Selecting and Simplifying: Rater Performance and Behavior When Considering Multiple Competencies

Theory: Assessment of clinical competence is a complex cognitive task with many mental demands often imposed on raters unintentionally. We were interested in whether this burden might contribute to well-described limitations in assessment judgments. In this study we examine the effect on indicators of rating quality of asking raters to (a) consider multiple competencies and (b) attend to multiple issues. In addition, we explored the cognitive strategies raters engage when asked to consider multiple competencies simultaneously. Hypotheses: We hypothesized that indications of rating quality (e.g., interrater reliability) would decline as the number of dimensions raters are expected to consider increases. Method: Experienced faculty examiners rated prerecorded clinical performances within a 2 (number of dimensions) × 2 (presence of distracting task) × 3 (number of videos) factorial design. Half of the participants were asked to rate 7 dimensions of performance (7D), and half were asked to rate only 2 (2D). The second factor involved the requirement (or lack thereof) to rate the performance of actors participating in the simulation. We calculated the interrater reliability of the scores assigned and counted the number of relevant behaviors participants identified as informing their ratings. Second, we analyzed data from semistructured posttask interviews to explore the rater strategies associated with rating under conditions designed to broaden raters' focus. Results: Generalizability analyses revealed that the 2D group achieved higher interrater reliability relative to the 7D group (G = .56 and .42, respectively, when the average of 10 raters is calculated). The requirement to complete an additional rating task did not have an effect. Using the 2 dimensions common to both groups, an analysis of variance revealed that participants who were asked to rate only 2 dimensions identified more behaviors of relevance to the focal dimensions than those asked to rate 7 dimensions: procedural skill = 36.2%, 95% confidence interval (CI) [32.5, 40.0] versus 23.5%, 95% CI [20.8, 26.3], respectively; history gathering = 38.6%, 95% CI [33.5, 42.9] versus 24.0%, 95% CI [21.1, 26.9], respectively; ps < .05. During posttask interviews, raters identified many sources of cognitive load and idiosyncratic cognitive strategies used to reduce cognitive load during the rating task. Conclusions: As intrinsic rating demands increase, indicators of rating quality decline. The strategies that raters engage when asked to rate many dimensions simultaneously are varied and appear to yield idiosyncratic efforts to reduce cognitive effort, which may affect the degree to which raters make judgments based on comparable information.     

Schmerzen in der laktierenden Brust

Breast abscesses in lactating women can result as a complication of mastitis, especially if treatment is delayed or inadequate. The reported incidence is up to 20%. Needle aspiration under ultrasound guidance has great value in the treatment of breast abscesses, even in lesions with a large volume. With a good cosmetic outcome, this method is likely to be well accepted as an alternative to surgical treatment.     

Assessment of cardiovascular risk and social framework of Cape Verdean university students studying in Portugal

Introduction

The migration of African populations to Europe poses problems of adaptation that may increase the risk of cardiovascular disease. We assessed the cardiovascular risk of Cape Verdean university students studying in Portugal (CV-PT) compared to Cape Verdean university students in Cape Verde (CV-CV) and to Caucasian university students in Portugal (PT-PT).

Multidrug-resistant tuberculosis: case reports study in a central state of Brazil

Multidrug-resistant tuberculosis (MDR-TB) is an emerging and worrisome health problem that threatens tuberculosis (TB) control worldwide. The clinical management of MDR-TB is a complex issue associated with the use of multiple drugs for a long period, usually accompanied by side effects and high costs. The objective of this work was to relate cases of MDR-TB occurring in Goiás, a central state of Brazil. We related five cases of MDR-TB, three women and two men. All were pulmonary cases. Three were in their second treatment and two in their first treatment. Surgical pulmonary resection was performed in one case. One death occurred. Lack of adherence, gastric intolerance to anti-TB drugs and poor clinical management were the main aspects related to the emergent resistance. A revision of the main clinical aspects of this disease was performed.     

Lactic acidosis in long-chain fatty acid β-oxidation disorders

Among the many disorders of fatty acid -oxidation known today, the disorders of long-chain fatty acid oxidation are the most severe and life-threatening. One remarkable abnormality, not observed in, for instance, medium-chain acyl-CoA dehydrogenase deficiency, is the moderate to severe lactic acidaemia in long-chain fatty acid -oxidation-deficient patients, suggesting that oxidation of pyruvate is also compromised. In order to understand the underlying basis of the lactic acidaemia in these patients, we have studied the formation of L-lactate and pyruvate in cultured skin fibroblasts incubated with D-glucose. All long-chain fatty acid -oxidation-deficient cell lines studied were found to show a moderate elevation of lactate when compared with control and medium-chain acyl-CoA dehydrogenase-deficient fibroblasts. Interestingly, differences were found between cells deficient in long-chain 3-hydroxyacyl-CoA dehydrogenase and very-long-chain acyl-CoA dehydrogenase, suggesting that saturated acyl-CoA esters and their 3-hydroxyacyl-CoA derivatives affect pyruvate metabolism differently.     

Changes in Caries Experience,Untreated Caries,Sealant Prevalence,and Preventive Behavior Among Third-Graders in New York State, 2002–2004 and 2009–2012

ObjectiveThis study assessed changes in caries experience, untreated caries, sealant prevalence, and preventive behavior among third-grade children in New York State to monitor progress toward state health objectives.MethodsWe analyzed children''s data from the 2002–2004 (n=10,865) and 2009–2012 (n=6,758) New York State Oral Health Survey. We calculated differences in weighted percentages and 95% confidence intervals for caries experience, untreated caries, sealant prevalence, and preventive behavior. We used logistic regression procedures to assess the independent effects and interaction terms on dental caries experience.ResultsThe percentage of children with dental caries and untreated caries decreased from 54.1% and 33.0% in 2002–2004 to 45.2% and 23.6% in 2009–2012, respectively. While this decrease was not uniform across income subgroups, the prevalence of sealants, a key measure of the use of preventive services, increased significantly from 16.7% to 36.0% among lower-income children.ConclusionsMeasurable improvement in reducing dental caries prevalence among third-grade children has been made in New York State, but this improvement was not uniform across subgroups. Specifically, disease prevalence among lower-income children remained high, underscoring the need to strengthen existing programs and identify additional policy and programmatic interventions.Researchers generally agree that the prevalence and severity of dental caries among U.S. and New York State (NYS) school-age children declined steadily from the 1970s to the 1990s. Although this trend has continued for older children in more recent years, this trend is uncertain among younger children aged 2–8 years.^1–3 Findings from analyses of 1988–1994 and 1999–2004 national surveys show that declines in dental caries observed in earlier decades among younger children may have plateaued or dental caries may even be increasing among subgroups of younger children.⁴ Because of the persistent higher disease rate, especially in low-income groups, prevention of tooth decay among children has become the focus of many prevention efforts.^5,6 Since 2001, the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration have provided grants and technical assistance to NYS to strengthen the infrastructure and capacity to promote fluoridation and improve its quality, as well as to strengthen school-based preventive and early treatment programs.Changes have also been made to increase insurance coverage for dental services and improve annual dental visits.^7,8 Child Health Plus, the state Children''s Health Insurance Program (CHIP), was implemented in 1997 to provide public health insurance for near-poor children from families previously not eligible for Medicaid. According to a U.S. Government Accounting Office report, nationally, Medicaid and CHIP beneficiaries, children in particular, showed increases in the use of dental services (from 28% in 1996 to 37% in 2010), but still visited the dentist less frequently than privately insured children (58% in 2010).⁹ In NYS, the Medicaid program enhanced the fee structure for dental procedures in 2000. In addition, professional organizations, advocacy groups, and foundations have made a concerted effort to promote prevention and access to care. The professional recommendation to initiate first dental visit shifted from age 3 to age 1 around 2003.¹⁰ To assess the collective effect of these and other efforts in NYS, we examined data on caries experience, untreated caries, sealant prevalence, and preventive behavior among third-grade children from the 2002–2004 and 2009–2012 NYS Oral Health Survey.     

Frailty Syndrome in Association with Depressive Symptoms and Functional Disability among Hospitalized Elderly

ABSTRACT

We sought to examine the frailty association with depression and functional disability in hospitalized older adults. In particular, we compared non-frail, pre-frail, and frail elderly hospitalized individuals. We performed a cross-sectional study with 255 hospitalized Brazilian elderly patients. We used a structured instrument to assess socio-economic data, the Fried frailty phenotype and used morbidity scales (Geriatric Depression; Katz; Lawton and Brody). The adjusted analysis revealed that frail elderly exhibit increased odds ratios (OR) for depressive symptoms (OR = 2.72, 95% CI: 1.12–6.62), disability related to basic activities (OR = 3.50, 95% CI: 1.26–9.60), and instrumental daily living (OR = 2.70, 95% CI: 1.12–6.44). Frailty in hospitalized older adults is associated with depressive symptomatology and functional disability.     

The development and validation of a method for quantifying olanzapine in human plasma by liquid chromatography tandem mass spectrometry and its application in a pharmacokinetic study

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