Ultrasound Performed by Emergency Physicians for Deep Vein Thrombosis: A Systematic Review.

Introduction: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported. Methods: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance. We performed systematic searches in MEDLINE and Embase for original, primary data articles from January 2012-June 2021 comparing the efficacy of POCUS performed by EPs to the local standard. Quality Assessment of Diagnostic Accuracy Studies-2 for individual articles are reported. We obtained summary measures of sensitivity, specificity, and their corresponding 95% confidence intervals (CI) using bivariate mixed-effects regression models. We performed meta-regression, subgroup, and sensitivity analyses as planned in the protocol CRD42021268799 submitted to PROSPERO. Results: Fifteen publications fit the inclusion criteria, totaling 2,511 examinations. Pooled sensitivity and specificity were 90% (95% CI 82%-95%) and 95% (CI 91%-97%), respectively. Subgroup analyses by EP experience found significantly better accuracy for exams performed by EP specialists (93%, CI 88%-97%) vs trainees (77%, CI 60%-94%). Specificity for EP specialists (97%, CI 94%-99%) was higher than for trainees (87%, CI 76%-99%, P = 0.01). Three-point compression ultrasound (CUS) was more sensitive than two-point CUS but was only statistically significant when limited to EP specialists (92% vs 88%, P = 0.07, and 95% vs 88%, P = 0.02, respectively). Conclusion: Point-of-care ultrasound performed by emergency physicians is sensitive and specific for the diagnosis of suspected DVT when performed by trained attending EPs. Three-point compression ultrasound examination may be more sensitive than two-point CUS.

LGBTQ+ health research guides: a multi-institutional analysis of usage patterns and user information needs.

Objective: LGBTQ+ health research guides can strengthen the LGBTQ+ community through connecting people to quality health services and information, and previous studies have recommended that health sciences libraries create and maintain these guides. Little evidence exists, though, on how these guides are used and how well they meet the needs of LGBTQ+ users. Using retrospective data retrieved from multiple LGBTQ+ health research guides, we examined the categories of LGBTQ+ health information most used, as well as how often guides were accessed. Based on these results, we hope to find patterns which can lead to best practices for libraries. Methods: Five North American academic health sciences libraries contributed select usage data from their LGBTQ+ health research guides, covering a three-year period (July 2018-June 2021). Data was analyzed in two ways. Firstly, the 20 most-clicked resources from each guide were categorized through open coding, to assess if certain information resource categories were more popular among guide users, allowing for inference of user needs. A time-series analysis was also conducted for two sites, using the Classical Seasonal Decomposition by Moving Averages method, to provide deeper insights into the data. Results: Open coding data showed consumer health information resources were used more often than other health resource categories. Resources from more locally based organizations and those with provider and services information were heavily used, indicating that users may be looking for information connecting to local health services and providers. The time series analysis allowed the potential positive effect of guide promotion to be showcased in ways that would not have been clear from the raw data. Conclusion: This study shows that people are accessing LGBTQ+ consumer health information through academic library research guides, with a preference for local information. Guide usage appears to be positively driven by outreach within one's institution and to the greater community. Locating external partners may increase guide impact and provide important links to local resources and services.

Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida.

Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.

Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review.

BACKGROUND: Although lasers have been the criterion standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects. OBJECTIVE: To evaluate all lasers used to remove tattoos and assess their efficacies and adverse effects. METHODS: Our systematic review searched PubMed, MEDLINE, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included articles was appraised by using specific assessment tools and given a high, moderate, or low risk of bias. RESULTS: Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 nonrandomized controlled trials, and 27 case series). Although quality-switched neodymium-doped yttrium-aluminum-garnet lasers are safe and effective, picosecond lasers have shown superiority with blue, green, and yellow tattoo pigments. Both are safe and effective for black tattoos. LIMITATIONS: Variability among studies. CONCLUSIONS: Picosecond lasers show superiority when treating blue, green, and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further randomized controlled trials are required to make a more definitive recommendation.

LGBTQ+ health research guides at North American health sciences libraries: a survey and content analysis.

OBJECTIVES: Current literature recommends online research guides as an easy and effective tool to promote LGBTQ+ health information to both health care providers and the public. This cross-sectional study was designed to determine how extensive LGBTQ+ health guides are among hospital and academic libraries and which features are most prevalent. METHODS: In order to locate LGBTQ+ health guides for content analysis, we searched for guides on the websites of libraries belonging to the Association of Academic Health Sciences Libraries (AAHSL) and the Canadian Association of Research Libraries (CARL). Additionally, we searched the Springshare interface for LibGuides with the word "health" and either "LGBT" or "transgender." Content analysis was performed to identify major characteristics of the located guides, including target audience and the information type provided. RESULTS: LGBTQ+ research guides were identified for 74 libraries. Of these, 5 were hospital libraries, and the rest were academic libraries. Of 158 AAHSL member libraries, 48 (30.4%) had LGBTQ+ guides on their websites. Nearly all guides (95.9%) provided general LGBTQ+ health information, and a large majority (87.8%) also had information resources for transgender health. Smaller percentages of guides contained information on HIV/AIDS (48.6%) and women's health (16.2%). CONCLUSIONS: Even though literature recommends creating LGBTQ+ health guides, most health sciences libraries are missing an opportunity by not developing and maintaining these guides. Further research may be needed to determine the usage and usefulness of existing guides and to better identify barriers preventing libraries from creating guides.

What Medical Students Want: A Library Survey of the First Ten Classes of a New College of Medicine.

In 2009, the Herbert Wertheim College of Medicine at Florida International University opened its doors. From the start, its medical library sought student feedback by administering a survey to each class. The responses found that students use online resources far more than the facility, that the hours are mostly adequate, and that most students prefer a combination of print and electronic textbooks. By analyzing the data, the library determined students' preferences for space, services, and resources and how those preferences have changed over time. This data will inform future decisions about the library's collection, services, and facility.

Disparities of HIV risk and PrEP use among transgender women of color in South Florida.

BACKGROUND: The majority of the transgender female population in South Florida are Latina and Black, and are at greatest risk for acquiring HIV, yet there is limited research focused on South Florida transgender women of color. The study objective was to describe the disparities among racial/ethnic minority transgender women regarding HIV screening, pre exposure prophylaxis (PrEP) knowledge and PrEP utilization. METHODS: Sixty transgender women, recruited from South Florida community-based organizations, completed a questionnaire on HIV prevention and PrEP awareness and use. Univariate statistics were generated to describe sexual risk behavior, PrEP awareness and use, and HIV screening by race/ethnicity. RESULTS: Of the 60 participants, 50.0% were Latina, 35.0% African American/non-Hispanic Black (AA/NHB), 11.7% white and 3.3% other race/ethnicity. 75.0% reported being screened for HIV in the last 12 months, 15.3% of the participants reported living with HIV (PLWH), while 18.6% reported an unknown status. Compared to Latinas, AA/NHB demonstrated more risk (≥2 sexual partners: 76.2% vs 53.3%; transactional sex: 47.6% vs. 26.7%; unprotected receptive anal sex: 42.9% v. 26.7%), and more engagement in routine care (81.0% vs. 76.7%) at least once a year. PrEP knowledge was 76.7% among Latinas, 71.4% among whites, 47.6% among Blacks, and 50.0% among other race/ethnicity. 65.0% of participants knew about PrEP. Of the 8.2% with current or previous PrEP use, none were AA/NHB. CONCLUSION: Findings suggest that education and public health campaigns in South Florida that promote HIV prevention should focus on increasing awareness and utilization of PrEP among racial/ethnic minority transgender, particularly among AA/NHB transgender women who are most at risk and had the lowest knowledge and use of PrEP.

[Epidermodysplasia verruciformis]. / Epidermodisplasia verruciforme.

We present the case of a 50-year-old Latin American woman who consulted her physician because of recent pruritic lesions on her arms and thighs. During the examination, we observed multiple flat papules on the limbs, as well as hypopigmented macules on the trunk which, according to the patient, began to appear during childhood. A histological study was performed on both types of lesions, and showed some enlarged keratinocytes with light blue cytoplasm in the upper layers of the epidermis. More than 20 types of HPV associated with EV (HPV-EV) have been described. Although it was previously thought that these were specific to EV, new molecular biology techniques have made it possible to isolate HPV-EV sequences in skin diseases, both benign and malignant, with epidermal hyperproliferation in the immunocompetent population.

Erupción forzada de dientes siguiendo la técnica seccional de doble arco con fines protésicos / Forced eruption of teeth following the double arch sectional technique with prosthetic purposes

La pérdida de la corona clínica cuya extensión se ubica subgingival o infraósea, representa para el odontólogo un problema al momento de restaurar un diente, por lo cual se pueden utilizar técnicas variadas para facilitar la restauración definitiva. Entre éstas se encuentra la erupción forzada, lograda mediante la ayuda de procedimientos ortodóncicos, desde pequeñas secciones de arco hasta el manejo integral de un tratamiento ortodóntico completo. El presente artículo muestra el manejo ortodóncico a través de la técnica de doble arco de un premolar superior el cual perdió la corona clínica, para luego ser restaurado de manera definitiva con un perno artificial colado y una corona de porcelana fundida sobre metal.