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BACKGROUND: The COVID-19 pandemic accelerated the shift to remote learning, heightening scrutiny of open-book examinations (OBEs) versus closed-book examinations (CBEs) within science, technology, engineering, arts and mathematics (STEM) education. This study evaluates the efficacy of OBEs compared to CBEs on student performance and perceptions within STEM subjects, considering the emerging influence of sophisticated large language models (LLMs) such as GPT-3. METHODS: Adhering to PRISMA guidelines, this systematic review analysed peer-reviewed articles published from 2013, focusing on the impact of OBEs and CBEs on university STEM students. Standardised mean differences were assessed using a random effects model, with heterogeneity evaluated by I2 statistics, Cochrane's Q test and Tau statistics. RESULTS: Analysis of eight studies revealed mixed outcomes. Meta-analysis showed that OBEs generally resulted in better scores than CBEs, despite significant heterogeneity (I2 = 97%). Observational studies displayed more pronounced effects, with noted concerns over technical difficulties and instances of cheating. DISCUSSION: Results suggest that OBEs assess competencies more aligned with current educational paradigms than CBEs. However, the emergence of LLMs poses new challenges to OBE validity by simplifying the generation of comprehensive answers, impacting academic integrity and examination fairness. CONCLUSIONS: While OBEs are better suited to contemporary educational needs, the influence of LLMs on their effectiveness necessitates further study. Institutions should prudently consider the competencies assessed by OBEs, particularly in light of evolving technological landscapes. Future research should explore the integrity of OBEs in the presence of LLMs to ensure fair and effective student evaluations.
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Aims: Catheter ablation, consisting of pulmonary vein isolation (PVI), is the most effective treatment modality for the management of symptomatic patients with atrial fibrillation (AF). Unfortunately, this procedure has a considerable relapse rate, ranging from 15 to 50% depending on AF type and other patient factors. Hypertension (HTN) is associated with a higher risk of developing AF and can also be managed with a catheter-based procedure-renal denervation (RDN). This meta-analysis aimed to compare the effect of PVI with and without RDN in hypertensive patients with AF. Methods and results: OVID MEDLINE and Embase were searched on 1 February 2023 and trials that reported the effects of RDN on AF recurrence in hypertensive patients were included. A total of 637 patients across 8 randomised controlled trials were included. The results from the pooled analysis showed that when compared with PVI alone, RDN added to PVI: (1) Lowered AF recurrence [RR 0.67 (0.53, 0.85), P = 0.001, I 2 = 23%, NNT = 5.9 patients]; (2) Reduced both systolic blood pressure and diastolic blood pressure, with medium effect size, as reflected by standardised mean differences of 0.5 (P = 0.02, I 2 = 80%) and 0.43 (P = 0.006, I 2 = 60%), respectively; and (3) was not associated with a decrease in estimated glomerular filtration rate (+7.19â mL/min/1.73 m2, P = 0.15, I 2 = 89%). Conclusion: Adding RDN to PVI in patients with AF and resistant HTN was associated with a reduction of blood pressure levels and AF recurrence. Consideration to RDN should be given as an adjunctive treatment for patients with AF and resistant HTN.
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Transthoracic echocardiography (TTE) is the most commonly used imaging modality to diagnose left ventricular thrombus (LVT), however, cardiac magnetic resonance (CMR) remains the gold standard investigation. A comparison of the diagnostic performance between two modalities is needed to inform guidelines on a diagnostic approach towards LVT. We performed a systematic review and meta-analysis to investigate the diagnostic performance of three methods of TTE (non-contrast, contrast, and apical wall motion scoring) for the detection of LVT compared to CMR as a reference test. Studies comprising 2113 patients investigated for LVT using both TTE and CMR were included in the meta-analysis. For non-contrast TTE, pooled sensitivity and specificity were 47% [95% confidence interval (CI): 32-62%], and 98% (95% CI: 96-99%), respectively. In contrast, TTE pooled sensitivity and specificity values were 58% (95% CI: 46-69%), and 98% (95% CI: 96-99%), respectively. Apical wall motion scoring on non-contrast TTE yielded a sensitivity of 100% [95% CI: 93-100%] and a specificity of 54% (95% CI: 42-65%). The area under the curve (AUC) values from our summary receiver operating characteristic curve (SROC) for non-contrast and contrast TTE were 0.87 and 0.86 respectively, with apical wall motion studies having the highest AUC of 0.93. Despite high specificity, routine contrast and non-contrast TTE are likely to miss a significant number of LVT, making it a suboptimal screening tool. The addition of apical wall motion scoring provides a promising method to reliably identify patients requiring further investigations for LVT, whilst excluding others from unnecessary testing.
The formation of left ventricular thrombus (LVT), a blood clot in the left pumping chamber of the heart, can lead to serious complications such as a stroke. Whilst cardiac magnetic resonance (CMR) is the best imaging tool to detect these clots, the most used tool is a transthoracic echocardiogram (TTE), which visualizes the heart by placing an ultrasound on the chest. This is due to the affordability and widespread availability of TTE. Thus, it is important to know how TTE compares to CMR when it comes to detecting LVT. This study pools the results of previous research to compare the diagnostic performance of three different methods of TTE compared to CMR for detecting LVT. Non-contrast TTE.Contrast TTE: The addition of an enhancing dye is thought to improve imaging.Apical wall motion scoring: Evaluating the movement of the heart's walls using TTE. Our results show that current methods of TTE may miss half of the patients with LVT and that the use of contrast did not provide significant improvement. Interestingly, the use of apical wall motion scoring was able to accurately detect all the patients with LVT. This shows promise as a future tool to reliably exclude patients from unnecessary testing, whilst identifying those who need further investigations.