Monday, November 28, 2011

New Articles from BioMed Central

Williams AM, Kitchen P, Eby J. Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis. BMC Compl Altern Med 2011;11:47

Background: An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province.
Methods: Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use.
Results: In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met.
Conclusions: The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments.

Zhang J, Peterson RF, Ozolins IZ. Student approaches for learning in medicine: what does it tell us about the informal curriculum? BMC Med Educ 2011;11:87

Background: It has long been acknowledged that medical students frequently focus their learning on that which will enable them to pass examinations, and that they use a range of study approaches and resources in preparing for their examinations. A recent qualitative study identified that in addition to the formal curriculum, students are using a range of resources and study strategies which could be attributed to the informal curriculum. What is not clearly established is the extent to which these informal learning resources and strategies are utilized by medical students. The aim of this study was to establish the extent to which students in a graduate-entry medical program use various learning approaches to assist their learning and preparation for examinations, apart from those resources offered as part of the formal curriculum.
Methods: A validated survey instrument was administered to 522 medical students. Factor analysis and internal consistence, descriptive analysis and comparisons with demographic variables were completed. The factor analysis identified eight scales with acceptable levels of internal consistency with an alpha coefficient between 0.72 and 0.96.
Results: Nearly 80% of the students reported that they were overwhelmed by the amount of work that was perceived necessary to complete the formal curriculum, with 74.3% believing that the informal learning approaches helped them pass the examinations. 61.3% believed that they prepared them to be good doctors. A variety of informal learning activities utilized by students included using past student notes (85.8%) and PBL tutor guides (62.7%), and being part of self-organised study groups (62.6%), and peer-led tutorials (60.2%). Almost all students accessed the formal school resources for at least 10% of their study time. Students in the first year of the program were more likely to rely on the formal curriculum resources compared to those of Year 2 (p = 0.008).
Conclusions: Curriculum planners should examine the level of use of informal learning activities in their schools, and investigate whether this is to enhance student progress, a result of perceived weakness in the delivery and effectiveness of formal resources, or to overcome anxiety about the volume of work expected by medical programs.

Erick PN, Smith DR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskeletal Dis 2011;12:60

Background: Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers comprise an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.
Methods: The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.
Results: This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers may be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.
Conclusion: Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.

Monday, November 21, 2011


On Thursday and Friday of last week, I spent time with faculty from all three of our campuses at a retreat held at the medical school at the University of Iowa. This was devoted to teaching faculty clinicians and clinical teaching faculty some of the skills involved in using evidence-based clinical practice. Topics looked at concepts such as risk and odds ratios, sensitivity and specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests. Our group was led by Dr. Marc Wilson, an internist at U Iowa who has also been long involved in the EBCP movement, and who has particular skills in facilitating physician groups. As a person who has worked with our Davenport faculty for some time now, and who is beginning to build contacts in our branch campuses, I realized that I was extremely grateful for all the work and the engagement I saw with our faculty. I realized that beyond that, I am grateful for a great many things, and so I wish to say thanks.

Thanks to our faculty for all the hard work you do. It may seem at times that it goes unnoticed, but I assure you this is not the case. We all share in your success when you publish a paper, or present new information at a conference, or reach a single student in a classroom setting. You make all of us proud.

I am grateful for the opportunity to work here at Palmer. It is a welcoming place to work, and it has provided a supportive environment in which to accomplish that work. I am lucky to work with the strongest set of faculty at any chiropractic college- at all of our campuses- and with the strongest set of administrators and staff as well.

I sent thanks to those whose work is often unheralded. Thanks to maintenance people, for support personal, janitorial staff, security and others. You all make this a better place, and you do so with good humor. And kudos to security, who often have to let me to the building when I show up at 3am because I am not able to sleep!

Again, I offer this short note of thanks to the college, to the people working in it, and to the jos it has given me. To all of you, please enjoy a restful holiday vacation. I hope you are able to spend it with family and friends, enjoying safe travels and good food. Happy holiday!

Monday, November 14, 2011

Making Microsoft Outlook More Productive For You

Most of us Outlook on a daily basis if for no other reason than to access our email. But it is a productive program that can help you control much of your day, and most of us do not take the time to use it to its full ability. I would like to offer a few ideas here that may help make your day more productive.

1. Turn off the new-message alert. Yes, I know that most of us have this on by default, so every time we get a new message sent to us, the program flags us that it has arrived. And I would bet that much of the time you then immediately go to the message to respond to it, or to at least read it. But think about it: how is this any different than someone sticking their head in your door every 5 minutes to ask you something? You can turn the alert off. Here is how:

Choose Tools, Options, and click E-mail Options.
a) Click Advanced E-Mail Options.
b) Uncheck the box next to "Play a sound."
c) Uncheck the box next to "Briefly change the mouse cursor."
d) Uncheck the box next to "Show an envelope icon in the notification area."
e) Uncheck the box next to "Display a New Mail Desktop Alert."
f) Click OK.

2. Modify the subject line of archived Outlook email. Often what starts as an email chain about one subject may morph into a chain about something completely different? So, for example, you and a colleague begin a short series of back and forth emails about the dinner you just had together, and in that series you note a question about a work-related topic of some import, say, about a change in educational funding for research. This is now an email you wish to save, but the original topic line is about the dinner you had, so you cannot easily find that email now that you need it. You can actually edit the subject line to make it easier for you to find or to catalogue it. Here is how:

In Outlook, open the e-mail in question (You can't do this with message previews; you have to double-click the message to open it in a new window.)
a) Click anywhere in the Subject line to place your cursor.
b) Edit the subject as you see fit.
c) Hit Enter, then accept the warning Outlook gives you.

3. Use Outlook to access your twitter account. For those of you who use twitter, you can use Outlook to read and manage your tweets. To do so, you need to add a plug-in to the system, known as Twlnbox. When you install this, it will add a new folder to your inbox (and you can then make individual folders for each sender, which may be of help in a large organization such as ours). From there, you can just provide your twitter user name and password and it will locate all the tweets to your account and put them in the folder. You can then read them like email. You can click the toolbar that the program will put on Outlook and use it to send our your own tweets, and it will also let you know when new tweets arrive.

These are just a few ideas about making Outlook do more of what you need it to do. This is based on a short article by Rick Broida from PCWorld, (

Monday, November 7, 2011

American Society for Bioethics and Humanities 2011 Conference

I just returned from attending the annual conference of the American Society for Bioethics and Humanities, which this year was held in Minneapolis(allowing me to visit both Surdyk’s for cheese and Kaczmarcuk’s for sausage, just saying). The theme for this year was “Generation(s) and Transformation(s)” reflecting an emerging theme in bioethics, that of “enhancement.” Enhancement is anything which enhances the development or ability of a person, most often applied to the developing fetus but also seen in developments in neurology, orthopedics (i.e., prosthetics) or even use of glasses or hearing aids. I come away from the meeting with a great deal of new knowledge as well as an understanding that bioethicists wear more bowties than any other group I have ever seen.

Over the course of three days, I attended the following sessions:

Gender, Reproduction and Bioethics: this included papers on approaching the ethics of treating LGBT populations as well as the ethics of disaster preparedness.

Queer Generations: A second session devoted to the specific ethical issues occurring over the lifespan of LGBT person.

Politics and Bioethics: featuring two prominent politically-oriented ethicists, John Arras and Jonathan Moreno, who looked at how ethics and politics conflict and come together in a pluralistic society.

Research Environment and Decision Making: this was mainly about ethical decision making in a research environment.

Bioethics in News and Theater: this looked at the confluence of bioethics and humanities as used in situations outside formal ethics courses.

Physicians’ Obligations: This program examined the obligations physicians have to patients, and also explored physician conscientious objections to treatment as well as the concept of “firing” patients.

Medical Ethics and Humanities Education in US Medical Schools: this was an overview of the development of a project designed to assess the state of training of ethics in the United States.

Ethics as Transformative: an interesting session which looked at teaching macroethics, as well as how to ethically break the law and how to settle arguments about enhancement.

Transformations over Two Generations: noted ethicist Dr. Ruth Macklin traced her career over a 40+ year period showing how the bioethics world began and became the force it is today.
Teaching Ethics: Of interest to me since I do, it looked at the use of debate and role play in teaching ethics to medical students.

Research Ethics: This session looked at how a controversy in bioethics occurred at one hospital, how consent forms may actually create therapeutic misconception rather than reduce it, and how people understand wrongdoing in ethics environments.

The Birth of a Bioethics Program: Steps, Strategies and Successes: this looks at the creation of a large ethics program in the Kaiser Permanente Health System, showing how much work had to be done to launch their ethics program.

Physician’s Role: about what doctors need to do when caring for patients.

Patient’s Role: a switch on the above, but with a focus on what it means to be seen as a patient.

This was all fertile ground, and I very much enjoyed a program that gave me additional knowledge in an area not too well understood to begin with.