Regional differences in the evolution of lung disease in children with cystic fibrosis

Progression of lung disease is a major event in children with cystic fibrosis (CF), but regional differences in its evolution are unclear. We hypothesized that regional differences occur beginning in early childhood. We examined this issue by evaluating 132 patients followed in the Wisconsin Neonatal Screening Project between 1985 and 2010. We scored chest x-rays obtained every 1–2 years with the Wisconsin chest x-ray system, in which we divided the lungs into quadrants, and gave special attention to ratings for bronchiectasis (BX) and nodular/branching opacities. We compared the upper and lower quadrant scores, and upper right and left quadrant scores, as patients aged using a multivariable generalized estimation equation (GEE) model. We did a confirmatory analysis for a subset of 81 patients with chest computerized tomography (CT) images obtained in 2000 and scored using the Brody scoring system. The chest x-ray analysis shows that the upper quadrants have higher BX (p<0.001) and nodular/branching opacities (p<0.001) scores than the lower quadrants. CT analysis likewise reveals that the upper quadrants have more BX (p=0.02). Patients positive for mucoid PA showed significantly higher BX scores than patients with nonmucoid PA (p= 0.001). Chest x-ray scoring also revealed that the upper right quadrant has more BX (p< 0.001) than the upper left quadrant, and CT analysis was again confirmatory (p< 0.001). We conclude that pediatric patients with CF develop more severe lung disease in the upper lobes than the lower lobes in association with mucoid PA infections and also have more severe lung disease on the right side than on the left side in the upper quadrants. A variety of potential explanations such as aspiration episodes may be clinically relevant and provide insights regarding therapies

Writing Multiple Choice Questions for Continuing Medical Education Activities and Self-Assessment Modules

The multiple-choice question (MCQ) is the most commonly used type of test item on radiologic graduate medical and continuing medical education examinations. Now that radiologists are participating in the maintenance of certification process, there is an increased need for self-assessment modules that include MCQs, and persons with itemwriting skills to develop such modules. Although principles of effective item-writing have been documented, violations of these principles are very common in medical education. Guidelines for test construction are related to development of educational objectives, defining levels of learning for each objective, and writing effective MCQs that test that learning. Educational objectives should be written in observable, behavioral terms that allow for an accurate assessment of whether the learner has achieved the objectives. Learning occurs at many levels, from simple recall to problem solving. The educational objectives and the MCQs that accompany those objectives should target all levels of learning appropriate for the given content. Characteristics of effective MCQs can be described in terms of the overall item, the stem, and the options. Flawed MCQs interfere with accurate and meaningful interpretation of test scores and negatively impact student pass rates. Therefore, in order to develop tests that are reliable and valid, items must be constructed that are free of such flaws. This review provides an overview of established guidelines for writing effective MCQs, a discussion of writing appropriate educational objectives and MCQs that match those objectives, and a brief review of item analysis