Checklist Total Score Research Articles

Association between leukocyte telomere length and hostility in US army service members

Hostility is a common form of emotionally charged anger which can lead to maladaptive and unhealthy behaviors. Significant association between shortened telomeres and greater levels of hostility has been observed in civilian populations, but has not yet been comprehensively studied in military populations. Our study investigates the relationship between hostility, post-traumatic stress disorder (PTSD), and leukocyte telomere length (LTL) in a sample of United States Army Special Operations personnel (n = 474) who deployed to Iraq and/or Afghanistan as part of combat operations. Hostility was measured with five items from the Brief Symptom Inventory (BSI). PTSD was determined using the PTSD Checklist (PCL) total score. The LTL was assessed using quantitative polymerase chain reaction methods and regression analyses were conducted to determine the association of hostility and telomere length. PTSD subjects reported higher hostility scores compared with those without PTSD. Among the participants with PTSD, those with medium or high level of hostility had shorter LTL than those with low level hostility (P < 0.01). Stepwise regression indicated that hostility level and age, but not gender and PTSD, were negatively correlated with LTL. Univariate regression showed that total hostility score was negatively associated with LTL (CI= −0.06 to −0.002, Beta= −0.095, p < 0.039) as well as a significant correlation between LTL and hostility impulses (HI) (CI= −0.108 to −0.009, Beta= −0.106, p < 0.021) and hostility controlling (HC) (CI= −0.071 to −0.002, Beta= −0.095, p < 0.004). Multiple regression analyses revealed that, while HC has no significant association with LTL, HI was still negatively correlated with LTL (p = 0.021). Our data indicates that LTL is associated with HI levels. Prevention and treatment efforts designed to reduce hostility may help mitigate risk for LTL shortening, a process of cellular aging, and thus slow accelerated aged-related health outcomes.

PTSD Symptoms Experienced and Coping Tactics Used by Crime Scene Investigators in the United States.

Few investigations have assessed the prevalence of posttraumatic stress experiences among Crime Scene Investigators (CSIs). We recruited a nationwide sample of 225 CSIs to complete online questionnaires assessing PTSD symptoms, use of specific coping tactics, perceived social support, trait resilience, and demographics. Seven symptoms had been experienced by at least 50% of participants during the previous month, and 9.3% had total checklist scores suggestive of PTSD. A significant regression analysis revealed that higher PTSD scores were associated with drinking alcohol more frequently to deal with stress, admitting more frequently one could not deal with stress and not trying to do so, lower social support, getting angry and letting emotions out more frequently, lower resilience, and finding comfort in one's religious beliefs. Given the proportions of CSIs that experience exposure-related stress, more should be done to mitigate the prevalence and severity of these symptoms.

Effects of Psychoeducation and Stress Coping Techniques on Posttraumatic Stress Disorder Symptoms.

This study examined the effects of psychoeducation and stress management techniques on Posttraumatic Stress Disorder (PTSD) symptoms in Libya. The 41 Libyan patients who volunteered to take part in the study were first assessed using the PTSD Checklist. They attended workshops on PTSD symptoms, stress management techniques, and communication skills on three successive days after which they were asked to answer the Coping Inventory for Stressful Situations two weeks after they completed the workshops. Among the 39% of the participants who were diagnosed with PTSD prior to the intervention, 15% met the diagnostic criteria for PTSD after the intervention. The preintervention scores were consistently higher than the postintervention scores, and there were significant differences in the PTSD Checklist total score and the re-experiencing, avoidance, and hyperarousal symptom scores. This study concluded that in mass-trauma events such as war and natural disasters, PTSD education can reduce the PTSD symptoms of those affected. Whether the benefits of psychoeducation on the participants are long term or short term is recommended for further study due to the limitations imposed by the willingness of the participants to participate, the amount of time they are willing to stay with the program, and the duration of the psychoeducation program itself.

The preliminary investigation of orexigenic hormone gene polymorphisms on posttraumatic stress disorder symptoms

Orexigenic hormones are a group of hormones that can up-regulate appetite. Current studies have shown that orexigenic hormones also play important roles in stress responses and may be implicated in regulation of fear memory. However, these conclusions lack evidence from human studies. In this study, we examined associations between orexigenic hormone genes and fear-related mental disorders by investigating main, G × E, and G × G effects of ghrelin and orexin gene single nucleotide polymorphisms (SNPs) on human posttraumatic stress disorder (PTSD) symptoms in 1134 Chinese earthquake survivors. SNPs Leu72Met of the GHRL gene (rs696217), Ile408Val of the HCRTR1 gene (rs2271933) and Val308Ile of the HCRTR2 gene (rs2653349) were genotyped. None of the SNPs showed significant main or G × E effects. However, a significant interaction effect between GHRL rs696217 and HCRTR1 rs2271933 was found to predict the PTSD Checklist (PCL-5) total score (P = 0.007). Further analysis revealed different interaction patterns in males and females. For females, the rs2271933 G allele was associated with an increased PCL-5 total score (B = 2.59, P = 0.024) when the rs696217 genotype TT/TG was present. For males, the rs696217 T allele is associated with an increased PCL-5 total score (B = 3.62, P = 0.040) when the rs2271933 genotype GG/GA was present. These current findings expand our knowledge of physiological function of the orexigenic hormone system, and suggest its involvement in development of fear-related mental disorders such as PTSD.

P65 - Incorporation of the fluoroless C-Arm Trainer at the American Urological Association hands on training percutaneous renal access

To assess for usefulness and validity evidence for incorporating the C-Arm Trainer (CAT) simulator into the annual AUA hands on course for training percutaneous nephrolithotomy (PCNL). The course started with a didactic session followed by four stations for training the “bull’s eye” technique using the CAT simulator. Each station included a pre-test, 30-min practice on the simulator, and post-test. All participants were assessed using a 4-item checklist. All participants were asked to fill in a qualitative self-assessment questionnaire after the pre- and the post-test, and respond to a course evaluation questionnaire and post-course survey. A total of 38 physicians, who attended the hands on course, voluntarily participated in the study. Only 21.1% had previous practice on PCNL simulators. Compared with the results of the checklist total score and the qualitative self-assessment questionnaire scores after the pre-test, there was significant improvement in the checklist total score (p < 0.001), temporal demands (p = 0.003), situational stress (p = 0.003, and performance (0.003) after the post-test. A total of 14 (36%) participants responded to the course evaluation questionnaire, 50% evaluated the course as excellent, 28.6% as very good, and 21.4% as good. Unfortunately, only five (13%) participants responded to the post-course survey, 4/5 implemented the new competencies and knowledge into their practice, and 3/5 have attempted to obtain fluoroscopic guided PCA without assistance. The CAT simulator was considered useful for training the percutaneous renal access procedure. There was significant improvement in the qualitative and quantitative assessment parameters after the post-test compared with the pre-test.

Incorporation of the fluoroless C-Arm Trainer at the American Urological Association hands on training percutaneous renal access.

To assess for usefulnessand validity evidence for incorporating the C-Arm Trainer (CAT) simulator into the annual AUA hands on course for training percutaneous nephrolithotomy (PCNL). The course started with a didactic session followed by four stations for training the "bull's eye" technique using the CAT simulator. Each station included a pre-test, 30-min practice on the simulator, and post-test. All participants were assessed using a 4-item checklist. All participants were asked to fill in a qualitative self-assessment questionnaire after the pre- and the post-test, and respond to a course evaluation questionnaire and post-course survey. A total of 38 physicians, who attended the hands on course, voluntarily participated in the study. Only 21.1% had previous practice on PCNL simulators. Compared with the results of the checklist total score and the qualitative self-assessment questionnaire scores after the pre-test, there was significant improvement in the checklist total score (p<0.001), temporal demands (p=0.003), situational stress (p=0.003, and performance (0.003) after the post-test. A total of 14 (36%) participants responded to the course evaluation questionnaire, 50% evaluated the course as excellent, 28.6% as very good, and 21.4% as good. Unfortunately, only five (13%) participants responded to the post-course survey, 4/5implemented the new competencies and knowledge into their practice, and 3/5have attempted to obtain fluoroscopic guided PCA without assistance. The CAT simulator was considered useful for training the percutaneous renal access procedure. There was significant improvement in the qualitative and quantitative assessment parameters after the post-test compared with the pre-test.

Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study.

Cutaneous allodynia is regarded as an expression of central sensitization in migraine. Although the gold standard is quantitative sensory testing, several practical assessment questionnaires have been developed to assess allodynia in migraine. We aimed to establish the first valid Turkish allodynia assessment questionnaire based on a 12-item allodynia symptom checklist and to evaluate the associated factors. The first part of the study included the translation and cultural adaptation of a Turkish version of the checklist. The Turkish version of the questionnaire was administered to 344 episodic and chronic migraine patients, who were chosen according to the International Classification of Headache Disorders -III beta criteria. The total checklist score showed excellent test-retest reliability (r=0.821). The internal consistency of the checklist was assessed using Cronbach alpha values and was found to be acceptable (Cronbach alpha for the checklist=0.767). Data analysis revealed that 10 items of the questionnaire adequately identified allodynic subjects. Cutaneous allodynia was present in 218 (63.4%) migraine patients. Allodynia was more prominent in patients experiencing migraine with aura (p=0.008) and in females (p<0.001). Multiple logistic regression analysis found that female gender, aura existence, longer headache duration, and higher attack frequency were the major determinants of cutaneous allodynia. Allodynia is common and has clinical significance in migraine; therefore, establishing a validated Turkish questionnaire for the assessment of allodynia was necessary. In this study, a Turkish version of the allodynia symptom checklist was validated and found to be convenient for the identification of allodynia in migraine patients.

Can Residents Assess Other Providers' Infant Lumbar Puncture Skills?: Validity Evidence for a Global Rating Scale and Subcomponent Skills Checklist.

The aims of this study were to provide validity evidence for infant lumbar puncture (ILP) checklist and global rating scale (GRS) instruments when used by residents to assess simulated ILP performances and to compare these metrics to previously obtained attending rater data. In 2009, the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) developed checklist and GRS scoring instruments, which were previously validated among attending raters when used to assess simulated ILP performances. Video recordings of 60 subjects performing an LP on an infant simulator were collected; 20 performed by subjects in 3 categories (beginner, intermediate, and expert). Six blinded pediatric residents independently scored each performance (3 via the GRS, 3 via the checklist). Four of the 5 domains of validity evidence were collected: content, response process, internal structure (reliability and discriminant validity), and relations to other variables. Evidence for content and response process validity is presented. When used by residents, the checklist performed similarly to what was found for attending raters demonstrating good internal consistency (Cronbach α = 0.77) and moderate interrater agreement (intraclass correlation coefficient = 0.47). Residents successfully discerned beginners (P < 0.01, effect size = 2.1) but failed to discriminate between expert and intermediate subjects (P = 0.68, effect size = 0.34). Residents, however, gave significantly higher GRS scores than attending raters across all subject groups (P < 0.001). Moderate correlation was found between GRS and total checklist scores (P = 0.49, P < 0.01). This study provides validity evidence for the checklist instrument when used by pediatric residents to assess ILP performances. Compared with attending raters, residents appeared to over-score subjects on the GRS instrument.

Use of an Objective Structured Assessment of Technical Skill After a Sports Medicine Rotation

The purpose of this study was to determine if the use of an Objective Structured Assessment of Technical skill (OSATS), using dry models, would be a valid method of assessing residents' ability to perform sports medicine procedures after training in a competency-based model. Over 18months, 27 residents (19 junior [postgraduate year (PGY) 1-3] and 8 senior [PGY 4-5]) sat the OSATS after their rotation, in addition to 14 sports medicine staff and fellows. Each resident was provided a list of 10 procedures in which they were expected to show competence. At the end of the rotation, each resident undertook an OSATS composed of 6 stations sampled from the 10 procedures using dry models-faculty used the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task-specific checklists, as well as an overall 5-point global rating scale (GRS) to score each resident. Each procedure was videotaped for blinded review. The overall reliability of the OSATS (0.9) and the inter-rater reliability (0.9) were both high. A significant difference by year in training was seen for the overall GRS, the total ASSET score, and the total checklist score, as well as for each technical procedure (P < .001). Further analysis revealed a significant difference in the total ASSET score between junior (mean 18.4, 95% confidence interval [CI] 16.8 to 19.9) and senior residents (24.2, 95% CI 22.7 to 25.6), senior residents and fellows (30.1, 95% CI 28.2 to 31.9), as well as between fellows and faculty (37, 95% CI 36.1 to 27.8) (P < .05). The results of this study show that an OSATS using dry models shows evidence of validity when used to assess performance of technical procedures after a sports medicine rotation. However, junior residents were not able to perform as well as senior residents, suggesting that overall surgical experience is as important as intensive teaching. As postgraduate medical training shifts to a competency-based model, methods of assessing performance of technical procedures become necessary.

Competency-Based Medical Education: Can Both Junior Residents and Senior Residents Achieve Competence After a Sports Medicine Training Module?

Competency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation. All residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge. Over eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains. Despite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience is critically important for achieving competency as measured by the Objective Structured Clinical Examination.

Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model

Background: As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. Hypothesis/Purpose: The purpose of this study was to validate a dry knee model for the assessment of performance of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the combination of a checklist and a previously validated global rating scale would be a valid and reliable means of assessing ACLR when performed by residents in a dry model. Study Design: Controlled laboratory study. Methods: All residents, sports medicine staff, and fellows were invited to perform a hamstring ACLR using anteromedial drilling and Endobutton fixation on a dry model of an anterior cruciate ligament. Previous exposure to knee arthroscopy and ACLR was recorded. A detailed surgical manuscript and technique video were sent to all participants before the study. Residents were evaluated by staff surgeons with task-specific checklists created by use of a modified Delphi procedure and the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Each procedure (hand movements and arthroscopic video) was recorded and scored by a fellow blinded to the year of training of each participant. Results: A total of 29 residents, 5 fellows, and 6 staff surgeons (40 participants total) performed an ACLR on the dry model. The internal reliability (Cronbach alpha) of the test when using the total ASSET score was very high (>0.9). One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between participants based on year of training (P < .001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (postgraduate year [PGY] 1-3) and senior residents (PGY 4 and 5) and senior residents and fellows (P < .05). A significant difference was seen between fellows and staff on the global rating (P < .05) but not on the checklist scores (P > .05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The interrater reliability (intraclass correlation coefficient) between the examiner ratings and the blinded assessor ratings for the total ASSET score was very high (>0.8). Conclusion: The results of this study provide evidence that the performance of an ACLR in a dry model is a reliable method of assessing a resident’s knowledge of the steps and instrumentation required, and the method shows evidence of validity. Clinical Relevance: These models may be used to ensure a minimal level of competence before residents and fellows perform ACLR in the operating room.

The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department

BackgroundEffective communication is critical for health care professionals, particularly in the Emergency Department (ED). However, currently, there is no standardized consultation model that is consistently practiced by physicians or used for training medical graduates. Recently, the 5Cs of Consultation model (Contact, Communicate, Core Question, Collaborate, and Close the Loop) has been studied in Emergency Medicine residents using simulated consultation scenarios. ObjectiveUsing an experimental design, we aimed to evaluate the efficacy of the 5Cs consultation model in a novel learner population (medical students) and in a “real time and real world” clinical setting. MethodsA prospective, randomized, controlled study was conducted at eight large, academic, urban, tertiary-care medical centers (U.S. and Canada). Intervention involved two experimental groups (asynchronous and live training) compared to a baseline control group. All participants placed up to four consult phone calls. A senior physician observed and assessed each call using a preapproved 5Cs checklist and a Global Rating Scale (GRS). ResultsParticipants who received training (asynchronous or live) scored significantly higher on the 5Cs checklist total and GRS than the control group. Both training methods (asynchronous and live) were equally effective. Importantly, learning gains were sustained as students' 5Cs checklist total and GRS scores remained consistently higher at their second, third, and fourth consult (relative to their first consult). At posttest, all participants reported feeling more confident and competent in relaying patient information. ConclusionMedical students can be trained to use the 5Cs model in a timely, inexpensive, and convenient manner and increase effectiveness of physician consultations originating from the ED.

Motor stereotypies in fragile X syndrome

The purpose of this study was to quantify the type and frequency of stereotypies in fragile X syndrome and to determine the relationship of observed stereotypies with gender, level of cognitive function, and parent-reported scores for repetitive behaviors. Subjects with fragile X syndrome were videotaped during the administration of a standardized conversation task, a standardized narrative task, and sitting alone. Two individuals rated the stereotypies on the videotapes (10 min each) using the stereotyped behavior scale. Intelligence quotient scores were collected and parents/guardians completed the Vineland adaptive behavior scale and the aberrant behavior checklist – community edition. Thirty-eight subjects were tested (mean age 17.1 ± 7.1 yr). The mean total of stereotypies was 11 ± 11.7 movements in 10 min and the mean stereotyped behavior scale score was 5.8 ± 5.5. The most common type of movement was rubbing him/herself, followed by body movement and repetitive movement. There were correlations between the stereotyped behavior scale score and intelligence quotient ( P = 0.0006), the aberrant behavior checklist total score ( P = 0.01), and the stereotypy subscore ( P = 0.0007). Stereotypies are common in fragile X syndrome and more frequent in individuals with lower intelligence quotients and more severe behavior. The stereotyped behavior scale measure correlated with parent completed checklists, but showed poor to moderate reliability for measurement of stereotypies by a single rater and test retest in fragile X syndrome.

Use of an Objective Structured Assessment of Technical Skill (OSATS) after a Sports Rotation

Objectives:While the acquisition of competent technical skill is a defining characteristic of surgery, it is not measured systematically in residency. As all post-graduate medical training slowly shifts to a competency-based model, effective assessments of surgical and other technical skills after modules will become necessary. However, the best method for of assessing competence in technical skill in this setting is unknown, and is limited by both cost and access to resources. We hypothesized that a multi-station Objective Structured Assessment of Technical skill (OSATS), using sawbones models, would be a valid and reliable method of assessing resident competence in surgical skills after a sports medicine rotation.Methods:At the start of their three-month sports medicine rotation, each resident was provided a list of 10 surgical skills in which they were expected to demonstrate competence (Table 1). At the end of the rotation, each resident undertook an OSATS comprised of six randomly chosen stations - low-fidelity sawbones models were used in all stations. Residents were evaluated by faculty / staff surgeons using a previously validated global rating scale (the Arthroscopic Surgical Skill Evaluation Tool (ASSET)), as well as task-specific checklists created using a modified Delphi procedure, and a final five-point global rating scale (GRS) using the Drefus model of skill acquisition (1=novice, 2=advanced beginner, 3=competent, 4=proficient, 5=expert). All arthroscopic procedures were recorded, and all hand movements were videotaped - the videos were reviewed by a single, blinded observer, and correlation sought between the faculty ratings and the observer ratings.Results:Over 18 months, 27 residents (19 junior, 8 senior) sat the OSATS after their rotation, as well as seven sports medicine staff and seven fellows, for a total of 41 participants. The overall reliability of the OSATS as measured by Cronbach's Alpha was very high (0.9). A significant difference by year in training was seen for the overall GRS, the total ASSET score, and the total checklist score, as well as for each individual technical skill (p<0.001) - this difference was also seen for all stations. Post hoc analysis demonstrated a significant difference in the total ASSET score between junior (PGY1-3) and senior (PGY4&5) residents, senior residents and fellows, as well as between fellows and faculty (p<0.05)(Figure 1). A high correlation was seen between the faculty assessments and the blinded observer assessments for each station (>0.8).Conclusion:The results of this study demonstrate that an OSATS using dry models is a valid and reliable means of assessing technical skill in orthopaedic residents after a sports medical rotation. Interestingly, junior residents were not able to perform technical skills as well as senior residents despite an identical rotation, suggesting that overall surgical experience and exposure is as important as intensive teaching.

Validation Of A Dry Model For The Assessment Of Resident Performance Of Anterior Cruciate Ligament Reconstruction (ACLR)

Objectives:As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. The purpose of this study was to validate the use of a sawbones model for the assessment of performance of anterior cruciate reconstruction (ACLR) by residents. We hypothesized that the combination of a checklist and a previously validated global rating scale be a valid and reliable means of assessing ACLR when performed by residents in a dry model.Methods:All residents, sports medicine staff and fellows were invited to perform an ACLR on an ACL Sawbones model. Demographics regarding previous exposure to knee arthroscopy and ACLR were collected. All participants were asked to perform a hamstring ACLR using an anteromedial portal with Endobutton fixation on the femur - a detailed surgical manuscript and technique video was sent to all residents prior to the study. Residents were evaluated by faculty using a task-specific checklist created using a modified Delphi procedure, and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Each procedure was recorded, with videotaping of the hand movements and arthroscopic video recordings of the intra-articular procedure. These videos were scored by a fellow blinded to the year of training of each resident.Results:A total of 29 residents, six staff and five faculty performed an ACLR on the sawbones model (40 total). The overall reliability (Cronbach's Alpha) of the test using the total ASSET score was very high (>0.9). The reliability for the femoral checklist was 0.75, for the tibial checklist was 0.78, and 0.68 for the graft passage and fixation. One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between residents based upon year of training (p<0.001). Post hoc analysis demonstrated a significant difference in global ratings and checklist scores between junior residents (PGY1-3) and senior residents (PGY4&5), seniors and fellows, and fellows and staff (p<0.05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The inter-rater reliability (ICC) between faculty rating and blinded assessor for the total ASSET score was very high (>0.8).Conclusion:The use of a sawbones models to assess resident performance of ACLR using the ASSET global rating scale is valid and reliable. These models may be used to ensure a minimal level of competence prior to resident performance of ACLR in the operating room.

Multi-Institutional Validation of an OSATS for the Assessment of Cystoscopic and Ureteroscopic Skills

We evaluated the internal and construct validity of an assessment tool for cystoscopic and ureteroscopic cognitive and psychomotor skills at a multi-institutional level. Subjects included a total of 30 urology residents at Ohio State University, Columbus, Ohio; Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; and Mayo Clinic, Rochester, Minnesota. A single external blinded reviewer evaluated cognitive and psychomotor skills associated with cystoscopic and ureteroscopic surgery using high fidelity bench models. Exercises included navigation, basketing and relocation; holmium laser lithotripsy; and cystoscope assembly. Each resident received a total cognitive score, checklist score and global psychomotor skills score. Construct validity was assessed by calculating correlations between training year and performance scores (both cognitive and psychomotor). Internal validity was confirmed by calculating correlations between test components. The median total cognitive score was 91 (IQR 86.25, 97). For psychomotor performance residents had a median total checklist score of 7 (IQR 5, 8) and a median global psychomotor skills score of 21 (IQR 18, 24.5). Construct validity was supported by the positive and statistically significant correlations between training year and total cognitive score (r = 0.66, 95% CI 0.39-0.82, p = 0.01), checklist scores (r = 0.66, 95% CI 0.35-0.84, p = 0.32) and global psychomotor skills score (r = 0.76, 95% CI 0.55-0.88, p = 0.002). The internal validity of OSATS was supported since total cognitive and checklist scores correlated with the global psychomotor skills score. In this multi-institutional study we successfully demonstrated the construct and internal validity of an objective assessment of cystoscopic and ureteroscopic cognitive and technical skills, including laser lithotripsy.

A Multicenter Study on Childhood Constipation and Fecal Incontinence: Effects on Quality of Life

To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning. This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report. Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory. Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.

An evaluation of a new tool to aid judgements of credibility in the medico-legal setting

Purpose Clinical psychologists and other health professionals are often requested to act as expert witnesses in Court. They are required to assess, and report upon, the reliability of the accounts of physical and psychological symptoms made by their clients. This study investigated the effectiveness of a checklist drawing upon relevant literature on lying and malingering to aid the detection of exaggeration of physical symptoms. Method Sixty-four participants were cast as interviewers and assigned to either a ‘checklist’ or ‘no checklist’ condition. Another 64 volunteers were assigned to either a ‘truth teller’ or ‘malingerer’ role and, after undergoing a cold pressor procedure, were interviewed about their experience. The interviewers with a checklist drawn from the literature were asked to rate the presence of 28 checklist items on 5-point Likert scales and to indicate whether or not they believed their interviewee was truthful or exaggerating his or her symptoms. The interviewers without the checklist were asked to simply indicate whether their interviewee was truthful or exaggerating. Results Evaluators who were not given the checklist did not classify their interviewees at a level significantly better than chance. Those using the checklist achieved an overall hit rate of 70%. Signal detection analysis supported the finding that those with the checklist showed greater discriminability. Nine checklist items significantly discriminated between truth tellers and malingerers. Furthermore, the total checklist score was significantly higher for exaggerated accounts than for truthful accounts. Conclusions Results suggest that a checklist based on the literatures into lying and malingering warrants further investigation. Such a tool would be useful as an aid for expert witnesses called to provide informed opinion on the likelihood that a claimant is exaggerating, malingering or otherwise misrepresenting difficulties.

Gut microbiome in Down syndrome.

BackgroundPremature aging seriously compromises the health status of Down Syndrome (DS) persons. Since human aging has been associated with a deterioration of the gut microbiota (GM)-host mutualism, here we investigated the composition of GM in DS.MethodsThe observational study presented involved 17 adult DS persons. We characterized the GM structure by 454 pyrosequencing of the V4 region of the 16S rRNA gene. DS microbiome was compared with that of age-matched healthy non-trisomic adults enrolled in the same geographic area.Results and ConclusionsThe dominant GM fraction of DS persons showed an overall mutualistic immune-modulatory layout, comparable to that of healthy controls. This makes GM a possible factor counteracting the genetic determined acceleration of immune senescence in DS persons. However, we also found detectable signatures specific for DS among subdominant GM components, such as the increase of Parasporobacterium and Sutterella. In particular, the abundance of this last microorganism significantly correlated with the Aberrant Behavior Checklist (ABC) total score, allowing us to hypothesize a possible role for this microbial genus in behavioral features in DS.

SCREENING FOR PTSD AMONG INCARCERATED MEN: A Comparative Analysis of Computer-Administered and Orally Administered Modalities.

Trauma exposure is overrepresented in incarcerated male populations and is linked to psychiatric morbidity, particularly posttraumatic stress disorder (PTSD). This study tests the feasibility, reliability, and validity of using computer-administered interviewing (CAI) versus orally administered interviewing (OAI) to screen for PTSD among incarcerated men. A 2 × 2 factorial design was used to randomly assign 592 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared with OAI, CAI produced equally reliable screening information on PTSD symptoms, with test-retest intraclass correlations for the PTSD Checklist (PCL) total score ranging from .774 to .817, and the Clinician-Administered PTSD scale and PCL scores were significantly correlated for OAI and CAI. These findings indicate that data on PTSD symptoms can be reliably and validly obtained from CAI technology, increasing the efficiency by which incarcerated populations can be screened for PTSD, and those at risk can be identified for treatment.