Total Test Score Research Articles

Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study.

Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

Translation and concurrent validity, sensitivity and specificity of Chinese version of Short Orientation Memory Concentration Test in people with a first cerebral infarction.

This study aimed to translate the English version of the Short Orientation-Memory-Concentration (SOMC) test into a Chinese version, denoted the C-SOMC test, and to investigate the concurrent validity, sensitivity, and specificity of the C-SOMC test against a longer and widely used screening instrument in people with a first cerebral infarction. An expert group translated the SOMC test into Chinese using a forward-backward procedure. Eighty-six participants (67 men and 19 women, mean age = 59.31 ± 11.57 years) with a first cerebral infarction were enrolled in this study. The validity of the C-SOMC test was determined using the Chinese version of Mini Mental State Examination (C-MMSE) as the comparator. Concurrent validity was determined using Spearman's rank correlation coefficients. Univariate linear regression was used to analyze items' abilities to predict the total score on the C-SOMC test and the C-MMSE score. The area under the receiver operating characteristic curve (AUC) was used to demonstrate the sensitivity and specificity of the C-SOMC test at various cut-off values distinguishing cognitive impairment from normal cognition. The total score for the C-SOMC test and the score for item 1 on this test exhibited moderate-to-good correlations with the C-MMSE score, with respective ρ-values of 0.636 and 0.565 (P < 0.001). The scores for each of items 2, 4, 5, 6, and 7 yielded fair correlations with C-MMSE score, with ρ-value from 0.272 to 0.495 (P < 0.05). The total score on the C-SOMC test and the item score were good predictors (adjusted R2 = 0.049 to 0.615) of the C-MMSE score, and six items were good predictors (adjusted R2 = 0.134 to 0.795) of the total score. The AUC was 0.92 for the C-SOMC test. A cut-off of 17/18 on the C-SOMC test gave optimal performance: correct classification of 75% of participants, with 75% sensitivity and 87.9% specificity. The C-SOMC test demonstrated good concurrent validity, sensitivity and specificity in a sample of people with a first cerebral infarction, demonstrating that it could be used to screen for cognitive impairment in stroke patients.

Evaluating Intersite Consistency Across 11 Geographically Distinct Pediatric Clerkship Training Sites: Providing Assurance That Educational Comparability Is Possible

We compared core pediatric clerkship student assessments across 11 geographically distinct learning environments following a major curriculum change. We sought to determine if intersite consistency existed, which can be used as a marker of program evaluation success.We evaluated students' overall pediatric clerkship performance along with individual assessments that target our clerkship learning objectives. Using the data of graduating classes from 2015 to 2019 (N = 859), we conducted an analysis of covariance and multivariate logistic regression analysis to investigate whether the performance varied across training sites.Of the students, 833 (97%) were included in the study. The majority of the training sites did not show statistically significant differences from each other. After controlling for the Medical College Admission Test total score and the average pre-clerkship National Board of Medical Examiners final exam score, the clerkship site only explained a 3% additional variance of the clerkship final grade.Over the ensuing 5-year period after a curriculum overhaul to an 18-month, integrated module pre-clerkship curriculum, we found that student pediatric clerkship performance in clinical knowledge and skills did not differ significantly across 11 varied geographic teaching sites when controlling for students' pre-clerkship achievement. Specialty-specific curriculum resources, faculty development tools, and assessment of learning objectives may provide a framework for maintaining intersite consistency when faced with an expanding network of teaching facilities and faculty.

An early microvascular training program of dental intern students and junior residents: a comparative prospective study

BackgroundClinical instructional strategies and the climate in which teaching and learning take place have a significant impact on the quality of dental education. Therefore, this study aimed to evaluate the impact of early microsurgery training on the skills of dental intern students who are planning to join an oral and maxillofacial surgical field (DIS) as compared with junior residents within an oral and maxillofacial surgery department who had no microsurgery experience (JR).MethodsA total of 100 trainees, 70 were DIS, while the other 30 were JR. The average age was 23.87 ± 2.05 years for DIS group and 31.05 ± 3.06 for JR group. All trainees attended a microsurgical course (theoretical and practical parts) for seven days within a Microvascular Laboratory for Research and Education of a university-affiliated tertiary hospital. Two blinded examiners had assessed the performance of trainees independently using a specific scoring system. The independent sample t-test was used to compare the effect of microsurgery training between DIS and JR groups. The significance level was set at 0.05.ResultsThe DIS group had showed higher attendance rate than JR group (p < 0.01), with a lower absence score in DIS than JR groups (0.33 ± 0.58 vs. 2.47 ± 1.36). The total score of the theoretical test was significantly different between both groups (p < 0.01). In this context, the DIS group had revealed higher total score than JR group (15.06 ± 1.92 vs. 12.73 ± 2.49). In term of tissue preservation, there was a significant difference between both groups, with the DIS had better performance score than JR (1.49 ± 0.51 vs. 0.93 ± 0.59). Further, the practical exam score was significantly higher in DIS group than JR group (p < 0.01).ConclusionOverall, the performance of dental intern students was favourably compared with junior residents in most aspects. Therefore, it is promising and essential for dental colleges to add a microsurgery course to the curriculum of dental intern students who plan to specialize in oral and maxillofacial surgery.

Özgül Fobi ve Sınav Kaygısı Olan Ergenlerde EMDR Terapinin Etkisinin İncelenmesi

This research is about the investigation of the Effect of EMDR Therapy on Adolescents between 15-17 years of age with Specific Phobia and Test Anxiety. The first hypothesis of the study is that “Adolescents who are treated with EMDR therapy will significantly decrease their fear scores of the phobia object (delusion, affective and total).” The second hypothesis is that "Sub-score and total test anxiety scores of adolescents who receive EMDR therapy will decrease significantly." The data on this research, collected by using Demographic Information Form, Test anxiety Inventory, DSM-5 Specific Phobia Scale for 11-17 Year-Old Children; through 31 adolescents living in Antalya (Turkey) and visiting the counselling centre for treatment between February 2022 and July 2022. Data were obtained and analysed in SPSS 25.0 package program. In the study, test anxiety sub-scale and total scores of adolescents who is receiving EMDR therapy with test anxiety, also total specific phobia scores of adolescents with specific phobia were compared as pre-test and post-test. As a result of the 5-session EMDR therapy, it was concluded that test anxiety sub-scale scores and total scores as well as specific phobia total scores decreased significantly in post-test measurement. Based on the research findings, it was considered that EMDR therapy gives positive results on adolescents with specific phobia and test anxiety.

The effectiveness of Driver’s model in teaching mathematics for developing intermediate school students conceptual understanding

This study aims to investigate the effectiveness of Driver’s model (DM) in developing the conceptual understanding (CU) of first-class intermediate students in geometry and polygons via quasi-experimental design, for a random sample of 62 female-students divided into two groups, the experimental group with 31 students who were taught the module by DM, and the control group with 31 students were taught the module by the traditional teaching method. The study found significant statistical variances regarding scores means between the two groups at the three levels of explanation, interpretation, and application for the experimental group with a high impact reached at0.31 along with a high impact, too, regarding the mean of the total score of CU test for the same group, which reached at 0.43. Thus, the study recommends using DM in mathematics teaching.

The Effect of Aquatic Exercise on Balance in Ambulatory Individuals With Down Syndrome: An Interventional Feasibility Study

Background: People with Down syndrome (DS) often present with ligamentous laxity, coordination difficulties, and decreased strength, which can lead to impaired balance. These impairments may contribute to delayed development of age-appropriate motor skills and can contribute to increased risk of falls. Although aquatic exercises have been found to improve balance in various populations, the effectiveness of aquatic exercise to improve balance for individuals with DS has not been thoroughly studied. Methods: Five participants with DS were tested using the second edition of the Pediatric Balance Scale (PBS-2), while their parents completed the Activities-specific Balance Confidence (ABC) scale. They then participated in an aquatic exercise intervention twice per week for 6 weeks. Following the 6-week intervention, the participants were tested again using the PBS-2 and the ABC scale. Results: Parents' ABC scores increased for 3 of the 5 participants, and there was a statistically significant difference between pre– and post–aquatic intervention PBS-2 total test scores for the group (P &lt; .05). Relevance: The results of this small feasibility study support the practicality of aquatic exercise to improve balance for children and young adults with DS. Further research using a larger sample size is recommended.

The effect of knowledge levels of intensive care nurses about pressure injuries on their attitude toward preventing pressure injuries

AimThe aim of this study was to determine the current knowledge levels of intensive care nurses about pressure injuries and their attitudes toward preventing pressure injuries, and to reveal the relationship between these variables. Materials and methodsThis descriptive cross-sectional study was conducted with 152 nurses, working in the Adult Intensive Care Units of a Training and Research Hospital. Data were collected between 10.08.2021 and 31.11.2021 with the Patient Information Form, Modified Pieper Pressure Ulcer Knowledge Test and Attitude toward Pressure Injury Prevention Scale. Frequency analysis, descriptive statistics, multiple logistic regression analysis and the structural equation modeling technique were used in the analysis of the study data. ResultsThe mean age of the nurses was 25.82 ± 3.42 years, 86.2% of them were female and 67.1% of them had a bachelor's degree. Total mean score of the Modified Pieper Pressure Ulcer Knowledge Test of the intensive care nurses was found to be 32.58 ± 6.58. The knowledge score of 113 out of 152 nurses was ≥60% or above. The total mean score of the Attitude toward Pressure Injury Prevention Scale was 42.00 ± 5.70 and a total of 76.97% (117 participants) of them were found to score 75% or above on the scale. The results of the regression analysis showed that educational degree, and status of having training about pressure injuries did not affect the total mean score of the Knowledge Test and the Attitude Scale. However, it revealed that the frequency of encountering a patient with pressure injuries in the unit where they work has affected the total mean score of the scales significantly (p < 0.05). As per the results of the structural equation model, the Modified Pieper Pressure Ulcer Knowledge Test scores of the nurses were found to have a statistically significant effect on the scores of the Attitude toward Pressure Injury Prevention Scale (p < 0.05). ConclusionThis study revealed that intensive care unit nurses had a positive attitude toward Pressure Injury Prevention and their knowledge was sufficient and that as the Modified Pieper Pressure Ulcer Knowledge Test scores increase, their positive attitude toward Pressure Injury Prevention also increases.

Hub structure in functional network of EEG signals supporting high cognitive functions in older individuals.

Maintaining high cognitive functions is desirable for "wellbeing" in old age and is particularly relevant to a super-aging society. According to their individual cognitive functions, optimal intervention for older individuals facilitates the maintenance of cognitive functions. Cognitive function is a result of whole-brain interactions. These interactions are reflected in several measures in graph theory analysis for the topological characteristics of functional connectivity. Betweenness centrality (BC), which can identify the "hub" node, i.e., the most important node affecting whole-brain network activity, may be appropriate for capturing whole-brain interactions. During the past decade, BC has been applied to capture changes in brain networks related to cognitive deficits arising from pathological conditions. In this study, we hypothesized that the hub structure of functional networks would reflect cognitive function, even in healthy elderly individuals. To test this hypothesis, based on the BC value of the functional connectivity obtained using the phase lag index from the electroencephalogram under the eyes closed resting state, we examined the relationship between the BC value and cognitive function measured using the Five Cognitive Functions test total score. We found a significant positive correlation of BC with cognitive functioning and a significant enhancement in the BC value of individuals with high cognitive functioning, particularly in the frontal theta network. The hub structure may reflect the sophisticated integration and transmission of information in whole-brain networks to support high-level cognitive function. Our findings may contribute to the development of biomarkers for assessing cognitive function, enabling optimal interventions for maintaining cognitive function in older individuals.

Setting defensible minimum-stations-passed standards in OSCE-type assessments

Introduction Alongside the usual exam-level cut-score requirement, the use of a conjunctive minimum number of stations passed (MNSP) standard in OSCE-type assessments is common practice across some parts of the world. Typically, the MNSP is fixed in advance with little justification, and does not vary from one administration to another in a particular setting—which is not congruent to best assessment practice for high stakes examinations. In this paper, we investigate empirically four methods of setting such a standard in an examinee-centred (i.e. post hoc) and criterion-based way that allows the standard to vary appropriately with station and test difficulty. Methods and results Using many administrations (n = 442) from a single exam (PLAB2 in the UK), we show via mixed modelling that the total number of stations passed for each candidate has reliability close to that of the total test score (relative g-coefficient 0.73 and 0.76 respectively). We then argue that calculating the MNSP based on the predicted number of stations passed at the ‘main’ exam-level cut-score (i.e. for the borderline candidate) is conceptually, theoretically and practically preferred amongst the four approaches considered. Further analysis indicates that this standard does vary from administration to administration, but acts in a secondary way, with approximately a quarter of exam-level candidate failures resulting from application of the MNSP standard alone. Conclusion Collectively, this work suggests that employing the identified approach to setting the MNSP standard is practically possible and, in many settings, is more defensible than using a fixed number of stations set in advance.

Manual Wheelchair Configuration in Unilateral Upper- and Lower-Extremity Propulsion: A Randomized Crossover Study to Assess Effects of Rear Wheel Axle Position and Frame Type

ObjectiveTo evaluate independence and exertion when using a lightweight wheelchair in comparison with ultra-lightweight wheelchairs (rigid and folding) for individuals with brain injury using a hemipropulsion technique. DesignRandomized cross-over. SettingRehabilitation hospital. ParticipantsIndividuals diagnosed with brain injury resulting in hemiplegia using a hemipropulsion technique to mobilize in a manual wheelchair for at least 4 hours per day were recruited for this study. InterventionsEighteen participants were randomly assigned to complete skills and endurance testing in 3 different wheelchair configurations over a 3-week period: lightweight wheelchair; ultra-lightweight folding wheelchair; and ultra-lightweight rigid wheelchair. Main Outcome MeasuresThe primary outcome in this study was the percentage capacity score from the modified Wheelchair Skills Test 4.1. Secondary outcomes included the Wheelchair Propulsion Test, 100-m Push Test, heart rate, and rate of perceived exertion. ResultsSignificant differences were found in the Wheelchair Skills Test (total score, low rolling resistance score, and the goal attainment score) favoring the ultra-lightweight wheelchairs over the lightweight wheelchair (P=.002, .001, and .016, respectively). Time to complete the 100-m push test was significantly faster for the ultra-lightweight rigid frame in comparison with the lightweight frame (P=.001; 30.89 seconds faster). Significance differences were not seen with the Wheelchair Propulsion Test measures across any of the wheelchair frames. Heart rate change and of perceived exertion were significantly lower for the ultra-lightweight rigid group in comparison with the lightweight group (P=.006 and .013, respectively). ConclusionsThese data suggest that using an ultra-light weight wheelchair may lead to improved ability to complete wheelchair skills needed for successful mobility and a decrease in the actual and perceived physiological burden associated with propulsion in comparison to a lightweight wheelchair. A rigid frame may also enable faster mobility in comparison to a folding frame when hemi-propelling.

Long-term lanadelumab treatment improves health-related quality of life in patients with hereditary angioedema

BackgroundHereditary angioedema (HAE) is associated with a substantial disease burden. Lanadelumab reduced the HAE attack rate during 132 weeks of follow-up in the HELP open-label extension (OLE) Study (NCT02741596). ObjectiveTo measure the impact of long-term lanadelumab treatment on patient-reported outcomes (PROs). MethodsRollover patients (completed the 26-week HELP study [NCT02586805]) and nonrollovers (newly enrolled) received lanadelumab 300 mg every 2 weeks. PROs (Angioedema Quality of Life Questionnaire [AE-QoL], Short Form Health Survey 12-item version 2, Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment–General Health Questionnaire, and EQ-5D-5L questionnaire) were assessed at baseline (day 0 of HELP OLE) and various time points until the end-of-study visit. The Angioedema Control Test, Treatment Satisfaction Questionnaire for Medication, and Global Impression of Treatment Response were administered starting at week 52. ResultsThe mean (SD) change in AE-QoL total score from baseline to end-of-study for rollovers (n = 90) was −10.2 (17.9), exhibiting further improvement from HELP in health-related quality of life (HRQoL); 48.9% of rollovers achieved the previously defined 6-point minimal clinically important difference. Nonrollovers (n = 81) reported a change of −19.5 (21.3). Controlled disease (Angioedema Control Test total score ≥10) was reported by 90.2% of rollovers and 95.9% of nonrollovers at the end of the study. Excellent treatment response was reported by 78.7% of patients and 82.4% of investigators. Results from other PROs indicated a slight improvement in anxiety, a high level of satisfaction with treatment, and increased work productivityor activity. ConclusionClinically meaningful improvement in HRQoL was exhibited with long-term lanadelumab treatment, supporting the benefit of lanadelumab therapy associated with attack prevention. Trial RegistrationClinicalTrials.gov Identifiers: NCT02586805 (HELP Study) and NCT02741596 (HELP open-label extension).

The application of medical professional English multimedia teaching in clinical education (Enseñanza multimedia del inglés médico profesional en la educación sanitaria)

ABSTRACT Studying foreign languages for medical students is an indispensable requirement in today’s job market. The purpose of the study is to establish the advantages and effectiveness of using multimedia tools in teaching medical English. The study included 133 second-year medical students (79 young men and 54 young women) aged 19 to 21 years. At the end of the study, the total score for the final test in the experimental group was 38.6% higher compared to the baseline. In the control group, it was 21.2% higher with a statistically significant intergroup difference. The final score for writing and grammar in the experimental group increased by 29.9 and 21.9% compared to the baseline and the control group, respectively. The use of multimedia tools in teaching English to medical students is highly effective and contributes to improved speaking, listening skills and long-term memorization of new information. Multimedia tools also increase the interest and motivation of medical students in learning English.

The relative age effect on fundamental movement skills in Chinese children aged 3–5 years

BackgroundThe cut-off date in the education system causes a relative age difference, with developmental advantages for children who are born on the “early side” of the cut-off date and disadvantages for those born later, which is known as the relative age effect (RAE). Very few studies have examined whether there is a RAE on the development of fundamental movement skills (FMSs) in preschool children, and no studies have been conducted in China. The purpose of this study is to identify whether a RAE exists on FMS in Chinese preschool children, comparing RAEs according to gender and age.MethodsFrom a total of 378 invited preschool children regularly registered at one Chinese kindergarten, a total of 288 healthy and typically developing preschoolers (4.33 ± 0.84 years-old; 56.6% boys) were included in this study. All children were required to take part in anthropometry and FMS assessments. Analysis of covariance (ANCOVA) was applied to examine the difference in each of the FMS items across quarter categories, year and gender groups, controlling for body mass index (BMI).ResultsFor the overall sample, the data show the significant main effects on the quarter of birth factor in locomotor skills (LC; F (3, 265) = 2.811, p = 0.04, ηp2 = 0.031), object control skills (OB; F (3, 265) = 6.319, p = 0.04, ηp2 = 0.031), and total test score (TTS; F (3, 265) = 5.988, p = 0.001, ηp2 = 0.063). There were also significant differences in the age effect on all the domains of FMS (FLC (2, 265) = 100.654, p < 0.001, ηp2 = 0.432; FOB (2, 265) = 108.430, p < 0.001, ηp2 = 0.450; FTTS (2, 265) = 147.234, p < 0.001, ηp2 = 0.526) but a gender effect only in LC (F (1, 265) = 20.858; p < 0.001; ηp2 = 0.073). For gender and quarter of birth groups, RAEs in LC only exists in girls. Moreover, regarding age and quarter of birth factors, RAEs are only found at younger ages.ConclusionsThis study suggests the existence of RAEs in the FMS of Chinese preschool children. Teachers need to be aware of the effect of RAEs on the FMS when approaching development, evaluation, and teaching approaches in preschools.

Cranial Nerve Affection in Adolescents with Type 1 Diabetes Assessed by Corneal Confocal Microscopy, Smell and Taste Tests

Aim. To determine whether adolescents with type 1 diabetes (T1D) have morphological changes of the corneal nerve fibers and reduced smell and taste function compared to healthy control subjects as a sign of cranial nerve affection and to evaluate possible associated risk factors for cranial nerve affection. Methods. The study was a part of the T1DANES study including 60 adolescents (15–&lt;19 years) and 23 healthy age-matched controls. First, clinical and biochemical data on the participants were obtained, and the second step involved a test day with neurological examinations including corneal confocal microscopy (CCM), olfactory testing with Sniffin’ Sticks, and gustatory assessment with taste-drop test. Results. The adolescents with T1D (mean diabetes duration 9.8 years, mean HbA1c 61 mmol/mol) had lower CCM parameters (corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, and corneal nerve fiber fractal dimension) compared to control subjects (all p &lt; 0.05 ). No differences in total score for smell test ( p = 0.66 ) and taste test ( p = 0.47 ) were found, but adolescents with T1D had reduced ability to taste sweet ( p &lt; 0.01 ). In total, 24% had two or more reduced CCM parameters, 12% had reduced smell test, and 23% had abnormal taste test. Higher waist to height ratio (WHtR) was the only risk factor found for reduced corneal nerve fiber density, and higher BMI-SDS and WHtR were found for impaired taste function. Having abnormal smell test increased the risk for having abnormal taste perception, and vice versa. Conclusion. Up to 29% of adolescents with T1D had abnormal test scores indicating cranial nerve affection. Lower corneal nerve fiber density and reduced ability to taste sweet were found in adolescents with T1D compared to control subjects. Clinical attention to smell and taste function seems important because it requires intervention for advising adolescents with impaired smell and taste function.

Examining changes in knowledge and practice in nurse practitioners after an online educational module on obstructive sleep apnea

AimsThe purpose of this study is to investigate primary care nurse practitioner (NP) knowledge and knowledge retention on obstructive sleep apnea (OSA) screening after an educational in-service. BackgroundThe prevalence of OSA is high and continues to rise amid the obesity epidemic. Approximately 75–90 % of individuals with moderate to severe OSA remain undiagnosed. Continuing education of OSA risk factors among primary care providers may increase screening rates, leading to early diagnosis and treatment. MethodsAn educational module was presented to NPs (n = 30) during a mandatory NP in-service at two sets of outpatient clinics. Knowledge was assessed with a pre-test and post-test survey consisting of 23 items. A 25-item follow-up test was administered five weeks after to assess knowledge retention. ResultsAn increase in total knowledge scores was demonstrated between the pre-test and post-test with a decrease in knowledge observed at follow-up. Follow-up test total mean scores remained above pre-test levels, indicating potential long-term learning. ConclusionsWhile learning was demonstrated, NPs acknowledged continued barriers to screening for OSA such as time and having no OSA screening tool available in the electronic medical record (EMR).

The Efficacy of High-fidelity Simulation-based Education in Enhancing Knowledge among Undergraduate Medical Students

Background: Medical education has experienced important changes in recent times. The concern for patient's safety is one of the key reasons for the change in medical curricula. Innovative instructional methods like simulation-based medical education (SBME) has evolved to address this problem. SBME has become an essential part of education and training for health professionals in many parts of the world. There are evidences that support that high-fidelity simulation (HPS) training has enhanced clinical knowledge among medical students.&#x0D; Aims: The objective of this study was to note the differences in the knowledge made by high-fidelity simulation-based medical education among undergraduate medical education.&#x0D; Study Design: It was a quasi-experimental time series study with Pre-test and Post-test interventions.&#x0D; Place and Duration of Study: Clinical Skills Lab, Faculty of Medicine, Manipal University College Malaysia, Melaka, between October 2015 and September 2017.&#x0D; Methodology: The study involved 347 final year undergraduate medical students. The participants were divided into groups during the simulation sessions and their knowledge was assessed individually with Multiple Choice Questions (MCQ) and also self-reported Pre-test and Post-tests. Paired t-test was used to determine the difference of MCQ scores between pre and post simulation sessions. One-way repeated measure ANOVA was performed to determine the significant difference in knowledge assessment of self-reported Pre-test and Post-test scores. P value &lt; .001 was taken to be of statistical significance.&#x0D; Results: In the unpaired t-test, Post-test MCQ scores were higher than Pre-test scores but not statistically significant (P = .013). A one-way repeated measured ANOVA with Bonferroni post hoc analysis demonstrated that the total scores of the self-reported knowledge tests were significantly increased over time (P &lt; .001).&#x0D; Conclusion: There is enhancement of knowledge as perceived by the students with self-reported knowledge tests but not statistically significant as revealed by the MCQ scores.

Safety and effectiveness of vortioxetine for major depressive disorder: Real-world evidence from a population-based study in South Korea

A post-marketing surveillance study was conducted to assess the real-world safety and effectiveness of vortioxetine for the treatment of major depressive disorder (MDD) in South Korea. Adult patients aged 19-94 years receiving vortioxetine for MDD at 72 hospitals and clinics in South Korea between 19th August 2014 and 18th August 2020 were included. Patients were followed for up to 24±2 weeks, at up to three visits. Adverse events (AEs) and effectiveness, assessed by both clinician and patient-reported measures, were analyzed. A total of 3,263 patients (mean age: 51.28 years) were included in the safety set; 1,095 were aged ≥65 years. The majority of the safety set (61.97%) were female. The overall rate of any AEs and serious AEs were 17.13 and 1.56%, respectively. The majority of AEs were mild (88.32%). The rates of AEs did not differ statistically by age (≥65 years: 16.89% [185/1,095] versus <65 years: 17.25% [374/2,168)], p=0.7989), sex (male: 15.95% [198/1,241] versus female: 17.85% [361/2,022], p=0.1623), or liver impairment (with liver impairment: 20.90% [14/67] versus without liver impairment: 17.05% [545/3,196], p=0.4087). Effectiveness was assessed in 1,918 patients. By 24±2 weeks, there were significant clinical improvements from baseline, assessed by change in Montgomery-Asberg Depression Rating Scale total score (mean±standard deviation [SD]: -10.49±9.42 points, p <0.0001), the proportion of patients with improved symptoms using the Clinical Global Impression - Improvement scores (79.29%), and in both patient-reported measures, with a significant improvement in the Korean Version of the Perceived Deficits Questionnaire-Depression (mean±SD: -6.06±13.23, p <0.0001) and Digit Symbol Substitution Test (mean±SD: 4.83±9.81, p <0.0001) total scores from baseline. Similar to the safety profiles, the proportions of patients with improved symptoms compared with baseline using the Clinical Global Impression - Improvement scores did not differ by age (≥65 years: 82.09% versus <65 years: 78.32%, p=0.0511), sex (male: 77.45% versus female: 81.01%, p=0.0587), or liver impairment (with liver impairment: 67.57% versus without liver impairment: 79.85%, p=0.0663). Vortioxetine appears to be well-tolerated and effective for treating MDD patients in the real-world setting in South Korea, irrespective of age, sex, and liver impairment, reflecting the known profile of vortioxetine based on studies worldwide.

Circadian rhythm disturbances in mood disorders: characterisation and clinical impact

IntroductionCircadian rhythms, defined as endogenous oscillations that regulate metabolism, physiology and behaviour, may be frequently disrupted in mood disorders, influencing their clinical presentation and course (Srinivasan V. et al. World J Biol Psychiatry. 2006;7(3):138-151).ObjectivesTo characterise circadian rhythm disruptions in a population of patients with mood disorders, analysing clinical and course differences in subjects with and without clinically significant circadian rhythm alterationsMethodsPatients selected for this cross-sectional study were assessed with CGI-BP, HAM-D, MRS, and PANSS. Circadian rhythm disturbances were evaluated with BRIAN. Patients with clinically relevant circadian rhythm disturbances were defined as BRIAN &gt; 36 (Mondin TC et al. J Psychiatr Res. 2017;84:98-104). Bivariate analyses were subsequently performed to compare subgroups of patients.ResultsIn our study, 61 subjects with DD or DB were enrolled. The overall mean BRIAN test score was 40.08 ± 10.26. When comparing the BRIAN test scores, both total and subscales, between subjects with DB and DD, social rhythms were significantly more altered in subjects with DB (8.63 ± 2.90 VS 6.80 ± 2.11, p=0.034). Subjects with disruption of circadian rhythms displayed greater severity of depressive symptoms (mean total HAM-D test score 16.06±8.61 VS 8.94±5.85; p&lt;0.003, mean CGI-BP severity of depression test score 3.14±1.68 VS 1.88±1.11; p&lt;0.010) and with a longer duration of untreated illness (6.14±8.64 VS 2.53±6.28; p= 0.040).ConclusionsAlterations in circadian rhythms should be routinely investigated in all individuals with mood disorders, especially BD, and may represent a transdiagnostic psychopathological construct that defines a more severe disease phenotype.Disclosure of InterestNone Declared

Abstract P2-14-09: Sensory Evaluation of Nipple-Areolar Complex after Nipple-Sparing Mastectomy: A Comparison of Incision Approaches

Abstract Background: Since nipple-sparing mastectomy (NSM) has been widely practiced, majority of previous studies have evaluated the effects of Nipple-areolar complex (NAC) preservation on body image adjustment. However, few have evaluated NAC sensation after NSM in a large sample size. This study aims to assess NAC sensation after NSM and compare the results according to different incisional approaches; specifically, inframammary fold (IMF) and peri-areolar. Methods: Post NSM patients from Oct 2019 to Nov 2021 have been recruited prospectively. A total of 115 patients (IMF 69 and peri-areolar 36) were evaluated for NAC sensory at various time points during follow up within 1.5 to 4 years after surgery. NAC sensation was scored by pin-prick test in a scale of 0 to 2 (0: no sensation, 1: dull sensation, 2: sharp sensation), divided in 5 areas of the NAC and summed up to a total of 10. Results: In all patients, a median of the pin-prick test total score on NAC was 3 (0-10). Pin-prick test of NAC showed numerically higher NAC sensory score in the IMF incision than in the peri-areolar group without a statistical significance (IMF: Median 4 Mean 3.83 ± 3.04, Peri-areolar Median 2 Mean 2.69 ± 3.64, p=0.062). When sensory scores were evaluated depending on NAC zones (A: Nipple, B: Upper outer, C: Upper inner, D: Lower outer, E: Lower inner) the IMF incision group showed better outcomes in zone B (p=0.015) and E (p=0.043). Simple linear regression analysis showed the possibility of incisional approach, diabetes mellitus (DM) history, previous radiotherapy of ipsilateral breast, post mastectomy radiotherapy (PMRT), adjuvant chemotherapy, tumor to nipple distance and laterality influencing NAC sensory with p&amp;lt; 0.2. When these factors were taken to multiple linear regression analysis, DM history (p=0.045), previous radiotherapy (p=0.001), postop radiotherapy (p=0.001), and adjuvant chemotherapy (p=0.001). Conclusion: NAC sensory deteriorated postoperatively in general. Scores of NAC sensation were numerically higher in the patients with IMF incision, although the difference was not statistically significant. NAC sensation was negatively affected by DM history, previous ipsilateral breast radiotherapy and post-NSM treatments such as chemotherapy and PMRT. While incision type may improve aesthetic outcomes, additional efforts are necessary to ameliorate the post-NSM NAC desensitization. Table 1. Patient characteristics Table 2. Linear regression analysis for clinical factors affecting NAC sensory Citation Format: Yoonwon Kook, Ji Soo Jang, Seung Ho Baek, Soong June Bae, Sung Gwe Ahn, Joon Jeong. Sensory Evaluation of Nipple-Areolar Complex after Nipple-Sparing Mastectomy: A Comparison of Incision Approaches [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-09.