Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6–59 Months in the ComPAS Cluster Randomized Controlled Trial

Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.

Saudi Standardized Tests and English Competence: Association and Prediction for Freshmen Medical Students’ Performance in Chemistry

The research is created to investigate the prediction of admission criteria for medical student achievement in chemistry in Saudi Arabia. It examines if the General Aptitude Test (GAT), the Scholastic Achievement Admission Test (SAAT), and English competence, can to a certain extent predict and foretell students&rsquo; achievement in the chemistry. The study sample consists of 240 participants, providing their grades in the admission criteria and chemistry. Regression analyses are utilized to define the weight of individual admission criterion prediction for student achievement in chemistry. It illustrates that admission criteria could predict students&rsquo; grades in chemistry with a variance of 30%. The results also show English competence does play a more significant rule in predicting students&rsquo; performance in chemistry. More research is needed to examine whether these criteria are also predictors with a large scale of students&rsquo; population.

Hospitalization patterns of uninsured as base for services and health need assessment

Background Solidarity is crucial for shifting from centralized to social health insurance model. Uninsured receive at least emergency and basic services free-of-charge. To which extent this policy really covers their health and services needs remains to be assessed. Methods DRGNational database (457 hospitals) was interrogated for continuous hospitalization of uninsured, 2014-2018. Use patterns were identified by episodes, LOS, diagnose, admission criterion. Avoidable admissions were assessed according to OECD criteria. Results Number of hospital episodes in uninsured varied annually, difference ranging from -13.5 to 6.3%; largest decrease in 2015 possibly due to day surgery implemented in 2014. About 2.5-3% of all episodes and hospitalization days were for uninsured. Use patterns identified: Most common admission criterion: Emergencies (95%) compared to Specific diagnosis&treatment, Births, Potentially endemic/epidemic diseases; Most frequent diagnosis: Emergency around birth,Mental disorders, Respiratory infections; Men 45 years old living in rural areas prevailed significantly; significant gender difference by age (9 years; t-test, p &lt; 0.05); 3% of hospitalizations could be avoided by assistance in prehospital (asthma, COPD, CHF, Diabetes&utation). Conclusions The use patterns identified show inequity in access and gaps in policy meant to ensure solidarity in health. Day surgery was inittially beneficial in reducing financial burden, but addressing to prehospital health services continues to be low inducing overload of emergency units. A solution could be higher involvement of other sectors to ensure socio-economic security for all. Free-of-charge emergency hospital services ensure access for life threatening conditions but shortcut pre-hospital and postpone initial visits until non-preventable/-manageable stages. Key messages Reconsider services package to increase access for uninsured. Develop bridges between domains able to meet health related needs by intersectorial collaborations: labor, social, economic, health etc. Periodic analyze hospitalizations of uninsured, together with legal framework and sectoral policies to allow an appropriate decisions making and tailored intervention design.

The Predictive Validity of Standardized Tests and English Proficiency for Saudi Medical Students’ Performance in Biology

The study is designed to examine the predictive power of Saudi-admission criteria for student performance in an introductory biology course. It focuses on the second semester at King Saud bin Abdulaziz University for Health Sciences. The study addresses whether the General Aptitude test (GAT), the Scholastic Achievement Admission Test (SAAT), and the students’ English proficiency, taken together can accurately predict student performance in the biology course. Their English proficiency was measured by using the average grade in the intensive English courses taken in the first semester, in addition to the average grade in the reading and communication proficiency tests. The research involved the results of 250 male students in the admission criteria and biology-course grades. Simple linear and multivariate regression models are used to determine the predictive variance of each admission criterion for student success in the biology course. The results demonstrate that the admission criteria are significant predictors, but with a variance of 26.6%. The results also show that individually, GAT and SAAT are the poorest predictors, whereas the reading and communication proficiency tests were the best. The findings reveal that the predictive power of these admission criteria as a combined model is low. Additionally, more investigation is necessary to ascertain whether these criteria are also low predictors in other subjects and in overall college learning.

Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study

Background: Empathy is critical to patient-centered care and thus is a valued trait in graduate health-care students. The relationship between empathy and civic-mindedness in health professions has not previously been explored. Objectives: (a) To determine whether significant differences occurred on the Jefferson Scale for Empathy–Health Professions Student Version (JSE-HPS) and Civic-Minded Professional scale (CMP) and its subscales across the curriculum, (b) to explore a potential relationship between civic-mindedness and empathy in a cohort of graduate physical therapy (PT) students at regular intervals, and (c) to explore the predictive ability of civic-mindedness on empathy scores. Methods: This study was a convenience sample of a cohort of 48 PT students who completed both the JSE-HPS and the CMP at 4 points of a service-learning intensive curriculum. Statistical analysis included descriptive statistics, a Friedman’s analysis of variance with Wilcoxon signed-ranks post hoc testing, and Spearman correlations with stepwise linear regressions. Results: Statistically significant differences were not found for the JSE-HPS. Civic-Minded Professional scores increased across the curriculum. The JSE-HPS, the CMP, and various CMP subscales were significantly correlated. The JSE-HPS pretest scores were predictive of the year 1 and 2 posttest JSE-HPS scores. Conclusion: This study’s findings indicate that service-learning and the resulting development of civic-mindedness supports empathy. Programs could use JSE-HPS pretests to identify individual graduate students need for empathy mentorship upon program entrance or as one admission criterion.

An Integrative Review on Standardized Exams as a Predictive Admission Criterion for RN Programs

Nursing programs reject qualified applicants due to limited clinical placements and faculty. By admitting the strongest candidates, schools of nursing will reduce attrition rates, increase NCLEX-RN pass rates, and speed the entry into practice of well-prepared nurses to help stem the nursing shortage. This integrative review identified the standardized admission exams most predictive of student success. Included were articles published between 2005 and 2016 that focused on admission criteria, RN programs, specific exams (e. g., HESI-A2, TEAS, SAT, CAAP, or ACT), NCLEX-RN performance, or program success. Standardized exams are effective predictors of success in programs of nursing and first-attempt NCLEX-RN. While predictive accuracy differs between exams, findings suggest that the HESI-A2 is currently the best predictor of success. By optimizing the use of standardized exams as admission criteria, nursing programs can reduce attrition rates and improve NCLEX-RN pass rates. This will maximize program capacity and contribute to a greater number of practicing nurses.

A Synthesis of Peer-Reviewed Literature on Team-Coordinated and Delivered Early Supported Discharge After Stroke

This review aimed to summarize data from peer-reviewed studies of team-coordinated and delivered early supported discharge (ESD) for postacute, poststroke rehabilitation. A systematic review was performed in Medline, Embase, and CINAHL for appropriate studies. Information on program details and patient cohorts was synthesized. All programs sought patients with mild-to-moderate functional impairment and minimal cognitive impairment (often based on Barthel Index and Mini-Mental State Examination scores, respectively). All also included at least one subjective admission criterion related to rehabilitation suitability or the suitability of the home environment. Based on the identified studies, ESD programs can assume that 15% of patients screened for ESD will be eligible and care should be provided for 4 to 5 weeks postdischarge. Although the benefits of team-coordinated and delivered ESD poststroke have been well-documented, this review may be helpful for clinicians, administrators, and policy makers looking to establish or refine an ESD program for stroke.

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

ObjectiveThe present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.DesignWe performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6–59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<−3 and MUAC≥115 mm.ResultsOf 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<−3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<−3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<−3 alone and 100 % by MUAC<130 mm.ConclusionsThe study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.