Graphical modeling for item difficulty in medical faculty exams.

BACKGROUND: There are different indexes used in the evaluation of exam results. One important index is the difficulty level of the item that is also used in this study to obtain control charts. This article offers some suggestions for the improvement of multiple-choice tests using item analysis statistics. MATERIALS AND METHODS: The graphical modeling is important for the rapid and comparative evaluation of test results. The control chart is a tool that can be used to sharpen our teaching and testing skills by inspecting the weaknesses of measurements and producing reliable items. The research data for the application of control charts were obtained using the results of the fourth and fifth-grade student's exams at Ondokuz Mayis University, Faculty of Medicine. I-chart or moving range chart (MR) is preferred for whole variable data. RESULTS: It is seen that all observations are within control limits for I-chart, but three points on MR-chart are settled on the LCL. Using X--chart with subgroups, it was determined that control measurements were within the upper and lower limits in both charts. The difficulty levels of items were examined by obtaining different variable control charts. The difficulty level of the two items exceeded the upper control limit in R- and S-charts. CONCLUSION: The control charts have the advantage for classifying items as acceptable or unacceptable based on item difficulty criteria.

Item analysis and evaluation in the examinations in the faculty of medicine at Ondokuz Mayis University.

BACKGROUND: Item analysis is an effective method in the evaluation of multiple-choice achievement tests. This study aimed to compare the classical and the latent class models used in item analysis, as well as their efficacy in the evaluation of the examinations of the medical faculty. MATERIALS AND METHODS: The achievement tests in the medical faculty were evaluated using different methods. The two methods used were the classical and the latent class models. Among the classical methods, Cronbach's alpha, split half methods, item discrimination, and item difficulty was investigated. On the other hand, various models of item response theory (IRT) and their statistics were compared in the group of latent class methods. RESULTS: Reliability statistics had values above 0.87. Item no. 7 was found easy, item no. 45 difficult and item no. 64 fairly difficult according to the evaluations done by classical and item response theories. In terms of item discrimination, item no. 45 had lower, item no. 7 had middle and item no. 64 had high discrimination levels. The distribution graph shows that personal abilities are good enough to tick the correct choice. CONCLUSION: In this study, similar results were obtained by classical and latent methods. IRT can be considered perfect at a mathematical level, and if its assumptions are satisfied, it can easily perform assessments and measurements for most types of complex problems. Classical theory is easy to understand and to apply, while IRT is, on the contrary, sometimes rather difficult to understand and to implement.

Cytodiagnosis of erosive melanoma and basal cell carcinoma of the skin using cutaneous tissue smear.

BACKGROUND: Cytomorphological assessment of erosive skin tumours offers a rapid and minimally invasive way to obtain a diagnosis. However, the studies so far conducted on this method have been relatively small. AIM: To conduct a large retrospective study on cytomorphological assessment of erosive skin tumours. METHODS: In this study, 86 cytological smears prepared from erosive cutaneous tumours clinically suspicious for melanoma were examined to test the diagnostic accuracy and practicability of cytomorphological evaluation of such tumours, and to compare the assessments of two investigators with different experience levels. In a subgroup of tumours, cytological assessment was compared with dermoscopic evaluation. RESULTS: There was agreement in the cytological and histopathological results for 68 of 86 cases (79%) assessed by the experienced investigator and in 64 of 86 cases (74%) assessed by the inexperienced investigator. The diagnosis was confirmed cytologically in 39 and 34 of 42 melanomas, and in 28 and 27 of 35 basal cell carcinomas, respectively. The sensitivity of the cytodiagnosis was not significantly different between the two investigators. The dermoscopic evaluation showed good agreement with the cytological results for melanoma (82.4%), although use of dermoscopy was only possible for 49.9% of the lesions because of difficulties with the samples. CONCLUSIONS: Cytological assessment of erosive melanoma and BCC lesions is a useful tool for gaining additional information on clinically uncertain skin tumours, and shows good agreement between different investigators.

Serum galectin-3 levels in patients with Behçet's disease: association with disease activity over a long-term follow-up.

BACKGROUND: There is a need for a laboratory marker that correlates with the clinical activity of Behçet's disease (BD). OBJECTIVE: We aimed to investigate whether serum galectin-3 (Gal-3) levels were affected during the course of the disease with regard to disease activity. METHODS: A total of 131 subjects were involved in the study as follows: Group 1: BD active (n = 39); Group 2: BD inactive (n = 31); Group 3: Disease controls with leucocytoclastic vasculitis confirmed with a skin biopsy (n = 22); and Group 4: Healthy control subjects (n = 39). The BD patients were followed regularly and samples were taken in their active and inactive periods of the disease over a 2-year period. RESULTS: Serum Gal-3 levels were significantly higher in active BD patients (mean 2.38) than inactive BD patients (mean 0.63; P < 0.0001) and the healthy control subjects (mean 0.75; P < 0.0001). There was no significant difference between the leucocytoclastic vasculitis and active BD patients (P = 0.093). Serum Gal-3 levels were positively correlated with clinical activity scores of active BD patients (r = 0.66, P < 0.0001). In addition, the Gal-3 levels were significantly higher in the active disease period when compared with the inactive period during the follow-up. There were no significant differences between the two inactive periods of the disease among the same patients. Further analyses revealed that patients with vascular involvement had significantly higher Gal-3 levels than the other active BD patients (mean 7.57; P = 0.007). LIMITATIONS: The limitation of the study is the small number of patients with vascular involvement in the active BD patient group. CONCLUSION: Gal-3 levels are correlated with the activity of Behçet's disease especially with the vascular involvement.

Axillary hair removal with 1064-nm Nd:YAG laser increases sweat production.

BACKGROUND: Laser-assisted hair removal has become a popular treatment for eradication of body hair. Many studies have been published concerning the safety and efficacy of several laser systems. Adverse events are hyperpigmentation, hypopigmentation, erythema, oedema, scarring, pain and blistering. Changes in sweating have not previously been reported. AIM: To investigate the effects on axillary sweating of hair removal by a 1064-nm neodymium:yttrium-aluminium-garnet (Nd:YAG) laser. METHODS: The sweating function of both axillae was evaluated objectively by the iodine starch test for planimetry measurement and subjectively using a visual analogue scale (VAS) before the treatment, and 1 month and 1 year after the last session. RESULTS: The difference in hyperhidrotic activity before and after treatment was significant (P < 0.05), and these differences persisted 1 year after the last evaluation. CONCLUSIONS: The results of this study confirm that treatment of axillary hair using the 1064-nm Nd:YAG laser can cause hyperhidrosis, and this effect is not transient. We did not evaluate the eccrine glands histologically, which is a limitation of the study.

Is advanced age a significant risk factor for laparoscopic cholecystectomy?

AIM: have been a few reports about the outcome of laparoscopic cholecystectomy (LC) in the elderly patients. The aim of this study was to assess if morbidity and mortality may be increased in the geriatric patients because of high incidence of co-morbidity. METHODS: From November 2000 to January 2009, 146 patients aged 60 years and older who underwent LC were reviewed. Patients were placed into two groups by ages: Group A (age = 60-74 years, N.=126), Group B (age ≥ 75, N.=20). RESULTS: One hundred forty six patients underwent LC for benign gallbladder disease during this study period There was no difference in operative time, ASA, distribution of sex between the two groups. Most patients were treated with LC for symptomatic cholelithiasis (82.5%) in both groups. There were sixty eight cases (53.96%) in the Group A and 14 (70%) patients in the Group B had co-morbid diseases (P>0.005). Conversion rates and morbidity was not different significantly according to ages for either group (P>0.05). The rate of conversion to OC was 9.5% in the Group A and 5% in the Group B. Five complications were occurred in the four patients. There was only one bile duct injury in the Group A. Conversion rates and postoperative complications were not affected by gender and co-morbid diseases (P>0.05) in our study whereas acute cholecystitis were found as a risk factor for conversion to open surgery and complications according to the cases preoperatively diagnosis (P=0.001). CONCLUSION: LC should be recommended with acceptable morbidity and mortality in the elderly. Morbidity and conversion to OC are not increased with advanced age even in the extremely elderly patients. Acute cholecystitis is correlated with a high risk factor for morbidity and conversion to OC.

Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study.

BACKGROUND: Knee osteoarthritis (OA) is a painful condition causing disability and muscle weakness. Shortwave diathermy (SWD) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice. However, the efficacy of SWD in knee OA is still inconclusive. AIM: The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain, function, muscle strength, quality of life and depression in patients with OA. DESIGN: This was a randomised, controlled clinical trial. SETTING: Inpatient Physiotherapy Department. POPULATION: Forty women aged between 42 and 74 years, with a diagnosis of bilateral primary knee OA. METHODS: Patients were sequentially randomized into two groups. Group 1 (N.=20) received SWD and isokinetic muscular strengthening exercises. Group 2 (N.=20) served as control group and they received isokinetic exercises only. Both of the programs were performed three days a week, for a duration of four weeks, and a total of 12 sessions. Patients were assessed before treatment (BT), after treatment (AT), and at a three-month follow-up (F). Outcome measures included visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, six minute walking distance, isokinetic muscle testing, Short Form 36 and Beck depression index. RESULTS: The patients with OA in each group had significant improvements in pain, disability, depression, walking distance, muscle strength, and quality of life AT and F when compared with their initial status (P<0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P>0.05) except some isokinetic peak torque measurements (F-BT scores of extension right 60°, 120° and flexion right 60°). CONCLUSION: Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain, disability, walking distance, muscle strength, quality of life and depression in patients with knee OA. CLINICAL REHABILITATION IMPACT: Considering the time and cost of combination therapy is now, the isokinetic exercise program, as it is efficient, may be preferable for the treatment of knee OA, alone.

Association of passive smoking with caries and related salivary biomarkers in young children.

OBJECTIVE: To investigate the association between passive smoking, as determined by salivary cotinine level, and caries, salivary pH, buffering capacity, flow rate and microbiological counts in young children. DESIGN: Ninety passive smokers (PS) with a mean age of 5.02 years and 90 healthy age-matched controls were included in this study. Family income, smoking habits of household members, parental education levels, child's tooth-brushing habit and child's daily dietary sugar exposure were recorded by questionnaire. Three categories were formed with respect to the number of cigarettes smoked. A dmft score was calculated according to the criteria recommended by the World Health Organization. The children were also investigated for stimulated salivary cotinine level, pH, flow rate, buffering capacity and salivary Streptococcus mutans and lactobacilli colonisation. RESULTS: There were no significant differences in tooth-brushing habit, sugar exposure, family income and parental education levels between the two groups (P>0.05). The mean cotinine level of the PS subjects was 1.58+/-4.3ng/ml. The dmft scores, and salivary S. mutans and lactobacilli colonisation in PS children were significantly higher than in the control subjects (P<0.05). Statistically significant decreases in salivary pH, flow rate and buffering capacity were found in the PS subjects (P<0.05). CONCLUSION: PS children are at increased risk of caries compared with control subjects.

Lack of association between leptin G2548A gene polymorphism and Behçet's disease.

BACKGROUND: Behçet's disease is a chronic, multisystem, inflammatory disease characterized by the predominance of T-helper 1 cytokines. The disease is also characterized by infiltration of lymphocytes and neutrophils into the affected tissues. Because cytokines are involved in the regulation of lymphocyte and phagocyte functions, they may play an important role in the pathogenesis of Behçet's disease. Leptin, a member of the gp 130 family of cytokines, induces a strong T-helper 1 response and is regarded as a proinflammatory inducer. Recent studies have shown that serum leptin concentration was increased in patients with Behçet's disease and correlated with disease activity. OBJECTIVES: We aimed to investigate the role of G2548A polymorphism of leptin gene in patients with Behçet's disease and compare the results with healthy controls. PATIENTS AND METHODS: A total of 93 subjects with Behçet's disease and 125 healthy controls were included in this study. Analyses of G-2548A polymorphism of the LEP gene were performed using the PCR-restriction fragment length polymorphism technique. The genotypes (GG, GA, and AA of leptin G2548A) and alleles (G and A of leptin 2548) were scored and the frequency was estimated. The frequencies of the alleles and genotypes in patients and controls were compared. We analysed the correlation between leptin gene polymorphism and the clinical features of BD. RESULTS: Both genotype and allele frequencies were not significantly different between controls and Behçet's disease patients [OR=0.67, 95% CI (0.35-1.29), P=0.197 and OR=0.77, 95% CI (0.52-1.15), P=0.184]. We did not find any significant relationship between leptin gene polymorphism and the clinical features of BD (P>0.05). CONCLUSION: In the present case-control study, we found no evidence of an association between the G-2548A variant of the leptin gene and BD among Turks. Further studies are needed to investigate serum leptin level to explain the mechanisms behind the lack of association between leptin G2548A gene polymorphism and BD.