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Evaluation of pain and patient satisfaction by music therapy in patients with endoscopy/colonoscopy.The Turkish Journal of Gastroenterology... Sep 2018Endoscopy and colonoscopy are frequently performed procedures to evaluate the gastrointestinal system. These procedures are sometimes disturbing and painful for the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIMS
Endoscopy and colonoscopy are frequently performed procedures to evaluate the gastrointestinal system. These procedures are sometimes disturbing and painful for the patient. In gastrointestinal suits, endoscopy and colonoscopy may be performed on awake or sedated patients. Music therapy is a common and non-pharmacological treatment for various medical conditions, pain, and anxiety. The aim of the present study was to add music therapy to sedation administered during endoscopy and colonoscopy. The effect of music treatment on drug consumption, anxiety, and pain was investigated.
MATERIALS AND METHODS
American Anesthesiologist Association I-III adult patients scheduled for endo/colonoscopy were randomized to music treatment and no music treatment groups. Patients with endoscopic ultrasound and endoscopic retrograde colangiopancreaticography were excluded from the study. Anxiety score and pain severity were evaluated before and after the procedure. Heart rate, mean arterial pressure, and oxygen saturation were recorded before, during, and after the procedure. Total drug consumption was recorded. Patient satisfaction and desire for the same protocol for recurrent procedures were investigated.
RESULTS
Music therapy added to deep sedation administered by anesthesiologists provided decreased anxiety score and propofol consumption. Patient satisfaction was increased, and patients reported a desire for the same protocol for recurrent procedures.
CONCLUSION
The present study may serve as the beginning of using music therapy for pain treatment in gastroenterology procedures in our hospital with/without sedation. Music and other non-pharmacological treatment methods must be remembered to increase patient comfort during enco/colonoscopies and other painful procedures.
Topics: Adolescent; Adult; Aged; Anxiety; Colonoscopy; Combined Modality Therapy; Conscious Sedation; Double-Blind Method; Endoscopy, Gastrointestinal; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Music Therapy; Pain, Procedural; Patient Satisfaction; Propofol; Treatment Outcome; Young Adult
PubMed: 30260780
DOI: 10.5152/tjg.2018.18200 -
NeuroImage Aug 2023Cognitive neuroscientists have been grappling with two related experimental design problems. First, the complexity of neuroimaging data (e.g. often hundreds of thousands...
Cognitive neuroscientists have been grappling with two related experimental design problems. First, the complexity of neuroimaging data (e.g. often hundreds of thousands of correlated measurements) and analysis pipelines demands bespoke, non-parametric statistical tests for valid inference, and these tests often lack an agreed-upon method for performing a priori power analyses. Thus, sample size determination for neuroimaging studies is often arbitrary or inferred from other putatively but questionably similar studies, which can result in underpowered designs - undermining the efficacy of neuroimaging research. Second, when meta-analyses estimate the sample sizes required to obtain reasonable statistical power, estimated sample sizes can be prohibitively large given the resource constraints of many labs. We propose the use of sequential analyses to partially address both of these problems. Sequential study designs - in which the data is analyzed at interim points during data collection and data collection can be stopped if the planned test statistic satisfies a stopping rule specified a priori - are common in the clinical trial literature, due to the efficiency gains they afford over fixed-sample designs. However, the corrections used to control false positive rates in existing approaches to sequential testing rely on parametric assumptions that are often violated in neuroimaging settings. We introduce a general permutation scheme that allows sequential designs to be used with arbitrary test statistics. By simulation, we show that this scheme controls the false positive rate across multiple interim analyses. Then, performing power analyses for seven evoked response effects seen in the EEG literature, we show that this sequential analysis approach can substantially outperform fixed-sample approaches (i.e. require fewer subjects, on average, to detect a true effect) when study designs are sufficiently well-powered. To facilitate the adoption of this methodology, we provide a Python package "niseq" with sequential implementations of common tests used for neuroimaging: cluster-based permutation tests, threshold-free cluster enhancement, t-max, F-max, and the network-based statistic with tutorial examples using EEG and fMRI data.
Topics: Humans; Cognitive Neuroscience; Research Design; Sample Size; Magnetic Resonance Imaging; Neuroimaging
PubMed: 37348624
DOI: 10.1016/j.neuroimage.2023.120232 -
Therapeutic Innovation & Regulatory... Mar 2023When simultaneous comparisons are performed, a procedure must be employed to control the overall level (also known as the Type I Error rate). Hochberg's stepwise testing...
When simultaneous comparisons are performed, a procedure must be employed to control the overall level (also known as the Type I Error rate). Hochberg's stepwise testing procedure is often used and here determination of the sample size needed to achieve a specified power for two pairwise comparisons when observations follow a normal distribution is addressed. Three different scenarios are considered: subsets defined by a baseline criterion, two treatments compared to a control, or one set of subjects nested within the other. The solutions for these three scenarios differ and are examined. The sample sizes for the differences in success probabilities for binomial distributions are presented using the asymptotic normality. The sample sizes and power using Hochberg's procedure are compared to the corresponding results using the Bonferroni approach.
Topics: Humans; Sample Size; Research Design
PubMed: 36280651
DOI: 10.1007/s43441-022-00468-z -
The American Journal of Gastroenterology Feb 2020Formative colonoscopy direct observation of procedural skills (DOPS) assessments were updated in 2016 and incorporated into UK training but lack validity evidence. We... (Observational Study)
Observational Study
INTRODUCTION
Formative colonoscopy direct observation of procedural skills (DOPS) assessments were updated in 2016 and incorporated into UK training but lack validity evidence. We aimed to appraise the validity of DOPS assessments, benchmark performance, and evaluate competency development during training in diagnostic colonoscopy.
METHODS
This prospective national study identified colonoscopy DOPS submitted over an 18-month period to the UK training e-portfolio. Generalizability analyses were conducted to evaluate internal structure validity and reliability. Benchmarking was performed using receiver operator characteristic analyses. Learning curves for DOPS items and domains were studied, and multivariable analyses were performed to identify predictors of DOPS competency.
RESULTS
Across 279 training units, 10,749 DOPS submitted for 1,199 trainees were analyzed. The acceptable reliability threshold (G > 0.70) was achieved with 3 assessors performing 2 DOPS each. DOPS competency rates correlated with the unassisted caecal intubation rate (rho 0.404, P < 0.001). Demonstrating competency in 90% of assessed items provided optimal sensitivity (90.2%) and specificity (87.2%) for benchmarking overall DOPS competence. This threshold was attained in the following order: "preprocedure" (50-99 procedures), "endoscopic nontechnical skills" and "postprocedure" (150-199), "management" (200-249), and "procedure" (250-299) domain. At item level, competency in "proactive problem solving" (rho 0.787) and "loop management" (rho 0.780) correlated strongest with the overall DOPS rating (P < 0.001) and was the last to develop. Lifetime procedure count, DOPS count, trainer specialty, easier case difficulty, and higher cecal intubation rate were significant multivariable predictors of DOPS competence.
DISCUSSION
This study establishes milestones for competency acquisition during colonoscopy training and provides novel validity and reliability evidence to support colonoscopy DOPS as a competency assessment tool.
Topics: Clinical Competence; Colonoscopy; Gastroenterology; General Surgery; Humans; Nurse Specialists; Observation; Reproducibility of Results; United Kingdom
PubMed: 31738285
DOI: 10.14309/ajg.0000000000000426 -
Briefings in Bioinformatics Jan 2022The growing expansion of data availability in medical fields could help improve the performance of machine learning methods. However, with healthcare data, using...
The growing expansion of data availability in medical fields could help improve the performance of machine learning methods. However, with healthcare data, using multi-institutional datasets is challenging due to privacy and security concerns. Therefore, privacy-preserving machine learning methods are required. Thus, we use a federated learning model to train a shared global model, which is a central server that does not contain private data, and all clients maintain the sensitive data in their own institutions. The scattered training data are connected to improve model performance, while preserving data privacy. However, in the federated training procedure, data errors or noise can reduce learning performance. Therefore, we introduce the self-paced learning, which can effectively select high-confidence samples and drop high noisy samples to improve the performances of the training model and reduce the risk of data privacy leakage. We propose the federated self-paced learning (FedSPL), which combines the advantage of federated learning and self-paced learning. The proposed FedSPL model was evaluated on gene expression data distributed across different institutions where the privacy concerns must be considered. The results demonstrate that the proposed FedSPL model is secure, i.e. it does not expose the original record to other parties, and the computational overhead during training is acceptable. Compared with learning methods based on the local data of all parties, the proposed model can significantly improve the predicted F1-score by approximately 4.3%. We believe that the proposed method has the potential to benefit clinicians in gene selections and disease prognosis.
Topics: Humans; Machine Learning; Privacy; Research Design
PubMed: 34874995
DOI: 10.1093/bib/bbab498 -
Journal of Clinical Epidemiology Dec 2022To explore the impact of methodological choices on the results of meta-analyses (MAs), with acupuncture for smoking cessation as a case study. (Review)
Review
OBJECTIVE
To explore the impact of methodological choices on the results of meta-analyses (MAs), with acupuncture for smoking cessation as a case study.
STUDY DESIGN AND SETTING
After performing an umbrella review (using MEDLINE, the COCHRANE Library, the Wan Fang database, and the Chinese Journal Full-text Database/March 2018) of MAs exploring the use of acupuncture for smoking cessation, we extracted all randomized controlled trials. Numerous MAs were performed as per every possible combination of various methodological choices (e.g., characteristics of the intervention and control procedures, outcome, publication status, language) to assess their vibration of effects or more precisely the existence of a Janus effect, that is, whether the 10th and 90th percentiles in the distribution of effect sizes were in opposite directions.
RESULTS
After including 7 MAs and 39 randomized controlled trials, we performed 496,528 MAs. The effect size was negative at the 10th percentile (-0.1, favoring controls) and positive at the 90th percentile (1.17, favoring acupuncture). In all, 104,491 MAs showed a statistically significant difference in favor of acupuncture, whereas 392,037 failed to demonstrate the efficacy of acupuncture (including 96 that showed a statistically significant difference in favor of the control).
CONCLUSION
The methodological choices made in performing pairwise MAs can result in substantial vibration of effects, occasionally leading to opposite results.
Topics: Humans; Acupuncture Therapy; Databases, Factual; Physical Therapy Modalities; Smoking Cessation; Vibration; Meta-Analysis as Topic; Randomized Controlled Trials as Topic
PubMed: 36150547
DOI: 10.1016/j.jclinepi.2022.09.001 -
Journal of Pediatric Surgery Jul 2020Determining the appropriate sample size is an integral component of any well-designed research study, grant application, or scientific manuscript. Surgeons intuitively... (Review)
Review
BACKGROUND/PURPOSE
Determining the appropriate sample size is an integral component of any well-designed research study, grant application, or scientific manuscript. Surgeons intuitively understand the concept of statistical power, but have limited knowledge in how to go about performing the calculations correctly. Our goal is to provide a strategy for pediatric surgeons to use when planning a study to determine the sample sizes required for detecting a clinically meaningful effect, which is important for interpreting and validating their results.
METHODS
We present a general 5-step approach for performing a sample size justification and statistical power analysis, and illustrate this approach using several surgical research examples. The 5 steps are: 1) Define the primary outcome of interest, 2) Define the magnitude of the effect or effect size and power desired, 3) Determine the appropriate statistics and statistical test that will be considered, 4) Perform the calculations to estimate the required sample size using software or a reference table, 5) Write the formal power and sample size statement for the manuscript, grant application, or project proposal.
CONCLUSIONS
Understanding sample size considerations and statistical power in the surgical research community will improve the quality of published articles. This primer can be used by pediatric surgeons in the process of determining the appropriate sample sizes for detecting a clinically meaningful effect with sufficient statistical power. Virtually all research studies in pediatric surgery should include a justification of sample size based on a power calculation as this leads to more meaningful inferences from the data and analysis.
TYPE OF STUDY
Review article.
LEVEL OF EVIDENCE
N/A.
Topics: General Surgery; Humans; Pediatrics; Research Design; Sample Size; Surgeons
PubMed: 31155391
DOI: 10.1016/j.jpedsurg.2019.05.007 -
Journal of Strength and Conditioning... Dec 2019Carvalho, L and Barroso, R. Ischemic preconditioning improves strength endurance performance. J Strength Cond Res 33(12): 3332-3337, 2019-Ischemic preconditioning (IPC)...
Carvalho, L and Barroso, R. Ischemic preconditioning improves strength endurance performance. J Strength Cond Res 33(12): 3332-3337, 2019-Ischemic preconditioning (IPC) has been used to improve performances in aerobic and anaerobic activities. However, a few studies aimed at observing the effects of IPC on resistance training. The purpose of this study is to examine the effects of IPC on the number of repetitions performed during high-load resistance training. We also aimed at investigating blood lactate concentration and muscle activation in an attempt to understand the physiological mechanisms that may be caused by IPC. Ten resistance-trained participants performed four 5-minute cycles of either IPC (250 mm Hg) or Placebo (10 mm Hg) before performing a single set to failure of knee extension exercise with 85% of 1 repetition maximum. We also assessed muscle activation during the set (EMGRMS), median power frequency (EMGMPF), and blood lactate concentration before, 3, 7, and 11 minutes after (peak value was identified and used to calculate delta to prevalues, Δlactate). Data are presented as mean, 90% confidence intervals (CIs), and were analyzed with paired t-test. The level of significance was set at p < 0.05. Participants performed on average 3.9 repetitions (90% CI = 2.4-5.4; p = 0.01), which is ∼20%, more in the IPC condition. There were no significant differences between IPC and Placebo for EMGMPF (5.0%; 90% CI = -5.2 to 15; p = 0.50), EMGRMS (4.5%; 90% CI = -8.8 to 17; p = 0.78), and Δlactate (44%; 90% CI = 11-144; p = 0.16). Our results demonstrate the effect of IPC just on the number of repetitions performed in high-load resistance exercise compared with the Placebo condition.
Topics: Adult; Cross-Over Studies; Electromyography; Exercise Test; Humans; Ischemic Preconditioning; Lactic Acid; Male; Muscle Strength; Muscle, Skeletal; Nutritional Status; Physical Endurance; Random Allocation; Resistance Training; Young Adult
PubMed: 30844989
DOI: 10.1519/JSC.0000000000002846 -
Journal of Biomedical Informatics Aug 2023The imputation of missing values in multivariate time series (MTS) data is critical in ensuring data quality and producing reliable data-driven predictive models. Apart... (Review)
Review
The imputation of missing values in multivariate time series (MTS) data is critical in ensuring data quality and producing reliable data-driven predictive models. Apart from many statistical approaches, a few recent studies have proposed state-of-the-art deep learning methods to impute missing values in MTS data. However, the evaluation of these deep methods is limited to one or two data sets, low missing rates, and completely random missing value types. This survey performs six data-centric experiments to benchmark state-of-the-art deep imputation methods on five time series health data sets. Our extensive analysis reveals that no single imputation method outperforms the others on all five data sets. The imputation performance depends on data types, individual variable statistics, missing value rates, and types. Deep learning methods that jointly perform cross-sectional (across variables) and longitudinal (across time) imputations of missing values in time series data yield statistically better data quality than traditional imputation methods. Although computationally expensive, deep learning methods are practical given the current availability of high-performance computing resources, especially when data quality and sample size are of paramount importance in healthcare informatics. Our findings highlight the importance of data-centric selection of imputation methods to optimize data-driven predictive models.
Topics: Benchmarking; Research Design; Time Factors; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 37429511
DOI: 10.1016/j.jbi.2023.104440 -
PloS One 2021Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning...
BACKGROUND
Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert's and the novice's performance to guide novice practitioners during their training process. This study compares experts' and novices' biomechanical variables during a simulated CVA performance.
METHODS
Seven experts and seven novices were part of this study. The participants' motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand's speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences.
RESULTS
There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk.
CONCLUSIONS
Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure's stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.
Topics: Adult; Anesthesiologists; Biomechanical Phenomena; Clinical Competence; Female; Humans; Internship and Residency; Male; Motion; Patient Simulation; Simulation Training; Task Performance and Analysis
PubMed: 33930076
DOI: 10.1371/journal.pone.0250941