Simulation and virtual reality in medical education and therapy: a protocol

This article was just published in Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society. (How's that for a title?) The December 2005 issue is free and it contains some pretty interesting articles, such as Factors Influencing Adolescents Engagement in Risky Internet Behavior and Relationships among Internet Attitudes, Internet Use, Romantic Beliefs, and Perceptions of Online Romantic Relationships.

Roy MJ, Sticha DL, Kraus PL, Olsen DE. Simulation and virtual reality in medical education and therapy: a protocol. Cyberpsychol Behav 2006;9:245-247.

Abstract: Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education- and treating their patients-via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.
PubMed Record  


History and overview of theories and methods of chiropractic

These two articles were published in a recent issue of Clinical Orhtopaedics & Related Research:

DeVocht JW. History and overview of theories and methods of chiropractic: a counterpoint. Clin Orthop Relat Res 2006;444:243-249.

Abstract: Spinal manipulation has been used for its therapeutic effects for at least 2500 years. Chiropractic as we know it today began a century ago in a simplistic manner but has developed into to a well-established profession with 33 colleges throughout the world. During the initial, bumpy years, many people thought it had little more value than a placebo. Nevertheless, there have always been satisfied recipients of chiropractic care during the years, and the profession slowly gained prominence–mostly by word of mouth. More recently, personal opinions based on isolated incidents have given way to the results of numerous clinical and basic science studies, primarily regarding low back pain. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Other studies have shown that chiropractic care compared with medical care is safer, costs no more and often costs much less, and has consistently greater patient satisfaction for treatment of similar conditions. Consequently, there is now better public and professional opinion of chiropractic with coverage by insurance companies and government agencies. That trend is likely to continue.
PubMed Record   

Homola S. Chiropractic: history and overview of theories and methods. Clin Orthop Relat Res 2006;444:236-242.

Abstract: Chiropractic is one of the most controversial and poorly defined healthcare professions with recognition and licensure in the United States. Chiropractic was started by D. D. Palmer, a magnetic healer who formulated the vertebral subluxation theory. The profession was developed by his son, B. J. Palmer. Although the definition of chiropractic as a method of correcting vertebral subluxations to restore and maintain health is questionable, spinal manipulation is of value in the treatment of some types of back pain. The chiropractic profession is still based on the vertebral subluxation theory, and has the confusing image of a back specialty capable of treating a broad scope of health problems. Despite opposition to use of spinal manipulation as a method of treating a broad scope of health problems (as opposed to the generally accepted use of manipulation in the treatment of back pain), chiropractors seek support as primary care providers in alternative medicine. It is essential to understand the theories, philosophies, and methods of chiropractic for an objective evaluation.
PubMed Record  

View all chiropractic posts.

Financial conflict of interest disclosure and voting patterns at Food and Drug Administration Drug Advisory Committee meetings

Thanks to Bob Morrow for sending along this reference from the current issue of JAMA.

Lurie P, Almeida CM, Stine N, Stine AR, Wolfe SM. Financial conflict of interest disclosure and voting patterns at Food and Drug Administration Drug Advisory Committee meetings. JAMA 2006;295:1921-1928.
CONTEXT: In January 2002, the US Food and Drug Administration (FDA) issued a draft guidance requiring more detailed financial conflict of interest disclosure at advisory committee meetings.
OBJECTIVES: To characterize financial conflict disclosures at drug-related meetings, and to assess the relationship between conflicts and voting behavior at meetings that considered specific products.
DESIGN AND SETTING: Cross-sectional study using agendas and transcripts from all FDA Drug Advisory Committee meetings (2001-2004) listed on the FDA Web site.
MAIN OUTCOME MEASURES: Conflict rates, type, and size. The relationship between having a conflict and voting in favor of the index drug was described for each voter using Mantel-Haenszel relative risks and Monte Carlo simulations; Spearman rho was used for a meeting-level analysis comparing rates of conflict with voting patterns. The impact of the removal of persons with conflicts of interest on the vote margins was also evaluated.
RESULTS: A total of 221 meetings held by 16 advisory committees were included in the study. In 73% of the meetings, at least 1 advisory committee member or voting consultant disclosed a conflict; only 1% of advisory committee members were recused. For advisory committee members (n = 1957) and voting consultants combined (n = 990), 28% (n = 825) disclosed a conflict. The most commonly specified conflicts were consulting arrangements, contracts/grants, and investments. Nineteen percent of consulting arrangements involved over 10,000 dollars, 23% of contracts/grants exceeded 100,000 dollars, and 30% of investments were over 25,000 dollars. The meeting-level analysis did not show a statistically significant relationship between conflict rates (“index conflict,” “competitor conflict,” or “any conflict”) and voting patterns, but a weak, statistically significant positive relationship was apparent for competitor conflict and any conflict in the Mantel-Haenszel analyses. The Monte Carlo analyses produced similar findings in the competitor conflict analysis only. In all 3 conflict categories, the exclusion of advisory committee members and voting consultants with conflicts would have produced margins less favorable to the index drug in the majority of meetings, but this would not have changed whether the majority favored or opposed the drug.
CONCLUSIONS: Disclosures of conflicts of interest at drug advisory committee meetings are common, often of considerable monetary value, and rarely result in recusal of advisory committee members. A weak relationship between certain types of conflicts and voting behaviors was detected, but excluding advisory committee members and voting consultants with conflicts would not have altered the overall vote outcome at any meeting studied.
 PubMed Record       Journal Record     Full Text

Friday Fun: Listen to Neil Young’s Living With War, for free

[See also Friday Fun: The ArchivesNeil Young's new album Living With War is available for free from his Living with War blog, starting today. The album will be available available in stores early May.

You can listen to it online  or host the music on your own site.  Here is Neil's Web site.

I can hardly wait to get home and listen to the new album. Then I will put on my old love beads and listen to Phil Ochs.

Getting it right: being smarter about clinical trials

Kramer BS, Wilentz J, Alexander D, Burklow J, Friedman LM, Hodes R, Kirschstein R, Patterson A, Rodgers G, Straus SE. Getting it right: being smarter about clinical trials [A major NIH meeting led to recommendations for conducting better clinical trials]. PLoS Med 2006;3:e144.
 Excerpt: Concerns about adverse events, including deaths, in recent large clinical trials, both publicly and privately sponsored, prompted Elias A. Zerhouni, Director, National Institutes of Health (NIH) to convene a meeting at the NIH on January 11-12, 2005, to discuss “Moving from Observational Studies to Clinical Trials: Why Do We Sometimes Get It Wrong?” (a detailed summary and video archive of the meeting are available here ). It is time for an ‘M and M’ [Morbidity and Mortality] conference [on medical evidence], Zerhouni said at the meeting. He challenged attendees to develop innovative ideas to aid decision and policy making, commenting that the credibility of the scientific enterprise was at stake. Forty percent of science news relates to health or medicine, he noted, and we are seeing a gradual erosion of public trust.   Free Full Text  

Spam Zombies from Outer Space

This paper by John Aycock and Nathan Friess of the Department of Computer Science, University of Calgary, will be presented next week at the European Institute for Computer Anti-Virus Research conference in Hamburg, Germany.

Spam Zombies from Outer Space
Abstract: How can better email worms be created? How can spyware claim more victims? How can better spam be sent? It turns out that these three questions are all related. We look at the future threat posed by email worms, spyware, and spammers that use zombie machines in a new way: sophisticated data mining of their victims’ saved email. The end result skirts many defenses, and could trick even experienced users. We present new defenses that can be deployed now against this threat.
Full Text                       Story from today's Globe and Mail