Tag: nevin manimala

Korean J Med Educ. 2021 Sep;33(3):191-201. doi: 10.3946/kjme.2021.199. Epub 2021 Aug 27.

ABSTRACT

PURPOSE: This study aims to design that using formative assessment as an instructional strategy in real-time online classes, and to explore the application of Bloom’s taxonomy in the development of formative assessment items.

METHODS: We designed the instruction using formative assessment in real-time online classes, developed the items of formative assessment, analyzed the items statistically, and investigated students’ perceptions of formative assessment through a survey.

RESULTS: It is designed to consist of 2-3 learning outcomes per hour of class and to conduct the formative assessment with 1-2 items after the lecture for each learning outcome. Formative assessment was 31 times in the physiology classes (total 48 hours) of three basic medicine integrated. There were nine “knowledge” items, 40 “comprehension” items, and 55 “application” items. There were 33 items (31.7%) with a correct rate of 80% or higher, which the instructor thought was appropriate. As a result of the survey on students’ perceptions of formative assessment, they answered that it was able to concentrate on the class and that it was helpful in achieving learning outcomes.

CONCLUSION: The students focused during class because they had to take formative assessment immediately after the learning outcome lecture. “Integration of lesson and assessments” was maximized by solving the assessment items as well as through the instructor’s immediate explanation of answers. Through formative assessment, the students were able to utilize metacognition by learning what content they understood or did not understand. Items that consider Bloom’s taxonomy allow students to remember, understand, and apply to clinical contexts.

PMID:34474526 | DOI:10.3946/kjme.2021.199

Stat Med. 2021 Sep 2. doi: 10.1002/sim.9184. Online ahead of print.

ABSTRACT

Current status data arise when each subject is observed only once and the failure time of interest is only known to be either smaller or larger than the observation time rather than observed exactly. For the situation, due to the use of imperfect diagnostic tests, the failure status could often suffer misclassification or one observes misclassified data, which may result in severely biased estimation if not taken into account. In this article, we discuss regression analysis of such misclassified current status data arising from the additive hazards model, and a simulation-extrapolation (SIMEX) approach is developed for the estimation. Furthermore, the asymptotic properties of the proposed estimators are established, and a simulation study is conducted to assess the empirical performance of the method, which indicates that the proposed procedure performs well. In particular, it can correct the estimation bias given by the naive method that ignores the existence of misclassification. An application to a medical study on gonorrhea is also provided.

PMID:34474502 | DOI:10.1002/sim.9184

J Reconstr Microsurg. 2021 Sep 2. doi: 10.1055/s-0041-1733994. Online ahead of print.

ABSTRACT

BACKGROUND: Free flaps have become a highly valuable tool for complex reconstructive surgeries. The requirement of red blood cell transfusion (RBCT) during the perioperative period is common and its effect on the free flap survival is debatable. The aim of this study was to determine the relationship between perioperative RBCT and vascular pedicle thrombosis (VPT).

METHODS: For this study 302 free flaps performed between January 2006 and December 2019 were retrospectively analyzed. It included their characteristics from before, during, and after the surgical procedure. The incidence of VPT and flap survival were calculated based on Kaplan Meier’s method and the relationship between VPT and perioperative variables were analyzed by Cox regression models.

RESULTS: The transfusion group was represented by 62 flaps (20.5%) and no transfusion by 240 flaps. The overall transfusion requirement was 20.5% and the cumulative incidence of VPT was 9.11%. A statistically significant relationship was not demonstrated between flap survival and transfusion status (HR = 1.73 IC 95%: 0.5 to 3.96; p = 0.192) (p = 0.192) independently from the number of units transfused, the preoperative diagnosis of anemia, and the type of flap used and did not establish an increased risk of VPT.

CONCLUSIONS: This study did not demonstrate an association between RBCT during preoperative period and the risk for VPT or microvascular free flap survival rate on postoperative follow up.

PMID:34474496 | DOI:10.1055/s-0041-1733994

Stat Med. 2021 Sep 2. doi: 10.1002/sim.9185. Online ahead of print.

ABSTRACT

The potential benefit of using a surrogate marker in place of a long-term primary outcome is very attractive in terms of the impact on study length and cost. Many available methods for quantifying the effectiveness of a surrogate endpoint either rely on strict parametric modeling assumptions or require that the primary outcome and surrogate marker are fully observed that is, not subject to censoring. Moreover, available methods for quantifying surrogacy typically provide a proportion of treatment effect explained (PTE) measure and do not directly address the important questions of whether and how the trial can be ended earlier using the surrogate marker. In this article, we specifically address these important questions by proposing a PTE measure to quantify the feasibility of ending trials early based on endpoint information collected at an earlier landmark point $t_0$ in a time-to-event outcome setting. We provide a framework for deriving an optimally predicted outcome for individual patients at $t_0$ based on a combination of surrogate marker and event time information in the presence of censoring. We propose a non-parametric estimator for the PTE measure and derive the asymptotic properties of our estimators. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining the potential of hemoglobin A1c and fasting plasma glucose to predict treatment effects on long term diabetes risk based on the Diabetes Prevention Program study.

PMID:34474500 | DOI:10.1002/sim.9185

Spine (Phila Pa 1976). 2021 Aug 31. doi: 10.1097/BRS.0000000000004215. Online ahead of print.

ABSTRACT

STUDY DESIGN: This was a dual-center study over an eight-year period on patients undergoing single level fusion surgery with either posterior- (PLIF) or transforaminal lumbar interbody fusion (TLIF). We analyzed prospectively collected pre- and postoperative data from the national Danish surgical spine database (DaneSpine).

OBJECTIVE: To compare clinical and patient-reported outcome (PRO) two years after TLIF or PLIF in patients with symptomatic lumbar mechanical disc degeneration.

SUMMARY OF BACKGROUND DATA: PLIF and TLIF are well-described techniques for treating lumbar mechanical disc degeneration but whether the theoretical differences between the two techniques translate to different clinical outcomes is unknown.

METHODS: The primary outcome was Oswestry Disability Index (ODI) score at two-year follow-up. Secondary outcome measures were scores on the European Quality of Life-5 Dimensions (EQ-5D) and visual analog scale (VAS) and the rate of intraoperative complications. To minimize baseline differences between the groups, propensity-score matching was employed in a 1:1 fashion, balancing the groups on preoperative factors including age, sex, back and leg pain, ODI, EQ-5D and previous spine surgery.

RESULTS: The matched cohort included 211 patients in each cohort. There was no significant difference between the groups in the mean score on the ODI at two years (PLIF: 33 ± 20 vs. TLIF: 35 ± 20, p = 0.328). We found no statistically significant differences in EQ-5D score (0.54 ± 0.35 vs. 0.51 ± 0.34, p = 0.327), VAS score for back pain (47 ± 32 vs. 48 ± 29, p = 0.570) or leg pain (42 ± 33 vs.41 ± 32, p = 0.936) between the PLIF and TLIF groups, respectively at two-year follow-up. Dural tears occurred in 9.5% in the PLIF group and 1.9% in the TLIF group (p = 0.002) corresponding to a relative risk of 5.0 (95%CI 1.7-14.4).

CONCLUSIONS: We found no significant difference in PRO at two-year follow-up between PLIF and TLIF for the treatment of lumbar disc degeneration. PLIF is associated with a five-times higher risk of dural tears.Level of evidence: 3.

PMID:34474454 | DOI:10.1097/BRS.0000000000004215

Spine (Phila Pa 1976). 2021 Aug 31. doi: 10.1097/BRS.0000000000004214. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cross-sectional study.

OBJECTIVE: This study aims to evaluate the effect size of postoperative glycemic variability on surgical outcomes among patients who have undergone one- to three-level lumbar fusion.

SUMMARY OF BACKGROUND DATA: While numerous patient characteristics have been associated with surgical outcomes after lumbar fusion, recent studies have described the measuring of postoperative glycemic variability as another promising marker.

METHODS: A total of 850 patients were stratified into tertiles (low, moderate, high) based on degree of postoperative glycemic variability defined by coefficient of variation (CV). Surgical site infections were determined via chart review based on the CDC definition. Demographic factors, surgical characteristics, inpatient complications, readmissions, and reoperations were determined by chart review and telephone encounters.

RESULTS: Overall, a statistically significant difference in 90-day adverse outcomes was observed when stratified by postoperative glycemic variability. In particular, patients with high CV had higher odds of readmission (OR = 2.19 [1.17, 4.09]; P = 0.01), experiencing a surgical site infection (OR = 3.22 [1.39, 7.45]; P = 0.01), and undergoing reoperations (OR = 2.65 [1.34, 5.23]; P = 0.01) compared with patients with low CV. No significant association was seen between low and moderate CV groups. Higher CV patients were more likely to experience longer hospital stays (β: 1.03; P = 0.01). Among the three groups, high CV group experienced the highest proportion of complications.

CONCLUSION: Our study establishes a significant relationship between postoperative glycemic variability and inpatient complications, length of stay, and 90-day adverse outcomes. While HbA1c has classically been used as the principal marker to assess blood glucose control, our results show CV to be a strong predictor of postoperative adverse outcomes. Future high-quality, prospective studies are necessary to explore the true effect of CV, as well as its practicality in clinical practice. Nevertheless, fluctuations in blood glucose levels during the inpatient stay should be limited to improve patient results.Level of Evidence: 4.

PMID:34474452 | DOI:10.1097/BRS.0000000000004214

J Glaucoma. 2021 Sep 2. doi: 10.1097/IJG.0000000000001935. Online ahead of print.

ABSTRACT

PRECIS: Glaucoma can cause disturbance in psychological and emotional functioning of patients, leading to anxiety and depression, even early in the disease. Identification and management of these problems should be included as a part of the holistic approach for patient care.

PURPOSE: To assess the prevalence of anxiety and depression in patients with primary glaucoma using a standard validated questionnaire.

METHODS: A cross-sectional prevalence study was carried out on 200 patients attending the glaucoma outpatient clinic at a tertiary care eye hospital in Pune, India. After obtaining written consent, all patients underwent a thorough ophthalmic examination. Those with primary glaucoma were included in the study and classified on the basis of the Hodapp-Parrish-Anderson criteria. Participants were asked to respond to the Hospital Anxiety and Depression Scale (HADS) questionnaire and responses were analyzed statistically.

RESULTS: Mean HADS- Anxiety (HADS-A) score was 4.5 (SD 3.4) while HADS-Depression (HADS-D) was 4.1 (SD 3.8). Severity of disease was associated with significantly higher HADS scores. Mean HADS-A scores were 3.1 (SD 2.9) mild glaucoma, 4.4 (SD 2.6) for moderate and 7.7 (SD 3.0) for advanced disease (P<0.001). Similarly mean HADS-D scores were 2.0 (SD 2.6), 4.2 (SD 3.0) and 8.3 (SD 3.3) respectively for mild, moderate and severe glaucoma (P<0.001). Based on HADS scores, a quarter of patients (25.5%) were symptomatic for anxiety or depression, out of which 25 (12.5%) could be classified as definite cases. Duration of treatment had no association with HADS scores.

CONCLUSION: An association exists between the amount of visual loss among patients with glaucoma, and symptoms of anxiety and depression, irrespective of disease duration. This information may help to choose treatment approaches most likely to be beneficial to the patients.

PMID:34474423 | DOI:10.1097/IJG.0000000000001935

J Glaucoma. 2021 Sep 2. doi: 10.1097/IJG.0000000000001934. Online ahead of print.

ABSTRACT

PRECIS: Bruch membrane opening minimum rim width (BMO-MRW) is overall a useful parameter for diagnosing early glaucoma in myopic eyes.

PURPOSE: The aim of this study was to determine the diagnostic value of BMO-MRW compared with peripapillary retinal nerve fiber layer (pRNFL) thickness for detecting early glaucoma in patients with moderate to severe myopia.

METHODS: One eye was randomly selected from each of the 253 subjects (127 normal controls, 82 with glaucoma suspect, and 44 with early glaucoma). All patients underwent visual acuity testing, refractive error assessment, slit-lamp inspection, intraocular pressure measurement, fundus photography, perimetry. BMO-MRW and pRNFL thickness data were obtained using spectral-domain optical coherence tomography. Area under the receiver operating characteristic curves (AUC) for global and sectoral thickness parameters were calculated.

RESULTS: Global analyses for the discrimination of early glaucoma in all myopic subjects showed comparable AUCs between BMO-MRW and pRNFL thickness [AUC 0.952 (95% confidence interval, 0.918-0.975) and 0.934 (95% confidence interval, 0.896-0.961), respectively, P=0.345]. However, in sectoral analysis, BMO-MRW showed significantly better diagnostic performance than pRNFL thickness except for the superotemporal sector. The AUC for discriminating early glaucoma from glaucoma suspect, BMO-MRW showed statistically better diagnostic performance in the inferotemporal, inferonasal, superonasal, and nasal sectors. When dividing the subject based on a threshold Bruch membrane opening (BMO) area of 2.5 mm2, the diagnostic power of BMO-MRW was generally lower except for the inferonasal sector in the subgroup with a large BMO area.

CONCLUSIONS: BMO-MRW was overall a useful parameter for diagnosing early glaucoma in myopic eyes. However, its diagnostic performance was decreased in myopic eyes with large BMO and there were no significant differences from pRNFL thickness.

PMID:34474421 | DOI:10.1097/IJG.0000000000001934

J Mech Behav Biomed Mater. 2021 Aug 25;124:104733. doi: 10.1016/j.jmbbm.2021.104733. Online ahead of print.

ABSTRACT

The contribution of the proteoglycan to the strain-rate-dependent mechanical behaviour of cartilage tissues has been suggested to decrease with an increase in the strain-rate. On the other hand, the contribution from the collagen network has been suggested to increase as the strain-rate increases. These conclusions are drawn mainly based on numerical studies conducted on high-load-bearing knee cartilage tissues, while experimental evidence of these behaviours have not been demonstrated previously. Further, in contrast to the reported findings on high-load bearing knee cartilage, our previous study on the low-load-bearing kangaroo shoulder cartilage indicated that proteoglycan and collagen contribution remained steady as the strain-rate increases. Therefore, in the present study, we experimentally investigate the contribution of proteoglycan and collagen network to the strain-rate-dependent behaviour of the kangaroo knee cartilage, and plausible reasons for the differences observed in relation to the kangaroo shoulder cartilage. Firstly, in order to quantify the contribution of proteoglycans and collagen network, the indentation testings on normal, proteoglycan, and collagen-degraded kangaroo knee cartilage were conducted at different strain-rates. Then, structural and compositional differences between the kangaroo knee and shoulder cartilage were assessed qualitatively through polarised light microscopy (PLM) imaging and histological staining. Identified differences in the collagen architecture and proteoglycan composition were incorporated in a fibril-reinforced porohyperelastic Finite Element (FE) model with the objective of explaining the mechanisms underlying differences observed between the two tissues. Experimental results on knee cartilage indicated that when the strain-rate increases, proteoglycan contribution decreases while collagen contribution increases, where statistically significant differences were identified at each strain-rate (p < 0.05). PLM images revealed a sizable deep zone in the kangaroo knee cartilage where collagen fibrils were oriented perpendicular to the subchondral bone. On the other hand, no such apparent deep zone was observed in the shoulder cartilage. FE model confirmed that the biomechanical differences observed in the knee and shoulder cartilage are due to the differences in the collagen fibril arrangement in the deep zone. From these results, it can be concluded that in high-load-bearing cartilage tissues, the collagen network in the deep zone assists in increasing the stiffness of tissue with strain-rate and plays a significant role in supporting transient loads. This, in turn, helps protect the solid matrix against large distortions and strains at the subchondral junction, pointing to the importance of the collagen network in deep zone in assisting high-load-bearing cartilage tissues.

PMID:34474320 | DOI:10.1016/j.jmbbm.2021.104733

Forensic Sci Int Genet. 2021 Aug 14;55:102570. doi: 10.1016/j.fsigen.2021.102570. Online ahead of print.

ABSTRACT

Latest innovations indicate that continuous tools are promising DNA trace assessment methods. In this study, we present the continuous software solution Statistefix 4.0. The software supports DNA experts in deducing DNA profiles for database queries and can help to preselect DNA samples suitable for further processing using advanced probabilistic search engines. The novel tool weights genotype contributions and deduces major contributors from high- and low-quality DNA traces. Peak height, degradation, stutter as well as allelic drop-in/-out events are incorporated in the statistical model. We analyzed reference and casework samples as well as artificially generated mixture samples for software evaluation. The tool offers the completely automated assessment of reference and mixture samples. Deconvolution outcomes of mixtures are compared with EuroForMix, GenoProof Mixture 3 and STRmix™. Data show that Statistefix 4.0 is as successful as analogously tested and implemented software. Deduced DNA profiles from casework samples highlight the potential benefit in routine casework. Statistefix 4.0 is freely available, works with replicates of different autosomal kits and enables bulk sample processing. This inter-laboratory study includes a variety of sample types and indicates a timesaving, robust and easily implemented software that supports DNA analysts in evaluating DNA traces.

PMID:34474323 | DOI:10.1016/j.fsigen.2021.102570