Significant Improvement In Total Score Research Articles

The Impact of Prophylaxis on the Quality of Life of Boys with Haemophilia—A Twin-centre Study from South India

Background and Aims: Quality of life (QOL) of boys with haemophilia was severely affected due to many reasons like frequent hospital visits and joint stiffness. This study aims to analyse the impact of the prophylaxis programme on the QOL of haemophiliac boys. Methods: This is a twin-centre cross-sectional study that included all boys with haemophilia aged between 4 and 18 years and receiving prophylaxis. The Canadian Haemophilia Outcome – Kids Life Assessment Tool (CHO-KLAT) Version 3 was used to compare pre-prophylaxis scores with post-prophylaxis scores obtained after four months of prophylaxis. Results: The mean (standard deviation [SD]) age of the study participants was 10.66 (1.28) years. About 88% had haemophilia A and 66.66% had good adherence to prophylaxis. The mean pre-prophylaxis total score was 45.6 (4.9) and the mean post-prophylaxis total score was 64.3 (5.4). Significant improvement in total scores and domain scores was observed in the post-prophylaxis group.

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799

A Prospective Randomized Trial Comparing Quality of Life in Adult Female Acne Treated with Azelaic Acid 15% Gel versus Oral Spironolactone.

In several countries, recent research has shown an increase in the prevalence of adult female acne (AFA), defined as the acne that appears in women aged over 25. This disease brings some particularities and challenges, such as a greater impact on quality of life (QoL) and chronicity. A negative impact on QoL has been observed, as well as anxiety, depression, anger, low self-esteem, and feelings of embarrassment and frustration. To quantify AFA's impact on QoL and the influence of two dermatological treatments. A prospective study including 40 women, aging from 25 to 44 years old, with mild-to-moderate acne was conducted. Participants underwent clinical, laboratory, and photographic evaluations. They were randomized into two treatment groups: group 1 - azelaic acid (AZA) 15% gel twice daily; group 2 - spironolactone (SPIRO) 100 mg/day and treated for 6 months. At baseline and at the end of treatments, a specific QoL questionnaire for acne, already translated and validated for Brazilian Portuguese (Acne-QoL-BR), was applied. It contains 19 questions allotted in four domains. Each item within a domain is scored from 0 to 6. The total score ranges from 0 to 114 and domains are distributed as follows: 0-30 (self-perception), 0-30 (role-emotional), 0-24 (role-social), 0-30 (acne-symptoms). Higher scores reflect better QoL. The mean age was 32.7 (SD: 5.42); 85% presented persistent acne. After treatment regardless of group, there was a significant improvement in total score and all domains' scores of acne QoL-BR (p < 0.001), with no difference between groups, despite one treatment being topical and the other systemic (p=0.918). Acne-QoL-BR is a useful tool for quantifying the impact of acne and should be used as an efficacy parameter in clinical trials.

The efficacy of applying the Interpersonal Effectiveness skills of dialectical behavior therapy into communication skills workshop for clinical nurses

BackgroundWe designed this open-pilot study to investigate the efficacy and feasibility of incorporating the Interpersonal Effectiveness skills from Dialectical Behavior Therapy (DBT-IE) into a 3-h clinical communication workshop for registered nurses. MethodA convenience sample of registered nurses were invited. The Professional Fulfillment Index, Perceived Stress Scale, Empathy Index, the Interpersonal Reactivity Index, and measures regarding quality of life, anxiety, depression, and insomnia were completed. A subgroup of participants received the Objective Structured Teaching Examinations (OSTE). Pre- and post-workshop assessments were conducted to identify the most empathetic or validated responses from case scenarios and to assess the self-rated levels of confidence regarding the capability to select the best answer. The satisfaction of the participants with respect to the workshop content, process, and the lecturer were also collected. Paired t-test was used for statistical analysis. ResultsAmong the 164 participants of the clinical communication workshop, 72 consented and their pre- and post-results were analyzed. Post-workshop assessment revealed significant improvement in professional fulfillment (p = 0.014), interpersonal coping ability (p = 0.038), and decrease in dysfunctional coping style (p < 0.001). The overall satisfaction score of participants was 4.68 (5-point Likert scale). In the subgroup that underwent pre- and post-workshop OSTE (n = 28), there was a significant improvement in total scores, pass rates, ratings from observational supervisors, simulated students, and simulated patients after the workshop (p < 0.001). ConclusionOur results demonstrated the effectiveness, acceptance, and feasibility of incorporating the DBT-IE skills into a clinical medical communication workshop through a teaching style comprising of rigorous interactions and hands-on practices.

The impact of a “short-term” basic intensive care training program on the knowledge of nonintensivist doctors during the COVID-19 pandemic: An experience from a population-dense low- and middle-income country

BackgroundThe utility of basic intensive care unit (ICU) training comprising a “1-day course” has been scientifically evaluated and reported in very few studies, with almost no such study from resource-limited settings. AimThe study assessed the utility of basic ICU training comprising of a “1-day course” in increasing the knowledge of nonintensivist doctors. Materials and methodsThis is an observational study conducted at a medical university in North India in 2020. The participants were nonintensivist doctors attending the course. The course was designed by intensivists, and it had four domains. The participants were categorised on the basis of their duration of ICU experience and broad speciality. Pretest and posttest was administered, which was analysed to ascertain the gain in the knowledge score. ResultsA total of 252 participants were included, of which the majority were from the clinical medicine speciality (85.3%) and had ICU experience of 1–6 months (47.6%). There was a significant improvement in the mean total score of the participants after training from 14/25 to 19/25, with a mean difference (MD) of 5.02 (p < 0.001). Based on ICU experience, in groups I (<1 month), II (1–6 months), and III (>6 months), there was a significant improvement in the total score of the participants after training with MD with 95% confidence interval (CI) limits of 5.27 (4.65–5.90), 4.70 (4.38–5.02), and 5.33 (4.89–5.78), respectively. In the clinical surgery specialty (n = 37), there was a significant improvement in the total score after training from 11/25 to 16.4/25 with an MD (95% CI limits) of 5.38 (4.4–6.3). Similarly, in the clinical medicine group (n = 215), the MD (95% CI limits) score after training was 4.95 (4.71–5.20), from 14.5/25 to 19.5/25. In feedback, more than half of the participants showed interest in joining ICU after training. ConclusionsTraining nonintensivist doctors for 1 day can be useful in improving their knowledge, regardless of their prior ICU experience and speciality.

Effectiveness of a case-based digital learning interprofessional workshop involving undergraduates in medical technology, radiological science, and physical therapy: A pre-post intervention study.

All healthcare professionals must understand information on a patient’s biophysical functions, and it is important to educate professionals on how to use this information in an interprofessional team for diagnosis. However, there is little interprofessional education for students of medical technology and radiological science involved in biophysical function diagnosis. In the present study, we developed a case-based interprofessional learning tool for using biophysical information for diagnosis. The study examined the effects of a collaborative exercise workshop for healthcare professional students using the tool. Participants were 234 students from three healthcare professions (medical technology, radiological science, and physical therapy). They completed the Japanese version of the Readiness for Interprofessional Learning Scale before and after the workshops. The workshops incorporated digital materials that allowed students to examine the test results of a virtual patient, answer questions, and discuss their diagnoses and prognoses. For analysis, a two-way analysis of variance was performed on the total score on the Readiness for Interprofessional Learning Scale of the three departments, and the effectiveness of the workshop for the three departments was compared. Statistical analyses showed no interaction between time and department (p = 0.283). After the workshop, students from all three departments showed significant improvements in total scores on the Readiness for Interprofessional Learning Scale (p < 0.01) with medium to large effect sizes (r = 0.33–0.52). In the comparison between departments, there was a significant difference in the awareness levels of only medical technology and radiological science students before the workshop (p = 0.015). This study conducted case-based learning workshops with students from three departments, in which a patient’s biophysical information was conveyed between occupational practices. The workshops improved the awareness of interprofessional education in students from all departments and revealed that interprofessional education is important for healthcare professions involved in biophysical function diagnosis.

AFFECTIVE BEHAVIORAL THERAPY (ABT): FUNDAMENTAL PRACTICE IN THERAPEUTIC LISTENING AND OCCUPATIONAL THERAPY FOR PRIMARY CARE WORKERS DURING THE COVID-19 PANDEMIC

in various communities. Primary healthcare workers (PHCW), are at the frontline of COVID-19 crisis, having to deal with infected patients and their families. Objective: To evaluate the efficacy of Affective Behavioral Therapy (ABT) for the treatment and prevention of mental health disorders for PHCW. Methods: PHCW from a primary care unit (PCU) were invited to participate in an ABT group. They answered the Patient Health Questionnaire-4 (PHQ-4) about how they felt before the sessions and after them. Results: 10 sessions were offered between April and June 2020 and 30 PHCW participated, 22 women and 08 men mean age was 36.8 (SD=9.7) years old. The average number of participants per session was 4.4 (SD=2.2). Pre- and post-intervention PHQ-4 scores showed significant improvement in total score (p &lt; 0.001). Conclusion: PHCWs mental health is strategic for the management of the community during crises related to natural crises. The ABT was effective in supporting the mental health of PHCW during the COVID-19 epidemic. Future controlled studies must be conducted in order to further test its efficacy. Keywords: COVID-19, mental health, primary care, therapeutic listening, occupational therapy, affective behavioral therapy

Psychosocial Program for Primary School Student to Overcome School Refusal Behavior

Background: School refusal behavior refers to a spectrum of problematic illegitimato absenteeism that includes youths who misschool or extended periods of time. School refusal behavior is the refusal to attend school due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school. The term school refusal was coined to reflect that children have problems attending school for a variety of different reasons and these reasons might not be the expression of a true phobia such as separation or social anxiety. Aim: The aim of the present study was to develop the psychosocial program for school students to overcome school refusal behavior at basic school education. Design: A quasi-experimental design was used to achieve the aim of the study. Setting: This study was conducted at primary schools from Benha City, Qalubia Governorate, which is followed The Ministry of Education in Egypt. Subject: A systematic random method from six grade primary schools 69 students from Benha district on students with school refusal behavior. Tools: Three tools were used for data collection. Tool 1- Students Questionnaire includessocio-demographic data of studentsand their parents, medical and surgical history of parents. Tool 2- School refusal Assessment Scale. Tool 3- Spence children Anxiety Scale. Results: There was a highly statistically significant improvement in total score of school refusal behavior and total score of anxiety between pre and post implementation of the program. Conclusion: The study demonstrated that psychosocial program had a positive effect on overcoming school refusal behavior and anxiety among students at basic school education. Recommendations: A psychosocial program should be given for all school refusal students to enhance their social adjustment, reduce anxiety and overcome school refusal.

Effect of Collagen Tripeptide and Adjusting for Climate Change on Skin Hydration in Middle-Aged Women: A Randomized, Double-Blind, Placebo-Controlled Trial.

Introduction: Although collagen is widely used in various forms as a functional ingredient in skin care products, the effect of oral supplementation of collagen tripeptides (CTPs) on human skin is unclear. Moreover, the majority of the positive outcomes of CTP reported so far have not considered the effect of weather conditions. Therefore, we tested the effect of CTP and adjusting for climate change on skin properties in middle-aged women.Materials and Methods: A randomized controlled trial was conducted with 84 women between 40 and 60 years of age. Participants were randomized to receive placebo or 1,000 mg CTP daily for 12 weeks. CTP was prepared from the skin of Nile Tilapia by the digestion method using collagenase from non-pathogenic bacteria of the genus Bacillus. Skin hydration, wrinkling, and elasticity were assessed at baseline and after 6 and 12 weeks with adjustments for temperature, humidity, and ultraviolet A exposure during the evaluation time using weather data from the regional meteorological office.Results: Of the 82 participants, 74 completed the trial without adverse effects. Compared with the control group, trans-epidermal water loss was reduced more in the CTP group after 12 weeks (P < 0.05). At 12 weeks, even after adjustment for humidity, temperature, and UVA in the region, the difference of the two groups in TEWL remained statistically significant (adjusted for humidity and temperature, P = 0.024; adjusted for UVA, P = 0.032; adjusted for temperature, high temperature, and ultraviolet A, P = 0.031). In terms of skin hydration, more improvement was evident in the CTP group than in the control group. In the subgroup analysis, subjects under 50 years of age showed a significant improvement in total score and moisture in the subjective skin improvement questionnaire after taking CTP for 12 weeks. Application of CTP was well-tolerated, and no notable adverse effect was reported from both groups.Discussion: Our findings suggest that oral ingestion of CTP from the Skin of Nile Tilapia (Oreochromis niloticus) is well-tolerated and helps reduce water loss in in middle-aged women.Clinical Trial Registration: www.clinicaltrials.gov/, Identifier: NCT03505684.

Efficacy of intravitreal injection of aflibercept in the treatment of neovascular age-related macular degeneration

Objectives To evaluate the visual and anatomical outcomes following intravitreal injection of aflibercept in patients with neovascular age-related macular degeneration (AMD). Background Neovascular AMD is considered a principal cause of visual impairment worldwide. It is associated with choroidal neovascularization, which causes exudation that affects vision. Early clinical trials showed that intravitreal injection of anti-vascular endothelial growth factor agents is associated with significant improvement of visual outcomes in the majority of eyes. Aflibercept is an anti-vascular endothelial growth factor agent that recently gained approval for treating neovascular AMD. Patients and methods This prospective study conducted at Menoufia University Hospitals, included 60 eyes of 46 patients with treatment–naive neovascular AMD. The patients received 3monthly aflibercept intravitreal injections. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure were measured at diagnosis and after each injection. Also, the patients were asked to fill the 25-item National Eye Institute Visual Function Questionnaire at baseline and at the end of the study. Results The mean BCVA improved from 0.061 (decimal fraction) to 0.081 after the third injection (P Conclusion Intravitreal aflibercept in neovascular AMD is associated with increased BCVA and reduced CMT. In addition, intravitreal aflibercept possibly has a benefit of improving the quality of vision-related functions.

Development and validation of a chronic disease nursing education program for enhancing clinical reasoning ability in undergraduate nursing students.

ABSTRACTThis study developed a chronic disease nursing educational program to enhance clinical reasoning in nursing students and then tested it for effectiveness. Before and after completing the program’s five 90-minute sessions, 54 second-year students in a four-year nursing degree program at a university completed a self-administered survey to evaluate their clinical reasoning ability. The measure used was the Scale to assess the Critical Thinking of Clinical Nurses. Results showed significant improvement in total scores and in the reasoning subscale scores, indicating the overall effectiveness of the program. However, no significant improvement was found in any of the measure’s subscales other than reasoning. Those skills could, potentially, be enhanced through clinical practicum.

Efficacy of sildenafil citrate in the treatment of female sexual dysfunction

Introduction: Female sexual dysfunction (FSD) defines as disturbances in the female sexual response cycle resulting in marked distress and interpersonal difficulties. Sildenafil citrate was effective in treatment of FSD through increasing blood flow to corpus cavernosum of clitoris, vagina and labia minor.Aim:To evaluate the effect of sildenafil citrate in treatment of female sexual dysfunction.Patients and Methods: An observational study had been done on 43 females complaining of FSD who were fulfilling the inclusion criteria. They were taken oral sildenafil citrate 25mg daily for 6 weeks and were evaluated by 19–items Female Sexual Function Index (FSFI) questionnaire before and after treatment.Results: Our results showed that 34.4% became normal with score of FSFI>26.5; while 65.6% showed some improvement but still have FSD (FSFI<26.5). There was significant improvement in all female sexual domains in FSFI ranged from 21% to 69%. There was significant improvement of total score in both 1st degree circumcision more than 2nd degree circumcisions with 41%- 35%, respectively.Conclusion: We concluded that the treatment of patients with FSD by sildenafil citrate 25mg daily for 6 weeks had significant improvement effect on all domains of FSD with no improvement in pain score and effective in1st degree circumcised female more than 2nd degree according to FSFI questionnaire.

플립러닝을 기반으로 한 대학 영어 문법 수업의 효과

The purpose of this study is to investigate the effects of flipped learning on Korean EFL students’ grammar knowledge, and examine their perceptions on flipped classrooms. The experimental group (n=15) participated in the flipped learning for 8 weeks, while the control group (n=15) was under a traditional teacher-centered grammar class during the same period. A questionnaire was conducted for data collection, and students’ reflective journals were used in order to voice their views on their learning. It was found that 1) the experimental group showed more significant improvements in total scores than the control group, 2) the students’ satisfaction about video lectures in the flipped classroom was positively correlated with their achievement, and 3) most participants in the experimental group considered deep learning ability effects (improving comprehension of classes, learning strategies, long-term memory effects, and thinking skills) as the main advantages of flipped learning. However, some participants stated communicative anxiety and the burden of time spent on video lectures as disadvantages. Based on the findings, some pedagogical implications for English education were suggested.

Developing a Suite of Motion-Controlled Games for Upper Extremity Training in Children with Cerebral Palsy: A Proof-of-Concept Study.

Aim: The Scratch programming language allows learner developers to write games. The Kinect2Scratch extension makes Scratch games with bodily motion control possible by connecting to Microsoft's Kinect sensor. This study examined the feasibility and possible efficacy of a suite of motion-controlled games designed for upper extremity (UE) training in children with cerebral palsy (CP) using Kinect2Scratch.Materials and Methods: This is a proof-of-concept study. We developed three games, requiring three UE movement patterns (shoulder holding, reaching, and handclap), for use in children with CP. The primary outcome was feasibility, addressed by adherence, engagement, satisfaction, and safety. The secondary outcome was efficacy, which was evaluated by Quality of Upper Extremities Skills Test (QUEST), Box and Block Test (BBT), Melbourne Assessment 2 (MA2) test, and ABILHAND-kids score.Results: Thirteen children with CP (mean age 6.9 years) received 24 sessions of training (30 minutes per session). The adherence rate was 100%. During the first 2 weeks of training, children had a significantly higher level of participation in Kinect2Scratch training than in conventional rehabilitation [Pittsburgh Participation Scale, median (interquartile range [IQR]), 6 (3–6) vs. 4 (3–6) P = 0.04]. However, during the last 2 weeks of training, there was no significant difference in participation between the Kinect2Scratch and conventional training [Pittsburgh Rehabilitation Participation Scale, median (IQR), 4 (3–5) vs. 4 (3–6) P = 0.55]. Most children enjoyed playing the games. The mean score of enjoyment was 4.54 ± 0.66. There were no adverse events during the training periods. The children had significant improvement in total score of QUEST and MA2. There were no significant improvements in BBT and ABILHAND-kids score.Conclusion: Using Kinect2Scratch games for UE training is a feasible adjunctive program for children with CP.

An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center.

Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts and skills of SDM was developed. This curriculum consisted of an innovative seven-step SDM model and a skills-focused SP case, integrated into the ambulatory rotation for senior medicine residents at the University of Pittsburgh Medical Center in 2015. Evaluation consisted of pre/postcurriculum surveys assessing residents' knowledge of and attitudes toward SDM. Skills development was assessed via pre/postcurricular audio recordings of clinical decision making. Thirty-six residents completed the curriculum (survey participation rate 88%). There was significant improvement in residents' knowledge (median score pre 75%, post 100%, P < .01); confidence (median composite score pre 2.87, post 3.0, P < .01, where 1 = not confident/important, 4 = very confident/important); and importance of SDM (median composite score pre 3.14, post 3.5, P < .01). Forty-four clinical recordings (31 pre, 13 post) were assessed using the Observing Patient Involvement in Decision-Making scale. Improvement in use of SDM skills was seen among all residents (mean increase 1.84 points, P = .27). When data were stratified post hoc by U.S. versus international medical graduates, there was significant improvement in total score (mean increase of 5.15 points, P = .01) among U.S. graduates only. SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents' knowledge of, attitudes toward, and demonstration of SDM skills.

Effect of educational programs on knowledge and self-management of patients with chronic obstructive pulmonary disease

Background Patient education has a vital role in caring for patients with chronic obstructive pulmonary disease (COPD), and a corner stone of self-management in chronic illnesses.Aim of the study This study aimed to evaluate the effect of educational programs on the knowledge and self-management of patients with COPD.Methods This study was carried out on 40 COPD patients at outpatient follow-up Medical Clinics at Tanta University Hospital. The researchers interviewed them using an interview schedule to assess the sociodemographic characteristics, patients’ medical history, physical examination, and knowledge regarding COPD and an observational checklist to assess self-care practice of the patient.Results The results have shown significant differences in relation to decrease in the signs of cough, sputum, and shortness of breath immediately and after 2 months of implementing the self-care management program, but there were no significant differences in relation to other signs of the disease. The majority of patients (95%) had poor knowledge, and all of them had unsatisfied practice regarding self-management skills for COPD before implementation. Immediately postimplementation of the educational program, the study showed highly statistically significant improvement in total score of knowledge, where the majority of them had a fair knowledge and good practice regarding COPD; these scores decreased in post-test 2.Conclusion This study concluded that the education of patients regarding knowledge for COPD and healthcare practice is very effective in improving their self-management skills, but they need reinforcement follow-up. Therefore, this study recommended that the healthcare personnel should provide health education for COPD patients on self-care to their improve knowledge which helps prevent complications and maintain their life.

Effectiveness of immunotherapy in children depends on place of living – A pilot study

BackgroundIt is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Allergen immunotherapy (AIT) is the only treatment of allergy modifying the immune response with the potential to change the natural history of allergic diseases. It seems that studies evaluating the efficacy of immunotherapy in large cohorts of allergic patients living in farm areas are needed to understand the influence of environment on immune response during AIT.Aim. To compare the clinical effectiveness of immunotherapy between children living in farm versus urban areas. Materials and methodsThis was a retrospective analysis of 87 children living in farm area (n=42) and city area (n=45), aged 8–16, who completed three years of subcutaneous immunotherapy due to allergic rhinitis/asthma. An AIT efficacy questionnaire has been designed to be filled in by the allergy specialist during a regular immunotherapy visit before and after AIT. ResultsWe observed significantly higher improvement in total score among children from farm area compared to children from city area (p<0.001). Between-group differences in symptoms and drug scores did not reached the level of significance. Multivariate logistic regression analysis (adjustment for the effect of gender and type of allergy) showed that living in farm areas was independently associated with significant improvement in total score after immunotherapy (OR: 10.9; 95%CI: 3.7–32.2). ConclusionThe current analysis of the better AIT effectiveness in the farm population has shown the protective influence of environmental exposures on asthma and allergic rhinitis in our children.

Combination inhaled steroid and long-acting beta₂-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease.

The long-acting bronchodilator tiotropium and single-inhaler combination therapy of inhaled corticosteroids and long-acting beta2-agonists (ICS/LABA) are commonly used for maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). Combining these treatments, which have different mechanisms of action, may be more effective than administering the individual components. To assess relative effects of the following treatments on markers of exacerbations, symptoms, quality of life and lung function in patients with COPD.• Tiotropium plus LABA/ICS versus tiotropium.• Tiotropium plus LABA/ICS versus LABA/ICS. We searched the Cochrane Airways Group Specialised Register of Trials (April 2015), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal and reference lists of relevant articles. We included parallel, randomised controlled trials (RCTs) lasting three months or longer conducted to compare ICS and LABA combination therapy in addition to inhaled tiotropium versus tiotropium alone or combination therapy alone. We independently assessed trials for inclusion, then extracted data on trial quality and outcome results. We contacted study authors to ask for additional information. We collected trial information on adverse effects. Tiotropium plus LABA/ICS versus tiotropiumWe included six studies (1902 participants) with low risk of bias that compared tiotropium in addition to inhaled corticosteroid and long-acting beta2-agonist combination therapy versus tiotropium alone. Investigators found no statistically significant differences in mortality between treatments (odds ratio (OR) 1.80, 95% confidence interval (CI) 0.55 to 5.91; two studies; 961 participants), a reduction in all-cause hospitalisations with the use of combined therapy (tiotropium + LABA/ICS) (OR 0.61, 95% CI 0.40 to 0.92; two studies; 961 participants; number needed to treat for an additional beneficial outcome (NNTB) 19.7, 95% CI 10.75 to 123.41). The effect on exacerbations was heterogeneous among trials and was not meta-analysed. Health-related quality of life measured by St. George's Respiratory Questionnaire (SGRQ) showed a statistically significant improvement in total scores with use of tiotropium + LABA/ICS compared with tiotropium alone (mean difference (MD) -3.46, 95% CI -5.05 to -1.87; four studies; 1446 participants). Lung function was significantly different in the combined therapy (tiotropium + LABA/ICS) group, although average benefit with this therapy was small. None of the included studies included exercise tolerance as an outcome.A pooled estimate of these studies did not show a statistically significant difference in adverse events (OR 1.16, 95% CI 0.92 to 1.47; four studies; 1363 participants), serious adverse events (OR 0.86, 95% CI 0.57 to 1.30; four studies; 1758 participants) and pneumonia (Peto OR 1.62, 95% CI 0.54 to 4.82; four studies; 1758 participants). Tiotropium plus LABA/ICS versus LABA/ICSOne of the six studies (60 participants) also compared combined therapy (tiotropium + LABA/ICS) versus LABA/ICS therapy alone. This study was affected by lack of power; therefore results did not allow us to draw conclusions for this comparison. In this update, we found new moderate-quality evidence that combined tiotropium + LABA/ICS therapy compared with tiotropium plus placebo decreases hospital admission. Low-quality evidence suggests an improvement in disease-specific quality of life with combined therapy. However, evidence is insufficient to support the benefit of tiotropium + LABA/ICS for mortality and exacerbations (moderate- and low-quality evidence, respectively). Of note, not all participants enrolled in the included studies would be candidates for triple therapy according to current international guidance.Compared with the use of tiotropium plus placebo, tiotropium + LABA/ICS-based therapy does not increase undesirable effects such as adverse events or serious non-fatal adverse events.

Assessing Freshman Engineering Students' Understanding of Ethical Behavior.

Academic dishonesty, including cheating and plagiarism, is on the rise in colleges, particularly among engineering students. While students decide to engage in these behaviors for many different reasons, academic integrity training can help improve their understanding of ethical decision making. The two studies outlined in this paper assess the effectiveness of an online module in increasing academic integrity among first semester engineering students. Study 1 tested the effectiveness of an academic honesty tutorial by using a between groups design with a Time 1- and Time 2-test. An academic honesty quiz assessed participants' knowledge at both time points. Study 2, which incorporated an improved version of the module and quiz, utilized a between groups design with three assessment time points. The additional Time 3-test allowed researchers to test for retention of information. Results were analyzed using ANCOVA and t tests. In Study 1, the experimental group exhibited significant improvement on the plagiarism items, but not the total score. However, at Time 2 there was no significant difference between groups after controlling for Time 1 scores. In Study 2, between- and within-group analyses suggest there was a significant improvement in total scores, but not plagiarism scores, after exposure to the tutorial. Overall, the academic integrity module impacted participants as evidenced by changes in total score and on specific plagiarism items. Although future implementation of the tutorial and quiz would benefit from modifications to reduce ceiling effects and improve assessment of knowledge, the results suggest such tutorial may be one valuable element in a systems approach to improving the academic integrity of engineering students.

Antipsychotic Treatment and Comorbid Anxiety: a Preliminary Study

Background Anxiety symptoms have variable prevalence rate of 26.3% to 50.4% in schizophrenic patients compared to 28.8% for general population. Some atypical antipsychotics (Quetiapine, Olanzapine) are effective in reducing anxiety in patients with schizophrenia or schizoaffective disorders. Objective The purpose of this preliminary study was to compare the efficacy of typical and atypical antipsychotics in reducing anxiety in patients diagnosed with schizophrenia and schizoaffective disorder hospitalized in Arad between 2013- 2014. Methods Considering the treatment, 63subjects patients were divided in two groups: T1 (treated with Olanzapine, Quetiapine) and T2 (treated with Haloperidolum, Risperidone, Aripiprazol). Results After treatment, the level of anxiety is reduced with significant improvement of total score of PANSS; the effect is higher in group T2 compared to T1. Before treatment, anxiety is positively correlated with total score of PANSSN (r=.285; p=0.010), PANSST (r=.260; p=0.040) and total score of HAM-D (r=.455; p Conclusions Various treatments are successful in reducing anxiety in psychotic patients. This conclusion is confirm duet our results: in group T2 the treatment has a higher effect on anxiety and lower size effect on intelligence.