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BMC Medical Research Methodology Jul 2022Meta-analysis is a central method for quality evidence generation. In particular, meta-analysis is gaining speedy momentum in the growing world of quantitative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Meta-analysis is a central method for quality evidence generation. In particular, meta-analysis is gaining speedy momentum in the growing world of quantitative information. There are several software applications to process and output expected results. Open-source software applications generating such results are receiving more attention. This paper uses Python's capabilities to provide applicable instruction to perform a meta-analysis.
METHODS
We used the PythonMeta package with several modifications to perform the meta-analysis on an open-access dataset from Cochrane. The analyses were complemented by employing Python's zEpid package capable of creating forest plots. Also, we developed Python scripts for contour-enhanced funnel plots to assess funnel plots asymmetry. Finally, we ran the analyses in R and STATA to check the cross-validity of the results.
RESULTS
A stepwise instruction on installing the software and packages and performing meta-analysis was provided. We shared the Python codes for meta-analysts to follow and generate the standard outputs. Our results were similar to those yielded by R and STATA.
CONCLUSION
We successfully produced standard meta-analytic outputs using Python. This programming language has several flexibilities to improve the meta-analysis results even further.
Topics: Humans; Programming Languages; Publications; Research Design; Software
PubMed: 35820854
DOI: 10.1186/s12874-022-01673-y -
Stroke Sep 2019Background and Purpose- Radial artery catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures, and...
Background and Purpose- Radial artery catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures, and there have been few studies that describe its safety and efficacy. We present our institution's experience in performing neuroendovascular interventions via a transradial approach, with excellent clinical outcomes and patient satisfaction measures. Methods- We conducted a retrospective analysis and identified 223 patients who underwent 233 consecutive neuroendovascular interventions via radial artery access at our institution. The incidence of perioperative and postprocedural complications was investigated. We identified a subset of 98 patients who have undergone both transradial and transfemoral cerebral angiograms and compared clinical outcomes and patient satisfaction measures between the 2 groups. Results- The overall incidence of complications was low across all procedures performed via transradial access. Peri-procedurally, only 2 patients had symptomatic radial artery spasm, and there were no instances of iatrogenic complications (vessel dissection, stroke, and hemorrhage). In 10 cases (4.3%), the intended procedure could not be completed via a transradial approach, and, thus, femoral artery access had to be pursued instead. Ten patients complained of minor postprocedural complications, although none required therapeutic intervention. The mean procedure time was shorter for diagnostic angiograms performed via transradial versus transfemoral access (18.8±15.8 versus 39.5±31.1 minutes; P=0.025). Patients overall reported shorter recovery times with transradial access, and the majority of patients (94%) would elect to have subsequent procedures performed via this route. Conclusions- Radial artery catheterization is a safe and durable alternative to perform a wide range of neuroendovascular procedures, with a low rate of complications. On the whole, patients prefer transradial compared with transfemoral access.
Topics: Cardiac Catheterization; Cerebral Angiography; Female; Hemorrhage; Humans; Middle Aged; Radial Artery; Retrospective Studies; Stroke; Treatment Outcome
PubMed: 31311466
DOI: 10.1161/STROKEAHA.119.025811 -
MedEdPORTAL : the Journal of Teaching... 2023Cervical intraepithelial neoplasia 3 is associated with a high degree of progression to cervical cancer. Its risk is markedly reduced after excisional treatment. Hence,...
INTRODUCTION
Cervical intraepithelial neoplasia 3 is associated with a high degree of progression to cervical cancer. Its risk is markedly reduced after excisional treatment. Hence, it is critical that providers accurately diagnose and treat this condition. We present a simulation-based module focused on resident mastery of performance of colposcopy and loop electrosurgical excision procedure (LEEP).
METHODS
Learners were obstetrics and gynecology residents. Guidelines on performance of colposcopy and LEEP were presented prior to module participation. We used pelvic task trainers, kielbasa sausages, and routine equipment for performance of colposcopy and LEEP. Colposcopy and LEEP sessions each lasted 30 minutes. Learners completed questionnaires before and after regarding comfort level on aspects of colposcopy and LEEP performance and level of agreement with statements on performing procedures independently. Comfort levels and degrees of agreement were based on 5-point Likert scales (1 = 3 = 5 = respectively).
RESULTS
Modules were held in November 2021 and May 2022. Thirty-four residents participated. Mean comfort scores significantly increased from 3.1 to 4.3 ( < .001) before and after the module for all steps. There was an increase in level of agreement with statements on being able to independently perform colposcopy (2.2 to 3.5, < .01) and LEEP (2.9 to 3.6, = .06).
DISCUSSION
Simulation-based modules on performance of colposcopy and LEEP significantly increased resident learner comfort in the performance of these procedures. Comfort in performing these procedures is important in providing comprehensive gynecologic care.
Topics: Pregnancy; Female; Humans; Colposcopy; Electrosurgery; Computer Simulation; Obstetrics; Pelvis
PubMed: 37691878
DOI: 10.15766/mep_2374-8265.11344 -
Paediatrics & Child Health Oct 2021Procedural practice by paediatricians in Canada is evolving. Little empirical information is available on the procedural competencies required of general paediatricians....
BACKGROUND AND OBJECTIVES
Procedural practice by paediatricians in Canada is evolving. Little empirical information is available on the procedural competencies required of general paediatricians. Accordingly, the aim of this study was to conduct a needs assessment of Canadian general paediatricians to identify procedural skills required for practice, with the goal of informing post-graduate and continuing medical education.
METHODS
A survey was sent to paediatricians through the Canadian Paediatric Surveillance Program (CPSP) (www.cpsp.cps.ca/surveillance). In addition to demographic information about practice type and location, participants were asked to indicate the frequency with which they performed each of 32 pre-selected procedures and whether each procedure was considered essential to their practice.
RESULTS
The survey response rate was 33.2% (938/2,822). Data from participants who primarily practice general paediatrics were analyzed (n=481). Of these, 71.0% reported performing procedures. The most frequently performed procedures were: bag-valve-mask ventilation of an infant, lumbar puncture, and ear curettage, being performed monthly by 40.8%, 34.1%, and 27.7% of paediatricians, respectively. The procedures performed by most paediatricians were also those found most essential to practice, with a few exceptions. Respondents performed infant airway procedures with greater frequency and rated them more essential when compared to the same skill performed on children. We found a negative correlation between procedures being performed and difficulty maintaining proficiency in a skill.
CONCLUSIONS
This report of experiences from Canadian general paediatricians suggests a wide variability in the frequency of procedural performance. It helps establish priorities for post-graduate and continuing professional medical education curricula in the era of competency-based medical education.
PubMed: 36874401
DOI: 10.1093/pch/pxaa103 -
PRiMER (Leawood, Kan.) 2022Performing clinical procedures is an essential component of family medicine (FM) residency training. A referral-based procedure clinic was established at our institution...
INTRODUCTION
Performing clinical procedures is an essential component of family medicine (FM) residency training. A referral-based procedure clinic was established at our institution in 2014, and a yearly 2-week rotation was established for residents. The objective of this study was to determine the effect of a procedure clinic rotation on the numbers of procedures performed during residency training.
METHODS
We conducted a retrospective review on graduating FM residents from 2009 to 2019. Data collected include type and number of procedures performed each postgraduate year. We analyzed data as mean number of procedures per resident per year. We conducted statistical comparison with Wilcoxon-Mann-Whitney two-sample rank-sum tests.
RESULTS
Residents who participated in the procedure clinic rotation performed significantly more dermatologic procedures per year, joint and soft tissue injections and intrauterine device (IUD) insertions and removals, but did not perform significantly more circumcisions, endometrial biopsies, incision and drainages, subdermal contraceptive implant procedures, toenail removals, or vasectomies.
CONCLUSION
The establishment of a 2-week procedure clinic rotation for FM residents was associated with a significant increase in dermatologic procedures, joint and soft tissue injections, and IUD procedures. Further research can explore the impact of this rotation on procedural competency and confidence.
PubMed: 35812790
DOI: 10.22454/PRiMER.2022.962965 -
Research Synthesis Methods May 2023We developed metadta, a flexible, robust, and user-friendly statistical procedure that fuses established and innovative statistical methods for meta-analysis,... (Meta-Analysis)
Meta-Analysis Review
We developed metadta, a flexible, robust, and user-friendly statistical procedure that fuses established and innovative statistical methods for meta-analysis, meta-regression, and network meta-analysis of diagnostic test accuracy studies in Stata. Using data from published meta-analyses, we validate metadta by comparing and contrasting its features and output to popular procedures dedicated to the meta-analysis of diagnostic test accuracy studies; (midas [Stata], metandi [Stata], metaDTA [web application], mada [R], and MetaDAS [SAS]). We also demonstrate how to perform network meta-analysis with metadta, for which no alternative procedure is dedicated to network meta-analysis of diagnostic test accuracy data in the frequentist framework. metadta generated consistent estimates in simple and complex diagnostic test accuracy data sets. We expect its availability to stimulate better statistical practice in the evidence synthesis of diagnostic test accuracy studies.
Topics: Software; Research Design; Network Meta-Analysis; Diagnostic Tests, Routine
PubMed: 36999350
DOI: 10.1002/jrsm.1634 -
Thoracic Surgery Clinics Nov 2019Failure to recognize a short esophagus during paraesophageal hernia repair can lead to poor functional outcomes and increased recurrence rates. Diagnosis is usually done... (Review)
Review
Failure to recognize a short esophagus during paraesophageal hernia repair can lead to poor functional outcomes and increased recurrence rates. Diagnosis is usually done intraoperatively when less than 2 to 3 cm of esophagus lie in the intraabdominal position. If aggressive esophageal mediastinal mobilization is unable to lengthen the esophagus, the surgeon should perform an esophageal lengthening procedure. A modified Collis gastroplasty is most commonly used and can be performed through a variety of transabdominal or transthoracic approaches. These procedures are safe, durable, and associated with good long-term outcomes. Patient selection and safe surgical technique are key in avoiding complications.
Topics: Esophagus; Fundoplication; Gastroplasty; Hernia, Hiatal; Herniorrhaphy; Humans; Laparoscopy; Mediastinum; Organ Size; Patient Selection
PubMed: 31564395
DOI: 10.1016/j.thorsurg.2019.07.004 -
Journal of Reconstructive Microsurgery Nov 2023Preparation of the recipient vessels is a crucial step in autologous breast reconstruction, with limited opportunity for resident training intraoperatively. The...
BACKGROUND
Preparation of the recipient vessels is a crucial step in autologous breast reconstruction, with limited opportunity for resident training intraoperatively. The Blue-Blood-infused porcine chest wall-a cadaveric pig thorax embedded in a mannequin shell, connected to a saline perfusion system-is a novel, cost-effective ($55) simulator of internal mammary artery (IMA) dissection and anastomosis intended to improve resident's comfort, safety, and expertise with all steps of this procedure. The purpose of this study was to assess the effect of the use of this chest wall model on resident's confidence in performing dissection and anastomosis of the IMA, as well as obtain resident's and faculty's perspectives on model realism and utility.
METHODS
Plastic surgery residents and microsurgery faculty at the University of Wisconsin were invited to participate. One expert microsurgeon led individual training sessions and performed as the microsurgical assistant. Participants anonymously completed surveys prior to and immediately following their training session to assess their change in confidence performing the procedure, as well as their perception of model realism and utility as a formal microsurgical training tool on a five-point scale.
RESULTS
Every participant saw improvement in confidence after their training session in a minimum of one of seven key procedural steps identified. Of participants who had experience with this procedure in humans, the majority rated model anatomy and performance of key procedural steps as "very" or "extremely" realistic as compared with humans. 100% of participants believed practice with this model would improve residents' ability to perform this operation in the operating room and 100% of participants would recommend this model be incorporated into the microsurgical training curriculum.
CONCLUSION
The Blue-Blood porcine chest wall simulator increases trainee confidence in performing key steps of IMA dissection and anastomosis and is perceived as valuable to residents and faculty alike.
Topics: Humans; Swine; Animals; Internship and Residency; Clinical Competence; Education, Medical, Graduate; Simulation Training; Thorax
PubMed: 36931312
DOI: 10.1055/a-2057-0766 -
ALTEX 2021The use of in vitro assays to inform decision-making requires robust and reproducible results across studies, laboratories, and time. Experiments using positive control...
The use of in vitro assays to inform decision-making requires robust and reproducible results across studies, laboratories, and time. Experiments using positive control materials are an integral component of an assay procedure to demonstrate the extent to which the measurement system is performing as expected. This paper reviews ten characteristics that should be considered when selecting a positive control material for an in vitro assay: 1) the biological mechanism of action, 2) ease of preparation, 3) chemical purity, 4) verifiable physical properties, 5) stability, 6) ability to generate responses spanning the dynamic range of the assay, 7) technical or biological interference, 8) commercial availability, 9) user toxicity, and 10) disposability. Examples and a case study of the monocyte activation test are provided to demonstrate the application of these characteristics for identification and selection of potential positive control materials. Because specific positive control materials are often written into testing standards for in vitro assays, selection of the positive control material based on these characteristics can aid in ensuring the long-term relevance and usability of these standards.
Topics: Biological Assay; Laboratories; Research Design
PubMed: 33637998
DOI: 10.14573/altex.2102111 -
Journal of Robotic Surgery Aug 2023RAPN training usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee capacity to perform RAPN...
RAPN training usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee capacity to perform RAPN at predetermined performance levels prior to in-vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes. The authors sought to examine the reliability, construct and discriminative validity of objective intraoperative performance metrics which best characterize the optimal and suboptimal performance of a reference approach for training novice RAPN surgeons. Seven Novice and 9 Experienced RAPN surgeons video recorded one or two independently performed RAPN procedures in the human. The videos were anonymized and two experienced urology surgeons were trained to reliably score RAPN performance, using previously developed metrics. The assessors were blinded to the performing surgeon, hospital and surgeon group. They independently scored surgeon RAPN performance. Novice and Experienced group performance scores were compared for procedure steps completed and errors made. Each group was divided at the median for Total Errors score, and subgroup scores (i.e., Novice HiErrs and LoErrs, Experienced HiErrs and LoErrs) were compared. The mean inter-rater reliability (IRR) for scoring was 0.95 (range 0.84-1). Compared with Novices, Experienced RAPN surgeons made 69% fewer procedural Total Errors. This difference was accentuated when the LoErr Expert RAPN surgeon's performance was compared with the HiErrs Novice RAPN surgeon's performance with an observed 170% fewer Total Errors. GEARS showed poor reliability (Mean IRR = 0.44; range 0.0-0.8), for scoring RAPN surgical performance. The RAPN procedure metrics reliably distinguish Novice and Experienced surgeon performances. They further differentiated performance levels within a group with similar experiences. Reliable and valid metrics will underpin quality-assured novice RAPN surgical training.
Topics: Humans; Robotic Surgical Procedures; Robotics; Reproducibility of Results; Surgeons; Clinical Competence; Nephrectomy
PubMed: 36689078
DOI: 10.1007/s11701-023-01521-1