Phramongkutklao College of Medicine

Simulation-based learning (SBL) is effective for EKG interpretation training in the advanced cardiac life support (ACLS) context, enhancing motivation, confidence, and learning outcomes. However, research on the psychometrics of assessment rubrics for ACLS skills among pre-clinical students is limited. This study investigates the validity and reliability of assessment rubrics for ACLS skills, including EKG interpretation, scenario and pharmacological management, and teamwork. An SBL course that integrates basic EKG interpretation into ACLS Stations was conducted at Phramongkutklao College of Medicine, utilizing high-fidelity mannequins to simulate realistic scenarios, enrolling 96 medical students. The course consisted of five independent stations, and each student was assessed once by two raters using ten-item assessment rubrics. The rubrics included three domains: (1) EKG and ACLS algorithm skills, (2) management and mechanisms of action, and (3) affective domains. Validity evidence on the content was gathered, and construct validity was confirmed with confirmatory factor analysis (CFA). Inter-rater and internal consistency reliability were calculated. Generalizability theory was utilized to analyse the data. Three expert reviews yielded an item-objective congruence index of 0.67-1.00, with iterative validation through alpha and beta tests. The CFA demonstrated a good fit, but two questions with loading factors below 0.30 were removed, resulting in an eight-item assessment form. An inter-rater correlation of 0.70 (p < 0.001) and a Cronbach's alpha of 0.76 was demonstrated. To achieve a Phi-coefficient ≥0.80, three raters and at least 10 items are required in a p×i×r crossed design. With eight items, r:(p×i) nested design reliability was 0.69, 0.79, and 0.83 for one, two, and three raters, respectively. While a single rater with 10 items achieved a Phi-coefficient of 0.74. The rubrics for assessing ACLS skills among pre-clinical students demonstrated acceptable validity and reliability. A condensed eight-item rubric with acceptable reliability is proposed as a practical tool for optimizing assessment in future evaluations relevant to the pre-clinical context.

Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.

This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I² statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.

The I² statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.

By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.

Several studies have reported the effectiveness and tolerability of cannabidiol (CBD)-enriched oil adjunctive treatment in children with drug-resistant epilepsy. This is the first multicenter cohort study of medical-grade CBD-enriched drugs in pediatric drug-resistant epilepsy in Thailand.

A prospective observational study was conducted across 19 Thai government hospitals between 2021 and 2023. The study aimed to assess CBD-enriched adjunctive treatment in pediatric drug-resistant epileptic patients with various etiologies ensuring a follow-up period of at least three months including cases wherein the medication was discontinued before three months.

Of 101 patients, 42% were male with a median age of 10 years, experiencing a seizure frequency of 75 per month, and having failed treatment with an average of seven types of antiseizure medications. The median follow-up duration was 15 months with a median modal CBD dose of 6 mg/kg/day. The ≥50% seizure reduction rate and the median monthly total seizure reduction showed consistent improvement with reductions at three-, six-, nine-, and 12-month and the latest follow-up visits. Most seizure types responded positively to treatment, except for complex motor seizures. The effective CBD dose varied within a range of 1-15 mg/kg/day. Adverse events were reported in 92% of patients, predominantly mild (95%) and including somnolence, increased liver enzymes, anorexia, and irritability. Thirty-three patients discontinued CBD, with 57% due to intolerable adverse events, 30% ineffectiveness, and 12% noncompliance.

The Thai medical-grade CBD-enriched oil is effective and tolerable for at least 12 months of adjunctive treatment in pediatric drug-resistant epilepsy in Thailand.