Category: Nevin Manimala

Med Educ Online. 2023 Dec;28(1):2189553. doi: 10.1080/10872981.2023.2189553.

ABSTRACT

PURPOSE: The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education.

METHODS: Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes.

RESULTS: Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001).

CONCLUSIONS: The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.

PMID:36919556 | DOI:10.1080/10872981.2023.2189553

J Psychoactive Drugs. 2023 Mar 15:1-11. doi: 10.1080/02791072.2023.2186286. Online ahead of print.

ABSTRACT

Medical cannabis use among U.S. Veterans has continued to rise. However, data on cannabis use by older Veterans is generally less available. This study aims to understand the characteristics of older Veterans who enrolled in the Medical Cannabis Patient Program in Illinois and analyze their health outcomes and co-use of cannabis and opioids using longitudinal survey data. Overall, participants reported positive outcomes for pain, sleep, and emotional problems because of cannabis use in two survey periods. Approximately, 62% and 85% respondents reported no change in memory and falls, respectively, with only 3% and 1% reporting a negative outcome for the conditions in both surveys. About 20.4% of those who indicated cannabis use only in the initial survey started to co-use opioids in the follow-up survey, while 44.1% of those who indicated the use of both substances in the initial survey reported no longer using opioids in the follow-up survey. However, these changes were not statistically significant ($\alpha =0.05).$ The logistic regression showed that both clinical and contextual factors affected co-use. In conclusion, older U.S. Veterans may be using cannabis to alleviate their pain and other chronic conditions. More research is needed to understand the effect of cannabis use on reducing or substituting opioids.

PMID:36919533 | DOI:10.1080/02791072.2023.2186286

J Periodontol. 2023 Mar 15. doi: 10.1002/JPER.22-0654. Online ahead of print.

ABSTRACT

BACKGROUND: Trans fatty acid (TFA) consumption has been reported to harbor pro-inflammatory and increasing oxidative stress properties, but there has been little research into its association with periodontitis. This study aimed to explore the potential association between TFAs and periodontitis.

METHODS: This large population-based study included participants from the National Health and Nutrition Examination Survey (2009-2010). Weighted binary and ordinal logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the relationship between plasma TFAs and periodontitis.

RESULTS: A total of 1433 eligible participants, 793 (55.3%) participants with periodontitis and 640 (44.7%) without periodontitis were included. Univariate logistic regression revealed significant associations between plasma trans-11-octadecenoic acid, trans-9-octadecenoic acid, the sum of trans-octadecenoic acids, and the sum of TFAs and periodontitis (all P<0.01). After controlling for the potential confounders, these four types of TFAs remained significantly associated with periodontitis (the ORs and 95% CIs per interquartile range increase were 1.16 (1.01-1.33), 1.20 (1.03-1.39), 1.18 (1.02-1.35), and 1.17 (1.01-1.35), respectively). Notably, these positive associations were more pronounced among overweight/obese populations. Additionally, plasma trans-9-octadecenoic acid levels were found to be associated with periodontitis severity.

CONCLUSIONS: This study suggests a significant positive association between certain plasma TFAs and chronic periodontitis, especially among overweight/obese populations. These findings provide new insights into periodontitis prevention from a dietary perspective. This article is protected by copyright. All rights reserved.

PMID:36919529 | DOI:10.1002/JPER.22-0654

Clin Shoulder Elb. 2023 Mar;26(1):49-54. doi: 10.5397/cise.2022.01375. Epub 2023 Feb 23.

ABSTRACT

BACKGROUND: Lateral epicondylitis is an increasingly debilitating condition in working population. Evidence for conservative treatment modalities has been inconclusive. Percutaneous pie crusting of the common extensor origin at the lateral epicondyle at the time of local corticosteroid injection (CSI) has been proposed sparsely. The objective of this study was to analyze if concomitant CSI and pie-crusting of the common extensor origin provides better outcome than CSI alone in lateral epicondylitis.

METHODS: This case-control study on 236 patients was conducted at a single center between January 1, 2020, and May 31, 2022. Patients were divided into two groups (n=118 each) based on their preference. Group A underwent CSI alone and group B underwent pie crusting along with CSI. The clinical and functional outcomes of all patients were evaluated at 2, 4, 6, and 12-week post-procedure using the visual analog scale (VAS) and Nirschl score. The mean time for return to daily activities was also compared.

RESULTS: Both groups showed significant improvement in post-procedure outcome at successive follow-ups on intragroup longitudinal analysis (VAS: F=558.384 vs. F=1,529.618, Nirschl: F=791.468 vs. F=1,284.951). On intergroup analysis, VAS of group B was superior to that of group A; however, it was statistically significant (P&lt;0.05) only from the 6-week follow-up onwards. Nirschl score of group B was significantly better throughout the period of follow-up (P&lt;0.05). Group B returned to daily activities faster than Group A (6.2±0.44 weeks vs. 7.18±0.76 weeks).

CONCLUSIONS: Concomitant pie crusting with CSI is recommended for lateral epicondylitis as it provides significantly better results than CSI alone.

PMID:36919507 | DOI:10.5397/cise.2022.01375

Clin Shoulder Elb. 2023 Mar;26(1):41-48. doi: 10.5397/cise.2022.01305. Epub 2023 Feb 22.

ABSTRACT

BACKGROUND: Shoulder instability procedures have low morbidity; however, complications can arise that result in readmission to an inpatient healthcare facility. The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission and reoperation following arthroscopic and open treatment for shoulder instability.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests, chi-square, and (where appropriate) Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission and reoperation following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed.

RESULTS: Of the 11,230 cases included in our sample, only 0.54% were readmitted, and 0.23% underwent reoperation within the 30-day postoperative period. Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission and reoperation: open repair, congestive heart failure (CHF), and hospital length of stay.

CONCLUSIONS: Unplanned 30-day readmission and reoperation after shoulder instability surgery is infrequent. Patients with American Society of Anesthesiologists class II, CHF, longer than average hospital length of stay, or an open procedure have higher odds of readmission than patients without those factors. Patients who have CHF, longer than average hospital length of stay, and open surgery have higher odds of reoperation than others. Arthroscopic procedures should be used to manage shoulder instability, if possible.

PMID:36919506 | DOI:10.5397/cise.2022.01305

Clin Shoulder Elb. 2023 Mar;26(1):32-40. doi: 10.5397/cise.2022.01130. Epub 2023 Feb 23.

ABSTRACT

BACKGROUND: The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections.

METHODS: We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P&lt;0.05.

RESULTS: The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003).

CONCLUSIONS: There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

PMID:36919505 | DOI:10.5397/cise.2022.01130

Orthod Craniofac Res. 2023 Mar 15. doi: 10.1111/ocr.12654. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the duration and age at the beginning of each stage corresponding to the circumpubertal period in the Middle Phalanx Maturation method (MPM) and to assess the differences between males and females.

MATERIALS AND METHODS: Sets of x-rays of the middle phalanx of the third finger taken at 6-month intervals were analyzed for 246 skeletal Class I subjects (102 females and 144 males) between 9 and 15 years of age. After staging, the duration of each stage was derived from chronological ages, and the difference between males and females for both duration and age at the beginning of each stage was investigated.

RESULTS: The median duration for MPS2 and MPS3 was 1 year for both sexes, while MPS4 showed a median duration of 1 year in females and 9 months in males, with no significant differences between the sexes. Mean age at the beginning of MPS2 was 10y11m for females and 11y11m for males; for MPS3 it was 11y8m for females and 13y1m for males; for MPS4 it was 12y9m for females and 13y11m for males; for MPS5 it was 13y4m for females and 14y3m for males. The differences between the sexes were statistically significant for all the stages (p<0.001).

CONCLUSIONS: This study confirms, with a relevant sample size, the median duration of 1 year for each MPM stage from MPS2 to MPS4. Despite the distinctive interindividual variability, the interquartile range is 6 months or less for all but one interval, confirming the soundness of results.

PMID:36919493 | DOI:10.1111/ocr.12654

Int J Cosmet Sci. 2023 Mar 15. doi: 10.1111/ics.12857. Online ahead of print.

ABSTRACT

OBJECTIVE: Until now, standardized evaluation of cosmetic effects was conducted mainly in still conditions such as pictures. In real life, the consumers’ experience of their cosmetics’ effects is dynamic and some of the benefits can be better observed under movement. In order to capture motion-related performance of cosmetics, we developed a video-based paired comparison on an online platform.

METHODS: We validated this new tool through the evaluation of an eyeshadow with high light reflection and color gradation especially visible under motion according to the observer point of view. This formula was compared with two marketed benchmarks. The three products were applied sequentially on the eyelid of 8 Japanese women. Videos were taken in standardized light, speed and face position with a rotating camera around the face. The videos were uploaded on an online secured platform and eyelid 3D effect, highlight and color gradation were evaluated through paired comparison test by 60 Japanese women from home on their PC or tablets. Those results were compared with picture based paired comparison by the same observers.

RESULTS: Video based paired comparison provided higher discrimination of products compared to picture-based comparison.

CONCLUSION: As compared to still camera acquisition, the evaluation of cosmetics based on videos is closer to real life experience and can bring higher discrimination especially for motion-related attributes.

PMID:36919483 | DOI:10.1111/ics.12857

Stat Methods Med Res. 2023 Mar 15:9622802231159213. doi: 10.1177/09622802231159213. Online ahead of print.

ABSTRACT

With the aim of providing better estimation for count data with overdispersion and/or excess zeros, we develop a novel estimation method-optimal weighting based on cross-validation-for the zero-inflated negative binomial model, where the Poisson, negative binomial, and zero-inflated Poisson models are all included as its special cases. To facilitate the selection of the optimal weight vector, a $K$-fold cross-validation technique is adopted. Unlike the jackknife model averaging discussed in Hansen and Racine (2012), the proposed method deletes one group of observations rather than only one observation to enhance the computational efficiency. Furthermore, we also theoretically prove the asymptotic optimality of the newly developed optimal weighting based on cross-validation method. Simulation studies and three empirical applications indicate the superiority of the presented optimal weighting based on cross-validation method when compared with the three commonly used information-based model selection methods and their model averaging counterparts.

PMID:36919477 | DOI:10.1177/09622802231159213

Med Teach. 2023 Mar 15:1-8. doi: 10.1080/0142159X.2023.2187683. Online ahead of print.

ABSTRACT

BACKGROUND: Although entrustment scales are increasingly applied in workplace-based assessments, their role in OSCEs remains unclear. We investigated raters’ perceptions using an entrustment scale and psychometric analyses.

METHOD: A mixed-methods design was used. OSCE raters’ (n = 162) perceptions were explored via questionnaire and four focus groups (n = 14). Psychometric OSCE properties were analyzed statistically.

RESULTS: Raters (n = 53, response rate = 41%) considered the entrustment scale comprehensible (89%) and applicable (60%). A total of 43% preferred the entrustment scale, 21% preferred the global performance scale, and 36% were undecided. Raters’ written comments indicated that while they appreciated the authenticity of entrustment levels, they considered them subjective. The focus groups highlighted three main themes: (1) recollections of the clinical workplace as a cognitive reference triggered by entrustment scales; (2) factors influencing entrustment decisions; and (3) cognitive load is reduced at the perceived cost of objectivity. Psychometric analyses (n = 480 students) revealed improvements in some OSCE metrics when entrustment and global performance scales were combined.

CONCLUSION: Entrustment scales are beneficial for high-stakes OSCEs and have greater clinical relevance from the raters’ perspective. Our findings support the use of entrustment and global performance scales in combination.

PMID:36919450 | DOI:10.1080/0142159X.2023.2187683