Medicine - Journal Articles

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    Behaviour change interventions for physical activity in adults with chronic obstructive pulmonary disease; a systematic review and meta-analysis
    (Elsevier B.V., 2023-11-14) Hanrahan, Ciara; Broderick, Julie; O'Connor, Terence M.; McVeigh, Joseph G.; University College Cork
    Background: Physical activity in adults with COPD is poor, but behaviour change interventions could help improve activity. This systematic review aims to examine behaviour change interventions to promote physical activity and health outcomes for adults with COPD. Methods: Eight databases were searched from inception until February 2022: Web of Science, CENTRAL, MEDLINE, EMBASE, APA PsychINFO, CINAHL, PROSPERO, Cochrane Airways Trials Register. Relevant studies were appraised to determine the impact of behaviour change interventions on physical activity outcomes. Interventions were mapped to Michie's Theoretical Domains Framework (TDF) and a meta-analysis and narrative synthesis conducted. The Cochrane risk of bias tool and the GRADE criteria evaluated bias and the quality and certainty of the evidence. Results: Twelve randomized controlled trials (RCTs) were included in the review (n= 1211). The most frequently utilized behaviour change interventions included counselling, stepcount monitoring, social support and goal setting. The most commonly measured outcomes across studies were steps-per-day, physical activity levels, exercise capacity and quality of life. A meta-analysis of comparable studies demonstrated there was no difference in stepcount in favour of behaviour change interventions with respect to steps-per-day (SMD 0.16, 95% CI -0.03, 0.36; p=0.10). There was some evidence of short-term improvement in physical activity and quality of life, with behaviour change interventions related to goals, behaviour regulation and social influences. Conclusions: People with COPD may benefit from behaviour change interventions to increase physical activity and quality of life in the short-term. The overall certainty and quality of the evidence is low however.
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    Ultrasound assessment of testicular volume - An interobserver variability study
    (Elsevier Inc., 2023-10-12) Roland Vils Pedersen, Malene; Otto, Peter Obel; Fredslund, Mads; Smedegaard, Claus; Jensen, Janni; McEntee, Mark F.; Kastrup Loft, Martina
    Background: Ultrasonography measurement of the testicles and subsequent calculation of the testicular volume is recommended as a part of a standard scrotal ultrasound examination. The interobserver variability of testicular volume measurement has implications for surgical recommendations. Therefore, this study aimed to investigate the interobserver variability in the measurement of testicular volume. Methods: Interobserver variability was established by comparing testicular measurements performed by two observers on the same patient during the same clinical appointment. The observers were blinded to each other's measurements. Testicular volume was calculated using the Lambert formula: length x width x height x 0.71. A total of three observers, A, B and C, participated in the study. The observers had between 4 to 20 years’ experience with scrotal ultrasound examinations. Results: In total, 24 patients’ were included (48 testicles). The patient´s mean age was 43 years (range 19-75 years). The overall mean right testicular volume was 19.8 ml (range 7.3–31.6 ml), and the left was 20.1 ml (range 7.1–36.1 ml). The interclass correlation coefficient (ICC) between observer A and B was excellent (ICC= 0.98, CI:0.92–0.99), between observer A and C, was excellent (ICC=0.91, CI: 0.77–0.97) and between B and C good (ICC=0.82, CI:0.51–0.93). Conclusion: Variability in estimating testicular volume is low, with interobserver agreement ranging from good to excellent. Ultrasound provides a highly reproducible tool to determine testicular volume.
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    Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants
    (Elsevier Inc., 2020-05-13) Rahmani, Jamal; Haghighian Roudsari, Arezoo; Bawadi, Hiba; Thompson, Jacqueline; Khalooei Fard, Razieh; Clark, Cain; Ryan, Paul M.; Ajami, Marjan; Rahimi Sakak, Fatemeh; Salehisahlabadi, Ammar; Abdulazeem, Hebatullah M.; Jamali, Mohammad Reza; Razaz, Jalaledin Mirzay
    Background: The relationship between body mass index (BMI) and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies. Method:A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values. Results: Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29–2.04, I2 = 95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70–0.92, I2 = 9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93–2.60, I2 = 0%). There was a significant linear relationship between BMI and risk of VTE (p < 0.001) and PE (p < 0.001). Conclusions: This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE.
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    Machine learning detects intraventricular haemorrhage in extremely preterm infants
    (MDPI, 2023-05-23) Ashoori, Minoo; O’Toole, John M.; O’Halloran, Ken D.; Naulaers, Gunnar; Thewissen, Liesbeth; Miletin, Jan; Cheung, Po-Yin; EL-Khuffash, Afif; Van Laere, David; Straňák, Zbyněk; Dempsey, Eugene M.; McDonald, Fiona B.; Science Foundation Ireland; Seventh Framework Programme; University College Cork
    Objective: To test the potential utility of applying machine learning methods to regional cerebral (rcSO2) and peripheral oxygen saturation (SpO2) signals to detect brain injury in extremely preterm infants. Study design: A subset of infants enrolled in the Management of Hypotension in Preterm infants (HIP) trial were analysed (n = 46). All eligible infants were <28 weeks’ gestational age and had continuous rcSO2 measurements performed over the first 72 h and cranial ultrasounds performed during the first week after birth. SpO2 data were available for 32 infants. The rcSO2 and SpO2 signals were preprocessed, and prolonged relative desaturations (PRDs; data-driven desaturation in the 2-to-15-min range) were extracted. Numerous quantitative features were extracted from the biosignals before and after the exclusion of the PRDs within the signals. PRDs were also evaluated as a stand-alone feature. A machine learning model was used to detect brain injury (intraventricular haemorrhage-IVH grade II–IV) using a leave-one-out cross-validation approach. Results: The area under the receiver operating characteristic curve (AUC) for the PRD rcSO2 was 0.846 (95% CI: 0.720–0.948), outperforming the rcSO2 threshold approach (AUC 0.593 95% CI 0.399–0.775). Neither the clinical model nor any of the SpO2 models were significantly associated with brain injury. Conclusion: There was a significant association between the data-driven definition of PRDs in rcSO2 and brain injury. Automated analysis of PRDs of the cerebral NIRS signal in extremely preterm infants may aid in better prediction of IVH compared with a threshold-based approach. Further investigation of the definition of the extracted PRDs and an understanding of the physiology underlying these events are required.
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    An investigation of preclinical medical students’ preference for summative or formative assessment for physiology learning
    (American Physiological Society, 2023-06-15) Rae, Mark G.; Abdulla, Mohammed H.
    Both summative and formative assessments are known to facilitate student learning and understanding and help students to identify areas of weakness. However, few studies have investigated students’ preference for either summative or formative evaluations, particularly in the area of preclinical medicine. The current study addresses this deficit by surveying 137 first-year graduate entry to medicine (GEM) preclinical medical students from 2 consecutive years (2018–2019 and 2019–2020), for their thoughts on the 6 summative (i.e., for a small percentage of marks), proctored and the 5 informal, formative (i.e., no marks available) continuous assessments in physiology that they encountered in semesters 1 and 2, respectively. Our survey revealed that between 75 and 90% of students felt that both evaluation formats were roughly equally useful (i.e., selecting options, “agree” or “strongly agree”) both for providing feedback about their understanding of physiology and for identifying deficits in their physiology knowledge. However, although a significantly larger number of students felt that summative evaluations motivated them to study more than the formative evaluations (P = 0.006), overall, more students favored formative over summative assessments. Notably, however, GEM students from nonbiomedical backgrounds were significantly more in favor of summative assessments than those from either biomedical backgrounds (P = 0.003) or the whole GEM survey cohort (P = 0.01). The implications of these findings will be discussed, with suggestions as to how the student views outlined here might be facilitated within an academic program to maximize both student learning as well as their motivation to study and keep up with taught material. NEW & NOTEWORTHY Although several studies have investigated the relative effectiveness of regular summative versus formative assessments as tools to facilitate student learning and understanding, ours is the first to explicitly solicit students’ views on, and preferences for, either regular formative or summative assessment in preclinical medicine. We demonstrate that, overall, students preferred formative- to summative-type assessments, due to the immediacy of feedback, but also that summative tests incentivized them to study and keep up with material more.