Retrospective Self-assessment Research Articles

Stand-alone transarterial flow diversion for treatment of carotid cavernous fistulas

ObjectiveCarotid-cavernous fistulas (CCFs) are rare arteriovenous communications allowing blood to flow from the carotid artery into the cavernous sinus. Although currently coil and/or liquid embolization remain the preferred treatment methods for CCFs, flow diverters (FD) stents represent a viable alternative to traditional embolization techniques. This study explores both the technical aspects and rationale behind using FD stents as a stand-alone treatment approach for CCFs. MethodsThe study includes records of 7 patients with CCFs treated at two comprehensive stroke centers from 2019 to 2023. Patients treated with FD stenting in conjunction with coil and/or liquid embolization were excluded from the study. ResultsFive patients were diagnosed with direct CCFs and 2 patients with indirect CCFs. Six patients were treated with the Surpass Evolve FD stent and 1 patient with the Pipeline FD stent. DSA follow-up was performed for an average duration of 14.4 months following FD placement. Complete fistula obliteration with no residual shunting was observed in all patients. Furthermore, all patients experienced a complete resolution of symptoms following treatment. ConclusionsThe authors’ experiences suggest the efficacy and safety of FD stenting as a stand-alone treatment option for CCFs. Compared to embolization, FD stents can better preserve the parent vessel and promote healing with less associated mass effect. Despite being a retrospective self-assessment with a relatively small sample size, to the authors’ knowledge, this study represents the largest individual case series of patients with CCF treated with stand-alone FD stenting.

How Athletic Swiss Patients Experience Their Return to Sports After Anterior Cruciate Ligament Reconstruction: Results from a Retrospective Self-Assessment.

Anterior cruciate ligament (ACL) ruptures are frequent injuries, especially in athletes. Return to sports after reconstruction of the ligament is a frequently debated topic and of high relevance for these patients. It is mostly achieved at 9-12 months post-surgery. However, the risk of subsequent knee injuries is high and psychological factors play an important role in the process and success of returning to sports. Little is known about patients' perception of their journey returning to sports. This study aims to fill the gap. The study aimed to include patients treated surgically for an ACL injury over 5 years at a specialized sports-medicine clinic. Patients were surveyed on the impact of the injury on their lives, their return to sports experience, and medical history. In total, 100 (of 474) patients aged 35.9 years responded. Within 5 years, 19% experienced a reoperation and 23% a new knee injury. Overall, 83% of patients returned to their main sport, 72% reached their pre-injury level. However, 45% reported at least one distinct or severe consequence of their ACL injury. The ability to return to sports had more impact on the perception of the course of treatment than the experience of new injuries or surgery. The rate of successful return to sports was comparable to previous reports despite a higher average age in this cohort. A successful return to sports seems to be a major determinant for the perception of impact from the injury and may be more important than the avoidance of repeat trauma.

Teaching listening for interpreting through mind mapping

Abstract Interpreting scholars claim that mind mapping can be used pedagogically to enhance trainees’ interpreting-specific listening skills. However, so far relevant empirical studies have been rare. A single-group post and retrospective self-assessment design was used to examine student interpreters’ attitudes towards the use of mind mapping in teaching listening for interpreting and its effectiveness. Eighty-two students were involved as participants. An instruction experience questionnaire was administered at the end of the pedagogical intervention to examine their attitudes towards the mind mapping exercise. Two self-assessments of knowledge and skills were conducted at the end of the pedagogical intervention to investigate their pre-test post-test gains. One was a retrospective self-assessment about their competence before the exercise (then self-assessment) and the other was a post self-assessment about their competence after the exercise (now self-assessment). The results indicate that the participants perceived mind mapping as a positive learning experience and that it was effective in developing students’ interpreting-specific listening knowledge and skills.

The outcomes of postgraduate palliative care education and training: assessment and comparison of nurses and physicians

BackgroundWithin Germany, there is a heterogeneous range of training and continuing education in palliative care for different professional groups. The German Society for Palliative Medicine (DGP), together with the German Hospice and Palliative Care Association (DHPV), have defined quality requirements for postgraduate training in palliative care. These requirements include the evaluation of course structures and the assessment of outcomes.AimTo assess the ‘learning gains’ in palliative care nurses and physicians undertaking continuing education programmes, and evaluate the structures and processes. To identify if/how the continuing education programmes could be improved.Material and methodsThe development of Nurses’ and Physicians’ learning was determined using a retrospective self-assessment procedure. The evaluation was based on learning objectives developed in the DGP Education Working Group, using a six-point Likert scale for each item, and space for ‘free-text’ comments. Assessments were conducted after training.ResultsFive hundred twenty nine self-assessments were recorded (456 nurses / 73 physicians). An increase in learning is demonstrated in all areas (knowledge, skills, social and self-competence) for each profession. The greatest gain was in symptom control. However, there were significant differences in the extent of learning gains between nurses and physicians.ConclusionAnalysis suggests current training results in improvements, but personal competences progress less than knowledge and skills. One way to improve this would be to introduce more interprofessional continuing education elements. Evaluation, as a basis for improving training concepts, is essential for continual development.

Mindfulness and compassion training on daily work with patients and within the multiprofessional palliative care team: a retrospective self-assessment study

BackgroundPalliative care teams work under challenging conditions in a sensitive setting with difficult tasks. The multi-professional team can play an important role. Mindfulness and compassion-based practices are used to build resilience. Our aim was to examine (1) feasibility and acceptability, (2) satisfaction and impact, and (3) opportunities and limitations of a mindfulness course.MethodsAn eight-week mindfulness and compassion course was delivered in a university-based specialized palliative care unit. A meditation teacher provided preparatory evening sessions and meditation exercises that could be integrated into daily activities. The scientific analysis of the course was based on a questionnaire developed for quality assessmentThe first two parts consisted of demographic, Likert-type, and free-text items. Part 3 consisted of learning objectives that were self-assessed after finishing the course (post-then). In the analysis, we used descriptive statistics, qualitative content analysis, and comparative self-assessment.ResultsTwenty four employees participated. 58% of participants attended 4 or more of the 7 voluntary mindfulness days. 91% expressed moderate to high satisfaction and would recommend the palliative care program to others. Three main categories emerged in the qualitative content analysis: providing feedback on the course, personal impact, and impact on professional life. The opportunity for self-care in a professional context was highlighted. Learning gains (CSA Gain) were high (38.5–49.4%) in terms of knowledge and techniques, moderate (26.2–34.5%) in terms of implementation of learned skills, and rather low (12.7–24.6%) in terms of changes to attitude.ConclusionOur evaluation shows that the participants of a mindfulness and compassion course considered it as a feasible and welcome tool to familiarize a multi-professional palliative care team with self-care techniques.Trial registrationInternal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2018074763 (registered retrospectively on 30th July 2018).

Features of personality traits in smoking students — residents of the Northern territories of Russia

AIM: To identify psychological factors of the risk of tobacco addiction among students of the European North of Russia.
 MATERIAL AND METHODS: The study involved 137 students of Arkhangelsk state universities, comprising 37 men and 100 women aged from 17 to 25 years, preselected for a number of characteristics (born in Arkhangelsk or the Arkhangelsk region; raised in a full, socially prosperous family; without financial and household problems; without chronic somatic and neurological diseases). Identification and analysis of tobacco smoking experience were carried out by retrospective self-assessment of the subjects. The psychological status of the respondents was determined by assessing the indicators of the Freiburg multifactorial personality questionnaire (FPI); accentuations of temperament and character, suggestibility, frustration, irritability and resentment; adventurousness, behavioral, social, professional, economic, political activity, and social destructiveness. The WilcoxonMannWhitney method and Fishers F-criterion were used for statistical analyzes.
 RESULTS: In the group of smoking men, high values of hyperthymia (Me=18 units), masculinity (Me=8 units), sociability (Me=9 units), behavioral activity (Me=7 units), and social activity (Me=7 units) were recorded. In the group of smoking women, high values of exaltation (Me=24 units), masculinity (Me=8 units), sociability (Me=9 units), and social activity (Me=7 units) were recorded.
 CONCLUSION: This study reports, for the first time, the features of personality traits in smoking boys and girls permanently residing in the Northern territories of the Russian Federation. Psychological factors of the risk of tobacco addiction formation in boys and girls permanently residing in the Northern territories of the Russian Federation have been determined.

Digital phenotyping for monitoring and prediction of physical activity level during pregnancy

Abstract Background Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. Physical activity (PA) during pregnancy may reduce the adverse pregnancy outcomes. Digital phenotyping can develop interactive risk profiles to better reflect a person’s daily mobility than traditional retrospective self-assessment questionnaires. Therefore, the aims of the proposed research are to 1) test the acceptability and applicability of the BEIWE app during pregnancy, 2) characterize daily physical mobility during pregnancy, and 3) describe differences in physical mobility in women with and without diabetes. Methods This prospective cohort study will include 20 pregnant women with GDM and 20 without GDM from the Diabetes Center of the Medical Clinic or outpatient clinics of the Tübingen Women’s Clinic, Tuebingen, Germany. The study was approved by the Ethics Committee of the University Hospital Tuebingen (004/2022BO1). At baseline (22 weeks gestation), participants will be instructed to download the app. Passive data (phenotypic information) is collected automatically during the observation period. The follow-up assessment will be conducted three weeks after delivery. The acceptance of the app and comparison of the groups with and without diabetes will be conducted through Statistical analysis. Results Recruitment of participants has started and follow-up assessment is estimated to be finalized in fall 2022. Study design and results will be presented at the conference. Conclusions PA during pregnancy has been associated with minimum risk of a pregnancy, and self-monitoring of PA via an app may play a role in improving pregnancy outcomes. However, the success of Apps depends on their validity and reliability, which lack evidence. Key messages • The result of the study will develop a qualification measure for PA with no intervention. • It also provides information for planning and conducting subsequent intervention studies.

Psychological features of alcohol consumption among student youth in the European North of Russia

AIM: to identify the psychological characteristics of alcohol consumption among students of the European North of Russia.
 METHODS: The study involved 137 students of state universities in the city of Arkhangelsk (37 men and 100 women aged 17-25), pre-selected for a number of reasons: Russians, born in the city of Arkhangelsk or the Arkhangelsk region, brought up in a complete, socially prosperous family, without financial and domestic problems without chronic somatic and neurological diseases. Identification and analysis of the experience of alcohol consumption at the prenosological level was carried out by retrospective self-assessment of the subjects. The psychological status of the respondents was determined by assessing the Freiburg multifactor personality questionnaire FPI, character accentuations, suggestibility, frustration, irritability and resentment, adventurousness, behavioral, social, professional, economic, political activity and social destructiveness. For statistical data processing, the WilcoxonMannWhitney method and Fishers F-test were used.
 RESULTS: High levels of adventurousness (Me=10.5 units), extraversion (Me=8 units), behavioral activity (Me=7 units), and low shyness (Me=2.5 units) were found in the group of males who used alcoholic drinks. High levels of emotivity (Me=18 units), adventurousness (Me=9.5 units), and social activity (Me=7 units) were found in the group of women who consumed alcoholic drinks.
 CONCLUSIONS: For the first time, an analysis was made of the manifestation of indicators of the psychological status of students (representatives of the Russian population of the European North of Russia) consumers at the prenosological level and non-consumers of alcohol. The psychological markers of alcohol consumption in boys and girls permanently residing in the conditions of the Northern territories of the Russian Federation were determined.

Italian Validation of the Pittsburgh Sleep Quality Index (PSQI) in a Population of Healthy Children: A Cross Sectional Study.

Background: Sleep disorders are one of the most discussed topics in scientific literature every year. Although they are one of the most studied topics, in both adults and children, knowledge of sleep disorders and their treatment is still not completely clear, and there is a need to deepen and analyze these disorders on a country-by-country basis. However, research in the Italian literature reveals a scarce quantity of tools to evaluate sleep quality in children. The Pittsburgh Sleep Quality Index (PSQI) is probably the most commonly used retrospective self-assessment questionnaire in the adult population. Purpose: We aimed to validate and analyze the psychometric characteristics of this tool in order to detect and explore the presence of sleep disorders in a healthy Italian population of children throughout the country. Methods: Individuals aged between 3 and 16 years without symptoms of insomnia were included in this study. The reliability and construct validity of the PSQI were assessed according to Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Results: We enrolled 222 individuals in this study (mean age 11 years). The PSQI demonstrated good internal consistency (Cronbach’s α = 0.719). Test–retest reliability was assessed on a randomized subgroup of the sample (n = 35). The PSQI showed good test–retest reliability with an intraclass correlation coefficient of 0.829 for the total score (95% confidence interval: 0.662–0.914). The Pearson correlation coefficient, used for construct validity, showed a statistically significant positive correlation with the Sleep Disturbance Scale for Children (SDSC). Conclusion: The PSQI proved to be a very reliable and valid tool to investigate sleep experiences in children.

SYST E MI C MANIFESTATIONS OF FUNCTIONAL, PSYCHOPHYSIOLOGICAL AND PSYCHOLOGICAL RISK FACTORS FOR THE DEVELOPMENT OF CHEMICAL ADDICTIONS IN MEN AND WOMEN

The aim of the work was to identify the links between indicators of functional and psychophysiological status with psychological characteristics that determine the risk of developing chemical addictions in men and women. The study was carried out with the participation of 309 people, 137 men and 172 women aged 18-30, students of state universities in Volgograd, Samara and Arkhangelsk. The level of consumption of legal psychoactive substances was assessed based on the results of a retrospective self-assessment by respondents of the frequency of alcohol intake and tobacco smoking experience. The psychological status of the study participants was determined by evaluating the indicators of the Freiburg multifactorial personality questionnaire, adventurousness and social destructiveness. The psychophysiological status of the subjects was assessed according to standard electroencephalography indicators. The functional status was characterized by analyzing the level of general nonspecific reactivity of the organism. As a result of the performed research, the systematic manifestation of functional, psychophysiological and psychological prerequisites for the individual formation of a person's propensity to consume legal psychoactive substances is substantiated. The combination of a high level of general nonspecific reactivity of the organism with low values of the alpha rhythm amplitude and pronounced adventurousness, both in men and women in the follicular or luteal phases of the ovarian-menstrual cycle, is a prognostic criterion for the risk of alcohol and tobacco addiction. Comprehensive accounting of phenotypic indicators of a person's predisposition to the demand for psychoactive substances is able to optimize the system of health-saving support for students.

PSYCHOPHYSICAL DISADAPTATION AS A FACTOR OF INITIATION OF THE CONSUMPTION OF PSYCHOACTIVE SUBSTANCES IN THE STUDENT ENVIRONMENT

The aim of the work was to determine the relationship between indicators of psychophysical maladjustment, individual functional status and consumption of psychoactive substances among students. The study involved 137 students of state universities in Arkhangelsk. Identification of the experience of using psychoactive substances was carried out using questionnaire and blank methods of retrospective self-assessment of the study participants. Determination of psychophysical maladaptation was carried out on the basis of a combination of psychological and psychosomatic symptoms of stress reactions and anxiety-depressive disorders. Stress resistance was assessed by analyzing the level of general nonspecific reactivity of the organism. The psychological status was determined by a combination of indicators of accentuations and personality traits that characterize the temperament and character of the individual. It was revealed that the regular use of alcohol (2 times a week or more) among students, in the overwhelming majority of cases, is associated with psychophysical maladjustment against the background of low human stress resistance. The level of smoking and samples of narcotic substances among students are positively, linearly related to the frequency of alcohol consumption. The psychological conditionality of the formation of anxiety-depressive and acute stress disorders simultaneously provokes the demand for psychoactive substances. A comprehensive assessment of the functional and psychological indicators of predisposition to psychophysical maladjustment can provide a prediction of the risk of chemical addiction formation among students.

Communication in the face of death and dying - how does the encounter with death influence the patient management competence of medical students? An outcome-evaluation

Background informationAs part of an elective course, the Interdisciplinary Centre for Palliative Medicine at Duesseldorf University Hospital offers medical students the opportunity to personally meet and talk to a seriously ill patient on one or more occasions. The future physicians are provided with an opportunity to broaden their professional competence, i.e. their knowledge and skills in patient-centred communication at the end of life, and enhance their personal competence, for example in how to professionally handle their own emotions. A topical e-learning module helps the students to prepare for the meetings, and writing a reflection paper forms the basis for the concluding reflection seminar.ObjectivesThe study’s objective is a global and outcome-based evaluation of the elective blended-learning course that provides real-world patient interaction. The outcome-based evaluation or outcome assessment aims to objectively evaluate changes identified in knowledge, skills and attitude among the participants of the elective-course. Furthermore, the evaluation aims to answer the question of whether changes especially in attitude (social skills and self-competence) should be expected after the students have met with severely ill or dying patients.MethodOn two questionnaires specifically developed for this survey the students were able to provide a global rating of the elective course and describe their learning gains in palliative care. The students’ learning gains were measured by means of 14 items reflecting the specific educational objectives of the offered elective course. Using the German school grading system as a rating scale, the students assessed their learning progress by retrospectively evaluating their skills before and after completion of the elective course (Comparative Self-Assessment, CSA).ResultsIn the time from April 2018 till March 2020, 62 students participated in the evaluation. Overall, learning progress among students could be observed across all areas of competence, and in 50% of all retrospective self-assessment items the learning gains were ≥ 50%. The highest learning gain (63.6%) was observed in the students’ ability to meet a severely ill patient without fear. The lowest learning gain was observed when students had to confront and accept their own mortality.ConclusionsThe offered elective course supports students in achieving social and self-competence development goals. According to the obtained results, contact with real-world patients helps mould the students’ attitude.

Impact of an Education Intervention on COVID-19 Vaccine Hesitancy in a Military Base Population.

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19) vaccine hesitancy is a major impediment to achieving herd immunity and overcoming the current pandemic. Our aim was to decrease the prevalence of vaccine hesitancy through an education intervention.MethodAn education intervention, consisting of a PowerPoint presentation addressing the two mRNA COVID-19 vaccine concerns/myths and a question and answer panel comprising health care providers from various specialties, was implemented to address vaccine hesitancy among personnel associated with Wright-Patterson Air Force Base through a series of virtual and in-person seminars. Participants completed a post-seminar survey as a retrospective self-assessment to identify attitudes and views surrounding vaccine hesitancy and the impact of the education intervention. Chi-squared test was used to examine relationships between categorical variables, and multiple logistic regression was used to identify risk factors for vaccine hesitancy pre- and post-seminar. All analyses were done using SPSS Statistics Version 25.0 (IBM, Armonk, NY). Institutional Review Board approval was not obtained before this study as it began as a non-research initiative and received non-research determination post hoc.ResultsFive hundred participants completed the survey. Mean age was 44.7 years with 13.4 and 86.6% medical and non-medical personnel, respectively. Nearly all (98.8%) had not received their first shot of the vaccine series. 402 (80.9%) were receptive to vaccination, and 95 (19.1%) were hesitant post-seminar. Of the 139 participants who reported they were initially hesitant after our intervention, 50 (36%) indicated that they were now receptive to the vaccine, while 89 (64%) remained hesitant. Of those 50, 48 (96%) had moderate to great amount of trust in COVID-19 vaccine information presented by physicians/other providers. Six respondents who wanted the vaccine before the intervention no longer wanted the vaccine. A medical occupation (OR = 4.85, 95% CI = 2.63-8.96, P < .001), little or no trust in COVID-19 vaccine information from physicians/other providers (OR = 19.48, 95% CI = 7.31-51.90, P < 0.001), and being age 30 or younger (OR = 1.81, 95% CI = 1.02-3.2, P = 0.041) were independent predictors of vaccine hesitancy. Trust in providers was a significant factor in change of intent from vaccine hesitant to receptive post-intervention (OR 0.13, 95% CI = 0.03-0.59, P = .008). Age and occupation were not significant factors associated with change in intent.ConclusionOur education intervention was effective in reducing COVID-19 vaccine hesitancy in a military base population. Study limitations include applications toward other military and non-military populations, the possibility of nonresponse bias, and absence of prior validated interventions. Area for future studies includes improvement upon educational intervention, development of other effective methods, and application of intervention in other populations.

Discourseology of Linguistic Consciousness: Neural Network Modeling of some Structural and Semantic Relationships

Objective. Study of the validity and reliability of the discourse approach for the psycholinguistic understanding of the nature, structure, and features of the linguistic consciousness functioning.&#x0D; Materials &amp; Methods. This paper analyzes artificial neural network models built on the corpus of texts, which were obtained in the process of experimental research of the coronavirus quarantine concept as a new category of linguistic consciousness. The methodology of feedforward artificial neural networks (multilayer perceptron) was used in order to assess the possibility of predicting the leading texts semantics based on the discourses ranks and their place in the respective linear sequence. Same baseline parameters were used to predict respondents' self-assessments of changes in their psychological well-being and in daily life routine during the quarantine, as well as to predict their preferences of the quarantine strategies. The study relied on basic ideas about discourse as a meaning constituted by the dispersion of other meanings (Foucault). The same dispersion mechanism realizes itself in interdiscourse interaction, forming a discursive formation at a higher level. The method of T-units (Hunt) was used to identify and count discourses in the texts. The ranking of discourses was provided based on the criterion of their semantic-syntactic autonomy.&#x0D; Results. The conducted neural network modeling revealed a high accuracy in predicting the work of the linguistic consciousness functions associated with retrospective self-assessment and anticipatory imagination of the respondents. Another result of this modeling is a partial confirmation of the assumption concerning existence a relationship between the structural parameters of the discursive field (the rank of the discourses and their place in the respective linear sequence) and the leading semantics of the text.&#x0D; Conclusions. A discourse approach to the study of linguistic consciousness, understanding of its structure and functioning features seems to be reasonably appropriate. The implementation of the approach presupposes the need to form a base of linguistic corpora with the inclusion in each text markup of such parameters as: the presence of specific discourses, their ranks, positions in the linear sequence of discourses.

The effect of feedback valence and source on perception and metacognition: An fMRI investigation

ABSTRACT Receiving feedback from our environment that informs us about the outcomes of our actions helps us assess our abilities (e.g., metacognition) and to flexibly adapt our behavior, consequently increasing our chances of success. However, a detailed examination of the effect of feedback on the brain activation during perceptual and confidence judgments as well as the interrelations between perceptual accuracy, prospective and retrospective confidence remains unclear. Here we used functional magnetic resonance imaging (fMRI) to examine the neural response to feedback valence and source in visual contrast discrimination together with prospective confidence judgments at the beginning of each block and retrospective confidence judgments after every decision. Positive feedback was associated with higher activation (or lower deactivation depending on the area) in areas previously involved in attention, performance monitoring and visual regions during the perceptual judgment than during the confidence judgment. Changes in prospective confidence were positively related to changes in perceptual accuracy as well as to the corresponding retrospective confidence. Thus, feedback information impacted multiple, qualitatively different brain processing states, and we also revealed the dynamic interplay between prospective, perceptual accuracy and retrospective self-assessment.

One-week multidisciplinary post-graduate palliative care training: an outcome-based program evaluation

BackgroundA multi-professional, post-graduate, one-week palliative care training program was piloted in November 2019 at the University of Ivano-Frankivsk, Ukraine. A formal evaluation of this program was performed.MethodsThis is a comparative, retrospective outcome-based evaluation of an educational intervention. Participants completed evaluation forms at the end of the course (post-intervention = T1), covering demographics, comparative retrospective self-assessment (40 items, 6-point Likert scale), organizational aspects, and general feedback (free text). At T1, the responses represent actual self-assessment, pre-interventional (T0) scores were generated by retrospective self-assessment. The Retrospective Performance Gain (RPG) was calculated on group level for the comparative self-assessment, demographic and organizational variables were analyzed by descriptive statistics, and free text answers were processed by qualitative methodology (content analysis).ResultsFifty-three of 56 attendants from all professions relevant to palliative care completed the evaluation forms (response 94,6%), with mean age 39y (22–64) and mean working experience 13,6y (1–44). Overall ratings of the program were very positive. Comparative retrospective self-assessment demonstrated a marked RPG from T0 to T1 on all items. Free text comments emphasized the need for regular nation-wide educational programs and for further education in bereavement care; inter-professional practice; communication; palliative care philosophy; professional self-care; specific nursing skills; dementia care; and advocacy, while the general contribution of the program to palliative care development in Ukraine was acknowledged.ConclusionsSystematic evaluation of a post-graduate international training program in palliative care may provide a mutual learning experience and map country-specific barriers and facilitators that have to be addressed when setting up palliative care services.

Self-rated health over a two-year period after breast cancer surgery: prospective ratings and retrospective rating by means of a health-line.

There are difficulties in clinical assessment of patients' health, and there is a need for evaluating instruments that measures self-rated health over time and that are based on the patient's own experiences of their health situation. To describe the trajectory of self-rated health given in a retrospective health-line and its correspondence with the ratings of health given at six different time points during 2years following a first breast cancer surgery. An explorative prospective cohort study presented according to the STROBE guideline. At six time points, 459 women (26-63years) completed assessments of self-rated health during 2years following a first breast cancer surgery. Subsequently, the women retrospectively rated health month by month over the two years by means of a health-line. The women were included consecutively in 2007-2009, last data collection was performed in 2012. Statistical analyses were used to compare the health-line with previous ratings. Most women (74-88%) rated their health as good, very good or excellent at all six time points. Health-line ratings were somewhat lower than the ratings made at the actual time-point; however, the illustrated trajectories back in time followed the same patterns as the women had reported during the two years. The lowest ratings of self-rated health were reported at four months after surgery. The retrospective illustrations varied greatly, and poorer health was reported by women undergoing chemotherapy, with lower education and who reported more life events. Even if the retrospective ratings by the health-line were somewhat lower than the ratings at the actual time-point, the health-line captures the health trajectory. The individual graphic illustration by means of a health-line may serve as a basis for assessment and support patient health narratives. The findings indicate that life event, lower education and chemotherapy influence concurrent and retrospective self-assessment of health.

The Impact of Childhood Maltreatment on Long-Term Outcomes in Disorder-Specific vs. Nonspecific Psychotherapy for Chronic Depression

BackgroundChildhood maltreatment (CM) predicted poorer outcomes in acute depression treatment with CBT, IPT and Supportive Psychotherapy (SP). The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) fared well in patients with chronic depression and CM during acute treatment, yet there is a considerable lack of empirical evidence for long-term outcomes. MethodsWe analyzed one and two-year follow-up data of 268 patients randomized to 24 sessions (20 weeks) of acute and 8 sessions (28 weeks) of extended treatment with CBASP or SP. Primary outcome was the number of well weeks as measured by the Longitudinal Interval Follow-Up Evaluation Interview (LIFE). Secondary outcomes included self- and clinician-rated depression symptoms. We investigated this moderating effect for any CM and for specific subtypes of CM. ResultsIntent-to-treat analyses revealed that the presence of CM did not significantly moderate long-term effects of CBASP compared to SP. The analysis of trauma subtypes revealed that patients with childhood emotional abuse had statistically significant worse outcomes than patients without (main effect, p=.015) and that the advantage of CBASP over SP was larger in patients with childhood emotional abuse than in patients without (interaction effect, p=.045) after 1 year. No significant effects were found for other trauma subtypes. LimitationsThe measurement of CM was limited to retrospective self-assessment. ConclusionsThe presence of CM did not significantly moderate long-term treatment effects of CBASP compared to SP. When trauma subtypes were considered, CBASP was more effective than SP after one year in patients who retrospectively reported emotional abuse.

From quality to outcomes: a national study of afterschool STEM programming

BackgroundState afterschool networks across the US are engaged in system-building efforts to improve the quality of science, technology, engineering, and math (STEM)-focused afterschool programming. This study examined national trends in STEM program quality, youth outcomes, and the connections between these two data sources.MethodsOne thousand five hundred ninety-nine youths (grades 4–12) enrolled in 158 STEM-focused afterschool programs across 11 state networks completed a retrospective self-assessment measuring STEM attitudes and social-emotional learning (SEL)/twenty-first-century skills. Two hundred fifty standardized observations of STEM activities were performed to measure STEM program quality.Results(1) Most youth (65–85%) reported increases in STEM engagement, identity, career interest, career knowledge, relationships, critical thinking, and perseverance, with the largest gains reported by those engaging with STEM activities for 4 weeks or more; (2) there were significant, strong correlations between STEM and SEL/twenty-first-century outcomes reported by youth; and (3) youth participating in higher-quality STEM programming reported more growth than peers participating in lower-quality programs.ConclusionThis effort demonstrates how investments in STEM program quality yield high returns for programs and youth and how collaborations between research and practice can track successes and challenges, determine investments in program management, and expand advocacy and policy efforts. Additionally, this study supports a growing body of literature that suggests a synergy between youth development and STEM learning approaches that can improve outcomes for youth.

How a Year of Clinical Experience Affects Students' Perspectives About the Supervision They Need to Perform Entrustable Professional Activities.

Assessment of entrustable professional activities (EPAs) requires a supervisor to determine a learner's need for supervision to perform the tasks. This study examines medical students' perspectives, after completing their core clerkships, about the supervision they need to perform tasks defined by the core EPAs for entering residency. Compared with assertions at the start of the clerkship year, on retrospective self-assessment, students reported needing higher levels of supervision predominantly for activities commonly done during clinical rotations. Students remain confident in their ability to perform tasks with autonomy in the post-clerkship phase, however, raising concern about their abilities to discern limitations and appropriately request supervision.