Global Rating Scores Research Articles

657 Evaluating the Effectiveness of Virtual Reality for Arthroplasty Training in Orthopaedic Trainees: A Systematic Review

Abstract Introduction Virtual Reality (VR) provides high-fidelity simulation, enabling trainees to practice surgical procedures whilst reducing patient risk. The focus in orthopaedic literature has been on basic surgical skills and arthroscopic procedures. Research into arthroplasty simulation resources is under-represented. This systematic review assesses current literature on the effectiveness of VR for arthroplasty training. Method A systematic literature search was conducted across all relevant bibliographic databases. Randomised controlled trials (RCTs) meeting the inclusion criteria were selected and assessed by three independent reviewers. The primary outcome was the standardised mean difference (SMD) in either the global rating score or task-specific checklists at pre/post-intervention. This outcome was extracted using a piloted data extraction tool. Studies were assessed for risk of bias using a piloted risk of bias tool. Results 628 studies were identified, of which 624 did not meet the inclusion criteria. The four studies included in the meta-analysis displayed a trend that VR improved surgical competence more than existing methods (SMD 1.57, 95% CI [-0.45 to 3.59]; P = 0.13). Secondary outcomes in all studies showed VR improved trainee confidence and provided a more enjoyable experience. Conclusions VR improved surgical competency and improved trainee confidence in performing arthroplasty procedures, therefore indicating that this training modality could benefit both trainees and patients in the future. However, there is a paucity of evidence for VR in arthroplasty training, making results less precise and creating significant inter-study heterogeneity. This highlights the need for further high-quality RCTs to be produced assessing the effectiveness of VR for arthroplasty training.

Effect of head-mounted displays on students' acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: A randomized controlled trial.

Although surgical suturing is one of the most important basic skills, many medical school graduates do not acquire sufficient knowledge of it due to its lack of integration into the curriculum or a shortage of tutors. E-learning approaches attempt to address this issue but still rely on the involvement of tutors. Furthermore, the learning experience and visual-spatial ability appear to play a critical role in surgical skill acquisition. Virtual reality head-mounted displays (HMDs) could address this, but the benefits of immersive and stereoscopic learning of surgical suturing techniques are still unclear. In this multi-arm randomized controlled trial, 150 novices participated. Three teaching modalities were compared: an e-learning course (monoscopic), an HMD-based course (stereoscopic, immersive), both self-directed, and a tutor-led course with feedback. Suturing performance was recorded by video camera both before and after course participation (>26 hours of video material) and assessed in a blinded fashion using the OSATS Global Rating Score (GRS). Furthermore, the optical flow of the videos was determined using an algorithm. The number of sutures performed was counted, visual-spatial ability was measured with the mental rotation test (MRT), and courses were assessed with questionnaires. Students' self-assessment in the HMD-based course was comparable to that of the tutor-led course and significantly better than in the e-learning course (P=0.003). Course suitability was rated best for the tutor-led course (x̄=4.8), followed by the HMD-based (x̄=3.6) and e-learning (x̄=2.5) courses. The median ΔGRS between courses was comparable (P=0.15) at 12.4 (95% CI 10.0-12.7) for the e-learning course, 14.1 (95% CI 13.0-15.0) for the HMD-based course, and 12.7 (95% CI 10.3-14.2) for the tutor-led course. However, the ΔGRS was significantly correlated with the number of sutures performed during the training session (P=0.002), but not with visual-spatial ability (P=0.626). Optical flow (R2=0.15, P<0.001) and the number of sutures performed (R2=0.73, P<0.001) can be used as additional measures to GRS. The use of HMDs with stereoscopic and immersive video provides advantages in the learning experience and should be preferred over a traditional web application for e-learning. Contrary to expectations, feedback is not necessary for novices to achieve a sufficient level in suturing; only the number of surgical sutures performed during training is a good determinant of competence improvement. Nevertheless, feedback still enhances the learning experience. Therefore, automated assessment as an alternative feedback approach could further improve self-directed learning modalities. As a next step, the data from this study could be used to develop such automated AI-based assessments.

The effects of low-dose radiation therapy in patients with mild-to-moderate Alzheimer's dementia: an interim analysis of a pilot study.

We aimed to determine whether low-dose radiotherapy (LDRT) is effective in patients with Alzheimer disease (AD). We included patients according to the following criteria: probable Alzheimer's dementia according to the New Diagnostic Criteria for Alzheimer's Disease; confirmation of amyloid plaque deposits on baseline amyloid positron emission tomography (PET); a Korean Mini-Mental State Examination 2nd edition (K-MMSE-2) score of 13-26; and a Global Clinical Dementia Rating (CDR) score of 0.5-2 points. LDRT was performed six times at 0.5 Gy each. Post-treatment cognitive function tests and PET-CT examinations were performed to evaluate efficacy. The medication for AD treatment was maintained throughout the study period. At 6 months after LDRT, neurological improvement was seen in 20% of patients. Patient #2 showed improvement in all domains of the Seoul Neuropsychological Screening Battery II (SNSB-II). Moreover, the K-MMSE-2 and Geriatric Depression Score-Short Form scores improved from 20 to 23 and from 8 to 2, respectively. For patient #3, the CDR score (sum of box score) improved from 1 (4.0) to 1 (3.5) at 3 months follow-up. Moreover, the Z scores for language and related functions, memory, and frontal executive function improved to -2.56, -1.86, and -1.32, respectively at the 6-month follow-up. Two patients complained of mild nausea and mild hair loss during LDRT, which improved after treatment. One of the five patients with AD treated with LDRT experienced a temporary improvement in SNSB-II. LDRT is tolerable in patients with AD. We are currently under follow-up and will conduct cognitive function tests after 12 months after LDRT. A large-scale randomized controlled trial with a longer follow-up period is warranted to determine the effect of LDRT on patients with AD.

Development and preliminary validation of an Objective Structured Assessment of Technical Skills (OSATS) for a partial pulpotomy procedure.

To develop an Objective Structured Assessment of Technical Skills (OSATS) tool for partial pulpotomy and to preliminary assess the validity of this tool. Secondary objectives were to check internal consistency as well as the interrater reliability of this specific checklist and to compare it with the previously validated global rating score (GRS). The study assessed three groups of dental participants (mix of practitioners or students) possessing differing levels of clinical experience (7 novices, 7 intermediates, 7 experts), during a partial pulpotomy procedure on a simulated tooth with deep caries, using a bespoke procedure-specific checklist (PSC) and the GRS. Two independent examiners received the study participants in groups of two, in order to be able to directly observe their actions and grade the different steps of the procedure from 1 to 5 on the PSC and GRS. The internal validity of the specific checklist was assessed using a Cronbach's alpha test. As the construct validity of such a tool can be determined when the tool differentiates performance based on the level of experience, the total score of the PSC of the three groups (e.g., novice group, intermediate group, experienced group) were compared using the Kruskal-Wallis and post-hoc Mann-Whitney pairwise U test. The total scores of the GRS were also analysed in the same manner. A correlation test (Correlation Matrices Test) was carried out for the entire sample between the specific checklist and the GRS (on total score). The intraclass correlation coefficient was used to measure the degree of agreement between the two evaluators. The statistical analysis was performed with XLSTAT® and Statistica® (significance p = .05). The partial pulpotomy specific checklist graded from one to five demonstrated good internal consistency (0.86) and a good interrater reliability (0.91), a correct construct validity (p generally < .05) and a good positive correlation with the validated GRS (r = .92). To address the need to develop education in vital pulp treatment, and more specifically the technical skills assessment of partial pulpotomy, an OSATS-specific checklist was developed and preliminary validated. The checklist will need to be validated in larger cohorts.

A Comparison of the Checklist Scoring Systems, Global Rating Systems, and Borderline Regression Method for an Objective Structured Clinical Examination for a Small Cohort in a Saudi Medical School.

This study aims to compare the effectiveness of using the checklist and global rating scores to evaluate the clinical competency of medical students in Objective Structured Clinical Examinations (OSCEs). Additionally, the study assesses the appropriateness of using the borderline regression method to set standards for small-scale OSCE exams and determines if the estimated passing marks differ significantly from the university's prefixed passing score of 70%. The study also examines whether the university should utilize the borderline regression method to determine passing scores for each OSCE exam instead of a set passing score. The study analyzed medical students' grades in 11 OSCE exams in the 2022-2023 academic year at Alfaisal University, Riyadh, Saudi Arabia. Students received family medicine clerkship rotations, and after each rotation, they took an OSCE exam consisting of three stations that family medicine consultants graded. The exam included a checklist of 30 tasks and a five-level global rank scale. The study collected all the checklist marks and global rank grades and analyzed them using IBM® Statistical Package for Social Sciences (SPSS® Statistics) software. The statistical tests used were descriptive statistics, the T-test, chi-square tests, Fisher's exact test, and Pearson correlation. The study showed that students were more likely to pass when using the global rating system than the checklist scoring system. Additionally, students had a significantly lower passing rate when using the higher cut-off passing score estimated using the borderline regression method compared to the pre-set passing score of 70% established by the university (with a p-value of 0.00). Each scoring system has advantages and disadvantages, but they complement each other. Combining scoring systems can produce a more comprehensive and precise evaluation of a candidate's performance. The study also emphasizes the importance of carefully selecting and validating cut-off points in OSCE exams to ensure fairness and consistency in assessment.

Generalized q‐sampling imaging‐based fiber tracking measures of white matter tracts in cognitive impairment

AbstractBackgroundDiffusion magnetic resonance imaging (dMRI) is a non‐invasive technique for exploring white matter fiber organization of the brain. As traditional diffusion tensor imaging (DTI) methods may provide inaccurate descriptions of local crossing and diverging fibers, we examined generalized q‐sampling imaging (GQI), a novel method providing better directional and quantitative information using dMRI data from community‐dwelling older adults.MethodWe examined baseline dMRI data from 227 adults aged 71±8 on average from the Wake Forest Alzheimer’s Disease Research Center’s Clinical Core, who had baseline and year‐1 follow‐up global Clinical Dementia Rating (CDR) score of 0 (indicates normal cognitive function) and 0.5 (akin to MCI). The primary outcome measure was cognitive migration status determined by CDR increase/decrease between baseline and follow‐up (mean difference = 13.9 months), shown in Figure. We performed atlas‐based fiber tracking analysis using GQ in DSI Studio to generate normalized quantitative anisotropy (NQA), DTI fractional anisotropy (DTI_FA) and restricted diffusion (RDI) measures in several AD‐related white matter (WM) tracts: Corpus Callosum (CC), Fornix, Cingulum bundle/Parahippocampal tracts (see Table 2: CFP; CP; CPP), Uncinate Fasciculus (UF), Superior Longitudinal Fasciculus (SLF) and Inferior Fronto‐Occipital Fasciculus (IFOF). We performed multinomial logistic regression (MLR) models adjusted for age, sex, and education, using cognitive migration status as the outcome and standardized GQI‐based diffusion indices sNQA, sRDI, and sDTI_FA as predictors.Result Table 1 lists the baseline demographics and biomarker characteristics for cognitive migration groups. MLR results in Table 2 show significant associations between diffusion indices and tracts for outcome 4 (Reversion) in reference to outcome 1 (stability of normal cognition). Decrease in sNQA in bilateral CP and right Fornix was significantly associated with higher odds of Reversion relative to the reference. Increase in sDTI_FA in left IFOF was associated with higher odds of reversion relative to reference. Decrease in sRDI in bilateral CFP, CPP, Fornix and UF and right CP was associated with higher reversion relative to reference.ConclusionIn early trajectories of cognitive impairment, RDI may be a sensitive diffusion marker for cognitive reversion in several AD‐related WM tracts. Future work will validate these markers in other cognitive migration groups (negative migration and MCI stability).

Memory Performance in Asymptomatic and Prodromal Familial Frontotemporal Lobar Degeneration: Findings from the ALLFTD Consortium (P13-6.001)

Memory Performance in Asymptomatic and Prodromal Familial Frontotemporal Lobar Degeneration: Findings from the ALLFTD Consortium (P13-6.001)

Utilization of a 3D Printed Simulation Training Model to Improve Microsurgical Training.

A prospective cohort study was conducted at our institution. A progressive microsurgical training curriculum was developed. A bespoke three-dimensional printed training platform was produced to enable residents to record training and assessment tasks. Microsurgical skills were blindly assessed before and after completing the training program using the University of Western Ontario Microsurgical Skills Assessment instrument. Plastic surgery residents at various stages of training were recruited (n = 10). A significant improvement in vessel preparation from a pre-training median of 3 (IQR 2 -4) versus a post-training of 4 (IQR 3 -5, P = 0.0035) and suturing with a pre-training median of 3 (IQR 2 -4) versus a post-training of 4 (IQR 3 -5, P = 0.0047) domains of the University of Western Ontario Microsurgical Skills Assessment score was demonstrated after completion of the training program. There was a significant improvement in the global rating score (3 ± 1 versus 5 ± 1, P = 0.0045). Participants felt more confident performing a microsurgical anastomosis following the training program. The use of the Konjac noodle model and video-based assessment using a three-dimensional printed model is an effective teaching tool that improves resident's microsurgical skills.

The use of peer support groups for emergency physicians during the COVID-19 pandemic.

To test the feasibility, receptivity, and preliminary effectiveness of peer support groups for emergency medicine physicians during the COVID-19 pandemic and gain a better understanding of their experiences with peer support. This pilot study used a quasi-experimental design to assess change in symptoms of distress, anxiety, depression and burn-out before and after participating in a virtual, group-based peer support intervention for a duration of 8 weeks. Pre-post change analyses were performed using two-sided, paired t tests. Feasibility was measured by attendance data to demonstrate the use of the intervention. Receptivity was measured using a global change rating and net promoter score at the end of each session and 8-week period, respectively. During the final session, qualitative data on physician experience was collected and then analyzed using conventional content analysis. Twenty-four emergency medicine physicians participated in the pilot study. The attendance goal was met by 20 (24, 83%) physicians and 19 (22, 86%) physicians reported they would recommend peer support groups to a friend of colleague. Positive standardized response mean effect sizes indicated modest improvement in nine of 12 symptom measurements with marginal significance (p < 0.10) for improvement in guilt [20, EffectSize(ES) = 0.45] and depression (21, ES = 0.39). Qualitative findings revealed high overall benefit with few adverse impacts of participation. Results demonstrate high physician receptivity, feasibility, and benefit from participation in peer support groups. Promising signs of improvement in distress, anxiety, depression, and burn out symptoms warrant additional studies with larger sample sizes and more robust research designs to establish the evidence base for peer support in the physicianpopulation.

Simulation-Based learning: Is it time for a paradigm shift in training postgraduates for crisis resource management? prospective interventional study

Background: Crisis resource management (CRM) skills are nontechnical skills that are often neglected during the training of residents in the management of clinical emergencies. This study was conducted to assess the utility of high-fidelity simulation to enhance the learning of CRM among internal medicine postgraduates (PGs). Materials and Methods: After obtaining IEC approval, a total of ten (five 1st year and five 3rd year) internal medicine PG students were included by convenience sampling. Each student participated in four simulated emergencies in the simulation laboratory of a tertiary care hospital, one before and three after CRM training. They participated in groups of 3–5 at intervals of 15–30 days. All the scenarios were video graphed and viewed by the investigators and each student was assessed in each session for CRM using Ottawa global rating score (GRS). The outcome variable was an overall score (OS-ordinal from 1to 7). After the last session, a questionnaire was administered to assess the perceptions of the participants about the course. After 1 year, the participants self-assessed their CRM in a real emergency using GRS and also identified barriers for the application of CRM in real life. The statistical tests used were paired t-test, Student's t-test, and repeated measures ANOVA. Results: The mean OS at baseline was 3.9 ± 1.5 and after training, it improved to 4.6 ± 1.26 (P = 0.024). In the three posttraining sessions, the OS did not decline and this indicated good retention of CRM (P = 0.056). PGs had a consistently favorable opinion of this course. The self-assessed OS in a real emergency was 5.7 ± 0.82. The barriers to CRM application in real emergencies were lack of practice and lack of team training. Conclusions: High fidelity simulation is an effective and acceptable method of teaching CRM to internal medicine PGs and should be incorporated into the PG curriculum.

Statistical harmonization of everyday functioning and dementia-related behavioral measures across nine surveys and trials.

Efforts to harmonize measures of everyday function and dementia-related behaviors are needed to synthesize across studies in dementia research. There have been some psychometric attempts to harmonize everyday function for secondary analysis, but far less for dementia-related behaviors. Statistical co-calibration was performed to generate factor scores representing everyday function and dementia-related behaviors for participants with dementia. We evaluated convergent criterion validity of factor scores and mapped the scores onto established clinical instruments. Factor analyses of included items fit well to available data. Harmonized factors showed expected associations with the Global Clinical Dementia Rating (CDR) score, with greater impairment (higher Global CDR score) corresponding to higher (more severe) levels on factor scores. We used large, well-characterized samples to derive harmonized factors representing everyday functions and dementia-related behaviors. These harmonized factors can be used to tackle questions about dementia phenotypes which require either large samples or unique subpopulations.

A Novel Method of Real-Time Assessment for Coronary Artery Anastomosis Skill.

Coronary anastomosis is the most key factor to accomplish coronary artery bypass grafting, which is one of the largest areas in cardiovascular surgery. Although we have organized on-site simulator training courses of coronary anastomosis using BEAT YOUCAN, it became difficult to continue it because of COVID-19. Therefore, we established a real-time evaluation sheet instead of an Objective Structured Assessment of Technical Skills (OSATS) evaluation sheet. The purposes of this study was to develop the real-time assessment system and to prove the correlation between the score obtained by the OSATS and the score obtained by the real-time evaluation system. A total of 22 videos from the qualifying round of real-time coronary anastomosis competition evaluated by both the modified OSATS and the real-time evaluation system were utilized in this study. The global rating score of OSATS was compared with the global rating score of real-time evaluation system. When examined the relationship between the OSATS total score and the real-time total score, there was a significant correlation (R = 0.752, p <0.001). The OSATS general definition score and the real-time total score also showed a strong correlation (R = 0.733, p <0.001). We developed a real-time assessment sheet to evaluate coronary anastomosis. This assessment sheet had a good correlation with the OSATS evaluation sheet.

Development and validation of an ovine cesarean surgery model and rubric

Clinical skills are learned through deliberate practice with specific feedback. However, it is not possible to provide such experience to each student in food animal reproductive procedures (e.g., cesarean surgery). Aims of this study were to create an ovine cesarean surgery model to facilitate skill acquisition, to create a scoring rubric to assess performance, and to gather validation evidence for the model and rubric. A commercially available ovine manikin was modified using poured silicone to create suturable skin, muscle, and uterus containing a commercially available fetal lamb manikin that could be manipulated and delivered. A scoring rubric consisting of a 16-item checklist and 5 global rating scores (GRS) was created. Model was tested by veterinarians (n = 14, experts) and veterinary students (n = 16, novices) in a validation study that evaluated evidence in content, internal structure, and relationship with other variables (level of training). Most experts (93%) felt that the model would be helpful to teach procedural steps; also experts (100%) agreed that the model would improve students’ skill in performing cesarean surgery. Novices scored lower than experts on the checklist and total GRS, and novices’ surgical times were longer than experts’ times. Content evidence and relationship with other variables evidence supported validation of the model and rubric. Checklist reliability (alpha = 0.58) could be improved by increasing the number of items and further refining them.

SAGE‐718 in Patients With Mild Cognitive Impairment or Mild Dementia due to Alzheimer’s Disease: Results From the Phase 2 LUMINARY Study

AbstractBackgroundCognitive impairment has a deleterious impact on patients with AD and their caregivers; new therapies are needed. SAGE‐718, a novel N‐methyl‐D‐aspartate receptor positive allosteric modulator, is being investigated for the treatment of cognitive impairment in patients with neurodegenerative diseases such as Alzheimer’s disease (AD). The LUMINARY Study is designed to evaluate the safety/tolerability of SAGE‐718 and its effects on cognitive symptoms in patients with AD.MethodLUMINARY (NCT04602624) is an open‐label, Phase 2 study evaluating SAGE‐718 (3mg QD for 14 days) in patients with AD. Patients (aged 50‐80 years) with Montreal Cognitive Assessment (MoCA) scores of 15‐24 were included. Treatment‐emergent adverse event (TEAE) incidence through Day 28 (primary endpoint), other safety outcomes (secondary endpoints), and cognitive and functional assessments were analyzed.ResultTwenty‐six patients (69.2% female; mean age 67 years), with a mean±SD MoCA of 20.7±2.61 were enrolled. Most patients (23/26) had a global Clinical Dementia Rating score of 0.5. Eight TEAEs were reported in 7 (26.9%) patients; all were mild/moderate; 6 were treatment related. No serious adverse events or deaths were reported. At Day 14, improvements from baseline were observed on multiple tests of executive functioning (Digit Symbol Substitution, Multitasking, One Touch Stockings, Spatial Working Memory, and 2‐Back tests) and learning and memory (Pattern Recognition Memory and Verbal Recognition Memory tests). Statistically significant MoCA improvement (+2.3 points vs baseline) was observed at Day 28. No changes in attention/psychomotor speed were observed. Functional assessments also captured notable improvement in some patients (Clinical Global Impressions Scales and Amsterdam Instrumental Activities of Daily Living Questionnaire), particularly on items measuring aspects of complex/higher order activities.ConclusionIn this study, SAGE‐718 was generally well tolerated and associated with cognitive and functional improvements in patients with AD. These results support further investigation of SAGE‐718 for the treatment of cognitive impairment associated with AD and other neurodegenerative diseases.

Update on the TOGETHER study: a patient‐ and investigator‐blind, randomized, placebo‐controlled study evaluating the efficacy, safety and tolerability of bepranemab, UCB0107, in prodromal‐to‐mild Alzheimer’s disease

AbstractBackgroundBepranemab is a recombinant, humanized, full‐length IgG4 monoclonal antibody that binds to a central tau epitope (amino acids 235‐250). Here, we update on the progress of the TOGETHER study (AH0003; NCT04867616) with bepranemab in early Alzheimer’s disease (AD).MethodTOGETHER is a global, multicenter, double‐blind, placebo‐controlled, parallel‐group study investigating the efficacy, safety and tolerability of bepranemab versus placebo. Patients with prodromal (National Institute on Aging‐Alzheimer’s Association [NIA‐AA] Stage 3) or mild (NIA‐AA Stage 4) AD (target N = 450) will be randomized (1:1:1) to receive one of two doses of bepranemab or placebo (intravenous, every 4 weeks), over an 80‐week treatment period, followed by an optional 48‐week open‐label‐extension period. Participants will have a global Clinical Dementia Rating (CDR) score of 0.5 (prodromal AD) or 0.5–1.0 (mild AD) and a CDR‐Memory Box score ≥0.5 at screening and baseline, a score of ≤85 for the delayed recall domain of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), mini‐mental state examination (MMSE) ≥20 at screening and must meet the NIA‐AA 2018 definition of cerebral beta‐amyloid (Aβ) accumulation, by either a positive centrally read positron emission tomography (PET) scan or a positive cerebrospinal fluid (CSF) pTau181/Aβ1‐42 ratio. The primary endpoint is change from baseline to Week 80 in CDR scale Sum of Boxes total score. Secondary endpoints include: pharmacokinetics; safety and tolerability; tau PET imaging and change from baseline in AD Assessment Scale‐Cognitive Subscale 14, Amsterdam Instrumental Activities of Daily Living questionnaire and MMSE at Weeks 56 and 80.ResultAs of March 1, 2022, 56/125 planned centers have enrolled participants across 8 countries: Belgium, Canada, France, Netherlands, Poland, Spain, UK and USA. Of the 538 participants who entered screening, 62 have been randomized so far and 334 failed screening. Predominant reasons for screen failure include not meeting RBANS, MMSE or Aβ positivity (CSF or PET) criteria.ConclusionThis proof‐of‐concept study employs clinical outcome measures, imaging, pharmacokinetics, and biomarkers to assess the ability of bepranemab to slow progression of AD when administered in the early stages of disease. Enrollment and randomization are underway with nearly half of the study centers active.

Generalized q‐sampling imaging‐based fiber tracking measures of white matter tracts in cognitive impairment

AbstractBackgroundDiffusion magnetic resonance imaging (dMRI) is a non‐invasive technique for exploring white matter fiber organization of the brain. As traditional diffusion tensor imaging (DTI) methods may provide inaccurate descriptions of local crossing, kissing and diverging fibers, we examined generalized q‐sampling imaging (GQI), a novel method providing better directional and quantitative information using dMRI data from community‐dwelling older adults.MethodWe examined baseline dMRI data from 227 adults aged 71±8 on average from the Wake Forest Alzheimer’s Disease Research Center’s Clinical Core, who had baseline and year‐1 follow‐up global Clinical Dementia Rating (CDR) score of 0 (indicates normal cognitive function) and 0.5 (akin to mild cognitive impairment [MCI]). The primary outcome measure was cognitive migration status determined by CDR increase/decrease between baseline and follow‐up (mean difference=13.9 months), shown in Figure. We performed atlas‐based fiber tracking analysis using GQI in DSI Studio to generate normalized quantitative anisotropy (NQA), DTI fractional anisotropy (DTI_FA) and restricted diffusion (RDI) measures in several AD‐related white matter (WM) tracts: Corpus Callosum (CC), Fornix, Cingulum bundle/Parahippocampal tracts (CFP; CP; CPP), Uncinate Fasciculus (UF), Superior Longitudinal Fasciculus (SLF) and Inferior Fronto‐Occipital Fasciculus (IFOF). We performed multinomial logistic regression (MLR) models adjusted for age, sex, and education, using cognitive migration status as the outcome, and standardized GQI‐based diffusion indices sNQA, sRDI, and sDTI_FA as predictors.ResultTable 1 lists the baseline demographics and biomarker characteristics for cognitive migration groups. MLR results in Table 2 show significant associations between diffusion indices and tracts for outcome 4 (Reversion) in reference to outcome 1 (stability of normal cognition). Decrease in sNQA in bilateral CP and right Fornix was significantly associated with higher odds of Reversion relative to the reference. Increase in sDTI_FA in left IFOF was associated with higher odds of reversion relative to reference. Decrease in sRDI in bilateral CFP, CPP, Fornix and UF and right CP was associated with higher reversion relative to reference.ConclusionIn early trajectories of cognitive impairment, RDI may be a sensitive diffusion marker for cognitive reversion in several AD‐related WM tracts. Future work will validate these markers in other cognitive migration groups (negative migration and MCI stability).

Comparing the Assessment Quality of Trained Versus Untrained Peer Examiners in Obstetrics and Gynaecology in OSCE

Background: Assessment has been shown in studies to have a significant impact on the learning process. There has been a lot of interest in making assessment an important element of the learning process for students. Senior medical students may be able to assist teachers with peer evaluations. There is little evidence to support the idea that peer examiners should be officially trained before taking on the job. Aim: To find the difference in teaching faculty scores of untrained and trained peer examiners in Obstetrics &amp; Gynecology OSCE. Study design: Cross-sectional (analytical) study Place and duration: The study was conducted at Sialkot Medical College Sialkot” affiliated with Imran Idrees Teaching Hospital in Obstetrics /Gynecology department over the period of 6 months from January 2022 to June 2022 Methodology: One hundred and five medical student of 4th year were enrolled for practice of OSCE examination. Forty final year medical students took part in the assessment program as peer examiners. One group of examiners were given 2-hour training session describing about the assigned OSCE stations, marking method, evaluation, and feedback methods. Other group was given only checklist to read with no prior training. Using the checklist and a global rating, senior faculty and peer student examiners (both trained and untrained groups) simultaneously assessed students in basic Obstetrics /Gynecology clinical skills at 4 OSCE stations. Every station ran for five minutes (3 minutes of evaluation while 2 minutes of feedback). A comparison between the check list and global rating scores of trained and untrained peer student examiners was made. SPSS version 21 was used to calculate intra-rater reliability was assessed to build the consensus of faculty examiners with the trained and untrained peer examiners according to checklist scores and global rating. Results: Student examiners found sitting at OSCE stations as a useful learning experience. Observing different performances at OSCE stations was so absorbing and it gave them awareness about examination procedure. Practical implication. Peer assessors in a formative OSCE could be successfully implemented in the curriculum of a large medical school with more than 100 students annually. They can be trained to conduct undergraduate assessments of their junior peers and can prove to be very reliable and effective assessors. Conclusion: Peer markers who underwent the formal training session showed the capacity to assess fourth-year students with suitable consistency and devotion. Hence training helped to improve peer marker consensus with faculty. Keywords: Peer examiners, OSCE, trained peer examiner, untrained peer examiner.

Evaluation of the impact of assistive artificial intelligence on ultrasound scanning for regional anaesthesia

BackgroundUltrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this exploratory study, we evaluated ultrasound scanning performance by non-experts in ultrasound-guided regional anaesthesia, with and without the use of an assistive AI device. MethodsTwenty-one anaesthetists, all non-experts in ultrasound-guided regional anaesthesia, underwent a standardised teaching session in ultrasound scanning for six peripheral nerve blocks. All then performed a scan for each block; half of the scans were performed with AI assistance and half without. Experts assessed acquisition of the correct block view and correct identification of sono-anatomical structures on each view. Participants reported scan confidence, experts provided a global rating score of scan performance, and scans were timed. ResultsExperts assessed 126 ultrasound scans. Participants acquired the correct block view in 56/62 (90.3%) scans with the device compared with 47/62 (75.1%) without (P=0.031, two data points lost). Correct identification of sono-anatomical structures on the view was 188/212 (88.8%) with the device compared with 161/208 (77.4%) without (P=0.002). There was no significant overall difference in participant confidence, expert global performance score, or scan time. ConclusionsUse of an assistive AI device was associated with improved ultrasound image acquisition and interpretation. Such technology holds potential to augment performance of ultrasound scanning for regional anaesthesia by non-experts, potentially expanding patient access to these techniques. Clinical trial registrationNCT05156099.

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.

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

BackgroundSimulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy.MethodsMEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499.ResultsA total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD −8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis.ConclusionMeta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.