Statistical Differences In Scores Research Articles

Fractional carbon dioxide laser combined with subcision for the treatment of three subtypes of atrophic acne scars: a retrospective analysis.

Fractional carbon dioxide (CO2) laser combined with subcision has been widely used for the clinical treatment, but the efficacy of the combined therapy on three types of atrophic acne scars remains unreported. This retrospective study analyzed the clinical data of 413 patients with atrophic acne scars, treated with fractional CO2 laser combined with subcision in the combined group and with fractional CO2 laser in the control group. The treatment efficacy was evaluated by the Investigator's Global Assessment (IGA) and the Échelle d'évaluation clinique des cicatrices d'acné (ECCA). We reported adverse reactions such as erythema, lump, skin sensitivity, acne recurrence, and hyperpigmentation that occurred in both treatment groups. The treatment efficiency of the combined group was significantly higher than that of the control group (P < 0.001). Among the three subtypes of atrophic acne scars, the ECCA scores in the combined group of boxcar-type and rolling-type scars after treatment were lower than those in the control group (P = 0.041, P < 0.001, respectively), and no statistical difference in scores between the two groups for icepick-type scars was seen (P = 0.062). There was no statistical difference in adverse reactions between the two groups (P = 0.361). Fractional CO2 laser combined with subcision is more effective than fractional CO2 laser in thetreatment of boxcar-type and rolling-type scars, but there is no significant difference in the treatment of icepick-type scars.

Examining Clinical Readiness and Performance of Students on Clinical Education Experiences: Is There an Influence From Virtual Learning?

Introduction. Peer simulation is a mechanism to enhance clinical reasoning and determine clinic readiness of Doctor of Physical Therapy students. In 2020, coursework that was traditionally face-to-face (F2F) was conducted completely online at many universities. Therefore, the purpose of this study was to examine if students who completed a stand-alone virtual simulation course presented with the same readiness and performance on their first full-time clinical education experience (CEE) as compared with students who completed the course during the previous 2 years in the traditional F2F format. Review of Literature. Prior to the COVID-19 pandemic, literature focused on virtual learning explored hybrid methods of delivering physical therapy education. There are limited studies exploring the impact of virtual learning on clinical performance of DPT students. Subjects. One hundred eight students completed their first full-time CEE during this 3-year period, with 34 having a virtual preparation and 74 having F2F coursework. Twelve of the clinical instructors (CIs) who had supervised students both virtually and in the previous 2 years were included in survey data analysis to compare cohorts. Methods. This study used final Clinical Performance Instrument (CPI) data to compare objective ratings of student performance from CIs as well as a standardized survey of student clinical readiness based on 22 items previously published. Both instruments were used to compare students from the class of 2022 (virtual cohort) to those from the previous 2 years (F2F cohort). Independent sample t tests were used to examine group differences in perceptions of student readiness and CPI data for compiled professional practice and patient management constructs. Results. Clinical Performance Instrument data revealed lower mean scores of students in all areas of performance in the virtual cohort as compared with F2F, but none of the differences reached statistical significance. For the clinical readiness survey, CIs rated students from the virtual cohort lower than prior students in overall readiness, as well as psychomotor, cognitive, and affective skill domains, including safety and accountability. However, none of the mean score differences reached statistical significance. Discussion and Conclusion. Although there was no statistical difference in scores on the CPI or perception of clinic readiness by CIs, students from the virtual cohort consistently scored lower on both instruments. Transition of students from F2F coursework for psychomotor skills to virtual formats should transpire with caution. As students transition back to traditional learning environments, programs should evaluate the effectiveness of various teaching methods to ensure excellence in physical therapist education.

Clinical observation on different frequency of auricular bloodletting combined with auricular point sticking for acne vulgaris

To observe the clinical efficacy of different treatment frequency of auricular bloodletting combined with auricular point sticking for acne vulgaris. A total of 90 patients with acne vulgaris were randomized into a treatment group 1 (30 cases, 2 cases dropped off), a treatment group 2 (30 cases, 4 cases dropped off) and a treatment group 3 (30 cases, 5 cases dropped off). Combination therapy of auricular bloodletting and auricular point sticking at Fei (CO14), Shenmen (TF4), Neifenmi (CO18) and Shenshangxian (TG2p) were given once a week, twice a week and 3 times a week in the treatment group 1, the treatment group 2 and the treatment group 3 respectively, 4 weeks were as one course and totally 3 courses were required in the 3 groups. Before treatment and after 1, 2, 3 courses of treatment, the scores of global acne grading system (GAGS), skin lesion and quality of life-acne (QoL-Acne) were observed, the clinical efficacy was evaluated after 3 courses of treatment and the recurrence rate was evaluated in follow-up of 1 month after treatment in the 3 groups. Compared before treatment, the scores of GAGS and skin lesion were decreased at each time point in the 3 groups (P<0.05), the QoL-Acne scores were increased after 1 course of treatment in the treatment group 3 and after 2, 3 courses of treatment in the 3 groups (P<0.05). There were no statistical differences in scores of GAGS, skin lesion and QoL-Acne among the 3 groups (P>0.05). There were no statistical differences in effective rate and recurrence rate among the 3 groups (P>0.05). Different frequency of auricular bloodletting combined with auricular point sticking have similar efficacy in treating acne vulgaris, all can improve the skin lesion and quality of life in patients with acne vulgaris, and have a cumulative effect and good long-term curative effect.

0158 Risk perception, outcome expectancy, and treatment self-efficacy among women and men with obstructive sleep apnea (OSA)

Abstract Introduction Continuous positive airway pressure (CPAP) is the first-line therapy for OSA. CPAP improves OSA severity, sleep architecture, and daytime symptoms. The effectiveness of CPAP, however, is limited to poor adherence. Individual's risk perception, outcome expectancy, and treatment self-efficacy predict CPAP adherence. CPAP adherence also differs by sex. However, it is unknown if predictors of CPAP use are different for women and men. We thus assessed sex differences in risk perception, outcome expectancy, and treatment self-efficacy among those with OSA. Methods Individuals enrolled to date (target n=267) in the NICEPAP study (NCT05067088), a prospective, observational cohort examining predictors of CPAP adherence, were included. Adults newly diagnosed with OSA prescribed CPAP therapy were included, while those with a need for non-CPAP therapy or unstable medical conditions (e.g., cancer receiving chemotherapy, severe lung, heart, or mental health disorders) were excluded. The exposure was sex. Co-primary outcomes were sub-scale scores from the Self-Efficacy Measure for Sleep Apnea (SEMSA) tool: Perceived Risk, Outcome Expectancies, and Treatment Self-Efficacy before starting CPAP. In addition, we assessed a comprehensive set of established psycho-social and biomedical CPAP adherence predictors using validated measures. SEMSA sub-scale scores for males and females were compared using Kruskal-Wallis statistics. Results We analyzed data for 33 females and 19 males. Females and males were 52 (41.0, 60.5) and 52 (35.0, 58) years old respectively (median [Q1, Q3]). Ten of 33 females and 4 of 19 males were Black with majority of others being White. The apnea-hypopnea index was 17.0 (9.1, 27.0) and 19.0 (13.3, 38.4), Epworth sleepiness scale and insomnia severity index scores were 9.0 (5.0, 12.0) &amp; 15.0 (11.0, 18.0) and 6.0 (4.0, 9.0) &amp; 17.0 (8.0, 19.5) for females and males respectively. There were no statistical differences in scores of Perceived Risk 2.4 (1.6, 2.9) vs 2.1 (1.8, 2.5) (p=0.717), Outcome Expectancies 2.8 (2.3, 3.4) vs 3.3 (2.4, 3.5) (p=0.371) or Treatment Self-Efficacy 3.1 (2.3, 3.7) vs 3.1 (2.0, 3.5) (p=0.977) for females vs. males. Conclusion We found no statistically significant differences in determinants of self-efficacy between women and men. Our findings may reflect a small sample size recruited to date or that self-efficacy of CPAP therapy is independent of sex. Support (If Any) This work was supported by Parker B. Francis Foundation and National Heart, Lung, and Blood Institute/NIH (1K23HL159259-01).

Medical Student Attitudes Towards Nutritional and Exercise Science Integration

Background Application of the fundamental principles of nutrition and exercise in clinical management can improve the outcomes of highly fatal diseases. The purpose of this study is to assess whether a knowledge gap in preventative measures of nutrition and exercise exists amongst medical students. We aim to see if current medical education provides students with the appropriate background for applying preventative medicine principles to clinical practice. Method Study participants were pooled from current 1st, 2nd, and 3rd year medical students. Of the total 614 students contacted, 42 1st year, 49 2nd year, and 45 3rd year students completed the survey. The survey consisted of 20 questions based on a 10-point Likert Scale that asked students to assess their own self-confidence on various aspects of nutrition and exercise education. Survey responses were aggregated and separated by year of medical training. Average response scores for each cohort were compared using a Mann-Whitney U test. Results Across the three classes, average self-confidence levels in baseline nutrition and exercise understanding were less than 6.6/10, and average confidence in their ability to educate patients on nutrition and exercise needs were less than 6.61/10. Yet, the average score for student perception of the importance of preventative medicine education was greater than 7.5/10. There were no statistical differences in scores amongst the three cohorts for 19 of 20 questions. Conclusion Finding no significant difference between self-confidence in an average 1st year and an average 3rd year medical student suggests an educational deficit in the current curriculum model. The self-confidence scores presented are concerning for poor understanding of exercise and nutritional science principles which could result in poor delegation of preventative advice in the clinical setting. As such, it appears that the current education model is not preparing students for counseling on patients regarding nutrition and exercise.

Randomized, double-blind, placebo-controlled clinical trial measuring the effect of a dietetic food on dermatologic scoring and pruritus in dogs with atopic dermatitis

BackgroundCanine atopic dermatitis (AD) is a common condition that often requires multimodal therapy. Including a diet in the multimodal management of AD may reduce medication doses, saving pet owners money and reducing side effects. The objective of this randomized, double-blind, placebo-controlled clinical trial was to determine if a diet fortified in antioxidants, polyphenols, and omega-3 fatty acids can reduce the clinical signs of AD. Forty client-owned dogs with AD were enrolled in the study and assigned to either an enriched diet (diet B) or control diet (diet A) for 60-days. CADESI-4 index scores and owner-reported pruritus scores were measured periodically.ResultsTotal CADESI-4 index scores for dogs eating diet B were lower on day 60 compared to baseline (P = 0.003). There was no statistical difference in scores for dogs eating diet A over a 60-day period. Diet B dogs had 25 and 49% reductions in CADESI-4 index scores on days 30 and 60, respectively (P = 0.0007) while diet A had no change over the study period. When comparing the percent change in owner-reported pruritus scores, diet B also performed better than diet A. By day 60, owners feeding diet B to their dogs reported a significant reduction (P < 0.0001) of 46.4% in itching, while those on diet A reported a 26.8% reduction, which was not statistically significant (P = 0.08).ConclusionsThese study results demonstrate feeding a diet enriched with ingredients to improve skin health and reduce inflammation improves the clinical signs of AD in dogs.

The effect of adding online homework assignments to a small introductory physical geology class

AbstractOnline homework (OLH) assignments were added to the Introduction to Physical Geology class at Dickinson State University in the fall semester of 2014. Anticipated advantages included timely feedback and opportunities for students to correct mistakes made during homework completion. The same instructor taught all lecture and laboratory sections over the course of the study, and student performance was compared for the 3 years prior to adopting the OLH and the 3 years after. Following adoption of the OLH, the average grade in the class increased by 7.5% and average test scores increased by 6.2%. The OLH did not significantly improve the performance of the top students (those who received an A), but it did improve the performance of the other students. Test grades showed a similar trend. The average test scores for those who received an A in the class were 88.0% before and 88.6% after adopting the OLH, whereas test averages for students who received less than an A were 63.9% before and 71.4% (7.5% improvement) after adopting the OLH. There was no statistical difference in scores in the Introduction to Physical Geology laboratory over the same period. Students are required to take the lecture and laboratory at the same time, so the student populations were virtually identical. The OLH applied to the lecture, where grades improved, but not to the laboratory, where grades remained consistent. Therefore, it was concluded that the OLH improved student performance.

Attitude and behavior of obstetric nursing staff in providing grief nursing for maternal women with fetal loss

Objective To understand the attitude and behavioral status quo of obstetric nursing staff in caring for maternal women with fetal loss, so as to provide effective reference for the establishment of obstetric grief nursing model. Methods By convenience sampling, nurses and midwives working in the obstetrics department in a ClassⅢ Grade A obstetrics and gynecology hospital of Beijing from March 1st to 31st of 2017 were selected. Self-designed Questionnaire on Attitude and Behavior of Obstetric Nurses on Grief Nursing was used to investigate the attitude and behaviour status of the obstetric nurses and midwives on grief nursing. The questionnaires were distributed collected by 2 charge nurses in obstetric department. The data were analyzed using SPSS 23.0 software. Results A total of 165 questionnaires were distributed and 165 ones were retrieved. The score of grief nursing attitudes of obstetric ward nurses was (37.03±7.01) , and the score of grief nursing behaviors was (27.08±5.61) ; the score of grief nursing attitudes of obstetric ward midwives was (39.15±7.22) , and the score of grief nursing behaviors was (16.76±4.51) .There were significant differences in the scores of grief nursing attitudes among nurses of different ages, working years and professional titles (P<0.05) ; there were statistical difference in scores of grief nursing behaviors from nurses with different working years and professional titles (P<0.05) . The highest score of grief nursing attitudes was (4.25±0.85) , and the lowest was (2.81±1.05) ; the highest score of grief behaviors was (4.33±0.98) , and the lowest was (1.79±1.04) . Conclusions Obstetric nurses' perception of grief nursing is relatively limited and lack of standardized obstetric grief nursing mode. It is necessary to further improve the education and training of sensitive culture of medical staff in grief nursing consultation. A standardized grief nursing model should be established according to the psychological status and actual psychological needs of the mothers with lost fetuses in China. Key words: Obstetrical nursing; Nurses; Cognition; Attitude; Fetal loss; Grief nursing

Feasibility of remote administration of the fundamentals of laparoscopic surgery (FLS) skills test using Google wearable device.

The fundamentals of laparoscopic surgery (FLS) program is a simulation-based training program designed to teach and assess the basic skills necessary for laparoscopic surgery. Preliminary work has demonstrated the feasibility of using Skype™ as a telesimulation modality in reliably scoring the exam for remote centers. Google Glass (GG) (Mountain View, California) is referred to as a wearable computer containing a heads-up display and front-facing camera allowing point-of-view video transmission. The objective of this study was to evaluate the feasibility of GG in scoring the technical skills component of the FLS exam. Twenty-eight participants were asked to complete the peg transfer and intracorporeal knot tasks of FLS using both GG and Skype™ setups. GG employed a third-party HIPAA-compliant video software (Pristine; Austin, TX) for video transmission. Participants were alternated between setups and evaluated by onsite and remote proctors. Times and errors were recorded by both proctors. Interrater reliability of their FLS scores was compared using Intraclass Correlation Coefficients (ICCs). GG experience was evaluated based on participant survey responses using a 5-point Likert scale. Interrater reliability for GG demonstrated a statistically significant correlation between onsite (OP) and remote (RP) proctors with ICCs of 0.985 (95% Confidence Interval [CI], 0.969-0.993) and 0.997 (95% CI 0.993-0.998), respectively, for peg and suture tasks. Skype™ demonstrated ICCs of 1.0 (95% CI 1.0-1.0). Average Likert scale responses found GG to be distracting (2.71), obstructive of the view (2.79), and a limitation to task execution (2.75). Overall, there was no statistical difference in scores between GG and Skype™ setups for either the peg (t = 1.446, p = 0.154) or suture task (t = - 0.710, p = 0.480), only 1 participant found the use of GG superior to Skype™. Our findings suggest that although GG are feasible in remote assessment of FLS with strong interrater reliability (ICC > 0.95), Skype™ was the preferred modality.

Creation and Validation of Tool to Assess Resident Competence in Neonatal Resuscitation

BackgroundThe American Board of Pediatrics requires that pediatricians be able to initiate stabilization of a newborn. After residency, 45% of general pediatricians routinely attend deliveries. However, there is no standard approach or tool to measure resident proficiency in newborn resuscitation across training programs. In a national survey, we found a large variability in faculty assessment of the amount of supervision trainees need for various resuscitation scenarios. Objective documentation of trainee performance would permit competency-based decisions on the level of supervision required and facilitate feedback on trainee performance. MethodsA simplified tool was created following the Neonatal Resuscitation Program (NRP) algorithm, with emphasis on communication, leadership, knowledge of equipment, and initial stabilization. To achieve content validity, the tool was evaluated by the NRP steering committee. To assess internal structure of the tool, we filmed 10 simulated resuscitation scenarios, 9 of which contained errors. Experienced resuscitation team members used the tool to assess performance of the team leader in the videos. To evaluate the response process, the tool was used to assess experienced resuscitators in real time at academic and non-academic sites. ResultsThe NRP steering committee approved the tool, providing evidence of content validity. Performance of the team leader in the simulated videos was assessed by 16 evaluators using the tool. There was an intraclass coefficient of 0.86, showing excellent agreement. There was no statistical difference in scores between 102 resuscitations led by experienced resuscitators at academic and nonacademic hospitals (P = .98), which demonstrates generalizability. ConclusionsThe tool we have developed to assess performance in initiating newborn resuscitation shows evidence of construct validity based on assessment of content and internal structure (interobserver agreement, response processes, and generalizability).

Teaching Professionalism in Orthopaedic Residency: Efficacy of the American Academy of Orthopaedic Surgeons Ethics Modules.

To aid implementing an ethics curriculum in an orthopaedic residency program, the American Academy of Orthopaedic Surgeons (AAOS) created 14 ethics scenarios. Because delivery of this curriculum could be burdensome, an online module-based curriculum might be optimal. Two cohorts of orthopaedic residents participated: cohort I completed 14 online ethics modules converted from the 14 AAOS ethics scenarios. For each module, we gave a multiple-choice assessment immediately before the module, immediately afterward, and 3 months afterward. Cohort II completed only the 14-module assessments at similar time intervals without any educational content. Cohort I demonstrated improvement in 3-month postmodule assessment scores in 11 of the 14 modules, 3 of which had statistical differences in baseline scores for cohort I and cohort II. We observed no statistical difference in scores within cohort II on repeat testing. This study demonstrates that 11 of the 14 AAOS ethics scenarios, converted to online modules, teach ethical concepts to orthopaedic residents. Orthopaedic residency programs may find it valuable to engage their residents in the ethics scenarios created by the AAOS to complement their ethics curriculum.

A randomised controlled trial to test the effectiveness of decision training on assessors\u2019 ability to determine optimal fitness-to-drive recommendations for older or disabled drivers

BackgroundDriving licensing jurisdictions require detailed assessments of fitness-to-drive from occupational therapy driver assessors (OTDAs). We developed decision training based on the recommendations of expert OTDAs, to enhance novices’ capacity to make optimal fitness-to-drive decisions. The aim of this research was to determine effectiveness of training on novice occupational therapists’ ability to make fitness-to-drive decisions.MethodsA double blind, parallel, randomised controlled trial was conducted to test the effectiveness of decision training on novices’ fitness-to-drive recommendations. Both groups made recommendations on a series of 64 case scenarios with the intervention group receiving training after reviewing two thirds of the cases; the control group, at this same point, just received a message of encouragement to continue. Participants were occupational therapy students on UK and Australian pre-registration programmes who individually took part online, following the website instructions. The main outcome of training was the reduction in mean difference between novice and expert recommendations on the cases.ResultsTwo hundred eighty-nine novices were randomised into intervention; 166 completed the trial (70 in intervention; 96 in control). No statistical differences in scores were found pre-training. Post training, the control group showed no significant change in recommendations compared to the experts (t(96) = −.69; p = .5), whereas the intervention group exhibited a significant change (t(69) = 6.89; p < 0.001). For the intervention group, the mean difference compared with the experts’ recommendations reduced with 95% CI from −.13 to .09. Effect size calculated at the post-training demonstrated a moderate effect (d = .69, r = .32).ConclusionsNovices who received the decision training were able to change their recommendations whereas those who did not receive training did not. Those receiving training became more able to identify drivers who were not fit-to-drive, as measured against experts’ decisions on the same cases.This research demonstrated that novice occupational therapists can be trained to make decisions more aligned to those of expert OTDAs. The decision training and cases have been launched as a free training resource at www.fitnesstodrive.com. This can be used by novice driver assessors to increase their skill to identify drivers who are, and are not fit-to-drive, potentially increasing international workforce capacity in this growing field of practice.

Effects of interdisciplinary team intervention on cognitive function and activity of daily living of Alzheimer's disease patients

Objective To explore effects of multidisciplinary team intervention in Alzheimer's disease patients and provide the basis for nursing of Alzheimer's patients. Methods A total of 125 patients with Alzheimer's disease in Hangzhou pension institutions from March to October 2015 were randomly divided into the control group and the observation group. There were 62 cases in the control group and 63 cases in the observation group. The control group was provided with the conventional model of nursing in the nursing home, and the observation group was cared by the multidisciplinary team. Mini mental state examination (MMSE) and activities of daily living assessment scale (ADL) were used to assess and observe the incidence of behavioral and psychological symptoms before and after the intervention. The observation lasted for six months with one evaluation every three months. Results Before the intervention, there were no statistical differences in scores of MMSE and ADL between two groups (P=0.865, 0.183) . After six months' intervention, scores of MMSE and ADL were significantly improved in both groups (P<0.05) ; the differences between two groups as well as between two time points were statistically significant (Fgroup=7.128, 4.213, P=0.009, 0.045; Ftime=9.519, 9.913, P=0.001, 0.001; Finteraction=16.76, 271.047, P<0.001) ; the interval value increased over time. The number of cases with behavioral and psychological symptoms in the observation group was significantly less than that in the control group (P<0.05) . Conclusions Multidisciplinary team nursing model can effectively improve cognitive function and activity of daily living of Alzheimer's disease patients. Key words: Alzheimer's disease; Cognition; Activities of daily living; Multidisciplinary team care

Profile of lifestyle of older elderly persons

Abstract Introduction: Lifestyle has been widely studied in recent years, especially in the context of longevity and aging well. Objective: The aim of this study was to analyze the lifestyle profile of older elderly persons and the relationship between lifestyle and chronic diseases. Method: A cross-sectional study evaluating 132 older persons aged over 74.6 years, who were resident of the Capão Redondo district of São Paulo, was carried out. The study was conducted in 23 institutions such as churches, community centers, parks, nursing homes and residences. All participants completed two questionnaires, with the first based on lifestyle and the second on socio-economic classification, and also answered some questions about the presence and control of non-communicable chronic diseases (NCDs). Result: the mean age was 78.8(±4.5) years and the respondents had a mean BMI of 25.5(±5.5). Most were women from social classes C and D. A total of 46 were former smokers, seven were smokers, and 82 had NCDs, with heart diseases the most prevalent. The mean lifestyle questionnaire score was 30.2(±3.5). There was no statistical difference in scores between those with NCDs and those that did not suffer from such diseases. The physical activity component had the lowest score, followed by the nutrition component. The prevalence of NCDs was significantly higher for smokers and former smokers than for those who had never smoked. Conclusion: The majority of older persons demonstrated an excellent lifestyle with healthy habits. Even those with a diagnosed NCD had a good lifestyle. Cardiovascular diseases were the most prevalent in this population. The risk of NCD was greater for smokers and former smokers than for those who had never smoked.

P0130 Quality of life in patients with colorectal carcinomatosis peritonei after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

<h3>Background</h3> An increasing number of patients with colorectal cancer are presenting with peritoneal carcinomatosis and more centres are performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While morbidity and mortality are shown to be acceptable after surgery, quality of life should be assessed. <h3>Methods</h3> 21 patients who had CRS and HIPEC from 2001 to 2012 for colorectal peritoneal carcinomatosis and who were still alive at follow up were included. The EORTC QLQ-CR29 was administered to the patients. Scores at baseline and at 6months and 12months after CRS and HIPEC were summarised by median and interquartile range, and changes were tested using the Wilcoxon matched-pairs signed-rank test. <h3>Findings</h3> After a median follow-up of 12months, there was no statistical difference in scores when comparing by age, sex, recurrence, PCI score, and presence of complications. There was no significant change in most scores, but body image score improved at 6months, while sexual interest scores and urinary frequency scores worsened at 6 and 12months, respectively. <h3>Interpretation</h3> Our study shows that colorectal peritoneal carcinomatosis patients can achieve a good quality of life after CRS and HIPEC, with improvement in body image scores.

Self-directed Learning and Its Impact on Menopausal Symptoms.

Background:One of the main criteria to verify the effectiveness of a health training program is to measure quality of life in menopausal women.Objectives:Hence the aim of this review was to evaluate the effects of self-directed learning (SDL) on MENQOl.Patients and Methods:The present single blind field study was conducted in Saadatmandi Health Center of Robat Karim (Iran, Southwest of Tehran Province) from August to December 2010. One handred and ten menopausal women were selected using convenience sampling method and then divided into two experimental (Self-directed Learning) and control groups of 55 each. Four manuals were developed to guide the women in the experimental group containing practical ways to treat menopausal symptoms. They were distributed among the participants for four weeks on a specific day. Menopausal Specific Quality of Life Questionnaire (MENQOL) was used to determine and compare quality of life scores of these women (before and three months after intervention sessions). The control group did not receive any intervention. Statistical analysis was performed by SPSS/16 software using Kolmogorov-Sminov, ANOVA, independent paired t test and Chi-square test.Results:There were significant statistical differences between two groups regarding the age of subjects; age of menopause; economic, educational and employment status; number of dead and living children; BMI and vasomotor, physical, sexual and psycho-social postmenopausal symptoms. The implementation of Self-directed Learning (SDL) model leads to a significant statistical difference in scores of vasomotor symptoms (16.32 ± 5.92 to 13.26 ± 5.31), psychosocial symptoms (34.8 ± 11 to 27.18 ± 10.83), physical symptoms (75.02 ± 18.07 to 61.42 ± 15.49), sexual symptoms (15.36 ± 6.10 to 12.00 ± 4.97) and the overall score for quality of life (141.5 ± 41.09 to 113.86 ± 36.6) (P < 0.001). No significant changes were found in the QOL scores of the control group.Conclusions:Implementation of self-directed learning provides a useful strategy that should be included in health intervention and national surveillance programs in order to improve health and therapeutic compliance in postmenopausal women.

Quality of life in patients with peritoneal surface malignancies after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundAn increasing number of patients are presenting with peritoneal carcinomatosis and more centers are performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While morbidity and mortality are shown to be acceptable, quality of life after surgery should be assessed. Methods63 patients who had CRS and HIPEC from 2001 to 2012 and who were still alive and on follow up were included. The EORTC-QLQ-C30 was administered to the patients. ResultsMedian age was 53 years (14–71). 44% had ovarian primaries, 21% had appendicael primaries and 19% had colorectal primaries. Median follow-up was 1.08 years (0.06–9.8). The median time from surgery to the questionnaire was 1.3 years (0.24–10.18). There was no statistical difference in scores when comparing by age, gender, recurrence, gender, PCI score, presence of a complication and type of primary cancer. Scores were highest less than 6 months after surgery, dropped subsequently but rose again after 2 years. Our patients had better scores compared to a control group of outpatient cancer patients at our institution as well as the reference EORTC group. ConclusionsIn keeping with previous quality of life studies done for CRS and HIPEC patients, we have shown that our patients can achieve a good quality of life after CRS and HIPEC even with recurrent disease.

Survey on knowledge of chronic heart failure and influencing factors in general practitioners in Beijing

Objective To investigate the knowledge of chronic heart failure (CHF) and influencing factors in general practitioners (GP) in Beijing. Methods A self-designed questionnaire contained total 28 items, including basic knowledge of CHF, non-drug management, drug management and other management; clinical cases were used to test clinical ability in 7 items. The questionnaire survey was conducted among GPs who participated in continuing education courses from 16 counties/districts in Beijing during January to June 2013. Results Total 720 questionnaires were distributed and 657 valid questionnaires were returned with a recovery rate of 91.3%. Total scores was 60.6. Scores of basic knowledge, non-drug management, drug management and other management was 63.1, 76.9, 44.0 and 56.9, respectively. There were statistical differences in scores of basic knowledge, non-drug management, drug management and other management between GPs with different diploma (F value: 36.8, 5.8, 21.6, 12.2, respectively; P 0.05). Conclusions The knowledge of CHF is less desirable in GPs of Beijing, so that measures should be taken to improve the GP's knowledge of CHF. Key words: General practitioners; Heart failure; Questionnaires

Ethnic differences in tumor proliferation in women with early-stage breast cancer.

560 Background: Hispanic women have a higher mortality rate and lower incidence of breast cancer (BC) compared to Caucasian women. Studies report higher tumor proliferation in African American (AA) women compared to Caucasian women. The 21-gene assay (OncotypeDX) Recurrence Score (Score) is based on the expression of 16 cancer related genes, including 5 proliferation genes that are grouped to provide the proliferation axis score (PAS). We evaluated the differences in the Score and PAS between Hispanic and Caucasian women with early-stage BC in a matched cohort analysis. Methods: Women with early-stage BC who had a Score obtained from 2005- 2011 were identified. Hispanic women were matched to Caucasians in a 1:2 ratio, based on age (+/- 10 years), stage, and nodal status. Lymphovascular invasion (LVI) and grade were collected. The Score result, 10-year distant recurrence, ER/PR/HER2 expression, and PAS were obtained from the OncotypeDX assay. Assuming equal variances, we expected &gt; 90% power to detect a difference in the mean PAS between Hispanic and Caucasian women Results: We identified 219 women who had OncotypeDX testing (74 Hispanic: 145 Caucasian). Of the 74 Hispanic women, 84% were from the Dominican Republic or Puerto Rico. Mean age was similar between groups (56.3 and 56.8). All but 8 patients were node(-). Mean PAS was higher in Hispanic (5.53, range: 3.9-7.8) vs Caucasian women (5.26, 3.7-7.3) (p=0.03, 95% CI: 0.03-0.51). The mean Score was 18.3 (0-54) and 16.3 (1-50) for Hispanic vs Caucasian women. There was no statistical difference in Score (p= 0.17) or 10-year distant recurrence (p=0.13) between groups. No differences were observed in median ER (9.8% vs 9.9%: Hispanic vs Caucasian), PR (7.3% vs 7.6%), or HER2 (9.1% vs 9.0%) by RT-PCR. Rates of LVI and grade 3 tumors were also not statistically different. Conclusions: Similar to higher PAS in AA women, Hispanic women with ER/PR(+), HER2(-) early-stage BC have higher tumor proliferation markers, measured by RT-PCR in the Oncotype DX assay, than Caucasian women. This may contribute to ethnic differences in BC mortality. We plan to evaluate ethnic differences in the 5 single PAS genes (CCNB1, MKI17, MYBL2, BIRC5, AURKA) to determine which are driving proliferation differences.

Impact on quality of life in teachers after educational actions for prevention of voice disorders: a longitudinal study

BackgroundVoice problems are more common in teachers due to intensive voice use during routine at work. There is evidence that occupational disphonia prevention programs are important in improving the quality voice and consequently the quality of subjects’ lives.AimTo investigate the impact of educational voice interventions for teachers on quality of life and voice.MethodsA longitudinal interventional study involving 70 teachers randomly selected from 11 public schools, 30 to receive educational intervention with vocal training exercises and vocal hygiene habits (experimental group) and 40 to receive guidance on vocal hygiene habits (control group control). Before the process of educational activities, the Voice-Related Quality of Life instrument (V-RQOL) was applied, and 3 months after conclusion of the activities, the subjects were interviewed again, using the same instrument. For data analysis, Prox MIXED were applied, with a level of significance α < 0.05. Results: Teachers showed significantly higher domain and overall V-RQOL scores after preventive intervention, in both control and experimental groups. Nevertheless, there was no statistical difference in scores between the groups.ConclusionEducational actions for vocal health had a positive impact on the quality of life of the participants, and the incorporation of permanent educational actions at institutional level is suggested.