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Verhaar N, Kopp V, Pfarrer C, Neudeck S, König K, Rohn K, Kästner S. Alpha 2 Antagonist Vatinoxan Does Not Abolish the Preconditioning Effect of Dexmedetomidine on Experimental Ischaemia-Reperfusion Injury in the Equine Small Intestine. Animals (Basel) 2023; 13:2755. [PMID: 37685019 PMCID: PMC10486550 DOI: 10.3390/ani13172755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Pharmacological preconditioning with dexmedetomidine has been shown to ameliorate intestinal ischaemia reperfusion injury in different species, including horses. However, it remains unknown if this effect is related to alpha2 adrenoreceptor activity. Therefore, the aim of this study was to determine the effect of dexmedetomidine preconditioning with and without the administration of the peripheral alpha2 antagonist vatinoxan. This prospective randomized experimental trial included 12 horses equally divided between two treatment groups. Horses in group Dex received a bolus of dexmedetomidine followed by a continuous rate infusion (CRI), while group DexV additionally received vatinoxan as bolus and CRI. A median laparotomy was performed under general anaesthesia, and jejunal ischaemia was applied for 90 min, followed by 30 min of reperfusion. Mucosal damage was evaluated in full thickness biopsies by use of a semiquantitative mucosal injury score and by determining the apoptotic cell counts with immunohistochemical staining for cleaved caspase-3 and TUNEL. Comparisons between the groups and time points were performed using non-parametric tests (p < 0.05). During pre-ischaemia and ischaemia, no differences could be found in mucosal injury between the groups. After reperfusion, group DexV showed lower mucosal injury scores compared to group Dex. The apoptotic cell counts did not differ between the groups. In conclusion, antagonizing the peripheral alpha2 adrenoreceptors did not negatively affect dexmedetomidine preconditioning.
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Affiliation(s)
- Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Veronika Kopp
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Christiane Pfarrer
- Institute for Anatomy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Stephan Neudeck
- Small Animal Clinic, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Kathrin König
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Karl Rohn
- Department of Biometry, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Sabine Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
- Small Animal Clinic, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
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Neudeck S, Twele L, Kopp V, Kästner S. Pharmacodynamics and plasma concentrations of dexmedetomidine with or without vatinoxan as a constant-rate infusion in horses anaesthetized with isoflurane-A pilot study. J Vet Pharmacol Ther 2021; 44:754-765. [PMID: 34159620 DOI: 10.1111/jvp.12992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
The aim was to determine the effects of vatinoxan on dexmedetomidine plasma concentrations and effects on cardiovascular and intestinal tissue pharmacodynamics. In a prospective randomized study, six horses were premedicated intravenously with dexmedetomidine 3.5 µg kg-1 followed by a constant-rate infusion of 7 µg kg-1 h-1 (group DEX) and six horses with dexmedetomidine of the same dose (bolus and constant-rate infusion) combined with vatinoxan 130 µg kg-1 followed by 40 µg kg-1 h-1 (group VAT). Anaesthesia was induced with ketamine and diazepam and maintained with isoflurane. Venous blood samples were withdrawn before and at predefined points in time after drug application. During sedation and anaesthesia, cardiopulmonary variables, gastrointestinal tissue perfusion and oxygenation were recorded. Data were analysed using two-way-ANOVA, unpaired-t-test and Dunnett's-t-test (p < 0.05). Group VAT had significantly higher oxygen delivery and lower oxygen extraction ratio, venous admixture, alveolar dead space and alveolar-arterial-oxygen difference. Tissue perfusion of buccal mucosa was reduced during anaesthesia in group DEX. Plasma concentrations of dexmedetomidine in group VAT (n = 6) and group DEX (n = 5) were comparable between groups. In the present pilot study, co-administration of vatinoxan with dexmedetomidine did not alter plasma concentrations of dexmedetomidine but ameliorated tissue perfusion and global oxygenation variables.
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Affiliation(s)
- Stephan Neudeck
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Lara Twele
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Veronika Kopp
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Sabine Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.,Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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VanderBroek AR, Engiles JB, Kästner SBR, Kopp V, Verhaar N, Hopster K. Protective effects of dexmedetomidine on small intestinal ischaemia-reperfusion injury in horses. Equine Vet J 2020; 53:569-578. [PMID: 32862437 DOI: 10.1111/evj.13337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/06/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Strangulating small intestinal lesions in the horse have increased morbidity and mortality compared to nonstrangulating obstructions due to mucosal barrier disruption and subsequent endotoxaemia. OBJECTIVES To investigate protective effects of dexmedetomidine on small intestinal ischaemia-reperfusion injury in the horse. STUDY DESIGN Randomised, controlled, experimental study. METHODS Eighteen systemically healthy horses were randomly assigned to three groups: control, preconditioning, and post-conditioning. During isoflurane anaesthesia, complete ischaemia was induced in a 1-m segment of jejunum for 90 minutes. Horses in the preconditioning and post-conditioning groups received dexmedetomidine (3.5 µg/kg followed by 7 µg/kg/h) before (preconditioning) or after beginning ischaemia (post-conditioning), and during reperfusion. Jejunal biopsies were collected before ischaemia (baseline-1), at the end of the ischaemic period (ischaemia), and 30 minutes after reperfusion (reperfusion-1). Additional biopsies were taken 24 hours after reperfusion from ischaemia-reperfusion-injured jejunum (reperfusion-2). Epithelial injury was scored histologically, and morphometric analyses were used to calculate villus surface area (VSA) denuded of epithelium. Data were analysed using analysis of variance, Kruskal-Wallis and Wilcoxon two-sample tests. RESULTS In the control group, epithelial injury scores and percentage of VSA denudation for ischaemia-reperfusion-injured jejunum were higher compared to baseline-1 at all time points. The ischaemia and both reperfusion samples from the pre- and post-conditioning groups had lower epithelial injury scores and percentage of VSA epithelial denudation compared to the control group, with no difference from baseline-1 at any time point for the preconditioning group. MAIN LIMITATIONS Preconditioning has limited application in the clinical setting with naturally occurring strangulating small intestinal lesions. CONCLUSIONS Dexmedetomidine was protective for small intestinal ischaemia-reperfusion injury in the horse when administered before or during ischaemia.
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Affiliation(s)
- Ashley R VanderBroek
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Julie B Engiles
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - Sabine B R Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Veronika Kopp
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Klaus Hopster
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
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Scholz C, Mann C, Kopp V, Kost B, Kainer F, Fischer MR. High-fidelity simulation increases obstetric self-assurance and skills in undergraduate medical students. J Perinat Med 2012; 40:607-13. [PMID: 23093253 DOI: 10.1515/jpm-2012-0052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Teaching intrapartum care is one of the most challenging tasks in undergraduate medical education. High-fidelity obstetric simulators might support students' learning experience. The specific educational impact of these simulators compared with traditional methods of model-based obstetric teaching has not yet been determined. STUDY DESIGN We randomly assigned 46 undergraduate medical students to be taught using either a high-fidelity simulator or a scale wood-and-leather phantom. Their self-assessments were evaluated using a validated questionnaire. We assessed obstetric skills and asked students to solve obstetric paper cases. MAIN OUTCOME MEASURES Assessment of fidelity-specific teaching impact on procedural knowledge, motivation, and interest in obstetrics as well as obstetric skills using high- and low-fidelity training models. RESULTS High-fidelity simulation specifically improved students' feeling that they understood both the physiology of parturition and the obstetric procedures. Students in the simulation group also felt better prepared for obstetric house jobs and performed better in obstetric skills evaluations. However, the two groups made equivalent obstetric decisions. CONCLUSION This study provides first data on the impact of high-fidelity simulation in an undergraduate setting.
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Bauer D, Holzer M, Kopp V, Fischer MR. Pick-N multiple choice-exams: a comparison of scoring algorithms. Adv Health Sci Educ Theory Pract 2011; 16:211-221. [PMID: 21038082 DOI: 10.1007/s10459-010-9256-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/20/2010] [Indexed: 05/30/2023]
Abstract
To compare different scoring algorithms for Pick-N multiple correct answer multiple-choice (MC) exams regarding test reliability, student performance, total item discrimination and item difficulty. Data from six 3rd year medical students' end of term exams in internal medicine from 2005 to 2008 at Munich University were analysed (1,255 students, 180 Pick-N items in total). Scoring Algorithms: Each question scored a maximum of one point. We compared: (a) Dichotomous scoring (DS): One point if all true and no wrong answers were chosen. (b) Partial credit algorithm 1 (PS(50)): One point for 100% true answers; 0.5 points for 50% or more true answers; zero points for less than 50% true answers. No point deduction for wrong choices. (c) Partial credit algorithm 2 (PS(1/m)): A fraction of one point depending on the total number of true answers was given for each correct answer identified. No point deduction for wrong choices. Application of partial crediting resulted in psychometric results superior to dichotomous scoring (DS). Algorithms examined resulted in similar psychometric data with PS(50) only slightly exceeding PS(1/m) in higher coefficients of reliability. The Pick-N MC format and its scoring using the PS(50) and PS(1/m) algorithms are suited for undergraduate medical examinations. Partial knowledge should be awarded in Pick-N MC exams.
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Affiliation(s)
- Daniel Bauer
- Faculty of Health, Institute for Teaching and Educational Research in Health Sciences, Witten/Herdecke University, Germany.
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Pajunen P, Landgraf R, Muylle F, Neumann A, Lindström J, Schwarz PE, Peltonen M, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE. Horm Metab Res 2010; 42 Suppl 1:S56-63. [PMID: 20391308 DOI: 10.1055/s-0029-1240976] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.
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Affiliation(s)
- P Pajunen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
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Lindström J, Neumann A, Sheppard KE, Gilis-Januszewska A, Greaves CJ, Handke U, Pajunen P, Puhl S, Pölönen A, Rissanen A, Roden M, Stemper T, Telle-Hjellset V, Tuomilehto J, Velickiene D, Schwarz PE, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res 2010; 42 Suppl 1:S37-55. [PMID: 20391307 DOI: 10.1055/s-0029-1240975] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.
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Affiliation(s)
- J Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare (THL), Helsinki, Finland
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Paulweber B, Valensi P, Lindström J, Lalic NM, Greaves CJ, McKee M, Kissimova-Skarbek K, Liatis S, Cosson E, Szendroedi J, Sheppard KE, Charlesworth K, Felton AM, Hall M, Rissanen A, Tuomilehto J, Schwarz PE, Roden M, Paulweber M, Stadlmayr A, Kedenko L, Katsilambros N, Makrilakis K, Kamenov Z, Evans P, Gilis-Januszewska A, Lalic K, Jotic A, Djordevic P, Dimitrijevic-Sreckovic V, Hühmer U, Kulzer B, Puhl S, Lee-Barkey YH, AlKerwi A, Abraham C, Hardeman W, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res 2010; 42 Suppl 1:S3-36. [PMID: 20391306 DOI: 10.1055/s-0029-1240928] [Citation(s) in RCA: 309] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. AIMS This guideline provides evidence-based recommendations for preventing T2DM. METHODS A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. RESULTS Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by >or= 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. CONCLUSIONS Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.
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Affiliation(s)
- B Paulweber
- Paracelsus Medical University, Salzburg, Austria
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Abstract
OBJECTIVES In an initial experimental study in the domain of learning about hypertension, a case-based, worked example approach was found to be most effective when erroneous examples and elaborated feedback were provided. However, combining erroneous examples with knowledge of correct result (KCR) feedback impaired learning. This study was designed to establish whether these findings could be replicated in the domain of learning about hyperthyroidism. METHODS A total of 124 medical students were randomly assigned to the four conditions of a 2 x 2 design (with errors versus without errors; elaborated feedback versus KCR feedback). Diagnostic knowledge was operationalised by a multiple-choice test, key feature problems and problem-solving tasks. Acceptance and subjective learning outcomes were assessed on three rating scales. RESULTS The combination of erroneous examples and elaborated feedback was the most effective learning condition, whereas erroneous examples with KCR feedback impaired knowledge acquisition. These effects were independent of differences in prior knowledge and time on task and replicated key findings of the study on hypertension diagnostics. Additionally, results showed that students in conditions with elaborated feedback assessed their learning outcomes as significantly higher than students receiving KCR feedback only. CONCLUSIONS By providing erroneous examples in combination with elaborated feedback in a computer-based learning environment, diagnostic knowledge was fostered. The approach of 'learning from worked examples' was successfully adapted to a complex domain and was found to support the acquisition of complex competencies.
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Affiliation(s)
- Veronika Kopp
- Institute for Teaching and Educational Research in Health Sciences, Private University of Witten/Herdecke, Germany
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Kopp V, Stark R, Fischer MR. Fostering diagnostic knowledge through computer-supported, case-based worked examples: effects of erroneous examples and feedback. Med Educ 2008; 42:823-9. [PMID: 18564096 DOI: 10.1111/j.1365-2923.2008.03122.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES A case-based, worked example approach was realised in a computer-based learning environment with the intention of facilitating medical students' diagnostic knowledge. In order to enhance the effectiveness of the approach, two additional measures were implemented: erroneous examples and elaborated feedback. In the context of an experimental study, the two measures were varied experimentally. METHODS A total of 153 medical students were randomly assigned to four experimental conditions of a 2 x 2-factor design (errors versus no errors, elaborated feedback versus knowledge of correct result [KCR]). In order to verify the sustainability of the effects, a subgroup of subjects (n = 52) was compared with a control group of students who did not participate in the experiment (n = 145) on a regular multiple-choice question (MCQ) test. RESULTS Results show that the acquisition of diagnostic knowledge is mainly supported by providing erroneous examples in combination with elaborated feedback. These effects were independent from differences in time-on-task and prior knowledge. Furthermore, the effects of the learning environment proved sustainable. CONCLUSIONS Our results demonstrate that the case-based, worked example approach is effective and efficient.
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Affiliation(s)
- Veronika Kopp
- Department of Internal Medicine, Medical Education Unit, University of Munich Hospital, Munich, Germany.
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Freude S, Ehlkes T, Kopp V, Leeser U, Krone W, Schröder H, Blokland A, Schubert M. Fettreiche Ernährung induziert dosisabhängig eine zerebrale Insulinresistenz und vermindert die kognitive Leistung in vivo. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bauer D, Kopp V, Fischer MR. Answer changing in multiple choice assessment change that answer when in doubt--and spread the word! BMC Med Educ 2007; 7:28. [PMID: 17718902 PMCID: PMC2020461 DOI: 10.1186/1472-6920-7-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 08/24/2007] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several studies during the last decades have shown that answer changing in multiple choice examinations is generally beneficial for examinees. In spite of this the common misbelief still prevails that answer changing in multiple choice examinations results in an increased number of wrong answers rather than an improved score. One suggested consequence of newer studies is that examinees should be informed about this misbelief in the hope that this prejudice might be eradicated. This study aims to confirm data from previous studies about the benefits of answer changing as well as pursue the question of whether students informed about the said advantageous effects of answer changing would indeed follow this advice and change significantly more answers. Furthermore a look is cast on how the overall examination performance and mean point increase of these students is affected. METHODS The answer sheets to the end of term exams of 79 3rd year medical students at the University of Munich were analysed to confirm the benefits of answer changing. Students taking the test were randomized into two groups. Prior to taking the test 41 students were informed about the benefits of changing answers after careful reconsideration while 38 students did not receive such information. Both groups were instructed to mark all answer changes made during the test. RESULTS Answer changes were predominantly from wrong to right in full accordance with existing literature resources. It was shown that students who had been informed about the benefits of answer changing when in doubt changed answers significantly more often than students who had not been informed. Though students instructed on the benefits of changing answers scored higher in their exams than those not instructed, the difference in point increase was not significant. CONCLUSION Students should be informed about the benefits of changing initial answers to multiple choice questions once when in reasonable doubt about these answers. Furthermore, reconsidering answers should be encouraged as students will heed the advice and change more answers than students not so instructed.
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Affiliation(s)
- Daniel Bauer
- Schwerpunkt Medizindidaktik, Medizinische Klinik Innenstadt, Klinikum der Universität München, Ziemssenstraße 1, 80336 Munich, Germany
| | - Veronika Kopp
- Schwerpunkt Medizindidaktik, Medizinische Klinik Innenstadt, Klinikum der Universität München, Ziemssenstraße 1, 80336 Munich, Germany
| | - Martin R Fischer
- Schwerpunkt Medizindidaktik, Medizinische Klinik Innenstadt, Klinikum der Universität München, Ziemssenstraße 1, 80336 Munich, Germany
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Abstract
OBJECTIVES To examine whether changing initial answers during a multiple-choice question (MCQ) test in medicine brings about better overall test results, as has been shown in other academic fields. METHODS A total of 36 answer books from the German Second National Medical Board Examination, with 580 MCQs (where 1 answer out of 5 must be selected), were used for analysis. RESULTS We confirmed that high-stakes MCQ test scores in medicine did indeed improve when students changed their answers once. Further changes of answers did not improve the scores. CONCLUSIONS In written, high-stakes medical examinations, we recommend that students be encouraged, after further reflection, to change their answers in MCQ tests for questions for which they had previously had doubts about the answers.
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Affiliation(s)
- Martin R Fischer
- University of Munich Hospital, Clinic for Internal Medicine, Downtown Campus, Munich, Germany.
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Fischer MR, Kopp V, Holzer M, Ruderich F, Jünger J. A modified electronic key feature examination for undergraduate medical students: validation threats and opportunities. Med Teach 2005; 27:450-5. [PMID: 16147800 DOI: 10.1080/01421590500078471] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The purpose of our study was the development and validation of a modified electronic key feature exam of clinical decision-making skills for undergraduate medical students. Therefore, the reliability of the test (15 items), the item difficulty level, the item-total correlations and correlations to other measures of knowledge (40 item MC-test and 580 items of German MC-National Licensing Exam, Part II) were calculated. Based on the guidelines provided by the Medical Council of Canada, a modified electronic key feature exam for internal medicine consisting of 15 key features (KFs) was developed for fifth year German medical students. Long menu (LM) and short menu (SM) question formats were used. Acceptance was assessed through a questionnaire. Thirty-seven students from four medical schools voluntarily participated in the study. The reliability of the key feature exam was 0.65 (Cronbach's alpha). The items' difficulty level scores were between 0.3 and 0.8 and the item-total correlations between 0.0 and 0.4. Correlations between the results of the KF exam and the other measures of knowledge were intermediate (r between 0.44 and 0.47) as well as the learners' level of acceptance. The modified electronic KF examination is a feasible and reliable evaluation tool that may be implemented for the assessment of clinical undergraduate training.
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Affiliation(s)
- Martin R Fischer
- Klinikum der Universität München, Medizinische Klinik-Innenstadt, München, Germany.
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Affiliation(s)
- P. V. Shibaev
- Chiral Photonics Inc., 115 Industrial East, Clifton, New Jersey 07012; Herman F. Mark Polymer Research Institute, Polytechnic University, Six Metrotech Center, Brooklyn, New York 11201; and Department of Physics, Queens College of the University of New York, 65-30 Kissena Boulevard, Flushing, New York 11367
| | - K. Tang
- Chiral Photonics Inc., 115 Industrial East, Clifton, New Jersey 07012; Herman F. Mark Polymer Research Institute, Polytechnic University, Six Metrotech Center, Brooklyn, New York 11201; and Department of Physics, Queens College of the University of New York, 65-30 Kissena Boulevard, Flushing, New York 11367
| | - A. Z. Genack
- Chiral Photonics Inc., 115 Industrial East, Clifton, New Jersey 07012; Herman F. Mark Polymer Research Institute, Polytechnic University, Six Metrotech Center, Brooklyn, New York 11201; and Department of Physics, Queens College of the University of New York, 65-30 Kissena Boulevard, Flushing, New York 11367
| | - V. Kopp
- Chiral Photonics Inc., 115 Industrial East, Clifton, New Jersey 07012; Herman F. Mark Polymer Research Institute, Polytechnic University, Six Metrotech Center, Brooklyn, New York 11201; and Department of Physics, Queens College of the University of New York, 65-30 Kissena Boulevard, Flushing, New York 11367
| | - M. M. Green
- Chiral Photonics Inc., 115 Industrial East, Clifton, New Jersey 07012; Herman F. Mark Polymer Research Institute, Polytechnic University, Six Metrotech Center, Brooklyn, New York 11201; and Department of Physics, Queens College of the University of New York, 65-30 Kissena Boulevard, Flushing, New York 11367
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