Sample Size Calculation Research Articles

Association between parental factors and child's behaviors during moderate sedation in pediatric dental care.

Managing young children with negative behaviors can be challenging in dental settings. Moderate sedation (MS) is often used as a treatment option for such children. However, children's behavior during MS may vary depending on several variables. These variables include parental factors, such as parental anxiety, coping strategies, and pain catastrophizing. However, this area, particularly in Saudi Arabia, remains underexplored. Therefore, this study aimed to assess the association among parental anxiety, coping style, pain catastrophizing, and children's behavior during MS among Saudi children. Based on sample size calculation, this cross-sectional observational study included 85 children aged 3-5 years undergoing dental treatment under MS at King Saud University, Riyadh, Saudi Arabia. Parental anxiety, coping styles, and pain catastrophizing were assessed using the Modified Dental Anxiety Scale, Brief Coping Orientation to Problems Experienced Scale, and Pain Catastrophizing Scale. Child behavior was evaluated using the Houpt scale during sedation visits, which was video-recorded and independently analyzed by a single evaluator. Data were analyzed using Pearson's chi-squared test, Mann-Whitney U test, and stepwise multivariate logistic regression analyses. The results showed no significant association among parental dental anxiety, pain catastrophizing, and child behaviors during MS. Specific parental coping strategies, such as acceptance, were positively associated with positive sedation outcomes (P = 0.03), while active coping strategies were linked to less favorable outcomes (P = 0.03). Female children had higher sedation failure rates (P = 0.02), and the number of dental treatments was positively associated with success rates (P = 0.03). Parental anxiety and pain catastrophizing did not significantly affect the success of sedation. However, acceptance as a coping strategy was significantly associated with sedation success in pediatric dental care under MS, whereas active coping strategies were associated with less favorable outcomes.

Effective Factors for Promoting Student Engagement in Educational Activities

This study investigates the Effective Factors for Promoting Student Engagement in Educational Activities at the Faculty of Education, Helmand University. The research employed a quantitative approach and utilized a sample of (278) students from a total population of (995), selected using the Rao Soft Sample Size Calculator. The study had a (95%) confidence interval and a (5%) error level. The primary objective of this research was to explore the effective factors for promoting students engagement in educational activities. Two questionnaires were used, one focusing on students' educational activities and the other on teachers' emotional behavior. Simple linear regression was applied to analyze the effects of the independent variable (teachers' emotional behavior) on the dependent variable (students' educational activities), with data analyzed using SPSS and Excel. The findings indicate that teachers' emotional behavior significantly influences students' educational performance and activities. Specifically, the study found that teachers' strict and serious behavior (83%), establishing communication with students' parents (80%), and friendly and sincere relationships between students and teachers (76%) have notable effects on students' educational activities. This suggests that when teachers exhibit a gentle, sincere, friendly, and supportive attitude towards students during the teaching process, students are more likely to attend classes enthusiastically and actively participate in their lessons.

Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial

BackgroundOne-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH.MethodsThis study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients.DiscussionIn this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions.Trial registrationClinicalTrials.gov NCT05686525. Registered on January 17, 2023, https://clinicaltrials.gov/study/NCT05686525.

Clinico-demographic features and the benign diseases requiring hysterectomy; A Cross Sectional Study.

Objective: To evaluate the relationship between the clinic-demographic features and the benign diseases requiring hysterectomy. Study Design: Cross sectional study. Setting: Department of Obstetrics & Gynecology, Peshawar Medical College and its Affiliate Tertiary Care Hospitals. Period: 03 Oct, 2020 to 03 Oct, 2021. Methods: It was a part of the dissertation mandated by the college of physician and surgeons as part of the FCPS program. Using WHO sample size calculator a sample size of 104 patients was obtained and consecutive sampling was done. Logistic regression was used to co-relate clinic-demographic features with different diseases with 5% level of significance. Results: Mean of age of the patients was 48.55 years (±10.5years SD), mean height was 5.508 feet (±1.1feet SD), mean weight was 73.20 kg (±15.4kg SD) and the mean BMI was 26.58 (±4.5 SD). Diabetes mellitus was significantly more common in patients with leiomyoma and abnormal uterine bleeding, whereas, the social class and body mass index did not have an impact on the benign gynecological condition (p>0.05). Conclusion: Patients with symptomatic fibroid uterus and abnormal uterine bleeding are more likely to be hypertensive and diabetic, whereas, BMI, social class and residence area does not significantly differ among patients.

A Study on Association Between Cognitive Development and Moral Reasoning in Students at Elementary Level

The purpose of this research study was to investigate the relationship between cognitive development and moral reasoning of students enrolled in secondary schools. The different aspects of cognitive development and moral reasoning of secondary school students and were also determined in this study. To achieve aforementioned objectives of the study, a sample of 355 students was selected by using the Taro Yamane's sample size calculator. The descriptive survey research design was used and a questionnaire was developed to collect the data. The findings of the study unveiled a notable correlation between cognitive development and moral reasoning, indicating that as cognitive faculties advanced, moral reasoning exhibited a trend toward heightened complexity and refinement. This significant results of the study stated that advancements in cognitive abilities have the potential to positively impact moral reasoning capabilities. Such revelations shed light on the synergistic interplay between cognitive and moral domains, accentuating the potential reciprocal influence between these two facets of human development.

405. SELECTIVE ANTERIOR GASTROPEXY WITH OR WITHOUT FUNDOPLICATION FOR THE TREATMENT OF GRADE III/IV HIATAL HERNIA

Abstract Background The optimal approach to a paraoesophageal hernia (PEH) repair is unclear. Several steps during the procedure are still for discussion. Most surgeons dealing with PEH surgery agree on removal of the hernia sac from the mediastinum and a hiatoplasty with non-absorbable suture. Whether to perform an anti-reflux procedure or/and a gastropexy is unclear. Few studies exist on the subject but without clear favor of an anti-reflux procedure and/or a gastropexy. The aim of this upcoming study is to test if the anti-reflux procedure is redundant for patients suffering from PEH with obstructive rather than regurgitation symptoms. Methods We are setting up a pragmatic, prospective, multicentre, two-armed study. Study beginning June 2024. Sample size calculation with 108 patients in each arm. Both arms will do hernia sac excision, closure of hiatus and gastropexy. One arm will in addition do an anti-reflux procedure. Our objectives are 1) To assess safety of anterior gastropexy with and without fundoplication regarding peri- and postoperative complications. 2) To compare efficacy of anterior gastropexy with and without fundoplication regarding symptom control and clinical recurrence. 3) To assess health related quality of life pre- and post-surgery in patients treated with the two strategies for PEH. Results Our primary outcome is disease specific and health related quality of life before surgery and 3-6-12 months after surgery. Secondary outcomes are per- and post-operative complications according to the clavien-dindo score and radiological status/recurrence 12 months after surgery. Conclusion The study will add on to existing knowledge about essential technical steps of PEH surgery. Do the patients benefit from a fundoplication or is this potentially complicating procedure redundant regarding long-term symptom control.

Assessment of Knowledge and Attitude of Asthmatic Patients and Their Caregivers Regarding the Disease Using an Asthma Knowledge Questionnaire in a Tertiary Care Hospital in Chennai.

Introduction Asthma, a significant non-communicable disease impacting all age groups, leads to productivity loss, particularly affecting children and causing disruption within families. This study aims to evaluate the knowledge and attitudes of asthmatic patients and caregivers through questionnaires, focusing on available treatment options. Aims and objectives The study aimed to assess the knowledge and attitudes of asthmatic patients and caregivers at a tertiary care hospital in Chennai, Tamil Nadu, India. Objectives included evaluating asthma knowledge using a questionnaire and assessing attitudes towards the disease and available treatment options. Materials and methods This cross-sectional study, conducted at the Department of Respiratory Medicine, Sree Balaji Medical College & Hospital, Chennai, focused on bronchial asthma patients and their caregivers in the Outpatient Department (OPD) from May 2021 to November 2022. The study included 150 participants selected randomly based on sample size calculations. Data, collected through a proforma, included demographic variables. Participants' knowledge and attitudes toward asthma were assessed using the Asthma Knowledge and Asthma Attitude questionnaires. Exclusion criteria comprised patients with a history of tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease, recent hemoptysis, or evidence of infective exacerbation. Results and discussion Among 150 participants, 44% were females and 56% were males. Asthma knowledge was present in 62.1% of females and 79.8% of males, while 37.9% of females and 20.2% of males lacked understanding. High prevalence rates of breathlessness (89.4% females, 90.5% males), wheezing (92.4% females, 81% males), and cough (77.3% females, 75% males) were noted. The knowledge questionnaire revealed a mean score of 4 out of 8, indicating a moderate understanding with significant gaps. Many lacked knowledge about affected sites, harbored misconceptions about pet contact, and dust exposure, and were uninformed about triggers, symptoms, and treatment. Lack of awareness regarding weather-related exacerbations, smoking effects, and medication purposes was evident. Reluctance towards long-term inhaler use underscored the necessity for comprehensive asthma education among patients and caregivers. Attitude questionnaire scores varied: 17 scored 16, 37 scored 18, 24 scored 19, 35 scored 21, 20 scored 24, and 17 scored 26, averaging 20.6, reflecting generally positive attitudes. The attitude questionnaire, with six questions, highlighted attitudes toward asthma. However, stigma around asthma affecting normal lives (77.3%), fear of lifelong medication use (84%), and embarrassment over public inhaler use (74%) highlighted areas for attitude improvement to enhance therapy compliance and patient outcomes. Conclusion Our study highlights concerns among asthma patients and caregivers, particularly those with limited education, regarding treatment side effects. Issues include apprehensions about inhaler therapy's addictive potential, insufficient awareness of asthma triggers, improper inhaler techniques, reluctance towards long-term inhaler use, and embarrassment over public use of inhalers contributing to the study's complexities.

Subcutaneous Onlay Laparoscopic Approach for small ventral hernias associated with divarication of rectus abdominis muscle

BackgroundVentral hernias when associated with divarication of rectus abdominis if repaired without concomitant repair of the divarication is plagued by higher rates of recurrences. Out of the many options available for the repair, Subcutaneous Onlay Laparoscopic Approach (SCOLA) with concurrent plication of the divarication is gaining popularity. MethodsAll patients with a ventral hernia associated with divarication of recti were included in this prospective study. The calculated sample size was 34 with a confidence level of 95% and a margin of error of 5%. The patient demographics, operative time, intraoperative and postoperative complications, need for post-operative blood transfusion, and the recurrence were recorded. Categorical data were compared using Student's t-test, whereas chi-square test was used to compare the nominal variables between the two groups. A P-value of <0.05 was considered to be statistically significant. ResultsThirty-six patients were analysed for the study with a mean age of 43.40 years. A total of 55.55% patients were female. Twelve patients had co-morbidities. Umbilical hernia was the most common hernia. The mean size of the hernial defect was 3.67 cm, and the mean operative time was 156.66 min (±31.02 min). The first 15 cases took longer time for the surgery (mean operative time 183.53 min [±19.73 min]). No intraoperative complications were recorded, except for one patient in whom we encountered an excessive bleeding but was tackled with harmonic scalpel. Eight patients (22.2%) had complications with Seroma formation being the commonest. ConclusionSCOLA is feasible and advantageous because of faster recovery and minimal complication and recurrence rates.

Assessment of sexual function and quality of life in breast cancer patients before and after the occurrence of therapy-related skin changes

Background Patients with breast cancer (BC) who receive adjuvant chemotherapy or other treatment modalities may potentially benefit from an enhanced prognosis of survival. Physical or aesthetic complications may, nevertheless, result in significant distress as a consequence of adverse dermatologic responses. There has been a heightened focus on matters related to quality of life (QoL) as the number of BC survivors has risen. Sexual disorders are reported by as many as 75% of women who undergo treatment for BC. Despite this, the majority of oncologists lack the necessary training to identify patients who are particularly susceptible to developing sexual disorders. Patients diagnosed with BC frequently experience female sexual dysfunction. Objective To compare and evaluate the impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL. Patients and methods This is a prospective cohort research on 58 cases diagnosed with BC, which was conducted in the outpatient clinic of the Clinical Oncology department, Faculty of Medicine, Menoufia University from April 2022 to February 2023. The calculated sample size for the current study using Epi info 7 programs was 56 women. The power of the study is 80% with a confidence level of 95% as determined by the Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University. Both sexual function and QoL were assessed before and 3–6 months after the occurrence of skin changes related to different treatment modalities using validated questionnaires irrespective of their tumor stage. Results Of the 58 patients, there was statistically significant variance regarding dermatological life quality index (DLQI) (P&lt;0.001), with 8.6% of patients experiencing a very large influence on their QoL, which increased to 19%. However, the number of patients having an extremely large influence on their quality of life changed from 0 to 5.2%. There was statistically significant variance (P&lt;0.001) regarding female sexual function index values among the six domains of female sexual function index before and after the occurrence of skin changes. There is a negative correlation between DLQI score and desire, arousal, lubrication, orgasm, and satisfaction scores, while there is a positive correlation between DLQI score and pain score. QoL was negatively affected by the occurrence of such skin lesions. Conclusion There was a significant negative impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL.

Changes in paternal perinatal depression and its predictors from third trimester of pregnancy to one-year post-partum: a longitudinal study

Introduction: Paternal depression is not as widely recognized as maternal depression. Studies in Japan have examined the factors associated with paternal depression, but these have been limited to specific regions rather than conducted on a nationwide scale. This study aimed to examine changes in paternal perinatal depression from the last trimester of pregnancy to one year postpartum. Additionally, we explored the relationship between paternal perinatal depression and fathers' feelings toward their infants. Methods: This study used a longitudinal design. We initially planned to collect data from over 384 cases based on sample size calculations, and successfully collected data from 494 men in the first survey. However, more than half of the participants dropped out in the second and subsequent surveys, resulting in 201 men completing the longitudinal survey over a one-year period. Results: The mean Edinburgh Postnatal Depression Scale, Japanese version (EPDS-J) score in the last trimester of pregnancy was 9.274 (95% confidence interval [CI] 8.413-10.134), which was the highest throughout the study period. The mean EPDS-J score was lowest at 3-5 months postpartum, with a score of 7.682 (95% CI 6.816-8.547). At all time points, occupational stress and partner relationships were associated with EPDS-J scores. Conclusions: Reducing paternal perinatal depression requires controlling for occupational stress and maintaining good marital relationships. The findings suggest that addressing work-life balance is crucial for Japanese fathers to enhance their whole-family well-being. Keywords: fathers, marital relationship, occupational stress, perinatal depression

Effect of Health Education on the Knowledge and Attitude Regarding the Human Papillomavirus Vaccine among Adolescent School Girls of a City in Western Maharashtra

Background: Human papillomavirus vaccine is effective in preventing cervical cancer and is especially recommended for girls above nine years of age. Understanding the level of awareness and attitude of the target population towards the HPV vaccine is imperative to create awareness where necessary. Aim and Objectives: To assess the baseline knowledge, attitudes, and behaviours concerning HPV vaccine among adolescent school girls in urban area, and to investigate the impact of health education on these parameters. Study design: Quasi-experimental Study setting: Secondary school in Pune city Target population: Adolescent girls Methods and Material: Calculated sample size was 200. A school was chosen randomly. All the willing female students from 8th-10th standards were enrolled. Awareness about HPV infection and vaccination, attitude and practices were assessed at the baseline and two weeks after the health education intervention, using a self-administered structured questionnaire. Results: Initially, only 2.5% had heard about the HPV vaccine and none had received it. Following health education, the proportion of students who correctly answered the questions regarding the HPV vaccine, diseases prevented and who can take the vaccine increased significantly by 94%, 71.5% and 72% respectively. Positive attitude regarding the risk of HPV infection and age for vaccination improved significantly by 78.5% and 48% respectively. Vaccine seeking behaviour improved significantly by 17.5%. Conclusions: Adolescent school girls had poor baseline knowledge and attitude regarding the HPV vaccine and health education significantly improved the same.

Correlation of Wellness Program Against Degenerative Indicators Through Experimental Pre-Posttest

The incidence of degenerative diseases, such as hyperuricemia, hypercholesterolemia, obesity, hypertension, and diabetes mellitus, is increasing, primarily due to unhealthy lifestyles. Holistic treatment, involving pharmacology and lifestyle modification, is recommended. The Wellness program, covering diet, exercise, and relaxation techniques like meditation and yoga offers a holistic approach to reduce the incidence of degenerative diseases. Adopting a Wellness program could have positive outcomes, including cost-effectiveness, nutritional balance, and improvements in both physical (through yoga) and mental (through meditation) well-being, but the potential downsides include lack of control groups, inadequate consideration of age and gender, insufficient sample sizes, limited observation days, and an excessive number of measured parameters. This study aims to see the effectiveness and influence of the Wellness program on reducing uric acid levels, cholesterol, blood sugar levels, systolic and diastolic blodd pressure. The intervention is designed for women aged 30-60 who experience rage. However, individuals who are consuming medications or supplements, pregnant, breastfeeding, or not following a prescribed diet are excluded. This study used the quasi-experimental pre-posttest design to see the Wellness program’s effectiveness on uric acid, blood pressure, blood sugar levels, and total cholesterol. Sample size calculation was performed using G*Power version 3.1.9.7, and data analysis utilized the T-paired sampled test. The findings from a 3-day study involving 47 participants revealed significant differences post-implementation of the Wellness program, indicating a reduction in uric acid levels and an increase in blood sugar levels with a p-value&lt;0.05.

Development and validation of the Women’s Self-care Knowledge and Attitude Questionnaire (WSKAQ)

BackgroundMenopausal women should learn self-care practices to enjoy a healthy lifestyle, positive health behaviors, and health status. In addition, the lack of self-care knowledge can lead to unhealthy attitudes and lifestyles, resulting in many complications. Improved self-care knowledge can foster positive attitudes, leading to healthier lifestyles as a beneficial cycle. However, menopausal women have limited knowledge about self-care and evaluation tools. Therefore, this study aimed to develop and investigate the validity and reliability of the Women’s Self-care Knowledge and Attitude Questionnaire (WSKAQ) in Iranian menopausal women.MethodsThis cross-sectional study was conducted on 249 menopausal women, aged between 45 and 65 years and at least one year post-menopause, with a minimum literacy level of elementary education. Validation properties included construct validity, exploratory (EFA), and discriminant validity. Reliability was further established through Cronbach’s α and McDonald’s Omega. PASS 15 and SPSS 27 software were used to select centers, calculate sample size and analyze the data, respectively.ResultsThe initial stage of construct validity involved the Kolmogorov–Smirnov test and EFA, resulting in a 6-item self-care knowledge subscale, 47.29% of the total data variance, and 7-item self-care attitude subscale, 55.50% of the total data variance. Independent t-test indicated that menopausal women with education level equal to or higher than diploma have significantly higher self-care attitude scores than those with lower than diploma (p = 0.007). Additionally, significant correlations were observed between self-care knowledge and attitude (r:0.30). Cronbach’s α and McDonald’s Omega coefficients of the 13-item WSKAQ were 0.77 and 0.78, respectively.ConclusionsBased on the results, the WSKAQ, consisting of 13 items, was validated and reliable for assessing the self-care knowledge and attitude of Iranian menopausal women.

Job Satisfaction on productivity of Non-Teaching Staff

Job satisfaction plays a vital role in management, influencing both employee engagement and the overall workplace culture. This article is guided by the following objectives: to establish the influence of remuneration; to determine the influence of communication; to investigate the influence of the work environment; and to examine the influence of training opportunities on the productivity of non-teaching staff in public secondary schools in Baringo County, Kenya. It employs a descriptive research approach to articulate and characterize current events. The target population comprises of 327 individuals, specifically School Accountants and School Secretaries. Utilizing the Krejcie and Morgan (1970) table for sample size calculation, a representative sample of 181 non-teaching staff members were selected. Simple random selection ensured each school had an equal opportunity for inclusion. Data collection involved document analysis, questionnaires and interview schedules. Descriptive analysis was applied, presenting processed data through frequency tables and percentages. Instrument validation was included, content validity, involving university lecturers and experts, while reliability was established through a pilot study, with a threshold Cronbach's alpha (α) of 0.7 indicating tool reliability. Based on the findings, it concludes that there is a moderate-positive and statistically significant correlation between remuneration on productivity of non-teaching staff in public secondary schools in Baringo Central sub county, Kenya (r = 0.531; p &lt; 0.05).

Green Human Resources Management Practices and Tertiary Institution Productivity in South West Nigeria

Abstract: Inadequate Implementation of Green human resources Practices in tertiary institutions in South West Nigeria has made the higher institution of learning to face challenges in integrating environmental conservatives policy in their operations. The study therefore examined the effect of green human resources practices on organizational productivity of tertiary institutions in Nigeria. The study adopted a cross- sectional survey research design with the aid of structured questionnaire. The population for the study are the employees of the all the six (6) Federal polytechnics in South Nigeria, totaling 5028. From this population, an aggregate sample size of 371 participants were selected using Taro Yamane sample size calculator where proportional allocation was used to select participants for inclusion per tertiary institution. Structural equation modeling using Smart-PLS 4.0 was used for data analysis; as results indicated that GIO ( , T-statistic = 3.512, p &lt; 0.05), GRCM ( , T-statistic = 8.385, p &lt; 0.05), and GRS ( , T-statistic = 4.711, p &lt; 0.05) have significant positive effects on organizational productivity. This highlights the importance of these green HR practices in enhancing productivity in the selected tertiary institutions in Southwest Nigeria. The study concluded that green human resources management practices is crucial in achieving optimal organizational productivity of the federal polytechnics in South West Nigeria. The study therefore recommended that the management of the federal Polytechnics in South West Nigeria should use environmental conservative employer branding to attract, select applicants and retain employees who have green orientation through a well-defined and circulated environmental sustainability human resources policy.

Dentinal Crack Formation Induced by Ultrasonic Tips and Laser as Compared to Conventional Burs During Root-end Preparation: A Systematic Review and Meta-analysis

Aim: The objective was to evaluate and compare the crack formation induced by ultrasonic tips and lasers with conventional burs during root-end preparation. Materials and Methods: The PROSPERO registration code for this study is CRD42023470898. Both manual and electronic database searches were performed up to 2023, August in three databases, namely, the Cochrane Library, PubMed and Google Scholar. In vitro or laboratory studies that employed the use of ultrasonic tips, LASER and conventional burs for root-end preparation on extracted teeth were collected. The data were extracted by two independent reviewers using a predesigned template. Information about the study design, year, full-text publications, inclusion and exclusion criteria were gathered. The PRISMA guidelines 2020 were followed in the reporting and execution of the systematic review and meta-analysis. To evaluate statistical heterogeneity, χ² values and I² values were employed in conjunction with a random-effects model for the meta-analysis. Results: A total of 689 articles were identified. After removing the duplicates in total 567 articles were screened. Finally, six articles were included in the meta-analysis. QUIN Risk of Bias tool showed an overall moderate risk of bias in the included studies. The pooled odds ratio for crack formation was 1.77 (0.82, 3.82) for ultrasonic tips and conventional burs suggesting higher odds of crack formation for ultrasonic tips. Conclusion: None of the included studies provided information on sample size calculation, sampling technique, randomization or blinding. The meta-analysis suggests higher chances of crack formation from ultrasonic followed by laser and conventional burs preparation. Therefore, efforts to standardize an acceptable procedure for root-end cavity preparation should be made in future study, along with encouragement of the clinical application of the same, taking into account issues like economic feasibility and convenience of usage.

Assessment of Stigma among Caregivers of Armed Forces Professionals Suffering from Mental Illness

Abstract Background: Having a person with mental illness in the family invariably leads to stigmatic experiences to the family members. Perceived stigma in caregivers leads to social isolation, psychological distress, and suboptimal functioning. Additionally, perceived stigma among such caregivers is one of the barriers that prevent them from taking appropriate care of their dependents with mental illness. There has been little research in this field in the Indian armed forces population. Objective: The objective of this study was to assess the perceived stigma among caregivers of armed forces personnel suffering from mental illnesses. Methods: The calculated sample size was 139 but in our study period of time (December 1, 2019–February 28, 2020) we received the enough number of patients and we continued our study with 150 study subjects which is enough more than the 139. Hence, the total number of 150 caregivers visiting the psychiatry outpatient department of a tertiary care military hospital in North India along with their mentally ill dependents were included in the study after obtaining valid informed consent. The subjects were interviewed, their sociodemographic data were collected, and stigma scores were assessed on a 15-item Explanatory Model Interview Catalogue (EMIC) Stigma Scale. Results: Total stigma score ranged from 20 to 40 with a median of 31. Caregivers with lower level of education, lower income, rural residency, elder age, and diagnosis of psychosis/substance abuse in dependent were found to have higher scores of perceived stigma. Conclusions: Caregivers of patients with mental illnesses experience significant stigma which needs to be addressed so that they can provide optimum care to their mentally ill dependents. Limitation: As EMIC does not provide any standard cutoff for low or high stigma or to categorize persons as having stigma or not, it was difficult to compare results with other studies that used different tools to assess stigma.

Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study.

Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC. The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration. This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly). The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled. This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care. ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057. PRR1-10.2196/52841.

Perspectives and guidance for developing artificial intelligence-based applications for healthcare using medical images

Artificial intelligence (AI) has significant potential to transform healthcare and improve patient care. However, successful development and integration of AI models requires careful consideration of study designs and sample size calculations for development and validation of models, publishing standards, prototype development for translation and collaboration with stakeholders. As the field is relatively new and rapidly evolving there is a lack of guidance and agreement on best practices for most of these steps. We engaged stakeholders in the form of clinicians, researchers from academia and industry, and data scientists to discuss various aspects of the translational pipeline and identified the challenges researchers in the field face and potential solutions to them. In this viewpoint, we present the summary of our discussions as a brief guide on the process of developing AI-based applications for healthcare using medical images. We organized the entire process into six major themes (i.e., The gaps AI can fill in healthcare, Development of AI models for healthcare: practical and important things to consider, Good practices for validation of AI models for healthcare: study designs and sample size calculation, Points to consider when publishing AI models, Translation towards products, Challenges and potential solutions from a technical perspective) and presented important points as a rule of thumb. We conclude that successful integration of AI in healthcare requires a collaborative approach, rigorous validation, adherence to best practices as described and cited, and consideration of technical aspects.

Feasibility of individualized home exercise programs for patients with head and neck cancer-study protocol and first results of a multicentre single-arm intervention trial (OSHO #94).

Patients with head and neck cancer (PwHNC) benefit from targeted exercise interventions: symptom relief, compensation for dysfunction, improvement in quality of life (QoL). Data on acceptance physical interventions in PwHNC are rare. The 'OSHO #94' trial investigates the short- and medium-term effects of individualized home exercise in PwHNC on QoL, physical activity and functionality. The study includes a feasibility phase (proof of concept) in order to evaluate the acceptance. Here we present the study protocol as well as the feasibility results. This prospective, multicentre, single-arm intervention study includes PwHNC ≥18 years of age in aftercare or palliative care with stable remission under immunotherapy. The study opened in January 01, 2021, with estimated completion by December 31, 2024. The PwHNC receive an individualized home exercise program consisting of mobilization, coordination, strengthening and stretching exercises. This should be carried out at least three times a week over 12 weeks for 15 to 30 minutes, supplemented by aerobic training two to three times a week for 30 minutes (intervention). Once weekly telephone calls with a physiotherapist are performed. Subsequently, there is a 12-week follow-up (FU) without exercise specifications/contact. Outcomes are measured before and after the intervention and following the FU. Primary outcome of the feasibility phase (n = 25) was the determination of the dropout rate during the intervention with a termination cut off if more than 30% PwHNC withdrew premature. The primary outcome of the OSHO #94' trial (N = 53) is the change in global QoL score from pre- to post-intervention (EORTC QLQ-C30). Secondary outcomes include clinical and patient-reported measures, training details as well as functional diagnostic data (e.g. level of physical activity, training frequency, flexibility, fall risk and aerobic performance). 25 PwHNC were enrolled onto the feasibility cohort. Only16% (4/25 patients) did not complete the study. Therefore, recruitment of PwHNC was continued. The dropout rate was adjusted from 30% (N = 60) to 20% (N = 53, calculated sample size n = 42 PwHNC and 20% (n = 11) to dropout). Individualized home exercise programs in PwHNC in aftercare seem feasible. Consequently, the aim is now to evaluate the short and medium-term effects of individualized home exercise.