Is Peer Assessment Reliable in Objectively Structured Clinical Examination?

Objective:The study was designed to evaluate the reliability of the peer assessment in the objectively structured clinical examination (OSCE) for the summative assessment of 4th grade students at the end of general surgery clerkship.Method:The study was planned prospectively with the permission of the Dean of Medicine Faculty and approval of the ethics committee. The 6th grade students who were in the surgery rotation participated in the study as peer assessors (PA). Both peers and department of general surgery assessed the students. Pass/fail point was accepted as 60. The scores of OSCE and performance evaluation given by peers and faculty were compared statistically.Results:Twenty-three students completed general surgery clerkship. Ten students (43.5%) were female. According to performance scores given by the faculty, 15 (65.2%) of the 23 students were successful, while all students were considered successful (having a grade of 60 or more) based on the scores of peer evaluation. There was a significant difference between the faculty members and PA with regard to the performance evaluation (p=0.008). The faculty members found five students (27.8%) successful in the OSCE (having a grade of 60 or more). However, ten students (43.5%) received a score of at least six from peer evaluation. Although there was a difference, it was not significant (p=0.063). Gender did not affect scoring in performance evaluation and OSCE application.Conclusion:Although there was a difference between faculty members and peer evaluators in the performance evaluation, no difference was observed in OSCE. In conclusion, OSCE assessment by peer evaluators is reliable

The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis

Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix—in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values

The Efficacy of Hemoglobin, Albumin, Lymphocytes, and Platelets as a Prognostic Marker for Survival in Octogenarians and Nonagenarians Undergoing Colorectal Cancer Surgery

Objectives: With the aging population worldwide, the octogenarians are becoming a substantial group and since cancer incidence increases by age, this group of patients is becoming more affected. However, no distinct treatment algorithm has been established for the elderly patients with cancer. The present study aimed to determine the prognostic value of several inflammatory parameters by comparing octogenarian patients treated surgically for colorectal cancer with their younger counterparts, as well as to predict and prevent age-related complications in this frail group of patients

Can Simple Tests Prior to Endoscopy Predict the OLGA Stage of Gastritis?

Gastritis is a progressive disease that evolves from a non-atrophic to atrophic state and progresses through intestinal metaplasia, with some cases leading eventually to gastric cancer. Since gastritis by definition is an inflammatory process of the mucosal lining of the stomach and is usually associated with pain, we aimed to identify any association between the severity of gastritis and pain and a simple inflammatory marker derived from a complete blood count (CBC). This was a prospective cross-sectional study which enrolled 155 consecutive adult patients who underwent an upper endoscopy. Prior to the endoscopy, all patients were given a questionnaire, numerical rating scale (NRS) and complete blood count evaluation. The biopsy was obtained from the gastric mucosa according to the modified Sydney classification and scored with the Operative Link for Gastritis Assessment (OLGA) scoring system. The results showed a significant correlation between NRS and intestinal metaplasia (p < 0.01); moreover, a correlation was also found between the NRS and OLGA stage (r = 0.469, p < 0.001). A nonlinear curve was constructed for OLGA stage estimation according to NRS scores (r2 was found to be 0.442, with p < 0.001). The results also showed a correlation between the neutrophil to the lymphocyte ratio (NLR) and OLGA stage (p < 0.01). No correlation was found between the other gastric parameters and NLR (p > 0.05). Helicobacter pylori positivity did not correlate with NRS and NLR. As a conclusion, pain measured by NRS and NLR, which are simply calculated from the CBC prior to endoscopy, may be used to predict OLGA stages and estimate the severity of gastritis in endoscopy patients

Effect and Tolerability of Same-Day Repeat Colonoscopy

Purpose/Aim of the study: The main purpose of the colonoscopy is screening for colorectal cancers and diagnosis of colorectal disease The cost-effectiveness of colonoscopy directly depend on the adequate bowel preparation. Inadequate colonoscopy is recommended to be re-scheduled within 1 year. Re-scheduling is an economic and patient burden. Thus instead of re-scheduling, another strategy may be attempted. The purpose of this study was to examine the usefulness and effect of the same day repeat colonoscopy after administration of an additional laxative dose. Materials and Methods: Patients with inadequate colonoscopy were enrolled in the study. The patients eligible for the enrollment were instructed to consume an additional laxative and scheduled in afternoon. The demographic data of the patient, the details of the index and repeat procedures were obtained by a questionnaire. Results: A total of 60 patients were enrolled in the study. The rate of adequate colonoscopy was 80%. Cecum intubation rate was 83.3%. There were no complications due to colonoscopy itself and additional laxatives. The polyp detection rate was 26.6%. The withdrawal time was 6.7 ± 1.34 min. Conclusion: The results of the present study showed that same day repeat colonoscopy with additional laxative dose can be a safe and effective method for repeat procedure of an inadequate colonoscopy. The patients tolerated and were satisfied with the same day protocol. Quality indicators of colonoscopy such as adenoma detection rate and cecum intubation rate were achieved. Same day bowel cleansing method may be considered as an alternative way rather than re-scheduling inadequate colonoscopy for a later time

The fate of suboptimal anastomosis after colon resection: An experimental study

BACKGROUND: The fate of suboptimal anastomosis is unknown and early detection of anastomotic leakage after colon resection is crucial for the proper management of patients

The protective effects of intratympanic dexamethasone and vitamin E on cisplatin-induced ototoxicity are demonstrated in rats

aydin, sedat/0000-0003-4939-5026WOS: 000291061600035PubMed: 20300971Cisplatin ototoxicity is a major dose-limiting factor in the treatment of several neoplasms. Dexamethasone and vitamin E are two slow-acting free radical cleaners, and they have been shown to ameliorate nephrotoxicity and endothelial cell damage in animals receiving cisplatin. The purpose of the study was to determine the effectiveness of vitamin E and dexamethasone as an otoprotectant intratympanically. Prospective, randomized controlled trial in the rat model. Wistar rats were sedated using 50 mg/kg intraperitoneal ketamine and 7.5 mg/kg xylazine. Baseline auditory brainstem response (ABR) testing was performed in response to clicks and 4.8-, 12-, 16-kHz tone bursts. After auditory thresholds were determined, the animals received intraperitoneal drug administration according to one of the four groups. The rat groups received (group I) % 09 NaCl solution intratympanically (IT), (group II) cisplatin (20 mg/kg) only intraperitoneally (IP), (group III) dexamethasone (0.1-0.3 ml) IT and (group IV) vitamin E solution (0.1-0.3 ml) IT followed after 30 min by 20 mg/kg cisplatin. After the 3-day follow-up, ABR testing was performed and threshold changes were recorded. Group II animals showed marked hearing loss with average threshold shifts of 39.7 +/- A 1.4 dB for clicks, 7.3 +/- A 2.6 dB at 4 kHz, 8.4 +/- A 1.6 dB at 8 kHz, 71.1 +/- A 4.2 dB at 12 kHz and 71.9 +/- A 5.9 dB at 16 kHz. No significant loss was observed in group III with shifts of 1.60 +/- A 1.3 dB, 4.75 +/- A 2.4 dB, 8.7 +/- A 3.4 dB, and 4.3 +/- A 2.1 dB for clicks and tone bursts at 4.8, 12, and 16 kHz, respectively. And similar findings were observed in group IV with shifts of 3.3 +/- A 1.4 dB, 7.2 +/- A 2.1 dB, 10.8 +/- A 2 dB, and 13.3 +/- A 3.1 dB for clicks and tone bursts at 4.8, 12, and 16 kHz, respectively. Significant protection was seen in group III and IV animals compared with group II animals. There is no side effect in IT administration of vitamin E and dexamethasone for hearing functions and two of them appear to have a easier, safer, usable protective effect against cisplatin ototoxicity