Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over ...traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics.
This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013-14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course.
Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001).
This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•PDT reached significant eradication of pathogenic microorganisms compared to diode laser and chemo-mechanical treatments in the young permanent teeth with CPP.•PDT could be suggested as a safe, ...feasible, and non-traumatic adjunctive to conventional treatment of the periapical lesion.•PDT might be an effective adjunct to the standard endodontic treatment of young permanent teeth with CPP.
The study aimed at determining antibacterial efficiency of adjuvant photodynamic therapy (PDT) and high-power diode laser (DL) in the treatment of chronic periapical periodontitis (CPP) in young permanent teeth.
Forty-four young permanent teeth with CPP were randomly divided into three groups (PDT, DL and control). Each tooth underwent standard chemo-mechanical treatment, while within tested groups was additionally treated by PDT or DL. Bacterial identification and quantification were provided by MALDI–TOF spectrometry and plate counting assay, performed after accessing the canal, following chemo-mechanical preparation, and after PDT or DL procedure where applicable.
Thirty-nine young permanent teeth with CCP (patients age 9.77 ± 1.43) completed the study. Before the treatments, 202 isolates belonging to 13 genera/species, including Streptococcus (36), Actinomyces (34), Peptostreptococcus micros (27), Veillonella (25) and Enterococcus faecalis (22), were recovered. Chemo-mechanical treatment reduced CFU count in the all three groups (p < 0.001), but complete eradication was not observed for any of isolated species. Adjuvant PDT and DL completely eradicated isolates of 8 and 6 bacterial genera/species, resulting in complete bacterial elimination from 53.8% and 30.8% of root canals, respectively. In the rest canals, total Δlog CFUs were 4.71 and 4.58.
The results indicated that both PDT and DL could be performed as adjuvants to standard endodontic treatment of the young permanent teeth with CPP.
Abstract The aim of this study was to provide a comprehensive meta-analytic review of the reliability of the Hamilton Rating Scale for Depression (HRSD) for the period 1960–2008, taking into ...consideration all three types of reliability: internal consistency, inter-rater, and test–retest reliability. This is the first such meta-analytic study of a clinician-administered psychiatric scale. A thorough literature search was conducted using MEDLINE and PsycINFO. The total number of collected articles was 5548, of which 409 reported one or more reliability coefficients. The effect size was obtained by the z -transformation of reliability coefficients. The meta-analysis was performed separately for internal consistency, inter-rater and test–retest reliability. A pooled mean for alpha coefficient in random effects model was 0.789 (95%CI 0.766–0.810). The meta-regression analysis revealed that higher alpha coefficients were associated with higher variability of the HRSD total scores. With regard to inter-rater reliability, pooled means in random effects model were 0.937 (95%CI 0.914–0.954) for the intraclass correlation coefficient, 0.81 (95%CI 0.72–0.88) for the kappa coefficient, 0.94 (95%CI 0.90–0.97) for the Pearson correlation coefficient, and 0.91 (95%CI 0.78–0.96) for the Spearman rank correlation coefficient. A meta-regression analysis showed positive association between inter-rater reliability and publication year. Test–retest reliability of HRSD ranged between 0.65 and 0.98 and generally decreased with extending the interval between two measurements (Spearman r between the duration of interval and test–retest reliability figures = –0.74). Results suggest that HRSD provides a reliable assessment of depression. Figures indicate good overall levels of internal consistency, inter-rater and test–retest reliability, but some HRSD items (e.g., “loss of insight”) do not appear to possess a satisfactory reliability.
Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention.
This study investigated the ...prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender.
We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender.
Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20-44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women.
Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As the existing data on the correlation of adiposity with adverse outcomes of carotid endarterectomy (CEA) are inconsistent, the aim of the present study is to examine the correlation of an increased ...body mass index with 30-day complications after carotid endarterectomy. The cohort study comprises 1586 CEAs, performed at the Clinic for Vascular Surgery in Belgrade, from 2012-2017. Out of them, 550 CEAs were performed in patients with normal body mass index (18.5-24.9), 750 in overweight (25.0-29.9), and 286 in obese (≥30) patients. The association of overweight and obesity with early outcomes of carotid endarterectomy was assessed using univariate and multivariate logistic regression analysis. Overweight patients, in whom CEAs were performed, were significantly more frequently males, compared to normal weight patients-Odds Ratio (OR) 1.51 (95% confidence interval- 1.19-1.89). Moreover, overweight patients significantly more frequently had non-insulin-dependent diabetes mellitus-OR 1.44 (1.09-1.90), and more frequently used ACEI in hospital discharge therapy-OR 1.41 (1.07-1.84) than normal weight patients. Additionally, the CEAs in them were less frequently followed by bleedings-OR 0.37 (0.16-0.83). Compared to normal weight patients, obese patients were significantly younger-OR 0.98 (0.96-0.99), and with insulin-dependent and non-insulin-dependent diabetes mellitus-OR 1.83 (1.09-3.06) and OR 2.13 (1.50-3.01) respectively. They also more frequently had increased triglyceride levels-OR 1.36 (1.01-1.83), and more frequently used oral anticoagulants in therapy before the surgery-OR 2.16 (1.11-4.19). According to the results obtained, overweight and obesity were not associated with an increased death rate, transient ischemic attack (TIA), stroke, myocardial infarction, or with minor complications, and the need for reoperation after carotid endarterectomy. The only exception was bleeding, which was significantly less frequent after CEA in overweight compared to normal weight patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cymbopogon martinii is an aromatic crop cultivated for the production of its essential oil (EO) which has different applications. Bearing in mind that C. martinii EO (CMEO) has already been proved ...for high antibacterial potential the aim of this study was to formulate stable CMEO nanoemulsions, being capable to combat Enterococcus faecalis biofilm, especially within infected tooth’s root canal. Ten emulsions with variable CMEO content (2.5–10 % v/v) and Tween 80 (T80, 2.5–15 % v/v) were formulated (designated as ECMEO:T80) and screened for volume-weighted mean diameter (D4,3) and stability, using dynamic light scattering measurements. Chemical composition of stable nanoemulsions was monitored by UV–VIS and FTIR, while their antibacterial activity was estimated in microdilution assay. Antibiofilm properties of selected nanoemulsions were tested in vitro (cristal violet assay) and ex vivo (within root canals of the extracted teeth). Results showed that formulations containing 10 % of T80 and CMEO volume ≤ 6 %, as well as those having constant 2.5 % of CMEO and variable T80 volume (≤ 10%), namely E2.5:2.5, E2.5:5, E2.5:7.5, E2.5:10, E4:10, and E6:10, were stable and nanosized (D4,3 <100 nm). FTIR and UV–VIS analyses confirmed successful encapsulation of the CMEO by T80 and showed that nanoemulsification did not affect CMEO composition. Evaluation of antibacterial potential showed that the most efficient were E6:10, E2.5:2.5 and E4:10 (MIC values 0.37–1.97 mg mL−1). Analysis of dependency of determined MICs on mean diameter and CMEO volume showed that antibacterial potential increased with both parameters. E6:10, E2.5:2.5 and E4:10 also reduced in vitro biofilm (inhibitory range 17.6–58.4 %), as well as intracanal biofilm (reduction ~2Log CFU). Presented results suggest E6:10, E4:10 and E2.5:2.5 as the good candidates for further research.
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•Emulsions with different ratio of C. martini oil and Tween 80 were prepared.•Characterization of the nanoemulsions showed successful oil encapsulation.•Nanoemulsions E6:10, E2.5:2.5, E4:10 proved high antibacterial effect.•Nanoemulsions E6:10, E2.5:2.5 and E4:10 reduced ex vivo intracanal biofilm.•Nanoemulsification improved antibiofilm potential of the C. martini oil.
Lone atrial fibrillation (AF) has been suggested to have a favorable long-term prognosis. Significant interest has been directed at factors predicting arrhythmia progression, and the HATCH score ...(hypertension, age ≥ 75 years, transient ischemic attack or stroke 2 points, COPD, and heart failure 2 points) recently has been proposed as a predictive score for AF progression. We investigated long-term outcomes in a large cohort of newly diagnosed lone AF and whether progression from paroxysmal to permanent AF confers an adverse impact on outcomes, including stroke and thromboembolism.
The study was an observational cohort of 346 patients with newly diagnosed lone AF with a mean follow-up of 12.1 ± 7.3 years.
Baseline paroxysmal AF was confirmed in 242 patients, and of these, 65 (26.9%) subsequently experienced progression to permanent AF. Older age and development of congestive heart failure during follow-up were the multivariate predictors of AF progression (both P < .01), which was documented in 19.8% of patients with a HATCH score of 0 vs 63.2% with a score of 2 (P < .001), although the predictive validity of the HATCH score per se was modest (C statistic, 0.6). The annual rate of thromboembolism and heart failure during follow-up were low (0.4% each), and five patients (1.4%) died. AF progression, development of cardiac diseases, and older age were multivariate predictors of adverse outcomes, including thromboembolism (all P < .05). Baseline CHADS(2) (congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, prior stroke or transient ischemic attack) score was not predictive for thromboembolism (C statistic, 0.50; 95% CI, 0.31-0.69).
This 12-year follow-up study provides confirmatory evidence of a generally favorable prognosis of lone AF, but adverse outcomes (including stroke and thromboembolism) are significantly influenced by age and the (new) development of underlying heart disease. Arrhythmia progression in lone AF is a marker of increased risk for adverse cardiovascular events.
• Fabeae legumes such as pea and faba bean form symbiotic nodules with a large diversity of soil Rhizobium leguminosarum symbiovar viciae (Rlv) bacteria. However, bacteria competitive to form root ...nodules (CFN) are generally not the most efficient to fix dinitrogen, resulting in a decrease in legume crop yields. Here, we investigate differential selection by host plants on the diversity of Rlv.
• A large collection of Rlv was collected by nodule trapping with pea and faba bean from soils at five European sites. Representative genomes were sequenced. In parallel, diversity and abundance of Rlv were estimated directly in these soils using metabarcoding. The CFN of isolates was measured with both legume hosts. Pea/faba bean CFN were associated to Rlv genomic regions.
• Variations of bacterial pea and/or faba bean CFN explained the differential abundance of Rlv genotypes in pea and faba bean nodules. No evidence was found for genetic association between CFN and variations in the core genome, but variations in specific regions of the nod locus, as well as in other plasmid loci, were associated with differences in CFN.
• These findings shed light on the genetic control of CFN in Rlv and emphasise the importance of host plants in controlling Rhizobium diversity.
Abstract Background To investigate baseline characteristics and long-term prognosis of carefully characterized asymptomatic and symptomatic patients with atrial fibrillation (AF) in a ‘real-world’ ...cohort of first-diagnosed non-valvular AF over a 10-year follow-up period. Methods and results We conducted an observational, non-interventional, and single-centre registry-based study of consecutive first-diagnosed AF patients. Of 1100 patients (mean age 52.7 ± 12.2 years and mean follow-up 9.9 ± 6.1 years), 146 (13.3%) had asymptomatic AF. Persistent or permanent AF, slower ventricular rate during AF (< 100/min), CHA2 DS2 –VASc score of 0, history of diabetes mellitus and male gender were independent baseline risk factors for asymptomatic AF presentation (all p < 0.01) with a good predictive ability of the multivariable model (c-statistic 0.86, p < 0.001). Kaplan–Meier 10-year estimates of survival free of progression of AF (log-rank test = 33.4, p < 0.001) and ischemic stroke (log-rank test = 6.2, p = 0.013) were significantly worse for patients with asymptomatic AF compared to those with symptomatic arrhythmia. In the multivariable Cox regression analysis, intermittent asymptomatic AF was significantly associated with progression to permanent AF (Hazard Ratio 1.6; 95% CI, 1.1–2.2; p = 0.009). Conclusions In a ‘real-world’ setting, patients with asymptomatic presentation of their first-diagnosed AF could have different risk profile and long-term outcomes compared to those with symptomatic AF. Whether more intensive monitoring and comprehensive AF management including AF ablation at early stage following the incident episode of AF and increased quality of oral anticoagulation could alter the long-term prognosis of these patients requires further investigation.
Background
Hip fractures in the elderly are followed by considerable risk of functional decline and mortality.
Questions/purposes
The purposes of this study were to (1) explore predictive factors of ...functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures.
Methods
A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables.
Results
Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5–520.1) for men and 301.6 (95% CI, 212.4–391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture.
Conclusions
Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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