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The Behavioral and Brain Sciences Feb 2024Integrative experiment design should be extended to thought-experiments. Thought-experiments are closely connected to "real" experiments. They are involved in devising...
Integrative experiment design should be extended to thought-experiments. Thought-experiments are closely connected to "real" experiments. They are involved in devising the design space of theories and possible experiments. The latter may be partitioned into experiments to be really performed and mere thought-experiments. The proposed extension of integrative experiment design lends guidance to a more methodical performance of thought-experiments.
Topics: Research Design
PubMed: 38311455
DOI: 10.1017/S0140525X23002340 -
Clinics (Sao Paulo, Brazil) 2024Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder, with main manifestations related to communication, social interaction, and behavioral... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder, with main manifestations related to communication, social interaction, and behavioral patterns. The slight dynamics of change in the child over time require that the onset of clinical manifestations presented by the child be more valued, with the aim of stabilizing the condition. Faced with a variety of methods for diagnosing ASD, the question arises as to which method should be used. This systematic review aims to recommend the best tools to perform screening and diagnosis.
METHODOLOGY
This systematic review followed the PRISMA guidelines. The databases MEDLINE, Embase, CENTRAL (Cochrane), and Lilacs were accessed, and gray and manual searches were performed. The search strategy was created with terms referring to autism and the diagnosis/broad filter. The studies were qualitatively evaluated and quantitatively. Statistical analysis was performed using Meta-diSc-2.0 software, the confidence interval was 95 %.
RESULTS
The M-CHAT-R/F tool demonstrated a sensitivity of 78 % (95 % CI 0.57‒0.91) and specificity of 0.98 (95 % CI 0.88-1.00). The diagnostic tools demonstrated sensitivity and specificity respectively of: ADOS, sensitivity of 87 % (95 % CI 0.79‒0.92) and specificity 75 % (95 % CI 0.73‒0.78); ADI-R demonstrated test sensitivity of 77 % (95 % CI 0.56‒0.90) and specificity 68 % (95 % CI 0.52‒0.81), CARS test sensitivity was 89 % (95 % CI 0.78‒0.95) and specificity 79 % (95 % CI 0.65‒0.88).
CONCLUSION
It is mandatory to apply a screening test, the most recommended being the M-CHAT-R/F. For diagnosis CARS and ADOS are the most recommended tools.
Topics: Child; Humans; Autism Spectrum Disorder; Sensitivity and Specificity; Mass Screening; Communication; Research Design
PubMed: 38484581
DOI: 10.1016/j.clinsp.2023.100323 -
Nigerian Journal of Clinical Practice Dec 2023The flexible bronchoscopy procedure, which is performed in awake conditions or under local anesthesia, is a difficult and complicated procedure for patients and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The flexible bronchoscopy procedure, which is performed in awake conditions or under local anesthesia, is a difficult and complicated procedure for patients and physicians. Propofol is a fast-acting sedative-hypnotic anesthetic with a rapid return. Ketamine hydrochloride is a fast-acting general anesthetic producing an anesthetic state characterized by deep analgesia, normal pharyngeal, and laryngeal reflexes.
MATERIALS AND METHOD
The study was planned in a randomized, prospective, and double-blind design. The drug(s) administered by the anesthesiologist was not known to the bronchoscopist and the patient. A total of 64 cases were included in the study (34/propofol, 30/ketamine-propofol (ketofol) group). Group propofol received 0.1 mL/kg propofol, and group ketofol received 0.1 mL/kg ketofol intravenously over approximately 30 seconds. Vital signs, non-invasive blood pressure, peripheral oxygen saturation, and pulse values of all cases were measured three times and were recorded just before the start of the procedure, after entering the trachea, and after the procedure was terminated. The Visual Analogue Scale (VAS) and The Ramsay scoring were additionally used in the present study.
RESULTS
Statistically significant differences were detected between the groups in terms of blood pressure and heart rates. Statistically significant differences were detected between the two groups according to The VAS scoring and additional dose requirement.
CONCLUSION
It must be noted that flexible bronchoscopy procedures, which are performed with local anesthesia by both the patient and the physician with a high degree of difficulty, especially combined drugs to be applied with anesthesia support, are more effective/comfortable/reliable, and have fewer complications and higher tolerability if there are no contraindications.
Topics: Humans; Propofol; Ketamine; Prospective Studies; Anesthetics, Intravenous; Bronchoscopy; Anesthesia; Double-Blind Method
PubMed: 38158347
DOI: 10.4103/njcp.njcp_245_23 -
Archives of Physical Medicine and... Dec 2023To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults'... (Review)
Review
OBJECTIVE
To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.
DATA SOURCES
PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.
STUDY SECTION
Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.
DATA EXTRACTION
The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.
DATA SYNTHESIS
Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.
CONCLUSIONS
Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.
Topics: Humans; Aged; Research Design; Sample Size
PubMed: 37119957
DOI: 10.1016/j.apmr.2023.04.007 -
Current Opinion in Organ Transplantation Dec 2023Penile transplantation has become an emerging option for patients with severe genital defects. Only transplantation restores anatomy, sexual, and reproductive function... (Review)
Review
PURPOSE OF REVIEW
Penile transplantation has become an emerging option for patients with severe genital defects. Only transplantation restores anatomy, sexual, and reproductive function of the penis. However, penile transplantation comes with important technical, psychosocial, ethical, and surgical challenges that must be considered for successful implementation. Indications for penile transplantation have yet to be clearly elucidated.
RECENT FINDINGS
Since 2006, only five penile transplants have been performed globally. Four of the five transplants have been performed following traumatic defects, and one was performed following a total penectomy from squamous cell carcinoma. Only two of the five penile transplants remain intact. However, long-term outcomes are encouraging with optimal surgical planning, patient selection, and immunologic compliance. Clinical implications and ethical considerations are discussed.
SUMMARY
Penile transplantation is a novel solution for penile defects not amenable to traditional reconstructive approaches. With an evidence-based surgical technique, potential advantages include improved urinary function, sensation, and cosmesis. While patient selection is challenging, there is an ongoing effort to identify potential candidates. Indications are discussed in this article.
Topics: Male; Humans; Urogenital System; Transplants; Patient Selection; Plastic Surgery Procedures
PubMed: 37909925
DOI: 10.1097/MOT.0000000000001111 -
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 -
Surgical Laparoscopy, Endoscopy &... Apr 2024As the use of the robotic platform increases among general surgeons, the amount of robotic cholecystectomies is expected to increase as well. The use of intraoperative...
BACKGROUND
As the use of the robotic platform increases among general surgeons, the amount of robotic cholecystectomies is expected to increase as well. The use of intraoperative cholangiography is valuable in assessing for choledocholithiasis. We describe our technique of performing robotic intraoperative cholangiograms with choledochoscopy. Out technique aids in efficiency since no undocking is required.
METHODS
Preoperatively, the decision to perform a cholangiogram is made based on physical exam, labs, and imaging findings. The procedure begins with obtaining a critical view of safety. The robotic arms are positioned in a manner that allows all 4 robotic arms to remain docked. A ductotomy is made and the cholangiocatheter is introduced. The cholangiogram images are then interpreted and if a stone is seen in the common bile duct we will then perform a transcystic common bile duct exploration using the SpyGlass Discover digital. A complete cholangiogram is then performed. The cystic duct is secured and the gallbladder is removed from the liver bed. The patients are watched overnight and discharged on postoperative day 1.
CONCLUSIONS
A robotic approach to performing a transcystic common bile duct exploration is a safe and reproducible treatment method for choledocholithiasis. Our approach offers an advantage since no undocking is required.
Topics: Humans; Choledocholithiasis; Gallbladder; Robotic Surgical Procedures; Laparoscopy; Common Bile Duct; Cholangiography; Cholecystectomy, Laparoscopic
PubMed: 38359352
DOI: 10.1097/SLE.0000000000001258 -
BMJ Open Dec 2023The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal...
INTRODUCTION
The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal osteoporosis, ranking the best acupuncture treatment and providing a reference for clinical treatment extensively.
METHODS AND ANALYSIS
Randomised controlled trials of different acupuncturerelated therapies for postmenopausal osteoporosis will be searched in the following databases from 1 January 2002 to 31 December 2022, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biomedical Literature Database. Overall, clinical efficacy rate, bone mineral density and a Visual Analogue Scale score are used as the primary outcome indicators. In addition, the secondary outcome indicator is adverse reactions. The entire screening process will be conducted by two independent investigators; meanwhile, Stata (V.14.0) and RevMan (V.5.4) will be used to conduct the network meta-analysis. If the data are permissible and feasible, we will also perform meta-regression and subgroup analyses to address the underlying causes of data inconsistency and heterogeneity in the statistical analyses. Besides, to improve the credibility of this network meta-analysis, we will evaluate the quality of evidence in this research according to the GRADE assessment.
ETHICS AND DISSEMINATION
Ethics approval is not required for network meta-analyses, which do not involve animals' or people's welfare. The results of this network meta-analysis will be submitted to a recognised journal for publication.
PROSPERO REGISTRATION NUMBER
CRD42023401003.
Topics: Female; Humans; Acupuncture Therapy; Bayes Theorem; Meta-Analysis as Topic; Network Meta-Analysis; Osteoporosis, Postmenopausal; Research Design; Systematic Reviews as Topic
PubMed: 38159952
DOI: 10.1136/bmjopen-2023-074740 -
BMJ Open Oct 2023Reference intervals and reference curves provide clinicians with a point of reference when evaluating patients' laboratory test results. In practical applications, the...
INTRODUCTION
Reference intervals and reference curves provide clinicians with a point of reference when evaluating patients' laboratory test results. In practical applications, the 2.5th and 97.5th percentiles of healthy reference population are typically used as lower and upper reference limits. Guidelines outlining analytical and methodological steps involved in reference intervals and curves estimation are available and there have been large-scale world-wide initiatives to provide reference intervals and curves for children. However, there is a lack of synthesised evidence regarding the results of such initiatives in general, but specifically in iron-related biomarkers, ferritin (in serum and plasma) and haemoglobin. Objectives of this review are to identify studies that have produced reference intervals and curves for ferritin and haemoglobin in paediatric populations and to synthesise all available evidence. We also aim to quantify heterogeneity across reference intervals and curves and identify and elucidate sources of heterogeneity, including heterogeneity in the methods employed in their development.
METHODS AND ANALYSIS
Using a comprehensive search strategy, we will identify eligible studies. Following electronic databases will be searched from inception: EMBASE, MEDLINE, SCOPUS and The Cochrane Library. We will also perform grey literature search to capture unpublished reference intervals and curves from healthy cohorts. Two researchers will independently screen retrieved citations against eligibility criteria in two stages, focusing first on titles and abstracts and then on full-text articles. Studies that provide reference intervals and curves for ferritin and haemoglobin for paediatric population will be eligible. Data extraction will include study characteristics, characteristics of reference population, methodological and analytical considerations and estimated reference intervals and curves. We will consider narrative synthesis and quantitative synthesis when appropriate.
ETHICS AND DISSEMINATION
Ethical approval is not required as data from already published studies will be used. Results will be disseminated through peer-reviewed publications and conference presentations.
PROSPERO REGISTRATION NUMBER
CRD42023399802.
Topics: Humans; Child; Ferritins; Systematic Reviews as Topic; Meta-Analysis as Topic; Hemoglobins; Peer Review; Research Design; Review Literature as Topic
PubMed: 37793936
DOI: 10.1136/bmjopen-2023-073783 -
The Clinical Teacher Apr 2024Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a...
BACKGROUND
Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a 3-year fellowship. However, skill acquisition is not uniform. Individualised training, adapted to the unique experiences and requirements of each trainee, may enhance competency.
APPROACH
An individualised, longitudinal critical procedure course was initiated at a large academic paediatric medical centre in July 2022 for PCC fellows (n = 5). The course, informed by procedural performance profiles (P3) generated through real-time clinical assessments in the paediatric intensive care unit (PICU), was split into three phases: (1) an Initial Simulation Bootcamp-a 2-day introductory session; (2) Quarterly Structured Booster Sessions (QSBS)-spaced repetition of deliberate practice training individualised to each fellow; and (3) an Annual Refresher Training-a core skills and advanced technique training day.
EVALUATION
Fellows began with minimal experience, which formed their initial P3s. Ninety-two percent (166/180) of bedside procedures received real-time feedback, enabling longitudinal P3 modification, which identified focus areas for the QSBS. The sessions were well attended and received. Eighty-nine percent (QSBS #1 5/5, QSBS #2 3/4) of respondents reflected positively on the course's impact on procedural understanding. The course was perceived as more effective than traditional modalities, except bedside training.
IMPLICATION
Implementation of a spaced repetition, deliberate practice course informed by longitudinally tracked real-life performance data is feasible for educators and preferred by trainees. This educational construct can be applied to other clinical skills, bringing precision medicine approach to training.
Topics: Humans; Child; Education, Medical, Graduate; Curriculum; Educational Measurement; Educational Status; Clinical Competence
PubMed: 38175794
DOI: 10.1111/tct.13719