OBJECTIVE: Dispersion is a form of intra-individual variability across neuropsychological tests that has been shown to predict cognitive decline. However, few studies have investigated the stability and predictive utility of both across- and within-domain dispersion. The current study aims to fill these gaps in the literature by examining multiple indices of dispersion in a longitudinal clinical sample of individuals diagnosed with mild cognitive impairment (MCI) at baseline.
METHODS: Two hundred thirty-eight MCI patients from a cognitive disorders clinic underwent testing at baseline and after approximately 1.5 years. Linear regression was used to examine whether baseline across- and within-domain dispersion predicted cognitive decline in individuals whose diagnostic classification progressed to dementia (i.e., MCI-Decline) and those who retained an MCI diagnosis at follow-up (i.e., MCI-Stable). Cognitive decline was operationalized dichotomously using group status and continuously using standardized regression-based (SRB) z-scores.
RESULTS: Dispersion variables at baseline and follow-up were positively correlated in both groups, with the exception of within-domain executive functioning and language dispersion in the MCI-Decline group. None of the dispersion variables predicted diagnostic conversion to MCI. Using SRB z-scores, greater across-domain dispersion predicted greater overall cognitive decline at follow-up, but this was not the case for within-domain variables with the exception of visuospatial skills.
CONCLUSIONS: Results suggest that across- and within-domain dispersion are relatively stable across time, and that across-domain dispersion is predictive of subtle cognitive decline in patients with MCI. However, these results also highlight that findings may differ based on the tests included in dispersion calculations.

Performance assessments for student pharmacists are required by the Accreditation Council for Pharmacy Education to monitor student knowledge, retention, and professional skill sets. Near the end of their Advanced Pharmacy Practice Experiences (APPEs), fourth-year pharmacy students (P4s) at the University of Texas at Austin College of Pharmacy must pass a milestone exam (P4ME) to graduate. The P4ME contains four sections: adult medicine, ambulatory care, community, and hospital. If a student fails one or more sections of the initial multiple-choice P4ME, they must retake that specific section(s) on the makeup P4ME. If a student fails the makeup multiple-choice P4ME, they participate in a case based oral exam designed to determine whether they meet minimal competencies to pass the P4ME. This report outlines the process undertaken by the faculty to develop a high-stakes P4 milestone oral exam. While only a few students have participated in the process, outcomes differentiated P4s eligible for graduation versus those who needed to repeat an APPE. Lessons learned about the oral exam process include minimizing the number of faculty in attendance, shortening the exam duration, and standardizing the exam process. Positive aspects include remediation led by a subject matter expert and implementation of a unique rubric to assess student performance. Overall, the authors find the P4 oral milestone exam to be a feasible assessment tool for students who perform poorly on the initial and makeup multiple-choice P4MEs.

BACKGROUND: Assessment of upper limb function is critical in the rehabilitation process of people with Parkinson\'s Disease (PD), and universally validated outcome measures are needed to allow comparisons across the practice. Moreover, the study of psychometric properties of the same tool on different clinical populations guarantees the possibility of reliably evaluating the same rehabilitation treatment in people with different clinical conditions.
OBJECTIVE: The aim of this research was to evaluate the psychometric characteristics of the Italian adaptation of the Jebsen Taylor Hand Function Test (JTHFT) in individuals with PD.
METHODS: The reliability and validity of the test were assessed in accordance with international standards. Internal consistency was measured using Cronbach\'s alpha, and test-retest reliability was determined via the intraclass correlation coefficient (ICC). The construct validity and cross-cultural validity of the test were evaluated using Pearson\'s correlation coefficient with three assessment tools on upper limb function, independence, and quality of life, with hand grip power measured by a dynamometer and an Italian pangram. Finally, responsiveness after a one month of rehabilitation treatment was measured using the Wilcoxon rank test.
RESULTS: Fifty-two Italian people with PD were recruited. Cronbach\'s alpha values ranged from 0.556 (non-dominant hand) to 0.668 (dominant hand); ICC values ranged from 0.754 to 0.988. Construct validity showed that several statistically significant correlations were detected. Wilcoxon\'s test showed that the assessment tool can detect a change in this population after treatment.
CONCLUSIONS: The JTHFT is a reliable, valid, and respondent tool to evaluate the upper limb and hand functionalities in PD patients. It should be added to the toolkit for measuring upper limb performance in this population, adding value to clinical evaluation and ensuring comparable results for different clinical populations and different countries.

Improving healthcare requires appropriate community involvement supported by appropriate partner engagement methods. This research aims to develop a complex tool for evaluating the social responsibility of health facilities regarding community involvement and development. We developed areas of a new reference framework for the sustainability of healthcare organizations, which includes the area of community involvement and expansion. It is made up of nine indicators. These were designed using the most representative activities reported by hospitals around the world. Their testing was conducted in an orthopedic emergency hospital. The designed indicators are community engagement actions; the interventions\' content adapted to the community; partnership and networking; the involvement of volunteers and training networks; the involvement and participation of professional associations; community-involved local opinion leaders; satisfaction with partnerships; initiatives together with the community; and educational visits. The testing and validation of health practices of the indicators highlighted their adequacy with the proposed purpose of the research and the promotion of sustainable development. We have also verified their compatibility with the requirements of national hospital accreditation legislation and the European framework for quality assurance in hospitals.

OBJECTIVE: To determine the impact of item-writing flaws and cognitive level on student performance metrics in one course series across two semesters at a single institution.
METHODS: Four investigators reviewed 928 multiple-choice items from an integrated therapeutics course series. Differences in performance metrics were examined between flawed and standard items, flawed stems and flawed answer choices, and cognitive levels.
RESULTS: Reviewers found that 80% of the items were flawed, with the most common types being implausible distractors and unfocused stems. Flawed items were easier than standard ones, with items becoming easier as they accumulate more flaws. These flaws benefited lower-performing students more than higher-performing ones, particularly up to two flaws. Items with flawed stems had the same difficulty as standard items, but those with flawed answer choices were significantly easier. Most items tested lower-level skills and have more flaws than higher-level items. There was no significant difference in difficulty between lower- and higher-level cognitive items, and higher-level items were more likely to have answer flaws than stem flaws.
CONCLUSIONS: Item-writing flaws differently impact student performance. Implausible distractors artificially lower the difficulty of questions, even those designed to assess higher-level skills. This effect contributes to a lack of significant difference in difficulty between higher- and lower-level items. Unfocused stems, on the other hand, likely increase confusion and hinder performance regardless of the question\'s cognitive complexity.

BACKGROUND: The increase in the migration of dentists educated outside the EU/EEA calls for the sharing of information and evaluation of recognition processes within countries in the EU. In 2017, the Swedish National Board of Health and Welfare implemented the Proficiency test, a recognition process for dentists who have completed an education programme outside the EU/EEA. The Proficiency test consists of a theoretical and an integrated clinical skills examination, followed by a 6-month clinical practice. The clinical skills examination is a two-part examination that includes an OSCE and an operative test on a dental manikin. This paper presents data from proficiency tests between 2018 and 2022, and explores factors related to grade fail, that is, demographics, theoretical exam scores and language comprehension.
METHODS: In a cohort study, demographics and factors associated with grade fail were explored using test results from theoretical and clinical skills examinations (n = 181) from 2018 to 2022. Pearson correlation coefficient and linear regression analysis were used for studying correlations and associations between exam results. Univariable linear and logistic regression models were used for background variable associations with clinical skills exam outcomes.
RESULTS: Higher age was a significant risk factor for failing the clinical skills examination and the OSCE. Higher scores in the theoretical exam reduced the odds of failing the OSCE but were not associated with results in the operative test or the overall results of the clinical skills examination. Regarding the OSCE there was a statistically significant difference within all professional qualifications explored between participants who passed and participants who failed the OSCE.
CONCLUSIONS: Four years of data collection reveal that age and previous theoretical exam results influence the odds of failing the clinical examination. The study results also highlight the necessity of multiple assessment formats to assess clinical and communication skills of foreign-trained dentists.

This study aimed to improve the predictive accuracy of the Braden assessment for pressure injury risk in skilled nursing facilities (SNFs) by incorporating real-world data and training a survival model. A comprehensive analysis of 126 384 SNF stays and 62 253 in-house pressure injuries was conducted using a large calibrated wound database. This study employed a time-varying Cox Proportional Hazards model, focusing on variations in Braden scores, demographic data and the history of pressure injuries. Feature selection was executed through a forward-backward process to identify significant predictive factors. The study found that sensory and moisture Braden subscores were minimally contributive and were consequently discarded. The most significant predictors of increased pressure injury risk were identified as a recent (within 21 days) decrease in Braden score, low subscores in nutrition, friction and activity, and a history of pressure injuries. The model demonstrated a 10.4% increase in predictive accuracy compared with traditional Braden scores, indicating a significant improvement. The study suggests that disaggregating Braden scores and incorporating detailed wound histories and demographic data can substantially enhance the accuracy of pressure injury risk assessments in SNFs. This approach aligns with the evolving trend towards more personalized and detailed patient care. These findings propose a new direction in pressure injury risk assessment, potentially leading to more effective and individualized care strategies in SNFs. The study highlights the value of large-scale data in wound care, suggesting its potential to enhance quantitative approaches for pressure injury risk assessment and supporting more accurate, data-driven clinical decision-making.

BACKGROUND: Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders.
OBJECTIVE: Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families.
METHODS: Twenty-nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi-structured interviews. Thematic analysis was used to develop themes from the data.
RESULTS: Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework.
CONCLUSIONS: Findings suggest that an effective outcome monitoring framework should be client-led, tailored to the individual\'s needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing.

With improved systemic treatment and prolonged survival even with metastatic disease, diagnosing, treating, and monitoring brain metastases has become a central topic in the care of patients with melanoma. Patients with brain metastases from melanoma are typically excluded from pivotal clinical trials. When allowed, inclusion and exclusion criteria are rather selective and do not reflect the larger population of melanoma patients with brain metastases who frequently present with neurological symptoms and signs and require steroid medications. Moreover, the lack of consensus on reporting symptomatic brain involvement complicates the interpretation and implications of trial results for the overall population of patients with melanoma and brain metastasis. Here, we review the evidence regarding brain metastasis from melanoma and discuss the challenges of longitudinal neurological clinical assessments, including tools to capture cognition and quality of life. Finally, we propose the adoption of standardized tools to interpret neurological deficits in patients with melanoma and brain metastases and to assess the neurological status in the context of clinical trials.

UNASSIGNED: The Tinnitus Functional Index (TFI) is a widely recognized measure for evaluating tinnitus and is frequently used in both therapeutic and research contexts. Unfortunately, TFI is currently not available in any Indian languages. In a multilingual country like India, cross-cultural adaptation, translation, and validation of such scales in regional languages are critical to improving their use for clinical and research purposes. Therefore, this study focused on translating and validating the TFI in Kannada for use among the Indian population.
UNASSIGNED: The original version of TFI was translated with the help of audiologists and linguistic experts who were proficient in Kannada. The translated version was content validation by five audiologists and a cognitive debriefing by native speakers to check the familiarity of words. The final version (TFI-K) was then administered to 181 participants with tinnitus. Along with the TFI, other scales like Tinnitus Handicap Inventory (THI) were also obtained to check the convergent validity. The obtained data was then subjected to various statistical analyses like internal consistency, convergent and discriminant validity, and factor analysis.
UNASSIGNED: The TFI-K was found to have an excellent internal consistency (Cronbach\'s α = 0.974) and good convergent validity (p < 0.001; r = 0.778) with THI-K. A principal component analysis with varimax rotation showed communalities ranging from 0.64 to 0.91. Scree plots with the TFI-K component showed a sharp decline after the first factor and approximately four factors above the eigenvalue of 1. The factor analysis results suggest that the TFI-K has a structurally intact 8-factor loading, with a few exceptions that are discussed in detail.
UNASSIGNED: The TFI-K has demonstrated remarkable dependability and satisfactory integrity, making it a valuable tool for assessment and treatment planning in clinical and research settings.
Tinnitus is known to impinge multiple domains.Assessing multiple domains provides a comprehensive understanding of the impact of tinnitus.Tinnitus Functional Index (TFI) has been cross-culturally translated into Kannada.Tinnitus Functional Index in Kannada (TFI-K) is reliable and valid and can be used clinically and in research.