Management of apparent life-threatening events in infants: a systematic review.

OBJECTIVE: To determine in patients who are well-appearing and without a clear etiology after an apparent life-threatening event (ALTE): (1) What historical and physical examination features suggest that a child is at risk for a future adverse event and/or serious underlying diagnosis and would, therefore, benefit from testing or hospitalization? and (2) What testing is indicated on presentation and during hospitalization? STUDY DESIGN: Systematic review of clinical studies, excluding case reports, published from 1970 through 2011 identified using key words for ALTE. RESULTS: The final analysis was based on 37 studies; 18 prospective observational, 19 retrospective observational. None of the studies provided sufficient evidence to fully address the clinical questions. Risk factors identified from historical and physical examination features included a history of prematurity, multiple ALTEs, and suspected child maltreatment. Routine screening tests for gastroesophageal reflux, meningitis, bacteremia, and seizures are low yield in infants without historical risk factors or suggestive physical examination findings. CONCLUSION: Some historical and physical examination features can be used to identify risk in infants who are well-appearing and without a clear etiology at presentation, and testing tailored to these risks may be of value. The true risk of a subsequent event or underlying disorder cannot be ascertained. A more precise definition of an ALTE is needed and further research is warranted.

A study in usability: redesigning a health sciences library's mobile site.

A mobile site redesign was conducted at a medium-sized academic health sciences library with the goal of creating a site that meets the mobile information needs of its users. The redesign phases included (1) needs assessment, (2) usability testing, and (3) site design. The survey results showed that Apple devices were the most prevalent; the most desirable activities performed on a mobile site were searching for articles, accessing full-text articles and e-books, searching databases, and searching the catalog. These activities guided the development of the usability testing tasks and the redesign. All phases were completed within six months, and the total project cost was $50 for incentive purchases.

Baseline assessment of public health informatics competencies in two Hudson Valley health departments.

Information technology has the capability to improve the way public health is practiced. Realization of this potential is possible only with a workforce ready to utilize these technologies. This project team assessed informatics competencies of employees in two county departments of health. The goal was to determine the status quo in terms of informatics competencies by surveying current levels of proficiency and relevance, and identify areas of needed training. A survey was adapted from the recommendations of a Working Group document by the Centers for Disease Control and Prevention and administered to all employees in the two health departments. Respondents evaluated proficiency and relevance for each of 26 recommended competencies. A gap score was generated between these two measures; results were compared to the recommendations of the Working Group. The following data for each job level are presented: mean gap scores by competency class; the percentage of respondents demonstrating a gap in the competencies reported to be most relevant; and the percentage of respondents meeting the target recommendations of the Working Group. The percentage of respondents who reached the targets was low in higher-level staff. And overall, employees reported low levels of relevance for most of the competencies. The average public health employee does not feel that prescribed informatics competencies are relevant to their work. Before the public health system can take advantage of information technology, relevant employee skills should be identified or developed. There needs to be a shift in thinking that will recognize the promise of information technology in everyday work.

Approaching usability: a study of an academic health sciences library web site.

A usability study was conducted at a medium-sized academic health sciences library with the goal of providing data to inform the future redesign of the library's Web page. A two-stage approach was used: (1) A preliminary survey designed to identify common tasks and issues on which to focus, and (2) usability testing. Responses to the survey indicated general satisfaction with the site and suggested areas for testing. Usability testing participants were asked to perform scripted tasks. The results indicate that users do have considerable difficulty navigating the site and recommendations are presented. This method of testing is recommended for health sciences libraries.