Gold Standard Assessment Tool Research Articles

PERSPECTIVE ON OBJECTIVE STRUCTURED CLINICAL EXAMINATION AMONG UNDERGRADUATE NURSING STUDENTS

An important trend in nursing education has been the move to an OUTCOME or COMPETENCY-BASED model, where the learning outcomes are defined and decisions about the curriculum are based on these. The aim of the study was to explore the perspectives of the students regarding OSCE (Objective structured clinical examination). A descriptive survey using 19 item three-point Likerts scale questionnaire was conducted. The study sample consisted of 190 B.Sc., (N) students. 76.31% students were agreed that OSCE is well structured and sequenced, 76.31% students agreed that OSCE represented an objective evaluation method of psychomotor skills and 76.42% students perceived their OSCE experience positively than traditional examination. In conclusion, the OSCE appears to be single gold-standard assessment tool for clinical competency. In combination with other assessment methods in the clinical settings, OSCE will provide a more comprehensive student psychomotor skill evaluation. OSCE experience gave new nursing graduates confidence to work as registered nurses in health care settings.

Risk factors and the nomogram model for malnutrition in patients with nasopharyngeal carcinoma.

For patients with nasopharyngeal carcinoma (NPC), the incidence of malnutrition is quite high, and malnutrition has severe effects on NPC patients. However, there is currently no recognized gold standard or specific nutritional assessment tool available to assess malnutrition in NPC patients. Our objective was to develop and verify a new nomogram model for NPC patients. Data were collected from NPC patients. To evaluate risk factors for malnutrition, univariate and multivariate logistic regression analyses were used. Based on the risk factors, a new nomogram model was developed. The efficacy of the model was evaluated and validated. Logistic regression analysis showed that age ≥ 65years, the number of chemotherapy cycles completed ≥ 1, a high total radiation dose received, low body mass index (BMI), low albumin, and low chloride were the risk factors. The assessment effect of the new model was good by evaluation and validation; it can be used as an assessment tool for malnutrition in NPC patients. Age ≥ 65years, completing ≥ 1 chemotherapy cycles, a high total radiation dose received, low BMI, low albumin, and low chloride levels are risk factors for malnutrition in NPC patients. The assessment effect of the new model, developed based on these risk factors, is good, and it can be used as an assessment tool for malnutrition in NPC patients.

Videographic Variability of Triple and Quintuple Horizontal Hop Performance.

Horizontal hops can provide insight into how athletes can tolerate high-intensity single-leg stretch loads and are commonly used in athlete monitoring and injury management. Variables like flight, contact, and total time provide valuable diagnostic information to sports science professionals. However, gold-standard assessment tools (eg,3-dimensional motion capture, force plates) require monetary and technological resources. Therefore, we used a tablet and free software to determine the between-rater, within-rater, and test-retest variability of the temporal events of multiple horizontal hop tests. Reliability study. Nine healthy males (20.8 [1.3]y, 71.4 [9.8]kg, 171.7 [4.5]cm) across various university sports teams and clubs volunteered and performed several triple (3-Hop) and quintuple (5-Hop) horizontal hops over 3 testing sessions. Six raters detected temporal events from video to determine between-rater variability, while a single rater quantified within-session and test-retest variability. The temporal variables of flight time, ground contact time for each individual hop, and the total time of each hoping series were determined. The consistency of measures was interpreted using the coefficient of variationand interclass correlation coefficients (ICC). Good to excellent between-rater consistency was observed for all hops (ICC = .85-1.00). Absolute (coefficient of variation ≤ 2.0%) and relative consistency (ICC = .98-1.00) was excellent. Test-retest variability showed acceptable levels of absolute consistency (coefficient of variation ≤ 8.7%) and good to excellent consistency in 10/16 variables (ICC = .81-.93), especially those later in the hopping cycle. A tablet and free digitizing software are reliable in detecting temporal events during multiple horizontal hops, which could have exciting implications for power diagnostics and return-to-play decisions. Therefore, rehabilitation and performance professionals can confidently utilize the highly accessible equipment from this study to track multiple hop performances.

Tissue Perfusion and the Braden Scale as Predictors of Pressure Injury Risk in the Intensive Care Unit Patient

Purpose: The national rate of pressure injury (PI) in the intensive care unit (ICU) 2016-2018 was 5.97%, while at one hospital in Honolulu, Hawaii it averaged 13%. The Braden scale is the gold standard PI risk assessment tool. Researchers have reported the Braden scale has limited value in the ICU setting and consider tissue perfusion to be the better indicator. The aim was to determine if tissue perfusion, as measured by noninvasive transcutaneous tissue oxygen levels, was a predictor of PI risk development.Methods: Electronic medical records of 161 patients admitted from January 1, 2017 to June 30, 2019 were retrospectively reviewed. Patients’ characteristics were summarized using descriptive statistics. Bivariate associations with the development of PI were examined using Fisher’s exact test for the categorical variables, and Wilcoxon rank-sum test for the continuous variables. A multivariable logistic model was fitted for the development of PI with adjustments for potential confounders.Results: Of 161 patients, 125 met the inclusion criteria. Length of stay, Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, and the Braden score were statistically significant predictors of PI risk development; tissue perfusion was not significant.Conclusion: ICU patients have a higher mortality and severity of illness. The Braden score guides implementation of PI preventative measures. The relationship between tissue perfusion and PI development may warrant further research. A broader clinical picture to incorporate the Braden scale and other risk factors in PI development such as Acute Physiology and Chronic Health Evaluation II score and use of vasopressors should be considered.

Maternal atopic conditions and autism spectrum disorder: a systematic review.

Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood-brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle-Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data.PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018.

The International Society of Thrombosis and Hemostasis (ISTH) criteria in intensive care units

BackgroundDisseminated Intravascular Coagulation (DIC) has been assessed by the International Society of Thrombosis and Hemostasis (ISTH) 2001 and the ISTH 2018-modified version. More investigations are needed to assess usability and visibility of those DIC scoring systems in the intensive care units (ICU). AimsThis study investigated the predictive performance of the ISTH–Overt DIC versions of 28–day mortality in ICUs compared to SOFA as a gold standard assessment tool of sepsis. MethodsA retrospective design (2015–2017) included 220 adult patients enrolled from medical and surgical ICUs in two major hospitals in Jordan. We calculated ISTH–Overt DIC scores and SOFA score on time of DIC diagnosis. Overt DIC was categorized based on a score of ≥ five for ISTH DIC 2001; and ≥ 4 for ISTH DIC 2018. Provided, a score > 12 was categorized as Multiple–Organ– Dysfunction–Syndrome (MODS) for Sequential Organ Failure Assessment (SOFA) score. Then, 28–day mortality follow-up was performed. ResultsMore than half of sample died before 28–days of follow–up. The analysis of Receiver Operating Characteristic (ROC) showed that higher scores of ISTH DIC 2001(≥ 5), ISTH DIC 2018 (≥ 4), and SOFA score (>12) were highly associated with 28–day mortality. The ISTH DIC 2001 and SOFA score were superior on the modified ISTH 2018 in predicting 28–day mortality, with an Area Under the Curve (AUC) of (0.724 vs. 0.822 vs. 0.507, respectively). Yet, the accuracy of the SOFA score was better than the ISTH DIC 2001. Conclusion: This study suggests that ISTH DIC 2001 score is helpful when applied on medical and surgical ICU Jordanian populations. It showed better results compared to the Modified ISTH DIC 2018 in mortality prediction, regardless of the underlying diseases.

Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in oncology unit of jimma tertiary hospital: A cross-sectional analysis

BackgroundCancer is becoming the most common global public health concern. Early malnutrition detection and treatment in patients with cancer is an important aspect of cancer management. Although Subjective global assessment (SGA) is a gold standard nutritional assessment tool, it is not routinely utilized due to it is tedious and needs patient literacy. Thus, early detection of malnutrition necessitates alternative parameters comparable with SGA. Therefore this study aims to evaluate serum albumin, Total Protein (TP), and Hemoglobin (Hgb) and their correlation with malnutrition in patients with cancer at Jimma Medical Center (JMC).MethodsFacility based cross-sectional study was conducted from October 15 to December 15, 2021 G.C at JMC among a total of 176 adult patients with cancer selected via a systematic sampling technique. Nutritional status and behavioural data were collected using the SGA tool and a structured questionnaire. Five ml of venous blood was collected and the level of serum albumin, TP and Hgb were measured using Cobas®6000 chemistry analyzer and hematology analyzer UniCel DxH 800. Descriptive statistics, independent t-test, Pearson’s correlation coefficient (r), and logistic regression analysis were implemented for analysis.ResultFrom the total of 176 study participants, 69.3% were females and the mean age was 50.1 ± 13.7 years. Based on SGA, 61.4% of the patients were malnourished. There was a significant decrease in the mean level of serum albumin, TP and Hgb in malnourished as compared to well-nourished patients. Serum albumin(r=-0.491), TP(r=-0.270), and Hgb (r=-0.451) had a significant correlation with SGA tool. Stage IV cancer AOR = 4.98 (1.23–20.07), Gastrointestinal (GI) cancer AOR = 3.39(1.29–8.88) and malnutrition AOR = 3.9(1.81–8.4) were significantly associated with hypoalbuminemia. Similarly, age of > 64 years AOR = 6.44(1.55–26.67), GI cancer AOR = 2.92(1.01–6.29) and malnutrition AOR = 3.14(1.43–6.94) were significantly associated with hypoproteinemia; and stage-IV cancer AOR = 3.94(1.11–13.35) and malnutrition AOR = 3.8(1.82–8.2) were significantly associated with low Hgb level.Conclusion and recommendationAltered level of serum albumin, TP and Hgb was correlated with the SGA tool of malnutrition. Therefore, it is suggested to be used as an alternative or additional screening tool for prompt detection of malnutrition in adult patients with cancer.

Assessment and Management of Appetite Loss in Older Adults: An ICFSR Task Force Report

The Appetite loss in older people is an important unmet clinical need in geriatrics. The International Conference on Frailty and Sarcopenia Research (ICFSR) organized a Task Force on April 20th 2022, in Boston, to discuss issues related to appetite loss in older people, in particular, the assessment tools currently available, its evaluation in the primary care setting, and considerations about its management. There is a high heterogeneity in terms of the etiology of appetite loss in older people and a gold standard assessment tool for evaluating this condition is still absent. Although this may render difficult the management of poor appetite in clinical practice, validated assessment tools are currently available to facilitate early identification of appetite loss and support care decisions. As research on biomarkers of appetite loss progresses, assessment tools will soon be used jointly with biomarkers for more accurate diagnosis and prognosis. In addition, efforts to foster the development of drugs with a favorable risk/benefit ratio to combat poor appetite should be strengthened.

Outpatient hysteroscopy is effective for uterine cavity evaluation following failed office-based endometrial biopsy.

Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population. We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in-office endometrial biopsy attempt. We conducted a retrospective cohort study of all patients referred to an academic outpatient hysteroscopy unit between January 2015 and January 2018, who underwent an outpatient hysteroscopy following failed endometrial biopsy. Data were collected from electronic medical records. Of the 407 consecutive patients who underwent an outpatient hysteroscopic procedure, 68 met inclusion criteria. Postmenopausal bleeding was the most common indication for initial biopsy, and most failures were attributed to cervical stenosis. Outpatient hysteroscopies were successfully completed in 96% of cases (n=65/68). Failure resulted from either anxiety and discomfort (n=2), or severe intrauterine adhesions (n=1). Overall, 10% of patients subsequently required an operating room-based hysteroscopy, either to complete a myomectomy or polypectomy, or to allow general anesthesia. Outpatient hysteroscopy identified endometrial hyperplasia and cancer in 4.5% and 3% of patients, respectively. Outpatient hysteroscopy following unsuccessful office endometrial biopsy attempts appears to be a feasible, safe, and cost-effective investigation strategy that may prevent the need for an operating room-based procedure in 90% of cases.

How clear is our current view on microbial dark matter? (Re-)assessing public MAG & SAG datasets with MDMcleaner.

As of today, the majority of environmental microorganisms remain uncultured and is therefore referred to as ‘microbial dark matter’ (MDM). Hence, genomic insights into these organisms are limited to cultivation-independent approaches such as single-cell- and metagenomics. However, without access to cultured representatives for verifying correct taxon-assignments, MDM genomes may cause potentially misleading conclusions based on misclassified or contaminant contigs, thereby obfuscating our view on the uncultured microbial majority. Moreover, gradual database contaminations by past genome submissions can cause error propagations which affect present as well as future comparative genome analyses. Consequently, strict contamination detection and filtering need to be applied, especially in the case of uncultured MDM genomes. Current genome reporting standards, however, emphasize completeness over purity and the de facto gold standard genome assessment tool, checkM, discriminates against uncultured taxa and fragmented genomes. To tackle these issues, we present a novel contig classification, screening, and filtering workflow and corresponding open-source python implementation called MDMcleaner, which was tested and compared to other tools on mock and real datasets. MDMcleaner revealed substantial contaminations overlooked by current screening approaches and sensitively detects misattributed contigs in both novel genomes and the underlying reference databases, thereby greatly improving our view on ‘microbial dark matter’.

Perception of Filipino Physicians on The Roles and Scope of Practice of Physical Therapy in the Philippines

Aim: To report the existing perceptions of Filipino physicians on the practice of physical therapy through the validated Perception on Physical Therapists Questionnaire (PoPTQ). Methods: This study utilized a multi-method quantitative research design. For Phase 1 (psychometric), 18 questionnaires were used to compute the Cronbach’s α of PoPTQ. A total of 134 questionnaires from Filipino physicians were analyzed for Phase 2 (cross-sectional), in which descriptive statistics and cross tab analysis were used to report the respondents’ perceptions. Both phases utilized online means of data gathering done via convenience sampling. Results: Phase 1 revealed an acceptable Cronbach's α value of 0.528 for all items of PoPTQ. Phase 2 showed that physicians who have attended lectures discussing the roles of physical therapists (PTs) or have experience with working with them have a higher referral rate than those with no prior exposure to PTs. Physicians believe that PTs can establish strong patient-therapist relationships and treat different patients. Furthermore, physicians positively acknowledge the roles of PTs in clinical and research settings. Conclusion and Implications: Adequate foundational knowledge, positive perceptions, and high awareness of PTs' roles and scope of practice are observed among physicians practicing locally. However, there is a need to increase collaboration opportunities between physical therapy students and physicians in their academic years and promote physical therapy roles specific to different medical specialties. Results of this study may assist in determining areas where the promotion of physical therapy roles is needed. This study can also aid in establishing a gold standard assessment tool for quantitative perception studies.

Creation and Validation of a Shorthand Knee MRI Bone Age Assessment Tool as an Alternative for Skeletal Maturity Assessment (203)

Objectives:In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle Atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was established as a simpler and more efficient alternative. Recently, a knee MRI bone age atlas (MRI atlas) was created potentially to circumvent the need for a left hand radiograph. Our objective is to create a shorthand version of the magnetic resonance imaging atlas.Methods:A shorthand bone age method (Figure 1) was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on the most characteristic criteria for each age that is best observed on a single MR image. For validation, we performed a retrospective assessment of skeletally immature patients that had a knee MRI and left hand radiograph within four weeks. Four readers who were familiar with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand read each of the images in a blinded fashion. Inter- and intra-observer reliability was evaluated using intraclass correlation coefficient (ICC), variability among observers was evaluated using percent agreement.Results:26 patients with a mean age of 13.6 years (range 9.0-16.9) met the inclusion criteria. The intra- and inter-observer reliability of all four assessment tools was excellent (ICC ≥ 0.8, p<0.001) (Table 1). When comparing the MRI shorthand to the MRI atlas, there was excellent agreement (ICC = 0.974), whereas the hand shorthand compared to the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 58% of reads among all four readers and 96% of reads had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of reads and 77% agreement within 1 year (Table 2).Conclusions:The MRI shorthand is a simple and efficient means of assessing skeletal maturity of adolescent patients with a knee MRI. This bone age assessment technique has inter-observer and intra-observer reliability equivalent or better than the standard means utilizing a left hand radiograph.

Creation and Validation of a Shorthand Magnetic Resonance Imaging Bone Age Assessment Tool of the Knee as an Alternative Skeletal Maturity Assessment

Background: In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was devised as a simpler and more efficient alternative. Recently, a knee magnetic resonance imaging (MRI) bone age atlas (MRI atlas) was created to circumvent the need for a left-hand radiograph. Purpose: To create a shorthand version of the knee MRI atlas. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A shorthand bone age assessment method was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on characteristic criteria for each age that are best observed on a single MRI scan. For validation, we performed a retrospective assessment of skeletally immature patients. One reader performed the bone age assessment using the MRI atlas and the MRI shorthand on 200 patients. Then, 4 readers performed the bone age assessment with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand on a subset of 22 patients in a blinded fashion. All 22 patients had a knee MRI scan and a left-hand radiograph within 4 weeks of each other. Interobserver and intraobserver reliability, as well as variability among observers, were evaluated. Results: A total of 200 patients with a mean age of 13.5 years (range, 9.08-17.98 years) were included in this study. Also, 22 patients with a mean age of 13.3 years (range, 9.0-15.6 years) had a knee MRI scan and a left-hand radiograph within 4 weeks. The intraobserver and interobserver reliability of all 4 assessment tools were acceptable (intraclass correlation coefficient [ICC] ≥ 0.8; P < .001). When comparing the MRI shorthand with the MRI atlas, there was excellent agreement (ICC = 0.989), whereas the hand shorthand compared with the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 50% of readings among all 4 readers, and 95% of readings had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of readings and 77% agreement within 1 year. Conclusion: The MRI shorthand is a simple and efficient means of assessing the skeletal maturity of adolescent patients with a knee MRI scan. This bone age assessment technique had interobserver and intraobserver reliability equivalent to or better than the standard method of utilizing a left-hand radiograph.

Clinical assessment of chemotherapy-induced peripheral neuropathy: a discrete choice experiment of patient preferences.

Up to 40% of cancer patients treated with neurotoxic chemotherapies experience chemotherapy-induced peripheral neuropathy (CIPN). Currently, there is no gold standard assessment tool for CIPN and there is little information in the literature on patient preferences for such assessments. This study aims to address this gap by identifying the features of a CIPN assessment tool that cancer patients value. An online discrete choice experiment (DCE) survey of neurotoxic chemotherapy-treated patients was implemented. Respondents completed 8 choice questions each. In each choice question, they chose between two hypothetical CIPN assessment tools, each described by six attributes: impact on quality of life; level of nerve damage detected; questionnaire length; physical tests involved; impact on clinic time; impact on care. The survey was completed by 117 respondents who had a range of cancers of which breast cancer was the most common. Respondents favoured an assessment tool that includes a physical test and that asks about impact on quality of life. Respondents were strongly opposed to clinicians, alone, deciding how the results of a CIPN assessment might influence their care especially their chemotherapy treatment. They were concerned about small changes in their CIPN, independent of clinical relevance. Respondents were willing to add half an hour to the usual clinic time to accommodate the CIPN assessment. The findings of this DCE will assist clinicians in choosing an assessment tool for CIPN that is satisfactory to both clinician and patient.

Elder Financial Abuse and Electronic Financial Instruments: Present and Future Considerations for Financial Capacity Assessments

Personal economic stability is one of the core social determinants of health and longevity, and managing one's finances is an instrumental activity of daily living. Impaired financial decision-making can lead to poor health, emotional distress, and loss of independence and safety. Older adults in the United States lose billions of dollars annually to elder financial abuse (EFA), which may be preceded by a decline of capacity to make financial decisions. A literature review regarding EFA, electronic financial instruments (EFI), medical and financial decision-making capacity evaluations, and biomedical ethics was performed. Currently, there is no gold standard clinical assessment tool for evaluating financial capacity. The instruments in use have yet to formally integrate modern EFI that present novel mechanisms through which EFA can occur. This article summarizes the current state of EFA in the United States, risk factors and strategies for prevention, and offers a clinician administered screening questionnaire for addressing EFI use along with a semi-structured approach to clinical financial capacity assessments.

Assessment of Bullying in Autism Spectrum Disorder: Systematic Review of Methodologies and Participant Characteristics

The growing body of literature on bullying in autism spectrum disorder (ASD) suggests individuals with ASD are bullied more frequently than their non-ASD peers. However, there is no gold standard assessment tool for bullying in ASD, and the use of differing methodologies generates varying prevalence estimates. This systematic review evaluates the assessment methods for bullying in ASD and summarizes the participant characteristics in this literature. None of the identified measures meet literature recommendations for bullying assessment in ASD. Additionally, there is a need for increased sample diversity regarding the gender, race, and cognitive ability of ASD participants. Recommendations for researchers and practitioners are discussed, including the need for a gold standard assessment tool and consistency in the operationalization of bullying.

Validity and reliability of modified PAQ-A and LTEQ in adolescents of Karachi, Pakistan

Introduction: Patient satisfaction is considered to be a vital component in the evaluation of the quality of care. Objectives: To evaluate the validity and reliability of the modified versions of Physical Activity Questionnaire for Adolescents (mPAQ-A) and Leisure Time Exercise Questionnaire (mLTEQ) against gold standard objective assessment tool pedometer in adolescent population of Pakistan Methods: A total of 265 adolescents (mean age=13 years; SD=0.98) were recruited. The participants of the study were selected through simple random sampling. Physical activity was assessed by using both objective (pedometer) and subjective instruments (mPAQ-A and mLTEQ questionnaires). Validity and reliability of modified tools were assessed by using Pearson's correlation coefficient (r), Cronbach's alpha and intra class correlation, respectively. Results: For validity, the correlation between mPAQ-A/mLTEQ, mPAQ-A/pedometer step counts and mLTEQ/pedometer step counts were all statistically significant. Higher correlation between subjective assessment tools (mPAQ-A/mLTEQ) was observed. Likewise, the difference of time interval also had no effect on the validity of both questionnaires. The internal and test-retest reliability of mPAQ-A was found to be higher than mLTEQ. According to the graph of ROC the mPAQ-A is more slightly superior to the mLTEQ. Conclusions: The questionnaire mPAQ-A in comparison to mLTEQ showed an acceptable to good validity and reliability among Pakistani adolescents.

Preoperative Binge Eating and Weight Loss After Bariatric Surgery: A Systematic Review and Meta-analysis.

Several studies have investigated if bariatric surgery candidates with binge eating disorder (BED) are at risk for suboptimal postoperative weight loss. The aim of this systematic review with meta-analysis was to evaluate the association between binge eating diagnosed preoperatively and weight loss after bariatric surgery. MEDLINE, EMBASE, CENTRAL, LILACS, and other specialized databases were searched on August 2020. Clinical trials and observational studies including individuals who had undergone any type of bariatric surgical treatment with preoperative evaluation of BED and at least one postoperative measure of weight were initially selected. Four reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. Nineteen studies, comprising 3223 participants (80.25% women; median age 41years), met the inclusion criteria for meta-analysis. At 6months postoperative, the percentage of total weight loss (%TWL) was not significantly different between BED and non-BED groups [6 studies, 914 participants: - 0.75% (95% CI, - 2.79 to 1.29; I2 = 0%)], even when analyzing only those three studies that included gold standard assessment tools. No significant differences were found at 12, 24, 36, or 60months. Pre-bariatric BED seems to have little or no influence on weight loss after surgery. However, many questions remain unanswered because of the use of different measures across studies. The heterogeneity among studies emphasizes the importance of investigators using the same assessment measures.

Evaluating co-created patient-facing materials to increase understanding of genetic test results.

Patients often have difficulty understanding genetic test reports. Technical language and jargon can impede comprehension and limit patients using results to act on findings. One potential way to improve patient understanding of genetic test reports is to provide patient-facing materials. This study aimed to examine understandability and actionability of co-created patient-facing materials for genetic test results in a research context. We combined interprofessional perspectives and patient engagement to co-create patient-facing materials for patients undergoing research genetic testing for congenital hypogonadotropic hypogonadism (Kallmann syndrome). The iterative development process was guided by principles of health literacy and human-centered design (i.e., design thinking). Readability was assessed using eight validated algorithms. Patients and parents evaluated materials using a web-based survey. The gold standard Patient Education Materials Assessment Tool for print materials (PEMAT-P) was employed to measure understandability (content, style, use of numbers, organization, design, use of visual aids) and actionability. PEMAT-P scores >80% were considered high quality. Results were analyzed descriptively and correlations performed to identify relationships between education/health literacy and PEMAT-P ratings. A consensus score of eight algorithms indicated the materials were an 8th -9th grade reading level. Our findings are consistent with the U.S. Department of Health and Human Services 'average difficulty' classification (i.e., 7th-9th grade). In total, 61 patients/parents evaluated the materials. 'Visual Aids' received the lowest mean PEMAT-P rating (89%). All other parameters scored 90%-97%. PEMAT-P scores did not differ according to educational attainment (less than college vs. college or more, p=0.28). Participants with adequate health literacy were more likely to approve of the 'organization' of information (p<0.05). Respondents with low health literacy had more favorable views of 'visual aids' (p<0.01). Involving patients in a co-creation process can produce high-quality patient-facing materials that are easier to understand.

5 Reasons Why Scoliosis X-Rays Are Not Harmful.

Radiographic imaging for scoliosis screening, diagnosis, treatment, and management is the gold standard assessment tool. Scoliosis patients receive many repeat radiographs, typically 10-25 and as many as 40-50, equating to a maximum 50 mGy of cumulative exposure. It is argued this amount of radiation exposure is not carcinogenic to scoliosis patients for 5 main reasons: 1. Estimated theoretical cumulative effective doses remain below the carcinogenic dose threshold; 2. Scoliosis patient x-rays are delivered in serial exposures and therefore, mitigate any potential cumulative effect; 3. Linear no-threshold cancer risk estimates from scoliosis patient cohorts are flawed due to faulty science; 4. Standardized incidence/mortality ratios demonstrating increased cancers from aged scoliosis cohorts are confounded by the effects of the disease entity itself making it impossible to claim cause and effect resulting from low-dose radiation exposures from spinal imaging; 5. Children are not more susceptible to radiation damage than adults. Radiophobia concerns from patients, parents, and doctors over repeat imaging for scoliosis treatment and management is not justified; it adds unnecessary anxiety to the patient (and their parents) and interferes with optimal medical management. X-rays taken in the evidence-based management of scoliosis should be taken without hesitation or concern about negligible radiation exposures.