Yoxas/statistical_literacy huggingface dataset:
Residents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed. The first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission. 370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population. Multiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.
Residents who are in need of remediation are prevalent across residency programs and often tend to be deficient in multiple competencies that the American Council for Graduate Medical Education (ACGME) has established. The purpose of this study was to determine the prevalence of residents requiring remediation, understand the scope of the challenges in resident remediation, and assess what resources were used to aid in remediation in obstetrics and gynecology programs. An anonymous survey was emailed to obstetrics and gynecology program directors. Survey responses were summarized through descriptive statistics. Obstetrics and gynecology residency program directors were invited to respond to this survey. Thirty-nine respondents out of 241 residency training programs responded (16%). The majority (84.6%) of programs had placed a resident on remediation. The most common area requiring remediation was professionalism (75.8%), followed by medical knowledge (72.7%), interpersonal communication (60.6%), laparoscopic technical skills (54.6%), and inpatient care (42.4%). Residents who required remediation were identified in a number of ways, most commonly through feedback from the Clinical Competency Committee (87.8%) and faculty feedback (84.8%). Program directors utilized a variety of resources, most commonly prior remediation plans from the program, to create remediation plans. Sixty percent of programs had residents who failed remediation. This study highlighted the prevalence of resident remediation in obstetrics and gynecology training programs and the importance of faculty in identifying residents in need of remediation, evaluating residents, and mentoring residents.
Residents' ability to interpret statistics is important for scholarly pursuits and understanding evidence-based medicine. Yet there is limited research assessing residents' statistical literacy and their training in statistics. In 2011 we surveyed US obstetrics-gynecology residents participating in the Council for Resident Education in Obstetrics and Gynecology In-Training Examination about their statistical literacy and statistical literacy training. Our response rate was 95% (4713 of 4961). About two-thirds (2980 of 4713) of the residents rated their statistical literacy training as adequate. Female respondents were more likely to rate their statistical literacy training poorly, with 25% (897 of 3575) indicating inadequate literacy compared with 17% (141 of 806) of the male respondents (P < .001). Respondents performed poorly on 2 statistical literacy questions, with only 26% (1222 of 4713) correctly answering a positive predictive value question and 42% (1989 of 4173) correctly defining a P value. A total of 51% (2391 of 4713) of respondents reported receiving statistical literacy training through a journal club, 29% (1359 of 4713) said they had informal training, 15% (711 of 4713) said that they had statistical literacy training as part of a course, and 11% (527 of 4713) said that they had no training. The findings suggest that statistical literacy training for residents could still be improved. A total of 37% (1743 of 4713) of obstetrics-gynecology residents have received no formal statistical literacy training in residency. Fewer residents answered the 2 statistical literacy questions correctly compared with previous studies.
Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization. We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.
Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized. Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC). Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri. This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis. With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different. Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.
Respiratory impairments refer to a reduction in pulmonary function, which may adversely affect an individual's health. Incentive spirometry is a technique designed to assist patients in achieving a pre-set airflow volume; the volume is determined from predicted values or baseline measurements. Our study aims to assess the effect of incentive spirometry on respiratory impairments. Fifty-four patients aged 40 years and above with obstructive, restrictive or mixed respiratory impairments attending the respiratory clinic at the Lagos State University Teaching Hospital, Ikeja (LASUTH), will be recruited and assigned to three groups of 18 participants based on the class of respiratory impairment. Participants in each category of respiratory impairment will be subdivided into three groups. A final group of six participants per class of impairment will participate in the experiment. Our study will be a double-blind, randomised control trial with two intervention groups and one parallel placebo control group. Pulmonary function will be assessed before and after every procedure while the six-minute walk test (6MWT), Medical Research Council dyspnoea scale and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified will be assessed fortnightly during our study. Data will be analysed using descriptive and inferential statistics and a repeated MANOVA; p < 0.05. The outcome of our study may reveal the effect of inspiratory and expiratory incentive spirometry on obstructive, restrictive or mixed respiratory impairments. Our study may contribute to the body of knowledge on pulmonary rehabilitation. Our study results may indicate if inspiratory incentive spirometry or expiratory incentive spirometry is better suited for the treatment of the respiratory impairment. www.pactr.org: PACTR202005904039357.
Respiratory Syncytial Virus (RSV) infection mainly affects newborns, infants and young children aged < 2 years. Since an RSV vaccine is in the European Medicines Agency's waitlist validation, nowadays the prevention only includes passive immunization with monoclonal antibodies (mAb). In the present study we aimed at investigating Italian paediatricians' knowledge, attitudes and behaviours towards RSV and its prevention. From February to May 2023, an anonymous online questionnaire, with answers based on the Likert scale, was administered to a sample of Italian paediatricians' members of the Italian Society of Paediatrics. Descriptive and inferential statistical analyses were performed using STATA 17. The paediatricians who answered the questionnaire were 507, mostly women (70.6%), aged 30-45 (33.1%), employed in hospitals in 66.6% of cases. The 10.8% of respondents reported that RSV is transmitted only among children younger than 2 years of age and 80.33% of participants that school-age children are not at risk of developing severe forms of RSV disease. The 25% of participants thought that active immunization is currently available to prevent RSV infection and 35.7% that does not exist passive immunization to prevent RSV for infants and newborns aged < 2 years. The 97.5% of physicians managed bronchiolitis cases and 65.6% of participants did not prescribe the administration of mAb. Higher age, seniority and RSV knowledge score were found to be associated with having a higher mAb knowledge score (p < 0.001) and having a higher RSV knowledge was associated with a higher mAb knowledge score (p < 0.001). The logistic regression model found that the odds of a positive attitude towards mAB knowledge score increased by over 3 times (OR 3.23, 95% CI [1.41, 7.40], p = 0.006) for being female and the odds of a positive attitude towards mAB knowledge score increased by almost 10 times (OR 9.73, 95% CI [3.06, 30.89], p < 0.001) for a one-unit increase in RSV knowledge score. Paediatricians' limited knowledge or awareness could represent a barrier to the implementation of preventive strategies against RSV infection. Strategies to improve paediatricians' education on RSV prevention are, therefore, crucial.
Respiratory syncytial virus (RSV) is a common cause of acute respiratory tract infection in children, including in Thailand. We conducted this study to evaluate the economic and clinical outcomes of patients <2 years old with RSV infection at a tertiary teaching hospital in Thailand. This was a retrospective cohort study during 2014-2021. To be eligible, patients had to report at least 1 positive RSV test and were <2 years old. Descriptive statistics were used to describe baseline characteristics, healthcare resource utilization, direct medical costs (1 US dollars [USD] = 31.98 Thai Baht) and clinical outcomes. Among 1370 RSV-positive patients, 49.9% of the patients (n = 683) were hospitalized at or within 3 days of RSV diagnosis with a median length of stay of 6 days (interquartile range [IQR]: 4-9 days), 38.8% were diagnosed with RSV-related respiratory complications (n = 532) and 1.5% died during the hospitalization episode (n = 20). A total of 22.5% of hospitalized patients (n = 154) received critical care during the hospitalization episode. The median cost of each RSV episode was USD539 (IQR: USD167-USD2106) and was higher among hospitalized patients (median: USD2112; IQR: USD1379-USD3182) compared with nonhospitalized patients (median: USD167; IQR: USD112-USD276). RSV infection represents a potentially important contributor to healthcare resource use and medical costs among children <2 years old in Thailand. Coupled with epidemiologic data, findings from our study will be useful to illustrate the overall economic burden associated with RSV infection among children in Thailand.
Respiratory syncytial virus (RSV) is an important cause of childhood hospitalizations. The aim of the study was to estimate the rates of RSV-related hospitalizations in children aged less than 5 years in Poland. This retrospective observational cohort study was based on data obtained from the National Health Fund in Poland regarding all acute respiratory tract infections and RSV-coded admissions of children (age < 5 years) to public hospitals between July 2015 and June 2023. Patients were stratified based on the following age groups: 0-1 month, 2-3 months, 4-6 months, 7-12 months, 13-24 months, and 25-60 months. The number of RSV-related hospitalizations increased every season, both before and through the ending phase of the coronavirus disease 2019 (COVID-19) pandemic. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infection. Hospitalization rates per 1000 inhabitants were the highest for children aged 0-12 months, reaching 47.3 in the 2022/23 season. Within this group, the highest hospitalization rate was observed for children aged 2-3 months-94.9 in the 2022/23 season. During the ending phase of the COVID-19 pandemic, the observed increase in admission rates was 2-, 4-, and 5-fold the pre-COVID rate for children aged <12 months, 12-24 months, and 25-60 months, respectively. In Poland, RSV infections cause a significant burden in hospitalized children aged less than 5 years. RSV-related hospitalizations were most frequent in children aged less than 1 year. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infections. After the pandemic, more RSV-related hospitalizations were observed in older children (aged 13 months and older) vs. the pre-pandemic phase.
Respiratory tract microbiota has been described as the gatekeeper for respiratory health. We aimed to assess the impact of standard-of-care and experimental anti-tuberculosis treatment regimens on the respiratory microbiome and implications for treatment outcomes. In this retrospective study, we analysed the sputum microbiome of participants with tuberculosis treated with six experimental regimens versus standard-of-care who were part of the HIGHRIF study 2 (NCT00760149) and PanACEA MAMS-TB (NCT01785186) clinical trials across a 3-month treatment follow-up period. Samples were from participants in Mbeya, Kilimanjaro, Bagamoyo, and Dar es Salaam, Tanzania. Experimental regimens were composed of different combinations of rifampicin (R), isoniazid (H), pyrazinamide (Z), ethambutol (E), moxifloxacin (M), and a new drug, SQ109 (Q). Reverse transcription was used to create complementary DNA for each participant's total sputum RNA and the V3-V4 region of the 16S rRNA gene was sequenced using the Illumina metagenomic technique. Qiime was used to analyse the amplicon sequence variants and estimate alpha diversity. Descriptive statistics were applied to assess differences in alpha diversity pre-treatment and post-treatment initiation and the effect of each treatment regimen. Sequence data were obtained from 397 pre-treatment and post-treatment samples taken between Sept 26, 2008, and June 30, 2015, across seven treatment regimens. Pre-treatment microbiome (206 genera) was dominated by Firmicutes (2860 [44%] of 6500 amplicon sequence variants [ASVs]) at the phylum level and Streptococcus (2340 [36%] ASVs) at the genus level. Two regimens had a significant depressing effect on the microbiome after 2 weeks of treatment, HR20mg/kgZM (Shannon diversity index p=0·0041) and HR35mg/kgZE (p=0·027). Gram-negative bacteria were the most sensitive to bactericidal activity of treatment with the highest number of species suppressed being under the moxifloxacin regimen. By week 12 after treatment initiation, microbiomes had recovered to pre-treatment level except for the HR35mg/kgZE regimen and for genus Mycobacterium, which did not show recovery across all regimens. Tuberculosis culture conversion to negative by week 8 of treatment was associated with clearance of genus Neisseria, with a 98% reduction of the pre-treatment level. HR20mg/kgZM was effective against tuberculosis without limiting microbiome recovery, which implies a shorter efficacious anti-tuberculosis regimen with improved treatment outcomes might be achieved without harming the commensal microbiota. European and Developing Countries Clinical Trials Partnership and German Ministry of Education and Research.
Responding to international research showing that early introduction of common food allergens can reduce the chance of developing allergies, in 2016 the Australasian Society of Clinical Immunology and Allergy (ASCIA) revised allergen introduction guidelines, recommending earlier introduction of allergens to infants in their first year. Australia has high food allergy rates, and limited understanding of adherence to allergen introduction guidelines, especially in rural areas. This project explored rural parent adherence to ASCIA guidelines. This was a mixed method cross sectional study using an online survey including multiple-choice and qualitative short answer responses. The sample were 336 women from two rural health districts in New South Wales. All were aged 18 or over, and either pregnant or had delivered a baby since July 2018. Descriptive statistics were used to measure behavioural alignment with the recommended guidelines, thematic analysis was used to analyse attitudes and explanations. In 84.3% of children, feeding adhered to all four guidelines studied, including no elimination of allergens during pregnancy (98%), age of introduction of solids (97.7%), continuation of breast milk/cow's milk formula during introduction of solids (95%), and age of introduction of allergens (92.9%). Adherence was not significantly correlated with the education (X2 = 17.9, P = .056), prior history of allergy [neither mother (X2 = 0.945,P = .623) nor previous children (X2 = 0.401,P = .818)], or primary care received during pregnancy. More than 90% of participants agreed or strongly agreed that the guidelines are realistic, trustworthy, and important for the health of their child. However, thematic analysis revealed that parents' perceptions of a child's individual progress, and medical conditions or other circumstances, such as challenges with breastfeeding, will often take precedence over adherence to specific guideline recommendations. High rates of adherence with ASCIA guidelines found here are comparable with findings from metropolitan studies and encouraging for future population health. Participant comments on the guidelines imply to rural policymakers that there are multiple influences on parent decisions about infant feeding, often including parents' own intuition and experiences. Further studies to improve understanding of the role of information, carers, and other influences on parent decision-making concerning feeding attitudes and behaviours will be necessary to optimise adherence in rural areas.
Responding to the need for authentic clinical training for students in the context of coronavirus disease 2019 (COVID-19), the Stellenbosch University Faculty of Medicine and Health Sciences developed an innovative 12-week longitudinal, integrated rotation for pre-final-year medical students, the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation. This saw 252 students being placed across 30 primary and secondary healthcare facilities in the Western and Northern Cape provinces. With a focus on service learning, the rotation was built on experiences and research of members of the planning team, as well as partnership relationships developed over an extended period. The focus of student learning was on clinical reasoning through being exposed to undifferentiated patient encounters and the development of practical clinical skills. Students on the distributed platform were supported by clinicians on site, alongside whom they worked, and by a set of online supports, in the form of resources placed on the learning management systems, learning facilitators to whom patient studies were submitted and wellness supporters. Important innovations of the rotation included extensive distribution of clinical training, responsiveness to health service need, co-creation of the module with students, the roles of learning facilitators and wellness supporters, the use of mobile apps and the integration of previously siloed learning outcomes. The IDEAL rotation was seen to be so beneficial as a learning experience that it has been incorporated into the medical degree on an ongoing basis.Contribution: Longitudinal exposure of students to undifferentiated patients in a primary health care context allows for integrated, self-regulated learning. This provides excellent opportunities for medical students, with support, to develop both clinical reasoning and practical skills.