Monday, February 16, 2015

February 2015 End-of-Term Youtube Extravaganza

We come again to the end of another term and as I have traditionally done, I offer up this set of fun and completely unrelated youtube clips for your viewing pleasure. I wish you a wonderful break, short as it is!

1.       Tangerine Dream Live in April 2014:  Formed by Edgar Froese way back in 1968, dream has been at the cutting edge of electronic music for neatly 50 years. Poignant, since Froese just passed away a month ago at age 70.

2.       Irish Mike and Big Giant Swords:  Okay, this is a show on Discovery Channel, but Irish Mike is one of the best new stars on TV. Surrounded by a group of inept helpers, save for female blacksmith Jessie (who really knows her stuff), Irish Mike makes big swords. While his wife and two cuter-than-cute little kids watch in bemusement.

3.       World Land Speed record:  I was once in a car that drive 110 mph. That was sort of scary since it was night time, I was not driving and I was coming home from a rock concert festival. So let’s go 7 times that fast! Here, you can see what it is like to drive at 743 mph…

4.       Franz Klammer 1976 Downhill:  This is simply the greatest downhill ski run in Olympic history. Klammer is on the edge of disaster the entire time.

5.       Everest traffic jam:  Remember when it was romantic to climb Mt. Everest? Nowadays you can be led up the mountain, and long lines leave people at risk. Here is a reminder of the risk.

6.       Extreme mountain biking:  I stand in awe of riders who can do this. I can’t.

7.       Mills Lake:  This is just a 4-minute clip of one of my favortite spots on earth. In Rocky Mountain national Park, about a 3-mile hike from the Bear lake parking area.

8.       Tornado chasing:  Yeah, I’m not going to do this. Reed Timmer is crazy!

9.       Gary Grimshaw:  Gary Grimshaw was one of the great poster artists. Everyone who knows me knows I love this kind of art, and Grimshaw was the man who created all the posters for the Detroit area when I was growing up. I own the Hendrix poster you will see around 1.30 into the clip.

10.   Leave ‘em laughing:  Speaks for itself…

Monday, February 9, 2015

Online Classes from edX

We live in interesting times, to be sure. The very nature of education is changing in ways that I believe few of us could have seen even 10 years ago. Technology is making  a radical difference in the way in which education is delivered. While certainly earning a degree such as chiropractic requires the learner to be present- after all, one cannot learn a psychomotor skill simply by watching a video- the online platform is becoming quite common. And as a result opportunity abounds.

I was directed the following course by one of our faculty members, Dr. Chris Roecker. He found the course through his own search efforts, but the course is one that we all could benefit from. This is a course on blended learning; that is, using online modalities while still teaching a course in person. The course is offered by edX, which is a platform linking readers to online classes offered by leading institutions. And what is interesting is that you can audit a course; that is, take it for free.
So I wanted to provide you with the url for the program. It is:

Feel free to check it out and consider signing up for a class.

Monday, February 2, 2015

One More New Paper

Croft P, Altman DG, Deeks JJ, Dunn KM, Hay AD, Hemingway H, LeREsche L, Peat G, Perel P, Petersen SE, Riley RD, Roberts I, Sharpe M, Stevens rj, Van Der Windt DA, Von Korff M, Timmis A. The science of clinical practice: disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice. BMC Medicine 2015, 13:20, doi:10.1186/s12916-014-0265-4

Background: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful.

Discussion: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous ‘yes’ or ‘no’ is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient’s future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome.
Summary: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.


Tuesday, January 20, 2015

Two New Papers

O’Mara-Eves A, Thomas J, McNaught J, Miwa M, Ananiadou S. Using text mining for study identification in systematic reviews: a systematic review of current approaches. Systematic Reviews 2015, 4:5  doi:10.1186/2046-4053-4-5

Background: The large and growing number of published studies, and their increasing rate of publication, makes the task of identifying relevant studies in an unbiased way for inclusion in systematic reviews both complex and time consuming. Text mining has been offered as a potential solution: through automating some of the screening process, reviewer time can be saved. The evidence base around the use of text mining for screening has not yet been pulled together systematically; this systematic review fills that research gap. Focusing mainly on non-technical issues, the review aims to increase awareness of the potential of these technologies and promote further collaborative research between the computer science and systematic review communities.

Methods: Five research questions led our review: what is the state of the evidence base; how has workload reduction been evaluated; what are the purposes of semi-automation and how effective are they; how have key contextual problems of applying text mining to the systematic review field been addressed; and what challenges to implementation have emerged?
We answered these questions using standard systematic review methods: systematic and exhaustive searching, quality-assured data extraction and a narrative synthesis to synthesise findings.

Results: The evidence base is active and diverse; there is almost no replication between studies or collaboration between research teams and, whilst it is difficult to establish any overall conclusions about best approaches, it is clear that efficiencies and reductions in workload are potentially achievable.
On the whole, most suggested that a saving in workload of between 30% and 70% might be possible, though sometimes the saving in workload is accompanied by the loss of 5% of relevant studies (i.e. a 95% recall).

Conclusions: Using text mining to prioritise the order in which items are screened should be considered safe and ready for use in 'live' reviews. The use of text mining as a 'second screener' may also be used cautiously. The use of text mining to eliminate studies automatically should be considered promising, but not yet fully proven. In highly technical/clinical areas, it may be used with a high degree of confidence; but more developmental and evaluative work is needed in other disciplines.

Finn Y, Cantillon P, Flaherty G. Exploration of a possible relationship between examiner stringency and personality factors in clinical assessments: a pilot study. BMC Medical Education 2014, 14:1052  doi:10.1186/s12909-014-0280-3

Background: The reliability of clinical examinations is known to vary considerably. Inter-examiner variability is a key source of this variability. Some examiners consistently give lower scores to some candidates compared to other examiners and vice versa – the ‘hawk- dove’ effect. Stable examiner characteristics, such as personality factors, may influence examiner stringency. We investigated whether examiner stringency is related to personality factors.

Methods: We recruited 12 examiners to view and score a video-recorded five station OSCE of six Year 1 undergraduate medical students at our institution. In addition examiners completed a validated personality questionnaire. Examiners’ markings were tested for statistically significant differences using non-parametric one way analysis of variance. The relationship between examiners’ markings and examiner personality factors was investigated using Spearman correlation coefficient.
Results: At each station there was a statistically significant difference between examiners markings, confirming the presence of inter-examiner variability. Correlation analysis showed no association between stringency and any of the five major personality factors. When we omitted an outlier examiner we found a statistically significant negative correlation between examiner stringency and openness to experience with a correlation coefficients (rho) of – 0.66 (p = 0.03). Conversely there was a moderate positive correlation between examiner stringency and neuroticism with a correlation coefficient (rho) of 0.73 (p = 0.01).

Conclusions: In this study we did not find any relationship between examiner stringency and examiner personality factors. However, following the elimination of an outlier examiner from the analysis, we found a significant relationship between examiner stringency and two of the big five personality factors (neuroticism and openness to experience). The significance of this outlier is not known. As this was a small pilot study we recommend further studies in this field to investigate if there is a relationship between examiner stringency in clinical assessments and personality factors.


Wednesday, January 14, 2015

The Most Accessed Article on Chiropractic and Manual Therapies for 2014

I apologize for the tardiness of this post; I was out ill the past day or so and am only just back. My colleague Dr. Stephen Perle, an associate editor for Chiropractic and Manual Therapies, tweeted a note indicating that this article, by Bronfort et al and from 2010, was the most accessed article of the past year. I thought it was a good reminder of this important paper.

Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK Evidence Report. Chiropr Osteop 2010;18:3, doi:10.1186/1746-1340-18-3


Background: The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.

Methods: The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.

Results: By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.

Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.

Conclusions: Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.

Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.



Monday, January 5, 2015


Welcome back. I hope that all of you had a marvelous break and return to work rested and ready for the new year.

Over the past 2 weeks I have done little work. This is not because I am lazy, as most of you are well aware. It is because like all of you, I work hard and I find that work seems to follow me home, so that even during the evening I am doing work by answering emails, etc. There is little chance for down time as a result. I think we run the danger of allowing work to dictate our life even when we are not at work any longer. So I “labored” hard to try to relax and just spend time with my wife and, where possible, with my kids. I read a lot. I think I finished 7 books. I went to the movies and saw “The Theory of Everything.” I ate well. It was great!
There is a lesson there, I suppose. Work hard, but relax and take personal time. Nothing new, I suppose.  But a good message to take into this new year.

Happy new year to you all!

Monday, December 15, 2014

The Teacher’s Toolkit

In his book “Essential Skills for a Medical Teacher,” (1) Professor Ron Harden discusses what he terms the “teacher’s toolkit.” He likens it to the tools a carpenter has- a set of tools which together help to construct a structure, all of which are necessary but are used for different purposes. Hew views a teacher in similar fashion. The teacher also needs many tools. Among those tools, Harden lists:

Presentation tool:  This would be something like PowerPoint, used to help present content to students.
An audience response system: At Palmer, we have clickers, which are linked to the computer system, but you could equally use nothing more than a set of colored cards, as they do at the McMaster University evidence-based training program.

Simulated patients or simulators: to stand in for real patients during learning exercises.
Video clips: to use to demonstrate concepts and content.

Podcasts: for students to engage with learning at a later time.
Online information sources: we should all be providing this to our students.

Networking tools: can we figure out how to adapt social media platforms to educational purposes.
Peer-to-peer teaching opportunities: so students can support each other.

The point here is simply to note that we have many tools available to use, and we should both use them and use them in ways that optimize learning.
Let me take this opportunity to wish you a very happy holiday season and a great new year. I’ll be back in January, but hope that you are able to enjoy your time away and come back refreshed.

1.       Harden RM, Laidlaw JM. Essential skills for a medical teacher. New York, NY; Churchill Livingstone, 2014