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Obstetrics and Gynecology Aug 2016The primary goal of sonohysterography is to visualize the endometrial cavity in more detail than is possible with routine transvaginal ultrasonography. Sonohysterography...
The primary goal of sonohysterography is to visualize the endometrial cavity in more detail than is possible with routine transvaginal ultrasonography. Sonohysterography also can be used to assess tubal patency. The indications for sonohysterography include, but are not limited to, evaluation of the following: abnormal uterine bleeding; uterine cavity, especially with regard to uterine leiomyomata, polyps, and synechiae; abnormalities detected on transvaginal ultrasonography, including focal or diffuse endometrial or intracavitary abnormalities; congenital abnormalities of the uterus; infertility; recurrent pregnancy loss; and suboptimal visualization of the endometrium on transvaginal ultrasonography. Sonohysterography should not be performed in a woman who is pregnant or who could be pregnant. Credentialing obstetrician-gynecologists to perform or supervise diagnostic sonohysterography should be based on education, training, experience, and demonstrated competence in performing and interpreting trans-vaginal ultrasonography and sonohysterography. The obstetrician-gynecologist should be skilled in the transcervical placement of catheters. The sonohysterography procedure, including benefits and risks, should be explained fully to the patient before the procedure is performed.
Topics: Contraindications; Documentation; Endosonography; Female; Humans; Patient Selection; Physician's Role; Technology Assessment, Biomedical; Uterus
PubMed: 27454735
DOI: 10.1097/AOG.0000000000001588 -
Psychological Methods Sep 2017In exploratory factor analysis (EFA), most popular methods for dimensionality assessment such as the screeplot, the Kaiser criterion, or-the current gold...
In exploratory factor analysis (EFA), most popular methods for dimensionality assessment such as the screeplot, the Kaiser criterion, or-the current gold standard-parallel analysis, are based on eigenvalues of the correlation matrix. To further understanding and development of factor retention methods, results on population and sample eigenvalue distributions are introduced based on random matrix theory and Monte Carlo simulations. These results are used to develop a new factor retention method, the Empirical Kaiser Criterion. The performance of the Empirical Kaiser Criterion and parallel analysis is examined in typical research settings, with multiple scales that are desired to be relatively short, but still reliable. Theoretical and simulation results illustrate that the new Empirical Kaiser Criterion performs as well as parallel analysis in typical research settings with uncorrelated scales, but much better when scales are both correlated and short. We conclude that the Empirical Kaiser Criterion is a powerful and promising factor retention method, because it is based on distribution theory of eigenvalues, shows good performance, is easily visualized and computed, and is useful for power analysis and sample size planning for EFA. (PsycINFO Database Record
Topics: Computer Simulation; Factor Analysis, Statistical; Monte Carlo Method; Sample Size
PubMed: 27031883
DOI: 10.1037/met0000074 -
Journal of Thoracic Disease Aug 2021Percutaneous tracheostomy is a commonly performed procedure for patients in the intensive care unit (ICU) and offers many benefits, including decreasing ICU length of... (Review)
Review
Percutaneous tracheostomy is a commonly performed procedure for patients in the intensive care unit (ICU) and offers many benefits, including decreasing ICU length of stay and need for sedation while improving patient comfort, effective communication, and airway clearance. However, there is no consensus on the optimal timing of tracheostomy in ICU patients. Ultrasound (US) and bronchoscopy are useful adjunct tools to optimize procedural performance. US can be used pre-procedurally to identify vascular structures and to select the optimal puncture site, intra-procedurally to assist with accurate placement of the introducer needle, and post-procedurally to evaluate for a pneumothorax. Bronchoscopy provides real-time visual guidance from within the tracheal lumen and can reduce complications, such as paratracheal puncture and injury to the posterior tracheal wall. A step-by-step detailed procedural guide, including preparation and procedural technique, is provided with a team-based approach. Technical aspects, such as recommended equipment and selection of appropriate tracheostomy tube type and size, are discussed. Certain procedural considerations to minimize the risk of complications should be given in circumstances of patient obesity, coagulopathy, or neurologic illness. Herein, we provide a practical state of the art review of percutaneous tracheostomy in ICU patients. Specifically, we will address pre-procedural preparation, procedural technique, and post-tracheostomy management.
PubMed: 34527365
DOI: 10.21037/jtd-19-4121 -
Trials Aug 2015Stepped wedge trials (SWTs) can be considered as a variant of a clustered randomised trial, although in many ways they embed additional complications from the point of... (Review)
Review
BACKGROUND
Stepped wedge trials (SWTs) can be considered as a variant of a clustered randomised trial, although in many ways they embed additional complications from the point of view of statistical design and analysis. While the literature is rich for standard parallel or clustered randomised clinical trials (CRTs), it is much less so for SWTs. The specific features of SWTs need to be addressed properly in the sample size calculations to ensure valid estimates of the intervention effect.
METHODS
We critically review the available literature on analytical methods to perform sample size and power calculations in a SWT. In particular, we highlight the specific assumptions underlying currently used methods and comment on their validity and potential for extensions. Finally, we propose the use of simulation-based methods to overcome some of the limitations of analytical formulae. We performed a simulation exercise in which we compared simulation-based sample size computations with analytical methods and assessed the impact of varying the basic parameters to the resulting sample size/power, in the case of continuous and binary outcomes and assuming both cross-sectional data and the closed cohort design.
RESULTS
We compared the sample size requirements for a SWT in comparison to CRTs based on comparable number of measurements in each cluster. In line with the existing literature, we found that when the level of correlation within the clusters is relatively high (for example, greater than 0.1), the SWT requires a smaller number of clusters. For low values of the intracluster correlation, the two designs produce more similar requirements in terms of total number of clusters. We validated our simulation-based approach and compared the results of sample size calculations to analytical methods; the simulation-based procedures perform well, producing results that are extremely similar to the analytical methods. We found that usually the SWT is relatively insensitive to variations in the intracluster correlation, and that failure to account for a potential time effect will artificially and grossly overestimate the power of a study.
CONCLUSIONS
We provide a framework for handling the sample size and power calculations of a SWT and suggest that simulation-based procedures may be more effective, especially in dealing with the specific features of the study at hand. In selected situations and depending on the level of intracluster correlation and the cluster size, SWTs may be more efficient than comparable CRTs. However, the decision about the design to be implemented will be based on a wide range of considerations, including the cost associated with the number of clusters, number of measurements and the trial duration.
Topics: Computer Simulation; Data Interpretation, Statistical; Humans; Models, Statistical; Patient Selection; Randomized Controlled Trials as Topic; Research Design; Sample Size; Time Factors
PubMed: 26282553
DOI: 10.1186/s13063-015-0840-9 -
The Journal of Hand Surgery Dec 2018Many conditions presenting to the hand surgeon are amenable to a bedside procedure rather than a formal operating room setting. With proper patient, room, and surgeon... (Review)
Review
Many conditions presenting to the hand surgeon are amenable to a bedside procedure rather than a formal operating room setting. With proper patient, room, and surgeon preparation, bedside procedures can provide an efficient and effective treatment for infection, trauma, and foreign bodies. Key differences from the operating room environment include patient expectations, analgesia, room setup, instrumentation, and surgical technique. This article provides a detailed primer for performing bedside procedures in the emergency department, outpatient clinic, and inpatient hospital room.
Topics: Abscess; Ambulatory Surgical Procedures; Anesthetics, Local; Contraindications, Procedure; Decompression, Surgical; Equipment and Supplies, Hospital; Foreign Bodies; Hemostasis, Surgical; Humans; Nerve Block; Orthopedic Procedures; Patient Positioning; Patient Selection; Tourniquets
PubMed: 29801937
DOI: 10.1016/j.jhsa.2018.03.031 -
Journal of Obstetrics and Gynaecology :... Aug 2021A pre-post interventional study of patients undergoing office hysteroscopy alone and in combination with endometrial biopsy was performed during October 2015-March 2018...
A pre-post interventional study of patients undergoing office hysteroscopy alone and in combination with endometrial biopsy was performed during October 2015-March 2018 to evaluate the effect of low dose vaginal misoprostol on patient's pain. Pain scores were assessed using the visual analog scale at the completion of the procedure. There were 646 patients included in the study. Of these, 462 had office hysteroscopy alone; 206 (44.6%) received 50 mcg of vaginal misoprostol the night prior to the procedure and the remaining 256 (55.4%) patients had no cervical ripening. The reported pain score following hysteroscopy was significantly lower among patients who received misoprostol [4(0-10) vs. 5(0-10); =.001]. Most patients (78.2%) did not report any misoprostol related side effects. Of the 184 patients who underwent a combination of office hysteroscopy and endometrial biopsy, 97 (52.7%) received pre-procedure vaginal misoprostol while 87 (47.3%) did not. Post procedure pain was independent of pre-treatment with vaginal misoprostol (6.3 ± 2.7 vs. 6.6 ± 2.7; = .54).Impact statement Office hysteroscopy and endometrial biopsy is increasingly performed for evaluation of various gynaecologic conditions, however, patients' perceived pain at the time of procedure may lead to incomplete procedures. Various doses of misoprostol have been tested to reduce patients' pain, however none lower than 200 mcg vaginally, and at these doses, side effects are reported. To date, there is a scarcity of published data on the use of low dose misoprostol (50 mcg) in gynaecologic procedures. Our study found that the use of low dose vaginal misoprostol prior to office hysteroscopy is associated with lower reported pain and tenaculum utilisation during the procedure. However, vaginal misoprostol prior to successive office hysteroscopy and endometrial biopsy failed to decrease the reported pain, and the overall pain score was higher than hysteroscopy alone. The use of low dose vaginal misoprostol (50 mcg) the evening prior to office hysteroscopy is associated with lower reported pain and tenaculum utilisation and is not associated with significant side effects. Therefore, 50 mcg of misoprostol could be used in clinical practice as a method to reduce patients' reported pain during office hysteroscopy.
Topics: Administration, Intravaginal; Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Biopsy; Endometrium; Female; Humans; Hysteroscopy; Middle Aged; Misoprostol; Oxytocics; Pain Measurement; Pain, Procedural; Preoperative Care; Research Design; Treatment Outcome; Young Adult
PubMed: 33962548
DOI: 10.1080/01443615.2020.1820968 -
Bulletin of the Hospital For Joint... Sep 2020Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment remains undetermined. Currently the main current treatment options are the Latarjet procedure or open or arthroscopic Bankart repair. The purpose of this study was to network meta-analyze the recent evidence to ascertain if the open Latarjet procedure and open or arthroscopic Bankart repair result in lower recurrence rates and subsequent revision procedures. The results were ranked with the P-score.
METHODS
A literature search was performed based on the PRISMA guidelines. Cohort studies comparing any of the open Latarjet procedure and open or arthrosopic Bankart repair for anterior shoulder instability were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R.
RESULTS
Twenty-nine studies with 2,474 patients were included. The open Latarjet procedure resulted in lower rates of recurrent instability and revisions due to recurrence compared to both open and arthroscopic Bankart repairs. The open Latarjet procedure resulted in the highest rate of return to play. However, the open Latarjet procedure also resulted in the highest complication rate.
CONCLUSION
Our network meta-analysis found the open Latarjet procedure had the lowest recurrence rates, lowest revisions rates, and highest rates of return to play in the surgical treatment of anterior shoulder instability. However, the Latarjet procedure has been shown to result in a higher complication rate, which needs to be considered when deciding which stabilization procedure to perform.
Topics: Arthroplasty; Arthroscopy; Comparative Effectiveness Research; Humans; Joint Instability; Network Meta-Analysis; Shoulder Dislocation; Shoulder Injuries
PubMed: 32857028
DOI: No ID Found -
Surgery Apr 2018Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience.... (Review)
Review
BACKGROUND
Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience. Surgeons operate with surgical instruments, whereas musicians perform with musical instruments. Both perform in high-stress, high-risk work environments, where small errors in motor performance or judgment can have immediate negative consequences. While there is abundant literature on musical performance and their impact on outcome, little similar research has been published in the field of surgery. We aimed at identifying expert musicians' practice and performance strategies that may aid surgeons to enhance their surgical performance.
METHODS
In the study, 82 relevant English-language articles from 1974 to 2017 matched applicable search terms. Nominal Group Technique was applied to identify 5 key domains that comprise important parallels between surgical and expert musical performance.
RESULTS
The 5 key domains identified were: (1) extensive training and deliberate practice, (2) dexterity and ambidexterity, (3) performance evaluation and competition, (4) performance-related injuries, and (5) performance anxiety. We found focused and mindful training in motor performance, not performing immediately after a hiatus from practice, training to improve the precision and responsiveness of the nondominant hand, continuous and critical self-evaluation, training in injury recognition and prevention, and pharmacologic factors to be of utmost importance.
CONCLUSION
Critical parallels exist between surgical and expert musical performance that may improve surgical outcomes by adopting musicians' strategies for combating physiological and psychologic performance-related issues. Raising surgeons' awareness for this subject content may improve surgical performance and patient outcomes, as well as help prevent occupational injuries.
Topics: Clinical Competence; Competitive Behavior; Humans; Music; Performance Anxiety; Practice, Psychological; Surgeons; Surgical Procedures, Operative; Work Performance
PubMed: 29336812
DOI: 10.1016/j.surg.2017.09.011 -
Canadian Medical Education Journal Nov 2023Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents' experiences with procedures vary widely,...
BACKGROUND
Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents' experiences with procedures vary widely, for unclear reasons.
OBJECTIVE
To explore IM residents' experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience.
METHODS
Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents' experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke's method.
RESULTS
We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials; 3) Faculty factors including availability to supervise, comfort level, and referral preferences, and 4) Resident-specific factors including preparation, prior experiences, and confidence. Some residents expressed procedure-related anxiety and avoidance.
CONCLUSION
Educational interventions aimed to improve procedural efficiency and ensure availability of supervisors may help facilitate residents to perform procedures, yet may not address procedure-related anxiety. Further study is required to understand better how procedure-averse residents can gain confidence to seek out procedures.
Topics: Humans; Internship and Residency; Education, Medical, Graduate; Canada; Focus Groups; Referral and Consultation
PubMed: 38045067
DOI: 10.36834/cmej.73122 -
Equine Veterinary Journal Sep 2020The goal of this editorial is to discuss best practice design, execution and reporting of a pharmacokinetic (PK) study in horses. Our target readers are clinicians who...
The goal of this editorial is to discuss best practice design, execution and reporting of a pharmacokinetic (PK) study in horses. Our target readers are clinicians who plan to perform this type of research, in a field, clinic or research setting but we also hope that this article might help readers of such work to appraise the articles and understand the quality of the studies. Our emphasis will be on appropriate study design and analytical method, drug and drug formulation choice and route of administration, animal choice, sample collection, storage and shipping, and reporting, rather than the PK data analysis itself.
Topics: Animals; Horses; Pharmaceutical Preparations; Research Design
PubMed: 32748990
DOI: 10.1111/evj.13312