Terms Of Sample Size Research Articles

A basket trial design based on constrained hierarchical Bayesian model for latent subgroups

ABSTRACT It is well known a basket trial consisting of multiple cancer types has the potential of borrowing strength across the baskets defined by the cancer types, leading to an efficient design in terms of sample size and trial duration. The treatment effects in those baskets are often heterogeneous and categorized by the cancer types being sensitive or insensitive to the treatment. Hence, the assumption of exchangeability in many existing basket trials may be violated, and there is a need to design trials without this assumption. In this paper, we simplify the constrained hierarchical Bayesian model for latent subgroups (CHBM-LS) for two classifiers to deal with the potential heterogeneity of treatment effects due to the single classifier of the cancer type. Different baskets are aggregated into subgroups using a latent subgroup modeling approach. The treatment effects are similar and exchangeable to facilitate information borrowing within each latent subgroup. Applying the simplified CHBM-LS approach to the real basket trials where baskets defined by only cancer types shows better performance than other available approaches. Further simulation study also demonstrates this CHBM-LS approach outperforms other approaches with higher statistical power and better-controlled type I error rates under various scenarios.

Nonlinear Tikhonov regularization in Hilbert scales for inverse learning

In this paper, we study Tikhonov regularization scheme in Hilbert scales for a nonlinear statistical inverse problem with general noise. The regularizing norm in this scheme is stronger than the norm in the Hilbert space. We focus on developing a theoretical analysis for this scheme based on conditional stability estimates. We utilize the concept of the distance function to establish high probability estimates of the direct and reconstruction errors in the Reproducing Kernel Hilbert space setting. Furthermore, explicit rates of convergence in terms of sample size are established for the oversmoothing case and the regular case over the regularity class defined through an appropriate source condition. Our results improve upon and generalize previous results obtained in related settings.

AYASOFYA: DINI SEMBOLLER VE İMGELER VE ZIYARETÇILER ARASINDA HOŞGÖRÜ ILE İÇ UYUMUN ARTIRILMASINA ETKILERI

The research investigated the influence of religious symbols, image emotions, and beliefs in increasing tolerance and inter-faith harmony among visitors at Hagia Sophia. Earlier research has shown Hagia Sophia as a heritage site promoting tolerance, peace, and harmony, yet a gap was found in terms of the impact of religious signs and images on visitors’ perception of tolerance and interfaith harmony. Therefore, in this research, interfaith harmony was used as an analytical tool to measure religious symbols, images, emotions, and beliefs and their influence on visitors. A sample of 100 local participants (Muslims and Christians) in Hagia Sophia was considered. The research scope was restricted to local visitors to gain better insight and understanding regarding religious symbols and images and their influence on increasing tolerance and interfaith harmony. The findings show that religious symbols increase tolerance and interfaith harmony among visitors. However, an insignificant effect of religious images and visitors’ beliefs was observed in influencing their perceptions of tolerance and harmony. Also, a statistically significant difference in scores of tolerance and interfaith harmony between Muslim and Christian visitors was found, while an insignificant difference in scores was noted regarding the visitors’ age. The research brings novelty, highlighting that religious symbols were significantly related to increasing tolerance and interfaith harmony. This difference in views among visitors can be credited to differences in religious beliefs and emotions among Muslims and Christians. The study has limitations in terms of sample size and its scope restricted to Turkey. It has implications for academics to investigate Hagia Sophia from theological and philosophical perspectives, using surveys from visitors across different nationalities and faiths and interviews of historians and experts to provide in-depth findings. Keywords: Hagia Sophia, Islam, Christianity, mosaics, calligraphy, tolerance, interfaith harmony, religious symbols and images, religious emotion and belief.

Adaptive platform trials: the impact of common controls on type one error and power

ABSTRACT Platform trials offer a framework to study multiple interventions in one trial with the opportunity of opening and closing arms. The use of common controls can increase efficiency as compared to individual controls. The need for multiplicity adjustment because of common controls is currently a debate among researchers, pharmaceutical companies, and regulators. The impact of common controls on the type one error in a fixed platform trial, i.e. when all treatments start and end recruitment at the same time, has been discussed in the literature before. We complement these findings by investigating the impact of a common control on the type one error and power in a flexible platform trial, i.e. when one arm joins the platform later. We derived the correlation of test statistics to assess the impact of the overlap and compared the results to a trial with individual controls. Furthermore, we evaluate the power, and the impact of multiplicity adjustment on the power in fixed and flexible platform trials. These methodological considerations are complemented by a regulatory guideline review. With multiple arms, the FWER is inflated when no multiplicity adjustment is applied. However, the FWER inflation is smaller with common controls than with individual controls. Even after multiplicity adjustment, a trial with common controls is often beneficial in terms of sample size and power. However, in some cases, the trial with common controls loses the efficiency gain and it might be advisable to run a separate trial rather than joining a platform trial.

Meta-analysis of the efficacy of budesonide and ambroxol hydrochloride inhalation in children with pneumonia and their effects on inflammatory response

Childhood pneumonia, often caused by acute upper respiratory tract infections or bronchitis, is one of the leading causes of mortality in children. Nebulized inhalation, as a low-risk treatment method, has garnered significant attention. However, its effectiveness and safety remain controversial. In this study, a systematic review of relevant literature on the use of budesonide (BUD) and ambroxol hydrochloride (AMB) inhalation in the treatment of childhood pneumonia was conducted, and a total of 10 articles were included. The meta-analysis revealed an odds ratio (OR) of 1.61 and an I2 value of 0.00 % for the effectiveness of combined BUD and AMB inhalation therapy in children with pneumonia, indicating no heterogeneity among the studies in terms of effectiveness. The OR values for BUD or AMB inhalation in alleviating cough, lung auscultation abnormalities, respiratory distress, body temperature, and cyanosis of the lips in children with pneumonia all favored the combined BUD therapy, showing significant relief of the aforementioned symptoms. However, due to variations in drug dosage and administration methods, high heterogeneity was observed. This study suggested that combined BUD and AMB inhalation therapy has better efficacy in treating childhood pneumonia, and BUD combined with AMB inhalation is more effective in alleviating symptoms such as cough, lung auscultation abnormalities, respiratory distress, normalizing body temperature, and reducing cyanosis of the lips. Nevertheless, further validation is required due to the limited sample size and substantial heterogeneity in the included studies. To sum up, this study provides the first analysis of the efficacy and inflammatory response of BUD and AMB inhalation in children with pneumonia. Future research should aim to verify and clarify these findings, considering the limitations of the existing studies in terms of sample size and heterogeneity.

The influence of school climate on teachers' job satisfaction: The mediating role of teachers' self-efficacy.

Improving the job satisfaction of vocational education teachers (VET) is necessary for maintaining the stability of the vocational education teaching force and is an essential support for enhancing the professional attractiveness and ensuring the quality of VET. Unlike previous studies, firstly, in terms of groups, the particular group of teachers in this study focuses on VET, which in reality is often overlooked compared to other groups of teachers due to the low level of recognition of vocational education (VE) in China. Secondly, this phenomenon is more prominent and less researched regionally in economically underdeveloped areas due to the uneven and disparate economic development between the East and West of China. In terms of sample size, previous studies have lacked large samples, making it difficult to obtain convincing and realistic results. Finally, most previous studies considered teachers' job satisfaction (TJS) in terms of external or internal factors alone. However, this study considers a combination of the external factor of the school climate (SC) in which VET works and the internal factor of teachers' self-efficacy (TSE) to explore the relationship with TJS and its impact. Based on data from a survey of 1035 teachers in China, a structural equation model estimation method was used to explore and analyze the impact of SC and TSE on their TJS and the specific role of the relationship. The research found that VET-perceived SC is positively predicting TJS; VET-perceived SC is positively predicting TSE; TSE is positively predicting TJS; TSE significantly mediates the relationship between SC and TJS. This study provides a theoretical perspective that integrates the external organizational influences of SC and introduces the internal psychological factor of TSE as a mediating variable to understand TJS. In practice, it helps raise the importance of VET and provides empirical data and intellectual support to the relevant government departments in improving TJS.

The Importance of Physical Education and Health Subjects for Students with Special Educational Needs in Malaysia

This article discusses the importance of physical and health education for students with special educational needs (SEN) in Malaysia. The study involved 200 respondents, including MBPK. This study uses a mixed methods approach, including surveys and focus group discussions with MBPK teachers and parents. Findings show that physical education can provide a variety of benefits, including improving physical fitness, social interaction, and emotional control. Participation in these classes can promote physical, social and emotional well-being, and help develop new physical skills. This study emphasizes the importance of providing equal access to physical education and health classes for MBPK and suggests that schools prioritize these subjects in their curriculum. However, this study has limitations in terms of sample size and generalizability to all MBPK. Further research is needed to explore the long-term effects of physical education and health classes on academic performance and social skills, as well as parents' and teachers' attitudes and beliefs towards inclusive physical education. The article suggests that the government should prioritize the inclusion of physical education and health in the curriculum for MBPK to promote their overall development and wellbeing. The study also highlighted the need for inclusive and adaptive physical education programs, as well as support for teachers and parents. Overall, the study shows that physical education and health classes have a significant positive effect on the academic, physical and psychological well-being of MBPK in Malaysia.

Exploring the Landscape of Latent Autoimmune Diabetes and Maturity Onset Diabetes of the Young in Africa: A Scoping Review

Background: Latent autoimmune diabetes in adults (LADA) and maturity onset diabetes of the young (MODY) are two forms of diabetes with varied disease symptoms. The prevalence of LADA is higher in adults than MODY. Both diseases contribute to the general burden of diabetes globally. While LADA is a sporadic autoimmune disorder, MODY is a heritable genetic disorder. The prevalence of LADA and MODY has not been fully documented in Africa due to the lack of robust diagnostic tools and the exorbitantly high cost of the available diagnostic tools. Methods: To understand the prevalence landscape of LADA and MODY in Africa, we conducted an extensive scoping review and mapped the various studies performed in Africa. We adopted the Joanna Briggs Institute literature review framework to conduct the scoping review of literature. Results: Research articles were included in the review analysis following exhaustive inclusion criteria to ensure that only qualified articles were included in the final analysis. Overall, 16 research articles met the inclusion criteria and were critically analyzed. An in-house data extraction sheet was used for data extraction from all the shortlisted articles. Information about the sample size, inclusion criteria, age, gender, and study design extracted from all the articles and analyzed. Majority of the studies adopted cross-sectional study design. In terms of sample sizes, the studies used relatively smaller sample sizes due to the high cost of the diagnosis and nature of the diseases. The prevalence rates of LADA and MODY varied in various countries ranging from 1.8 to 18%. Conclusion: African countries are significantly under-represented. The scarcity of research on LADA and MODY research in Africa is evidence of the urgent need to invest more resources in this area. This would guide future research and shape the road towards understanding diabetes in Africa.

THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Crossref Member Badge Erfolgreich durch internationale Zusammenarbeit OBSTETRICS DOI 10.35630/2023/13/4.817 Received 11 July 2023; Accepted 19 July 2023, Published 15 August 2023 THE ROLE OF UTEROCERVICAL ANGLE IN DETERMINING THE THREAT OF PRETERM BIRTH Ufuk Atlıhan orcid id logo , Umit Derundere orcid id logo Private Karatas Hospital, Izmir, Turkey download article (pdf) cfl.ufuk@gmail.com ABSTRACT Preterm labor is one of the leading causes of perinatal morbidity and mortality and is thought to complicate approximately 10-12% of pregnancies. Defined as birth before 37 weeks of gestation, preterm labor is one of the most common obstetric complications worldwide. Although the pathogenesis of preterm labor is not fully understood, intraamniotic infection or hemorrhage, uteroplacental ischemia, uterine overstretching and immunologic processes have been proposed in its etiology. However, there is still no definitive prediction tool. Sonographic assessment of the cervical structure by measuring cervical length (CL) has been used as a popular prediction tool to predict preterm labor. The uterocervical angle (UCA) is defined as the angle between the lower anterior uterine segment and the endocervical canal. Recently, UCA has been proposed as an alternative to CL for predicting preterm labor. In recent years, several studies have investigated the potential impact of UCA for preterm labor prediction. Our study aimed to determine whether the uterocervical angle, a new ultrasonographic marker for predicting preterm labor, is associated with the risk of spontaneous preterm delivery. The present study included 186 singleton pregnant women who gave birth in our hospital between January 2018 and December 2022. The data of the included patients were retrospectively evaluated from the hospital database and patient files. Regarding the primary outcome of our study, we found that there was a statistically significant difference in UCA and cervical length between women who delivered spontaneously preterm and women who delivered at term (p<0.05). In the second trimester ultrasonography evaluation, the mean UCA was wider and the mean cervical length was shorter in the preterm group. Contrary to other studies in the literature, smoking and history of preterm delivery as risk factors were not included in our study. The exact reasons for some of the differences between our findings and the studies reported in the literature are not clear, but may be attributed to several factors. First, the patient type was heterogeneously selected in the cited studies. There are large differences in terms of sample size and studies that may be attributed to such heterogeneity. In conclusion, wider UCA and shorter cervical length in the second trimester are associated with spontaneous preterm delivery. Measurement of UCA is a reproducible technique and the UCA value was found to increase from the first trimester to the second trimester. We recommend the inclusion of UCA in current clinical practice in addition to cervical length measurement as a predictive factor that can be used in decision-making regarding the management of women at risk of preterm delivery. However, future studies are needed to assess the diagnostic accuracy of this index and should specifically consider the use of thresholds and related outcomes (preterm birth rates based on specific gestational weeks).

Best practices in phase III clinical trials on DMTs for multiple sclerosis: a systematic analysis and appraisal of published trials

BackgroundGreat advances have been made in the field of multiple sclerosis (MS) therapy due to the publication of numerous randomised clinical trials (RCTs). In this study, we carried out a...

Evaluation of EuroQol Valuation Technology (EQ-VT) Designs to Generate National Value Sets: Learnings from the Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study.

Countries develop their EQ-5D-5L value sets using the EuroQol Valuation Technology (EQ-VT) protocol. This study aims to assess if extension in the conventional EQ-VT design can lead to development of value sets with improved precision. A cross-sectional survey was undertaken in a representative sample of 3,548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. A novel extended EQ-VT design was created that included 18 blocks of 10 health states, comprising 150 unique health states and 135 observations per health state. In addition to the standard EQ-VT design, which is based on 86 health states and 100 observations per health state, 3 extended designs were assessed for their predictive performance. The extended designs were created by 1) increasing the number of observations per health state in the design, 2) increasing the number of health states in the design, and 3) implementing both 1) and 2) at the same time. Subsamples of the data set were created for separate designs. The root mean squared error (RMSE) and mean absolute error (MAE) were used to measure the predictive accuracy of the conventional and extended designs. The average RMSE and MAE for the standard EQ-VT design were 0.055 and 0.041, respectively, for the 150 health states. All 3 types of design extensions showed lower RMSE and MAE values as compared with the standard design and hence yielded better predictive performance. RMSE and MAE were lowest (0.051 and 0.039, respectively) for the designs that use a greater number of health states. Extending the design with inclusion of more health states was shown to improve the predictive performance even when the sample size was fixed at 1,000. Although the standard EQ-VT design performs well, its prediction accuracy can be further improved by extending its design. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. The EQ-5D-5L value sets are developed using the standardized EuroQol Valuation Technology (EQ-VT) protocol. This is the first study to empirically assess how much can be gained from extending the standard EQ-VT design in terms of sample size and/or health states. It not only presents useful insights into the performance of the standard design of the EQ-VT but also tests the potential extensions in the standard EQ-VT design in terms of increasing the health states to be directly valued as well as the number of observations recorded to predict the utility value of each of these health states.The study demonstrates that the standard EQ-VT design performs good, and an extension in the design of the standard EQ-VT can lead to further improvement in its performance. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. Extending the design with inclusion of more health states marginally improves the predictive performance even when the sample size was fixed at 1,000.The findings of the study will streamline the systematic process for generating precise EQ-5D-5L value sets, thus facilitating the conduct of credible, transparent, and robust outcome valuation in health technology assessments.

Using a Sample Size Calculation Framework for Clinical Prediction Models When Developing and Selecting Mapping Algorithms Based on Linear Regression.

To propose using a framework for calculating the sample size for clinical prediction models when developing and selecting mapping algorithms from a health-related quality-of-life (HRQOL) measure onto the score of a preference-based measure (PBM) using linear regression. The framework was summarized for health economics researchers. Mapping studies that mapped the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 onto the EQ-5D-3L index using linear regression were evaluated in terms of sample size. The required sample size for each study was calculated using 4 criteria: global shrinkage factor ≥ 0.9, difference between the apparent and adjusted R2 ≤ 0.05, multiplicative margin of error in the estimated residual standard deviation ≤ 1.1, and absolute margin of error in the estimated model intercept ≤ 0.025. Ten mapping studies were identified. The information required to calculate the sample size was successfully extracted from previous mapping studies. Four of 10 mapping studies did not have sufficient sample sizes. Further extension of this framework to other regression approaches used in mapping studies is necessary. The sample size should be considered when developing and selecting a mapping algorithm based on linear regression. No recommendation or guidance is available for the sample size to develop and select a mapping algorithm from a health-related quality-of-life measure onto the score of a preference-based measure.This research proposes using a framework for calculating the sample size for clinical prediction models in sample size consideration for mapping algorithms using linear regression.A survey showed that the information required to calculate the sample size could be successfully extracted from previous mapping studies and that 4 of 10 mapping studies did not have sufficient sample sizes.

Ultraviolet Radiation Transmission in Buildings’ Fenestration: Part I, Detection Methods and Approaches Using Spectrophotometer and Radiometer

Fenestration, comprising windows and other openings in a building, influences occupant health and well-being while also enhancing energy efficiency through optimized design and placement. Selecting glazing materials that block or filter harmful UV radiation is crucial, as is having reliable methods to measure their UV transmission. This research paper, which comprises Part I of II, conducts an exhaustive analysis of the predominant methodologies and associated challenges inherent in assessing ultraviolet (UV) radiation transmission and deterioration status in fenestration, with particular emphasis on the usage of spectrophotometers and radiometers. It details the economic and operational challenges associated with these instruments and the limitations they pose in terms of sample size and the impact of glazing material degradation over time. Additionally, the paper provides a comparative analysis of UV radiation transmission characteristics across different glazing configurations such as green or yellow patterned glass, laminate glass, clear glass treated with UV protection film, and float glass. The review identifies laminated glass material as offering the best protection. Although spectrophotometers and radiometers offer high levels of accuracy in transmission data detection, their adoption is hindered by considerable financial and operational challenges. The paper underscores the need for developing alternative methodologies that are economically viable, operationally less complex, and are capable of overcoming the limitations of the traditional methods of detection, which will facilitate optimal fenestration configurations for UV protection and energy efficiency in buildings. The proposed Part II paper will explore UV imaging, image processing, and computer vision techniques as potential alternative approaches.

Calculating the power of a planned individual participant data meta-analysis of randomised trials to examine a treatment-covariate interaction with a time-to-event outcome.

Before embarking on an individual participant data meta-analysis (IPDMA) project, researchers should consider the power of their planned IPDMA conditional on the studies promising their IPD and their characteristics. Such power estimates help inform whether the IPDMA project is worth the time and funding investment, before IPD are collected. Here, we suggest how to estimate the power of a planned IPDMA of randomised trials aiming to examine treatment-covariate interactions at the participant-level (i.e., treatment effect modifiers). We focus on a time-to-event (survival) outcome with a binary or continuous covariate, and propose an approximate analytic power calculation that conditions on the actual characteristics of trials, for example, in terms of sample sizes and covariate distributions. The proposed method has five steps: (i) extracting the following aggregate data for each group in each trial-the number of participants and events, the mean and SD for each continuous covariate, and the proportion of participants in each category for each binary covariate; (ii) specifying a minimally important interaction size; (iii) deriving an approximate estimate of Fisher's information matrix for each trial and the corresponding variance of the interaction estimate per trial, based on assuming an exponential survival distribution; (iv) deriving the estimated variance of the summary interaction estimate from the planned IPDMA, under a common-effect assumption, and (v) calculating the power of the IPDMA based on a two-sided Wald test. Stata and R code are provided and a real example provided for illustration. Further evaluation in real examples and simulations is needed.

The neuroanatomical hallmarks of chronic tinnitus in comorbidity with pure-tone hearing loss

Tinnitus is one of the main hearing impairments often associated with pure-tone hearing loss, and typically manifested in the perception of phantom sounds. Nevertheless, tinnitus has traditionally been studied in isolation without necessarily considering auditory ghosting and hearing loss as part of the same syndrome. Hence, in the present neuroanatomical study, we attempted to pave the way toward a better understanding of the tinnitus syndrome, and compared two groups of almost perfectly matched individuals with (TIHL) and without (NTHL) pure-tone tinnitus, but both characterized by pure-tone hearing loss. The two groups were homogenized in terms of sample size, age, gender, handedness, education, and hearing loss. Furthermore, since the assessment of pure-tone hearing thresholds alone is not sufficient to describe the full spectrum of hearing abilities, the two groups were also harmonized for supra-threshold hearing estimates which were collected using temporal compression, frequency selectivity und speech-in-noise tasks. Regions-of-interest (ROI) analyses based on key brain structures identified in previous neuroimaging studies showed that the TIHL group exhibited increased cortical volume (CV) and surface area (CSA) of the right supramarginal gyrus and posterior planum temporale (PT) as well as CSA of the left middle-anterior part of the superior temporal sulcus (STS). The TIHL group also demonstrated larger volumes of the left amygdala and of the left head and body of the hippocampus. Notably, vertex-wise multiple linear regression analyses additionally brought to light that CSA of a specific cluster, which was located in the left middle-anterior part of the STS and overlapped with the one found to be significant in the between-group analyses, was positively associated with tinnitus distress level. Furthermore, distress also positively correlated with CSA of gray matter vertices in the right dorsal prefrontal cortex and the right posterior STS, whereas tinnitus duration was positively associated with CSA and CV of the right angular gyrus (AG) and posterior part of the STS. These results provide new insights into the critical gray matter architecture of the tinnitus syndrome matrix responsible for the emergence, maintenance and distress of auditory phantom sensations.

Normative echocardiography data of myocardial adaptation to extrauterine life: a review of prospective studies.

Recent research has increased focus and interest in characterizing the physiology of the transition circulation using echocardiography. Critique of published normative neonatal echocardiography data among healthy term neonates has not been performed. We have performed a comprehensive literature review using the key terms: cardiac adaptation, hemodynamics, neonatal transition, term newborns. Studies were included if they had reported echocardiography indices of cardiovascular function in the presence of maternal diabetes, intrauterine growth restricted newborns and prematurity and had a comparison group of healthy term newborns within first seven postnatal days. Sixteen published studies evaluating transitional circulation in healthy newborns were included. There was marked heterogeneity in the methodologies used; specifically, inconsistency in time of evaluation and imaging techniques used makes it challenging to determine specific trends of expected physiologic changes. Some studies revealed nomograms for echocardiography indices, though limitations persist in terms of sample size, number of reported parameters and consistency of measurement technique. A comprehensive standardized echocardiography framework which includes consistent techniques for assessment dimensions, function, blood flow, pulmonary/systemic vascular resistance, and shunts pattern is warranted to ensure consistency in the use of echocardiography to guide care of healthy and sick newborns.

A multi-well bioreactor for cartilage tissue engineering experiments

Cartilage tissue engineering necessitates the right mechanical cues to regenerate impaired tissue. For this reason, bioreactors can be employed to induce joint-relevant mechanical loading, such as compression and shear. However, current articulating joint bioreactor designs are lacking in terms of sample size and usability. In this paper, we describe a new, simple-to-build and operate, multi-well kinematic load bioreactor and investigate its effect on the chondrogenic differentiation of human bone marrow-derived stem cells (MSCs). We seeded MSCs into a fibrin-polyurethane scaffold and subsequently exposed the samples to a combination of compression and shear for 25days. The mechanical loading activates transforming growth factor beta 1, upregulates chondrogenic genes, and increases sulfated glycosaminoglycan retention within the scaffolds. Such a higher-throughput bioreactor could be operated in most cell culture laboratories, dramatically accelerating and improving the testing of cells, new biomaterials, and tissue-engineered constructs.

Outcomes of concomitant surgical ablation in patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy: A systematic review and meta-analysis

ObjectiveStudies investigating the efficacy of concomitant surgical atrial fibrillation (AF) ablation in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing myectomy are scarce and limited in terms of sample size. We aim to summarize current outcomes of concomitant surgical AF ablation in HOCM patients undergoing surgical myectomy. MethodsThis systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all studies reporting any of the following outcomes of concomitant surgical AF ablation in HOCM patients: freedom from recurrence of AF, overall survival and complications. Outcomes were evaluated using traditional meta-analysis at given time-points and using pooled Kaplan-Meier curves. ResultsA total of 13 studies were included, resulting in a total of 616 individual patients available for analysis. AF was paroxysmal in 68.1% of the patients (95% CI 56.0–78.2%; I2 = 87.1%; 8 studies, 583 participants). The majority of patients (86.2%) underwent either conventional Cox Maze III or IV (95% CI 39.7–98.3%; I2 = 92.4%; 8 studies, 616 patients) procedure. The incidence of early post-operative pacemaker implantation was 6.1% (95% CI 3.1–11.8%). Overall survival at 3, 5 and 7 years was 95.6% (95% CI 93.4–97.9%), 93.6% (95% CI 90.8–96.5%) and 90.5% (95% CI 86.5–94.6%), respectively. Freedom from recurrent AF at 3, 5 and 7 years was 77.6% (95% CI 73.7–81.7%), 70.6% (95% CI 65.8–75.7) and 63.2% (95% CI 56.2–73.8%), respectively. ConclusionThis meta-analysis supports concomitant surgical AF ablation at the time of surgical myectomy in HOCM patients, as it seems to be safe and effective in terminating AF.

Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study

Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system's capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system's full range of capabilities. This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system's capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage.

Obesity and PTSD: A review on this association from childhood to adulthood

BackgroundIn recent years, psychological factors, including anxiety and post-traumatic stress disorder, have emerged as possible background factors for obesity and its comorbidities. Post-traumatic stress disorder (PTSD) has been associated with higher body mass index (BMI) and metabolic syndrome (MetS) compared to other psychiatric disorders, but this association remains partly mysterious and intriguing, especially considering the effect of childhood trauma. MethodWe decided to conduct a review in order to obtain the most recent information on this association with a focus on developmental elements. ResultsThe studies considered were very heterogeneous, in terms of sample size and results, and do not lend themselves to meta-analysis but rather to discursive synthesis. ConclusionThere are many different and complex planes of interrelationship between PTSD and obesity which offer different therapeutic clues for the clinician. Integrated psychotherapies and interventions focusing on exercise and mindfulness can be used in different settings to promote recovery from both disorders.