Transitional care clinics for patients discharged from hospital without a primary care provider: A systematic review.

BACKGROUND: The transition from hospital to home is a high-risk period. Timely follow-up care is essential to reducing avoidable harms such as adverse drug events, yet may be unattainable for patients who lack attachment to a primary care provider. Transitional care clinics (TCCs) have been proposed as a measure to improve health outcomes for patients discharged from hospital without an established provider. In this systematic review, we compared outcomes for unattached patients seen in TCCs after hospital discharge relative to care as usual. METHODS: We searched the following bibliographic databases for articles published on or before August 12, 2022: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PsycINFO, and Web of Science. Five studies were identified that examined the effects of a dedicated postdischarge clinic on emergency department (ED) visits, readmissions, and/or mortality within 90 days of discharge for patients with no attachment to a primary care provider. RESULTS: Studies were heterogeneous in design and quality; all were from urban centers within the United States. Four of the five studies reported a reduction in either the number of ED visits or readmissions in patients seen in a TCC following hospitalization. CONCLUSIONS: TCCs may be effective in reducing hospital contacts in the period following hospital discharge in patients with no established primary care provider. Further studies are required to evaluate the health benefits attributable to the implementation of TCCs across a broad range of practice contexts, as well as the cost implications of this model.

Approaches to locum physician recruitment and retention: a systematic review.

A robust workforce of locum tenens (LT) physicians is imperative for health service stability. A systematic review was conducted to synthesize current evidence on the strategies used to facilitate the recruitment and retention of LT physicians. English articles up to October 2023 across five databases were sourced. Original studies focusing on recruitment and retention of LT's were included. An inductive content analysis was performed to identify strategies used to facilitate LT recruitment and retention. A separate grey literature review was conducted from June-July 2023. 12 studies were retained. Over half (58%) of studies were conducted in North America. Main strategies for facilitating LT recruitment and retention included financial incentives (83%), education and career factors (67%), personal facilitators (67%), clinical support and mentorship (33%), and familial considerations (25%). Identified subthemes were desire for flexible contracts (58%), increased income (33%), practice scouting (33%), and transitional employment needs (33%). Most (67%) studies reported deterrents to locum work, with professional isolation (42%) as the primary deterrent-related subtheme. Grey literature suggested national physician licensure could enhance license portability, thereby increasing the mobility of physicians across regions. Organizations employ five main LT recruitment facilitators and operationalize these in a variety of ways. Though these may be incumbent on local resources, the effectiveness of these approaches has not been evaluated. Consequently, future research should assess LT the efficacy of recruitment and retention facilitators. Notably, the majority of identified LT deterrents may be mitigated by modifying contextual factors such as improved onboarding practices.

The efficacy of prehospital IV fluid management in severely injured adult trauma patients: a systematic review and meta-analysis.

PURPOSE: The most widely used prehospital strategy for the management of hemorrhagic shock or trauma accompanied by hypotension is fluid resuscitation. Though current guidelines suggest early and aggressive fluid resuscitation, contemporary literature suggests a more restrictive approach. Our objective was to evaluate the effectiveness of low/ no IV fluids in comparison to standard resuscitation in reducing mortality for trauma patients in the prehospital setting. METHODS: Population-adults with blunt or penetrating trauma in the prehospital setting with severe injury (defined as SBP < 90 mm Hg and/or a shock index > (1). Intervention-low-dose/no IV fluids. Comparison-standard resuscitation. Outcome-mortality. A librarian-assisted search of five databases (Medline, Embase, Web of Science, and CINAHL, Cochrane trials) was completed in June 2021 (updated in November 2022). ROBINS-1 and ROB-2 tools were used to assess risk of bias in observational and randomized studies, respectively. An inverse variance method and random-effects model of statistical analysis were utilized, with data reported as risk ratios with related 95% confidence intervals. Heterogeneity of studies was assessed through analysis of the I2 RESULTS: Seven studies (six observational and one randomized trial) were included, with three thousand and fifty study participants included for analysis. Four studies compared high- to low-dose fluids, and three compared fluids to no fluids. We found no difference in mortality when comparing standard resuscitation to restricted resuscitation (RR 0.99, 95% CI [0.80-1.22], I2 = 54%). CONCLUSION: Weak, primarily observational evidence suggests that standard fluid resuscitation has no significant mortality benefit over restricting/withholding IV fluids in severe/hypotensive trauma. This review adds evidence to questioning the requirement for IV fluids in trauma given the lack of mortality benefit, in addition to demonstrating the need for more randomized studies in this area.

RéSUMé: OBJECTIF: La stratégie préhospitalière la plus utilisée pour la prise en charge du choc hémorragique ou du traumatisme accompagné d'hypotension est la réanimation liquidienne. Bien que les directives actuelles suggèrent une réanimation liquidienne précoce et agressive, la littérature contemporaine suggère une approche plus restrictive. Notre objectif était d'évaluer l'efficacité des liquides intraveineux faibles ou inexistants par rapport à la réanimation standard pour réduire la mortalité des patients traumatisés en milieu préhospitalier. MéTHODES: Population - adultes ayant subi un traumatisme contondant ou pénétrant en milieu préhospitalier et présentant des lésions graves (définies par une PAS < 90 mm Hg et/ou un indice de choc > 1). Intervention - faible dose/absence de fluides IV. Comparaison - réanimation standard. Résultat - Mortalité. Une recherche assistée par un bibliothécaire dans 5 bases de données (Medline, Embase, Web of Science et CINAHL, essais Cochrane) a été effectuée en juin 2021 (mise à jour en novembre 2022). Les outils ROBINS-1 et ROB-2 ont été utilisés pour évaluer le risque de biais dans les études observationnelles et randomisées respectivement. Une méthode de variance inverse et un modèle d'analyse statistique à effets aléatoires ont été utilisés, les données étant présentées sous forme de rapports de risque avec les intervalles de confiance à 95 % correspondants. L'hétérogénéité des études a été évaluée par l'analyse de l'I2. RéSULTATS: Sept études (six études d'observation et un essai randomisé) ont été incluses, avec 3050 participants à l'analyse. Quatre études ont comparé des fluides à forte dose à des fluides à faible dose, et trois ont comparé des fluides à l'absence de fluides. Nous n'avons trouvé aucune différence dans la mortalité en comparant la réanimation standard à la réanimation restreinte (RR 0,99, IC à 95 % [0,80­1,22], I2 = 54 %). CONCLUSION: Des preuves faibles, essentiellement observationnelles, suggèrent que la réanimation liquidienne standard ne présente aucun avantage significatif en termes de mortalité par rapport à la restriction/rétention des liquides IV dans les cas de traumatismes graves/hypotensifs. Cette revue ajoute des preuves à la remise en question de la nécessité des fluides IV en traumatologie, étant donné l'absence de bénéfice en termes de mortalité, en plus de démontrer le besoin de plus d'études randomisées dans ce domaine.

User Experience (UX) Librarianship and Health Sciences Libraries (HSLs).

This article provides the results of an investigation into how health sciences librarians with user experience (UX) duties describe their roles and initiatives. Through an online survey, 40 respondents provided details on institutional demographics, work plans, participant recruitment, and data collection. Four interviews were also conducted. This investigation provides perspectives on UX within the health sciences library (HSL) environment including barriers and successes. It is hoped that the results of this article will influence research into timely and efficient UX initiatives within HSLs and provide librarians, staff, and administrators the information they need to support decision making.

Balancing the story of fetal alcohol spectrum disorder: A narrative review of the literature on strengths.

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain- and body-based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths-based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths-based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well-being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self-awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory-driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population.

Embracing the value of research data: Introducing the JCHLA/JABSC Data Sharing Policy.

Health sciences researchers are being asked to share their data more frequently due to funder policies, journal requirements, or interest from their peers. Health sciences librarians (HSLs) have simultaneously begun to provide support to researchers in this space through training, participating in RDM efforts on research grants, and developing comprehensive data services programs. If supporting researchers' data sharing efforts is a worthwhile investment for HSLs, it is crucial that we practice data sharing in our own research endeavours. Sharing data is a positive step in the right direction, as it can increase the transparency, reliability, and reusability of HSL-related research outputs. Furthermore, being able to identify and connect with researchers in relation to the challenges associated with data sharing can help HSLs empathize with their communities and gain new perspectives on improving support in this area. To that end, the Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du Canada (JCHLA/JABSC) has developed a Data Sharing Policy to improve the transparency and reusability of research data underlying the results of its publications. This paper will describe the approach taken to inform and develop this policy.

A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder.

Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well-being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.

Left to their own devices: medical learners' use of mobile technologies.

BACKGROUND: Although many medical learners and teachers are using mobile technologies within medical education, there has been little evidence presented describing how they use mobile devices across a whole curriculum. METHODS: The Northern Ontario School of Medicine (NOSM) introduced a new mobile device program in 2010. Incoming undergraduate medical learners received a laptop and an iPad and learners entering year three of the four-year program received a laptop and an iPhone. A survey was sent to all learners to gather information on their use of and attitudes toward these devices. A combination of quantitative and qualitative methods was used to analyze the data and to generate a series of themes that synthesized student behaviors, perceptions and attitudes. RESULTS: Context and learner autonomy were found to be important factors with learners using multiple devices for different purposes and adopting strategic approaches to learning using these devices. The expectation that school-issued devices would be regularly and enthusiastically used to replace more traditional study media was not reflected in practice. CONCLUSIONS: Learners' approaches to using mobile devices are heterogeneous as is the extent to which they use them. Learners adapt their use of mobile devices to the learning cultures and contexts they find themselves in.