Multiple-choice Research Articles

The development, implementation, and evaluation of a pre-rotation quiz to improve resident preparedness for an abdominal wall reconstruction surgical rotation.

Although hernia repair constitutes a significant portion of surgical training, education around more complex hernia concepts such as abdominal wall reconstruction (AWR) or paraesophageal hernia repair may be lacking. We developed and implemented a pre-rotation quiz for residents on an AWR and minimally invasive surgery service. We also investigated the staff and resident perception of resident knowledge and experience of the rotation before and after quiz implementation. The multiple-choice quiz questions were written by clinical and research fellows, validated by four staff, two fellows, and two senior residents and implemented in June 2023. Questions assessed knowledge of anatomy, operative steps, mesh materials, clinical trials, and postoperative management specific to ventral, inguinal, and paraesophageal hernia repairs. Residents were notified of the summative quiz three weeks prior and provided with reference materials specific to quiz questions. Anonymous Likert-type surveys were distributed to staff and residents between 3/2023 and 3/2024. Responses were assessed based on the overall score as well as individual domains and then compared based on whether they were completed before or after implementation of the quiz. 17 seniors and 29 juniors rotated on service and all completed the pre-rotation quiz between 7/1/2023-3/4/2024. The mean first attempt score was 72%(± 12.4%) for junior residents and 88.4%(± 9.6%) for senior residents. Staff reported overall resident knowledge improved after quiz implementation (maximum 90, mean(SD): 46.25(± 8.58) vs. 75.5(± 11.24),p = 0.05). Sixteen(45.7%) residents responded to the survey before quiz implementation and 23(50%) after. Residents only reported improved knowledge regarding current literature (maximum 5, mean(SD):3.2 ± 0.98 vs. 3.8 ± 0.78,p = 0.04). Implementing a pre-rotation quiz effectively improves staff perception of resident knowledge and preparation.

Effects of multidisciplinary therapy on energy balance, inflammation, and metabolic diseases in adolescents with obesity: A narrative review.

Obesity is a consequence of multiple factors, including genetics, lifestyle and nutritional choices, physical activity, sleep duration, screen time, and mood disorders. These behavioral elements can impair the regulation of energy balance and obesity management that link obesity to a constellation of chronic conditions that lead to a high prevalence of cardiometabolic risk factors, metabolic syndrome, and nonalcoholic fatty liver disease. Multidisciplinary therapy is defined as an approach delivered by a multidisciplinary-trained health team covering at least two components of behavior, physical activity/exercise, dietary habits, and/or psychological counseling associated with clinical interventions. This narrative review summarizes the effects of multidisciplinary therapy on neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, metabolic syndrome, nonalcoholic fatty liver diseases, behavior, and quality of life. We found that multidisciplinary therapy, including medical, nutritional, exercise, and behavioral counseling, and/or education, was useful for addressing outcomes such as visceral adiposity, neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, nonalcoholic fatty liver disease, and metabolic syndrome. The effects were mediated by improvements in neuroendocrine regulation of energy balance, downregulation of the pro-inflammatory states, and a reduction in comorbidities. Multidisciplinary therapy also improved mood disorders and quality of life.

Patient-related perceptions and experience measures of non-surgical endodontic treatment – A cross-sectional study

Objectives: This study assessed the outpatients’ perceptions of non-surgical root canal treatment (RCT) and compared them with their post-treatment experiences. Material and Methods: Eighty participants were selected for this cross-sectional study based on inclusion and exclusion criteria. Two surveys were conducted from October 01, 2023, to November 30, 2023 (Pretreatment survey) – one conducted before the RCT includes a survey about the patient’s past RCT experiences and demographics such as age, sex, and level of educational status. Multiple-choice questions were employed to determine patient concerns related to RCT, while modified visual analog scales (0–100) were used to assess pain and anxiety (Post-treatment survey) – done after the endodontic procedure with a root canal filling material. It outlines the patient’s experience, any discomfort experienced during treatment, the significance of tooth retention, and Re-RCT. Results: No difference was found in the demographic analysis. Out of the 80 participants, 33 participants (41.25%) presented with pretreatment anxiety, and 12 participants (15%) reported post-treatment. In the pretreatment survey, the primary concerns were pain and cost, which were reported at 27.55% and 10%, respectively. The post-treatment survey detailed that the time and the need for Re-RCT were the concerns, with reported rates of 11.25% and 10%, respectively. An absolute difference was found between anticipated and pre-operative pain and between experienced and pre-operative pain. However, no difference was found between anticipated and experienced pain 89% of the patients were willing to go for RCT again if needed. Conclusion: Treatment success is the goal for any dental procedure performed, which might be perceived differently by the patient and dentist. Consideration of patient perceptions and experiences, along with the dentist’s opinions, will help enhance endodontic treatment success.

THE INFLUENCE OF KURIKULUM MERDEKA ON THE UNDERSTANDING OF EDUCATIONAL CONCEPTS OF GRADE IV STUDENTS OF SDN 71 PALEMBANG

This study aims to determine the effect of Merdeka Curriculum learning on understanding the concept of education for fourth grade students of SD Negeri 71 Palembang. The Merdeka Curriculum is expected to increase student involvement and creativity in learning, especially in subjects that are often considered boring and theoretical. The method used in this research is a quantitative experiment with a pretest-posttest control group design. The research sample consists of two groups, namely the experimental group taught using the Merdeka Curriculum approach and the control group using conventional learning. Data were collected through multiple choice tests that measured students' understanding of the principles of Pancasila and citizenship. The results showed that learning with the Merdeka Curriculum had a significant effect on student understanding, with a t_count value of 12.430 which is greater than the t_table of 2.015. This study concludes that the application of Merdeka Curriculum can improve students' understanding of the concept of Citizenship, especially in understanding bad behavior in oneself and the environment.

Theory of Mind Development in Middle Childhood and Adolescence: Accuracy and Preference for Mental-State Reasoning

ABSTRACT While there is a steady increase in research examining growth of theory of mind (ToM) over middle childhood and adolescence, there remains a paucity of studies on how older children employ ToM to interpret the behaviors of others. We conducted two studies and used a new task – the Mr Bean task – based on a wordless video to examine understanding of a variety of mental states and a preference for mental state reasoning in children and adults. Study 1 examined 131 children (5–13 years) and 418 adults in New Zealand and included open-ended questions requiring participants to explain agents’ behaviors. Study 2 also used a Mr Bean video and tested 80 children (6–16 years) and 49 young adults in New Zealand but asked multiple-choice questions, each with a correct mental state option, a correct general reasoning option, and an incorrect version of each option. Our study provided the following novel findings. First, children’s ToM continued to progressively improve from middle childhood to adolescence, and through to adulthood in that, relative to adults, children erred more frequently when they reasoned using mental states. Second, explanations referring to emotions, intentions and cognitions were used more frequently with age. Third, children were less likely to use mental state reasoning and more likely to use general reasoning compared to adults; only adults preferred to use mental state rather than general reasoning. Fourth, the advantage in adult ToM was related to their superior vocabulary but not fluid intelligence. Our findings provide clear evidence that not just ToM accuracy, but also preference for mental state reasoning continue to evolve from middle childhood through to adulthood.

A national cross-sectional study on the retention of basic life support knowledge among nurses in Palestine.

17.9million deaths worldwide were attributable to cardiovascular diseases. Basic life support is one of the crucial strategies that could increase chances of cardiac arrest victims' survival rate by nurses and other healthcare providers. The aims of this study was to examine the retention of the BLS knowledge among nurses in Palestine. A descriptive cross-sectional design was used to collect data from 108 nurses between February 2022 and April 2022 from two AHA-ITCs in Palestine. The instrument consisted of two sections; demographics and knowledge test which was developed by the researcher and contain a written examination containing 25 multiple-choice questions. Out of 160 distributed questionnaires, 108 were completed by nurses as a convenience sampling technique. Over half of the participants were male (54.6%), and the majority had a bachelor's degree in nursing (75%). Analysis identified that there was a significant difference (t (107) = 18.02, p < 0.001) and less knowledge score in the year 2022 (M = 65.48, SD = 15.42), compared to the year 2020 (M = 92.09, SD = 4.01). The mean knowledge reduction was 26.61 and P < 0.001. The results showed no statistically significant differences in terms of level of BLS knowledge in all sociodemographic, except the level of education. The results of this study revealed weak retention of BLS knowledge among nurses in Palestine between the years 2020 and the year of 2022. Nurses must regularly participate in BLS training and attend frequent in-service CPR training at least every 6-months to decrease the likelihood of knowledge and skills loss over time. Blended learning BLS is one of the methods to retain more knowledge and skills of BLS.

The Influence of the STAD and NHT Learning Models on Students' Cognitive Achievement and Learning Motivation on Colloid Material in Banyumas

This study aims to assess the impact of the Student Team Achievement Division (STAD) and Numbered Head Together (NHT) learning models on students’ cognitive achievement and learning motivation in colloidal material at MA Negeri 1 Banyumas. The study uses a quantitative approach with a quasi-experimental design, involving students from six XI science classes of MA Negeri 1 Banyumas. The first experimental group was taught using the STAD model, while the second group was taught using the NHT model. The sampling technique used was random sampling. Instruments included multiple-choice tests to measure cognitive achievement and learning motivation. Data analysis was carried out using an independent t-test. The results showed that both the STAD and NHT models had a significant impact on students’ cognitive achievement and learning motivation in colloid material. The p-values ​​for the NHT learning model were 0.47 and 0.39, while the p-values ​​for the STAD learning model were 0.17 and 0.16.

Automatic distractor generation in multiple-choice questions: a systematic literature review

Background Multiple-choice questions (MCQs) are one of the most used assessment formats. However, creating MCQs is a challenging task, particularly when formulating the distractor. Numerous studies have proposed automatic distractor generation. However, there has been no literature review to summarize and present the current state of research in this field. This study aims to perform a systematic literature review to identify trends and the state of the art of automatic distractor generation studies. Methodology We conducted a systematic literature following the Kitchenham framework. The relevant literature was retrieved from the ACM Digital Library, IEEE Xplore, Science Direct, and Scopus databases. Results A total of 60 relevant studies from 2009 to 2024 were identified and extracted to answer three research questions regarding the data sources, methods, types of questions, evaluation, languages, and domains used in the automatic distractor generation research. The results of the study indicated that automatic distractor generation has been growing with improvement and expansion in many aspects. Furthermore, trends and the state of the art in this topic were observed. Conclusions Nevertheless, we identified potential research gaps, including the need to explore further data sources, methods, languages, and domains. This study can serve as a reference for future studies proposing research within the field of automatic distractor generation.

Leveraging large language models to construct feedback from medical multiple-choice Questions.

Exams like the formative Progress Test Medizin can enhance their effectiveness by offering feedback beyond numerical scores. Content-based feedback, which encompasses relevant information from exam questions, can be valuable for students by offering them insight into their performance on the current exam, as well as serving as study aids and tools for revision. Our goal was to utilize Large Language Models (LLMs) in preparing content-based feedback for the Progress Test Medizin and evaluate their effectiveness in this task. We utilize two popular LLMs and conduct a comparative assessment by performing textual similarity on the generated outputs. Furthermore, we study via a survey how medical practitioners and medical educators assess the capabilities of LLMs and perceive the usage of LLMs for the task of generating content-based feedback for PTM exams. Our findings show that both examined LLMs performed similarly. Both have their own advantages and disadvantages. Our survey results indicate that one LLM produces slightly better outputs; however, this comes at a cost since it is a paid service, while the other is free to use. Overall, medical practitioners and educators who participated in the survey find the generated feedback relevant and useful, and they are open to using LLMs for such tasks in the future. We conclude that while the content-based feedback generated by the LLM may not be perfect, it nevertheless can be considered a valuable addition to the numerical feedback currently provided.

OGC SO29 - Patient perceptions survey on the best timed oesophago-gastric dietetic pathway

Abstract Background It is well established that patients with oesophago-gastric (OG) cancer often present with malnutrition and impact symptoms such as anorexia, dysphagia and abdominal symptoms. Dietetic input is imperative in assessing and managing these symptoms early to improve outcome measures such as nutritional status, clinical outcomes and quality of life. A service evaluation was conducted to explore patient perceptions of early dietetic intervention in the Greater Manchester OG two week wait (TWW) pathway. There is no known prior research exploring the aims of this project. The results provide a novel insight into patient perceptions. Method A mixed methods survey using Microsoft Forms including open and close-ended questions was completed using transcription of responses via telephone consultation for 8 participants. For multiple choice responses, quantitative analysis was undertaken utilising Microsoft Forms analytics. Thematic analysis was completed with the use of computer assisted qualitative data analysis software (CAQDAS). Results 100% of respondents strongly agreed that receiving information about eating and drinking during investigations was important to them. 100% of respondents disagreed that dietetic advice was difficult to understand and follow. 75% of respondents felt dietetic input to be helpful in managing nutritional impact symptoms. 25% of participants responded neutrally. 100% of respondents felt their individual needs and concerns were addressed and would recommend the service to friends/family (88% strongly agreed; 12% agreed respectively). Conclusion Dietetic input was viewed positively by service users undergoing the OG TWW pathway. Patients reported feeling reassured, and valued communication, accessibility, and a personal approach. Some patients experienced delays in receiving prescribed nutritional supplements. Consistency of nutritional information requires improvement across the multidisciplinary team. Unfamiliarity with dietetic input limits the ability of participants to provide perspectives on service improvement. These findings suggest that specialist nutritional assessment and advice is beneficial to patients. Future research should be conducted to explore the long-term impact of early dietetic interventions on health outcomes in OG cancer patients.

Abstract 4134824: Evaluation of ChatGPT-4.0 and Google Bard ‘s Capabilities in Clinical Decision Support in Cardiac Electrophysiology

Background: ChatGPT-4.0 and Bard have shown clinical decision support (CDS) potential in general medicine, but their role in EP is unknown. This study aims to evaluate ChatGPT and Bard’s CDS potential by assessing their accuracy in multiple-choice questions (MCQs), guideline recommendations (GRs) and treatment (Tx) suggestions. Methods: Two chatbots were tested with 15 clinical vignettes (CVs) and 47 case-related MCQs from Heart Rhythm Case Reports, focusing on ablation, arrhythmia and CIEDs management. CVs included narrative diagnostic images results. 3 tasks were performed: 1) Generating GRs, rated 0 for incorrect or correct but irrelevant to the primary problem, 0.5 for correct for the primary problem, 1 for case-specific (CS) if relevant to both the primary problem and concomitant conditions (e.g. afib with HF); 2) Suggesting Tx steps, scored 0 for incorrect, 0.5 for correct and 1 for CS. Tx was deemed correct if referenced in the case or guidelines, and CS if used in the case. For Tx responses not CS, a prompt was provided before reassessment. The prompt included one similar CV and its Tx from PubMed case reports. 3) Answering MCQs, rated 1 for correct and 0 for incorrect. Welch's T-test was used for analysis. Results: Bard outperformed ChatGPT in generating CS-GRs (P = 0.01). However, there was no significant difference in CS-Tx suggestions with a prompt (P value = 0.12, Figure 1C) or without a prompt (P value = 0.59, Figure 1A). When prompted for non-CS-Tx responses, ChatGPT significantly improved from 0.66 to 0.93 (P value = 0.02), suggesting an enhanced ability to provide CS-Tx plans post-prompt. In contrast, Bard showed no notable improvement (0.73 vs. 0.76, P value = 0.79, Figure 1B). Both chatbots demonstrated similar MCQ accuracy, with scores below 70%, indicating EP training gaps or the need for prompts to activate existing knowledge. Conclusion: This study showed Bard's superiority in generating GRs and ChatGPT's remarkable improvement in suggesting Tx when external knowledge is provided, revealing their CDS potential in specialized fields.

Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession.

Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. To conduct a needs assessment among CCLS and examine the role in hospice and palliative care. CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes. Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

Can AI-powered avatars replace human trainers? An empirical test of synthetic humanlike spokesperson applications

Purpose This study aims to investigate the effectiveness of widely adopted but under-studied synthetic humanlike spokespersons (SHS) compared to organic human spokespersons in workplace training videos. The primary aim is to evaluate whether employees will rate training videos more negatively when they perceive their trainer to be synthetic such as those videos made with the AI-powered tools Synthesia or HeyGen. Results suggest that while ratings are more negative when the viewer perceives syntheticness, the change is only mild across most measures deployed here. When measures were calculated by using actual modality and not perceived modality, no significant change in rating was found. This study deployed three measures: actual knowledge transfer, perceived effectiveness and brand impression. It is guided by a convergence of AI Literacy Theory, the Technology Acceptance Model and the Theory of Reasoned Action. Design/methodology/approach Over 250 professionals assessed the effectiveness of training videos in a 2 × 2 trial design. Participants were randomly assigned to view one of four training videos featuring either a synthetic or organic spokesperson for a fictional business. After watching the video, participants answered Likert-scale survey questions and multiple-choice quiz-style questions to provide comparative measurements of actual knowledge transfer effectiveness, perceived effectiveness, brand impression and the effectiveness of the synthetic deception. The study used both ANOVA and multiple regression analyses to control for potential confounding variables and ensure the robustness of the findings. Findings The results indicate no significant differences between SHS and organic human spokespersons in terms of actual effectiveness (quiz scores), perceived effectiveness or brand impression, based on actual modality comparisons. However, when respondents perceived syntheticness, the avatar triggered the negative uncanny valley phenomenon and slightly decreased overall scores in perceived effectiveness and brand impression. Notably, more than half of respondents did not detect that the SHS was synthetic. Demographic variables such as gender, age or household income had no significant impact on the results. Practical implications Organizations can justifiably consider incorporating SHS into their training programs, leveraging these synthetic agents to deliver cost-effective and scalable learning solutions. The findings suggest that SHS can be used effectively for goals such as actual knowledge transfer without compromising training quality, and that other perceptual goals may be within reach as well. This may offer a viable alternative to traditional, organic human spokespersons, opening up new opportunities for enhancing training efficiency and accessibility across various industries. Originality/value Synthetic avatars, as outlined here, are a demonstrably effective new option in the array of available learning technologies. They are being adopted en masse but without significant study of their effectiveness. This research provides foundational quantitative assessments designed to address that gap in the literature and practice. The data presented here is highly valuable for practitioners and scholars interested in cutting-edge learning tools. Given the rapid advancement of technology, this study provides an important benchmark for evaluating future improvements in these tools. Furthermore, it offers actionable recommendations for integrating AI-powered avatars into professional development, enhancing understanding of the roles advanced technologies play in educational and training programs.

Building bridges and the chance to do better tomorrow: global resource sharing moving forward

Purpose The purpose of this paper is to disseminate the American Library Association (ALA) Reference and User Services Association (RUSA) Sharing and Transforming Access to Resources Section (STARS) international interlibrary loan (ILL) Committee 2023 international ILL survey results and findings. The survey evaluates current international resource sharing operations, identifies trends and challenges and recommends promoting services within the global library community. Design/methodology/approach The survey used the Qualtrics platform and included multiple-choice and open-ended questions. The survey questionnaire was built upon the 2019 and 2015 instruments to facilitate longitudinal data analysis and comparison. The committee added new questions related to the COVID-19 pandemic and controlled digital lending (CDL). The survey was distributed to libraries worldwide via multiple channels, in all seven official International Federation of Library Associations and Institutions (IFLA) languages. Qualitative comparative analysis methodology was applied to analyze the survey results. Findings The survey results reveal the challenges and opportunities to engage in international ILL activities. The importance of sharing electronic resource content continues to grow as library collections shift from print to electronic resources. Originality/value The 2023 international ILL survey is the first offered in all seven official IFLA languages and included questions on the topics of COVID-19 and CDL. It contributes to the literature by providing global trends and perspectives on current international resource sharing practices, challenges and opportunities facing the global resource sharing community and recommendations on building bridges to do better in the future.

Abstract 4112926: Echocardiography in Hypertrophic Cardiomyopathy: Virtual Continuing Medical Education Advances Physician Knowledge and Confidence

Purpose: This study examined whether online CME could improve the knowledge and confidence of cardiologists regarding the use of echocardiography for HCM diagnosis and management. Methods: The CME intervention comprised of a series of 6 online interviews between 1 moderator and 2 expert faculty. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, and 1, rated on a Likert-type scale, assessed confidence. A paired samples t-test was conducted on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (significance level, P &lt; .05). Data were collected August 8-September 8, 2023. Results: 165 cardiologists answered all assessment questions during the study period. Analysis of pre- vs. post-intervention responses demonstrated a significant improvement in overall knowledge; average correct responses increased from 48% pre-assessment to 74% post-assessment ( P &lt;.001). Specific areas of improvement include: Knowledge of the quantification of LVOT gradients, MR, and LVEF in the echocardiographic workup of HCM: 21% improved and 62% reinforced; the correct response increased (P&lt;.001) from 65% (pre) to 84% (post). Knowledge of the utility of echocardiography for follow-up and monitoring response to HCM treatment: 48% improved and 35% reinforced; the correct response increase (P&lt;.001) from 39% (pre) to 70% (post). Post-education, 48% of cardiologists had a measurable increase in their ability to diagnose HCM using echocardiographic parameters, resulting in 43% who were mostly or very confident after education (24% pre vs 43% post; P&lt;.001). Conclusion: This study demonstrated the success of online CME at improving the knowledge and confidence of cardiologists related to the use of echocardiography to identify and manage HCM.

Healthcare provider-related perceptions toward deprescribing inappropriate medications among older adult outpatients.

To examine healthcare provider-related perceptions toward deprescribing inappropriate medications among older adults. A cross-sectional, correlational study used a convenience sample of outpatient older adults to measure their perception toward deprescribing using a Patient's Perceptions of Deprescribing (PPoD), which include 57 multiple-choice questions related to patients' sociodemographic data, health, medicines, healthcare providers, and experience of care provided by the clinic. Data were collected by a graduate nursing student from one pharmacy in a public hospital, five days per week, via in-person interviews. Data were analyzed for 200 participants. The level of patient collaboration with their primary care providers (PCPs) is linked to their trust in PCPs, beliefs about medication use, PCP knowledge, and medication concerns (p < .0001). Patient involvement in medication deprescribing decision-making is also associated with trust in PCPs and willingness to stop a medication (p < .0001). Additionally, trust in PCPs is related to patient involvement in decision-making, PCP knowledge, general health, collaboration with PCPs, and receiving conflicting information about a medicine (p = .010). Lastly, PCP medication knowledge is associated with trust in PCPs, views on the importance of medicines, medication concerns, seeking help with medicines, interactions with clinical pharmacists, and being advised by a clinical pharmacist to discontinue medication (p < .0001). The study found that older adults' trust in their PCP, collaboration with their PCP, involvement in the decision-making of deprescribing, and knowledge about medication are associated with clinical and medicine-related factors. Therefore, PCPs should discuss the benefits of deprescribing inappropriate medications to prevent long-term side effects. Future studies should focus on the effectiveness of evidence-based deprescribing protocols for older adults.

Abstract 4114994: Nursing Management Practice Variations related to Externalized Ventricular and Lumbar Drains

Introduction/Background: Nursing management of neurologic patients may include placement of externalized ventricular drains (EVDs) or lumbar drains (LDs) to monitor/drain cerebrospinal fluid (CSF), but knowledge and practice related to EVD management varies widely, despite a high potential for life-threatening complications. Limited data exists relative to the relationship between intracranial pressure (ICP) and CSF drainage. These gaps may undermine patient safety. Research Question: What are the nursing practices and perspectives regarding management of EVDs and LDs? Methods/Approach: A 16-question multiple-choice/text entry survey was distributed electronically to nurses and advanced practice nurses who were members of the American Association of Neuroscience Nurses. Data analysis included chi-square test for multiple choice responses, and qualitative data was analyzed using a six-step thematic analysis and an inductive approach. Results/Data: Of 219 participants, 42.8% reported roles as Neuroscience ICU nurses, and 39.2% managed an EVD at least 75% of the time. Neuro ICU nurses were most likely to have a patient with an EVD ( p =.002). Approximately 63% of respondents reported consulting with colleagues about EVDs nearly every time they cared for a patient with an EVD. Nurses reported a very high care burden, including re-leveling the transducer 4 or more times per shift (n=76), and re-zeroing every 8 hours (n=72) to assure accurate calibration. Of these 82.2% reported that they re-zeroed the EVD more often to obtain an accurate reading. Approximately 25% reported accidental over-drainage, some with negative outcomes. Many (79.3%) reported caring for patients with LDs, 47.4% to diagnose normal pressure hydrocephalus. The nursing care workload was described as 30-120 minutes each shift. Conclusion: A wide heterogeneity of nursing practices was revealed in EVD and LD management. No standardized nursing care practices have been adopted by nurses for the management of CSF. The complications of these practice variations have been shown to result in untoward patient outcomes. Increased patient morbidity and mortality are linked to catheter infection and over/under drainage of CSF and may be directly related nursing practice. This reveals critical need for improved, standardized care nursing practices in the management of EVDs and LDs, and an empiric understanding of the relationship between intracranial pressure and the volume and rate of CSF drainage.

Digital Screen Usage Amongst Doctors: Demographics, Patterns of Use and Effect of Health Parameters

Background: Advances in digital technology have led to widespread availability of digital devices and consequent increased usage amongst across the population including practising healthcare professionals. Increased ‘Digital Screen time’ and its effect on physical, psychological health, and sleep patterns has been predominantly evaluated in children, adolescents and adults from various walks of life. Purpose of the Study: The purpose of this survey was to evaluate the impact of Digital Screen usage (time and patterns) spent on portable and desktop digital devices amongst physicians, surgeons and radiologists. Material &amp; Methods: An online cross-sectional survey of an 11-part questionnaire (multiple choice questions and free text box) was circulated amongst orthopaedic surgeons, radiologists and physicians in India and the UK, to evaluate demographics, speciality and place of practice; Digital platform usage reasons and time; effect on mental health, physical health, sleep time amongst practising healthcare professionals. Results: There was an even spread amongst the various age groups. Smartphones were the commonest device utilised for digital screening in 90 (67.7%) doctors with 29 (38.5%) of doctors reporting more than five hours of daily screen time. Sixty-three (47%) of doctors used this for academic purposes, whereas 43 (32%) used it for entertainment more than for academic purposes. Thirty-nine doctors (29%) were unaware of whether screen usage affected mental health. Seventy-two (53%) were of the opinion that screen usage was having a negative effect on their physical health whilst 81 (60%) thought that it was having an adverse effect on their sleeping time respectively. Conclusion: A significant proportion of doctors appear to be using digital devices beyond the recommended ‘Digital Screen time’ by various national or international healthcare organisations. There is an emerging need to highlight the deleterious effect of excessive ‘Digital Screen time’ on various health parameters and be part of a global health narrative to mitigate ill-effects and a sustainable lifestyle.

Longitudinal email-based electrocardiogram interpretation curriculum for paediatric residents.

Electrocardiograms are frequently obtained in infants and children. Training specific to paediatric electrocardiogram interpretation is necessary given that cardiac physiology and electrocardiogram findings in children are different than adults and change throughout infancy and childhood. Distributed practice may be an effective method to improve paediatric residency electrocardiogram education efforts. A pre-survey was administered to paediatric and internal medicine/paediatrics residents to ascertain baseline comfort with electrocardiogram interpretation. Subsequently, residents were emailed a clinical vignette with an associated electrocardiogram and multiple-choice question 1-2 times monthly. After submitting their answer, residents were taken to a webpage explaining key concepts explored in the clinical vignette. After 6 and 12 months, a survey was administered asking residents to again rate their confidence in the same electrocardiogram interpretation skills. The longitudinal email-based curriculum increased exposure to electrocardiogram training. Six months of participation in the curriculum correlated with significant increases in confidence in electrocardiogram interpretation skills. While there was no further increase in confidence seen at 12 months, the improvement seen at 6 months was durable. Participation in the curriculum most significantly correlated with changes in confidence in ability to utilise a stepwise approach for electrocardiogram interpretation. The curriculum resulted in durable improvement in confidence in electrocardiogram interpretation skills for paediatric residents at our centre, suggesting that email-based distributive practice can be an effective method for skill and knowledge improvement for complex educational topics.

TEL Pedagogies: Gamification – Grammar Guru

The Centre for English Communication (CEC) developed and launched Grammar Guru (GG), a browser-based game application, as part of Singapore Management University’s (SMU) TEL initiative in 2023. GG is used as part of CEC’s blended learning resources, which complements our core curriculum module for undergraduates, Writing &amp; Reasoning (WR). GG is an upgraded iteration of Power Grammar 1.0, a basic grammar game developed by students several years ago. GG is an effective TEL tool for teaching grammar as it uses gamification to make learning engaging and caters to the needs of learners with different language proficiency levels. GG improves student engagement through gamification. Gamification is the application of game design, techniques and elements in non-game contexts and activities (Deterding et al., 2011, p. 1). Research shows gamification is highly effective in increasing student engagement, attention, motivation, creativity, digital literacy and performance level (Barua &amp; Bharali, 2023; Fernandez-Antolin et al. 2021; Skritsovali, 2023). GG includes elements such as points, leaderboards, hints, and non-playable characters (NPC) to teach grammar in a professional, corporate context. By contextualizing grammatical and linguistic forms in sentences and paragraphs, GG helps students achieve greater competence and fluency in their English language abilities. The gamification elements make learning more interactive and enjoyable which improves students’ knowledge retention and application. A primary quantitative study conducted by CEC established that “the positive correlation observed suggests that the higher level a student played, the higher the student’s English language proficiency”. CEC is currently conducting a qualitative study to gather students’ feedback. GG also addresses the requirements of learners with diverse language proficiency levels by varying the difficulty of questions. These questions include sentence and text correction, matching, re-arrangement, true/false, fill-in-the-blanks and multiple-choice questions. Players work their way through eight levels that comprises Junior and Senior Intern, Junior and Senior Management Trainee, Junior and Senior Middle Management and Junior and Senior Director. Perez (2020) and Langendah (2016) highlight how certain game elements such as storytelling, challenges, progression, and feedback can boost student drive and learning. The gamification elements in GG have a similar effect, motivating learners of different proficiency levels. GG’s interface is designed to be simple and intuitive. Regardless of students’ socioeconomic background or gaming aptitude, they would be able to navigate it effectively. One challenge GG faces is striking a balance between entertainment and education. Limited game development funds result in limited game design features and less engaging gameplay for students, especially in comparison to commercial games with substantial budgets that offer high entertainment value through advanced graphics and intricate storylines. Furthermore, as CEC instructors are not game design experts, we have limited knowledge that restricts our capacity in designing and maintaining GG. Currently, CEC outsources game design and maintenance to a third parties. This results in instructors not being able to directly make changes to the game questions and content. Moreover, the process of retrieving relevant data for analysis is tedious and time consuming. Despite these constraints, thoughtful and strategic approaches can create valuable TEL resources that improve student learning.