Short Answer Open-Ended versus Multiple-Choice Questions: A Comparison of Objectivity

Objectives: We designed our study with the hypothesis that open ended Short Answer type Questions (SAQs), no matter how carefully framed, cannot be as objective as Multiple Choice type Questions (MCQs).Methods: The study was conducted on 1st year MBBS students (n=99) studying at AIIMS, Jodhpur. Awritten test on 'Blood & Immunity' was conducted containing same questions in two formats; twelve MCQs (type E) in section Aand 12 SAQs in section B. Maximum marks for all questions in both sections were equal. All the answers of section B were evaluated separately by two different examiners to reduce the subjectivity and a model answer sheet for both the sections was prepared and provided to both the examiners.Results: The difference in the scores in Section B SAQs that were evaluated by two different examiners was not statistically significant. Mean of the marks awarded by the two examiners was taken as the final score of each student in section B. The difference in the scores by the students in the two sections was also non-significant (p=0.14). A significant correlation (r=0.99, p<0.0001) was found in SAQ and MCQ scores. Bland- Altman analysis also showed no proportion of bias and the two methods of scoring were in agreement with each other.Conclusion: The results suggest that meticulously-framed open-ended short answer type questions can be as objective as multiple choice type questions.Keywords: Multiple choice questions, medical education, assessment, open-ended questions

Clinical spectrum and laboratory profile of scrub typhus in children: A study from tertiary care hospital in Uttarakhand, Northern India

Background: Scrub typhus is a mite-born disease scrub. It commonly manifests as an acute febrile illness with multi-system involvement. It is regarded as a life-threatening disease in children, with serious complications usually occurring in the 2nd week of illness. Aims and Objectives: The aims of this study were to explore the clinical and laboratory profile of children with scrub typhus. Materials and Methods: All children admitted with scrub typhus over 1-year duration were enrolled in the study. The clinical, laboratory profile, and outcome were observed and analyzed. Results: A total of 47 children were diagnosed with scrub typhus, 17 (36.1%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), headache (82.4%), vomiting (82.4%), seizures (41.2%), and altered sensorium (70.6%). The mean duration of fever was 6.57 days, eight children (7%) had persistent fever for >14 days duration. Other complications reported were hepatitis 2 (4.3%), hepatosplenomegaly in 18 (38.3%) acute respiratory distress syndrome 2 (4.3%), and shock 31 (66%). The mean cerebrospinal fluid (CSF) protein, glucose, and cell count was 65.75±9.27 mg/dL, 45.00±7.23 mg/dL, and 65.94±52.72 cells/mm3 of CSF, respectively, with lymphocyte count of more than 96% in all cases. Most patients had lymphocytic pleocytosis and the mean lymphocyte percentage was 96.2%±4.5%. Out of all 47 patients, 45 (84.61%) patients recovered with appropriate antibiotics in both groups, while two (15.38%) patients expired in the group without meningitis. Conclusion: A high degree of suspicion and knowledge of the geographical distribution of Rickettsial diseases is crucial for its early diagnosis and favorable outcome. Scrub typhus should be considered in the differential diagnosis of aseptic meningitis

IUPS Physiology Education Workshop series in India: organizational mechanics, outcomes, and lessons

Peer reviewe

Operations perspective to competency-based medical education: Experiences of IUPS-ICMR Physiology Education Workshop series (2018-2019) conducted in India

Peer reviewe

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE®, EMBASE™, CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), −12 mmHg; 95% confidence interval (CI), −17 to −8] and heart rate (MD, −8 beats·min−1; 95% CI, −11 to −5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum