Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review.

BACKGROUND: The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. METHODS: Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies (N = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. RESULTS: Of 3054 included studies, 70.7% (n = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). CONCLUSIONS: Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors.

Expert searcher, teacher, content manager, and patient advocate: an exploratory study of clinical librarian roles.

OBJECTIVE: The research explored the roles of practicing clinical librarians embedded in a patient care team. METHODS: Six clinical librarians from Canada and one from the United States were interviewed to elicit detailed descriptions of their clinical roles and responsibilities and the context in which these were performed. RESULTS: Participants were embedded in a wide range of clinical service areas, working with a diverse complement of health professionals. As clinical librarians, participants wore many hats, including expert searcher, teacher, content manager, and patient advocate. Unique aspects of how these roles played out included a sense of urgency surrounding searching activities, the broad dissemination of responses to clinical questions, and leverage of the roles of expert searcher, teacher, and content manager to advocate for patients. CONCLUSIONS: Detailed role descriptions of clinical librarians embedded in patient care teams suggest possible new practices for existing clinical librarians, provide direction for training new librarians working in patient care environments, and raise awareness of the clinical librarian specialty among current and budding health information professionals.

Impact of mHealth Interventions on Supporting Dietary Adherence in Cardiovascular Disease: A Systematic Review.

INTRODUCTION: A systematic review was conducted to determine if mobile health (mHealth) interventions, and which intervention characteristics, effectively support dietary adherence and reduce risk factors in patients with cardiovascular disease (CVD). METHOD: Using 7 databases, studies involving adult participants with specific CVD diagnoses, mHealth intervention testing, and dietary adherence assessment were identified. Systematic reviews, qualitative studies, or studies testing interventions involving open dialogue between participants and health care providers or researchers were excluded. Two independent reviewers conducted screening and assessed the risk of bias. RESULTS: Thirteen studies involved participants with prehypertension (n = 1), hypertension (n = 9), coronary artery disease (n = 2), and heart failure (n = 1). mHealth interventions in 8 studies improved dietary adherence, 4 showed mixed results, and 1 showed no improvements. Eight studies found interactive text and/or application-based mHealth intervention features effectively improved dietary adherence. One study had a low risk of bias, 2 had some concerns/moderate risk, and 10 had a high/critical or serious risk. DISCUSSION: In most included studies, mHealth interventions positively impacted dietary adherence for patients with CVD. IMPLICATIONS FOR RESEARCH AND PRACTICE: Clinicians may recommend mHealth interventions to support nutrition education and self-management for their patients with CVD.

Evidence-based Medicine Simulation: A Novel and Practice-relevant Approach to Teaching Real-time Literature Searching to Emergency Medicine Residents.

INTRODUCTION: Evidence-based medicine (EBM) and literature searching skills are competencies within the emergency medicine (EM) residency curriculum. Previously in our residency program, a librarian taught literature searching instruction, including a classroom-based overview of search engines. Learners reported low engagement and poor retention. To improve engagement, interest, and skill retention, we used a novel approach: simulation to teach real-time literature searching. METHODS: Based on a needs assessment of our EM residents, we created a literature searching workshop using a flipped classroom approach and high-fidelity simulation. Goals of the session were to be interactive, engaging, and practice-relevant. With a librarian, we developed a brief list of EM-relevant databases, including tips for searching and links to sites/apps. Prereadings also covered the hierarchy of evidence and formulating a good clinical (PICO) question. Residents (12 junior residents) participated in a high-fidelity simulation involving a stable patient whose management required a literature search to inform decisions. Feedback was collected on the simulation experience. RESULTS: Residents received the list of EM-relevant databases 7 days prior and were instructed to set up and test the resources on their smartphones. The day of the session, one resident volunteered to lead the simulation; all residents participated in the search on their smart phones. Collectively, it took 4.5 minutes to find a study that adequately addressed the clinical question and to manage the patient accordingly. Feedback on the simulation was positive. Students found it "very real and practical" and "immediately institutable into practice." It helped residents learn to efficiently and effectively search the literature while managing a stable patient. CONCLUSION: A flipped-classroom simulation-based teaching strategy made learning literature searching more interesting, engaging, and applicable to EM practice. Based on popular demand, we will continue to use this teaching method.

Prone cardiopulmonary resuscitation: A scoping and expanded grey literature review for the COVID-19 pandemic.

AIM: To identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines. METHODS: This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/cardiac arrest. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media. RESULTS: Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome (neurological status at hospital discharge). Seven cases described full neurological recovery. CONCLUSION: This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO2, and arterial pressure tracing, with patients turned supine if insufficient.

Human parainfluenza virus 3 neuraminidase activity contributes to dendritic cell maturation.

Mechanisms of dendritic cells (DCs) immunomodulation by parainfluenza viruses have not been characterized. We analyzed whether the human parainfluenza 3 (HPF3) virus hemagglutinin-neuraminidase glycoprotein (HN) might influence DC maturation. HN possesses a receptor binding function and a neuraminidase or desialidating activity. To assess whether the neuraminidase activity of HN affects DC maturation, human myeloid DCs were exposed to either live or UV-inactivated HPF3 viruses containing wild type or a mutated form of HN with decreased neuraminidase activity. Exposure of human DCs to either UV-inactivated or live virus induced up-regulation of CD83 and CD86 surface markers, morphological changes, and a cytokine expression pattern consistent with maturation. However, the level of maturation was found to be lower in DCs infected with the neuraminidase deficient variant as compared to the wild type. These results suggest that during the course of viral infection, HN's neuraminidase activity may play an important role contributing to maturation and activation of DCs.

A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia.

Disordered sleep in persons with dementia is a contributing factor for a range of health problems. The evidence base for non-pharmacological interventions has not been evaluated and clearly presented in the literature. This paper provides a structured Critical Literature Review of the evidence for non-pharmacological interventions to reduce disordered sleep in persons with dementia. The systematic search retrieved 29 studies that were evaluated for methodological quality. The quality of evidence ranged from conclusive for light therapy and activity to inconclusive for most other interventions. There is a paucity of conclusive research for non-pharmacological sleep interventions for persons with dementia. Most of the evidence about effective interventions is anecdotal and untested. There is a need for rigorous scientific inquiry, coupled with tacit knowledge to build a strong evidence base on non-pharmacological interventions for disordered sleep for persons with dementia.

Characterization of human metapneumovirus infection of myeloid dendritic cells.

Recent in vivo studies suggest that hMPV is a poor inducer of inflammatory cytokines and that clinical symptoms may not be related to immune-mediated pathogenesis as it has been proposed for respiratory syncytial virus (RSV) and human parainfluenza 3 (HPF3). Dendritic cells (DCs) are specialized antigen presenting cells, and very effective at inducing specific CTLs after encountering invading viruses. Interactions of hMPV with DCs have not been characterized. We hypothesized that the relatively mild inflammatory responses observed in vivo after hMPV infection might be at least in part due to hMPV's poor ability to stimulate and activate DCs. hMPV actively infected immature monocyte-derived CD11c+/HLA-DR+ DCs. However, in contrast to RSV or HPF3, hMPV caused no gross cytopathic effects such as syncytia, lytic infection, or massive apoptosis. DCs exposed to hMPV show no cytopathic effects under tissue culture conditions permissive for viral replication. The surface maturation markers CD83 and CD86 were not significantly up-regulated in infected DCs as compared to uninfected controls, while expression of CD80 appeared increased. Stimulation of hMPV-infected DCs with LPS resulted in the enhanced expression of all these surface markers indicating that hMPV is not generally suppressing DC maturation. Overall, cytokine expression remained low. These results indicate that hMPV does not induce effective DC maturation in vitro and suggest that the weak stimulation of DCs may account for the overall low immunogenicity of this virus observed in vivo.