An analysis of ALA-accredited MLS curricula indicates deficiencies in the initial training provided for public librarians.

BACKGROUND: Public librarians often address patron inquiries regarding health concerns. However, prior research indicates that public librarians may be unprepared to meet the health information requests of patrons. OBJECTIVE: This study examined the availability of health-themed courses in American Library Association (ALA) accredited Master of Library and Information Studies/Science (MLIS) programs. METHODS: Accredited MLIS programs were identified using the ALA directory. Curricula were reviewed for health content and public librarianship, children's, and young adult concentrations. Descriptive and bivariate analyses assessed the percent of programs that offered various health-related course content and the differences in availability of such content. RESULTS: Of the 59 accredited MLIS programs, only 35 (59.32%) listed at least one health elective and none listed a required health course. No MLIS programs that had a public library concentration (n = 21) listed a required or elective health course, two programs with a children's concentration (n = 25) listed health course electives, and one program with a young adult concentration (n = 25) listed a health course elective. CONCLUSION: ALA-accredited MLIS programs should consider increasing their offerings or requiring health-related courses to improve the training of public librarians to meet the health information needs of communities.

α-Ketol and α-iminol rearrangements in synthetic organic and biosynthetic reactions.

In the presence of a suitable acid or base, α-hydroxyaldehydes, ketones, and imines can undergo isomerization that features the 1,2-shift of an alkyl or aryl group. In the process, the hydroxy group is converted to a carbonyl and the aldehyde/ketone or imine is converted to an alcohol or amine. Such α-ketol/α-iminol rearrangements are used in a wide variety of synthetic applications including asymmetric synthesis, tandem reactions, and the total synthesis and biosynthesis of natural products. This review explores the use of α-ketol rearrangements in these contexts over the past two decades.

Improving Adherence to Care Recommendations Using a Community Health Worker (CHW) Intervention with the Pediatric Medical Home.

While CHW interventions improve health outcomes, evidence identifying specific domains of CHW-delivered support resulting in positive outcomes is limited. Our goals were to identify domains of CHW-delivered support that assist families with adhering to recommended pediatric care; and, to identify predictors of successful completion of an enriched medical home intervention (EMHI) using trained CHWs making home visits to provide health education and support positive health behaviors. We performed a prospective descriptive study of 88 families participating in a protocol-based EMHI. Completers (N = 46) finished the program with mutual agreement that the family can independently adhere to recommended clinical care. Non-completers (N = 42) were lost to follow-up or dropped out of the program before reaching this milestone. Using Grounded Theory, two trained coders evaluated CHW tasks recorded in an electronic database and classified these tasks across 17 domains. We assessed predictors of EMHI completion using logistic regression. The 88 EMHI participants were primarily <24 months of age (80 %), Hispanic (56 %), and Medicaid enrollees (67 %). Hispanic families (OR = 2.76, p = 0.04) and those with self-reported program goals to 'facilitate family's creation of a system to keep track of child's medical information' (OR = 3.11, p = 0.02) or a 'newborn-specific goal' (OR = 3.21, p = 0.04), such as feeding and safety tips, were more likely to complete the EMHI compared to their counterparts. The most consistent CHW tasks were supporting medical appointments, medication maintenance, and providing health education. CHW interventions designed to improve health behavior outcomes of 'at-risk' families, including Medicaid enrollees, may benefit from support in goal-setting and strategies to systematically manage their child's medical care.

The Future of Respiratory Care: Results of a New York State Survey of Respiratory Therapists.

BACKGROUND: In the current health-care environment, respiratory care may need to make significant changes to academic preparation and clinical practice. The purpose of this research was to assess current needs of respiratory therapists (RTs) in New York State and to understand how RTs perceive their future clinical and academic roles. METHODS: This study employed a descriptive, cross-sectional non-experimental design. Between October and December 2014, a 32-item online survey was distributed via e-mail to the 2,170 members of the New York State Society of Respiratory Care. Descriptive statistics were used to summarize responses, and bivariate analyses were assessed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The response rate was 22% and resulted in 435 valid surveys returned. Seventy percent of 415 respondents agreed that the practice of respiratory care is at risk of losing practitioners. The most important incentive for retention of practitioners in the field was professional growth and an expanded scope of clinical practice. Specifically, the most important of these roles was gaining the ability to assess patients, develop a plan of care, and receive reimbursement for services. Sixty-four percent of 415 respondents strongly agreed that the minimum academic standard for RTs should be raised to the baccalaureate level. Of 415 respondents, the majority (78%) agreed that it is important for therapists to remain in the profession and to be an active member of the American Association for Respiratory Care (83%). CONCLUSIONS: These data are useful to the profession, notably for academic programs that must meet the need for a more highly prepared and skilled workforce. The findings emphasize that viability of the profession in the current health-care environment calls for the evolution of a more autonomous RT who can be reimbursed for services and obtain salaries that are competitive with other health professions.

The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials.

OBJECTIVE: To determine the effects of patient navigation (PN) on healthcare utilization outcomes using meta-analysis and the quality of evidence. METHODS: Medical and social science databases were searched for randomized controlled trials published in English between 1989 and May 2015. The review process was guided by PRISMA. Included studies were assessed for quality using the Downs and Black tool. Data were extracted to assess the effect of navigation on: health screening rates, diagnostic resolution, cancer care follow-up treatment adherence, and attendance of care events. Random-effects models were used to compute risk ratios and I2 statistics determined the impact of heterogeneity. RESULTS: Of 3985 articles screened, 25 articles met inclusion criteria. Compared to usual care, patients who received PN were significantly more likely to access health screening (OR 2.48, 95% CI, 1.93-3.18, P<0.00001) and attend a recommended care event (OR 2.55, 95% CI, 1.27-5.10, P<0.01). PN was favoured to increase adherence to cancer care follow-up treatment and obtain diagnoses. Most studies involved trained lay navigators (n=12) compared to health professionals (n=9). CONCLUSION: PN is effective to increase screening rates and complete care events. PRACTICE IMPLICATIONS: PN is an effective intervention for use in healthcare.

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia.

STUDY OBJECTIVES: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. DESIGN: Prospective, observational, cohort study. SETTING: Twenty ICUs throughout the United States. PATIENTS: A total of 398 ICU patients meeting predefined criteria for suspected VAP. INTERVENTIONS: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. MEASUREMENTS AND RESULTS: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%), and cardiac complications (10.8%). The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 +/- 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 +/- 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2 days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; chi2= 13.25; p = 0.001). CONCLUSIONS: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants further clinical study.

Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial.

OBJECTIVES: To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment. SETTING: 3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre. PARTICIPANTS: CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants. INTERVENTION: The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers. OUTCOME MEASURES: The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction. RESULTS: Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24). CONCLUSIONS: There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest to their home. TRIAL REGISTRATION NUMBER: NCT02204449; Results.

A review of breast, cervical, and colorectal cancer screening interventions in older women.

Although cancer-screening guidelines recommend periodic testing for women 50 years of age and older, these tests are underused. A search of databases identified 156 community-based breast, cervical, and colorectal cancer screening intervention studies published before April 2003. Most were conducted in the United States. More than half used randomization procedures or pre-post measures, and one third used both. Most reported significant intervention effects. Cervical and combined cervical and breast studies had higher rates of pre-post designs, and breast studies had the highest percentage using randomization. Although effective community-based breast and cervical interventions have been conducted, there is an urgent need for amplification of colorectal cancer screening.