Do-it-yourself shuffling and the number of runs under randomness

A common class of problem in statistical science is estimating, as a benchmark, the probability of some event under randomness. For example, in a sequence of events in which several outcomes are possible and the length of the sequence and number of outcomes of each type known, the number of runs gives an indication of whether the outcomes are random, clustered, or alternating. This note explains and illustrates a simple method of random shuffling that is often useful. We show how the conditional probability distribution of the number of runs may be derived easily in Stata, thus yielding p-values for testing the null hypothesis that the type of outcome is random. We also compare our direct approach with that using the simulate command. Copyright 2003 by StataCorp LP.alternation, categorical data, clustering, conditional distribution, forvalues, p-value, permutation, run, sequence, simulate, simulation

The role, remit and training needs of Dementia Champions : Results from an online survey

Background: Dementia Champions play a critical role in implementing the goals of the National Dementia Strategy. Whilst there is no common definition of what a Dementia Champion is, their role is often to act as change agents in improving the experience, care, treatment and outcomes for people with dementia, their families and carers. This can be in general hospitals, community and long term care settings and at the interface between hospital and community services. Professionals and clinicians across Health and Social Care have taken up the role of Dementia Champion in addition to their existing responsibilities. Aim: The first part of the Project was completed in 2014. In its second phase the Project focused on exploring how Dementia Champions perceived their role, its remit, and which training they thought they would need in order to meet the needs of people living with dementia and to co-ordinate their care in various clinical contexts. Methods: An online survey was conducted. Findings: Most perceived dementia awareness training as useful, but limited. Areas for further development were context specific skills training, education programmes that were formally recognised, and clarification around the expectations of the role. Conclusion: Expectations of ‘champion roles’ in dementia need to be re-visited, specifically in relation to the remit of the role and the level of education, preparation and support required for DCs to become change agents in dementia care.Final Published versio

HBSC England National Report: Health Behaviour in School-aged Children (HBSC) : World Health Organization Collaborative Cross National Study

Findings from the 2014 HBSC study for Englan

Modified dietary fat intake for treatment of gallstone disease

Madden AM, Trivedi D, Smeeton NC, Culkin A., 'Modified dietary fat intake for treatment of gallstone disease', Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD012608, DOI: 10.1002/14651858.CD012608. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Protocol: To assess the benefits and harms of modifying dietary fat intake in the treatment of gallstone disease.Peer reviewedFinal Published versio

Modified dietary fat intake for treatment of gallstone disease (Protocol)

© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.This is a protocol for a Cochrane Review (Intervention). To assess the benefits and harms of modifying dietary fat intake in the treatment of gallstone disease.Peer reviewe

The importance of recovery and staffing on midwives’ emotional wellbeing: a UK national survey

© 2024 The Authors. Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: There is currently a gap in the evidence on how working practices, such as the ability to take rest breaks, finish on time or intershift recovery influence outcomes. Aim: The aim of this study was to explore the association of individual characteristics, work-related factors and working practices on emotional wellbeing outcomes of UK midwives. Methods: An online cross-sectional survey collated data between September and October 2020. Outcomes explored were work-related stress, burnout, being pleased with their standard of care, job satisfaction and thoughts about leaving midwifery. Univariate analysis identified the explanatory variables to be investigated using multivariable logistic regression. Findings: A total of 2347 midwives from the four UK nations completed the survey. No standard approach in monitoring safe staffing or in-shift or intershift recovery was found. There were high levels of work-related stress, burnout and thoughts about leaving midwifery, and low levels of job satisfaction, with just half of midwives reporting they were satisfied with the standard of care they could provide. Multivariable regression revealed that working practices variables, generally related to impeded recovery or compounded by staffing issues, had a significant association with poorer emotional wellbeing outcomes. Conclusion: This research has demonstrated an association between impeded recovery, including a lack of formal methods to monitor this, and poorer emotional wellbeing outcomes, and that staffing levels are highly influential in determining outcomes. There is a need to re-evaluate current approaches to job design and how midwives are expected to work.Peer reviewe

Modified dietary fat intake for treatment of gallstone disease in people of any age

© 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Background The prevalenceof gallstones varies between less than 1% and 64% in different populations andis thought to be increasing in response to changes in nutritional intake andincreasing obesity. Some people with gallstones have no symptoms butapproximately 2% to 4% develop them each year, predominantly including severeabdominal pain. People who experience symptoms have a greater risk ofdeveloping complications. The main treatment for symptomatic gallstones ischolecystectomy. Traditionally, a low-fat diet has also been advised to managegallstone symptoms, but there is uncertainty over the evidence to support this. Objectives To evaluatethe benefits and harms of modified dietary fat intake in the treatment ofgallstone disease in people of any age. Search methods We searchedthe Cochrane Hepato-Biliary Group Controlled Trials Register, the CochraneCentral Register of Controlled Trials in the Cochrane Library, MEDLINE ALLOvid, Embase Ovid, and three other databases to 17 February 2023 to identifyrandomised clinical trials in people with gallstones. We also searched onlinetrial registries and pharmaceutical company sources, for ongoing or unpublishedtrials to March 2023. Selectioncriteria We includedrandomised clinical trials (irrespective of language, blinding, or status) inpeople with gallstones diagnosed using ultrasonography or conclusive imagingmethods. We excluded participants diagnosed with another condition that maycompromise dietary fat tolerance. We excluded trials where data fromparticipants with gallstones were not reported separately from data from participantswho did not have gallstones. We included trials that investigated otherinterventions (e.g. trials of drugs or other dietary (non-fat) components)providing that the trial groups had received the same proportion of drug orother dietary (non-fat) components in the intervention. Data collectionand analysis We intended toundertake meta-analysis and present the findings according to Cochranerecommendations. However, as we identified only five trials, with dataunsuitable and insufficient for analyses, we described the data narratively. Main results We includedfive trials but only one randomised clinical trial (69 adults), published in1986, reported outcomes of interest to the review. The trial had four dietaryintervention groups, three of which were relevant to this review. We assessedthe trial at high risk of bias. The dietary fat modifications included amodified cholesterol intake and medium-chain triglyceride supplementation. Thecontrol treatment was a standard diet. The trial did not report on any of theprimary outcomes in this review (i.e. all-cause mortality, serious adverseevents, and health-related quality of life). The trial reported on gallstonedissolution, one of our secondary outcomes. We were unable to apply the GRADEapproach to determine certainty of evidence because the included trial did notprovide data that could be used to generate an estimate of the effect on thisor any other outcome. The trial expressed its finding as "no significant effectof a low-cholesterol diet in the presence of ursodeoxycholic acid on gallstonedissolution." There were no serious adverse events reported. The includedtrial reported that they received no funding that could bias the trial resultsthrough conflicts of interest. We found no ongoing trials. Authors'conclusions The evidenceabout the effects of modifying dietary fat on gallstone disease versus standard diet is scant. We lack results from high-quality randomised clinical trialswhich investigate the effects of modification of dietary fat and other nutrientintakes with adequate follow-up. There is a need for well-designed trials thatshould include important clinical outcomes such as mortality, quality of life,impact on dissolution of gallstones, hospital admissions, surgicalintervention, and adverse events.Peer reviewe

Assessing prevalence, knowledge and use of cognitive enhancers among university students in the United Arab Emirates: A quantitative study

BackgroundCognitive enhancers (CE) are often used to improve memory, alertness and cognitive capacity. These products are commercially and pharmaceutically available. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE).AimsTo assess the prevalence of CE intake; evaluate students’ knowledge of these substances; and identify student characteristics associated with CE usage.MethodA cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE universities. Associations between student characteristics and CE use were investigated using the chi-squared test and multiple logistic regression. Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender.ResultsOne quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students.ConclusionsUniversities need to address the prevalence of CE use amongst their students by providing effective support programs

Exploring the baseline knowledge and experience of healthcare professionals in the United Kingdom on Novel Psychoactive Substances

Submitted 28 january 2020. Reviwers' comments received 11 February 2020. Accepted 26 February 2020. Published 2 March 2020.Objective: This survey aimed to explore knowledge and experience on novel psychoactive substances (NPS) of healthcare professionals (HCPs). The study also aimed to assess how HCPs would like to improve their knowledge of NPS. Methods: Seventy paper questionnaires were disseminated in 2017 within continuing education events to pharmacists, nurses and general practitioners (GPs). Additionally, 127 online surveys were completed using the Qualtrics platform by other HCPs and mental health nurses in six United Kingdom (UK) independent mental health hospitals long-stay in-patient rehabilitation services. Two educational sessions involving pharmacists and GPs were also held in late 2017 and mid-2018. Knowledge of NPS by HCPs was evaluated prior to the start of the educational events. Evaluation forms were handed out post-sessions to garner feedback, especially on areas for improvement for future sessions. Statistical analysis of data was undertaken using SPSS (V.25). Results: Most HCPs reported only 'basic' to 'intermediate' NPS knowledge. Substance misuse service staff felt more informed, were more often consulted and had greater confidence regarding NPS compared to hospital and primary care professionals. A negative association was found between the age of the HCP and knowledge of NPS. Most participants expressed a need for regular training and updates as insufficient NPS-related information is currently received. Conclusions: An improvement within the self-reported knowledge of HCPs on NPS is evident in comparison to previous studies. Continued education of HCPs on NPS is fundamental for the provision of improved harm reduction services, which can enhance overall care for NPS service users.Peer reviewedFinal Published versio