Amniotic fluid volume and pregnancy outcomes in twin pregnancies: A systematic review and meta-analysis.

Objective: To analyse amniotic fluid volume (AFV), specifically oligohydramnios or polyhydramnios, and associated pregnancy and neonatal outcomes in twin gestations through systematic review and meta-analysis. Methods: We utilised systematic review methodology to identify items within published and grey literature resources. Prospective and retrospective studies with a control group were included. Inclusion criteria were as follows: studies in English, twin pregnancy in which AFVs and associated pregnancy and/or neonatal outcomes were evaluated. Exclusion criteria included the presence of an anomalous fetus, chromosome abnormality, monochorionic diamniotic twin pregnancy complicated by twin-twin transfusion syndrome or twin-reversed arterial perfusion, twin gestations undergoing therapeutic interventions (i.e. fetoscopic laser photocoagulation and serial amniocentesis) and monochorionic monoamniotic twin pregnancy. Results: The literature search identified 1068 abstracts, only four met criteria for inclusion and analysis. The pooled data (two studies per outcome) revealed no significant difference in rate of pre-term delivery (OR: 2.94; CI: 0.20-43.81), pre-term delivery less than 32 weeks (OR: 1.97; CI: 0.43-9.12), umbilical cord pH < 7 (OR: 2.66; CI: 0.22-32.51), rate of stillbirth (OR: 4.13; CI: 0.40-42.70), neonatal death (OR: 1.48; CI: 0.05-43.94), rate of NICU admission (OR: 1.38; CI: 0.61-3.11) or rate of small-for-gestational-age (SGA) infants (OR: 1.39; CI: 0.33-5.94). Conclusion: Based on the pooled data (two studies per outcome), there was no difference in the fate of pre-term delivery, umbilical cord pH < 7, stillbirth, neonatal death or SGA infants. What is disturbing is the lack of studies (1946-2020) that analysed the association between AFV and pregnancy outcomes in twin pregnancies.

Telehealth for genetic counseling: A systematic evidence review.

Telehealth options, such as telephone counseling or videoconferencing, for service delivery in genetic counseling are becoming more widely accepted. However, until now, there has not been a systematic review of the literature focused specifically on genetic counseling outcomes for telehealth. We performed a systematic evidence review to compare telehealth genetic counseling (THGC), including videoconferencing and telephone counseling, across specialties to in-person genetic counseling (IPGC) for a range of outcomes specific to patient and provider experiences and access to care. Several biomedical databases were queried up to January 11, 2021, to identify original research evaluating THGC. Through this search, 42 articles met the inclusion criteria including 13 randomized controlled trials and 29 non-randomized observational studies encompassing 13,901 patients. Most included studies focused only on cancer genetic counseling; however, adult, pediatric, and prenatal specialties were also represented. The majority of studies evaluated patient and/or access to care outcomes. Though most studies reported high patient satisfaction with THGC, as well as comparable rates of trust and rapport, confidence in privacy, health behavior changes, and psychosocial outcomes, few represented diverse populations. Data of provider experiences were limited and varied with more disadvantages noted compared with patient experiences, particularly in studies involving telephone genetic counseling. Studies consistently reported a decrease in the patients' costs and time required for travel when patients are seen via THGC compared to IPGC with a similar reduction in costs to the health system. Overall, results from our evidence synthesis suggest THGC is non-inferior or comparable to IPGC across many domains, even considering that many of the studies included in this review were conducted with telehealth systems, notably videoconferencing, that were less robust and reliable than what is available today. There are notable limitations within this body of literature, leading to potential uncertainty in the generalizability of our analysis. We outline several recommendations for future studies.

Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review.

This scoping review identifies the best practices of community-based participatory research with Pacific Islanders in the United States and United States Affiliated Pacific Islands. Eighty-four articles from January 2000 to December 2017 were included in the review. Best practices included the importance of engaging Pacific Islander community leaders as research staff, community co-investigators, and community advisory board members. Best practices also focused on removing barriers to research by using participants' native languages, conducting research within the geographic community, and spending significant time to build trust. Novel best practices included honoring Pacific Islanders' cultural practices such as protocols for engagement, reciprocity, and social and spiritual inclusiveness and honoring Pacific Islanders' collectivist cultural structure. The goal of this scoping review is to aid community-academic partnerships working to improve the health of Pacific Islanders.

Outcomes of disease prevention and management interventions in food pantries and food banks: a scoping review.

OBJECTIVE: Food insecurity affects millions of Americans and is associated with a range of adverse health outcomes. Food insecure individuals often obtain food from food pantries/banks, prompting health researchers to implement disease prevention/management interventions at these sites. This review examined the existing peer-reviewed research on disease prevention/management interventions implemented in food pantries/banks. DESIGN: Scoping review. DATA SOURCES: Databases searched included MEDLINE, Web of Science, CINAHL and Cochrane. Search strategies included Medical Subject Headings and key terms, including food pantry, food bank, food shelf, food aid and related concepts. ELIGIBILITY CRITERIA: Studies were included if they described an intervention involving food pantries/banks where at least one biometric indicator was included as an outcome variable. Articles focused solely on the quality of foods distributed, the diet quality of food pantry/bank clients or government food aid programmes were excluded. DATA EXTRACTION AND SYNTHESIS: Extracted data included publication details, intervention type, study design, participant characteristics, study outcomes, and barriers and facilitators of intervention implementation. RESULTS: A total of 3317 articles were assessed for eligibility. Six studies met the predefined inclusion criteria. The studies employed a range of intervention approaches to manage or prevent a number of chronic diseases, including obesity, type 2 diabetes and HIV. The studies examined a range of biometric outcomes, including body mass index, glycated haemoglobin and blood pressure. Information about the food pantries/banks where the interventions were conducted was lacking. The studies documented multiple barriers and facilitators related to costs, sustainability and organisational capacity. CONCLUSIONS: To our knowledge, this is the first review to examine disease prevention and management interventions conducted in food pantries and food banks. Given the high number of households who obtain food from food pantries/banks and the chronic health conditions associated with food insecurity, this review highlights the need for more high-quality research in this setting.

Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients.

INTRODUCTION: Prevalence of adult deformity surgery in the elderly individuals continues to increase. These patients have additional considerations for the spine surgeon during surgical planning. We perform an informative review of the spinal and geriatric literature to assess preoperative and intraoperative factors that impact surgical complication occurrences in this population. SIGNIFICANCE: There is a need to understand surgical risk assessment and prevention in geriatric patients who undergo thoracolumbar adult deformity surgery in order to prevent complications. METHODS: Searches of relevant biomedical databases were conducted by a medical librarian. Databases searched included MEDLINE, Web of Science, CINAHL, IPA, Cochrane, PQ Health and Medical, SocINDEX, and WHO's Global Health Library. Search strategies utilized Medical Subject Headings plus text words for extensive coverage of scoliosis and surgical technique concepts. RESULTS: Degenerative scoliosis affects 68% of the geriatric population, and the rate of surgical interventions for this pathology continues to increase. Complications following spinal deformity surgery in this patient population range from 37% to 62%. Factors that impact outcomes include age, comorbidities, blood loss, and bone quality. Using these data, we summarize multimodal risk prevention strategies that can be easily implemented by spine surgeons. CONCLUSIONS: After evaluation of the latest literature on the complications associated with adult deformity surgery in geriatric patients, comprehensive perioperative management is necessary for improved outcomes. Preoperative strategies include assessing physiological age via frailty score, nutritional status, bone quality, dementia/delirium risk, and social activity support. Intraoperative strategies include methods to reduce blood loss and procedural time. Postoperatively, development of a multidisciplinary team approach that encourages early ambulation, decreases opiate use, and ensures supportive discharge planning is imperative for better outcomes for this patient population.

Best practices for community-engaged participatory research with Pacific Islander communities in the USA and USAPI: protocol for a scoping review.

INTRODUCTION: Community-based participatory research is a partnership approach to research that seeks to equally involve community members, organisational representatives and academic partners throughout the research process in a coequal and mutually beneficial partnership. To date, no published article has synthesised the best practices for community-based participatory research practices with Pacific Islanders. METHODS AND ANALYSIS: The reviewers will examine studies' titles, abstracts and full text, comparing eligibility to address discrepancies. For each eligible study, data extraction will be executed by two reviewers and one confirmation coder, comparing extracted data to address any discrepancies. Eligible data will be synthesised and reported in a narrative review assessing coverage and gaps in existing literature related to community-based participatory research with Pacific Islanders. DISCUSSION AND DISSEMINATION: The purpose of this review is to identify best practices used when conducting community-based participatory research with Pacific Islanders; it will also extrapolate where the gaps are in the existing literature. This will be the first scoping review on community-based participatory research with Pacific Islanders. To facilitate dissemination, the results of this scoping review will be submitted for publication to a peer-reviewed journal, presented at conferences and shared with community-based participatory research stakeholders.

Outcomes of disease prevention and management interventions in food pantries and food banks: protocol for a scoping review.

INTRODUCTION: Food insecurity is a difficulty faced in many households. During periods of food insecurity, households often seek food supplied by food pantries and food banks. Food insecurity has been associated with increased risk for several health conditions. For this reason, food pantries and food banks may have great promise as intervention sites, and health researchers have begun targeting food pantries and food banks as sites for disease prevention or management interventions. The aim of the scoping review is to examine disease prevention or management interventions implemented in food pantries and food banks. METHODS AND ANALYSIS: Relevant electronic databases (eg, MEDLINE, Cumulative Index to Nursing and Allied Health Literature-CINAHL Complete, Science Citation Index, Cochrane Database of Systematic Reviews) will be searched for articles with a publication date of 1997 or later using Medical Subject Headings and key terms, including food aid, food banks, food pantries, food shelves, hunger, food insecurity and related concepts. For each de-duplicated study record identified by the search strategy, two reviewers will independently assess whether the study meets eligibility criteria (eg, related to intervention type, context). The reviewers will examine studies' titles, abstracts and full text, comparing eligibility decisions to address any discrepancies. For each eligible study, data extraction will be executed by two reviewers independently, comparing extracted data to address any discrepancies. Extracted data will be synthesised and reported in a narrative review assessing the coverage and gaps in existing literature related to disease prevention and management interventions implemented in food pantries. ETHICS AND DISSEMINATION: The review's results will be useful to healthcare practitioners who work with food-insecure populations, healthcare researchers and food pantry or food bank personnel. The results of this scoping review will be submitted for publication to a peer-reviewed journal, and the authors will share the findings with food pantry and food bank stakeholder groups with whom they work.

Comparison of Intraoperative versus Postoperative Parathyroid Hormone Levels to Predict Hypocalcemia Earlier after Total Thyroidectomy.

OBJECTIVE: To determine differences in the mean parathyroid hormone (PTH) levels for normocalcemic and hypocalcemic total thyroidectomy patients who were tested for PTH during the intraoperative or early postoperative period. DATA SOURCES: MEDLINE, the Cochrane Database, and other databases from 1960 to 2014 in the English language and specific to humans for relevant articles. REVIEW METHODS: Studies were included if PTH was obtained within 24 hours of thyroidectomy. Studies were excluded (1) if only a hemithyroidectomy was performed, (2) if means of studied PTH values were not reported in the article, or (3) if the time of the PTH draw fell outside of defined "intraoperative" or "early postoperative" windows. PTH values were divided into 3 groups: preoperative (control group), intraoperative (ie, discharge decisions were based on PTH values drawn in the operating room), and early postoperative (ie, PTH values at 1 to 4 hours after surgery were used as a guide). RESULTS: The reported means of perioperative PTH levels and percentage of patients who developed hypocalcemia were collected from 14 studies. PTH evaluated at both the intraoperative and early postoperative periods was significantly lower in patients who became hypocalcemic versus patients who remained normocalcemic. There was no significant difference when PTH was measured intraoperatively or early postoperatively. CONCLUSION: Intraoperative PTH has no significant disadvantage versus early postoperative PTH when used as a clinical guide for discharge after thyroidectomy.

Impact of simulation training on self-efficacy of outpatient health care providers to use electronic health records.

OBJECTIVES: To examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients' safety. METHODS: Two-hundred and ninety-three physicians and 94 nurses participated in the study. Participants first attended two computer classroom training sessions on how to use EMRs. Subsequently, the participants attended simulation training and practiced application of EMRs while encountering standardized patients. They answered questionnaires on a seven-point Likert-type scale prior to and immediately after simulation training. The questionnaires assessed their perceptions about the importance of EMRs in helping patients and improving patients' safety and their confidence and preparedness level to use EMRs. RESULTS: The overall self-efficacy of physicians and nurses to use EMRs increased after simulation training as compared to before simulation training. The physicians' and nurses' ratings about importance of EMRs to help patients' and improve patients' safety after simulation training were relatively unchanged compared to the ratings before simulation training. Additionally, participants described simulation training as exceptional, because it was an interactive learning opportunity to use EMRs within a simulated clinical setting with a simulated patient. CONCLUSIONS: Simulation training in the current study enhanced physicians' and nurses' level of self-confidence and preparedness to use EMRs. To train health care providers how to use EMRs, simulation training should be considered as an interactive and effective method of teaching prior to implementation of EMRs in medical institutions.

Multi-ingredient, caffeine-containing dietary supplements: history, safety, and efficacy.

PURPOSE: Our objective was to review the history, safety, and efficacy of caffeine-containing dietary supplements in the United States and Canada. METHODS: PubMed and Web of Science databases (1980-2014) were searched for articles related to the pharmacology, toxicology, and efficacy of caffeine-containing dietary supplements with an emphasis on Ephedra-containing supplements, Ephedra-free supplements, and energy drinks or shots. FINDINGS: Among the first and most successful dietary supplements to be marketed in the United States were those containing Ephedra­combinations of ephedrine alkaloids, caffeine, and other phytochemicals. A decade after their inception, serious tolerability concerns prompted removal of Ephedra supplements from the US and Canadian markets. Ephedra-free products, however, quickly filled this void. Ephedra-free supplements typically contain multiple caffeine sources in conjunction with other botanical extracts whose purposes can often be puzzling and their pharmacologic properties difficult to predict. Ingestion of these products in the form of tablets, capsules, or other solid dosage forms as weight loss aids, exercise performance enhancers, or energy boosters have once again brought their tolerability and efficacy into question. In addition to Ephedra-free solid dosage forms, caffeine-containing energy drinks have gained a foothold in the world market along with concerns about their tolerability. IMPLICATIONS: This review addresses some of the pharmacologic and pharmaceutical issues that distinguish caffeine-containing dietary supplement formulations from traditional caffeine-containing beverages. Such distinctions may account for the increasing tolerability concerns affiliated with these products.

Academic health sciences librarians' contributions to institutional animal care and use committees.

The study gathered data about librarians' membership in institutional animal care and use committees (IACUCs) and their professional activities supporting animal researchers. Libraries affiliated with medical schools that were members of the Association of American Medical Colleges were surveyed. A survey was distributed via library directors' email discussion lists and direct email messages. Sixty surveys were completed: 35 (58%) reported that librarians performed database searches for researchers, and 22 (37%) reported that a librarian currently serves on the IACUC. The survey suggests that academic health sciences librarians provide valuable, yet underutilized, services to support animal research investigators.

Maternal mortality in the Mississippi Delta region.

OBJECTIVE: To compare the maternal mortality rate (MMR) in the Mississippi Delta region of the United States with that of the non-Delta region states. METHODS: Analyzed data come from national birth certificate and death certificate data for 1999-2007. Data were aggregated for analysis by region, counties of the Delta Regional Authority, non-Delta regions of the eight Delta states, and the 42 non-Delta states. The MMR was calculated using birth data as the denominator and maternal mortality data as the numerator. RESULTS: During the 9 years of the study, there were more than 36 million births in the United States and 5002 reported maternal deaths. The national MMR was 13.5/100,000 (95% confidence interval [CI] 13.1-13.9/100,000). The MMR reported in the non-Delta states was 13.6/100,000 (95% CI 13.2-14.0/100,000); in the non-Delta counties of the Delta states, the MMR was 13.1/100,000 (95% CI 12.1-14.0/100,000); and the MMR was 18.5/100,000 (95% CI 16.1-20.9/100,000) in Delta counties. The odds of maternal death in Delta counties is 1.39 times (95% CI 1.22-1.59) higher compared with non-Delta counties or non-Delta states. There was no statistically significant difference between the MMR in non-Delta states and the MMR in non-Delta counties of Delta states. After controlling for maternal race/ethnicity, age, marital status, and education in a multivariable model, the MMR in the Delta counties compared with non-Delta counties and non-Delta states remains significantly increased (odds ratio 1.16, 95% CI 1.01-1.32). CONCLUSIONS: Overall, maternal mortality is significantly greater in the Delta region of the United States compared with the non-Delta portion. After controlling for maternal race/ethnicity, age, marital status, and education, the odds of maternal death remains 16% higher in the Delta region of the United States compared with the non-Delta United States.