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Schuler N, Shepard L, Saxton A, Russo J, Johnston D, Saba P, Holler T, Smith A, Kulason S, Yee A, Ghazi A. Predicting Surgical Experience After Robotic Nerve-sparing Radical Prostatectomy Simulation Using a Machine Learning-based Multimodal Analysis of Objective Performance Metrics. Urol Pract 2023; 10:447-455. [PMID: 37347812 DOI: 10.1097/upj.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Machine learning methods have emerged as objective tools to evaluate operative performance in urological procedures. Our objectives were to establish machine learning-based methods for predicting surgeon caseload for nerve-sparing robot-assisted radical prostatectomy using our validated hydrogel-based simulation platform and identify potential metrics of surgical expertise. METHODS Video, robotic kinematics, and force sensor data were collected from 35 board-certified urologists at the 2022 AUA conference. Video was annotated for surgical gestures. Objective performance indicators were derived from robotic system kinematic data. Force metrics were calculated from hydrogel model integrated sensors. Data were fitted to 3 supervised machine learning models-logistic regression, support vector machine, and k-nearest neighbors-which were used to predict procedure-specific learning curve proficiency. Recursive feature elimination was used to optimize the best performing model. RESULTS Logistic regression predicted caseload with the highest AUC score for 5/7 possible data combinations (force, 64%; objective performance indicators + gestures, 94%; objective performance indicators + force, 90%; gestures + force, 93%; objective performance indicators + gestures + force, 94%). Support vector machine predicted the highest AUC score for objective performance indicators (82%) and gestures (94%). Logistic regression with recursive feature elimination was the most effective model reaching 96% AUC in predicting case-specific experience. Most contributory features were identified across all model types. CONCLUSIONS We have created a machine learning-based algorithm utilizing a novel combination of objective performance indicators, gesture analysis, and integrated force metrics to predict surgical experience, capable of discriminating between surgeons with low or high robot-assisted radical prostatectomy caseload with 96% AUC in a standardized, simulation-based environment.
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Affiliation(s)
- Nathan Schuler
- Simulation Innovation Lab, Carnegie Center for Surgical Innovation, Johns Hopkins University, Baltimore, Maryland
| | - Lauren Shepard
- Simulation Innovation Lab, Carnegie Center for Surgical Innovation, Johns Hopkins University, Baltimore, Maryland
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Jillian Russo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Daniel Johnston
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Patrick Saba
- SUNY Upstate Medical University Norton College of Medicine, Syracuse, New York
| | - Tyler Holler
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Andrea Smith
- Data and Analytics, Intuitive Surgical, Inc, Peachtree Corners, Georgia
| | - Sue Kulason
- Data and Analytics, Intuitive Surgical, Inc, Peachtree Corners, Georgia
| | - Andrew Yee
- Data and Analytics, Intuitive Surgical, Inc, Peachtree Corners, Georgia
| | - Ahmed Ghazi
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
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Cho SH, Choi HS. Effect of Types of Dementia Care on Quality of Life and Mental Health Factors in Caregivers of Patients with Dementia: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11091245. [PMID: 37174787 PMCID: PMC10178038 DOI: 10.3390/healthcare11091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
In Eastern cultures, particularly in South Korea, caregiving for dementia patients at home is common, yet even after facility placement, families may experience ongoing burden due to cultural factors. The aim of this study was to examine the burden experienced by caregivers of dementia patients, considering cultural factors influencing in-home care and facility-based care. Using a cross-sectional study design, we compared the quality of life, depression, subjective happiness, and subjective health of family caregivers providing in-home care (FCHC) and informal family caregivers (IFCGs). Data from the 2019 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (KDCA) that met the study criteria were selected and statistically analyzed. The results showed that psychological/emotional and economic burdens were the primary burden factors for both FCHC and IFCGs. Statistically significant differences were found between the two groups in terms of quality of life, depression, subjective happiness, and subjective health. Specifically, FCHC demonstrated a lower quality of life, and both groups experienced moderate to severe depression, indicating the need for mental health management for caregivers of individuals with dementia. As not all FCHC can be transitioned to IFCGs, interventions tailored to specific caregiving types should be developed to improve the quality of life, depression, subjective happiness, and subjective health of caregivers of individuals with dementia.
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Affiliation(s)
- Seung-Hyun Cho
- Department of Occupational Therapy, College of Health Sciences and Social Welfare, Woosuk University, Wanju 55338, Republic of Korea
| | - Hyun-Se Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
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de Mello Ferreira Dos Reis M, Barros EAC, Monteiro L, Pazeto CL, Baccaglini WRC, Glina S. Premature ejaculation prevalence among young men who have sex with men: a cross-sectional study with internet users in the metropolitan region of São Paulo, Brazil. Sex Med 2023; 11:qfac016. [PMID: 36910706 PMCID: PMC9978591 DOI: 10.1093/sexmed/qfac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 03/06/2023] Open
Abstract
Background There are only a few studies about the prevalence and correlates of premature ejaculation (PE) among men who have sex with men (MSM). Aim (1) To estimate PE prevalence according to 3 assessment methods: self-reported time from penetration to ejaculation (ejaculation latency time [ELT]); Premature Ejaculation Diagnostic Tool (PEDT); and a direct question about the self-perception of ejaculation as being normal, too early (premature), or retarded. (2) To assess the agreement of the 3 assessment methods and identify factors associated with PE according to each method and their combination. Methods We evaluated data from 226 MSM who participated in a cross-sectional study about sexual behavior among men living in the metropolitan region of São Paulo, Brazil. They responded anonymously to an online survey between May 2019 and March 2020. We calculated the agreement of the 3 assessment methods and their association with other characteristics using logistic regression models. Outcomes Outcomes included the prevalence of PE according to the assessment methods and the association measures (PE vs sociodemographic characteristics and sexual behavior). Results The prevalence of PE among MSM was 21.2% (95% CI, 16.1%-27.1%) according to the PEDT, 17.3% (95% CI, 12.6%-22.8%) per self-report, and 6.2% (95% CI, 3.4%-10.2%) by estimated ELT ≤2 minutes. The agreement among the 3 assessments was fair (kappa, 0.31; 95% CI, 0.25-0.37; P < .001). Association with PE varied by assessment method: obesity and shorter time for ejaculation with anal sex vs masturbation were associated with PE according to the PEDT and ELT but not self-evaluation. Perception about ideal time to ejaculate ≤5 minutes increased the chance of PE based on ELT. Higher chances of self-reported PE were associated with trying to hold back ejaculation, and lower chances were associated with higher frequencies of masturbation. Clinical Implications Combining tools to investigate PE allows the identification of characteristics associated with this condition and may result in improvement in the care of MSM. Strengths and Limitations This anonymous online survey provided the privacy necessary for participants to respond freely about sensitive questions, with a low risk of social adequacy bias. However, as it was a secondary analysis of a larger study, it could not evaluate comorbidities (eg, erectile dysfunction, prostatitis, depression) and the use of condoms. Conclusion The prevalence of PE among MSM is high and varies according to the instrument used for the assessment, and the agreement among the 3 assessments was only fair.
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Affiliation(s)
| | | | - Leonardo Monteiro
- Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | | | | | - Sidney Glina
- Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
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Konkel K, Reyes M, Diak IL, Cao K, McCulley L. Serious Skin Injuries Following Exposure to Unapproved Mole and Skin Tag Removers. J Clin Aesthet Dermatol 2023; 16:14-7. [PMID: 36743972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective We sought to describe skin injuries associated with unapproved topical mole and skin tag removers containing concentrated salicylic acid, Sanguinaria canadensis, or other caustic agents. Methods We identified skin injuries associated with unapproved non-device topical mole and skin tag removers reported to the US Food and Drug Administration (FDA) through October 30, 2021 or described in Amazon consumer product reviews between 2019 and 2021. Results We identified 38 cases, including 30 from Amazon consumer product reviews and eight reported to the FDA. Twenty-eight were from 2021. The most common reason for use was for mole and/or skin tag removal. Listed ingredients included salicylic acid, Sanguinaria canadensis, botanicals (includes homeopathic products), and calcium oxide. Seven cases involved products without ingredients listed. Adverse events included burns, pain, and ulceration, some resulting in permanent scarring and disfigurement. There were 14 facial injuries, including four adjacent to the eye. Reported treatments included antibiotics, hospital care, wound care, and dermatology advice to have a skin graft. Limitations Limitations include underreporting of adverse events to the FDA, limited clinical details and potential bias in consumer reviews, and poor replicability of review searches due to the dynamic nature of the Amazon website. Conclusion Unapproved, non-device topical mole and skin tag removers are associated with serious skin injuries. We found Amazon consumer reviews to be a novel and useful data source for safety surveillance of these types of skin products. When dermatologists are consulted about skin injuries, exposure to these products should be considered in the differential diagnosis.
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Wong TY, Tsang YC, Yeung KWS, Leung WK. Self-Reported Gum Bleeding, Perception, Knowledge, and Behavior in Working-Age Hong Kong Chinese-A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19. [PMID: 35565144 DOI: 10.3390/ijerph19095749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/10/2022]
Abstract
Gingivitis and periodontitis are highly prevalent in Hong Kong, where the provision of oral health services is predominantly private. This cross-sectional study aimed to investigate the association between the oral symptoms of gum bleeding and self-reported behavioral factors, beliefs, and knowledge among Hong Kong Chinese. The research team commissioned the Public Opinion Programme of The University of Hong Kong to conduct a structured, population-based, computer-assisted telephone interview (CATI), which covered questions related to the demography, perception, and knowledge (including traditional Cantonese beliefs) of gum health, dental attendance, oral health behavior, and dental anxiety. A total of 1,265 individuals aged 25−60 years old were successfully contacted, and 704 (55.7%) reported prior gum bleeding experience. A total of 516 individuals (64.9% females, median 55−60 years) completed the CATI satisfactorily, and 321 (62.2%) experienced gum bleeding in the past 12 months. The factors that were significantly associated with reports of gum bleeding in the past 12 months include having periodontitis, sensitive teeth, having tertiary or higher education, flossing/interdental cleaning, not cleaning teeth well enough, lack of sleep, consuming too much ‘heaty’ food, avoiding going to the dentist when gums are bleeding, and waiting for gum bleeding to subside (p < 0.05, r2 =0.198; forward stepwise logistic regression). Within the limitations of this study, approximately half of the Hong Kong working-age adults surveyed reported experiencing gum bleeding, and 62.2% of the participants experienced it within the past 12 months. Members of Hong Kong’s working-age population who reported having higher levels of education appeared more readily aware of their gum problems. Those with bleeding gums, especially those who have discernable periodontitis, poor dental awareness/behaviors, and/or a poor lifestyle should be targeted to receive education and encouragement, which will allow them to take action and improve their own gum health.
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ÇINAR E, AKKOÇ Y, ÇALIŞ F, BAKLACI M, EKMEKÇİ Ö, YÜCEYAR N. Reliability and Validity of the Turkish Version of the Multiple Sclerosis Knowledge Questionnaire. Noro Psikiyatr Ars 2022; 59:123-126. [PMID: 35685048 PMCID: PMC9142025 DOI: 10.29399/npa.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/09/2020] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Multiple Sclerosis Knowledge Questionnaire (MSKQ) is a self-administered inventory assessing patients' knowledge about Multiple Sclerosis. In this study, we aimed to test the reliability and validity of MSKQ in Turkish patients. METHODS Patients with Multiple Sclerosis who attended an education seminar in our university hospital were enrolled in the study. RESULTS Fifty-eight patients completed and returned the questionnaire twice, before and after the seminar. Mean number of items that were answered correctly in the first round was 12.8 (5.2), which increased to 18.7 (3.2) in the second round after the seminar. This increase was found to be significant (p<0.01). CONCLUSION Questions regarding general characteristics of the disease were found to be answered correctly more often than those questions regarding diagnostic and treatment options. This finding indicates that patients may be more interested in the general characteristics of the disease and in the factors that may have started the disease process. Higher number of incorrect answers regarding diagnostic and treatment strategies may be caused by a lack of interest on the part of the patient who may perceive these subjects to be too complex or who may choose to leave decision-making to healthcare professionals. Also, physicians may be unable to inform patients in these areas because of a lack of time or resources. New molecules developed for the treatment of Multiple Sclerosis makes it even more difficult for patients to follow and form their own opinions about the treatment process. These results show us that patient education is essential and our patients need more educational resources, especially regarding treatment options. The significant increase in the number of correct answers after the education seminar supports the need for broader patient education (p<0.01). Turkish version of MSKQ is a reliable and valid measure for assessing patients' level of knowledge.
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Affiliation(s)
- Ece ÇINAR
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Yeşim AKKOÇ
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Funda ÇALIŞ
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Musa BAKLACI
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Özgül EKMEKÇİ
- Department of Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Nur YÜCEYAR
- Department of Neurology, Ege University School of Medicine, İzmir, Turkey
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Kim Y, Lee H, Lee M, Lee H, Kim S, Konlan KD. The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health. Int J Environ Res Public Health 2021; 18:ijerph18073604. [PMID: 33807255 PMCID: PMC8038059 DOI: 10.3390/ijerph18073604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.
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Affiliation(s)
- Youlim Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03722, Korea; (Y.K.); (M.L.); (H.L.)
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03722, Korea; (Y.K.); (M.L.); (H.L.)
- Correspondence: ; Tel.: +82-2-2228-3373
| | - Mikyung Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03722, Korea; (Y.K.); (M.L.); (H.L.)
| | - Hyeyeon Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03722, Korea; (Y.K.); (M.L.); (H.L.)
| | - Sookyung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea; (S.K.); (K.D.K.)
| | - Kennedy Diema Konlan
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul 03722, Korea; (S.K.); (K.D.K.)
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Phatama KY, Aziz A, Bimadi MH, Oktafandi IGNAA, Cendikiawan F, Mustamsir E. Knee Injury and Osteoarthritis Outcome Score: Validity and Reliability of an Indonesian Version. Ochsner J 2021; 21:63-7. [PMID: 33828426 DOI: 10.31486/toj.20.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The Knee injury and Osteoarthritis Outcome Score (KOOS) is a useful diagnostic tool to assess knee ligament injury and osteoarthritis, but no validated Indonesian version of the KOOS was available. Methods: We used the forward-backward translation protocol to develop the Indonesian version of the KOOS. The translated questionnaire was administered twice to 51 subjects diagnosed with a knee ligament injury and osteoarthritis. Validity of the questionnaire was assessed by analyzing the correlation between the score of each subscale and the overall score of the 36-Item Short Form Health Survey (SF-36) using the Pearson correlation coefficient. Reliability was measured by evaluating internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient). Results: For construct validity, moderate Pearson correlation coefficients were found between the KOOS subscales and the SF-36. Cronbach α was 0.84 to 0.97 for all subscales, indicating adequate internal consistency. The test-retest reliability was excellent, with intraclass correlation coefficients ranging from 0.91 to 0.99 for all subscales. No significant differences were found in the KOOS subscale responses between the first administration of the questionnaire and the second administration within 21 days. Conclusion: The Indonesian version of the KOOS was determined to be valid and reliable and is therefore an objective instrument for evaluating knee ligament injury and knee osteoarthritis in the Indonesian population.
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Morse KE, Ostberg NP, Jones VG, Chan AS. Use Characteristics and Triage Acuity of a Digital Symptom Checker in a Large Integrated Health System: Population-Based Descriptive Study. J Med Internet Res 2020; 22:e20549. [PMID: 33170799 PMCID: PMC7717918 DOI: 10.2196/20549] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/07/2020] [Accepted: 11/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a limited supply of highly trained health care professionals, creating a need for scalable technological solutions. Digital symptom checkers are artificial intelligence–supported software tools that use a conversational “chatbot” format to support rapid diagnosis and consistent triage. The COVID-19 pandemic has brought new attention to these tools due to the need to avoid face-to-face contact and preserve urgent care capacity. However, evidence-based deployment of these chatbots requires an understanding of user demographics and associated triage recommendations generated by a large general population. Objective In this study, we evaluate the user demographics and levels of triage acuity provided by a symptom checker chatbot deployed in partnership with a large integrated health system in the United States. Methods This population-based descriptive study included all web-based symptom assessments completed on the website and patient portal of the Sutter Health system (24 hospitals in Northern California) from April 24, 2019, to February 1, 2020. User demographics were compared to relevant US Census population data. Results A total of 26,646 symptom assessments were completed during the study period. Most assessments (17,816/26,646, 66.9%) were completed by female users. The mean user age was 34.3 years (SD 14.4 years), compared to a median age of 37.3 years of the general population. The most common initial symptom was abdominal pain (2060/26,646, 7.7%). A substantial number of assessments (12,357/26,646, 46.4%) were completed outside of typical physician office hours. Most users were advised to seek medical care on the same day (7299/26,646, 27.4%) or within 2-3 days (6301/26,646, 23.6%). Over a quarter of the assessments indicated a high degree of urgency (7723/26,646, 29.0%). Conclusions Users of the symptom checker chatbot were broadly representative of our patient population, although they skewed toward younger and female users. The triage recommendations were comparable to those of nurse-staffed telephone triage lines. Although the emergence of COVID-19 has increased the interest in remote medical assessment tools, it is important to take an evidence-based approach to their deployment.
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Affiliation(s)
- Keith E Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Nicolai P Ostberg
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Veena G Jones
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States.,Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Albert S Chan
- Clinical Leadership Team, Sutter Health, Sacramento, CA, United States.,Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
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Thortveit ET, Aase A, Petersen LB, Lorentzen ÅR, Mygland Å, Ljøstad U. Subjective health complaints and exposure to tick-borne infections in southern Norway. Acta Neurol Scand 2020; 142:260-266. [PMID: 32392618 DOI: 10.1111/ane.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Whether tick-borne infections can cause chronic subjective health complaints is heavily debated. If such a causal connection exists, one would expect to find more health complaints among individuals exposed to tick-borne infections than among non-exposed. In this study, we aimed to assess if exposure to tick-borne infections earlier in life, evaluated by examination of serum for IgG antibodies to tick-borne microbes, was associated with self-reported somatic symptom load. MATERIALS & METHODS All individuals with residential address in Søgne municipality in southern Norway, aged 18-69 years, were invited to participate in the study. Blood samples were analyzed for IgG antibodies to different tick-borne microbes, and somatic symptom load was charted by the Patient Health Questionnaire-15 (PHQ-15). RESULTS Out of 7424 invited individuals, 2968 (40.0%) were included in the study. We detected IgG antibodies to Borrelia burgdorferi sensu lato (Bb) in 22.9% (95% CI 21.4-24.4). Bb seropositive individuals reported less frequently moderate to severe somatic symptom load (ie, PHQ-15 sum score ≥ 10) than seronegative individuals (12.5% versus 17.7%, difference 5.2% [95% 2.1-8.0]). However, when adjusting for several other variables in a multivariable linear regression model, presence of serum IgG antibodies to Bb was not associated with somatic symptom load. Presence of IgG antibodies to other tick-borne microbes than Bb, or seropositivity to at least two microbes, was also not associated with somatic symptom load. CONCLUSION Presence of serum IgG antibodies to tick-borne microbes was not associated with self-reported somatic symptom load.
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Affiliation(s)
| | - Audun Aase
- Department of Infectious Disease Immunology Norwegian Institute of Public Health Oslo Norway
| | - Lizette Balle Petersen
- Department of Infectious Disease Immunology Norwegian Institute of Public Health Oslo Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- The Norwegian National Advisory Unit on Tick‐Borne Diseases Sørlandet Hospital Trust Arendal Norway
| | - Åse Mygland
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Habilitation Sørlandet Hospital Trust Kristiansand Norway
| | - Unn Ljøstad
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Baddour NA, Robinson-Cohen C, Lipworth L, Bian A, Stewart TG, Jhamb M, Siew ED, Abdel-Kader K. The Surprise Question and Self-Rated Health Are Useful Screens for Frailty and Disability in Older Adults with Chronic Kidney Disease. J Palliat Med 2019; 22:1522-1529. [PMID: 31259659 DOI: 10.1089/jpm.2019.0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Self-rated health (SRH) and the surprise question (SQ) capture perceptions of health and are independent risk factors for poor outcomes. Little is known about their association with physiologic and functional decline. Objective: Determine the association of SRH and SQ with frailty and functional status in older adults with chronic kidney disease (CKD) and their utility as screening tools. Design: Prospective cohort study. Setting/Subjects: Two hundred seventy-two adults, age ≥60 years, with advanced CKD seen in nephrology clinic. Measurements: Patients completed SRH and were evaluated for frailty (Fried criteria and Clinical Frailty Scale [CFS]) and functional status (Katz and Lawton indices of activities of daily living [ADLs] and instrumental ADLs [iADLs]). Providers completed the SQ. Correlations were evaluated using Spearman's rho. Results: Fifteen percent of patients were frail, 8% had ≥1 ADL deficit, and 29% had ≥1 iADL deficit. SRH and SQ were moderately correlated with frailty and iADLs. A SRH of excellent, very good, or good was predictive of nonfrail status (Fried negative predictive value [NPV]: 0.92; CFS NPV: 0.92) and preserved ADL function (NPV for ≥1 deficit: 0.96). A SQ response of 5, 4, or 3 (i.e., surprised) was predictive of nonfrail status and preserved ADL function (CFS NPV: 0.90; ADL ≥1 deficit NPV: 0.95). A SQ response of 1 or 2 had a positive predictive value of 0.64 for ≥1 iADL deficit. Conclusions: Subjective health measures may be useful screening tools for frailty and functional status.
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Affiliation(s)
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward D Siew
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Khaled Abdel-Kader
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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Tompson A, Fleming S, Lee MM, Monahan M, Jowett S, McCartney D, Greenfield S, Heneghan C, Ward A, Hobbs R, McManus RJ. Mixed-methods feasibility study of blood pressure self-screening for hypertension detection. BMJ Open 2019; 9:e027986. [PMID: 31147366 PMCID: PMC6549634 DOI: 10.1136/bmjopen-2018-027986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the feasibility of using a blood pressure (BP) self-measurement kiosk-a solid-cuff sphygmomanometer combined with technology to integrate the BP readings into patient electronic medical records- to improve hypertension detection. DESIGN A concurrent mixed-methods feasibility study incorporating observational and qualitative interview components. SETTING Two English general practitioner (GP) surgeries. PARTICIPANTS Adult patients registered at participating surgeries. Staff working at these sites. INTERVENTIONS BP self-measurement kiosks were placed in the waiting rooms for a 12-month period between 2015 and 2016 and compared with a 12-month control period prior to installation. OUTCOME MEASURES (1) The number of patients using the kiosk and agreeing to transfer of their data into their electronic medical records; (2) the cost of using a kiosk compared with GP/practice nurse BP screening; (3) qualitative themes regarding use of the equipment. RESULTS Out of 15 624 eligible patients, only 186 (1.2%, 95% CI 1.0% to 1.4%) successfully used the kiosk to directly transfer a BP reading into their medical record. For a considerable portion of the intervention period, no readings were transferred, possibly indicating technical problems with the transfer link. A comparison of costs suggests that at least 52.6% of eligible patients would need to self-screen in order to bring costs below that of screening by GPs and practice nurses. Qualitative interviews confirmed that both patients and staff experienced technical difficulties, and used alternative methods to enter BP results into the medical record. CONCLUSIONS While interviewees were generally positive about checking BP in the waiting room, the electronic transfer system as tested was neither robust, effective nor likely to be a cost-effective approach, thus may not be appropriate for a primary care environment. Since most of the cost of a kiosk system lies in the transfer mechanism, a solid-cuff sphygmomanometer and manual entry of results may be a suitable alternative.
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Affiliation(s)
- Alice Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mei-Man Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Monahan
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - David McCartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sheila Greenfield
- Institute of Applied Health Service Research, University of Birmingham, Birmingham, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alison Ward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rivera M, Cano Ó, Rodríguez-Losada J, Sánchez R. Psychometric variables of the EMUN-AR scale using Rasch analysis. Biomedica 2019; 39:113-31. [PMID: 31021552 DOI: 10.7705/biomedica.v39i1.4103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Indexed: 11/21/2022]
Abstract
Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated.
Objective: To validate the EMUN-AR scale using Rasch models.
Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps.
Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds.
Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.
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Affiliation(s)
- Helen Lunt
- Diabetes Centre, Christchurch, New
Zealand
- Helen Lunt, MD, Diabetes Centre, 550 Hagley
Ave, Christchurch 8011, New Zealand.
| | | | - Huan Chan
- Diabetes Centre, Christchurch, New
Zealand
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15
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Rönnby S, Lundberg O, Fagher K, Jacobsson J, Tillander B, Gauffin H, Hansson PO, Dahlström Ö, Timpka T. mHealth Self-Report Monitoring in Competitive Middle- and Long-Distance Runners: Qualitative Study of Long-Term Use Intentions Using the Technology Acceptance Model. JMIR Mhealth Uhealth 2018; 6:e10270. [PMID: 30104183 PMCID: PMC6111145 DOI: 10.2196/10270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 11/27/2022] Open
Abstract
Background International middle- and long-distance running competitions attract millions of spectators in association with city races, world championships, and Olympic Games. It is therefore a major concern that ill health and pain, as a result of sports overuse, lead to numerous hours of lost training and decreased performance in competitive runners. Despite its potential for sustenance of performance, approval of mHealth self-report monitoring (mHSM) in this group of athletes has not been investigated. Objective The objective of our study was to explore individual and situational factors associated with the acceptance of long-term mHSM in competitive runners. Methods The study used qualitative research methods with the Technology Acceptance Model as the theoretical foundation. The study population included 20 middle- and long-distance runners competing at national and international levels. Two mHSM apps asking for health and training data from track and marathon runners were created on a platform for web survey development (Briteback AB). Data collection for the technology acceptance analysis was performed via personal interviews before and after a 6-week monitoring period. Preuse interviews investigated experience and knowledge of mHealth monitoring and thoughts on benefits and possible side effects. The postuse interviews addressed usability and usefulness, attitudes toward nonfunctional issues, and intentions to adhere to long-term monitoring. In addition, the runners’ trustworthiness when providing mHSM data was discussed. The interview data were investigated using a deductive thematic analysis. Results The mHSM apps were considered technically easy to use. Although the runners read the instructions and entered data effortlessly, some still perceived mHSM as problematic. Concerns were raised about the selection of items for monitoring (eg, recording training load as running distance or time) and about interpretation of concepts (eg, whether subjective well-being should encompass only the running context or daily living on the whole). Usefulness of specific mHSM apps was consequently not appraised on the same bases in different subcategories of runners. Regarding nonfunctional issues, the runners competing at the international level requested detailed control over who in their sports club and national federation should be allowed access to their data; the less competitive runners had no such issues. Notwithstanding, the runners were willing to adhere to long-term mHSM, provided the technology was adjusted to their personal routines and the output was perceived as contributing to running performance. Conclusions Adoption of mHSM by competitive runners requires clear definitions of monitoring purpose and populations, repeated in practice tests of monitoring items and terminology, and meticulousness regarding data-sharing routines. Further naturalistic studies of mHSM use in routine sports practice settings are needed with nonfunctional ethical and legal issues included in the evaluation designs.
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Affiliation(s)
- Sara Rönnby
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Oscar Lundberg
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristina Fagher
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Jenny Jacobsson
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bo Tillander
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per-Olof Hansson
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Toomas Timpka
- Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Bernhoff G, Landén Ludvigsson M, Peterson G, Bertilson BC, Elf M, Peolsson A. The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders. J Pain Res 2016; 9:397-404. [PMID: 27358576 PMCID: PMC4912326 DOI: 10.2147/jpr.s104747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: −0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
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Affiliation(s)
- Gabriella Bernhoff
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Landén Ludvigsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Rehab Väst, County Council of Östergötland, Östergötland, Sweden
| | - Gunnel Peterson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Bo Christer Bertilson
- Musculoskeletal Functions and Pain, Division of Family Medicine, NVS, Karolinska Institutet, Kista, Sweden; Academic Primary Health Care Center, Stockholm County Council, Kista, Sweden
| | | | - Anneli Peolsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Almalki M, Gray K, Martin-Sanchez F. Activity Theory as a Theoretical Framework for Health Self-Quantification: A Systematic Review of Empirical Studies. J Med Internet Res 2016; 18:e131. [PMID: 27234343 PMCID: PMC4909388 DOI: 10.2196/jmir.5000] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/16/2015] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-quantification (SQ) is a way of working in which, by using tracking tools, people aim to collect, manage, and reflect on personal health data to gain a better understanding of their own body, health behavior, and interaction with the world around them. However, health SQ lacks a formal framework for describing the self-quantifiers' activities and their contextual components or constructs to pursue these health related goals. Establishing such framework is important because it is the first step to operationalize health SQ fully. This may in turn help to achieve the aims of health professionals and researchers who seek to make or study changes in the self-quantifiers' health systematically. OBJECTIVE The aim of this study was to review studies on health SQ in order to answer the following questions: What are the general features of the work and the particular activities that self-quantifiers perform to achieve their health objectives? What constructs of health SQ have been identified in the scientific literature? How have these studies described such constructs? How would it be possible to model these constructs theoretically to characterize the work of health SQ? METHODS A systematic review of peer-reviewed literature was conducted. A total of 26 empirical studies were included. The content of these studies was thematically analyzed using Activity Theory as an organizing framework. RESULTS The literature provided varying descriptions of health SQ as data-driven and objective-oriented work mediated by SQ tools. From the literature, we identified two types of SQ work: work on data (ie, data management activities) and work with data (ie, health management activities). Using Activity Theory, these activities could be characterized into 6 constructs: users, tracking tools, health objectives, division of work, community or group setting, and SQ plan and rules. We could not find a reference to any single study that accounted for all these activities and constructs of health SQ activity. CONCLUSIONS A Health Self-Quantification Activity Framework is presented, which shows SQ tool use in context, in relation to the goals, plans, and competence of the user. This makes it easier to analyze issues affecting SQ activity, and thereby makes it more feasible to address them. This review makes two significant contributions to research in this field: it explores health SQ work and its constructs thoroughly and it adapts Activity Theory to describe health SQ activity systematically.
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Affiliation(s)
- Manal Almalki
- Health and Biomedical Informatics Centre, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
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Nagler M, Feller S, Beyeler C. Retrospective adjustment of self-assessed medical competencies - noteworthy in the evaluation of postgraduate practical training courses. GMS Z Med Ausbild 2012; 29:Doc45. [PMID: 22737200 PMCID: PMC3374141 DOI: 10.3205/zma000815] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 12/18/2011] [Accepted: 01/17/2012] [Indexed: 11/30/2022]
Abstract
Aim: The efficacy of postgraduate practical training courses is frequently
evaluated by self-assessment instruments. The present study analyses the effect of a basic
course in laparoscopic surgery on self-assessed medical competencies. Methods: The 3-day course included teaching of knowledge and training of
practical skills. In relation to course evaluation, a questionnaire for self-assessment
was applied at the beginning of the course ('pre-course'), at the end of the course ('post-course') and at the end of the course to reassess pre-course competencies ('retrospective
pre-course').
Results: 89 out of 110 participants (81%) attending 10 courses
completed all the questionnaires; 83% were postgraduate trainees in surgery and
82% were inexperienced as an independent surgeon. At the beginning of the course most
trainees rated themselves as 'moderately competent' or 'fully
competent' with respect to the various task levels as well as to specific areas of
medical competencies. At the end of the course however pronounced retrospective revisions
of self-assessment to lower ratings became apparent. Statistically significant differences
were seen for the task 'performing surgical procedures under supervision' and
for most of the practical skills trained during the course (p <0.01). In contrast, no
significant differences were observed for knowledge taught during the course as well as
for 'ability to work in a team' and 'ability to concentrate', which
were not foci of the course. Conclusions: Surgeons with little experience change their self-assessment of
pre-course competencies to a lower level after participation in a practical postgraduate
training course. Evaluations comparing 'pre-course' and 'post-course'
ratings only – without 'retrospective pre-course' ratings – may
underestimate the training effects. This phenomenon needs to be taken into account when
evaluations are dependent exclusively on self-assessment instruments.
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Affiliation(s)
- Michael Nagler
- Universitätsklinik für Hämatologie und Hämatologisches Zentrallabor, Inselspital, Bern, Schweiz.
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