Triad of rubric assessment, constructive feedback and video recorded surgeries key assessment for competent ophthalmic surgeon

Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student & Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries & constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee.Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons.Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent.This will ultimately improve the overall quality of patient care.

Test-retest reliability of the HEXACO-100—And the value of multiple measurements for assessing reliability

Despite the widespread use of the HEXACO model as a descriptive taxonomy of personality traits, there remains limited information on the test-retest reliability of its commonly-used inventories. Studies typically report internal consistency estimates, such as alpha or omega, but there are good reasons to believe that these do not accurately assess reliability. We report 13-day test-retest correlations of the 100- and 60-item English HEXACO Personality Inventory-Revised (HEXACO-100 and HEXACO-60) domains, facets, and items. In order to test the validity of test-retest reliability, we then compare these estimates to correlations between self- and informant-reports (i.e., cross-rater agreement), a widely-used validity criterion. Median estimates of test-retest reliability were .88, .81, and .65 (N = 416) for domains, facets, and items, respectively. Facets’ and items’ test-retest reliabilities were highly correlated with their cross-rater agreement estimates, whereas internal consistencies were not. Overall, the HEXACO Personality Inventory-Revised demonstrates test-retest reliability similar to other contemporary measures. We recommend that short-term retest reliability should be routinely calculated to assess reliability.

Reliability of televisits for patients with mild relapsing–remitting multiple sclerosis in the COVID-19 era

Background Evidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely. Objectives This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits. Methods In total, 76 patients with relapsing–remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants. Results The inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70–0.91; p < 0.001). Conclusions Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.

Interpretation Biases in Pain: Validation of Two New Stimulus Sets

Adults with chronic pain interpret ambiguous information in a pain and illness related fashion. However, limitations have been highlighted with traditional experimental paradigms used to measure interpretation biases. Whilst ambiguous scenarios have been developed to measure interpretation biases in adolescents with pain, no scenario sets exist for use with adults. Therefore, the present study: (i) sought to validate a range of ambiguous scenarios suitable for measuring interpretation biases in adults, whilst also allowing for two response formats (forced-choice and free response); and (ii) investigate paradigm efficacy, by assessing the effects of recent pain experiences on task responding. A novel ambiguous scenarios task was administered to adults (N = 241). Participants were presented with 62 ambiguous scenarios comprising 42 that could be interpreted in a pain/pain-illness or non-pain/non-pain illness manner: and 20 control scenarios. Participants generated their own solutions to each scenario (Word Generation Task), then rated how likely they would be to use two researcher-generated solutions to complete each scenario (Likelihood Ratings Task). Participants also rated their subjective experiences of pain in the last 3 months. Tests of reliability, including inter-rater agreement and internal consistency, produced two ambiguous scenario stimulus sets containing 18 and 20 scenarios, respectively. Further analyses revealed adults who reported more recent pain experiences were more likely to endorse the pain/pain-illness solutions in the Likelihood Ratings Task. This study provides two new stimulus sets for use with adults (including control items) in pain research and/or interventions. Results also provide evidence for a negative endorsement bias in adults.

Inter-rater agreement among shoulder surgeons on treatment options for proximal humeral fractures among shoulder surgeons

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures.Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomograms of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed.Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity.Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

Developing Deep Learning Models for the Classification of Pediatric Elbow Radiographic Abnormalities of Comparable Performance to Physicians: Strategies for Model Optimization With Small Sized Development Sets

BackgroundTo compare the performance of an AI model based on strategies designed to overcome small sized development sets to pediatric ER physicians at a classification triage task of pediatric elbow radiographs. Methods1,314 pediatric elbow lateral radiographs (mean age: 8.2 years) were retrospectively retrieved, binomially classified based on their annotation as normal or abnormal (with pathology), and randomly partitioned into a development set (993 images), tuning set (109 images), second tuning set (100 images) and test set (112 images). The AI model was trained on the development set and utilized the EfficientNet B1 compound scaling network architecture and online augmentations. Its performance on the test set was compared to a group of five physicians (inter-rater agreement: fair). Statistical analysis: AUC of AI model - DeLong method. Performance of AI model and physician groups - McNemar test. ResultsAccuracy of the model on the test set - 0.804 (95% CI, 0.718 - 0.873), AUROC - 0.872 (95% CI, 0.831 - 0.947). AI model performance compared to the physician group on the test set - sensitivity 0.790 (95% CI 0.684 to 0.895) vs 0.649 (95% CI 0.525 to 0.773), p value 0.088; specificity 0.818 (95% CI 0.716 to 0.920) vs 0.873 (95% CI 0.785 to 0.961), p value 0.439.ConclusionsThe AI model for elbow radiograph triage designed with strategies to optimize performance for a small sized development set showed comparable performance to physicians.

Axillary Web Syndrome: characterization of the different forms of clinical presentation of the cord.

ObjectiveDescribe and characterize the forms of presentation and manifestation of the cord present in the Axillary Web Syndrome.Materials and MethodsAfter a favorable opinion from the Research Ethics Committee of the Federal University of Goiás, the construction of items for the Axillary Web Syndrome Classification Scale began, based on the search for concepts involved in its diagnosis. The various steps of construction, application and validation of the instrument occurred from April 2020 to August 2021. The research took place at the outpatient clinic of Mastology at Hospital das Clínicas (Goiás). In the evaluation position: supine, upper limb ipsilateral to the breast operated in abduction, extension and external rotation of the shoulder, extension and supination of the elbow, extension of the wrist and fingers, information on the specific characteristics of the cord was recorded.ResultsThe means presented by the evaluators were almost identical for the variables related to the characterization of the cord, indicating a strong correlation, Cronbach's alpha was 0.894 for evaluator 1 and 0.879 for evaluator 2, indicating strong internal consistency. Inter-rater agreement was 100% (p>0.001) for almost all variables evaluated, with the lowest Kappa coefficient (0.77 p>0.001) for “Length”.ConclusionA consensus on classification criteria can be useful among researchers and practitioners. The fibrous cord classification items compiled in this study address its forms of presentation and manifestation and contribute to standardizing the assessment and classification of Axillary Web Syndrome.