A psychometric analysis of a newly developed summative, multiple choice question assessment adapted from Canada to a Middle Eastern context.

INTRODUCTION: Accreditation necessitates that assessment methods reflect the standards established by the accrediting body. The process of adapting assessments to a new context can present unique challenges with uncertainty around psychometric defensibility of the adapted exam. METHODS: A psychometric analysis of a summative multiple-choice-question (MCQ) assessment, adapted from Canada, for graduating pharmacy students from a Canadian accredited program in Qatar was conducted. Rates of difficult items, item discrimination measured by point biserial correlation (rpb), and non-functioning distractors (NFDs) were calculated to identify deficiencies and challenges with an adapted exam. Challenges encountered throughout the adaption process and recommendations were documented. RESULTS: Overall score of a 90-item, four option, MCQ exam ranged from 46.7% to 78.9% (mean of 61.9%). For difficulty, there were 17 items with less than 30% of students answering correctly, while 29 items had unacceptable or poor discrimination (rpb < 0.1). NFDs occurred in 78 items with 49 containing at least two NFDs. DISCUSSION AND CONCLUSIONS: Difficulty of the exam was deemed acceptable yet discriminator ability requires improvement. The high frequency of questions with NFDs suggests that faculty have difficulty developing plausible distractors for an adapted MCQ exam. This could be due to a lack of training or requirement for inclusion of too many distractor options. While it is feasible to implement an assessment adapted from a different learning environment, measures need to be taken to improve psychometric defensibility. The high number of questions with NFDs indicates that the current method of exam development does not encourage the incorporation of functional distractors.

Trends in the use of older overactive bladder agents and uptake of fesoterodine and mirabegron in Canada.

AIMS: To examine early trends in the use of overactive bladder (OAB) agents across Canada, with a focus on initial uptake and reimbursement of two newer agents: fesoterodine, an anticholinergic, and mirabegron, a therapeutically novel beta-3 agonist. METHODS: We conducted a population-based cross-sectional study of outpatient prescriptions for long-acting oral OAB agents dispensed to individuals in Canada between May 2010 and April 2015 to examine the differences in the uptake of the newer agents and their reimbursement through cash, private, and public payers. RESULTS: The national dispensing rate of OAB agents increased by 60% from May 2010 to April 2015 (from 924 to 1475 units per 10 000). We observed an increase in the dispensing rate of fesoterodine, solifenacin, and mirabegron, but a decrease in that of tolterodine and oxybutynin. Mirabegron was adopted rapidly after Health Canada approval, growing to a rate of 191 units per 10 000 by study completion, with its uptake being primarily funded through private payers (72.2%). Conversely, fesoterodine's uptake was minimal (8.3 units per 10 000) prior to its listing on public plans. This increased to 185 units per 10 000 by study completion, with the majority (65%) paid for by public insurers. CONCLUSIONS: The differences in the uptake and reimbursement of two new OAB agents emphasize the impact of therapeutically novel agents on the prescription rates of older OAB agents with significant adverse effects. Further studies are needed to explain changes in the dispensing rates as more provinces list the newer drugs on their formulary.

Does outcome reporting bias "cause" cancer? Risks associated with hidden data on Angiotensin receptor blockers.

Conflicting reports have been published regarding the influence of angiotensin receptor blockers (ARBs) on the incidence of cancer. One meta-analysis reported a 1% absolute increase in the incidence of cancer associated with ARBs over 4 years. Contrasting findings were reported in an industry-sponsored meta-analysis and in another meta-analysis, both of which showed no difference in the incidence of cancer in ARB treatment groups relative to control groups. The US Food and Drug Administration has recently asserted that evidence does not support an association between ARBs and the development of cancer. The current review compares the 3 published meta-analyses assessing the association between ARBs and cancer and shows that outcome reporting bias contributed to the conflicting results. Given the prevalence of this form of bias in the scientific literature, the processes for systematic reviews and meta-analyses are under siege, and there is an important role for health care regulators to play. If all outcome data from clinical trials were to be reported in the public domain, independent analyses could be performed and the results of industry-sponsored trials verified. Furthermore, if regulators were to mandate the publication, in the public domain, of all clinical outcomes collected in clinical trials, outcome reporting bias could be eliminated.