Standardized Assessment Research Articles

Validation of the ankle-specific pediatric arthritis ultrasound scoring system in children with juvenile idiopathic arthritis

ObjectiveTo validate the ankle-specific Pediatric Arthritis Ultrasound Scoring System (PAUSS-ankle) in children with juvenile idiopathic arthritis (JIA). MethodsPatients with a diagnosis of JIA prospectively underwent a standard clinical assessment and musculoskeletal ultrasound (MSUS) of one or both ankles. B-mode and Power-Doppler mode MSUS images were acquired and scored according to the PAUSS-ankle protocol. A subset of patients received a contrast-enhanced MRI (ceMRI) of the affected ankle. ceMRI scoring for synovitis was performed according to the Rheumatoid Arthritis MRI System (RAMRIS). Test characteristics of the PAUSS-ankle scores were evaluated with ceMRI as reference. Associations between the findings on physical examination, PAUSS-ankle, and RAMRIS were investigated. ResultsThirty-two patients with JIA contributed 63 MSUS and 15 ceMRIs of the ankles. The PAUSS-ankle total B-mode score had a moderate correlation with physical examination findings (correlation (r)=0.43, p < 0.001). The PAUSS-ankle B-mode score ≥1 exhibited a sensitivity of 79 % and specificity of 100 %, demonstrating excellent diagnostic accuracy with an area under the curve (AUC)= 0.89 (confidence intervals, CI, 0.78–1.00) while clinical assessment had a sensitivity of 57 % and AUC= 0.71 (CI: 0.58–0.85). The PAUSS-ankle B-mode score had significant strong correlations (r = 0.68–0.90, p < 0.005) with the RAMRIS for the assessment of disease severity for each joint area and the ankle joint as a whole. ConclusionOur findings demonstrate excellent diagnostic accuracy of the PAUSS-ankle in detecting the presence and severity of ankle synovitis when compared to ceMRI. The PAUSS-ankle holds significant promise as an accurate measurement that may complement current clinical standards.

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices.

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

Three-dimensional morphometry of the human thoracic aorta using centerline analysis based on least-squares plane fitting

ObjectiveA novel approach to 3-dimensional morphometry of the thoracic aorta was developed by applying centerline analysis based on least-squares plane fitting, and a preliminary study was conducted using computed tomography imaging data. MethodsWe retrospectively compared 3 groups of patients (16 controls without aortic disease, and 16 cases each with acute type B aortic dissection and congenital bicuspid aortic valve). In addition to the standard assessment indices for curvature κ and torsion τ, we conducted coordinate transformation based on the least-squares plane, divided the centerline into 3 representative features (transverse, anterior-posterior, and longitudinal displacements), and analyzed the overall and local displacement in each direction. The transverse displacement, represented by the distance of the centerline from the least-squares plane, was curve-fitted to the damped oscillation waveform. Thereafter, damped oscillation parameters were compared for each group. ResultsCurvature κ exhibited a bimodal distribution, with peaks observed in the ascending aorta and aortic arch, and torsion τ exhibited a transition from positive to negative values in the arch. There were significant differences in the mean displacement between the groups for each direction (transverse P = .0083, anteroposterior P = .010, longitudinal P = 1.32 × 10−6). Furthermore, interval integral analysis revealed that several intervals exhibited significant differences between groups in each direction. The amplitude of damped oscillation parameters was significantly larger in the bicuspid aortic valve group than in the control and type B aortic dissection groups. ConclusionsThe novel analytical approach permitted a quantitative assessment of the 3-dimensional morphological differences between the control, type B aortic dissection, and bicuspid aortic valve groups.

Assessment of Obesity-related Metabolic Conditions: a novel objective scoring system better informs metabolic disease severity

BackgroundReporting of obesity-associated metabolic disease severity and longitudinal response to bariatric surgery is not standardized. We updated our co-morbidity scoring tool to the Assessment of Obesity-related Metabolic Conditions (AOMC) to combine pharmacotherapy and biochemical data to score diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS) severity. ObjectivesThe aim of this study is to determine whether the AOMC system more accurately stages metabolic disease severity than a clinically based Assessment of Obesity-Related Comorbidities (AORC) system. SettingUniversity hospital, United States. MethodsA retrospective cohort study of prospectively collected demographic, clinical, and biochemical data was performed on adults evaluated for bariatric surgery over 6years. AORC versus AOMC scores and disease severity were compared using McNemar’s and Wilcoxon’s tests. ResultsOf 1442 patients, AOMC newly diagnosed metabolic disease in more patients than did AORC: DM (73.4% versus 44.5%), HTN (91.7% versus 67.9%), and DYS (63.8% versus 53.4%). Of those on pharmacotherapy, AOMC found fewer patients with adequately controlled disease: DM (39.9% versus 97.7%), HTN (64.7% versus 99.3%), and DYS (51.8% versus 99.0%). For those in whom both scores could be calculated, disease severity was upstaged in most patients: DM (65.9%), HTN (42.9%), and DYS (30.9%). There were also significant shifts toward higher scores for all conditions and severity classifications, with more patients diagnosed with pre–metabolic and severe disease (untreated/uncontrolled). ConclusionsOur study demonstrated that the severity of DM, HTN, and DYS is vastly under-represented by clinical history alone and lacks standardized assessments. Our AOMC tool more accurately describes longitudinal metabolic response to bariatric surgery.

Optimizing the Application of International Classification Standards of Function, Disability &amp; Health (ICF) Cases Musculosceletal Disorders in Employees Permata Hospital Bekasi

Optimal health services are an absolute requirement for government administrators and private parties. Optimizing health services can be done through innovation, to bring services closer to the community, more easily accessible, higher quality and cheaper. The application of innovation is expected to make communication between medical personnel better, each individual is encouraged to work more quickly, precisely and carefully, and innovation is expected to give birth to a better work culture. The direct service to the community that is quite highlighted is health services. On this basis, we carry out service interventions in the form of workshops and mentoring for PERMATA BEKASI Hospital employees to further optimize service innovation. The workshops carried out included the latest ICF (Japan) international standard assessment system that can be applied in Indonesian health services, Optimizing Employees in preventing Musculosceletal disorder problems and Implementing and optimizing the addition of Dry needle services for Musculosceletal disorder cases. The activity was carried out on June 29 2024. Before conducting the workshop, service innovations that had been implemented were identified. As a result, the residency, which previously had been appealed to several international hospitals, including Japan and Thailand, is still in the process of standardization efforts carried out by countries whose index of health services or hospitals can be an example and motivation.

The prevalence of presbyphagia in older adults: asystematic review and meta-analysis.

Presbyphagia is defined as structural, physiological and innervational alterations in the swallowing process as aresult of aging and is considered to be involved in the etiology of dysphagia. This systematic review and meta-analysis aimed to estimate the prevalence of presbyphagia in older adults without disease-related dysphagia. In this study five databases were searched in October 2023 with no time limitation. Combined effect sizes of presbyphagia prevalence were calculated using random effect models. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity. Egger's test and afunnel plot were employed to examine publication bias. Atotal of 19studies were selected for analysis. Overall, the prevalence of presbyphagia in older adults was 30.8% (95% confidence interval [CI] 24.8-36.7%). Publication bias was adjusted for using the fill-and-trim method and the corrected pooled prevalence of presbyphagia was 17.3% (95% CI 11.0-23.6%). In addition, the meta-regression findings revealed that the assessment tool had significant effects upon heterogeneity. Although the pooled prevalence of presbyphagia in older adults was 17.3%, the lack of large representative studies limited the interpretation of these findings. In the future, further large studies that diagnose presbyphagia using standardized assessment tools would facilitate new avenues to reduce the risk of dysphagia in older adults.

Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy.

In the 2021 version of the Standardized Critical Care EEG Terminology, the American Clinical Neurophysiology Society introduced new definitions, including for the cyclic alternating pattern of encephalopathy (CAPE). CAPE refers to changes in background EEG activity, with two patterns alternating spontaneously in a regular manner. CAPE shares remarkable similarities with the cyclic alternating pattern, a natural EEG phenomenon occurring in normal non-rapid eye movement sleep, considered the main electrophysiological biomarker of sleep instability. This review explores similarities and differences between cyclic alternating pattern and CAPE and, leveraging the existing expertise on cyclic alternating pattern, aims to extend knowledge on CAPE. A standardized assessment of CAPE features is key to ascertain its prevalence and clinical significance among critically ill patients and to encompass the impact of confounding factors such as anesthetic and sedative agents. Although the preservation of non-rapid eye movement sleep-related elements has a well-known prognostic value in the critical care setting, the clinical importance of cyclic oscillating patterns and the prognostic significance of CAPE remain to be elucidated.

Re-evaluation and operative indications after induction therapy for thymic epithelial tumors.

Thymic epithelial tumors (TETs), encompassing thymoma and thymic carcinoma, represent a rare and heterogeneous group of thoracic malignancies with varying prognoses and treatment strategies. Surgical resection is the cornerstone of therapy for localized stages, but the management of locally advanced or unresectable TETs often involves induction therapy, including chemotherapy and/or radiation therapy, as a neoadjuvant approach aimed at downstaging the tumor to facilitate subsequent resection. This review synthesizes current knowledge on the re-evaluation process and operative indications following induction therapy for TETs, highlighting the pivotal role of accurate assessment in guiding surgical decisions and optimizing patient outcomes. Induction therapy's efficacy is contingent upon precise re-evaluation methods to accurately gauge treatment response and assess resectability post-therapy. This review discusses the various modalities employed in re-evaluation, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT), and the significance of tumor markers, underlining their strengths and limitations. The adoption of modified RECIST criteria for TETs by the International Thymic Malignancy Interest Group (ITMIG) underscores the necessity for standardized assessment guidelines to ensure consistency and reliability across studies and clinical practices. Furthermore, we explore the implications of induction therapy on surgical decision-making, emphasizing the criteria for determining the suitability of patients for surgical intervention post-therapy. The review addresses the challenges and future perspectives associated with the re-evaluation process, including the potential for advanced imaging techniques and the integration of molecular and genetic markers to enhance the precision of treatment response assessment. In conclusion, the re-evaluation of TETs post-induction therapy is a complex but critical component of the multidisciplinary management approach for these patients. Standardizing re-evaluation methodologies and incorporating novel diagnostic tools could significantly improve the prognostication and treatment stratification, ultimately enhancing the therapeutic outcomes for patients with advanced TETs.

The Effectiveness, Benefits and Challenges of the Implementation of Flipped Classroom in English Teaching and Learning: A Systematic Review

The aim of doing this systematic review is to fill up the gap on the benefits, challenges, and impacts of flipped classrooms in English language instruction and learning. The research incorporates data from 36 empirical studies that were published between 2017 and 2023. Examining peer-reviewed literature from databases including Web of Science, ERIC, and Scholar Google, the review's content analysis shows the finding are: Flipped classrooms have a positive impact on (1) student learning outcomes, which increased students’ academic achievement; (2) students’ motivation to learn and classroom engagement; (3) enhances social interaction skills and independent learning through group activities. The challenges include that: (1) Some students lack motivation; therefore, they skip watching lectures and materials on video outside of the classroom; (2) there are Issues related to technology, include unreliable internet connections and insufficient technical assistance and so on will set back the outcome. Despite the potential of the flipped classroom model to promote the effectiveness of English language learning, in order to fully realize this potential, improved technological infrastructure, professional development opportunities for teachers, and the cultivation of students' self-directed learning skills are required to address the pedagogical and technological obstacles that arise during implementation. Future studies should concentrate on standardized assessment techniques, cross-cultural and educational environment comparisons, and long-term learning results.

Toward Sustainable Lifelong Learning: Feedforward Effects of Challenge Recollections on Adult Learning Identity

ABSTRACTLittle research has examined how prior learning experiences influence adult learning attitudes and lifelong learning engagement. We adopted a person‐centric approach to examine past work‐related learning experiences and assessed the effects of recalled challenges on current learning attitudes, intentions, and behavior in the same domain. Surveying alumni from an online master's degree program, we found that recollected challenges from past learning entail multifaceted challenge foci (e.g., curriculum‐related vs. social obstacles). Learners reporting more challenges in curriculum and social dimensions reported less positive attitudes toward lifelong learning, supporting the notion that negative learning experiences may hinder the development of self‐identity as a lifelong learner. Limited support was obtained for predictions about relationships between past challenges and post‐graduation learning intentions and behavior. The person‐centric approach also permits the analysis of past learning experiences that are not well captured by standard assessments of “successful” adult learning.

Understanding Musculoskeletal Risks in Retail Workers: An Ergonomic Assessment of Store 24H

Musculoskeletal disorders (MSDs) are prevalent in retail environments, often resulting from repetitive tasks, awkward postures, and prolonged standing. This study examined musculoskeletal discomfort and ergonomic risk factors within the retail environment of convenience stores, focusing on the prevalence of MSDs among employees of Store 24H, Dungun, Terengganu, Malaysia. The assessment began with a job task description, followed by workplace observation and worker input. Utilising a systematic approach, the research integrated two standardized assessment tools; the Cornell Musculoskeletal Questionnaire (CMQ) and the Initial Ergonomic Risk Assessment (ERA) Form Checklist, to identify the discomfort area and ergonomic risk factors associated with job tasks. Three job tasks were identified in the Store 24H environment; operating cash registers, customer service and restocking. The findings indicate a notable prevalence of MSDs associated with the identified high-risk tasks. Repetitive motions, awkward postures, prolonged standing, and forceful exertion were observed as primary ergonomic risk factors for these tasks which contribute to musculoskeletal discomfort in the neck, shoulder, back, hip, and knee. Additionally, forceful exertion and vibration exhibit high risks towards restocking tasks, resulting in restocking as the top contributor towards the MSDs. Hence, the findings highlight the need for advanced ERA and mitigation strategies, including workstation redesign, task rotation, ergonomic training and accessories, to promote employee well-being and reduce the incidence of MSDs among employees of Store 24H. Implementing these measures is essential for promoting the health and well-being of employees, decreasing the occurrence of musculoskeletal disorders, and improving overall safety and productivity in the workplace.

Markers of predicting discharge from forensic psychiatric hospitals in Czechia.

Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.

The Impact of Artificial Intelligence in Educational System

The way we teach and learn could be completely transformed by artificial intelligence (AI), which could make the process more efficient, personalized, and interesting. Artificial intelligence (AI) in education is the application of AI technologies, like natural language processing and machine learning, to improve the educational process. Through the use of algorithms, teachers are able to customize learning for each student by analyzing data, finding trends, and making predictions. Artificial intelligence (AI) and its potential impact on education have gained widespread attention because of ChatGPT's impressive performance on standardized academic assessments. For the development and implementation of AI-driven technologies in schools, colleges, and universities to be sustainable, a thorough knowledge of their effects on the current educational system is needed. The application of AI in education has a lot of potential advantages. One of the biggest benefits of AI in education is personalized learning, which allows students to learn at their own pace and in a fashion that best fits their learning preferences. This can improve student results. Chatbots, automated grading and evaluation, and intelligent tutoring systems can boost productivity, free up teachers' time, and deliver more precise and consistent feedback. Some of the challenges that need to be resolved are potential bias, cost, lack of confidence, and privacy and security concerns. AI can improve data analysis, empowering teachers to make facts-based decisions. There are some impacts of artificial intelligence in educational system that are covered in this review. These are the applications of artificial intelligence in automated assessment, intelligent tutoring systems, personalized learning, and collaborative teacher-student learning.

Assessments of expected MPA outcomes can inform and improve biodiversity conservation: Case studies using The MPA Guide

Global, regional, and national targets have been set to protect and conserve at least 30 % of the ocean by 2030, in recognition of the important benefits of healthy ocean ecosystems, including for human well-being. Many of these targets recognize the importance of the quality, not just quantity, of areas that are included in the 30 %, such as marine protected areas (MPAs). For example, the Convention on Biological Diversity’s Global Biodiversity Framework Target 3 calls for areas to be effectively conserved and managed, ecologically representative, well-connected, and equitably governed. Protecting a percent area is not the sole goal – protection must be effective and equitable. To better understand the quality of biodiversity conservation afforded, in addition to the quantity of area protected, we looked at MPAs across 13 studies that used The MPA Guide and related tools to track Stage of Establishment and Level of Protection as measures of expected biodiversity conservation outcomes across diverse locations, scales, and cultural, political, and conservation contexts. We show that standardized assessments of MPA quality can help to (1) evaluate and improve existing MPAs; (2) plan new MPAs; (3) compare the quality of MPA protection across various scales; (4) track MPA quality, including progress towards coverage targets; (5) enable clear communication and collaboration, and (6) inform actions needed to achieve policy targets and their underlying environmental and social goals, among others. We share common opportunities, challenges, and recommendations for tracking MPA quality at various scales, and using these quality assessments to measure progress towards global targets.

TINJAUAN YURIDIS TERHADAP STANDARDISASI PRODUK HELM IMPOR

Business entities that carry out trade activities by importing helmets into the country without adhering to the Indonesian National Standard (SNI) is a form of violation related to Standardization and Conformity Assessment. The main issue is whether imported helmets entering the Indonesian market comply with the standardization requirements set forth in Law Nomor 20 of 2014 on Standardization and Conformity Assessment, and what sanctions are imposed on importers who violate these provisions. The study uses a normative type of research and descriptive research methods, which is then analyzed qualitatively, and conclusions are drawn using deductive reasoning. The findings indicate that business entities without an Indonesian National Standard (SNI) certificate who distribute and trade imported helmet products without being accompanied by Indonesian National Standard (SNI) standardization violate the provisions of Article 25 paragraph (4) of Law Nomor 20 of 2014. Such violations can result in criminal sanctions in accordance with Articles 65 and 67 of Law Number 20 of 2014, which include a maximum prison sentence of 5 (five) years and/or can be subject to a maximum fine of IDR 35,000,000,000.

Prevention of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy.

Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues. This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings. This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study. This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.

ОСТЕОПОРОЗ КАК ФАКТОР РИСКА СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ

Cardiovascular disease and bone fractures caused by osteoporosis are the leading causes of death in older adults. The purpose of this study was to demonstrate the correlation between overall risk of cardiovascular events and low bone density in postmenopausal women, and its impact on the incidence of major cardiovascular events. Our prospective study included 300 postmenopausal women. All those examined were divided into three groups depending on the measured bone tissue density: Group I – 84 examined with osteoporosis; Group II – 115 patients with osteopenia; and group III – 101 subjects with normal bone density. For all subjects, the overall ten-year risk of a fatal cardiovascular event was calculated using the SCORE system tables. Results. After 36 months of observation, cardiovascular diseases occurred in 19 (6.3%) subjects. Significant differences in the incidence of cardiovascular events were demonstrated between patients with osteoporosis, osteopenia and normal bone density (x2=28.7; p&lt;0.001), as well as between patients with high and low cardiovascular risk (x2=22, 6; p). &lt;0.001). Multivariate logistic regression analysis showed that smoking (2.23; 95% CI: 1.02–6.19; p=0.035) and an increase in total cardiovascular score (1.36; 95% CI: 1.17–1 .58; p&lt;0.001) are related. with an increased risk of cardiovascular events, while an increase in T-score was associated with a decreased risk of cardiovascular events (0.42; 95% CI: 0.25 to 0.73; p=0.002). Measurement of bone density with a standardized assessment of overall cardiovascular risk may be useful in selecting women in need of intensive prevention and treatment of atherosclerosis.

A Survey of Post-Graduate Satisfaction With Orthopaedic Residency Training at a Single Institution.

The Accreditation Council for Graduate Medical Education (ACGME) has called for self-study within residency programs. Post-graduate surveys allow the graduate to reflect upon their residency experience after years of autonomous practice. Despite their potential utility, a standardized assessment of residency training from the perspective of orthopaedic alumni does not exist. In this study, we aimed to create, analyze, and share with our alumni a post-graduate survey based on ACGME core competencies. The survey was developed by full-time orthopaedic faculty and reviewed by a survey methodologist to ensure clarity and an ideal survey format. In May 2020, the survey was emailed to all 90 graduates from 2000 to 2019. Respondents were polled on current clinical practice and satisfaction with program-specific initiatives, residency requirements, and learning environment issues based on a 7-point Likert scale. Respondents were also given the opportunity to provide open-ended responses. Data were collected within the survey platform and subdivided into 3 cohorts based on years since graduation. The response rate was 71% (64/90). The likelihood of fellowship training increased with recency since graduation. Most respondents are in either private or health-system-owned practice but 23% work in an academic center.The oldest cohort had greater variability in clinical practice. Most program-specific initiatives received high satisfaction scores, but graduates within the past 5 years had the lowest satisfaction scores. Instruction of skills included in ACGME competencies received generally favorable reviews, but professional development skills, such as starting a practice and evaluating job opportunities, received low marks.The overall satisfaction with the program was high (86%) but was lowest among most recent graduates. The post-graduate survey demonstrates areas of strength and weakness and highlights dissatisfaction among recent graduates. The data will drive specific curricular changes within our program. The survey will be shared to promote self-study within other programs.

Brain fog assessment in patients recovered from COVID-19 in China: a development and validation study

Background Post coronavirus disease 2019 (COVID-19) pandemic, the widespread emergence and persistence of brain fog has led to a decline in people’s productivity and quality of life. However, the clinical characteristics of COVID-19-associated brain fog are unclear, and standardized assessments are lacking. This study aims to develop a scale for brain fog assessment and support clinical practice and research. Methods The 17-item Brain Fog Assessment (BFA) scale was developed using a standardized methodology, including literature review, focus group discussions (FGDs), expert evaluation, and psychometric validation. Eighteen potential items were generated following the literature review. These items were subsequently refined during FGDs, which included input from patients, caregivers, and multidisciplinary experts in neurology, cognitive neuroscience, and psychology. After thorough deliberation and expert evaluation, the item pool was finalized into a 17-item scale. We recruited 1,325 patients recovered from COVID-19 from Chinese communities. Psychometric properties were assessed by reliability and validity analysis. Results Exploratory factor analysis of the BFA scale revealed a three-factor mode comprising ‘cognitive decline’ (nine items), ‘confusion − disorientation’ (five items), and ‘fatigue’ (three items). The internal consistency of each factor was strong (Cronbach’s α: 0.82–0.92). Confirmatory factor analysis showed that the model fit, convergent validity, and discriminant validity of the scale were satisfactory. The test-retest reliability was strong (intraclass correlation coefficient = 0.84). Criterion-related validity analysis showed a strong correlation to the Wood Mental Fatigue Inventory (r = 0.70, p < 0.001). Individuals with a higher BFA score tended to score lower on the Montreal Cognitive Assessment (r = −0.23, p = 0.015). Conclusions We established a novel BFA scale to quantify multiple clinical aspects of COVID-19-associated brain fog. Using the BFA scale, fatigue and declining performance in memory, attention, and thought were identified as the main symptoms of COVID-19-associated brain fog. This scale has potential implications for disease monitoring and therapy development for individuals with COVID-19-associated brain fog.

Advancing medical laboratory practice in Pakistan: insights from a focus group study on technologists’ training needs

BackgroundThe realm of medical laboratory technology (MLT) training and education is unstructured in Pakistan. The primary challenge currently confronting the workforce in MLT is the absence of standardized curricula and assessments in education and training. This was an exploratory study aiming to inquire experiences of trainees, alumni and teaching coordinators regarding the technologist training program in a single institute at Pakistan.MethodsTo gain an in depth understanding of MLT program, three focus group discussions (FGDs) were held at Department of Pathology and Laboratory Medicine, Aga Khan University, Pakistan during Feb-April 2024. A team of pathologists and educationists developed interview guides for FGDs in English. Interviews were bilingual, transcribed verbatim and coded using thematic analysis. Participants included current trainees, alumni, teaching and learning coordinators and moderators for the interview.ResultsA total of 29 participants were engaged; these included current MLT trainees (n = 10), alumni (n = 10), and teaching/learning coordinators and sectional supervisors (n = 9). Five main themes emerged from the analysis of FGDs: (Scott MG, Rifai N, Smith B, Oellerich M, Panteghini M, Apple F et al. The changing face of laboratory medicine: a more service and less academically oriented profession? 2015;61(2):322-9.) Recognition of key features of the MTT program, (Ferraro S, Braga F, Panteghini MJCC, Medicine L. Lab Med new Healthc Environ. 2016;54(4):523–33.) Evaluating curriculum design, (Waheed U, Ahmad M, Wazeer A, Saeed M, Saba N, Rasheed FJMJMS. Medical laboratory science education; shaping competent and skilled healthcare professionals. 2023;1(1):58–63.) Teaching and learning strategies, (Ned-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM. Competency guidelines for public health laboratory professionals. 2015.) Addressing the need to improve assessment methods, and (Linder RJJM, Education B. Educating medical laboratory technologists: revisiting our assumptions in the current economic and health-care environment. 2012;13(2):150-4.) Navigating the transition from a trainee to a competent technologist.ConclusionOur investigation demonstrated its potential as a valuable needs assessment study, highlighting key strengths, drawbacks, and challenges of the existing MTT program. Importantly, these findings at our institute can inform further research efforts to design competency-based MLT education and training programs in Pakistan.