Psychometric properties of a novel knowledge assessment tool of mechanical ventilation for emergency medicine residents in the northeastern United States / 보건의료교육평가

PURPOSE: Prior descriptions of the psychometric properties of validated knowledge assessment tools designed to determine Emergency medicine (EM) residents understanding of physiologic and clinical concepts related to mechanical ventilation are lacking. In this setting, we have performed this study to describe the psychometric and performance properties of a novel knowledge assessment tool that measures EM residents' knowledge of topics in mechanical ventilation. METHODS: Results from a multicenter, prospective, survey study involving 219 EM residents from 8 academic hospitals in northeastern United States were analyzed to quantify reliability, item difficulty, and item discrimination of each of the 9 questions included in the knowledge assessment tool for 3 weeks, beginning in January 2013. RESULTS: The response rate for residents completing the knowledge assessment tool was 68.6% (214 out of 312 EM residents). Reliability was assessed by both Cronbach's alpha coefficient (0.6293) and the Spearman-Brown coefficient (0.6437). Item difficulty ranged from 0.39 to 0.96, with a mean item difficulty of 0.75 for all 9 questions. Uncorrected item discrimination values ranged from 0.111 to 0.556. Corrected item-total correlations were determined by removing the question being assessed from analysis, resulting in a range of item discrimination from 0.139 to 0.498. CONCLUSION: Reliability, item difficulty and item discrimination were within satisfactory ranges in this study, demonstrating acceptable psychometric properties of this knowledge assessment tool. This assessment indicates that this knowledge assessment tool is sufficiently rigorous for use in future research studies or for assessment of EM residents for evaluative purposes.

Mammalian target of rapamycin inhibition in polycystic kidney disease: From bench to bedside

Autosomal dominant polycystic kidney disease (ADPKD) is the most common life-threatening hereditary disease in the USA resulting in chronic kidney disease and the need for dialysis and transplantation. Approximately 85% of cases of ADPKD are caused by a mutation in the Pkd1 gene that encodes polycystin-1, a large membrane receptor. The Pkd1 gene mutation results in abnormal proliferation in tubular epithelial cells, which plays a crucial role in cyst development and/or growth in PKD. Activation of the proliferative mammalian target of rapamycin (mTOR) signaling pathway has been demonstrated in polycystic kidneys from rodents and humans. mTOR inhibition with sirolimus or everolimus decreases cysts in most animal models of PKD including Pkd1 and Pkd2 gene deficient orthologous models of human disease. On the basis of animal studies, human studies were undertaken. Two large randomized clinical trials published in the New England Journal of Medicine of everolimus or sirolimus in ADPKD patients were very unimpressive and associated with a high side-effect profile. Possible reasons for the unimpressive nature of the human studies include their short duration, the high drop-out rate, suboptimal dosing, lack of randomization of "fast" and "slow progressors" and the lack of correlation between kidney size and kidney function in ADPKD. The future of mTOR inhibition in ADPKD is discussed.

Brief introduction of TCM education in New England School of Acupuncture in the USA / 中国针灸

New England School of Acupuncture is the first Chinese Medicine School in the United States. From the aspects of school history, status of students and situation of teachers, curriculum design, clinical practice and scientific research, this present article makes a simple introduction for this school, and briefly compares the Chinese Medicine education between China and west. Different from China, the American education is more lively and vivid, open and flexible, but lacks enough attention on the study of classic and clinical practice. In a word, China and the West could learn from each other and make the best of the both worlds.

Quality of Cohort Studies Reporting Post the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement / 한국역학회지

The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist are addressed. Six top scientific medical journals with high impact factor were selected including New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal, Archive of Internal Medicine, and Canadian Medical Association Journal. Ten cohort studies published in 2010 were selected randomly from each journal. The percentage of items in the STROBE checklist that were addressed in each study was investigated. The total percentage of items addressed by these studies was 69.3 (95% confidence interval: 59.6 to 79.0). We concluded that reporting of cohort studies published in the most prestigious scientific medical journals is not clear enough yet. The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise.

Expanded newborn screening by tandem mass spectrometry: the Massachusetts and New England experience.

In February 1999, Massachusetts introduced expanded newborn screening for 20 rare metabolic disorders by MS/MS. Medium chain acyl-CoA dehydrogenase deficiency (MCADD) was mandated, in addition to 9 previously screened disorders, while the remaining 19 were offered as an optional pilot. Approximately 98% of parents have elected to participate in the optional program. Maine added MCAD in September 1999, and the optional disorders in July 2001. The other New England states are currently studying the benefits of adding additional testing. Expanded MS/MS screening in Massachusetts has thus far yielded a prevalence of approximately 1: 10,000 [200,000 screened--22 total cases--MCAD (7), VLCAD (1), SCAD (5), PA (2), 3-MCC (1), citrullinemia (1), ASA (1), argininemia (1), CPT11 (1) and 2 patients (argininemia and CPT11) with a severe neonatal presentation who died in the immediate newborn period]. All surviving patients have normal developmental outcomes so far. To evaluate the benefit of expanded newborn screening in the New England Region, the New England Consortium of Metabolic Centers has undertaken a prospective 3 year study, comparing the outcomes of patients identified by MS/MS with those diagnosed clinically. To date 22 screened patients (10 MCAD, 4 SCAD, 1 VLCAD, 1 CPT11, 13-MCC, 2 PA, 1 ASA, 1 citrullinemia and 1 argininemia) have been enrolled along with 24 clinically identified patients (7 MCAD, 1 SCAD, 1 VLCAD, 1 LCHAD, 1 argininemia, 1 tyrosinemia type 1, 6 PA, 3 GA 1, 2 GA 11, 1 MMA). Studies include: medical exam, neuropsychological assessment (Bayley Test and Stanford-Binet Test of Intelligence) and medical record review. Preliminary data suggest that the screened patients have an improved clinical outcome with fewer hospitalizations and so far, no neurological complications.