Best Laid Plans

Sorry to say, no new blog for this week. After trying to come home yesterday from California, by flying from San Jose to Minneapolis, and then to O'Hare in the midst of a huge set of storms, after being kept on the tarmac at O'Hare for hours waiting for the storm to clear so we could go the gate, and then having to drive home at 2am, getting there at 5:30am, and then coming to work to give make-up exams, I find I have no lesson to impart, except that one should never ever travel anywhere with me. I am the black hole of travellers...

Some Nuances about IRB Processes

I am always grateful that we have so many people at our campuses willing to conduct research. And I know that for those that are new to it, the IRB and its procedures and processes can seem a bit mystifying, as well as look like an impediment to what you wish to do. Since all IRB submissions initially are sent to me, I have noted some continuing issues that occur fairly frequently, and I thought I might here describe them to you.

On Initial Submission: When you first submit an application to the IRB, please make sure that you do complete every question on the form. Many will require no answer at all, so just put an NA as your response (for example, if you are conducting a survey, the entire series of questions related to the use of ionizing radiology are not applicable). And make sure you get the last page signed by your immediate supervisor. This ensures that your supervisor is okay with the time that you will need to do your research. When you submit, you will need to provide the IRB secretary with proof that all investigators have up-to-date certificates of Protection of Human Research Participants training, and that you send a roster as well. Forms for this are found on the IRB website (w3.palmer.edu/irb). And take time to complete the application and provide detail. We cannot move your application forward without these pieces of information, and ensuring you have them at initial submission will smooth the process of approving your application.

Amendments: Any time you make a change in an approved protocol, you need to submit an amendment form to the IRB. This is for any change at all, since your project was approved only for what you initially told us you would do. So, if an investigator left the college and you added someone new, send the form. If you decide to change a question on a survey, it needs an amendment. And if it affects the consent document that was already approved, it will need to go back to the IRB for reconsideration.

Renewal and Termination: All approvals for projects are good only for one year. At the end of that year, you must submit a renewal form, so that the IRB can take another look at your work and okay its continuation. This is your responsibility; if you get a note from the IRB reminding you about this, you are already late and in danger of having your work stopped until such time as you complete the renewal application. This is a legal requirement. Also, when you are done with your work, you are required to send a notice of termination to the IRB so that it can remove your project from those which are annually tracked. This uses the same form as the renewal request.

I know this may at times seem arcane and complicated, but it really isn’t. It takes just a bit of time and some thoughtfulness to ensure your work is handled correctly. And all of us working with and for the IRB thank you for that.

Three New from Biomed Central Journals

Hofman B, Myhr AI, Holm S. Scientific dishonesty—a nationwide survey of doctoral students in Norway. BMC Medical Ethics 2013, 14:3 doi:10.1186/1472-6939-14-3

ABSTRACT

Background: The knowledge of scientific dishonesty is scarce and heterogeneous. Therefore this study investigates the experiences with and the attitudes towards various forms of scientific dishonesty among PhD-students at the medical faculties of all Norwegian universities.

Method: Anonymous questionnaire distributed to all post graduate students attending introductory PhD-courses at all medical faculties in Norway in 2010/2011. Descriptive statistics.

Results: 189 of 262 questionnaires were returned (72.1%). 65% of the respondents had not, during the last year, heard or read about researchers who committed scientific dishonesty. One respondent had experienced pressure to fabricate and to falsify data, and one had experienced pressure to plagiarize data. On average 60% of the respondents were uncertain whether their department had a written policy concerning scientific conduct. About 11% of the respondents had experienced unethical pressure concerning the order of authors during the last 12 months. 10% did not find it inappropriate to report experimental data without having conducted the experiment and 38% did not find it inappropriate to try a variety of different methods of analysis to find a statistically significant result. 13% agreed that it is acceptable to selectively omit contradictory results to expedite publication and 10% found it acceptable to falsify or fabricate data to expedite publication, if they were confident of their findings. 79% agreed that they would be willing to report misconduct to a responsible official.

Conclusion: Although there is less scientific dishonesty reported in Norway than in other countries, dishonesty is not unknown to doctoral students. Some forms of scientific misconduct are considered to be acceptable by a significant minority. There was little awareness of relevant policies for scientific conduct, but a high level of willingness to report misconduct.

Burr SA, Brodier E, Wilkinson S. Delivery and use of individualised feedback in large class medical teaching. BMC Medical Education 2013, 13:63 doi:10.1186/1472-6920-13-63

ABSTRACT

Background: Formative feedback that encourages self-directed learning in large class medical teaching is difficult to deliver. This study describes a new method, blueprinted feedback, and explores learner's responses to assess its appropriate use within medical science teaching.

Methods: Mapping summative assessment items to their relevant learning objectives creates a blueprint which can be used on completion of the assessment to automatically create a list of objectives ranked by the attainment of the individual student. Two surveys targeted medical students in years 1, 2 and 3. The behaviour-based survey was released online several times, with 215 and 22 responses from year 2, and 187, 180 and 21 responses from year 3. The attitude-based survey was interviewer-administered and released once, with 22 responses from year 2 and 3, and 20 responses from year 1.

Results: 88-96% of learners viewed the blueprinted feedback report, whilst 39% used the learning objectives to guide further learning. Females were significantly more likely to revisit learning objectives than males (p = 0.012). The most common reason for not continuing learning was a 'hurdle mentality' of focusing learning elsewhere once a module had been assessed.

Conclusions: Blueprinted feedback contains the key characteristics required for effective feedback so that with further education and support concerning its use, it could become a highly useful tool for the individual and teacher.

Stuber K, Bruno P, Kristmanson K, Ali Z. Dietary supplement recommendations by Saskatchewan chiropractors: results of an online survey. Chiropractic & Manual Therapies 2013, 21:11 doi:10.1186/2045-709X-21-11

ABSTRACT

Background: Chiropractors receive training in nutrition during their education, previous surveys have found that chiropractors frequently provide recommendations to patients relating to nutrition and dietary supplement intake. However, it has not been ascertained which specific supplements chiropractors recommend or the types of health conditions for which supplement recommendations are made.

Objective: The purpose of this study was to determine which dietary supplements are most commonly recommended by chiropractors in the province of Saskatchewan,Canada and the health conditions for which supplement recommendations are made.

Design: An online survey of licensed chiropractors practicing in the province of Saskatchewan, Canada was distributed three times following online and in-person notifications of the survey.

Statistical analyses performed: Descriptive statistics were reported, predominantly in the form of means and proportions.

Results: A response rate of 45% was obtained. All of the respondents (100%) indicated providing nutritional advice or counselling to patients, while nearly all (99%) indicated providing dietary supplement recommendations to patients. Respondents estimated that they provide nutritional advice or counselling to 31% of their patients on average, and recommend dietary supplements to an average of 25% of their patients. The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics. The most common reasons to recommend dietary supplements were for “general health and wellness” (82% of respondents), “bone health” (74%), “rheumatologic, arthritic, degenerative, or inflammatory conditions’ (72%), and “acute and/or chronic musculoskeletal conditions” (65%).

Conclusion: The majority of respondents indicated providing nutritional counselling and recommendations for dietary supplements to their patients. Respondents generally recommend a small number of dietary supplements and provide these recommendations and counselling to fewer than half of their patients on average, while tending to focus on conditions most closely related to the scope of practice of chiropractors. The findings of this study may have been limited by selection bias owing to the low response rate and as those who respond to surveys are often more likely to respond positively.

 

Atomic Learning Revisited

Several months I purchased a site license to the Atomic Learning website.  I am gratified to know that those of you have used it have found it a worthwhile resource. My goal here is entice those of you who have not used to consider doing so.  I thought that by simply letting you know of what is on there, you may wish to investigate further.

As an example, the site has training videos dedicated to developing student resources using iBook Author. The following sections can be found there:

• Getting Started
• Basic Procedures to Master
• Templates and Layouts
• Chapters, Sections and Pages
• General Info about Objects
• Working with Text
• Graphics and Shapes
• Tables and Charts
• Widgets
• Previewing, Sharing, Publishing and Archiving

Each one of these general topics can be expanded to link to as many as 10 individual video clips demonstrating more detailed information about each major topic section. No clip is more than a couple minutes long, meaning that you can take these at your leisure, and you can in relatively short order be provided what amounts to a full program demonstrating how you can create classroom resources using iBooks Author. And this is but one program topic on a website that links you to literally hundreds of such programs.

Among the programs that can find resources for are the following: Access, Acrobat, BlackBoard, Camtasia, clickers, Dragon Naturally Speaking, EndNote, Excel, FileMaker, Firefox, Google Docs, HTML, Internet Explorer, moodle, Office, Outlook, Photoshop, PowerPoint and Word. And for each, you can pick various versions of the program, matching whatever you have on your computer.

This is a wonderful resource, and as you explore the site, you will also find that it has a separate area for education-related topics, such as plagiarism, copyright, collaborative learning and so on. I implore you to play with this, have fun with it, and learn from it.

Michael Pollan: Cooked

We’re off on a bit of a tangent this week. All of us are engaged in helping to train chiropractors. Part of that involves working with patients to help them modify their dietary habits, in order to help reduce obesity, hypertension, diabetes and the risk that comes with having those conditions. Thus, we include courses in nutrition in our curriculum, and we look at interventions designed to help patients improve their health naturally. All this by way of suggesting that we look carefully at Michael Pollan’s new book, “Cooked.”

Pollan reports on the changing nature of food delivery in the United States. In his earlier book “The Omnivore’s Dilemma,” he focused on the growth of the factory farm and the implications for the long-term health of US citizens. In this book, I can reduce his core argument down to a sound bite, but it is a very important sound bite: Cook more by yourself, using natural products, and have family meals each day.  Pollan finds that the average person spends no more than 27 minutes a day in food preparation, uses corporate products to make meals, and often does not have family dinners.

Confession: I am marries to a woman who spent many years of her life as a professional chef. She worked initially in a gourmet grocery and later owned her own h9igh-end catering business, where she often cooked for celebrities and politicians in the Chicago area. In fact, she once made a dinner for the president of McDonald Corporation. And she still cooks, and loves to cook. So, we don’t go out to dinner (except when we travel), and we make dinner every day, using the best produce we can find.

But this puts us at odds with the vast majority of Americans now. I often look at the grocery carts of people checking out at the same time we are, and I often see pre-made foods in high abundance, and I still see lots of white bread, sugared pop, and prepared foods. Pollan wants to change this, and this book is a broadside against the current state of the American food industry.

In the book, Pollan looks at what he calls Fire, Water, Air and Earth. In the section devoted to Fire, he discusses barbecue- not the kind of barbecue you might think about when I say the word, but about how fire transforms meat, how historically this meant something significant in human evolution, and how today’s pit masters harness the power of wood to make something spectacular. In Water, he examines braising food, using boiling water to create sauces and make the inedible edible. Air is about baking bread; how yeasts cause flour to rise, to allow air to enter, and to help then create a variety of bread styles. And in Earth, the focus in on fermentation, of which there is now an entire movement, one that my wife and I are members of. We were introduced to fermentation by our son, who was making not just beer, but also sauerkraut, kimchee, and kombucha. All are fermented products. And all are pretty easy to make, none more so than sauerkraut.

Here is how easy. To make sauerkraut, shred a couple of cabbages. We use red cabbage. Put in a clean glass jar, and liberally salt the cabbage. Place a weight on top- we use a plate with a baggie of water on it. Cover with a towel, and stick it in your basement. Come back in three weeks. When you do, and when you look at the jar, you will see all the bubbles of fermentation taking place. We then put the kraut in smaller storage vessels and stick them in the fridge. It is ready to eat. And the first time scares you because you know this is a controlled rotting process- but it’s great.

So, I recommend this book to you, and suggest it provides a pathway to a better and more sustainable food lifestyle. Well worth the read.

TED Talks

TED, which stands for Technology, Entertainment and Design, is an annual conference put on by the Sapling Foundation, and which is designed to allow for “ideas worth spreading.” Most of us have seen one or two TED presentations, but all of them are interesting, unique and informative.  If you have never seen a TED talk, I am offering here some which I think are best.

1.       Eric Dishman: Health care should be a team sport: http://www.ted.com/talks/eric_dishman_health_care_should_be_a_team_sport.html

2.       Barry Schwartz: The paradox of choice: http://www.ted.com/talks/barry_schwartz_on_the_paradox_of_choice.html

3.       Stephen Hawking: Questioning the universe: http://www.ted.com/talks/stephen_hawking_asks_big_questions_about_the_universe.html

4.       Hans Rosling: Stats that reshape your worldview: http://www.ted.com/talks/hans_rosling_shows_the_best_stats_you_ve_ever_seen.html

5.       Jill Bolte Taylor: Stroke of insight: http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html

6.       Elizabeth Gilbert: Your elusive creative genius: http://www.ted.com/talks/elizabeth_gilbert_on_genius.html

7.       Ken Robinson: Schools kill creativity: http://www.ted.com/talks/ken_robinson_says_schools_kill_creativity.html

8.       Dan Pink: The puzzle of motivation: http://www.ted.com/talks/dan_pink_on_motivation.html

9.       Chimamanda Adichie: The danger of a single story: http://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story.html

10.   Roger Ebert: Remaking my voice: http://www.ted.com/talks/roger_ebert_remaking_my_voice.html

In particular the speech by Roger Ebert, whom I considere the greatest critic in any field, is quite moving. I highly recommend spending time with TED.

Evidence in Action

As part of our R25 initiative, one of the desires we had was to demonstrate how to use evidence, in the form of information available to readers in scientific articles, as a means to resolve clinical scenarios. Dr. Christine Goertz and I had, initially sort of unknown to each other, been in conversation with leadership in the American Chiropractic Association to provide articles for the Journal of the American Chiropractic Association. We hoped to raise the profile of Palmer College faculty members while at the same time providing ACA members with information they could apply in practice. From this the idea of the Evidence-in-Action column was born.

In brief, we invited faculty from all three campuses to write short articles in which the author initially sets out a clinical scenario- often drawn from a real case, sometimes from a “created’ scenario- and then show how a piece of literature was then used to provide guidance in managing the patient. By doing so, we could begin to introduce the reader to core concepts in evidence-based practice: sensitivity and specificity, likelihood ratios, odds and risk ratios, and so on. Each article concentrated on a single core concept, so that this was done slowly and sensitively. And in each article, we highlighted the skills and knowledge of individual Palmer faculty.

According to the editor of JACA, this column has been one of the most well-received changes of the past few years. It has generated positive press and numerous compliments. We have committed to continuing this for the future, and at present have at least 3 new columns in preparation. To date, we have provided 18 such columns to the journal. This newsletter will link to past articles, and as new ones come on line, we will add them as well.

We hope that you find these articles interesting and informative and that you also take pride in the work of your fellow faculty members. And we invite you to consider preparing one as well. If you are interested, please contact Dr. Dana Lawrence at dana.lawrence@palmer.edu and he will help you get started.

Enjoy!