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BMJ Open Nov 2022Rapid sequence intubation (RSI) is an advanced airway technique to perform endotracheal intubation in patients at high risk of aspiration. Although RSI is recognised as...
INTRODUCTION
Rapid sequence intubation (RSI) is an advanced airway technique to perform endotracheal intubation in patients at high risk of aspiration. Although RSI is recognised as a life-saving technique and performed by many physicians in various settings (emergency departments, intensive care units), there is still a lack of consensus on various features of the procedure, most notably patient positioning. Previously, experts have commented on the unique drawbacks and benefits of various positions and studies have been published comparing patient positions and how it can affect endotracheal intubation in the context of RSI. The purpose of this systematic review is to compile the existing evidence to understand and compare how different patient positions can potentially affect the success of RSI.
METHODS AND ANALYSIS
We will use MEDLINE, EMBASE and the Cochrane Library to source studies from 1946 to 2021 that evaluate the impact of patient positioning on endotracheal intubation in the context of RSI. We will include randomised control trials, case-control studies, prospective/retrospective cohort studies and mannequin simulation studies for consideration in this systematic review. Subsequently, we will generate a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram to display how we selected our final studies for inclusion in the review. Two independent reviewers will complete the study screening, selection and extraction, with a third reviewer available to address any conflicts. The reviewers will extract this data in accordance with our outcomes of interest and display it in a table format to highlight patient-relevant outcomes and difficulty airway management outcomes. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to assess included studies for bias.
ETHICS AND DISSEMINATION
This systematic review does not require ethics approval, as all patient-centred data will be reported from published studies.
PROSPERO REGISTRATION NUMBER
CRD42022289773.
Topics: Humans; Intubation, Intratracheal; Patient Positioning; Prospective Studies; Rapid Sequence Induction and Intubation; Research Design; Retrospective Studies; Systematic Reviews as Topic; Randomized Controlled Trials as Topic
PubMed: 36332945
DOI: 10.1136/bmjopen-2022-062988 -
BMJ Open Jul 2023Decisions regarding the optimal vascular access for haemodialysis patients are becoming increasingly complex, and the provision of vascular access is open to variations...
INTRODUCTION
Decisions regarding the optimal vascular access for haemodialysis patients are becoming increasingly complex, and the provision of vascular access is open to variations in systems of care as well as surgical experience and practice. Two main surgical options are recognised: arteriovenous fistula and arteriovenous graft (AVG). All recommendations regarding AVG are based on a limited number of randomised controlled trials (RCTs). It is essential that when considering an RCT of a surgical procedure, an appropriate definition of quality assurance (QA) is made for both the new approach and the comparator, otherwise replication of results or implementation into clinical practice may differ from published results. The aim of this systematic review will be to assess the methodological quality of RCT involving AVG, and the QA measures implemented in delivering interventions in these trials.
METHODS AND ANALYSIS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. A systematic search will be performed of the MEDLINE, Embase and Cochrane databases to identify relevant literature. Studies will be selected by title and abstract review, followed by a full-text review using inclusion and exclusion criteria. Data collected will pertain to generic measures of QA, credentialing of investigators, procedural standardisation and performance monitoring. Trial methodology will be compared against a standardised template developed by a multinational, multispecialty review body with experience in vascular access. A narrative approach will be taken to synthesise and report data.
ETHICS AND DISSEMINATION
Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations, with the ultimate aim of providing recommendations for future RCT of AVG design.
Topics: Humans; Renal Dialysis; Publications; Text Messaging; Research Design; Systematic Reviews as Topic
PubMed: 37419647
DOI: 10.1136/bmjopen-2023-071646 -
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 -
Research Synthesis Methods Dec 2019Although dual independent review of search results by two reviewers is generally recommended for systematic reviews, there are not consistent recommendations regarding...
BACKGROUND
Although dual independent review of search results by two reviewers is generally recommended for systematic reviews, there are not consistent recommendations regarding the timing of the use of the second reviewer. This study compared the use of a complete dual review approach, with two reviewers in both the title/abstract screening stage and the full-text screening stage, as compared with a limited dual review approach, with two reviewers only in the full-text stage.
METHODS
This study was performed within the context of a large systematic review. Two reviewers performed a complete dual review of 15 000 search results and a limited dual review of 15 000 search results. The number of relevant studies mistakenly excluded by highly experienced reviewers in the complete dual review was compared with the number mistakenly excluded during the full-text stage of the limited dual review.
RESULTS
In the complete dual review approach, an additional 6.6% to 9.1% of eligible studies were identified during the title/abstract stage by using two reviewers, and an additional 6.6% to 11.9% of eligible studies were identified during the full-text stage by using two reviewers. In the limited dual review approach, an additional 4.4% to 5.3% of eligible studies were identified with the use of two reviewers.
CONCLUSIONS
Using a second reviewer throughout the entire study screening process can increase the number of relevant studies identified for use in a systematic review. Systematic review performers should consider using a complete dual review process to ensure all relevant studies are included in their review.
Topics: Algorithms; Databases, Bibliographic; Humans; Information Storage and Retrieval; Observer Variation; Periodicals as Topic; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Systematic Reviews as Topic
PubMed: 31272125
DOI: 10.1002/jrsm.1369 -
BMJ Open Oct 2021Three-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional medical...
INTRODUCTION
Three-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training, as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research.
METHODS AND ANALYSIS
The protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy was developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1 June 2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789).Two independent reviewers will screen titles, abstracts and perform full-text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis will be performed.
ETHICS AND DISSEMINATION
Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences.
REGISTRATION DETAILS
The scoping review protocol has been registered on the Open Science Framework (https://osf.io/ta789).
Topics: Delivery of Health Care; Humans; Peer Review; Research Design; Review Literature as Topic
PubMed: 34620652
DOI: 10.1136/bmjopen-2020-045546 -
The Journal of Sexual Medicine Apr 2022Despite an increasing number of publications on Peyronie's disease (PD), evidence-based clinical decision-making remains challenging due to the small number of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite an increasing number of publications on Peyronie's disease (PD), evidence-based clinical decision-making remains challenging due to the small number of well-designed clinical trials.
AIM
To perform a critical analysis of reporting quality in PD systematic reviews (SR) and meta-analyses (MA).
METHODS
Study protocol registration was performed on the Open Science Framework platform. In January 2021, a systematic electronic search of the Medline/PubMed, Embase, Ovid, Scopus, Joanne Briggs Institute, and Cochrane databases was performed. Search terms included "Peyronie's disease" and "systematic review OR meta-analysis OR meta-analysis." Eligibility criteria were English-language, relevance to PD and specification of "systematic review" or "meta-analysis" in the title or abstract. Oxford Center for Evidence-Based Medicine levels of evidence were used to classify original studies reviewed within each publication. Risk of bias was assessed using the ROBIS tool. Data were tabulated and reported as means with standard deviation, median with interquartile range and t-testing as appropriate. Strength of association between variables was calculated using Pearson correlation coefficient. Statistical analyses were performed on RStudio (version 1.4.1106).
OUTCOMES
Outcomes included review type, level of evidence, authorship, journal, publication date, "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR-2) score and "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) score.
RESULTS
From 1974 to 2021, 340 articles were identified. After review, 17 full length articles were included. Thirteen were SR, 2 MA and 2 was combined. Significant heterogeneity was seen in evidence level of included studies. There was median 54% adherence to AMSTAR-2 criteria and 74% adherence to PRISMA criteria. Overall AMSTAR-2 confidence rating was Critically Low in 11 of 17 studies. Correlation analysis revealed very high positive association between AMSTAR 2 and PRISMA adherence (+0.95). ROBIS revealed "High" concern regarding methods used to collect data and appraise 12/17 studies (71%), and "High" concern regarding synthesis and findings in 8 of 17 studies (47%).
CLINICAL IMPLICATIONS
Many SR include markedly heterogenous levels of evidence and fail to meet accepted methodological criteria for reporting.
STRENGTHS AND LIMITATIONS
Main strengths include extensive literature review and analysis of standardized study reporting. One limitation is that aggregate scoring of AMSTAR-2 and PRISMA is not intended as primary method of quality assessment; however effect was minimized by reporting critical domains, overall quality assessments and specifics on globally poorly reported domains.
CONCLUSION
More high quality randomized controlled PD trials are necessary; SR and MA should focus on these studies alone. Bole R, Gottlich HC, Ziegelmann MJ, et al. A Critical Analysis of Reporting in Systematic Reviews and Meta-Analyses in the Peyronie's Disease Literature. J Sex Med 2022;19:629-640.
Topics: Bibliometrics; Evidence-Based Medicine; Humans; Male; Meta-Analysis as Topic; Penile Induration; Research Design; Systematic Reviews as Topic
PubMed: 35177375
DOI: 10.1016/j.jsxm.2022.01.008 -
JAMA Network Open Feb 2022Limited data exist regarding the characteristics of hospitals that do and do not participate in voluntary public reporting programs.
IMPORTANCE
Limited data exist regarding the characteristics of hospitals that do and do not participate in voluntary public reporting programs.
OBJECTIVE
To describe hospital characteristics and trends associated with early participation in the American College of Cardiology (ACC) voluntary reporting program for cardiac catheterization-percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study analyzed enrollment trends and characteristics of hospitals that did and did not participate in the ACC voluntary public reporting program. All hospitals reporting procedure data to the National Cardiovascular Data Registry (NCDR) CathPCI or ICD registries that were eligible for the public reporting program from July 2014 (ie, program launch date) to May 2017 were included. Stepwise logistic regression was used to identify hospital characteristics associated with voluntary participation. Enrollment trends were evaluated considering the date US News & World Report (USNWR) announced that it would credit participating hospitals. Data analysis was performed from March 2017 to January 2018.
MAIN OUTCOMES AND MEASURES
Hospital characteristics and participation in the public reporting program.
RESULTS
By May 2017, 561 of 1747 eligible hospitals (32.1%) had opted to participate in the program. Enrollment increased from 240 to 376 hospitals (56.7%) 1 month after the USNWR announcement that program participation would be considered as a component of national hospital rankings. Compared with hospitals that did not enroll, program participants had increased median (IQR) procedural volumes for PCI (481 [280-764] procedures vs 332 [186-569] procedures; P < .001) and ICD (114 [56-220] procedures vs 62 [25-124] procedures; P < .001). Compared with nonparticipating hospitals, an increased mean (SD) proportion of participating hospitals adhered to composite discharge medications after PCI (0.96 [0.03] vs 0.92 [0.07]; P < .001) and ICD (0.88 [0.10] vs 0.81 [0.12]; P < .001). Hospital factors associated with enrollment included participation in 5 or more NCDR registries (odds ratio [OR],1.98; 95% CI, 1.24-3.19; P = .005), membership in a larger hospital system (ie, 3-20 hospitals vs ≤2 hospitals in the system: OR, 2.29; 95% CI, 1.65-3.17; P = .001), participation in an NCDR pilot public reporting program of PCI 30-day readmissions (OR, 2.93; 95% CI, 2.19-3.91; P < .001), university affiliation (vs government affiliation: OR, 3.85, 95% CI, 1.03-14.29; P = .045; vs private affiliation: OR, 2.22; 95% CI, 1.35-3.57; P < .001), Midwest location (vs South: OR, 1.47; 95% CI, 1.06-2.08; P = .02), and increased comprehensive quality ranking (4 vs 1-2 performance stars in CathPCI: OR, 8.08; 95% CI, 5.07-12.87; P < .001; 4 vs 1 performance star in ICD: OR, 2.26; 95% CI, 1.48-3.44; P < .001) (C statistic = 0.829).
CONCLUSIONS AND RELEVANCE
This study found that one-third of eligible hospitals participated in the ACC voluntary public reporting program and that enrollment increased after the announcement that program participation would be considered by USNWR for hospital rankings. Several hospital characteristics, experience with public reporting, and quality of care were associated with increased odds of participation.
Topics: Cardiac Catheterization; Cardiology; Cross-Sectional Studies; Defibrillators, Implantable; Female; Forecasting; Hospitals; Humans; Male; Percutaneous Coronary Intervention; Research Design; United States
PubMed: 35142829
DOI: 10.1001/jamanetworkopen.2021.47903 -
The Journal of Investigative Dermatology Feb 2021Qualitative research has gained increasing prominence in health-related research and is experiencing greater use in dermatology. A major strength of and reason to...
Qualitative research has gained increasing prominence in health-related research and is experiencing greater use in dermatology. A major strength of and reason to perform qualitative research is that it allows one to gain an understanding of the insider (e.g., patient, medical provider, other players in the healthcare system) perspectives on health and insights about their behaviors, motivations, and expectations. This is particularly important in the field of dermatology where most diseases are, fortunately, not directly fatal but have major effects on affected individuals' lives in ways that are often not readily quantifiable. As such, it is important for dermatologists, both researchers and clinicians, to understand the basic tenets of qualitative methodology to properly utilize qualitative methods, evaluate the qualitative literature, and identify relevant findings to apply to clinical practice. In this article, we provide an overview of qualitative research and some of the more commonly used qualitative methods with an aim to increase awareness and appreciation of the power of qualitative studies.
Topics: Data Analysis; Data Collection; Dermatology; Humans; Qualitative Research; Research Design; Sample Size
PubMed: 33504436
DOI: 10.1016/j.jid.2020.11.029 -
BMC Medical Research Methodology Oct 2023Growth studies rely on longitudinal measurements, typically represented as trajectories. However, anthropometry is prone to errors that can generate outliers. While...
BACKGROUND
Growth studies rely on longitudinal measurements, typically represented as trajectories. However, anthropometry is prone to errors that can generate outliers. While various methods are available for detecting outlier measurements, a gold standard has yet to be identified, and there is no established method for outlying trajectories. Thus, outlier types and their effects on growth pattern detection still need to be investigated. This work aimed to assess the performance of six methods at detecting different types of outliers, propose two novel methods for outlier trajectory detection and evaluate how outliers affect growth pattern detection.
METHODS
We included 393 healthy infants from The Applied Research Group for Kids (TARGet Kids!) cohort and 1651 children with severe malnutrition from the co-trimoxazole prophylaxis clinical trial. We injected outliers of three types and six intensities and applied four outlier detection methods for measurements (model-based and World Health Organization cut-offs-based) and two for trajectories. We also assessed growth pattern detection before and after outlier injection using time series clustering and latent class mixed models. Error type, intensity, and population affected method performance.
RESULTS
Model-based outlier detection methods performed best for measurements with precision between 5.72-99.89%, especially for low and moderate error intensities. The clustering-based outlier trajectory method had high precision of 14.93-99.12%. Combining methods improved the detection rate to 21.82% in outlier measurements. Finally, when comparing growth groups with and without outliers, the outliers were shown to alter group membership by 57.9 -79.04%.
CONCLUSIONS
World Health Organization cut-off-based techniques were shown to perform well in few very particular cases (extreme errors of high intensity), while model-based techniques performed well, especially for moderate errors of low intensity. Clustering-based outlier trajectory detection performed exceptionally well across all types and intensities of errors, indicating a potential strategic change in how outliers in growth data are viewed. Finally, the importance of detecting outliers was shown, given its impact on children growth studies, as demonstrated by comparing results of growth group detection.
Topics: Child; Humans; Cluster Analysis; Research Design; Infant; Child Development
PubMed: 37833647
DOI: 10.1186/s12874-023-02045-w -
Journal of the American Medical... Nov 2019Clinical trials, prospective research studies on human participants carried out by a distributed team of clinical investigators, play a crucial role in the development...
OBJECTIVE
Clinical trials, prospective research studies on human participants carried out by a distributed team of clinical investigators, play a crucial role in the development of new treatments in health care. This is a complex and expensive process where investigators aim to enroll volunteers with predetermined characteristics, administer treatment(s), and collect safety and efficacy data. Therefore, choosing top-enrolling investigators is essential for efficient clinical trial execution and is 1 of the primary drivers of drug development cost.
MATERIALS AND METHODS
To facilitate clinical trials optimization, we propose DeepMatch (DM), a novel approach that builds on top of advances in deep learning. DM is designed to learn from both investigator and trial-related heterogeneous data sources and rank investigators based on their expected enrollment performance on new clinical trials.
RESULTS
Large-scale evaluation conducted on 2618 studies provides evidence that the proposed ranking-based framework improves the current state-of-the-art by up to 19% on ranking investigators and up to 10% on detecting top/bottom performers when recruiting investigators for new clinical trials.
DISCUSSION
The extensive experimental section suggests that DM can provide substantial improvement over current industry standards in several regards: (1) the enrollment potential of the investigator list, (2) the time it takes to generate the list, and (3) data-informed decisions about new investigators.
CONCLUSION
Due to the great significance of the problem at hand, related research efforts are set to shift the paradigm of how investigators are chosen for clinical trials, thereby optimizing and automating them and reducing the cost of new therapies.
Topics: Clinical Trials as Topic; Data Mining; Databases, Factual; Deep Learning; Electronic Health Records; Humans; Insurance Claim Reporting; Patient Selection; Research Personnel
PubMed: 31188432
DOI: 10.1093/jamia/ocz064