Checklist Total Score Research Articles

Development of Airway Hemorrhage Simulation Scenarios With Pilot of an Airway Team Leader Assessment Tool.

Airway hemorrhage requires rapid treatment to prevent adverse patient outcomes. Simulation education programs are challenged to recreate learning environments with adequate fidelity for team management of airway hemorrhage. We developed Airway Hemorrhage Simulation Scenarios consisting of low-cost partial-task simulators to mimic airway hemorrhage (nasopharyngeal, oropharyngeal, expanding neck hematoma) and multiple methods to assess team leader performance in emergent airway management [Airway Team Leader Assessment Tool (ATLAT), Airway Checklist Performance, and Global Performance Rating]. We assigned trainees in Emergency Medicine (EM) and Critical Care (CC) sequentially to 1 of the 3 possible hemorrhage scenarios, and each trainee participated in a single 1-hour session composed of 3 repeated opportunities of deliberate practice of the assigned scenario. We assessed the trainees after session 1 and session 3 with independent expert evaluators of trainee performance using the ATLAT, Airway Checklist Performance, and Global Performance Rating. We collected data on 26 trainees: 19 EM residents [postgraduate year (PGY) 1-3] and 7 CC fellows (PGY 4-7). Trainees had significant improvement for all ATLAT domain measures, Airway Checklist Total Score, and Global Performance Rating between session 1 and session 3. Our pilot evaluation suggests that deliberate practice of Airway Hemorrhage Simulation Scenarios improves airway team leader performance from multiple disciplines in managing high-acuity, low-occurrence airway hemorrhage.

Experiencing anesthesia and surgery early in life impairs cognitive and behavioral development.

The impact of anesthesia and surgery on neurocognitive and behavioral development in infants and children remains inadequately understood. To investigate the impact of early-life exposure to general anesthesia and surgery on cognitive and behavioral development. Children aged 0-3 years who underwent general anesthesia and surgical procedures between 2012 and 2015 were included. The cognitive and behavioral development of these children at ages 4-6 years was assessed. Age-, race-, and gender-matched children from the same geographic region, who did not undergo general anesthesia or surgery, served as the control group. The Wechsler Preschool Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to evaluate children's total intelligence quotient (FSIQ) and specific cognitive domains. The Gesell Development Schedules (GSCH) and Child Behavior Checklist (CBCL) were employed to assess behavioral and personality development. Additionally, the study analyzed the effects of various factors including anesthesia drugs, surgery duration, number of surgeries, age, weight, ethnicity, and gender on postoperative neurocognitive and behavioral outcomes. The study included 447 children with anesthesia/surgical exposure (AS) and 459 children in the control group. Analysis of cognitive and behavioral development showed a significant difference in the working memory index (WMI) between the AS and control groups (p < 0.05). Exploratory findings indicated that children administered remifentanil exhibited lower developmental quotient (DQ) values, whereas those given fentanyl showed higher (worse) Child Behavior Checklist (CBCL) total scores. Moreover, increased anesthesia/surgical exposures, younger age and lower body weight at exposure, and longer surgery durations were associated with cognitive and behavioral developmental challenges. This study examined the impact of early-life exposure to surgery and anesthesia on postoperative cognitive and behavioral development. Findings indicate that higher frequency of exposure to surgery and anesthesia, younger age, and lower body weight at exposure could negatively influence cognitive and behavioral development. Furthermore, variations in the effects of different anesthetics on behavior and cognition were observed. Caution is advised regarding the use of opioid analgesics such as remifentanil and fentanyl for more rigorous clinical applications.

Efficacy of oral sodium chloride in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy: A randomized controlled trial (SCHO Trial)

IntroductionHyponatremia is a well-documented adverse effect of oxcarbazepine treatment, but no clinical trial has yet been conducted to explore any intervention for reducing the incidence of hyponatremia. Materials and MethodsThis open-label trial evaluated the efficacy of add-on daily oral sodium chloride supplementation of 1–2 g/day for 12 weeks in reducing the incidence of hyponatremia in children receiving oxcarbazepine monotherapy aged 1–18 years. Apart from comparing the incidence of symptomatic and severe hyponatremia, serum and urine sodium levels, serum and urine osmolality, changes in behavior and cognition, and the number of participants with recurrence of seizures and requiring additional antiseizure medication (ASM) were also compared. ResultsA total of 120 children (60 in each group) were enrolled. The serum sodium level at 12 weeks in the intervention group was higher than that of the control group (136.5 ± 2.6 vs 135.4 ± 2.5 mEq/L, p = 0.01). The number of patients with hyponatremia was significantly lower in the intervention group (4/60vs14/60, p = 0.01). However, the incidence of symptomatic and severe hyponatremia (0/60vs1/60, p = 0.67 for both), changes in social quotient and child behavior checklist total score (0.6 ± 0.8 vs 0.7 ± 0.5, p = 0.41 and 0.9 ± 1.2 vs 1.1 ± 0.9, p = 0.30 respectively), the number of patients with breakthrough seizures (9/60vs10/60, p = 0.89), and the number of patients requiring additional ASMs (8/60vs10/60, p = 0.79) were comparable in both groups. ConclusionsDaily oral sodium chloride supplementation is safe and efficacious in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy. However, sodium chloride supplementation does not significantly reduce more clinically meaningful outcome measures like symptomatic and severe hyponatremia.Trial registry No. CTRI/2021/12/038388.

Clinical phenotypic spectrum of CTNNB1 neurodevelopmental disorder.

Pathogenic heterozygous loss of function variants in CTNNB1 are associated with CTNNB1 neurodevelopmental disorder. We report the clinical phenotype of individuals with CTNNB1 neurodevelopmental disorder using both caregiver-reported data (medical history, adaptive function, quality of life, and behavior issues) and in-person clinical assessments (neurological, motor, and cognitive function) in 32 individuals with likely pathogenic or pathogenic CTNNB1 variants. Most individuals had truncal hypotonia, muscle weakness, hypertonia, dystonia, microcephaly, and many had a history of tethered cord. Visual problems included strabismus, hyperopia, and familial exudative vitreoretinopathy. Half of individuals walked without an assistive device. The mean Gross Motor Functional Measure-66 score was 56.6 (SD = 14.8). Average time to complete Nine-Hole Peg Test was slower than norms. Mean general conceptual ability composite scores from Differential Ability Scales Second Edition were very low (M = 58.3, SD = 11.3). Fifty-five percent of individuals had low adaptive functioning based on the Vineland Adaptive Behavioral Scales. Based upon the Child Behavior Checklist total problems score, the majority (65%) of individuals had behavioral challenges. The mean overall Quality of Life Inventory-Disability score was 81.7 (SD = 11.9). These data provide a detailed characterization of clinical features in individuals with CTNNB1 neurodevelopmental disorder.

Effectiveness and Tolerability of Combination Pharmacotherapy With Stimulant and Non-Stimulant in Children With Attention Deficit Hyperactivity Disorder.

This study aimed to investigate the effectiveness and safety of combining psychostimulants and nonstimulants for patients under treatment for attention deficit hyperactivity disorder (ADHD). The study included 96 patients aged 6-12 years who were diagnosed with ADHD, among whom 34 received combination pharmacotherapy, 32 received methylphenidate monotherapy, and 30 received atomoxetine monotherapy. Statistical analysis was conducted to compare treatment and adverse effects among groups and to analyze changes before and after combination pharmacotherapy. The difference between combination pharmacotherapy and monotherapy was investigated. Logistic regression analysis was used to identify the predictors of combination pharmacotherapy. No significant differences were observed between the groups in terms of age or pretreatment scores. The most common adverse effect experienced by 32% of patients in the combination pharmacotherapy group was decreased appetite. Clinical global impression- severity score decreased significantly after combination pharmacotherapy. All three groups showed significant clinical global impression- severity score improvements over time, with no significant differences among them. The predictive factors for combination pharmacotherapy included the Child Behavior Checklist total score internalizing subscale. Combination pharmacotherapy with methylphenidate and atomoxetine is a relatively effective and safe option for patients with ADHD who do not respond to monotherapy.

Development and Validation of an Equine Castration Model and Rubric.

Castration is one of the most common surgeries performed in equine practice. Veterinary students require deliberate practice to reach competence in surgical procedures including equine castration, but availability of patients limits students' practice opportunities. A recumbent equine castration model was created and evaluated using a validation framework consisting of content evidence (expert opinion), internal structure evidence (reliability of scores produced by the accompanying rubric), and evidence of relationship with other variables, specifically the difference in scores between experts and students. A convenience sample of third-year students who had never performed equine castration (n = 24) and veterinarians who had performed equine castration (n = 25) performed surgery on the model while being video recorded. Participants completed a post-operative survey about the model. All veterinarians (100%) agreed or strongly agreed that the model was suitable for teaching students the steps to perform equine castration and for assessing students' skill. The checklist produced scores with good internal consistency (α = 0.805). Veterinarians performed the castration faster than the students (p = .036) and achieved a higher total global rating score (p = .003). There was no significant difference between groups in total checklist score or individual checklist items, except veterinarians were more likely to check both sides for bleeding (p = .038). The equine castration model and rubric validated in this study can be used in a low-stress clinical skills environment to improve students' skills to perform what is otherwise a challenging field procedure. Model use should be followed with live animal practice to complete the learning process.

Is Frailty a Mortality Predictor in Subjects with Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) has been frequently associated with frailty. The association between frailty and mortality in patients with COPD has not yet been fully elucidated and it remains controversial whether frailty or airflow limitation is more important in predicting mortality. A total of 141 subjects with stable COPD completed pulmonary function tests and the Kihon Checklist at baseline between 2015 and 2022 and were followed for a maximum of 95 months. Using the Kihon Checklist Total score, we classified patients' frailty status as robust (0-3), pre-frail (4-7), and frail (8-25). At baseline, there were 67 (47.5%) in the robust group, 36 (25.5%) pre-frail, and 38 (27.0%) frail. Death was confirmed in 29 (20.5%). Univariate Cox proportional hazards analyses revealed that all predictive relationships of frailty and airflow limitation with mortality were statistically significant, and the C-index was similar, ranging from 0.63 to 0.66. According to the Log rank test and the Cox regression model, there was a significant difference between the frail and robust groups, (p=0.004 and p=0.005, respectively). No significant differences were found in either comparison with the pre-frail group. When stratification of frailty and FEV1 as well as sex were included as explanatory variables, multivariate Cox regression analysis showed a significant difference between the robust and frail groups with respect to mortality when the robust group was used as the reference (p=0.024). The robust and pre-frail groups did not differ significantly (p=0.163). The mortality of frail COPD patients is higher than those classed as robust. Despite frailty being a substantial mortality predictor, it is uncertain whether or not it is a better predictor than FEV1.

Impact of trauma, support, and control perceptions during childbirth on post-traumatic stress disorder among Syrian immigrant adolescent pregnant women

ObjectiveThe probability of experiencing mental health problems in the perinatal period is high for adolescent women. Immigration is a complicated phenomenon that increases the risk of encountering temporary or permanent psychological problems. This study aims to determine Syrian immigrant adolescent women's support and control perception levels during childbirth, birth trauma levels, and posttraumatic stress disorder incidence and affecting factors. MethodsThis study used a prospective cohort design and was conducted in a hospital in Adana, a city in southern Turkey, between February and April 2022. It included 122 Syrian adolescent immigrant women, and data were collected in two interviews. While the first interview was conducted within the first 24 hours following birth, the second interview was conducted one month after birth. Data were collected through structured interviews using standardized questionnaires, including the Personal Information Form, the City Birth Trauma Scale, the Support and Control in Birth Scale, and the Post-traumatic Stress Disorder Checklist for DSM-5. FindingsThe average age of participating women was 17.40±0.94. The participants’ Perceived Support and Control in Birth Scale total score was 100.55±20.12, the City Birth Trauma Scale total score was 43.11±13.29, and the Post-traumatic Stress Disorder Checklist total score was 30.36±16.86. Of all the participating women, 26% were found to have post-traumatic stress disorder symptoms in the postpartum period. A relationship was found between support and control perceptions during childbirth and post-traumatic stress disorder symptoms. ConclusionThis study found that immigrant adolescent women's support and control perceptions during childbirth were better than expected, and they had a high level of perceived trauma during childbirth. The presence of birth trauma emerged as a robust predictive factor for posttraumatic stress disorder, underscoring its critical role in maternal mental health. A positive childbirth experience, which is important for all women, has become an increasing need for immigrant women. There is a need for developing and sustaining health policies guaranteeing culturally sensitive care to prevent immigrant women from having a traumatic birth experience.

Effectiveness of collaborative tele-mental health care for children with attention deficit hyperactivity disorder in United Arab Emirates.

Attention deficit hyperactivity disorder is a common neurodevelopmental disorder. Accessing services for this disorder is a worldwide challenge and requires innovative interventions. We aimed to investigate the effectiveness of tele-collaborative care for attention deficit hyperactivity disorder in primary health care centres in Dubai. Six trained physicians started collaborative care clinics across Dubai. Eligible children aged 6-12 years attending primary health care centres with attention deficit hyperactivity disorder were randomly selected to receive telehealth collaborative care, or standard treatment. Baseline assessments were conducted using the Vanderbilt Behavioral Assessment Scale, the Columbia Impairment Scale, the Childhood Behavior Checklist, and the Strength and Difficulties Questionnaire. Waiting times and clinical and functional outcomes were measured in both groups and compared. Continuous variables were presented as means and standard deviations, categorical variables such as sex were presented as numbers and percentages, and continuous outcome variables were compared using the Student t-test. Among the referred children (n = 112), 11 boys and 6 girls met the eligibility criteria (mean age 7.8 years). The dropout rate at 6 months in the control group was 80%, compared with 50% in the intervention group. The mean waiting time was significantly shorter in the intervention group (1.3 weeks) than the control group (7.1 weeks); P = 0.026. The mean difference in the Childhood Behavior Checklist total score over time was significantly higher in the intervention group (P = 0.042), but the mean difference in the Vanderbilt scale was not significant. Tele-collaborative care for children with attention deficit hyperactivity disorder within primary health care is feasible.

Generalizability of 3D CNN models for age estimation in diverse youth populations using structural MRI

Recently, several studies have investigated the neurodevelopment of psychiatric disorders using brain data acquired via structural magnetic resonance imaging (sMRI). These analyses have shown the potential of sMRI data to provide a relatively precise characterization of brain structural biomarkers. Despite these advances, a relatively unexplored question is how reliable and consistent a model is when assessing subjects from other independent datasets. In this study, we investigate the performance and generalizability of the same model architecture trained from distinct datasets comprising youths in diverse stages of neurodevelopment and with different mental health conditions. We employed models with the same 3D convolutional neural network (CNN) architecture to assess autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), brain age, and a measure of dimensional psychopathology, the Child Behavior Checklist (CBCL) total score. The investigated datasets include the Autism Brain Imaging Data Exchange II (ABIDE-II, N = 580), Attention Deficit Hyperactivity Disorder (ADHD-200, N = 922), Brazilian High-Risk Cohort Study (BHRCS, N = 737), and Adolescent Brain Cognitive Development (ABCD, N = 11,031). Models’ performance and interpretability were assessed within each dataset (for diagnosis tasks) and inter-datasets (for age estimation). Despite the demographic and phenotypic differences of the subjects, all models presented significant estimations for age (p value < 0.001) within and between datasets. In addition, most models showed a moderate to high correlation in age estimation. The results, including the models' brain regions of interest (ROI), were analyzed and discussed in light of the youth neurodevelopmental structural changes. Among other interesting discoveries, we found that less confounded training datasets produce models with higher generalization capacity.

Social and Behavioral Problems in School-Aged Children After Maternal Postpartum Depression: A Secondary Analysis of Future of Families and Child Wellbeing Study.

To examine the relation between perinatal depression at child age 1 year and behavioral issues and altered social functioning at school age. The Future of Families (formerly Fragile Families) and Child Wellbeing Study longitudinal cohort age 9 nationally representative urban sample was used to examine associations between maternal depression at child age 1 and child behavior and social functioning at age 9 (n = 2,305 children and their mothers). Measures included the Composite International Diagnostics Interview (depression), Child Behavior Checklist total score (child behavior problems) and social function subscale. Clinical significance of child behavior problems and social function problems were determined by normed T-scores. Analyses included chi square, t-tests, and linear regression using SAS 9.4 Survey procedures. Higher household income was associated with lower behavior problem scores (F = 8.76, p < 0.0001, R2 = 0.07. School-aged children whose mothers had major depression at child age 1 (10.8%) were more than twice as likely to have clinically significant behavior problems (OR 2.46, p < 0.0001) than children whose mothers did not have depression (4.1%). Further, children with depressed mothers were more than twice as likely to have clinically significant social function problems than children whose mothers were not depressed (OR = 2.09, p < 0.0001). Children whose mothers were depressed at child age 1 have higher risk of having behavior problems and poor social functioning at age 9. Early and repeated maternal depression screening is needed to treat the disease sooner and attempt to avoid these outcomes.

Effects of Parent-Child Sandplay Therapy for preschool children with autism spectrum disorder and their mothers: A randomized controlled trial

PurposeTo evaluate the effects of the Parent-Child Sandplay Therapy (PCST) Program on autism behaviors, social responsiveness and sleep quality among preschool children with autism spectrum disorder (ASD), and their mothers' parenting stress. Design and methodsA prospective, randomized controlled, parallel-group trial was employed. Fifty-two child-mother dyads were randomly assigned to an intervention group (n = 26) or a control group (n = 26) from February 2017 to February 2019. The intervention group was treated with a 20-week PCST Program plus an Applied Behavior Analysis-based program (ABA-based program), whereas the control group received only the ABA-based program. Outcome measures included the Autism Behavior Checklist total scores, Social Responsiveness Scale scores, Children's Sleep Habits Questionnaire scores, and Parenting Stress Index-Short Form scores, measured at baseline, post-intervention (20 weeks after baseline) and follow-up assessments (32 weeks after baseline). ResultsFinally, 43 dyads completed the study. The linear mixed model analysis resulted in a significant group*time interaction effect of ABC score (Est = 2.027, t = 3.277; p < 0.01), SRS score (Est = 3.377, t = 6.095; p < 0.01), PSI-SF score (Est = 3.873, t = 4.253, p < 0.01), and CSHQ score (Est = 3.158, t = 6.485; p < 0.05). ConclusionOur findings suggested that the PCST Program could potentially improve social interaction and sleep quality of preschool children with ASD while decreasing parenting stress. Practice implicationsThe PCST Program was found to be a feasible and a promising treatment for children with mild-to-moderate ASD as well as for their parents. It was a nurse-led program, which could be integrated into the usual nursing care of children with autism spectrum disorder in special education schools.Trial registration: Chinese Clinical Trials Registry, ChiCTR2100047699.

Association of social participation (including inconsistent participation) with the progression of frailty among older adults: Community-based cohort study in Japan.

This study examined the relationship between continuity of social participation and progression of frailty among community-dwelling older adults, by baseline frailty level. This study was part of a 3-year community-based cohort study among adults aged ≥65 years, living independently in a rural municipality in Japan. Mail surveys were carried out in 2016, 2018 and 2019. This study involved 2799 participants who responded to the question about social participation in every survey. Frailty was evaluated by Kihon Checklist total scores. Social participation was categorized into consistent non-participation, interrupted recent non-participation, interrupted recent participation and consistent participation. We assessed the relationship between social participation and change in frailty scores using general linear regression analysis, stratifying the participants into groups by their frailty level at baseline. There was a smaller frailty score increase in the robust (β -0.61, 95% CI -0.99 to -0.22) and prefrail groups (β -0.73, 95% CI -1.18 to -0.27) for consistent participation than consistent non-participation. Interrupted recent participation showed significant suppression in the prefrail group (β -0.96, 95% CI -1.60 to -0.32). Social participation had no clear effect on progression in the frail group. Consistent social participation might reduce the progression of frailty in robust and prefrail people. Inconsistent participation might also help to reduce progression in prefrail older adults. It is important for prefrail older adults to return to their social activities and continue to engage as long as possible, even if their participation was intermittent in the past. Geriatr Gerontol Int 2023; 23: 25-31.

Resveratrol Treatment of Autism Spectrum Disorder-A Pilot Study.

Considering autism spectrum disorder (ASD) as a neurodevelopmental condition associated with immune system impairments, we aimed to evaluate the potential benefits, efficacy, tolerability, and safety of the anti-inflammatory, antioxidant, and neuroprotective trans -resveratrol (RSV) in behavioral impairments and in a set of 8 microRNAs (miR) related to the immune system in pediatric subjects with ASD. This is an open-label pilot trial over a 3 months (90 days) study follow-up period designed to assess the effect of 200 mg/d RSV on 5 boys aged 10 to 13 (11.8 ± 1.1) years diagnosed with ASD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . The RSV treatment significantly reduced the Aberrant Behavior Checklist total score ( P = 0.042) and Irritability ( P = 0.041), with no alteration in Stereotypical Behavior ( P = 0.066), Hyperactivity ( P = 0.068), and Lethargy/Social Withdrawal ( P = 0.078) subscales. On the Clinical Global Impression scale, 3 individuals showed marked improvement in behavior; one showed mild improvement, and the other had no changes. The RSV treatment increased the miR-195-5p ( P = 0.043), an important modulator of targets related to inflammatory and immunological pathways. RSV administration did not present adverse effects and did not alter clinical laboratory results. RSV is a safe molecule for administrating in the pediatric population, able to modulate behavior alterations and molecules associated with the immune system, becoming a promising therapeutic strategy for large-scale studies in ASD, to investigate both behavioral and molecular approaches.

A three-dimensional (3D) printed simulator as a feasible assessment tool for evaluating hip arthroscopy skills

PurposeThe aims of this study were (1) to develop a three-dimensional (3D) printed simulator that facilitates the simulation of surgical skills for portal placement, intra-articular identification of anatomical structures and arthroscope navigation for hip arthroscopy and (2) to concurrently examine the feasibility of using this simulator as an assessment tool to evaluate trainees’ surgical competencies.MethodsA simulator was developed using a combination of medical imaging, computer-aided design, and 3D printing. A cross-sectional study was conducted with 29 participants divided into 3 subgroups (novice, intermediate and experienced). All participants performed related skills on the simulator, and their performance was evaluated using different assessment parameters. The participants’ qualitative feedback regarding the simulator was also collected. The data collated from each group of participants were subsequently compared.ResultsSignificant differences were observed between the three subgroups of participants with regard to the total checklist score (F2,26 = 11.3), total Arthroscopic Surgical Skill Evaluation score (F2,26 = 92.1), overall final global rating scale score (F2,26 = 49), number of times the participants used fluoroscopy (F2,26 = 7.4), and task completion times (F2,26 = 23.5). The participants’ performance in the simulated operation was correlated with their prior clinical experience. There was mainly positive feedback with regard to the fidelity and utility of the simulator in relation to the surgeons’ prior clinical experience.ConclusionsThis study demonstrated that a reliable hip arthroscopic simulator can be developed for use by orthopedic surgeons to evaluate their hip arthroscopic skills before performing actual surgical operations.Level of evidenceLevel III.

A new educational tool for neuropsychological test raters in the dementia field: A Delphi study

Neuropsychological testing is the primary endpoint of clinical research in the field of dementia, making it essential for the rater to accurately calculate test data for an extensive assessment. However, many raters lack adequate skill to complete neuropsychological tests with sufficient confidence. Therefore, we developed and examined the utility of a checklist and a manual as tools for educating raters on their basic behaviours when conducting comprehensive neuropsychological evaluations in the field of dementia. We conducted a seven-step comprehensive study to develop rater training tools and examine their usefulness between April 2019 and February 2021 involving: 1. Development of a draft checklist, 2. Delphi review rounds, 3. Design of the final checklist, 4. Item weighting, 5. Examination of reliability, 6. Creating the manual, and 7. Examination of the usefulness of learning through rater educational tools (checklist and manual). The Delphi review round led to a highly reliable and valid checklist and manual. The total checklist score improved significantly (t= 2.37, P =0.029) before and after manual learning. We found that the appropriate basic behaviours required by the rater to conduct neuropsychological testing skilfully within the dementia field could be acquired with this tool. Using a robust development process, we integrated expert knowledge and experience, and developed a checklist and a manual for learning the basic behaviours of neuropsychological test raters in the field of dementia. Establishing standards of basic behaviour for neuropsychological raters will help promote dementia research and advances in medicine.

SP7.5 Psychomotor assessments of fundamental ability are associated with the future operative performance of surgical trainees

Abstract Introduction Assessments of visuospatial, psychomotor and perceptual ability correlate with simulated operative performance. This study investigates the association between fundamental technical ability and future operative performance as measured through both in-theatre and simulation-based assessments. Methods Core surgical trainees in the Republic of Ireland recruited from 2016–2019 participated in validated assessments of fundamental technical ability; Pictorial Surface Orientation (PicSOr) testing of perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and psychomotor testing using a grooved pegboard. Operative performance was assessed using the in-theatre Supervised Structured Assessment of Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS) assessments (multi-station simulation-based assessments) performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point Operative Performance score. Univariate (Pearson) correlations and multiple linear regression were used to explore the association between fundamental ability and operative performance, controlled for both operative experience and centile scores from the trainee's undergraduate medical degree. Results Aggregated fundamental ability scores strongly correlated with performance in all submitted SSAOP assessments using the Total Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002), independent of operative experience and centile scores. Fundamental ability scores were also predictive of OSS assessment scores on multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03). Conclusion Fundamental technical ability is predictive of future performance in both in-theatre workplace-based assessments of operative skill and simulation-based assessments of operative performance.

Baseline Assessments of Psychomotor Aptitude Are Associated With the Future Operative Performance of Surgical Trainees: A Prospective Observational Cohort Study.

This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance. Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking. Core surgical residents in Ireland recruited from 2016 to 2019 participated in assessments of baseline perceptual, visuospatial, and psychomotor ability; Pictorial Surface Orientation (PicSOr) testing, digital visuospatial ability testing, and manual dexterity testing. Operative performance was prospectively assessed using the in-theater Supervised Structured Assessment of Operative Performance (SSAOP) tool, and simulation-based Operative Surgical Skill (OSS) assessments performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point operative performance score. OSS assessments were scored using procedure-specific checklists. Univariate correlations and multiple linear regression analyses were used to explore the association between fundamental ability measures and operative performance. A total of 242 residents completed baseline psychomotor ability assessments. Aggregated fundamental ability scores were associated with performance in submitted workplace-based SSAOP assessments using the Total Checklist score ( P =0.002) and Overall Performance scores ( P =0.002), independent of operative experience, and undergraduate centile scores. Aggregated ability scores were also positively associated with simulation-based OSS assessment scores on multivariable analysis ( P =0.03). This study indicates that visuospatial, psychomotor, and perceptual ability testing scores are associated with the future operative performance of surgical residents.

Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans

ObjectiveThe study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. MethodThe analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. ResultsThe primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90–0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. ConclusionsResults support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.

Identifying Cofactors Contributing to Food Insecurity in Elderly Maine Residents Living at Home

ObjectivesThe purpose of this study was to identify cofactors that contribute to food insecurity in Maine’s older adults living at home, examine how the COVID-19 pandemic affected access to nutritious food, and make recommendations for program expansion and development. MethodsThis study was a cross-sectional survey design of older adults aged 65 years and older participating in the Meals on Wheels program in Maine (n = 58) in early 2021. Research participants were compensated with grocery store gift cards. The DETERMINE Nutrition Checklist total nutrition scores and USDA Six-Item Food Security scores were compared to self-reported access to food to see how accurately older adults view their nutritional status. Chi-squared analysis was used to examine associations among food insecurity and demographic traits. A probability of p ≤ 0.05 was chosen for significance. ResultsRegion of residence and food security score were significantly associated; 55.2% (n = 32) of participants had scores (0–1) indicating they were food secure. One-quarter of participants had low food security, and 11 persons had very low food security. DETERMINE scores were not statistically significant for either age range or region, suggesting that risk of malnutrition functioned independently from region and age range. However, 75.9% (n = 44) of participants received scores indicating that they were at high risk of malnutrition. Only 20 persons regularly used SNAP benefits, and few people took advantage of other food programs such as the Senior Farmers Market Nutrition Program and food pantries. ConclusionsFood security among Maine seniors is not necessarily related to finances, especially during the COVID-19 pandemic. The most common cofactors influencing access to food were physical access and ability, and fear or guilt of asking for help. Future work should seek to survey older adults, especially those in the most rural and impoverished counties, who are not currently using food support services such as Meals on Wheels to better evaluate food insecurity among older Maine residents. Funding SourcesMaine Top Scholar Award and NIFA Hatch funds were used in this study.