How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease.

BACKGROUND: Early diagnosis is mandatory for the medical care of children and adolescents with pediatric-onset inflammatory bowel disease (PIBD). International guidelines ('Porto criteria') of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend medical diagnostic procedures in PIBD. Since 2004, German and Austrian pediatric gastroenterologists document diagnostic and treatment data in the patient registry CEDATA-GPGE on a voluntary basis. The aim of this retrospective study was to analyze whether the registry CEDATA-GPGE reflects the Porto criteria and to what extent diagnostic measures of PIBD according to the Porto criteria are documented. METHODS: Data of CEDATA-GPGE were analyzed for the period January 2014 to December 2018. Variables representing the Porto criteria for initial diagnostic were identified and categorized. The average of the number of measures documented in each category was calculated for the diagnoses CD, UC, and IBD-U. Differences between the diagnoses were tested by Chi-square test. Data on possible differences between data documented in the registry and diagnostic procedures that were actually performed were obtained via a sample survey. RESULTS: There were 547 patients included in the analysis. The median age of patients with incident CD (n = 289) was 13.6 years (IQR: 11.2-15.2), of patients with UC (n = 212) 13.1 years (IQR: 10.4-14.8) and of patients with IBD-U (n = 46) 12.2 years (IQR: 8.6-14.7). The variables identified in the registry fully reflect the recommendations by the Porto criteria. Only the disease activity indices PUCAI and PCDAI were not directly provided by participants but calculated from obtained data. The category 'Case history' were documented for the largest part (78.0%), the category 'Imaging of the small bowel' were documented least frequently (39.1%). In patients with CD, the categories 'Imaging of the small bowel' (χ2 = 20.7, Cramer-V = 0.2, p < 0.001) and 'Puberty stage' (χ2 = 9.8, Cramer-V = 0.1, p < 0.05) were documented more often than in patients with UC and IBD-U. CONCLUSION: The registry fully reproduces the guideline's recommendations for the initial diagnosis of PIBD. The proportion of documented diagnostic examinations varied within the diagnostic categories and between the diagnoses. Despite technological innovations, time and personnel capacities at participating centers and study center are necessary to ensure reliable data entry and to enable researchers to derive important insights into guideline-based care.

[Cues and pseudocues in surgical multiple choice questions from the German state examination]. / "Cues" und "pseudocues" in chirurgischen MC-Fragen des deutschen Staatsexamens.

AIM: Multiple choice questions (MCQs) are the most common written test item in medical examinations. Writing MCQs is difficult and cues can decrease test validity. The aim of this article is to describe the prevalence and pattern of cues in surgical MCQs in the central German medical examination questions from 2000-2011. METHOD: All surgical questions were entered into a database. The questions were reviewed for cues and pseudocues independently by three students of different academic background and one clinical physician. RESULTS: Initially, 1014 questions were included, 22 questions were not rated uniformly by the reviewers and 3 questions were excluded because no consensus could be reached. Overall 15.2 % of the questions analyzed contained some type of cue or pseudocue. Of the total questions 0.2 % contained type A cues (i.e. disruption of grammatical flow), 6.5 % contained type B cues (i.e. heterogeneous length or differentiation), 4.0 % contained type C cues (two or more answers described closely related topics, serving to focus attention), 0.6 % contained type D convergence cues (i.e. answers with the most items in common with distractors are correct), 0.7 % contained type E verbal association cues (i.e. connection in the use of words leading to the correct answer) and 1.0 % contained type F cues (i.e. answers with absolute terms). Pseudocues were found in 3.7 % of the questions. DISCUSSION: The proportion of questions that contained cues or pseudocues should lead to further efforts to avoid such factors compromising test reliability by specific attention in the process of question design and review. CONCLUSION: Cues are still an important consideration in designing MCQs and are present in considerable numbers in medical state examination questions. Pseudocues should be explicitly avoided so as not to compromise validity and reliability.

Comparison of femoral and carotid blood pressure during laparoscopy in piglets.

PURPOSE: The impact of a capnoperitoneum on the known blood pressure (BP) difference of the upper and lower limb was studied in piglets. METHODS: Eleven German Landrace piglets (body weight, 4.3-7.4 kg; mean body weight, 6.2 kg) were studied. Arterial lines were placed in the right carotid and right femoral artery for pressure monitoring. Intraabdominal pressure levels were increased in steps of 6 mm Hg up to 24 mm Hg. RESULTS: We found that elevated intraabdominal pressures up to 24 mm Hg did not change the preexisting systolic BP difference between the carotid and femoral arteries. Systolic femoral artery pressure constantly remained 5% higher than its carotid counterpart. In addition, mean and diastolic values were not affected. CONCLUSIONS: Arterial BP measurements recorded at the legs of piglets when abdominal pressure is increased by up to 24 mm Hg can be used for intraoperative assessment of systemic arterial BP.