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PURPOSE To assess the effect of tooth morphology on the amount of tooth structure removal and the effect of different assessment methods on the detected amount of removed tooth structure. MATERIALS AND METHODS Eight test groups (n = 10) of standardized artificial teeth were prepared for partial and full crowns. All teeth were prepared by the same operator following predefined preparation parameters. Tooth structure removal was measured using three different assessment methods: digital volumetric analysis (DVA), weight analysis (WA), and combined computer-aided manufacture and weight analysis (CAMWA). Nonparametric repeated-measures analysis of variance and post hoc analyses were used to determine the influence of tooth morphology and assessment method on the detected amount of tooth structure removal. RESULTS For partial crown preparations, only the tooth morphology had a significant impact on the detected amount of tooth structure removal (P < .0001), not the different assessment methods used (P = .08). Tooth structure removal was not significantly different between the canine and incisor groups, but was for the other groupwise comparisons. For full crown preparations, the tooth morphology (P = .047) and different assessment methods (P = .01) had an impact on the detected tooth structure removal. However, only a few groupwise comparisons reached the significance level. CONCLUSION The amount of tooth structure removal depended on the tooth morphology and the type of assessment method, which should be taken into account when comparing results across studies. The detected amount of tooth structure removal was below the values described in the literature, independent of the assessment method used.

Purpose The purpose of this article is to perform a literature review of current evidence studying the use of the Eat, Sleep, Console method of assessment for managing infants with Neonatal Opioid Withdrawal Syndrome, more commonly known as Neonatal Abstinence Syndrome. Results Four main themes emerged from the review. When Eat, Sleep, Console was utilized as the assessment method for infants with Neonatal Opioid Withdrawal Syndrome, a decrease in the pharmacological intervention was observed, length of hospitalization decreased along with the overall cost of treatment, and caregiver presence and involvement in the care of their infants improved. Conclusions Replacing traditional assessment tools with the ESC method for the management of newborn infants with NOWS has proven to have a positive impact on patient outcomes. Further research is needed to study the long-term outcomes of utilizing this method and to compare the impact of various pharmacotherapy drugs when employing the ESC method as the assessment tool. Multidisciplinary collaboration alongside extensive caregiver education and involvement is essential to the success of the ESC method.

Insomnia, whether situational or chronic, affects over a third of the general population in today's society. However, given the lack of non-contact and non-inductive quantitative evaluation approaches, most insomniacs are often unrecognized and untreated. Although Polysomnography (PSG) is considered as one of the assessment methods, it is poorly tolerated and expensive. In this paper, with the recent development of Internet-of-Things devices and edge computing techniques, we propose a detrended fractal dimension (DFD) feature for the analysis of heart-rate signals, which can be easily acquired by many wearables, of good sleepers and insomniacs. This feature was derived by calculating the fractal dimension (FD) of detrended signals. For the trend component removal, we improved the null space pursuit algorithm and proposed an adaptive trend extraction algorithm. The experimental results demonstrated the efficacy of the proposed DFD index through numerical statistics and significance testing for healthy and insomnia groups, which renders it a potential biomarker for insomnia assessment and management.

PURPOSE: To assess test-retest repeatability of the accommodative response (AR) in children with and without amblyopia and adults using the Grand Seiko autorefractor. DESIGN: Prospective reliability assessment. METHODS: Test-retest of accommodation was obtained while participants viewed 20/150 sized letters at 33 cm using the Grand Seiko autorefractor in children 5 to

Objectives We recently reported the major role depression and apathy in awareness among Alzheimer patients, using the stage of the disease as an exposure factor and exploring different assessment methods. Using the same patient data, we aimed here to explore the different dimensions of awareness assessed by different sub-scales in awareness scales. Method Sixty-one Alzheimer patients were examined using four awareness scales relating to three assessment methods: (a) patient-caregiver discrepancy; (b) clinical rating; and (c) prediction of performance discrepancy. Global cognition, executive functioning, autonomy, depression and apathy were also assessed. Multivariate logistic models were performed using disease stage as an exposure factor for awareness scales and sub-scales. Correlations across the different factors and patient and caregiver awareness ratings were computed. Results The patient-caregiver discrepancy and clinical rating methods (a, b) both identified the factors associated with awareness in the overall scales and the sub-scales as being depression and/or apathy. Depression correlated with patient self-ratings while apathy correlated with caregiver ratings. The prediction of performance discrepancy method (c) identified different factors in the overall scale, executive factors in three sub-scales involving executive domains and the memory factor in a sub-scale involving the mnesic domain. Discussion The awareness scales using a referential based on a human rating (a, b) suggest that awareness is unidimensional, with depression impacting self-reports and apathy influencing caregiver/clinical reports. Scales based on a test rating (c) appear to be more closely associated with the dimensions assessed. This highlights the role of the reference system for awareness assessment in Alzheimer's disease.

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.

Background Systematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening. Objective To test implementation of a brief app-directed protocol for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA). Design Prospective cohort study. Setting Large urban academic medical center and small rural community hospital. Participants 527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs). Measurements On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method. Results Delirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%). Limitation Two sites; limited diversity. Conclusion An app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists. Primary funding source National Institute on Aging.

BACKGROUND In patients with knee osteoarthritis (KOA), the descending genicular artery (DGA) showed abnormal angiogenesis. However, the non-invasive assessment method of DGA remains unclear. The aim of this study was to clarify the characteristics of blood flow velocity of the DGA in patients with KOA and to examine the factors involved in the changes. METHODS The KOA group included 22 knees of 22 patients with KOA (4 males, 18 females; mean age, 72.3 ± 7.5 years) and the control group included 22 knees (4 males, 18 females; mean age, 71.3 ± 5.4 years) of 22 healthy adults. The peak systolic blood flow velocity (PSV) in each group was measured using ultrasonography. The KOA group was classified into the effusion group and the non-effusion group based on observed effusion, and the PSV was compared between the two groups. The relationships between PSV and suprapatellar bursa intracavitary distance, pain, femorotibial angle, Japanese Knee Osteoarthritis Measure were also investigated. RESULTS The PSV in the KOA group (51.5 ± 12.9 cm/s) was significantly higher than that in the control group (29.3 ± 4.4 cm/s) (P

Multiple-choice testing with dichotomous scoring is one of the most common assessment methods utilized in undergraduate education. Determining students’ perceptions toward different types of multiple-choice testing formats is important for effective assessment. The present study compared two alternative multiple-choice testing formats used in a second-year required chemistry course: (i) Immediate Feedback Assessment Technique (IFAT®) and (ii) Personal Point Allocation (PPA). Both testing methods allow for partial credit, but only the IFAT® provides immediate feedback on students’ responses. Both survey and interview data indicated that, overall, most students preferred IFAT® to the PPA testing method. These positive ratings were related to potential increase in reward, ease of use, and confidence. IFAT® was also perceived to be less stress producing and anxiety provoking than PPA. Interview data not only supported these findings, but also indicated individual differences in preference for each of these two methods. Additionally, students’ feedback on strategies used for either testing method and suggestions on how to improve the methods are discussed.

Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor (R)) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients (r) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated (r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28-0.72, respectively). The neural component assessed by the NeuroFlexor (R) associated significantly with the elastic components of NeuroFlexor (R) (r = 0.46, 95%CI: 0.18-0.67) and Wristalyzer (r = 0.36, 95%CI: 0.06-0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS (r = 0.58, 95%CI: 0.34-0.75 vs. 0.49, 95%CI: 0.22-0.69 and r = 0.51, 95%CI: 0.25-0.70 vs. 0.30, 95%CI: 0.00-0.55); elastic components associated with PRoM (r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor (R) and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation.

The article presents modern views on the problem of falls in the elderly. There is a global trend of changing the demographic situation - the permanent increase in the proportion of elderly and senile people in the general population, the issues of geriatrics as one of the medical specialties are becoming the most relevant. Among the problems that geriatricians and all specialists involved in the treatment of elderly patients have to solve, one of the most serious is the problem of falls. The article provides a medical review of the assessment of the frequency of falls depending on gender, age, diseases and external factors. The main risk factors for falls and their prevention measures are discussed in detail. Special attention is given to the fear of falls as a significant risk factor. The methods of validation the risk factor with the use of unified questionnaires - “The scale of assessment of the fear of fa lls” and “the Falls efficacy scale” are presented. The purpose of this article is to attract the attention of practitioners to the problem of falls and the fear of falls as one of the significant risk factors, methods of its identification and prevention

The present study was undertaken to evaluate effect of traditional anterior repair versus site specific anterior repair in reduction of urinary symptoms in women with Pelvic organ Prolapse. During the study period of 2 years 140 women belonging to reproductive, peri-menopausal and postmenopausal age groups were included in the study. Employing past literature, the sample size calculated was 140. All women were assessed pre-operatively by the assessment method – Pelvic organ prolapse quantification (POP-Q) system. 70 women belonging to Group A were treated according to vaginal hysterectomy with traditional anterior repair and 70 women belonged to Group B who were treated according to vaginal hysterectomy with site specific anterior repair. Post-operatively, all women were followed up till 7th post-operative day and were assessed for anatomical and functional improvement to determine a better method for repair in reduction of urinary symptoms in women with pelvic organ prolapse. Our study shows functional and anatomical outcomes of traditional anterior repair and site specific anterior repair. 48 of 70 women (68.2%) who were subjected to traditional anterior repair and 52 of 70 women (73.4%) who were subjected to site specific anterior repair had marked functional improvement after surgery. 58 of 70 women (83.2%) belonging to traditional anterior repair group and 67 of 70women (95.3%) belonging to Site specific anterior repair group had considerable anatomical improvement post-operatively. This impresses the role of site specific anterior repair in women with pelvic organ prolapse for attaining better functional and anatomical outcome. Keywords: Pelvic organ prolapse, Traditional repair, Site specific repair, Vaginal hysterectomy, POP-Q, Urinary symptoms

Background: Regulators increasingly use formalized programs that are based on continuing professional development (CPD) activities to ensure that physicians are fit to practice. There is convincing evidence regarding the positive effects of CPD activities on performance and patient outcomes. However, there is limited available studies, investigating its effect in anesthesia, specifically. Moreover, although there exists considerable evidence linking specific CPD activities to improved performance, only few studies have investigated the effect of combinations of activities, or formalized systems, as a whole. Consequently, to address this uncertainty regarding the impact of CPD activities, within anesthesiology, this systematic review aims to establish which activities anesthesiologists are engaged in and their impact on clinical competence and subsequent patient outcomes. Methods: A systematic review of the current literature regarding CPD for fully qualified anesthesiologists will be undertaken. Characteristics of the included studies will be summarized descriptively, and the screening process will be outlined using the preferred reporting items for systematic reviews and meta-analysis flow diagram. Given the diverse methods adopted within medical education research, it is anticipated that there will be significant heterogeneity between the included studies and therefore, a meta-analysis will not be possible and a narrative synthesis approach will be usd. The outcomes of interest include type of CPD learning activity and/or assessment method anesthesiologists are engaged in; and their effectiveness, either as standalone activities or as part of formalized systems. Conclusion: The aim of the study was to give an overview of the breadth and nature of CPD activities, and their effects on fully qualified anesthesiologists' clinical competences and patient outcomes.

BACKGROUND: Radiographic methods to assess skeletal maturity (SM) have a key role in adolescent idiopathic scoliosis (AIS) management, allowing to predict risk of spinal curve progression. Cervical vertebral maturation (CVM) has been recently introduced as an alternative tool to assess skeletal maturity; however, its clinical role is still debated. OBJECTIVE: This systematic review aimed to investigate the reliability of CVM in the SM assessment of growing subjects, comparing it to hand wrist maturation (HVM). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched from inception until 31st December 2020 to identify observational studies presenting: growing subjects as participants; CVM methods as intervention; HVM methods as comparator; reliability for SM assessment as outcome. A 10-item quality tool has been used to assess study quality. RESULTS: Out of 205 papers, 12 papers were included in the data synthesis. We classified 10 studies (83.3%) as medium-quality studies and 2 studies (16.7%) as high-quality studies. Eight studies reported a significant correlation between CVM Baccetti and different HWM methods. CONCLUSION: Taken together, these findings suggested that CVM might be considered as reliable SM assessment method compared to HWM in growing subjects. However, further studies are warranted to confirm these findings.

Velocity fluctuations caused by unsteady flows substantially increase mechanical loads on tidal turbine blades and represent a major challenge to tidal energy converters. Overcoming the challenges posed by high levels of turbulence and large waves is a significant concern for turbine developers. Here we quantify turbulence and characterize wave-turbulence interaction in two prospective tidal energy sites in Australia: Banks Strait and Clarence Strait. Turbulence characterization was derived from deployments lasting up to 3 months. Our datasets represent the longest turbulence measurements at tidal sites published to date, setting a benchmark in tidal energy site characterization. Banks Strait data was affected by wave orbital velocities at mid-water column for nearly the entire period, whilst Clarence Strait data rarely presented significant wave-turbulence interactions. Turbulence intensities varied mostly between 12% and 17% in both sites. Higher turbulent kinetic energy density was observed in Banks Strait, although one of Clarence Strait stations revealed faster current speeds exceeding 2.8 m/s. Investigation of strong wind events suggests turbulence parameters were not majorly affected. Our findings are valuable to obtain more realistic turbine performance and loadings estimates from numerical models and considerably contribute towards efforts to establish best-practice turbulence assessment methods in tidal energy sites.

Visible light (VL) can induce pigmentary alterations, especially in dark-skinned individuals, and exacerbate photodermatoses and pigmentary disorders. Currently, there is no standardized method for assessing sunscreen protection against VL. On the basis of a critical review of published in vitro and in vivo methods, a VL photoprotection assessment method based on pigmentation is proposed.

Bullying victimization is a prevalent concern for neurodivergent (e.g., autistic, ADHD) youth. Bullying assessment methods vary widely and there is currently no questionnaire specific to neurodivergent youth. The Assessment of Bullying Experiences (ABE) was created to fill this gap. The ABE questionnaire was completed by 335 parents of school-age youth characterized as autistic, having ADHD, or community comparison. Exploratory and Confirmatory Factor Analysis identified a four-factor solution, aligning with verbal, physical, relational, and cyber victimization. Construct validity analyses indicate the ABE converges with an existing bullying questionnaire and diverges from disruptive behavior or internalizing symptoms. The ABE questionnaire is a valid measure of bullying that furthers understanding of nuance in peer victimization for neurodivergent youth and informs group-specific intervention.

Introduction Global rating scales (GRSs) such as the Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Surgery (GOALS) are assessment methods for surgical procedures. The aim of this study was to establish construct validity of Procedure-Based Assessment (PBA) and to compare PBA with GRSs for laparoscopic cholecystectomy. Material and methods OSATS and GOALS GRSs were compared with PBA in their ability to discriminate between levels of performance between trainees who can perform the procedure independently and those who cannot. Three groups were formed based on the number of procedures performed by the trainee: novice (1-10), intermediate (11-20) and experienced (>20). Differences between groups were assessed using the Kruskal-Wallis and Mann-Whitney U tests. Results Increasing experience correlated significantly with higher GRSs and PBA scores (all p < .001). Scores of novice and intermediate groups overlapped substantially on the OSATS (p = .1) and GOALS (p = .1), while the PBA discriminated between these groups (p = .03). The median score in the experienced group was higher with less dispersion for PBA (97.2[85.3-100]) compared to OSATS (82.1[60.7-100]) and GOALS (80[60-100]). Conclusion For assessing skill level or the capability of performing a laparoscopic cholecystectomy independently, PBA has a higher discriminative ability compared to the GRSs.

The COVID-19 pandemic presented an enormous and immediate challenge to assessing clinical skills in healthcare professionals. Many institutions were unable to deliver established face-to-face assessment methods such as Objective Structured Clinical Assessments (OSCEs). Assessors needed to rapidly institute alternative assessment methods to ensure that candidates met the clinical competences required for progression. Using a systematic review, we aimed to evaluate the feasibility, and acceptability of remote methods of clinical skills assessment, including remote structured clinical assessments and the submission of video recordings. We searched for studies reporting on Remote Clinical Assessments or its variants in MEDLINE, Embase and The Cochrane library from 2000 to March 2021. Twenty eight studies were included in the review; 20 studies related to remote structured clinical examinations or OSCEs and 8 reported the use of video submissions. The participants of the different studies included medical students, nursing students, dental students and doctors in training. A variety of different online platforms were utilised including Zoom, Skype, webcams, and Adobe Connect online. The studies found that delivery of remote clinical assessments is possible and provides an alternative method of assessing many clinical skills, but most also acknowledge limitations and challenges. They are acceptable to both candidates and examiners, and where measured, show moderate agreement with on-site clinical assessments. Current evidence is based on studies with low methodological quality and for the most part, small sample sizes.

We describe a computer-assisted program for conducting well-body assessments of children with neurodevelopmental disabilities attending a private special education school. Classroom instructors completed daily assessments to detect the presence of bodily injuries and other skin trauma, determine the need for medical treatment, and monitor healing status. Evaluations performed with the classroom instructors revealed that they implemented the program with high integrity and rated several procedural components favorably. Compared to “paper form” data recording, clinicians and supervisors judged the computer-assisted program to track student injuries more thoroughly and record student injuries more accurately. The importance of health monitoring among persons with neurodevelopmental disabilities, advantages of technology-based assessment methods, and practice considerations are discussed.

The paradigm of medical education is evolving with the introduction of competency-based medical education (CBME) and it is crucial that residency programs adapt. In this paper, we provide an overview of the current status of medical education in Hematology in Canada including models of training, assessment methods, anticipated challenges, and the effects of the COVID-19 pandemic. We will also discuss additional training that can be pursued after a Hematology residency, with a particular focus On Transfusion Medicine as it was one of the first programs to implement a competency-based curriculum. Finally, we explore the future directions of medical education in Hematology and Transfusion Medicine.

PurposeThis meta-epidemiological study aimed to systematically review case reports regarding sports nutrition supplements and adverse events (AEs), specifically addressing the issue of causality assessments.MethodsThrough a systematic literature search we identified all published case reports of AEs associated with sports nutrition supplements between 1 January 2008 and 1 March 2019. Data regarding AEs, suspected supplements, relevant causality assessment factors and the reporting of clinical reasoning and/or systematic causality assessment methods were extracted.ResultsIn all, 72 publications were included, reporting 134 supplements and 37 different AEs in 97 patients (85% males; median age: 30 years [range: 14–60]). Information regarding previous health and regular prescription drugs was not presented in 30% (29/97) and 46% (45/97) of cases, respectively. In 23% (22/97) of the cases, no alternative cause was mentioned. Clinical reasoning was identified in 63% (61/97), and in 13% (8/61) of these, a systematic causality assessment method was applied. In cases with clinical reasoning, a theoretic rationale (92% vs 78%, P = 0.05), a description of previous cases (90% vs 72%, P = 0.021) and body fluid analysis (18% vs 3%, P = 0.027) were reported to a greater extent. Among cases with clinical reasoning, the application of a systematic causality assessment method captured additional important aspects: use of medication (100% vs 55%, P = 0.015), alcohol use (88% vs 43%, P = 0.020) and illicit drug use (88% vs 40%, P = 0.011).ConclusionsIn published case reports where sports nutrition supplements were suspected to have caused AEs, essential factors for causality assessment were left out in a non-negligible proportion. Clinical reasoning was identified in most cases whereas a systematic causality assessment method was applied in a minority. Factors of importance for causality assessment were reported to a greater extent in cases including clinical reasoning, and the application of a systematic causality assessment method captured additional aspects of importance.

Background: Assessment drives learning and improving the quality of assessment has a remarkable impact on the quality of learning. Objective Structured Clinical Examination is termed more reliable and valid as compared to conventional practical examination. Objective: The objective of this study was to find the perception of postgraduate family medicine trainees about the OSCE assessment method and compare those having previous experience with those having no previous experience. Methodology: This was a cross-section study conducted at the end of exit examination of diploma in family medicine at the Family Medicine Department, Khyber Medical University Peshawar. Data were collected on an eleven items questionnaire on a five-point Likert Scale. Study participants were categorized based on their previous experience of the OSCE, and were grouped into two categories. Data were analyzed by using Fisher’s Exact test and a p-value of ? 0.05 was considered statistically significant. Results: 56 out of 60 candidates returned completed questionnaires. The response rate was 93.33% where the majority were males 52(92.9%). Participants with experience of the OSCE were 22 (39.3%) while 34 (60.7%) were having no experience of the assessment method. There was a significant difference (p= 0.001) in the perception about the OSCE with the simulated patient than real patient, fairness and reliability of the OSCE, stress and length of the OSCE and reduction of bias in the OSCE. The perception about weightage to be given to the OSCE in any examination was significantly different (p=0.004) between the two groups. Conclusion: Participants of both groups (experienced vs non-experienced) agreed on some aspects of the OSCE. Their opinion differed about the fairness, validity and stress related to the OSCE assessment method. This difference is probably explained by the inadequacy of an experience to form an opinion. Keywords: Conventional practical examination, Family medicine, OSCE.

Herbal-induced liver injury (HILI) is an important and increasingly concerning cause of liver toxicity, and this study presents recent updates to the literature. An extensive literature review was conducted encompassing September 2019 through March 2021. Studies with clinically significant findings were analyzed and included in this review. We emphasized those studies that provided a causality assessment methodology, such as Roussel Uclaf Causality Assessment Method scores. Our review includes reports of individual herbals, including Garcinia cambogia, green tea extract, kratom as well as classes such as performance enhancing supplements, Traditional Chinese medicine, Ayurvedic medicine and herbal contamination. Newly described herbals include ashwagandha, boldo, skyfruit, and ‘Thermo gun’. Several studies discussing data from national registries, including the United States Drug-Induced Liver Injury (DILI) Network, Spanish DILI Registry, and Latin American DILI Network were incorporated. There has also been a continued interest in hepatoprotection, with promising use of herbals to counter hepatotoxicity from anti-tubercular medications. We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration. The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.

People with schizophrenia bring up positive and negative symptoms, among these symptoms cause sufferers to have no interest in one particular activity. This study aims to increase the activity of people with schizophrenia. The assessment methods used are interviews, observation, Wechsler Adult Intelligence Scale (WAIS), Thematic Apperception Test (TAT), Graphics and Wartegg Test. To deal with these problems, Scheduling Activity Method isused. The results obtained are the subject’s activity in leisure time increases so that daydreaming and hallucinating activities are reduced.

To quantify and understand how to assess the quality of life and health-related QoL of parents with children with congenital abnormalities. We conducted a systematic review with meta-analysis. The search was carried out in 5 bibliographic databases and in ClinicalTrials.gov. No restriction on language or date of publication was applied. This was complemented by references of the studies found and studies of evidence synthesis, manual search of abstracts of relevant congresses/scientific meetings and contact with experts. We included primary studies (observational, quasi-experimental and experimental studies) on parents of children with CA reporting the outcome quality of life (primary outcome) of parents, independently of the intervention/exposure studied. We included 75 studies (35 observational non-comparatives, 31 observational comparatives, 4 quasi-experimental and 5 experimental studies). We identified 27 different QoL instruments. The two most frequently used individual QoL instruments were WHOQOL-Bref and SF-36. Relatively to family QoL tools identified, we emphasized PedsQL FIM, IOFS and FQOL. Non-syndromic congenital heart defects were the CA most frequently studied. Through the analysis of comparative studies, we verified that parental and familial QoL were impaired in this population. This review highlights the relevance of assessing QoL in parents with children with CA and explores the diverse QoL assessment tools described in the literature. Additionally, results indicate a knowledge gap that can help to draw new paths to future research. It is essential to assess QoL as a routine in healthcare providing and to implement strategies that improve it.

Introduction Preterm birth ( Methods Search terms were generated from inspection of relevant high-impact papers and a recent meta-analysis. Five databases were searched from database creation until December 2020 with PRISMA guidelines followed throughout. Results 10,900 papers were retrieved, with 52 papers included in the final analyses, further classified by assessment method (screening tools N=30, diagnostic assessment N=29). Pooled prevalence estimates for autism in preterm samples was 20% when using screening tools and 6% when using diagnostic assessments. The odds of an autism diagnosis were 3.3 times higher in individuals born preterm than in the general population. Conclusions The pooled prevalence estimate of autism characteristics in individuals born preterm is considerably higher than in the general population. Findings highlight the clinical need to provide further monitoring and support for individuals born preterm.

Background. Medical education empowers students to transform theoretical knowledge into practice. Assessment of knowledge, skills and attitudes determines students’ competency to practice. Assessment methods have been adapted, but not evaluated, to accommodate educational challenges. Objectives. To evaluate whether assessment criteria align with obstetrics learning outcomes. Methods. We conducted a collaborative action research study, in which we reviewed and analysed learning outcomes and assessments according to Bigg’s model of constructive alignment. Data were analysed as per levels of Bloom’s taxonomy. Results. Final-year students have two 3-week modules in obstetrics, with 75% overlap in learning outcomes and assessments. Ninety-five percent of learning outcomes were poorly defined, and 11 - 22% were inappropriately assessed. Summative assessments were comprehensive, but continuous assessments were rudimentary without clear educational benefit. There is a deficiency in assessment of clinical skills and competencies, as assessments have been adapted to accommodate patient confidentiality and increasing student numbers. The lack of good assessment practice compromises the validity of assessments, resulting in assessments that do not focus on higher levels of thinking. Conclusion. There was poor alignment between assessment and outcomes. Combining the obstetrics modules, and reviewing learning outcomes and assessments as a single entity, will improve the authenticity of assessments.

Dandruff is a common scalp condition that can be improved by regular use of shampoos containing anti-fungal actives. The efficacy of anti-dandruff shampoos can be assessed by measuring scalp flaking, one of the important dandruff symptoms. A randomized, double-blind trial is often used with one of two clinical designs: whole-head parallel design and split-head paired design. We aimed to explore the difference in product differentiation between these two designs using the same two test shampoos and the same scalp flaking assessment method (Total Weighted Head Score Adhered Flakes-TWHS AF).A clinical study was conducted with a 2- to 3-week wash-out phase and a 4-week test phase, consisting of 2 cells: 120 subjects with whole-head parallel design, divided into 2 subgroups (1:1) using on-site controlled washing method (either wash their own hair at a study site, under the instruction of a study supervisor or wash their own hair at home, as per instructions, but without supervision) and 35 subjects with split-head paired design using salon-staff washing method. Both cells employed hair washing at frequency of three times a week and TWHS AF measurement once a week from the baseline assessment.Both designs gave similar differences in TWHS AF between products: 5.6 units (95% CI: 4.1-7.0 units) in whole-head design and 5.9 units (95% CI: 4.9-6.9 units) in split-head design.Split-head paired design shows a similar ability of detecting product difference as whole-head parallel design, whereas it is a choice of more efficient and more cost-effective, as only a quarter of the subjects are required to demonstrate the efficacy between anti-dandruff shampoos.Les pellicules sont une affection courante du cuir chevelu qui peut être améliorée par l’utilisation régulière de shampooings contenant des principes actifs antifongiques. L’efficacité des shampooings antipelliculaires peut être évaluée en mesurant la desquamation du cuir chevelu, l’un des symptômes importants associés aux pellicules. Il est souvent fait recours à une étude randomisée et en double aveugle reposant sur l’une des deux conceptions cliniques suivantes: une conception parallèle portant sur la tête entière et une conception appariée par séparation de la surface de la tête. Nous avons cherché à étudier en quoi des produits se différenciaient entre ces deux conceptions, en utilisant les deux mêmes shampooings d’examen et la même méthode d’évaluation de la desquamation du cuir chevelu (score total pondéré des pellicules collées sur la tête [Total Weighted Head Score Adhered Flakes, TWHS AF]). MÉTHODES: Une étude clinique a été menée avec une fenêtre thérapeutique de deux à trois semaines et une phase d’examen de quatre semaines, composée de deux cellules: 120 sujets recrutés selon une conception parallèle portant sur la tête entière, répartis en deux sous-groupes (1:1), avec un lavage réalisé au centre d’après une méthode contrôlée (lavage par le sujet dans l’un des centres de l’étude, réalisé sous les instructions d’un superviseur de l’étude, ou lavage par le sujet à son domicile, en suivant les instructions, mais sans surveillance) et 35 sujets recrutés selon une conception appariée par séparation de la surface de la tête, avec un lavage réalisé selon la méthode employée par le personnel des salons de coiffure. Pour les deux cellules, le lavage des cheveux avait lieu à une fréquence de trois fois par semaine et le score TWHS AF était mesuré une fois par semaine à partir de l’évaluation de référence. RÉSULTATS: Les deux conceptions ont permis d’observer des différences similaires des scores TWHS AF entre les produits: 5,6 unités (IC à 95%: 4,1 à 7,0 unités) avec la conception portant sur la tête entière et 5,9 unités (IC à 95%: 4,9 à 6,9 unités) avec la conception par séparation de la surface de la tête.Par comparaison avec la conception parallèle portant sur la tête entière, la conception appariée par séparation de la surface de la tête montre une capacité de détection similaire de la différence entre les produits, mais constitue un choix plus efficace et plus rentable, car elle n’exige de démontrer l’efficacité entre les shampooings antipelliculaires que chez un quart des sujets.

The paper highlights the need to determine applicability of various ergonomic assessment methods. The methods such as Ovako working posture analysing system (OWAS), Rapid entire body assessment (RE...

Purpose Little is known on the beliefs, perceptions and practices of hypertension specialists in addressing non-adherence to therapy. Therefore, a survey was undertaken amongst healthcare professionals (HCPs) managing hypertension in the European Society of Hypertension (ESH) Centres of Excellence. Materials and methods Cross-sectional data were obtained between December 2020 and April 2021 using an online anonymous structured questionnaire including 26 questions/136 items, that was sent to all ESH Excellence centres. Results Overall 67 from 187 centres (37.3%) responded and 200 HCPs from 30 countries answered the questionnaire. Participants (60% men) were mainly physicians (91%) and nurses (8%) from University hospitals (77%). Among physicians, 83% had >10 years professional experience. Average time dedicated to discuss medications was 1-5 min in 48% and 6-10 min in 29% of cases. Interviews with patients about adherence were the most frequently used assessment method. Chemical detection of medications in urine was available in 36% of centres. One third of physicians involved their patients regularly in treatment decisions. The most frequent methods to improve adherence included simplification of medication therapy, more frequent visits, and home blood pressure monitoring. Conclusions: The level of implementation of tools to detect and improve adherence in hypertension management in ESH excellence centres is low. Structured educational activities and access to the newest objective measures to detect non-adherence might improve these deficits. Conclusions The level of implementation of tools to detect and improve adherence in hypertension management by HCPs in ESH excellence centres is low. Structured educational activities focussing on adherence management and access to the newest objective measures to detect non-adherence might improve these deficits.

Aims To compare flow rates for Australian bottle/teat systems marketed as ‘slow’ or ‘extra-slow’ flow, and to examine flow consistency within each teat type. Methods Established assessment methods were used to test 27 types of teats. Fifteen teats of each type were tested by measuring the amount of infant formula extracted in 1-min by a breast pump system. Teats were compared within ‘slow’ and ‘extra-slow’ categories, a coefficient of variation was calculated for each teat type, and a cluster analysis was performed to group teats with similar flow. Results There was significant variability observed between teats in the same 'slow' and 'extra-slow' categories, and sometimes between teat brands. Cluster analysis revealed 5 clusters. Many teats were considered to have moderate to high variability in flow rate. Conclusions This study provides information regarding Australian bottle/teat systems. This is of relevance to those who support the neonatal bottle-feeding journey, particularly with premature or medically complex neonates.

Objective: Since the introduction of the Observed Structured Clinical Examination (OSCE) in medical education more than four decades ago, OSCEs have been adopted by a majority of healthcare professional education programmes, including pharmacy. This article aims to review the best practices as well as explore novel approaches to the use of OSCE in pharmacy education. Method: As with any assessment method, the development of OSCE stations starts with blueprinting. Personnel involved in the OSCE are briefed and adequately trained, based on their expertise and prior experience to ensure the efficient running of the OSCE as well as help maintain the reliability and validity of the assessment process. Conclusion: The OSCE assesses a range of clinical and communication skills, yet it is resource-intensive and requires extensive planning. However, it must be considered an important and essential means to develop and assess the skills required by the pharmacy graduates for safe future practice.

With COVID-19 widespread flooding all over the world, the entire medical practice as well as medical education has been effected by this pandemic spread. Efficient and clear understanding of pathology, which the basic science that investigates the etiology and pathogenic mechanisms of diseases, during this periodis necessity to orient medical educators in their endeavor in planning new medical curriculum. Aim of study: to evaluatestudents’ perception of pathology coursein the undergraduate stage in Syrian universities. Study design: A survey study for students of medicine and dentistry was conducts using questionnaire that was delivered to the students electronically. Results: 248 responses distributed to 47% of males and 53% of females. Most of them (54.7%) pointed out to the overloaded of curricula with information that is repeated in other courses. Whereas, (50.6%) agreed that the assessment methods are reliable. Still participants revealed not to choose pathology as a future career because they prefer other specialties. Conclusion: We concluded that despite some weaknesses that the teaching of the pathology curricula suffers from, it still retains its importance as a specialty even if some sectors need further modifications, but it maintains many positive points as to the assessment methods and the comprehensiveness of the topics it provides. © 2021, SciDoc Publishers. All rights reserved.

The dental profession is an important segment of human health care services all over the world. Dental schools in Europe and United States have evolved their curriculum to keep abreast with advances in dentistry;like connective tissue biophysics and molecular engineering through an objectively structured and clinically oriented curriculum. However, dental education in our country is still mostly traditional. This article examines the new approaches to teaching and learning in dental schools/ colleges that are shaping dental curriculum globally. Articles relating to curricular trends in dental education and advancement in the dental profession published between 2010-2020 were searched in medical search engines. However, few relevant articles published before this period were also consulted. The current trends in dental curricula show new teaching, learning, and assessment methods like small group discussions, case-based learning, competency-based learning, Inquiry-based teaching-learning, and peer-assisted learning. The curricular format is integrated and new innovative assessment techniques like the assessment of multiple systematic reviews (AMSTAR) are being employed. Virtual reality, interdisciplinary teaching, and distributed community models in dental education are being implemented. The emergence of COVID-19 has also affected dental education and as a result, e-learning formats and assessment techniques have become increasingly popular. Dental schools abroad have revamped their curriculum with the advances in newer technologies and research related to dentistry. There is a need to immediately update and redesign the present dental curriculum in our country as well. © 2021, Army Medical College. All rights reserved.

Background: -Video-based teaching, a distance learning tools is widely beingused in the present COVID-19 pandemic. Present study compares cognitive and affective domains learning outcomes between traditional and video-based physiology lecture. Methods and material: -A total of 25female students of Applied Medical College, Prince Sattam bin Abdul Aziz University, kingdom of Saudi Arabia during 2019 were selected for the study. Physiology course consist of 45 credit hours in a fifteen-week semester. Students were evaluated by various methods for different levels of cognitive and affective domains between traditional method of endocrine physiology lecture session and video-based digestive physiology lecture session. Marks obtained by each student in all the assessment methods of cognitive and affective domains were calculated to get a total mean score and expressed in percentage and compared between the traditional and video-based physiology lecture. Results: -The total mean score for all the assessment methods of the cognitive domains in the digestive physiology lecture with video was 70% and endocrine lecture without video was 50%.The total mean score for affective domain in the digestive physiology lecture with video was 80% and endocrine lecture without video was 50%.Cognitive domain show no major difference between traditional endocrine physiology and video-based digestive physiology lecture, while student performance was good for affective domain in the lecture supported by video. Conclusion: -Video-based teaching helps the learner to achieve objectives of the different levels of affective domain compared to cognitive domain as well as compared to traditional lecture with no video. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.833-839

Background The increase in cardiovascular disease cases that require minimally invasive treatment is inducing a new need to train physicians to perform them safely and effectively. Nevertheless, adaptation to simulation-based training has been slow, especially for complex procedures. Objectives We describe a newly developed mitral valve repair (MVR) simulator, equipped with new objective performance assessment methods, with an emphasis on its use for training the MitraClip™ procedure. Methods The MVR contains phantoms of all anatomical structures encountered during mitral valve repair with a transvenous, transseptal approach. In addition, several cameras, line lasers, and ultraviolet lights are used to mimic echocardiographic and fluoroscopic imaging and with a remote eye tracker the cognitive behaviour of the operator is recorded. A pilot study with a total of 9 interventional cardiologists, cardiac surgeons and technical experts was conducted. All participants performed the MitraClip procedure on the MVR simulator using standard interventional tools. Subsequently, each participant completed a structured questionnaire to assess the simulator. Results The simulator functioned well, and the implemented objective performance assessment methods worked reliably. Key performance metrics such as x-ray usage were comparable with results from studies assessing these metrics in real interventions. Fluoroscopy imaging is realistic for the transseptal puncture but reaches its limits during the final steps of the procedure. Conclusion The functionality and objective performance assessment of the MVR simulator were demonstrated. Especially for complex procedures such as the MitraClip procedure, this simulator offers a suitable platform for risk-free training and education., Cardiovascular Engineering and Technology, 12 (5), ISSN:1869-408X, ISSN:1869-4098

The limitations of self-report measures of dietary intake are well-known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self-Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent–child dyads participated in two, 3-d dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake between assessments, and between each assessment method and the Estimated Energy Requirement (EER). Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (P = 0·0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (P = 0·008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, P = 0·09). Median satisfaction and ease of use scores were five out of six for both methods. A higher proportion of parents reported that the ASA24 was more time-consuming than the RFPM (74·4 % v. 25·6 %, P = 0·002). Utilisation of both methods is warranted given their high satisfaction among parents.

Breast cancer patients frequently develop radiation dermatitis (RD) when undergoing post-operative radiation therapy (RT). Traditional RD assessment methods measure clinician-reported outcomes (CROs), but patient-reported outcomes (PROs) have gained recent popularity. The purpose of this prospective analysis was to compare PROs with CROs of breast RD.Demographic and treatment characteristics were prospectively collected for patients receiving post-operative RT between February 2018 to September 2020. Patients and clinicians completed a skin symptom assessment at baseline, weekly during RT, and at a one- to three-month follow-up visit. Skin treatments used by patients were collected. Concordance between each PRO and CRO was determined using percent concordance and concordance index (C-statistic) by logistic regression analysis.A total of 777 patients were included in the present study. All skin symptom assessment items were significantly underreported by clinicians in comparison to patients (p 0.0001), with a low to moderate level of concordance (C-statistic range: 0.58-0.70; percent concordance range: 29-50%). The majority of patients used moisturizing creams as a prophylactic measure (65.1%), as per institutional guidelines.There were significant discrepancies between PROs and CROs when assessing breast RD. CROs alone are insufficient in measuring RD as they fail to capture the impact on patient quality of life. The study findings highlight the need for improved RD symptom assessment and support the development of a new tool with both patient and clinician components.

The study aimed to explore the feasibility of an image registration technique for assessing the accuracy of intraoperative osteotomy of pelvic tumors by 3-dimensional (3D)-printed patient-specific templates. Patients with malignant pelvic tumors who were admitted to our hospital between March 2014 and December 2020 were retrospectively enrolled. Patients underwent hemi-pelvic resection and reconstruction by 3D-printed individualized prostheses. The registration between the designed model and the postoperative segmented model of the prosthesis was used to obtain the intraoperative osteotomy plane and reduce metal artifacts in postoperative computed tomography (CT) images. The distance and angle between the planned and actual osteotomy planes were then used to assess the accuracy of the intraoperative osteotomy. Eight patients with 13 osteotomy planes were enrolled, including four males and four females. The median age at the time of imaging examination was 44 years (range, 33–54 years). All intraoperative osteotomy planes were assessed successfully. The mean distance between the planned and true intraoperative osteotomy planes was −0.69 cm (−7.5–7.35 cm), and the mean angle was 6.57°±3.36° (1.05°–11.88°). This new assessment method of registering the designed model and the postoperative CT segmented model of the prosthesis may be used to assess the accuracy of intraoperative osteotomy for pelvic tumors, using 3D printed patient-specific templates.