Monday, July 27, 2015

Two New Papers from Biomed Central

Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Ther 2015,23:19  doi:10.1186/s12998-015-0063-x

Background: There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system (VBA) stroke. The objective of this study was to compare the associations between chiropractic care and VBA stroke with recent primary care physician (PCP) care and VBA stroke.

Methods: The study design was a case–control study of commercially insured and Medicare Advantage (MA) health plan members in the U.S. population between January 1, 2011 and December 31, 2013. Administrative data were used to identify exposures to chiropractic and PCP care. Separate analyses using conditional logistic regression were conducted for the commercially insured and the MA populations. The analysis of the commercial population was further stratified by age (<45 a="" analysis="" as="" associations="" calculated="" chiropractic="" conducted="" descriptive="" determine="" different="" exposure="" for="" hazard="" manipulative="" measure="" o:p="" odds="" of="" periods.="" proxy="" ratios="" relevance="" secondary="" the="" to="" treatment.="" using="" visits="" was="" were="" years="">
Results: There were a total of 1,829 VBA stroke cases (1,159 – commercial; 670 – MA). The findings showed no significant association between chiropractic visits and VBA stroke for either population or for samples stratified by age. In both commercial and MA populations, there was a significant association between PCP visits and VBA stroke incidence regardless of length of hazard period. The results were similar for age-stratified samples. The findings of the secondary analysis showed that chiropractic visits did not report the inclusion of manipulation in almost one third of stroke cases in the commercial population and in only 1 of 2 cases of the MA cohort.

Conclusions: We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.

Muramoto M, Matthews E, Ritenbaugh C, Nichter MA. Intervention development for integration of conventional tobacco cessation interventions into routine CAM practice. BMC Compl Altern Med 2015,15:96  doi:10.1186/s12906-015-0604-9

Background: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners – that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal.

Methods: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation.
Results: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention.

Conclusions: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner’s role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners’ work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners’ clinical behavior is underway.



Wednesday, July 15, 2015

Desire2Learn Brightspace Roll-Out

That’s the news for this week. We rolled out our new learning management system, Brightspace. We had an in-service in which Doug Black of our Port orange campus spoke to teaching faculty, while Craig Mencl, also of the Port Orange campus, spoke to clinicians. The idea was to demonstrate how easy to use the system is. After the in-service, a number of us were available for one-on-one sessions with individual faculty, and I am happy to say a good number of people took advantage of that.

Users will quickly find out that is rather easy to upload content. Using the “Module” section, you can organize your course however you like. For me, right now, I am organizing it by modules simply title “Week One,” “Week Two,” etc. Thus, if all you wanted to do was recreate what you have on the portal- and you should provide everything on Brightspace that you did on the portal- that is a matter of a few minutes work (outside of uploading large video files, for example, which have to process over time).
But Brightspace is not a content-delivery system alone. If that is all it did, we could have stayed with the portal. Brightspace offers you the ability to do so much more. You can create discussion boards, develop self-assessments, send out mass or individual communications, have a blog for an individual class, etc. Over the course of this current term, you can get comfortable with the LMS, and be ready to expand what you do the next.

Your sandbox is a good place to experiment with what the system offers. What you do there will affect nothing anywhere else. Feel free to experiment and take advantage of this.
Note: next week I will be away riding RAGBRAI. No post until I return.