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Statistics as a Tool in the Physician's Black Bag
The era of evidence-based practice began in the 1990s with the hope patient outcomes would be improved by eliminating clinical bias and clinically unsound practices. Clinical guidelines which had been previously written by panels of experts were slowly replaced by careful analysis of existing clinical studies and more rigorous designs of new clinical studies based on sound scientific and statistical principles. This still leaves the practitioner with the responsibility of understanding what the evidence is showing them. This article reviews the statistical thinking that underlies the evidence-based literature. We will review some evolutionary changes to statistical analysis being advocated by statisticians and discuss some nuances related to the use of statistics describing diagnosis and treatment in clinical settings.
Journal Article
Environmental factors promoting the effective use of a computer-assisted clinical case for second-year osteopathic medical students
Computer-aided clinical cases (CACC) have the potential to complement and/or supplement other types of problem-based learning exercises in modern medical curricula. Deploying a CACC learning experience requires institutional commitment to technology and a belief by administration, faculty, and students that “climbing a steep growth curve” is worth the effort. Several aspects of the institutional environment at the Kirksville College of Osteopathic Medicine (KCOM) led to the development of the CACC exercise described in this article, including the need to design a uniform, supplemental, Internet-based learning experience and assessment exercises for students doing clinical rotations at off-site facilities. The CACC learning experience was enthusiastically accepted by second-year medical students as an integrative and clinically relevant educational experience. The success of this CACC exercise has helped to promote the development of other innovative applications of technology to medical education at KCOM.
Journal Article
Medical Students' Diagnostic Accuracy and Treatment Plans
Physician-mentored patient rounds (PMPR) were used to assess diagnostic accuracy and treatment plans of preclinical medical students. During 4 PMPR sessions, students gathered patient history, observed a physical exam, analyzed diagnostic tests, and developed treatment plans for a patient with chronic obstructive pulmonary disease. Of 470 students, 99.4% correctly diagnosed the patient. Nearly 78% prescribed long-acting beta-agonists or long-acting muscarinic antagonists. Most included appropriate pharmacologic treatments. Only 47% included smoking cessation in their treatment.
Journal Article
Physician-Mentored Patient Rounds to Observe and Assess Entrustable Professional Activities 1 and 2 in Preclinical Medical Students
Thirteen entrustable professional activities (EPAs) for entering residency were created to aid medical educators as they prepare preclinical students for their residency and to assess student readiness for residency. The A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM) developed a program called physician-mentored patient rounds (PMPR), which focuses on EPA 1 and EPA 2.To determine whether PMPRs could be used to assess expected behaviors of EPA 1 (gather a history and perform a physical examination) and EPA 2 (prioritize a differential diagnosis after a clinical encounter).The PMPR sessions at ATSU-KCOM take place over several weeks (30-minute sessions per week), during which students gather a patient's history (sessions 1 and 2), observe a physical examination by the physician mentor (session 2), analyze diagnostic test results (session 3), and formulate a treatment plan (session 4). The PMPRs in this study used a real patient with confirmed chronic obstructive pulmonary disease (COPD). This study did not include the session-4 treatment plan. Between sessions, students completed an assignment to further demonstrate their behaviors as expected in the EPAs. Student responses were analyzed and summarized for physician feedback in the subsequent PMPR session. Students’ diagnostic accuracy was measured at the conclusion of each session.A total of 516 students were included in the study. The PMPR weekly attendance was high (453-475). Although history gathering in the large-group setting was disorderly, diagnostic accuracy over the 3-session period improved. After history taking, 411 students (86.5%) included COPD in the differential diagnosis. A smaller number, 235 students (49.5%), listed COPD as the most likely diagnosis. After the physical examination, 439 included COPD in the differential diagnosis, and 385 listed COPD as the most likely diagnosis. After analysis of diagnostic test results, 468 students listed COPD as the most likely diagnosis.Physician-mentored patient rounds seem to be an effective means to assess preclinical students’ expected behaviors as described in EPA 1 and EPA 2.
Journal Article
Career and Technical Education, Work Study, & School Supervised Work: How Do They Impact Employment/or Students with Disabilities?
The researchers examined whether three predictors of post-school employment outcomes identified by the National Secondary Transition Technical Assistance Center (NSTTA C, 20 J 3) remained significant for five subgroups of students with: (a) learning disabilities, (b) intellectual disabilities, (c) multiple disabilities, (d) emotional disabilities, and (e) other health impairments. The three predictors used in this study were: (a) vocational (career and technical) education, (b) work study, and (c) school-supervised community work while in high school. The researchers conducted a secondary analysis on a sample of5,307 youth with disabilities, of which 4,952 fell into one of the five disability subgroups used in this analysis. The authors found that competitive employment after graduation was predicted by career and technical education and work-study for students with other health impairments and learning disabilities and by school-supervised work experiences for students with multiple disabilities.
Journal Article
Utilizing Small Telescopes Operated by Citizen Scientists for Transiting Exoplanet Follow-up
Due to the efforts by numerous ground-based surveys and NASA's Kepler and Transiting Exoplanet Survey Satellite (TESS), there will be hundreds, if not thousands, of transiting exoplanets ideal for atmospheric characterization via spectroscopy with large platforms such as James Webb Space Telescope and ARIEL. However their next predicted mid-transit time could become so increasingly uncertain over time that significant overhead would be required to ensure the detection of the entire transit. As a result, follow-up observations to characterize these exoplanetary atmospheres would require less-efficient use of an observatory's time-which is an issue for large platforms where minimizing observing overheads is a necessity. Here we demonstrate the power of citizen scientists operating smaller observatories (≤1 m) to keep ephemerides \"fresh,\" defined here as when the 1 uncertainty in the mid-transit time is less than half the transit duration. We advocate for the creation of a community-wide effort to perform ephemeris maintenance on transiting exoplanets by citizen scientists. Such observations can be conducted with even a 6 inch telescope, which has the potential to save up to ∼10,000 days for a 1000-planet survey. Based on a preliminary analysis of 14 transits from a single 6 inch MicroObservatory telescope, we empirically estimate the ability of small telescopes to benefit the community. Observations with a small-telescope network operated by citizen scientists are capable of resolving stellar blends to within 5″/pixel, can follow-up long period transits in short-baseline TESS fields, monitor epoch-to-epoch stellar variability at a precision 0.67% 0.12% for a 11.3 V-mag star, and search for new planets or constrain the masses of known planets with transit timing variations greater than two minutes.
Journal Article
The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease
Background
The use of manipulation has long been advocated in the treatment of chronic obstructive pulmonary disease (COPD), but few randomized controlled clinical trials have measured the effect of manipulation on pulmonary function. In addition, the effects of individual manipulative techniques on the pulmonary system are poorly understood. Therefore, the purpose of this study was to determine the immediate effects of four osteopathic techniques on pulmonary function measures in persons with COPD relative to a minimal-touch control protocol.
Methods
Persons with COPD aged 50 and over were recruited for the study. Subjects received five, single-technique treatment sessions: minimal-touch control, thoracic lymphatic pump (TLP) with activation, TLP without activation, rib raising, and myofascial release. There was a 4-week washout period between sessions. Protocols were given in random order until all five techniques had been administered. Pulmonary function measures were obtained at baseline and 30-minutes posttreatment. For the actual pulmonary function measures and percent predicted values, Wilcoxon signed rank tests were used to test within-technique changes from baseline. For the percent change from baseline, Friedman tests were used to test for between-technique differences.
Results
Twenty-five subjects were enrolled in the study. All four tested osteopathic techniques were associated with adverse posttreatment changes in pulmonary function measures; however, different techniques changed different measures. TLP with activation increased posttreatment residual volume compared to baseline, while TLP without activation did not. Side effects were mild, mostly posttreatment chest wall soreness. Surprisingly, the majority of subjects believed they could breathe better after receiving osteopathic manipulation.
Conclusion
In persons with COPD, TLP with activation, TLP without activation, rib raising, and myofascial release mildly worsened pulmonary function measures immediately posttreatment relative to baseline measurements. The activation component of the TLP technique appears to increase posttreatment residual volume. Despite adverse changes in pulmonary function measures, persons with COPD subjectively reported they benefited from osteopathic manipulation.
Journal Article
Disproportionality in Transition Services: A Descriptive Study
The purpose of this study was to examine disproportionality in transition services for students with disabilities. The authors predicted that students' transition services and secondary programs would be driven not only by their postschool goals, but also by their gender, ethnicity, disability, and school setting. To test this hypothesis, the researchers examined school records and interviews of more than 4,500 students in a northeastern state who graduated or aged out of special education in the years 2005—2008. The authors found that secondary programs and transition services varied significantly for students from differing school settings and differing gender, ethnicity, and disability groups and that this often resulted in poor alignment between students' goals and their secondary curricula and transition services. The authors propose that these findings indicated the need for earlier transition planning and better connections between middle and high schools.
Journal Article
Observing Exoplanet Transits with the Citizen Continental-America Telescopic Eclipse (CATE) Experiment Telescope Network
The Citizen Continental-America Telescopic Eclipse (CATE) Experiment established a standardized set of observation procedures and 72 volunteer observation teams with identical equipment along the path of the 2017 total solar eclipse. CATE successfully imaged the solar corona from 66 of the 72 observation sites resulting in a high dynamic range animation of 90 minutes of solar corona data collected by volunteer citizen science teams. A subgroup of CATE began work in the fall of 2017 to evaluate use of the standard CATE observation setup for exoplanet transit observations. Light curves and analysis of data using AstroImageJ of two well know transiting exoplanets, HD209458b (V = 7.65, depth = 1.5%) and HD189733b (V = 7.67, depth = 2.4%) are presented along with modifications to CATE telescopes required for successful exoplanet follow up observations.
Dissertation