Greater Increase In Scores Research Articles

Clinical Outcomes of Talus Bone Marrow Edema: Comparing Plaster Cast, Crutches, and Walking Boot Treatments.

BACKGROUND Bone marrow edema (BME) basically involves localized hemorrhage and subtle compression fracture within the bone. We compared outcomes of 70 patients with traumatic BME of the talus, treated with a plaster cast, crutches, or walking boot. MATERIAL AND METHODS MRIs diagnosed 70 patients with talus BME who were randomly assigned into 3 groups of different treatments: Group 1 (n=33) patients were treated with plaster cast's Group 2 (n=21) patients used crutches, and Group 3 (n=16) patients used walking boots. The outcome variables were AOFAS and VAS scores. RESULTS No significant difference was demonstrated in the pre-treatment AOFAS scores between the groups (P>0.05). The AOFAS scores differed significantly after treatment, with Group 2 had the greatest increase in scores (P=0.002) and significantly higher AOFAS scores compared to Group 1 (100 [79-100] vs 94 [75-100], P=0.001). No significant difference was found in pre-treatment VAS scores between the groups (P=0.007). The post-treatment VAS scores were significantly reduced, especially for Group 2. Within-group analysis demonstrated a significant decrease of VAS scores for all groups (P<0.001). CONCLUSIONS Use of non-weight-bearing crutches for 3 weeks had better clinical results than use of a plaster cast when treating talus traumatic bone marrow edema. This was reflected in higher AOFAS and VAS, suggesting use of crutches is associated with better pain management and improved function.

Longitudinal Trends in Patient-Reported Outcomes in the First Year After Lumpectomy Versus Mastectomy.

It is unclear how patient-reported outcomes (PROs) change longitudinally after breast cancer surgery. We sought to compare trends in PROs among patients who underwent lumpectomy versus mastectomy over the first year after surgery. Newly diagnosed stage 0-III female patients with breast cancer who underwent lumpectomy or mastectomy at an academic breast center between June 2019 and March 2023 were invited to participate in a longitudinal PRO study. Enrolled patients received the BREAST-Q™ module, a validated tool measuring domains, such as satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Scores for each domain were compared between the lumpectomy and mastectomy groups over the first year after surgery. Linear mixed models were used to estimate the change in PRO scores over time. The cohort included 203 who underwent lumpectomy and 144 who underwent mastectomy. Patients who underwent lumpectomy were older, more likely to receive adjuvant radiation and endocrine therapy, and less likely to receive adjuvant chemotherapy. Patients who underwent lumpectomy demonstrated greater increases in scores over time for satisfaction with breasts, psychosocial well-being, and sexual well-being compared with patients who underwent mastectomy, after adjusting for the abovementioned covariates and receipt of reconstruction. The lumpectomy group had a larger decline in physical well-being over time compared with the mastectomy group. Patients who underwent lumpectomy demonstrated greater satisfaction with their breasts, psychosocial well-being, and sexual well-being but worse physical well-being over the first year after surgery compared with patients who underwent mastectomy. These results may help inform early-stage breast cancer patients making decisions about their surgical care.

Comorbid Attention Deficit Hyperactivity Disorder in Women with Premenstrual Dysphoric Disorder.

Background: This study evaluated the associations between inattention, impulsivity, and attention deficit hyperactivity disorder (ADHD) in women with premenstrual dysphoric disorder (PMDD) across the menstrual cycle. Methods: This study enrolled 58 women with PMDD and 50 controls. Symptoms were assessed using the Attention and Performance Self-Assessment Scale and the Dickman Impulsivity Inventory during the pre-ovulatory (PO), mid-luteal (ML), and late luteal (LL) phases of the menstrual cycle. Results: The chi-square analysis revealed a significant association between ADHD and PMDD. Women with PMDD experienced a greater increase in scores of prospective everyday memory problems and difficulties maintaining focused attention from the PO phase to LL phase than the controls; in addition, they had higher scores in dysfunctional impulsivity during the LL phase than the controls. Among women in the PMDD group, those with ADHD had higher scores in prospective everyday memory problems and dysfunctional impulsivity during the PO and ML phases than those without ADHD. Women in the PMDD group without ADHD had a greater increase in scores of prospective everyday memory problems, difficulties maintaining focused attention, and dysfunctional impulsivity from the PO phase to the LL phase than the controls. Conclusion: Our study demonstrated that women with PMDD were more likely to have comorbid ADHD and higher levels of inattention across the menstrual cycle. PMDD was associated with increased impulsivity during the LL phase, independent of ADHD, but it was not associated with a persistent elevation of impulsivity. Furthermore, PMDD women with comorbid ADHD experienced higher inattention and impulsivity during the PO and ML phases than those without it. Thus, ADHD comorbidity should be assessed when assessing or intervening in the symptoms of inattention and impulsivity in women with PMDD.

Testing Interventions to Address Bias About Patients with Opioid Use Disorder in the Emergency Department

IntroductionReducing nurse bias about patients with opioid use disorder in the emergency department is critical for providing nonjudgmental care, enhancing patient outcomes, supporting effective communication, and promoting a holistic approach to care. Emergency nurses can make a positive impact on the lives of individuals diagnosed as having opioid use disorder by providing care that is free from stigma and discrimination. MethodsThe study used an observational, pretest-posttest design to compare educational sessions addressing bias and stigma toward patients with opioid use disorder. The study population consisted of emergency nurses who self-selected into a virtual learning experience consisting of e-modules or simulation-based experience consisting of simulation-based experience consisting of simulation, discussion, and a speaker. ResultsAfter the intervention, the simulation-based experience group showed an increase in total score postintervention from a mean of 118.6 to a mean of 127.1 (P < .001). The virtual learning experience group also showed an increase in total score postintervention from a mean of 116.3 to 120.7 (P < .001). Although both groups showed an increase in scores over time, the simulation-based experience group had a greater increase (P = .0037). Within the simulation-based experience, there was an increase in scores across all age groups (P < .05) but a significantly greater increase in scores among younger nurses (18-29 years) than the older age groups (P = .006). DiscussionOpioid use disorder is a complex condition that requires a comprehensive and holistic approach to care. Study results indicate that providing an educational experience to address stigma about patients diagnosed as having opioid use disorder can significantly affect nurse perceptions about these patients and their self-efficacy when working with them. However, investing in a simulation-based educational experience provides a stronger experience and results in greater change, particularly for younger, less experienced emergency nurses.

Just TRAC it! Transitioning Responsibly to Adult Care Using Smart Phone Technology

PurposeThere is little evidence on whether smartphone technology influences transition readiness among adolescents with heart disease. Just TRAC it! is a method of using existing smartphone features (Notes, Calendar, Contacts, Camera) to manage personal health. We evaluated the impact of Just TRAC it! on self-management skills. MethodsRandomized clinical trial of 16–18 year-olds with heart disease. Participants were randomly allocated 1:1 to either usual care (education session) or intervention (education session including Just TRAC it!). The primary outcome was change in TRANSITION-Q score between baseline, 3 and 6 months. Secondary outcomes were frequency of use and perceived usefulness of Just TRAC it! Analysis was intention-to-treat. ResultsWe enrolled 68 patients (41% female, mean age 17.3 years), 68% having previous cardiac surgery and 26% had cardiac catheterization. TRANSITION-Q scores were similar at baseline and increased over time in both groups but were not significantly different between groups. Each additional point at the baseline score brought, on average, a 0.7-point increase in TRANSITION-Q score (95% CI 0.5–0.9) at each of 3 and 6 months. The Camera, Calendar and Notes apps were reported as most useful. All intervention participants would recommend Just TRAC it! to others. DiscussionA nurse-led transition teaching with versus without Just TRAC it! improved transition readiness, with no significant difference between groups. Higher baseline TRANSITION-Q scores were associated with greater increase in scores over time. Participants had a positive reception to Just TRAC it! and would recommend it to others. Smartphone technology may be useful in transition education.

Quality of Life in Patients Undergoing Percutaneous Coronary Intervention.

Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure to treat coronary artery occlusion. The quality of life (QoL) is a way to measure the impact of illness and additionally its treatments to traditional measures of clinical outcomes. The aim of the present study was to explore the levels of QoL pre-PCI, 6 and 12 months after PCI, as well as the factors associated with the QoL pre-PCI. In the present study, 100 patients undergoing PCI were enrolled. Data were collected through the completion of the SF-36 Health Survey (SF-36), which included participants' characteristics. The statistical significance level was p < 0.05. Patients had moderate levels of QoL at baseline, with a median general health score of 45 (IQR: 30-65). A gradual statistically significant increase in scores was observed in all subcategories of the patients' QoL at 6 and 12 months after PCI (p < 0.001). A greater increase in scores was observed in physical functioning, physical role, emotional role and social functionality. In terms of the pre-PCI phase, it was found that physical functionality was statistically significantly associated with educational level (p = 0.005), occupation (p = 0.026) and whether the patients had children (p = 0.041). The physical and emotional role was significantly associated with gender (p = 0.046 and p = 0.040) and educational level (p = 0.030 and p = 0.001). Energy-fatigue was significantly associated with gender (p = 0.001), age (p = 0.028), marital status (p = 0.001), educational level (p = 0.001), whether the patients had children (p= 0.012) and other diseases (p = 0.001). Emotional well-being was significantly associated with family history of coronary artery disease (p = 0.011) and the frequency of physical exercise (p = 0.001). Social functioning was significantly associated with gender (p = 0.033), marital status (p = 0.034) and educational level (p = 0.002). Pain was not found to be significantly associated with patients' demographics. General health was significantly associated with gender (p = 0.003), age (p = 0.043), educational level (p = 0.001), other diseases (p = 0.005) and the frequency of physical exercise (p = 0.001). Information about the QoL of PCI and its determinants is important to define an effective and comprehensive care plan.

The effect of daily peanut consumption on cognitive function and indicators of mental health among healthy young women

Background: Peanuts and tree nuts contain many bioactive compounds that may provide health benefits. There is some evidence to suggest that regular consumption of peanuts and peanut butter may improve cognitive function and mood, however, there are no prior studies examining whether daily intake of dry roasted, skinless peanuts improves cognition. Objective:The objective of this study was to determine the effect of consuming 49 g/day of peanuts for 12 weeks on cognitive function and mental health, compared to consuming a peanut-free diet, among healthy young women. Methods:This was a pre-post test study of 65 women (n = 32 in peanut group, n = 29 in control group). Participants in the peanut group consumed an individually portioned pack of peanuts each day for 12 weeks. Cognitive function was assessed using the CNS Vital Signs computerized neurocognitive test battery. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-42). Differences in endpoints between groups were assessed using ANCOVA tests. Results:There was a significant difference between the two groups in reaction time (6.9 points; p = 0.029), with the control group having a greater increase in scores. There was a significant within-group effect of peanuts on processing speed, with the peanut group increasing scores by 6.3 points (95% CI: 2.7, 9.8). There was no effect of peanut consumption on depression, anxiety, or stress scores. Conclusion:Further research is needed to fully understand the effect of different types of peanut products on cognition. Keywords: cognition, mental health, peanuts, nuts

Nurturing Problem Posing in Young Children: Using Multiple Representation within Students’ Real-World Interest

Problem-posing activities have been shown to motivate students’ learning while promoting a multifaceted and interesting educational environment. Moreover, these activities enable students to be engaged in personal interpretations of their own mathematical thinking. The purpose of this study was to determine if using a hands-on learning intervention with multiple representations could improve students’ problem-posing skills. The researchers examined the answers of the participants (n = 14) with the greatest increase in scores from pre to posttest after participating in 20 problem-posing intervention activities to determine how the intervention allowed students to pose valid, real-world semi-structured problems. The researchers qualitatively analyzed the posed problems for logical real-world contexts and the alignment of the setup of each problem to determine if the students’ posed problems were logical and solvable. Results from this study confirm that students were able to build stronger understanding of mathematical content when they were engaged in authentic problem-posing activities that were meaningful to them. Thus, teachers need to include purposeful and focused problem-posing activities into their classroom lessons.

Changes in Diet Quality over 10 Years Are Associated with Baseline Sociodemographic and Lifestyle Factors in the Multiethnic Cohort Study

Trends in diet quality among US adults indicate a steady improvement, but data on longitudinal individual-level changes in diet quality are still limited. We examined changes in diet quality over 10 y and sought to determine whether baseline sociodemographic and lifestyle factors predicted the changes in a multiethnic population. Data were from 63,255 African American, Native Hawaiian, Japanese American, Latino, and white men and women (45-75 y old at baseline) in the Multiethnic Cohort, who completed a quantitative food frequency questionnaire at baseline (1993-1996) and 10-y follow-up (2003-2007) and had no prevalent cancer or heart disease at either survey. Overall diet quality was measured by use of the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) score. We used a general linear model with adjustment for covariates to compare diet quality changes by baseline characteristics in men and women separately. Overall diet quality improved over 10 y by 3.2 points in men and 2.9 in women assessed using the HEI-2015, although scores for some components worsened (saturated and trans fats, indicating increased intake) or remained unchanged at a low quality level (whole grains, dairy, and sodium). In multivariable models where changes in HEI-2015, AHEI-2010, and DASH were harmonized to a 100-point score, greater increases in scores in both men and women were found for Japanese American ethnicity (increase by 0.5-4.7 in the 3 scores, P <0.03), higher education (by 0.5-1.5, P≤0.001), normal weight (BMI 18.5 to <25, by 0.6-2.5, P≤0.01), nonsmoking (by 1.5-2.7, P <0.001), higher moderate/vigorous physical activity level (by 0.3-0.8, P≤0.04), and multivitamin use (by 0.4-0.7, P <0.001) at baseline. Sociodemographic and lifestyle factors, closely associated with diet quality, also predicted subsequent changes in diet quality over time in this multiethnic population.

Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study

ObjectivesThis study assessed the impact of a Dementia Education Workshop on the confidence and attitudes of general practitioner (GP) registrars (GPR) and GP supervisors (GPS) in relation to the early...

Developing Korean nursing students' global health competencies: A mixed methods approach to service learning in rural Vietnam

BackgroundOwing to globalization, there is a need for enhanced global health competencies among nursing students. In this context, global service learning programs are important opportunities for nursing students. ObjectivesTo explore the effect of a short-term service learning program in a developing country on the global health competencies of students attending a South Korean nursing college. DesignA mixed methods design. SettingThe Global Nursing Internship is a two-week pre-experience, eight-day on-site, and one-week post-experience program. ParticipantsThe on-site activities involved 15 nursing students participating in global health activities in a rural Vietnamese community. MethodsA self-reported questionnaire was used to assess changes in global health competencies in six domains, measured on a four-point Likert scale. Student satisfaction with each activity was measured on a five-point Likert scale. After completing the program, the participants wrote a self-reflection essay. The Wilcoxon signed rank test was used to analyze global health competencies, and content analysis was used to analyze participants' self-reflections. ResultsRegarding global health competencies, the overall mean score showed a significant increase at the post-program evaluation (Z = −3.41, p = .001). A pre-post-program comparison showed that the domain of “health care in low-resource settings” displayed the greatest increase in scores. The mean overall satisfaction with the program was high (mean = 4.31, standard deviation = 0.17). In the students' view, as expressed in their essays, their global health knowledge and attitude had improved. ConclusionsThe program was useful in promoting global health competencies, empathy, and confidence and should be embedded among the essential requirements of nursing curricula. Suggestions are provided to develop an enhanced pre-experience program that could help students prepare better for on-site activities. As cultural competency is crucial for nurses, nursing educators should consider integrating similar global service learning programs into their existing nursing curricula.

Importance of knowledge in the behavioural treatment of panic disorder.

Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist. The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment. Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment. The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans' knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction. In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

Strengthening palliative care delivery in developing countries: a training workshop model in Botswana.

The persistent global unmet need for palliative care continues to be felt acutely in Sub-Saharan Africa, where the volume is growing and access to palliative services remains underdeveloped. Recognizing the increasing urgency of bolstering palliative care infrastructure, several countries, such as Botswana, have established national policies and strategies to enhance care delivery. Given that education and training are essential components in pursuing this goal, we present a model for a training workshop that was successful in increasing the palliative care knowledge base and skill set in a group of nurses. A 2-day palliative care workshop was conducted for 15 nurses in Gaborone, Botswana in October 2014. Ten nurses completed pre- and post-workshop tests consisting of 21 questions spanning palliative care topics and delivery skills. The survey category with the highest pre-test score of 70% was principles of palliative care. Ninety percent of participants demonstrated statistically significant improvement in post-test scores in comparison to pre-test results. The greatest increase in scores were observed in the categories of communication, end-of-life care and syringe driver use for administration of analgesic medications. The lowest post-test score category was spirituality, though it consisted of one survey question. Here we provide quantitative data that supports the success of the training workshop model presented. Improvement in palliative care knowledge and treatment skills, as evidenced by the increased scores from pre- to post-test results, suggests the efficacy of this 2-day training program in advancing palliative care education of nurses. Given the unmet need for healthcare workers trained in palliative care, this model could serve as a valuable tool for expanding and strengthening the delivery of care in settings where patients have limited access to palliative care services.

Effects of robot-assisted therapy on upper extremity function and activities of daily living in hemiplegic patients: A single-blinded, randomized, controlled trial.

Many robots can induce passive movements and passive resistance movements to facilitate recovery of upper-extremity function, but it is rare to find robots that can also enable active resistance movements. The purpose of this study was to investigate the effects of robot-assisted therapy on upper-extremity function and the ability to perform activities of daily living (ADL) in patients with stroke-induced hemiplegia. Thirty patients with stroke-induced hemiplegia were randomly assigned to the experimental and control groups, with 15patients in each group. All subjects underwent general occupational therapy consisting of five 30-min sessions per week for 8weeks, in addition to 30min of robot-assisted therapy for the experimental group and 30additional min of general occupational therapy for the control group for each session. Both the experimental and control groups showed a statistically significant increase in post-treatment Fugl-Meyer assessment and modified Barthel index scores compared to the pre-treatment scores. Intergroup comparisons revealed that the experimental group showed a statistically significant greater increase in scores for all assessments than the control group did (p< 0.05). The findings from this study showed that combining robot-assisted therapy with general occupational therapy may enhance upper-extremity function and the ability to perform ADL in patients with stroke-induced hemiplegia compared to those obtained with general occupational therapy alone.

Fostering Creativity in the Classroom for High Ability Students: Context Does Matter

Researchers have argued for the importance of the classroom context in developing students’ creative potential. However, the emphasis on a performative learning culture in the classroom does not favour creativity. Thus, how creative potential can be realised as one of the educational goals in the classrooms remains a key question. This study measured creativity across three secondary schools using the Wallach-Kogan Creative Thinking Test (WKCT). A total of 283 students enrolled in the Express programme and 290 students enrolled in the Integrated Programme (IP) volunteered in the study. The same cohort of students took the 38-item WKCT twice; once at the beginning of Secondary One and then at the end of Secondary Three. Four aspects of creativity, namely fluency, flexibility, unusualness, and uniqueness, were investigated. Our analyses showed that (i) IP students showed a greater increase in scores over time when compared to Express students; (ii) when Programme and PSLE (Primary School Leaving Examination) were used to predict creativity scores in a multiple regression, the predictive power of Programme increased from Secondary 1 to Secondary 3 while that of PSLE decreased; and (iii) flexibility scores were more resistant to change than fluency scores. These findings suggest that the classroom context matters and that the removal of high-stakes examination can provide room for the development of creative potential.

Emotional intelligence development in radiation therapy students: a longitudinal study

AbstractPurposeEmotional intelligence (EI) is an increasingly important aspect of a health professional’s skill set. It is strongly associated with empathy, reflection and resilience; all key aspects of radiotherapy practice. Previous work in other disciplines has formed contradictory conclusions concerning development of EI over time. This study aimed to determine the extent to which EI can develop during a radiotherapy undergraduate course and identify factors affecting this.Methods and materialsThis study used anonymous coded Likert-style surveys to gather longitudinal data from radiotherapy students relating to a range of self-perceived EI traits during their 3-year degree. Data were gathered at various points throughout the course from the whole cohort.ResultsA total of 26 students provided data with 14 completing the full series of datasets. There was a 17·2% increase in self-reported EI score with ap-value&lt;0·0001. Social awareness and relationship skills exhibited the greatest increase in scores compared with self-awareness. Variance of scores decreased over time; there was a reduced change in EI for mature students who tended to have higher initial scores. EI increase was most evident immediately after clinical placements.ConclusionsRadiotherapy students increase their EI scores during a 3-year course. Students reported higher levels of EI immediately after their clinical placement; radiotherapy curricula should seek to maximise on these learning opportunities.

Prior Podcast Experience Moderates Improvement in Electroencephalography Evaluation After Educational Podcast Module.

There is continued interest in using technology to enhance medical education and the variables that may affect its success. Anesthesiology residents and fourth-year medical students participated in an electroencephalography (EEG) educational video podcast module. A 25-item evaluation tool was administered before any EEG education was provided (baseline), and the podcast was then viewed. Another 25-item evaluation tool was administered after podcast viewing (after podcast). Ten EEG interpretations were completed with a neurophysiologist with an additional 25-item evaluation tool administered after the interpretations (after 10 EEG interpretations). Participants were surveyed concerning technology and podcasting experience before the educational module and their responses to the podcast educational model. Multiple analyses were performed (1) to evaluate differences in improvement in EEG evaluation scores between the podcast module and the standard didactics (control group); and (2) to evaluate potential moderation by technology and the podcast experience on the change in mean EEG evaluation scores from after the podcast module to after 10 EEG interpretations. A total of 21 anesthesiology residents and 12 fourth-year medical students participated. Scores on the 25-item evaluation tool increased with each evaluation time (P ≤ 0.001). Moderation analyses revealed that individuals with more podcast experience (≥4 previous podcasts) had greater increases in scores after a podcast and 10 EEG interpretations compared with individuals with less experience (≤3 previous podcasts) (P = 0.027). Furthermore, compared with a control group with similar baseline characteristics that received only standard didactics without a podcast, those in the podcast group had greater increases in mean EEG evaluation scores between baseline and after 10 EEG interpretations. In reviewing the improvement in EEG evaluation after a podcast education module, those with more podcast experience achieved greater gains in EEG evaluation scores. For EEG education, those receiving the podcast education module showed greater increases in scores compared with those receiving didactic teaching without podcasting, as measured by change in a mean EEG evaluation scores.

The role of assessment environment on self-reported alcohol use and perceived group norms: Comparing Web-based surveys to a group setting involving handheld keypads

This study examines how self-reporting of alcohol-related perceived group norms and individual attitudes and behaviours varies as a function of assessment environment – an online assessment using electronic surveys completed alone and a live assessment using electronic handheld ‘clickers’ completed within one's salient reference group. Social comparison theory (Festinger, ) is used to help explain the study and interpret results. A total of 657 National Collegiate Athletic Association Division I student-athletes (59% female) from two universities completed both the independent online and the in-group assessment using clickers. Results indicate that student-athletes overestimated both drinking and attitudes towards drinking of peers in their specific groups. Student-athletes also responded with higher scores on all measures when assessed live using clickers with other members of their peer group, as opposed to the individual online assessment. Gender moderates the relationship between type of assessment context and all outcome measures, such that the presence of in-group members results in a greater increase in scores for males than females. Findings hold implications for health practitioners interested in understanding how the presence of group members influences self-reported health data and how the use of new technologies contributes to learning in social environments.

HEAD‐TO‐HEAD COMPARISON OF PRACTICE WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPUTER AND MECHANICAL SIMULATORS BY EXPERIENCED ENDOSCOPISTS AND TRAINEES

The endoscopic retrograde cholangiopancreatography (ERCP) mechanical simulator (EMS) and computer simulator (ECS) are described herein. No direct hands-on comparison has been reported to reflect the perception of trainers and trainees regarding the efficacy of each model for trainee ERCP education. We compared the trainers' and trainees' assessments of the EMS and ECS for trainee education. Eighteen gastrointestinal trainees and 16 trainers with varying ERCP experience completed a questionnaire survey before and after practice with each simulator at hands-on ERCP practice workshops. They carried out scope insertion, selective bile duct cannulation, guidewire negotiation of a bile duct stricture, biliary papillotomy and insertion of a single biliary stent using both simulators. Main outcome measurement was respondents' assessments of comparative efficacy of EMS and ECS practice for trainee education. Compared to pre-practice evaluation, both EMS and ECS received higher scores after hands-on practice. Both trainers and trainees showed significantly greater increases in scores for EMS when compared with ECS in facilitating understanding of ERCP procedure, enhancing confidence in carrying out ERCP and the simulator as a credible option for supplementing clinical ERCP training (P < 0.05). Participants also scored EMS significantly higher in realism and usefulness as an instructional tool. Both computer and mechanical simulators are accepted modalities for ERCP training. The current data (based on a head-to-head comparison of hands-on practice experience) indicate EMS practice is rated higher than ECS practice in supplementing clinical ERCP training. EMS offers the additional advantage of coordinated practice with real equipment and accessories.

A controlled study of team-based learning for undergraduate clinical neurology education

BackgroundTeam-based learning (TBL), a new active learning method, has not been reported for neurology education. We aimed to determine if TBL was more effective than passive learning (PL) in improving knowledge outcomes in two key neurology topics - neurological localization and neurological emergencies.MethodsWe conducted a modified crossover study during a nine-week internal medicine posting involving 49 third-year medical undergraduates, using TBL as the active intervention, compared against self-reading as a PL control, for teaching the two topics. Primary outcome was the mean percentage change in test scores immediately after (post-test 1) and 48 hours after TBL (post-test 2), compared to a baseline pre-test. Student engagement was the secondary outcome.ResultsMean percentage change in scores was greater in the TBL versus the PL group in post-test 1 (8.8% vs 4.3%, p = 0.023) and post-test 2 (11.4% vs 3.4%, p = 0.001). After adjustment for gender and second year examination grades, mean percentage change in scores remained greater in the TBL versus the PL group for post-test 1 (10.3% vs 5.8%, mean difference 4.5%,95% CI 0.7 - 8.3%, p = 0.021) and post-test 2 (13.0% vs 4.9%, mean difference 8.1%,95% CI 3.7 - 12.5%, p = 0.001), indicating further score improvement 48 hours post-TBL. Academically weaker students, identified by poorer examination grades, showed a greater increase in scores with TBL versus strong students (p < 0.02). Measures of engagement were high in the TBL group, suggesting that continued improvements in scores 48 hours post-TBL may result from self-directed learning.ConclusionsCompared to PL, TBL showed greater improvement in knowledge scores, with continued improvement up to 48 hours later. This effect is larger in academically weaker students. TBL is an effective method for improving knowledge in neurological localization and neurological emergencies in undergraduates.