Increase In Mean Scores Research Articles

Exploring the Efficacy of the Production-Oriented Approach in Improving English Interpreting Skills—A Case Study

The demand for efficient English interpreters have been on a constant rise in the rapid evaluation of globalization—the skilled interpreters are a prerequisite for international interactions across diplomatic, business, and cultural domains. The traditional models in practice to train the interpreters are based on theoretical knowledge with less emphasis on practical skills required for effective real-world communication. In contrast, the Production-Oriented Approach (POA) focuses more on Practical Language Application (PLA), considered a better alternative to conventional training methodologies. This study challenges to analyze the effectiveness of the POA in improving English Interpreting Skills (EIS) by creating a case study at a top university in China. The work employed a quantitative research design on a study involving 47 students in pre-test/post-test experiments to measure the boosts achieved in EIS direct features to POA implementation. Results indicated significant improvements in the experimental groups, with undergraduates and graduates showing mean score increases of 13 and 12 points, respectively, after the implementation of POA.

IMMU-50. IMPACT OF SARS-COV-2 MRNA VACCINES ON PD-L1 EXPRESSION IN INTRACRANIAL TUMORS

Abstract Although immune checkpoint inhibitor (ICI) effectiveness is correlated with intra-tumoral PD-L1 expression, there are no clinically available methods to improve sensitivity to ICIs by modulating PD-L1 expression. mRNA vaccines stimulate robust interferon-dependent innate immune activation leading to four-fold increases in PD-L1 expression on peripheral and intratumoral myeloid cells and enhanced sensitivity to immune checkpoint blockade in preclinical models (Sayour, Grippin, et al., NanoLetters, 2018; Mendez-Gomez, et al., Cell, 2024). We hypothesized that mRNA vaccines targeting SARS-COV-2 would similarly enhance PD-L1 expression in intracranial tumors. To test this hypothesis, we utilized institutional databases to identify 5,524 patients at our institution with pathology reports including the term “PD-L1” from August 2020 to November 2023. Pathological data and dates of SARS-COV-2 vaccination were compiled for each patient. Across the entire cohort (n=5,524), receipt of a SARS-COV-2 mRNA vaccine within 100 days of biopsy was associated with a 55% increase in mean tumor proportion score (TPS) (14% vs 8.9%, p=0.029). In the subset of patients with intracranial tumors (n=187), receipt of a SARS-COV-2 mRNA vaccine within 100 days of biopsy was associated with a massive increase in TPS (57% vs 7.2%, p<0.001). To evaluate the impact of this change on clinical outcomes with immunotherapy, we utilized a second institutional database to assemble a cohort of patients with Stage IV melanoma with intracranial metastasis treated with immune checkpoint blockade during the period August 2020 through November 2023. Patients who received a SARS-COV-2 vaccine within 100 days of initiation of ICI (n=10) exhibited numerically improved overall survival compared to those without SARS-COV-2 mRNA vaccine (n=38) (HR 0.50, 95% CI 0.22-1.2, p=0.06). Median overall survival was 545 days among patients without COVID mRNA vaccination and was not met among those with COVID mRNA vaccination. This data supports further investigation of the immune modulating effect of SARS-COV-2 mRNA vaccines in patients with intracranial tumors treated with immune checkpoint blockade.

Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis

BackgroundTotal hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training.MethodsWe conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed.ResultsA total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.ConclusionsIn patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.)

Empowering Medical Students to Address Patient-Initiated Mistreatment at the Transition to Residency: An Education Quality Improvement Study.

Mistreatment from patients is prevalent and has far-reaching negative consequences. To develop a practice-based curriculum on patient-initiated mistreatment and examine participant perceptions before and after the curriculum. Single medical school in the United States. 306 senior medical students from classes 2022 and 2023. A single patient-initiated mistreatment session delivered during specialty-specific residency preparation courses (RPCs) featuring a literature discussion, a response framework, and patient-actor skills practice. Between February 2022 and October 2023, 22 sessions occurred. Electronic surveys were delivered before, following, and approximately eight months after each session. A total of 257 (84.0%) and 174 (56.9%) participants completed pre- and post-session surveys, respectively. Significant increases in mean scores were noted for confidence in recognizing mistreatment (pre-session 4.25, post-session 4.68; p < 0.001) and comfort in addressing mistreatment personally (pre-session 2.86, post-session 4.30; p < 0.001) and as a bystander (pre-session 2.98, post-session 4.27; p < 0.001). In the follow-up survey, participants noted that the session was useful in preparing them for residency. A novel patient-initiated mistreatment curriculum empowered students, resulting in enhanced confidence in responding and sustained skill usage. Medical schools may consider including this training for all graduating students.

The effects of e-learning using educational multimedia on the ethical decision-making and professionalism of nursing students during the COVID-19 pandemic: a quasi-experimental study

BackgroundThe COVID-19 pandemic has created a great challenge for educational systems worldwide. During this time, educational centers have been encouraged to use e-learning programs to protect the population against infection. Online teaching has the greatest effect on the process of teaching-learning for certain topics, including professional behavior and commitment, which has prompted educational systems to use creative strategies for a greater effect on learners. The present study aims to determine the effects of e-learning using educational multimedia on the ethical decision-making and professionalism of nursing students during the COVID-19 pandemic.MethodsThis study was conducted using a quasi-experimental design with a control group. The statistical population comprised second-semester nursing students in a first-rank nursing school in north western Iran. The samples were selected using simple random sampling and were divided into experimental (n = 40) and control (n = 40) groups. In the first stage of teaching, the conventional training method of the COVID-19 pandemic was used in both groups. In the second stage of teaching, an in-person workshop was organized for the control group and an e-learning workshop using educational multimedia for the experimental group. Data were collected by a tool with three parts: Demographic information, the Nursing Dilemma Test (NDT) by Crisham based on the Nurse Principled Thinking, and the Nursing Students Professional Behaviors Scale (NSPBS) designed by Goz. Data were analyzed in SPSS 25 software.ResultsThere was a statistically significant increase in the post-test mean score of professionalism (125.70 ± 6.20 vs. 120.95 ± 9.28) and ethical decision-making (46.17 ± 3.81 vs. 44.02 ± 3.21) in the experimental group compared to the control group (P < 0.05).ConclusionThe learning environment affects learning, and e-learning using educational multimedia has a greater impact than in-person workshops on improved learning outcomes with regard to ethical decision-making and professionalism.

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BackgroundIn adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional ‘downstream effects’ of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.MethodsThis retrospective observational study analysed hospitalisation claims data (2016–2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum’s de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).ResultsMortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98–4.18]) and 1-year follow-up (RR 2.76 [2.73–2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65–86% of VPD cases had new comorbidities diagnosed (versus 13–41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).ConclusionsThis analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

Developmental profile of Filipino children born during the SARS-COV-2 pandemic: pilot study.

The Philippines experienced one of the longest restriction periods during the COVID-19 pandemic. This study aimed to provide a developmental profile of 18-25 month-old children and identify factors associated with their development during their early years being born and raised during the pandemic. The study population was recruited through convenience sampling among families living in proximity to the daycare centers in Cainta, Rizal, Philippines. 116 children qualified to participate and underwent developmental screening using the Early Childhood Care and Development (ECCD) Checklist and their parents were interviewed related to demographic and social factors. The mean score of the children's Overall Development is 106.47 (SD = 13.43) indicating that children's skills were within the expected range of 80-119. Girls had significantly higher mean scores compared to boys [M Girl = 111.23, SD Girl = 9.95 vs. M Boy = 101.18, SD Boy = 14.83 t(114) = -4.32 p < 0.001]. Mean scores were highest among children whose mothers completed a high school education (M High School = 107.76, SD HighSchool = 12.47) compared to those who have some or have completed an elementary education (M SomeElem = 72.50, SD SomeElem = 6.36 and M Elem = 103.58, SD Elem = 13.86 respectively) [F(2, 113) = 8.18, p < 0.001]. Unadjusted linear regression shows a modest increase in mean scores as the number of household members increased [ꞵ = 0.86, (CI: 0.02, 1.70), t-score (1, 113) = 2.03, p = 0.045]. The developmental skills of 18-25 month-old children born and raised during the COVID-19 pandemic in an urban municipality in the Philippines are within average scores. Both hindering and protective demographic factors were identified as associated with the children's developmental evaluation scores. It is important to acknowledge these factors and continue monitoring the children's development and address needs among children who may need further support.

Quantification of facial symmetry in orthognathic surgery: A novel approach integrating 3D contour maps and hyper-dimensional computing

This study aimed to enhance the evaluation of facial symmetry crucial for planning and assessing outcomes of orthognathic surgery (OGS). An innovative approach combining three-dimensional (3D) facial contour lines with hyperdimensional (HD) computing was developed for this purpose. Data were collected using 3D cone beam computed tomography (CBCT) at Chang Gung Memorial Hospital from 2016 to 2021. A comprehensive dataset was compiled, including images from 150 normal individuals and 2500 patients, totaling 5150 preoperative and postoperative facial images. A machine learning model was trained to analyze these images, and 3D contour data were used to create a facial symmetry quantification system with HD computing. Additionally, 3D CBCT data from 200 patients before and after OGS were retrospectively reviewed for clinical application. The developed facial symmetry algorithm demonstrated an overall accuracy of 84.1 %. Postoperative facial symmetry scores improved significantly, with a mean score increase of 53 %, from 2.40 to 3.63. The study culminated in the creation of a web-based system that leverages HD computing and 3D contour mapping to automate facial symmetry assessment. This system offers a user-friendly interface for rapid and accurate evaluations, facilitating better communication between clinicians and patients.

Impact of the COVID-19 pandemic on patients with peripheral arterial disease in China: a multicenter cross-sectional study

This study aims to understand the repercussions of the COVID-19 pandemic on hospitalized patients with peripheral arterial disease (PAD) in China, who did not contract SARS-CoV-2. We conducted a multicenter cross-sectional analysis comparing the characteristics and outcomes of hospitalized PAD patients across two distinct periods: Pre-pandemic (P1, from January 2018 to December 2019) and during the pandemic (P2, from January 2020 to December 2021). During P1, 762 hospitalized patients were treated, with an average age of 72.3 years, while 478 patients were treated in P2, with an average age of 65.1 years. Notably, hospitalized patients admitted during the pandemic (P2) exhibited a significantly higher incidence of chronic limb-threatening ischemia (CLTI, 70% vs 54%), diabetic foot infection (47% vs 29%), and infra-popliteal lesions (28% vs 22%). Furthermore, these patients demonstrated a marked deterioration in their Rutherford category and an increased mean score in the Wound, Ischemia, and foot Infection classification system (WIfI). Treatment during the pandemic emerged as a predictor of reduced procedural success and increased major adverse limb events. Factors such as the presence of diabetic foot infection, renal impairment, and deteriorating WIfI scores were identified as independent risk indicators for major adverse limb events. Our results demonstrate that intensive care was provided to severe cases of PAD even during the challenging circumstances of the COVID-19 pandemic. Despite the unprecedented pressures on healthcare systems, patients with severe PAD, particularly those with CLTI, continued to receive necessary in-patient care. The findings underscore the importance of timely medical interventions and extended follow-up for patients exhibiting high-risk factors.

The Clinician-reported Genetic testing Utility InDEx (C-GUIDE) for Prenatal Care: Initial evidence of content and construct validity

ObjectiveTo develop and assess the face and construct validity of the Clinician-reported Genetic testing Utility InDEX (C-GUIDETM) for genetic testing in prenatal care. MethodsFollowing a literature review and consultation with clinical experts, a preliminary draft of C-GUIDE Prenatal was developed. Its face and content validity were then assessed by 19 prenatal genetics’ providers using interviews and surveys. Feedback informed further revisions. To test construct validity, four geneticist raters completed C-GUIDE on a retrospective sample of cases that received prenatal genetic testing and completed a concurrent global assessment of utility of these cases using an anchor item. A generalized estimating equations model was used to adjust for rater correlation and measure the association between C-GUIDE scores, global item scores, and potential clinical variables. ResultsTo develop C-GUIDE Prenatal, 7 items were removed, 10 items were modified, and 4 items were added. For 101 cases rated for validation, on average, a 1-point increase in the global item score was associated with an increase of 1.1 in the C-GUIDE score (p=0.04). Compared to uninformative results, informative positive and informative negative results were associated with a mean increase of 10.7 (SE=1.05) (p<0.001) and 5.6 (SE=1.85) (p<0.001), respectively. As indications for testing, known/familial variants were associated with a mean increase in the C-GUIDE score of 4.7 (SE=2.21) (p < 0.001) compared to ultrasound findings. C-GUIDE scores increased by a mean of 3.0 (SE=0.23) among cases for whom pregnancies were ongoing compared to those for whom they were not (p<0.01). ConclusionsThe significant positive associations between C-GUIDE total and the global item score and between C-GUIDE total, result type, indication for testing, and pregnancy status in the expected directions provide evidence of construct validity.

IMPROVING SPEAKING THROUGH INSIDE AND OUTSIDE CIRCLE STRATEGY

This research used a classroom action research design conducted at SMPN 2 Ubud, Bali. The pre-test results showed that students needed help with fluency, comprehensiveness, and grammar speaking skills. In addition, this research aimed to determine whether seventh-grade students' speaking skills could be improved by implementing the Inside and Outside Circle strategy. The research was carried out in two cycles, with two sessions. Tests and questionnaires served as the research instruments. Fifty-eight were the results of the pre-test, while 69 and 79 were the post-test I and II findings. After that, the data was examined by contrasting the pre-test and post-test results, which led to a notable increase in the individuals' mean scores. Questionnaires were distributed as supplementary data after the previous cycle. The individuals' positive reactions to the strategy's implementation were evident from the questionnaire's results. According to the results of the research instrument, the inside and outside circle strategy can improve students' speaking abilities.

Finerenone Improves Outcomes in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction Irrespective of Age: A Prespecified Analysis of FINEARTS-HF.

Background: Finerenone improves outcomes in patients with HF and mildly reduced or preserved ejection fraction (HFmrHF/HFpEF). It is important to understand the efficacy and safety of finerenone in these patients according to age. Methods: The aim of this analysis was to evaluate the interaction between age and the efficacy and safety of finerenone in the FINEARTS-HF trial (Finerenone trial to investigate efficacy and safety compared to placebo in patients with heart failure). A total of 6,001 patients aged 40-97 years were stratified by quartile (Q 1-4) of baseline age: Q1 40-66 years (n=1,581), Q2 67-73 years (n=1,587), Q 3 74-79 years (n=1,421), and Q4 ≧ 80 years (n=1,412). FINEARTS-HF evaluated the impact of age on the efficacy of finerenone with respect to the primary composite outcome of cardiovascular death and total (first and recurrent) HF events, including HF hospitalization or urgent HF event, along with secondary efficacy and safety outcomes. Results: The incidence of primary outcome increased with age. Finerenone reduced the risk of the primary outcome consistently across all age categories: RR (95% CI) Q1 0.70 (0.53- 0.92), Q2 0.83 (0.64-1.07), Q3 0.98 (0.76-1.26), and Q4 0.85 (0.67-1.07); p for interaction =0.27. Similarly, a consistent effect was observed for the components of the primary outcome. The mean increase in Kansas City Cardiomyopathy Questionnaire-total symptom score from baseline to 12 months was greater with finerenone than placebo, with a consistent effect across all age categories: mean placebo-corrected change (95% CI) Q1 2.87 (1.09-4.66), Q2 1.24 (-0.59-3.07), Q3 0.94 (-0.98-2.86), and Q4 1.24 (-0.90-3.38); P-interaction=0.50. Adverse events were similar across all age categories. The odds of experiencing hypotension, elevated creatinine, or hyperkalemia (increased) or hypokalemia (decreased) related to finerenone did not differ by age. Conclusions: In the FINEARTS-HF trial, finerenone reduced the primary outcome and components of the primary outcome, and improved symptoms across a wide age spectrum. In addition, finerenone was safe and well-tolerated, irrespective of age. Trial Registration: URL: https://clinicaltrials.gov Unique Identifiers: NCT04435626 and EudraCT 2020-000306-29.

Coping with COVID-19: a prospective cohort study on young Australians' anxiety and depression symptoms from 2020–2021

BackgroundStudies have shown that the coronavirus (COVID-19) pandemic negatively impacted the mental health of young Australians. However, there is limited longitudinal research exploring how individual factors and COVID-19 related public-health restrictions influenced mental health in young people over the acute phase of the COVID-19 pandemic. This study aimed to identify risk and protective factors associated with changes in individual symptoms of anxiety and depression among young Australians during the COVID-19 pandemic.MethodsThis prospective cohort study collected data on anxiety and depression symptoms of young Australians aged 15–29 years old using the Depression, Anxiety and Stress Scale short form (DASS-21). We delivered four online questionnaires from April 2020 to August 2021 at intervals of 3, 6, and 12 months after the initial survey. We implemented linear mixed-effects regression models to determine the association among demographic, socioeconomic, lifestyle and COVID–19 public health restrictions related factors and the severity of anxiety and depression symptoms over time.ResultsAnalyses included 1936 young Australians eligible at baseline. There was a slight increase in DASS-21 anxiety mean scores from timepoint 3 to timepoint 4. DASS-21 depression scores showed slight fluctuations across timepoints with the highest mean score observed in timepoint 2. Factors associated with increases in anxiety and depression severity symptoms included LGBTQIA + identity, financial insecurity both before and during the pandemic, higher levels of loneliness, withdrawal or deferral of studies, spending more time on social media, and difficulties to sleep. Risk factors for only depression symptoms include unemployment during COVID-19 pandemic and being in lockdown. Living with someone was a protective factor for both anxiety and depression symptoms, pre-COVID-19 unemployment for depression symptoms, and older age and unemployment during the pandemic for anxiety symptoms.ConclusionThese findings indicate that during the first year of the pandemic in Australia, there were significant changes in young people’s mental health which were associated with multiple demographic, socioeconomic, lifestyle, and lockdown factors. Hence, in future public health crises, we suggest more inclusive guidelines that involve young people in their development and implementation ensuring that their unique perspectives and needs are adequately considered.

Emergency Response Competencies Strengthened by Sustainable Education: First Aid Training Program for Teachers

The primary aim of this study is to assess the knowledge, attitudes, and skills of primary school teachers regarding the management of musculoskeletal trauma through first aid interventions and to determine the effectiveness of a sustainable training program. The preparedness of 138 teachers who received first aid training for trauma intervention and the impact of these trainings on health practices were examined by pre- and post-tests. It was determined that 87% of the teachers participating in the study had not received emergency trauma training before. Pre-training test results showed that the participants had a low level of awareness. However, the increase in mean scores from 6 to 16 and the decrease in standard deviation after the training revealed a significant increase in teachers’ knowledge, attitudes, and skills. These results suggest that emergency trauma training programs significantly increase teachers’ ability to respond to emergencies and emphasize the importance of sustainable first aid training. Analyses based on gender and branch revealed that post-training test scores were similar and all teachers showed high performance. The findings emphasize the need for systematic and comprehensive emergency trauma training programs for all teachers and the importance of these programs for sustainable health and safety practices.

INFLUENCE OF ENGLISH LANGUAGE EXPOSURE MEDIA ON THE STUDENTS’ SPEAKING ABILITY

This research was conducted to find out whether English Language Exposure Media influence students’ speaking ability or not. This research also concentrated on utilizing different types of English language exposure media within the curriculum, including music videos, podcasts, and songs. All of the media were presented in English language to give them the exposure of the language. A pre-experimental design was utilized, incorporating a pre-test, post-test, and two treatment phases. Data were gathered using a measurement technique that involved a speaking test. The research findings revealed that the pre-test score averaged 54.60, while the post-test score averaged 78.33. The mean score difference between the pre-test and post-test was 25.73, indicating an improvement in students' speaking abilities following the treatments. The effect size (ES) was calculated to be 2.38, which is classified as a strong effect (ES &gt; 1.00). The research demonstrated a substantial improvement in students' speaking ability, with a mean score increase from 54.60 to 78.33, indicating the effectiveness of English language exposure media. Future research could explore the long-term impact of English language exposure media on students' speaking skills. Additionally, examining the effectiveness of different types of media and their influence on various language skills would provide a more comprehensive understanding.

Two-Phase Individual Assessments: A Second-Chance Assessment Strategy With Individualized Feedback to Promote Assessment for Learning.

High-stakes multiple-choice question (MCQ) exams in medical education typically focus on assessment of learning at a single point without providing feedback for improvement. Educators can achieve a more balanced approach to MCQ exams by combining efficient assessment of learning with the feedback and improvement opportunities of assessment for learning. As part of a curriculum renewal at Baylor College of Medicine's MD program, the Two-Phase Individual Assessment (TPIA) model was launched within a 4-week preclinical Foundations of Medicine course in August 2023. The TPIA model featured weekly assessments, each consisting of 2 MCQ exams given on the same day with a 4-hour study period in between. Exams were paired, consisting of an equal number of items that addressed the same learning objectives. After the initial exam, students received an individualized feedback report indicating correctly and incorrectly answered objectives. Students applied individualized feedback reports to self-identify and remediate deficiencies in preparation for the second-chance exam. Only the highest score counted toward the final grade. Among 230 medical student participants, significant performance improvements between morning and afternoon exams were observed across the first 3 weekly TPIAs, with mean score increases of 4.93, 5.06, and 10.86. Mean change in performance in week 4 was not significant. Student end-of-course survey responses indicated a strong preference for the TPIA format. Responses highlighted the value of offering individualized feedback, providing unstructured time to address knowledge gaps, and ensuring a corresponding opportunity for improvement. Future research will extend TPIA's implementation in more clinical-oriented courses to validate TPIA's effectiveness and explore its effect on long-term knowledge retention through more cumulative examinations. Integrating TPIA-based approaches may advance educational systems toward developing a culture of feedback and embracing second chances to support learning and professional growth, thereby preparing medical professionals for the demands of 21st-century medicine.

Surgeon stress, anxiety, and workload: a descriptive study of participant reported responses to fundamentals of laparoscopic surgery exercises

BackgroundStress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study’s primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures.MethodsSurgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and “stressed” environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation.ResultsOf the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p < .001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p < .001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in “stressed” simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the “stressed” environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r = .40) and strongly positively correlated post-simulation (r = .70), however only stress was strongly correlated to workload (r = .79).ConclusionStress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload.Graphical

The Impact of Obesity on Childbirth Expectations.

Positive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well-being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs. Using an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one-way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors. In total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P =.008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P <.001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.95; P =.027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11-6.32; P <.001 and aOR, 4.77; 95% CI, 3.37-6.74; P<.001, respectively). Women living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well-being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.

Comparing Mental Strain and Subjective Sensations With and Without a Wearable Chair While Performing Simulated Suturing Tasks.

Introduction Prolonged standing during surgery is a cause of musculoskeletal disorders in surgeons. Wearable chairs have reportedly reduced musculoskeletal strain effectively when used in industry. However, discomfort and instability issues may remain. This study examines whether using a wearable chair for surgical procedures imposes negative effects, such as mental or physical strain on surgeons prior to its clinical implementation. Methods This prospective cross-over study compared mental strain and subjective sensations in simulated suturing tasks with and without using Archelis®, a wearable chair (Archelis Inc, Yokohama, Japan). Six surgeons participated in the study. Mental strain was examined using heart rate variations calculated during tasks. Four subjective sensations (fatigue, comfort, balance, and workability) after each task and differences in body localized pain pre- and post-task were compared using a 10 centimetres (cm)-visual analog scale (VAS) score questionnaire. Results Results showed no significant differences in mental strain nor subjective sensations with or without the wearable chair. The mean VAS scores for all four subjective sensations with the wearable chair were relatively positive. There was a slight yet insignificant post-task increase in VAS mean scores for body-localized pain in the lower legs. Conclusions Significant negative effects on surgeons from the wearable chair were not observed during simulated suturing procedures. This demonstrates no major barriers in the initial phases of wearable chairs integration into the surgery environment.

The Effect of Breathing and Relaxation Exercises Training on Psychological Well-Being and Sleep Quality in Individuals Diagnosed With Schizophrenia: A Randomized Controlled Study.

This study was conducted to determine the effect of breathing and relaxation exercises training on psychological well-being and sleep quality in individuals diagnosed with schizophrenia. This study was conducted at a community mental health center between October 2022 and April 2023 as a randomized controlled study with a pretest-posttest control group. The study's participants were 64 individuals diagnosed with schizophrenia (31 in the experimental group and 33 in the control group). The Descriptive Characteristics Form, the Psychological Well-being Scale, and the Pittsburg Sleep Quality Index were used to collect data. The individuals in the experimental group underwent 6 sessions of breathing and relaxation exercises training in the form of group training, and no training was applied to the individuals in the control group. It was determined that the individuals in the experimental group had an increase in the total mean score of psychological well-being and a decrease in the total mean score of sleep quality after breathing and relaxation exercise training. In addition, a statistically significant difference was found between the posttest psychological well-being and sleep quality total mean scores of the experimental and control groups (P <.05). It can be said that breathing and relaxation exercises training can be used as an effective intervention to increase the psychological well-being and sleep quality of individuals diagnosed with schizophrenia and can be used in addition to pharmacological treatment.