The use of transthoracic echocardiography in caesarean section surgical patients in the intensive care unit: A retrospective cohort study.

Data regarding transthoracic echocardiography (TTE) application to obstetric patients are scant. Often, anaesthetists preparing for caesarean section are unaware of the proportion of obstetric patients who have relevant cardiac disease. This audit aimed at undertaking a retrospective analysis of TTE performed in intensive care unit patients after caesarean section. Over five years, 56 women were eligible. Echocardiographic abnormalities were deemed relevant if graded as of moderate severity. The most common reason was dyspnoea (41%). Echocardiography demonstrated structural abnormality in 29% or functional abnormality in 38%. It may be appropriate to undertake preoperative echocardiography more commonly in high-risk obstetric patients.

Dilated Cardiomyopathy in Pregnancy: Outcomes From an Australian Tertiary Centre for Maternal Medicine and Review of the Current Literature.

BACKGROUND: Peripartum cardiomyopathy is associated with significant risks of decline in left ventricular function and adverse maternal and fetal outcome in subsequent pregnancy. The risks of pregnancy in women with dilated cardiomyopathy are unclear. We aimed to assess the outcome of pregnancy in women with dilated cardiomyopathy seen at our institution and to review the literature on this subject. METHODS: A retrospective audit of the outcomes of 14 pregnancies to 12 women with dilated cardiomyopathy. RESULTS: There were no cardiac events and no woman had a decline in left ventricular function during pregnancy. There was a high rate of prematurity and adverse fetal outcome related to this, including four neonatal deaths. CONCLUSION: Maternal outcomes in this small series were satisfactory though only three women had moderate-severe left ventricular dysfunction at baseline. There was a high rate of premature delivery and adverse neonatal outcome.

Partnering to Analyze Selection of Resources by Medical Students for Case-Based Small Group Learning: A Collaboration between Librarians and Medical Educators.

Librarians and medical educators analyzed the quality of information resources used by first- and second-year medical students in their case-based small group learning summaries. Librarians provided instruction on using library resources and gave formal feedback to students about appropriate resources for basic science and clinical questions. The team found that students used a high number of clinical and basic science journal articles and textbooks with a number of factors influencing their resource choices. The study demonstrates numerous areas where librarians can play a key role in assisting students to find and assess information to answer clinical questions.

Negative predictive value of dobutamine stress echocardiography for perioperative risk stratification in patients with cardiac risk factors and reduced exercise capacity undergoing non-cardiac surgery.

BACKGROUND: Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with greater than one recognised cardiac risk factor and self-reported reduced exercise capacity. AIM: To determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major non-cardiac surgery. METHODS: Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre were retrospectively reviewed to determine rates of major adverse cardiac events (MACE) during the index hospitalisation and 30 days post-discharge. Echocardiography and outcome data were obtained through a folder audit and echolab database. RESULTS: Out of the 79 DSE performed for perioperative risk stratification, 11 (14%) were positive (DSE +ve) and 68 (86%) were negative (DSE -ve). Management in the DSE +ve group included medical optimisation without invasive intervention (n = 7(64%)), diagnostic coronary angiography (n = 3(27%)) and coronary artery bypass graft (n = 1(9%)). None of the patients underwent percutaneous coronary intervention preoperatively. Perioperative MACE in the DSE +ve group was 36% compared to 4% in the DSE-ve group (P = 0.006). DSE +ve was a powerful predictor of perioperative inpatient MACE (OR 12.4, 95% CI 2.3-67, P = 0.003). The positive predictive value of DSE +ve status was 36%, whereas the negative predictive value of DSE-ve status for perioperative MACE was 96%. CONCLUSION: DSE for perioperative risk stratification had a high clinical utility in patients undergoing major non-cardiac surgery. In particular, a normal DSE had a high negative predictive value for perioperative MACE.

Patron perception and utilization of an embedded librarian program.

OBJECTIVE: The study measured the perceived value of an academic library's embedded librarian service model. SETTING: The study took place at the health sciences campuses of a research institution. METHODS: A web-based survey was distributed that asked respondents a series of questions about their utilization of and satisfaction with embedded librarians and services. RESULTS: Over 58% of respondents reported being aware of their embedded librarians, and 95% of these were satisfied with provided services. CONCLUSIONS: The overall satisfaction with services was encouraging, but awareness of the embedded program was low, suggesting an overall need for marketing of services.

Adapting an embedded model of librarianship, college by college.

Librarians are increasingly moving out of the library and into the wider university setting as patrons spend more time seeking information online and less time visiting the library. The move to embed librarians in colleges, departments, or customer groups has been going on for some time but has recently received more attention as libraries work to find new ways to reach patrons that no longer need to come to the physical library. Few universities have attempted to embed all their librarians. This case study describes how one group of health sciences librarians dispersed its professional staff throughout its campuses and medical centers.

Literature searching in medical education: online tutorial development from idea to creation.

The medical education literature is growing, and the result is not only greater knowledge, but an increasing complexity in locating quality evidence-based information. In 2008, eight librarians partnered with the Association of American Medical Colleges to research, conceptualize, and build an online module to develop medical educators' search skills. Developing an online instructional module is a time-consuming, multi-stage process requiring the expertise of content, technical, and design specialists working in concert. Many lessons were learned, including the power of collaborative tools; the benefits of including specialists, such as graphic designers; the benefit of thoroughly surveying existing resources; and the importance of choosing technology wisely.

Screening colonoscopies by primary care physicians: a meta-analysis.

PURPOSE: There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS: We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS: We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS: Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.

EMBASE versus MEDLINE for family medicine searches: can MEDLINE searches find the forest or a tree?

OBJECTIVE: Many physicians access electronic databases to obtain up-to-date and reliable medical information. In North America, physicians typically use MEDLINE as their sole electronic database whereas in Europe, physicians typically use EMBASE. While MEDLINE and EMBASE are similar, their coverage of the published literature differs. Searching a single literature database (eg, MEDLINE or EMBASE) has been shown not to yield all available citations, and using two or more databases yields a greater percentage of these available citations. This difference has been demonstrated in a variety of disciplines and in family medicine using the term "family medicine," but differences have not been shown using specific diagnostic terms common in family medicine. We sought to determine whether searching EMBASE with terms for common family medicine diagnoses yields additional references beyond those found by using MEDLINE alone. DESIGN: Literature search comparison. SETTING: An academic medical centre in the United States. INTERVENTIONS: Fifteen family medicine topics were selected based on common diagnoses in US primary care health visits as described in a National Health Care Survey on Ambulatory Care Visits. To promote relevance to family medicine physicians and researchers, the qualifiers "family medicine" and "therapy/therapeutics" were added. These topics were searched in EMBASE and MEDLINE. Searches were executed using Ovid search engine and were limited to the years 1992 to 2003, the English language, and human subjects. Total, duplicated, and unique (ie, nonduplicated) citations were recorded for each search in each database. MAIN OUTCOME MEASURES: Number of citations for the 15 topics. RESULTS: EMBASE yielded 2246 (65%) of 3445 total citations, whereas MEDLINE yielded 1199 citations. Of the total citations, only 177 articles were cited in both databases. EMBASE had 2092 unique citations to MEDLINE's 999 unique citations. EMBASE consistently found more unique citations in 14 of the 15 searches (P = .0005). CONCLUSION: Overall, EMBASE provides twice as many citations per search as MEDLINE and provides greater coverage of total retrieved citations. More citations do not necessarily mean higher-quality citations. In a comprehensive search specific to family medicine, combined EMBASE and MEDLINE searches could yield more articles than MEDLINE could alone.

Variations in Medical Subject Headings (MeSH) mapping: from the natural language of patron terms to the controlled vocabulary of mapped lists.

OBJECTIVES: This study compared the mapping of natural language patron terms to the Medical Subject Headings (MeSH) across six MeSH interfaces for the MEDLINE database. METHODS: Test data were obtained from search requests submitted by patrons to the Library of the Health Sciences, University of Illinois at Chicago, over a nine-month period. Search request statements were parsed into separate terms or phrases. Using print sources from the National Library of Medicine, Each parsed patron term was assigned corresponding MeSH terms. Each patron term was entered into each of the selected interfaces to determine how effectively they mapped to MeSH. Data were collected for mapping success, accessibility of MeSH term within mapped list, and total number of MeSH choices within each list. RESULTS: The selected MEDLINE interfaces do not map the same patron term in the same way, nor do they consistently lead to what is considered the appropriate MeSH term. CONCLUSIONS: If searchers utilize the MEDLINE database to its fullest potential by mapping to MeSH, the results of the mapping will vary between interfaces. This variance may ultimately impact the search results. These differences should be considered when choosing a MEDLINE interface and when instructing end users.