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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 -
International Journal of Sports Medicine Oct 2022This study examined the validity and compared the precision and accuracy of a distance-time linear model (DTLM), a power law and a nomogram to predict the distance...
This study examined the validity and compared the precision and accuracy of a distance-time linear model (DTLM), a power law and a nomogram to predict the distance running performances of female runners. Official rankings of French women ("senior" category: between 23 and 39 years old) for the 3000-m, 5000-m, and 10,000-m track-running events from 2005 to 2019 were examined. Performances of runners who competed in the three distances during the same year were noted (n=158). Mean values and standard deviation (SD) of actual performances were 11.28±1.33, 19.49±2.34 and 41.03±5.12 for the 3000-m, 5000-m, and 10,000-m respectively. Each performance was predicted from two other performances. Between the actual and predicted performances, only DTLM showed a difference (0.05). The magnitude of the differences in these predicted performances was small if not trivial. All predicted performances were significantly correlated with the actual ones, with a very high correlation coefficient (0.001; 0.90), except for DTLM in the 3000-m, which showed a high correlation coefficient (0.001; >0.895). Bias and 95% limits of agreement were acceptable because, whatever the method, they were≤-3.7±10.8% on the 3000-m, 1.4±4.3% on the 5000-m, and -2.5±7.4% on the 10,000-m. The study confirms the validity of the three methods to predict track-running performance and suggests that the most accurate and precise model was the nomogram followed by the power law, with the DTLM being the least accurate.
Topics: Adult; Athletic Performance; Female; Humans; Linear Models; Nomograms; Research Design; Running; Young Adult
PubMed: 35395690
DOI: 10.1055/a-1821-6179 -
Journal of the American Medical... Jan 2021Real-world data (RWD), defined as routinely collected healthcare data, can be a potential catalyst for addressing challenges faced in clinical trials. We performed a... (Review)
Review
OBJECTIVE
Real-world data (RWD), defined as routinely collected healthcare data, can be a potential catalyst for addressing challenges faced in clinical trials. We performed a scoping review of database-specific RWD applications within clinical trial contexts, synthesizing prominent uses and themes.
MATERIALS AND METHODS
Querying 3 biomedical literature databases, research articles using electronic health records, administrative claims databases, or clinical registries either within a clinical trial or in tandem with methodology related to clinical trials were included. Articles were required to use at least 1 US RWD source. All abstract screening, full-text screening, and data extraction was performed by 1 reviewer. Two reviewers independently verified all decisions.
RESULTS
Of 2020 screened articles, 89 qualified: 59 articles used electronic health records, 29 used administrative claims, and 26 used registries. Our synthesis was driven by the general life cycle of a clinical trial, culminating into 3 major themes: trial process tasks (51 articles); dissemination strategies (6); and generalizability assessments (34). Despite a diverse set of diseases studied, <10% of trials using RWD for trial process tasks evaluated medications or procedures (5/51). All articles highlighted data-related challenges, such as missing values.
DISCUSSION
Database-specific RWD have been occasionally leveraged for various clinical trial tasks. We observed underuse of RWD within conducted medication or procedure trials, though it is subject to the confounder of implicit report of RWD use.
CONCLUSION
Enhanced incorporation of RWD should be further explored for medication or procedure trials, including better understanding of how to handle related data quality issues to facilitate RWD use.
Topics: Clinical Trials as Topic; Databases as Topic; Electronic Health Records; Humans; Registries; Research Design; United States
PubMed: 33164065
DOI: 10.1093/jamia/ocaa224 -
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 -
Statistical Methods in Medical Research Jul 2023Statistical sequential analysis of binary data is an important tool in clinical trials such as placebo-controlled trials, where a total of individuals are randomly...
Statistical sequential analysis of binary data is an important tool in clinical trials such as placebo-controlled trials, where a total of individuals are randomly allocated into two groups, one of size receiving the treatment/drug, and the other of size for placebo. The ratio , namely "matching ratio," determines the expected proportion of adverse events from the treatment group among the individuals. Bernoulli-based designs are used for monitoring the safety of post-licensed drugs and vaccines as well. For instance, in a self-control design, is the ratio between the risk and the control time windows. Irrespective of the type of application, the choice of is a critical design criterion as it determines the sample size, the statistical power, the expected sample size, and the expected time to signal the sequential procedure. In this paper, we run exact calculations to offer a statistical rule of thumb for the choice of . All the calculations and examples are performed using the package.
Topics: Humans; Sample Size; Research Design; Vaccines
PubMed: 37278182
DOI: 10.1177/09622802231176031 -
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 -
Research Quarterly For Exercise and... Dec 2020: To provide a review of current articles that have used observation interventions to enhance motor skill acquisition or performance of applied tasks, and to situate the... (Review)
Review
: To provide a review of current articles that have used observation interventions to enhance motor skill acquisition or performance of applied tasks, and to situate the research within the Applied Model for the Use of Observation (AMUO) with the goal of forming a basis for evidence-based guidelines for practitioners. : Key words (e.g., observation/modeling) were searched in varied data bases (e.g., Google Scholar/PubMed), along with a citation search of the relevant AMUO article, to generate a pool of articles for possible review. Selection criteria included publication between 2011 and 2018, and that the research focus was on the effects of an observation intervention on the acquisition or performance of an applied motor task. : Forty-eight articles were reviewed, with 21 of these targeting the basic question of whether observation is effective, and the remaining pertaining to the , and features of the AMUO. The effectiveness of observation interventions was not only affirmed, but also extended to a wider scope of populations and settings. Greater insight into the necessary information with respect to the demonstration () and whether it should be before, after, or during physical practice () was obtained. As well, advantages of combining model types () and providing control to the learner () were reported. : While more clarity was brought to certain features of the AMUO that could be used to provide evidence-based guidelines, more research is needed to fully inform practitioners for the effective use of observation interventions.
Topics: Humans; Learning; Models, Educational; Motor Skills; Observation; Physical Education and Training; Research Design
PubMed: 32004119
DOI: 10.1080/02701367.2019.1693489 -
Annals of Plastic Surgery Jun 2023The armamentarium of a plastic surgeon is vast, consisting of an array of surgical procedures from head to toe. Unfortunately, plastic surgeons have been losing portions...
BACKGROUND
The armamentarium of a plastic surgeon is vast, consisting of an array of surgical procedures from head to toe. Unfortunately, plastic surgeons have been losing portions of their operative domain to other surgical subspecialties for years. The number of subspecialties invading our niche is bothersome, but more concerning is the fact that losing the reins of these core procedures results in less surgical exposure and competency for plastic surgery residents.Lately, in academic institutions, otolaryngologists seem to be performing most rhinoplasty procedures, resulting in fewer surgeries performed by plastic surgeons. Trainees must perform 10 rhinoplasties to fulfill graduation requirements but, more importantly, residents should graduate feeling competent and confident performing rhinoplasties. The aims of this study are to determine the number of rhinoplasties being performed at academic centers each year and to evaluate the trend with regard to which specialties are performing these procedures.
METHODS
Three academic institutions with plastic surgery and otolaryngology residency programs searched medical records for rhinoplasty Current Procedural Terminology codes from January 1, 2009, to December 31, 2019. The total numbers of rhinoplasties performed each year, by each specialty, were tallied.
RESULTS
Growth rate in rhinoplasty volume among participating institutions ranged from 27% to 149%. At these institutions, plastic surgeons performed less than one third of all rhinoplasties. In 2009, 10% of rhinoplasties were performed by plastic surgeons at institution 1, 22% at institution 2, and 18% at institution 3. In 2019, the volume of rhinoplasties performed by plastic surgeons was 5%, 12%, and 27%, respectively. The 3 ENT departments had statistically significant increasing trends in rhinoplasty volume. Institutions 1 and 2's plastic surgery departments showed that negative volume trends, however, were not statistically significant. Institution 3's plastic surgery department has had an increasing trend, which was statistically significant.
CONCLUSIONS
Otolaryngology is performing most rhinoplasties at several academic institutions. This is concerning for the education of plastic surgery trainees. Academic plastic surgeons must focus on increasing the number of rhinoplasties performed to adequately train residents this core procedure. If rhinoplasties are not made a priority now, this surgery may become a historic operation instead of a vital skill in plastic surgeons' armamentarium.
Topics: Humans; Rhinoplasty; Plastic Surgery Procedures; Surgery, Plastic; Surgeons; Otolaryngology; Internship and Residency
PubMed: 37115851
DOI: 10.1097/SAP.0000000000003531