R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation

To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.

A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors

BACKGROUND

Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

METHODS

We conducted a cross-sectional, international 30-item survey through e-mails.

RESULTS

In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

CONCLUSION

Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

A systematic review of neurological airway respiratory cardiovascular other-surgical severity (NARCO-SS) score as a pediatric perioperative scoring system

OBJECTIVE

To systematically identify and synthesize the available evidence of the neurological airway respiratory cardiovascular other-surgical severity (NARCO-SS) score as compared to other pediatric specific perioperative scoring systems.

DESIGN

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. All studies in all languages comparing NARCO-SS with pediatric perioperative scoring systems against outcomes were included. Records were screened and data were extracted by three independent reviewers into standardized pilot-tested extraction templates.

DATA SOURCES

Electronic searches were performed in MEDLINE, Embase, Scopus, and CINAHL (from inception to February 2023).

REVIEW METHODS

The references were uploaded to a validated software for systematic reviews (Rayyan) and screened against the inclusion criteria. Full text of included studies were reviewed and the available data were tabulated. We conducted Risk of Bias analysis on the included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

RESULTS

A meta-analysis could not be performed due to differences in outcome definitions across the included studies. Correlations between NARCO-SS scores, ASA-PS scores and the predefined outcomes of each study were presented as a narrative synthesis. The included studies were determined to have a high risk of bias using the PROBAST.

CONCLUSIONS

This review has identified a need for high-quality studies assessing NARCO-SS before recommendations for clinical practice can be made. Addressing its limitations and enhancing the NARCO-SS through targeted refinements of its individual descriptive categories could potentially lead to improvement in its overall predictive accuracy and facilitate wider adoption into clinical practice.

Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder

The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.9% girls; Mage = 15.56, SD = 1.37) consecutively referred to two specialist outpatient clinics in Stockholm, Sweden (n = 97) and London, England (n = 85). An exploratory factor analysis identified three factors, namely "threat monitoring", "camouflaging", and "avoidance", explaining 48.15% of the variance. The scale showed good internal consistency (McDonalds omega = 0.83) and adequate convergent validity with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A; rs = 0.42) and the Clinical Global Impression-Severity Scale (rs = 0.32). Sensitivity to change was adequate, with AAI total scores and individual factor scores significantly decreasing over time in the subgroup of participants receiving multimodal treatment for BDD (n = 79). Change of AAI scores over treatment showed a positive statistically significant moderate-to-good correlation (r = 0.55) with changes in BDD symptom severity, measured by the BDD-YBOCS-A. The study provides empirical support for the use of the AAI in young people with BDD in clinical settings.

ADHD and Anxiety Symptoms: Does Construct or Assessment Type Matter More?

OBJECTIVE

This study examined the relationships between self-reported ADHD symptoms, self-reported anxiety, and continuous performance test (CPT) performance.

METHOD

128 postsecondary students referred for clinical evaluation for possible ADHD and related conditions completed the Conners Adult ADHD Rating Scale, the Behavior Assessment Scale for Children, Third Edition, and either of two CPTs.

RESULTS

Multiple regression models found that when self-reported anxiety and CPT performance were used to simultaneously predict self-reported ADHD symptoms, CPT performance was not a significant predictor, whereas self-reported anxiety was. This finding was replicated across two different subsamples that took different CPTs.

CONCLUSION

Self-reported anxiety and ADHD symptoms are strongly related, but neither of these variables is significantly related to CPT performance. Implications for clinical practice and future research are discussed.

Assessing competency in exodontia: A UK perspective

INTRODUCTION

Assessment ensures that undergraduate students and postgraduate trainees are providing optimal patient care. Numerous assessment methods are currently being used within the United Kingdom. Therefore, the purpose of this review was to provide an overview of the methods used to assess competency in exodontia and compare methods against criteria defined for good assessment.

MATERIALS AND METHODS

A systematic narrative review was carried out. Databases were electronically searched for published studies assessing the competence of undergraduate students and postgraduate trainees in exodontia up to October 2023.The validity, reproducibility, equivalence, feasibility, educational impact, catalytic effect and acceptability of each assessment method was considered.

RESULTS

In this review, 591 undergraduate students (n = 529) and postgraduate dental trainees (n = 62) had their competence in exodontia assessed. Undergraduate students were assessed on simple exodontia with forceps and elevators, whereas postgraduate trainees were assessed on the surgical removal of mandibular third molars. Only one study took place in a simulated dental environment, the remaining (n = 7) took place in a clinical environment. A range of formative and summative assessment methods were identified including structured clinical objective tests (SCOT), self-assessment, peer assessment and logbooks. Common marking criteria such as global rating and checklist scales were also highlighted.

CONCLUSION

This review highlights the lack of evidence to support one form of assessment and the lack of consensus on assessment within the United Kingdom. Further research related to this topic, alongside the opinion of trainees and trainers is required to improve assessments. This will maximise learning opportunities for trainees and translate to better patient care.

Ten tips for effective use and quality assurance of multiple-choice questions in knowledge-based assessments

Multiple-choice questions (MCQs) are the most popular type of items used in knowledge-based assessments in undergraduate and postgraduate healthcare education. MCQs allow assessment of candidates' knowledge on a broad range of knowledge-based learning outcomes in a single assessment. Single-best-answer (SBA) MCQs are the most versatile and commonly used format. Although writing MCQs may seem straight-forward, producing decent-quality MCQs is challenging and warrants a range of quality checks before an item is deemed suitable for inclusion in an assessment. Like all assessments, MCQ-based examinations must be aligned with the learning outcomes and learning opportunities provided to the students. This paper provides evidence-based guidance on the effective use of MCQs in student assessments, not only to make decisions regarding student progression but also to build an academic environment that promotes assessment as a driver for learning. Practical tips are provided to the readers to produce authentic MCQ items, along with appropriate pre- and post-assessment reviews, the use of standard setting and psychometric evaluation of assessments based on MCQs. Institutions need to develop an academic culture that fosters transparency, openness, equality and inclusivity. In line with contemporary educational principles, teamwork amongst teaching faculty, administrators and students is essential to establish effective learning and assessment practices.

Dental students' perceptions of simultaneous live and online OSCEs during the COVID-19 pandemic

INTRODUCTION

The Objective Structured Clinical Examination (OSCE) is a valid, reliable and reproducible assessment method traditionally carried out as a live examination but recently also provided online. The aim was to compare any differences in the perceptions of dental students participating in online and live OSCE using mixed methods.

MATERIALS AND METHODS

All Finnish fourth-year undergraduate dental students (n = 172) attended the exam in April 2021. Due to the COVID-19 pandemic, the official administrative restrictions in teaching in universities still existed in April 2021. By the time of the national OSCE, the pandemic situation varied in different parts of the country. Therefore, two of the universities conducted a live OSCE and two an online version of the OSCE. Data were collected after the OSCE using a voluntary anonymous electronic questionnaire with multiple-choice and open-ended questions (response rate 58%). Differences between the OSCE versions were analysed using the Mann-Whitney U test and open answers with qualitative content analysis.

RESULTS

The students considered both types of OSCE good in general. The main differences were found concerned adequate time allocation and overall technical implementation, in favour of the live OSCE. While a qualitative analysis revealed exam anxiety as the most often mentioned negative issue, overall, comments were positive.

CONCLUSION

Variation in the assessments between different question entities seemed to be wider than between the implemented OSCE versions. Time management in the OSCE should be further developed by managing the assignment of tasks.

Development of health literacy assessment scale for Thai stroke patients

BACKGROUND

One important factor influencing the treatment and rehabilitation results for stroke patients is their level of health literacy. In order to acquire comprehensive information for appropriate treatment and rehabilitation programs that will promote the optimal possible health outcomes, health literacy assessment should be done in stroke patients from the earliest stages of stroke onset.

OBJECTIVES

This research aimed to develop a health literacy assessment scale for Thai stroke patients and to evaluate the HL levels of those patients using that assessment scale.

METHODS

A draft version of the scale has been developed based on the literature review and focus group discussions. After tryout, content validity, corrected item-total correlation and internal consistency were examined. A confirmatory factor analysis (CFA) was conducted in 400 patients with stroke to test the construct validity.

RESULTS

The Health Literacy Assessment Scale for Thai Stroke Patients was successfully developed. The complete version featured 50 health literacy-related questions, along with seven demographic-related questions. This tool demonstrated good psychometric properties, including content validity (Item-objective congruence; IOC > 0.50), internal consistency (Cronbach's alpha = 0.951 to 0.955, overall = 0.94). Confirmatory factor analysis (CFA) also revealed good construct validity.

CONCLUSIONS

The Health Literacy Assessment Scale for Thai Stroke Patients (HLS-Th) is measuring five components cover all health literacy aspects necessary for Thai stroke patient. This novel measurement scale is an accurate psychometric tool for assessing the level of health literacy among Thai stroke survivors.

A method for assessing student ability to apply anatomical knowledge within a traditional anatomy laboratory examination

Fidelity between teaching activities and assessment methods is an important goal of knowledge and performance evaluations in medical education. Ideally, assessment methods provide evidence of learning that reflects the types of knowledge described in the learning objectives of the course. The most reliable assessments involve the same or similar tasks as those used during the instructional components of the course. Our preclinical human anatomy course includes, in addition to traditional lecture and cadaver-based laboratory learning activities, a series of applied human anatomy learning activities intended to emphasize human anatomy as it is encountered in living human individuals. The learning activities involve psychomotor behaviors including inspection, palpation, and auscultation, techniques used in the physical examination, as well as other activities designed to emphasize anatomical structures and tissues as they may be found in patient populations. We describe here our method for measuring student success in learning human anatomy in this manner, highlighting the direct linkage between the learning activities and the assessment tasks. We describe our performance scoring method and how we include this data in the calculation of an anatomy examination grade. As an indicator of our success with this approach, we include performance scores for the applied anatomy questions included on the laboratory component of our unit examinations for two successive academic years. We conclude with summary comments from students regarding the applied anatomy learning activities and assessment approach and offer suggestions for addressing specific challenges associated with the use of these types of assessment methods.

The neural network algorithm-based quality assessment method for university English translation

These results highlight the transformative potential of neural network algorithms in providing consistency and transparency while reducing the inherent subjectivity in human evaluations, revolutionizing translation quality assessment in academia. The findings have significant implications for academia, as reliable translation quality evaluations are crucial for fostering cross-cultural knowledge exchange. However, challenges such as domain-specific adaptation require further investigation to improve and maximize the effectiveness of this novel approach, ultimately enhancing the accessibility of academic content and promoting global academic discourse. The proposed method involves using neural network algorithms for assessing college-level English translation quality, starting with data collection and preparation, developing a neural network model, and evaluating its performance using human assessment as a benchmark. The study employed both human evaluators and a neural network model to assess the quality of translated academic papers, revealing a strong correlation (0.84) between human and model assessments. These findings suggest the model's potential to enhance translation quality in academic settings, though additional research is needed to address certain limitations. The results show that the Neural Network-Based Model achieved higher scores in accuracy, precision, F-measure, and recall compared to Traditional Manual Evaluation and Partial Automated Model, indicating its superior performance in evaluating translation quality.

Impaired lexical access for unique entities in individuals with subjective cognitive decline

Subjective cognitive decline (SCD) may serve as an early indicator of Alzheimer's disease (AD). However, accurately quantifying cognitive impairment in SCD is challenging, mainly because existing assessment tools lack sensitivity. This study examined how tasks specifically designed to assess knowledge of famous people, could potentially aid in identifying cognitive impairment in SCD. A total of 60 adults with SCD and 60 healthy controls (HCs) aged 50 to 82 years performed a famous people verbal fluency task and a famous people naming task. In the famous people fluency task, the results showed that the individuals with SCD produced significantly fewer famous names in the total time allowed than the HCs, and this difference was also found in the first and the second time interval. In the famous people naming task, the performance of the SCD group was significantly lower than that of the HC group only in the more recent period of fame. Overall, these results suggest that retrieving the names of famous people was more difficult for people with SCD than for people without cognitive complaints. They also suggest that famous people verbal fluency and naming tasks could be useful in detecting cognitive decline at the preclinical stage of AD.

Identifying potential cases of eating disorders in an acute medical hospital

OBJECTIVE

To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED.

METHOD

The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit.

RESULTS

Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record.

DISCUSSION

Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment.

PUBLIC SIGNIFICANCE

People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.

A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study

BACKGROUND

Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients.

OBJECTIVE

We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis.

METHODS

In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing).

RESULTS

ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to "general questions" (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9).

CONCLUSIONS

Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation.

How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample

BACKGROUND

The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown.

METHODS

The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings.

RESULTS

Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties.

CONCLUSIONS

The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.

Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study

BACKGROUND

Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home.

OBJECTIVE

In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers.

METHODS

Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant's willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis.

RESULTS

The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024.

CONCLUSIONS

This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55192.

Intensive care nurses' perceptions and awareness of delirium and delirium prevention guidelines

BACKGROUND

Delirium is an acute and fluctuating disturbance of cognition and is a common occurrence in critically ill patients. It is a manifestation of an acute brain dysfunction often attributed to higher survival rates and a subsequently aging population. Intensive Care Unit (ICU) treatment and survival often contributes towards development of delirium, and lack of or inappropriate management can translate into the development of long-term psychological effects that last even after discharge. While a lot is already known about this topic, and several assessment tools exist, these are not being consistently used by ICU nurses and as a result delirium often goes unrecognized, with unwarranted consequences.

AIMS

The study aimed to explore the perception of delirium among ICU nurses, and the extent of their awareness about guidelines to assess and prevent delirium in ICU patients. It also sought to understand the application of delirium guidelines in ICU practice.

STUDY DESIGN

A quantitative, exploratory, self-reporting survey was conducted among 145 ICU nurses from one critical care unit in the Republic of Ireland.

RESULTS

The overall response rate was 71% (103/145). Most nurses (85%) who participated in this survey believed delirium was expected. However, only 45% acknowledged it is a complication. Only 31% of nurses monitored delirium using a validated scale and few observed this as a part of routine care. Most nurses had received education; however, this did not translate to their clinical practice.

CONCLUSIONS

Guidelines on managing delirium may not be routinely implemented in the ICU settings of hospitals in the Republic of Ireland.

RELEVANCE TO CLINICAL PRACTICE

As the findings suggest, a gap exists between theory and practice, necessary revision of policy or creating a new policy, supplemental educational sessions such as bedside sessions, e-learning module, study day or seminars need to be organized to improve nurses' awareness related to delirium and delirium prevention guidelines.

Exploration of a somatosensory interactive assessment tool for children with intellectual disabilities

Based on the functional assessment concept and embodied assessment requirements, the present study aimed to design and develop an assessment tool for children with intellectual disabilities with the help of somatosensory interactive (SI) technology. The sample in this study consisted of 73 children with intellectual disabilities and 70 children with typical development. Data were collected through three SI tasks, four traditional executive function tasks, and user experience interviews to analyse the effectiveness of the SI assessment tool. The results showed that the SI assessment tool had good scale validity, discriminant validity, and the ability to identify intellectual disabilities. Children preferred SI tasks and showed higher involvement and more positive emotions. The SI tool with three SI tasks is a more scientific, effective, and advanced tool for assessing children with intellectual disabilities.

Authors' Reply: "Evaluating GPT-4's Cognitive Functions Through the Bloom Taxonomy: Insights and Clarifications"

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Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study

Background

Accurately assessing an individual's diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message.

Objective

This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool.

Methods

This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment.

Results

A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P≤.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed.

Conclusions

Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness.

LEVEL OF SUPERVISION FOR THE EPAS COMMON TO GENERAL PEDIATRICS AND THE SUBSPECIALTIES DECREASES FROM RESIDENCY TO FELLOWSHIP

OBJECTIVES

To compare level of supervision (LOS) ratings of graduating pediatric residents with their assessments as fellows for the 5 Entrustable Professional Activities (EPAs) common to general pediatrics and the subspecialties and to determine if the difference between ratings from residency to fellowship is less for the QI and PRACTICE MANAGEMENT EPAs, since the skills needed to perform these may be less context-dependent.

METHODS

We compared ratings of graduating residents with their assessments as fellows using LOS data from 2 sequential EPA studies.

RESULTS

There were 65 ratings from 41 residents at the 1st fellow assessment. At graduation, most residents needed little to no supervision for all EPAs with 94% (61/65) of ratings level 4 or 5. In contrast, only 5/65 (8%) of the 1st fellow assessments were level 4 or 5. The ratings difference for the QI and PRACTICE MANAGEMENT EPAs was similar to the others.

CONCLUSIONS

LOS ratings for the EPAs common to generalists and subspecialists reset as residents become fellows. There was no evidence that the QI and PRACTICE MANAGEMENT EPAs are less context-dependent. This study provides additional validity evidence for using these LOS scales to assess trainees in pediatric residency and fellowship.

Implementation of a programmatic assessment model in radiation oncology medical physics training

PURPOSE

In 2019, a formal review and update of the current training program for medical physics residents/registrars in Australasia was conducted. The purpose of this was to ensure the program met current local clinical and technological requirements, to improve standardization of training across Australia and New Zealand and generate a dynamic curriculum and programmatic assessment model.

METHODS

A four-phase project was initiated, including a consultant desktop review of the current program and stakeholder consultation. Overarching program outcomes on which to base the training model were developed, with content experts used to update the scientific content. Finally, assessment specialists reviewed a range of assessment models to determine appropriate assessment methods for each learning outcome, creating a model of programmatic assessment.

RESULTS

The first phase identified a need for increased standardized assessment incorporating programmatic assessment. Seven clear program outcome statements were generated and used to guide and underpin the new curriculum framework. The curriculum was expanded from the previous version to include emerging technologies, while removing previous duplication. Finally, a range of proposed assessments for learning outcomes in the curriculum were generated into the programmatic assessment model. These new assessment methods were structured to incorporate rubric scoring to provide meaningful feedback.

CONCLUSIONS

An updated training program for Radiation Oncology Medial Physics registrars/residents was released in Australasia. Scientific content from a previous program was used as a foundation and revised for currency with the ability to accommodate a dynamic curriculum model. A programmatic model of assessment was created after comprehensive review and consultation. This new model of assessment provides more structured, ongoing assessment throughout the training period. It contains allowances for local bespoke assessment, and guidance for supervisors by the provision of marking templates and rubrics.

Twelve tips for supporting medical learners through high-stakes assessment challenges

Learners across the medical education continuum will encounter numerous high-stakes exams and assessments. Effectively preparing for and performing well on these types of assessments can be challenging for learners for a wide variety of reasons. It is imperative that medical educators provide appropriate support for learners who experience challenges with high-stakes exams, particularly given the complexity of factors like life circumstances of individual learners and the significance of these assessments for career advancement/progression. Grouped into areas including educator mindset, information-gathering, and developing and executing a study plan, the following 12 tips will help medical educators be better prepared to meaningfully support learners in need of assessment remediation and guidance.

The Montreal Cognitive Assessment detects cognitive deficits that go unnoticed during clinical observation in the acute phase after stroke

BACKGROUND

Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored.

METHODS

Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored.

RESULTS

The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients' charts (25%) differed significantly (p < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening.

CONCLUSIONS

The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes.

Providing rigor in bee colony strength auditing methods

The primary method used to audit honey bee (Apis mellifera Linnaeus, 1758 [Hymenoptera: Apidae]) colony strength for almond pollination services, Nasr et al.'s (1990) frame-top cluster count method, is a subjective visual audit that relies on an auditor's spot assessment and may lack rigor and repeatability. We created novel, open-source software for the analysis of frame-top cluster count photographic assessments to improve methodological rigor and repeatability. We evaluated 2 existing visual audit methods, created 3 novel audit method variations, and determined between-method conversion factors using linear modeling. The software has potential applications in apiological research, apiarist and orchardist colony auditing, as well as training future generations of apiarists in auditing techniques. The software enhances the rigor and repeatability of Nasr et al.'s (1990) frame-top cluster count population assessment. In this article, we introduce the novel open-source software and between-method regression equations and review the tested visual assessment methods and their application.

Development and psychometric evaluation of the asthma Action plan questionnaire (AAPQ)

OBJECTIVE

To develop a practical and psychometrically sound tool to evaluate caregiver knowledge of their child's asthma action plan (AAP).

METHODS

A pilot study was conducted in a sample of 40 caregivers of children with asthma to assess the content validity, item difficulty, and item discrimination of the Asthma Action Plan Questionnaire (AAPQ). The inter-rater and intra-rater agreement of the AAPQ's scoring rubric were also examined. Subsequently, a large-scale study was conducted in a sample of 80 caregivers of children with asthma and 40 caregivers of children without current asthma and no prior exposure to patients with asthma to evaluate the internal consistency, test-retest reliability, and known-groups validity of the AAPQ.

RESULTS

The 7-item AAPQ demonstrated acceptable content validity (a scale-content validity index of 0.98) and internal consistency (Cronbach's alpha =.63 and mean inter-item correlation coefficient of.20) and very strong test-retest reliability over a two-to-four-week period (r = .88, p < .001). The AAPQ discriminated between caregivers of children with asthma and caregivers of children without asthma (M ± SD 8.3 ± 1.6 vs. 4.3 ± 1.7, p < .001, respectively).

CONCLUSION

The AAPQ is a valid and reliable questionnaire that provides an assessment of caregivers' knowledge of their child's AAP and can guide educational interventions by healthcare providers.

The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview

Cerebrovascular diseases, including ischemic strokes, hemorrhagic strokes, and vascular malformations, are major causes of morbidity and mortality worldwide. The advancements in neuroimaging techniques have revolutionized the field of cerebrovascular disease diagnosis and assessment. This comprehensive review aims to provide a detailed analysis of the novel imaging methods used in the diagnosis and assessment of cerebrovascular diseases. We discuss the applications of various imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography, highlighting their strengths and limitations. Furthermore, we delve into the emerging imaging techniques, including perfusion imaging, diffusion tensor imaging (DTI), and molecular imaging, exploring their potential contributions to the field. Understanding these novel imaging methods is necessary for accurate diagnosis, effective treatment planning, and monitoring the progression of cerebrovascular diseases.

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

This article provides a comprehensive analysis of modern techniques used in the assessment of cutaneous flaps in reconstructive surgery. It emphasizes the importance of preoperative planning and intra- and perioperative assessment of flap perfusion to ensure successful outcomes. Despite technological advancements, direct clinical assessment remains the gold standard. We categorized assessment techniques into non-invasive and invasive modalities, discussing their strengths and weaknesses. Non-invasive methods, such as acoustic Doppler sonography, near-infrared spectroscopy, hyperspectral imaging thermal imaging, and remote-photoplethysmography, offer accessibility and safety but may sacrifice specificity. Invasive techniques, including contrast-enhanced ultrasound, computed tomography angiography, near-infrared fluorescence angiography with indocyanine green, and implantable Doppler probe, provide high accuracy but introduce additional risks. We emphasize the need for a tailored decision-making process based on specific clinical scenarios, patient characteristics, procedural requirements, and surgeon expertise. It also discusses potential future advancements in flap assessment, including the integration of artificial intelligence and emerging technologies.

Bioethical knowledge in students and health professionals: a systematic review

Introduction

Bioethics training is essential for healthcare professionals as it enables them to address ethical dilemmas in their clinical practice. However, there is still a lack of rigorous teaching programs, and assessing bioethical knowledge poses challenges.

Methodology

Systematic review using the PRISMA method.

Results

Analysis of 27 studies reveals a lack of ethical knowledge and skills among healthcare professionals and students. Specific training in bioethics is effective in developing bioethical competencies. Different approaches have been employed, including integrated training in academic curricula and intensive or ongoing programs. The results demonstrate improvements in knowledge, attitudes, and ethical values, although regularly updating these courses is recommended.

Conclusion

Specific training, institutional support, and considering regional and disciplinary differences are necessary to enhance ethics in the practice of healthcare professionals.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437146, identifier CRD42023437146.

Injured worker participation in assessment during the acute phase of workers compensation rehabilitation: a scoping review

PURPOSE

Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation.

METHOD

An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment.

RESULTS

Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW.

CONCLUSIONS

Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Development and validation of the newly developed Preschool Theory of Mind Assessment (ToMA-P)

Introduction

Theory of mind (ToM) refers to the ability to understand and attribute mental states to oneself and others. A ToM measure is warranted for preschool children to assess their ToM development from a multidimensional perspective (i.e., cognitive and affective dimensions). This study aimed to develop the Preschool Theory of Mind Assessment (ToMA-P) and to evaluate its construct validity and applicability.

Methods

The ToMA-P was developed based on comprehensive literature review and revised with expert panel feedback. Its psychometric properties were evaluated in 205 typically developing preschoolers with Rasch analysis for its dimensionality, item difficulties, and convergent validity.

Results

The results indicated that all ToMA-P items, except for one, fit the hypothesized two-dimensional construct. The item difficulties in the cognitive and affective dimensions followed developmental sequences. The ToMA-P scores exhibited good convergent validity, as evidenced by its significant correlations with age, verbal comprehension, adaptive functions, and daily ToM performance (p < 0.05). Children's responses and behaviors also showed that the ToMA-P has good applicability.

Discussion

This study provides empirical evidence that the ToMA-P measures cognitive and affective ToM following developmental sequences, and that it has potential as a clinical tool for assessing ToM in preschool children.

Using Computer Vision to Annotate Video-Recoded Direct Observation of Physical Behavior

Direct observation is a ground-truth measure for physical behavior, but the high cost limits widespread use. The purpose of this study was to develop and test machine learning methods to recognize aspects of physical behavior and location from videos of human movement: Adults (N = 26, aged 18-59 y) were recorded in their natural environment for two, 2- to 3-h sessions. Trained research assistants annotated videos using commercially available software including the following taxonomies: (1) sedentary versus non-sedentary (two classes); (2) activity type (four classes: sedentary, walking, running, and mixed movement); and (3) activity intensity (four classes: sedentary, light, moderate, and vigorous). Four machine learning approaches were trained and evaluated for each taxonomy. Models were trained on 80% of the videos, validated on 10%, and final accuracy is reported on the remaining 10% of the videos not used in training. Overall accuracy was as follows: 87.4% for Taxonomy 1, 63.1% for Taxonomy 2, and 68.6% for Taxonomy 3. This study shows it is possible to use computer vision to annotate aspects of physical behavior, speeding up the time and reducing labor required for direct observation. Future research should test these machine learning models on larger, independent datasets and take advantage of analysis of video fragments, rather than individual still images.

Biomechanical Assessment Methods Used in Chronic Stroke: A Scoping Review of Non-Linear Approaches

Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.

Efficacy of a Virtual 3D Simulation-Based Digital Training Module for Building Dental Technology Students' Long-Term Competency in Removable Partial Denture Design: Prospective Cohort Study

Background

Removable partial denture (RPD) design is crucial to long-term success in dental treatment, but shortcomings in RPD design training and competency acquisition among dental students have persisted for decades. Digital production is increasing in prevalence in stomatology, and a digital RPD (D-RPD) module, under the framework of the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT) system reported in our previous work, may improve on existing RPD training models for students.

Objective

We aimed to determine the efficacy of a virtual 3D simulation-based progressive digital training module for RPD design compared to traditional training.

Methods

We developed a prospective cohort study including dental technology students at the Stomatology College of Chongqing Medical University. Cohort 1 received traditional RPD design training (7 wk). Cohort 2 received D-RPD module training based on text and 2D sketches (7 wk). Cohort 3 received D-RPD module pilot training based on text and 2D sketches (4 wk) and continued to receive training based on 3D virtual casts of real patients (3 wk). RPD design tests based on virtual casts were conducted at 1 month and 1 year after training. We collected RPD design scores and the time spent to perform each assessment.

Results

We collected the RPD design scores and the time spent to perform each assessment at 1 month and 1 year after training. The study recruited 109 students, including 58 (53.2%) female and 51 male (56.8%) students. Cohort 1 scored the lowest and cohort 3 scored the highest in both tests (cohorts 1-3 at 1 mo: mean score 65.8, SD 21.5; mean score 81.9, SD 6.88; and mean score 85.3, SD 8.55, respectively; P<.001; cohorts 1-3 at 1 y: mean score 60.3, SD 16.7; mean score 75.5, SD 3.90; and mean score 90.9, SD 4.3, respectively; P<.001). The difference between cohorts in the time spent was not statistically significant at 1 month (cohorts 1-3: mean 2407.8, SD 1370.3 s; mean 1835.0, SD 1329.2 s; and mean 1790.3, SD 1195.5 s, respectively; P=.06) but was statistically significant at 1 year (cohorts 1-3: mean 2049.16, SD 1099.0 s; mean 1857.33, SD 587.39 s; and mean 2524.3, SD 566.37 s, respectively; P<.001). Intracohort comparisons indicated that the differences in scores at 1 month and 1 year were not statistically significant for cohort 1 (95% CI -2.1 to 13.0; P=.16), while cohort 3 obtained significantly higher scores 1 year later (95% CI 2.5-8.7; P=.001), and cohort 2 obtained significantly lower scores 1 year later (95% CI -8.8 to -3.9; P<.001).

Conclusions

Cohort 3 obtained the highest score at both time points with retention of competency at 1 year, indicating that progressive D-RPD training including virtual 3D simulation facilitated improved competency in RPD design. The adoption of D-RPD training may benefit learning outcomes.

Convergent Validity Between the Motor Domain of PediaTracTM and Ages and Stages in Term and Preterm Infants at 2, 4, 6, and 9 Months of Age

The primary aim of this study was to evaluate the convergent validity of the Motor domain (MOT) of PediaTracTM v3.0, an online developmental tracking instrument based on caregiver reports, with fine and gross motor domains (ASQ-FM and ASQ-GM) of the Ages and Stages Questionnaire (ASQ-3) in infants between 2- and 9 months of age. Participants were caregivers of 571 infants born term or preterm (gestational age <37 weeks) enrolled in a multi-site psychometric study of PediaTracTM. Findings revealed significant correlations between MOT and ASQ-3 scores at 2, 4, 6, and 9 months across time periods, term-preterm status, and biological sex. A significantly higher percentage of infants born preterm, compared with those born at term, was identified as a moderate or high risk on both the ASQ-3 and PediaTrac. Future investigations are warranted to further examine the psychometric properties of the MOT domain, including sensitivity, specificity, and positive and negative predictive value.

Recommendations of the French Society of Rheumatology for the management in current practice of patients with Polymyalgia Rheumatica

OBJECTIVE

To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR) Methods: Following standard procedures, a systematic review of the literature by 5 supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts.

RESULTS

Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and 5 to the assessment of the disease, its activity and co-morbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, 5 concern the reduction of corticosteroid therapy and follow-up, and 2 concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6).

CONCLUSION

These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR.

The Body Image Virtual Reality Assessment (BIVRA): Measuring the body representation through virtual reality

Our physical and psychological well-being is significantly influenced by how we perceive our body, in addition to our thoughts and emotions associated with it. Dysfunctional body perceptions and attitudes play a key role in the development and maintenance of severe conditions such as eating disorders in both males and females. Given its relevance, some attempts have been made to improve body image assessment methods in terms of perceptual accuracy and body satisfaction taking advantage of technological advances such as virtual reality. However, existing applications have mainly focused on women and clinical conditions. In this study, we presented the Body Image Virtual Reality Assessment (BIVRA), a virtual reality figure rating scale to assess body image in both male and female subjects. We tested BIVRA's ability to measure perceptual accuracy and compared its results with a standardized body satisfaction questionnaire. Additionally, we investigated gender differences. BIVRA was found to be effective in assessing body image. We observed that a perceptually based task successfully captured both low and high levels of body representations, shedding light on the significant gender differences. The association between BIVRA and the body satisfaction questionnaires was moderated by gender, with a stronger association for women. While further validation of BIVRA is needed to fully exploit its potential, our results suggest that the integration of virtual reality into the assessment of body image and related disorders may significantly enhance our understanding of individuals struggling with body image issues and has the potential to advance current methods and techniques.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Battle of the sections: Student outcomes and course feedback support combined prosection and dissection laboratory formats to maximize student success

Gross anatomy laboratories frequently utilize dissection or prosection formats within medical curricula. Practical examination scores are consistent across the formats, yet these examinations assessed larger anatomical structures. In contrast, a single report noted improved scores when prosection was used in the hand and foot regions, areas that are more difficult to dissect. The incorporation of prosected donors within "Head and Neck" laboratories provided an opportunity to further characterize the impact of prosection in a structurally complex area. Retrospective analysis of 21 Head and Neck practical examination questions was completed to compare scores among cohorts that utilized dissection exclusively or incorporated prosection. Mean scores of practical examination questions were significantly higher in the prosection cohort (84.27% ± 12.69) as compared with the dissection cohort (75.59% ± 12.27) (p < 0.001). Of the 12 questions that performed better in the prosection cohort (88.42% ± 8.21), 10 items mapped to deeper anatomical regions. By comparison, eight of nine questions in the dissection cohort outperformed (88.44% ± 3.34) the prosection cohort (71.74% ± 18.11), and mapped to anatomically superficial regions. Despite the mean score increase with positional location of the questions, this effect was not statically significant across cohorts (p = 1.000), suggesting that structure accessibility in anatomically complex regions impacts performance. Student feedback cited structure preservation (71.5%) and time savings (55.8%) as advantages to prosection; however, dissection was the perceived superior and preferred laboratory format (88.6%). These data support combined prosection and dissection formats for improving student recognition of deeply positioned structures and maximizing student success.

On the relation between oral contraceptive use and self-control

In two studies we examined the relation between oral contraceptive (OC) use and self-reported levels of self-control in undergraduate women using OCs (Study 1: OC group N = 399, Study 2: OC group N = 288) and naturally cycling women not using any form of hormonal contraceptives (Study 1: Non-OC group N = 964, Study 2: Non-OC group N = 997). We assessed the self-overriding aspect of self-control using the Brief Self-Control Scale (BSCS) and strategies for self-regulation using the Regulatory Mode Scale (RMS), which separately measures the tendency to assess one's progress towards a goal (assessment), and the tendency to engage in activities that move one towards an end goal (locomotion). In Study 1, we found no significant differences between OC and non-OC groups in their levels of self-overriding or self-regulatory assessment. However, we found that those in the OC group reported significantly greater levels of self-regulatory locomotion compared to those in the non-OC group, even after controlling for depression symptoms and the semester of data collection. The findings from Study 2 replicated the findings from Study 1 in a different sample of participants, with the exception that OC use was also related to higher levels of assessment in Study 2. These results indicate that OC use is related to increases in self-regulatory actions in service of goal pursuit and perhaps the tendency to evaluate progress towards goals.

Using Motivation Assessment as a Teaching Tool for Large Undergraduate Courses: Reflections From the Teaching Team

Introduction

Student motivation is a critical predictor of academic achievement, engagement, and success in higher education. Motivating students is a crucial aspect of effective teaching.

Statement of the Problem

Although there is a wealth of research on student motivation, practical guidance for putting theory into practice in challenging teaching environments (i.e., large-format introductory courses) is lacking. We discuss a first step toward motivating students: understanding how motivated they are and using that information to inform teaching.

Literature Review

Anxiety, impeded motivation, and high student-to-teacher ratio are all challenges associated with teaching foundational introductory courses, such as statistics. The Expectancy-Value-Cost model of motivation provides theoretical background to assist with these courses. We discuss the implementation and use of motivation assessments as a teaching tool.

Teaching Implications

Motivation assessments are feasible and useful while teaching large-format introductory courses. Instructor reflections lend insights as to how to use these assessments to improve pedagogy.

Observer-based and computerized measures of the patient's mentalization in psychotherapy: A scoping review

OBJECTIVE

In recent decades, mentalizing has found its permanent place both in therapeutic practice and in psychotherapy research. Inconsistent results and null results are often found. Therefore, the different methodological approaches should be examined in more detail. A scoping review was conducted to provide an overview of the approaches that measure the patient's mentalizing ability based on therapy sessions or in the course of psychotherapy.

METHOD

For the scoping review, a literature search was conducted in four databases. A total of 3217 records were identified.

RESULTS

We included 84 publications from 43 independent studies. Most studies used the Reflective Functioning Scale and applied the scale to therapy sessions or the Adult Attachment Interview. The other identified approaches used a computerized text analysis measure or clinician-report measures. Mostly good psychometric properties of the measures were reported. The Reflective Functioning Scale applied to the Adult Attachment Interview was the only measure that proved to be sensitive to change.

CONCLUSION

More economical variants to the time-consuming Reflective Functioning Scale applied to the Adult Attachment Interview are being developed continuously. In some cases, there is no standardized approach, or the measures are used only sporadically and require further and more comprehensive psychometric evaluations.

A Systematic Review of Empirical Studies Measuring Training Effects on Biases Evidenced by Professionals toward Intimate Partner Violence

A professional's response to a client's disclosure of intimate partner violence (IPV) is shown to significantly impact client outcomes. The quality of a professional's response is largely influenced by that professional's beliefs or biases surrounding IPV. This systematic review examined empirical studies conducted in North America and published between 2000 and 2020 evaluating training effects on biases held by professional groups toward victim-survivors of IPV. Search and extraction were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses standards across seven electronic databases. A total of 17 studies met inclusion criteria. Participant groups included professionals from medical, academic, and social/community service disciplines. All included studies reported significant gains on at least one measure of bias. Upon visual inspection, we found no correlations between characteristics of training interventions and reported outcomes on measures of bias. We discuss results in terms of challenges to measuring bias and functional relationships between training interventions, measures of bias, and professional behavior. Variation presented across studies within and between disciplines in regards to training methodology and measurement of bias. Experts in the field of IPV call for a more cohesive approach. We propose the behavior analytic conceptualization of bias as a framework through which interdisciplinary efforts might be unified toward addressing IPV-related biases. Through this lens, we discuss environmental cues within professional settings that might be influencing problematic IPV-related bias. We offer preliminary recommendations for curricular enhancements. We advocate for revision of terms commonly used in IPV-related research and intervention to better reflect and honor diversity across persons experiencing IPV.

Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Harmonizing the structured interview for psychosis-risk syndromes (SIPS) and the comprehensive assessment of at-risk mental states (CAARMS): An initial approach

The two most used semi-structured psychometric instruments that define criteria for being at clinical high risk (CHR) for psychosis are the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Structured Interview for Psychosis-Risk Syndromes (SIPS). Although very similar there are important differences between these two measures. Developing harmonized psychometric criteria for defining CHR and associated outcomes would be beneficial for future research. This article describes the first step in this process by reporting on a NIMH workshop held in Washington DC, in February 2019 that was attended by experts in the field. The aim of this workshop was to examine the similarities and differences between the two measures and consider how the harmonization process could proceed.

Occupational therapy in maternal health: Exploring the Barkin Index of Maternal Functioning as a potential tool

INTRODUCTION

Transitioning into the role of a mother encompasses many physical and psychosocial changes, affecting the way a woman may function. Maternal health is an emerging area of practice for occupational therapists, and therefore, screening and assessment tools to support work in this area are needed. The Barkin Index of Maternal Functioning (BIMF) is a quantitative outcome measure that is used by health professionals to assess maternal functioning. Currently, its ability to measure occupational performance is unclear.

METHODS

Utilising a mixed methods design, this study analysed the extent to which the BIMF assesses maternal function from an occupational perspective. Thirteen first-time mothers with a baby 12 months of age or younger participated in the study. Results from the BIMF were compared with themes developed from semi-structured qualitative interviews that explored the occupational experiences of first-time mothers.

FINDINGS

Seven themes were developed from the interviews. The BIMF addressed three themes, including changes to engagement in basic activities of daily living and leisure, transitioning into motherhood, emotions, self-efficacy, and social support. However, four themes were not captured by the BIMF, including changes to partner relationships, identity shift, influence of 'person' factors, and changes to social experiences in early motherhood.

CONCLUSION

Findings suggest that a new tool with a holistic perspective of mothers as occupational beings is needed to be able to identify occupational performance issues and the potential need for occupational therapy support. This study identified key experiences of occupational performance for new mothers.