Monday, January 25, 2010

Recent Literature of Note

Every now and again I think it is a good idea to provide some links to new information that you might find inriguing or even controversial. Here are abstracts and information for three new article of interest to our profession. I have provided links to each article.

1. Mirtz TA, Morgan L, Wyatt L, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropr Osteop 2009;17:13.

Background: Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
Aim: The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
Methods: The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
Results: The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
Conclusion: There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.

2. Siemans RD, Punnen S, Wong J, Kanji N. A survey on the attitudes towards research in medical school. BM C Med Ed 2010;10:4.

Background: An observed decrease of physician scientists in medical practice has generated much recent interest in increasing the exposure of research programs in medical school. The aim of this study was to review the experience and attitudes regarding research by medical students in Canada.
Methods: An anonymous, cross-sectional, self-report questionnaire was administered to second and fourth year students in three medical schools in Ontario between February and May of 2005. Questions were primarily closed-ended and consisted of Likert scales. Descriptive and correlative statistics were used to analyze the responses between students of different years and previous research experience.
Results: There was a 47% (327/699) overall response rate to the questionnaire. Despite 87% of respondents reporting that they had been involved in some degree of research prior to medical school, 43% report that they have not been significantly involved in research activity during medical school and 24% had no interest in any participation. There were significant differences in the attitudes towards research endeavors during medical school between students in their fourth year compared to second year. The greatest barriers to involvement in research in medical school appear to be time, availability of research mentors, formal teaching of research methodology and the perception that the student would not receive appropriate acknowledgement for work put towards a research project.
Conclusion: The results of this self-report survey outline the significant differences in attitudes towards mandatory research as a component of critical inquiry and scholarship in the undergraduate curriculum in Ontario medical schools.

3. Rayner J, McLachlan H, Forster DA, Cramer R. Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners. BMC Compl Alt Med 2009;9;52.

Background: Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.
Methods: Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.
Results: Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.
Conclusions: The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.

Wednesday, January 20, 2010

Taking Back Control of E-Mail: (Part 2)

Continuing our discussion of the recommendations made by John Freeman (1), these are a few more of the considerations he offers:

6. Read the entire incoming e-mail before replying. Because time has become of the essence, we have a tendency to want to handle each piece of e-mail as quickly as possible. Sometimes we respond to fast, and we do not provide the information that was needed. Be able to respond that e-mail with the information it requests, in the time frame it asks for. If you cannot, provide that information to the person you are writing; let them know when you will get that information to them. And don’t set up a large file system for all the e-mails you send and that you receive; most experts recommend against this.

7. Do not debate complex or sensitive matters by e-mail. This is how flame wars start. Often this happens because we cannot send intonation or affect with our message, and it is then misunderstood. Bad feelings build up over time. It is far better for most meetings to occur face-to-face, but we often use e-mail to avoid face-to-face meetings. If you cannot do face-to-face, then use the phone; if not the phone, try Skype. Complex question require thought and strategy, and e-mail does not lend itself to complicated discussion; we need time to explain out thoughts in such cases. Being present helps you more than you might think.

8. If you have to work as a group by e-mail, meet your correspondents face-to face. By doing so you put faces to names and you begin to build trust. It may not always be possible to do so, but many mechanisms exist to help create “face-to-face” scenarios, such as, again, Skype or other videoconferencing technology. This will help put out fires before they have a chance to begin.

9. Set up your desk to do something else besides e-mail. I’ve set my computer off to a side of my desk, and have kept my work area free from the computer, so I am not constantly looking at it. I am not reminded, this way, of the messages on it asking my attention. I spend too much time on the computer as it is, and a lot of my collaborative works takes place through the computer. All of us need to get out more and interact in person, me as much as anyone.

10. Schedule media-free time every day. Get away from the computer. I have had what I call “youtube fugues” occur wherein I want to find one single youtube clip, do so, and then begin linking to related clips. Before I know it, 2 hours has passed, and I have not been productive. So get away from the technology, from your computer and your handheld and your laptop and your cell phone and PDA, and so on. Get your attention back, because right now, as our work speeds up, we become fragmented and do not work in long bursts any more.

We can get some control back. We can re-engage with the outside world, but it will take some work. Otherwise, we will be subsumed into The Matrix.

1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009

Monday, January 11, 2010

Taking Back Control (of E-Mail): Part 1

Following up last week’s discussion of how e-mail has come to tyrannize our lives, John Freeman (1) has provided a few modest suggestions to help us gain back a small measure of control, at a time when the use of e-mail is expanding exponentially. For example, soon US airlines will offer e-mail service during flights; this has added significance in that if you can get wireless access 5 miles above the earth when you are travelling at 600 miles per hour, you can get it anywhere (including the top of Mt. Everest). And we need to get past one of the signal points of the book: e-mail makes us feel needed, and we treat it like we do gambling at Las Vegas (we keep checking our e-mail in the hope that we get a message that really matters, similar to playing the slots, for example). So here are a few suggestions.

1. Don’t send. This is the first, most basic, and most important step. Sending e-mail only creates more e-mail. When you don’t send a message, other people don’t have to send messages and this stops the cycle of endless unnecessary notes that fly back and forth (“Thank you.” “No, thank you,” etc. ad infinitum). This will also help you begin to ask yourself an important question: is this e-mail necessary? Does it need to arrive immediately? This will be difficult at first, and I know that I fail at this regularly, always letting someone know I received their message, often as soon as I received it. This also helps stop the endless paper(less) trail.

2. Don’t check it first think in the morning or late at night. In fact, don’t check it when you head to the bathroom, take your kids out or are spending time with your spouse. One of the real problems with e-mail is that it breaks the boundary between work and private time; you are often expected to respond to an e-mail as soon as it arrives, no matter what time it arrives. I can attest to this; when I was at NUHS I would go on vacation, place an out-of-office message on my machine with instructions as to whom to contact for an emergency, and come back to angry people who were upset I had not responded to them on the day they wrote me. We need to break the workaholic cycle, and we should not be getting e-mails from our boss or co-worker that was sent at 3am. Unless, of course, the nature of our work absolutely requires it.

3. Check it twice a day. This is nearly impossible for many people to imagine. But you can check your e-mail less than you do. E-mail interrupts our work, leading us to work in smaller and smaller chunks of times on projects, and taking our attention away from what we were doing. Set an agenda for your day.

4. Keep a written to- do list and incorporate e-mail into it. I know people use all sorts of means to track their to- do items, including day planners, Outlook reminders and calendars, other computer calendars (such as Mac’s iCalendar), and so on. I go low tech; I use a piece of paper in which I list my reminders. Using this list pulls you out of the computer and allows you (and me) to think about what I need to do to get things done, and I can then send a couple of direct e-mails to those who need to know where I am.

5. Give good e-mail. Watch Dr. Marchiori here. He does this well. Short notes back to you, direct answers to questions, no fluff, no fooling around. I appreciate this, and I do not feel I have to then send him another e-mail to let him know I got his e-mail. Keep your messages short, folks. Sometimes you can just put your entire message in the "RE:" line.

Next week, I will finish up on the ideas that Johnson brings up. I am beginning to follow them, and they do make life easier once you get past your initial hesitancy to not go and read your e-mail and respond immediately. Takes time, but worth it!

1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009

Monday, January 4, 2010

The Tyranny of E-Mail

Welcome back to work, and let me please wish you a very happy new year. I hope that you were able to enjoy your time off and am now well rested and ready to get back at it.

While I was away on break, I had occasion to replace my cell phone. This is of no apparent note, except for the fact that doing so allowed me to finally be able to text message and to access my email when away from my computer. This seems a good thing in today’s busy world. But while I was on vacation I also had occasion to read an interesting and intriguing new book, John Freeman’s The Tyranny of E-Mail (1). After doing so, I had serious room for thought.

I can remember a time before e-mail existed. I can also remember a time when, as the dean of postgraduate education at National University of Health Sciences, I was receiving more than 300 e-mails per day, all of which required action. I know that I tend to respond to e-mail promptly, often within seconds of when I receive a message. This is not unusual. As Freeman notes, studies have shown that in corporate environments, the average time from when an e-mail is sent to when a response is received is less than 3 minutes. I know that I have had meetings with administrators where they have interrupted their face-to-face meeting with me to respond to an e-mail that just came in on their Blackberry or iPhone; I am struck by the fact that they felt it necessary to do so when all they had to do was wait 10 minutes for me to finish up. I do not mean this as a rant, but e-mail is transfiguring the nature of how we work, and in some ways of how we learn.

The average worker now receives approximately 200 e-mail messages per day. In 2007, 35 trillion e-mail were sent globally, compared to 3 million text messages and just 165 billion phone calls. Part of the reason for this is the growth of hand-held devices, such as the Blackberry I just purchased. There is at least one study which has shown that 59% of people with hand-held devices that can receive e-mail respond to their email as soon as one arrives. This is flat-out scary.

And this is the environment in which we teach. No doubt we have all taught classes where at least one of our students has sent a text message during class. And the reason for the book calling e-mail "tyrannical" is this: when you receive an e-mail and you do not respond, you are actually preventing someone else from getting work done. But the faster you respond, the faster you get new e-mails back, and this cycle onto itself. And e-mails create e-mails, ad infinitum; you send a short note of thanks, only to get back an e-mail which also thanks you back, and you feel the need to respond to that, and this ends up creating yet more e-mails. And then there is the ubiquitous “cc” trail, which amps up the amount of e-mail as everyone on the “cc” list feels compelled to add something, and more messages fly back and forth. People stop using spelling and grammar correctly in order to save time in order to send out more and more e-mails. And through all of this you cannot read mood or personality, because all you have is text, not intonation or facial expression, so you resort to emoticons to help convey mood, use a smiley face to let the reader know you are not being sarcastic. And so it goes. We use out-of-office replies to let people know we will not respond to their e-mail- because they can’t get work done if we don’t. Some people use the out-of-office message just go to the doctor for an hour.

We need to take back control. Next week, I’ll talk about how we might do just that.

1. Freeman J. The tyranny of e-mail. New York; Scribner, 2009