Category: Statistics

Clin Teach. 2021 Aug 22. doi: 10.1111/tct.13411. Online ahead of print.

ABSTRACT

BACKGROUND: The Clinical Teacher Training (CTT) programme was originally developed as an interprofessional, blended learning programme, to support health professionals working across health services within Australia, although it has also been delivered internationally. With the disruption of COVID-19, we rapidly moved to ‘online only’ delivery. We sought to modify the programme, ensuring that the constructivist paradigms important for our learner experience through the original blended format were maintained in the online platform.

APPROACH: Consisting of 10 modules on a range of topics, the new CTT online only programme was facilitated online across 6 weeks with asynchronous and synchronous assessable activities, and provision of peer and facilitator feedback. The learning outcomes for each module were similar to the ‘blended learning’ format. The new programme was delivered three times throughout 2020 and completed by a total of 208 health professionals from across 10 metropolitan and rural health districts.

EVALUATION: The focus of our evaluation was on the programme’s final 2020 iteration, for which we had ethics approval. Participants (n = 59) were from diverse health professions, across five metropolitan and rural health districts. We prioritised the learner experience in constructing our evaluation strategy. Quantitative and qualitative data were collected by post-course questionnaire and analysed using descriptive statistics and thematic analysis. Twenty participants (34%) responded to the post-course questionnaire. Participants valued the structure, topics, clear outcomes, timeframe, online resources, small group activities, feedback and the flexibility and accessibility afforded by online only delivery. However, participants identified a need for additional ‘real-time’ engagement in activities. Faculty were surprised by the time required to adequately facilitate online learning, and similarly, valued the real-time interactions.

IMPLICATIONS: The online only CTT programme provided an excellent, scalable framework to ensure continued provision of a relevant and accessible training resource for clinicians working in metropolitan and regional/rural health services. Learner-reported achievement of programme learning outcomes was not negatively impacted by online only delivery. Balancing these resource advantages with learner preferences and our desire to build active teaching networks, we will continue to host the majority of the programme online, while offering short face-to-face sessions within local contexts.

PMID:34423533 | DOI:10.1111/tct.13411

Andrology. 2021 Aug 22. doi: 10.1111/andr.13101. Online ahead of print.

ABSTRACT

BACKGROUND: Testicular MRI parameters, including apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized metabolite concentrations represent useful noninvasive fingerprints of nonobstructive azoospermia (NOA). NOA etiology might correlate with the spermatogenesis status.

OBJECTIVES: To assess possible association between apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and metabolite concentrations with NOA etiology.

MATERIALS AND METHODS: This retrospective study included 48 consecutive men with NOA and 18 age-matched controls. All participants underwent scrotal MRI. Testicular apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized metabolite concentrations were calculated. NOA men were classified into three groups, based on etiology: group 1, idiopathic; group 2, genetic causes; and, group 3, non-genetic causes. Parametric and nonparametric statistical tests were used to evaluate differences in MRI parameters between NOA groups and normal testes (group 4). Regression analysis was performed to assess the most predictive MRI factor of NOA etiology.

RESULTS: Differences in mean apparent diffusion coefficient (P < .001), fractional anisotropy (P < .001), magnetization transfer ratio (P < .001), and normalized concentrations of total choline (P = .005), glucose (P = .012), myo-inositol (P = .024), and lipids (P = .010) were observed among groups. Regression analysis failed to identify the most discriminating MRI feature for NOA etiology.

DISCUSSION AND CONCLUSION: Apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio and normalized concentrations of total choline, glucose, myo-inositol, and lipids are helpful in discriminating NOA etiology. MRI may provide useful, noninvasive information on microstructural and biochemical milieu of NOA testes. This article is protected by copyright. All rights reserved.

PMID:34423558 | DOI:10.1111/andr.13101

J Occup Health. 2021 Jan;63(1):e12270. doi: 10.1002/1348-9585.12270.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effectiveness and feasibility of functional movement screen (FMS) evaluation system and individualized intervention measures in preventing military training injuries.

METHODS: A total of 420 recruits from a unit of the People’s Liberation Army of China were included as the research object. According to random grouping method, they were divided into observation group (Group A) and control group (Group B), with 210 patients in each group. Before recruit training, individual FMS was performed, and functional correction training was performed in the observation group according to the test scores, while no intervention measures were applied in the control group. After 3 months of training, the tests were repeated. Age, body mass index (BMI), and incidence of military training injuries were recorded during the training period.

RESULTS: There was no statistical difference between the two groups in age, BMI, FMS score before the training (P > .05). After receiving functional correction training, the FMS score of the Group A was higher than that of the Group B, and the difference was statistically significant (P < .05). The incidence of military training injury in Group A and Group B was 20.95% and 44.02%, respectively (P < .05), and the difference was statistically significant.

CONCLUSION: The evaluation system of FMS and individualized intervention measures are feasible and effective in predicting and reducing the occurrence of military training injuries.

PMID:34423506 | DOI:10.1002/1348-9585.12270

Dermatol Ther. 2021 Aug 22. doi: 10.1111/dth.15107. Online ahead of print.

ABSTRACT

Recently, topical Tranexamic acid (TXA) has been used in melasma management. On detail search of literature, this may be the first study assessing efficacy on combining of Topical TXA with GA peel in melasma. To assess efficacy, safety and improvement in quality of life index on combining 30% GA peel with 5% TXA solution topically in melasma of epidermal type. 60 patients of epidermal melasma were categorised into two groups: Combination group were treated with 30% GA peel at 2 weekly intervals with 5% TXA solution applied twice daily and Control group were treated with only 30% GA peel every 2 weeks for 12 weeks. Melasma area severity index (MASI) was used for assessing clinical improvement. Hi-MELASQOL and HRQOL scales were used to measure Melasma related quality of life and were compared between both groups. At each visit adverse effects were noted. A significantly decreasing trend was seen regarding the MASI score when compared within the group, but the difference was statistically not significant between the two groups at 12 weeks. Similarly, there was significant improvement in Hi-MELASQOL and HRQOL in both the groups, but the difference between them was statistically not significant. Side effects experienced by patients in both groups were trivial and did not requiring stoppage of therapy. Topical TXA with GA peel has comparable result with GA peel alone, but the therapeutic response was achieved in patients of combination group earlier in comparison to control group patients. This article is protected by copyright. All rights reserved.

PMID:34423510 | DOI:10.1111/dth.15107

J Clin Nurs. 2021 Aug 22. doi: 10.1111/jocn.15996. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: This study introduced simulation-based education in nurse education programs in Tanzania and Madagascar and explored nursing students’ experiences with this pedagogic method as a mode of learning.

BACKGROUND: Simulation-based education has barely been introduced to education programs in resource-constrained settings. The study was conducted in two nurse education programs: one in rural Tanzania and the other in the mid-land of Madagascar. Both institutions offer diploma programs in nursing. Simulation-based education has not been included in the teaching methods used in these nursing programs.

DESIGN: A descriptive and convergent mixed method design was employed.

METHODS: Ninety-nine nursing students were included in the study. Simulation sessions followed by data collection took place once in 2017 and twice in 2018. Data were collected by means of several questionnaires and six focus groups. The data were analyzed using descriptive statistics and qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) was used to report the results.

RESULTS: The quantitative data revealed that the students rated all the questions related to the simulation design elements, educational practices, and students’ satisfaction and self-confidence in learning with scores of above four on a 5-point Likert scale. The qualitative data from the first theme, building competence and confidence, further emphasized and outlined the quantitative results. Additionally, the qualitative data revealed a second theme, improving through encouragement and corrections. The students clearly expressed that they wanted to be aware of their weaknesses to be able to improve; however, the provision of feedback should be carried out in an encouraging way.

CONCLUSION: The findings indicated that the nursing students were satisfied with simulation as a pedagogic method, as it improved their competence and prepared them for professional practice. Further research is necessary to explore whether the students are able to transfer their knowledge into clinical practice.

RELEVANCE TO CLINICAL PRACTICE: Simulation as a pedagogic method is valuable for the learning of clinical skills and preparation for clinical practice.

PMID:34423486 | DOI:10.1111/jocn.15996

Oncologist. 2021 Aug 22. doi: 10.1002/onco.13949. Online ahead of print.

ABSTRACT

LESSONS LEARNED: Long-term safety of radium-223 with enzalutamide was confirmed in this clinical trial. PSA-PFS2 was prolonged with the combination compared with enzalutamide alone.

BACKGROUND: Previously, we showed the combination of radium-223 and enzalutamide to be safe and associated with improved efficacy based on a concomitant decline in serum bone metabolism markers compared with enzalutamide alone in a phase II trial of men with metastatic castration resistant prostate cancer (mCRPC) [1].

METHODS: Secondary endpoints were not included in our initial report, and we include them herein, after a median follow-up of 22 months. These objectives included long term safety, PSA progression-free survival (PFS), and radiographic progression-free survival ; PSA-PFS2 (time from start of protocol therapy to PSA progression on subsequent therapy); time to next subsequent therapy (TTNT); and overall survival (OS). Survival analysis and log-rank tests were performed using the R statistical package v.4.0.2 (https://www.r-project.org). Statistical significance was defined as p < .05.

RESULTS: Of 47 patients (median age, 68 years), 35 received the combination and 12 enzalutamide alone. After a median follow-up of 22 months, final safety results did not show any increase in fractures or other adverse events in the combination arm. PSA-PFS2 was significantly improved, and other efficacy parameters were numerically improved in the combination over the enzalutamide arm.

CONCLUSION: The combination of enzalutamide and radium-223 was found to be safe and associated with promising efficacy in men with mCRPC. These hypothesis-generating results portend well for the ongoing phase III PEACE-3 trial in this setting.

PMID:34423501 | DOI:10.1002/onco.13949

J Adv Nurs. 2021 Aug 23. doi: 10.1111/jan.15020. Online ahead of print.

ABSTRACT

AIM: To compare and evaluate operating room nurses’ opinions about robotic surgery with their individual innovativeness metric scores. The aim was also to identify the experiences, adaptation processes and influencing factors of operating room nurses working in robotic surgery rooms in Turkey.

DESIGN: This was a comparative descriptive study.

METHODS: The sample included 114 operating room nurses working in 12 institutions that performed robotic surgery in Turkey. Data were collected between January 2018 and September 2019 using the Demographic Characteristics of Nurses and Robotic Surgery Evaluation Form and the Individual Innovativeness Scale, and were analysed using a quantitative statistical approach (independent samples t-test, one-way analysis of variance and Kruskal-Wallis H test). The data obtained from the Robotic Surgery Evaluation section, which consisted of open-ended and closed-ended questions, were analysed with appropriate steps. In particular, answers to open-ended questions were grouped and coded according to their content.

RESULTS: Operating room nurses held positive opinions about robotic surgery. Only 35.8% of the nurses had received training before joining the robotic team, while 55.2% had individually searched for information. Operating room nurses with robotic surgery experience had significantly higher (p < .001) individual innovativeness scores. Over 85% of nurses who received training adapted to robotic surgery in 3 months or less, while nurses with higher individual innovativeness scores adapted in a statistically significantly (p < .05) shorter period. Training, teamwork, and practical experience were mentioned as facilitating factors; inadequate training and technical problems were reported as obstructing factors.

CONCLUSION: Operating room nurses hold positive opinions about robotic surgery; nurses with robotic surgery experience have higher levels of individual innovativeness; and nurses who have received training are significantly better adapted.

IMPACT: What problem did the study address? This study addresses the need for a better understanding of operating room nurses’ opinions and experiences about robotic surgery and the influencing factors of adapting to it. This study also offers an evaluation and comparison of the nurses’ individual innovativeness characteristics and the correlation with their adaptation processes to the new role. What were the main findings? The main findings show a correlation between specific education/training and nurses’ adaptation to the new role of robotic surgery, the individual innovativeness characteristics metric of nurses with or without robotic surgery experience and the time frame of their adaptation. Where and on whom will the research have an impact? This research traces the profile of current operating room nurses working in the robotic surgery field and the factors influencing their experience. These findings and conclusions have a much broader impact than in Turkey alone. The findings raise awareness of the importance of educating and preparing operating room nurses before introducing them to the new roles and responsibilities inherent to robotic surgery.

PMID:34423468 | DOI:10.1111/jan.15020

J Card Surg. 2021 Aug 21. doi: 10.1111/jocs.15933. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of the present study is to explore the effect of different feeding intervals on the feeding outcomes of infants who underwent ventricular septal defect (VSD) closure.

METHODS: This study is a prospective, randomized controlled trial conducted by a provincial hospital in China. According to different feeding intervals, 78 eligible participants were randomly divided into Group A (2-h interval, n = 39) and Group B (3-h interval, n = 39). The basic clinical data, total feeding time, incidence of feeding intolerance, and nurse job satisfaction scores of the two groups were collected.

RESULTS: The total feeding time in Group A was significantly longer than that in Group B (142.5 ± 15.4 vs. 132.0 ± 16.1 min/d, p = .020). The nurse job satisfaction scores in Group A were significantly lower than those in Group B (101.7 ± 9.8 vs. 108.8 ± 10.1, p = .005). There were no significant differences in the duration of mechanical ventilation (3.7 ± 1.1 vs. 3.9 ± 1.0 d, p = .272), length of ICU stay (4.5 ± 1.1 d vs. 4.7 ± 0.9 d, p = .451), or length of hospital stay (13.2 ± 1.4 vs. 13.3 ± 1.0 d, p = .642) between the two groups. Although the incidence of feeding intolerance in Group A was slightly lower than that in Group B, the difference was not statistically significant.

CONCLUSION: Feeding at an interval of 2 or 3 h has no significant effect on the feeding outcomes of infants, and feeding at intervals of 3 h can reduce nurses’ workload and improve nursing job satisfaction.

PMID:34423474 | DOI:10.1111/jocs.15933

J Card Surg. 2021 Aug 22. doi: 10.1111/jocs.15931. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess postoperative and long-term outcomes of patients receiving either pericardial or synthetic repairs.

METHODS: We conducted a single-center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N = 38) with either autologous pericardium (n = 30) or CorMatrix (n = 8) between April 2009 and July 2016. Short- and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan-Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, postoperatively, and at outpatient follow-up.

RESULTS: At 5 years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (p = .01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between preoperative and postoperative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) postoperatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, eight (100%) had moderate to severe AR which improved to three (38%) postoperatively and increased to seven (88%) at time of follow-up.

CONCLUSION: In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.

PMID:34423475 | DOI:10.1111/jocs.15931

Dev Med Child Neurol. 2021 Aug 22. doi: 10.1111/dmcn.15022. Online ahead of print.

ABSTRACT

Prospective parents whose fetus is diagnosed with a neurological anomaly go through a complex range of emotions. They describe their discussions of antenatal counselling from health care professionals as focusing too much on the nature of the anomaly involving unintelligible medical terminology, when what they really want is a picture of the best- and worst-case scenarios. Whilst information on the level of risk for their fetus is important, it is not the parents’ primary concern. When statistics for risk are given, they may not be as well understood as the health care professionals think. This review discusses the published evidence on antenatal counselling and recommendations for explaining risk to parents of fetuses with neurological anomalies. From this data we make recommendations for the organization of antenatal counselling services.

PMID:34423423 | DOI:10.1111/dmcn.15022