Rarely selected distractors in high stakes medical multiple-choice examinations and their recognition by item authors: A simulation and survey

Background Many medical exams use 5 options for multiple choice questions (MCQs), although the literature suggests that 3 options are optimal. Previous studies on this topic have often been based on non-medical examinations, so we sought to analyse rarely selected, 'non-functional' distractors (NF-D) in high stakes medical examinations, and their detection by item authors as well as psychometric changes resulting from a reduction in the number of options. Methods Based on Swiss Federal MCQ examinations from 2005-2007, the frequency of NF-D (selected by <1% or <5% of the candidates) was calculated. Distractors that were chosen the least or second least were identified and candidates who chose them were allocated to the remaining options using two extreme assumptions about their hypothetical behaviour: In case rarely selected distractors were eliminated, candidates could randomly choose another option - or purposively choose the correct answer, from which they had originally been distracted. In a second step, 37 experts were asked to mark the least plausible options. The consequences of a reduction from 4 to 3 or 2 distractors - based on item statistics or on the experts' ratings - with respect to difficulty, discrimination and reliability were modelled. Results About 70% of the 5-option-items had at least 1 NF-D selected by <1% of the candidates (97% for NF-Ds selected by <5%). Only a reduction to 2 distractors and assuming that candidates would switch to the correct answer in the absence of a 'non-functional' distractor led to relevant differences in reliability and difficulty (and to a lesser degree discrimination). The experts' ratings resulted in slightly greater changes compared to the statistical approach. Conclusions Based on item statistics and/or an expert panel's recommendation, the choice of a varying number of 3-4 (or partly 2) plausible distractors could be performed without marked deteriorations in psychometric characteristics

Autonomes Nervensystem und Immunabwehr: Bedeutung der noradrenergen Innervation für die Migration von Splenozyten in die Milz

Sowohl "naive" wie auch "memory" T-Lymphozyten verweilen bei allen Säugetieren nur kurz im Blutkreislauf und wandern in lymphatisches und nicht-lymphatisches Gewebe ein. Bei sekundären Immunorganen geschieht dies über Blut- und Lymphgefäße, bei der Milz ausschließlich über die Blutbahn, hier spielt die Regulation der Milzdurchblutung eine zentrale Rolle für die Zellaufnahme. Eine Tatsache, die besondere Bedeutung bekommt, da die Milz pro Tag etwa die gleiche Menge von Lymphozyten aufnimmt, wie alle lymphatischen Gewebe zusammengenommen, die durch den ductus thoracicus drainiert werden. Diese Arbeit untersucht zwei Aspekte der Emigration in die Milz : einerseits wird der Einfluss der Innervation und damit der Regulation der Durchblutung und andererseits der Einfluss von bakteriellem Endotoxin (LPS von e. coli) und damit die Bedeutung einer Immunstimulation der Milz auf die Zellaufnahme geprüft. Die noradrenerge Innervation der Milz adressiert in erster Linie die glatte Gefäßmuskulatur, (60 - 80% der Fasern erreichen diese, 20-30% gehen an T-Zellen der weißen Pulpa), die Bedeutung des Blutkreislaufs für die Zirkulation von Zellen wird durch diese Experimenten reflektiert. Zu den Wirkungen von bakteriellem Endotoxin gehört die Stimulation Lymphozyten, die Produktion von Interleukin-1 (IL-1ß) und die Heraufregulation von Adhäsions-molekülen, hier wird die Bedeutung von lokalen molekularen Faktoren widergespiegelt. Die Untersuchungen fanden an narkotisierten WKY-Ratten statt, bei denen die Aufnahme von fluoreszenzmarkierten Splenozyten aus dem Blut in die Milz über maximal 24 Stunden gemessen wurde. Die hauptsächlichen Ergebnisse sind: 1. Die Stimulation des Empfängertieres mit LPS 6 Stunden vor der Injektion von markierten Spenderzellen führt zu einer signifikant erhöhten Aufnahme von Leukozyten. 2. Nach lokaler Ausschaltung der noradrenergen Innervation durch chirurgische Durchtrennung des Milznerven kommt es ebenfalls zu einer signifikant erhöhten Zellaufnahme; diese kommt der Aufnahme nach Immunstimulation gleich. 3. Nach genereller Ausschaltung der sympathisch-noradrenergen Übertragung durch Entleerung der präsynaptischen vesikulären Speicher mittels Reserpin kommt es zu einer signifikant geringeren Aufnahme von Leukozyten im Vergleich zu den Kontrollen. 4. Die Milzdurchblutung ist nach LPS- Stimulation und lokaler Denervierung auf das 2,5 fache der Ruhedurchblutung gesteigert, die Durchblutung anderer parenchymatöser Organe und das HMV bleiben unverändert. Bei systemischer Denervierung wird die Durchblutung auch in anderen parenchymatösen Organen erhöht, der prozentuale Anteil der Milzdurchblutung am HMV ist gleich oder sogar geringer als unter Kontrollbedingungen. 5. Diese Ergebnisse weisen darauf hin, dass eine vermehrte lokale Durchblutung und das damit verbundene erhöhte Zellangebot die Zellaufnahme in die Milz fördern. Eine generelle Vasodilatation dagegen führt zu einer Umverteilung auf Kosten der Milzdurchblutung und wirkt sich nachteilig auf die Zellaufnahme in dieses Organ aus. Die Ergebnisse zeigen, dass neben lokalen molekularen Mechanismen auch hämodynamische Faktoren wesentlich an der Regulation der Aufnahme von Leukozyten aus dem Blut in die Milz beteiligt sind. 6. Die Bedeutung von Adhäsionsmolekülen und von Chemokinen für den Mechanismus der Zellemigration werden nicht in Frage gestellt; jedoch wird die Bedeutung der autonomen Regulation für die Definition der Rahmenbedingungen, unter denen molekulare Mechanismen wirksam werden können, herausgestellt

Outcome of a four-hour smoking cessation counselling workshop for medical students

Introduction Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling. We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes. Material and Methods Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation. Results Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p < 0.0005). Major features of the students’ counselling skills improved. Significant and highly relevant attitude changes reflected increased motivation to counselling smokers. Conclusions Implementing a four-hour smoking intervention workshop into a medical curriculum was highly effective in improving students’ knowledge, skills and attitudes towards smoking counselling, as well as providing them with additional clinical competencies

Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

<p>Abstract</p> <p>Background</p> <p>Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.</p> <p>Methods</p> <p>Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff.</p> <p>Results</p> <p>The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.</p> <p>Conclusions</p> <p>Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.</p

A modified score to identify and discriminate neuropathic pain: a study on the German version of the neuropathic pain symptom inventory (NPSI)

<p>Abstract</p> <p>Background</p> <p>Neuropathic pain must be correctly diagnosed for optimal treatment. The questionnaire named Neuropathic Pain Symptom Inventory (NPSI) was developed in its original French version to evaluate the different symptoms of neuropathic pain. We hypothesized that the NPSI might also be used to differentiate neuropathic from non-neuropathic pain.</p> <p>Methods</p> <p>We translated the NPSI into German using a standard forward-backward translation and administered it in a case-control design to patients with neuropathic (n = 68) and non-neuropathic pain (headache and osteoarthritis, n = 169) to validate it and to analyze its discriminant properties, its sensitivity to change, and to detect neuropathic pain subgroups with distinct profiles.</p> <p>Results</p> <p>Using a sum score (the NPSI-G score), we found sensitivity to change (r between 0.37 and 0.5 for pain items of the graded chronic pain scale) and could distinguish between neuropathic and other pain on a group basis, but not for individual patients. Post hoc development of a discriminant score with optimized diagnostic properties to distinguish neuropathic pain from non-neuropathic pain resulted in an instrument with high sensitivity (91%) and acceptable specificity (70%). We detected six different pain profiles in the patient group with neuropathic pain; three profiles were found to be distinct.</p> <p>Conclusions</p> <p>The NPSI-G potentially combines the properties of a diagnostic tool and an instrument to identify subtypes of neuropathic pain.</p

Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19

PURPOSE: Our purpose was to investigate the feasibility of pharmacy-initiated pharmacogenetic (PGt) screening in primary care with respect to patient willingness to participate, quality of DNA collection with saliva kits, genotyping, and dispensing data retrieved from the pharmacy. METHODS: Polypharmacy patients aged >60 years who used at least one drug with Anatomical Therapeutic Chemical (ATC) code N06AA01-N06AX19 (antidepressants), A02BC01-A02BC05 (proton-pump inhibitors), N05AA01-N05AH04 (antipsychotics), or C07AB02 (metoprolol) in the preceding 2 years were randomly selected. DNA was collected with saliva kits and genotyped for CYP2D6 and CYP2C19 with the AmpliChip. Pharmacy dispensing records were retrieved and screened for drugs interacting with the patient's CYP2D6 and CYP2C19 genotype by using the evidence-based PGt guidelines from the Dutch Pharmacogenetics Working Group. RESULTS: Out of the 93 invited patients, 54 (58.1%) provided informed consent. Nine saliva samples (16.7%) contained too little DNA. Call rates for CYP2D6 and CYP2C19 were 93.3% and 100%, respectively. Frequencies of genotype-predicted phenotype were 2.4%, 38.1%, 54.8%, and 4.8% for CYP2D6 poor metabolizers (PM), intermediate metabolizers (IM), extensive metabolizers (EM), and ultrarapid metabolizers (UM) respectively. For CYP2C19 genotype-predicted phenotype, frequencies were 2.2%, 15.6%, and 82.2% for PM, IM, and EM, respectively. CONCLUSIONS: This study shows that pharmacy-initiated PGt screening is feasible for a primary care setting

Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

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Examining sex differences in pleiotropic effects for depression and smoking using polygenic and gene‐region aggregation techniques

Sex differences in rates of depression are thought to contribute to sex differences in smoking initiation (SI) and number of cigarettes smoked per day (CPD). One hypothesis is that women smoke as a strategy to cope with anxiety and depression, and have difficulty quitting because of concomitant changes in hypothalamic–pituitary–adrenocortical (HPA) axis function during nicotine withdrawal states. Despite evidence of biological ties, research has not examined whether genetic factors that contribute to depression‐smoking comorbidity differ by sex. We utilized two statistical aggregation techniques—polygenic scores (PGSs) and sequence kernel association testing—to assess the degree of pleiotropy between these behaviors and moderation by sex in the Health and Retirement Study (N = 8,086). At the genome‐wide level, we observed associations between PGSs for depressive symptoms and SI, and measured SI and depressive symptoms (all p < .01). At the gene level, we found evidence of pleiotropy in FKBP5 for SI (p = .028), and sex‐specific pleiotropy in females in NR3C2 (p = .030) and CHRNA5 (p = .025) for SI and CPD, respectively. Results suggest bidirectional associations between depression and smoking may be partially accounted for by shared genetic factors, and genetic variation in genes related to HPA‐axis functioning and nicotine dependence may contribute to sex differences in SI and CPD.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150605/1/ajmgb32748.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150605/2/ajmgb32748_am.pd