Characterization of medical students recall of factual knowledge using learning objects and repeated testing in a novel e-learning system.

BACKGROUND: Spaced-repetition and test-enhanced learning are two methodologies that boost knowledge retention. ALERT STUDENT is a platform that allows creation and distribution of Learning Objects named flashcards, and provides insight into student judgments-of-learning through a metric called 'recall accuracy'. This study aims to understand how the spaced-repetition and test-enhanced learning features provided by the platform affect recall accuracy, and to characterize the effect that students, flashcards and repetitions exert on this measurement. METHODS: Three spaced laboratory sessions (s0, s1 and s2), were conducted with n=96 medical students. The intervention employed a study task, and a quiz task that consisted in mentally answering open-ended questions about each flashcard and grading recall accuracy. Students were randomized into study-quiz and quiz groups. On s0 both groups performed the quiz task. On s1 and s2, the study-quiz group performed the study task followed by the quiz task, whereas the quiz group only performed the quiz task. We measured differences in recall accuracy between groups/sessions, its variance components, and the G-coefficients for the flashcard component. RESULTS: At s0 there were no differences in recall accuracy between groups. The experiment group achieved a significant increase in recall accuracy that was superior to the quiz group in s1 and s2. In the study-quiz group, increases in recall accuracy were mainly due to the session, followed by flashcard factors and student factors. In the quiz group, increases in recall accuracy were mainly accounted by flashcard factors, followed by student and session factors. The flashcard G-coefficient indicated an agreement on recall accuracy of 91% in the quiz group, and of 47% in the study-quiz group. CONCLUSIONS: Recall accuracy is an easily collectible measurement that increases the educational value of Learning Objects and open-ended questions. This metric seems to vary in a way consistent with knowledge retention, but further investigation is necessary to ascertain the nature of such relationship. Recall accuracy has educational implications to students and educators, and may contribute to deliver tailored learning experiences, assess the effectiveness of instruction, and facilitate research comparing blended-learning interventions.

[Urinary Incontinence in Women Who Practice Recreational Exercise: A Cross-Sectional Study]. / A Incontinência Urinária em Mulheres Praticantes de Exercício Recreativo: Um Estudo Transversal.

INTRODUCTION: Urinary incontinence affects up to one third of women in Portugal. Exercise can be a precipitating/aggravating factor but also protective, if appropriate. The aim of this study was to determine the prevalence of urinary incontinence in women who practice recreational exercise, to assess its relationship with the type of exercise and other coexisting risk factors, and assess whether the topic is addressed in gyms. MATERIAL AND METHODS: Cross-sectional study using self-reported questionnaires in gyms in Porto and Vila Nova de Gaia, Portugal. RESULTS: Two hundred and ninety women completed the questionnaires. From these, 67.6% were under 40 years old, 25.2% reported incontinence, and 53.4% had at least one risk factor unrelated to exercise. There was a statistically significant association (p < 0.05) between incontinence, obesity and constipation. High impact exercises were included in the training of 62.1% continent and 50.9% incontinent women. The topic of incontinence and strengthening of the pelvic floor muscles was addressed in only 5.5% in the initial assessment, 9.7% in collective training, and in 13.5% of the 37 women with individualized training. DISCUSSION: The higher proportion of continent women - compared to incontinent - who practiced strenuous exercise suggests that this might be a provocative factor for some, although there was no statistically significant association between incontinence and type of exercise. CONCLUSION: Urinary incontinence affects women who practice recreational exercise, regardless of age and exercise characteristics. It is rarely addressed in gyms, and it is necessary to raise the awareness of professionals to enhance the preventive/therapeutic effects of exercise on the function of the pelvic floor and in the control of modifiable risk factors.

Introdução: A incontinência urinária afeta até um terço das mulheres em Portugal. O exercício pode ser fator precipitante/de exacerbação, mas também protetor, se for adequado. O objetivo deste estudo é determinar a prevalência de incontinência urinária em mulheres praticantes de exercício recreativo, avaliar a relação com o tipo de exercício e outros fatores de risco coexistentes, e aferir se o tema é abordado nos ginásios.Material e Métodos: Estudo transversal através de questionários de auto-preenchimento em ginásios do Porto e Vila Nova de Gaia.Resultados: Duzentas e noventa mulheres completaram os questionários. Destas, 67,6% tinham menos de 40 anos, 25,2% referiam incontinência e 53,4% tinham pelo menos um fator de risco não relacionado com exercício. Verificou-se uma associação estatisticamente significativa (p < 0,05) entre incontinência, obesidade e obstipação. Exercícios de alto impacto eram incluídos nos treinos de 62,1% das mulheres continentes e 50,9% das incontinentes. O tema incontinência e fortalecimento muscular do pavimento pélvico foi abordado em apenas 5,5% na avaliação inicial, 9,7% em treinos coletivos e em 13,5% das 37 mulheres com treinos individuais.Discussão: A maior proporção de mulheres continentes, comparativamente às incontinentes, que praticavam exercício extenuante, sugere que este era um fator provocativo para algumas, não se verificando, contudo, uma associação estatisticamente significativa entre incontinência e tipo de exercício.Conclusão: A incontinência urinária afeta mulheres praticantes de exercício recreativo, independentemente da idade e características do exercício. É raramente abordada nos ginásios, sendo necessário sensibilizar os profissionais para potenciar os efeitos preventivos/terapêuticos do exercício na função do pavimento pélvico e no controlo de fatores de risco modificáveis.

Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury.

Ultrasound elastography (USE) is a recent technology that has experienced major developments in the past two decades. The assessment of the main mechanical properties of tissues can be made with this technology by characterisation of their response to stress. This article reviews the two major techniques used in musculoskeletal elastography, compression elastography (CE) and shear-wave elastography (SWE), and evaluates the studies published on major electronic databases that use both techniques in the context of tendon pathology. CE accounts for more studies than SWE. The mechanical properties of tendons, particularly their stiffness, may be altered in the presence of tendon injury. CE and SWE have already been used for the assessment of Achilles tendons, patellar tendon, quadriceps tendon, epicondylar tendons and rotator cuff tendons and muscles. Achilles tendinopathy is the most studied tendon injury with USE, including the postoperative period after surgical repair of Achilles rupture tendon. In relation to conventional ultrasound (US), USE potentially increases the sensitivity and diagnostic accuracy in tendinopathy, and can detect pathological changes before they are visible in conventional US imaging. Several technical limitations are recognised, and standardisation is necessary to ensure repeatability and comparability of the results when using these techniques. Still, USE is a promising technique under development and may be used not only to promote an early diagnosis, but also to identify the risk of injury and to support the evaluation of rehabilitation interventions. KEY POINTS: • USE is used for the assessment of the mechanical properties of tissues, including the tendons. • USE increases diagnostic performance when coupled to conventional US imaging modalities. • USE will be useful in early diagnosis, tracking outcomes and monitoring treatments of tendon injury. • Technical issues and lack of standardisation limits USE use in the assessment of tendon injury.