Eating attitudes of migraine patients in Turkey: a prospective multi-center study.

BACKGROUND: Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study. METHODS: The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups. RESULTS: EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055). CONCLUSIONS: Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.

Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study.

OBJECTIVE: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets. METHODS: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical. RESULTS: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05. CONCLUSIONS: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Employment Preferences of Cardiologists in Türkiye: A Discrete Choice Experiment.

OBJECTIVE: The homogeneous distribution of physicians is important for ensuring patients' access to health services. To encourage physicians to work in underserved areas, policymakers create incentives. Understanding physicians' employment preferences is essential when developing these incentive packages. This study aims to quantitatively reveal the preferences of cardiologists in Türkiye using a discrete choice experiment (DCE). METHODS: A DCE questionnaire was distributed electronically to all cardiologists in Türkiye. It included 14 different pairs of hypothetical job offers based on seven parameters likely to influence their employment preferences. The data were analyzed using a conditional logit model. The coefficients (CEs) of conditional logistic regression and the willingness-to-accept (WTA) values were calculated. RESULTS: The analysis included 278 cardiologists. It revealed that the most influential parameter was location (CE: 2.86). To move to an undesirable location, the average participant would require an earnings increase of at least 123.3% relative to the average potential earnings of a cardiologist. Other parameters included availability of suitable facilities (CE: 1.07, WTA: 46.3%), harmony with co-workers (CE: 0.92, WTA: 39.61%), working conditions (CE: 0.68, WTA: 29.26%), and the number of night shifts (CE: 0.61, WTA: 26.34%). CONCLUSION: 'Location' emerged as the most important factor in the employment preferences of cardiologists in Türkiye. However, several other monetary and non-monetary factors were also influential, suggesting that policymakers should adopt a holistic approach when developing incentives for cardiologists.

ChatGPT to generate clinical vignettes for teaching and multiple-choice questions for assessment: A randomized controlled experiment.

AIM: This study aimed to evaluate the real-life performance of clinical vignettes and multiple-choice questions generated by using ChatGPT. METHODS: This was a randomized controlled study in an evidence-based medicine training program. We randomly assigned seventy-four medical students to two groups. The ChatGPT group received ill-defined cases generated by ChatGPT, while the control group received human-written cases. At the end of the training, they evaluated the cases by rating 10 statements using a Likert scale. They also answered 15 multiple-choice questions (MCQs) generated by ChatGPT. The case evaluations of the two groups were compared. Some psychometric characteristics (item difficulty and point-biserial correlations) of the test were also reported. RESULTS: None of the scores in 10 statements regarding the cases showed a significant difference between the ChatGPT group and the control group (p > .05). In the test, only six MCQs had acceptable levels (higher than 0.30) of point-biserial correlation, and five items could be considered acceptable in classroom settings. CONCLUSIONS: The results showed that the quality of the vignettes are comparable to those created by human authors, and some multiple-questions have acceptable psychometric characteristics. ChatGPT has potential in generating clinical vignettes for teaching and MCQs for assessment in medical education.

ChatGPT for generating multiple-choice questions: Evidence on the use of artificial intelligence in automatic item generation for a rational pharmacotherapy exam.

PURPOSE: Artificial intelligence, specifically large language models such as ChatGPT, offers valuable potential benefits in question (item) writing. This study aimed to determine the feasibility of generating case-based multiple-choice questions using ChatGPT in terms of item difficulty and discrimination levels. METHODS: This study involved 99 fourth-year medical students who participated in a rational pharmacotherapy clerkship carried out based-on the WHO 6-Step Model. In response to a prompt that we provided, ChatGPT generated ten case-based multiple-choice questions on hypertension. Following an expert panel, two of these multiple-choice questions were incorporated into a medical school exam without making any changes in the questions. Based on the administration of the test, we evaluated their psychometric properties, including item difficulty, item discrimination (point-biserial correlation), and functionality of the options. RESULTS: Both questions exhibited acceptable levels of point-biserial correlation, which is higher than the threshold of 0.30 (0.41 and 0.39). However, one question had three non-functional options (options chosen by fewer than 5% of the exam participants) while the other question had none. CONCLUSIONS: The findings showed that the questions can effectively differentiate between students who perform at high and low levels, which also point out the potential of ChatGPT as an artificial intelligence tool in test development. Future studies may use the prompt to generate items in order for enhancing the external validity of the results by gathering data from diverse institutions and settings.

Effectiveness of using 2D atlas and 3D PDF as a teaching tool in anatomy lectures in initial learners: a randomized controlled trial in a medical school.

BACKGROUND: Anatomy is a crucial part of medical education, and there have been attempts to improve this field by utilizing various methods. With the advancement of technology, three-dimensional (3D) materials have gained popularity and become a matter of debate about their effectiveness compared to two-dimensional (2D) sources. This research aims to analyze the effectiveness of 3D PDFs compared to 2D atlases. METHODS: This study is a randomized controlled trial involving 87 Year-1 and Year-2 medical students at Gazi University Faculty of Medicine, Turkey. The study was conducted in two steps. In Step-1, students were randomized to watch lecture videos on liver anatomy and male genitalia anatomy supplemented with either a 3D PDF (intervention group) or 2D atlas (control group) images. Following the video lectures, a test (immediate test) was administered. In Step-2, the same test (delayed test) was administered 10 days after the immediate test. The test scores were compared between the intervention and control groups. In addition to the descriptive analyses, Chi-square and Mann-Whitney U tests were performed. RESULTS: In the immediate test, while there was no significant difference between the groups for the liver test (p > 0.05), 3D PDF group's scores (Median = 24.50) was significantly higher than the 2D atlas group's in the genitalia test (Median = 21.00), (p = 0.017). The effect size (Cohen's d) was 0.57. In the delayed test, there was no significant difference between the groups in the liver and genitalia tests (p > 0.05). However, the effect size in the immediate genitalia test was 0.40. Year-1 students' immediate test of genitalia performances were significantly higher in the 3D PDF group (Median = 24.00) than the 2D atlas group (Median = 19.00), (p = 0.016). The effect size was 0.76. Also, Year-1 students' 3D PDF group (Median = 20.50) presented with significantly higher performance than the 2D atlas group (Median = 12.00), (p = 0.044) in the delayed test of genitalia, with the 0.63 effect size. CONCLUSION: 3D PDF is more effective than 2D atlases in teaching anatomy, especially to initial learners. It is particularly useful for teaching complex anatomical structures, such as male genitalia, compared to the liver. Hence, it may be a valuable tool for medical teachers to utilize during lectures.

How does evidence-based medicine training affect medical students' views on traditional, complementary, and alternative medicine and the conspiracy theories about COVID-19: a nationwide study.

AIM: It was aimed to explore the relationship between evidence-based medicine (EBM) training and medical students' views on traditional, complementary, and alternative medicine (TCAM) and their views on conspiracies about COVID-19. BACKGROUND: Medical students constitute the future workforce of primary health care services. The relationship between EBM training and their views on conspiracies about COVID-19 is critical to explore for providing a better primary health care. The relationship EBM training and medical students' views on TCAM is also important in this regard. METHODS: This is a cross-sectional study. Turkish medical students were surveyed about EBM training, TCAM, and COVID-19 conspiracies. The electronic survey form consisted of five parts: Demographic characteristics, views and self-perceived knowledge about TCAM and the methods, views on the origin of SARS-COV-2, participation in EBM training, and views on TCAM training. A total of 49 medical schools provided response. Along with descriptive statistics, Chi-square test was utilized. FINDINGS: Among 2577 participants, 24.0% of them believed SARS-COV-2 was artificially designed. The students who have participated in EBM training via both lecture and small group discussions have a less positive view on TCAM than both the students who have not participated in any EBM training (p < 0.05) and the students who participated in only-lectures (p < 0.05). There was a significant association between EBM training and whether believing COVID-19 (SARS-COV-2) has been designed purposefully by some people or it has emerged naturally χ2 (1) = 17.21 p < 0.001. The odds of thinking COVID-19 emerged naturally was 1.85 times higher (95% CI: 1.38-2.47) if the students have participated in EBM training via both lectures and small group discussions than if they have not participated in any EBM training. EBM training affects medical students in terms of beliefs on COVID-19 conspiracies.

Exploratory Factor Analysis of a Computerized Case-Based F-Type Testlet Variant.

A testlet is a cluster of questions related to a single content area. F-type testlet is a specific type of linear testlets that contains evolving scenarios. There is no study that carried out a factor analysis of an F-type testlet exam in the context of medical education and related disciplines. We aimed to determine to what extent disciplinary domains account for the variability of student performance on an online case-based F-type testlet variant. Final year undergraduate medical students (N = 441) participated in the online exam that consisted of ten case-based F-type testlets. Six of the testlets were pediatrics, four were internal medicine. Exploratory factor analysis was carried out. It revealed that the structure has two factors. Pediatrics testlets loaded factor 1 (loadings between 0.56 and 0.77), and internal medicine testlets loaded factor 2 (loadings between 0.65 and 0.79). The results showed that disciplinary domains account for the variability of the performance on F-type testlets. The results suggest that context specificity still exists in this type of exam. In order to more thoroughly evaluate the clinical reasoning skills of students, medical educators must still ensure that clinical reasoning exams include a comprehensive representation of all relevant content areas.

e-PBL with multimedia animations: a design-based research.

BACKGROUND: This study was conducted to explore the effectiveness of online problem-based learning (e-PBL) with multimedia animation scenarios by comparing the face-to-face (f2f) PBL method with paper-based scenarios. Adapting different f2f teaching methodologies to online environments is a significant problem that urgently needs attention, particularly in health education. METHODS: This study is part of design-based research and consists of three phases, which comprise design, analysis, and re-design. First, the animation-based problem scenarios were developed, and the learning environment (e-PBL) elements were organized. Then animation-based scenarios and the e-PBL environment were used, and problems related to the use of the environment were determined with an experimental study which was based on a pretest-posttest control group design. Finally, we used the following three measurement tools in the data collection process: a scale to determine the effectiveness of PBL, an attitude scale toward PBL, and the Clinical Objective Reasoning Exams (CORE). The study group in this research comprised 92 medical undergraduates (47 female and 45 male). RESULTS: There were similar scores between the two groups (e-PBL and f2f) in terms of the effectiveness of the platforms, the attitudes of the medical undergraduates, and the CORE scores. Also, there were positive relationships between the attitude scores, grade point average (GPA), and PBL scores of the undergraduates. Another significant positive relationship was found between the CORE scores and the GPA. CONCLUSIONS: The animation-supported e-PBL environment positively effects the participants' knowledge, skills, and attitude. Students who have high academic scores attitude positively towards e-PBL. Providing problem scenarios as multimedia animations is the innovative face of the research. They have been produced inexpensively with off-the-shelf web-based animation apps. These technological advances may democratize the production of video-based cases in the future. Although the results of this study were obtained before the pandemic, they showed no differences between e-PBL and f2f-PBL in terms of effectiveness.

Nivolumab-induced sensory ganglionopathy.

INTRODUCTION: Nivolumab is s a human monoclonal antibody. Due to its widespread use in many cancers, including Merkel cell carcinoma, adverse reactions associated with nivolumab, such as neuropathies, endocrinopathies, gastrointestinal problems, and skin toxicities have been increasing. Sensory ganlionopathy is rarely observed in these patients. CASE DESCRIPTION: We present a 63-year-old male with a medical history of Merkel cell carcinoma that recurred two times in the inguinal region. After undergoing surgery with adjuvant radiotherapy, a second surgery was performed. The patient suffered from tingling in all four limbs plus difficulty in walking after initiation of the third dose of nivolumab. MANAGEMENT AND OUTCOME: After 1 month of 1 mg/kg/day methylprednisolone treatment, he showed significant improvement. Subsequently, the systemic corticosteroid regimen was tapered to 5 mg every other day. The treatment resulted in significant improvement in all extremities. DISCUSSION: Sensory ganlionopathy can be seen as a side effect of an immune checkpoint inhibitor, even though it is very extraordinary. This is the case in the literature to develop sensory ganlionopathy due to nivolumab. We believe that patients using nivolumab may develop sensory ganlionopathy and management should be taken on this point.

Validation of IFMSA social accountability assessment tool: exploratory and confirmatory factor analysis.

BACKGROUND: IFMSA Social Accountability Assessment Tool has been developed for medical students by medical students to assess medical schools. However, its psychometric characteristics are unknown since it was developed without any analysis. We aimed to reveal its reliability and validity. METHODS: 1122 undergraduate medical students from various years in Gazi University Faculty of Medicine have participated in the study. They have answered the Turkish version of IFMSA Social Accountability Assessment Tool created through a translation process by experts. Exploratory and confirmatory factor analyses were carried out. RESULTS: Exploratory factor analysis showed that factor loadings were between 0.46 and 0.73 for Factor 1, 0.68 and 0.87 for Factor 2. The two-factor model, which consists of "Community Centeredness" and "Socio-Demographic Characteristics", was evaluated through confirmatory factor analysis. The goodness-of-fit statistics of the model showed well-fit: CMIN/df 4.46, GFI 0.96, CFI 0.95, RMSEA 0.05, SRMR 0.03. Standardized regression weights were between 0.43 and 0.77. CONCLUSION: The tool has acceptable psychometric characteristics, with good reliability and validity. It could be considered as a point of departure for the change in the way of being socially accountable since it enables medical students to explore the weak areas of their medical schools in terms of social accountability.

The effect of watching lecture videos at 2× speed on memory retention performance of medical students: An experimental study.

AIM: This study aimed to determine how watching lecture videos at 1× and 2× speeds affects memory retention in medical students. METHODS: A posttest-only experimental design was utilized. The participants were 60 Year-1 and Year-2 medical students. The participants were assigned to one of two groups through stratified randomization: Group 1 would watch the video at 1× speed, and Group 2 at 2× speed. Their performance was assessed using a test comprising 20 multiple-choice questions. The test has been applied immediately after watching the video (Immediate test), and, again after one week (Delayed test). Parametric and non-parametric statistical tests were performed. RESULTS: In the Immediate test, the mean score of the 1× speed group was 11.26 ± 4.06, while 2× speed group's mean score was 10.16 ± 2.46. The difference was not significant t(58) = 1.26, p > .05. In the Delayed test, the mean score of 1× speed group was 9.66 ± 3.94, while 2× speed group's mean score was 8.36 ± 2.80. The difference was not significant t(55) = 1.42, p > .05. CONCLUSIONS: Watching the video lecture at 2× speed did not impair memory retention in medical students. This may help students to save time in their dense curricula.[Box: see text].

Teaching rational prescribing in undergraduate medical education: a systematic search and review.

AIM: This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education. METHODS: This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching. RESULTS: Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes. CONCLUSION: The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported.

What do Turkish, Spanish, and Pakistani medical students value in specialty training positions? A discrete choice experiment.

BACKGROUND: The aim of this study was to find out specialty training preferences of senior medical students from three medical schools in Turkey, Spain, and Pakistan. METHODS: A Discrete Choice Experiment was carried out using an electronic form for students in three countries in 2021-2022 term. Each choice set in the form consisted of two hypothetical specialty training positions. The attributes were location, earnings, working conditions, personal perspective, quality of education, probability of malpractice, and prestige. Conditional logit model was used to estimate participants' preferences and "willingness to accept" values. RESULTS: The most valued attribute was "personal perspective on specialty area" for Turkish and Spanish students, while this attribute was not meaningful for Pakistani students. Turkish students needed a 204% of change in their income for a swap between the specialty that they like and not like. This tradeoff necessitated a 300% change for Spanish students. The most valued attribute for Pakistani students, which was "working conditions", necessitated a 97% increase in income to switch from working in good conditions to working in poor conditions. CONCLUSION: In this first multinational DCE study in the medical education literature, we found the preferences of medical students in Turkey, Spain, and Pakistan are affected to various extents by several factors.

Obstetric Ultrasonography in Postgraduate Radiology Training: A National Survey Study.

ABSTRACT: There is no study in the literature that reveals the adequacy of obstetric ultrasonography (US) training in Turkey. We aimed to evaluate the adequacy of obstetric US training radiologists had received during their residency and determine how competent they considered themselves to be in this regard.A survey (27 items for residents, 21 items for specialists) was sent to all the radiology residents and specialists in Turkey through the mail list of the Turkish Society of Radiology.Ninety-one residents and 217 specialists participated in our study. Sixteen residents (17.6%) had received theoretical courses, 21 residents (23.1%) and 59 specialists (27.2%) had attended in-house obstetric US rotations, and 5 residents (5.5%) and 23 specialists (10.6%) had attended obstetric US rotations in another institution. When questioned separately for each trimester, only 11% to 36.3% of the residents stated that they took care of a sufficient number of patients. In general, 62.6% of the residents and 25.3% of the specialists did not consider themselves to be absolutely competent in obstetric US. The competency sources were specified as residency training by 44 residents (48.6%) and 55 specialists (25.3%), postgraduate training by 2 residents (2.2%) and 78 specialist (35.9%).In Turkey, current obstetric US training does not provide the experience that will allow physicians with radiology training to easily perform and interpret obstetric US. The main reasons for this situation include the limited number of patients the physicians took care of as a resident, insufficient rotation time, and lack of theoretical courses they attended.

Photo-supercapacitors based on nanoscaled ZnO.

In this study, zinc oxide (ZnO) powders in two different morphologies, nanowire (NW) and nanoflower (NF), have been synthesized by the hydrothermal method. The eligibility of the pristine ZnO nanopowders as a photo-active material has been revealed by designing P-SC devices via the facile drop-casting method on both glass and plastic substrates in large-area applications. The impact of physical properties and especially defect structures on photo-supercapacitor (P-SC) performance have been explored. Although the dark Coulombic efficiency (CE%) of both NW and NF-based P-SC were very close to each other, the CE% of NW P-SC increased 3 times, while the CE% of NF P-SC increased 1.7 times under the UV-light. This is because the charge carriers produced under light excitation, extend the discharge time, and as confirmed by electron paramagnetic resonance, photoluminescence, and transmission electron microscopy analyses, the performance of P-SCs made from NF powders was relatively low compared to those produced from NW due to the high core defects in NF powders. The energy density of 78.1 mWh kg-1 obtained for NF-based P-SCs is very promising, and the capacitance retention value of almost 100% for 3000 cycles showed that the P-SCs produced from these materials were entirely stable. Compared to the literature, the P-SCs we propose in this study are essential for new generation energy storage systems, thanks to their ease of design, adaptability to mass production for large-area applications, and their ability to store more energy under illumination.

DMSA-coated cubic iron oxide nanoparticles as potential therapeutic agents.

Aim: Superparamagnetic cubic iron oxide nanoparticles (IONPs) were synthesized and functionalized with meso-2,3-dimercaptosuccinic acid (DMSA) as a potential agent for cancer treatment. Methods: Monodisperse cubic IONPs with a high value of saturation magnetization were synthesized by thermal decomposition method and functionalized with DMSA via ligand exchange reaction, and their cytotoxic effects on HeLa cells were investigated. Results: DMSA functionalized cubic IONPs with an edge length of 24.5 ± 1.9 nm had a specific absorption rate value of 197.4 W/gFe (15.95 kA/m and 488 kHz) and showed slight cytotoxicity on HeLa cells when incubated with 3.3 × 1010, 6.6 × 1010 and 9.9 × 1010 NP/mL for 24, 48 and 72 h. Conclusion: To the best of our knowledge, this is the first study to investigate both the cytotoxic effects of DMSA-coated cubic IONPs on HeLa cells and hyperthermia performance of these nanoparticles.

Telemedicine curriculum in undergraduate medical education: a systematic search and review.

The number of patient-doctor appointments carried out using telemedicine has surpassed in-person appointments. In spite of this, it is unclear that telemedicine curricula in undergraduate medical education reflect the real importance by means of the effectiveness of these approaches. We aimed to systematically search and review the studies that are on undergraduate telemedicine curricula. We searched the Web of Science, PubMed, and Scopus using the keywords such as telemedicine, medical education, and curriculum. Our search was limited to publication dates between January 1, 2000, and February 1, 2020. We elicited the information of the curricula as to their countries, participants, aims or objectives, teaching methods, and evaluation of effectiveness. We also evaluated the quality of the studies using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument. Out of 461 studies, seven articles were selected based on selection criteria for further review. The studies were mostly from the USA. The participant numbers were between seven and 268. There were several modes of delivery but lectures and patient encounters were used mostly. In four studies, the effectiveness was evaluated only by using satisfaction surveys, and the results were satisfactory. A study reported the acquisition and application of skills as a result. There is no well-established telemedicine curriculum in the undergraduate years. The methods vary but the effectiveness of the educational programs does not have a robust evidence base. It is evident that undergraduate medical education needs a curriculum backed by strong scientific data on its effectiveness.