Checklist Scores Research Articles

Development and Use of an Induction of General Endotracheal Anesthesia Checklist Assessment for Medical Students in a Clinical Setting During Their Introductory Anesthesiology Clerkship.

The American Association of Medical Colleges deemed performing lifesaving procedures, such as airway management, a necessary medical student competency for transitioning to residency. Anesthesiology clerkships provide the unique opportunity for medical students to practice these procedures in a safe and controlled environment. We aimed to develop a checklist that assesses medical students' ability to perform the main steps of a general anesthesia induction with endotracheal intubation in the clinical setting. We created a Checklist containing items aligned with our clerkship objectives. We modified it after receiving feedback and trialing it in the clinical setting. Medical students were evaluated with the Checklist using a pre- and post-clerkship study design: (1) in a simulation setting at the beginning of the clerkship; and (2) in the operating room at the end of the clerkship. Using paired t-tests, we calculated pre- and post-clerkship Checklist scores to determine curriculum efficacy. A P value of <.05 was determined to be statistically significant. We examined rater agreement between overall scores with intraclass correlation coefficients (ICC). Thirty medical students participated in the study. The ICC for agreement was 0.875 (95% confidence interval [CI], 0.704-0.944). The ICC for consistency was 0.897 (95% CI, 0.795-0.950). There was a statistically significant improvement in the score from baseline to final evaluation of 3.6 points (95% CI, 2.5-5.2; P = .001). The statistically significant change in Checklist scores suggests that our medical students gained knowledge and experience during the introductory clerkship inducing general anesthesia and were able to demonstrate their knowledge in a clinical environment.

Development and validation of a risk prediction model for post-traumatic stress disorder symptoms in patients with acute myocardial infarction in China.

At present, there are many influencing factors of post-traumatic stress disorder (PTSD) symptoms in patients with acute myocardial infarction (AMI), but based on this, there are few studies on the risk prediction model of PTSD symptoms. The aim of this study was to investigate the risk factors of PTSD symptoms in patients with AMI and to construct a risk prediction model. From April 2021 to March 2022, 287 patients were enrolled from a hospital in Shandong Province, China. According to the PTSD Checklist (PCL-C) scores 30 days after discharge, the participants were divided into a PTSD symptoms group (92 cases) and a non-PTSD symptoms group (195 cases). The demographic data, disease factors, treatment factors, and laboratory examination indicators were compared between the 2 groups; independent risk factors were screened out, and a risk prediction model was constructed by logistic regression. Area under the curve (AUC) was used as the internal verification of the model prediction. From April 2022 to June 2022, 72 patients with AMI in a hospital in Shandong Province were selected. PCL-C data were collected 30 days after discharge, and finally external validation of the model was performed. Five factors, including gender [odds ratio (OR) =3.325], diabetes history (OR =2.292), creatine kinase isozyme (OR =1.046), insomnia score (OR =2.045), and fear of disease progression score (OR =1.126) were included to construct the risk prediction model. According to the Hosmer-Lemeshow test, P=0.785. The AUC was 0.910, the maximum value of Youden index was 0.751, the sensitivity was 0.870, the specificity was 0.881, and the accuracy rate of practical application was 67.64%. The risk prediction model of PTSD symptoms in patients with AMI established in this study is consistent and effective. It can provide a reference for clinical assessment of PTSD symptoms risk in patients with AMI.

Neurobehavioral Associations with NREM and REM Sleep Architecture in Children with Autism Spectrum Disorder.

Objective: Insomnia and daytime behavioral problems are common issues in pediatric autism spectrum disorder (ASD), yet specific underlying relationships with NonRapid Eye Movement sleep (NREM) and Rapid Eye Movement (REM) sleep architecture are understudied. We hypothesize that REM sleep alterations (REM%, REM EEG power) are associated with more internalizing behaviors and NREM sleep deficits (N3%; slow wave activity (SWA) 0.5–3 Hz EEG power) are associated with increased externalizing behaviors in children with ASD vs. typical developing controls (TD). Methods: In an age- and gender-matched pediatric cohort of n = 23 ASD and n = 20 TD participants, we collected macro/micro sleep architecture with overnight home polysomnogram and daytime behavior scores with Child Behavior Checklist (CBCL) scores. Results: Controlling for non-verbal IQ and medication use, ASD and TD children have similar REM and NREM sleep architecture. Only ASD children show positive relationships between REM%, REM theta power and REM beta power with internalizing scores. Only TD participants showed an inverse relationship between NREM SWA and externalizing scores. Conclusion: REM sleep measures reflect concerning internalizing behaviours in ASD and could serve as a biomarker for mood disorders in this population. While improving deep sleep may help externalizing behaviours in TD, we do not find evidence of this relationship in ASD.

A three-dimensional (3D) printed simulator as a feasible assessment tool for evaluating hip arthroscopy skills

PurposeThe aims of this study were (1) to develop a three-dimensional (3D) printed simulator that facilitates the simulation of surgical skills for portal placement, intra-articular identification of anatomical structures and arthroscope navigation for hip arthroscopy and (2) to concurrently examine the feasibility of using this simulator as an assessment tool to evaluate trainees’ surgical competencies.MethodsA simulator was developed using a combination of medical imaging, computer-aided design, and 3D printing. A cross-sectional study was conducted with 29 participants divided into 3 subgroups (novice, intermediate and experienced). All participants performed related skills on the simulator, and their performance was evaluated using different assessment parameters. The participants’ qualitative feedback regarding the simulator was also collected. The data collated from each group of participants were subsequently compared.ResultsSignificant differences were observed between the three subgroups of participants with regard to the total checklist score (F2,26 = 11.3), total Arthroscopic Surgical Skill Evaluation score (F2,26 = 92.1), overall final global rating scale score (F2,26 = 49), number of times the participants used fluoroscopy (F2,26 = 7.4), and task completion times (F2,26 = 23.5). The participants’ performance in the simulated operation was correlated with their prior clinical experience. There was mainly positive feedback with regard to the fidelity and utility of the simulator in relation to the surgeons’ prior clinical experience.ConclusionsThis study demonstrated that a reliable hip arthroscopic simulator can be developed for use by orthopedic surgeons to evaluate their hip arthroscopic skills before performing actual surgical operations.Level of evidenceLevel III.

Comparison of a dichotomous versus trichotomous checklist for neonatal intubation

BackgroundTo compare validity evidence for dichotomous and trichotomous versions of a neonatal intubation (NI) procedural skills checklist.MethodsNI skills checklists were developed utilizing an existing framework. Experts were trained on scoring using dichotomous and trichotomous checklists, and rated recordings of 23 providers performing simulated NI. Videolaryngoscope recordings of glottic exposure were evaluated using Cormack-Lehane (CL) and Percent of Glottic Opening scales. Internal consistency and reliability of both checklists were analyzed, and correlations between checklist scores, airway visualization, entrustable professional activities (EPA), and global skills assessment (GSA) were calculated.ResultsDuring rater training, raters gave significantly higher scores on better provider performance in standardized videos (both p < 0.001). When utilized to evaluate study participants’ simulated NI attempts, both dichotomous and trichotomous checklist scores demonstrated very good internal consistency (Cronbach’s alpha 0.868 and 0.840, respectively). Inter-rater reliability was higher for dichotomous than trichotomous checklists [Fleiss kappa of 0.642 and 0.576, respectively (p < 0.001)]. Sum checklist scores were significantly different among providers in different disciplines (p < 0.001, dichotomous and trichotomous). Sum dichotomous checklist scores correlated more strongly than trichotomous scores with GSA and CL grades. Sum dichotomous and trichotomous checklist scores correlated similarly well with EPA.ConclusionsNeither dichotomous or trichotomous checklist was superior in discriminating provider NI skill when compared to GSA, EPA, or airway visualization assessment. Sum scores from dichotomous checklists may provide sufficient information to assess procedural competence, but trichotomous checklists may permit more granular feedback to learners and educators. The checklist selected may vary with assessment needs.

Low-Cost, Low-Resource Training Model to Enhance and Sustain Serious Illness Conversation Skills for Internal Medicine Residents.

Background: Funding and limited resources are barriers to required training of residents in serious illness conversation (SIC) skills. Objectives: To examine the effectiveness of a low-cost, low-resource (LCLR) SIC training embedded within a required palliative care rotation. Design: Pre-post prospective cohort study design. Setting/Subjects: Second year internal medicine (IM) residents received an LCLR three-hour training in the SIC Guide (SICG) with a single-faculty member and paired-participant practice replacing actors during a required two-week palliative medicine rotation. Measures: SIC competence checklist measured within simulated patient encounters longitudinally. Results: Twenty resident average SIC checklist scores improved from 11 (95% confidence interval [CI] 9-13) at the beginning of rotation to 19 (95% CI 17-20) at the end of rotation and 18 (95% CI 16-20) at six months after the rotation. Conclusions: LCLR SIC training for IM residents significantly increased the sustained use of basic SIC skills, but was less effective for more complex skills.

Teaching veterinary surgical skills: Comparison of massed versus spaced instruction.

To determine the effect of massed instruction (MI) versus spaced instruction (SI) of veterinary surgical skills on students' cognitive load and skill retention. Prospective randomized cohort study STUDY POPULATION: First-year veterinary students from Louisiana State University (LSU; n=47) and Lincoln Memorial University (LMU; n=101). Students were randomized to MI (two skills in a single session of twice the duration) or SI (one skill per session on two consecutive days). Instructors, instructional ratio, and total educational time was equivalent. Following instruction, students completed a cognitive load questionnaire and underwent a structured assessment immediately after (LMU only), 1day after, and 3-4 weeks after learning the second skill. Students completed two supervised practice sessions one and 2 weeks after the initial laboratory session(s). Overall cognitive load did not differ between groups (p > .05), although LMUs MI group reported higher physical and time demands, effort, and frustration. At initial assessment, SI students scored higher than MI students for the first skill at both LSU (mean checklist score=27.7 vs. mean=24; p=.004) and LMU (mean global rating score=4.76 vs. mean=4.55; p=.029). Differences between groups were no longer evident by 3-4 weeks after instruction. SI may lead to improved immediate performance; however, supervised practice was sufficient to overcome the initial disparity. SI may be beneficial for initial skill performance. However, SI and MI students had similar performance after 3 weeks, suggesting the more convenient curricular design of MI may be sufficient as long as practice sessions are incorporated.

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

ABSTRACT Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

Spin of information and inconsistency between abstract and full text in RCTs investigating upper limb rehabilitation after stroke: An overview study.

Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting Trials for Abstracts (CONSORT-A) and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p < 0.01) and the spin checklist (p < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k = 0.31), while a moderate agreement (k = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2 = 0.46) with journal Impact Factor (p < 0.01), CONSORT Guideline endorsement (p = 0.04), and abstract word number (p = 0.02). A lower spin was associated with a higher journal Impact Factor (p = 0.01) and CONSORT Guideline endorsement (p = 0.01). Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts.

A new educational tool for neuropsychological test raters in the dementia field: A Delphi study

Neuropsychological testing is the primary endpoint of clinical research in the field of dementia, making it essential for the rater to accurately calculate test data for an extensive assessment. However, many raters lack adequate skill to complete neuropsychological tests with sufficient confidence. Therefore, we developed and examined the utility of a checklist and a manual as tools for educating raters on their basic behaviours when conducting comprehensive neuropsychological evaluations in the field of dementia. We conducted a seven-step comprehensive study to develop rater training tools and examine their usefulness between April 2019 and February 2021 involving: 1. Development of a draft checklist, 2. Delphi review rounds, 3. Design of the final checklist, 4. Item weighting, 5. Examination of reliability, 6. Creating the manual, and 7. Examination of the usefulness of learning through rater educational tools (checklist and manual). The Delphi review round led to a highly reliable and valid checklist and manual. The total checklist score improved significantly (t= 2.37, P =0.029) before and after manual learning. We found that the appropriate basic behaviours required by the rater to conduct neuropsychological testing skilfully within the dementia field could be acquired with this tool. Using a robust development process, we integrated expert knowledge and experience, and developed a checklist and a manual for learning the basic behaviours of neuropsychological test raters in the field of dementia. Establishing standards of basic behaviour for neuropsychological raters will help promote dementia research and advances in medicine.

Effectiveness of an Educational Program Regarding Vasoactive Drugs at the Level of Knowledge and Practices among Nurses Working in Critical Care Units

Background: Critical care-unit nurses have the responsibility of medication preparation and administration. Vasoactive drugs are lifesaving drugs that are commonly used in critical-care units. However, the inappropriate administration of vasoactive drugs may lead to poor patient outcomes and complications. Purpose: The present study aimed to evaluate the effectiveness of an educational program of vasoactive-drug administration in critical care-unit nurses' knowledge and practice. Methods: A one-group pre-test-post-test design was used for this study. A convenience sample of 102 registered nurses working at different critical-care units at a university-affiliated hospital was recruited. The researchers provided the study participants with a valid educational program on knowledge and practices related to the administration of vasoactive drugs. Three tools were used to collect data; a demographics form, a vasoactive-drug knowledge questionnaire and a vasoactive-drug observational checklist. Results: There were significant differences in the nurses’ vasoactive-drug knowledge and the total vasoactive-drug observational checklist scores before and after the implementation of the educational program with p  0.001. Experiences in the current critical-care unit and course-related vasoactive drugs were significant predictors of the pre-knowledge test scores. Experience in the current critical-care unit was a significant predictor of the pre-practice test scores. Conclusion: The implemented educational program significantly improved critical care-unit nurses’ knowledge and practice related to the administration of vasoactive drugs. Implications for Nursing: The educational program increased nurses’ knowledge, competence and confidence regarding vasoactive-drug administration. Keywords: Nurses’ knowledge, Nurses’ practice, Vasoactive medication, Educational program.

SP7.5 Psychomotor assessments of fundamental ability are associated with the future operative performance of surgical trainees

Abstract Introduction Assessments of visuospatial, psychomotor and perceptual ability correlate with simulated operative performance. This study investigates the association between fundamental technical ability and future operative performance as measured through both in-theatre and simulation-based assessments. Methods Core surgical trainees in the Republic of Ireland recruited from 2016–2019 participated in validated assessments of fundamental technical ability; Pictorial Surface Orientation (PicSOr) testing of perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and psychomotor testing using a grooved pegboard. Operative performance was assessed using the in-theatre Supervised Structured Assessment of Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS) assessments (multi-station simulation-based assessments) performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point Operative Performance score. Univariate (Pearson) correlations and multiple linear regression were used to explore the association between fundamental ability and operative performance, controlled for both operative experience and centile scores from the trainee's undergraduate medical degree. Results Aggregated fundamental ability scores strongly correlated with performance in all submitted SSAOP assessments using the Total Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002), independent of operative experience and centile scores. Fundamental ability scores were also predictive of OSS assessment scores on multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03). Conclusion Fundamental technical ability is predictive of future performance in both in-theatre workplace-based assessments of operative skill and simulation-based assessments of operative performance.

A Correlational Study to assess the knowledge and practice of diet on Dysmenorrhea and occurrence of Dysmenorrhea among adolescent girls in a selected nursing college at Kollam

Introduction: Dysmenorrhea is the painful menstruation of sufficient magnitude as to incapacitate day to day activities. Food customs are speculated to not only influence the present lifestyle but also to induce gynecological disorders such as dysmenorrhea and irregular menstruation daily eating habits of the women significantly affect reproductive changes. The primary objective of the study was to evaluate the correlation between the practice of diet on dysmenorrhea and occurrence of dysmenorrhea among adolescent girls in a selected nursing college at Kollam. Methodology: Quantitative approach with correlational research study undertaken in Holy Cross College of Nursing, Kollam. Non probability purposive sampling was used as sampling technique. The samples consist of 60 adolescent girls. The self-prepared and content validated structured questionnaire, checklist and WaLLIDD Score were used for the data collection. Data were analyzed by descriptive and inferential statistics. Result: The results showed that among 60 adolescent girls, 40% (24) have adequate knowledge and 60% (36) have moderate knowledge. In case of practice of diet on dysmenorrhea, 22(36.7%) has good practice and 38(63.3%) have poor practice. Karl Pearson co-efficient of correlation r =-0.107 shows that the practice of diet on dysmenorrhea was negatively correlated with occurrence of dysmenorrhea. At 0.05 level of significance, there is no association between knowledge on dysmenorrhea and selected sociodemographic variable. Conclusion: The study outcome revealed that the practice of diet on dysmenorrhea was inversely proportional to the occurrence of dysmenorrhea among adolescent girls.

Associations of Pediatric Symptom Checklist Scores with Sexual Activity and Sexually Transmitted Infections in Urban Adolescents.

To assess the association between the Youth Pediatric Symptom Checklist-17 (YPSC-17) and adolescents' reports of ever having sex and with having positive testing results for sexually transmitted infections (STIs). Analyzed electronic data from primary care clinics for 27,901 adolescents aged 13-17 years with responses to the YPSC-17 and urine screen results for gonorrhea/chlamydia. On the YPSC-17 in total 8.3% screened positive. Over one quarter (26%) reported ever having sex and 11% of sexually active youth had a positive STI test. Logistic regression analyses revealed increased odds of sexual activity among those positive on the YPSC-17 total (aOR 1.87, 95% CI 1.68-2.08) or any subscale (INT-aOR 1.43, 95% CI 1.32-1.55; EXT-aOR 1.62, 95% CI 1.40-1.88; ATT-aOR 1.67, 95% CI 1.47-1.90). In addition, sexually active youth with positive EXT (aOR 1.41 95% CI 1.00-1.98) scores were more likely to have STIs. The YPSC-17 can identify adolescents with heightened risks for STIs.

American College of Surgeons Objective Assessment of Skills in Surgery (ACS OASIS): A Formative Assessment of Junior Residents’ Technical Skills

The objective assessment of technical skills of junior residents is essential in implementing competency-based training and providing specific feedback regarding areas for improvement. An innovative assessment that can be easily implemented by training programs nationwide has been developed by expert surgeon educators under the aegis of the American College of Surgeons (ACS) Division of Education. This assessment, ACS Objective Assessment of Skills in Surgery (ACS OASIS) uses eight stations to address technical skills important for junior residents within the domains of laparoscopic appendectomy, excision of lipoma, central line placement, laparoscopic cholecystectomy, trocar placement, exploratory laparotomy, repair of enterotomy, and tube thoracostomy. The purpose of this study was to implement ACS OASIS at a number of sites to study its psychometric rigor. The ACS OASIS was pre-piloted at two programs to establish feasibility and to gather information regarding implementation. Each skills station was 12 minutes long, and the faculty completed a checklist with 5 to 15 items, and a global assessment scale. The study was then repeated at three pilot sites and included 29 junior residents who were assessed by a total of 44 faculty. Psychometric data for the stations and checklists were collected and analyzed. The pre-pilot sites were Geisinger and University of Tennessee Knoxville.Data were gathered from pilot sites that included Wellspan Health, Duke University, and University of California Los Angeles. The mean checklist score for all learners was 76% (IQR of 66%-85%). The average global rating was 3.36 on a 5-point scale with a standard deviation of 0.56. The overall cut score derived using the borderline group method was at 68% with 34% of performances requiring remediation. Using this criterion, the average number of stations that were completed by each learner without need for remediation was five.The station discrimination index ranged from 0.27 to 0.65 (all above the threshold of 0.25), demonstrating solid psychometric characteristics at the station level. The internal-consistency reliability was 0.76 with SEM of 5.8%. The inter-rater reliability (intraclass correlation) was high at 0.73 with general agreement of 79% between the two raters. The station discrimination was at 0.45 (range of 0.27 to 0.65) indicating a high level of differentiation between high and low performers. Using the generalizability theory, the G-coefficient reliability was at 0.72 with the reliability projection flattening after 8 stations. Overall, 75% to 82% the faculty and learners rated ACS OASIS as realistic and beneficial. ACS OASIS is a psychometrically sound technical skills assessment tool that can provide useful information for feedback to junior residents and support efforts to remediate gaps in performance.

Baseline Assessments of Psychomotor Aptitude Are Associated With the Future Operative Performance of Surgical Trainees: A Prospective Observational Cohort Study.

This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance. Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking. Core surgical residents in Ireland recruited from 2016 to 2019 participated in assessments of baseline perceptual, visuospatial, and psychomotor ability; Pictorial Surface Orientation (PicSOr) testing, digital visuospatial ability testing, and manual dexterity testing. Operative performance was prospectively assessed using the in-theater Supervised Structured Assessment of Operative Performance (SSAOP) tool, and simulation-based Operative Surgical Skill (OSS) assessments performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point operative performance score. OSS assessments were scored using procedure-specific checklists. Univariate correlations and multiple linear regression analyses were used to explore the association between fundamental ability measures and operative performance. A total of 242 residents completed baseline psychomotor ability assessments. Aggregated fundamental ability scores were associated with performance in submitted workplace-based SSAOP assessments using the Total Checklist score ( P =0.002) and Overall Performance scores ( P =0.002), independent of operative experience, and undergraduate centile scores. Aggregated ability scores were also positively associated with simulation-based OSS assessment scores on multivariable analysis ( P =0.03). This study indicates that visuospatial, psychomotor, and perceptual ability testing scores are associated with the future operative performance of surgical residents.

Implementing laboratory quality management in Africa and central Asia: a model for healthcare improvement.

Optimized laboratory services are recognized as an integral part of high-quality healthcare delivery. However, these services are often unavailable or substandard in resource-limited countries. The implementation of quality management systems (QMSs) in the laboratory can transform laboratory services and ultimately improve patient care in these settings. The Clinical and Laboratory Standards Institute, through its Global Health Partnerships (GHP) program, has intervened in 32 laboratories to implement QMSs and improve performance. Standardized checklists were used before and after the structured intervention to quantify the impact of this program. QMS implementation resulted in a statistically significant improvement in overall mean checklist scores. All participating laboratories demonstrated improvement in their quality and performance, with 13 laboratories achieving national accreditation within the time frame of this study. A structured program that utilizes well-recognized, standardized checklists and has leadership and laboratory team support, professional training with onsite guidance (i.e. train the trainer) and access to professionals experienced with QMS implementation and maintenance can lead to significant improvements in quality in resource-limited countries.

Implementing an intensified mentorship approach towards accelerated medical laboratory accreditation in 10 counties in Kenya.

BackgroundDespite Kenya’s roll-out of the Strengthening Laboratory Management Towards Accreditation programme in 2010, most laboratories had not made significant or tangible improvements towards accreditation by 2016. In April 2016, the University of Maryland, Baltimore enrolled 27 facilities in the standard Strengthening Laboratory Management Towards Accreditation programme.ObjectiveThis study aimed to describe and evaluate the implementation of an intensified mentorship strategy on laboratory accreditation.MethodsIn October 2017, the University of Maryland, Baltimore implemented intensive mentorship in 27 hospital laboratories in Nairobi, Kiambu, Meru, Embu, Muranga, Nyeri, Laikipia, Nyandarua, Tharaka-Nithi, and Kirinyaga counties in Kenya. Laboratories were paired with competent mentors whose skills were matched to facility gaps. Baseline and follow-up assessments were done between April 2016 and March 2019 using the World Health Organization’s Stepwise Laboratory Quality Improvement Process Towards Accreditation Checklist and overall scores of the 12 Quality System Essentials and star ratings (from zero to five, based on scores) used to evaluate the effectiveness of the intensified mentorship.ResultsIn September 2017, 14 laboratories scored zero stars, three scored one star, eight scored two stars, one scored three stars, and one laboratory was accredited. By March 2019, eight laboratories were accredited, five scored four stars, 10 scored three stars, three scored two stars, and only one scored one star. The average score change with the intensified approach was 81.5 versus 53.9 for the standard approach.ConclusionThe intensified mentorship strategy resulted in fast-tracked progress towards laboratory accreditation and can be adopted in similar resource-limited settings.

Preliminary evidence for the effectiveness of concurrent exposure and response prevention for OCD and prolonged exposure for PTSD

Several case studies describe utilizing combined approaches to treating individuals with co-occurring obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), yet empirical support for concurrent approaches is lacking. Further, no study has described a combined exposure and response prevention (ERP) and prolonged exposure (PE) approach despite theoretical and implementation similarities. Given the noted challenges in treating co-occurring OCD and PTSD, particularly in cases of dynamic comorbidity, the current study sought to provide empirical support for concurrent ERP + PE in a small sample of individuals diagnosed with co-occurring OCD and PTSD. Retrospective data was analyzed from eight patients (87.5% dynamic comorbidity) who underwent concurrent ERP + PE in a behavioral health hospital system. Effectiveness of ERP + PE was comparable to previous research on the separate treatments; patients experienced an average reduction in Yale-Brown Obsessive-Compulsive Scale-Self-Report scores of 11.75 and PTSD Checklist scores of 22.50, effect sizes of 1.65 and 1.44, respectively. Broadly, these preliminary findings suggest that a concurrent approach to treating co-occurring OCD and PTSD is effective even with dynamic comorbidity and that concurrent ERP + PE, specifically, yields promising treatment outcomes. The current study provides a foundation for future exploration of other treatment types and approaches. Replication of findings in larger, prospective samples is needed.

Cutaneous allodynia and thermal thresholds in chronic migraine: The effect of onabotulinumtoxinA

ObjectiveCutaneous allodynia (CA) is a common symptom in migraine. Its incidence is more frequent in the chronic migraine (CM). CA usually occurs during pain attacks. However, it can also be interictal and its frequency and severity seem to be correlated with the duration of the disease. Several quantitative sensory testing (QST) studies have revealed variable results about mechanical and thermal allodynia accompanying migraine. This study aimed to investigate the effects of CA and onabotulinumtoxinA (BoNT-A) injection on the thermal thresholds measured by QST in patients with CM. The effects of BoNT-A on headaches, CA, and other accompanying symptoms of migraine were also evaluated. MethodsSingle BoNT-A injections were performed in 22 female cases (mean age: 38.1 ± 7.2 years) with CM. Patients were evaluated at 1–7 days before, 28–35, and 84–91 days after the injection. The 22 healthy women in the control group (mean age: 36.6 ± 7.6 years) were examined once. Headache and its characteristics, medication intake, allodynia, presence of anxiety, and depression symptoms were evaluated through relevant scales. The heat (HDT) and cold (CDT) detection thresholds on the forehead and hand were measured bilaterally with QST. The presence of brush allodynia for patients was examined by applying a 4 × 4 gauze pad over the same areas. ResultsThe patients in the CM group had migraine for an average of 22.5 ± 6.1 years and CM for 6.1 ± 3.2 years. The average number of painful days per month was 22.1 ± 4.0 days. All the patients had migraine attacks with CA (mean 5.6/month). The average allodynia symptom checklist (ASC-12) score was 7.8 ± 6.2. Thermal thresholds measured in the patients with CM were similar to those of the controls. Thermal thresholds did not show significant differences between the symptomatic and the asymptomatic sides at the last migraine attack. There was also no correlation between the allodynia revealed by the physical examination and the thermal thresholds detected by QST. The ASC-12 score decreased significantly with BoNT-A injection (p = 0.030), but no significant change was observed in thermal thresholds after this treatment. ConclusionThere was no significant correlation between CA and thermal thresholds. BoNT-A was successful in relieving headache and other associated symptoms, including CA, but had no significant effect on QST parameters.