Evaluation of iodine nutritional status during pregnancy by estimated 24-h urinary iodine excretion: population variation range and individual accuracy

Objective:

To explore the accuracy of estimated 24-h urinary iodine excretion (24-h UIE_est) in assessing iodine nutritional status.

Design:

Fasting venous blood, 24-h and spot urine samples were collected during the day. The urinary iodine concentration (UIC) and urinary creatinine concentration (UCrC) were measured, and the urinary iodine-to-creatinine ratio (UI/Cr), 24-h UIE_est, and 24-h urinary iodine excretion (24-h UIE) were calculated. At the population level, correlation and consistency between UIC, UI/Cr, 24-h UIE_est and 24-h UIE were assessed using correlation analysis and Bland–Altman plots. At the individual level, receiver operating characteristic (ROC) curves were used to analyse the accuracy of the above indicators for evaluating insufficient and excessive iodine intake. The reference interval of 24-h UIE_est was established based on percentile values.

Setting:

Indicator can accurately evaluate individual iodine nutrition during pregnancy remains controversial.

Participants:

Pregnant women (n 788).

Results:

Using 24-h UIE as standard, the correlation coefficients of 24-h UIE_est from different periods of the day ranged from 0·409 to 0·531, and the relative average differences ranged from 4·4 % to 10·9 %. For diagnosis of insufficient iodine intake, the area under the ROC curve of 24-h UIE_est was 0·754, sensitivity and specificity were 79·6 % and 65·4 %, respectively. For diagnosis of excessive iodine intake, the area of 24-h UIE_est was 0·771, sensitivity and specificity were 66·7 % and 82·0 %, respectively. The reference interval of 24-h UIE_est was 58·43–597·65 μg.

Conclusions:

Twenty-four-hour UIE_est can better indicate iodine nutritional status at a relatively large sample size in a given population of pregnant women. It can be used for early screening at the individual level to obtain more lead time for pregnant women.

Impact of supplemental individual verbal defense on confidence, engagement, and performance in a team-based learning therapeutics course

BACKGROUND AND PURPOSE

Team-based learning (TBL) has been successfully applied to multiple healthcare education disciplines. A primary tenet of TBL is the development of solutions leveraging the collective knowledge of a team rather than the individual competency of any one student. In an effort to enhance individual student accountability, an individual verbal defense (IVD) format was implemented in a multi-campus TBL-based pharmacotherapeutics course. The study sought to investigate the use of TBL-IVD embedded within a traditional TBL format on student engagement, teaching style preferences, and exam performance compared to a TBL-only format.

EDUCATIONAL ACTIVITY AND SETTING

In this cross-sectional study, second-year pharmacy students enrolled in a pharmacotherapeutics course during fall 2019 completed an 11-item survey. The survey was designed to assess TBL-IVD on student engagement and teaching style preference. Free-response qualitative feedback was solicited to assess positive-negative themes related to the activity. Aggregate exam performance for community-acquired pneumonia (CAP) related content was compared to historical exam data to assess the impact on student performance.

FINDINGS

The majority of students (72%, n = 54) preferred the TBL-IVD compared to a TBL-only format. Students reported higher engagement with TBL-IVD (84%, n = 63). Correct exam responses for CAP related content were higher in the TBL-IVD group (67% vs. 55%, P < .001). Positive themes included an increased opportunity to defend recommendations verbally and increased interaction with an on-campus faculty member.

SUMMARY

The study demonstrates the addition of IVD can enhance student perceptions, confidence, and performance within a large, multi-campus, TBL-based pharmacotherapeutics course.

Picture naming yields highly consistent cortical activation patterns: Test-retest reliability of magnetoencephalography recordings

Reliable paradigms and imaging measures of individual-level brain activity are paramount when reaching from group-level research studies to clinical assessment of individual patients. Magnetoencephalography (MEG) provides a direct, non-invasive measure of cortical processing with high spatiotemporal accuracy, and is thus well suited for assessment of functional brain damage in patients with language difficulties. This MEG study aimed to identify, in a delayed picture naming paradigm, source-localized evoked activity and modulations of cortical oscillations that show high test-retest reliability across measurement days in healthy individuals, demonstrating their applicability in clinical settings. For patients with a language disorder picture naming can be a challenging task. Therefore, we also determined whether a semantic judgment task ('Is this item living?') with a spoken response ("yes"/"no") would suffice to induce comparably consistent activity within brain regions related to language production. The MEG data was collected from 19 healthy participants on two separate days. In picture naming, evoked activity was consistent across measurement days (intraclass correlation coefficient (ICC)>0.4) in the left frontal (400-800 ms after image onset), sensorimotor (200-800 ms), parietal (200-600 ms), temporal (200-800 ms), occipital (400-800 ms) and cingulate (600-800 ms) regions, as well as the right temporal (600-800 ms) region. In the semantic judgment task, consistent evoked activity was spatially more limited, occurring in the left temporal (200-800 ms), sensorimotor (400-800 ms), occipital (400-600 ms) and subparietal (600-800 ms) regions, and the right supramarginal cortex (600-800 ms). The delayed naming task showed typical beta oscillatory suppression in premotor and sensorimotor regions (800-1200 ms) but other consistent modulations of oscillatory activity were mostly observed in posterior cortical regions that have not typically been associated with language processing. The high test-retest consistency of MEG evoked activity in the picture naming task testifies to its applicability in clinical evaluations of language function, as well as in longitudinal MEG studies of language production in clinical and healthy populations.

Educational strategy for the development of skills in exchange transfusion: a randomized clinical trial protocol

BACKGROUND

Exchange transfusion is a highly complex procedure that requires high levels of expertise. Trainee paediatricians do not have adequate training in exchange transfusion because opportunities to perform this procedure in practice are scarce. This protocol seeks to compare two educational interventions for exchange transfusion that allow students to develop competencies to perform the technique in an appropriate and safe way.

METHODS/DESIGN

This is a randomized parallel single-blind clinical trial with allocation by simple randomization to the educational intervention (simulation or a digital didactic environment). Students from the paediatric specialization who volunteer to participate will be included. A practical evaluation of the procedure will be performed through a simulated scenario using a standardized clinical case. The main outcome is defined as the result of evaluation using the Objective Structured Clinical Examination; superior performance will be defined when the percentage is greater than or equal to 85%, and non-superior performance will be defined when the result is less than 84%. The chi-square independence test or the Fisher exact test will be used to evaluate the effect of the interventions. Multivariate analysis will be performed using a non-conditional logistic regression model. Stata 15® software will be used.

DISCUSSION

Exchange transfusion is a procedure that requires expertise to achieve adequate outcomes. The inclusion of new educational strategies, such as simulation and digital didactic environments, is seen as a training option that can improve performance in clinical skills, reduce adverse events and increase the level of trust.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04070066. Registered on 28 August 2019. https://clinicaltrials.gov.

[Is interdisciplinary multimodal pain therapy threatened? : Increasing controversy on the necessity for inpatient treatment]

Interdisciplinary multimodal pain therapy (IMST) is recognized as a scientifically founded form of therapy for inpatient treatment of chronic pain conditions. The indications are assessed by private practitioners and must be confirmed by physicians at the inpatient institution. The health insurance companies are obliged to remunerate this treatment but are allowed to test the conditions in individual cases. Recently, reports from members of the German Pain Society on a drastic increase in testing and rejection quotas have become more frequent. Therefore, this article discusses the legal foundations of the treatment of patients with chronic pain in the inpatient sector. Hard criteria for treatment in a certain sector could not be established. A decision in individual cases will depend on the complexity of the disease in the individual patient. A treatment in hospital is principally only necessary when the treatment corresponds to the generally recognized state of medical knowledge and treatment options in daycase units have not been successful. Important guidance can be found in the treatment guidelines of the medical specialist societies. The transfer to a more intensive treatment sector must be made dependent on the severity and complexity of the symptoms and the insufficient effectiveness of the treatment in the previous sector. Simple ICD-10 diagnoses are not suitable as decision-making criteria and therefore, also not as testing criteria for the indications for inpatient treatment. Decompensated and acutely exacerbated chronic pain conditions must as a rule be treated in hospital, also due to the mental component of the pain disease.