Introducing Summative Progress Testing in Radiology Residency: Little Change in Residents' Test Results After Transitioning from Formative Progress Testing.

INTRODUCTION: Educational effects of transitioning from formative to summative progress testing are unclear. Our purpose was to investigate whether such transitioning in radiology residency is associated with a change in progress test results. METHODS: We investigated a national cohort of radiology residents (N > 300) who were semi-annually assessed through a mandatory progress test. Until 2014, this test was purely formative for all residents, but in 2014/2015, it was transitioned (as part of a national radiology residency program revision) to include a summative pass requirement for new residents. In 7 posttransitioning tests in 2015-2019, including summatively and formatively tested residents who followed the revised and pre-transitioning residency program, respectively, we assessed residents' relative test scores and percentage of residents that reached pass standards. RESULTS: Due to our educational setting, most posttransitioning tests had no residents in the summative condition in postgraduate year 4-5, nor residents in the formative condition in year 0.5-2. Across the 7 tests, relative test scores in postgraduate year 1-3 of the summative resident group and year 3.5-4.5 of the formative group differed significantly (p < 0.01 and p < 0.05, respectively, Kruskal-Wallis test). However, scores fluctuated without consistent time trends and without consistent differences between both resident groups. Percentage of residents reaching the pass standard did not differ significantly across tests or between groups. DISCUSSION: Transitioning from formative to summative progress testing was associated with overall steady test results of the whole resident group in 4 post-transitioning years. We do not exclude that transitioning may have positive educational effects for resident subgroups.

Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer.

BACKGROUND: Reduced muscle density is associated with an increased risk of postoperative complications. We examined the prognostic value of muscle density as a predictor of postoperative complications in elderly patients undergoing surgery for colorectal cancer. METHODS: Patients (≥70 years) who underwent surgery for colorectal cancer between 2006 and 2013 were selected from a prospective single centre database. The Hounsfield Unit Average (HUA or HU/mm2) of the psoas muscles at the level of the third lumbar vertebra was calculated on the scan. High and low muscle density groups were identified based on the lowest gender specific HUAC quartile. Major postoperative complications (Clavien-Dindo (CD) ≥3) within 30 days after surgery were retrospectively documented. Logistic regression analysis was used to identify risk factors for postoperative complications. RESULTS: A total of 373 patients (median age = 78 years) were included in this study. The mean muscle density score was 24.5 ± 4.3 HU/mm2 for males and 26.3 ± 5.0 HU/mm2 for females. The cut-off point for the lowest gender specific quartile was ≤22.0 HU/mm2 for males and ≤23.5 HU/mm2 for females. After multivariable regression, there was a statistically significant association between muscle density and CD ≥ 3 (OR = 1.84 (95% CI 1.11-3.06), p = 0.019). Anastomotic leakage in patients with a primary anastomosis (n = 287) occurred more often in patients with low muscle density (11.7% vs 23.3%, p = 0.016). The associations remained significant after correction for confounders. CONCLUSION: Low muscle density is associated with major postoperative complications in older patients who undergo surgery for colorectal cancer.

Cognitive dysfunction and its clinical and radiological determinants in patients with symptomatic arterial disease and diabetes.

BACKGROUND AND AIMS: Both vascular disease and diabetes type 2 (DM2) decrease cognitive functioning in elderly people. It is uncertain if DM2 affects cognition independent of vascular disease. In patients with symptomatic arterial disease, we studied the effect of DM2 on cognition and identified clinical and radiological determinants for impaired cognition in patients with DM2. METHODS: 766 patients (mean age 58.8+/-9.5 years; 108 DM2) with symptomatic arterial disease underwent neuropsychological testing. In 542 patients (77 DM2), volumes of brain tissue, ventricles and white matter lesions were obtained by segmentation of brain MR images. Infarcts were distinguished into small (lacunar) or large (cortical or subcortical). RESULTS: Patients with arterial disease and DM2 performed worse on neuropsychological tests compared to similar patients without DM2 (adjusted composite z-score: beta -0.14 [-0.25 to -0.02]). Insulin treatment, systolic and diastolic blood pressures were significantly associated with cognition in patients with DM2. Large infarcts, global and cortical atrophy on MRI were independently associated with cognition in patients with DM2. CONCLUSION: The presence of DM2 in patients with symptomatic arterial disease is associated with decreased cognitive functioning. Insulin treatment, high blood pressure, brain atrophy and large infarcts were determinants for cognitive dysfunction in patients with DM2 and arterial disease.

A fetal circle of Willis is associated with a decreased deep white matter lesion load.

OBJECTIVE: To investigate the relationship between morphologic differences in the circle of Willis and the presence and location of white matter lesions (WMLs). METHODS: Two hundred forty-three consecutive patients with clinical manifestations of atherosclerotic disease underwent MRI of the brain and MR angiography of the circle of Willis. RESULTS: Subjects with a fetal configuration of the circle of Willis demonstrated a decreased load of small (p < 0.01) and medium (p < 0.01) deep WMLs compared with subjects with a nonfetal configuration of the posterior part of the circle of Willis. CONCLUSION: A fetal configuration of the posterior part of the circle of Willis may be an important protecting determinant in the etiology of white matter lesions.