Daniel Zahra

A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participant-blinded randomised controlled trial

BackgroundNeuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced. Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk. The type of insole best suited to achieve this is unknown. This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet.MethodA participant-blinded randomised controlled trial recruited 119 neuropathic participants with diabetes who were randomly allocated to custom-made functional or prefabricated insoles. Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system. Primary outcomes were: peak pressure, forefoot pressure time integral, total contact area, forefoot rate of load, duration of load as a percentage of stance. Secondary outcomes were patient perceived foot health (Bristol Foot Score), quality of life (Audit of Diabetes Dependent Quality of Life). We also assessed cost of supply and fitting. Analysis was by intention-to-treat.ResultsThere were no differences between insoles in peak pressure, or three of the other four kinetic measures. The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue (27% vs. 22%), remained more effective at six month follow-up (30% vs. 24%, p=0.001), but was more expensive (UK £656 vs. £554, p<0.001). Full compliance (minimum wear 7 hours a day 7 days per week) was reported by 40% of participants and 76% of participants reported a minimum wear of 5 hours a day 5 days per week. There was no difference in patient perception between insoles.ConclusionThe custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure. We recommend that where clinically appropriate, the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy.Trial registrationClinical trials.gov (NCT00999635). Note: this trial was registered on completion.

The work and social adjustment scale: Reliability, sensitivity and value

Abstract Objective. To investigate the psychometric properties of the Work and Social Adjustment Scale (WSAS) as an outcome measure for the Improving Access to Psychological Therapy programme, assessing its value as an addition to the Patient Health (PHQ-9) and Generalised Anxiety Disorder questionnaires (GAD-7). Little research has investigated these properties to date. Methods. Reliability and responsiveness to change were assessed using data from 4,835 patients. Principal components analysis was used to determine whether the WSAS measures a factor distinct from the PHQ-9 and GAD-7. Results. The WSAS measures a distinct social functioning factor, has high internal reliability, and is sensitive to treatment effects. Conclusions. The WSAS, PHQ-9 and GAD-7 perform comparably on measures of reliability and sensitivity. The WSAS also measures a distinct social functioning component suggesting it has potential as an additional outcome measure.

Enhanced Visual Statistical Learning in Adults With Autism

OBJECTIVE Individuals with autism spectrum disorder (ASD) are often characterized as having social engagement and language deficiencies, but a sparing of visuospatial processing and short-term memory (STM), with some evidence of supranormal levels of performance in these domains. The present study expanded on this evidence by investigating the observational learning of visuospatial concepts from patterns of covariation across multiple exemplars. METHOD Child and adult participants with ASD, and age-matched control participants, viewed multishape arrays composed from a random combination of pairs of shapes that were each positioned in a fixed spatial arrangement. RESULTS After this passive exposure phase, a posttest revealed that all participant groups could discriminate pairs of shapes with high covariation from randomly paired shapes with low covariation. Moreover, learning these shape-pairs with high covariation was superior in adults with ASD than in age-matched controls, whereas performance in children with ASD was no different than controls. CONCLUSIONS These results extend previous observations of visuospatial enhancement in ASD into the domain of learning, and suggest that enhanced visual statistical learning may have arisen from a sustained bias to attend to local details in complex arrays of visual features.

Accounting for test reliability in student progression: the reliable change index

Developed by Jacobson and Truax, the reliable change index (RCI) provides a measure of whether the change in an individuals score over time is within or beyond that which might be accounted for by measurement variability. In combination with measures of whether an individuals final score is closer to those of one population or another, this provides useful individual‐level information that can be used to supplement traditional analyses.

'IF You Drink Alcohol, THEN You Will Get Cancer': Investigating How Reasoning Accuracy Is Affected by Pictorially Presented Graphic Alcohol Warnings.

AIMS To investigate the cognitive processing of emotive pictorial warnings intended to curb alcohol misuse, using novel methodologies adapted from the reasoning literature to assess whether emotive pictorial warnings alter reasoning. METHOD In Study 1, individuals completed a version of the Wason selection task-evaluating warnings in which content type (Alcohol and Non-Alcohol) and emotional valence (Positive and Negative) were manipulated through imagery. In Study 2, people evaluated the certainty of outcomes described by alcohol-related and non-alcohol-related warnings in the form of If-Then statements. RESULTS Study 1 found that in alcohol-related warnings, there was no difference in reasoning accuracy between positive and negative content. However, fewer correct responses followed exposure to negative general-health messages. Study 2 suggested that when a warning involves the potential consequences of drinking alcohol, accuracy is improved when the content is negative. However, when considering the consequences of abstinence, accuracy was greatest when the content was positive. This was supported by an inference by content interaction. CONCLUSION In conclusion, negative imagery should be used with caution in health warnings, and goals carefully considered. In some cases imagery of negative outcomes may improve reasoning, however, its use in alcohol-related messages does not appear to be consistently beneficial.

Online addiction: privacy risks in online gaming environments

In this paper we investigated the levels of addiction and personal data disclosure within Massively Multiplayer Online Role Playing Game environments (MMORPGs). The study made use of an online survey which embraced a combination of a six point behavioural addiction framework, Self Determination Theory and Impression Management theory to assess addictive behaviour and consequential data disclosure amongst a sample representative of 188 Singaporean based MMORPG gamers. Results found that pathological gaming addiction had a direct effect on levels of personal and sensitive data disclosure and participants who were disclosing high amounts of data were considered more vulnerable to exploitation and predation.

Preparedness of undergraduate dental students in the United Kingdom:: a national study

Aims To evaluate the self-perceived preparedness of final year dental undergraduate students in the United Kingdom.Methods Dental undergraduate students in their final year were invited by email through the Dental Schools Council (DSC) to provide their responses to an online preparedness assessment scale. The data analysis was carried out using the RUMM2030 software which is specifically designed for Rasch analysis, a measurement model based on item response theory.Results Students felt adequately prepared to carry out simple clinical procedures and communication skills. However, low scores were reported on ability to assess orthodontic treatment needs, treatment planning, crowns, endodontics, research skills, referral for suspected oral cancer and raising concerns regarding inappropriate behaviour of colleagues.Conclusions The scale used in this study explored the self-perceived preparedness on a range of cognitive, clinical and behavioural attributes. The data show that the students felt prepared for the majority of the attributes expected from dentists. However, a number of areas were identified where students may benefit from further training and consolidation.

Twelve tips for assessment psychometrics

Abstract It is incumbent on medical schools to show, both to regulatory bodies and to the public at large, that their graduating students are “fit for purpose” as tomorrow’s doctors. Since students graduate by virtue of passing assessments, it is vital that schools quality assure their assessment procedures, standards, and outcomes. An important part of this quality assurance process is the appropriate use of psychometric analyses. This begins with development of an empowering, evidence-based culture in which assessment validity can be demonstrated. Preparation prior to an assessment requires the establishment of appropriate rules, test blueprinting and standard setting. When an assessment has been completed, the reporting of test results should consider reliability, assessor, demographic, and long-term analyses across multiple levels, in an integrated way to ensure the information conveyed to all stakeholders is meaningful.

Discrimination, harassment and non-reporting in UK medical education

Discrimination and harassment create a hostile environment with deleterious effects on student well‐being and education. In this study, we aimed to: (i) measure prevalences and types of discrimination and harassment in one UK medical school, and (ii) understand how and why students report them.

Impact of early clinical exposure on the learning experience of undergraduate dental students

AIMS The aim of this research was to evaluate the impact of early clinical exposure on the learning experiences of undergraduate dental students. METHODS This study was based on mixed methods. The first phase involved administering a purposely designed questionnaire consisting of 16 items, grouped into three subscales. The second phase of the research was conducted using qualitative semi-structured interviews to explore the perceptions and experiences of stakeholders regarding early clinical exposure. RESULTS In total, 134 undergraduate dental students and eight clinical supervisors responded to the questionnaire and reported positive perceptions regarding the learning experiences, professional relationship and learning environment. Qualitative interviews were conducted with 12 participants, and early clinical exposure was perceived to be useful in providing a context to theoretical learning and development of interpersonal skills. Curriculum overload and further need for consolidation were highlighted as the main challenges. CONCLUSIONS This study provided insights into the clinical training model in an undergraduate dental programme and highlights the benefits and challenges of early clinical exposure in the study population. The study served as a vehicle for engagement with a range of stakeholders using a mixed methods approach to inform further development of the training model.