Objective: Impairment in the ability to provide informed consent is common in persons with brain metastasis. However, little is known about what factors contribute to this impairment in the patient group. Our objective is to determine if the associations between demographic, cognitive, and clinical variables correlate with the ability to provide informed consent in persons with brain metastasis. Methods: We administered a comprehensive neuropsychological battery to a group of 61 persons with brain metastasis. Demographic and clinical information was also collected. All diagnoses were made by board-certified oncologists and were verified histologically. Statistical analyses included Pearson's product-moment correlations, point biserial correlations, and linear regression. Results: Results indicated that combinations of education, verbal memory, executive function, whole brain radiation therapy, and chemotherapy affected various aspects of the ability to provide informed consent. Subsequent regression models demonstrated that these variables contributed a significant amount of shared variance to the ability to provide informed consent. Conclusion: We found that the ability of persons with brain metastasis to provide informed consent is a cognitively complex ability that is also affected by education and treatment variables. This information can help clinical researchers in identifying persons with brain metastasis at risk of an impaired ability to provide informed consent and aid in the consenting process.
A BS TRACT: Background: Primary dystonia is conventionally considered as a motor disorder, though an emerging literature reports associated cognitive dysfunction.Objectives: Here, we conducted meta-analyses on studies comparing clinical measures of cognition in persons with primary dystonia and healthy controls (HCs). Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO (January 2000-October 2020). Analyses were modeled under random effects. We used Hedge's g as a bias-corrected estimate of effect size, where negative values indicate lower performance in dystonia versus controls. Between-study heterogeneity and bias were primarily assessed with Cochran's Q, I 2 , and Egger's regression. Results: From 866 initial results, 20 studies met criteria for analysis (dystonia n = 739, controls n = 643; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = À0.56, P < 0.001), with low heterogeneity (Q = 25.26, P = 0.15, I 2 = 24.78). Within-domain effects of primary dystonia were motor speed = À0.84, nonmotor speed = À0.83, global cognition = À0.65, language = À0.54, executive functioning = À0.53, learning/memory = À0.46, visuospatial/construction = À0.44, and simple/complex attention = À0.37 (P-values <0.01). High heterogeneity was observed in the motor/nonmotor speed and learning/memory domains. There was no evidence of publication bias. Moderator analyses were mostly negative but possibly underpowered. Blepharospasm samples showed worse performance than other focal/cervical dystonias. Those with inherited (ie, genetic) disease etiology demonstrated worse performance than acquired. Conclusions: Dystonia patients consistently demonstrated lower performances on neuropsychological tests versus HCs. Effect sizes were generally moderate in strength, clustering around À0.50 SD units. Within the speed domain, results suggested cognitive slowing beyond effects from motor symptoms. Overall, findings indicate dystonia patients experience multidomain cognitive difficulties, as detected by neuropsychological tests.
Introduction Medical simulation is widely used in the United States medical curriculum. However, learning outcomes based on simulation have yet to be reported. In this study, we aim to characterize the objective performance of first-and second-year medical students following eight weeks of medical simulation-based learning. Methods First-(n=25) and second-year (n=15) medical students were recruited for this study. We designed and administered a novel pre-experience examination to collect participant demography and assess simulation and non-simulation knowledge. Following 14 high-fidelity simulation scenarios over the course of eight weeks, we administered an identical post-experience examination and compared performance, primarily using a within-subjects analytic design. Results Student performance improved by an average of 18% following the medical simulation experience, and firstyear students demonstrated greater benefit (22%) as compared to second-years (12%). Relative to first-years, second-year students showed higher overall performance on both pre-and post-examination. Demographic factors and prior medical experience were not significantly associated with assessment performance and score improvement. Conclusions Our data supported the efficacy of simulation-based learning as evidenced by the significant improvement in objective performance on a standardized examination. That is, both first-and second-year medical students demonstrated test-score improvement following an eight-week medical simulation program. Of note, the first-year students exhibited greater benefit (at the group level). Importantly, these findings were statistically unrelated to participant demographic and background variables. Collectively, this study provides preliminary evidence that medical simulation in the pre-clinical phase of undergraduate medical education is an effective tool for student learning.
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