiced by
laypeople in these settings.
A Pubmed search performed by this
author found only two peer-reviewed
articles on flossing. The first had to do
with ankle range of motion, jumping
and sprinting performance, and the
second was a follow-up to that study.
Compression flossing is widely used, yet
there is essentially no evidence for or
against it in the literature.
Strict adherents to EBP would
likely pass over both cupping and
flossing as options for patients with
neuromusculoskeletal problems. Flossing
has no apparent high-quality research
for or against it at all, and the systematic
reviews of cupping are not favorable.
Comparatively, the evidence-informed
approach would look at more types of
evidence. Cupping has been used in
a variety of cultures for thousands of
years and flossing, while much newer,
is commonly used in athletic circles. An
evidence-informed practitioner would
take this anecdotal evidence and use
into account.
Furthermore, an EIP approach takes
into higher account the principles
underlying these therapies. Both
therapies engage the skin and underlying
tissues like fascia and muscle. Cupping
creates decompression of tissues while
flossing creates compression. Providers
can manipulate the cups or floss once
they are placed, creating shear patterns
in the tissues; and it is known that
certain receptors (Ruffini endings) in
tissues respond favorably to shear and
compression and can create local and
global tissue tone changes.5
Cupping and flossing create increased
sensory input into the areas they are
applied to. Given that acute and chronic
pain has been shown to “smudge” the
sensory cortex’s representation of
affected body parts6 and have a negative
effect on tactile acuity,7,8 could adding
stimulation to these areas via cups or
floss have a beneficial effect for patients?
Cupping and flossing both allow for the
addition of active movement, creating
different types of strain, shear and the
potential for haptic feedback that allows
patients to use cups as targets for
movement patterns — or, when coupled
with compression bands, to maintain
body positions during movements in
tasks that make them maintain a certain
amount of tension in a band through a
movement.5
There is no evidence, for or against,
the use of cupping or compression
flossing when coupled with meaningful
movement; however, there is certainly
biological plausibility and foundational
science that supports the potential of
44 C H I R O P R A C T I C E C O N O M I C S • M A R C H
1 1 , 2 0 1 9 C H I R O E C O . C O M
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isplay&utm_campaign=issue4
http://ChiroEco.com
RESEARCHRESULTS
R E FE R E N CE S
1 Sackett DL, et al. Evidence-based medicine: what it is and
what it isn’t. BMJ.
1996;312:71-72.
2 Woodbury GM and Kuhnke JL. Evidence-based practice vs.
evidence-informed
practice: What’s the difference? Wound Care Canada.
2014;12(1):18-21.
3 Estabrooks CA. Will evidence-based nursing practice make
practice perfect?
Canadian Journal of Nursing Research. 1998;30(1):15-36.
4 Miles A and Loughlin M. Models in the balance: evidence-
based medicine
versus evidence-informed individualized care. Journal of
Evaluation in Clinical Practice.
2011;17:531-536.
5 Capobianco S. FMT RockPods and FMT RockFloss. Seminar
presented at the
meeting of RockTape Instructors, Cancun, Mexico. January
2019.
6 Schabrun SM et al. Smudging of the motor cortex is related to
the severity of low
back pain. Spine. 2017 Aug 1;42(15):1172-1178.
7 Harvie DS. Tactile acuity is reduced in people with chronic
neck pain.
Musculoskelet Sci Pract. 2018 Feb;33:61-66.
8 Adamczyk W et al. Lumbar tactile acuity in patients with low
back pain and
healthy controls: systematic review and meta-analysis. Clin J
Pain. 2018 Jan;34(1):82-94.
these therapies. An evidence-informed
approach would combine anecdotal
evidence, the potential underlying
mechanisms, risk and reward analysis,
and would balance these against
EBP guidelines that suggest that an
intervention for low back pain, for
example, should yield significant objective
changes within a trial of six visits.
Such an approach does not throw the
evidence that is available out the window,
nor does it so rigidly adhere to a certain
type of study that it stifles the potential
for outcomes in an intervention with the
patient. This type of approach is patient-
focused and outcome-focused and has
the best potential for putting the needs of
the patient first before all else.
STEVE AGOCS, DC, is assistant dean of
chiropractic education at Cleveland University-
Kansas City as well as a course instructor on
chiropractic history and technique. Agocs
is a post-graduate educator sponsored by
RockTape with an interest in movement,
instrument assisted soft tissue manipulation,
kinesiology taping, functional cupping, flossing
and pain science. He can be contacted at
[email protected]
C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R
O P R A C T I C E C O N O M I C S 45
http://www.impacinc.net?utm_source=chiroeco&utm_medi um=d
isplay&utm_campaign=issue4
http://ChiroEco.com
Copyright of Chiropractic Economics is the property of Doyle
Group and its content may not
be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's
express written permission. However, users may print,
download, or email articles for
individual use.
Research
H o w To R ead a
Research Article
b y Brian K. W alsh, MBA, RRT-NPS, FAARC
There are several reasons why a respiratory therapist
should read a research article. This article will review a
few to highlight the importance of reading and under-
standing research articles.
The first, and likely the best, reason to read is the pro-
fessional obligation to m aintain competence. Respira-
tory care is a profession and one of the aspects of being a
professional is the capability to self-teach, self-learn and
evolve your practice. Respiratory therapists are accused
of practicing the same way they were taught in respira-
tory school. If you ever wonder why our practice varies,
it’s likely because of the influence of research articles. To
maintain relevance, we must review scientific articles.
The second reason to read research is to review an
article in preparation for an upcoming meeting or dis-
cussion. Our practice should be reviewed as part of a
comprehensive quality-improvement process. This is
healthy, and we should always look to improve our prac-
tice and associated outcomes.
The third reason is for the joy of it. Now, I know you
are starting to laugh, but I really do enjoy exploring re-
search articles. It’s not the reading or mental exercise I
enjoy, it’s the practice change that improves the care we
provide that warms my heart.
Now that you have picked a research article to read
from the reasons above or others, I have a few sugges-
tions in how to tackle a research article.
Be skeptical or suspicious
Read critically. I often skip the abstract and go right
to the introduction. Within the introduction the authors
are tasked with introducing the problem or topic and
convincing you there is a problem and that they believe
a new way is needed. Often, if you first read the abstract
and stop there, you miss the full message. The abstract is
the h a rd s e ll, is word limited and often very dense. If the
introduction doesn’t pull you in, then you should move
on to another article that does. If the authors’ introduc­
tion pulls you in, then continue on, but don’t assume the
authors are right — critically critique their assumptions,
logic, and reasoning.
Identify the question
Summarize the introduction in a few sentences. I
often highlight three or four sentences and rewrite the
question to fully synthesize the problem and ques-
tion. The research question should be toward the end
of the introduction. Rewriting the question helps you
identify possible conclusions. I even list some possible
conclusions.
A newer section most journals are offering now is
a quick look or brief summary section th at helps you
identify within a few sentences the current practice and
what this paper contributes to our understanding.
Identify the method to their m adness
The m ethods section often intimidates the reader.
This section is responsible for the perception you are
either a researcher or a genius to be able to understand
a research article; this is simply not true. The methods
section is typically action packed and may take some
work to understand, but it can be done. Certain proce-
dures or methods may be understood by the authors
and even reviewers. However, this can translate within
the authors’ mind that everyone understands the m eth­
ods when the reader does not. This leads to the occa-
sional miscommunication, but don’t let th at stop you.
To truly understand, you may have to look up referenced
methods if they aren’t explained completely. Diagram­
ming each experiment and the order of events can help.
I am a visual thinker and this often helps me more fully
understand the results.
Read creatively
Based on your experience and expertise, start to take
a guess at the results or conclusions. It’s easy to find
fault, but there comes a time in the article to get excited
about the opportunity and switch to a more creative or
positive evaluation. What are some of the opportunities?
Could you implement changes in your practice? Could
this help your patients?
3 2 AARC T im e s M a rc h 2 0 1 6
R e s e a r c h
Drumroll please
The results are often sentences of facts and very
dry to read. Because our mind can out process (out-
put) our reading speed (input) this becomes a source
of confusion. Since your mind is already creating a dia-
log and developing conclusions before you completely
read the results, you m ust try not to jump to conclu-
sions. Focus on words like “significant” or “non-sig-
nificant.” Check out the graphs and tables — they are
often the best way to fully understand the data. Sta-
tistical analysis is standardized by study design and
data type. Don’t be afraid to look up these methods,
as they have strengths and weaknesses that should
be understood. Look for p-values < 0.05. P-values less
than a given significance level (0.05) suggest that the
observed data is inconsistent with the null hypothe-
sis. Some researchers refer to p-values of 0.05-0.1 as a
trend. If it didn’t reach statistical significance but was
coming close, this may be something to watch or to
consider studying in the future.
Explore the gab section
The discussion section is a
very valuable section of the au-
thors’ thoughts and limitations.
This section is a synthesis of
the introduction, methods, and
results that won’t be in the con­
clusion. The discussion section is
a place to find some of your u n -
answered questions. Authors will
elaborate on design strengths or
weaknesses, unexpected results,
and possible future directions.
Read the conclusion last
I know this is likely contrary
to what others have taught, but
reading the conclusion first often
leads to im proper conclusions.
The conclusion can only be read
in the context of the entire study.
If you are provided proof, it’s time
to turn your healthy skepticism
to acceptance and get to work al-
lowing the research to positively
influence your practice.
Compare results
If possible, look up the refer-
ences or similar research. Learn
what others think of the research.
Is this sim ilar or different to
what others have found? If the research paper is a lit-
tle older, is it cited in review articles? Editorials are
a wonderful source to see experts in the profession
debate relevance and impact. Not all research articles
will have an accompanying editorial, but if they do, it’s
worth the extra read.
Research manuscripts are the most common way
scientific information is distributed because reading is
the most common and universal way we learn. In this
information age, new knowledge is being published
every day, and it can be overwhelming. Reading a re-
search article takes work, but there are a few tricks
that can help improve your efficiency.
• Develop a method of reading that works for you.
Set aside time each week to read or work on your
method to improve yourself professionally. This is
one of the healthiest habits you can develop.
• Skim titles in journals. Respiratory Care is a won­
derful resource and is our profession’s science jour­
nal. Skim the titles and read every month. The editors
and reviewers have your best interest in mind. Each
month they prepare state-of-the-art articles for your
viewing pleasure. If you only had
time to read one journal, Respira-
tory Care would be my choice.
• Use technology. Technology can
help identify and sort informa-
tion. Most major medical search
engines allow you to set up an
account with notifications. When
articles are published that meet
your search criteria, you will re-
ceive a notification. Most jour-
nals have Facebook or Twitter
accounts th at you can follow to
get the latest updates. I also use
apps like UpToDate and Docphin
to help organize topics and re-
view hot topics more efficiently.
While technology is positively
impacting our research productiv-
ity and acquisition of knowledge,
there is no replacement for critical
and creative reading of research
articles. There are no fancy short-
cuts and, unfortunately, know-
ing the literature alone will not
improve your practice. The best
achievable result is being able to
apply your newly found knowl-
edge from reading a research arti-
cle to your daily practice. ■
ABOUT THE AUTHOR
B rian K. W alsh , MBA, RRT-
NPS, FAARC, is clin ical
r e s e a rc h c o o rd in a to r
in th e d e p a r t m e n t o f
a n e s th e s ia , d iv isio n o f
c ritic a l care, a t B o sto n
C h ild re n ’s H o sp ital
in B oston, MA, a n d a
PhD s t u d e n t a t R ush
U n iv e rsity in C hicago,
IL. He is th e AARC’s
p re s id e n t- e le c t.
34 AARC Times March 2016
Copyright of AARC Times is the property of Daedalus
Enterprises, Inc. and its content may
not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's
express written permission. However, users may print,
download, or email articles for
individual use.
Stats & FactsOBSERVER
FPAJournal.org12 Journal of Financial Planning | August
2016
OBSERVER
“With the
fi nalization of
this rule, we are
putting in place
a fundamental
protection into
the American
retirement
landscape.”
—Thomas Perez,
U.S. Secretary of Labor,
referring to the DOL’s
Confl ict of Interest Final
Rule, ThinkAdvisor
How to Evaluate
Research-Based Writing
Retreat attendees. “They know how to
conduct research, but they don’t always
know what the critical questions are
that you need answers to.”
EVERY MONTH you get the Journal,
you may wonder about the academic
contributions. Most likely they are help-
ful to you, but perhaps there are times
when you aren’t quite sure what to make
of that research.
The Journal’s practitioner editor Dave
Yeske, DBA, CFP®, co-owner of the
planning fi rm Yeske Buie, notes that
in order to become a true profession,
advisers need to base their practices on
research-based writing. And in order
to do that, advisers need to understand
how to evaluate such writing.
At FPA Retreat in April, Yeske gave a
presentation on how to read and apply
research-based writing. He provided
eight questions to ask yourself in order to
better evaluate research-based writing.
1. What is the problem or ques-
tion? What are the researchers
trying to address?
2. How did they conceptualize that
problem; how did they structure
it? Look for what the researchers are
measuring. For example, client trust
and relationship commitment have
become well-represented measures
in fi nancial planning literature.
3. What are the key fi ndings from
prior research? Good research
will build on research that came
before to lay the foundation for the
current research to build upon.
4. What was their methodol-
ogy? Does it seem like the
researchers make sense?
5. What were the results of the
testing? A formal academic paper
will never prove anything, Yeske
said. Rather, it will fail to disprove
something.
6. Were the results compelling? Do
the authors connect all the dots for
you? Does their data answer the
question?
7. What are the practical applica-
tions? Do the researchers tell you
how you could use this informa-
tion? If not, are you still able to
fi nd a practical use for the data that
is being presented?
8. Will this change the way you
practice? Will you be able to
incorporate this into your practice?
“As a profession we need to all
become better at recognizing research-
based writing and [being] able to apply
it,” Yeske said.
For more information on applying
theory to practice, visit the FPA Theory
in Practice Knowledge Circle, www.
OneFPA.org/Community/Knowledge-
Circles.
“We need to deepen our connection
with academics,” Yeske said to FPA
Copyright of Journal of Financial Planning is the property of
Financial Planning Association
and its content may not be copied or emailed to multiple sites or
posted to a listserv without
the copyright holder's express written permission. However,
users may print, download, or
email articles for individual use.

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Theory servant leadership description the briefing shoul

  • 1. Theory: Servant Leadership Description: The briefing should be comprised of a presentation that is about 1 minute per person and has one slide per person outlining your take on the theory of leadership (with the additional cover slide and reference slides. The slides should: 1) summarize the theory 2) explain how it adds to leadership studies 3) discuss criticisms of the theory 4) present some new material on the theory (last five years {the more recent the better}) 5) provide your group’s assessment of the approach with respect to today's workforce and current global environment (e.g. is it useful, practical, easy, dated). Contact: Slide: Theory Summary Slide Information: What is Servant Leadership Theory? Servant leadership is often described as an approach to leadership that does not follow common sense. Why do you think that is? Well, when we think about leaders we don’t necessarily think about leaders being a servant. Leaders lead and servants follow. In our textbook Northouse (2019) shares that much of what we know about Servant Leadership originated in the writings of
  • 2. author Robert K. Greenleaf in 1970,1972 and 1977. According to Dirk Dierendonck, most of the academic and nonacademic writing has been prescriptive and not focused on what servant leadership actually is in practice. Servant leadership emphasizes that leaders need to be attentive to the concerns of their followers, they need to have the ability to emphasize with them and nurture them. Servant leaders are willing to put their followers first and see ways for each of them to reach their full personal capacity. According to Mário Franco and Augusto Antunes (2020), servant leaders are ethical and are always looking to serve the greater good of an organization. Contact: Slide: How It Adds to Leadership Studies Slide Information: Contact: Slide: Discuss Criticisms of the Theory Slide Information: Contact: Slide: New Material on the Theory Slide Information: Contact: Slide: Group’s Assessment of the Approach with Respect to Today’s Workforce and Current Global Environment Slide Information:
  • 3. Resources: Franco, M., & Antunes, A. (2020). Understanding servant leadership dimensions. Nankai Business Review International,11(3), 345-369. doi:10.1108/nbri-08-2019-0038 Greenleaf, R. K. (1970). The servant as leader. Westfield, IN: Greenleaf Center for Servant Leadership. Greenleaf, R. K. (1972). The institution as servant. Westfield, IN: Greenleaf Center for Servant Leadership. Greenleaf, R. K. (1977). Servant leadership: A journey into the nature of legitimate power and greatness. New York, NY: Paulist Press. Northouse, P. G. (2019). Leadership: theory and practice (8th ed.) Los Angeles: Sage Publications. EVERY MODERN HEALTH CARE PRACTITIONER IS SURELY FAMILIAR WITH DAVID SACKETT’S 1996 DESCRIPTION OF EVIDENCE-BASED MEDICINE AS “THE CONSCIENTIOUS, EXPLICIT, AND JUDICIOUS USE OF CURRENT BEST EVIDENCE IN MAKING DECISIONS ABOUT THE CARE OF INDIVIDUAL
  • 4. PATIENTS. The practice of evidence- based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”1 The intent of evidence-based practice (EBP) was to marry the best and most current quantitative scientific research evidence with the clinical experience of the practitioner, earned through clinical practice with patients, to create optimal decision-making for the treatment of a problem. Evidence-based rigidity Over the years, however, critics of EBP have argued that this approach turns clinicians into technicians who follow a recipe, with individual patient and CHECKING THE EVIDENCE Patient-centered chiropractic care and emerging treatments call for your own evidence-informed inquiry when evidence-based research falls short B Y S T E V E A G O C S , D C TIME TO READ: 10-12 MIN. T H E T A K E A W A Y Evidence-informed practice is gaining popularity among chiropractors and health care providers over evidence-based practice, especially when it comes to newer procedures with little existing peer-reviewed research. Evidence-informed
  • 5. practice advocates using conventional wisdom and common sense, and giving higher value to qualitative studies, case reports, scientific principles and expert opinions. RESEARCH RESULTS 40 C H I R O P R A C T I C E C O N O M I C S • M A R C H 1 1 , 2 0 1 9 C H I R O E C O . C O M http://ChiroEco.com RESEARCHRESULTS practitioner values, as well as the circum- stances of each patient, being lost in the mix.2 The majority of providers, left to their own devices, would probably not express this tendency. However, the adoption of evidence-based practice guidelines such as the American College of Occupational and Environmental Medicine or Official Disability Guidelines that dominate the third-party pay struc- ture has certainly contributed to the idea that the research component of EBP is what really matters and the other factors are less important. One could make the argument that, over time, EBP became research-focused rather than patient-focused. Any chiropractor who has been told they have six visits to make significant
  • 6. changes with a patient with low back pain or else their care is the wrong option, for example, understands the frustration that can come with EBP guidelines. It is easy to see how practitioners can have a negative outlook on the evidence when it is used to guide care (or the lack thereof) for patients who depend on third-party pay structures. Also inherent to evidence-based practice is the type of research that is considered. Practice guidelines like the ACOEM or ODG mentioned previously, systematic reviews and meta-analyses get the highest ranking. However, as with any type of research these can have their own inherent biases and are not without problems, especially when being applied to a patient whose circumstances may not exactly match the research inquiry. In practice, EBP tends to put the highest value on these types of research, assessment and diagnosis, and factors like prevalence.2 Rarely, however, does a patient’s presentation exactly match the inquiries of EBP and the evidence, and so, how does a provider use all of the available research to better serve the patient at hand? Evidence-informed, patient-centered In more recent years the term “evidence- informed practice” (EIP) has found
  • 7. One could make the argument that, over time, evidence-based practice became research-focused rather than patient-focused. C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R O P R A C T I C E C O N O M I C S 41 http://www.mybreakthrough.com/mdp?utm_source=chiroeco&ut m_medium=display&utm_campaign=issue4 http://ChiroEco.com RESEARCHRESULTS activator.com 1-602-224-0220 PASADENA March 2, 2019 KANSAS CITY March 16, 2019 COLUMBUS March 23, 2019 DENVER April 6, 2019 ATLANTA April 13, 2019 CHICAGO
  • 8. April 27, 2019 DALLAS April 27, 2019 MINNEAPOLIS May 4, 2019 CALGARY May 18, 2019 TYSON’S CORNER June 1, 2019 Students can attend for $99 and New Doctors* for $179! REGISTER TODAY at www.Activator.com or call 1-602-224-0220 for more information ACTIVATOR METHODS SPRING 2019 SEMINAR SCHEDULE *A “New Doctor” is a doctor that has not attended a seminar in the last five years. Spring2019-ChiroEcon-2.25x9.625-061918.indd 1 1/25/19 9:54 AM
  • 9. its way into the lexicon of health care providers. While it may seem like mincing words, there is a significant difference between what has become evidence- based practice and this newer approach. Proponents of EIP suggest that the goal of collecting evidence to help inform a provider on a particular case should go further than the singular goal of reducing bias and that a wider range of research information should be used. Estabrooks advocated that providers add “some of our own conventional wisdom and common sense” and give higher value to qualitative studies, case reports, scientific principles and expert opinions.3 Miles and Loughlin have promoted the use of evidence-informed practice to mean the process is person-centered rather than research and evidence-focused4 and this is, perhaps, the most important distinction between evidence-informed and evidence-based practice styles. To better illustrate the differences in evidence-based and evidence-informed practices, let us consider two therapies gaining popularity among manual therapists and chiropractors: cupping and compression “flossing.” Cupping gained wide popularity in the United States during the 2016 Olympics when U.S. swimmer Michael Phelps was seen with the now-familiar cupping marks on his shoulder and back. The media
  • 10. exploded with curiosity about cupping therapy. Of course, the endless debates about “if it works” or not came with it. Cupping and compression-band flossing Cupping has been used for more than 3,000 years throughout Asia, Greece, Egypt and the Saharan region, Iran, and throughout the Muslim world. A medical textbook published in Europe in 1694 shows an illustration of a man having cupping performed on his buttocks. Yet, a 2014 systematic review of cupping concluded that, “because of the unrea- sonable design and poor research quality, the clinical evidence of cupping is very low,” and a 2011 review found that, “the effectiveness of cupping is currently not well-documented for most conditions.” Compression-band flossing, aka “voodoo flossing,” has quite a fuzzy An evidence-informed approach would combine anecdotal evidence, the potential underlying mechanisms, risk and reward analysis, and would balance these against EBP guidelines that suggest that an intervention for low back pain, for example, should yield significant
  • 11. objective changes within a trial of six visits. 42 C H I R O P R A C T I C E C O N O M I C S • M A R C H 1 1 , 2 0 1 9 C H I R O E C O . C O M http://www.activator.com?utm_source=chiroeco&utm_medium= display&utm_campaign=issue4 http://ChiroEco.com RESEARCHRESULTS history; however, there is clear evidence of it being utilized in powerlifting gyms before gaining popularity in the CrossFit community through the book and videos of physical therapist Kelly Starrett. Today it is rare to not see it being practiced by laypeople in these settings. A Pubmed search performed by this author found only two peer-reviewed articles on flossing. The first had to do with ankle range of motion, jumping and sprinting performance, and the second was a follow-up to that study. Compression flossing is widely used, yet there is essentially no evidence for or against it in the literature. Strict adherents to EBP would likely pass over both cupping and flossing as options for patients with neuromusculoskeletal problems. Flossing has no apparent high-quality research
  • 12. for or against it at all, and the systematic reviews of cupping are not favorable. Comparatively, the evidence-informed approach would look at more types of evidence. Cupping has been used in a variety of cultures for thousands of years and flossing, while much newer, is commonly used in athletic circles. An evidence-informed practitioner would take this anecdotal evidence and use into account. Furthermore, an EIP approach takes into higher account the principles underlying these therapies. Both therapies engage the skin and underlying tissues like fascia and muscle. Cupping creates decompression of tissues while flossing creates compression. Providers can manipulate the cups or floss once they are placed, creating shear patterns in the tissues; and it is known that certain receptors (Ruffini endings) in tissues respond favorably to shear and compression and can create local and global tissue tone changes.5 Cupping and flossing create increased sensory input into the areas they are applied to. Given that acute and chronic pain has been shown to “smudge” the sensory cortex’s representation of affected body parts6 and have a negative effect on tactile acuity,7,8 could adding
  • 13. stimulation to these areas via cups or floss have a beneficial effect for patients? Cupping and flossing both allow for the addition of active movement, creating different types of strain, shear and the potential for haptic feedback that allows patients to use cups as targets for movement patterns — or, when coupled with compression bands, to maintain body positions during movements in tasks that make them maintain a certain amount of tension in a band through a movement.5 There is no evidence, for or against, the use of cupping or compression flossing when coupled with meaningful movement; however, there is certainly biological plausibility and foundational science that supports the potential of 44 C H I R O P R A C T I C E C O N O M I C S • M A R C H 1 1 , 2 0 1 9 C H I R O E C O . C O M http://www.impacinc.net?utm_source=chiroeco&utm_medium=d isplay&utm_campaign=issue4 http://ChiroEco.com RESEARCHRESULTS R E FE R E N CE S 1 Sackett DL, et al. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996;312:71-72.
  • 14. 2 Woodbury GM and Kuhnke JL. Evidence-based practice vs. evidence-informed practice: What’s the difference? Wound Care Canada. 2014;12(1):18-21. 3 Estabrooks CA. Will evidence-based nursing practice make practice perfect? Canadian Journal of Nursing Research. 1998;30(1):15-36. 4 Miles A and Loughlin M. Models in the balance: evidence- based medicine versus evidence-informed individualized care. Journal of Evaluation in Clinical Practice. 2011;17:531-536. 5 Capobianco S. FMT RockPods and FMT RockFloss. Seminar presented at the meeting of RockTape Instructors, Cancun, Mexico. January 2019. 6 Schabrun SM et al. Smudging of the motor cortex is related to the severity of low back pain. Spine. 2017 Aug 1;42(15):1172-1178. 7 Harvie DS. Tactile acuity is reduced in people with chronic neck pain. Musculoskelet Sci Pract. 2018 Feb;33:61-66. 8 Adamczyk W et al. Lumbar tactile acuity in patients with low back pain and healthy controls: systematic review and meta-analysis. Clin J Pain. 2018 Jan;34(1):82-94. these therapies. An evidence-informed approach would combine anecdotal
  • 15. evidence, the potential underlying mechanisms, risk and reward analysis, and would balance these against EBP guidelines that suggest that an intervention for low back pain, for example, should yield significant objective changes within a trial of six visits. Such an approach does not throw the evidence that is available out the window, nor does it so rigidly adhere to a certain type of study that it stifles the potential for outcomes in an intervention with the patient. This type of approach is patient- focused and outcome-focused and has the best potential for putting the needs of the patient first before all else. STEVE AGOCS, DC, is assistant dean of chiropractic education at Cleveland University- Kansas City as well as a course instructor on chiropractic history and technique. Agocs is a post-graduate educator sponsored by RockTape with an interest in movement, instrument assisted soft tissue manipulation, kinesiology taping, functional cupping, flossing and pain science. He can be contacted at [email protected] C H I R O E C O . C O M M A R C H 1 1 , 2 0 1 9 • C H I R O P R A C T I C E C O N O M I C S 45 http://www.impacinc.net?utm_source=chiroeco&utm_medi um=d isplay&utm_campaign=issue4 http://ChiroEco.com
  • 16. Copyright of Chiropractic Economics is the property of Doyle Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Research H o w To R ead a Research Article b y Brian K. W alsh, MBA, RRT-NPS, FAARC There are several reasons why a respiratory therapist should read a research article. This article will review a few to highlight the importance of reading and under- standing research articles. The first, and likely the best, reason to read is the pro- fessional obligation to m aintain competence. Respira- tory care is a profession and one of the aspects of being a professional is the capability to self-teach, self-learn and evolve your practice. Respiratory therapists are accused of practicing the same way they were taught in respira- tory school. If you ever wonder why our practice varies, it’s likely because of the influence of research articles. To maintain relevance, we must review scientific articles. The second reason to read research is to review an article in preparation for an upcoming meeting or dis-
  • 17. cussion. Our practice should be reviewed as part of a comprehensive quality-improvement process. This is healthy, and we should always look to improve our prac- tice and associated outcomes. The third reason is for the joy of it. Now, I know you are starting to laugh, but I really do enjoy exploring re- search articles. It’s not the reading or mental exercise I enjoy, it’s the practice change that improves the care we provide that warms my heart. Now that you have picked a research article to read from the reasons above or others, I have a few sugges- tions in how to tackle a research article. Be skeptical or suspicious Read critically. I often skip the abstract and go right to the introduction. Within the introduction the authors are tasked with introducing the problem or topic and convincing you there is a problem and that they believe a new way is needed. Often, if you first read the abstract and stop there, you miss the full message. The abstract is the h a rd s e ll, is word limited and often very dense. If the introduction doesn’t pull you in, then you should move on to another article that does. If the authors’ introduc­ tion pulls you in, then continue on, but don’t assume the authors are right — critically critique their assumptions, logic, and reasoning. Identify the question Summarize the introduction in a few sentences. I often highlight three or four sentences and rewrite the question to fully synthesize the problem and ques- tion. The research question should be toward the end
  • 18. of the introduction. Rewriting the question helps you identify possible conclusions. I even list some possible conclusions. A newer section most journals are offering now is a quick look or brief summary section th at helps you identify within a few sentences the current practice and what this paper contributes to our understanding. Identify the method to their m adness The m ethods section often intimidates the reader. This section is responsible for the perception you are either a researcher or a genius to be able to understand a research article; this is simply not true. The methods section is typically action packed and may take some work to understand, but it can be done. Certain proce- dures or methods may be understood by the authors and even reviewers. However, this can translate within the authors’ mind that everyone understands the m eth­ ods when the reader does not. This leads to the occa- sional miscommunication, but don’t let th at stop you. To truly understand, you may have to look up referenced methods if they aren’t explained completely. Diagram­ ming each experiment and the order of events can help. I am a visual thinker and this often helps me more fully understand the results. Read creatively Based on your experience and expertise, start to take a guess at the results or conclusions. It’s easy to find fault, but there comes a time in the article to get excited about the opportunity and switch to a more creative or positive evaluation. What are some of the opportunities? Could you implement changes in your practice? Could
  • 19. this help your patients? 3 2 AARC T im e s M a rc h 2 0 1 6 R e s e a r c h Drumroll please The results are often sentences of facts and very dry to read. Because our mind can out process (out- put) our reading speed (input) this becomes a source of confusion. Since your mind is already creating a dia- log and developing conclusions before you completely read the results, you m ust try not to jump to conclu- sions. Focus on words like “significant” or “non-sig- nificant.” Check out the graphs and tables — they are often the best way to fully understand the data. Sta- tistical analysis is standardized by study design and data type. Don’t be afraid to look up these methods, as they have strengths and weaknesses that should be understood. Look for p-values < 0.05. P-values less than a given significance level (0.05) suggest that the observed data is inconsistent with the null hypothe- sis. Some researchers refer to p-values of 0.05-0.1 as a trend. If it didn’t reach statistical significance but was coming close, this may be something to watch or to consider studying in the future. Explore the gab section The discussion section is a very valuable section of the au- thors’ thoughts and limitations. This section is a synthesis of
  • 20. the introduction, methods, and results that won’t be in the con­ clusion. The discussion section is a place to find some of your u n - answered questions. Authors will elaborate on design strengths or weaknesses, unexpected results, and possible future directions. Read the conclusion last I know this is likely contrary to what others have taught, but reading the conclusion first often leads to im proper conclusions. The conclusion can only be read in the context of the entire study. If you are provided proof, it’s time to turn your healthy skepticism to acceptance and get to work al- lowing the research to positively influence your practice. Compare results If possible, look up the refer- ences or similar research. Learn what others think of the research. Is this sim ilar or different to what others have found? If the research paper is a lit- tle older, is it cited in review articles? Editorials are a wonderful source to see experts in the profession debate relevance and impact. Not all research articles will have an accompanying editorial, but if they do, it’s worth the extra read.
  • 21. Research manuscripts are the most common way scientific information is distributed because reading is the most common and universal way we learn. In this information age, new knowledge is being published every day, and it can be overwhelming. Reading a re- search article takes work, but there are a few tricks that can help improve your efficiency. • Develop a method of reading that works for you. Set aside time each week to read or work on your method to improve yourself professionally. This is one of the healthiest habits you can develop. • Skim titles in journals. Respiratory Care is a won­ derful resource and is our profession’s science jour­ nal. Skim the titles and read every month. The editors and reviewers have your best interest in mind. Each month they prepare state-of-the-art articles for your viewing pleasure. If you only had time to read one journal, Respira- tory Care would be my choice. • Use technology. Technology can help identify and sort informa- tion. Most major medical search engines allow you to set up an account with notifications. When articles are published that meet your search criteria, you will re- ceive a notification. Most jour- nals have Facebook or Twitter accounts th at you can follow to get the latest updates. I also use apps like UpToDate and Docphin
  • 22. to help organize topics and re- view hot topics more efficiently. While technology is positively impacting our research productiv- ity and acquisition of knowledge, there is no replacement for critical and creative reading of research articles. There are no fancy short- cuts and, unfortunately, know- ing the literature alone will not improve your practice. The best achievable result is being able to apply your newly found knowl- edge from reading a research arti- cle to your daily practice. ■ ABOUT THE AUTHOR B rian K. W alsh , MBA, RRT- NPS, FAARC, is clin ical r e s e a rc h c o o rd in a to r in th e d e p a r t m e n t o f a n e s th e s ia , d iv isio n o f c ritic a l care, a t B o sto n C h ild re n ’s H o sp ital in B oston, MA, a n d a PhD s t u d e n t a t R ush U n iv e rsity in C hicago, IL. He is th e AARC’s p re s id e n t- e le c t. 34 AARC Times March 2016 Copyright of AARC Times is the property of Daedalus
  • 23. Enterprises, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Stats & FactsOBSERVER FPAJournal.org12 Journal of Financial Planning | August 2016 OBSERVER “With the fi nalization of this rule, we are putting in place a fundamental protection into the American retirement landscape.” —Thomas Perez, U.S. Secretary of Labor, referring to the DOL’s Confl ict of Interest Final Rule, ThinkAdvisor How to Evaluate
  • 24. Research-Based Writing Retreat attendees. “They know how to conduct research, but they don’t always know what the critical questions are that you need answers to.” EVERY MONTH you get the Journal, you may wonder about the academic contributions. Most likely they are help- ful to you, but perhaps there are times when you aren’t quite sure what to make of that research. The Journal’s practitioner editor Dave Yeske, DBA, CFP®, co-owner of the planning fi rm Yeske Buie, notes that in order to become a true profession, advisers need to base their practices on research-based writing. And in order to do that, advisers need to understand how to evaluate such writing. At FPA Retreat in April, Yeske gave a presentation on how to read and apply research-based writing. He provided eight questions to ask yourself in order to better evaluate research-based writing. 1. What is the problem or ques- tion? What are the researchers trying to address? 2. How did they conceptualize that problem; how did they structure it? Look for what the researchers are measuring. For example, client trust and relationship commitment have
  • 25. become well-represented measures in fi nancial planning literature. 3. What are the key fi ndings from prior research? Good research will build on research that came before to lay the foundation for the current research to build upon. 4. What was their methodol- ogy? Does it seem like the researchers make sense? 5. What were the results of the testing? A formal academic paper will never prove anything, Yeske said. Rather, it will fail to disprove something. 6. Were the results compelling? Do the authors connect all the dots for you? Does their data answer the question? 7. What are the practical applica- tions? Do the researchers tell you how you could use this informa- tion? If not, are you still able to fi nd a practical use for the data that is being presented? 8. Will this change the way you practice? Will you be able to incorporate this into your practice?
  • 26. “As a profession we need to all become better at recognizing research- based writing and [being] able to apply it,” Yeske said. For more information on applying theory to practice, visit the FPA Theory in Practice Knowledge Circle, www. OneFPA.org/Community/Knowledge- Circles. “We need to deepen our connection with academics,” Yeske said to FPA Copyright of Journal of Financial Planning is the property of Financial Planning Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.