Initial Session Research Articles

Early experience with coronary debulking devices in a newcomer facility after introducing revised facility criteria in Japan.

Coronary debulking devices are essential in obtaining optimal results in percutaneous coronary intervention (PCI) for severely calcified lesions. However, since the introduction of these devices in Japan, the presence of full-time cardiovascular surgeons in their own facilities has been an essential condition (on-site surgical back-up) as the facility criteria for their use. The criteria were revised in April 2020, making their implementation possible at our hospital. Between May 2020 and January 2022, we administered PCIs using rotational atherectomy (RA) for 33 lesions in 28 patients and orbital atherectomy system (OAS) for 36 lesions in 27 patients. The most preferred strategy in our hospital is OAS via the distal radial approach using a 6Fr Glide sheath or RA via the femoral approach using a 7Fr sheath. The percentages of usable imaging modality as an initial device without lesion modification were 57.1 and 66.7% in the RA and OAS groups, respectively. In the RA procedure, 1.5- and 2.0-mm Rota burrs were more frequently adopted for the initial and second sessions, respectively. In the OAS procedure, the debulking was always initiated at a low speed. Nineteen of the 27 patients underwent additional high-speed debulking. Pre-procedural quantitative coronary angiographic analysis revealed that the minimal lumen diameter was significantly smaller in the RA than in the OAS group. Debulking procedures were successful in all patients excluding two instances of procedure-related complications in the RA group, one of which was coronary perforation safely treated via covered stent deployment without any resulting hemodynamic instability. Our early experience with coronary debulking devices with off-site surgical back-up clearly reveals the safety and feasibility of this procedure in a newcomer facility.

The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland

BackgroundIntercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience.MethodsInternal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student’s unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance.ResultsMean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session (P = < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience.ConclusionsSBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments.

Safety and Efficacy of Radial Versus Femoral Artery Access for Mechanical Thrombectomy Procedures Following Intravenous Administration of Tissue Plasminogen Activator

BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures is a safe and effective alternative to the transfemoral artery (TFA) approach. We compared the efficiency and periprocedural outcomes of TRA and TFA approaches for acute stroke interventions in patients receiving intravenous tissue plasminogen activator.MethodsA retrospective cohort study analyzed data from patients at a large cerebrovascular center from January 1, 2014, to March 31, 2021. Baseline characteristics, periprocedural efficiency and efficacy, and in‐hospital outcomes were compared between intervention cohorts (TRA and TFA).ResultsOf 314 patients analyzed, 21 (7%) underwent a TRA approach and 293 (93%) underwent a TFA approach. Complications occurred in one (5%) of 21 patients in the TRA cohort and 20 (7%) of 293 patients in the TFA cohort. Access site complications were present in 12 (4%) patients with TFA, and no patients with TRA experienced access site complications. The mean length of stay was significantly longer for the TFA cohort (8.8 days [standard deviation, 8.5 days]) versus the TRA cohort (4.8 days [standard deviation, 2.9 days]) (P=0.02). Linear regression analysis showed that femoral access, Medicaid insurance, and discharge National Institutes of Health Stroke Scale score &gt;10 predicted longer length of stay (P≤0.046). However, when the time to initial physical or occupational therapy session was added to the model, access site was no longer significant (P=0.42).ConclusionThe TRA approach may reduce periprocedural complications and hospital length of stay compared with the TFA approach. The shorter length of stay associated with TRA access appeared to be associated with earlier initiation of physical or occupational therapies.

Validation of the patients-specific functional scale in patients with haemophilia.

A complete functional assessment is essential to measure health status and treatment effects in patients with haemophilia. The Patient-Specific Functional Scale (PSFS) is a reliable, valid, simple and quick scale that measures physical function in patients with musculoskeletal disorders. However, the reliability and validity of the PSFS have not been evaluated in patients with haemophilia. The aim of this study was to validate the Patient-Specific Functional Scale in patients with haemophilia. Twenty-eight patients with haemophilia participated in the study. They completed the PSFS and the Haemophilia Activity List (HAL) scales by telephone during an initial session, and then repeated the assessment in a follow-up session 1week apart. Reliability was analysed by the internal correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). The concurrent validity of the PSFS was determined by correlating the initial score of the PSFS scale to the initial score of the HAL scale. Correlations were calculated by means of scatter plots and Pearson product-moment r correlation coefficient. ICC and SEM values showed excellent reliability for the PSFS scale, with a SDC of 1. A significant moderate correlation was found between the results of the PSFS and the HAL (r=.57, P <.001). The PSFS is a reliable and valid scale to measure the functionality of people with haemophilia.

Person-Centered Memory Care Through Montessori for Dementia and Ageing: A Quality Improvement Study.

Montessori for Dementia and Ageing (MDA) is a philosophy to support person-centered care (PCC) and autonomy of older adults. This quality improvement project documented outcomes of implementation of the MDA philosophy in a long-term care memory neighborhood. After an initial training session, MDA was implemented with weekly, 2-hour on-site coaching sessions over the course of two semesters (28 weeks) with a community of 20 female persons living with dementia (PWD). Primary outcomes were negative responsive behaviors of PWD, whereas the secondary outcome included percentage of active engagement of PWD. Mean number of negative responsive behaviors was 62.21 at baseline, which decreased to 33.82 at the end of the project per the Cohen-Mansfield Agitation Inventory. At baseline, PWD were actively engaged in 18.15% of observed opportunities, according to the Engage portion of the Resident-Centered Assessment of Interactions with Staff and Engagement Tool. At the end of the project, PWD were actively engaged in 40.56% of observed opportunities. Results suggest that MDA is feasible to implement PCC in a long-term care memory neighborhood. [Journal of Gerontological Nursing, 48(8), 6-9.].

Fractional CO2 laser and adjunctive therapies in skin of color melasma patients

BackgroundAblative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized.ObjectiveTo evaluate the safety and outcomes of ablative fractional CO2 lasers on refractory melasma in patients with skin of color.MethodsA retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO₂ laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session.ResultsAmong the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance (P < .05). The CO₂ laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO₂ laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement.LimitationsRetrospective study design with short follow-up period and a small sample size.ConclusionAblative CO2 laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.

Development of a Personalized Tobacco Cessation Intervention Package (PTCIP) for Persons with Schizophrenia in India.

Among persons with schizophrenia (PwS), tobacco use is higher in comparison to the general population, contributing to greater morbidity and mortality. Pharmacological interventions combined with psychosocial interventions are effective in tobacco cessation. While the effectiveness of extant psychosocial interventions-when used in isolation-seems limited, developing better combinations of interventions could help treatment providers deliver tobacco cessation services to PwS at different stages of motivation to quit. We aimed to develop a personalized tobacco cessation intervention package (PTCIP) for PwS. The stage-based intervention package was developed through a systematic review of interventions for tobacco cessation, the authors' clinical experience, and expert validation. The components of the intervention package, developed for PwS visiting the outpatient psychiatric department, were retained, removed, or added based on the content validity ratio (CVR). The final components included brief advice, principles of motivational interviewing, psychoeducation, decisional balance matrix, positive reinforcement, offering various treatment options, personalized feedback using a smoking-risk calculator, and prediction of cardiovascular risk using the WHO package of essential noncommunicable disease (PEN). The delivery of the intervention package was refined based on pilot testing in eight participants. The tailored package was designed to be delivered by a mental health professional as a single comprehensive 40 min to 45 min face-to-face session, integrated with routine follow-up visits, followed by two telephonic conversations in the second and third week of the initial session. The package needs to be tested in a randomized controlled trial for its effectiveness.

Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study.

BackgroundPhysical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences.ObjectiveThis study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement.MethodsA mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire–Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked.ResultsThe International Physical Activity Questionnaire–Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC.ConclusionsEarly results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC.

Conceptual Invariance, Trajectories, and Outcome Associations of Working Alliance in Unguided and Guided Internet-Based Psychological Interventions: Secondary Analysis of a Randomized Controlled Trial.

BackgroundThe role of working alliance remains unclear for many forms of internet-based interventions (IBIs), a set of effective psychotherapy alternatives that do not require synchronous interactions between patients and therapists.ObjectiveThis study examined the conceptual invariance, trajectories, and outcome associations of working alliance across an unguided IBI and guided IBIs that incorporated clinician support through asynchronous text messaging or video messaging.MethodsAdults with high education attainment (n=145) with subclinical levels of anxiety, stress, or depressive symptoms were randomized to 1 of 3 treatment conditions for 7 weeks. All participants received treatments from MyCompass, an unguided IBI using cognitive behavior therapy. Participants in condition 2 and 3 received supplemental, asynchronous clinician support through text and video, respectively. Working alliance with the IBIs was measured weekly using select items from the 12-item version of the Agnew Relationship Measure. Symptom and functional outcomes were assessed at baseline, at the end of treatment, and 1-month follow-up.ResultsWorking alliance with the IBIs was conceptually invariant across the 3 conditions. Working alliance followed a quadratic pattern of change over time for all conditions and declined significantly only in the text-support condition. After controlling for baseline symptoms, higher baseline levels of working alliance predicted less depression and less functional impairment at follow-up, whereas faster increases in working alliance predicted less worry at the end of treatment and at follow-up, all of which only occurred in the video-support condition.ConclusionsWorking alliance with the IBIs was generally established in the initial sessions. Although working alliance is conceptually invariant across IBIs with or without clinician support, the associations between working alliance and treatment outcomes among IBIs may differ depending on clinician involvement and the modalities of support.Trial RegistrationClinicalTrials.gov NCT05122429; https://clinicaltrials.gov/ct2/show/NCT05122429

Use and Trends of Diabetes Self-Management Technologies: A Correlation-Based Study.

Applications and systems for diabetes self-management are growing and involve a vast majority of factors to consider. This study was aimed at examining the integration of portable technologies for diabetes self-management, as well as benefits and issues arising of its use. From a web-based study on several groups of people with diabetes, most of them accustomed to the daily use of devices and applications for self-control, a deeper analysis based on correlations and inference was conducted considering information about the disease, technology knowledge and devices handling, use of technologies for diabetes control and management, and training with devices from a clinical and educational viewpoint. In this study, more than 70% of participants use Continuous Glucose Systems and additional devices (41.85% also use insulin pumps) which impacts positively on the knowledge of incoming technologies. The “easy to use” factor of current apps for diabetes self-management is the most valuable feature. Also, 88.98% of participants did not use gamification-based methods during the initial training sessions, although gamification is a useful technique in learning stages. An inference analysis shows how specific characteristics of diabetes devices and apps should improve. On the basis of the results, we discuss about benefits, shortcomings, and the state of these technologies and patient needs for the future.

Dismissing Attachment and Global and Daily Indicators of Subjective Well-Being: An Experience Sampling Approach.

The present research examined whether a dismissing attachment style (i.e., being high in attachment avoidance and low in attachment anxiety) is a risk factor for low subjective well-being (SWB). Specifically, we examined the associations between dismissing attachment and two indicators of SWB: global life satisfaction and daily affect. Self-reports of attachment and overall life satisfaction were collected from 257 adults at an initial lab session. Afterward, experience sampling methodology was used to gather repeated measures of positive and negative affect, as well as social context, from the sample for 8 days. Our findings indicate that, on average, dismissing people reported fairly modest levels of overall life satisfaction. Moreover, they experienced relatively low levels of both negative affect and positive affect across the 8-day study period. Overall, our results suggest that dismissing people have a "muted" or dull emotional life.

Decision-Making Scoring System for the Repetition of Conventional Transarterial Chemoembolization in Patients With Inoperable Hepatocellular Carcinoma.

Patients with unresectable hepatocellular carcinoma treated with conventional transarterial chemoembolization (cTACE) have heterogeneous tumor burden and liver function. Therefore, the selection of patients for repeated cTACE is challenging owing to different outcomes. This study aimed to establish a decision-making scoring system for repeated cTACE to guide further treatment. All patients with hepatocellular carcinoma who underwent cTACE between 2008 and 2019 were included and randomly assigned into training (n = 324) and validation (n = 162) cohorts. Tumor Size, number of Masses, Albumin-bilirubin score, baseline Alpha-fetoprotein level, and Response to initial cTACE session were selected to generate a "SMAART" score in the training cohort. Patients were stratified according to the SMAART score: low risk, 0-2; medium risk, 3-4; and high risk, 5-8. Prediction error curves based on the integrated Brier score and the Harrell C-index validated the SMAART scores and compared them with the Assessment for Retreatment with Transarterial chemoembolization (ART) score. The low-risk group had the longest median overall survival of 39.0 months, followed by the medium-risk and high-risk groups of 21.2 months and 10.5 months, respectively, with significant differences (P < 0.001). The validation cohort had similar results. The high-risk group had 63.1% TACE refractory cases. The Harrell C-indexes were 0.562 and 0.665 and the integrated Brier scores were 0.176 and 0.154 for ART and SMAART scores, respectively. The SMAART score can aid clinicians in selecting appropriate candidates for subsequent cTACE. A SMAART score of ≥5 after the first cTACE session identified patients with poor prognosis who may not benefit from additional cTACE sessions.

A Peer Supervision Pilot Scheme

AimsFollowing mixed feedback from Foundation (FY) trainees during their Psychiatry placements, Cheshire and Wirral Partnership NHS Trust introduced a pilot scheme whereby FY and General Practice (GP) trainees were paired with a current Psychiatry Core Trainee (CT). This was in addition to regular Clinical Supervisor meetings with weekly self-directed sessions encouraged. Suggestions included covering portfolio requirements or facilitating joint learning. The study aimed to improve FY/GP experience through increased learning and relationship-building opportunities. It equally offered leadership experience for CTs and development of supervision skills. Feedback gathered from the initial pilot would highlight difficulties and guide future peer supervision schemes.MethodsAll FY/GP trainees allocated to the Trust from April–August 2021 were included. CTs were included by default but given the option to opt-out (opt-out policy). Pairings were made based on locality where possible (group sizes ranging from 2 to 3) and an initial supervisor training session was provided by the Director of Medical Education. Online feedback surveys were sent to all participants at baseline and after the pilot.Results44 doctors were included in the pilot scheme, of which 26 completed the pre-pilot survey and 16 completed the post-pilot survey. Expected personal benefit prior to the scheme averaged 7.1/10, where 10 was deemed “extremely helpful” and 1 “not at all”. Following the scheme, experienced personal benefit was valued at 4.7/10. Reported benefits of the scheme were friendship, support and learning, although around a third described no benefit whatsoever. The most common problem encountered was that of being unable to meet and was seen in almost half of cases, with detailed feedback citing rota clashes or working on separate sites. Other problems included poor engagement and feeling the pairing was a poor match. Written feedback stated that the scheme was a good idea and well-supported, however there were challenges with its execution.ConclusionResponse rates were low throughout but particularly in the post-pilot survey, limiting interpretation. Overall, final scores did not appear to reflect initial optimism. The next cycle will include only CTs who have requested to be involved (opt-in policy), to establish whether this improves engagement. It will additionally incorporate a mid-point review to highlight and address issues at an earlier stage. The scheme is due to be repeated in 2022 and re-evaluated.

Proceedings of the 17th Annual International INEBRIA Conference

Proceedings of the 17th Annual International INEBRIA Conference

Feasibility, efficacy, and cautionary note of endoscopic resection for gastric tube cancer after esophagectomy

BackgroundGastric tube cancer (GTC), whose usual histology is adenocarcinoma, occurs frequently as a result of improved survival after esophagectomy. Whether endoscopic resection (ER) for GTC is safe and suitable and guidelines for treatment and follow-up remains unclear.MethodsPatients with GTC who underwent ER at Kanagawa Cancer Center Hospital between 1997 and 2020 were studied retrospectively to evaluate clinical characteristics and short- and long-term outcomes.ResultsTwenty-two consecutive patients with 43 lesions were treated in 42 sessions of ER. Lesions were discovered at a median of 9.0 (0–21.8) years after esophageal surgery. Nine (40.9%) patients had multiple lesions at the time of the initial ER session. However, six (54.5%) of the 11 co-existing lesions were overlooked. The location of the middle third was an estimated risk factor for overlooking (p = 0.028). In endoscopic submucosal dissection (ESD) cases, the en bloc dissection rate was as high as 97.1%, and the rates of bleeding, perforation, and aspiration pneumonitis were 17.6%, 0%, and 2.9%, respectively. The bleeding rate was relatively higher than that in usual gastric ESD. Twelve patients (54.5%) experienced synchronous and/or metachronous multiple GTCs during their life span. Thirteen (61.9%) patients died during the median follow-up period of 5.9 (0.7–15.5) years. One patient (7.7%) died of GTC recurrence, 15.4 years after the initial non-curative ER date; 3 (23.1%) patients died of esophageal cancer recurrence, and 3 (23.1%) died of other organ malignancies. The 5-year overall survival rate was 85.0%, and the 5-year disease-specific survival rate was 100%.ConclusionsER is feasible for GTCs. However, the rate of bleeding was high in ESD cases. Life-long endoscopic screening of metachronous lesions is desirable. Care should be taken not to overlook lesions in the middle third of the gastric tube. Early detection of esophageal cancer recurrence and other organ malignancies may improve prognosis.

Exploring the Effectiveness of Counseling Intervention on Sedative Drug Addiction at Penjara Kajang

The COVID-19 pandemic which strike Malaysia and worldwide is a nightmare for most individuals. It brought various implications that in turn change the pattern of human’s life. There are some individuals who fail to adapt causing them to experience emotional disturbances that contribute to mental health problems. It also contributes to various social problems including drug abuse, domestic violence, divorce and others. Hence, this study was conducted to identify the causes and effects of sedative drug abuse as well as to examine the level of effectiveness of counseling interventions and coping strategies in solving this problem. This study was conducted qualitatively involving interview sessions and individual counseling sessions to one of the detainees in Kajang Prison who was involved in sedative drug abuse. The implementation of counseling sessions through Motivational Interviewing (MI) approach and Reality Therapy were conducted. The use of Motivational Interviewing in the initial session is seen to be effective in increasing client motivation. While the use of reality theory is seen to help clients in making decisions, plan and taking action. In conclusion, the right and proper counselling approach can help clients in the issue of drug addiction as well as the selection of coping strategies in dealing with the problems faced.

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

BackgroundTo evaluate the safety and efficacy of bilateral balloon pulmonary angioplasty (BPA) as compared with unilateral BPA for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH).MethodWe reviewed 210 consecutive BPA sessions for 92 CTEPH patients, including 124 unilateral BPA sessions and 86 bilateral BPA sessions. Radiation exposure, operation details, lesions characteristics and the occurrence of complications were compared between unilateral BPA and bilateral BPA. 131 BPA sessions with a hemodynamics follow-up were included for efficacy analysis, in which hemodynamics changes were compared. Logistic regression analysis was used to identify factors associated with the occurrence of complications.ResultBilateral BPA treated more lobes, arteries and lesions [3 (2, 4) vs. 2 (1, 3) lobes, p < 0.001; 8 (5.5, 10) vs. 6 (4, 8) vessels, p = 0.003; 9 (7, 12) vs. 8 (5, 10) lesions, p = 0.01] in one single session than unilateral BPA in a comparable operation duration and amount of contrast media given. Overall, the occurrence of complications was similar between bilateral BPA and unilateral BPA [9 (10.5%) vs. 12 (9.7%), p = 0.83]. Hemodynamics effects didn’t differ significantly between bilateral BPA and unilateral BPA in a single session [mPAP, − 4.5 ± 8.6 vs. − 3.6 ± 7.3 mmHg, p = 0.52; PVR, − 1.1 (− 3.5, 0.8) vs. − 1.8 (− 5.2, 0.3) Wood units, p = 0.21]. For the initial BPA session, bilateral BPA also treated more lobes, arteries and lesions than unilateral BPA [3 (2, 4) vs. 2 (1, 2) lobes, p < 0.001; 8.0 (5.8, 9.3) vs. 6.0 (4.0, 8.0) vessels, p = 0.04; 9 (6, 12) vs. 7 (4, 10) lesions, p = 0.02]. The occurrence of complications was also similar [5 (13.2%) vs. 5 (9.3%), p = 0.80], even in patients with poor baseline hemodynamics. Univariate regression analysis reveals the number of lobes treated/session, but not bilateral BPA, as predictive factors of complications.ConclusionBilateral BPA may be safely and effectively performed in patients with CTEPH without increasing operation duration and radiation burden, even in patients with unfavorable baseline hemodynamics.

Periodic reinforcement of knowledge and attitude towards basic life support skills among the medical undergraduates: A necessity of undergraduate medical education

Introduction and Aim: A sudden cardiac arrest can be a life-threatening emergency with poor survival rates. By learning basic life support (BLS) and practicing simple cardiopulmonary resuscitation (CPR), the patient is likely to survive until arrival of expert medical help. The study therefore aims to determine if trained medical undergraduate students retain knowledge and attitude regarding skills. Methods: About 150 students in the first year of medical school participated in the current study. The students attended two BLS training sessions of three hours each. The students were evaluated at six weeks and followed up at six months following the initial training session. The psychomotor skills were check-listed, and the performance was scored between 0 to 5. Data on knowledge and attitudes were collected with a pre-validated self-administered questionnaire. Results: Among the participants, 69% were males, and 33% were females. The mean age group of study subjects was 21 ± three years. The skill scores (p=0.001) and knowledge scores (p=0.001) were significantly different at six weeks and six months after the initial training. Six weeks after the initial training session, the percentage of correct responses for knowledge questions was significantly higher than six months later. Approximately 86.3% of participants felt the BLS training was adequate to perform resuscitation confidently, while only 66.7% were confident after six months of training (p=0.001). Also, the number of students confident to give BLS during a medical emergency was significantly higher at six weeks after the initial training session than six months (p=0.001). Conclusion: The study shows significant decay in psychomotor skills and knowledge and attitude among the medical undergraduates. Therefore, regular hands-on training with certifiable courses is required to reinforce skills and update knowledge regarding BLS.

Assessing the Effect of Restudying Anatomy with Flashcards versus Handouts in Study Groups Equalized by Memory Test Scores

IntroductionRetrieval practice through testing can strengthen long‐term memory. Experimentally, this concept known as the “testing effect” has often been demonstrated using word pairs. As many health science students quiz with flashcards to enhance recall, can the testing effect be detected within the more complex study of anatomy? It was hypothesized that participants utilizing flashcards for review would score higher on tests than those restudying a handout.MethodsStudents were recruited from Pacific Northwest University of Health Sciences (PNWU). On day 1 of the study, subjects were given 3 memory tests (assessing memory of printed words, pictures, and spoken words), the scores of which were combined and used to assign participants to groups with approximately equal “memory.” Participants studied a handout on ruminant digestive anatomy, a topic novel to most students. After the initial study session, subjects were divided into a “flashcard group” (FG) or a “handout group” (HG) and reviewed the learned material via their assigned method. Participants then took a 15‐question test, indicating whether they were confident or not for each answer, and took a similar test 1 and 3 weeks later. Participants completed surveys on demographics, existing knowledge of ruminants and anatomical terms, wellness, and study behaviors on day 1 of the study. Data were analyzed using Mann Whitney U test, Fischer’s exact test, Pearson Correlation Coefficient, and repeated measures ANOVA using SPSSv25.0 software with p&lt;0.05 considered statistically significant. This study was deemed exempt by PNWU IRB (#2021‐015).ResultsThough not statistically so, mean scores were higher in the FG than in the HG for each of the ruminant digestive anatomy assessments. For day 1 test score means (FG 10.67 ± 1.50 vs HG 9.00 ± 2.68), a large effect size (ηp2=0.16) was detected. While the FG started with more experience with anatomical terms (p=0.046), this experience was not significantly correlated with day 1 test scores (n=17). Though the FG tended to perform better on day 1 tests, the HG was more confident in their answer choices (mean confidence scores HG 10.00 ± 1.10 vs FG 7.78 ± 1.72), with a large effect size present (ηp2=0.38). Memory scores were not significantly different between the FG and the HG. Though not significant, most memory scores were negatively correlated with age. Sleep was negatively correlated with memory scores, which was significant for memory of printed words (r=‐0.56; p=0.019). Female memory scores consistently ranked higher than male scores.ConclusionsParticipants who restudied with flashcards tended to outperform those restudying handouts on tests covering a novel anatomy topic, suggesting that the testing effect may have occurred. Interestingly, the opposite pattern was seen in confidence, with those studying handouts seemingly more confident in their test answers. Utilizing memory test scores resulted in evenly distributed groups with respect to memory, and some intriguing potential differences were seen related to sleep on the night before day 1 of the study, age, and gender. This study was limited by a small sample size and should be expanded to further investigate the effect of various restudy techniques, such as using flashcards or handouts while learning anatomy.

Effects of Partner vs Individual Restudy Techniques on Knowledge and Confidence While Learning Anatomy

For health science students to learn huge amounts of information they must optimize their ability to retain information. Quiz‐based learning has been shown to be more effective than passive restudying, a phenomenon known as the “testing effect.” In medicine, appropriate self‐assessment of ones’ own knowledge is an important quality to limit medical error. We hypothesized partner study groups (PG) would outperform individual groups (IG) on knowledge tests based on increased adherence to quiz‐style learning. We thought PG would appropriately indicate their confidence on answer choices since they quizzed with and received feedback from their partner on incorrect answers while studying.Graduate level students recruited from Pacific Northwest University of Health Sciences were given information on a novel anatomical topic in an initial study session. They then were split into groups: IG restudied the material by themselves and PG as student pairs. Following the restudy session, students’ knowledge of the topic was assessed by a 15‐question test. Follow‐up tests occurred 1 week and 3 weeks later. Each test item required the student to indicate if they felt confident or not in their answer. Answers marked as confident that were incorrect were labeled as “misinformed” answers. Students filled out surveys to report prior knowledge, study habits, and reflections on their learning experience on day 1 of the study. Data were analyzed using SPSS software with p &lt; .05 via two‐sided testing considered statistically significant using repeated measures ANOVA and Mann‐Whitney U tests.Day 1 surveys completed (n = 17) showed PG and IG were not significantly different for age, gender, memory scores, or prior knowledge. PG reported feeling the material was easier to learn compared to IG (p = .024). Knowledge tests at day 1, week 1 and week 3 were completed by 15 students. PG had lower average test scores than IG on each of the 3 tests; the difference between groups was not significant (p = .302), but there was a moderate effect size (ηp2= .082). PG reported more confidence on answers (p = .272, ηp2 = .092). The number of misinformed answers was more for the PG compared to IG; while not significant, there was a moderate to large effect size measured (p = .205, ηp2= .121). For all students, confidence on answers dropped significantly between day 1 and week 1 (p &lt; .0001), and on average had less misinformed answers (p = .0854).This study found, contrary to our initial hypothesis, students who studied alone were more likely to do better on knowledge tests. However, the findings also suggest that students who studied in partner groups found it easier to learn and felt more confident while taking the tests despite performing worse. There was an increase in misinformed answers for partner groups compared to individuals, likely because they were more confident overall. This corresponded with total student data; participants were more accurate in their assessment of their knowledge after day 1. When total confidence decreased, there were fewer misinformed answers. A follow up study is warranted to evaluate why there was higher confidence seen in partner groups, even when they did not know the correct answer. The limitations of this study include a low sample size and students were from a single institution.