Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno test

<p>Abstract</p> <p>Background</p> <p>Validated instruments are needed to evaluate the programmatic impact of Evidence Based Practice (EBP) training and to document the competence of individual trainees. This study aimed to translate the Fresno test into Spanish and subsequently validate it, in order to ensure the equivalence of the Spanish version against the original English version.</p> <p>Methods</p> <p>Before and after study performed between October 2007 and June 2008. Three groups of participants: (a) Mentors of family medicine residents (expert group) (n = 56); (b) Family medicine physicians (intermediate experience group) (n = 17); (c) Family medicine residents (novice group) (n = 202); Medical residents attended an EBP course, and two sets of the test were administered before and after the course. The Fresno test is a performance based measure for use in medical education that assesses EBP skills. The outcome measures were: inter-rater and intra-rater reliability, internal consistency, item analyses, construct validity, feasibility of administration, and responsiveness.</p> <p>Results</p> <p>Inter-rater correlations were 0.95 and 0.85 in the pre-test and the post-test respectively. The overall intra-rater reliability was 0.71 and 0.81 in the pre-test and post-test questionnaire, respectively. Cronbach's alpha was 0.88 and 0.77, respectively. 152 residents (75.2%) returned both sets of the questionnaire. The observed effect size for the residents was 1.77 (CI 95%: 1.57-1.95), the standardised response mean was 1.65 (CI 95%:1.47-1.82).</p> <p>Conclusions</p> <p>The Spanish version of the Fresno test is a useful tool in assessing the knowledge and skills of EBP in Spanish-speaking residents of Family Medicine.</p

Observational evidence for self-interacting cold dark matter

Cosmological models with cold dark matter composed of weakly interacting particles predict overly dense cores in the centers of galaxies and clusters and an overly large number of halos within the Local Group compared to actual observations. We propose that the conflict can be resolved if the cold dark matter particles are self-interacting with a large scattering cross-section but negligible annihilation or dissipation. In this scenario, astronomical observations may enable us to study dark matter properties that are inaccessible in the laboratoryComment: 4 pages, no figures; added references, pedagogical improvements, to appear in PR

The dark matter content of the blue compact dwarf NGC 2915

NGC 2915 is a nearby blue compact dwarf with the HI properties of a late-type spiral. Its large, rotating HI disk (extending out to R ~ 22 B-band scale lengths) and apparent lack of stars in the outer HI disk make it a useful candidate for dark matter studies. New HI synthesis observations of NGC 2915 have been obtained using the Australian Telescope Compact Array. These data are combined with high-quality 3.6 $\mu$m imaging from the Spitzer Infrared Nearby Galaxies Survey. The central regions of the HI disk are shown to consist of two distinct HI concentrations with significantly non-Gaussian line profiles. We fit a tilted ring model to the HI velocity field to derive a rotation curve. This is used as input for mass models that determine the contributions from the stellar and gas disks as well as the dark matter halo. The galaxy is dark-matter-dominated at nearly all radii. At the last measured point of the rotation curve, the total mass to blue light ratio is ~ 140 times solar, making NGC 2915 one of the darkest galaxies known. We show that the stellar disk cannot account for the steeply-rising portion of the observed rotation curve. The best-fitting dark matter halo is a pseudo-isothermal sphere with a core density $\rho_0\sim 0.17 \pm 0.03$ \msun pc$^{-3}$ and a core radius $r_c\sim 0.9 \pm 0.1$ kpc.Comment: MNRAS in press. 17 pages, 15 figure

Study protocol of psychometric properties of the Spanish translation of a competence test in evidence based practice: The Fresno test

<p>Abstract</p> <p>Background</p> <p>There are few high-quality instruments for evaluating the effectiveness of Evidence-Based Practice (EBP) curricula with objective outcomes measures. The Fresno test is an instrument that evaluates most of EBP steps with a high reliability and validity in the English original version. The present study has the aims to translate the Fresno questionnaire into Spanish and its subsequent validation to ensure the equivalence of the Spanish version against the English original.</p> <p>Methods and design</p> <p>The questionnaire will be translated with the back translation technique and tested in Primary Care Teaching Units in Catalonia (PCTU). Participants will be: (a) tutors of Family Medicine residents (expert group); (b) Family Medicine residents in their second year of the Family Medicine training program (novice group), and (c) Family Medicine physicians (intermediate group). The questionnaire will be administered before and after an educational intervention. The educational intervention will be an interactive four half-day sessions designed to develop the knowledge and skills required to EBP. Responsiveness statistics used in the analysis will be the effect size, the standardised response mean and Guyatt's method. For internal consistency reliability, two measures will be used: corrected item-total correlations and Cronbach's alpha. Inter-rater reliability will be tested using Kappa coefficient for qualitative items and intra-class correlation coefficient for quantitative items and the overall score. Construct validity, item difficulty, item discrimination and feasibility will be determined.</p> <p>Discussion</p> <p>The validation of the Fresno questionnaire into different languages will enable the expansion of the questionnaire, as well as allowing comparison between countries and the evaluation of different teaching models.</p

B-cell regeneration profile and minimal residual disease status in bone marrow of treated multiple myeloma patients

© 2021 by the authors.B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (≥50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naïve B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19− nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome.This work has been supported by the International Myeloma Foundation-Black Swan Research Initiative, the EuroFlow Consortium (grant LSHB-CT-2006-018708); Centro de Investigación Biomédica en Red de Cáncer (CIBER-ONC; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain and FONDOS FEDER), numbers: CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480; grant from Bilateral Cooperation Program between Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES (Brasília/Brazil) and Dirección General de Políticas Universitárias (DGPU)-Ministério de Educación, Cultura y Deportes (Madrid/Spain) number DGPU 311/15; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) numbers: E26/110.105/2014 and E26/102.191/2013; grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico of Brazil (CNPQ), number: 400194/2014-7. R.M.d.P. was supported by a grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/DGPU), number: 000281/2016-06 and CAPES/PROEX 641/2018, Brazil; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) number: E01/200/537/2018

The Antioxidant Potential of the Mediterranean Diet in Patients at High Cardiovascular Risk: An In-Depth Review of the PREDIMED

Cardiovascular disease (CVD) is the leading global cause of death. Diet is known to be important in the prevention of CVD. The PREDIMED trial tested a relatively low-fat diet versus a high-fat Mediterranean diet (MedDiet) for the primary prevention of CVD. The resulting reduction of the CV composite outcome resulted in a paradigm shift in CV nutrition. Though many dietary factors likely contributed to this effect, this review focuses on the influence of the MedDiet on endogenous antioxidant systems and the effect of dietary polyphenols. Subgroup analysis of the PREDIMED trial revealed increased endogenous antioxidant and decreased pro-oxidant activity in the MedDiet groups. Moreover, higher polyphenol intake was associated with lower incidence of the primary outcome, overall mortality, blood pressure, inflammatory biomarkers, onset of new-onset type 2 diabetes mellitus (T2DM), and obesity. This suggests that polyphenols likely contributed to the lower incidence of the primary event in the MedDiet groups. In this article, we summarize the potential benefits of polyphenols found in the MedDiet, specifically the PREDIMED cohort. We also discuss the need for further research to confirm and expand the findings of the PREDIMED in a non-Mediterranean population and to determine the exact mechanisms of action of polyphenols

The impact of dark matter cusps and cores on the satellite galaxy population around spiral galaxies

(Abridged) We use N-body simulations to study the effects that a divergent (i.e. "cuspy") dark matter (DM) profile introduces on the tidal evolution of dwarf spheroidal galaxies (dSphs). Our models assume cosmologically-motivated initial conditions where dSphs are DM-dominated systems on eccentric orbits about a host galaxy composed of a dark halo and a baryonic disc. We find that the resilience of dSphs to tidal stripping is extremely sensitive to the halo cuspiness; whereas dwarfs with a cored profile can be easily destroyed by the host disc, those with cusps always retain a bound remnant. For a given halo profile the evolution of the structural parameters as driven by tides is controlled solely by the total amount of mass lost. This information is used to construct a semi-analytic code that simulates the hierarchical build-up of spiral galaxies assuming different halo profiles and disc masses. We find that tidal encounters with discs tend to decrease the average mass of satellites at all galactocentric radii. Interestingly, satellites accreted before re-ionization (z>6), which may be singled out by anomalous metallicity patterns, survive only if haloes are cuspy. We show that the size-mass relation established from Milky Way (MW) dwarfs strongly supports the presence of cusps in the majority of these systems, as cored models systematically underestimate the masses of the known Ultra-Faint dSphs. Our models also indicate that a massive M31 disc may explain why many of its dSphs fall below the size-mass relationship derived from MW dSphs. We use our models to constrain the mass threshold below which star formation is suppressed in DM haloes, finding that luminous satellites must be accreted with masses above 10^8--10^9 M_sol in order to explain the size-mass relation observed in MW dwarfs.Comment: 17 pages, 14 figures, MNRAS accepted after minor revisio

A cluster randomized controlled trial to evaluate the effectiveness of the clinically integrated RHL evidence -based medicine course

<p>Abstract</p> <p>Background and objectives</p> <p>Evidence-based health care requires clinicians to engage with use of evidence in decision-making at the workplace. A learner-centred, problem-based course that integrates e-learning in the clinical setting has been developed for application in obstetrics and gynaecology units. The course content uses the WHO reproductive health library (RHL) as the resource for systematic reviews. This project aims to evaluate a clinically integrated teaching programme for incorporation of evidence provided through the WHO RHL. The hypothesis is that the RHL-EBM (clinically integrated e-learning) course will improve participants' knowledge, skills and attitudes, as well as institutional practice and educational environment, as compared to the use of standard postgraduate educational resources for EBM teaching that are not clinically integrated.</p> <p>Methods</p> <p>The study will be a multicentre, cluster randomized controlled trial, carried out in seven countries (Argentina, Brazil, Democratic Republic of Congo, India, Philippines, South Africa, Thailand), involving 50-60 obstetrics and gynaecology teaching units. The trial will be carried out on postgraduate trainees in the first two years of their training. In the intervention group, trainees will receive the RHL-EBM course. The course consists of five modules, each comprising self-directed e-learning components and clinically related activities, assignments and assessments, coordinated between the facilitator and the postgraduate trainee. The course will take about 12 weeks, with assessments taking place pre-course and 4 weeks post-course. In the control group, trainees will receive electronic, self-directed EBM-teaching materials. All data collection will be online.</p> <p>The primary outcome measures are gain in EBM knowledge, change in attitudes towards EBM and competencies in EBM measured by multiple choice questions (MCQs) and a skills-assessing questionniare administered eletronically. These questions have been developed by using questions from validated questionnaires and adapting them to the current course. Secondary outcome measure will be educational environment towards EBM which will be assessed by a specifically developed questionnaire.</p> <p>Expected outcomes</p> <p>The trial will determine whether the RHL EBM (clinically integrated e-leraning) course will increase knowledge, skills and attitudes towards EBM and improve the educational environment as compared to standard teaching that is not clinically integrated. If effective, the RHL-EBM course can be implemented in teaching institutions worldwide in both, low-and middle income countries as well as industrialized settings. The results will have a broader impact than just EBM training because if the approach is successful then the same educational strategy can be used to target other priority clinical and methodological areas.</p> <p>Trial Registration</p> <p>ACTRN12609000198224</p