Continuous glucose monitoring (CGM)-derived time in range (TIR) correlates with hemoglobin A1c (A1c) among patients with type 2 diabetes mellitus (T2DM); however, there is a paucity of data evaluating its association with microvascular complications. We conducted this systematic review to examine the association between TIR and microvascular complications of diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN). We conducted a comprehensive literature search on PubMed, Scopus, and Web of Science online databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text original articles that evaluated the association between CGM-derived TIR and risk of microvascular complications and were published between 2010 and June 2021 were included in our systematic review. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using qualitative synthesis. Eleven studies on a total of 13 987 patients were included in the systematic review. The median sample size, baseline A1c, and diabetes duration were 466 patients (range: 105–5901), 8.2% (SD 0.5%), and 11.3 years (1.0), respectively. Majority of the studies were conducted in Asia (10 out of 11). Four studies evaluated the relationship between CGM-derived TIR and DR and CGM-derived TIR and DN, while seven studies evaluated the relationship between CGM-derived TIR and DPN. A 10% increase in TIR was associated with a reduction in albuminuria, severity of DR, and prevalence of DPN and cardiac autonomic neuropathy. In addition, an association was observed between urinary albumin to creatinine ratio but not with estimated glomerular filtration rate. This review summarizes recent evidence supporting an association between CGM-derived TIR and microvascular complications among patients with T2DM. A larger-scale multicenter investigation that includes more diverse participants is warranted to further validate the utility of TIR as a predictor of diabetic microvascular complications.
Background: Assessment is an integral part of all forms of learning. Formative assessment in different forms have evolved as a mean to find the learning gaps (what students already know in compare to what they need to know). As a result it becomes possible to give appropriate feedback to the students to close this gap. Summative assessment on the other hand is purposefully designed to make judgments about students’ performance and produce grades.Aims and Objectives: The main purpose of this study is to explore students’ view with regards to the impact of formative assessment on the outcome of summative assessment in basic science MD program.Materials and Methods: A cross sectional descriptive study was conducted involving 142 students of an International medical school. A questionnaire was designed, pretested, and finally used to record different opinions of the students and data was collected, analyzed, and interpreted.Results: Majority of the respondents (78%) favored that the feedback collected from formative assessment remains important for them as it helps to fill their learning gaps. Respondents by large (76.8%) also agreed that formative assessment helps the faculty to identify student’s weak point. A huge percentage (80.8%) of respondents was in agreement that formative assessment inspires them for deep learning and regular study. However, a fair number of respondents (36.4%) thought that frequently scheduled formative assessment impede their independent learning thus negatively impact their performance in summative exam.Conclusion: Formative assessment if scheduled properly can have a positive impact on the summative assessment.Asian Journal of Medical Sciences Vol.8(4) 2017 38-43
Background. Platelet-rich plasma (PRP) and its derivatives are used in several aesthetic, dental, and musculoskeletal procedures. Their efficacy is primarily due to the release of various growth factors (GF), interleukins, cytokines, and white blood cells. However, the PRP preparation methods are highly variable, and studies lack consistency in reporting complete procedures to prepare PRP and characterize PRP and its derivatives. Also, all the tissue-specific (in vivo and in vitro) interactions and functional properties of the various derivatives/factors of the PRP have not been taken into consideration by any study so far. This creates a potential space for further standardization of the PRP preparation methods and customization of PRP/PRP derivatives targeted at tissue-specific/pathology specific requirements that would enable efficacious and widely acceptable usage of PRP as main therapy, rather than being used as adjuvant therapy. The main objective of our study was to investigate the variability in PRP preparation methods and to analyze their efficacy and reliability. Method. This study considered articles published in the last 5 years, highlighting the variability in their PRP preparation methods and characterization of PRP. Following the PRISMA protocol, we selected 13 articles for the study. The selected articles were assessed using NHLBI quality assessment tool. Results. We noted differences in (1) approaches to producing PRP, (2) extent of characterization of PRP, (3) small scale and large-scale preparation methods, (4) in vitro and in vivo studies. Conclusion. We identified two studies describing the procedures which are simple, reproducible, economical, provide a good yield of platelets, and therefore can be considered methods for further tissue-specific and pathology-specific standardizations of PRP and its derivatives. We recommend further randomized studies to understand the full therapeutic potential of the constituents of PRP and its derivatives.
Background: Medical education has been reliant on didactic lectures, which are predominantly teacher-centered learning. Competency-based education was introduced in North America and with this came a paradigm shift in how schools conceptualize curricula and measure learning outcomes. This modern approach started a change away from traditional lecture-based and teacher-centered curricula to a more student-centric approach using various tools. Competency based education is widely regarded as an outcome-based approach to design, implement and evaluate the curriculum using widely accepted competencies. Authorities recommend seven core competencies which have various indicators to address student performance. The main purpose of this research is to utilize active learning tools to enhance this approach and then assess competencies in the first year of medical school to improve academic outcomes as well as exposing students to competency domains on which they will be assessed and to ultimately create a complete physician. Methods: The study was conducted at a medical school during the first semester of medical school and included 145 students. Various active learning tools, such as modified case-based learning, quizzes, and case discussions, were used to assess competency in a biochemistry and genetics course, and these were compared to questions based on concepts delivered by the traditional lecture method. Results: Student performance on high-stakes examinations after active learning sessions on content and concepts had statistically higher average percentages on the second, third and fourth examinations. The average Diff (p) for the second, third, and fourth examination to the questions being considered for the study were (Diff p= 0.84, 0.83, and 0.92) with a positive moderate correlation for the second examination (r= 0.535) and strong positive correlation for the third and fourth examination (r=0.745 and r=0.856) for their final biochemistry grades. Conclusion: The study shows some positive and significant results that active learning methods are a useful and meaningful way to deliver a curriculum for a competency-based education system, and may be better suited than traditional lectures for providing content and assessing competencies which are necessary to become a complete physician.
Background Platelet-rich plasma (PRP) and its derivatives are used in several aesthetic, dental, and musculoskeletal procedures. Their efficacy is primarily due to the release of various growth factors (GF), interleukins, cytokines, and white blood cells. However, the PRP preparation methods are highly variable, and studies lack consistency in reporting complete procedures to prepare PRP and characterize PRP and its derivatives. Also, all the tissue-specific (in vivo and in vitro) interactions and functional properties of the various derivatives/factors of the PRP have not been taken into consideration by any study so far. This creates a potential space for further standardization of the PRP preparation methods and customization of PRP/PRP derivatives targeted at tissue-specific/pathology specific requirements that would enable efficacious and widely acceptable usage of PRP as main therapy, rather than being used as adjuvant therapy. The main objective of our study was to investigate the variability in PRP preparation methods and to analyze their efficacy and reliability. Method This study considered articles published in the last 5 years, highlighting the variability in their PRP preparation methods and characterization of PRP. Following the PRISMA protocol, we selected 12 articles for the study. The selected articles were assessed using NHLBI quality assessment tool. Results We noted differences in 1) approaches in producing PRP, 2) extent of characterization of PRP, 3) small scale and large-scale preparation methods, 4) in vitro and in vivo studies. Conclusion We identified two studies describing the procedures which are simple, reproducible, economical, provide a good yield of platelets, and therefore can be considered methods for further tissue-specific and pathology-specific standardizations of PRP and its derivatives. We recommend further randomized studies to understand the full therapeutic potential of the constituents of PRP and its derivatives.
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