scholarly journals Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking (Preprint)

2020 ◽  
Author(s):  
Maximilian C Fink ◽  
Victoria Reitmeier ◽  
Matthias Stadler ◽  
Matthias Siebeck ◽  
Frank Fischer ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cognitive Load ◽  
Standardized Patients ◽  
Assessment Methods ◽  
Virtual Patients ◽  
History Taking ◽  
Quality Of Evidence ◽  
Diagnostic Competences ◽  
Evidence Generation

BACKGROUND Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. OBJECTIVE The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. METHODS We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. RESULTS Perceived authenticity (1-tailed <i>t</i><sub>81</sub>=11.12; <i>P</i>&lt;.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (<i>r</i>=0.05) and neither equivalent (<i>P</i>=.09) nor statistically significant (<i>P</i>=.32). Cognitive load was equivalent in both assessment methods (<i>t</i><sub>82</sub>=2.81; <i>P</i>=.003). Intrinsic cognitive load (1-tailed <i>r</i>=−0.30; <i>P</i>=.003) and extraneous load (1-tailed <i>r</i>=−0.29; <i>P</i>=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed <i>r</i>=0.38; <i>P</i>&lt;.001); this finding did not hold for SPs (1-tailed <i>r</i>=0.05; <i>P</i>=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed <i>t</i><sub>85</sub>=2.49; <i>P</i>=.01). CONCLUSIONS The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students’ grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.

Randomized controlled trials

2003 ◽  
pp. 177-202
Author(s):  
Sube Banerjee
Keyword(s):  
Randomized Controlled Trials ◽  
Case Control ◽  
Controlled Trials ◽  
History Taking ◽  
Cross Sectional ◽  
Quality Of Evidence ◽  
Laboratory Science ◽  
Randomized Controlled ◽  
Why Questions

There are three main questions in health care: ‘what is going on?’, ‘why?’ and ‘what do we do about it?’. ‘What is going on?’ forms the basis for clinical assessment including history taking, examination, and diagnosis. The question ‘why?’ underlies all aetiological research from laboratory science to epidemiology. The cross-sectional, case–control and cohort methodologies discussed in other chapters in this book provide the methodology for addressing ‘why?’ questions. However, just as medicine is more than diagnosis it also covers treatment, medical research is more than aetiology: it also necessarily extends to the evaluation of interventions. Aetiological research which cannot be translated into health benefits through new or improved interventions is at best sterile and at worse selfindulgent, begging another important question: ‘so what?’. Flawed evaluations of interventions can be even more problematic since these may harm rather than help. Intervention studies (of which randomized controlled trials (RCTs) are the most important type, on the basis of quality of evidence available from them) take aetiological insights into action and provide the best evidence upon which to found clinical practice. In this chapter we will consider some of the more important factors in the design, conduct, analysis, and interpretation of RCTs.

Quality of Virtual Patients on WeChat for Nursing History-Taking Training

2019 ◽  
Vol 36 ◽  
pp. 37-46
Author(s):  
Jie Luo ◽  
Jing Zheng ◽  
Huan He ◽  
Ting Liu ◽  
Juanjuan Zhao ◽  
...  
Keyword(s):  
Virtual Patients ◽  
History Taking ◽  
Nursing History

Coaching Teachers to Enhance the Implementation Quality of Evidence-Based Programs

2013 ◽  
Author(s):  
Kimberly D. Becker ◽  
Dana Darney ◽  
Celene Domitrovich ◽  
Catherine Bradshaw ◽  
Nicholas S. Ialongo
Keyword(s):  
Evidence Based ◽  
Implementation Quality ◽  
Quality Of Evidence ◽  
Evidence Based Programs

scholarly journals Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses

2021 ◽  
Vol 10 (7) ◽  
pp. 1478
Author(s):  
Alexandra Voinescu ◽  
Jie Sui ◽  
Danaë Stanton Fraser
Keyword(s):  
Virtual Reality ◽  
Cerebral Palsy ◽  
Brain Injury ◽  
Upper Limb ◽  
Umbrella Review ◽  
High Quality ◽  
Quality Of Evidence ◽  
Upper Limb Function ◽  
Meta Analyses

Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.

scholarly journals Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (6) ◽  
pp. 3189
Author(s):  
Nisha Naicker ◽  
Frank Pega ◽  
David Rees ◽  
Spo Kgalamono ◽  
Tanusha Singh
Keyword(s):  
Occupational Health ◽  
Health Services ◽  
Informal Economy ◽  
Odds Ratio ◽  
Health Services Use ◽  
Quality Of Evidence ◽  
Formal Economy ◽  
Relative Differences ◽  
Services Use

Background: There are approximately two billion workers in the informal economy globally. Compared to workers in the formal economy, these workers are often marginalised with minimal or no benefits from occupational health and safety regulations, labour laws, social protection and/or health care. Thus, informal economy workers may have higher occupational health risks compared to their formal counterparts. Our objective was to systematically review and meta-analyse evidence on relative differences (or inequalities) in health services use and health outcomes among informal economy workers, compared with formal economy workers. Methods: We searched PubMed and EMBASE in March 2020 for studies published in 1999–2020. The eligible population was informal economy workers. The comparator was formal economy workers. The eligible outcomes were general and occupational health services use, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, depression, noise-induced hearing loss and respiratory infections. Two authors independently screened records, extracted data, assessed risk of bias with RoB-SPEO, and assessed quality of evidence with GRADE. Inverse variance meta-analyses were conducted with random effects. Results: Twelve studies with 1,637,297 participants from seven countries in four WHO regions (Africa, Americas, Eastern Mediterranean and Western Pacific) were included. Compared with formal economy workers, informal economy workers were found to be less likely to use any health services (odds ratio 0.89, 95% confidence interval 0.85–0.94, four studies, 195,667 participants, I2 89%, low quality of evidence) and more likely to have depression (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26,260 participants, I2 87%, low quality of evidence). We are very uncertain about the other outcomes (very-low quality of evidence). Conclusion: Informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for relative differences in the other eligible outcomes. Further research is warranted to strengthen the current body of evidence and needed to improve population health and reduce health inequalities among workers.

Ondansetron reduces the incidence of hypotension after spinal anaesthesia in non-caesarean delivery: A systematic review and meta-analysis

2021 ◽  
pp. 175045892096415
Author(s):  
Tito D Tubog ◽  
Richard S Bramble
Keyword(s):  
Systematic Review ◽  
Arterial Pressure ◽  
Spinal Anaesthesia ◽  
Caesarean Delivery ◽  
Meta Analysis ◽  
Systolic Arterial Pressure ◽  
Incidence Rates ◽  
Induced Hypotension ◽  
Quality Of Evidence

The incidence rates of spinal anaesthesia-induced hypotension vary depending on the surgical procedures. This systematic review and meta-analysis evaluates the efficacy of prophylactic ondansetron in reducing the incidence of spinal anaesthesia-induced hypotension in non-caesarean delivery. Thirteen trials consisting of 1166 patients were included for analysis. Compared to placebo, there is a low quality of evidence that ondansetron was effective in reducing the incidence of spinal anaesthesia-induced hypotension (RR 0.62, 95% CI 0.44 to 0.87; p = 0.005) and bradycardia (RR 0.54, 95% CI 0.32 to 0.90; p = 0.02). We also found a moderate quality of evidence that ondansetron lowered the number of rescue ephedrine (RR 0.61, 95% CI 0.43 to 0.87; p = 0.007). Patients treated with ondansetron have higher mean arterial pressure 15 to 20 minutes after spinal anaesthesia induction and higher systolic arterial pressure 5, 10, 15 and 20 minutes after spinal anaesthesia. The evidence suggests that prophylactic administration of ondansetron results in the reduction of the incidence of spinal anaesthesia-induced hypotension, bradycardia and rescue ephedrine in patients undergoing non-caesarean delivery under spinal anaesthesia.

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