Yoxas/statistical_literacy huggingface dataset:
Clinicians, researchers, regulators, and other decision-makers increasingly rely on evidence from real-world data (RWD), including data routinely accumulating in health and administrative databases. RWD studies often rely on algorithms to operationalize variable definitions. An algorithm is a combination of codes or concepts used to identify persons with a specific health condition or characteristic. Establishing the validity of algorithms is a prerequisite for generating valid study findings that can ultimately inform evidence-based health care. This paper aims to systematize terminology, methods, and practical considerations relevant to the conduct of validation studies of RWD-based algorithms. We discuss measures of algorithm accuracy; gold/reference standard; study size; prioritizing accuracy measures; algorithm portability; and implication for interpretation. Information bias is common in epidemiologic studies, underscoring the importance of transparency in decisions regarding choice and prioritizing measures of algorithm validity. The validity of an algorithm should be judged in the context of a data source, and one size does not fit all. Prioritizing validity measures within a given data source depends on the role of a given variable in the analysis (eligibility criterion, exposure, outcome or covariate). Validation work should be part of routine maintenance of RWD sources.
Clinicians' information-seeking behaviours impact patient care quality. Earlier studies indicated that barriers to accessing information deter clinicians from seeking answers to clinical questions. To explore primary care clinicians' information-seeking behaviour at point-of-care, focusing on when and how they seek answers to clinical questions. Semi-structured interviews were conducted with 45 clinicians after clinical sessions to investigate their information-seeking habits. Follow-up interviews were conducted after a week for those intending to address unanswered queries. Two thirds of clinicians encountered questions during care, with nearly three quarters resolving them during the session. Colleagues, guidelines and online platforms were common information sources, with smartphones being used to access Google, WhatsApp or UpToDate®. Facilitators included reliable sources and the drive to confirm knowledge, while barriers included ineffective search methods and high workload. Despite challenges, most clinicians expressed satisfaction with their information-seeking process. The findings underscore the increasing use of smartphones for accessing clinical information among Singaporean primary care clinicians and suggest the need for tailored training programmes and guidelines to optimise information-seeking practices. Insights from this study can inform the development of training programmes and guidelines aimed at improving information-seeking practices among primary care clinicians, potentially enhancing patient care quality.
Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates. The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes. Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements. The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period. We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes.
Clostridioides difficile infection (CDI) is a clinical and laboratory diagnosis. Populations at higher risk of developing disease require a high clinical index of suspicion for laboratory testing to avoid incorrect assumptions of colonization. Common risk factors include recent antibiotic use, elderly (>65 years old), and immunocompromised patients. C. difficile assays should be ordered in an algorithm approach to diagnose an infection rather than colonization. Screening tests are widely available in hospital systems, but novel molecular testing may aid in diagnosis in patients with inconclusive or discordant antigen and toxin test results. Methods: Data was extracted from PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases based on the keywords "clostridioides difficile", "toxin assay", and "toxic megacolon". The data extracted is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 27 reports were included in this systematic review. Testing patients with a significant gastrointestinal surgical history, hypogammaglobulinemia, inflammatory bowel disease, intensive care unit, and immunocompromised patients for CDI is highly recommended. Diarrhea in these subsets of patients requires correlation of clinical context and an understanding of assay results to avoid over- and under-treating. CDI should be considered in all patients with traditional risk factors. Heightened clinical suspicion of CDI is required in patients with hypogammaglobulinemia, transplant recipients, patients with gastrointestinal surgical history, and inflammatory bowel disease. Testing should be limited to patients with clinical manifestations of CDI to ensure a high pretest probability for test interpretation. Healthcare workers should adhere to testing algorithms to optimize yield in the appropriate clinical context. Diagnostic assays should follow a sequential, stepwise approach to categorize the toxin expression status of the bacteria accurately.
Clostridioides difficile is the main pathogen of antimicrobial-associated diarrhoea and health care facility-associated infectious diarrhoea. This study aimed to investigate the prevalence, toxin genotypes, and antibiotic resistance of C. difficile among hospitalized patients in Xi'an, China. We isolated and cultured 156 strains of C. difficile, representing 12.67% of the 1231 inpatient stool samples collected. Among the isolates, tcdA + B + strains were predominant, accounting for 78.2% (122/156), followed by 27 tcdA-B + strains (27/156, 17.3%) and 6 binary toxin gene-positive strains. The positive rates of three regulatory genes, tcdC, tcdR, and tcdE, were 89.1% (139/156), 96.8% (151/156), and 100%, respectively. All isolates were sensitive to metronidazole, and the resistance rates to clindamycin and cephalosporins were also high. Six strains were found to be resistant to vancomycin. Currently, the prevalence rate of C. difficile infection (CDI) in Xi'an is 12.67% (156/1231), with the major toxin genotype of the isolates being tcdA + tcdB + cdtA-/B-. Metronidazole and vancomycin were still effective drugs for the treatment of CDI, but we should pay attention to antibiotic management and epidemiological surveillance of CDI.
Co-creation within higher education emphasizes learner empowerment to promote collaboration between the students and staff, enabling students to become active participants in their learning process and the construction of resources with academic staff. Concurrently, a diminishing number of higher education institutions offer in vivo practical classes, resulting in an in vivo skills shortage. To address this, and to actively engage students in their own learning, we describe the co-creation of a student-led drug trial using Lumbriculus variegatus. Under blinded conditions, final-year undergraduate biomedical science students, under the tutelage of academic staff and fellow students, were involved in the co-creation of an in vivo practical class to determine the effects of histamine and histamine receptor inverse agonists mepyramine and loratadine. Throughout this process, undergraduate- and masters-level students played key roles in every aspect of practical delivery and data analysis. Herein, students demonstrated the test compounds, both in isolation and in combination, resulted in reduced stereotypical movements of L. variegatus (p < .05, n ≥ 6). 15% of students in the class responded to a feedback survey (n = 8) after the class. Students reported the class provided "real life" insights into in vivo research and enabled the development of hands-on skills which would be useful in applying in their future careers. All students reported that they enjoyed the class with 25% (n = 2) reporting concerns about animal use in research, enabling useful discussions about animals in research. Moreover, these student-led in vivo trials add to the pharmacological knowledge of L. variegatus promoting education-led research.
Co-curricular activities equip students with essential skills and knowledge for personal and professional growth. Despite their importance, many students exert minimal effort to complete the assigned tasks. Instructors perceive that the lack of emphasis on final exams in co-curricular subjects reduces student effort and commitment. Moreover, poor time management and lack of effort in completing tasks have increased across various subjects in recent years. Therefore, it is important to investigate the factors that contribute to student commitment towards co-curricular subjects. In this study, the submission status of 339 tasks was retrieved from the student learning system to measure student commitment based on whether tasks were submitted on time, delayed, or not submitted. A chi-square test f was used to investigate the relationship between students' demographic characteristics and their commitment. The findings revealed a significant association between student commitment and the type of task given (p < 0.001). Students were more likely to submit presentations on time compared to written assignments. Projects were more likely to be delayed, while written assignments had a high frequency of no submission. Age was a significant predictor of commitment (p < 0.05), with students over 20 more likely to submit on time and students under 20 more likely to ignore submission. Gender was also a significant predictor of commitment (p < 0.001), with female students having a higher percentage and frequency of on-time submissions while male students having a higher number of no submissions. However, no significant association was found between the study year and commitment (p > 0.05), indicating that the year of the study could not determine the level of commitment to the course. Overall, these findings could be used to guide the preparation of tasks and assignments in co-curricular subjects to enhance student commitment and holistic development.
Co-production of research with communities and stakeholders is recognised as best practice, but despite this, transparent reporting and reflective accounts on co-producing research is lacking. Born in Bradford Age of Wonder (AoW) is a large longitudinal health research project, following the health trajectories of up to 30,000 young people across the Bradford district; moreover, AoW has been entirely co-produced with teachers, parents, and young people. This paper describes the co-production of the Born in Bradford Age of Wonder (AoW) project and shares general reflections on co-production from peer researchers involved in co-producing AoW. A co-operative inquiry (CI) approach was used to gather written reflections on co-production from ten peer researchers (one teacher, one parent, eight young people) involved in co-producing the AoW project. Written reflections were collected and rough "themes" were identified using thematic analysis. Four key 'themes' were identified: (1) promoting young people's voice and views (2) identifying impacts of co-production, (3) fostering a collaborative ethos, and (4) suggested improvements to the co-production work in AoW. Peer researchers' reflections highlighted how co-production can positively impact research projects such as AoW, whilst also holding broader benefits including giving young people a voice, facilitating their personal development, and fostering a collaborative ethos both within AoW and with partner organisations. Suggested improvements to AoW co-production included supporting greater numbers of young people and researchers to engage in co-production, organising more regular sessions, and establishing clearer communication channels. Peer researchers' reflections highlight positive impacts of engaging in co-production, both for research projects (including AoW) and for peer researchers' personal and professional development. That said, continued efforts are needed in AoW to meet young people's needs and interests, maintain trusting relationships, and foster sustained growth of co-production efforts within and beyond the AoW project. Evaluation of AoW co-production, along with wider partnership building are key to these efforts.
Coaching is an increasingly popular means to provide individualized, learner-centered, developmental guidance to trainees in competency based medical education (CBME) curricula. Aligned with CBME's core components, coaching can assist in leveraging the full potential of this educational approach. With its focus on growth and improvement, coaching helps trainees develop clinical acumen and self-regulated learning skills. Developing a shared mental model for coaching in the medical education context is crucial to facilitate integration and subsequent evaluation of success. This paper describes the Royal College of Physicians and Surgeons of Canada's coaching model, one that is theory based, evidence informed, principle driven and iteratively and developed by a multidisciplinary team. The coaching model was specifically designed, fit for purpose to the postgraduate medical education (PGME) context and implemented as part of Competence by Design (CBD), a new competency based PGME program. This coaching model differentiates two coaching roles, which reflect different contexts in which postgraduate trainees learn and develop skills. Both roles are supported by the RX-OCR process: developing Relationship/Rapport, setting eXpectations, Observing, a Coaching conversation, and Recording/Reflecting. The CBD Coaching Model and its associated RX-OCR faculty development tool support the implementation of coaching in CBME. Coaching in the moment and coaching over time offer important mechanisms by which CBD brings value to trainees. For sustained change to occur and for learners and coaches to experience the model's intended benefits, ongoing professional development efforts are needed. Early post implementation reflections and lessons learned are provided.
Coaching is an interactive process of performance improvement accomplished by fostering a coachee's ability to critically self-evaluate, create goals, and develop a plan for action. It is being increasingly used in medical education, both at the undergraduate and graduate levels. The American Medical Association (AMA) recommends robust faculty development for any coaching program. Our institution created a mandatory coaching program for students starting in August 2022 with 22 faculty coaches. We used Kern's 6-step model for curriculum development to create our institution's faculty development for coaches. This manuscript describes the process of development, implementation, and early program evaluation for the curriculum for faculty coaches for the first 4 months of our mandatory coaching program. The objectives and teaching strategies are outlined. Our program evaluation consisted of immediate and follow-up surveys of faculty attendees. Content in the faculty development program describing the medical student curriculum, assessment, and student resources improved faculty perceived knowledge and confidence. Specific training in coaching skills, including a simulation using standardized students was used and found to be essential. We offer lessons learned from our coaches regarding timing and content for any faculty development curriculum for new coaches. Considerations for future faculty development curricula for academic coaching programs include timing of the faculty development, content consideration after three coaching sessions, and potential content additions and deletions. The curriculum outlined can be taken and immediately adapted for any school of medicine embarking on a coaching program for students.
Codeine-containing compound analgesics (CCCAs) are associated with dependence and, when taken in excess, significant risks of harm. A previous audit showed significant costs related to admissions for gastrointestinal (GI) complications of CCCA. Based on this and other evidence of harm, the Australian Therapeutic Goods Administration changed CCCAs to prescription only in 2018. We aimed to identify the costs associated with codeine-related GI complications and whether the schedule change in 2018 led to a reduced clinical and financial strain on the health care system. We conducted an audit of GI admissions and associated costs of CCCAs at a tertiary teaching hospital in Adelaide between 2016 and 2020. Patients were grouped by 2-year time periods before (group 1) and following (group 2) schedule change. Costs for the index presentation were multiplied for subsequent presentations. Costs and outcomes were compared for groups (standard statistics; P value < 0.05 significant.) RESULTS: Three hundred forty patients (group 1, n = 164; group 2, n = 119) were identified, with the majority of these admitted due to nonsteroidal anti-inflammatory drugs (NSAIDs) only. For CCCAs (NSAID-containing), the same patients were admitted repeatedly with a reduction from 31 to eight admissions (P = 0.005), following rescheduling. The total cost of CCCA admissions was reduced from AU$ 561 691 for group 1 to AU$ 261 764 for group 2 (P < 0.001). Australian rescheduling of CCCAs in 2018 resulted in a reduction in hospital admissions and costs related to GI complications. The cost savings, even in a single hospital department, were substantial.
Coffee holds a cherished place in Ethiopian culture, its consumption among students raises concerns despite its perceived benefits for alertness and productivity. Moderate caffeine intake remains unproblematic, but exceeding 400 mg daily can trigger detrimental health effects such as fatigue, memory impairment, and even attention-deficit disorder. Research on problematic coffee use among young adults, specifically Ethiopian students, remains limited, hindering our understanding of its potential scope and impact. To address this knowledge gap, researchers at Dilla University, Ethiopia, undertook a comprehensive study in 2022, focusing on the university's student population. This investigation holds significant potential to unveil the previously obscured landscape of excessive coffee consumption in this demographic and inform future research and potential interventions. An institutional-based cross-sectional study design was conducted in August-July, 2022. To measure problematic coffee use, this study used the Diagnostic Statistical Manual five criteria for substance use disorder. Those who scored >2 out of 11 criteria were considered to have problematic coffee use. To measure a significant association between the outcome and independent variable, a multivariable logistic regression analysis at p < 0.05 and 95% confidence interval was employed. This study included 414 respondents. More than half of the respondents, 347 (59.7%) were male. Out of all respondents, 182 (44.0%) had a boy/girlfriend. Nearly half of the respondents, 218 (52.7%) were orthodox, Christian religion followers. According to this study's findings, 137 (33.1%) respondents were considered to have problematic coffee use. Multivariable logistic regression analysis showed that 5-10 years duration of coffee use (AOR = 4.62, 95% CI: 2.96-7.85; p = 0.001), start to use coffee before joining university (AOR = 2.977, 95% CI: 1.332-6.653; p = 0.008) and 6-9 cups of daily coffee use (AOR = 3.26, 95% CI: 2.14-5.89; p = 0.00) were associated with problematic coffee use. This study showed that one-third of the respondents had problematic coffee use. The starting point, duration, and amount of use had a strong association with problematic coffee use. Hence, focusing on addressing the mental health challenges associated with problematic/excessive coffee consumption among higher education students is advisable. Additionally, promoting awareness of problematic/excessive coffee use and its potential remedies is recommended.
Cognitions about climate change are of critical importance for climate change mitigation as they influence climate-relevant behaviors and the support of climate policy. Using about 30,000 observations from a large-scale representative survey from 23 European countries, this study provides two major findings. First, important policy-relevant climate change cognitions do not only differ by individuals' ideological identity (left versus right) but-independently-by their moral identity, that is, the pattern of endorsement of the moral foundations: Care, Fairness, Liberty, Loyalty, Authority, and Purity/Sanctity. In particular, controlling for ideological position, the cognitions that the world climate is changing, that climate change is human-made, and that climate change impacts are bad are significantly negatively related to stronger endorsement of the Authority and Sanctity foundations while being positively related to stronger endorsement of the Loyalty and Fairness foundations. Second, not only the ideology-related cognitive divide but the morality-related divide is larger in individuals with tertiary education, consistent with the idea that individuals with greater science literacy and numeracy use these skills to adjust their cognitions to their group identity. The finding that better education may amplify rather than attenuate the ideology and morality dependence of decision-relevant climate change cognitions sheds doubt on the proposition that better education unambiguously furthers the prospects for climate change mitigation.