Methodology for a correlate of protection for group B Streptococcus: Report from the Bill & Melinda Gates Foundation workshop held on 10 and 11 February 2021

Worldwide, childhood mortality has declined significantly, with improvements in hygiene and vaccinations against common childhood illnesses, yet newborn mortality remains high. Group B Streptococcus (GBS) disease significantly contributes to newborn mortality and is the leading cause of meningitis in infants. Many years of research have demonstrated the potential for maternal vaccination against GBS to confer protection to the infant, and at least three vaccine candidates are currently undergoing clinical trials. Given the relatively low disease incidence, any clinical vaccine efficacy study would need to include at least 40,000 to 60,000 participants. Therefore, a path to vaccine licensure based on a correlate of protection (CoP) would be the preferred route, with post-approval effectiveness studies demonstrating vaccine impact on reduction of disease burden likely to be required as part of conditional marketing approval. This workshop, hosted by the Bill & Melinda Gates Foundation on 10 and 11 February 2021, discussed considerations and potential statistical methodologies for establishing a CoP for GBS disease. Consensus was reached that an antibody marker with global threshold predictive of a high level of vaccine protection would be most beneficial for licensure assessments. IgG binding antibody in cord blood would likely serve as the CoP, with additional studies needed to confirm a high correlation with functional antibody and to demonstrate comparable kinetics of natural versus vaccine-induced antibody. Common analyses of ongoing seroepidemiological studies include estimation of absolute and relative disease risk as a function of infant antibody concentration, with adjustment for confounders of the impact of antibody concentration on infant GBS disease including gestational age and maternal age. Estimation of an antibody concentration threshold indicative of high protection should build in margin for uncertainties from sources including unmeasured confounders, imperfect causal mediation, and variability in point and confidence interval estimates across regions and/or serotypes.     

Incompetent parenting: Its causes and cures

The author argues that the current sharp increase in the proportion of unsocialized youth is primarily due to overburdened, incompetent, or sociopathic parenting. Because socialization, like language-learning, occurs in early childhood, the only solution to this problem is to provide alternative rearing environments for highrisk children. Parental training, adoption, professionalized foster care, group homes, and boarding schools are components of the necessary infrastructure. The best long-term solution, parental licensure, might become politically feasible once voters come to fully understand the costs to the children, and to the commonweal, of the tradition that places procreative rights at the head of the list of human rights.     

融合型试题在口腔执业医师资格考试中测试效果的初步观察

目的初步观察融合型试题在口腔执业医师资格考试中的测量效果。方法抽样选取部分历年实测试题,应用多专业融合试题开发方式对其进行改造后再次施测,分析试题融合前后难易度及区分度参数变异情况,采用配对设计资料t检验方法进行统计分析。结果试题经多专业融合改造后,难易度无明显变化,区分度却显著提高;并且这一规律集中体现在成绩中间组考生群体。结论提示融合型试题在口腔执业医师资格考试中具有较好的测量效果。     

Waiting and watching: Nurse migration trends before a change to the National Council Licensure Examination as entry to practice for Canada's nurses

Background

A number of factors in the health care environment, including a change in regulatory policy, may affect a country's nursing workforce and nurse migration and mobility.

Purpose

This study compared the characteristics of Canadian-educated nurses who had migrated to the United States to work with their colleagues in the United States and Canada in anticipation of a change in Canada's RN entry to practice requirements in 2015.

Methods

We conducted a retrospective comparative study of nurses in Canada and the U.S. using 2008 data from the US National Sample Survey of Registered Nurses and the Canadian Institute of Health Information.

Discussion

There was little change in the number of Canadian-educated nurses working in the United States in 2008 compared with 2004. We found differences between U.S. nurses and Canadian-educated nurses working in the United States in educational level, work status, work location, and age. No differences were found between Canadian-educated nurses working in the United States and those working in Canada.

Conclusions

This research highlights the value of international comparisons of the nursing workforce, especially in the context of anticipated regulatory changes, which may affect a country's nursing health human resources.     

Impact of New Regulations On Assessing Driving Status (INROADS): A South Australian seizure clinic cohort

The ability to drive is important to patients and driving restriction often leads to restriction of employment and social opportunities. In March 2012, Austroads released revised Assessing Fitness to Drive Guidelines (AFTDG) with significant changes for drivers with seizures and epilepsy. Our study aimed to assess the impact of the 2012 AFTDG on a Seizure Clinic cohort compared to the previous 2003 AFTDG and an individual’s current driving status. We also aimed to quantify the difference in AFTDG interpretation between expert and non-expert doctors. We performed a retrospective observational audit of case notes for all patients managed in a public hospital outpatient Seizure Clinic between 1 March 2010 and 1 March 2012. A total of 142 patients were included in the analysis. Comparison between the 2003 and 2012 AFTDG resulted in reduced eligibility to drive a private vehicle by 2.1% (52.5% versus 50.4%) and commercial vehicle by 2.2% (4.5% versus 2.3%). The proportion of those currently driving against guideline recommendations increased (private 8.8% versus 19%; commercial 50% versus 100%) and the non-expert assessor was more likely to agree with the experts with the 2012 AFTDG. In summary, the 2012 AFTDG has had a measurable impact on driving eligibility in individuals with seizure although it is easier to interpret for non-expert doctors. Greater awareness of the 2012 AFTDG is required to reduce the proportion of patients driving against current recommendations.     

The effects of taking a practice examination on scores in the Qualifying Examination of the Medical Council of Canada

A practice examination has been prepared annually at the University of Toronto for use by those who will take the Qualifying Examination of the Medical College of Canada. Passing the Qualifying Examination is an important step in gaining the Licentiate of the Medical College of Canada (the LMCC) and thus in becoming licenced.
The effect of taking the practice examination on scores on the LMCC exam was investigated. The practice examination is a smaller replica of the LMCC exam, with questions spanning major medical specialties presented in both multiple-choice and patient management problem (PMP) format. It was conjectured that the effect of practice would be greater on the PMP score than on the multiple-choice score.
Analysis of covariance was used to compare the LMCC examination scores of senior students, who had taken the practice examination, with the scores of those who had not. The comparison was performed for two graduating classes, separately, and involved the use of a score summarizing each student's performance in the third year of the curriculum as a covariate. In each graduating class, the practice effect on PMP scores is statistically significant. In neither class alone is the practice effect on multiple-choice scores statistically significant, although a combination of results in the two classes is statistically significant.
The presence of practice effects can be taken to indicate a flaw in the testing process. The elimination of practice effects, through experiences like the practice examination, would make the entire testing process more valid.     

全程教学模式在实习护生执业护士资格考试训练中的应用

目的探索医院护生护士执业资格考试训练的全程教学模式。方法以2011届45名护生为对照组实施常规临床带教方法,2012届48名“订单式”护生为研究组,通过对护士执业资格考试现状分析,依托院长基金课题支持,开展教学改革,实行以执业考试训练为基础的全程教学模式。比较两届护生当年参加全国执业考试通过率和独立上岗时间。结果护生参加全国护士执业考试通过率对照组为91．11％,研究组为100．00％,差异有统计学意义（x2=37．23,P〈0．01）。护生应聘后独立上岗时间对照组为（11．00±0．87）周,研究组为（10．00±0．56）周,差异有统计学意义（t=6．63,P〈0．01）。结论结合护生毕业当年即可参加全国护士执业资格考试的新形势,实习中全程教学与国家执业护士资格考试大纲、临床实践双接轨,适应了医疗工作对高素质护理人才的需求,体现了教学工作的“双赢”。     

Association between graduates' factors and success rate on the Saudi Pharmacist Licensure Examination: A single-Institution cross-sectional study

IntroductionThe Saudi Pharmacists Licensure Examination’s (SPLE) initial results were revealed in February 2020, which showed enormous inconsistency with the passing rates. Hence, we aimed to investigate the predictors of pharmacy graduates’ success rate on the SPLE of a single-college in Saudi Arabia.MethodsIn a cross-sectional study of 2019-graduates, data were collected via-phone interviews and retrieved from the college’s database. Graduates’ data were retrieved from the college’s database, which includes high school grade point average (GPA), General Aptitude Test, Scholastic Achievement Admission Test, preparatory year GPA, pharmacy GPA, and all courses' grades. The data collected via-phone interview includes information that was not recorded in the college’s database, such as date of birth, SPLE score, and the number of SPLE attempts. We only included students who agreed to be interviewed and had attempted the SPLE at least once. We developed a prediction model using correlational analyses and stepwise multiple linear regression to examine graduates’ factors in predicting success on the SPLE.ResultsOut of the 149 graduates, 105 fulfilled the inclusion criteria. Around 84% of them passed the SPLE. Correlation analyses showed a significant direct correlation between preparatory year GPA and pharmacy GPA with SPLE scores (r = 0.228, P = 0.0193 and r = 0.533, P < 0.0001, respectively). In addition, the results showed that all of the four SPLE content areas were positively correlated with SPLE scores (P < 0.0001). The stepwise multivariable regression showed that being a male graduate and scoring high-grade points in pharmacology and therapeutics courses were significantly associated with high SPLE scores (P = 0.0053, P = 0.0256, and P = 0.0001, respectively).ConclusionThis single cross-sectional study found that being a male, pharmacology GPA, and therapeutics GPA were significantly associated with a higher SPLE score. Further studies should focus on the GPA cut off below which we should give remediation to improve SPLE passing rate.