Yoxas/statistical_literacy huggingface dataset:
Primary care education is a unique clinical experience for medical students. It is community-based and provides an opportunity for students to learn consultation skills with multiple sources of workplace-based feedback. Meaningful and demonstrable utilisation of this feedback by students remains an educational challenge. We showcase achievable changes to educational tasks in an established curriculum, which aim to improve student feedback literacy and create a feedback loop which improves on previous provision of unidirectional, terminal feedback. The changes have been well-received, with student and educator engagement being positive. Students have demonstrated critical reflection on feedback, and development in consultation and clinical reasoning skills.
Primary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based care can be protective against clinician burnout, and opportunities for interprofessional education (IPE) on professional development and leadership could encourage primary care transformation. Despite an increasingly important role in the primary care workforce, IPE initiatives training physician assistants (PAs) alongside physicians are rare. We describe the design, curriculum, and outcomes from an interprofessional primary care transformation fellowship for community-based primary care physicians and PAs. The Community Primary Care Champions (CPCC) Fellowship was a one-year, part-time fellowship which trained nine PAs, fourteen physicians, and a behavioralist with at least two years of post-graduate clinical experience in six content pillars: quality improvement (QI), wellness and burnout, mental health, social determinants of health, medical education, and substance use disorders. The fellowship included a recurring schedule of monthly activities in self-study, lectures, mentoring, and community expert evening discussions. Evaluation of the fellowship included pre, post, and one-year follow-up self-assessments of knowledge, attitudes, and confidence in the six content areas, pre- and post- wellness surveys, lecture and discussion evaluations, and midpoint and exit focus groups. Fellows showed significant improvement in 24 of 28 self-assessment items across all content areas post-fellowship, and in 16 of 18 items one-year post-fellowship. They demonstrated reductions in emotional exhaustion and depersonalization post-fellowship and increased confidence in working in interprofessional teams post-fellowship which persisted on one-year follow-up assessments. All fellows completed QI projects and four presented their work at national conferences. Focus group data showed that fellows experienced collaborative, meaningful professional development that was relevant to their clinical work. They appreciated the flexible format and inclusion of interprofessional community experts in evening discussions. The CPCC fellowship fostered an interprofessional community of practice that provided an effective IPE experience for physicians and PAs. The learning activities, and particularly the community expert discussions, allowed for a flexible, relevant experience, resulting in personal and professional growth along with increased confidence working within interprofessional teams.
Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units. This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations. Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations. The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.
Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. The responses of 4'063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.
Primary Health Care (PHC) is capable of achieving broad coverage and effectiveness. This study evaluated the factors associated with the prioritization that municipal health managers in the state of Rio Grande do Sul (RS) give to PHC. A cross-sectional analytical study was carried out between August 2017 and May 2019 using an online FormSUS questionnaire, consisting of 44 questions divided into 4 blocks, sent to 497 municipal health managers. Multiple logistic regression was performed to analyze factors associated with PHC prioritization. Out of 404 participants, 66.8% reported a maximum degree of prioritization. Managers with a postgraduate degree showed greater prioritization than those with elementary education (78.5% vs 58.8%, p<0.01). Regarding the postgraduate area, managers with training in public health prioritized PHC more than in other areas, or with no postgraduate studies, respectively with 84%, 77.1% and 61.8% (p<0.01). After adjusting for covariates, having a postgraduate degree in public health or in another area remained associated with greater chances of prioritization. The results may encourage initiatives that consider the level and area of education for this position focusing on technical, and not strictly political criteria.
Primary human hepatocytes are used in all facets of liver research, from in vitro studies of xenobiotic disposition and toxicity to the clinical management of liver failure. Unfortunately, cellular stress during isolation and cryopreservation causes a highly unpredictable loss of the ability to attach and form cell-matrix and cell-cell interactions. Reasoning that this problem could be mitigated at the post-thawing stage, we applied label-free quantitative global proteomics to analyze differences between attached and non-attached fractions of cryopreserved human hepatocyte batches. Hepatocytes that were unable to attach to a collagen matrix showed many signs of cellular stress, including a glycolytic phenotype and activation of the heat shock response, ultimately leading to apoptosis activation. Further analysis of the activated stress pathways revealed an increase in early apoptosis immediately post-thawing, which suggested the possibility of stress reversal. Therefore, we transiently treated the cells with compounds aimed at decreasing cellular stress via different mechanisms. Brief exposure to the pan-caspase apoptosis inhibitor Z-VAD-FMK restored attachment ability and promoted a differentiated morphology, as well as formation of 3D spheroids. Further, Z-VAD-FMK treatment restored metabolic and transport functions, with maintained sensitivity to hepatotoxic insults. Altogether, this study shows that differentiation and function of suboptimal human hepatocytes can be restored after cryopreservation, thus markedly increasing the availability of these precious cells.
Primary hypothyroidism, the most common form of hypothyroidism, requires effective patient understanding and management for successful long-term treatment. This study aimed to investigate the influence of patient knowledge, attitude, practice (KAP), depression, and medication adherence on treatment response in primary hypothyroidism. A cross-sectional observational study was conducted at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Iraq between September 2022 and March 2023. We enrolled 111 patients with signs and symptoms of primary hypothyroidism over 6 months. A validated questionnaire assessed patient knowledge, attitude, practice (KAP), depression, and medication adherence. Thyroid-stimulating hormone (TSH) levels were measured to assess treatment response. Data were analyzed using SPSS v26, with categorical variables presented as percentages. The student's t-test was used to assess statistical significance, with P - valuess below 0.05 considered significant and P - values below 0.01 considered highly significant. The mean age of patients was 45 ± 11.9 years. Approximately 34% of patients had insufficient knowledge, and 30% indicated a positive attitude towards their treatment. A total of 35% of patients had excellent practice. There was no statistically significant association between KAP and age or gender. There was a significant positive correlation between higher levels of education and improved KAP scores. A total of 44.1% of participants reported moderate depression, and 58% demonstrated adherence to levothyroxine (LT4) treatment. Despite good adherence, the combination of fair knowledge and moderate-to-severe depression resulted in suboptimal outcomes for replacement treatment.
Primary metastatic breast cancer (pMBC) accounts for 5-10% of annual breast cancers with a median survival of 3-4 years, varying among subtypes. In Denmark, the incidence of breast cancer increased until 2010, followed by a stabilisation. Several factors influencing pMBC incidence and survival, including screening prevalence, staging methods, and classification standards, remain pivotal but inadequately documented. This retrospective observational study involving pMBC patients diagnosed between 2000 and 2020 encompassed all Danish oncology departments. Data from the Danish Breast Cancer Group database and the National Patient Register included diagnosis specifics, demographics, treatment, and follow-up. Between 2000 and 2020, 3,272 patients were diagnosed with pMBC, a rise from 355 patients in 2000-2004 to 1,323 patients in 2015-2020. The increase was particularly observed in patients aged 70 years or older. Changes in tumour subtypes were observed, notably with a rise in human epidermal growth factor receptor 2 (HER2)-positive cases but a steady distribution of estrogen receptor (ER) status. Diagnostic practices changed over the two decades, with 6% evaluated with PET/CT (positron emission tomography-computed tomography) or CT (computed tomography) with a bone evaluation in 2000-2004 and 65% in 2015-2020. Overall survival (OS) improved from 23 months in 2000-2004 to 33 months in 2015-2020. In patients with ER-positive and HER2-positive disease, the multivariable model showed improved survival by year of diagnosis, and further, patients with ER-negative/HER2-negative disease fared worse the first 2 years after diagnosis. Our study delineates changes in the treatment and survival of pMBC over two decades. Stage migration, screening introduction, and changes in registration practice, however, prevent a valid assessment of a possible causal relationship.
Primary neuroendocrine neoplasms of the breast (Br-NENs) are rare. The classification has been updated in recent years making interpretation of the data published challenging. It is unclear whether neuroendocrine differentiation is associated with poorer prognosis and what treatment approaches should be applied. The database for breast cancer patients treated between 2009 and 2022 at the Maria Sklodowska-Curie National Research Institute of Oncology Branch Krakow was explored to search for Br-NENs. Patients' medical and pathological data were collected and analyzed. We included 22 females with Br-NEN without metastases at the time of diagnosis. The median age was 64 years (range: 28-88), Of the cases, 18 were hormone receptor positive, all were HER-2 negative, the median Ki67 was 27% (10-100%). The median tumor size at the time of diagnosis was 29.5mm (7-75mm), 9 patients were N-positive. DCIS was present in 5 cases. Only one case was negative for chromogranin and synaptophysin staining, but data were missing for 4 cases. Nine patients received adjuvant chemotherapy, mainly based on anthracyclines and taxanes, while 16 received adjuvant hormonal therapy and 15 received postoperative radiotherapy. Radical surgery was performed in all patients, but two underwent suboptimal tumorectomy. One patient had local recurrence, three experienced metastatic disease, all involving the lungs, but these patients are still alive. The median follow-up was 96 months (8-153). Two patients died, with a follow up time of no recurrence >4 years. Our results were compared to twelve case series collecting clinical data on Br-NENs, with median patient number of 10.5 (range: 3-142). Br-NENs represent a heterogenous group of diseases, lacking data from prospective studies or clinical trials. There are no established treatment standards tailored for Br-NENs. Our patients' cohort exhibited a favorable prognosis, potentially attributed to lower tumor stage and Ki67 index compared to other reported case series. We suggest that radical surgery and postoperative radiotherapy be administered akin to standard treatment for breast cancer of no special type. ESMO also advocates for this approach in systemic treatment, although we recommend considering platinum-based chemotherapy for patients with poorly differentiated Br-NENs exhibiting high Ki67.
Primary treatment of localized prostate cancer can result in bothersome urinary, sexual, and bowel symptoms. Yet clinical application of health-related quality-of-life (HRQOL) questionnaires is rare. We employed user-centered design to develop graphic dashboards of questionnaire responses from patients with prostate cancer to facilitate clinical integration of HRQOL measurement. We interviewed 50 prostate cancer patients and 50 providers, assessed literacy with validated instruments (Rapid Estimate of Adult Literacy in Medicine short form, Subjective Numeracy Scale, Graphical Literacy Scale), and presented participants with prototype dashboards that display prostate cancer-specific HRQOL with graphic elements derived from patient focus groups. We assessed dashboard comprehension and preferences in table, bar, line, and pictograph formats with patient scores contextualized with HRQOL scores of similar patients serving as a comparison group. Health literacy (mean score, 6.8/7) and numeracy (mean score, 4.5/6) of patient participants was high. Patients favored the bar chart (mean rank, 1.8 [P = .12] vs line graph [P < .01] vs table and pictograph); providers demonstrated similar preference for table, bar, and line formats (ranked first by 30%, 34%, and 34% of providers, respectively). Providers expressed unsolicited concerns over presentation of comparison group scores (n = 19; 38%) and impact on clinic efficiency (n = 16; 32%). Based on preferences of prostate cancer patients and providers, we developed the design concept of a dynamic HRQOL dashboard that permits a base patient-centered report in bar chart format that can be toggled to other formats and include error bars that frame comparison group scores. Inclusion of lower literacy patients may yield different preferences.
Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. The Wellness4Teachers email program is expected to improve the participating teachers' mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program's launch. The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program's impact on subscribers' mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. PRR1-10.2196/44370.
Printed educational materials (PEMs) have been used for patient education in various settings. The purpose of this study was to determine the readability, understandability, and actionability of trauma-related educational material from the Pediatric Orthopaedic Society of North America (POSNA, Orthokids), as well as determine its efficacy in educating pediatric orthopaedic trauma patients and caregivers. The readability, understandability and actionability of PEMs was assessed using the Patient Education materials Assessment Tool (PEMAT). Five reviewers ranging in experience independently evaluated the educational materials. The efficacy of PEMs was assessed prospectively by randomizing patients into 2 groups. The first group (Education) received the OrthoKids educational material related to the patient's fracture. The second group (No Education) did not receive the educational material. At the first follow-up visit, parents/guardians in both groups completed surveys. Statistical analyses included descriptive and univariate statistics. The understandability of PEMs was similar (68% to 74%); however, the educational materials had varying actionability scores ranging from 20% for femoral shaft fractures to 60% for elbow fractures. In total, 101 patients were randomized to assess the efficacy of educational materials (Education=51, No Education=50). There were no significant differences in sex, age, race/ethnicity, and level of education between caregivers in both groups ( P > 0.05). Only 61% (31/51) participants in the Education group reported using the educational material; however, 67% to 68% of participants in either group reported wanting PEMs. Participants in the group that did not receive PEMs were significantly more likely to use the internet to find more information (74% vs. 51%, P < 0.05). This study suggests that participants that did not receive PEMs were significantly more likely to search the internet for more information. Improving the quality and actionability of educational resources on electronic platforms is needed to improve patient education. A multi-modal approach using PEMs that includes a list of high-quality online sources would likely be most effective in educating pediatric trauma patients and caregivers. I.