Performance of binary prediction models in high-correlation low-dimensional settings: a comparison of methods

Background Clinical prediction models are developed widely across medical disciplines. When predictors in such models are highly collinear, unexpected or spurious predictor-outcome associations may occur, thereby potentially reducing face-validity of the prediction model. Collinearity can be dealt with by exclusion of collinear predictors, but when there is no a priori motivation (besides collinearity) to include or exclude specific predictors, such an approach is arbitrary and possibly inappropriate. Methods We compare different methods to address collinearity, including shrinkage, dimensionality reduction, and constrained optimization. The effectiveness of these methods is illustrated via simulations. Results In the conducted simulations, no effect of collinearity was observed on predictive outcomes (AUC, R2, Intercept, Slope) across methods. However, a negative effect of collinearity on the stability of predictor selection was found, affecting all compared methods, but in particular methods that perform strong predictor selection (e.g., Lasso). Methods for which the included set of predictors remained most stable under increased collinearity were Ridge, PCLR, LAELR, and Dropout. Conclusions Based on the results, we would recommend refraining from data-driven predictor selection approaches in the presence of high collinearity, because of the increased instability of predictor selection, even in relatively high events-per-variable settings. The selection of certain predictors over others may disproportionally give the impression that included predictors have a stronger association with the outcome than excluded predictors.

Effect of Matrix Rhythm Therapy Along With Conventional Physiotherapy Management in Quadriplegic Patient: A Case Study

A 26-year old Yemeni girl with a gunshot injury with cervical spine fracture at C6-C7 Level injury in June 2018 with complete loss of sensation in all the limbs, motor loss below C3 level with loss of saddle sensation and anal tone. The patient sustained spinal cord injury at C6-7 levels and edema extending upto C3 level, resulting in quadriplesgia.She was airlifted in medevac from yemen to Sultan Qaboos Hospital Salalah Oman in 28th June 2018.The patient underwent extensive Neuro surgical procedures for cervical fracture and spinal decompression.Additionally, the patient received education and counseling, nursing and nutritional intervention, and comprehensive physical therapy treatment including Matrix Rhythm therapy and other conventional Physiotherapy management.We conclude that Physiotherapy management with other medical disciplines are crucial in recovary of the patient and to improve quality of life.

La lingua tra medicina, linguistica e retorica in Galeno

Starting from Galen’s analysis of the tongue as the organ of speech, this article investigates the views of the physician from Pergamon regarding the language issue in relation to how to communicate the contents of the medical disciplines. Within a controversial context of a dispute with his rival physicians, Galen rejects the proliferation of new definitions or the use of terms in a meaning which was at odds with the tradition without providing a proper explanation. In a well calibrated balance between respect for the use and literary tradition, he gives more importance to communicative clarity, at a time when Greek was subjected to various modifications or distortions.

PEDAGOGICAL CONDITIONS OF TRAINING FUTURE MASTERS OF MEDICINE FOR PEDAGOGICAL ACTIVITY IN HIGHER MEDICAL INSTITUTIONS OF EDUCATION

The training of future masters of medicine for teaching is extremely important. On the shoulders of doctors rests the responsibility for people's lives, for the future of the nation. The modern doctor, interacting with patients and colleagues, should take the position of not only a physician, but also the position of a teacher, educator, assistant, friend, and mentor. Pedagogy helps to form, develop and implement all these qualities. Knowledge in the field of pedagogy helps a doctor to become a worthy profession representative, easy to communicate with varous group of population, while demonstrating high professionalism and generosity. The aim of the study is to reflect the pedagogical conditions of training of future masters of medicine for teaching in higher medical educational institutions. Research methods applied: system analysis, logical and theoretical generalization, grouping and comparison. It has been established that pedagogical conditions provide the creation of an educational environment for the training of future masters of medicine in higher medical educational institutions. By pedagogical conditions of training the future masters of medicine for pedagogical activity in higher medical educational institutions is understood: (i) the orientation of the educational process on the formation of motivational and value attitude of future masters of medicine to pedagogical activity in the health care system; (ii) pedagogically oriented connotation of the content and methods of studying the general scientific and medical disciplines; (iii) optimal combination of educational forms, methods, technologies in the obtaining by future masters of medicine the pedagogical component in medical practice; (iv) stimulating the future masters of medicine to personal and professional self-development.

The Development of Laparoscopy—A Historical Overview

The advent of laparoscopy marked a fundamental change in the evolution of medicine. The procedure progressed consistently after the first time it was performed in a human being nearly a hundred years ago. The 1960's and 1980's witnessed groundbreaking changes. During this time, laparoscopy evolved from a purely diagnostic procedure into an independent surgical approach. Outstanding pioneers of the times were Palmer, Frangenheim and Semm. Laparoscopy advanced rapidly and influenced gynecology as well. The procedure was initially attacked most vociferously by the surgical fraternity. However, within a short period of time the pendulum shifted: laparoscopy became the preferred surgical approach for a variety of diseases—whether benign or malignant—in several medical disciplines. Laparoscopy has become a routine approach in the twenty-first century. Technical advancements have led to robot-assisted surgery. Future developments will include artificial intelligence and augmented reality. In the present article we address past milestones, current practices, and future challenges in laparoscopy.

A new taxonomy was developed for overlap across ‘Overviews of systematic reviews’: a meta-research study of research waste

Background Multiple ‘overviews of reviews’ conducted on the same topic (“overlapping overviews”) represent a waste of research resources and can confuse clinicians making decisions amongst competing treatments. We aimed to assess the frequency and characteristics of overlapping overviews. Methods MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews were searched for overviews that: synthesised reviews of health interventions and conducted systematic searches. Overlap was defined as: duplication of PICO eligibility criteria, and not reported as an update nor a replication. We categorized overview topics according to 22 WHO ICD-10 medical classifications, overviews as broad or narrow in scope, and overlap as identical, nearly identical, partial, or subsumed. Subsummation was defined as when broad overviews subsumed the populations, interventions and at least one outcome of another overview. Results Of 541 overviews included, 169 (31%) overlapped across similar PICO, fell within 13 WHO ICD-10 medical classifications, and 62 topics. 148/169 (88%) overlapping overviews were broad in scope. Fifteen overviews were classified as having nearly identical overlap (9%); 123 partial overlap (73%), and 31 subsumed (18%) others. Conclusions One third of overviews overlapped in content and a majority covered broad topic areas. A multiplicity of overviews on the same topic adds to the ongoing waste of research resources, time and effort across medical disciplines. Authors of overviews can use this study and the sample of overviews to identify gaps in the evidence for future analysis, and topics that are already studied which do not need to be duplicated.

Topic overlap and research waste at the ‘Overviews of systematic reviews’ level: a meta-research study

Background Multiple ‘overviews of reviews’ conducted on the same topic (“overlapping overviews”) represent a waste of research resources and can confuse clinicians making decisions amongst competing treatments. We aimed to assess the frequency and characteristics of overlapping overviews. Methods MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews were searched for overviews that: synthesised reviews of health interventions and conducted systematic searches. Overlap was defined as: duplication of PICO eligibility criteria, and not reported as an update nor a replication. We categorized overview topics according to 22 WHO ICD-10 medical classifications, overviews as broad or narrow in scope, and overlap as identical, nearly identical, partial, or subsumed. Subsummation was defined as when broad overviews subsumed the populations, interventions and at least one outcome of another overview. Results Of 541 overviews included, 169 (31%) overlapped across similar PICO, fell within 13 WHO ICD-10 medical classifications, and 62 topics. 148/169 (88%) overlapping overviews were broad in scope. Fifteen overviews were classified as having nearly identical overlap (9%); 123 partial overlap (73%), and 31 subsumed (18%) others. Conclusions One third of overviews overlapped in content and a majority covered broad topic areas. A multiplicity of overviews on the same topic adds to the ongoing waste of research resources, time and effort across medical disciplines. Authors of overviews can use this study and the sample of overviews to identify gaps in the evidence for future analysis, and topics that are already studied which do not need to be duplicated.

Reference Range of Penile Dimensions of the Adult Male and Correlation with Somatometric Parameter in a Tertiary Care Hospital of Bangladesh: A Prospective Study

Background: The penile size has always been a symbol of manliness and pride. Many adult think that there penile length are not adequate and goes to different medical disciplines. There is no study in Bangladesh regarding penile size and somatometric parameter. The results will help in counseling patients afraid of their penile size , also in clinical and research purpose. Objective: To assess the penile size in different dimensions such as flaccid, stretch, and girth (circumferential) penile length and its relationship with age, height, weight, and BMI. Materials and Methods: The study was conducted on 300 adult males with no penile abnormalities. Length of penises in flaccid, stretch, and circumference were measured. Age ,height, weight were measured and BMI (body mass index) was calculated. Correlation of penile dimensions with somatometric parameters were analyzed. Results: The average flaccid penile length(FPL) was 7.81 cm, the mean stretch length(SPL) was 11.21 cm, and the mean circumferential length(CPL) was 8.65 cm. The penile length in the three dimensions was significantly different from each other (p<0.05). A significant correlation was found among the three penile dimensions (p<0.05). Conclusion: The penile size in different dimensions can be varied with age,height,weight and BMI. KYAMC Journal. 2021;12(3): 122-126

Performance of ENMC and EULAR/ACR classification systems applied to a single tertiary center cohort of dermatomyositis patients

Background There have been numerous classification systems to diagnose corresponding myositis subtypes and select appropriate therapeutic measures. However, the lack of a broad consensus on diagnostic criteria has led to clinical uncertainties. The objective of this study was to compare two commonly used dermatomyositis-classification systems regarding their clinical practicability and to point out their specific advantages and disadvantages. Methods This study included 30 patients diagnosed with dermatomyositis at the Charité university hospital, Berlin, Germany from 2010 to 2017. Patient files with complete data and defined historical classifications were enrolled and ENMC (2003) and EULAR/ACR (2017) criteria retrospectively applied. Results According to the ENMC approach, 14 patients were classified as "definite" and 12 as "probable" dermatomyositis. One patient exhibited an "amyopathic dermatomyositis" and three a "DM without dermatitis". Regarding the criteria probability of the EULAR/ACR set, 16 patients had a "high", 13 a "medium" and one a "low probability". There was a significant difference (p = 0.004) between the subclasses of the ENMC in relation to the EULAR/ACR score. The agreement between the classification probabilities of "definite/high" (κ = 0.400) and "possible/medium" (κ = 0.324) was fair. Conclusions It is important to find a consensus among the medical disciplines involved and to establish a structured procedure. Future studies with newer approaches are warranted to conclusively decide which system to use for the physician.

IMPACT OF COVID 19 PANDEMIC ON ACUTE GENERAL SURGICAL EMERGENCY MANAGEMENT- A TERTIARY CARE HOSPITAL BASED STUDY

BACKGROUND: The COVID-19 pandemic is standing as a never before threat to the healthcare systems and hospital operations worldwide.Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of surgery. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services. OBJECTIVES: This study was aimed to evaluate the changes in approach to management and the perioperative outcome of patients with acute surgical emergency during COVID-19 pandemic. STUDY DESIGN AND METHODS:We performed a retrospective observational study in patients presented with acute surgical emergency between April 2020 to June 2021. RESULTS: A total of 298 patients were included, among whom 12 (3.4%) were COVID 19 positive. 274 non-COVID patients and 8 COVID-19 positive patients underwent emergency surgery.While 12 non-COVID (4.1%) and 4 COVID-19 positive patients (40%) underwent conservative management. None of the hospital staff involved in the surgeries of COVID-19 positive patients developed any symptoms related to COVID-19. CONCLUSION: This study showed that the patients with surgical emergency both with or without COVID-19 infection were successfully treated,without influencing each other,through appropriate isolation measures,although managed in the same hospital. Importance can also be given towards conservative management particularly for COVID-19 positive patients presenting with surgical emergency selectively with proper monitoring. So it can be concluded that, although the management of surgical patients during the COVID-19 pandemic is a global challenge,adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.