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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 -
Minerva Cardiology and Angiology Dec 2021Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Preprocedural... (Review)
Review
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Preprocedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for preprocedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Patient Selection; Transcatheter Aortic Valve Replacement
PubMed: 33703862
DOI: 10.23736/S2724-5683.21.05573-0 -
Medical Problems of Performing Artists Dec 2022It is widely believed that posture and balance stressors are factors in playing-related pain for musicians using hand-held musical instruments. This purpose of this... (Review)
Review
It is widely believed that posture and balance stressors are factors in playing-related pain for musicians using hand-held musical instruments. This purpose of this scoping review was to assess the available literature relative to the effects of posture and balance in musicians with neuromusculoskeletal injuries. A search of Medline, Web of Science, and SportDiscus seeking articles combining posture and balance considerations with pain in performing artists was performed. From 1,403 articles initially identified by the search parameters, the further abstract/title review for relevance and inclusiveness of pain and posture/balance variables in performing artists resulted in the retention of 29 articles for this full-text scoping review. The full-text analysis assessed publication type, study design, participant population, methodology, statistical methods, main results, and whether the study evaluated the relationship between posture/balance and pain in musicians. Overall, most of the studies including musicians were observational or descriptive. Although, in recent years, there has been an increase in the number of interventional studies regarding posture, balance and pain in musicians, there is still minimal evidence about the contribution of posture and balance characteristics to pain in musician performers. To reliably establish a predictable relationship with injury symptomatology experienced by musicians, it is essential to integrate standardized, validated measurements of posture and balance in the evaluation of all musicians who report to a health professional with neuromusculoskeletal pain. This will not only allow researchers to determine the effect of postural righting dysfunction on neuromusculoskeletal injuries in musicians, but also may provide a foundation for clinicians to develop effective interventions.
Topics: Humans; Musculoskeletal Pain; Posture; Postural Balance; Upper Extremity; Research Design
PubMed: 36455112
DOI: 10.21091/mppa.2022.4032 -
Academic Medicine : Journal of the... Mar 2024Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for...
Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for bedside procedure training and implementation is available. Bedside procedure training and credentialing processes across large institutions may vary among departments and specialties, leading to variable standards, creating an environment that lacks consistent accountability, and making quality improvement difficult. In this Scholarly Perspective, the authors describe a standardized bedside procedure training and certification process for graduate medical education with a common, institution-wide educational framework for teaching and assessing the following 7 important bedside procedures: paracentesis; thoracentesis; central venous catheterization; arterial catheterization; bladder catheterization or Foley catheterization; lumbar puncture; and nasogastric, orogastric, and nasoenteric tube placement. The proposed framework is a 4-stage process that includes 1 preparatory learning stage with simulation practice for knowledge acquisition and 3 clinical stages to guide learners from low-risk to high-risk practice and from high to low supervision. The pilot rollout took place at Henry Ford Hospital from December 2020 to July 2021 for 165 residents in the emergency medicine and/or internal medicine residency programs. The program was fully implemented institution-wide in July 2021. Assessment strategies encompass critical action checklists to confirm procedural understanding and a global rating scale to measure performance quality. A major aim of the bedside procedure training and certification was to standardize assessments so that physician trainers from multiple specialties could train, assess, and supervise any participating trainee, regardless of discipline. The authors list considerations revealed from the pilot rollout regarding electronic tracking systems and several benefits and implementation challenges to establishing institution-wide standards. The proposed framework was assembled by a multidisciplinary physician task force and will assist other institutions in adopting best approaches for training physicians in performing these critically important and difficult-to-perform procedures.
Topics: Humans; Clinical Competence; Education, Medical, Graduate; Curriculum; Physical Examination; Thoracentesis; Internship and Residency
PubMed: 38039977
DOI: 10.1097/ACM.0000000000005574 -
Journal of Laparoendoscopic & Advanced... Jan 2019The results of studies comparing two-dimensional (2D) and three-dimensional (3D) laparoscopy have shown variable results. We aimed to review the literature and develop... (Comparative Study)
Comparative Study Review
BACKGROUND AND AIMS
The results of studies comparing two-dimensional (2D) and three-dimensional (3D) laparoscopy have shown variable results. We aimed to review the literature and develop an appropriate instrument to compare 2D and 3D laparoscopy. We further aimed to use the data extracted to perform a pilot study.
METHODS
Sixty-seven recent articles on 3D laparoscopy were reviewed and data extracted on factors influencing outcome variables. These variables were used to design a pilot study of 28 novices using a randomized crossover design. The results were analyzed using descriptive statistics and the Wilcoxon signed-rank tests.
RESULTS
Seven themes were identified to influence the outcome of 3D studies: applied technique (1), experience of subjects (2), study design (3), learning curve (4), subjective qualitative reports (5), laparoscopic tasks (6), and chosen outcome variables (7). The consecutively developed five laparoscopic simulation tasks contained placing a rubber band over hooks, ring and pearl transfer, threading a pipe cleaner through loops, and placing a suturise. The pilot study showed a primary benefit of 3D laparoscopy that was unrelated to repetition. Two tasks served well to assess first-time performance, and two tasks promise to serve well to assess a learning curve if performed repeatedly.
CONCLUSION
We were able to identify important issues influencing the outcome of studies analyzing 3D laparoscopy. These may help evaluate future studies. The developed tasks resulted in meaningful data in favor of 3D visualization, but further studies are necessary to confirm the pilot test results.
Topics: Clinical Competence; Cross-Over Studies; Humans; Imaging, Three-Dimensional; Laparoscopy; Learning Curve; Pilot Projects; Random Allocation; Research Design; Students, Medical
PubMed: 30256710
DOI: 10.1089/lap.2018.0164 -
Minerva Cardiology and Angiology Dec 2021There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging... (Review)
Review
There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging in the pre-procedural and periprocedural period is essential for procedural and clinical success. Echocardiographic-based techniques are particularly important in these procedures, especially for interventional guidance. This review summarizes the current devices in use and how imaging is used for patient selection, procedural planning, and interventional guidance. The most commonly used method of transcatheter tricuspid intervention is edge-to-edge repair using the MitraClip or TriClip devices (Abbott, Santa Clara, CA, USA). Randomized controlled data is pending but observational studies have demonstrated success, especially in the setting of smaller coaptation gaps and adequate transesophageal imaging windows. Direct annuloplasty with the Cardioband (Edwards Lifesciences, Irvine, CA, USA) has also been used in many centers and has demonstrated success when the anatomy and mechanism of tricuspid regurgitation are appropriate for annuloplasty based on imaging evaluation. Lastly, transcatheter valve replacement is becoming more common using several investigational devices and relies heavily on imaging methods to achieve procedural success.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Treatment Outcome; Tricuspid Valve
PubMed: 34472772
DOI: 10.23736/S2724-5683.21.05697-0 -
Journal of Special Operations Medicine... 2017Resuscitative endovascular balloon occlusion of the aorta (REBOA) has a place in civilian trauma centers in the United States, and British physicians performed the first...
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has a place in civilian trauma centers in the United States, and British physicians performed the first prehospital REBOA, proving the concept viable for civilian emergency medical service. Can this translate into battlefield REBOA to stop junctional hemorrhage and extend "golden hour" rings in combat? If yes, at what level is this procedure best suited and what does it entail? This author's perspective, after treating patients on the battlefield and during rotary wing evacuation, is that REBOA may have a place in prehospital resuscitation but patient and provider selection are paramount. The procedure, although simple in description, is quite complicated and can cause major physiologic changes best dealt with by experienced providers. REBOA is incapable of extending the golden hour limiting the procedure's utility.
Topics: Aorta; Balloon Occlusion; Clinical Competence; Emergency Medical Services; Endovascular Procedures; Hemorrhage; Humans; Patient Selection; Resuscitation; War-Related Injuries
PubMed: 28285483
DOI: 10.55460/JI27-4D3H -
BMJ Quality & Safety Apr 2016Optimal approaches to teaching bedside procedures are unknown. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Optimal approaches to teaching bedside procedures are unknown.
OBJECTIVE
To identify effective instructional approaches in procedural training.
DATA SOURCES
We searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.
STUDY SELECTION
We included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data from full-text articles.
MAIN OUTCOMES AND MEASURES
We included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as 'negative' or 'positive' based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.
RESULTS
We found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training.
CONCLUSIONS AND RELEVANCE
This systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).
Topics: Clinical Competence; Curriculum; Female; Humans; Male; Methods; Patient Care; Point-of-Care Testing; Practice Guidelines as Topic; Randomized Controlled Trials as Topic
PubMed: 26543067
DOI: 10.1136/bmjqs-2014-003518 -
AJR. American Journal of Roentgenology Apr 2017The purpose of this study is to develop a tool to assess the procedural competence of radiology trainees, with sources of evidence gathered from five categories to...
OBJECTIVE
The purpose of this study is to develop a tool to assess the procedural competence of radiology trainees, with sources of evidence gathered from five categories to support the construct validity of tool: content, response process, internal structure, relations to other variables, and consequences.
SUBJECTS AND METHODS
A pilot form for assessing procedural competence among radiology residents, known as the RAD-Score tool, was developed by evaluating published literature and using a modified Delphi procedure involving a group of local content experts. The pilot version of the tool was tested by seven radiology department faculty members who evaluated procedures performed by 25 residents at one institution between October 2014 and June 2015. Residents were evaluated while performing multiple procedures in both clinical and simulation settings. The main outcome measure was the percentage of residents who were considered ready to perform procedures independently, with testing conducted to determine differences between levels of training.
RESULTS
A total of 105 forms (for 52 procedures performed in a clinical setting and 53 procedures performed in a simulation setting) were collected for a variety of procedures (eight vascular or interventional, 42 body, 12 musculoskeletal, 23 chest, and 20 breast procedures). A statistically significant difference was noted in the percentage of trainees who were rated as being ready to perform a procedure independently (in postgraduate year [PGY] 2, 12% of residents; in PGY3, 61%; in PGY4, 85%; and in PGY5, 88%; p < 0.05); this difference persisted in the clinical and simulation settings. User feedback and psychometric analysis were used to create a final version of the form.
CONCLUSION
This prospective study describes the successful development of a tool for assessing the procedural competence of radiology trainees with high levels of construct validity in multiple domains. Implementation of the tool in the radiology residency curriculum is planned and can play an instrumental role in the transition to competency-based radiology training.
Topics: Clinical Competence; Diagnostic Imaging; Educational Measurement; Humans; Image Interpretation, Computer-Assisted; Internship and Residency; Ontario; Pilot Projects; Psychometrics; Radiology; Reproducibility of Results; Sensitivity and Specificity; Software; Work Performance
PubMed: 28199127
DOI: 10.2214/AJR.16.17173