17 research outputs found

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

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    Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

    Measurement and Analysis of Learner’s Motivation in Game-Based E-Learning

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    Computer games started to be integrated in the learning process in order to bridge the gap between the new learner generation and the traditional learning process. However, today’s game-based e-learning environments do not provide different types of adaptation, with learners receiving mostly “one size fits all” educational games despite the existing differences between them in terms of learner knowledge, motivation, etc. In this context, game-based e-learning can lead to demotivated learners. Therefore, there is a need for adaptation strategies. In order to make adaptation possible, real-time assessment of the game-play process as well as of the learning process is needed. Since learner motivation plays an important role in both the learning and the gaming process, and can easily change, new techniques for automated assessment of learner motivation are needed. This chapter presents current trends in game-based e-learning assessment in general focusing on the assessment of learner motivation in particular. Methods for gathering information on player/learner motivation are also presented. Information on learner motivation can be gathered (1) through dialog-based interaction, (2) through game-play-based interaction and/or (3) through additional equipment. This chapter also proposes four generic metrics for the measurement and analysis of motivation in game-based e-learning based on metrics that were used in e-learning. Each metric is presented and its usage and interpretation in gaming-based e-learning are discussed
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