Thursday, March 3, 2016

Clinical Research Oriented Workshop (CROW) Meeting: March 3, 2016

Present:  Kairn Kelley, Ben Littenberg, Connie van Eeghen

Start Up:  Post-Valentine Day chocolate stories abound

1.                  Discussion: Kairn’s third manuscript: Association between Competing Words and Dichotic Digits Tests
a.       There are three points made in the literature that Kairn could address
                                                  i.      Is right ear dominant
                                                ii.      Comparison of children with/without special needs
                                              iii.      How often do “conflicting test findings” occur – how normal is that
b.      How do the scores compare across children
                                                  i.      Test output: percent correct in each ear, a total, right minus left (4 measures) (Competing Words)
1.      Criteria exist to evaluate scores as normal or abnormal (dichotomous) based on total score
2.      2 children were “abnormal”
                                                ii.      For Digits: total score but focused on R and L ear scores, no published criteria to evaluate (although directions are given that one should evaluate)
1.      Criteria exist to evaluate, separate ears, if one abnormal, then abnormal result
2.      Either 45% were abnormal; ~22% were abnormal by a different evaluation method
                                              iii.      Therefore, Word test more specific than Digit more specific than Modern Digit, based on parental report
1.      Digits tests are more sensitive: puts more kids in “abnormal” outcome
2.      Tests are NOT interchangeable and not equivalent
3.      If the test results disagree, and digits is positive, then…
4.      It never happens that results disagree and digits is negative
a.       But if the Words test was moved to be more sensitive/less specific, then there would be children positive for Words and negative for Digits
5.      Why:
a.       Thresholds are different
b.      The tests are not very precise and include an amount of randomness
c.       Consider a critique of the Digits test
                                                  i.      False positives, overly sensitive, compared to Words test
                                                ii.      No normative data
                                              iii.      Confusion about “means” vs. “cut offs”
                                              iv.      Recommend using Words until Digits is validated and standardized (and alphabetized?)
                                                v.      Concerns:
1.      Words test is insufficiently sensitive (overly specific?)
2.      What are the comparators: Parental concerns, school placement
3.      Critique of the guidelines takes on a larger scope
a.       Statement is found to be false per Kairn’s data
                                                                                                                          i.      Reliability
                                                                                                                        ii.      Use of two SD (see Willan Gaylen, clinical path at Cleveland Clinic critiqued two SD for a clinical test, rather than finding outliers)
                                                                                                                      iii.      Right ear advantage
                                                                                                                      iv.      Effect of age
                                                                                                                        v.      Distributed randomly
d.      Next steps
                                                  i.      Talk with expert (Musyak): “I was trying to demonstrate x but the data are saying y…”
                                                ii.      Write up a critique of the Digits Test
                                              iii.      Send draft to expert
                                              iv.      Acknowledge in paper
                                                v.      Inform the editor

2.                  Next Workshop Meeting(s): Thursdays, 1:30 p.m. – 2:30 p.m., at Given Courtyard South Level 4.   
a.       March 10, 2016: (TBD – Kairn to follow up)
b.      March 17, 2016:

Recorder: Connie van Eeghen

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