Systematic Review and Meta-Analysis of the Financial Impact of 30-Day Readmissions for Selected Medical Conditions: A Focus on Hospital Quality Performance.

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). METHODS: Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance. INFORMATION SOURCES: A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers. SYNTHESIS OF RESULTS: The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01-16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44-7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82-10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14-21,871.85) for THA/TKA. DISCUSSION: Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions. CONCLUSIONS: This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance.

Dentists' knowledge of non-surgical root canal treatment, a systematic review.

OBJECTIVES: Dental practice is based upon dentists' cognitions, knowledge being foundational. Knowledge is attained through education and perception. Although knowledge is modulated by beliefs, attitudes, preferences, and behaviors, it is essential to evidence-based practice. Cross-sectional studies uniformly demonstrate that community NSRCT is of sub-optimal quality worldwide, is lack of knowledge a problem? Our purpose was to measure dentists' knowledge of root canal treatment (NSRCT). DATA: Quantitative and qualitative data were extracted: purpose, topics assessed, authors cited knowledge sources, number of dentists studied, number of questions, authors descriptors of knowledge level,% correct answers by question, authors recommendations. SOURCES: OVID Medline, EMBASE, Web of Science, and hand-searching. STUDY SELECTION: Studies which had measured dentists' knowledge of non-surgical root canal treatment that was valuable, reliable, and had practical implications which could be implemented. A total of 51 papers from 19 countries measured the knowledge of 15,580 dentists using 445 questions on 29 root canal treatment topics. CONCLUSIONS: 'Gold standards' were from literature, external bodies, or expert consensus in 47, 31, and 2 papers respectively. Levels of knowledge by percentage correct answers among studies were poor to moderate and varied considerably. The mean, for the 50 studies where overall study percentages could be calculated, was 57 %, standard deviation 17 %, and a range of 16 % to 82 %. Authors' adjectives describing knowledge levels were generally negative. Additional education was advised in 49 papers, but without evidence that education was inadequate; 6 papers recommended increased use of protocols; only 5 papers advocated research on the cause of lack of knowledge. CLINICAL SIGNIFICANCE: Dentists' root canal treatment knowledge was found to be poor to moderate, as well variable. This may constrain quality of care. However, provision of information without attention to dentists' cognitions and motivations may not be successful. Educational strategies and goals should be re-evaluated. Evidence-based practice faces many barriers.

Complications of traditional bonesetting in contemporary fracture care in low- and middle-income countries: A systematic review.

OBJECTIVE: To provide an overview of the evidence on the prevalence and pattern of complications among patients treated by traditional bonesetting presenting for modern orthopaedic services in low- and middle-income countries (LMIC). METHODS: Systematic review following PRISMA guidelines. Articles were identified by searching PubMed, Embase, ScienceDirect, SCOPUS, and Web of Science using the keywords "fracture care", "traditional bonesetters" and "complications". Papers included for review were original articles set in an LMIC that directly reported the prevalence and pattern of musculoskeletal complications of traditional bonesetters' fracture treatment in LMIC settings. RESULTS: A total of 176 papers were screened for eligibility and 15 studies were finally included. Nine were prospective studies, six were retrospective studies. All were hospital-based, observational studies that investigated the outcomes of treatment of fractures by traditional bonesetters published between 1986 and 2018. In total, this review covers 1389 participants with 1470 complications of fracture treatment. CONCLUSION: Traditional bonesetting complications are associated with significant morbidity. However, traditional bonesetters have the potential to contribute positively to primary fracture care when they are trained.

The Variability and Determinants of Testosterone Measurements in Children: A Critical Review.

AIMS: This critical review aimed to summarize: (1) the variability and determinants of testosterone (T) measurements; and (2) reference values for the variability and determinants of T measurements in children. BACKGROUND: As T is a representative androgen, it has been widely used to explain male vulnerability to child health and developmental problems. T measurements in children, however, have been challenging because of low levels, diurnal and episodic secretion patterns, limited quantity and quality of the samples, and inconsistent study findings. METHODS: The search strategy used PubMed, CINAHL, Cochrane Library, Embase, Scopus, and Google Scholar. Studies published between 2008 through 2020 that examined factors influencing T measurement were included. The final 30 studies were selected using two appraisal forms. We extracted five categories of data from the reports. FINDINGS: Variability and determinants of T measurement included assay methods, the source of samples, and child demographic and environmental characteristics. T levels were higher 1-3 months after birth and in males up to 1 year; fewer sex differences were found up to 10-12 years. Serum T levels measured by using liquid chromatography-mass spectrometry were most reliable because immunoassays overestimated the levels, especially in neonates. T levels were stable at different temperatures and durations of storage, although sample collection remained an ongoing challenge for researchers. CONCLUSION: Depending on the study aims and feasibility, mass-spectrometry, multi-methods, and multi-materials are the recent trends in T measurement. Immunoassays may be an option if the study aims for relative rather than absolute comparisons.

Starting with I: Combating Anti-Blackness in Libraries.

When millions saw footage of George Floyd's murder by police during the COVID-19 pandemic where marginalized groups had higher death rates, increased awareness and action arose because Black people are treated differently in the United States. Many libraries subsequently created statements and committees to commit to reduce inequities in libraries; however, Black bodies are still being harmed. Therefore, this editorial details the Start and End with I concept and provides concrete steps for making change. It is time to center the voices that have been dismissed and ignored for too long. Are you willing to do what it takes?

Medical Library Association Diversity and Inclusion Task Force Report.

The Medical Library Association (MLA) appointed a Diversity and Inclusion Task Force (DITF) in 2017. Sandra G. Franklin, AHIP, FMLA, chaired the task force and guided initiatives. From 2017 to 2020, the task force completed a review of MLA defining documents-including the mission, vision, values, and code of ethics-resulting in language updates to these documents. As MLA transitioned through the communities process, the DITF contributed to the transition. Other recommended essential changes to MLA profiles to promote awareness included updating pronouns to promote gender inclusivity and suggestions for the Annual Meeting Innovation Task Force. DITF members actively brought diversity and inclusion programming and engagement to MLA members at annual meetings. The task force held a fish bowl conversation, an open forum, and a Diversity Dialogues roundtable discussion; provided interactive discussion boards; and designed an MLA diversity button. Beyond MLA annual meetings, the task force hosted two critical librarianship meetings and a Twitter chat to engage MLA members with diversity and inclusion topics. Task force members promoted diversity and inclusion beyond their task force appointments with presentations at chapter meetings and other non-DITF MLA annual meeting programming. A notable task force accomplishment included completing a survey of MLA members to gather baseline demographic characteristics, including never before collected data about disability, socioeconomics, and caregiver status. This report provides an overview of DITF activities from 2017 to 2020.

Teaching Cultural Competence and Cultural Humility in Dental Medicine.

Dental students need to be equipped as clinicians to treat diverse communities and to recognize oral health disparities that are rooted in the social determinants of health. Library instruction is frequently focused on information literacy topics. Within the health sciences this might include critical appraisal or evidence synthesis, and instruction centered on locating and using library resources. This paper details the unique experiences of two liaison librarians to the School of Dental Medicine who taught the topics of cultural competence and cultural humility to first-year dental medicine students. While the authors do not discuss typical information literacy instruction in this paper, they share strategies used to design the instruction sessions, reflections on teaching these themes, lessons learned, and suggestions for other liaison librarians who might have an interest in teaching about cultural competence or cultural humility.

Applying an information literacy rubric to first-year health sciences student research posters.

OBJECTIVE: This article describes the collection and analysis of annotated bibliographies created by first-year health sciences students to support their final poster projects. The authors examined the students' abilities to select relevant and authoritative sources, summarize the content of those sources, and correctly cite those sources. METHODS: We collected images of 1,253 posters, of which 120 were sampled for analysis, and scored the posters using a 4-point rubric to evaluate the students' information literacy skills. RESULTS: We found that 52% of students were proficient at selecting relevant sources that directly contributed to the themes, topics, or debates presented in their final poster projects, and 64% of students did well with selecting authoritative peer-reviewed scholarly sources related to their topics. However, 45% of students showed difficulty in correctly applying American Psychological Association (APA) citation style. CONCLUSION: Our findings demonstrate a need for instructors and librarians to provide strategies for reading and comprehending scholarly articles in addition to properly using APA citation style.