Poor Confidence Research Articles

Experiences and Perceptions of School-Based Speech-Language Pathologists Related to Literacy: Results From a National Survey

School-based speech-language pathologists (SLPs) play an important role in supporting children with reading and writing difficulties. The purpose of this study was to describe the training, experiences, and knowledge of SLPs who work in preschool, elementary school, or middle/high school settings in relation to children with reading and writing difficulties. Preschool and school-based SLPs (N = 280) participated in an online survey, with items related to preservice and in-service training experiences, experiences and perceptions of competence related to reading and writing assessment and instruction with students on their caseload, and knowledge of reading and writing. The majority of respondents reported limited preservice coursework and clinical training experiences with students with reading and writing difficulties. Many SLPs reported that more than half of the students on their caseload had reading and writing difficulties, but many SLPs (approximately 40%) had poor confidence in their abilities in assessment and intervention with children with reading and writing difficulties. Nearly all SLPs indicated that they would benefit from additional training and experience with children with reading and writing difficulties. We provide some initial suggestions for graduate coursework, clinical training experiences, and tailored professional development. https://doi.org/10.23641/asha.21809514.

UK CoPACK Study: knowledge and confidence of healthcare workers in using personal protective equipment and related anxiety levels during the COVID-19 pandemic

Healthcare workers (HCWs) are at increased risk of coronavirus 2019 (COVID-19) infection. Personal protective equipment (PPE) and infection control guidelines help limit transmission. However, poor confidence leads to higher levels of anxiety rates and infection. We assessed knowledge and confidence in PPE among HCWs and associated anxiety. A cross-sectional, multi-centre survey using a validated questionnaire assessing actual and self-perceived knowledge on PPE was distributed among HCWs across the UK. Confidence in PPE and levels of anxiety were assessed using the General Anxiety Disorder-7 (GAD-7) tool. In total, 1,055 responses were received; 99% had familiarity with PPE guidance; however, only 15% correctly answered questions on PPE guidance; 86% and 80% had received mask-fitting and donning-doffing training, respectively; 33% indicated poor/very poor hospital communication. Confidence and anxiety were related to: profession; comorbidities; self-perceived knowledge; and PPE training and communication. Confidence in PPE was poor and anxiety was related to inadequate information and training. Thus, improved communication is required for effective response to subsequent COVID-19 waves and similar pandemics.

Out of Sight, Out of Mind: Is Diminishing Undergraduate Exposure to Ophthalmology Threatening the Competence of our Doctors?

UK medical schools are no longer required to include ophthalmology rotations in clinical attachments. The current state of ophthalmic education has sadly seen little improvement over the last few decades with studies 25 years ago also reflecting an inadequate system, resulting in general practitioners with poor confidence in looking after patients presenting to them. Scantling-Birch and colleagues go as far as to say that we have a current crisis in ophthalmic education, where we may be seeing non-ophthalmologists in medico-legally indefensible positions, unable to complete a basic examination. Declining exposure to ophthalmology and the issues relating to its undergraduate education are not limited to the UK; Mottow-Lippa discusses the similar decline in the United States and stresses that efforts from the profession are needed if we want to preserve doctors who are competent in basic ophthalmic examination.

Knowledge and confidence on prescribing antibiotics among medical graduates from a Sri Lankan university

Inappropriate antimicrobial prescription is the main contributory factor to rapidly growing antibiotic resistance. This cross-sectional study was done to assess the knowledge, attitudes, and practices of antibiotic use among medical graduates at the University of Peradeniya using an online questionnaire. The medical graduates rated their education in cardiology to be ‘sufficient’ or ‘more than sufficient’ compared to infectious diseases and antimicrobials (p<0.05). Confidence in diagnostics was higher than therapeutics in infectious diseases. Most were aware of local antimicrobial guidelines but nearly half (46.1%) believed these were used less than 50% in the clinical setting. The average knowledge score was 57.5% and participants scored well (>75%) in deciding when not to use antibiotics and scored less (<50%) in therapeutics of less common infections. Poor knowledge and confidence amongst medical graduates were observed in antimicrobial prescribing. Antibiotic stewardship should be emphasized in medical curricula to improve the prescribing practice among doctors.

Perception vs Reality: Examining Trainee Participation and Handoffs in Robotic General Surgery

INTRODUCTION: Despite expansion of robotic surgery, resident participation during robotic cases remains poorly characterized. The aim of this study was to compare perceptions of case participation and handoffs between trainees and faculty against objective robotic metrics. METHODS: Post-case assessments evaluating trainee participation and intra-operative handoffs were distributed to faculty and trainees following case conclusion. Metrics including percent active control time (%ACT)—defined as percent of trainee console time spent actively manipulating robotic instruments—and handoff counts between dual consoles were reviewed from the robotic platform. Wilcoxon and intra-class correlation tests were applied. RESULTS: From December 2021-January 2022, 20 robotic cases with matched trainee/faculty assessments were included (Table 1). On subset analysis, reliability between trainee-reported and objective %ACT ranged from “moderate” to “excellent” (ICC = 0.915, 95% CI 0.743-0.972). Reliability between faculty-reported and objective %ACT ranged from “good” to “excellent” (ICC = 0.954, 95% CI 0.868-0.985). Mean difference between trainee-reported and objective %ACT vs faculty-reported and objective %ACT was significant (mean -6.5 vs 2.2, p = 0.0078). There was no significant difference in reported handoff counts, however, the groups reported aligned handoff reasoning in only 53% of cases, most often due to pedagogical takeover or graded autonomy. There was no significant difference in reported case difficulty or educational effectiveness between groups. Table 1. - Robotic Case Series Demographic Information Case type Cases by trainee level Cholecystectomy 6 (30%) PGY2 1 (5%) Gastric bypass 6 (30%) PGY3 3 (15%) Inguinal hernia 4 (20%) PGY4 11 (55%) Hiatal hernia 4 (20%) PGY5 2 (10%) Fellow 3 (15%) Total 20 20 CONCLUSION: In this pilot case series, faculty more reliably and accurately estimated trainee robotic case participation. Trainees underestimated their case participation on average compared to objective metrics. Further studies must investigate the foundation of poor trainee case confidence and faculty-trainee handoff misalignment in robotic surgery.

33567 Overview of the systematic reviews with network meta-analysis evaluating the efficacy or safety of the systemic treatments in moderate-to-severe psoriasis

Background: Network meta-analyses (NMAs) have become successful in addressing gaps in comparative effectiveness of systemic treatments (ST) in psoriasis. Their increasing number carries a risk of overlap and reproducibility issues. We aimed to assess redundancy across these NMAs and to describe their characteristics. Methods: We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of ST compared with placebo or an active comparator. Four electronic databases were searched up to 02/25/2021. Our main outcome was the number of redundant NMAs and their overlaps. We described their characteristics, the confidence in the results, the reporting issues, the studies’ funding, and the presence of spin. Results: In total, 47 redundant NMAs were included. Two (4%) included all available treatments. Both efficacy and safety were evaluated in 14/47 (30%) NMAs and both short and long-term evaluations were assessed in 5/47 (11%). Confidence in the results was critically low for 39/47 (83%) NMAs. Only 10/47 (23%) registered a protocol. Pharmaceutical funding was present in 26/47 NMAs (55%). Spin was present in all of the abstracts and reporting was poor in most of them according to the PRISMA-checklist. Almost half of the NMA failed to check for heterogeneity or consistency. Discussion: Our overview showed heterogeneous methods and poor confidence in the results in a majority of the redundant NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable evidence.

Intraspecies variation of the mitochondrial genome: An evaluation for phylogenetic approaches based on the conventional choices of genes and segments on mitogenome.

Intraspecies nucleotide sequence variation is a key to understanding the evolutionary history of a species, such as the geographic distribution and population structure. To date, numerous phylogenetic and population genetics studies have been conducted based on the sequences of a gene or an intergenic region on the mitochondrial genome (mtDNA), such as cytochrome c oxidase subunits or the D-loop. To evaluate the credibility of the usage of such ‘classic’ markers, we compared the phylogenetic inferences based on the analyses of the partial and entire mtDNA sequences. Importantly, the phylogenetic reconstruction based on the short marker sequences did not necessarily reproduce the tree topologies based on the analyses of the entire mtDNA. In addition, analyses on the datasets of various organisms revealed that the analyses based on the classic markers yielded phylogenetic trees with poor confidence in all tested cases compared to the results based on full-length mtDNA. These results demonstrated that phylogenetic analyses based on complete mtDNA sequences yield more insightful results compared to those based on mitochondrial genes and segments. To ameliorate the shortcomings of the classic markers, we identified a segment of mtDNA that may be used as an ‘approximate marker’ to closely reproduce the phylogenetic inference obtained from the entire mtDNA in the case of mammalian species, which can be utilized to design amplicon-seq-based studies. Our study demonstrates the importance of the choice of mitochondrial markers for phylogenetic analyses and proposes a novel approach to choosing appropriate markers for mammalian mtDNA that reproduces the phylogenetic inferences obtained from full-length mtDNA.

Challenges in the cross-sectoral collaboration on vulnerable pregnant women: a qualitative study among Danish general practitioners

BackgroundVulnerable pregnant women, defined as women threatened by social, psychological, or physical risk factors, need special support during pregnancy to prevent complications in pregnancy, birth, and childhood. Proper cross-sectoral collaboration in antenatal care is paramount to delivering sufficient supportive care to these women. General practitioners (GPs) often face barriers when assessing vulnerable pregnant women and may; as a result, under-identify and underreport child abuse. Little is known about how the cross-sectoral collaboration in antenatal care affects the GP’s opportunities of managing vulnerable pregnant women. This study explores GPs’ perceived barriers and facilitators in the antenatal care collaboration on vulnerable pregnant women and in the reporting of these women to social services.MethodsA qualitative study with semi-structured focus group interviews among twenty GPs from the Region of Southern Denmark. A mixed inductive and deductive analytic strategy was applied, structured according to the Theoretical Domains Framework (TDF).ResultsThree themes emerged: I) collaborative experience, II) motivation, and III) organizational working conditions. Barriers were lacking experience, i.e. knowledge, skills, and attention to antenatal care collaboration and reporting, inadequate organizational working contexts, i.e. insufficient pathways for communication between health care and social care systems, and laws restricting feedback on the consequences of reporting. This decreased the GPs motivation, i.e. poor confidence in navigating the system, fear of breaking the patient alliance when collaborating in antenatal care and reporting with the social services. GPs motivation to collaborate and report was increased by knowing the working contexts of their collaborative partners in the antenatal care and social services system and by a strong doctor-patient relationship enabling them to describe the vulnerability to collaborators.ConclusionsGPs experience system-related barriers to collaborating and reporting on vulnerable pregnant women within the health care sector and in the interplay with the social services sector. Organizational development of cross-sectoral antenatal care collaboration should imply user involvement of all collaborative partners. Results suggest that health authorities should consider establishing accessible communication pathways between the GPs and the social services to improve options for proper cross-sectoral communication and feedback to GPs, thereby improving care trajectories of vulnerable pregnant women.

Extemporaneous compounding confidence progression from undergraduate to practice: a pharmacy education perspective

This study examined how undergraduate students, graduate interns and registered pharmacists perceived their competence in extemporaneous compounding. A cross-sectional observational study was conducted using a self-administered survey and participants ranked how confident they felt about compounding certain products using a Likert's scale and free-text responses. Pharmacy students perceived to be as confident as the interns and pharmacists in preparing 'simple' products, such as solutions, suspensions, creams and ointments. A lack of frequent practice was related to poor confidence by all three groups. Integration of theoretical, legal and ethical and patient counselling aspects in extemporaneous compounding curriculum could enhance learning and outcomes.

Are people with obsessive-compulsive disorder under-confident in their memory and perception? A review and meta-analysis.

People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one's cognitive processes. For example, poor confidence in recall accuracy can cause doubt about one's memory and motivate repeated checking. At the same time, people with OCD also display performance deficits in a variety of cognitive tasks, so their reduced confidence must be evaluated in relation to their actual performance. To that end, we conducted an exhaustive review and meta-analysis of studies in which OCD participants and non-clinical control participants performed cognitive tasks and reported their confidence in their performance. Our search resulted in 19 studies that met criteria for inclusion in the quantitative analysis, with all studies addressing either memory or perception. We found that both performance and reported confidence were lower in OCD than in control participants. Importantly, however, confidence was more impaired than performance in participants with OCD. These findings suggest that people with OCD are less confident in their memory and perception than they should be, indicating a genuine under-confidence in this population. We discuss potential mechanisms that might account for this finding and suggest avenues for further research into under-confidence and related meta-cognitive characteristics of OCD.

Targeted maximum likelihood estimation of causal effects with interference: A simulation study.

Interference, the dependency of an individual's potential outcome on the exposure of other individuals, is a common occurrence in medicine and public health. Recently, targeted maximum likelihood estimation (TMLE) has been extended to settings of interference, including in the context of estimation of the mean of an outcome under a specified distribution of exposure, referred to as a policy. This paper summarizes how TMLE for independent data is extended to general interference (network-TMLE). An extensive simulation study is presented of network-TMLE, consisting of four data generating mechanisms (unit-treatment effect only, spillover effects only, unit-treatment and spillover effects, infection transmission) in networks of varying structures. Simulations show that network-TMLE performs well across scenarios with interference, but issues manifest when policies are not well-supported by the observed data, potentially leading to poor confidence interval coverage. Guidance for practical application, freely available software, and areas of future work are provided.

Knee Confidence Trajectories Over Eight Years and Factors Associated With Poor Trajectories in Individuals With or at Risk for Knee Osteoarthritis.

To identify distinct trajectories of lack of knee confidence over an 8-year follow-up period and to examine baseline factors associated with poor trajectories in individuals with or at risk for knee osteoarthritis (OA). The Osteoarthritis Initiative is a prospective cohort study of individuals with or at high risk for knee OA. Confidence in the knees was assessed within the Knee Injury and Osteoarthritis Outcome Score instrument querying how much the individual is troubled by lack of confidence in his/her knee(s), rated as not-at-all (score=0), mildly (score=1), moderately (score=2), severely (score=3), and extremely (score=4) troubled, reported annually from baseline to 96 months. Lack of knee confidence was defined as a score of ≥2. We used latent class models to identify subgroups that share similar underlying knee confidence trajectories over an 8-year period and multivariable multinomial logistic regression models to examine baseline factors associated with poor trajectories. Among 4,515 participants (mean ± SD age 61.2 ± 9.2 years, mean ± SD BMI 28.6 ± 4.8 kg/m2 ; 2,640 [58.5%] women), 4 distinct knee confidence trajectories were identified: persistently good (65.6%); declining (9.1%); poor, improving (13.9%); and persistently poor (11.4%). Baseline predictors associated with persistently poor confidence (reference: persistently good) were younger age, male sex, higher body mass index (BMI), depressive symptoms, more advanced radiographic disease, worse knee pain, weaker knee extensors, history of knee injury and surgery, and reported hip and/or ankle pain. Findings suggest the dynamic nature of self-reported knee confidence and that addressing modifiable factors (e.g., BMI, knee strength, depressive symptoms, and lower extremity pain) may improve its long-term course.

Reflections on English Speaking Anxiety of Engineering Students: Pilot Project

Human beings scream for effective communication skills in this modern age of space technology. The 21st-century demands the engineering universities to address the speaking skill deficiencies of engineering students. This research discovers factors responsible for English speaking anxiety of engineering students. A qualitative research design was implemented and semi-structured interviews were piloted. A purposive sampling approach was employed.Outcomes revealed engineering students faced hesitation, poor confidence, poor mental approach,poor English, unknown fears, poor vocabulary, dearth of speaking opportunities, fear of criticism,nervousness, stress, lack of motivation, poor communication skill, poor language, and low self-esteem as English-speaking anxiety factors of engineering students. Additionally, they used deep breathing, giving space for thinking and code switch in gas strategies to overcome English-speaking anxiety.

Knowledge, perception, and clinical experiences on molar incisor hypomineralization amongst Portuguese dentists

AimMolar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists.MethodsA cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS).ResultsOverall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training.ConclusionsThe average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH.

Active involvement of nursing staff in reporting and grading complication-intervention events-Protocol and results of the CAMUS Pilot Nurse Delphi Study.

ObjectivesThe aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien‐Dindo Classification (CDC) in nursing staff.Subjects and MethodsThe 12‐part REDCap‐based Delphi survey was developed in conjunction with expert nurse, urologist and methodologist input. Certified local and international inpatient and outpatient nurses specialised in urology, perioperative nurses and urology‐specific advanced practice nurses/nurse practitioners will be included. A minimum sample size of 250 participants is targeted. The survey assesses participant demographics, nursing experience and opinion on complication reporting and the proposed CAMUS reporting recommendations; grading of intervention events using the existing CDC and the proposed CAMUS Classification; and rating various clinical scenarios. Consensus will be defined as ≥75% agreement. If consensus is not reached, subsequent Delphi rounds will be performed under Steering Committee guidance.ResultsTwenty participants completed the pilot survey. Median survey completion time was 58 min (IQR 40–67). The survey revealed that 85% of nursing participants believe nurses should be involved in future complication reporting and grading but currently have poor confidence and inadequate relevant background education. Overall, 100% of participants recognise the universal demand for reporting consensus and 75% hold a preference towards the CAMUS System. Limitations include variability in nursing experience, complexity of supplemental grades and survey duration.ConclusionThe integration of experienced nursing opinion and participation in complication reporting and grading systems in a modern and evolving hospital infrastructure may facilitate the assimilation of otherwise overlooked safety data. Incorporation of focused teaching into routine nursing education will be essential to ensure quality control and stimulate awareness of complication‐related burden. This, in turn, has the potential to improve patient counselling and quality of care.

A systematic review and mixed-methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm.

Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety. To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm. Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity. Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is 'manipulative' or 'attention-seeking' were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff-prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care. There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

COVID-19 Vaccine Hesitancy and Determinants of Acceptance among Healthcare Workers, Academics and Tertiary Students in Nigeria.

The COVID-19 pandemic has resulted in millions of human deaths, prompting the rapid development and regulatory approval of several vaccines. Although Nigeria implemented a COVID-19 vaccination program on 15 March 2021, low vaccine acceptance remains a major challenge. To provide insight on factors associated with COVID-19 vaccine hesitancy (VH), we conducted a national survey among healthcare workers, academics, and tertiary students, between 1 September 2021 and 31 December 2021. We fitted a logistic regression model to the data and examined factors associated with VH to support targeted health awareness campaigns to address public concerns and improve vaccination rates on par with global efforts. A total of 1525 respondents took part in the survey, composed of healthcare-workers (24.5%, 373/1525), academics (26.9%, 410/1525), and students (48.7%, 742/1525). Only 29% (446/1525) of the respondents were vaccinated at the time of this study. Of the 446 vaccinated respondents, 35.7% (159/446), 61.4% (274/446) and 2.9% (13/446) had one, two and three or more doses, respectively. Reasons for VH included: difficulty in the vaccination request/registration protocols (21.3%, 633/1079); bad feelings towards the vaccines due to negative social media reports/rumours (21.3%, 633/1079); personal ideology/religious beliefs against vaccination (16.7%, 495/1079); and poor confidence that preventive measures were enough to protect against COVID-19 (11%, 323/1079). Some health concerns that deterred unvaccinated respondents were: innate immunity issues (27.7%, 345/1079); allergic reaction concerns (24.6%, 307/1079); and blood clot problems in women (21.4%, 266/1079). In the multivariable model, location of respondents/geopolitical zones, level of education, testing for COVID-19, occupation/job description and religion were significantly associated with VH. Findings from this study underscore the need for targeted awareness creation to increase COVID-19 vaccination coverage in Nigeria and elsewhere. Besides professionals, similar studies are recommended in the general population to develop appropriate public health interventions to improve COVID-19 vaccine uptake.

Overlapping network meta-analyses on psoriasis systemic treatments, an overview: quantity does not make quality.

Network meta-analyses (NMAs) have become successful in addressing gaps in the comparative effectiveness of systemic treatments in moderate-to-severe psoriasis. However, their increasing number carries both a risk of overlap and reproducibility issues that can hamper clinical decision-making. In this overview, we aimed to assess redundancy across these NMAs and to describe their characteristics. We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of systemic treatments compared with placebo or with an active comparator. PubMed/MEDLINE, Epistemonikos, PROSPERO and the Evidence update of the Centre of Evidence-Based Dermatology of the University of Nottingham were searched up to 25 February 2021. Our main outcome was the number per year of redundant NMAs and the extent of their overlap. We also described their features, especially, the confidence in the results of the reviews, the funding of the studies and the presence of spin (a description that overstates efficacy and/or understates harm), reporting issues and methodological characteristics. In total, 47 redundant NMAs were included. Only two of 47 (4%) included all available treatments. Both efficacy and safety were evaluated in 14 of 47 (30%) NMAs and both short- and long-term evaluations were assessed in five of 47 (11%). Confidence in the results was critically low for 39 of 47 (83%) NMAs and only 10 of 47 (21·3%) registered a protocol. Twenty-six of 47 NMAs (55%) received pharmaceutical funding. Contract research organizations were involved in 19 of 47 (40%) NMAs. Reporting was poor across most of the NMA abstracts and spin was present in all of the abstracts. Almost half of the NMAs failed to consider important limitations such as heterogeneity (considered in 32%) or consistency (considered in 66%). In addition to a duplication of efforts, our overview showed heterogeneous methods and poor confidence in the results in a majority of the included NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable and comprehensive evidence.

Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture.

BACKGROUNDElderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures, and are prone to negative emotions, which affect treatment compliance.AIMTo evaluate the effects of evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fractures.METHODSA total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups (n = 60 each) according to different nursing methods. The basic rehabilitation methods of the two groups were consistent, but patients in the intervention group received evidence-based nursing interventions at the same time. Differences between groups in the scores of motion phobia, pain fear, rehabilitation training compliance, self-efficacy, nursing satisfaction, and hip joint function were compared before and after the intervention. RESULTSBefore the intervention, there were no statistically significant differences in motion phobia and pain fear scores between the groups (all P > 0.05). However, motion phobia scores at 1 wk after intervention initiation (P < 0.05), and pain fear scores at 1 wk and 2 wk after intervention initiation (all P < 0.05), were significantly lower in the intervention group than in the routine group. On the first day of intervention, there was no significant difference in rehabilitation treatment compliance between the groups (P > 0.05); however, at 2 wk after intervention initiation, rehabilitation compliance was significantly better in the intervention group than in the routine group (P < 0.05). Before the intervention, there were no statistically significant differences in the scores for the two self-efficacy dimensions (overcoming difficulties and rehabilitation exercise self-efficacy) and the total self-efficacy score between the groups (all P > 0.05). After 2 wk of intervention, the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group (all P < 0.05). At 3 and 6 mo after surgery, hip function as evaluated by the Harris hip score, was significantly better in the intervention group than in the routine group (P < 0.05). Additionally, overall nursing satisfaction was significantly higher in the intervention group than in the routine group (P < 0.05). CONCLUSIONEvidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery, and improve rehabilitation treatment compliance and patient self-efficacy, which promote hip function recovery.

Simultaneous multi-slice steady-state free precession myocardial perfusion with iterative reconstruction and integrated motion compensation

PurposeSimultaneous multi-slice (SMS) balanced steady-state free precession (bSSFP) acquisition and iterative reconstruction can provide high spatial resolution and coverage for cardiac magnetic resonance (CMR) perfusion. However, respiratory motion remains a challenge for iterative reconstruction techniques employing temporal regularisation. The aim of this study is to evaluate an iterative reconstruction with integrated motion compensation for SMS-bSSFP first-pass myocardial stress perfusion in the presence of respiratory motion. MethodsThirty-one patients with suspected coronary artery disease were prospectively recruited and imaged at 1.5 T. A SMS-bSSFP prototype myocardial perfusion sequence was acquired at stress in all patients. All datasets were reconstructed using an iterative reconstruction with temporal regularisation, once with and once without motion compensation (MC and NMC, respectively). Three readers scored each dataset in terms of: image quality (1:poor; 4:excellent), motion/blurring (1:severe motion/blurring; 3:no motion/blurring), and diagnostic confidence (1:poor confidence; 3:high confidence). Quantitative assessment of sharpness was performed. The number of uncorrupted first-pass dynamics was measured on the NMC datasets to classify patients into ‘suboptimal breath-hold (BH)’ and ‘good BH’ groups. ResultsCompared across all cases, MC performed better than NMC in terms of image quality (3.5 ± 0.5 vs. 3.0 ± 0.8, P = 0.002), motion/blurring (2.9 ± 0.1 vs. 2.2 ± 0.8, P < 0.001), diagnostic confidence (2.9 ± 0.1 vs. 2.3 ± 0.7, P < 0.001) and sharpness index (0.34 ± 0.05 vs. 0.31 ± 0.06, P < 0.001). Fourteen patients with a suboptimal BH were identified. For the suboptimal BH group, MC performed better than NMC in terms of image quality (3.8 ± 0.4 vs. 2.6 ± 0.8, P < 0.001), motion/blurring (3.0 ± 0.1 vs. 1.6 ± 0.7, P < 0.001), diagnostic confidence (3.0 ± 0.1 vs. 1.9 ± 0.7, P < 0.001) and sharpness index (0.34 ± 0.05 vs. 0.30 ± 0.06, P = 0.004). For the good BH group, sharpness index was higher for MC than NMC (0.34 ± 0.06 vs 0.31 ± 0.07, P = 0.03), while there were no significant differences observed for the other three metrics assessed (P > 0.11). There were no significant differences between suboptimal BH MC and good BH MC for any of the reported metrics (P > 0.06). ConclusionsIntegrated motion compensation significantly reduces motion/blurring and improves image quality, diagnostic confidence and sharpness index of SMS-bSSFP perfusion with iterative reconstruction in the presence of motion.