Difference In Overall Success Rates Research Articles

Ultrasound-Assisted Lumbar Puncture in Children: A Meta-Analysis.

Success rates of lumbar puncture are rather low in children. Ultrasound guidance has been suggested to increase success rate. To systematically compare lumbar puncture success with and without ultrasound in children. PubMed, Scopus, and Web of Science databases were searched in January 2023. Randomized controlled trials including children (aged <18 years) and comparing ultrasound-assisted lumbar puncture to palpation-marked lumbar puncture were included. One author extracted, and the other author validated data. Seven studies were included. First puncture success rate was 71.7% (190 of 265) in the ultrasound group and 58.9% (155 of 263) in the palpation group (risk ratio [RR], 1.22; (confidence interval [CI], 1.00-1.50; 5 studies). First puncture success rate with ultrasound was higher in infants (RR, 1.41; CI, 1.10-1.80; 3 studies), but not in older children (RR, 1.07; CI, 0.98-1.17; 2 studies). Overall success rate was 89.3% (276 of 309) in the ultrasound group and 80.3% (248 of 309) in the palpation group (RR, 1.11; CI 0.95-1.30; 7 studies). Evidence quality was rated low because of risk of bias (3 studies high risk of bias) and imprecision. Ultrasound use may improve first puncture success rate in infants but not in older children. We did not find evidence of difference in overall success rate. Better quality evidence is needed before implementing ultrasound guidance in practice.

Techniques to Improve Peripheral Intravenous Catheter Placement

Techniques to Improve Peripheral Intravenous Catheter Placement

Ultrasound guidance for arterial (other than femoral) catheterisation in adults.

Ultrasound guidance for arterial (other than femoral) catheterisation in adults.

How to improve reliability of cut-off scores in dental competency exam: A comparison of rating methods in standard setting.

The aim of this study was to find ways to improve reliability of cut-off scores that are typically used to make high-stake decisions in dental education by empirically comparing two different rating methods, Yes/No and Percentage methods. The two rating methods are commonly used when the Angoff's method is applied to determine a cut-off score that divides the examinees into minimally competent group (pass) and incompetent group (fail). The expert panel data were collected using both methods from 11 to 13 panel members in two consecutive years, respectively; The data were analysed within the generalisability theory framework to quantify relative influences of each factor (eg panel, item, rating rounds) on the variability of cut-off scores, standard error of measurement and panel agreement. The results suggest that (a) the two methods can make a substantial difference in overall success rates for college senior students, (b) item-related variance components are generally large and whilst rater-related variance components are small, (c) standard errors of measurement for the cut-off scores decreased from Cohort 1 to Cohort 2 as the number of items are increased and as the expert panel members are more trained and (d) the Percentage method yielded higher agreement amongst the panel in both years. The results provide practical guidelines for dental educators who make efforts to control the quality of final competency exams and cut-off scores with respect to standard setting practices and panel data analysis. It can be concluded that evaluations with Percentage method results in more reliable outcomes compared to those with Yes/No method when criterion-referenced assessment is applied to determine the cut-off scores of competency tests at schools.

Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis.

Anterior shoulder dislocations are the most common type of joint dislocation with the majority treated with closed reduction. Reduction methods can be grouped into their principle mode of action: traction-countertraction, leverage and scapular manipulation. The best method has yet to be identified and our aim was to find the most effective, safe and least painful method of closed reduction for acute anterior shoulder dislocations. A search of the online databases of CENTRAL, MEDLINE and Embase was performed to identify randomised control trials (RCTs) comparing closed reduction methods for anterior shoulder dislocations. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve eligible RCTs were included with a total of 1055 patients. Our meta-analysis showed traction-countertraction methods are marginally less painful than leverage methods by 0.86 points on the VAS scale but leverage methods are quicker by 20s. Amongst traction-countertraction methods, the Spaso technique was the least painful and quickest, albeit with no difference in overall success rate. A meta-analysis was not possible for comparisons involving scapular manipulation due to the paucity of studies, but within two studies, scapular manipulation was significantly less painful than both leverage and traction-countertraction methods by 1.5 and 2.3 points (VAS), respectively. Traction-countertraction methods are less painful but slowerthan leverage methods with no difference in complication rates. However, there was no difference in overall reduction success rate between any of the groups. I.

Ultrasound guidance for arterial (other than femoral) catheterisation in adults

Ultrasound guidance for arterial (other than femoral) catheterisation in adults

Evaluating the efficacy of short duration Mitomycin C in safe surgery system trabeculectomy combined with cataract surgery.

Purpose: To compare the efficacy of 0.2 mg/ml Mitomycin C (MMC) applied for 1-minute versus 2-minutes in patients undergoing combined surgery for primary glaucoma coexistent with cataract.Materials and methods: This was a randomized controlled clinical trial of 63 patients operated on for primary glaucoma (POAG or PACG) with visually significant cataract. All patients underwent safe surgery system trabeculectomy with manual small incision cataract surgery (MSIC) and implantation of PC IOL. Patients were randomized into intra-operative MMC 0.2 mg/ml for 1-minute (study group) and MMC 0.2 mg/ml for 2-minutes (control group). Success was measured on the basis of two different intraocular pressure (IOP) goals (IOP ≤21 mmHg, IOP ≤18 mmHg) and mean IOP reduction from baseline at the end of 12 months.Results: At 12 months, significant decreases in mean IOP were observed in both groups (P<0.001).The mean IOP reduction was 31.33±9.06% in the study group, as compared to 43.32±9.38% in the control group (P<0.001). The overall success for IOP ≤21 mm Hg was 80.5% in the study group and 90.9% in the control group (P<0.05). Kaplan-Meier analysis showed an insignificant difference in overall success rates of the two groups.Conclusion: The IOP reduction with 2-minute MMC (0.2 mg/ml) is more effective than 1-minute MMC after 12 months. It offers a decrease in anti-glaucoma medications and substantial visual recovery in combined surgery done for primary glaucoma coexistent with cataract.

Analysis of the distribution and scholarly output from National Institute of Academic Anaesthesia (NIAA) research grants.

SummaryThe National Institute of Academic Anaesthesia (NIAA) was founded in 2008 to lead a UK strategy for developing academic anaesthesia. We aimed to assess the distribution of applications and quantify the academic returns of NIAA‐supported research grants, as this has hitherto not been analysed. We sought data on the baseline characteristics of all grant applicants and recipients. Every grant recipient from 2008 to 2015 was contacted to ascertain the status of their supported research projects. We also examined Google Scholar, Scopus® database and InCites Journal Citation Reports for citation, author and journal metrics, respectively. In total, 495 research project applications were made, with 150 grants being awarded. Data on 121 out of 150 (80.7%) grant awards, accounting for £3.5 million, were collected, of which 91 completed studies resulted in 140 publications and 2759 citations. The median (IQR [range]) time to first or only publication was 3 (2–4 [0–9]) years. The overall cost per publication was £14,970 (£7457–£24,998 [£2212–£73,755]) and the cost per citation was £1515 (£323–£3785 [£70–£36,182]), with 1 (0–2 [0–8]) publication and 4 (0–25 [0–265]) citations resulting per grant. The impact factor of journals in which publications arose was 4.7 (2.5–6.2 [0–47.8]), with the highest impact arising from clinical and basic science studies, particularly in the fields of pain and peri‐operative medicine. Grants were most frequently awarded to clinical and basic science categories of study, but in terms of specialty, critical care medicine and peri‐operative medicine received the greatest number of grants. Superficially, there seemed a geographical disparity, with 123 (82%) grants being awarded to researchers in England, London receiving 48 (32%) of these. However, this was in proportion to the number of grant applications received by country or city of application, such that there was no significant difference in overall success rates. There was no significant difference in productivity in terms of publications and citations from grants awarded to each city. The 150 grants were awarded to 107 recipients (identified as the most senior applicant for each grant), 27 of whom received ≥ two grants. Recipients had a median career total of 21 (8–76 [0–254]) publications and 302 (44–1320 [0–8167]) citations, with an h‐index of 8 (3–22 [0–54]). We conclude that a key determinant of grant success is simply applying. This is the first study to report the distribution and scholarly output of individual anaesthesia research grants, particularly from a collaborative body such as the NIAA, and can be used as a benchmark to further develop academic anaesthesia in the UK and beyond.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial.

This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. 114 children aged 3-6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Long-term results of viscocanalostomy and phacoviscocanalostomy: a twelve-year follow-up study.

To evaluate the long-term efficacy and safety results of viscocanalostomy and phacoviscocanalostomy. The charts of 49 glaucoma patients who underwent viscocanalostomy or phacoviscocanalostomy surgery between February 1999 and August 2004 were reviewed retrospectively. Thirty-one eyes of 21 glaucoma patients who underwent filtering procedure with a postoperative follow-up of at least 5y were included in the study. Results of complete ophthalmologic examinations were recorded and statistically analyzed. Long-term surgical outcome was defined as an overall success when intraocular pressure (IOP) was found as ≤20 mm Hg with or without antiglaucomatous medication at the last follow-up visit, while it was defined as a complete success when IOP was measured ≤20 mm Hg without antiglaucomatous medication. Mean age was 68.1±9.6y (range: 32-81y). Mean follow-up time was 101.5±27.3mo (range: 60-144mo). Viscocanalostomy was performed in 8 eyes (25.8%) and phacoviscocanalostomy was performed in 23 eyes (74.2%). The mean preoperative IOP was 23.1±7.6 mm Hg with 2.1±1.0 medications, while mean IOP was 16.8±3.8 mm Hg with 0.9±1.1 medication at the last follow-up visit. Both the IOP decrease and the reduction in the antiglaucomatous medication were statistically significant (P<0.001 and P<0.001). No case required further glaucoma surgery. Overall success and complete success were found as 87.1% and 51.6%, respectively. Complete success rate was statistically higher in phacoviscocanalostomy group compared with the viscocanalostomy group (P=0.031), however there was no significant difference in overall success rate between two groups (P=0.072). Both viscocanalostomy and phacoviscocanalostomy provide good IOP reduction in the long-term period.

A Randomized Controlled Trial on the Efficacy of High-Dose Granulocyte Transfusion Therapy in Neutropenic Patients with Infection

▪Bacterial and fungal infections continue to be a major problem in patients with prolonged severe neutropenia. Early controlled trials suggested that granulocyte transfusions were modestly effective in this setting, but the doses provided were later considered inadequate. Recent studies have shown that the dose can be increased substantially by administering G-CSF ± dexamethasone to granulocyte donors. Although these cells circulate in neutropenic recipients and appear to function normally, the evidence for clinical efficacy has been inconclusive.We report here the result of the RING study, a recently completed randomized controlled trial on the efficacy of high-dose granulocyte transfusion therapy, carried out as part of the NHLBI Transfusion Medicine/Hemostasis Clinical Trials Network. Fourteen clinical sites participated. Eligible subjects were those with neutropenia (ANC<500) and proven/probable/presumed bacterial or fungal infection. Subjects were randomized to receive either 1) standard antimicrobial therapy or 2) standard antimicrobial therapy plus daily granulocyte transfusions from normal donors stimulated with G-CSF (450µg) and dexamethasone (8mg). The primary end point was a composite one; survival plus a microbial response, both evaluated 42 days after randomization. Microbial response was determined by a blinded adjudication panel.The target sample size was 236 subjects, designed to provide 80% power to detect a 20% difference in success rates between treatment and control groups; however, only 114 subjects could be enrolled. Patient infections were 36% invasive fungal, 27% invasive bacterial, 11% fungemia, and 26% bacteremia. Subjects in both arms were well matched in terms of demographics, underlying disease, types and sites of infection, and severity of illness. Fifty six subjects were randomized to the granulocyte arm; 51 received at least one transfusion; the mean time from eligibility to the first transfusion was 2.3 +/- 1.2 days. Among these 51 subjects, the median number of transfusions was 5 (quartiles 3 and 9), given over a median of 6 days (quartiles 4 and 11). The median number of granulocytes administered per transfusion was 54.9 x109 (quartiles 26.1 x109, 72.5 x109). Fourteen percent of these patients had > Grade 3 hypoxemia develop during or within six hours after a granulocyte transfusion, requiring ventilation in one patient (2%). No deaths were attributed to adverse effects associated with the transfusions.Among subjects with sufficient data to determine the primary outcome, success rates were 42% (20/48) and 43% (21/49) for the granulocyte and control groups, respectively (p> 0.99) on Intention to Treat (ITT) analysis, and 49% (17/35) and 41% (16/39), respectively, for subjects who adhered to their assigned treatments (Per Protocol (PP) analysis)(p=0.64). There was also no significant difference between treatment groups in a model of the primary outcome that adjusted for baseline prognostic factors (e.g. ventilator use, high Zubrod score). Differences in primary end point success rates for granulocyte and control arms did not differ significantly for any infection type whether analyzed by ITT or PP. Outcomes for patients who received the first transfusion within 2 days of eligibility were similar to outcomes for patients who received the first transfusion later. For patients who received at least three granulocyte transfusions, those who received an average dose per transfusion of >50x109 granulocytes had a higher success rate (57.7%)(n=26) than those receiving <5x109 cells per transfusion (11.1%)(n=9)(p = 0.04); while supporting the hypothesis that dose is critical to the outcome, this result needs be interpreted with caution because of the low numbers and poor outcome of the low dose group. There was no significant difference between the granulocyte and control arms on overall survival to either 42 or 90 days after randomization.Because of incomplete patient enrollment, the power of this study to detect a 20% difference in overall success rates was reduced to approximately 40%. Thus it is possible that a true convincing favorable effect was missed, particularly, as suggested, in the subset of patients who received daily transfusions containing at least 50x109 granulocytes per transfusion. DisclosuresOff Label Use: In the study being discussed, G-CSF is administered to normal blood donors. This is an off-label use of G-CSF. McCullough:Fresenius/Kabe: Membership on an entity’s Board of Directors or advisory committees. Ness:Terumo BCT: Consultancy.

Outcome of conjunctival flap repair for corneal defects with and without an acellular submucosa implant in 73 canine eyes.

To report and compare the success rate of a conjunctival pedicle flap (CPF) alone vs. a CPF with an underlying acellular submucosa implant for the repair of deep or perforating corneal wounds in dogs. Records of 69 dogs (73 eyes) receiving a CPF with or without an acellular submucosa implant between 2004 and 2012 were reviewed. Successful outcome was defined as a comfortable eye with vision at the last post-operative evaluation. Age, breed, underlying corneal disease, surgical time, lesion characteristics, topical therapies, and postoperative complications were investigated. Groups consisted of dogs that had a CPF alone (n = 37) and dogs that had a CPF plus an acellular submucosa implant (n = 36). Age, lesion size, surgical time, and time to discontinuation of topical anti-proteolytic medications was not significant between groups. Topical antibiotic use was terminated 13 days sooner (P ≤ 0.01) in dogs with an acellular submucosa implant. The combined success rate of all corneal wounds was 93% with success rate of corneal perforations, descemetoceles, and deep stromal wounds being 89%, 95%, and 100%, respectively. There was no difference in overall success rate between groups. Increasing age was associated with a negative outcome (P ≤ 0.01). Lesion size, presence of a corneal perforation, and concurrent keratoconjunctivitis sicca was not associated with a negative outcome. A comparable success rate is achieved for deep or perforating corneal wounds stabilized with a CPF alone vs. a CPF plus acellular submucosa. Glaucoma, persistent uveitis, and cataract formation were not reported as post-operative complications in this study population.

Differences between left and right radial approach

Results of the studies showed, that in the hands of expert operators, there were no differences in overall success rate, procedure total duration time, number of catheters used and amount of contrast used in coronary procedures used left or right radial approach. Similarly, in a series of patients undergoing PCI for acute myocardial infarction, no significant difference between right and left radial approaches was found in procedure success rate, procedure duration, room-to-balloon time, and safety profile. However, the left radial artery route offers a few advantages over the right radial approach. In TALENT trial (Left Versus Right Transradial Approach for Percutaneous Coronary Procedures) 1,540 patients were randomized to either right or left radial routes. The study found that among trainees, the left radial approach was associated with a significantly shorter learning curve, reductions in cannulation and fluoroscopy times. This difference may be explained by the anatomical variations between the right and left vasculature. Right radial artery has the higher incidence of loops and the right subclavian artery is often more tortuous than the left, especially in short and elderly patients. Additionally, in the right radial approach, the catheter has to traverse two bifurcations at the right subclavian and brachiocephalic arteries, making catheter manipulation more challenging. Sub study of TALENT trail shown that both approaches are related with similar radiation dose for operators at the body, shoulder, or thyroid level, with a possible significant lower radiation at the wrist with right radial approach. In conclusion use of the right radial approach should be avoided in patients older than 70 years when trainee practitioners are on the learning curve.

Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars

Calcium hydroxide indirect pulp treatment (CH-IPT) and antibiotic sterilization using a mixture of three antibiotics (3Mix-MP) of deep caries are similar non-invasive vital pulp treatments. No studies have compared their clinical and radiographic success rates in primary molars. To compare the clinical and radiographic success rates of CH-IPT and 3Mix-MP in carious lesions approaching the pulp of mandibular primary molars. Eighty-two mandibular primary molars from 50 children, aged 3-8years, with carious lesions approaching the pulp, and meeting the inclusion criteria, were randomly assigned for either treatment. After treatment, blinded clinical/radiographic evaluation was performed at 6-11 and 12-29month recalls. At 6-11months, the overall success rates of CH-IPT and 3Mix-MP were 82% and 81% (P=0.91), respectively. At 12-29months, the success rates were 94% and 78% (P=0.08), respectively. The most frequently observed failure at the 12-29month recall was internal resorption (one CH-IPT tooth and three 3Mix-MP teeth). There was no statistically significant difference in overall success rates between CH-IPT and 3Mix-MP in treating deep caries approaching the pulp in mandibular primary molars at either 6-11month or 12-29month follow-up.

Effectiveness of Oral Midazolam for Paediatric Dental Care: A retrospective study in two Specialist Centres

To analyse retrospectively the outcomes for children undergoing oral care under conscious sedation with oral midazolam and local analgesia at Leeds dental Institute, England and Westmead Dental Hospital, Sydney, Australia. Secondly, the study assessed the suitability of oral midazolam for paediatric dental treatment. Retrospective study of clinical outcomes based on dental records. All children included in the study had been treated between September 2000 to August 2004 and full dental records were available. The dental records were examined using a standard pro forma sheet and data collected for: age, previous behaviour using the Frankl [1962] scale, units of work planned and achieved using the modified index of O'Sullivan and Curzon [1991], midazolam dosage and treatment outcome. The study population consisted of 101 children aged 1-11 years in both Leeds (57 children) and Westmead (44 children). There were significant differences between Leeds and Westmead with respect to age (mean +/-SD) in years 5.0+/-1.0 versus 2.9+/-1.6; number of treatment visits 1.7 versus 1.1; sedation dose used 0.5-0.7 mg/kg versus 02.-0.3; type and amount of treatment planned 8.3 units versus 3.3 and achieved 7.5 versus 2.2, for both centres respectively. There was also a difference in overall success rates of rendering the children dentally fit of 65% v. 91%, respectively. Oral midazolam was found to be a useful drug for the management of young children with behaviour problems. It was found, however, not to be effective in all cases and for the provision of all types of paediatric dentistry. The results indicate that, when using oral midazolam in children, the treatment should be restricted to simple restorations and extractions over a maximum of two visits.