Peer review improves psychometric characteristics of multiple choice questions

Abstract

Purpose: For new and emerging medical schools, developing a system to peer-review and evaluate the assessment processes through faculty development programs can be a challenge. This study evaluates the impact of peer-review practices on item analysis, reliability, and the standard error of measurement of multiple-choice questions for summative final examinations.

Methods: This study used a retrospective cohort design of two consecutive academic years in 2012 and in 2013. Psychometric analyses of multiple-choice questions of three summative final examinations in Medicine, Pediatrics, and Surgery for sixth year medical students at the College of Medicine Taif University were used. Formal peer review of multiple-choice questions began in 2013, using guidelines from the National Board of Medical Examiners. Psychometric analyses of multiple-choice questions included item analysis (item difficulty and item discrimination) and calculation of internal-consistency reliability and the standard error of measurement. Data analyses were conducted using Stata.

Results: Results showed significant improvement in psychometric indices, particularly item discrimination and reliability by .14 and .12 points, respectively, following the implementation of the peer review process across the three exams. Item difficulty remained unchanged for Pediatrics and Surgery.

Conclusion: Peer-review practices of multiple-choice questions using guidelines can lead to improved psychometric characteristics of items; these findings have implications for faculty development programs in improving item quality, particularly for medical schools in early stages of transforming assessment practices.     

Negative ANA-IIF in SLE patients: what is beyond?

Clinical Rheumatology - The antinuclear antibody (ANA) test has high sensitivity in diagnosing and classifying systemic lupus erythematosus (SLE). To describe the immunological pattern of SLE...     

Systemic and regional hemodynamic effects of high-dose epinephrine infusion in hypoxic piglets resuscitated with 100% oxygen

Shock and poor regional perfusion are common in asphyxiated neonates. We compared the systemic and regional hemodynamic effects of high-dose epinephrine (E) with those of dopamine combined with low-dose epinephrine (DE) infusions in a neonatal model of hypoxia-reoxygenation. Neonatal piglets (1-3 days, 1.5-2.5 kg) were acutely instrumented to continuously monitor systemic arterial pressure (SAP), pulmonary artery pressure, cardiac index (CI), and blood flows at the left common carotid, superior mesenteric, and renal arteries. Either epinephrine (1 microg.kg(-1).min(-1)) or dopamine (10 microg.kg(-1).min(-1)) and epinephrine (0.2 microg.kg(-1).min(-1)) were given for 2 h in hypoxic piglets resuscitated with 100% oxygen (n = 8 per group) in a randomized blinded fashion. Control piglets received hypoxia and reoxygenation but no catecholamine infusion (n = 7). Alveolar hypoxia (PaO2, 33-37 mmHg) caused reduced CI (89-92 vs. 171-186 mL.kg(-1).min(-1) of baseline, P < 0.05), hypotension (SAP, 28-32 mmHg) with pH 7.05 to 7.10, and decreased regional flows. Upon reoxygenation, CI and SAP improved but gradually deteriorated to 131 to 136 mL.kg(-1).min(-1) and 41 to 49 mmHg at 2 h of reoxygenation, respectively. E and DE administration similarly improved CI (167 +/- 60 and 166 +/- 55 vs. 121 +/- 35 mL.kg(-1).min(-1) of controls) and SAP (53 +/- 7 and 56 +/- 10 vs. 39 +/- 8 mmHg of controls), respectively, and the pulmonary vascular resistance (vs. controls, all P < 0.05). Heart rate and pulmonary artery pressure were not different between groups. Systemic oxygen delivery and consumption were increased in E- and DE-treated groups with no difference in extraction ratio between groups. There were no differences in regional blood flows and oxygen delivery between groups. After hyperlactatemia with hypoxia, plasma lactate levels decreased with no difference between groups. Epinephrine given as the sole agent is as effective as dopamine and low-dose epinephrine combined in treating shock and hypotension that follow the resuscitation of hypoxic neonatal piglets, with no reduction in regional perfusion.     

Elevated temperature applied during gonadal transformation leads to male bias in zebrafish (Danio rerio)

Temperature effects on sex determination or differentiation exist in many fish species, with high temperatures predominantly producing more males. The present study aimed at elucidating the genetic background of temperature effects on sex differentiation in zebrafish. Experimental fish were generated by matings between 4 or 6 golden females and a normal or a mitotic gynogenetic male, respectively. All the larvae were reared at 28.5°C until they were divided into 3 groups per full-sib family, a control group raised at 28.5°C and 2 treatment groups reared at 35°C from 20 to 30 dpf or 25 to 35 dpf, respectively. Backcross progenies, reared at 28.5°C, were derived from F1 temperature-treated sons (35°C, 25-35 dpf) that were sired by a mitotic gynogenetic male and their corresponding mothers. No significant differences were observed regarding the survival rate between the control and treatment groups. Significant differences in the phenotypic male proportions from the controls were observed in groups treated at 35°C. The sex ratio in zebrafish was influenced by the male spawner, the female spawner, and a significant interaction of genotype by temperature. Backcross experiments point to a continuum of major genetic, minor genetic, and environmental factors in the expression of the phenotypic sex in zebrafish.     

Biodegradable Nanofibrous Membranes for Medical and Personal Protection Applications: Manufacturing,Anti-COVID-19 and Anti-Multidrug Resistant Bacteria Evaluation

Biodegradable nanofibrous hybrid membranes of polyvinyl alcohol (PVA) with ZnO and CuO nanoparticles were manufactured and characterized, and their anti-COVID-19 and anti-multidrug resistant bacteria activities were also evaluated. The morphological structures of the prepared PVA composites nanofibers were observed by scanning electron microscope (SEM), which revealed a homogenous pattern of the developed nanofibers, with an average fibrous diameter of 200–250 nm. Moreover, the results of the SEM showed that the fiber size changed with the type and the concentration of the metal oxide. Moreover, the antiviral and antibacterial potential capabilities of the developed nanofibrous membranes were tested in blocking the viral fusion of SARS-COV-2, as a representative activity for COVID-19 deactivation, as well as for their activity against a variety of bacterial strains, including multi-drug resistant bacteria (MDR). The results revealed that ZnO loaded nanofibers were more potent antiviral agents than their CuO analogues. This antiviral action was attributed to the fact that inorganic metallic compounds have the ability to extract hydrogen bonds with viral proteins, causing viral rupture or morphological changes. On the other hand, the anti-multi-drug resistant activity of the prepared nanofibers was also evaluated using two techniques; the standard test method for determining the antimicrobial activity of immobilized antimicrobial agents under dynamic contact conditions and the standard test method for determining the activity of incorporated antimicrobial agents in polymeric or hydrophobic materials. Both techniques proved the superiority of the ZnO loaded nanofibers over the CuO loaded fibers. The results of the antiviral and antibacterial tests showed the effectiveness of such nanofibrous formulas, not only for medical applications, but also for the production of personal protection equipment, such as gowns and textiles.     

Differential diagnosis of a vanishing brain space occupying lesion in a child

We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging(MRI) of the brain revealed presence of intraaxial large mass(25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1 W and hyperintense signals in T2 W and fluid attenuated inversion recovery(FLAIR) images and homogenously enhanced with gadolinium(Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol(2 g/12 h per 2 d) and dexamethasone(8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy(brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion(lymphoma or glioma). Marked clinical improvement(up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1 W and hyperintense signals in T2 W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy(300 mg/12 h). At October 2014, single voxel proton(1H) MR spectroscopy(MRS) showedreduced N-acetyl-aspartate(NAA)/creatine(Cr), choline(Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.     

Enhanced and persistent levels of interleukin (IL)‐17+CD4+ T cells and serum IL‐17 in patients with early inflammatory arthritis

Prognosis of patients with early inflammatory arthritis (EIA) is highly variable. The aim of this study was to compare, longitudinally and cross-sectionally, the levels of cytokine-expressing cells in peripheral blood (PB) from patients with EIA to those in established rheumatoid arthritis (RA) and healthy controls (HC). PB mononuclear cells from HC (n = 30), patients with EIA (n = 20) or RA (n = 38) were stimulated with phorbol myristate acetate (PMA)/ionomycin for 3 h, and stained for cell markers and cytokines. Serum cytokines and chemokines were measured by Luminex. Patients with EIA were reassessed at 6 and 12 months. The percentage of interleukin (IL)-17⁺interferon (IFN)-γ⁻CD4⁺ T cells [T helper type 17 (Th17)] was increased in RA and EIA versus HC. Serum IL-1β, IL-2, IL-4 IL-17 and macrophage inflammatory protein (MIP)-1α were increased in RA and EIA versus HC. IL-1Ra, IL-15 and IFN-α were increased in EIA versus HC. IL-6 and tumour necrosis factor (TNF)-α was increased in RA but not EIA versus HC. Disease activity scores in EIA patients improved over 12 months'' treatment. Th17 percentage at baseline was correlated with both rheumatoid factor (RF) titre and functional deficit at 12 months. Baseline levels of serum granulocyte–macrophage colony-stimulating factor (GM-CSF), IL-6 and IL-8 were correlated with Larsen score at 12 months. There were no significant changes in cytokine-expressing CD4⁺T cells over time, although the percentage of IL-6⁺ monocytes increased. IL-17⁺CD4⁺ T cells and serum IL-17 levels are increased in EIA. IL-6-expressing monocytes increase during the first year of disease, irrespective of disease-modifying anti-rheumatic drug (DMARD) therapy. We observed incomplete clinical responses, suggesting EIA patients need more intensive early therapy.