LGBTQ+ health research guides: a multi-institutional analysis of usage patterns and user information needs.

Objective: LGBTQ+ health research guides can strengthen the LGBTQ+ community through connecting people to quality health services and information, and previous studies have recommended that health sciences libraries create and maintain these guides. Little evidence exists, though, on how these guides are used and how well they meet the needs of LGBTQ+ users. Using retrospective data retrieved from multiple LGBTQ+ health research guides, we examined the categories of LGBTQ+ health information most used, as well as how often guides were accessed. Based on these results, we hope to find patterns which can lead to best practices for libraries. Methods: Five North American academic health sciences libraries contributed select usage data from their LGBTQ+ health research guides, covering a three-year period (July 2018-June 2021). Data was analyzed in two ways. Firstly, the 20 most-clicked resources from each guide were categorized through open coding, to assess if certain information resource categories were more popular among guide users, allowing for inference of user needs. A time-series analysis was also conducted for two sites, using the Classical Seasonal Decomposition by Moving Averages method, to provide deeper insights into the data. Results: Open coding data showed consumer health information resources were used more often than other health resource categories. Resources from more locally based organizations and those with provider and services information were heavily used, indicating that users may be looking for information connecting to local health services and providers. The time series analysis allowed the potential positive effect of guide promotion to be showcased in ways that would not have been clear from the raw data. Conclusion: This study shows that people are accessing LGBTQ+ consumer health information through academic library research guides, with a preference for local information. Guide usage appears to be positively driven by outreach within one's institution and to the greater community. Locating external partners may increase guide impact and provide important links to local resources and services.

Residual limb support devices on wheelchairs for people with transtibial amputations: A scoping review and survey of rehabilitation professionals in Nova Scotia.

PURPOSE: To determine what research evidence exists for the use of residual limb supports (RLSs) for people with transtibial amputations and to describe clinicians' use of such supports in Nova Scotia. METHODS: Scoping review of published and gray literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews as a guide and an anonymous online and paper-based clinician survey. RESULTS: We identified 22 publications meeting criteria for review. Seventeen (77%) of the publications were practice guidelines or systematic reviews about care of people with lower-limb amputations, 4 (18%) involved research about the design of stump supports, and 1 (5%) researched the use of supports. Generally, the use of RLSs was recommended (e.g., to prevent contractures, control edema, and to provide comfort), but many authors acknowledged that the evidence was weak, and additional evidence in support of these treatment goals could not be found. We received 44 survey responses from health care professionals involved with the care of people with transtibial amputations in Nova Scotia. Of the 43 health care professionals who responded to the question "… what percent of patients/clients with transtibial amputations do you estimate receive stump supports …," the mean (standard deviation) was 86.1% (21.1). The most common reasons for recommending a stump support were to prevent knee contracture (38 [86.4%]), and to prevent swelling (13 [29.5%]). CONCLUSIONS: Most clinicians who provide services to people with amputations in Nova Scotia believe that RLSs have benefits such as the prevention of contractures, the reduction of edema, and improved patient comfort. However, there is little high-quality research evidence to support their use. There is a need to perform the necessary research or to modify practice guidelines.

Quantification and characterization of plastics in near-shore surface waters of Atlantic Canada.

Plastics are a ubiquitous pollutant in the marine environment. Despite growing concerns, quantitative and qualitative data on microplastics in aquatic and marine environments of Atlantic Canada is just emerging. Surface water plastics were measured and categorized by morphology (thread, microfibre, fragment, foam, film, pellet, and microbead) in two locations in Nova Scotia and one in Newfoundland and Labrador, Canada. All sites within the three locations contained plastic with an average abundance of 9669 items/km2. Most plastics (68 %) were sized as microplastics (0.425-5 mm), and plastic fragments were the most common morphological type. Polyethylene accounted for a third (30 %) of all particles found across all three locations, followed by polypropylene (23 %). Results can inform future research for community-based environmental groups, government, and academia.

Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions.

BACKGROUND: Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. METHODS: Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for "Communication about Medicines" and "Care Transitions." Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. RESULTS: Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions "staff told you what the medicine was for" (14.2%; p = 0.018), "staff describe possible effects" (21.2%; p = 0.004), and "understood the purpose of taking medications" (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. CONCLUSIONS: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.

Diagnostic accuracy of Kleihauer-Betke (Kb) testing to predict fetal outcomes associated with fetomaternal hemorrhage: a retrospective cohort study.

OBJECTIVE: To evaluate the diagnostic and screening utility of Kleihauer-Betke (KB) testing as a triage tool in predicting adverse fetal outcomes associated with fetomaternal hemorrhage (FMH). STUDY DESIGN: Single center retrospective cohort study evaluated a primary composite outcome of fetal complications associated with FMH between KB-negative and KB-positive test groups. Screening tests for sensitivity, specificity, positive predictive value and negative predictive value were determined. RESULTS: 641 women (97%) had KB-negative and 22 (3%) had KB-positive tests. The primary composite outcome between KB-negative and KB-positive pregnancies was similar (30% vs. 36%, p = 0.54). Screening exhibited high specificity (97%), however, test sensitivity was poor (4%) with only moderate positive and negative predictive values (36.4 and 69.7%). CONCLUSION: Fetal outcomes associated with FMH were not significantly different between KB-positive and KB-negative test cohorts; KB testing offers no diagnostic precision in the emergency triage evaluation of women with suspected FMH.

Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP). DATA SOURCES: We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017. STUDY SELECTION: Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP. DATA EXTRACTION: Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool. DATA SYNTHESIS: Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p < .0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. CONCLUSIONS: There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. Implications for rehabilitation A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings.

Time to Awakening Is Often Delayed in Patients Who Receive Targeted Temperature Management After Cardiac Arrest.

Post cardiac arrest, neuroprognostication remains a complex and clinically challenging issue for critical care providers. For this reason, our primary objective in this study was to determine the frequency of survival and favorable neurological outcomes in post-cardiac arrest patients with delayed time to awakening. To assess whether early withdrawal of care may adversely impact survival, we also sought to describe the time to withdrawal of care of non-surviving patients. We performed a retrospective study of patients resuscitated after cardiac arrest in two large academic community hospitals. We performed a structured chart review of patients treated with therapeutic hypothermia (TH) at one hospital from 2009 to 2015 and at a second hospital from 2013 to 2015. Demographics and Utstein style variables were recorded on all patients, as well as temporal variables to characterize the time interval from Return of Spontaneous Circulation (ROSC) to awakening as recorded by ICU nurses and defined as Glasgow Coma Scale (GCS) of >8. Descriptive data were also captured regarding time to withdrawal of care. We pre-hoc defined delayed awakening as >72 hours post ROSC or >72 hours post rewarming. Our primary outcome was survival to hospital discharge with a secondary outcome of a favorable cerebral performance category of 1 or 2. During this study period, 321 patients received TH, with 111 (34.6%) discharged alive and, of these, 67 (68.5%) experienced a good neurological outcome. Awakening more than 72 hours after return of circulation was common with 31 patients surviving to discharge. Of these, 16 of 31 (51.6%) were found to have a good neurological outcome on hospital discharge. Of the patients who died before discharge, 54 (29.5%) had care withdrawn less than 72 hours after ROSC. A delayed time to awakening is not infrequently associated with a good neurological outcome after TH in patients resuscitated from cardiac arrest.

Atypical Presentation of Sarcoidosis on ¹8F-FDG PET/CT.

On (18)F-FDG PET, inflammatory processes can be one of the most confounding factors for interpretation, particularly when the presentation of the process is atypical, as it was in the case of sarcoidosis reported here. Clinicians should be aware that sarcoidosis may mimic lung malignancies and lymphomas, regardless of typical or atypical appearance on (18)F-FDG PET.

Basic life support and cardiopulmonary resuscitation training for pharmacy students and the community by a pharmacy student committee.

OBJECTIVE: To create a self-sufficient, innovative method for providing cardiopulmonary resuscitation (CPR) education within a college of pharmacy using a student-driven committee, and disseminating CPR education into the community through a service learning experience. DESIGN: A CPR committee comprised of doctor of pharmacy (PharmD) students at the University of Tennessee College of Pharmacy provided CPR certification to all pharmacy students. The committee developed a service learning project by providing CPR training courses in the community. Participants in the course were required to complete an evaluation form at the conclusion of each training course. ASSESSMENT: The CPR committee successfully certified more than 1,950 PharmD students and 240 community members from 1996 to 2009. Evaluations completed by participants were favorable, with 99% of all respondents (n = 351) rating the training course as either "excellent" or "good" in each of the categories evaluated. CONCLUSION: A PharmD student-directed committee successfully provided CPR training to other students and community members as a service learning experience.