CHIR12005 - Foundations of Chiropractic Practice 3
Term 1 - 2017


All details in this unit profile for CHIR12005 have been officially approved by CQUniversity and represent a learning partnership between the University and you (our student). The information will not be changed unless absolutely necessary and any change will be clearly indicated by an approved correction included in the profile.

Overview

This unit continues from Foundations of Chiropractic Practice 2. You will build your knowledge of the principles and practice of chiropractic management approaches. You will demonstrate your psychomotor skills acquisition in manipulative/adjusting techniques of the thoracic, lumbar spine and lower extremities. You will review your muscle testing and musculoskeletal screening assessment protocols GALS (gait, arms, legs, spine). You will continue to improve your palpation skills. Throughout the unit, you will investigate chiropractic ethics, code of conduct, risk management and guidelines and will apply your knowledge of related functional anatomy, and biomechanics. You will continue to develop your critical thinking skills and awareness of current public health issues and its integration into chiropractic.

Details

Career Level Undergraduate
Unit Level Level 2
Credit Points 6
Student Contribution Band 2
Fraction of Full-Time Student Load 0.125

Pre-requisites or Co-requisites


Effective 2016:

Pre-requisite:

BMSC11001 Human Body Systems 1

and

CHIR11003 Foundations of Chiropractic Practice 2

Co-requisite:

CHIR12004 Neuromusculoskeletal Anatomy 1

Attendance Requirements

All on-campus students are expected to attend scheduled classes – in some units, these classes are identified as a mandatory (pass/fail) component and attendance is compulsory. International students, on a student visa, must maintain a full time study load and meet both attendance and academic progress requirements in each study period (satisfactory attendance for International students is defined as maintaining at least an 80% attendance record).

Offerings

Term 1 - 2017
  • Brisbane
  • Mackay
  • Sydney

Website

This unit has a website, within the Moodle system, which is available two weeks before the start of term. It is important that you visit your Moodle site throughout the term. Go to Moodle

Recommended Student Time Commitment

Each 6-credit Undergraduate unit at CQUniversity requires an overall time commitment of an average of 12.5 hours of study per week, making a total of 150 hours for the unit.

Class Timetable

Assessment Overview

Assessment Task Weighting
1. Practical Assessment 40%
2. Portfolio 20%
3. Examination 40%

This is a graded unit: your overall grade will be calculated from the marks or grades for each assessment task, based on the relative weightings shown in the table above. You must obtain an overall mark for the unit of at least 50%, or an overall grade of ‘pass’ in order to pass the unit. If any ‘pass/fail’ tasks are shown in the table above they must also be completed successfully (‘pass’ grade). You must also meet any minimum mark requirements specified for a particular assessment task, as detailed in the ‘assessment task’ section (note that in some instances, the minimum mark for a task may be greater than 50%). Consult the University’s Grades and Results Procedures for more details of interim results and final grades.

All University policies are available on the IMPortal.

You may wish to view these policies:

  • Grades and Results Procedure
  • Assessment Policy and Procedure (Higher Education Coursework)
  • Review of Grade Procedure
  • Academic Misconduct Procedure
  • Monitoring Academic Progress (MAP) Policy and Procedure – Domestic Students
  • Monitoring Academic Progress (MAP) Policy and Procedure – International Students
  • Refund and Excess Payments (Credit Balances) Policy and Procedure
  • Student Feedback – Compliments and Complaints Policy and Procedure
  • Acceptable Use of Information and Communications Technology Facilities and Devices Policy and Procedure

This list is not an exhaustive list of all University policies. The full list of University policies are available on the IMPortal.

Feedback, Recommendations and Responses

Every unit is reviewed for enhancement each year. At the most recent review, the following staff and student feedback items were identified and recommendations were made.

Feedback Source Recommendation
The faculty is aware of the challenges in a consistent delivery and assessment of the material in this unit. Changes have been put in place to standardise the learning outcomes and goals and to provide the student with more feedback opportunities in this unit. From ongoing Foundations faculty workshops; mentor-mentee processes in place; class representatives to help with communication challenges; and more strict monitoring This has prompted the construction of specific and well defined rubrics and marking criteria – with a detailed instruction to be given throughout the unit, by tutors, as all as focusing on the requirements of student self-directed learning.
On successful completion of this unit, you will be able to:
  1. Discuss the principles and practice of chiropractic management.
  2. Apply your psychomotor skills to adjusting/manipulative set-ups at an intermediate level for the thoracic, lumbar spine and lower extremities.
  3. Demonstrate soft tissue therapeutic procedures and non-force techniques at an intermediate level.
  4. Analyse the body using functional analysis and musculoskeletal assessment protocols eg GALS (gait, arms, legs and spine)
  5. Recognise findings from your musculoskeletal assessment including observation, range of movement and motion palpation to recommend appropriate chiropractic management protocols.
  6. Describe issues pertaining to chiropractic ethics and the code of conduct.
  7. Investigate matters pertaining to current public health issues and how they impact clinical care.

Alignment of Assessment Tasks to Learning Outcomes

Assessment Tasks Learning Outcomes
1 2 3 4 5 6 7
1 - Practical Assessment      
2 - Portfolio          
3 - Examination      

Alignment of Graduate Attributes to Learning Outcomes

  • Introductory Level
  • Intermediate Level
  • Graduate Level
Graduate Attributes Learning Outcomes
1 2 3 4 5 6 7
1. Communication  
2. Problem Solving      
3. Critical Thinking        
4. Information Literacy    
5. Team Work        
6. Information Technology Competence            
7. Cross Cultural Competence      
8. Ethical practice  

Alignment of Assessment Tasks to Graduate Attributes

  • Introductory Level
  • Intermediate Level
  • Graduate Level
Assessment Tasks Graduate Attributes
1 2 3 4 5 6 7 8
1 - Practical Assessment      
2 - Portfolio      
3 - Examination      

Prescribed Textbooks

Chiropractic Technique
Author/s: Thomas F. Bergmann, David H. Peterson Year: 2010
Edition: 3rd ed Publisher: Mosby Elsevier
City: Philadelphia State: PA
Country: USA
View textbooks at the CQUniversity Bookshop

Other Resources

These are not compulsory, but may assist you:
Functional Anatomy Musculoskeletal Anatomy, Kinesiology and Palpation for Manual Therapists
Author/s: Christy Cael Year: 2010
Edition: 1st ed Publisher: LWW
City: Baltimore State: MD 21201
Country: United States
Muscle Manual
Author/s: Nikita A. Vizniak Year: 2008
Edition: 1st edn Publisher: Professional Health Systems
Country: Canada
Extremity Manual Textbook
Author/s: Nikita A.Vizniak Year: 2014
Edition: 1st edn Publisher: Professional Health Systems
Country: Canada
Blink: The Power of Thinking Without Thinking
Author/s: Malcolm Gladwell Year: 2007
Edition: 1 edn Publisher: Back Bay Books
Country: United Kingdom
The Doctors Who Give No Medicine: The science and results of Upper Cervical Spinal Care:
Author/s: Jeffrey Hannah Year: March 6, 2013
Edition: 1st ed Publisher: International Health Publishing
Country: Australia
Other resources may be available at CQUniversity Library. Note:

Functional Anatomy Musculoskeletal Anatomy, Kinesiology and Palpation for Manual Therapists is the essential textbook for students of Foundations of Chiropractic Practice 3 as it provides students with the essential peripheral anatomy and biomechanics they will need in order to cover the required peripheral biomechanics and develop their peripheral psychomotor skills.

The Nikita A. Vizniak texts bridge the gap between classroom education and practical clinical application.They contain current, easily accessible information on topics including musculoskeletal anatomy, muscle testing, palpation, trigger point referral patterns and more.

IT Resources

You will need access to the following IT resources:
  • CQUniversity Student Email
  • Internet
  • Unit Website (Moodle)
All submissions for this unit must use the Harvard (author-date) referencing style (details can be obtained here), OR American Psychological Association (APA) referencing style (details can be obtained here). For further information, see the Assessment Tasks below.
Unit CoordinatorMartin Harris (m.harris@cqu.edu.au)
Note: Check the Term-Specific section for any additional contact information provided by the teaching team
Week Begin Date Module/Topic Chapter Events and Submissions
Week 1 06-03-2017

1. Overview : Course Introduction; Formative Assessment Tasks and Learning Outcomes; The Flipped Classroom Approach

2. Osteology and Myology of the Upper Limb

3. Biomechanics of the Upper Limb

4. Chirobics Drills

5. Introduction to Reflective Writing; Usage of Mahara for ePortfolio

6. Lab Orientation and Skills Chirobics

Powerpoint presentations and/or Videos; Additional resources will be available on moodle

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 2 13-03-2017

1. Listing System: GORP OMN; Palpation of Thoracic Spine

2. Thoracic Spine Osteology and Myology

3. Thoracic Spinal Biomechanics

4. Thoracic Set Ups and Adjustments

5. Vitalism/ Materialism

6. Public Health as applies to the Impact of Musculoskeletal Health

Powerpoint presentations and/or Videos; Bergman & Peterson pages 215- 217

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 7

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 3 20-03-2017

1. Trigger Point Therapy

2. Thoracic Spine Osteology and Myology continued

3. Thoracic Spine and Breathing Posture and Role of Exercise

4. Thoracic Set Ups and Adjustments

5. Epistomology; Principles of Chiropractic Philosophy

6. Naturalism

Powerpoint presentations and/or Videos; Bergman & Peterson pages 221- 223

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 7

Muscle Manual: Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 4 27-03-2017

1. Trigger Point Therapy of Lower Limb

2. Lumbar Spine Osteology and Myology

3. Lumbar and Lumbopelvic Region

4. Lumbar Spine Set Ups and Adjustments

5. Chiropractic Health Care message

6. Reintroduction to Critical Thinking

Powerpoint presentations and/or Videos; Bergman & Peterson pages 253-258

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 7

Muscle Manual: Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 5 03-04-2017

1. Lumbar Pelvic Region

2. Lumbar Spine Osteology and Myology continued

3. Lumbar and Lumbopelvic Region

4. Lumbar Spine Set Ups and Adjustments

5. Role of the Chiropractor as a Primary Contact Primary Care Practitioner in the Realm of Public Health and Wellbeing

6. Health Promotion Campaign

Powerpoint presentations and/or Videos; Bergman & Peterson pages

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 7

Muscle Manual: Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Vacation Week 10-04-2017

Vacation Week - No Scheduled activities or Lectures

Week 6 17-04-2017

1. Hip and Pelvis

2. Hip Osteology and Myology; Sacrum and Pelvis

3. Review Lower Limb Muscle Tests; Pelvis and Hip Biomechanical Dysfunction; Lower Crossed Syndrome

4. Hip Motion palpation Set Ups and Adjustments

5. What are Clinical Guidelines?

Powerpoint presentations and/or Videos; Bergman & Peterson pages 337- 349

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 8

Muscle Manual: Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 7 24-04-2017

1. Knee Joint

2. Knee Osteology and Myology

3. Biomechanics of the Knee

4. Knee palpation Set Ups and Adjustment

5. Professionalism and APRHA

Powerpoint presentations and/or Videos; Bergman& Peterson pages 349- 359

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 8

Muscle Manual :Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 8 01-05-2017

1. Ankle and Foot

2. Ankle and Foot Osteology and Myology

3. Gait Analysis

4. Ankle and Foot Set Ups and Adjustments

Powerpoint presentations and/or Videos; Bergman & Peterson pages 364-372

Functional Anatomy; Christy Cael Lippincott Williams & Wilkins Chapter 9

Muscle Manual: Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 9 08-05-2017

1. Postural Functional Assessment GALS (Gait, Arms, Legs, Spine)

2. GALS Assessment

3. Evolution of Chiropractic Medicine.

4. Systematic Review Meta Analysis and their impact on Clinical Practice

Powerpoint presentations and/or Videos; Bergman & Peterson pages

Muscle Manual:Dr N. Vizniak

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term: On Line Quiz

Week 10 15-05-2017

1. Neurological Examination and Clinical Assessment

2. Lifting and Sitting Biomechanics

3.Review Set Ups and Adjustments

4. Neurological Examination of the Lower Limb

Powerpoint presentations and/or Videos;

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

Week 11 22-05-2017

1. Review Material and Practice OSCE

2. Outcome Measures

3. Finish Entries in ePortfolio

4. Mock OSCE

Powerpoint presentations and/or Videos;

In-Class Activity within the practical labs each week. Each weeks's activity will vary in content and will involve all learning outcomes for this unit throughout the term.

ePortfolio Written Assessment Due Friday (26 May 17) 05:00 PM AEST
Week 12 29-05-2017

1. Review Material for end of term

2. OSCE

Powerpoint presentations and/or Videos;

No In-Class Activity scheduled for this week but wil address any concerns for the upcoming OSCE.

Practical Assessment

Practical Assessment OSCE Due Thursday (01 Jun 17) 04:00 PM AEST
Review/Exam Week 05-06-2017

REVIEW EXAMINATION WEEK

Exam Week 12-06-2017

EXAMINATION WEEK

CHIR12005 is the 3rd unit in Foundations of Chiropractic Practice program.

A weekly Zoom session will be made available to each of you to attend and obtain direction on any of the topics required in this unit. They will be scheduled every week (QLD) time throughout this term. There will also be a Q & A Forum setup where you can be encouraged to ask questions that you may have. This forum will monitored as some of the answers you obtain will be shared to all.

The tutors will be expected to attend weekly meetings and discussions with the unit co-ordinator so that everyone will be consistent in delivery of material and answers to questions.

If you wish to speak to the tutors, they can, in turn, forward details to myself for the benefit of the entire 2nd year cohort.

I can be contacted on m.harris@cqu.edu.au

1 Practical Assessment

Assessment Title Practical Assessment OSCE
Task Description

In practice, the chiropractor is required to combine a variety of psychomotor skills. All skills/techniques taught within this unit must be mastered. You must have a strong understanding of their applications. The primary focus of this assessment will be on the contextual nature of the adjustment/manipulation in addition to refining the skill itself. Each of these stations will require the student to complete various techniques over a specific time period, with an allowance of 1 minute reading/planning time prior to the commencement of the assessment.

Station 1 - You will be required to perform two lower limb adjustments from those covered in the course demonstrating correct technique, appropriate patient handling. Furthermore, you will be required to perform the physical examination components below correlating your findings to your examiner by viva voce:

  1. Observational analysis of the region in question;
  2. Static palpation of the region;
  3. Range of motion assessment of the joint;
  4. Motion palpation of the joint;
  5. Perform the appropriate adjustment for the lesion in question.

The tasks will be allocated to you randomly according to series of station cards which have been previously composed.

Station 2 - Performance of GALS (Gait, Arms, Legs and Spine) functional assessment demonstrating the correct technique with appropriate patient handling and viva voce assessment. The tasks will be allocated to you randomly according to series of station cards which have been previously composed.

Station 3 - You will be required to perform two spinal adjustments demonstrating correct technique, appropriate patient handling. Furthermore, you will be required to perform the physical examination components below correlating your findings to your examiner by viva voce:

  1. Regional structural analysis of the region in question;
  2. Gross range of motion assessment of a spinal region;
  3. Regional static palpation of the spinal region;
  4. Segmental range of motion assessment of a spinal segment;

Must perform the appropriate adjustment for the lesion in question. The tasks will be allocated to you randomly according to series of station cards which have been previously composed.

Please note:

  1. You present for your OSCE dressed as you would present to a skills class environment. Any student not adhering to the dress code may be excluded from the assessment;
  2. Each station is timed. You will have the set time to complete the station, therefore if a station is not completed within the allocated time the practical element will be stopped and you will be marked based on your performance to that point;
  3. Clinical and skills staff may be present as part of the examiners on the assessment date;
  4. The assessment will be recorded using a video camera to enable moderation, however, these recordings will not be available for student feedback.
Assessment Due Date Week 12 Thursday (01-Jun-2017) 04:00 PM AEST
The practical test will be held on campus in the scheduled time for this course. The test will be held in the practical room.
Return Date to Students Review/Exam Week Friday (09-Jun-2017)
The results will be visible in Moodle
Weighting 40%
Assessment Criteria

Station 1 - Your performance will be graded using a marking rubric which will be provided to you in Week 10 when the course focus switches to exam preparation. This marking rubric will grade your performance according to the following:

  • Infection control
  • Draping
  • Verbal Consent
  • Static palpation of the region
  • Range of motion assessment of the joint
  • Motion palpation of the joint
  • Perform the appropriate adjustment for the lesion in question
  • Appropriate interpretation of findings
  • Practitioner position
  • Patient position
  • Patient handling
  • Examiners over all impression

Station 2 - Your performance will be graded using a marking rubric which will be provided to you in Week 10 when the course focus switches to exam preparation. This marking rubric will grade your performance according to the following areas:

  • Infection control
  • Verbal Consent
  • Static palpation of the region
  • Range of motion assessment of the joint
  • Clear Instructions given
  • Patient handling
  • Technical performance

Station 3 - Your performance will be graded using a marking rubric which will be provided to you in Week 10 when the unit focus switches to exam preparation. This marking rubric will grade your performance according to the following area:

  • Infection control
  • Draping
  • Verbal Consent
  • Static palpation of the region
  • Range of motion assessment of the joint
  • Motion palpation of the joint
  • Perform the appropriate adjustment for the lesion in question
  • Appropriate interpretation of findings
  • Practitioner position
  • Patient position
  • Patient handling
  • Examiners over all impression
Conditions Minimum mark or grade - 50%. Further information can be found in Moodle. You must achieve the minimum grade in order to pass this course.
Referencing Style Harvard (author-date) or American Psychological Association (APA)
Submission Hard copy

Practical assessments are performed in-class in the scheduled time

Learning Outcomes Assessed
This section can be expanded to view the assessed learning outcomes

2. Apply your psychomotor skills to adjusting/manipulative set-ups at an intermediate level for the thoracic, lumbar spine and lower extremities.

3. Demonstrate soft tissue therapeutic procedures and non-force techniques at an intermediate level.

4. Analyse the body using functional analysis and musculoskeletal assessment protocols eg GALS (gait, arms, legs and spine)

5. Recognise findings from your musculoskeletal assessment including observation, range of movement and motion palpation to recommend appropriate chiropractic management protocols.

Graduate Attributes
This section can be expanded to view the assessed graduate attributes

1. Communication

2. Problem Solving

3. Critical Thinking

5. Team Work

8. Ethical practice



2 Portfolio

Assessment Title ePortfolio Written Assessment
Task Description

In this unit you will further develop your understanding of the role and skill sets required of a chiropractor through investigating the knowledge, skills and dispositions required. To help with your development on this journey of self-discovery you will create a journal for each lecture you attend and provide reflections of the On-Campus activities discussions, activities and material presented during the term. The journal provides evidence of the quality and quantity of your in-class learning.

Your ePortfolio can be used as a way to evaluate and enhance your learning and/or be used to critically reflect and develop deeper learning. It may be used to evolve skills set which will be essential during your professional career such as documenting your professional portfolio, professional achievements and continued professional development.

Assessment Due Date Week 11 Friday (26-May-2017) 05:00 PM AEST
Via turnitin
Return Date to Students Review/Exam Week Friday (09-Jun-2017)
Via turnitin
Weighting 20%
Assessment Criteria

You will be required to reflect on the theoretical and practical content of the unit and enter comments in your journal which can be then entered electronically into your ePortfolio.

Throughout the term you will be given on-campus activities (based upon the learning outcomes for this unit) that you will comment and reflect on in your ePortfolio and will involve the following criteria.

1. Does the student discuss the principles and practice of chiropractic management?

2. Can the student demonstrate psychomotor skills of adjusting/manipulative set-ups at an intermediate level for the thoracic, lumbar spine and lower extremities?

3. Does the student demonstrate soft tissue therapeutic procedures and non-force techniques at an intermediate level?

4. Can the student analyse the body using functional analysis and musculoskeletal assessment protocols eg GALS (gait, arms, legs and spine)?

5. Does the student recognise findings from your musculoskeletal assessment including observation, range of movement and motion palpation to recommend appropriate chiropractic management protocols?

6. Can the student describe issues pertaining to chiropractic ethics and the codes of conduct?

7. Can students investigate matters pertaining to current public health issues and how they impact clinical care?

Note that you will continue to develop your portfolio in future units in the course.

There will be a specific rubric for the ePortfolio that is available in your Moodle site that you can refer to for further information.

There will be a specific rubric for each on- campus activity that your unit co-ordinator and /or tutor will complete each week for CHR12005 on-campus activity.

You will receive a PASS/FAIL for all in on-campus activities which is required to continue to CHIR12006 in Term 2 – regardless of the OSCE practical and Final Examination results.

Conditions Minimum mark or grade - 50%. Further information can be found in Moodle. A minimum grade is required to pass this subject.
Referencing Style Harvard (author-date) or American Psychological Association (APA)
Submission Online

Via Turnitin

Learning Outcomes Assessed
This section can be expanded to view the assessed learning outcomes

6. Describe issues pertaining to chiropractic ethics and the code of conduct.

7. Investigate matters pertaining to current public health issues and how they impact clinical care.

Graduate Attributes
This section can be expanded to view the assessed graduate attributes

1. Communication

2. Problem Solving

3. Critical Thinking

4. Information Literacy

6. Information Technology Competence



Examination

Outline Complete an examination
Date During the University examination period
Weighting 40%
Condition Minimum percentage of examination marks required to pass course - 50%. Further information can be found in Moodle. You must achieve the minimum grade in order to pass this course.
Length 120 minutes
Details Dictionary - non-electronic, concise, direct translation only (dictionary must not contain any notes or comments).
No Calculators Permitted
Closed Book
Learning Outcomes Assessed
This section can be expanded to view the assessed learning outcomes

1. Discuss the principles and practice of chiropractic management.

4. Analyse the body using functional analysis and musculoskeletal assessment protocols eg GALS (gait, arms, legs and spine)

6. Describe issues pertaining to chiropractic ethics and the code of conduct.

7. Investigate matters pertaining to current public health issues and how they impact clinical care.

Graduate Attributes
This section can be expanded to view the assessed graduate attributes

1. Communication

2. Problem Solving

3. Critical Thinking

4. Information Literacy

6. Information Technology Competence

Engagement

CHIR12005 aligns with the University graduate capabilities and generic skills that ensures you can engage with the workplace and wider community

Graduate Attributes

Graduate attributes are aligned with the learning outcomes with the formative on-campus activity,

examination and portfolio.

Indigenisation of Curriculum

Consideration is given to aboriginal and Torres Strait islander aspects of musculoskeletal conditions and

culturally competent patient care particularly with regard to adjusting skills. Course and research material

are reviewed for their aboriginal and Torres Strait Islander cultural sensitivity.

Internationalisation of Curriculum

Course readings include relevant international information including references. Students are encouraged

to search for information internationally and think about their studies and future working life in an

international context.

Sustainability

Consideration is given to course lectures, readings and teaching that do not have negative consequences

for future generations. Ergonomic or health and safety considerations are relevant in CHIR12005.

Work Related Learning

Program knowledge, practice/research skills, ethical conduct and professional behaviour are taught to improve patient related care.


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