Student Performance on an Objective Structured Clinical Exam Delivered Both Virtually and In-Person

OBJECTIVE

Passing a milestone objective structured clinical examination (OSCE) is a graduation requirement for the University of Waterloo Pharmacy students. In January 2021, the milestone OSCE was offered concurrently both virtually and in-person, with students being able to choose their desired format. The purpose of this study was to compare student performance between the 2 formats and to identify factors that may have predicted student choice of format.

METHODS

Objective structured clinical examination scores for in-person and virtual exam-takers were compared using 2-tailed independent t tests with Bonferroni correction. Pass rates were compared using χ2 analysis. Prior academic performance variables were analyzed to identify predictors of the chosen exam format. Student and exam personnel surveys were used to capture OSCE feedback.

RESULTS

A total of 67 students (56%) participated in the in-person OSCE, and 52 students (44%) participated virtually. There were no significant differences in overall exam averages or pass rates between the 2 groups. However, virtual exam-takers scored lower in 2 of 7 cases. Previous academic performance did not predict the choice of exam format. Feedback surveys indicated that the exam organization was perceived as a strength regardless of format, but in-person students felt more prepared for the exam than virtual exam-takers with technical challenges and difficulty navigating station resources being noted as barriers in the virtual offering.

CONCLUSION

Virtual and in-person administration of a milestone OSCE resulted in similar student performance, with slightly lower performance on 2 individual case scores with virtual delivery. These results may inform the future development of virtual OSCEs.

A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement

BACKGROUND

Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement.

METHODS

A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's hospital to determine the incidence, severity, impact, and contributory factors of clinician-reported non-routine events (NREs, i.e., deviations from optimal care) and 30-day NSQIP occurrences in neonates receiving a G-tube.

RESULTS

Clinicians reported at least one NRE in 32 of 36 (89%) G-tube cases, averaging 3.0 (Standard deviation: 2.5) NRE reports per case. NSQIP-P review identified 7 cases (19%) with NSQIP-P occurrences and each of these cases had multiple reported NREs. One case in which NREs were not reported was without NSQIP-P occurrences. The odds ratio of having a NSQIP-P occurrence with the presence of an NRE was 0.695 (95% CI 0.06-17.04).

CONCLUSION

Despite being considered a "simple" operation, >80% of neonatal G-tube placement operations had at least one reported NRE by an operative team member. In this pilot study, NRE occurrence was not significantly associated with the subsequent reporting of an NSQIP-P occurrence. Understanding contributory factors of NREs that occur in neonatal surgery may promote surgical safety efforts and should be evaluated in larger and more diverse populations.

LEVEL OF EVIDENCE

IV.

Inhibitory control, working memory and coping with stress: Associations with symptoms of anxiety and depression in adults with Huntington's disease

OBJECTIVE

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease characterized by neuropsychiatric symptoms (e.g., anxiety and depression), where individuals suffer high levels of stress from the social, physical, and cognitive burden of the disease. The present study examined two factors associated with increased risk for symptoms of anxiety and depression: executive function skills (inhibitory control/attention and working memory) and skills to cope with stress.

METHOD

Adults with HD completed the NIH Toolbox measures of inhibitory control/attention and working memory, as well as self-report measures of coping with HD-related stress and symptoms of anxiety and depression. Path analyses were used to test direct and indirect associations among the subtypes of executive functioning, coping, and symptoms.

RESULTS

No significant associations were found in the full sample (n = 47), due to a significant portion of the sample with very low executive function abilities. Additional analyses were conducted on a subset of the sample (participants in the top three quartiles on both measures of executive functioning, n = 32). Significant indirect associations emerged among inhibitory control/attention skills, secondary control coping (e.g., acceptance and reappraisal), and symptoms of anxiety and depression in the subsample. Higher inhibitory control/attention skills were associated with greater use of secondary control coping, and greater use of these coping skills was related to lower symptoms of anxiety and depression. No direct or indirect associations were found among working memory skills, coping, and symptoms of anxiety and depression.

CONCLUSIONS

Implications for interventions to enhance executive function and coping skills in adults with HD are highlighted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Defining the Epidemiology of Safety Risks in Neonatal Intensive Care Unit Patients Requiring Surgery

OBJECTIVE

The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)-events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation-in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room.

METHODS

A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children's hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in 109 neonates were observed. The incidence and description of NREs were collected via structured researcher-administered survey tool of involved clinicians. Primary measurements included clinicians' ratings of NRE severity and contributory factors and trained research assistants' ratings of preventability.

RESULTS

One or more NREs were reported in 101 (78%) of 129 observed cases for 247 total NREs. Clinicians reported 2 (2) (median, interquartile range) NREs per NRE case with a maximum severity of 3 (1) (possible range = 1-5). Trained research assistants rated 47% of NREs as preventable and 11% as severe and preventable. The relative risks for National Surgical Quality Improvement Program - pediatric major morbidity and 30-day mortality were 1.17 (95% confidence interval = 0.92-1.48) and 1.04 (95% confidence interval = 1.00-1.08) in NRE cases versus non-NRE cases.

CONCLUSIONS

The incidence of NREs in neonatal perioperative care at an academic children's hospital was high and of variable severity with a myriad of contributory factors.

Neurobiological and Psychosocial Correlates of Communication Between Huntington's Disease Patients and Their Offspring

OBJECTIVE

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that presents significant challenges to family communication. The investigators examined observations of communication between parents with HD and their offspring talking about the challenges of HD and explored potential correlates of their communication.

METHODS

The sample included parents with HD and their adolescent and young-adult offspring (N=64). Parent communication and chorea were independently coded from video recordings. Parents and offspring completed working memory assessments and self-reports of neuropsychiatric symptoms, stress, and coping.

RESULTS

Evidence was found for the association of observed parent-offspring communication with disease markers, psychosocial characteristics, and neurocognitive function. For parents, disease markers and working memory were correlates of communication, whereas offspring's psychiatric symptoms, stress, and coping were associated with their communication.

CONCLUSIONS

These findings have potential implications for clinical interventions to enhance communication and quality of life for HD families.

Healthcare Delivery and Huntington's Disease During the Time of COVID-19

BACKGROUND

Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington's disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD.

OBJECTIVE

The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels.

METHODS

This observational study of a clinical HD population during the 'safer-at-home' orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity.

RESULTS

Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden.

CONCLUSION

A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.

Risk-Taking Behaviors in Huntington's Disease

BACKGROUND

Risky behaviors are common in Huntington's disease (HD) and can lead to significant adverse consequences. However, the prevalence and scope of these symptoms have not been studied systematically, and no empirically validated measures are available to screen for them.

OBJECTIVE

To test a novel screening tool designed to assess risk-taking behaviors in HD.

METHODS

We administered the Risk Behavior Questionnaire (RBQ-HD) to HD patients and caregivers at Vanderbilt University Medical Center between 2018-2019. Patients completed the questionnaire based on self-report; caregivers provided collateral reports. Clinical and demographic information were obtained from the electronic medical record.

RESULTS

60 patients and 60 caregivers completed the RBQ-HD. 80% of patients (n = 48) and 91.7% of caregivers (n = 60) reported at least one risky behavior. Adverse social behaviors, impulsive/compulsive behaviors, and reckless driving were the most common behavioral domains reported. Male patients were more likely to report risky behaviors than females (92.3% vs. 70.6%, p = 0.04). The number of risky behaviors reported by patients and caregivers was negatively correlated with patient age (r = -0.32, p = 0.01; r = -0.47, p = 0.0001, respectively). Patient and caregiver reports were highly correlated in matched pairs (n = 30; r = 0.63, p = 0.0002).

CONCLUSION

These findings emphasize that risky behaviors are highly prevalent in HD and can be effectively identified through the use of a novel screening measure. We hypothesize that early pathological involvement of frontostriatal and mesolimbic networks may be important factors in the development of these behaviors.

Mother-Child Communication: The Influence of ADHD Symptomatology and Executive Functioning on Paralinguistic Style

Paralinguistic style, involving features of speech such as pitch and volume, is an important aspect of one's communicative competence. However, little is known about the behavioral traits and cognitive skills that relate to these aspects of speech. This study examined the extent to which ADHD traits and executive functioning (EF) related to the paralinguistic styles of 8- to 12-year-old children and their mothers. Data was collected via parent report (ADHD traits), independent laboratory tasks of EF (working memory, inhibitory control, and cognitive flexibility), and an interactive problem-solving task (completed by mothers and children jointly) which was coded for paralinguistic speech elements (i.e., pitch level/variability; volume level/variability). Dyadic data analyses revealed that elevated ADHD traits in children were associated with a more exaggerated paralinguistic style (i.e., elevated and more variable pitch/volume) for both mothers and children. Mothers' paralinguistic style was additionally predicted by an interaction of mothers' and children's ADHD traits, such that mothers with elevated ADHD traits showed exaggerated paralinguistic styles particularly when their children also had elevated ADHD traits. Highlighting a cognitive mechanism, children with weaker inhibitory control showed more exaggerated paralinguistic styles.

Prospective randomized comparison of rotational angiography with three-dimensional reconstruction and computed tomography merged with electro-anatomical mapping: a two center atrial fibrillation ablation study

PURPOSE

To compare the efficacy and accuracy of rotational angiography with three-dimensional reconstruction (3DATG) image merged with electro-anatomical mapping (EAM) vs. CT-EAM.

METHODS

A prospective, randomized, parallel, two-center study conducted in 36 patients (25 men, age 65 ± 10 years) undergoing AF ablation (33 % paroxysmal, 67 % persistent) guided by 3DATG (group 1) vs. CT (group 2) image fusion with EAM. 3DATG was performed on the Philips Allura Xper FD 10 system. Procedural characteristics including time, radiation exposure, outcome, and navigation accuracy were compared between two groups.

RESULTS

There was no significant difference between the groups in total procedure duration or time spent for various procedural steps. Minor differences in procedural characteristics were present between two centers. Segmentation and fusion time for 3DATG or CT-EAM was short and similar between both centers. Accuracy of navigation guided by either method was high and did not depend on left atrial size. Maintenance of sinus rhythm between the two groups was no different up to 24 months of follow-up.

CONCLUSION

This study did not find superiority of 3DATG-EAM image merge to guide AF ablation when compared to CT-EAM fusion. Both merging techniques result in similar navigation accuracy.

Auxiliary-field quantum Monte Carlo simulations of neutron matter in chiral effective field theory

We present variational Monte Carlo calculations of the neutron matter equation of state using chiral nuclear forces. The ground-state wave function of neutron matter, containing nonperturbative many-body correlations, is obtained from auxiliary-field quantum Monte Carlo simulations of up to about 340 neutrons interacting on a 10(3) discretized lattice. The evolution Hamiltonian is chosen to be attractive and spin independent in order to avoid the fermion sign problem and is constructed to best reproduce broad features of the chiral nuclear force. This is facilitated by choosing a lattice spacing of 1.5 fm, corresponding to a momentum-space cutoff of Λ=414  MeV/c, a resolution scale at which strongly repulsive features of nuclear two-body forces are suppressed. Differences between the evolution potential and the full chiral nuclear interaction (Entem and Machleidt Λ=414  MeV [L. Coraggio et al., Phys. Rev. C 87, 014322 (2013).

Humour Use Between Spouses and Positive and Negative Interpersonal Behaviours During Conflict

The present research investigated the relation between the use of positive, negative and instrumental humour in the context of romantic relationships and relational well-being as assessed by positive and negative patterns of conflict resolution behaviour. A sample of 116 heterosexual married couples completed scales of relational humour use as well as conflict resolution behaviour. Behaviour of couples while attempting to resolve a relationship based conflict was also coded by independent raters. Actor-Partner Interdependence Model (APIM) analyses showed patterns of actor and partner effects for each type of humour use. Specifically, positive humour use of both partners predicted more positive conflict resolution, whereas negative humour use of both partners predicted less positive conflict resolution. Additionally, instrumental humour use of both partners seemed to predict greater apathy during conflict resolution. Implications for considering couple humor use, assessed for both partners of the dyad, for understanding relational well-being are discussed.

On the strength of connections between localist mental modules as a source of frequency-of-occurrence effects

Frequency-of-occurrence effects (e.g., effects of word frequency or familiarity) are widely thought to arise through differences in resting levels of activation in localist input-output modules. A different account posits that these effects at least partially reflect the strength of connections between various localist modules. Given that Arabic numerals appear more frequently than their alphabetic counterparts, we contrasted reaction times to stimuli in both formats in a naming/reading-aloud task and a parity-judgment task. The script effect (the difference between reaction times to Arabic and to alphabetic formats) was large in the parity-judgment task but absent in the naming/reading-aloud task. This script-by-task interaction follows naturally from the idea that at least part of the effect of frequency of occurrence of a printed word or digit (and other instances of familiarity) resides in the strength of connections between specialized localist input-output modules and a localist semantic module. This conclusion is likely applicable across a variety of domains.

Initial experience of subfascial endoscopic perforator vein surgery in patients with severe chronic venous insufficiency

Subfascial Endoscopic Perforator Surgery (SEPS) is a foolproof method of treatment of perforating veins reflux without direct surgical manipulation in the area of trophic disturbances. In this paper, we present initial case series, consisted of 5 patients with severe chronic venous insufficiency (CEAP classes C4-C6), SEPS being used in complex treatment. The criteria used for selection of the patients for SEPS was presence of incompetent perforating veins in the area of trophic disturbances, confirmed by duplex scanning of the venous system. Dual-port SEPS technique with using of space-maker was performed in combination with high ligation and below-knee stripping of long saphenous vein. No early postoperative complications related to SEPS were noted. Healing of all active venous ulcers among patients in class C6 and decrease of clinical severity score in all cases were achieved during follow-up period ranged from 2 to 13 months. Results of treatment in the presented case series confirm high effectiveness of SEPS in severe chronic venous insufficiency.

Revealing some oncofetal antigens in peripheral blood mononuclear cells of donors and patients with B-chronic lymphocytic leukemia

Eidelman et al. showed that the expression of functional carcinoembryonic antigen (CEA) on the surface of cells can block terminal differentiation and maintain their proliferative capabilities. This led us to analyze the expression of CEA, trophoblast-specific beta-1-glycoprotein (TSG) and embryonic prealbumin-1 (EPA) in peripheral blood mononuclear cells (PBMs) isolated from healthy donors and patients with B-chronic lymphocytic leukemia (B-CLL). We demonstrated that the PBMs of patients with B-CLL differed from PBMs of healthy donors by having greater numbers of CEA-, EPA- and TSG-positive cells.

Extreme short-bowel syndrome in an infant

This full term male infant required a 90% enterectomy for congenital intestinal volvulus shortly after birth. The remaining small bowel consisted of 8 cm of proximal jejunum anastomosed to 5 cm of terminal ileum. The ileocecal valve was intact. Parenteral nutrition was administered for the first 21 months, including 17 months of home parenteral nutrition. The child's oral diet was mother's milk until 28 months of age when he was switched to an elemental diet. Solids were introduced at 6 months of age. Presently, at 36 months of age, the infant is off parenteral nutrition and is maintaining good nutritional status on a diet of 150 calories per kilo per day. His major problem has been an extreme allergy to cow's-milk protein. This infant is remarkable, since, despite record short bowel length, he maintained a completely normal growth and development, had remarkably few serious complications, spent relatively little time in hospital, and has documented improvement of G.I. absorption and radiographic contrast studies.