Meta-análisis: Intervalos de confianza e Intervalos de predicción / Meta-analysis: Confidence intervals and Prediction intervals

En los informes meta-analíticos se suelen reportar varios tipos de intervalos, hecho que ha generado cierta confusión a la hora de interpretarlos. Los intervalos de confianza reflejan la incertidumbre relacionada con un número, el tamaño del efecto medio paramétrico. Los intervalos de predicción reflejan el tamaño paramétrico probable en cualquier estudio de la misma clase que los incluidos en un meta-análisis. Su interpretación y aplicaciones son diferentes. En este artículo explicamos su diferente naturaleza y cómo se pueden utilizar para responder preguntas específicas. Se incluyen ejemplos numéricos, así como su cálculo con el paquete metafor en R.(AU)

Several types of intervals are usually employed in meta-analysis, a fact that has generated some confusion when interpreting them. Confidence intervals reflect the uncertainty related to a single number, the parametric mean effect size. Prediction intervals reflect the probable parametric effect size in any study of the same class as those included in a meta-analysis. Its interpretation and applications are different. In this article we explain in de-tail their different nature and how they can be used to answer specific ques-tions. Numerical examples are included, as well as their computation with the metafor Rpackage.(AU)

Improving interprofessional collaboration: building confidence using a novel HIV curriculum for healthcare workers across sub-Saharan africa.

The 21st century presents significant global health challenges that necessitate an integrated health workforce capable of delivering person-centered and integrated healthcare services. Interprofessional collaboration (IPC) plays a vital role in achieving integration and training an IPC-capable workforce in sub-Saharan Africa (SSA) has become imperative. This study aims to assess changes in IPC confidence among learners participating in a team-based, case-based HIV training programme across diverse settings in SSA. Additionally, it sought to examine the impact of different course formats (in-person, synchronous virtual, or blended learning) on IPC confidence. Data from 20 institutions across 18 SSA countries were collected between May 1 and December 31, 2021. Logistic regression analysis was conducted to estimate associations between variables of interest and the increases in IPC confidence. The analysis included 3,842 learners; nurses comprised 37.9% (n = 1,172) and physicians 26.7% (n = 825). The majority of learners (67.2%, n = 2,072) were pre-service learners, while 13.0% (n = 401) had graduated within the past year. Factors significantly associated with increased IPC confidence included female gender, physician cadre, completion of graduate training over 12 months ago, and participation in virtual or in-person synchronous workshops (p < .05). The insights from this analysis can inform future curriculum development to strengthen interprofessional healthcare delivery across SSA.

Experience and number of patients as associated factors toward clinical confidence among nursing students in caring for tuberculosis patients in Indonesia.

BACKGROUND: Nurses and nursing students are at greater risk of tuberculosis (TB) exposure due to their higher intensity contact with patients. In Indonesia, a country with high TB incidence, it is crucial to assess undergraduate nursing students' clinical confidence during their clinical practicums. PURPOSE: This study aimed to explore factors associated with nursing students' clinical confidence in caring for TB patients. METHODS: This cross-sectional study utilized an internet survey based on the United States National TB Curriculum Consortium (NTCC) in September and November 2020. The survey questions focused on TB knowledge, beliefs about the value of TB instruction, and clinical confidence in caring for TB patients. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and hierarchical regression were used for data analysis. The Indonesian version of the original NTCC survey was used. RESULTS: The study found that nursing students' knowledge about TB increased with their year of study (r = 0.290, p < .001). However, students perceived TB instruction as less valuable as they neared graduation (r = -0.233, p < .001) and with more frequent practice in the TB unit (r = -0.162, p < .001). Students who spent more time learning about TB outside of class perceived the TB instruction in the nursing curriculum more positively (r = 0.181, p < .004). The study also found a significant difference between nursing students' belief in the value of TB education and their clinical confidence in caring for TB patients (F = 5.711, p < .001). Furthermore, experience caring for TB patients and the number of TB patients cared for predicted clinical confidence. CONCLUSIONS/IMPLICATIONS: This study highlights the need for improved curriculum content and teaching methods regarding TB for nursing students. It also suggests that experience caring for TB patients and the number of TB patients cared for can improve clinical confidence in nursing students. Given the high incidence of TB in Indonesia, this study's findings could have important implications for the country's healthcare system.

Developing an Automated Virtual Reality Therapy for Improving Positive Self-Beliefs and Psychological Well-Being (Phoenix VR Self-Confidence Therapy): Tutorial.

Unlabelled: Virtual reality (VR) is an immersive technology in which delivery of psychological therapy techniques can be automated. Techniques can be implemented similarly to real-world delivery or in ways that are not possible in the real world to enhance efficacy. The potential is for greater access for patients to effective therapy. Despite an increase in the use of VR for mental health, there are few descriptions of how to build and design automated VR therapies. We describe the development of Phoenix VR Self-Confidence Therapy, designed to increase positive self-beliefs in young patients diagnosed with psychosis in order to improve psychological well-being. A double-diamond, user-centered design process conducted over the course of 18 months was used, involving stakeholders from multiple areas: individuals with lived experience of psychosis, clinical psychologists, treatment designers, and VR software developers. Thirteen meetings were held with young patients diagnosed with psychosis to increase the understanding and improve the assessment of positive self-beliefs, help design the scenarios for implementing therapeutic techniques, and conduct user testing. The resulting Phoenix therapy is a class I United Kingdom Conformity Assessed (UKCA)-certified medical device designed to be used on the standalone Meta Quest 2 (Meta Platforms) headset. Phoenix aims to build up 3 types of positive self-beliefs that are connected to psychological well-being. In a community farm area, tasks are designed to increase a sense of mastery and achievement ("I can make a difference"); in a TV studio, users complete an activity with graded levels of difficulty to promote success in the face of a challenge ("I can do this"); and in a forest by a lake, activities are designed to encourage feelings of pleasure and enjoyment ("I can enjoy things"). Phoenix is delivered over the course of approximately 6 weekly sessions supported by a mental health provider. Patients can take the headsets home to use in between sessions. Usability testing with individuals with lived experience of psychosis, as well as patients in the National Health Service (aged 16-26 years), demonstrated that Phoenix is engaging, easy to use, and has high levels of satisfaction.

Children With Cerebral Palsy's Experiences With Adaptive Climbing: A Qualitative Study on Parents' Perspectives.

Background: Interest in adaptive sports for children with cerebral palsy (CP) is growing, but current evidence on the benefits and indications for one sport, adaptive climbing, is limited. Purpose: We sought to describe perceived changes observed by parents of children with CP who participated in adaptive climbing. Methods: Parents whose children with CP participated in 5 or more adaptive climbing sessions were eligible to participate and were emailed a recruitment letter and flyer. Data were collected through semi-structured interviews, using a moderator guide. Interviews were transcribed and content analyzed, with data grouped into concepts, categories, and themes until data saturation. Results: Ten parents (9 mothers, 1 father) of 10 children with CP (5 girls, 5 boys; ages 7 to 19 years) were interviewed for 15 to 45 minutes each, yielding 4 themes. First, parents perceived that adaptive climbing challenged the children physically (in reach, balance, strength, and head/neck and lower limb motion); second, that it sharpened children's cognitive skills (in focus, problem-solving, and strategic thinking); third, that it raised children's confidence (socially, physically, and emotionally); and fourth, that it expanded children's sense of what they could do (in mastering a challenge, claiming an athletic identity, and participating in a sport like their peers). Conclusions: In this qualitative study, parents described physical, cognitive, and psychosocial benefits of adaptive climbing for their children with CP. These descriptions can be used to inform future studies of children with CP who participate in adaptive climbing.

The C-Brace® microprocessor controlled stance and swing orthosis improves safety, mobility, and quality of life at one year: Interim results from a prospective registry.

Introduction: The C-Brace microprocessor-controlled stance and swing control orthosis has been shown to improve function, mobility, and quality of life. A systematic registry to gather long-term, real-world safety and effectiveness data in patients fit with a C-Brace has not been performed. Methods: International multicenter registry. Patients undergoing routine C-Brace fittings were assessed at baseline and 1 year after fitting. Primary outcomes were fast walking speed (FWS) measured by 25-foot or 10-meter walk test, Timed Up and Go (TUG) and the Activity-specific Balance Confidence (ABC) Scale. Secondary and exploratory outcomes included the Patient-specific Functional Scale (PSFS), falls, pain, PROMIS Pain Interference (PI), and quality of life. Results: 48 subjects with 1-year baseline and follow up data were analyzed. With the C-Brace, FWS improved by + 0.26 ± 0.33 m/s (p < .0001), TUG by -8.1 ± 14.6 sec (p < .0001), and ABC by + 24.9 ± 25.8% (p < .0001). Mean falls reduced from 33 ± 77 to 3.0 ± 5.6 (p = .0005). PSFS increased by 3.60 ± 2.34 points (p < .0001). Outcomes for pain, PI and quality of life showed significant improvements with the C-Brace. Conclusion: The C-Brace is an effective option to improve safety, mobility, and quality of life for patients needing a KAFO for ambulation.

Evaluating Student Satisfaction and Self-Confidence in Simulation-Based Anesthesiology Training among Final-Year Medical Students.

Simulation-based training (SBT) is increasingly recognized in medical education for enhancing clinical skills and confidence. This study evaluated the impact of SBT on satisfaction and self-confidence among final-year medical students at Jazan University, Saudi Arabia. A total of 117 students participated in a cross-sectional study after attending SBT sessions focused on anesthesiology. Data were collected via a questionnaire assessing satisfaction and self-confidence. Statistical analyses included descriptive and inferential statistics. Results showed mean satisfaction and self-confidence scores of 3.64 ± 0.79 and 3.70 ± 0.90, respectively, with no significant differences by gender or age. A strong association was noted between the learning experience ratings and both satisfaction and self-confidence (p < 0.001). The highest satisfaction was with the instructor's teaching style, whereas the lowest was with the motivation provided by teaching materials. For self-confidence, the highest scores related to the instructor's guidance, while the lowest concerned the application of SBT to critical skills learning. A strong positive correlation was found between satisfaction and self-confidence (R = 0.847, p < 0.001). The study concludes that SBT significantly enhances student satisfaction and self-confidence, emphasizing the importance of learner-centered methods and interactive learning in medical education.

'Just because I have prostate cancer doesn't mean that I can't do things' - men's experiences of the acceptability of an exercise intervention for prostate cancer during treatment.

BACKGROUND: Structured exercise has an important role in mitigating the extensive side effects caused by ongoing prostate cancer treatments, specifically androgen deprivation therapy (ADT) and radiation therapy (RT). Little is known about men's experiences of, and preferences for, structured exercise programmes during active cancer treatment. This study aimed to inform the acceptability of a 6-month supervised intervention that emphasised increasing and varied intensities of aerobic and resistance exercise, by exploring the experiences of men who participated. METHODS: Individual semi-structured interviews were conducted with an interviewer independent of the exercise study and data was analysed using a descriptive qualitative design. RESULTS: Twelve prostate cancer patients were interviewed including participants who completed (n = 9) and withdrew from (n = 3) the intervention. Four main themes captured how men experienced the intervention: (1) Navigating the Unknown: Building confidence amidst vulnerability (subtheme- pushing the limits), (2) Building Trust: The credibility and approach of the exercise instructor (subtheme- appropriateness of supervised vs. independent exercise), (3) Flexibility in Delivery, (4) Finding Purpose: Exercise as a means of escapism and regaining control during treatment. CONCLUSION: While an initial lack of self-confidence can be a barrier to exercise participation, exercise programmes have the potential to provide psychosocial benefits, rebuild confidence and empower men throughout their cancer treatment and into recovery. Structured exercise is acceptable during treatment including RT and can offer a form of escapism and sense of control for men navigating their cancer journey. Trust building, flexible delivery and credibility alongside a challenging exercise prescription are important facilitators of acceptability for men. Strategies to embed exercise from the point of diagnosis through ADT and RT should reflect men's experiences of exercise during treatment. TRIAL REGISTRATION: The trial has been registered on ClinicalTrials.gov as of the 14th of December 2021 (NCT05156424).

Exact test and exact confidence interval for the Cox model.

The Cox proportional hazards model is commonly used to analyze time-to-event data in clinical trials. Standard inference procedures for the Cox model are based on asymptotic approximations and may perform poorly when there are few events in one or both treatment groups, as may be the case when the event of interest is rare or when the experimental treatment is highly efficacious. In this article, we propose an exact test of equivalence and efficacy under a proportional hazard model with treatment effect as the only fixed effect, together with an exact confidence interval that is obtained by inverting the exact test. The proposed test is based on a conditional error method originally proposed for sample size reestimation problems. In the present context, the conditional error method is used to combine information from a sequence of hypergeometric distributions, one at each observed event time. The proposed procedures are evaluated in simulation studies and illustrated using real data from an HIV prevention trial. A companion R package "ExactCox" is available for download on CRAN.

Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method.

BACKGROUND:  Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. OBJECTIVE:  To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. METHODS:  Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. RESULTS:  The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. CONCLUSIONS:  Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.

Impact of COVID-19 on vaccine confidence and uptake: A systematic literature review.

During the coronavirus disease 2019 (COVID-19) pandemic, scheduled vaccinations were postponed, mass vaccination programmes were suspended and opportunities for healthcare workers to administer vaccines ad hoc decreased. The aims of this systematic literature review were to determine the impact of the COVID-19 pandemic on vaccine confidence, intent and uptake in preexisting routine childhood or adult vaccination programmes, and to identify factors associated with changes in acceptance, intent and uptake of preexisting vaccines. Medline and Embase were searched for studies in Australia, Brazil, Canada, China, Japan, the USA, and European countries, published between 1 January 2021 and 4 August 2022. A complementary gray literature search was conducted between 11 and 13 October 2022, and supplemented with additional gray research in October 2023. In total, 54 citations were included in the review. Study design and geography were heterogeneous. The number of adults who received or intended to receive an influenza or pneumococcal vaccine was higher during the pandemic than in previous seasons (n = 28 studies). In addition, increased acceptance of adult vaccinations was observed during 2020-21 compared with 2019-20 (n = 12 studies). The rates of childhood vaccinations decreased during the COVID-19 pandemic across several countries (n = 11 studies). Factors associated with changes in intention to receive a vaccination, or uptake of influenza vaccine, included previous vaccination, older age, higher perceived risk of contracting COVID-19, anxiety regarding the pandemic and fear of contracting COVID-19. Acceptance and uptake of influenza and pneumococcal vaccines generally increased after onset of the COVID-19 pandemic.

Developing critical enquiry, capacity, capability and confidence in the health and care workforce.

BACKGROUND: Health and care staff have limited opportunities to design, deliver and lead critical enquiry activities. AIMS: To explore barriers and enablers of building capacity, capability and confidence of these practitioners who wish to undertake critical enquiry activity. METHODS: A realist conceptual framework including the development of middle range theory allowed analysis of the scholarship process and outcomes. Data were collected through snap surveys, interviews (face to face and online) and project output (posters). RESULTS: Nine scholars completed the programme and all participated in the study. They all experienced an increase in capacity, capability and confidence in critical enquiry activity. Six overarching themes arose from analysis of the interviews and snap survey data: value; expertise; attitudes; meaningful, responsive support; brain space; and skill and knowledge acquisition. DISCUSSION: A combined focus on people and project while staff remained embedded in their work area was key for the growth of skills and knowledge and creating impact from projects. Guilt at having dedicated time to take part in the programme was a self-imposed barrier to building capacity and capability. Social capital (gained from bringing together individuals from different groups with shared values) facilitated bonding, which increased psychological safety and helped enable capability and confidence. CONCLUSION: The combination of theory and practice embedded in a real-world context led to positive outcomes for staff, patients, carers and the facilitation team as real-life changes were made in clinical environments.

Examining the Relationship and the Gender Differences between Re-Injury Worry, Confidence, and Attention after a Sport Musculoskeletal Injury.

Introduction: A sport injury is an unfortunate event that can significantly impact the injured athletes' psychology. There have been no studies examining gender differences in the psychological state after a sport-related musculoskeletal injury. Τhe aims of the current study were to (a) investigate the relationship between re-injury worry levels, confidence, and attention in the injured athletes who followed a rehabilitation program in order to return to competition, and (b) compare differences in these psychological factors between male and female athletes. Methods: A cross-sectional research design was used. A total of 60 athletes (30 men and 30 women) volunteered to participate, aged 25.50 ± 5.25 years old, all of whom had experienced a musculoskeletal injury within the past year. Three validated questionnaires, i.e., the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire of Rehabilitated Athletes Returning to Competition, and the Attention Questionnaire of Rehabilitated Athletes Returning to Competition, were completed by the participants on their first competitive game after their rehabilitation program. Results: All of the athletes experienced average levels of re-injury worry due to their opponents' ability and distraction attention, and high levels of confidence and functional attention. Many factors from the questionnaires were correlated with each other. Men experienced lower levels of re-injury worry due to rehabilitation compared to the women athletes (U = 329.00, p < 0.05), and women exhibited higher "Re-injury Worry due to Opponent's Ability" compared to the men athletes (U = 292.00, p < 0.01). Conclusions: A strong relationship was found between re-injury worry, confidence, and attention, with few gender differences. Since there is no previous research examining re-injury worry, confidence, and attention between men and women, future research with larger and more homogeneous samples is needed to confirm the present results.

Diabetes self-care activities and its correlates in patients with diabetic neuropathy.

BACKGROUND: Diabetic neuropathy is the most common chronic complication observed in patients with diabetes and has significant clinical implications, such as decreased quality of life and increased morbidity and mortality rates. Studies on the factors affecting diabetes self-care activities pertaining to patients with diabetic neuropathy are limited. Therefore, a more in-depth study targeting individuals with diabetic neuropathy is required to develop patient-centred nursing interventions. AIM: This study aimed to identify diabetes self-care activities among patients with diabetic neuropathy and determine their correlates. METHODS: This study employed a descriptive correlational design and the study subjects consisted of 99 patients with diabetic neuropathy. Descriptive statistics and hierarchical regression analyses were used to analyse the factors affecting diabetes self-care activities. This study follows the STROBE guidelines to ensure rigorous reporting of cross-sectional studies. RESULTS: Our findings revealed positive correlations between diabetes self-care activities and factors including knowledge of diabetes foot care, diabetes foot care practices, interpretation of diabetic neuropathy and foot care confidence. Foot care confidence positively correlated with diabetes foot care knowledge, practices and interpretation of neuropathy, but negatively related to diabetic stress. In determining the impact of these factors on diabetes self-care activities, hierarchical regression analysis revealed that patients with higher diabetes foot care practices and foot care confidence demonstrated higher levels of diabetes self-care activities. CONCLUSION: The study findings confirmed that diabetic foot care practices and foot care confidence significantly influenced self-care activities in patients with diabetic neuropathy. Considering these results, customizing the intervention content to match diabetic foot care practices and diabetic foot care confidence can enhance self-care activities in patients with diabetic neuropathy. PATIENT OR PUBLIC CONTRIBUTION: Survey questionnaires were completed by patients with diabetic neuropathy in this study.

A closer look at how experience, task domain, and self-confidence influence reliance towards algorithms.

Prior research has demonstrated experience with a forecasting algorithm decreases reliance behaviors (i.e., the action of relying on the algorithm). However, the influence of model experience on reliance intentions (i.e., an intention or willingness to rely on the algorithm) has not been explored. Additionally, other factors such as self-confidence and domain knowledge are posited to influence algorithm reliance. The objective of this research was to examine how experience with a statistical model, task domain (used car sales, college grade point average (GPA), GitHub pull requests), and self-confidence influence reliance intentions, reliance behaviors, and perceived accuracy of one's own estimates and the model's estimates. Participants (N = 347) were recruited online and completed a forecasting task. Results indicate that there was a statistically significant effect of self-confidence and task domain on reliance intentions, reliance behaviors, and perceived accuracy. However, unlike previous findings, model experience did not significantly influence reliance behavior, nor did it lead to significant changes in reliance intentions or perceived accuracy of oneself or the model. Our data suggest that factors such as task domain and self-confidence influence algorithm use more so than model experience. Individual differences and situational factors should be considered important aspects that influence forecasters' decisions to rely on predictions from a model or to instead use their own estimates, which can lead to sub-optimal performance.

Are we adequately managing the oral health needs of children: a survey of the experience of general dentists and self-assessed confidence in pediatric dentistry.

Childhood caries is a public health problem with a significant burden on the community. The specialist dental workforce cannot adequately manage all treatment needs in children. Therefore, the general dental community remains critical in delivering care to children. The purpose of this study was to investigate the self-rated confidence of general practitioners in treating children. A cross-sectional survey was designed that involved general dentists in various primary care centers in Jordan. Participants were asked to complete a questionnaire about their experience and self-perceived level of confidence in performing various procedures in children using the Likert scale. Descriptive statistics, t-tests and one-way analysis of variance (ANOVA) were used for data analysis. A total of 150 general dentists completed the questionnaire. The overall confidence score was high (3/4). Most respondents (86.7%) reported high confidence in providing prophylaxis and preventive treatment. The lowest level of confidence was reported for dental trauma and interceptive orthodontics. No statistically significant gender disparity was found except for the management of dental trauma in which males were significantly more confident than females. Regarding years of experience, confidence levels in dental trauma management were significantly higher among dentists with 5-10 years of experience compared to the recently graduated and the longest qualified dentists (p = 0.008). Similarly, for interceptive orthodontics, participants with 5-10 years of practice were significantly more confident compared to dentists in the other groups (p = 0.021). One-third of participants (30.1%) were not willing to treat children and considered them disruptive to their practice. Overall, This study revealed low levels of confidence in dental trauma management and interceptive orthodontics in children. Modification of dental curricula to increase clinical exposure should positively reflect on future levels of confidence. Strategies should be implemented to encourage general dentists to treat children to ensure equitable access for all.

Confidence sets for intraclass correlation coefficients in test-retest curve measurements.

Evaluating test-retest reliability is crucial in biomechanical research, as it validates experimental results. While methods for reliability of scalar outcome variables are well-established, methods to assess reliability of continuous curve data (such as joint angle trajectories during gait) remain less explored. This study investigates methods for constructing confidence sets for curve-level intraclass correlation coefficients (ICC), which can be expressed as either an ICC curve or an integrated ICC. Currently, no standardised guidelines exist in biomechanics for reporting curve-level ICC uncertainty. Nonparametric bootstrapping techniques are proposed for both the ICC curve's confidence bands and the integrated ICC's confidence intervals, and these methods are validated through Monte Carlo simulations, covering various effect sizes and curve characteristics. Additionally, these methods are applied to assess the test-retest reliability of knee kinematics in three different planes during landing of one-leg hops, where less uncertainty is observed for the ICC curve and integrated ICC in the frontal plane compared to other planes. When the entire time domain is of primary empirical interest, we recommend using a rank-based bootstrap confidence band to express ICC uncertainty, as it yields increasingly precise and valid results as the number of individuals increases, with the coverage rate approaching the correct level of 95%. When a single summary metric is of primary interest, we recommend using the integrated ICC along with a typical bootstrap confidence interval based on the normal distribution, as the coverage rate remains adequately accurate and stable at around the correct level of 95% across varying number of individuals.

MANGOU (Miyazaki Advanced New General Surgery of University) Wet Lab Training Relieves Anxiety About Surgical Skills in Surgical Education: A Cross-Sectional Study.

PURPOSE: To increase the number of medical students or residents who want to become surgeons, we must evaluate our program that recruits new young surgeons. METHODS: We planned surgical training programs for medical students and residents that we named the MANGOU (Miyazaki Advanced New General surgery Of University) training project in the Department of Surgery, Miyazaki University, Japan. From January 2016 through December 2022, we asked trainees who attended this training to complete questionnaires to evaluate their interest in surgery, confidence in surgical skills, and training. Scoring of the questionnaire responses was based on a 5-point Likert scale, and we evaluated this training prospectively. RESULTS: Among the 109 trainees participating in this training, 61 answered the questionnaires. Two participants found the training boring, but 59 (96.7%) enjoyed it. All of them answered "Yes" to wanting to participate in the next training. Respective pre- and post-training scores were as follows: confidence in surgical skills, 2.2 ± 1.0 and 3.0 ± 1.0 (p < 0.0001); interest in surgery, 4.2 ± 0.8 and 4.4 ± 0.5 (p = 0.0011); and willingness to become surgeons, 3.9 ± 0.7 and 4.1 ± 0.6 (p = 0.0011). All scores rose after MANGOU training. CONCLUSION: We planned MANGOU surgical wet lab training for medical students and residents that aimed to educate and recruit new surgeons. After joining the MANGOU training, the trainees' anxiety about surgery was reduced, their confidence in performing surgical procedures improved, they showed more interest in surgery, and they increased their motivation to become surgeons.

Inference in High-Dimensional Online Changepoint Detection.

We introduce and study two new inferential challenges associated with the sequential detection of change in a high-dimensional mean vector. First, we seek a confidence interval for the changepoint, and second, we estimate the set of indices of coordinates in which the mean changes. We propose an online algorithm that produces an interval with guaranteed nominal coverage, and whose length is, with high probability, of the same order as the average detection delay, up to a logarithmic factor. The corresponding support estimate enjoys control of both false negatives and false positives. Simulations confirm the effectiveness of our methodology, and we also illustrate its applicability on the U.S. excess deaths data from 2017 to 2020. The supplementary material, which contains the proofs of our theoretical results, is available online.

Stigma and its associations with self-confidence and sexual relations in 4 types of premature ejaculation.

BACKGROUND: Although men with premature ejaculation (PE) always show more negative emotions, including embarrassment, guilt and worry, this may be related to the stigma of PE. To investigated stigma and its associations with self-confidence and sexual relations in 4 PE syndromes, a survey was conducted in our hospital from December 2018 to December 2019 among 350 men with self-reported PE and 252 men without self-reported PE. The stigma, self-confidence and sexual relations were assessed by the Social Impact Scale (SIS) and Self-Esteem and Relationship questionnaire (SEAR), respectively. Ejaculation control, sexual life satisfaction and distress caused by PE were evaluated by the Index of PE. RESULTS: Men with self-reported PE had higher internalized shame and social isolation scores and lower SEAR scores than control subjects. The highest score of internalized shame and social isolation and the lowest score of SEAR appeared in men with lifelong PE (LPE). After age adjustment, the positive relationships were stronger between distress about PE and internalized shame. Whereas, the stronger negative associations were found between social isolation and sexual satisfaction. The strongest association was observed between social isolation and sexual relationship. Therefore, the stigma associated with PE adversely affects the self-confidence, self-esteem, and sexual relationships of men with PE. CONCLUSION: Men with PE, especially LPE, have a high level of stigma and disharmonious sexual relations, and often lack self-confidence and self-esteem, which have a certain negative impact on their physical and mental health and life. These will be the key issues to be considered when we formulate a personalized treatment plan for PE.

RéSUMé: CONTEXTE: Bien que les hommes atteints d'éjaculation précoce (EP) montrent plus d'émotions négatives toujours, notamment de l'embarras, de la culpabilité et de l'inquiétude, cela peut être lié à la stigmatisation de l'EP. Afin d'étudier la stigmatisation et ses associations avec la confiance en soi et les relations sexuelles dans 4 syndromes d'EP, une enquête a été menée dans notre hôpital de décembre 2018 à décembre 2019 auprès de 350 hommes atteints d'EP autodéclarée et de 252 hommes sans EP autodéclarée. La stigmatisation, la confiance en soi et les relations sexuelles ont été évaluées respectivement à l'aide de l'échelle d'impact social (SIS) et du questionnaire sur l'estime de soi et les relations (SEAR). Le contrôle de l'éjaculation, la satisfaction de la vie sexuelle et la détresse causée par l'EP ont été évalués par l'indice d'EP. RéSULTATS: Les hommes ayant une EP autodéclarée avaient des scores de honte intériorisée et d'isolement social plus élevés, et des scores SEAR inférieurs, à ceux des sujets témoins. Le score le plus élevé de honte intériorisée et d'isolement social, et le score le plus bas de SEAR, sont apparus chez les hommes atteints d'EP à vie (EPL). Après ajustement sur l'âge, les relations positives étaient plus fortes entre la détresse due à l'EP et la honte intériorisée. Les associations négatives les plus fortes ont été trouvées entre l'isolement social et la satisfaction sexuelle. Par conséquent, la stigmatisation associée à l'EP affecte négativement la confiance en soi, l'estime de soi et les relations sexuelles des hommes atteints d'EP. CONCLUSION: Les hommes atteints d'EP, en particulier ceux atteints d'EPL, ont un niveau élevé de stigmatisation et de relations sexuelles disharmonieuses, et ils manquent souvent de confiance en soi et d'estime de soi; ce qui a un impact négatif certain sur leur santé physique et mentale, et sur leur vie. Ce seront les questions clés à prendre en compte lorsque nous formulerons un plan de traitement personnalisé pour l'EP.