Exploring whether (and how) self-reflection can improve practice as a teacher educator

The present essay describes a model under which a method of self-improvement of teacher-educator practice can be implemented by analyzing personal practices. I will focus my argument on investigating self-reflection and the subject under investigation will be the educator: how can they self-reflect in order to enhance their learning and hence their practice. The first step of the model is self-reflection. The second step will be self-study. The final step will be self-research techniques (such as autoethnography). This final step will provide the validity for improving personal practice in a possibly reliable way such that practices of narcissism and self-replicating redundancies or errors are avoided. By acknowledging the multiple identities a teacher assumes in their professional practice allows them to analyze them systematically and eventually improve on them

Spotlight on eluxadoline for the treatment of patients with irritable bowel syndrome with diarrhea

Background: Irritable bowel syndrome with diarrhea (IBS-D) has limited options for treatment currently, including mainly anti-motility medications, antispasmodics, and antidepressants. This review discusses the properties of a new drug, eluxadoline, a gut-targeting mu- and kappa-opioid receptor agonist and a delta-opioid receptor antagonist, and its efficacy and safety in patients with IBS-D. / Materials and methods: A systematic review of the literature was undertaken to identify studies that had investigated eluxadoline as a treatment in IBS-D. A narrative review of other information is provided with respect to pharmacological and chemical properties. Where suitable, meta-analysis was performed with a random-effects model to produce a pooled estimate. / Results: Eluxadoline showed efficacy improving stool consistency (standardized mean difference [SMD]: -0.29 at 12 weeks, p = 0.0004; -0.46 at 26 weeks, p = 0.0001), global symptoms (SMD: -0.15 at 12 weeks, p = 0.006; -0.14 at 26 weeks, p = 0.02), quality of life (SMD: 0.21 at 12 weeks, p < 0.0001; 0.16 at 26 weeks, p = 0.007), pain (SMD: -0.17 at 12 weeks, p = 0.001; -0.16 at 26 weeks, p = 0.01), and adequate relief (odds ratio [OR]: 1.99 at 12 weeks, p < 0.00001; 1.78 at 26 weeks, p < 0.0001). It also improved IBS severity and other abdominal symptoms such as bloating, discomfort, and risk of urgency and fecal incontinence. Its main side effects included constipation (OR: 3.49, p < 0.00001), vomiting (OR: 3.42, p = 0.0002), abdominal pain (OR: 1.78, p = 0.007), and nausea (OR: 1.42, p = 0.07). The overall quality of trials was satisfactory with the meta-analyses providing largely homogeneous outcomes. / Conclusion: Eluxadoline’s place in clinical practice might prove useful since the pharmacological options of IBS-D are limited and eluxadoline showed a positive effect in treating the symptoms of IBS-D

Plantar keratoderma of Sézary syndrome

Sézary syndrome is an extremely rare form of cutaneous T-cell lymphoma. It presents suddenly and is associated with a poor prognosis. Clinical recognition is crucial for the diagnostic process and initiation of appropriate treatment. Plantar keratoderma is usually pathognomonic for Sézary syndrome and clinicians should be alerted to its presence

Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis

Background: Citrulline has been described as a marker of intestinal function or absorption but evidence varies according to clinical settings. Objective: The objective of this article is to examine the evidence of plasma citrulline as a marker of intestinal function and absorption in various clinical settings. Methods: Studies were examined for p values, means and standard deviations, correlation coefficients or other metrics depicting the association of citrulline with intestinal function. A random effects model was used to produce a pooled estimate. A hierarchical summary receiver operating curve model was fitted for diagnostic accuracy measures. Results: Citrulline levels are correlated strongly with small bowel length in short bowel syndrome patients (r  = 0.67). Citrulline is strongly negatively correlated (r  = –0.56) with intestinal disease severity with regards to enteropathies (coeliac disease, tropical enteropathy, Crohn’s disease, mucositis, acute rejection in intestinal transplantation). Citrulline cut-off levels have an overall sensitivity and specificity of 80% and 84% respectively. Citrulline levels in untreated coeliac patients compared to controls were reduced by 10 µmol/l. Citrulline levels increase with gluten-free diet and with improvement of enteropathy. Citrulline is decreased in critical illness and sepsis. Conclusion: These findings allow us to advocate quite reasonably that citrulline is a marker of acute and chronic intestinal insufficiency

The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose: Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect. Method: The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses. Results: The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I2 = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics. Conclusions: Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students

Publication Bias in Meta-Analysis: Confidence Intervals for Rosenthal's Fail-Safe Number

The purpose of the present paper is to assess the efficacy of confidence intervals for Rosenthal's fail-safe number. Although Rosenthal's estimator is highly used by researchers, its statistical properties are largely unexplored. First of all, we developed statistical theory which allowed us to produce confidence intervals for Rosenthal's fail-safe number. This was produced by discerning whether the number of studies analysed in a meta-analysis is fixed or random. Each case produces different variance estimators. For a given number of studies and a given distribution, we provided five variance estimators. Confidence intervals are examined with a normal approximation and a nonparametric bootstrap. The accuracy of the different confidence interval estimates was then tested by methods of simulation under different distributional assumptions. The half normal distribution variance estimator has the best probability coverage. Finally, we provide a table of lower confidence intervals for Rosenthal's estimator

Exploring the distribution for the estimator of Rosenthal's "fail-safe' number of unpublished studies in meta-analysis

The present article discusses the statistical distribution for the estimator of Rosenthal's ‘file-drawer’ number NR, which is an estimator of unpublished studies in meta-analysis. We calculate the probability distribution function of NR. This is achieved based on the central limit theorem and the proposition that certain components of the estimator NR follow a half-normal distribution, derived from the standard normal distribution. Our proposed distributions are supported by simulations and investigation of convergence

Structural empowerment is a strong predictor of organizational commitment in nurses: A systematic review and meta-analysis

AIMS: The aim of this systematic review and meta-analysis is to explore the relationship between structural empowerment and organizational commitment and to examine a theoretical model under which empowerment could potentially affect organizational performance. DESIGN: PRISMA guidelines for systematic reviews and meta-analyses were used and quality assessment of articles was performed. DATA SOURCES: Electronic database searches were conducted in Google Scholar, PubMed/Medline, CINAHL, Scopus, and EMBASE from January 1950–1 January 2019, which resulted in 204 retrieved studies, published between 1994–2018. REVIEW METHODS: A random effects model was used to produce a pooled estimate of effect sizes (correlation coefficient, Cronbach's alpha), with analysis of heterogeneity and publication bias. A meta-analytic structural equation model of the constructs analysed was also performed. RESULTS: The final review included 22 studies. The meta-analytic means of structural empowerment, organizational commitment, job satisfaction, and psychological empowerment alpha reliabilities were 0.87, 0.84, 0.85, and 0.87, respectively. Heterogeneity but no publication bias was present in these outcomes. Structural empowerment was strongly correlated with organizational commitment (r = 0.43). The meta-analytic correlation coefficients of organizational commitment with psychological empowerment and job satisfaction were 0.53 and 0.47, respectively. Structural empowerment was correlated with job satisfaction and psychological empowerment with correlation coefficients of 0.57 and 0.44, respectively. Finally, job satisfaction was correlated with psychological empowerment with a correlation coefficient of 0.53. A meta-analytic structural equation model was tested with good fit which predicted performance (commitment and job satisfaction) from empowerment (structural and psychological). CONCLUSION: Structural empowerment is strongly correlated to organizational commitment and with psychological empowerment, they increase organizational performance. Organizations should attempt to make structural empowerment as widespread as possible to create an effective workplace culture. IMPACT: Structural empowerment in nurses is important to help deliver an effective workplace culture where nurses can be committed and have reduced intention-to-leave. Structural empowerment was strongly correlated with organizational commitment. Organizational commitment was significantly correlated with psychological empowerment and job satisfaction. Structural empowerment was correlated with job satisfaction and psychological empowerment as well. A meta-analytic structural equation model with good fit predicted performance. These results will affect nursing researchers and practitioners. Results indicate a need for organizational restructuring that promotes empowerment and formation of theoretical models that connect empowerment to performance

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016) Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7(1): 1-30 [DOI: 10.13105/wjma.v7.i1.1]

BACKGROUND: Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation. AIM: To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency. METHODS: A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis. RESULTS: Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained. CONCLUSION: The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales

Correction: EU development aid towards sub-saharan africa: Exploring the normative principle [Soc. Sci., 4 (2015) (85-116)] DOI: 10.3390/socsci4010085

The authors wish to make the following change to their paper (Bountagkidis et al. 2015). The captions describing regions of the African continent are incorrect. The correct version of Figure 1 is as follows