Category: Nevin Manimala

Am J Pharm Educ. 2021 Sep 10:8696. doi: 10.5688/ajpe8696. Online ahead of print.

ABSTRACT

Objective. The ability of pharmacy students to self-regulate and reflect on knowledge and skills is important as proficient self-assessment skills guide learning strategies and prompt students to bridge their knowledge gaps. The objective was to determine how well third-year pharmacy students self-assess, to explore the rationales behind their self-assessments and determine whether there is a correlation between self-assessment accuracy and academic performance. Methods. A quasi-experimental one-group pre-/post-test design was conducted with third-year pharmacy students. Examiner grades, student self-assessment grades, comparative reports and end-of-semester grades were collected. Students were categorised into tertiles based on academic performance for data analysis. Paired t-tests, Pearson’s r and percentage agreements were conducted to investigate self-assessment accuracy. Correlational statistical tests were implemented to examine the relationships between self-assessment accuracy and academic performance. Results. 162 third-year pharmacy students were included. On average, students demonstrated poor self-evaluation skills and underestimated themselves by 4.9%. Lower performing students were generally overconfident in evaluating their performance. There was no significant correlation between self-assessment accuracy and academic performance on the subsequent end-of-semester examination question. Conclusion. On average students tended to underestimate their academic performance. Further research on self-assessment can help understand how students think about their performance which may help to improve education methods such as inclusion of reflective practices after case-based activities.

PMID:34507958 | DOI:10.5688/ajpe8696

Radiography (Lond). 2021 Sep 7:S1078-8174(21)00060-2. doi: 10.1016/j.radi.2021.05.007. Online ahead of print.

ABSTRACT

INTRODUCTION: This study developed and piloted the first online training package to support implementation and delivery of brief smoking cessation interventions for therapeutic radiographers in four radiotherapy departments in England.

METHODS: A previously reported systematic literature review and data analysis from the previously reported pre-focus group questionnaire and focus groups enabled the development of an online training package. The questionnaire was repeated by the participating therapeutic radiographers following completion of the training resource (n = 31). The results of the comparative questions from the pre and post questionnaires were analysed using the Statistical Package for Social Sciences (SPSS Version 24).

RESULTS: In total, 43 therapeutic radiographer participants completed the pre-questionnaire and 31 participants continued to complete the post questionnaire, having completed the online training package. The previously conducted focus groups identified several barriers to the delivery of smoking cessation, that were addressed through the development of an online training package. Following the completion of the training; therapeutic radiographers had increased knowledge and confidence regarding smoking cessation, the number of therapeutic radiographers who believe that smoking cessation is part of their role increased and therapeutic radiographers more routinely have conversations about smoking cessation.

CONCLUSION: The training resource improved therapeutic radiographers’ knowledge and confidence and increased awareness of the role of the therapeutic radiographer in the provision of smoking cessation interventions. Challenges remain that continue to prevent some therapeutic radiographers from delivering smoking cessation interventions and strong leadership and implementation of strategy and guidance is essential to ensure wider implementation. Recording and measuring impact of interventions remains an area to be addressed, alongside cultural changes and reassurance around the therapeutic relationship.

IMPLICATIONS FOR PRACTICE: This training tool has proven to be effective in the sample within this study and should be disseminated and evaluated more widely across radiotherapy provision within the United Kingdom.

PMID:34507902 | DOI:10.1016/j.radi.2021.05.007

Int Orthod. 2021 Sep 7:S1761-7227(21)00112-1. doi: 10.1016/j.ortho.2021.08.005. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to evaluate craniofacial characteristics and upper airway morphology in adolescents with Attention Deficit Disorder with Hyperactivity (ADHD) compared to controls (CON).

MATERIALS AND METHODS: Records from July 2014 to May 2018 of patients who were seeking orthodontic treatment at a single institute and had full pre-treatment orthodontic records including cone-beam computed tomography (CBCT) were reviewed. Comprehensive cephalometric variables were measured to determine craniofacial morphology. Upper airway volume (UAV), minimum cross-sectional area (MCA), and linear measurements were calculated at multiple planes.

RESULTS: A total of 87 adolescents (ADHD, 29; CON, 58) were included in the study. Overall, UAV and MCA in ADHA group were smaller than CON. Statistical significance was evident in airway widths at planes A (P=0.002), C (P=0.042), and D (P<0.001), and airway area at plane D (lower hypopharynx) (P<0.001), with the ADHD group showing narrower widths and area compared to CON. The most common skeletal classification in the ADHD group was sequenced as Class II, Class I then Class III, with percentages of (58.6%), (31%) and (10.3%), respectively. No significant differences were found between the groups for any of the skeletal, dental, and soft tissue cephalometric variables.

CONCLUSIONS: ADHD affected adolescents have similar craniofacial characteristics, but narrower upper airway dimensions compared to controls. Further investigations with larger samples are warranted to further elucidate the relationship between SDB and ADHD.

PMID:34507915 | DOI:10.1016/j.ortho.2021.08.005

Pancreatology. 2021 Aug 18:S1424-3903(21)00527-5. doi: 10.1016/j.pan.2021.08.004. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Increased intrapancreatic fat is associated with pancreatic diseases; however, there are no established objective diagnostic criteria for fatty pancreas. On non-contrast computed tomography (CT), adipose tissue shows negative Hounsfield Unit (HU) attenuations (-150 to -30 HU). Using whole organ segmentation on non-contrast CT, we aimed to describe whole gland pancreatic attenuation and establish 5th and 10th percentile thresholds across a spectrum of age and sex. Subsequently, we aimed to evaluate the association between low pancreatic HU and risk of pancreatic ductal adenocarcinoma (PDAC).

METHODS: The whole pancreas was segmented in 19,456 images from 469 non-contrast CT scans. A convolutional neural network was trained to assist pancreas segmentation. Mean pancreatic HU, volume, and body composition metrics were calculated. The lower 5th and 10th percentile for mean pancreatic HU were identified, examining the association with age and sex. Pre-diagnostic CT scans from patients who later developed PDAC were compared to cancer-free controls.

RESULTS: Less than 5th percentile mean pancreatic HU was significantly associated with increase in BMI (OR 1.07; 1.03-1.11), visceral fat (OR 1.37; 1.15-1.64), total abdominal fat (OR 1.12; 1.03-1.22), and diabetes mellitus type 1 (OR 6.76; 1.68-27.28). Compared to controls, pre-diagnostic scans in PDAC cases had lower mean whole gland pancreatic HU (-0.2 vs 7.8, p = 0.026).

CONCLUSION: In this study, we report age and sex-specific distribution of pancreatic whole-gland CT attenuation. Compared to controls, mean whole gland pancreatic HU is significantly lower in the pre-diagnostic phase of PDAC.

PMID:34507900 | DOI:10.1016/j.pan.2021.08.004

J Hand Surg Am. 2021 Sep 7:S0363-5023(21)00478-0. doi: 10.1016/j.jhsa.2021.07.028. Online ahead of print.

ABSTRACT

PURPOSE: The etiology of Kienböck disease remains unclear, although mechanical, vascular, and metabolic risk factors have been suggested. We aimed to investigate the association of the angle between the curvatures of the distal radius and the development of Kienböck disease.

METHODS: The lunate facet inclination (LFI), scaphoid facet inclination, and interfacet angle (IFA) values were measured using posteroanterior plain radiographs of 82 patients diagnosed with Kienböck disease. The results were compared with normative angular reference values published based on an analysis of 400 wrists of Caucasian patients aged between 20 and 45 years. The posteroanterior radiographs were divided into 3 categories: negative, neutral, and positive based on ulnar variance, and the relationship between ulnar variance and facet angles was evaluated.

RESULTS: The IFA value was significantly higher than the normative angular reference value in the patients with Kienböck disease. Conversely, the LFI values were significantly lower in the Kienböck patient group. There were no statistically significant differences in the IFA and LFI values among the ulnar variance groups.

CONCLUSIONS: Measuring IFA and LFI allows the evaluation of the bifacet curvature of the distal radius articular surface in the coronal plane. Steep IFA and shallow LFI are associated with Kienböck disease. Increased IFA may lead to abnormal load transmission to the intermediate column, which might eventually lead to increased stress on the lunate.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

PMID:34507867 | DOI:10.1016/j.jhsa.2021.07.028

Geriatr Nurs. 2021 Aug 20:S0197-4572(21)00280-9. doi: 10.1016/j.gerinurse.2021.08.012. Online ahead of print.

ABSTRACT

BACKGROUND: There are known significant relationships between greater physical activity and less depression, and greater social isolation and greater depression; therefore, it is important to understand these relationships among older adults during COVID-19.

METHODS: The Physical Activity Scale for Elders, Geriatric Depression Scale, and PROMIS Social Isolation were administered. Path analysis was performed to evaluate the relationship between physical activity, social isolation, and depression.

RESULTS: Of 803 surveys received, Consistent with our a-priori model, higher social isolation predicted greater depression. (p<0.001).

CONCLUSION: Older adults may suffer a high emotional price during times of imposed social distancing.

PMID:34507833 | DOI:10.1016/j.gerinurse.2021.08.012

Int J Nurs Educ Scholarsh. 2021 Sep 10. doi: 10.1515/ijnes-2021-0056. Online ahead of print.

ABSTRACT

OBJECTIVES: There is limited knowledge about students’ experiences with virtual simulation when using a video conferencing system. Therefore, the aim of this study was to explore how second-year undergraduate nursing students experienced learning through virtual simulations during the COVID-19 pandemic.

METHODS: The study had an exploratory design with both quantitative and qualitative approaches. In total, 69 nursing students participated in two sessions of virtual simulation during spring 2020, and 33 students answered online questionnaires at session 1. To further explore students’ experiences, one focus group interview and one individual interview were conducted using a video conferencing system after session 2. In addition, system information on use during both sessions was collected.

RESULTS: Changes in the students’ ratings of their experiences of virtual simulation with the Body Interact™ system were statistically significant. The virtual simulation helped them to bridge gaps in both the teaching and learning processes. Four important aspects of learning were identified: 1) learning by self-training, 2) learning from the software (Body Interact™), 3) learning from peers, and 4) learning from faculty.

CONCLUSIONS: We conclude that virtual simulation through a video conferencing system can be useful for student learning and feedback from both peers and faculty is important.

PMID:34506698 | DOI:10.1515/ijnes-2021-0056

J Neuroimaging. 2021 Sep 10. doi: 10.1111/jon.12926. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: The gold standard for imaging of meningiomas is MRI with gadolinium-based contrast agent. Due to increased costs, time, and uncertain chronic effects of gadolinium exposure, use of noncontrast T2-weighted imaging (T2WI) in lieu of contrast-enhanced MRI has been an increasing focus of research across various diagnostic scenarios. The purpose of this study was to evaluate the diagnostic accuracy of T2WI in detecting changes in meningioma tumor volume.

METHODS: Imaging and clinical data were reviewed for 82 consecutive patients undergoing MR-surveillance of intracranial meningioma. Using volumetric-T2WI, two neuroradiologists independently calculated tumor volumes. Measurements were compared to a baseline study contrast-enhanced T1 tumor volume. Using contrast-enhanced sequences as the reference standard, statistical analysis was performed to determine the accuracy of T2WI in detecting changes of meningioma volume.

RESULTS: Using only T2WI, readers detected meningioma volume change ≥ 20% in 19/82 patients and volume change <20% in 63/82 patients. Reader accuracy for detecting change in tumor volume on T2WI ≥ 20% was 0.85, sensitivity 0.65, specificity 0.93, positive predictive value (PPV) 0.79, and negative predictive value (NPV) 0.87. For meningiomas >1 ml, reader accuracy for detecting change in tumor volume on T2WI ≥20% was 0.90, sensitivity 0.78, specificity 0.95, PPV 0.88, and NPV 0.91. Change in tumor volume on T2WI ≥20% was detected with 100% accuracy for posterior fossa meningiomas. Inter-reader agreement for all meningiomas was moderate (κ = 0.45) improving to substantial agreement (κ = 0.77) with tumor volumes >1 ml.

CONCLUSION: Volumetric-T2WI detects changes in meningioma volume with comparable accuracy to gold standard T1 postcontrast imaging, particularly with higher tumor volumes and posterior fossa locations.

PMID:34506680 | DOI:10.1111/jon.12926

Oncologist. 2021 Sep 10. doi: 10.1002/onco.13969. Online ahead of print.

ABSTRACT

BACKGROUND: We externally validated Fujimoto’s Post-Transplant Lymphoproliferative Disorder (PTLD) scoring system for risk prediction by using the Taiwan Blood and Marrow Transplant Registry Database (TBMTRD), and aimed to create a superior scoring system using machine learning methods.

MATERIALS AND METHODS: Consecutive allogeneic hematopoietic cell transplant (HCT) recipients registered in the TBMTRD from 2009 to 2018 were included in this study. The Fujimoto PTLD score was calculated for each patient. The machine learning algorithm, LASSO, was used to construct a new score system, which was validated using the 5-fold cross validation method.

RESULTS: We identified 2,148 allogeneic HCT recipients, of which 57 (2.65%) developed PTLD in the TBMTRD. In this population, the probability for PTLD development by Fujimoto score at five years for patients in the low, intermediate, high and very high-risk groups were 1.15%, 3.06%, 4.09%, 8.97%, respectively. The score model had acceptable discrimination with a C-statistic of 0.65 and a near-perfect moderate calibration curve (HL test P of 0.81). Using LASSO regression analysis, a four-risk-group model was constructed and the new model showed better discrimination in the validation cohort when compared with The Fujimoto PTLD score (C-statistic: 0.75 vs. 0.65).

CONCLUSION: Our study demonstrated a more comprehensive model when compared with Fujimoto’s PTLD scoring system, which included additional predictors identified through machine learning that may have enhanced discrimination. The widespread use of this promising tool for risk stratification of patients receiving HCT allows identification of high-risk patients that may benefit from preemptive treatment for PTLD.

IMPLICATIONS FOR PRACTICE: We validated the Fujimoto score for the prediction of PTLD development following HSCT in an external, independent, and nationally representative population. We also developed a more comprehensive model with enhanced discrimination for better risk stratification of patients receiving HSCT, potentially changing clinical managements in certain risk groups. Previously unreported risk factors associated with the development of PTLD after HSCT were identified using the machine learning algorithm, LASSO, including pre-HSCT medical history of mechanical ventilation, and the chemotherapy agents used in conditioning regimen.

PMID:34506688 | DOI:10.1002/onco.13969

Oncologist. 2021 Sep 10. doi: 10.1002/onco.13965. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer among women worldwide, and the second leading cause of brain metastases (BrM). We assessed the treatment patterns and outcomes of women treated for breast cancer BrM at our institution in the modern era of stereotactic radiosurgery (SRS).

MATERIALS AND METHODS: We conducted a retrospective analysis of women (≥ 18 years old) with metastatic breast cancer who were treated with surgery, whole brain radiotherapy (WBRT) or SRS to the brain at the Sunnybrook Odette Cancer Center, Toronto, Canada between 2008 and 2018. Patients with a history of other malignancies and those with an uncertain date of diagnosis of BrM were excluded. Descriptive statistics were generated and survival analyses were performed, with subgroup analyses by breast cancer subtype.

RESULTS: Among 683 eligible patients, 153 (22.4%) had triple negative (TNBC), 188 (27.5%) had HER2+, 246 (36.0%) had hormone receptor (HR)+/HER2-, and 61 (13.3%) had breast cancer of unknown subtype. The majority of patients received fist line WBRT (n=459, 67.2%) or SRS (n=126, 18.4%). The median brain-specific progression-free survival and median overall survival (OS) were 4.1 months (IQR 1.0-9.6 months) and 5.1 months (IQR 2.0-11.7 months) in the overall patent population, respectively. Age >60 years, presence of neurological symptoms at BrM diagnosis, first line WBRT and HER2- subtype were independently prognostic for shorter OS.

CONCLUSION: Despite the use of SRS, outcomes among patients with breast cancer BrM remain poor. Strategies for early detection of BrM and central nervous system-active systemic therapies warrant further investigation.

IMPLICATIONS FOR PRACTICE: Although triple negative and HER2+ breast cancer have a predilection for metastasis to the central nervous system (CNS), patients with hormone receptor (HR)+/HER2- breast cancer represent a high proportion of patients with breast cancer brain metastases (BrM). Hence, clinical trials should include patients with BrM and evaluate CNS-specific activity of novel systemic therapies when feasible, irrespective of breast cancer subtype. In addition, given that symptomatic BrM are associated with shorter survival, we propose that screening programs for the early detection and treatment of breast cancer BrM warrant further investigation in an era of minimally toxic stereotactic radiosurgery.

PMID:34506676 | DOI:10.1002/onco.13965