RESUMO
BACKGROUND: OSCE are widely used for assessing clinical skills training in medical schools. Use of traditional pass fail cut off yields wide variations in the results of different cohorts of students. This has led to a growing emphasis on the application of standard setting procedures in OSCEs. PURPOSE/AIM: The purpose of the study was comparing the utility, feasibility and appropriateness of 4 different standard setting methods with OSCEs at XUSOM. METHODS: A 15-station OSCE was administered to 173 students over 6 months. Five stations were conducted for each organ system (Respiratory, Gastrointestinal and Cardiovascular). Students were assessed for their clinical skills in 15 stations. Four different standard setting methods were applied and compared with a control (Traditional method) to establish cut off scores for pass/fail decisions. RESULTS: OSCE checklist scores revealed a Cronbach's alpha of 0.711, demonstrating acceptable level of internal consistency. About 13 of 15 OSCE stations performed well with "Alpha if deleted values" lower that 0.711 emphasizing the reliability of OSCE stations. The traditional standard setting method (cut off score of 70) resulted in highest failure rate. The Modified Angoff Method and Relative methods yielded the lowest failure rates, which were typically less than 10% for each system. Failure rates for the Borderline methods ranged from 28% to 57% across systems. CONCLUSIONS: In our study, Modified Angoff method and Borderline regression method have shown to be consistently reliable and practically suitable to provide acceptable cut-off score across different organ system. Therefore, an average of Modified Angoff Method and Borderline Regression Method appeared to provide an acceptable cutoff score in OSCE. Further studies, in high-stake clinical examinations, utilizing larger number of judges and OSCE stations are recommended to reinforce the validity of combining multiple methods for standard setting.
RESUMO
OBJECTIVES: Multiple myeloma (MM) is a malignant disorder characterized by proliferation of a single clone of plasma cells derived from ß-cells in the bone marrow. It is the second most common adult hematological malignancy, and it is the most common cancer with skeletal components as its primary site. The purpose of the retrospective study was to assess the hematological profile, different biochemical parameters, and the serum electrophoresis patterns of patients consistent with clinical symptoms of multiple myeloma. MATERIALS AND METHODS: A retrospective study of 99 patients diagnosed with multiple myeloma (MM) was carried out at the Hematology Department of Benghazi Medical Center (BMC) in Benghazi, Libya from January 2010 to March 2017. Information on the laboratory features was obtained at presentation (before treatment) and analyzed. RESULTS: Of the 99 study detected cases of multiple myeloma at diagnosis, 14% were younger than 45 years and 35% were 70 years or older. The mean age was 61 years, of which 42 (42.4%) were males and 57 (57.6%) were females. Anemia was seen in roughly half of the diagnosed cases, most of which was normocytic normochromic anemia. High erythrocyte sedimentation rate (ESR) was seen in 65.3% of cases and increased neutrophil-to-lymphocyte ratio (NLR) was seen in 29.7%. Other abnormal serum levels with regard to the cases are as follows: hyperproteinemia in 30%, low albumin/globulin (A/G) ratio in 54.2%, hypercalcemia in 11.3%, serum creatinine level of >2.0 mg/dL in 27.2% cases, and increased ß2-microglobulin in 67%. Serum protein electrophoresis revealed a localized band in 70.8% of patients. Monoclonal bands were seen in 44 cases (95.7%) and a bi-clonal pattern in two cases (4.3%), 78% of M-band showed migration to γ-region of electrophoretogram and 18% to ß-region. Hypogammaglobulinemia was detected in 32.8% and hypergammaglobulinemia was detected in 49.2%. Of the hypergammaglobulinemia, 18.1% showed polyclonal gammaglobulinemia. Bence Jones protein was positive in 50% cases. IgG was the commonest type, followed by IgA then light chain. In 26.5% of cases, the only diagnosis was multiple myeloma. Light chain multiple myeloma patients had high α2 globulin concentration and normal A/G ratio. Apart from the diagnosis of multiple myeloma, a number of cases had varying diagnoses including the following: 4% non-secretory myeloma, 2% amyloidosis with nephrotic syndrome, 2% liver cirrhosis, and 18.2% renal failure. Most patients presented in stage III. CONCLUSIONS: The presence of anemia, high ESR, and low A/G ratio in elderly patients should alert the clinician to investigate along the lines of multiple myeloma. In this study, unfortunately, the laboratory investigations were insufficient for diagnosing this disease in most patients. Most patients were diagnosed at stage III. Absence of paraprotein in the blood does not exclude multiple myeloma. It was further observed that most of the patients presented with significant renal damage, which attributed to hyperuricemia, hypercalcemia, or high NLR. Multiple causes of renal failure occur in myeloma and are often present at the time of diagnosis.