Maximum Achievable Score Research Articles

Radiologic Decision-Making for Imaging in Pulmonary Embolism: Accuracy and Reliability of Large Language Models—Bing, Claude, ChatGPT, and Perplexity

Abstract Background Artificial intelligence chatbots have demonstrated potential to enhance clinical decision-making and streamline health care workflows, potentially alleviating administrative burdens. However, the contribution of AI chatbots to radiologic decision-making for clinical scenarios remains insufficiently explored. This study evaluates the accuracy and reliability of four prominent Large Language Models (LLMs)—Microsoft Bing, Claude, ChatGPT 3.5, and Perplexity—in offering clinical decision support for initial imaging for suspected pulmonary embolism (PE). Methods Open-ended (OE) and select-all-that-apply (SATA) questions were crafted, covering four variants of case scenarios of PE in-line with the American College of Radiology Appropriateness Criteria. These questions were presented to the LLMs by three radiologists from diverse geographical regions and setups. The responses were evaluated based on established scoring criteria, with a maximum achievable score of 2 points for OE responses and 1 point for each correct answer in SATA questions. To enable comparative analysis, scores were normalized (score divided by the maximum achievable score). Result In OE questions, Perplexity achieved the highest accuracy (0.83), while Claude had the lowest (0.58), with Bing and ChatGPT each scoring 0.75. For SATA questions, Bing led with an accuracy of 0.96, Perplexity was the lowest at 0.56, and both Claude and ChatGPT scored 0.6. Overall, OE questions saw higher scores (0.73) compared to SATA (0.68). There is poor agreement among radiologists' scores for OE (Intraclass Correlation Coefficient [ICC] = −0.067, p = 0.54), while there is strong agreement for SATA (ICC = 0.875, p < 0.001). Conclusion The study revealed variations in accuracy across LLMs for both OE and SATA questions. Perplexity showed superior performance in OE questions, while Bing excelled in SATA questions. OE queries yielded better overall results. The current inconsistencies in LLM accuracy highlight the importance of further refinement before these tools can be reliably integrated into clinical practice, with a need for additional LLM fine-tuning and judicious selection by radiologists to achieve consistent and reliable support for decision-making.

The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session

IntroductionAccurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses. MethodsThis prospective longitudinal interventional study was performed among registered nurses at the emergency departments in a Johannesburg Academic Hospital. The study aimed to determine their current knowledge and practical skills on endotracheal tube cuff manometry and assess the effectiveness of a training program. The training program was provided once, in the form of a narrated PowerPoint presentation developed by the researchers and involved theoretical and practical components. The participants' theoretical knowledge and practical skills were measured by using questionnaires and skill assessments. The theoretical and practical scores were compared pre- and post-training. ResultsOf the 63 registered nurses employed in the emergency departments, 95 % (60) participated in this study. 86 % reported having never received any formal training on endotracheal tube cuff manometry. Only 38.9 % used cuff manometry as standard practice and only 12.8 % checked it at appropriate 12-hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8 % and post-training of 64.5 % (p = 0.001).The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1 % and a post-training average of 93.3 % (p = 0.001). ConclusionThis study showed inadequate knowledge and skills on endotracheal cuff pressure manometry among registered nurses in the emergency department. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training.

An injury risk-based comprehensive framework for testing and assessing ADAS functions in critical road scenarios

Assisted driving is currently considered a key aspect for improving road safety, and automakers and OEMs are working to achieve higher levels of vehicle automation by introducing new technologies and Advanced Driver Assistance Systems (ADAS) in the circulating fleet. This trend requires test protocols for vehicle safety assessment to be frequently reviewed and updated, considering the latest advances in the state of the art regarding ADAS functions and systems. As of today, performance assessment programs (such as NCAP) mainly evaluate how an ADAS behaves in terms of crash avoidance in specific critical scenarios, which represent the most frequent crash constellations among real-world impacts. However, enhanced safety can be also obtained in case the impact is not avoided if a decrease in Injury Risk (IR) for the involved road users is achieved by ADAS intervention, compared to the case of no intervention.The purpose of this work is to propose an overall framework to draft or update test protocols for ADAS performance assessment based on real car-to-car impact observations, representative of impact scenarios in terms of both occurrence frequency and IR. First, the in-depth accident database IGLAD is analyzed to identify the most relevant car-to-car accident scenarios based on a relevance indicator, i.e., the risk level being the multiplication of the occurrence frequency and IR for a specific scenario. For each relevant scenario, a risk level-based strategy to identify one significant closing speed between vehicles for the tests is defined; the test collision speed for the two vehicles is determined analogously, and the risk level for each combination of speeds in a scenario represents the maximum achievable score by the ADAS if the collision is averted. Considering the well-established Euro NCAP framework as a relevant starting point for the definition of test protocols, two examples are highlighted regarding the proposal of a new test protocol and an update of an already existing one. Finally, a method is proposed for ADAS performance assessment if the impact is not avoided, scaling the maximum achievable score based on the IR reduction consequent to the ADAS intervention.

Assessment of oral manifestations of systemic health related knowledge of medical students pursuing internship programme at a tertiary health care centre

AimClinicians across the entire medical profession are responsible for detection, prevention and imparting importance of oral health to the patients. However, many studies conducted so far show lack of knowledge of medical students regarding dental conditions. The present observational study was undertaken to evaluate the knowledge of oral manifestations of systemic diseases amongst medical students undergoing Internship program at a tertiary centre. Materials & methodA self-structured Questionnaire comprising of 20 questions was used as a survey tool to assess the understanding of 100 medical students undergoing internship program. They were explained about the purpose of the study. The questionnaire consisted of an objective part Yes/No (7 questions) and subjective part designed on likert scale(13 questions). There were questions on their view on current curriculum for dentistry in medical undergraduate training and possible enhancement in teaching modalities. The subjective part had five options to choose from, Strongly agree, Agree, Neutral, Disagree And Strongly Disagree. Statistical analysisThe responses of objective questions was recorded and percentage calculated for both options. The total score was obtained for each participant based on their reponses to the subjective questions based on the Likert scale. Student t-test was applied to calculate means between male and female students. ResultsFor all objective questions, percentage was calculated for affirmative and negative responses. The responses were calculated on scale5-1 for the subjective questions. Reverse scoring was done for questions 10,11,12 i. e scale 1–5. The maximum achievable score in this category was 65 which was further divided into three category as Excellent score range 55–65, Good score range 45–54, Unsatisfactory score range 35–44. The number of students in excellent category were 11, Good 66, unsatisfactory 23. The average score obtained was 48.175. The mean scores for males was 48.0161 and for females it was 48.142. The scores were slightly better for females but the difference was statistically insignificant as (p-value = 0.455056). ConclusionThe present study showed good level of Knowledge on oral manifestations of systemic diseases among medical students as compared to other studies which forms an integral part of medical curriculum. The students responses on enhancing dental curriculum and teaching aids for improved education tools can help the faculty provide a better teaching learning experience.

Status of countrywide laboratory services quality and capacity in primary healthcare facilities in Tanzania: Findings from Star Rating Assessment.

Accurate disease diagnosis relies on a well-organized and reliable laboratory system. This study assesses the quality of laboratory services in Tanzania based on the nationwide Star Rating Assessment (SRA) of Primary Healthcare (PHC) facilities conducted in 2017/18. This cross-sectional study utilized secondary data from all the country's PHC facilities stored in the SRA database. Laboratory service quality was assessed by aggregating scores as percentages of the maximum achievable score across various indicators: dedicated laboratory department/room, adequate equipment, staffing levels, adherence to testing protocols, establishment of turnaround times, internal and external quality controls, and safety and supplies management. Scores equal to or exceeding 80% were deemed compliant. Multiple linear regression was used to determine the influence of facility characteristics (level, ownership, location, staffing) on quality scores, with statistical significance set at p < 0.05. The study included 6,663 PHC facilities (85.9% dispensaries, 11% health centers, 3.2% hospital-level-1), with the majority being public (82.3% vs. 17.7%) and located in rural areas (77.1% vs. 22.9%). On average, facilities scored 30.8% (SD = 35.7), and only 26.6% met staffing requirements. Compliance with quality standards was higher in private (63% vs. 19%, p<0.001) and urban facilities (62% vs. 16%, p<0.001). More than half of the facilities did not meet either of the eight quality indicators. Quality was positively linked to staffing compliance (Beta = 5.770) but negatively impacted by dispensaries (Beta = -6.342), rural locations (Beta = -0.945), and public ownership (Beta = -1.459). A score of 30% falls significantly short of the national target of 80%. Improving laboratory staffing levels at PHC facilities could improve the quality of laboratory services, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure the quality of laboratory services and clients' satisfaction.

Experience in forming entrepreneurial education in Kazakhstan universities in the conditions of information and digital development

Information and digital technologies can help in shaping the experience of using online courses for student entrepreneurs. This study constitutes an original investigation dedicated to the cultivation of entrepreneurial education experience within Kazakhstani universities, situated within the context of informational and digital development and the contemporary challenges encountered by all nations in the global arena. The main objective of this research was to determine how the academic performance of students studying entrepreneurship through online courses changed over time. The study enrolled 282 second-year and third-year students of the faculty of public administration, business, and law from one Kazakh university. In this study, an experimental design was employed to ascertain the effectiveness of integrating MOOC through the amalgamation of statistical data analysis and paired t-tests. The primary mode of assessment was testing, encompassing closed-end assessments comprising one hundred questions based on the outcomes of a specific course. Each question held a point value of one, with the maximum achievable score being one hundred points. The authors juxtaposed mean scores across different time intervals to ascertain the intervention’s impact on student performance. The Student’s t-test was utilized to compare the mean values by identifying significant disparities at the 0.05 level. The academic achievements of second-year students in some disciplines improved after the MOOC implementation compared to Point 1. According to the calculations, there was a significant difference in student performance before and after learning with MOOC; the mean score difference and t-value with the paired value are higher than the t-value in the tests of the first and last assessments. Thus, online courses have shown their effectiveness in improving student performance in all ten subjects of the entrepreneurial course. This contributed to improved efficiency of the educational process and the implementation of information and digital technology in the online environment without losing its productivity. This research is of practical value as it indicates the need to integrate information and digital technologies into entrepreneurial education. Educational institutions, curricula, and scientific research may use these findings.

Assessing the Impact of Training on Healthcare Providers' Adherence to Infection Control Measures in Hemodialysis Services.

Background and objective Developing and implementing nursing interventions to educate nurses on infection control procedures in hemodialysis units is of utmost importance and offers significant benefits in enhancing the quality of care. This study aimed to assessthe impact of training on nursing professionals' practices of hospital infection control measures inhemodialysis services. The research also intended to explore the potential association between these practices and various sociodemographic variables. Materials and methods Thiswas a single-group, pre- and post-interventional study carried out in Haryana State, India. A pretested questionnaire consisting of 29 statements, the responses of which were measured on a 5-point Likert scale, was used as the study tool. Descriptive and statistical tests like paired-t-test were used to analyze the data. Results The practices section of the questionnaire comprised 29 statements, the responses to which were measured on a five-point Likert scale. The scoring ranged from 5 ("strongly agree", i.e., positive practice) to 1 ("strongly disagree", i.e., negative practice). The maximum achievable score was 145 and the minimum achievable score was 9. The pre-test group (i.e., before training intervention) had a mean practice score of 115.0945 [standard deviation (SD)=9.34, standard error of the mean (SE)=0.66]. However, the post-test group (i.e. after training intervention) had a mean score of 135.26 (SD=8.34, SE=0.59). The study found that structured training significantly increased the mean practice score (t=-33.70, p=0.001). In addition, the study also highlighted the significant association of mean practice scores with various demographic variables among the pre-test and post-test groups. The improvement in mean practice scores among the post-test group after the structured training program reveals that such interventions will ultimately lead to a decrease in central line-associated bloodstream infections (CLABSIs) among hemodialysis patients. Conclusions Our findings showed that the educational intervention led to significant improvements in the practices of the participants.

Ecological transition for the built environment: natural insulating materials in green building rating systems

The regenerative concept of design and construction is gaining relevance, as it is changing the sustainability paradigm toward the ecological transition for the built environment, representing a track on which economic and financial support policies are currently being routed. One of the ways to achieve ecological transition is to use sustainable insulating materials in buildings. In addition, certification systems have been developed to actualize and renovate the concept of sustainability. The literature review showed that no studies deal with the influence of different insulating materials on green building rating systems. This research applies ITACA and LEED protocols to quantify the impact of insulating materials on certification levels. Starting from the comparison between these protocols and the analysis of credits related to sustainable building materials within LEED, the rating systems were applied to an existing multi-story residential building by varying the insulating materials for the building envelope, such as glass wool, expanded polystyrene (EPS), and two types of natural materials (e.g., mineralized wood fiber and kenaf). The results showed that every envelope configuration obtained the certification in both protocols, except EPS, which did not obtain the certification in LEED. However, although kenaf and mineralized wood fiber can be considered sustainable materials, they do not reach the maximum achievable category score influenced by the insulating material choice.

P.60 Is there correlation between North Star ambulatory assessments and performance upper limb module in ambulant boys with Duchenne muscular dystrophy?

Duchenne muscular dystrophy is a rapidly progressive X-linked neuromuscular disorder. The majority of boys, with and without treatments, lose ambulation by late teenage years. The North Star Ambulatory Assessment (NSAA) and the Performance of Upper Limb Module (PUL 2.0) are validated outcome measures used to assess change over time. The NSAA assesses gross motor function in ambulant boys (maximum score 34) while currently in the UK the PUL 2 is used predominantly to assess upper limb function in non-ambulant boys. The study aims to ascertain whether upper limb function starts to deteriorate in the ambulant population by applying both scales, and to assess which upper limb activities are most difficult in the younger age group. The PUL, which has a mixture of proximal and distal activities, has 22 items with a maximum achievable score of 42. It uses the Brook scale as an entry point. The boys engage well with this scale, finding it less challenging than some NSAA items (e.g standing from the floor, hopping). Cross sectional data was collected from 100 ambulant boys or those who recently lost ambulation (within 6 months of assessment) seen regularly in our neuromuscular service. Ages range from 4y 5m to 15y 2m for the ambulant boys. Ages for recently non-ambulant were 9y 7m to 13y 5m. In both ambulant and recently non-ambulant boys, scores for the North Star ambulatory assessment reduced with age. The corresponding scores for the PUL did not deteriorate with age and the majority of boys scored 35 or above. 20% scored maximum of 42, the youngest being 6y 4m. Four boys scored below 30 with NSAA below 6. Hardest items are lifting 1kg and 500g weights above shoulder level. This data shows that the majority of ambulant boys and recently non-ambulant boys with DMD maintain their upper limb function. Studies on older boys show a reduction in PUL 2.0. Further longitudinal studies are projected to show how function changes with loss of walking.

A survey of hand hygiene practices among Indian medical undergraduates

BackgroundHand hygiene is the simplest and most effective method to prevent hospital acquired infections (HAI). Compliance with hand hygiene among health providers is, however, widely variable due to significant knowledge gaps and behavioral issues. The knowledge and practices of hand hygiene among medical undergraduate students, the future health workforce in the current COVID-19 pandemic will enable a reality check and ensure course correction at an early stage of their learning. MethodsAn online questionnaire-based survey based on a standard, validated WHO 25-point (multiple-choice question and Yes/No answers) hand hygiene survey was undertaken among medical undergraduate students in an urban city from April to June 2020. Each correct response was awarded 1 point, and an incorrect response was awarded 0 points. The maximum achievable score was 25, and the minimum score was 0. ResultsA total of 457 students with a mean age 20.24 ± 1.27 years completed the survey. A total of 415 (90.8%) students received hand hygiene training in the past three years. Overall 27.6% (n = 126) students had good knowledge, 65.4% (n = 299) had moderate and 7% (n = 32) had poor knowledge of hand hygiene practices. ConclusionsThere were significant knowledge gaps regarding hand hygiene among medical undergraduate students in the midst of the COVID-19 pandemic. There is a need to strengthen existing teaching methods to positively impact behavioral change and potentially translate into better hand hygiene compliance among the future health workforce of the country.

EQUAL Score Scedosporiosis/Lomentosporiosis 2021: a European Confederation of Medical Mycology (ECMM) tool to quantify guideline adherence.

BackgroundInvasive scedosporiosis and lomentosporiosis are life-threatening fungal infections in immunocompromised patients with complex diagnostic and treatment patterns.ObjectivesTo develop a scoring tool to facilitate and quantify adherence to current guideline recommendations for diagnosis, treatment and follow-up of invasive scedosporiosis and lomentosporiosis.MethodsExperts from European Confederation of Medical Mycology (ECMM) excellence centres reviewed current guidelines for scedosporiosis and lomentosporiosis. Recommendations for diagnosis, treatment and follow-up were summarized, assembled and weighted according to their strength of recommendation and level of evidence (strongly recommended = 3 points; moderately recommended = 2 points; marginally recommended = 1 point; recommended against = 0 points). Additional items considered of high importance for clinical management were also weighted.ResultsA total of 170 recommendations were identified. A 21-item tool was developed and embedded into the EQUAL score card. Nine items for diagnosis with 18 achievable points were assembled. For treatment, three general recommendation items with a maximal score of 9 were identified, while for specific antifungal treatment the two fungal pathogens were separated. Three and four items were established for scedosporiosis and lomentosporiosis, respectively, with a maximum achievable score of 3 due to the separation of different treatment options with the maximum point value of 3 for voriconazole-based treatment. Follow-up comprised two items (4 points maximum). Key recommendations for clinical outcome were weighted accordingly.ConclusionsWe propose the EQUAL Score Scedosporiosis/Lomentosporiosis to quantify adherence to current guideline recommendations for management of these rare infections. The score remains to be validated in real-life patient cohorts and correlated with patient outcome.

Providing an Approach for Evaluating the Organizational Level of Contractors in Terms of Safety, Health and Environment (HSE)

Introduction: One of the main components of the contractor management system is the assessment of their Health, Safety, and Environmental (HSE) performance. Therefore, the purpose of this study is to provide a practical structure for evaluating HSE performance at the contractor level.&#x0D; Methods: In this analytical study, the main factors were selected according to the seven main elements of HSE management system and then the sub-factors related to each main factor were determined. Then the questionnaires were sent to experts for weighting in terms of the degree of importance of the main factors and sub-factors. Based on the output of experts 'opinions, the relative importance of the main and sub-factors was calculated and the HSE performance evaluation model was created in the contractors' organization level. Finally, in order to validate, the proposed structure was investigated at the organization level of three main construction contractors of a specialized petrochemical parent company.&#x0D; Results: The final model consists of 7 main factors and 119 sub factors. The maximum achievable score is 300 and the minimum is 60, which indicates a very good and very poor level of performance in terms of HSE, respectively. The performance evaluation results showed that the first contractor has scored higher in terms of HSE than the second and third contractors.&#x0D; Conclusion: Due to the comprehensiveness of proposed structure, it could be used to evaluate the performance of the organizational level of different contractors which the results of the evaluation could be used as an input criterion for the selection of contractors. In addition, contractors can identify their organizational weaknesses in the HSE field and try to eremove them and improve their HSE level.&#x0D;

Increased Relative Functional Gain and Improved Stroke Outcomes: A Linked Registry Study of the Impact of Rehabilitation

ObjectivesIt is unclear how acute care influences patient outcomes in those who receive rehabilitation. We aimed to determine the associations between acute stroke therapies, outcomes during inpatient rehabilitation and self-reported outcomes at 90-180 days after stroke. Materials and MethodsPatient-level data from adults with acute stroke registered in the Australian Stroke Clinical Registry (AuSCR, 2014–2017) were linked with data from the Australasian Rehabilitation Outcomes Centre (AROC). The main outcome was relative function gain (RFG), which is a measure of the FIM change achieved between admission to discharge as a proportion of the total gain possible based on admission FIM, relative to the maximum achievable score. Multilevel logistic/median regression analyses were used to investigate the association between RFG achieved in rehabilitation and (1) acute stroke therapies; (2) 90–180 day outcomes (health-related quality of life using EuroQoL-5D-3L; independence according to modified Rankin Scale (score 0–2) and self-reported hospital readmission). ResultsOverall, 8397/8507 eligible patients from the AuSCR were linked with corresponding AROC data (95% linkage rate; median age 75 years, 43% female); 4239 had 90–180 days survey data. Receiving thrombolysis (16% of the cohort) had a minimal association with RFG in rehabilitation (coefficient: 0.03; 95% Confidence Interval [CI]: 0.01, 0.05). Greater RFG achieved whilst in in-patient rehabilitation was associated with better longer-term HR-QoL (coefficient 21.77, 95% CI 17.8, 25.8) including fewer problems with mobility, self-care, pain, usual activities and anxiety/depression; greater likelihood of independence (adjusted Odds Ratio: 10.66; 95% CI 7.86, 14.45); and decreased odds of self-reported hospital readmission (adjusted Odds Ratio: 0.53; 95% CI 0.41, 0.70) within 90-180 days post-stroke. ConclusionsStroke survivors who achieved greater RFG during inpatient rehabilitation had better HR-QoL and were more likely to be independent at follow-up. Acute care processes did not appear to impact RFG or long-term outcomes for those who accessed inpatient rehabilitation.

Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial

BackgroundSARS-CoV-2 entry in human cells depends on angiotensin-converting enzyme 2, which can be upregulated by inhibitors of the renin–angiotensin system (RAS). We aimed to test our hypothesis that discontinuation of chronic treatment with ACE-inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) mitigates the course o\\f recent-onset COVID-19.MethodsACEI-COVID was a parallel group, randomised, controlled, open-label trial done at 35 centres in Austria and Germany. Patients aged 18 years and older were enrolled if they presented with recent symptomatic SARS-CoV-2 infection and were chronically treated with ACEIs or ARBs. Patients were randomly assigned 1:1 to discontinuation or continuation of RAS inhibition for 30 days. Primary outcome was the maximum sequential organ failure assessment (SOFA) score within 30 days, where death was scored with the maximum achievable SOFA score. Secondary endpoints were area under the death-adjusted SOFA score (AUCSOFA), mean SOFA score, admission to the intensive care unit, mechanical ventilation, and death. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT04353596.FindingsBetween April 20, 2020, and Jan 20, 2021, 204 patients (median age 75 years [IQR 66–80], 37% females) were randomly assigned to discontinue (n=104) or continue (n=100) RAS inhibition. Within 30 days, eight (8%) of 104 died in the discontinuation group and 12 (12%) of 100 patients died in the continuation group (p=0·42). There was no significant difference in the primary endpoint between the discontinuation and continuation group (median [IQR] maximum SOFA score 0·00 (0·00–2·00) vs 1·00 (0·00–3·00); p=0·12). Discontinuation was associated with a significantly lower AUCSOFA (0·00 [0·00–9·25] vs 3·50 [0·00–23·50]; p=0·040), mean SOFA score (0·00 [0·00–0·31] vs 0·12 [0·00–0·78]; p=0·040), and 30-day SOFA score (0·00 [10–90th percentile, 0·00–1·20] vs 0·00 [0·00–24·00]; p=0·023). At 30 days, 11 (11%) in the discontinuation group and 23 (23%) in the continuation group had signs of organ dysfunction (SOFA score ≥1) or were dead (p=0·017). There were no significant differences for mechanical ventilation (10 (10%) vs 8 (8%), p=0·87) and admission to intensive care unit (20 [19%] vs 18 [18%], p=0·96) between the discontinuation and continuation group.InterpretationDiscontinuation of RAS-inhibition in COVID-19 had no significant effect on the maximum severity of COVID-19 but may lead to a faster and better recovery. The decision to continue or discontinue should be made on an individual basis, considering the risk profile, the indication for RAS inhibition, and the availability of alternative therapies and outpatient monitoring options.FundingAustrian Science Fund and German Center for Cardiovascular Research.

Long-Term Quality of Life after Pancreatic Surgery for Intraductal Papillary Mucinous Neoplasm

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) represent the most common precancerous cystic lesions of the pancreas. The aim of our study was to investigate if resection for non-invasive IPMNs alters quality of life (QoL) in a long-term follow-up. Methods: Patients (n = 50) included in the analysis were diagnosed and resected from 2010 to 2016. QoL was assessed at a median of 5.5 years after resection. At that point in time, the current QoL as well as the QoL before resection was evaluated retrospectively. The standardised European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Pancreatic Cancer (EORTC QLQ – PAN26) was applied for the QoL assessment. Results: After a median of 66 months postoperatively, the total QoL score significantly worsened (92.13 vs. 88.04, p = 0.020, maximum achievable score = 100) for patients (median age at surgery 68.0 years), mostly due to digestive symptoms. During the same follow-up period, median Eastern Cooperative Oncology Group (ECOG) performance status did not worsen (p = 0.003). Conclusions: Long-term QoL statistically significantly worsened after pancreatic resection for IPMN. The extent of worsening, however, was small, and QoL still remained excellent. Therefore, resection in cases of IPMN is appropriate, if indicated carefully.

Journal Club Presentation: An Evaluation Study Based on the CIIP Model

Background: Journal club (JC) is an accepted method to improve the knowledge of researchers by reviewing and discussing scientific texts and could also be effective in enhancing the quality of teaching and research in educational settings. Objectives: The present study aimed to evaluate JC meetings from the perspective of postgraduate students in Kermanshah University of Medical Sciences (KUMS) in Kermanshah, Iran based on the CIPP evaluation model. Methods: This descriptive-analytical study was conducted on 62 postgraduate students selected from the schools of health, nutritional sciences, and food industry of KUMS in 2019. The participants were selected via convenience sampling. Data were collected using a self-report questionnaire. Data analysis was performed in SPSS version 16 using bivariate correlation, one-way ANOVA, and t-test. Results: Positive, significant correlations were observed between the CIPP domains. In addition, the grade point average of the students had positive, significant correlations with the input and process domains. The items of the input domain regarding the relevance of the papers regarding the current issues of the field of study, appropriateness of the time of the event, and need to participate in JC meetings received the lowest average percentage of the maximum achievable score. Conclusions: According to the results, careful planning is required for the implementation of JC meetings by taking into account the relevant papers regarding the current issues of the field of study and time of the event.

Knowledge of malaria control and attitudes towards community involvement among female community volunteers: effect of capacity building in a rural community, southeast Nigeria

Introductioncommunity volunteers have limited skills but are an important link between the community and health facilities. We determined the effect of a capacity building intervention on knowledge of malaria control and attitudes towards community involvement among female community volunteers as part of a larger community-based intervention study on pregnant women and children under five.Methodswe conducted a before and after intervention study (no randomization or controls) among female community volunteers in Amagu community in Abakaliki Local Government Area. The intervention consisted of training sessions on knowledge of malaria and its control. The training took the form of lectures, role plays and practical demonstrations. Supportive supervision by trained community health extension workers was also provided during their field work. We compared pre-training test and post-training test scores after six months interval and analysed the data using paired t test at 5% level of significance with EPI INFO software version 7.2.3.Resultsthe mean age of the participants was 28.5(± 6.0) years. All had a minimum level of secondary education. There was significant improvement in the mean scores of their knowledge of malaria signs and symptoms (p < 0.001), preventive measures (p < 0.001) and appropriate drug treatment (p < 0.001) in the post-training test when compared with the pre-training test. The overall mean knowledge scores pre and posttest were 147.8 and 169.8 respectively (p < 0.001) out of a maximum achievable score of 195. Also there was significant improvement in the perception of the participants on community involvement in promoting referral of pregnant women with fever (p = 0.001), the use of intermittent preventive therapy with sulphadoxine-pyrimethamine (p = 0.048) and funding initiatives to sustain activities (p = 0.037).Conclusioncapacity building of female community volunteers coupled with supportive supervision by trained community health workers improved the female community volunteers´ knowledge of malaria, its control and their perception of community involvement in control activities. It is recommended that the use of community volunteers as a low cost health resource can be explored further for incorporation into existing policies on malaria control in resource constrained environments.

Feasibility and Safety of Bilateral Hybrid EEG/EOG Brain/Neural-Machine Interaction.

Cervical spinal cord injuries (SCIs) often lead to loss of motor function in both hands and legs, limiting autonomy and quality of life. While it was shown that unilateral hand function can be restored after SCI using a hybrid electroencephalography/electrooculography (EEG/EOG) brain/neural hand exoskeleton (B/NHE), it remained unclear whether such hybrid paradigm also could be used for operating two hand exoskeletons, e.g., in the context of bimanual tasks such as eating with fork and knife. To test whether EEG/EOG signals allow for fluent and reliable as well as safe and user-friendly bilateral B/NHE control, eight healthy participants (six females, mean age 24.1 ± 3.2 years) as well as four chronic tetraplegics (four males, mean age 51.8 ± 15.2 years) performed a complex sequence of EEG-controlled bilateral grasping and EOG-controlled releasing motions of two exoskeletons visually presented on a screen. A novel EOG command performed by prolonged horizontal eye movements (>1 s) to the left or right was introduced as a reliable switch to activate either the left or right exoskeleton. Fluent EEG control was defined as average “time to initialize” (TTI) grasping motions below 3 s. Reliable EEG control was assumed when classification accuracy exceeded 80%. Safety was defined as “time to stop” (TTS) all unintended grasping motions within 2 s. After the experiment, tetraplegics were asked to rate the user-friendliness of bilateral B/NHE control using Likert scales. Average TTI and accuracy of EEG-controlled operations ranged at 2.14 ± 0.66 s and 85.89 ± 15.81% across healthy participants and at 1.90 ± 0.97 s and 81.25 ± 16.99% across tetraplegics. Except for one tetraplegic, all participants met the safety requirements. With 88 ± 11% of the maximum achievable score, tetraplegics rated the control paradigm as user-friendly and reliable. These results suggest that hybrid EEG/EOG B/NHE control of two assistive devices is feasible and safe, paving the way to test this paradigm in larger clinical trials performing bimanual tasks in everyday life environments.

European confederation of medical mycology quality of clinical candidaemia management score: A review of the points based best practice recommendations.

Candidaemia is associated with high mortality. In the last few years, several guidelines have been published on the management of Candida bloodstream infection. However, adherence to the practice guidelines has been suboptimal. In order to facilitate and objectively measure the adherence to good practice recommendations, a scoring criterion was published by the European Confederation of Medical Mycology (ECMM). The ECMM Quality (EQUAL) of Clinical Candidaemia Management is an audit tool that comprises of 10 quality indicators. Each quality indicator is allotted between 1 and 3 points. The maximum achievable score is 22 or 19 in patients with or without a central venous catheter, respectively. This paper reviews each of the 10 quality indicators and provides the context for improving quality within the individual domains. The review also suggests areas that are in need of further clarity or areas which merit attention in the future updates of the EQUAL scoring system so that clinicians are able to derive maximum benefit from the audit tool. The EQUAL scoring tool is an important milestone in the quality improvement aspect of the management of candidaemia and contributes to the various components of clinical governance in the management of Candida infection of the bloodstream.

Gross Motor Functions Assessed Through The Tgmd-3 In Down Syndrome Individuals And Related Gender Differences

PURPOSE: Down Syndrome (DS) individuals show a markedly reduced general coordination, resulting in an overall reduced motor proficiency which limits their participation and, consequently, inclusion in sport activities. In this work we aim to characterize gross motor functions in DS, assessed by means of the Test of Gross Motor Development (TGMD 3), and assess possible gender-related differences. METHODS: Thirty-six age- and gender-matched DS individuals (Age: 29.1±7.5 years; Stature: 1.53±0.09 m; Mass: 67±14 kg; BMI: 28.6±14.1 kg/m2; n = 18 females (FE), 18 males (MA)), recruited in 5 European countries, performed the TGMD version 3 (TGMD-3). Participants were matched also for their daily physical activity (p = 0.6) as assessed by the international physical activity questionnaire (IPAQ). TGMD-3 includes 13 skills classified as Locomotor Skills (Running, Galloping, Hopping, Skipping, Horizontal jumping, and Sliding) or Ballistic Skills (Two-hand and One-hand striking, Dribbling, Overhand throwing, Underhand throwing, Catching, and Kicking). For each skill, two attempts were performed. A video analysis was performed to assess if the performance criteria were respected. For each criterion, the participant scored 1 if the performance criterion was respected and 0 if not. Individual scores of the two attempts for each skill classified as Locomotor or Ballistic were separately summed. The total gross motor functions score was the sum of Locomotor and Ballistic skills. All scores were computed as a percentage of the maximum achievable score. MA and FE scores were compared using RM-ANOVAs (α=0.05). RESULTS. The participants had a total gross motor function score of 51% on average, similar for MA and FE (F1,34 = 1.39; p = 0.24; M = 54%; F= 48%). No significant differences between MA and FE were observed for the total scores of Locomotor or Ballistic skills (F1,34 = 1.45; p = 0.23). At single skill level, MA outperformed FE in the kicking skill (F1,34= 8.14; p = 0.007; M = 47%; F = 22%). CONCLUSION. These results highlight gross motor functions limitations in this population, showing a similar impairment of MA and FE, especially for locomotor functions. The different score obtained between MA and FE in the kicking skill may reflect an European cultural bias. Co-funded by the Erasmus + Programme of the European Union, GA 2018-2512.