Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men.

OBJECTIVES: To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia. DESIGN: We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. METHODS: Six indicators were measured: (1) state-wide total HIV laboratory tests; (2) number of GBM attending publicly-funded clinics; (3) 12-monthly testing uptake; (4) annual testing frequency; (5) HIV testing with a STI diagnosis; and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas-born. RESULTS: Overall, 43,560 GBM attended participating clinics (22,662 Australian-born, 20,834 overseas-born) from 2010-2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p<0.001 for all) in testing uptake (83.9% to 95.1%); testing with a STI diagnosis (68.7% to 94.0%); annual HIV testing frequency (1.4 to 2.7); and a decreasing trend (p<0.01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian-born and overseas-born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian-born GBM (7.1% to 2.8%), but an increasing trend in overseas-born GBM (15.3% to 16.9%) (p<0.001 for all).

Ebola outbreak preparedness planning: a qualitative study of clinicians' experiences.

OBJECTIVES: The 2014-15 Ebola outbreak in West Africa highlighted the challenges many hospitals face when preparing for the potential emergence of highly contagious diseases. This study examined the experiences of frontline health care professionals in an Australian hospital during the outbreak, with a focus on participant views on information, training and preparedness, to inform future outbreak preparedness planning. STUDY DESIGN: Semi-structured interviews were conducted with 21 healthcare professionals involved in Ebola preparedness planning, at a hospital in Australia. METHODS: The data were systematically coded to discover key themes in participants' accounts of Ebola preparedness. RESULTS: Three key themes identified were: 1) the impact of high volumes of-often inconsistent-information, which shaped participants' trust in authority; 2) barriers to engagement in training, including the perceived relative risk Ebola presented; and finally, 3) practical and environmental impediments to preparedness. CONCLUSIONS: These clinicians' accounts of Ebola preparedness reveal a range of important factors which may influence the relative success of outbreak preparedness and provide guidance for future responses. In particular, they illustrate the critical importance of clear communication and guidelines for staff engagement with, and implementation of training. An important outcome of this study was how individual assessments of risk and trust are produced via, and overlap with, the dynamics of communication, training and environmental logistics. Consideration of the dynamic ways in which these issues intersect is crucial for fostering an environment that is suitable for managing an infectious threat such as Ebola.

Randomized controlled trial of asthma risk with paracetamol use in infancy--a feasibility study.

BACKGROUND: There is non-experimental evidence that paracetamol (acetaminophen) use may increase the risk of developing asthma. However, numerous methodological issues need to be resolved before undertaking a randomized controlled trial to investigate this hypothesis. OBJECTIVE: To establish the feasibility of a randomized controlled trial of liberal paracetamol as usually given by parents/guardians vs. a comparator (restricted paracetamol in accordance with WHO guidelines, ibuprofen or placebo), and childhood asthma risk. METHODS: Questionnaires were completed by parents/guardians of infants admitted to Wellington Hospital with bronchiolitis to assess views about comparator treatments. Subsequently, infants of parents/guardians who provided informed consent were randomized to restricted or liberal paracetamol use for 3 months with paracetamol use recorded. RESULTS: Of 120 eligible participants, 72 (60%) parents/guardians completed the questionnaire. Ibuprofen, restricted paracetamol and placebo were acceptable to 42 (58%), 29 (40%) and 9 (12%) parents/guardians, respectively. 36 (30%) infants were randomized to restricted or liberal paracetamol. Paracetamol use was greater for the liberal vs. restricted group for reported [Hodges-Lehmann estimator of difference 0.94 mg/kg/day (95% CI 0.2-3.52), P = 0.02] and measured use [Hodges-Lehmann estimator of difference 2.11 mg/kg/day (95% CI 0.9-4.18), P = 0.004]. The median reported and measured use of paracetamol was 2.0-fold and 3.5-fold greater in the liberal vs. restricted group. CONCLUSIONS AND CLINICAL RELEVANCE: Although separation in paracetamol dosing is likely to be achieved with a liberal vs. restricted paracetamol regime, ibuprofen is the preferred comparator treatment in the proposed RCT of paracetamol use and risk of asthma in childhood.

Pediatric nursing practice: keeping pace with technological advances.

Over the past 25 years, extensive technological and medical advances have had a major impact on the way pediatric nursing is practiced. Pediatric nurses have expanded their nursing roles, established professional organizations and certification standards to ensure clinical competence at the bedside, and tirelessly advocated for the health care needs of children and their families. In addition, pediatric nurses have collaborated with other health care providers to institute family-centered and developmentally appropriate philosophies of care. All of these changes will assist pediatric nurses to remain focused on the most important aspect of their work: Supporting the unique needs of children and their families.

Effects of training status on the metabolic responses to high carbohydrate and high fat meals.

The purpose of this study was to determine if there is a difference between the way in which aerobically trained and untrained women metabolize fats and carbohydrates at rest in response to either a high-fat or high-carbohydrate meal. Subjects, 6 per group, were fed a high CHO meal (2068 kJ, 76% CHO, 23% fat, 5% protein) and a high fat meal (2093 kJ, 21% CHO, 72% fat, 8% protein) in counterbalanced order. Resting metabolic rate (RMR) was measured every half-hour for 5 hours. RMR was similar between groups. However, after ingesting a high CHO meal, trained subjects had a peak in metabolism at minute 60, not evident in the untrained subjects. In addition, postprandial RER from minutes 120-300 were lower and fat use was greater after the high CHO meal for the trained subjects. These results suggest that aerobically trained women have an accelerated CHO uptake and overall lower CHO oxidation following the ingestion of a high CHO meal.

Health sciences library building projects, 1998 survey.

Twenty-eight health sciences library building projects are briefly described, including twelve new buildings and sixteen additions, remodelings, and renovations. The libraries range in size from 2,144 square feet to 190,000 gross square feet. Twelve libraries are described in detail. These include three hospital libraries, one information center sponsored by ten institutions, and eight academic health sciences libraries.

Health sciences library building projects, 1996-1997 survey.

Nine building projects are briefly described, including four new libraries, two renovations, and three combined renovations and additions. The libraries range in size from 657 square feet to 136,832 square feet, with seating varying from 14 to 635. Three hospital libraries and four academic health sciences libraries are described in more detail. In each case an important consideration was the provision for computer access. Two of the libraries expanded their space for historical collections. Three of the libraries added mobile shelving as a way of storing print materials while providing space for other activities.

The Briscoe Library, University of Texas Health Science Center.

The Briscoe Library at the University of Texas Health Science Center at San Antonio opened in 1983, to replace and expand space for the growing campus. Work on the design phase began in 1979, once the legislature allocated $9.5 million for the new building. Of the 23 design objectives specified in the building program, flexibility to accommodate changing services and technology was given first priority. Details cover layout and technology, as well as changes to the environment and the building since it opened.

Assessment of physicians' information needs in five Texas counties.

In 1990, a questionnaire was mailed to all physicians in four counties in the lower Rio Grande Valley of Texas and to a random sample of physicians in Bexar County, Texas (San Antonio). Two hundred and eighty of 573 Valley physicians (48.9%) and 162 of 273 Bexar County physicians (59.3%) responded to the survey, for an overall response rate of 52.2%. The two groups were compared primarily to determine differences between physicians who have access to established medical libraries and physicians who practice in remote areas without local access to medical information. Demographic variables, professional practice characteristics, and patient characteristics were compared. Information resource use, particularly reasons for use and non-use of MEDLINE, was explored. Questions also were asked about the availability of various types of information technology. The results indicated that differences in the health care profile did not affect the information usage of the physicians but that differences did exist between the two groups in the use of MEDLINE and libraries. There was no statistically significant difference in either group's rating of experience with using databases, with more than 40% in each group rating themselves as not at all experienced.

Children's literature: the death experience.

Children learn about death and dying through a variety of social, psychologic, and intellectual experiences. A review of 25 children's books provides insight into themes, values, and beliefs children learn about death through reading.

National Library of Medicine resource grants: application and review.

National Library of Medicine resource grants provide assistance in developing information services or activities, which are then made available to others. The resource grant program was redefined in 1989 to establish information access grants and information systems grants. The preparation of a resource grant proposal is discussed, with examples included for some sections. All applicants must use the PHS 398 application form, which is geared to research grants. The review process and reapplication are described. Problems with National Institutes of Health grant proposals that have been reported in the literature are discussed.

Improving access to computer-based library and drug information services in patient-care areas.

A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.

Selective nontreatment of handicapped newborns: how do we decide?

The selective nontreatment of handicapped newborns is an issue that has been of prominent legal debate since the 1982 Department of Health and Human Services "Baby Doe Regulations." It is also an issue of great ethical debate. This article analyzes the dilemma using the principle of nonmaleficence. In addition, the related constructs of ordinary versus extraordinary care, the qualifications of personhood, and the quality of life versus sanctity of life are explained. Nonmaleficence is discussed in terms of the ethical decision-making impact upon the child, the family, health care professionals, and society.

Implementing change: the installation of an integrated library system at UTHSCSA.

The implementation of the Library Information System (LIS) and the distributed PHILSOM system at the University of Texas Health Science Center at San Antonio Library is described. These systems were installed over a ten-month period in 1982-1983. Aspects of the implementation, including equipment, staffing, scheduling, data preparation, and public relations, are reviewed. Evaluation of LIS and its costs are discussed.

The new library building at the University of Texas Health Science Center at San Antonio.

The new University of Texas Health Science Center at San Antonio Library opened in June 1983, replacing the 1968 library building. Planning a new library building provides an opportunity for the staff to rethink their philosophy of service. Of paramount concern and importance is the need to convey this philosophy to the architects. This paper describes the planning process and the building's external features, interior layouts, and accommodations for technology. Details of the move to the building are considered and various aspects of the building are reviewed.

Evaluation of the TALON Cooperative Acquisitions Program for monographs.

The TALON Cooperative Acquisitions Program for monographs (TALON/CAP) was implemented in 1979 by eleven resource libraries in the South Central Regional Medical Library Program. Each participating library acquired books from selected publishers within a profile covering subject and format. The program was evaluated by comparing interlibrary loan requests, surveying participants, and analyzing cataloging records. The results were that ten of the eleven libraries significantly increased their coverage of assigned publishers, and that academic medical libraries are not all buying the same books, even from major medical publishers. The fifty-six publishers in the program accounted for 60% to 83% of the titles with 1977-80 imprints held by participating libraries. The computer-generated collection analysis reports provide a baseline for future collection management studies.