Monday, November 24, 2014

Thanksgiving. Thank You.!

On this occasion of a short week and a time to celebrate thanks, I send mine to you. I am grateful to all who work here, who give so much of their time and their energy. I hope that you enjoy the time off later this week, I hope you are with family (as I will be- 3 children coming, with 3 spouses, 1 grandchild and 1 twin sister to a spouse), and I hope that you are able to eat, relax and catch your breath.

Happy Thanksgiving!

Monday, November 17, 2014

Three New Papers

Rowher A, Schoonees A, Young T. Methods used and lessons learnt in conducting document reviews of medical and allied health curricula - a key step in curriculum evaluation. BMC Medical Education 2014, 14:236  doi:10.1186/1472-6920-14-236

ABSTRACT
Background: This paper describes the process, our experience and the lessons learnt in doing document reviews of health science curricula. Since we could not find relevant literature to guide us on how to approach these reviews, we feel that sharing our experience would benefit researchers embarking on similar projects.
Methods: We followed a rigorous, transparent, pre-specified approach that included the preparation of a protocol, a pre-piloted data extraction form and coding schedule. Data were extracted, analysed and synthesised. Quality checks were included at all stages of the process.
Results: The main lessons we learnt related to time and project management, continuous quality assurance, selecting the software that meets the needs of the project, involving experts as needed and disseminating the findings to relevant stakeholders.

Conclusion: A complete curriculum evaluation comprises, apart from a document review, interviews with students and lecturers to assess the learnt and taught curricula respectively. Rigorous methods must be used to ensure an objective assessment.

Jones MR, West DJ, Harrington BJ, Cook CJ, Bracken RM, Shearer DA, Kilduff L. Match play performance characteristics that predict post-match creatine kinase responses in professional rugby union players. BMC Sports Science, Medicine and Rehabilitation 2014, 6:38  doi:10.1186/2052-1847-6-38
ABSTRACT
Background: Rugby union players can take several days to fully recover from competition. Muscle damage induced during the match has a major role in player recovery; however the specific characteristics of match play that predict post-match muscle damage remains unclear. We examined the relationships between a marker of muscle damage and performance characteristics associated with physical contacts and high-speed movement in professional rugby union players.

Methods: Twenty-eight professional rugby union players (15 forwards, 13 backs) participated in this study. Data were obtained from 4 European Cup games, with blood samples collected 2?h pre, and 16 and 40?h post-match, and were subsequently analysed for creatine kinase (CK). Relationships between changes in CK concentrations and number of physical contacts and high-speed running markers, derived from performance analysis and global positioning system (GPS) data, were assessed.
Results: Moderate and moderate-large effect-size correlations were identified between contact statistics from performance analysis and changes in CK at 16 and 40?h post-match in forwards and backs, respectively (e.g. backs; total impacts vs. ?CK (r?=?0.638, p?

Conclusions: Our data demonstrate that muscle damage induced by professional rugby union match play is to some extent predicted by the number of physical contacts induced during performance. Furthermore, we show for the first time that muscle damage in backs players is predicted by high-speed running measures derived from GPS. These data increase the understanding of the causes of muscle damage in rugby union; performance markers could potentially be used to tailor individual recovery strategies and subsequent training following rugby union competition.

Young KJ. Gimme that old time religion: the influence of the healthcare belief system of chiropractic’s early leaders on the development of x-ray imaging in the profession.School of Arts; Senior Lecturer, School of Health Professions, Murdoch University, South Street, Murdoch 6150, Australia  Chiropr ManTher 2014, 22:36  doi:10.1186/s12998-014-0036-5
ABSTRACT

Background: Chiropractic technique systems have been historically documented to advocate overutilization of radiography. Various rationales for this have been explored in the literature. However, little consideration has been given to the possibility that the healthcare belief system of prominent early chiropractors may have influenced the use of the diagnostic modality through the years. The original rationale was the visualisation of chiropractic subluxations, defined as bones slightly out of place, pressing on nerves, and ultimately causing disease. This paradigm of radiography has survived in parts of the chiropractic profession, despite lacking evidence of clinical validity. The purpose of this paper is to compare the characteristics of the chiropractic technique systems that have utilised radiography for subluxation detection with the characteristics of religion, and to discover potential historical links that may have facilitated the development of those characteristics.

Discussion: Twenty-three currently or previously existing technique systems requiring radiography for subluxation analysis were found using a search of the internet, books and consultation with experts. Evidence of religiosity from the early founders’ writings was compared with textbooks, published papers, and websites of subsequently developed systems. Six criteria denoting religious thinking were developed using definitions from various sources. They are: supernatural concepts, claims of supremacy, rules and rituals, sacred artefacts, sacred stories, and special language. All of these were found to a greater or lesser degree in the publicly available documents of all the subluxation-based chiropractic x-ray systems.
Summary: The founders and early pioneers of chiropractic did not benefit from the current understanding of science and research, and therefore substituted deductive and inductive reasoning to arrive at conclusions about health and disease in the human body. Some of this thinking and rationalisation demonstrably followed a religion-like pattern, including BJ Palmer’s use of radiography. Although access to scientific methods and research education became much advanced and more accessible during the past few decades, the publicly available documents of technique systems that used radiography for chiropractic subluxation detection examined in this paper employed a historically derived paradigm for radiography that displayed characteristics in common with religion.

 

Monday, November 10, 2014

Coursera

This will be a brief but an important post. You may have heard of Coursera. It is an education platform that “partners with top universities and organizations worldwide to offer courses online for anyone to take, for free.” And this is no small thing. Just to give you an idea of their power, I want to draw your attention to a program that was brought to my attention by my friend and colleague, Dr. Stephen Perle, of the University of Bridgeport College of Chiropractic. The specific course he told me about is entitled “Instructional Methods in Health Professions Education.”  It will be offered 4 times in the next year, with the next session beginning in February of 2015.

A link to information about this course can be found at https://www.coursera.org/course/instructmethodshpe. On this page, you can view an introductory video, look at the course objectives, and view the week-by-week format. It is free.
Please look this over and consider taking a course!

Monday, November 3, 2014

World Federation Educational Conference, Miami, October 30-November 1, 2014

I am just back from a program where I was fortunate enough to be a member of the planning committee. This was a program put on by the World Federation of Chiropractic, dedicated to looking at the educational advances and opportunities within the chiropractic profession. What follows below is the full list of presentations.

  • A Case Example of Change: Chiropractic Education and Practice in Denmark.
  • Ten-Year Experience of Chiropractic Services and Education in the US Veterans’ Administration Healthcare System.
  • Integration of Chiropractic Services in Primary Care Teams and Hospitals in the Province of Ontario, Canada.
  • Teaching an Inter-professional Approach to Managing Low Back Pain in the Primary Care Setting.
  • Chiropractors in Academic Hospitals: Opportunities for Integrated Education.
  • Interdisciplinary Clinical Training in a Chiropractic College Setting: Dental and Chiropractic Co-management of Temporomandibular Joint Disorders (TMD).
  • Inter-professional Education Initiatives to Improve Pain Care: the VA Connecticut Healthcare System Experience.
  • Interdisciplinary Clinical Education: Midwifery and Chiropractic Students’ Perceptions of Combined Service in a Chiropractic Teaching clinic in the UK.
  • Healthcare Professional Education and Chiropractic.
  • Establishing Interdisciplinary Practice in Two Challenging Environments: A View from the Field.
  • Incorporating Inter-professional Education (IPE) in a Curriculum – Benefits, Methods, Challenges.
  • Preparing Faculty and Students for Integrated Care – Values and Skills.
  • Creating a Climate for Innovation.
  • Scope of Diagnostic Imaging/Laboratory/Other Exams.
  • SMT Remains the Core – But What Other Manual Treatments?
  • McKenzie Method: Given its Evidence Base it Should be Core Curriculum.
  • The Role of Chiroprctic in Wellness and Lifestyle Assessment and Advice.
  • The Significance of Evidence-Based Care for Education and Practice Today.
  • The Rise and Role of Spinal Care Pathways.
  • The Jordan Hospital Spine Care Program.
  • Outcomes Chosen for CareResponse and Reasons Why.
  • EHR as the New Standard of Care: Empowering Outcomes, Evidence and Research.
  • The Masters and Doctors Degree Programmes in Chiropractic Medicine at the University of Zurich Faculty of Medicine: An Example of Interdisciplinary Education.
  • The Place of Anatomy Education in Inter-professional Health Curricula: An Example from Australia and New Zealand.
  • A Descriptive Study Relating the Experience of Radiographic Film Interpretation by Graduating Interns: Preliminary Results.
  • Faculty Development Increases Attitudes and Use of Evidence-Based Clinical Practice.
  • A Study to Describe Process of Introducing Validated Outcome Measures (CareResponse) as Part of Final Year Clinic Training and Management of Patients at the Welsh Institute of Chiropractic.
  • An Innovative Teaching Strategy Used to Address the Role of Chiropractors As Community Health Care Advocates: A Case Report .
  • Creating an Evidence-Based Teaching Program.
  • Establishing Inter-Professional Clinical Training Opportunities.
  • Alternate Career Paths – Research and Education.
  • Effective Use of the OSCE in Current Health Sciences Education.
  • Clinical Skills Testing for Chiropractic Licensure in a Changing Healthcare Environment: Signposts of Change and Navigating the Transition.
  • Accreditation Standards: Do they Require Amendment in the Changing Healthcare Environment: A North American View.
  • Accreditation Standards: Do they Require Amendment in the Changing Healthcare Environment: A European View.
  • Teaching Anatomy at Two New York City Medical Schools.
  • Serving as a Medical Director for Chiropractic for the Washington State Department of Labor and Industries.
  • For the NIH to PCORI and Lessons Learned.
  • The Canadian Experience.
  • The Role of a Chiropractic Researcher at Palladian Health.
  • Environment for Innovation: Exploring Associations with Individual Disposition Toward Change, Organizational Conflict, Justice and Trust.
  • Preparing the Leaders of Tomorrow – The Evolution of the Residency Program at the Canadian Memorial Chiropractic College.
  • Alternative Careers for Doctors of Chiropractic through a Master of Science Program in Clinical Research.
  • A Chiroprctic Academy of Educators.
  • Insertion of Chiropractic in Public Health System.
  • The “Flipped Classroom”.
  • What the Best College Teachers and Students Do.
  • Perspectives from Chiropractic Education.

Monday, October 27, 2014

The Rest of ASBH

And here are more programs from the recent conference of the American Society for Bioethics and Humanities. And may I say, Buffy the Vampire Slayer came up in one of the sessions!
  • Made vulnerable: notes of privilege; or how when you say their name, the bodies go missing
  • Assessing public attitudes about the ethics of research on medical practice
  • Beneath the covers: film, philosophy and sex
  • Moral sources for collaborative, practice-based ethics: a transformation for education and practice
  • Theory confirmation, risk and hermeneutics in the early phases of medical research
  • Shared vulnerabilities in research
  • Guinea pigs for peace: why American World War II conscientious objectors volunteered as research subjects
  • Fiction and bioethics: from speculation to practice 
  • My donor taught me: reflections from anatomy lab
  • Building research integrity and capacity: professional development for research support staff
  • Ethics of authorship in interprofessional team-based research
  • Big brother is watching? The ethics of electronic adherence monitoring- an interdisciplinary outlook
  • Migration and health: opportunities and challenges from the bioethics perspective
  • Industry-academy relations: ethical and policy concerns
  • Whole genome sequencing: the devil in the DNA
  • Ethics in the CTSA program: past, present and a changing future
  • Understanding patients’ views on consent for research enrollment in the setting of acute cardiac illness
  • Exploring ethics rationales for patient engagement in research
  • Medical researchers’ ancillary care obligations: a relationship-based approach
  • How to write an exam in bioethics

Monday, October 13, 2014

ASBH Annual Conference 2014

Later this week I will be attending the annual conference of the American Society for Bioethics and Humanities. This is the nation’s largest bioethics conference, and it is always highly entertaining and educational. It makes me consider issues from new perspectives and it shows the full gamut of bioethics scholarship across the country. It features some of the world’s leading ethicists and philosophers, and it also includes many sessions where people working in the field present their research. There are preconference workshops, plenary sessions, paper sessions and affinity group meetings. The affinity groups are groups who gather around common interests. For example, there is an affinity group on rural bioethics, one on Jewish bioethics, another on sexuality and gender identity, one on neuroethics, and so on. These are less formal meetings that occur over meal hours, where people can discuss common interests. I usually try to attend the affinity group on research, and then on whatever hits my fancy at the time.

Below is a list of the general sessions, which will give you an overview of the scope of the conference.

  • Articulating the Goals and Assessing the Impact of Bioethics Projects: A Report from the ABPD Working Group
  • Made Vulnerable: Notes on Privilege; or, How When You Say Their Names, the Bodies Go Missing
  • Moral Sources for Collaborative, Practice-Based Ethics: A Transformation for Education and Practice
  • Sanctity of Life, by L. J. Schneiderman: A Staged Reading
  • Collaborative Solutions to Challenges in Health Care and Education: A Forum Theatre Workshop
  • Bioethics Literacy Across the Lifespan
  • Migration and Health: Opportunities and Challenges from the Bioethics Perspective
  • A Global Perspective on Women’s Rights to Health and Safety: Progress or Regress?
  • From Clinical to Community Sequencing: Emerging Ethical, Legal, and Social Issues in Genomics
We are off at the Davenport campus next week, so I will post upon my return.

Monday, October 6, 2014

The Common Rule: General requirements for Informed Consent

I know that a good number of us have been developing and conducting research in our educational setting. And there are times when we will need to consider developing a consent document; however, not all of us have experience in writing one. Federal law actually stipulates what must be in a consent document, and rather than me summarizing those elements for you, I thought I would simply provide you the specific language, from 45CFR46 (46.116)(1).

Except as provided elsewhere in this policy, no investigator may involve a human being as a subject in research covered by this policy unless the investigator has obtained the legally effective informed consent of the subject or the subject's legally authorized representative. An investigator shall seek such consent only under circumstances that provide the prospective subject or the representative sufficient opportunity to consider whether or not to participate and that minimize the possibility of coercion or undue influence. The information that is given to the subject or the representative shall be in language understandable to the subject or the representative. No informed consent, whether oral or written, may include any exculpatory language through which the subject or the representative is made to waive or appear to waive any of the subject's legal rights, or releases or appears to release the investigator, the sponsor, the institution or its agents from liability for negligence.

 (a) Basic elements of informed consent. Except as provided in paragraph (c) or (d) of this section, in seeking informed consent the following information shall be provided to each subject:
 (1) A statement that the study involves research, an explanation of the purposes of the research and the expected duration of the subject's participation, a description of the procedures to be followed, and identification of any procedures which are experimental;
 (2) A description of any reasonably foreseeable risks or discomforts to the subject;
 (3) A description of any benefits to the subject or to others which may reasonably be expected from the research;
 (4) A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject;
 (5) A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained;
 (6) For research involving more than minimal risk, an explanation as to whether any compensation and an explanation as to whether any medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained;
 (7) An explanation of whom to contact for answers to pertinent questions about the research and research subjects' rights, and whom to contact in the event of a research-related injury to the subject; and
 (8) A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits to which the subject is otherwise entitled.
 (b) Additional elements of informed consent. When appropriate, one or more of the following elements of information shall also be provided to each subject:
 (1) A statement that the particular treatment or procedure may involve risks to the subject (or to the embryo or fetus, if the subject is or may become pregnant) which are currently unforeseeable;
 (2) Anticipated circumstances under which the subject's participation may be terminated by the investigator without regard to the subject's consent;
 (3) Any additional costs to the subject that may result from participation in the research;
 (4) The consequences of a subject's decision to withdraw from the research and procedures for orderly termination of participation by the subject;
 (5) A statement that significant new findings developed during the course of the research which may relate to the subject's willingness to continue participation will be provided to the subject; and
 (6) The approximate number of subjects involved in the study.
 (c) An IRB may approve a consent procedure which does not include, or which alters, some or all of the elements of informed consent set forth above, or waive the requirement to obtain informed consent provided the IRB finds and documents that:
 (1) The research or demonstration project is to be conducted by or subject to the approval of state or local government officials and is designed to study, evaluate, or otherwise examine: (i) public benefit or service programs; (ii) procedures for obtaining benefits or services under those programs; (iii) possible changes in or alternatives to those programs or procedures; or (iv) possible changes in methods or levels of payment for benefits or services under those programs; and
 (2) The research could not practicably be carried out without the waiver or alteration.
 (d) An IRB may approve a consent procedure which does not include, or which alters, some or all of the elements of informed consent set forth in this section, or waive the requirements to obtain informed consent provided the IRB finds and documents that:
 (1) The research involves no more than minimal risk to the subjects;
 (2) The waiver or alteration will not adversely affect the rights and welfare of the subjects;
 (3) The research could not practicably be carried out without the waiver or alteration; and
 (4) Whenever appropriate, the subjects will be provided with additional pertinent information after participation.
 (e) The informed consent requirements in this policy are not intended to preempt any applicable federal, state, or local laws which require additional information to be disclosed in order for informed consent to be legally effective.
 (f) Nothing in this policy is intended to limit the authority of a physician to provide emergency medical care, to the extent the physician is permitted to do so under applicable federal, state, or local law.

References

1.       http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html, accessed October 3, 2014