Sample Size Calculation Research Articles

Simulation-based sample size calculations of marginal proportional means models for recurrent events with competing risks.

In randomised controlled trials, the outcome of interest could be recurrent events, such as hospitalisations for heart failure. If mortality rates are non-negligible, both recurrent events and competing terminal events need to be addressed when formulating the estimand and statistical analysis is no longer trivial. In order to design future trials with primary recurrent event endpoints with competing risks, it is necessary to be able to perform power calculations to determine sample sizes. This paper introduces a simulation-based approach for power estimation based on a proportional means model for recurrent events and a proportional hazards model for terminal events. The simulation procedure is presented along with a discussion of what the user needs to specify to use the approach. The method is flexible and based on marginal quantities which are easy to specify. However, the method introduces a lack of a certain type of dependence. This is explored in a sensitivity analysis which suggests that the power is robust in spite of that. Data from a randomised controlled trial, LEADER, is used as the basis for generating data for a future trial. Finally, potential power gains of recurrent event methods as opposed to first event methods are discussed.

The Impact of Nurse Educators’ Attitude on Nursing Students' Academic Performance and Ethical Growth at the Department of Nursing, Eastern Technical University of Sierra Leone

Introduction: Sierra Leone faces significant healthcare challenges, including a shortage of healthcare professionals and concerns over the competence and ethical behaviour of nurses. Understanding the role of nurse educators in shaping the next generation of nurses is essential for addressing these challenges and improving healthcare delivery. Aim: To examine the impact of Nurse Educators’ attitudes on Nursing Students' academic performance and Ethical Growth at the Department of Nursing, Eastern Technical University of Sierra Leone. Methods: The study was a descriptive cross-sectional mixed-methods design, incorporating both quantitative and qualitative approaches, and utilised a stratified random sampling method to survey students between August and October 2023. The sample size was determined using an online Raosoft sample size calculator and the WallStreetMojo formula, ensuring a 5% margin of error at a 95% confidence interval. Data collection involved a self-designed 5-point Likert scale questionnaire, assessed for reliability and internal consistency using Cronbach's alpha, with analysis conducted through descriptive statistics, factor analysis, and the chi-square test of independence, maintaining a significance level of p ≤ 0.05. Result: Findings that emerged include the positive influence of educators' attitudes, commitment, and effective teaching methods, underscoring their crucial role in cultivating a conducive learning environment. Similarly, negative findings reveal apprehensions regarding clinical preparation, student participation, and the perceived influence of educators' behaviour on academic progress and motivation. Statistical analyses, including chi-square tests, reveal the statistical significance of the relationships between nurse educators' attitudes and students’ academic performance and ethical growth. Qualitative themes, including respect, fairness, and equality emerged, highlighting the intricate nature of professional relationships between educators and students. Conclusion: The study sheds light on nurse educators' influence on students' academic performance and ethical growth, emphasising the importance of addressing both positive aspects and areas of concern for a holistic learning environment. The qualitative responses emphasised a collective desire for a supportive and respectful atmosphere and implementing the study's recommendations is seen as vital for enhancing professional relationships in nursing education.

Pengaruh Praktek Kerja Industri (Prakerin), Informasi Dunia Kerja Dan Motivasi Memasuki Dunia Kerja Terhadap Kesiapan Kerja Siswa SMK

This study aims to analyze the effect of Industrial Work Practice (PRAKERIN), information on the world of work, and motivation to enter the world of work on the work readiness of XII grade students at the Vocational High School for Agricultural Development (SMK PP) Negeri Padang. By using a sample of 105 students, the sampling technique was carried out using Raosoft Sample Size Calculator Software. The results of data analysis show that the variable that has the most influence on the work readiness of vocational students is Industrial Work Practice (PRAKERIN), with a beta value of 0.477. This study highlights the importance of practical experience in shaping vocational students' work readiness, and emphasizes the need for increased information and motivation related to the world of work. The implication of this finding is the need to improve and develop the PRAKERIN program at SMK PP Negeri Padang, as well as the important role of information and motivation in preparing students to enter the world of work. This research contributes to the understanding of the factors that influence vocational students' work readiness, so that it can be the basis for developing more effective educational strategies and policies in the future.

Pro-Environmental Transformation of the Equine Sector-Facilitators and Challenges.

To improve horse welfare and ensure a sustainable equestrian future, we need to understand human behavior in relation to the challenges of the sector. The purpose of this paper is to map and analyze how individuals within the equine sector in Sweden and Norway define the environmental challenges they are faced with and how these are related to questions about horse welfare. A mixed-methods parallel design was used. The data consist of survey answers and semi-structured interviews. The survey, responded to by 697 Swedish and Norwegian participants, ensured statistical validity and power through a sample size calculation yielding approximately 385 participants. To deepen the understanding, 36 semi structured interviews with Swedish and Norwegian interviewees were conducted. An analysis of convergencies and divergencies between the data sets provided robust insights into the perceptions and behaviors within the equine sector in Sweden and Norway. The findings show that the equine sector has cultivated a stronger environmental commitment over the last 15 years (Svala, 2008). However, many participants express a perceived lack of influence on this transformation. The COM-B model (Michie, Van Stralen & West, 2011; Michie, Atkins & West, 2014) and previous research on 'thinking structures on climate delay' (Wormbs & Wolrath, 2023) are used to interpret the data. The analysis indicates that there is an overall capacity for change, and that skills and knowledge exist, but some individuals desire more information and a deeper understanding of the issues at hand. Higher barriers to change were found in the opportunity component, where physical constraints such as location, resources, and time seem challenging for individual actors to influence. Economic factors are also identified as impediments to transformation. Cultural norms related to orderliness within stables, although not directly addressing ecological nor ethical challenges, might serve as a foundation for promoting environmental initiatives that will also improve horse welfare.

Analysis of the impact of indoor thermal comfort data characteristics on dataset quality

The impact of data characteristics on dataset quality is of significant guidance in the field of thermal comfort field surveys. In this paper, a Chinese thermal comfort database has been established, comprising quality-controlled on-site survey data. The database encompasses 41,977 sets of on-site survey data collected from 50 cities across 24 provinces, spanning a period of nearly 20 years from 2001 to 2021. It includes the five thermal zones in China and encompasses three seasons—summer, transitional, and winter—as well as four types of buildings: office buildings, residential buildings, student dormitories, and classrooms. The database exhibits an extensive data distribution, demonstrating a certain level of representativeness in terms of environmental temperature and survey locations. Based on this established database, the thermal sensation model was employed as the criterion for evaluating dataset quality. This study analyzed the impact of data characteristics on dataset qualityfrom three perspectives: sample size, data distribution, and data range. A sample size calculation method using interval estimation was adopted, determiningthat a minimum sample size of 350 is required for on-site thermal comfort surveys in office and residential buildings. A comparison revealed that compared to data with the normal distribution and uniform distribution, data with the positively skewed distribution exhibit lower neutral temperatures, while data with the negatively skewed distribution exhibit higher neutral temperatures. The thermal sensation model constructed based on data with uniform distribution demonstrates greater robustness. As the temperature range decreases, the neutral temperature increases in winter and decreases in summer, resulting in reduced accuracy of the constructed thermal sensation model.

Randomized, Single Blind, Standard Controlled, Equivalence Clinical Trial to Evaluate the Comparative Efficacy of Eladi Kasaya Versus Tranexamic Acid Tablet in the Management of Asrigdara (Heavy Menstrual Bleeding): A Clinical Trial Protocol

Introduction: Excessive menstrual bleeding is a common problem in reproductive age group females, and it is reported that 1 in 20 lifetime chances, a female needs consulting the physician for excessive and prolonged menstrual bleeding. Ayurvedic literature describes excessive menstrual bleeding as Asrigdara (HMB). Eladi kasaya is one of the treatment modalities for heavy menstrual bleeding given in classics and hence chosen for the current clinical trial.
 Methods: We planned a prospective, randomized, controlled, and equivalence trial on the patients with Heavy menstrual bleeding (blood loss > 80 ml) for the last two cycles or more. Eladi Kasaya 50 ml with honey and sharkara(sugar) thrice a day will be given from day 1 to day 7 for 3 consecutive menstrual cycles to Group A and Tablet Tranexamic acid 500mg thrice a day to Group B. Primary outcome measures are menstrual blood loss improvement, reduction in pain assessed by visual analog scale, and change in Haemoglobin concentration. The secondary outcome measure is improvement in quality of life. All adverse drug reactions will be monitored and reported to Ayush Suraksha, pharmacovigilance center, Maharashtra. Following sample size calculation 46 patients will be recruited in each group to demonstrate equivalence with 80% power. The duration of study will be 2 years. The study is approved through Institutional Ethics Committee dated 07/10/2022, MGACHRC/IEC/Oct-2022/585. Participant recruitment shall be started after getting registered with the Clinical Trial Registry of India.
 Results: Current manuscript is a clinical protocol, hence results are yet to derive from the study. Results will be presented in conferences and shall be attempted to publish in indexed/peer-reviewed medical journals.
 Conclusion: Conclusion shall be drawn after completion of the clinical study.

Factors that Influence Stunting in the Maratua District of Berau, Indonesia

Highlights:1. This study investigated the factors contributing to stunting in a remote area, which has not received sufficient attention from key stakeholders.2. The findings of this study can serve as a reference for the government in addressing stunting through intervention strategies that incorporate paternal roles to improve children's nutritional status. AbstractStunting is a community health problem with significant impacts. The estimated prevalence rate of stunting was 24.4% in Indonesia and 25.7% in the Berau Regency. Stunting is a growth disorder caused by chronic malnutrition during the first 1,000 days of life. It is characterized by a height-for-age Z-score below -2 standard deviations from the child growth standards median of the World Health Organization, an insufficient growth rate, and a reduced potential final height. The contributing factors to stunting include maternal variables, as mothers are the primary caregivers. The objective of this study was to determine the factors for stunting and specifically investigate if there is a relationship between maternal employment and stunting in the Maratua District of Berau, Indonesia. This study used a cross-sectional research design. The sample size was determined using the Sample Size Calculator from the World Health Organization for a two-sided test (α = 0.05; β = 0.2; p1 = 0.63; p2 = 0.25; 95% CI). The data were collected from the nutrition report and anthropometric measurements at Maratua Primary Healthcare Center. The research was carried out at the Integrated Health Posts (Pos Layanan Terpadu/ Posyandu) in the Maratua District. The toddlers (n = 56) were examined with their parental consent. Toddlers with overnutrition, obesity, and acute infectious diseases were excluded from this study. The data were processed using Chi-square and Fisher tests (p < 0.05). In the analysis, no significant relationship was found between stunting and maternal employment. However, the results revealed that fathers who were not fishermen had a 6.3 times greater risk of having stunted toddlers compared to fathers who worked as fishermen. Fathers with a junior high school degree showed a 6.1 times higher risk of having stunted toddlers than fathers with different educational levels. In conclusion, stunting in the Maratua District is associated with the fathers' educational attainment and employment.

What Is the Association Between Agency and Levels of Capability and Comfort in Musculoskeletal Care? A Systematic Review.

People who take active responsibility for their health demonstrate agency. Agency in the context of chronic illness management with disease-modifying treatments is commonly linked to adherence and confidence in care seeking. In musculoskeletal health, agency is commonly observed in the accommodation of conditions related to aging and reflected in studies of people not seeking care. The development of agency measures originates from the realm of medical management of chronic illness rather than that of musculoskeletal disease, which is often optional or discretionary. With growing interest in the universal adoption of agency as a performance measure for quality payment programs, there is a need to better understand how agency is measured across musculoskeletal conditions, and how agency may be a modifiable correlate of capability, comfort, mindset, and circumstances. We systematically reviewed the evidence regarding agency among people seeking musculoskeletal specialty care and asked: (1) Are greater levels of agency associated with greater levels of comfort and capability? (2) Are greater levels of agency associated with better mental and social health? Following the PRISMA guidelines, we performed searches on May 22, 2023, with searches spanning September 1988 (in PubMed and Web of Science) and September 1946 (in Ovid Medline) to May 2023. We included original clinical studies addressing the relationship between agency and levels of comfort, capability, mindset, and circumstances (by utilizing patient-reported agency measures [PRAMs], patient-reported outcome measures [PROMs], and mental and social health measures) involving adult patients 18 years or older receiving specialist care for musculoskeletal conditions. We identified 11 studies involving 3537 patients that addressed the primary research question and three studies involving 822 patients that addressed the secondary question. We conducted an evidence quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) and found the overall evidence quality to be relatively high, with loss to follow-up and lack of reporting of sample size calculation the most consistent study shortcomings. The measures of capability varied by anatomical region. The Patient Activation Measure (a validated 10- or 13-item survey originally designed to assess a patient's level of understanding and confidence in managing their health and ability to engage in healthcare related to chronic medical illness) was used as a measure of agency in 10 studies (one of which also used the Effective Consumer Scale) and attitudes regarding one's management of musculoskeletal disorders in one study. We registered this systematic review on PROSPERO (Reg CRD42023426893). In general, the relationships between PRAMs and PROMs are weak to moderate in strength using the Cohen criteria, with 10 of 11 studies demonstrating an association between levels of agency and levels of comfort and capability. The three studies addressing mental health found a weak correlation (where reported) between levels of agency and levels of symptoms of depression and anxiety. The finding that agency in patients seeking care for musculoskeletal conditions is associated with greater comfort, capability, and mental health supports the prioritization of agency modification during musculoskeletal specialty care. This might include behavioral health and cognitive debiasing strategies along with strategies and services promoting self-management. Our work also points to an opportunity to develop agency measures better suited for discretionary care that more directly assess the cultivation of healthy mindsets, behaviors, and accommodative attitudes toward the discomfort and incapability experienced during aging. Level II, prognostic study.

Does Maxillomandibular Fixation Technique Affect Occlusion Quality in Segmental LeFort I Osteotomy?

BackgroundSegmental maxillary osteotomies require precise occlusal control due to variability in individual segment positioning. The role of maxillomandibular fixation (MMF) technique on occlusal control has not been validated. PurposeThe purpose is to measure and compare the accuracy of occlusal positioning among MMF techniques. Study design, setting, sampleThis was a double-blinded in vitro study on experiment models to simulate a 3-piece LeFort I osteotomy. The models were constricted posteriorly and expanded using 3 different MMF techniques and compared to the unaltered baseline occlusion. Based on sample size calculation, 32 separate attempts were made for each MMF technique. Predictor variableThe predictor variable was MMF technique (brackets, MMF screws, embrasure wires). Main outcome variablesThe primary outcome variable was the visual occlusal analysis score (VOAS), a 1.00 to 4.00 continuous scale measuring the similarity of the achieved occlusion to the planned (control) occlusion assessed by an oral and maxillofacial surgeon and an orthodontist. High VOAS indicated greater occlusal accuracy, with 3.50 defined as the threshold for accuracy. The secondary outcome variable was the linear error of the achieved occlusion at the canine and first molar teeth, with lower error indicating greater accuracy. An a priori accuracy threshold of 0.5mm was set for this variable. CovariatesNone. AnalysesKruskal-Wallis test with post hoc testing was used to analyze the difference in the outcome variables of interest. P-value < 0.05 was considered statistically significant. ResultsThirty-two attempts for each technique showed that brackets had higher VAOS than MMF screws and embrasure wires (median differences 1.49 and 0.48, P<0.001), and had lower linear occlusal error (median differences 0.35 to 0.99mm, P<0.001). Conclusions and RelevanceMMF technique influences the quality of occlusal control, with greater visual rating scores and lower linear errors seen with brackets than with embrasure wires or MMF screws.

Anxiety associated painful temporomandibular disorders in Peruvian dental students during the major waves of COVID-19 infection: A cohort study

Abstract Aim: During the major waves of coronavirus disease 2019 (COVID-19) infection, Peru had the highest case fatality rate in the world. This situation may have caused psychological conditions with somatic consequences in students who were susceptible to infection due to exposure to infected patients. The present study was designed to investigate the association between anxiety levels and painful temporomandibular disorders in dental students from two Peruvian provinces during the major waves of COVID-19 infection. Materials and Methods: The study conducted was both longitudinal and analytical. The total population consisted of 558 dental students from Peru, with 314 from Chimbote and 244 from Trujillo. No sample size calculation was necessary as the entire student population was invited to participate. Of the 366 students who initially joined the closed cohort, only 204 remained at the end of the study. During the first and second waves of COVID-19 infections, the Zung anxiety diagnostic test and the diagnostic criteria for painful temporomandibular disorder (DC/TMD) triage questionnaire were used to assess anxiety levels. The study also evaluated variables such as sex, age, marital status, academic year of study, area of residence, housing type, and occupation. The study employed statistical analysis to determine the relative risk (RR) of painful TMD incidence during the first and second waves of COVID-19 infections. A logit model was also used to determine the presence of painful TMD, with odds ratio (OR) as the measure. The statistical significance level was set at P &lt; 0.05. Results: During the initial wave of COVID-19 infections, 50% (95% CI: 43.1–56.9%) of the 204 students experienced anxiety, while 26.5% (95% CI: 20.4–32.6%) reported TMD. Furthermore, those who exhibited anxiety were eight times more likely to develop TMD (OR = 8.88, 95% CI: 3.95 - 19.97). In the second wave, 62.3% (95% CI: 55.6–69.0%) of students reported anxiety, and 86.3% (95% CI: 81.6–91.0%) reported TMD. Additionally, individuals with anxiety were found to have a significantly higher likelihood of developing painful TMD, with a nine-fold increase in risk (OR = 9.87, 95% CI: 5.08–19.19). The cohort of students exposed and not exposed to anxiety during the first and second waves of COVID-19 infection showed a 4.58 times higher risk (95% CI: 2.61–8.03) of developing painful TMD due to anxiety. Conclusion: Between the first and second waves of COVID-19 infection, the prevalence of anxiety and painful temporomandibular disorder (TMD) increased among dental students. This establishes anxiety as a significant predisposing factor for the development of painful TMD over time.

The Relationship Between Personnel Development and Employee Performance at Zhuoyue Human Resources Service Co. LTD., Hohhot, People’s Republic of China

Background and Aim: The important factors of effective performance are those related to the working environment or organization, such as the environment in the organization, organizational policies and administrative control, command, the nature of the work, the relationship between people at all levels of the organization, compensation, management, budget, etc., and the factors caused by the operator. Thus, this study aims to study the personal development level of Huhohaote Zhuoyue Human Resource Service Co., LTD employees. To study the work efficiency level of employees in Hohhot Zhuoyue Human Resource Service Co., LTD., People's Republic of China. Study the relationship between employee development and performance in Hohhot Zhuoyue Human Resource Service Co., LTD. Materials and Methods: To study and provide suggestions on talent development and employee performance of Hohhot Zhuoyue Human Resource Service Co., LTD., People's Republic of China. The study subjects were 80 employees of Zhuoyue Human Resource Service Co., LTD., Huhohot City, People's Republic of China. The sample size calculation formula of Yamane Taro was adopted to determine the sample size. The analysis was carried out statistically. Data include frequency distribution, percentage, mean, and standard deviation. Pearson correlation coefficient statistics were used to test the hypothesis. The statistical significance level was 0.05. Results: The research results found that: (1) the Talent development level of employees of Huhhot Zhuoyue Human Resources Service Co., LTD., People's Republic of China; Overall, is at the highest level. (2) The work efficiency level of employees of Huhhot Zhuoyue Human Resource Service Co., LTD., People's Republic of China. Overall, this is a high level. (3) Analysis results of the relationship between employee development and employee work efficiency in Huhhot Zhuoyue Human Resource Service Co., LTD., People's Republic of China. In general, the relationship between the two is at a high level. The lowest level equals -0.292. 4) Suggestions for talent development and work performance of employees of Hohhot Zhuoyue Human Resources Service Co., LTD., People's Republic of China are as follows: Increase modern training forms, so that theoretical knowledge and practical knowledge applied to practical work, and organize training consistent with the job responsibilities of employees. Training should be targeted and purposeful. A sufficient budget should be provided for training so that trainees can put their knowledge to good use and apply what they have learned to practical work. Employees should be brought to more successful departments to learn so that they can become role models in the work. Employees should be provided with financial support for further education. Professional trainers should be allowed to explain specific work knowledge to employees. Training should be provided in line with employees' interests, and the company should cultivate employees' sense of service and be recognized in the enterprise. Conclusion: The relationship between human resource development and employee performance is moderate in Hohhot Zhuoyue Human Resource Service Co., LTD.

Sample size calculation for comparing two ROC curves

AbstractBiomarkers are key components of personalized medicine. In this paper, we consider biomarkers taking continuous values that are associated with disease status, called case and control. The performance of such a biomarker is evaluated by the area under the curve (AUC) of its receiver operating characteristic curve. Oftentimes, two biomarkers are collected from each subject to test if one has a larger AUC than the other. We propose a simple non‐parametric statistical test for comparing the performance of two biomarkers. We also present a simple sample size calculation method for this test statistic. Our sample size formula requires specification of AUC values (or the standardized effect size of each biomarker between cases and controls together with the correlation coefficient between two biomarkers), prevalence of cases in the study population, type I error rate, and power. Through simulations, we show that the testing on two biomarkers controls type I error rate accurately and the proposed sample size closely maintains specified statistical power.

Sample size determination for time-to-event endpoints in randomized selection trials with generalized exponential distribution

Randomized selection trials are frequently used to compare experimental treatments that have the potential to be beneficial, but they often do not include a control group. While time-to-event endpoints are commonly applied in clinical investigations, methodologies for determining the required sample size for such endpoints, except exponential distribution, are lacking. In recent times, there has been a shift in clinical trials, with a growing emphasis on progression-free survival as a primary endpoint. However, the utilization of this measure has typically been restricted to specific time points for both sample size determination and analysis. This alteration in approach could wield a substantial influence on the clinical trial process, potentially diminishing the capacity to discern variances between treatment groups. In the calculation of sample sizes for randomized trials, this investigation operates under the assumption that the time-to-event endpoint conforms to either an exponential, Weibull, or generalized exponential distribution.

Impact of Entrepreneurial Orientation on Small and Medium Enterprises Performance

The study aims to investigate the impact of entrepreneurial orientation on small and medium enterprises' performance. A survey-based quantitative research design was used to collect primary data from registered SMEs. There are 3010 registered small and medium-sized enterprises. A stratified sampling technique was used for calculating sample size, and 353 respondents were selected for data collection with the help of a questionnaire; analysis was performed through descriptive statistics such as frequency, percentages, and regression analysis were performed. The result shows There is a positive impact of risk-taking on small and medium sized enterprises' performance, a positive impact of innovation on small and medium-sized enterprises' performance, a positive impact of proactiveness on small and medium-sized enterprises' performance, a positive impact of autonomy the on small and medium-size enterprises' performance. The competitive aggressiveness has a positive impact on small and medium-size enterprises' performance. The study recommended the relationship between entrepreneurial orientation and SME performance is a topic of significant significance and potential for providing clues to the keys to success in this vital economic sector. When we know how entrepreneurial orientation affects SME performance, policy leaders in government and businesses, financial institutions or industry associations, and other stakeholders will be able to devise tailored strategies that promote a favourable environment for the growth and continued existence of Small and Medium-sized Enterprises; Further research can also shed light on some of the actionable advice for SMEs to improve their entrepreneurial capability and competitive advantage.

The long-term neurodevelopmental outcomes of toddlers with SARS-CoV-2 infection in the neonatal period: a prospective observational study

BackgroundThe effect of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus in the neonatal period on developing brain is still unknown. This study aims to investigate the long-term neurodevelopmental outcomes of newborns exposed to SARS-CoV-2 & Delta variant.MethodsAt a tertiary referral center, a prospective observational cohort research was carried out. All babies who were equal to or more than 34 gestational weeks gestation and were admitted to the NICU between January 2021 and January 2022 due to SARS-CoV-2 infection (Delta - or Delta +) were included in the study. Infants who were hospitalized for non-SARS-CoV-2 reasons at similar dates and who had no history of invasive mechanical ventilation were incorporated as a control group using a 2:1 gender and gestational age match. Thirty infants were assigned to the study group and sixty newborns to the control group based on the sample size calculation. These toddlers’ neurodevelopment was evaluated between the ages of 18 and 24 months using the Bayley-II scale.ResultsWe enrolled 90 infants. SARS-CoV-2-positive infants had poorer psychomotor development index (PDI) scores and significantly greater mildly delayed performances (MDPs) at 18–24 months (PDI p = 0.05, MDPs p = 0.03, respectively). Delta variant showed statistically significant lower MDI and PDI scores (MDI p=0.03, PDI p=0.03, respectively). A smaller head circumference of SARS-CoV-2-positive toddlers was detected in the first year (p < 0.001), which improved at the second age.ConclusionSARS-CoV-2-positive neonates revealed lower PDI scores and greater MDPs at 18th-24th months. The effect is most noticeable in Delta variant. Longer-term examination of neurodevelopmental outcomes and reevaluation of these children between the ages of 5 and 12 are critical.

Evaluation of Quality of Endodontic Retreatment: A Cross-sectional Study among Private Moroccan Dentists

Objectives: To study the attitude of dentists towards root canal retreatment performed in the private sector in Casablanca. Material and methods: To conduct a descriptive cross-sectional study, an anonymous questionnaire was distributed to a representative sample of 314 Moroccan dentists. Sample size calculation and sampling were performed using Epi info software. Data were analyzed using the SPSS (Statistical Package for the Social Sciences) software. Qualitative variables were expressed by their effective and percentage, and quantitative ones by their mean and standard deviation. Results: 91.5% of dentists used endodontic retreatment in their daily practice, and 84.4% of these dentists routinely indicated it when faced with a missing root canal filling or a painful apical lesion. When disobturating, 51.1% of dentists used Desocclusol as a root canal solvent, and 57.4% opted for a combination of manual and rotary mechanized instrumentation. The most common accidents encountered were instrument fractures (68.4%), followed by stoppers (45.7%). Conclusion: The results of this study show that dentists in Casablanca were not complying with the preliminary stages of endodontic retreatment. However, we noted an evolution towards the use of new mechanized preparation techniques and digital radiography.

Predictors of Job Satisfaction and Association with Psychological Distress Among Academic Medicine Faculty in Kazakhstan.

The growing concern for the faculty's well-being is allied with the emotionally demanding nature of teaching, which has an adverse effect on physical and mental health. There is abundant evidence that academic medicine faculty are subjected to high rates of dissatisfaction, distress, burnout, and turnover among medical educators. This study is dedicated to the exploration of the association between job satisfaction and psychological distress among academic medicine faculty in Kazakhstan. The observational cross-sectional study was conducted among medical educators in Kazakhstan between 1 October and 25 December. The survey was completed by 715 representatives of academic medicine staff. The sample size was calculated by Epi Info Sample Size Calculator, version 7.0. Multinomial logistic regression analysis using the forced entry procedure was applied to identify the factors associated with job satisfaction. The prevalence of job satisfaction, depression, anxiety, and stress was 19.2%, 40.6%, 41.3%, and 53%, respectively. Three variables were significantly associated with job satisfaction: having a partner (AOR=0.79; 95% CI 0.38-1.659), having work experience of 5-10 years (AOR=0.32; 95% CI 0.14-0.74), and holding a Ph.D. degree (AOR=0.40; 95% CI 0.18-0.91). Job satisfaction was significantly associated with depression (p=0.005) and stress (p<0.001). Compared to previous research in this area, our findings reported a higher prevalence of psychological distress and dissatisfaction. Potential reason for higher rates of dissatisfaction may be the global disruption due to COVID-19 pandemic.

Comparison of Peyton's Four-Step Approach With the Conventional Bedside Technique in Teaching Clinical Examination Skills to Medical Students.

Conventional bedside teaching (CBT) is an integral and classical method for imparting clinical skills to undergraduates in medical schools. It is a traditionally successful approach, especially when it comes to imparting patient-doctor relationship skills and knowledge on clinical management.Peyton's four-step approach (PFSA) is one of the newer structured instructional approaches for teaching-learning, especially for imparting procedural and complex psychomotor skills.The present study compares the application of PFSA in teaching complex systemic examination skills to the CBT technique in teaching the same skill to MBBS students. The impact of the acquisition of this examination skill was assessed statistically to compare PFSA and CBT methodologies. The target population was MBBS (Bachelor of Medicine and Bachelor of Surgery)students; for this study, the phase II MBBS students were considered as the study population since they were relatively naïve to clinical bedside examination skills. Students were allotted groups and they were taught clinical skills through CBT and PFSA separately. Using the OpenEpi toolkit Version 3 open-source sample size calculator for comparing two means, the sample size was 30 students in each group. The students were assessed for their competency and were also made to fill out a feedback questionnaire to compare the two methods of education dispensing. Results: The results of this study showed that PFSA is definitely suitable for teaching clinical examination skills. The acquisition of skills was found non-inferior to CBT while the retention of these skills was found to be equally good or even superior with PFSA than with CBT. Conclusion:PFSA has already been proven to be a good teaching method for the acquisition of complex procedural skills. This study expands the role of PFSA in teaching clinical bedside examination skills to medical students.Further large-scale studies may clarify the learning impact and outcomes of PFSA in clinical bedside teaching.

Study on prognosis of acutely ruptured intracranial aneurysms (SPARTA): a protocol for a multicentre prospective cohort study

BackgroundRuptured intracranial aneurysms resulting in subarachnoid haemorrhage can be treated by open surgical or endovascular treatment. Despite multiple previous studies, uncertainties on the optimal treatment practice still exists. The resulting treatment variation may result in a variable, potentially worse, patient outcome. To better inform future treatment strategies, this study aims to identify the effectiveness of different treatment strategies in patients with ruptured intracranial aneurysms by investigating long-term functional outcome, complications and cost-effectiveness. An explorative analysis of the diagnostic and prognostic value of radiological imaging will also be performed.MethodsThis multi-centre observational prospective cohort study will have a follow-up of 10 years. A total of 880 adult patients with a subarachnoid haemorrhage caused by a ruptured intracranial aneurysm will be included. Calculation of sample size (N = 880) was performed to show non-inferiority of clip-reconstruction compared to endovascular treatment on 1 year outcome, assessed by using the ordinal modified Rankin Scale. The primary endpoint is the modified Rankin Scale score and mortality at 1 year after the initial subarachnoid haemorrhage. Patients will receive ‘non-experimental’ regular care during their hospital stay. For this study, health questionnaires and functional outcome will be assessed at baseline, before discharge and at follow-up visits.DiscussionDespite the major healthcare and societal burden, the optimal treatment strategy for patients with subarachnoid haemorrhage caused by ruptured intracranial aneurysms is yet to be determined. Findings of this comparative effectiveness study, in which in-between centre variation in practice and patient outcome are investigated, will provide evidence on the effectiveness of treatment strategies, hopefully contributing to future high value treatment standardisation.Trial registration numberNCT05851989Date of registrationMay 10th, 2023

Effectiveness of IT-supported patient recruitment: study protocol for an interrupted time series study at ten German university hospitals

BackgroundAs part of the German Medical Informatics Initiative, the MIRACUM project establishes data integration centers across ten German university hospitals. The embedded MIRACUM Use Case “Alerting in Care - IT Support for Patient Recruitment”, aims to support the recruitment into clinical trials by automatically querying the repositories for patients satisfying eligibility criteria and presenting them as screening candidates. The objective of this study is to investigate whether the developed recruitment tool has a positive effect on study recruitment within a multi-center environment by increasing the number of participants. Its secondary objective is the measurement of organizational burden and user satisfaction of the provided IT solution.MethodsThe study uses an Interrupted Time Series Design with a duration of 15 months. All trials start in the control phase of randomized length with regular recruitment and change to the intervention phase with additional IT support. The intervention consists of the application of a recruitment-support system which uses patient data collected in general care for screening according to specific criteria. The inclusion and exclusion criteria of all selected trials are translated into a machine-readable format using the OHDSI ATLAS tool. All patient data from the data integration centers is regularly checked against these criteria. The primary outcome is the number of participants recruited per trial and week standardized by the targeted number of participants per week and the expected recruitment duration of the specific trial. Secondary outcomes are usability, usefulness, and efficacy of the recruitment support. Sample size calculation based on simple parallel group assumption can demonstrate an effect size of d=0.57 on a significance level of 5% and a power of 80% with a total number of 100 trials (10 per site). Data describing the included trials and the recruitment process is collected at each site. The primary analysis will be conducted using linear mixed models with the actual recruitment number per week and trial standardized by the expected recruitment number per week and trial as the dependent variable.DiscussionThe application of an IT-supported recruitment solution developed in the MIRACUM consortium leads to an increased number of recruited participants in studies at German university hospitals. It supports employees engaged in the recruitment of trial participants and is easy to integrate in their daily work.