Assessment Program Research Articles

Editorial Comment on “Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology”

Editorial Comment on “Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology”

Source apportionment of major ions and trace metals in the lacustrine systems of Schirmacher Hills, East Antarctica

The fabric of the Antarctic lacustrine system has a crucial role in assimilating the anthropogenic inputs and mitigating their long time impacts on climate change. Here, we present the changes in the concentrations of major ions and trace metals in the surface water of the lacustrine system to understand the extent of anthropogenic impacts from the adjacent Schirmacher Hills, East Antarctica. The results show that the land-locked lakes (closed-basin lakes surrounded by topographical barriers such as mountains or bedrock formations) in the region have a moderate enrichment in elemental concentrations compared to the pro-glacial lakes (marginal freshwater bodies that form at the terminus of a glacier or ice sheet). The water quality index (WQI: 7.58–12.63) and pollution evaluation index (PEI: 1.36–2.35) remained normal, indicating that the water in these lake are of good quality. However, a significant correlation between lithogenic elements (Al, Fe) and potentially toxic elements (Cd, Cr, and Ba), suggests an increase in the anthropogenic impacts. Based on the principal component analysis (PCA), the source of trace metals to the lacustrine systems appears to be the surrounding environment, followed by aerosol dust particles. Hierarchical cluster analysis (HCA) revealed that regional topography significantly impacts the supply of major ions/trace metals to these lakes. The present study provides baseline data and can be used to estimate and forecast future local and/or global anthropogenic contaminations in the lacustrine system of Schirmacher Hills, East Antarctica. Moreover, the presence of research stations (Maitri and Novolazarevskaya), tourist activities, and the potential for anthropogenic stressors necessitate continued monitoring and impact assessment programs within the Schirmacher Hills lacustrine systems. These programs are crucial for safeguarding this pristine ecosystem from future environmental disturbances under a changing Antarctic climate, as mandated by the Antarctic Treaty System and the Indian Antarctic Act.

Youth crime and the faulty commodity in education: Students with disabilities invisible in the neoliberalism of Australian education

Australian society is teetering on the brink of anarchy under the threat of rapidly rising youth crime. Statistics showing offences committed by children aged 10 to 17 has risen by 18.2% since 2022. Research indicates that these figures are directly affected by educational outcomes impacted by disability and disengagement at school. Australian education in the 21st century continues to operate as an institutionalised industrial mechanism of neoliberalism losing the ability to perceive the individual in its process. Leaving students with disability on the fringes of education results in disengagement, and exclusion and what is now beginning to be seen as a common pattern emerging in youth crime. Since 2010, the My School neoliberalism of education has transformed Australian students into commodities to produce a prosperous government economy. Students reduced to Human Capital. Schools are now placed as if on the stock market of My School league tables. They are regulated in the market and commodified through the National Assessment Program – Literacy and Numeracy (NAPLAN), standardised testing. The study used a mixed methodology to explore the faulty commodity in the state education system in Australia – the ‘invisible’ students with disabilities. How this may have impacted the increasing youth crime figures and future outcomes re also examined. In addition to the social contract of legislation, the Queensland Education Act (2006), pledges that all students receive ‘a high-quality education to maximise educational potential’ ( Queensland Parliamentary Council, 2015 : 24) is failing disadvantaged students and society. How schools educate students within a veiled system that continues to hide and remove the unwanted product, the students with disabilities from the marketplace of My School is also investigated. The action of Capitalism sustained in education through the hidden curriculum of NAPLAN is also examined.

Assessing the impact of the COVID-19 pandemic on patients referred to a lung cancer rapid assessment clinic in Ontario, Canada

RATIONALE The COVID-19 pandemic negatively impacted lung cancer (LC) outcomes. The Lung Diagnostic Assessment Program (LDAP) in Southeastern Ontario is a rapid assessment clinic for patients with suspected LC. OBJECTIVE Characterize the impact of COVID-19 on presentations and timeliness of care within LDAP. METHODS Retrospective study of LDAP-referred patients pre-COVID-19 (December 2019–March 2020) with matched cohorts post-COVID-19 Year 1 (December 2020–March 2021), and Year 2 (December 2021–March 2022). Data included: patient demographics, LC diagnosis, stage, timeliness of care and symptoms. Statistical analysis included unpaired t-tests and chi-squared tests. MEASUREMENTS AND MAIN RESULTS We reviewed 273 patients pre-COVID-19, 287 post-COVID-19 Year 1 and 218 Year 2. Post-COVID-19, more patients were suspected to have cancer at referral (pre-COVID-19, 28.6% vs. post-COVID-19 Year 2, 37.2%, p = 0.03), and more patients did not attend consultation (9.8%, 10.7% vs 1.0% pre-COVID-19, p = 0.0002) due to hospitalization or declining assessment. Average time from referral to consultation was longer during post-COVID-19 Year 1 (12.2 vs. 17.0 days, p = 0.003) but unchanged by Year 2; times from referral to diagnosis and treatment were unchanged across cohorts (42.7 vs. 44.1 vs. 40.9, p = NS) and (74.0 vs. 66.2, vs. 70.3, p = NS, respectively). Post-COVID-19 patients reported longer symptom duration (5.0 vs. 3.5 months, p = 0.04). CONCLUSIONS During the COVID-19 pandemic, patient characteristics and timeliness of care within LDAP were unchanged, but more patients experienced clinical decline and longer symptom duration prior to consultation. While care within LDAP was relatively insulated, barriers to care prior to referral may have contributed to later presentation.

THE IMPACT OF DIFFERENTIATED PEDAGOGY ON THE IMPROVEMENT OF HIGHER-ORDER THINKING SKILLS AMONG YEAR 5 STUDENTS IN THE SCIENCE SUBJECT AT SK. ST. AUGUSTINE (M), MERADONG

Higher-order thinking skills (HOTS) are a vital aspect in the transformation of the education system in Malaysia. However, thinking skills are less effectively implemented in the Malaysian education system, leading to a lack of Higher- Order Thinking (HOT) skills among Malaysian pupils. One of the factors contributing to this problem is the teaching approach used by teachers during teaching and learning sessions in the classroom. The presence of students with a variety of learning styles, interests, and levels of ability in a classroom has been a challenge for teachers to undertake teaching and learning activities and subsequently the established teaching and learning objectives. According to the 2022 International Student Assessment Programme Report (PISA), Malaysia is ranked 53rd out of 81 participating countries, which is the lowest ranking when compared to other countries. This is the result of the student's inability to answer assessment questions that require high-level thinking skills. The same situation also occurred where Malaysia’s performance in the Trend in International Mathematical and Scientific Studies (TIMSS) programme in 2019 showed that Malaysia was ranked 26th out of 39 participating countries. (TIMSS 2019). Differentiated Pedagogy (DP) is proposed as a solution, as it meets the learning needs and backgrounds of students who are different from the abilities aspect. The purpose of this study was to examine the impact of different pedagogy methods on the improvement of higher-order thinking skills within 5th-year primary school pupils in science subjects. The study was conducted using an experimental method by implementing differentiated pedagogical learning on a sample of 40 pupils selected purposefully from a school in the Meradong district. The sample of this study was divided by class, which was Year 5 of St. Thomas (n = 20) was used as a control group taught using conventional teaching methods, and Year 5 of St. Matthew (n = 20) was assigned to an experimental group taught using Differentiated Pedagogy method. The sample was given a high-level thinking skills test to determine the performance of pupils before and thereafter the implementation of differentiated pedagogy in learning the unit of 'Matter'. The results of this study indicated an improvement in higher-order thinking skills (HOTs) application in the treatment group that was taught utilizing differentiated pedagogy compared to that of the control group. This study suggests the use of this differentiated pedagogy in other schools as well as in other subjects.

Metricfy: Aplikasi Pembelajaran Numerasi berbasis Web

The low numeracy literacy among students is primarily due to two factors: a lack of interest in numeracy learning and limited learning resources. The Ministry of Education and Culture's National Assessment Programme in 2022 revealed that numeracy skills in Indonesia remain low, with only about 40,63% of students demonstrating numeracy competence. Improvement is necessary to achieve better results. The aim of this research is to develop an interactive numeracy application for student learning and assess its suitability. Development utilised Rapid Application Development (RAD) with three main phases: requirement planning, design, and implementation. Data collection involved surveys and quantitative descriptive analysis. In the final development phase, the application underwent testing to ensure functionality and effectiveness. Functional testing using black box methods showed all features performed as expected. Additionally, a System Usability Scale (SUS) survey administered to students yielded a score of 78.05, categorised as "acceptable" (good), indicating the application meets usability and effectiveness standards.

Changes in pre-haemodialysis serum creatinine levels over 2years and long-term survival in maintenance haemodialysis.

Pre-haemodialysis (HD) serum creatinine levels are reliable and inexpensive markers of muscle mass and important predictors of survival in patients with stable chronic HD. We aimed to assess whether changes in pre-HD serum creatinine levels during a 2-year period are linked to long-term patient survival. We retrospectively analysed patients enrolled in a periodic HD quality assessment program. Of the 21846 participants in the fourth HD quality assessment program, 13765 were presented in the fifth, of which 10299 eligible patients were included in this study. We assessed the change in serum creatinine levels over 2years. The patients were categorized into the following three groups: stable group (patients with change in serum creatinine<1mg/dL during 2years of HD, n=5664), increasing group (patients with increase in serum creatinine≥1mg/dL, n=2419) and decreasing group (patients with decrease in serum creatinine≥1mg/dL, n=2216). The duration of HD at baseline was 62-83months, with diabetic kidney disease being the most common cause of kidney failure in 36.4% of patients. The 5-year patient survival rates in the stable, increasing and decreasing groups were 69.1%, 71.3% and 66.8%, respectively. The decreasing group had poorer patient survival than the other two groups (P=0.083 for stable vs. increasing group; P=0.011 for stable vs. decreasing group; P<0.001 for increasing vs. decreasing group). There was no significant difference in the cardiovascular event-free survival rate among the three groups. Multivariable Cox regression analyses revealed the highest hazard ratio (HR) for mortality in the decreasing group (HR 1.33, 95% confidence interval [CI] 1.21-1.45, P<0.001 vs. stable group; HR 1.50, 95% CI 1.34-1.69, P<0.001 vs. increasing group). The increasing group exhibited a lower risk of mortality than the stable group (HR 0.88, 95% CI 0.81-0.97, P=0.008). Subgroup analyses based on age, HD vintage, sex, Charlson comorbidity index score, presence of diabetes and baseline serum creatinine level tertiles revealed that the decreasing group exhibited the highest mortality among all subgroups. Our results demonstrate that changes in pre-HD serum creatinine levels over 2years of HD were associated with all-cause mortality in patients undergoing HD. This finding suggests a simple and promising approach for clinicians in the prognosis and management of patients undergoing HD.

Menganalisis Perbandingan Pendidikan Kurikulum Dinegara Indonesia Dan Negara Finlandia

When viewed from educational issues. In particular, the Indonesian curriculum can be categorized as a country whose education curriculum is still low, when compared with countries that have advanced education systems. Coupled with evidence from reports from the Organization for Economic Cooperation and Development (OECD) conducting an international survey using a test called the Program for Assessment (PISA). The method used in this paper is a literature review because it compares education systems, especially the curriculum between Indonesia and Finland. The curriculum components in question are results and discussion. Data collection methods are related to the topic of this paper. Primary School Curriculum in Finland and Indonesia The 2014 Finnish National Core Curriculum (FNCC) is divided into two parts. The general part includes the importance of the local curriculum, the local curriculum process, the mission and general objectives of basic education, as well as evaluation. In the primary school curriculum, the parts that relating to subjects is divided into several levels (grade 1, grade 2, and grades 3 to 6). The Finnish curriculum is designed to provide standard content and serve as a guide for educational institutions. Subjects are adapted by local authorities to the needs of students, schools, and even parents can participate in editing the curriculum and its objectives.Education in Finland is based on an integrated curriculum system.The Indonesian curriculum also includes several core subjects such as language, religious education, citizenship education, social studies, mathematics, science, physical education and sports, skills and vocational, arts and culture, as well as local content.

External quality assessment programs of laboratory testresults conducted by the Central Center for Quality Researchin Laboratory Diagnostics in 2022

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; In 2022, the Central Center for Quality Research in Laboratory Diagnosticsconducted 16 tests as part of seven programs for external assessment of the quality oflaboratory test results. As many as 1,437 medical diagnostic laboratories participated inthe programs. Only the clinical chemistry program was carried out with a frequency offour tests a year, the remaining six programs (in the field of hematology, acid-base balanceparameters and electrolytes ISE, coagulology) and three immunochemistry programs(including basic analytes, extended analytes, and cardiac markers) were conducted witha frequency of two tests a year. External quality assessment programs in the field ofspecialized immunochemistry and glycated hemoglobin HbA1c, by decision of the Ministerof Health, were withdrawn from implementation in 2022. Due to the earlier purchase ofcontrol materials for these programs by the organizer, the Central Center carried out onlyone test for each of them, without issuing annual certificates.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; As in the previous year, the Central Center purchased controlmaterials from renowned producers of in vitro diagnostic material devices for the programsbeing implemented. In order to ensure the quick and safe delivery of samples of controlmaterials to laboratories, in 2022 the organizer maintained the five-year-old transportprocedure using courier mail. The methods of assessing control results in the programshave not changed; the same method of calculating reference values, individual assessmentsof participants' control results and annual assessments has been maintained.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The results submitted by program participants in 2022 are presented in aggregateform in tables and figures. The initial tables I-IV contain organizational data of individualprograms, while the next tables V-VI present the collective results of all programs conductedin 2022. Further tables, i.e. VII-XIV, contain detailed data on the correctness of the assessedresults in individual programs and the percentage of correct results according to all criteriafor the assessed analytes.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; As compared to 2021, in all programs implemented in 2022, slight differenceswere obtained in the percentage of correct results according to the most favorable criterionfor the participant (from –0.64% to +1.44%); average +0.58%. Also, the annual regularityscores obtained in 2022 are comparable to the results of 2021. The differences range from–0.02 to +0.15 points.&lt;/br&gt;

The Noteworthiness of Constructive Feedback and Student-Reflection to Approach Competence-Based Curriculum: An Explanatory Study of Medical Schools in Indonesia

Background: Competence-based medical curriculum requires the acquisition of complex abilities that should be assessed longitudinally. The programmatic assessment model can facilitate a complete picture of students' competencies. The five components of learning, assessment, supporting activities; and intermediate to final evaluation provide holistic learning experiences for students and mentors to participate in the learning strategies. We aim to assess the application of longitudinal components of the programmatic assessment model to the current assessment system based on student perceptions.Methods: This study used a cross-sectional mixed-method sequential explanatory design at six medical schools in Surabaya, East Java of Indonesia. The instrument was 43 items of validated questionnaire based on the five components and the focus group discussions. Results: This study obtained 442 respondents. The results reflected high reliability with a Cronbach alpha value of 0.969, and the validity test showed R arithmetic &gt; R table (R table 0.128 for n 442). The current assessment system was perceived as ‘good’, with 3.9 on 5 points Likert scale; but the ‘supporting activities’ where reflection and feedback lied; was at the lowest score although insignificant. Students underlined the lack of formative aspects (reflection, feedback, mentorship, and middle evaluation).Conclusion: The overall assessment system is well-perceived by the students; however, the 'supportive activities' component has been minimally applied. So the 'assessment of previous learning' is still prominent in the current assessment system.

Development of a peripheral blood morphology proficiency assessment program using the CellaVision® Proficiency Software

Abstract Objectives Proficiency programs allow hospital laboratories to evaluate and improve diagnostic performance. A cloud-based proficiency program was launched in 2017 to standardize peripheral blood morphology assessments in hospital laboratories across the province of Nova Scotia. Methods The CellaVision® Proficiency Software was used to evaluate peripheral blood morphology assessments. A different blood film featuring a specific red or white cell finding or normal morphology was evaluated each month. Each hospital’s proficiency slide completion and pass rates were monitored, which helped inform remediation efforts. Results In 2017, 213 medical laboratory technologists from 14 hospital laboratories enrolled in the proficiency program. The average completion rate for monthly proficiency assessments between 2017 and 2022 was 90 %. During that time, the pass rate increased from 59 to 95 % and 73 to 89 % for red and white blood cell assessments, respectively. By 2022, four hospital laboratories and 83 medical laboratory technologists stopped performing peripheral blood assessments. Conclusions The CellaVision® Proficiency Software facilitated a centralized peripheral blood morphology proficiency assessment program for geographically distributed hospital sites. The use of this software increased the quality of peripheral blood morphology assessments in Nova Scotia by simplifying the evaluation of and education on peripheral blood morphology skills.

The invisible cohort: Reporting of students with disability in the national assessment program for literacy and numeracy

The National Assessment Program for Literacy and Numeracy (NAPLAN) is intended to assess all Australian students in Years 3, 5, 7 and 9 to ensure equity and inclusion. This paper explores the extent to which equity and inclusion are achieved for students with disability through NAPLAN reporting. Document analysis of publicly accessible NAPLAN reports, technical reports, handbooks and protocols was conducted to evaluate how this cohort is represented in NAPLAN reports. This paper demonstrates the paucity of NAPLAN reporting about students with disability. It highlights opportunities for NAPLAN data from this cohort to be reported and used to inform educational decisions at all levels (teachers, schools, systems and parents) for students with disability.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.

Accelerated Predictive Stability Study of a Pediatric Drug Product for a Supplemental New Drug Application.

In this paper, we report two Accelerated Stability Assessment Program (ASAP) studies for a pediatric drug product. Whereas the first study using a generic design failed to establish a predictive model, the second one was successful after troubleshooting the first study and customizing the study conditions. This work highlighted important lessons learned from designing an ASAP study for formulations containing excipients that could undergo phase change at high humidity levels. The stability predictions by the second ASAP model were consistent with available long-term stability data of the drug product under various storage conditions in two different packaging configurations. The ASAP model was part of the justifications accepted by the health authority to submit a stability package with reduced long-term stability data from the primary stability batches for a Supplemental New Drug Application (sNDA).

Hazard assessment of seismic-collapsed loess landslides on the Loess Plateau as exemplified by the M6.2 earthquake in Jishishan County, China

The Loess Plateau is marked by intense neotectonic activity and frequent earthquakes. Its unique physico-mechanical properties, combined with the granular overhead pore structure of loess, render it prone to seismic landslides triggered by strong earthquakes. Different types of loess seismic landslides have distinct formation mechanisms, disaster-causing characteristics, and risk assessment programs. In this study, the risk of seismic-collapsed loess landslides as one of the types of loess seismic landslides was evaluated on the Loess Plateau. A risk zoning map for seismic-collapsed loess landslides on the Loess Plateau, considering various exceedance probabilities, was compiled by assessing eight factors. These factors include peak ground acceleration, microstructure of loess, and were evaluated using both the minimum disaster-causing seismic peak ground acceleration zoning method and the analytic hierarchy process. The following conclusions were obtained: (1) Earthquakes are the primary inducing factor for seismic-collapsed loess landslides, with other factors serving as influencers, among which the microstructure of loess carries the highest weight; (2) Across various exceedance probabilities, the likelihood of seismic-collapsed loess landslides occurring at 63% of the 50-year exceedance probability is low. Moreover, as the minimum hazard-causing seismic peak ground acceleration increases, the risk of occurrence of seismic-collapsed loess landslides rises, leading to a gradual expansion of the area share in moderate and high-risk zones; (3) Hazard evaluation results align well with existing data on seismic-collapsed loess landslides and findings from field investigations. The case of seismic-collapsed loess landslides induced by the M6.2 magnitude earthquake in Jishishan County, China, is presented as an illustration. The combined use of the minimum hazard-causing seismic peak ground acceleration zoning method and the analytic hierarchy process method offers a reference for geohazard hazard assessment, with earthquakes as the primary inducing factor and other factors as influencers.

Pediatric Acute Respiratory Distress Syndrome Severity and Health-Related Quality of Life Outcomes: Single-Center Retrospective Cohort, 2011-2017.

To determine factors associated with health-related quality of life (HRQL) decline among pediatric acute respiratory distress syndrome (PARDS) survivors. Retrospective cohort study. Academic children's hospital. Three hundred fifteen children 1 month to 18 years old with an unplanned PICU admission from December 2011 to February 2017 enrolled in the hospital's Outcomes Assessment Program. None. Pre-admission baseline and median 6-week post-discharge HRQL were assessed using the Pediatric Quality of Life Inventory or the Functional Status II-R. Patients meeting retrospectively applied Second Pediatric Acute Lung Injury Consensus Conference criteria for PARDS were identified, and PARDS severity was classified using binary (mild/moderate, severe) and trichotomous (mild, moderate, severe) categorization for noninvasive ventilation and invasive mechanical ventilation (IMV). PARDS occurred in 41 of 315 children (13.0%). Clinically important HRQL decline (≥ 4.5 points) occurred in 17 of 41 patients (41.5%) with PARDS and 64 of 274 without PARDS (23.4%). On multivariable generalized linear regression adjusted for age, baseline Pediatric Overall Performance Category, maximum nonrespiratory Pediatric Logistic Organ Dysfunction score, diagnosis, length of stay, and time to follow-up, PARDS was associated with HRQL decline (adjusted relative risk [aRR], 1.70; 95% CI, 1.03-2.77). Four-hour and maximum PARDS severity were the only factors associated with HRQL decline. HRQL decline occurred in five of 18 patients with mild PARDS at 4 hours, five of 13 with moderate PARDS (aRR 2.35 vs. no PARDS [95% CI, 1.01-5.50]), and seven of ten with severe PARDS (aRR 2.56 vs. no PARDS [95% CI, 1.45-4.53]). The area under the receiver operating characteristic curve for discrimination of HRQL decline for IMV patients was 0.79 (95% CI, 0.66-0.91) for binary and 0.80 (95% CI, 0.69-0.93) for trichotomous severity categorization. HRQL decline is common among children surviving PARDS, and risk of decline is associated with PARDS severity. HRQL decline from baseline may be an efficient and clinically meaningful endpoint to incorporate into PARDS clinical trials.

Effect of exercise based cardiac rehabilitation on LV systolic function &amp; exercise stress parameters in patients with ischemic cardiomyopathy post anterior STEMI

Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).

Validity evidence for the clinical communication skills assessment tool (CCSAT) from 9 years of implementation in a high stakes medical student OSCE

ObjectivesCommunication and other clinical skills are routinely assessed in medical schools using Objective Structured Clinical Examinations (OSCEs) so routinely that it can be difficult to monitor and maintain validity. We report on the accumulation of validity evidence for the Clinical Communication Skills Assessment Tool (CCSAT) based on its use with 9 cohorts of medical students in a high stakes OSCE. MethodsWe describe the implementation of the CCSAT including information on the underlying model, the tool’s items, domains, scales and scoring, and its role in curriculum. Internal structure is explored through item, internal consistency, and confirmatory factor analyses. Evidence for CCSAT validity is synthesized within prevailing frameworks (Messick12 and Kane13) based on continuous quality improvement and use of the CCSAT for feedback, remediation, curricular design, and research. ResultsImplementation of the CCSAT over time has facilitated our communication skills curriculum and training. Thoughtful case development and investment in standardized patient training has contributed to data quality. Item analysis supports our behaviorally anchored scale (not done, partly and well done) and the skills domains suggested by an a priori evidence-based clinical communication model were confirmed via analysis of actual student data. Evidence synthesized across the frameworks suggests consistent validity of the CCSAT for generalization inferences (that it captures the construct), responsiveness (sensitivity to change/difference), content validity/internal structure, relationships to other variables, and consequences/implications. More evidence is needed to strengthen validity of CCSAT scores for understanding extrapolation inferences and real-world implications. Conclusions and Practice ImplicationsThis pragmatic approach to evaluating validity within a program of assessment serves as a model for medical schools seeking to continuously monitor the quality of clinical skill assessments, a need made particularly relevant since the US NBME no longer requires the Step 2 Clinical Skills exam, leaving individual schools with the responsibility for ensuring graduates have acquired the requisite core clinical skills. We document strong evidence for CCSAT validity over time and across cohorts as well as areas for improvement and further examination.

Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT.

Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10-15%, and around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease. To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care. Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost-utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease. Secondary care elective settings. Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion. Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management. The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones' condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation. Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6-15.0) and 4.7 months (interquartile range 2.6-7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference -0.0, 95% confidence interval (-1.7 to 1.7); p-value 0.996; n = 203 observation/conservative, n = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), p < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost-utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference -£1033). A non-significant quality-adjusted life-year difference of -0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals. The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery. This trial is registered as ISRCTN55215960. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in Health Technology Assessment; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.

ETC 07 - Veterinary Occupational Health and Infection Control Assessment Program (VOHICA)

ETC 07 - Veterinary Occupational Health and Infection Control Assessment Program (VOHICA)