ASSOCIATION BETWEEN HIP EXTENSION STRENGTH AND STAND-UP ABILITY IN GERIATRIC PATIENTS

Difficulty in rising from the seated position is a serious and frequent problem for elderly patients. Among the factors that may contribute to this difficulty are: pain, level of awareness, loss of joint motion, lose of neuromuscular control, loan of balance control, and muscle weakness. The importance of this last factor is not well documented in the geriatric population. This clinical pilot Study investigated the association between hip extension strength, when measured in the .seated position, and the ability to stand up in 58 nursing home patients, ages 44 to 98 yearn. Strength wan measured by a modified manual muscle test and stand-up ability wan determined by the commonly used clinical scale of assistance, maximal, moderate, minimal, and independent. The association between these two ordinal classification was found by a Chi square test to be statistically significant P < 0.01. This result is somewhat surprising because the significant association was found even though many of the patients had a diagnosis of CVA and/or OBS. The clinical implication is that hip extension muscle strength is an important factor in standing up. Thus, it may be an important target area for treatment remediation.     

Reports

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.     

Scores From Riding's Cognitive Styles Analysis Have Poor Test–Retest Reliability

Background: The Cognitive Styles Analysis (CSA) purports to assess two cognitive style dimensions, wholist-analytic (WA) and verbalizer-imager (VI). CSA score reliability has not been studied in medical education. Purpose: The objective of this study was to evaluate test–retest reliability and learner-perceived accuracy of CSA scores. Method: CSA scores were measured twice and perceived accuracy of classifications once among 89 family medicine residents, internal medicine residents, and medical students. Results: Mean ± standard deviation interval between tests was 564 ± 136 days. Test–retest correlation for WA scores was 0.30, and for VI scores was 0.12. Upon retesting 44 learners (49%) were classified under a different WA style, and 56 learners (63%) were classified under a different VI style. There were 58 of 73 learners (79%) who agreed or strongly agreed with their WA classification, whereas 51 of 76 (67%) agreed with their VI classification. Conclusions: CSA scores have poor test–retest reliability. Educators may wish to avoid using the CSA and should exercise caution when interpreting CSA scores.     

SEX AND HANDEDNESS DIFFERENCES IN EYE-HAND VISUAL REACTION TIMES IN HANDBALL PLAYERS

Sex and handedness differences in the eye-dominant hand, the right eye-right hand and the left eye-left hand visual reaction times were studied in 270 right-handed and 56 left­-handed young handball players. Reaction­ time was assessed by a software package. All visual reaction times were longer in women than in men. In the eye-dominant hand and the left eye-­left hand visual reaction times, the left-handers had a superiority over the right handers, but there was no difference between the right eye-right hand visual reaction times of the right- and left-handers. In right-handers, all visual reaction times were longer in women than in men, but there was no sex difference in left-handers. The results suggest that left-handed players have probably an intrinsic neurological advantage.     

Dyscalculia and the Calculating Brain

Dyscalculia, like dyslexia, affects some 5% of school-age children but has received much less investigative attention. In two thirds of affected children, dyscalculia is associated with another developmental disorder like dyslexia, attention-deficit disorder, anxiety disorder, visual and spatial disorder, or cultural deprivation. Infants, primates, some birds, and other animals are born with the innate ability, called subitizing, to tell at a glance whether small sets of scattered dots or other items differ by one or more item. This nonverbal approximate number system extends mostly to single digit sets as visual discrimination drops logarithmically to “many” with increasing numerosity (size effect) and crowding (distance effect). Preschoolers need several years and specific teaching to learn verbal names and visual symbols for numbers and school agers to understand their cardinality and ordinality and the invariance of their sequence (arithmetic number line) that enables calculation. This arithmetic linear line differs drastically from the nonlinear approximate number system mental number line that parallels the individual number-tuned neurons in the intraparietal sulcus in monkeys and overlying scalp distribution of discrete functional magnetic resonance imaging activations by number tasks in man. Calculation is a complex skill that activates both visual and spatial and visual and verbal networks. It is less strongly left lateralized than language, with approximate number system activation somewhat more right sided and exact number and arithmetic activation more left sided. Maturation and increasing number skill decrease associated widespread non-numerical brain activations that persist in some individuals with dyscalculia, which has no single, universal neurological cause or underlying mechanism in all affected individuals.     

Development and validation of artificial intelligence models for preoperative prediction of inferior mesenteric artery lymph nodes metastasis in left colon and rectal cancer

BackgroundDissection of lymph nodes at the roots of the inferior mesenteric artery (IMAN) should be offered only to selected patients at a major risk of developing IMAN involvement. The aim of this study is to present the first artificial intelligence (AI) models to predict IMAN metastasis risk in the left colon and rectal cancer patients.MethodsA total of 2891 patients with descending colon including splenic flexure, sigmoid colon and rectal cancer undergoing major primary surgery and IMAN dissection were included as a study cohort, which was then split into a training set (67%) and a testing set (33%). Feature selection was conducted using the least absolute shrinkage and selection operator (LASSO) regression model. Seven AI algorithms, namely Support Vector Machine (SVM), Logistic Regression (LR), Extreme Gradient Boosting (XGB), Light Gradient Boosting (LGB), Decision Tree Classifier (DTC), Random Forest (RF) classifier, and Multilayer Perceptron (MLP), as well as traditional multivariate LR model were employed to construct predictive models. The optimal hyperparameters were determined with 5 fold cross-validation. The predictive performance of models and the expert surgeon was assessed and compared in the testing set independently.ResultsThe IMAN involvement incidence was 4.6%. The optimal set of features selected by LASSO included 10 characteristics: neoadjuvant treatment, age, synchronous liver metastasis, synchronous lung metastasis, signet ring adenocarcinoma, neural invasion, lymphovascular invasion, CA199, endoscopic obstruction, T stage evaluated by MRI. The most accurate model derived from MLP showed excellent prediction power with area under the receiver operating characteristic curve (AUROC) of 0.873 and produced 81.0% recognition sensitivity and 82.5% specificity in the testing set independently. In contrast, the judgment of IMAN metastasis by expert surgeon yield rather imprecise and unreliable results with a significantly lower AUROC of 0.509. Additionally, the proposed MLP had the highest net benefits and the largest reduction of unnecessary IMAN dissection without the cost of additional involved IMAN missed.ConclusionMLP model was able to maintain its prediction accuracy in the testing set better than other models and expert surgeons. Our MLP model could be used to help identify IMA nodal metastasis and to select candidates for individual IMAN dissection.     

Enigma variations: Unraveling interprofessional education in time and place

Abstract

Designing the learning environment for the health care professionals of tomorrow is less than complete unless and until it includes interprofessional education (IPE). Progress depends on establishing a shared understanding of IPE between architects and teachers as the dialogue between them during the forum confirmed. My brief presentation provided no more than the catalyst. This paper goes further. It locates IPE within a coherent, consistent and pervasive rationale distilled over time from its roots in different countries and fields of practice, including the formulation of objectives, the adaptation of a repertoire of learning methods, the adoption of a definition and values and the framing of principle and competency-based outcomes, before alerting readers to some of the many complexities during the planning process.     

Assessment of a Large-Scale Peer Learning Program’s Value by Manual Review of Case Submissions

ObjectivePrior studies used submission numbers or report addendum rates to measure peer learning programs’ (PLP) impact. We assessed the educational value of a PLP by manually reviewing cases submitted to identify factors correlating with meaningful learning opportunities (MLOs).MethodsThis institutional review board–exempted, retrospective study was performed in a large academic radiology department generating >800,000 reports annually. A PLP facilitating radiologist-to-radiologist feedback was implemented May 1, 2017, with subsequent pay-for-performance initiatives encouraging increasing submissions, >18,000 by 2019. Two radiologists blinded to submitter and receiver identity categorized 336 randomly selected submissions as a MLO, not meaningful, or equivocal, resolving disagreements in consensus review. Primary outcome was proportion of MLOs. Secondary outcomes included percent engagement by subspecialty clinical division and comparing MLO and report addendum rates via Fisher’s exact tests. We assessed association between peer learning category, pay-for-performance interventions, and subspecialty division with MLOs using logistic regression.ResultsOf 336 PLP submissions, 65.2% (219 of 336) were categorized as meaningful, 27.4% (92 of 336) not meaningful, and 7.4% (25 of 336) equivocal, with substantial reviewer agreement (86.0% [289 of 336], κ = 0.71, 95% confidence interval 0.64-0.78). MLO rate (65.2% [219 of 336]) was five times higher than addendum rate (12.9% [43 of 333]) for the cohort. MLO proportion (adjusted odds ratios 0.05-1.09) and percent engagement (0.5%-3.6%) varied between subspecialty divisions, some submitting significantly fewer MLOs (P < .01). MLO proportion did not vary between peer learning categories.ConclusionEducational value of a large-scale PLP, estimated through manual review of case submissions, is likely a more accurate measure of program impact. Incentives to enhance PLP use did not diminish the program’s educational value.     

Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory

Issue: The morbidity and mortality conference (MMC) remains a central activity within the departments of our academic healthcare institutions. It is deeply rooted in the premise that we can learn from our mistakes, thereby improving the care we provide. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. As a result the purpose of MMC has become clouded and ill-defined: Is it an educational conference that promotes mastery of clinical acumen, or is it a venue to drive quality improvement by addressing systems-based issues in delivering care? Or can it serve both purposes? Evidence: Review of the history of MMC, the literature, and critical application of education theory demonstrates the source of the confusion and the challenges in viewing it through the exclusive lens of either education or quality improvement. Application of experiential learning theory helps resolve this discord showing how the conference facilitates the development of clinical mastery while informing quality improvement programs about important and relevant systems-based issues. Implication: Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. This model builds on previously described models, is grounded in the literature, and helps clarify its role from both the educational and the quality improvement perspectives.