RESUMEN
OBJECTIVES: Using library subscriptions and accessible on handheld devices, this study sought to promote authoritative health information apps, and evidence-based point-of-care resources. METHODS: Three cohorts of internal medicine residents were issued iPads at the beginning of their second year, and were trained to skillfully access resources from the digital library. Pre- and post-intervention surveys were respectively administered at the beginning of the second year and end of the third year of training. The residents' computer experience and computer knowledge was assessed. Additionally, before and after formal introduction to iPads, perceptions on the use of computers to access clinical information were assessed. Survey responses were compared using two sample methods and summarized through descriptive statistics. RESULTS: Sixty-eight residents completed the pre-survey questionnaires and 45 completed the post-surveys. There were significant improvements in the residents' level of computer experience, and familiarity with medical apps. Furthermore, there was increased knowledge obtained in accessing clinical information through electronic medical records. Residents positively perceived the potential effects of computers and electronic medical records in medicine. CONCLUSION: Study findings suggested that health science libraries can be instrumental in providing search skills to health professionals, especially residents in training. Participants showed appreciation of iPads and library support that facilitated successful completion of their related tasks. Replicating this study with a larger sample derived from multiple sites is recommended for future studies. Participation of mid-level healthcare professionals, such as Physician Assistants and Nurse Practitioners is suggested.
RESUMEN
BACKGROUND: Survival of HIV-infected children continues to increase and the use of antiretrovirals (ARVs) is expanding; however there are few data regarding the incidence of renal dysfunction and associated risk factors among HIV-infected children and youth. METHODS: A total of 2102 children enrolled in Pediatric AIDS Clinical Trials Group Study 219/219C, were followed and assessed prospectively for >30 months. Occurrence of clinical events and laboratory abnormalities were recorded using standardized criteria and forms. Therapeutic decisions were made by clinicians at each site. Occurrence of persistent renal laboratory abnormalities was the main outcome measure. RESULTS: Four hundred forty-six (22%) enrollees exhibited at least one persistent renal laboratory abnormality. Elevated serum creatinine (Cr) was more common than persistent proteinuria (15% vs. 8%). The incidence of new renal laboratory abnormalities was 3.7 events per 100 person-years with rates increasing between 1993 and 2005. Older age (>or=6 years vs. <6 years), Hispanic ethnicity, and Black non-Hispanic race were associated with increased risk of renal dysfunction, but CDC clinical class and plasma HIV RNA levels were not. Subjects exposed to ARV regimens containing tenofovir and/or indinavir had approximately twice the risk of developing renal dysfunction compared with persons exposed to other ARVs. The risk of renal dysfunction was also elevated for other antivirals (hazard ratio = 5.4) and amphotericin B (hazard ratio = 28). CONCLUSIONS: Persistent renal function abnormalities occur frequently in HIV-infected children. Improved survival, Black race and Hispanic ethnicity, and exposure to tenofovir, indinavir, and other antimicrobial agents increase the risk for renal dysfunction. All HIV-infected children should be monitored closely for evidence of renal disease.
