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Significant reductions in symptom catastrophizing and PTSD symptoms were observed during treatment, with large effect sizes, ds = 1.42 and 0.94, respectively, ps less then .001. Cross-lagged analyses revealed that early change in symptom catastrophizing predicted later change in PTSD symptoms; early changes in PTSD symptom severity did not predict later change in symptom catastrophizing. These findings are consistent with the conceptual models that posit a causal relation between catastrophizing and PTSD symptom severity. The clinical implications of the findings are discussed.Research designs are broadly divided into observational studies (i.e. cross-sectional; case-control and cohort studies) and experimental studies (randomised control trials, RCTs). Each design has a specific role, and each has both advantages and disadvantages. Moreover, while the typical RCT is a parallel group design, there are now many variants to consider. It is important that both researchers and paediatricians are aware of the role of each study design, their respective pros and cons, and the inherent risk of bias with each design. While there are numerous quantitative study designs available to researchers, the final choice is dictated by two key factors. First, by the specific research question. That is, if the question is one of 'prevalence' (disease burden) then the ideal is a cross-sectional study; if it is a question of 'harm' - a case-control study; prognosis - a cohort and therapy - a RCT. Second, by what resources are available to you. This includes budget, time, feasibility re-patient numbers and research expertise. All these factors will severely limit the choice. While paediatricians would like to see more RCTs, these require a huge amount of resources, and in many situations will be unethical (e.g. potentially harmful intervention) or impractical (e.g. rare diseases). This paper gives a brief overview of the common study types, and for those embarking on such studies you will need far more comprehensive, detailed sources of information.Background Precise and accurate alignments in total knee arthroplasty are important predictors for survivorship and functional outcomes. We aim to compare accelerometer-based navigation (ABN) to conventional instrumentation (CONV), patient-specific instrumentation (PSI) and computer-assisted surgery (CAS) in published literature. Methods A systematic search of publications from databases (MEDLINE, EMBASE and Cochrane) was obtained from inception to 15 August 2018. A random-effects meta-analysis was used to pool odd ratios for outliers greater than 3° for the hip-knee-ankle, coronal and sagittal femoral and tibial angles (CFA, CTA, SFA, STA). Secondary outcomes included procedural characteristics and functional outcomes. Results Thirteen studies, involving 1566 patients, met inclusion that compared ABN (50.2%) to CONV (49.8%) and five comparing ABN to CAS/PSI. The pooled odds ratios for percent outliers of greater than 3° from the mechanical axis for the hip-knee-ankle (relative risk 0.58, P = less then 0.05) and CFA (relative risk 0.42, P = 0.02) was significantly lower for ABN compared to CONV. The pooled odds ratios for CTA, SFA and STA were not significantly different. No differences were identified in comparison to PSI/CAS. There was no statistically significant difference in procedural characteristics and functional outcomes. Conclusions The use ABN in total knee arthroplasty is a successful method of increased precision and accuracy for the restoration of the mechanical axis. In addition, there is no significant compromise in procedural or functional outcomes.Objective To assess the association between levels of vitamin D and urinary incontinence (UI) in pregnancy. Design A cross-sectional study. Tacrolimus Secondary analysis of a randomised controlled trial. Setting Two university hospitals in Norway. Population 851 healthy, pregnant women >18 years in gestational week 18-22 with a singleton live fetus. Methods Data on UI were collected from a questionnaire at inclusion and serum analysis of 25-hydroxy vitamin D (25(OH)D) was performed. Univariable and multivariable logistic regression analyses were applied to study associations between exposure and outcomes. Main Outcome Measures Prevalence of self-reported UI, stress (SUI) and urge (UUI) or mixed UI. Results In total 230/851 (27%) of the participants were vitamin D insufficient (25(OH)D less then 50nmol/L) and 42% reported to have any UI. Women with 25(OH)D less then 50nmol/L were more likely to report any UI (p=0.03) and SUI (p less then 0.01) compared to women with 25(OH)D ≥50nmol/L. In a univariable logistic regression analysis, serum levels of 25(OH)D less then 50nmol/L was associated with increased risk of any UI (Odds Ratio, OR 1.5 with 95% Confidence interval CI (1.0, 2.1)), SUI only (OR 1.7 (1.2, 2.4)), but not mixed UI or UUI only (OR 0.8 (0.5,1.5)). In a multivariable logistic regression model, serum levels of 25(OH)D less then 50nmol/L was associated with a higher risk of experiencing SUI only (OR 1.5 (1.1,2.2)). Conclusions Serum 25(OH)D less then 50nmol/L was associated with increased risk of any UI and SUI in particular.Background Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAPs associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. Methods Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. Results In total, 80 studies (11 with a comparison group and 69 without) including 39148 patients were retrieved. In the non-comparison studies, the overall symptomatic VTE incidence was 2.76% (95% CI 2.24-3.28%), and 0.08 (95% CI, 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95%CI 2.94-4.76%). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (PICCs) (OR= 0.
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