Monday, August 25, 2014

Three New From Biomed Central

Archibald D, Macdonald CJ, Plante J, houge RJ, Fiallos J. Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program. BMC Medical Education 2014, 14:174  doi:10.1186/1472-6920-14-174


Background: As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning.
Methods: Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups.

Results: Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors.
Conclusions: iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful iPad users. To facilitate collection of information through the iPad, the design of electronic data-input forms should consider the participants' reported negative perceptions towards typing data through mobile devices. Technology deployment projects should gather sufficient evidence from pilot studies in order to guide efforts to adapt resources and infrastructure to relevant needs of Family Medicine teachers and learners.

Willison DJ, Ondrusek N, Dawson A, Emerson C, Ferris LE, Saginur RI, Sampson H, Upshur R. What makes public health studies ethical? Dissolving the boundary between research and practice. BMC Medical Ethics 2014, 15:61  doi:10.1186/1472-6939-15-61

Background: The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory.
Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle – from initial planning through to knowledge exchange.

Discussion: The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives.
The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond.

Summary: Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond.

Van der Worp MP, de Wijer A, Staal JB, MWG Nijhuis- van der Sanden.  Reproducibility of and sex differences in common orthopaedic ankle and foot tests in runners. BMC Musculoskeletal Disorders 2014, 15:171  doi:10.1186/1471-2474-15-171

Background: For future etiologic cohort studies in runners it is important to identify whether (hyper)pronation of the foot, decreased ankle joint dorsiflexion (AJD) and the degree of the extension of the first Metatarsophalangeal joint (MTP1) are risk factors for running injuries and to determine possible sex differences.
These parameters are frequently determined with the navicular drop test (NDT) Stance and Single Limb-Stance, the Ankle Joint Dorsiflexion-test, and the extension MTP1-test in a healthy population. The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners, using minimal equipment in order to make them applicable in large cohort studies. Furthermore, we aimed to determine possible sex differences of these tests.

Methods: The three orthopaedic tests were administered by two sports physiotherapists in a group of 42 (22 male and 20 female) recreational runners. The intra-class correlation (ICC) for interrater and intrarater reliability and the standard error of measurement (SEM) were calculated. Bland and Altman plots were used to determine the 95% limits of agreements (LOAs). Furthermore, the difference between female and male runners was determined.
Results: The ICC’s of the NDT were in the range of 0.37 to 0.45, with a SEM in the range of 2.5 to 5 mm. The AJD-test had an ICC of 0.88 and 0.86 (SEM 2.4° and 8.7°), with a 95% LOA of -6.0° to 6.3° and -5.3° to 7.9°, and the MTP1-test had an ICC of 0.42 and 0.62 (SEM 34.4° and 9.9°), with a 95% LOA of -30.9° to 20.7° and -20° to 17.8° for the interrater and intrarater reproducibility, respectively.

Females had a significantly (p < 0.05) lower navicular drop score and higher range of motion in extension of the MTP1, but no sex differences were found for ankle dorsiflexion (p ≥ 0.05).
Conclusion: The reproducibility for the AJD test in runners is good, whereas that of the NDT and extension MTP1 was moderate or low. We found a difference in NDT and MTP1 mobility between female and male runners, however this needs to be established in a larger study with more reliable test procedures.


Monday, August 18, 2014

IRB Application Materials Checklist

When you are considering conducting research, you have to complete and submit an application to the IRB. We use a check list to ensure that we have all the require elements needed to properly assess each application. Often, initial applications are incomplete so I thought I would list here all the required components of an application.

Certificate from the Human Protections Administrator: when you submit your application I will review it and decide whether it is exempt or whether it requires submission to the full IRB. When I do, I generate a form that is sent back to you informing you of that decision.
IRB application: clearly, this is required. But I would say that 9 times out of 10, there are missing elements in the application. Please go through the entire application and complete every section, even the ones that don’t appear necessary to you (such as a question about the use of radiology when you are conducting a survey). There are also pull-down menus that you need to complete.
IRB application signature page: the final page of the IRB application is a signature page. It requires not just your signature, but that of your supervisor. Make ure that both of you have singed this prior to submission.

Personnel roster: This can be downloaded off the IRB website or from the portal. It requires you to list all the people involved in the project, and it asks you to define their role. All involved must have completed the NIH Protections of Human Research Participants training program and have an up-to-date certificate on file.
CV/biosketch: we are required to have a copy of your most recent curriculum vitae of NIH biosketch on file. This will the case for all the personnel involved in the study. For many of you, we already hold the information, but for anyone new, we will need it, and for those that are old, they should regularly updated.

PHRP certificate: this is the NIH required training. It can be accessed at When you are done, it will allow you to print a certificate. We track these in a database. They must be updated annually.
IRB approvals from other institutions: where applicable, we will need copies of IRB approvals from any other institution involved in the research.

Recruitment material: If you are recruiting participants for your study, the IRB needs to see your recruiting material, even copies of emails you intend to send.
Study materials: we need copies of the survey you intend to give, or the script you will use for recruitment or for conducting qualitative research (such as focus group).

Educational material: we need copies of any material provided to the patient or participant.
Informed consent document: this is critically important, and must be included with an application where applicable.

With the deadline  2015 ACC-RAC coming up, we usually see an increasing number of applications in August. This list here will help ensure you are able to have your application processed in timely fashion.




Monday, August 11, 2014

Palmer Homecoming 2014

Another Homecoming has come and gone, but I feel that this one was an exceptionally strong event. For those of you who were unable to attend here is a partial list of some of the great speakers and topics we presented.

Plenary Sessions
Dennis Marchiori: Strengthening Palmer’s Core

Christopher Colloca: Validating our Traditional Chiropractic Philosophy with Contemporary Science
Christine Goertz: Chiropractic Quality, Cost and risks: What the Evidence Says and Why You Should Care

Deed Harrison: Chiropractic BioPhysics: Research Evidence
Bharon Hoag: A Vision of Chiropractic in Today’s Healthcare

Gerry Clum: Black and White in a World of Gray!

Breakout Sessions
Todd Hubbard: The Upper Cervical Complex: Anatomical and Biomechanical

Ron Boesch, Chris Roecker and Mike Tunning: Using EvidenceBased Orthopedic Exams in Practice
Charles Blum: Introduction to Sacro Occipital TechniqueIncorporating an EvidenceBased Chiropractic System ofAnalysis and Treatment

Roger Hynes, Alana Callendar: 100 Years of Fellowship and Education,

James Cox: Cox Flexion Distraction Spinal Manipulation: Biomechanics and Clinical Outcomes
Michelle Barber: Meditations on Philosophy

Brett Winchester: The Current Concepts in Motion Palpation
Lora Tanis: Tiny TuneUps, Evaluation and Adjusting Strategies for the Neonate

Lou Freedman, Dan Weinert: Neuroimmunomodulation,
Michelle Barber, Virginia Barber: Two Barbers, No Waiting: Bringing Customer Service to the Forefront of the DoctorPatient Interaction

Deed Harrison: The Spine as the Foundation for Health and Disease: A Contemporary Chiropractic BioPhysics® (CBP®) Technique Presentation

Brian Justice: Primary Spine Care: A RealWorld Approach to Chiropractic Practice in the Evolving Health Care System

Mary Frost: Digital Marketing Basics
Tracy Littrell: Radiographic Positioning and View Selection
M. Deborah Sesker, Cheryl Child: The Third Era of Healthcare,
Nate Hinkeldey, Michael Olsen, Mike Petrie, Mike Tunning: Interdisciplinary Care Models: Working Together to Benefit the Patient

Anna Allen: Professional Boundaries
Lia Nightingale: Recognizing Food Allergies: Challenges and Opportunities

Ron Boesch, Dave Juehring, Mike Petrie, Mike Tunning: An Overview of Movement Development, Injury, and Recovery
Ian McLean: Radiography for Chiropractors

Ron Boesch: What, When, Where of Testing…Patient Management
Jeff Sklar: Chiropractors in Cancer HospitalsUsing Evidence-Based Orthopedic Exams in PracticeUsing Evidence-Based Orthopedic Exams in PracticeUsing Evidence-Based Orthopedic Exams in Practice

Monday, August 4, 2014

A Couple of New Books

Dr. Mike Tunning and Dr. Michelle Barber, as part of their effort to create an Academy of Chiropractic Educators, were kind enough to provide me copies of 2 new books, both of which I am finding highly informative. Both are worth your time and effort.

The first book is “Teaching Naked: How Moving technology Out of Your College Classroom Will Improve Student Learning.” (Bowen JA. John Wiley and Sons; San Francisco, CA, 2012). Now, before you think the author is recommending that we jettison technology, that’s now what he means by moving it out of the classroom. He wants student using it outside the classroom because that is how modern students learn. His focus is on what takes place during those classroom hours we have; how to better use the time and more effectively engage students. He describes ways to maximize face-to-face contact between student and faculty, focusing on “the human dimension” of learning. Thus, the book provides great ideas on how to engage our students, looking at how they prepare before they show up and how we engage them as they do. He yokes technology to this process, so it is used effectively and in a way that students easily understand.
The second book is “Crucial Conversations” Tools for Talking When the Stakes are High.” (Second edition. PattersonK, Greeny J, McMillan R, Switzler A. McGraw Hill; New York, NY, 2012). The book is devoted to the concept of a crucial conversation, which is an event with the capacity to transform people and relationships; it is a form of bonding that can occur through deep conversation and understanding. The book looks at a fundamental idea- that human problems occur when people disagree with each other about high-stakes emotional issues. We can actually see that in our own classrooms over concepts as fundamental as what chiropractic is. How do you feel when you propose an idea only to see others disagree with you and argue against yours? Are you irritated? Angry? Hurt? What do you do? How do you handle classroom discord? This book provides a superb example of what you might do to better communicate, and therefore teach, your students in such circumstances.

I recommend that you read these books- they have great ideas and concepts and easily translated methods you can begin using now.