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Hao KA, Calfee RP, Waljee JF, Srinivasan RC. Study Design and Analysis in Hand Surgery Research: Tips for Success. J Hand Surg Am 2023; 48:941-946. [PMID: 37178066 DOI: 10.1016/j.jhsa.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
Hand surgeons are constantly faced with evaluation of new evidence to identify best practices in clinical care. However, even the most rigorous study designs have limitations due to biases, generalizability, and other flaws. Here, we highlight seven common aspects of study design and analysis that should be considered by hand surgeons when interpreting findings. The evaluation of these practices can optimize the peer-review process and assess the value of evidence to be incorporated into clinical practice.
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Affiliation(s)
- Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI
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Kabeil M, Gillette R, Moore E, Cuff RF, Chuen J, Wohlauer MV. A primer on cohort studies in vascular surgery research. Semin Vasc Surg 2022; 35:404-412. [DOI: 10.1053/j.semvascsurg.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
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Singh S, Batra P, Raghavan S, Sharma K, Srivastava A. Evaluation of Alt-RAMEC With Facemask in Patients With Unilateral Cleft lip and Palate (UCLP) Using Cone Beam Computed Tomography (CBCT) and Finite Element Modeling-A Clinical Prospective Study. Cleft Palate Craniofac J 2021; 59:166-176. [PMID: 33754882 DOI: 10.1177/10556656211000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluate the effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol on patients with unilateral cleft lip and palate (UCLP) along with maxillary protraction using cone beam computed tomography (CBCT) records and a finite element modeling (FEM) model. MATERIALS AND METHODS Twenty-five patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective single-arm cohort study after obtaining necessary informed consent. A 9-week Alt-RAMEC protocol using a custom-made fan-shaped expansion screw was initiated, which was followed by 6-month facemask wear. Pre (T1) and posttreatment (T2) records including CBCT were taken and were evaluated for treatment changes in all 3 dimensions using paired t test. Additionally, a FEM model (ANSYS 15.0) using the Alt-RAMEC protocol was also analyzed for the displacement and stress on various craniofacial structures. RESULTS Significant forward movement of the maxilla along with clockwise rotation of mandible along with statistically significant increase in lower molar height and upper incisor proclination (P < .05) was observed. CBCT evaluation showed a statistical significant decrease in buccal alveolar bone thickness and increase in molar inclination (P < .05). Finite element modeling analysis highlighted that the maximum displacement occurred at the anterior region with stresses radiating till the anterior nasal spine, zygomatic arch, and sphenoid bone. CONCLUSION Alt- RAMEC protocol combined with facemask protraction can lead to significant maxillary advancement, with some transient decrease in buccal bone thickness noted thereby warranting long-term studies to further assess its effect on the dentofacial apparatus.
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Affiliation(s)
- Shalvi Singh
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Sreevatsan Raghavan
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Karan Sharma
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Amit Srivastava
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
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Agley J, Jun M, Eldridge L, Agley DL, Xiao Y, Sussman S, Golzarri-Arroyo L, Dickinson SL, Jayawardene W, Gassman R. Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial. JMIR Ment Health 2021; 8:e25860. [PMID: 33338986 PMCID: PMC7817353 DOI: 10.2196/25860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. OBJECTIVE This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. METHODS This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. RESULTS Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. CONCLUSIONS This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. TRIAL REGISTRATION Clinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/17900.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Mikyoung Jun
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Lori Eldridge
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Daniel L Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Yunyu Xiao
- School of Social Work, Indiana University Bloomington and Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Steve Sussman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Psychology, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States.,School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Stephanie L Dickinson
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
| | - Wasantha Jayawardene
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
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Luni FK, Daniels J, Link MS, Joglar JA, Zungsontiporn N, Wu R, Kaplish N, Malik SA. Meta-analysis of Usefulness of Phrenic Nerve Stimulation in Central Sleep Apnea. Am J Cardiol 2020; 125:1738-1744. [PMID: 32295701 DOI: 10.1016/j.amjcard.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Transvenous neurostimulation of the phrenic nerve (PNS) is a potentially improved and unique approach to the treatment of central sleep apnea (CSA). There have been multiple studies with limited individuals evaluating the efficacy of PNS. Our aim was to review and pool those studies to better understand whether phrenic nerve stimulation is efficacious in the treatment of CSA. The initial search on Pubmed retrieved a total of 97 articles and after screening all articles, only 5 could be included in our quantitative analysis. Pooling of data from 5 studies with a total of 204 patients demonstrated a reduction of mean apnea hypopnea index with PNS compared to controls by -26.7 events/hour with 95% confidence interval and P value of [CI (-31.99, -21.46), I2 85, p 0.00]. The mean difference in central apnea index was -22.47 [CI (-25.19, -19.76), I2 0, p 0.00]. The mean reduction in the oxygen desaturation index of 4% or more demonstrated a decrease in PNS group by -24.16 events/hour [(CI -26.20, -22.12), I2 0, p 0.00] compared with controls. PNS resulted in mean reduction in arousal index of -13.77 [CI (-16.15, -11.40), I2 0, p 0.00]. The mean change in percent of time spent in rapid eye movement sleep demonstrated a nonsignificant increase in PNS group by 1.01 % [CI (-5.67, 7.86), I293, p 0.75]. In conclusion, PNS therapy for treating CSA demonstrated positive outcomes but larger randomized studies are needed to evaluate the safety and clinical outcomes.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - James Daniels
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jose A Joglar
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Nath Zungsontiporn
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wu
- Department of Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Neeraj Kaplish
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Sonia Ali Malik
- Department of Neurology and Family Medicine, UT Southwestern Medical Center, Dallas, Texas.
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