Discriminating Features of Narrative Evaluations of Communication Skills During an OSCE

Construct: Authors examined the use of narrative comments for evaluation of student communications skills in a standardized, summative assessment (Objective Structured Clinical Examinations [OSCE]). Background: The use of narrative evaluations in workplace settings is gaining credibility as an assessment tool, but it is unknown how assessors convey judgments using narratives in high-stakes standardized assessments. The aim of this study was to explore constructs (i.e., performance dimensions), as well as linguistic strategies that assessors use to distinguish between poor and good students when writing narrative assessment comments of communication skills during an OSCE. Approach: Eighteen assessors from Qatar University were recruited to write narrative assessment comments of communication skills for 14 students completing a summative OSCE. Assessors scored overall communication performance on a 5-point scale. Narrative evaluations for the top and bottom 2 performing students for each station (based on communication scores) were analyzed for linguistic strategies and constructs that informed assessment decisions. Results: Seventy-two narrative evaluations with 662 comments were analyzed. Most comments (77%) were written without the use of politeness strategies. A further 22% of comments were hedged. Hedging was used more commonly in poor performers, compared to good performers (30% vs. 15%, respectively). Overarching constructs of confidence, adaptability, patient safety, and professionalism were key dimensions that characterized the narrative evaluations of students’ performance. Conclusions: Results contribute to our understanding regarding the utility of narrative comments for summative assessment of communication skills. Assessors’ comments could be characterized by the constructs of confidence, adaptability, patient safety, and professionalism when distinguishing between levels of student performance. Findings support the notion that judgments are arrived at by clustering sets of behaviors into overarching and meaningful constructs rather than by solely focusing on discrete behaviors. These results call for the development of better-anchored evaluation tools for communication assessment during OSCEs, constructively aligned with assessors’ map of the reality of professional practice.     

Photobiomodulation Therapy Affects the Elastic Modulus,Cytoskeletal Rearrangement and Migration Capability of Human Osteosarcoma Cells

Lasers in Medical Science - Photobiomodulation (PBM) therapy utilizes low-power lasers to modulate the viability of living human cells and leads to changes in proliferation, differentiation,...     

Effect of DHA+EPA on oxidative stress and apoptosis induced by ischemia‐reperfusion in rat kidneys

Apoptosis, as well as necrosis, has an important role in post‐ischemic renal pathology. The effect of pretreatment with Docosahexaenoic acid+Eicosapentaenoic acid (DHA+EPA) on renal injury and apoptotic protein expression was evaluated. Right nephrectomy was completed on male Wistar rats (255–300 g). The rats received DHA+EPA (200 mg/kg/day) of distilled water orally for 14 days before ischemia reperfusion (IR) or sham operation. A total of 81 rats were divided into three main groups with 6, 24 and 48 h of post‐operation or reperfusion period. Serum creatinine (SCr), BUN, creatinine clearance (CCr) and fractional excretion of sodium (FE_Na) were measured. Tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) activities, Bax and Bcl‐2 protein expressions and renal histological injury were determined. SCr, BUN and FE_Na increased 6–48 h of reperfusion (P < 0.01). Tissue MDA content and Bax expression increased (P < 0.01) and CAT and SOD activities decreased (P < 0.05) in the IR group. DHA+EPA decreased SCr and BUN, FE_Na, tissue MDA levels (P < 0.05 vs. IR) and increased CAT and SOD activities and Bcl‐2 expression (P < 0.05 vs. IR) for 6–48 h after ischemia. IR induced mild (6 h, P < 0.05) and severe (24–48 h, P < 0.01) tissue damage. Mild‐to‐moderate tissue damage was observed in DHA+EPA groups from 6 to 48 h of reperfusion period (P < 0.05 vs. IR, 24–48 h). In conclusion, the results suggest that pre‐ischemic exposure to DHA+EPA could improve the outcome of early graft function by inhibition of IR‐induced oxidative stress and apoptosis.     

The impact and utility of encounter patient decision aids: Systematic review,meta-analysis and narrative synthesis

Objective

To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows.

Evaluation of sexual reproductive health needs of women with spinal cord injury in Tehran,Iran

Sexuality and Disability - Physical disability is one of the factors influencing the sexual and reproductive health (SRH) of people. Women with a severe disability receive fewer Pap smear tests,...     

Choosing to biopsy or refer suspicious Melanocytic lesions in general practice

ABSTRACT: BACKGROUND: General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy technique is a crucial first step in management, as it is recognized that poor techniques can mislead, delay, or miss a diagnosis of melanoma. There has been little published on the biopsy decisions and techniques of GPs. This study aims to describe the current management choices made by GPs for suspicious melanocytic skin lesions and to compare their choices with the best practice guidelines. METHODS: An anonymous survey of GPs presented with three clinical scenarios with increasing complexity of melanoma in which a referral or biopsy decision was specified. RESULTS: 391 mailed surveys with a 76.3% response rate. Mean biopsy experience was 4.14 biopsies per GP per month. The rates of choosing to refer among the three scenarios were 31%, 52% and 81% respectively, with referral to surgery being the most common choice (81%). Most biopsy techniques (55%) were chosen according to best practice guidelines, although non-guideline biopsy techniques chosen included shave (n = 10), punch biopsy (n = 57), wide excisions (n = 65), and flaps (n = 10). The few GPs (n = 5) who identified themselves as skin specialist GPs were no more likely to adhere to guidelines than their colleagues. CONCLUSION: A majority of referrals and biopsies were chosen by GPs according to best practice guidelines, but concern remains for the high proportion of GPs making non-guideline based choices. How GPs choose to biopsy or refer needs further training, audit, and research if Australia is to improve the outcome of melanoma management in general practice.     

Clinical characteristics of human brucellosis in patients with various monoarticular involvements

Clinical Rheumatology - The aim of the study was to determine the main demographic, epidemiological, clinical characteristics, and outcome in patients with various types of brucellar monoarticular...