Benefits of semiology taught using near-peer tutoring are sustainable

Background Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. Methods This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students’ clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. Results 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. Conclusions Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.

Combining Lovastatin and Minocycline for the Treatment of Fragile X Syndrome: Results From the LovaMiX Clinical Trial

Background: Limited success of previous clinical trials for Fragile X syndrome (FXS) has led researchers to consider combining different drugs to correct the pleiotropic consequences caused by the absence of the Fragile X mental retardation protein (FMRP). Here, we report the results of the LovaMiX clinical trial, the first trial for FXS combining two disease-modifying drugs, lovastatin, and minocycline, which have both shown positive effects when used independently.Aim: The main goals of the study were to assess the safety and efficacy of a treatment combining lovastatin and minocycline for patients with FXS.Design: Pilot Phase II open-label clinical trial. Patients with a molecular diagnostic of FXS were first randomized to receive, in two-step titration either lovastatin or minocycline for 8 weeks, followed by dual treatment with lovastatin 40 mg and minocycline 100 mg for 2 weeks. Clinical assessments were performed at the beginning, after 8 weeks of monotherapy, and at week 20 (12 weeks of combined therapy).Outcome Measures: The primary outcome measure was the Aberrant Behavior Checklist-Community (ABC-C) global score. Secondary outcome measures included subscales of the FXS specific ABC-C (ABC-CFX), the Anxiety, Depression, and Mood Scale (ADAMS), the Social Responsiveness Scale (SRS), the Behavior Rating Inventory of Executive Functions (BRIEF), and the Vineland Adaptive Behavior Scale second edition (VABS-II).Results: Twenty-one individuals out of 22 completed the trial. There were no serious adverse events related to the use of either drugs alone or in combination, suggesting good tolerability and safety profile of the combined therapy. Significant improvement was noted on the primary outcome measure with a 40% decrease on ABC-C global score with the combined therapy. Several outcome measures also showed significance.Conclusion: The combination of lovastatin and minocycline is safe in patients for FXS individuals and appears to improve several elements of the behavior. These results set the stage for a larger, placebo-controlled double-blind clinical trial to confirm the beneficial effects of the combined therapy.

Ecological and/or Nutritional Scores for Food Traffic-Lights: Results of an Online Survey Conducted on Pizza in France

Understanding the hierarchy for consumers between different labels signaling various characteristics defining food sustainability is still an open question. A web survey was conducted in France to examine how providing different scores about the environment and/or nutrition could influence purchase intents for one pizza. 1200 participants were recruited in France in April 2021. They were asked about their purchase intents for one pizza, before and after seeing nutritional and/or ecological scores associated with colors going from green to red. A Global-Score synthetizing both nutritional and ecological dimensions was also tested. The results show that the appearance of scores and colors significantly affect the purchase intents for this pizza. Indeed, for each type of score (namely nutritional, ecological or global), the dominant effect comes from the reduction in purchase intents related to the red color, although green or yellow colors also change purchase intents but to a lesser extent. With the red color, the nutritional score leads to more significant decreases in purchasing intents than the ones related to the ecological score or the Global-Score. With an additional round, the appearance of another score complementing the alternative one underlines that the negative impact of the red color for one score on purchase intents is not outweighed by the positive impact of the green color for the other score.

Mental Imagery Skills in Alcohol-Dependent Subjects and Their Associations With Cognitive Performance: An Exploratory Study During Residential Rehabilitation

People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks.

Standards for the Weighting of Criteria and the Measurement of Interaction

This article discusses the need for standards for the assignment of importance to criteria and the measurement of interaction between them in multiple criteria analyses of complex systems. A strategy for criteria evaluation is considered that is suitable to account for the interaction among a wide variety of imprecisely assessed criteria applied simultaneously. It is based on the results of collecting sample information on preferences according to the specified criteria instead of merely an abstract comparison of the criteria. The comparison of alternatives is based on objectives that determine the formation of preferences. It is facilitated by a rating in terms of preference probabilities. Probabilistic standards grant homogeneity of measurements by different criteria, which is useful for the combination of the criteria. These standards apply to a sampling evaluation conducted via pairwise trichotomic comparison of the alternatives according to each criterion, followed by the combination of these multiple evaluations into a single global score by means of the Choquet Integral with respect to a capacity determined by applying preference concentration to the sets of probabilistic assessments. Examples of practical application are discussed.

26. Is There a Correlation Between Reactogenicity and Immune Responses of the Adjuvanted Recombinant Zoster Vaccine (RZV)? A Post-hoc Analysis

Background RZV (GSK) contains the varicella-zoster virus antigen glycoprotein E (gE) and the adjuvant system AS01B that enhances gE-specific immune responses through stimulating innate immunity. AS01B may contribute to the development of transient local or systemic post-vaccination reactions. A hypothesis that the magnitude of those reactions is predictive of immunogenicity and efficacy (i.e., “no pain, no gain”) remains untested. To evaluate potential correlations between RZV’s reactogenicity and immunogenicity in adults aged ≥ 50 years, a post-hoc analysis was conducted using data from 2 large phase 3 studies (NCT01165177, NCT01165229). Methods Reactogenicity was calculated as a single score per symptom (maximum grade recorded over 7 days post-vaccination). A global score obtained by adding each maximum severity for all reported symptoms (multivariate reactogenicity models) and a score for each reactogenicity symptom (univariate reactogenicity models) were estimated. Results The analysis included 904 and 147 RZV recipients with completed post-vaccination symptom diary cards and with anti-gE antibody results or cell-mediated immunity (CMI) results, respectively. The global score of reactogenicity post-dose 2 was significantly associated with anti-gE antibody response (p&lt; 0.001, estimate 0.112) although the absolute antibody increase associated with reactogenicity was minimal (1.29-fold increase), while the association with CMI response was not statistically significant (p=0.073, estimate 0.230). There was a weak, but statistically significant association between gE-specific immune responses and the maximum pain post-dose 2 score (p=0.001, estimate 0.041), irrespective of post-vaccination time. Nevertheless, there are observations of immune responses in participants for whom pain was not reported. Conclusion A weak but statistically significant correlation was found between injection site pain intensity and immune responses in adult RZV recipients aged ≥ 50 years. However, participants reporting no pain were also able to mount a strong immune response, therefore pain cannot be a surrogate marker to inform on the level of immune response or on likelihood of being protected against herpes zoster. Funding GlaxoSmithKline Biologicals SA Disclosures Andrea Callegaro, PhD, GSK group of companies (Employee, Shareholder) David O. Willer, PhD, GSK group of companies (Employee, Other Financial or Material Support, Receive GSK shares as part of employment renumeration) Wivine Burny, PhD, GSK group of companies (Employee) Caroline Hervé, PhD, GSK group of companies (Employee) Joon Hyung Kim, MD, GSK group of companies (Employee, Shareholder) myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support) Toufik Zahaf, PhD, GSK group of companies (Employee, Shareholder) Anthony L. Cunningham, F.A.H.M.S., MD, M.B.B.S., B. Med. Sci. (Hons), F.R.A.C.P., F.R.C.P.A., F.A.S.M., GSK group of companies (Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau) Arnaud Didierlaurent, PhD, GSK group of companies (Other Financial or Material Support, previous employee until 03/2020)Sanofi (Speaker’s Bureau)

The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan

Background Shared decision-making (SDM) is significantly associated with promoting the quality of end-of-life (EOL). The attitude of nurses toward the end of life can affect EOL care, but there are few SDM-related clinical learning programs focused on EOL. In this study, therefore, we evaluated the effectiveness of an EOL-simulation education program on attitudes toward SDM among nurses, using an objective structured clinical examination (OSCE). Methods We used a quasi-experimental study design to evaluate nurses working at a medical center in Taiwan. We recruited 100 nurses and assigned them to an experimental group (n = 50) and a control group (n = 50). The experimental group received the SDM attitude (SDMA) cultivation program, and the control group did not. After the intervention, all participants were examined in an OSCE to assess the efficacy of their learning. A p value of.05 was considered statistically significant. Results The average score of the experimental group was higher than that of the control group in the dimensions “empathic communication” and “mastery learning”, but these differences were not significant. SDMA score is significantly and positively correlated with SDMA global score, standardized patient survey (SPS) score, and SPS global score (r = .92, .56, and .50, respectively; p < .01). Conclusions Simulations concerning EOL care that incorporate SDM components would be effective for training clinical nurses. This study can serve as a reference for nursing-administration managers who may consider designing SDM-related education programs to improve the quality of clinical nursing care.

Detección de déficits neuromusculares a través del análisis del patrón de salto y aterrizaje en deportistas adolescentes

El objetivo principal del presente estudio fue analizar el rendimiento de la técnica del salto y aterrizaje en deportistas adolescentes mediante la versión modificada del Tuck Jump Assessment (TJA). Como objetivo secundario se compararon los resultados obtenidos, según sexo. Se puntuó cada variable de la herramienta mediante el análisis en video de la prueba de los 75 participantes incluidos en el estudio. Las variables contempladas fueron la puntuación global del TJA y cada criterio del instrumento: 1) Valgo de la extremidad inferior en el aterrizaje; 2) Muslos no paralelos (punto máximo de salto); 3) Muslos no alineados durante la fase de vuelo; 4) Mala alineación de los pies con los hombros; 5) Posición de los pies no paralela (de la punta al talón); 6) Contacto desigual de los pies (aterrizaje asimétrico); 7) Demasiado ruido en el aterrizaje; 8) Pausa entre saltos; 9) La técnica empeora antes de los 10 segundos; 10) No aterriza en el mismo punto (salto consistente). Los valores promedios de la puntuación global de la versión modificada del TJA fueron 8,85±2,31 en el total de la muestra (8,85±2,63 hombres vs. 8,86±2,14 mujeres). Los resultados de la comparación según sexo indicaron diferencias significativas en el criterio 1 (χ2=10,288; p< 0,01), en el criterio 2 (χ2=20,788; p< 0,01), en el criterio 4 (χ2=22,587; p< 0,01) y en el criterio 10 (χ2=8,883; p< 0,01). En consecuencia, el análisis del patrón de salto y aterrizaje permite identificar alteraciones neuromusculares y biomecánicas del patrón de salto-aterrizaje. The main objective of the present study was to analyze the performance of the jump and landing technique in adolescent team sports athletes through the modified version of the Tuck Jump Assessment, (TJA). As a secondary objective, the results obtained were compared, according to sex. Each outcome measure of the tool was scored through video analysis of the test of the 75 participants included in the study. The main outcome measures were the total score of TJA and each of the ten items: Knee valgus at landing (1), thighs do not reach parallel (2), thighs not equal side-to-side (3), foot placement not shoulder width apart (4), foot placement not parallel (5), foot contact timing not equal (6), excessive landing contact noise (7), pause between jumps (8), technique declines prior to ten seconds (9), and does not land in the same footprint (10). The variables contemplated were the global score of the TJA and the ten criteria of the instrument. The average values of the global score of the modified version of the TJA were 8.85±2.31 in the total sample (8.85±2.63 men vs. 8.86±2.14 women). The results of the gender comparison indicated significant differences in item 1 (χ2=10,288; p< 0,01), item 2 (χ2=20,788; p<0,01), item 4 (χ2=22,587; p<0,01) and item 10 (χ2=8,883; p< 0,01). Consequently, the analysis of the jump and landing pattern makes it possible to identify neuromuscular and biomechanical alterations of the jump-landing pattern. O objetivo principal do presente estúdio fue analisar o rendimiento da técnica do salto e aterrissagem em deportistas adolescentes mediante a versão modificada do Tuck Jump Assessment (TJA). Como objetivo secundário se comparar os resultados obtidos, según sexo. Se puntuó cada variável do herramienta mediante a análise no vídeo da prueba dos 75 participantes incluidos no estudio. As variáveis contempladas na versão global do TJA e cada critério do instrumento: 1) Valgo de la extremidad inferior en el aterrizaje; 2) Muslos no paralelos (ponto máximo de salto); 3) Muslos no alineados durante la fase de vuelo; 4) Mala alineación de los pies con los hombros; 5) Posición de los pies no paralela (de la punta al talón); 6) Contacto desigual de los pies (aterrizaje asimétrico); 7) Demasiado ruido en el aterrizaje; 8) Pausa entre saltos; 9) La técnica empeora antes de los 10 segundos; 10) No aterriza en el mismo punto (salto consistente). Os valores prometidos da versão global modificada do TJA fueron 8,85 ± 2,31 no total da muestra (8,85 ± 2,63 hombres vs. 8,86 ± 2,14 mujeres). Os resultados da comparação segundo sexo indicaron diferencias relevantes no critério 1 (χ2 = 10.288; p <0,01), no critério 2 (χ2 = 20.788; p <0,01), no critério 4 (χ2 = 22.587 ; p <0,01) e o critério 10 (χ2 = 8.883; p <0,01). Na sequência, a análise do patrón de salto y aterrizaje permite identificar alterações neuromusculares y biomecánicas del patrón de salto-aterrizaje.

The Relationship Between Self-Perceived Hearing Ability and Binaural Speech-in-Noise Performance in Adults With Normal Pure-Tone Hearing

Purpose This study examined the relationship between self-perceived hearing abilities and binaural speech-in-noise performance in young to middle-age adults with normal pure-tone hearing. Method Sixty-six adults with normal hearing (thresholds ≤ 25 dB HL at 250–8000 Hz) participated. Self-perceived hearing abilities were assessed using the Adult Auditory Performance Scale (AAPS). The AAPS provides a single global score of self-perceived hearing abilities and individual subscale scores for six listening conditions, namely, Quiet, Ideal, Noise, Multiple Inputs, Auditory Memory, and Auditory Attention. Binaural speech-in-noise performance was measured with the Listening in Spatialized Noise–Sentences Test (LiSN-S). Results Results revealed significant correlations between the AAPS and the LiSN-S. Listeners who scored higher on the AAPS (greater self-perceived hearing difficulty) performed poorer on the LiSN-S. The strongest correlations were observed between the AAPS Noise subscale score and the LiSN-S low- and high-cue conditions. Age was significantly correlated with both pure-tone hearing and the LiSN-S spatial advantage, with older participants exhibiting poorer thresholds and smaller spatial advantages. Pure-tone hearing was also significantly correlated with binaural speech-in-noise performance. Listeners with poorer thresholds performed poorer across multiple LiSN-S conditions. Linear regression revealed that a significant amount of the variance in LiSN-S performance was accounted for by pure-tone hearing as well as the AAPS global score and Noise subscale score. Conclusions Results demonstrate a clear relationship between an individual's self-perceived hearing ability and their binaural speech-in-noise performance. In addition, minimal threshold elevation within the normal range and age (i.e., middle adulthood) had a negative impact on binaural speech-in-noise performance. The results support the inclusion of speech-in-noise testing for all patients, even those whose pure-tone hearing falls within the traditional normal range.