Häufigkeit und Verlauf invasiver Pilzinfektionen bei neutropenischen Patienten unter besonderer Berücksichtigung von Umweltfaktoren, antimykotischer Prophylaxe und Grunderkrankung: eine retrospektive Analyse

Invasive Pilzinfektionen stellen auf Grund ihrer noch immer hohen Mortalität nach wie vor ein bedeutendes Risiko für Patienten mit akuten Leukämien und nach allogener Stammzell-transplantation dar. Die meisten dieser Infektionen werden durch Aspergillus- und Candidaspezies verursacht. Im Rahmen dieser Arbeit wurde untersucht, welche Faktoren in dieser Situation das Auftreten invasiver Pilzinfektionen beeinflussen. Hierfür wurden insgesamt 533 Aufenthalte von 342 Patienten mit akuter myeloischer Leukämie (AML), akuter lymphatischer Leukämie (ALL) oder Stammzelltransplantation in den Jahren 2012 - 2014 betrachtet. Bei 32 stationären Aufenthalten von 29 Patienten wurden 5 nachgewiesene und 27 wahrscheinliche invasive Pilzinfektionen identifiziert. Es zeigte sich, dass besonders Patienten mit einer AML als Grunderkrankung von einer invasiven Pilzinfektion betroffen waren. Als wichtigster Risikofaktor stellte sich jedoch die Neutropeniedauer über zehn Tage heraus. Alle Patienten mit invasiver Pilzinfektion wiesen eine solch lange Neutropeniedauer auf. Weitere Faktoren, die das Risiko für eine invasive Pilzinfektion erhöhten, waren ein hoher ECOG-Status (p = 0,002) und die zusätzliche Gabe immunsupprimierender Medikamente (p = 0,040). Auch bei Patienten nach allogener Stammzelltransplantation und nach bereits durchgemachter invasiver Pilzinfektion traten vermehrt Infektionen auf, der Unterschied war jedoch statistisch nicht signifikant. Insgesamt starben sieben der Patienten mit invasiver Pilzinfektion, was einem Anteil von 24 Prozent entspricht. Bei einem Großteil der Patienten bestand auch hier eine AML als Grunderkrankung. Eine allogene Stammzelltransplantation und auch ein weibliches Geschlecht scheint sich negativ auf den Verlauf einer invasiven Pilzinfektion auszuwirken. Zusammenfassend zeigt sich weiterhin eine relativ hohe Inzidenz invasiver Pilzinfektionen bei Patienten mit akuten Leukämien. Die Identifizierung von Risikofaktoren ermöglicht eine risikoadaptierte spezifische Prophylaxe. So ist beispielsweise eine lange Neutropeniedauer mit einem hohen, die autologe Stammzelltransplantation mit einem niedrigen Risiko assoziiert

Comparison between Long-Menu and Open-Ended Questions in computerized medical assessments. A randomized controlled trial

BACKGROUND: Long-menu questions (LMQs) are viewed as an alternative method for answering open-ended questions (OEQs) in computerized assessment. So far this question type and its influence on examination scores have not been studied sufficiently. However, the increasing use of computerized assessments will also lead to an increasing use of this question type. Using a summative online key feature (KF) examination we evaluated whether LMQs can be compared with OEQs in regard to the level of difficulty, performance and response times. We also evaluated the content for its suitability for LMQs. METHODS: We randomized 146 fourth year medical students into two groups. For the purpose of this study we created 7 peer-reviewed KF-cases with a total of 25 questions. All questions had the same content in both groups, but nine questions had a different answer type. Group A answered 9 questions with an LM type, group B with an OE type. In addition to the LM answer, group A could give an OE answer if the appropriate answer was not included in the list. RESULTS: The average number of correct answers for LMQs and OEQs showed no significant difference (p = 0.93). Among all 630 LM answers only one correct term (0.32%) was not included in the list of answers. The response time for LMQs did not significantly differ from that of OEQs (p = 0.65). CONCLUSION: LMQs and OEQs do not differ significantly. Compared to standard multiple-choice questions (MCQs), the response time for LMQs and OEQs is longer. This is probably due to the fact that they require active problem solving skills and more practice. LMQs correspond more suitable to Short answer questions (SAQ) then to OEQ and should only be used when the answers can be clearly phrased, using only a few, precise synonyms. LMQs can decrease cueing effects and significantly simplify the scoring in computerized assessment

Development of an e-learning portal for pediatric endocrinology: educational considerations

Background: Global accessibility and dissemination of developments in pediatric endocrinology prompted to examine how to develop an educational interactive e-SPE web portal. Methods: A systematic approach was used to identify the relevant aspects of accessibility and dissemination. An orientation at the big idea was made, executed by an analysis of the needs of student and teacher pediatric endocrinologists, a definition of the learning objectives, a research in educational literature and an exploration of ICT design specifications. Results: The intensive collaboration between medical, educational and information technology disciplines resulted in a portal design. The portal meets requirements of adult learning, stresses interaction between partners in learning and offers direct feedback during the learning process. The portal supports the development of not only knowledge but also competences both at junior and advanced levels. Conclusion: When the e-SPE portal is completed, the options for summative assessment will be examined as a medium for international certification in conjunction with local and national requirements (http://espe.elearning.nl). Copyrigh

A new framework for designing programmes of assessment

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals

Changes in postgraduate medical education and training in clinical radiology

Postgraduate medical education and training in many specialties, including Clinical Radiology, is undergoing major changes. In part this is to ensure that shorter training periods maximise the learning opportunities but it is also to bring medical education in line with broader educational theory. Learning outcomes need to be defined so that there is no doubt what knowledge, skills, attitudes and behaviours are expected of those in training. Curricula should be developed into competency or outcome based models and should state the aims, objectives, content, outcomes and processes of a training programme. They should include a description of the methods of learning, teaching, feedback and supervision. Assessment systems must be matched to the curriculum and must be fair, reliable and valid. Workplace based assessments including the use of multisource feedback need to be developed and validated for use during radiology training. These should be used in a formative and developmental way, although the overall results from a series of such assessments can be used in a more summative way to determine progress to the next phase of training. Formal standard setting processes need to be established for ‘high stakes’ summative assessments such as examinations. In addition the unique skills required of a radiologist in terms of image interpretation, pattern recognition, deduction and diagnosis need to be evaluated in robust, reliable and valid ways. Through a combination of these methods we can be assured that decisions about trainees’ progression through training is fair and standardised and that we are protecting patients by establishing national standards for training, curricula and assessment methods

Recent trends in stream macroinvertebrates: warm-adapted and pesticide-tolerant taxa increase in richness

Recently, a plethora of studies reporting insect declines has been published. Even though the common theme is decreasing insect richness, positive trends have also been documented. Here, we analysed nationwide, systematic monitoring data on aquatic insect richness collected at 438 sites in Switzerland from 2010 to 2019. In addition to taxonomic richness, we grouped taxa in accordance with their ecological preferences and functional traits to gain a better understanding of trends and possible underlying mechanisms. We found that in general, richness of aquatic insects remained stable or increased with time. Warm-adapted taxa, common feeding guilds and pesticide-tolerant taxa showed increasing patterns while cold-adapted, rarer feeding guilds and pesticide-sensitive taxa displayed stable trends. Both climate and land-use-related factors were the most important explanatory variables for the patterns of aquatic insect richness. Although our data cover the last decade only, our results suggest that recent developments in insect richness are context-dependent and affect functional groups differently. However, longer investigations and a good understanding of the baseline are important to reveal if the increase in temperature- and pesticide-tolerant species will lead to a decrease in specialized species and a homogenization of biotic communities in the long term

Biochemical visual literacy with constructive alignment : outcomes, assessment, and activities

Article first published online: 11 FEB 201

Even a little sleepiness influences neural activation and clinical reasoning in novices

Funding: This study was funded by a grant from the Scottish Medical EducationResearch Consortium (SMERC). SMERC had no involvement in thestudy design; collection, analysis, and interpretation of data; writing ofthe report; or the decision to submit the report for publication. Acknowledgements: We thank the students who took part in this project, and the Instituteof Education for Medical and Dental Sciences, University of Aber-deen, for supporting this project. We thank the American College ofPhysicians for the questions used in this study. We thank ProfessorCLELANDET AL.7of9&C?JRFѥ1AGCLACѥ0CNMPRQSusan Jamieson, University of Glasgow, for her support at the stageof seeking funding for this work.Peer reviewedPublisher PD