Emergency department management of patients with right heart failure.

Right heart failure (RHF) can result from many cardiac, pulmonary, and systemic pathologies. Common causes of RHF include pulmonary embolism, left heart failure, congenital heart disease, chronic lung disease, acute myocardial infarction, infiltrative disease, infectious disease, and valvular abnormalities. Acute and chronic RHF confer a high risk for morbidity and mortality in the acute care setting, and interventions commonly used in emergency care can prompt acute decompensation if the RHF is not recognized. The severity of presentation may range from compensated clinically silent cardiovascular dysfunction to venous congestion, multiorgan failure, and circulatory collapse. This review describes the pathophysiology of right heart failure and offers an evidence-based approach to the diagnosis, management, and disposition of both acute and chronic RHF.

Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis.

OBJECTIVE: To systematically review the current literature for articles describing the effect of myofunctional therapy on pediatric obstructive sleep apnea (OSA) and to perform a meta-analysis on the sleep study data. METHODS: Three authors (A.B., K.K. and M.C.) independently searched from inception through April 20, 2020 in PubMed/MEDLINE, Scopus, Embase, Google Scholar and The Cochrane Library. Mean difference (MD), standard deviations and 95% confidence intervals were combined in the meta-analysis for apnea-hypopnea index (AHI), mean oxygen saturations, and lowest oxygen saturations (nadir O2). RESULTS: 10 studies with 241 patients met study criteria and were further analyzed. The AHI reduced from 4.32 (5.2) to 2.48 (4.0) events/hr, a 43% reduction. Random effects modeling demonstrated a mean difference in AHI of -1.54 (95% CI -2.24,-0.85)/hr, z-score is 4.36 (p < 0.0001). Mean oxygen saturation increased by 0.37 (95% CI 0.06,0.69) percent, z-score is 2.32 (p = 0.02). There was no significant increase in nadir O2. CONCLUSIONS: Despite heterogeneity in exercises, myofunctional therapy decreased AHI by 43% in children, and increased mean oxygen saturations in children with mild to moderate OSA and can serve as an adjunct OSA treatment.

Creating a new "reality" for medical education: the Nexus Reality Lab for virtual reality.

BACKGROUND: The Technology Team at the Ruth Lilly Medical Library, Indiana University (IU), first started exploring virtual reality (VR) in 2016. In 2017, we began offering weekly sessions dubbed VRidays ("VR Fridays") to give students an opportunity to experience the technology. We also purchased a portable VR setup that allowed us to demonstrate VR at our regional campuses. DESCRIPTION: To lower the entry barrier to VR, the Technology Team collaborated with the IU Advanced Visualization Lab to establish a reality lab in our collaborative learning space. The lab opened in the fall of 2018 and consists of four high-end VR stations that are accessible to students at any time, but they can also make an appointment for a more guided experience. Information and instructions are available on a LibGuide. CONCLUSION: We are currently collecting data on the number of unique users and evaluating application usage. We are working on a feedback mechanism and looking to develop collaborative partnerships across the university.

A University-Wide Collaborative Effort to Designing a Makerspace at an Academic Health Sciences Library.

This article describes the planning and development of a 3D printing makerspace at an academic health sciences library. At the start of 2015, a new library Technology Team was formed consisting of a team leader, an emerging technologies librarian, and a library systems analyst. One of the critical steps in the development of the proposal and with the planning of this project was collaborating and partnering with different departments and units outside the library. These connections helped shape the design of the makerspace.

Occupation-Based Intervention for Addictive Disorders: A Systematic Review.

Addictive disorders disrupt individuals' occupational lives, suggesting that occupational therapists can play a crucial role in addiction rehabilitation. Occupation-based interventions are those in which an occupation is performed, and occupations are defined as those activities a person engages in to structure time and create meaning in one's life. This review asked: In persons with addictive disorders, are occupation-based interventions more effective than treatment as usual in improving short and long-term recovery outcomes? A systematic literature search was performed by a medical librarian in Ovid MEDLINE, PsychINFO, Social Work Abstracts, OTSeeker, HealthSTAR, CINAHL, and ACPJournalClub. Authors screened 1095 articles for inclusion criteria (prospective outcome studies examining the effectiveness of an occupation-based intervention with a sample primarily consisting of a diagnosis of a substance-related or addictive disorder and with at least five participants), and two authors appraised the resulting 66 articles using a standard appraisal tool, yielding 26 articles for qualitative synthesis and 8 with shared outcome measures for quantitative analysis. Occupation-based interventions in the areas of work, leisure, and social participation were found to have been used to treat addictive disorders. Occupation-based interventions in the area of social participation all elicited better outcomes than their respective control/comparison groups. Not all occupation-based interventions in the area of leisure elicited better outcomes than their comparison group, but in the eight articles with shared outcome measures, quantitative analysis demonstrated leisure interventions produced larger effect sizes than social participation interventions.

Improving Access to HIV and AIDS Information Resources for Patients, Caregivers, and Clinicians: Results from the SHINE Project.

BACKGROUND: Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) remains a significant international public health challenge. The Statewide HIV/AIDS Information Network (SHINE) Project was created to improve HIV/AIDS health information use and access for health care professionals, patients, and affected communities in Indiana. OBJECTIVE: Our objective was to assess the information-seeking behaviors of health care professionals and consumers who seek information on the testing, treatment, and management of HIV/AIDS and the usability of the SHINE Project's resources in meeting end user needs. The feedback was designed to help SHINE Project members improve and expand the SHINE Project's online resources. METHODS: A convenience sample of health care professionals and consumers participated in a usability study. Participants were asked to complete typical HIV/AIDS information-seeking tasks using the SHINE Project website. Feedback was provided in the form of standardized questionnaire and usability "think-aloud" responses. RESULTS: Thirteen participants took part in the usability study. Clinicians generally reported the site to be "very good," while consumers generally found it to be "good." Health care professionals commented that they lack access to comprehensive resources for treating patients with HIV/AIDS. They requested new electronic resources that could be integrated in clinical practice and existing information technology infrastructures. Consumers found the SHINE website and its collected information resources overwhelming and difficult to navigate. They requested simpler, multimedia-content rich resources to deliver information on HIV/AIDS testing, treatment, and disease management. CONCLUSIONS: Accessibility, usability, and user education remain important challenges that public health and information specialists must address when developing and deploying interventions intended to empower consumers and support coordinated, patient-centric care.

Teaching first-year medical students where to go first: connecting information needs to e-resources.

The purpose of this project was to introduce first-year medical students to electronic resources that are best suited for different types of background questions. Specific questions from a case study were presented, and the students generalized them into a "type" of question. They then identified the best e-resources for that type of question. This is their first introduction to the lifelong learning competency in the Indiana University School of Medicine competency-based curriculum.

Use of an audience response system in an evidence-based mini-curriculum.

Since 2002, library faculty at the Indiana University School of Medicine have taught third-year medical students how to retrieve the best evidence from MEDLINE to address their clinical questions. In preparation for their Neurology, Medicine, and Psychiatry clerkships, students attended a review of evidence-based medicine principles and techniques for searching the literature. The session was team-taught by two faculty members, one from the Internal Medicine department and the other from the Library. The librarian reviewed important MEDLINE principles for constructing a good subject search and applying appropriate evidence-based filters. During the clerkships, students were asked to generate clinical questions arising from their patient encounters, searched MEDLINE for the best evidence, critiqued the results, and then applied them back to their patients' care. Library faculty provided individualized feedback on the student searches. A follow-up session two months later reinforced MEDLINE principles, used student searches as examples, and extended the discussion to other evidence-based, point-of-care resources. To add to the interactivity of the follow-up sessions, librarians used an audience response system to measure students' understanding of literature retrieval techniques and to gauge student preferences for information seeking on clinical topics. Overall, the sessions have been well-received by the students.