Persistent service even in disruptive times: an introduction to resilience engineering.

Building resilient libraries will take energy and courage. It will take a willingness to step outside our traditional roles and engage in the messy, tough work of redefining ourselves and our institutions [1].

Promoting Health Data Fluency Skills by Expanding Data and Informatics Work in Libraries: The Role of a Health Library Informaticist.

Health sciences libraries offer core resources and services to expand the knowledge and efficiencies of their communities. Increasingly with the growth of big data, open data, and electronic health records, clinical and translational researchers must be more fluent in finding, manipulating, managing, visualizing, and sharing data. To meet such needs, libraries are increasingly creating roles to educate and collaborate on topics related to health informatics and health data. This column provides examples of the work of the health library informaticist at the Blaisdell Medical Library, University of California, Davis, and how the role facilitates health professions students, faculty and staff to access, manage, and use data assets and software tools for working with data.

The Relationship between Croup and Gastroesophageal Reflux: A Systematic Review and Meta-Analysis.

OBJECTIVE: The mechanism by which recurrent croup occurs is unknown. Gastroesophageal reflux is commonly implicated, although this relationship is only loosely documented. We conducted a systematic review with a meta-analysis component to evaluate the relationship between recurrent croup and gastroesophageal reflux disease (GERD), and to assess for evidence of improvement in croup symptoms when treated. STYLE DESIGN: Systematic Review and Meta Analysis. METHODS: We searched five separate databases. Studies were included if they discussed the relationship between croup and GERD in children, >5 subjects, and available in English. Literature retrieved was assessed according to pre-specified criteria. Retrieved articles were reviewed by two independent authors and decisions mediated by a third author. If there was a difference of opinion after first review, a second review was performed to obtain consensus. Heterogeneity was calculated and summarized in forest plots. RESULTS: Of 346 initial records, 15 met inclusion criteria. These were two retrospective cohort and 13 cross-sectional studies. Thirteen of 15 articles support an association between recurrent croup and GERD. Although heterogeneity is high among studies that reported prevalence of GERD, there is less uncertainty in results for improvement to recurrent croup after GERD treatment. Most studies lacked a control group and all carry a moderate-to-high risk of bias. CONCLUSION: There is limited evidence linking GERD to recurrent croup; Further research is needed to assess for causality as most studies are retrospective, lack a control group, and have a study design exposing them to bias. Patients treated with reflux medication appear to demonstrate a reduced incidence of croup symptoms. LEVEL OF EVIDENCE: 1 Laryngoscope, 131:209-217, 2021.

Health sciences library leadership skills in an interprofessional landscape: a review and textual analysis.

Academic medical libraries sit at the crossroads of the complex landscape of the health sciences. Medical librarians in these environments must navigate and lead endeavors and services that involve many professions. In addition to being excellent leaders in their own professions, medical librarians must also improve their skills in leading in an interprofessional context by informing themselves of the qualities and skills valued in connected professions. In this project, the authors set out to understand leadership principles from three professions closely affiliated with medical librarianship to identify a core interdisciplinary leadership skill set. To do so, we conducted a mapping review of the existing literature from the last five years around leadership in academic medicine, academic nursing, hospital administration, and medical librarianship to identify core leadership skills across the disciplines and discover potential differences. We used text analysis and descriptive analysis to extract skills that were mentioned and uncover trends in the identified literature. Modern medical librarians must extend their leadership beyond the internal library setting, particularly as they become more involved with connecting and collaborating with leaders across disciplines. To successfully navigate such an interdisciplinary landscape and enhance the impact of the library in the broader organization, it is important to have the skills and vocabulary of leadership across the various professions.

Reporting and Categorization of Blood Culture Contaminants in Infants and Young Children: A Scoping Review.

BACKGROUND: Blood cultures are obtained routinely for infants and young children for the evaluation for serious bacterial infection. Isolation of organisms that represent possible contaminants poses a management challenge. The prevalence of bacteremia reported in this population is potentially biased by inconsistent contaminant categorization reported in the literature. Our aim was to systematically review the definition and reporting of contaminants within the literature regarding infant bacteremia. METHODS: A search of studies published between 1986 and mid-September 2016 was conducted using Medline/PubMed. Included studies examined children aged 0 to 36 months for whom blood culture was performed as part of a serious bacterial infection evaluation. Studies that involved children in an intensive care unit, prematurely born children, and immunocompromised children or those with an indwelling catheter/device were excluded. Data extracted included contaminant designation methodology, organisms classified as contaminants and pathogens, and contamination and bacteremia rates. DISCUSSION: Our search yielded 1335 articles, and 69 of them met our inclusion criteria. The methodology used to define contaminants was described in 37 (54%) study reports, and 16 (23%) reported contamination rates, which ranged from 0.5% to 22.8%. Studies defined contaminants according to organism species (n = 22), according to the patient's clinical management (n = 4), and using multifactorial approaches (n = 11). Many common organisms, particularly Gram-positive cocci, were inconsistently categorized as pathogens or contaminants. CONCLUSIONS: Reporting and categorization of blood culture contamination are inconsistent within the pediatric bacteremia literature, which limits our ability to estimate the prevalence of bacteremia. Although contaminants are characterized most frequently according to organism, we found inconsistency regarding the classification of certain common organisms. A standardized approach to contaminant reporting is needed.

Extending medical librarians' competencies to enhance collection organisation.

BACKGROUND: Like many health library associations, the Medical Library Association (MLA) developed competencies guiding lifelong learning and competence for medical librarians. Medical librarians should be able to develop skills in identified areas. One MLA indicator of organising resources defines expert skill as the ability to develop classification and metadata schemes for unique collections. OBJECTIVES: This manuscript reviews available curricula for selected library programmes in the United States and Canada, along with professional development and informal opportunities for skill development to identify how medical librarians, who are not experts in cataloging or metadata and not employed as cataloging or metadata librarians, can progress in competency. METHODS: The authors reviewed library school and continuing education programming around metadata, along with answers from a pre-existing informal poll regarding cataloging and metadata roles in health sciences libraries. Data were collected and examined using descriptive statistics. DISCUSSION: Gaps and opportunities for education around organising resources are discussed, including library school courses, formal continuing education opportunities and informal learning (e.g. peer support networks, on-the-job learning). CONCLUSION: Education in organising resources should be created throughout the educational journey of librarianship. Continuing educational opportunities in organising resources should be created by professional organisations that expect competency in this area.

"Game on!" Teaching gamification principles for library instruction to health sciences information professionals using interactive, low-tech activities and design-thinking modalities.

BACKGROUND: Gamification is correlated with increased motivation and engagement of learners and is increasingly being incorporated into library instruction. Opportunities for librarians to learn and practice principles of gamification can be helpful for those desiring to incorporate gamification into instruction. This report describes the development and delivery of an interactive special content session at MLA '18, the 2018 Medical Library Association annual meeting in Atlanta, Georgia, focusing on principles of low-tech game design for health sciences library classroom instruction. CASE PRESENTATION: The special content session, titled "Design, Play, Learn: A Special Content Session to Design a Game for Database Instruction," was designed and delivered using multimodal instruction (e.g., flipped classroom, didactic component, active learning) that also incorporated principles of design thinking. A pre- and post-survey was given to all participants at the beginning and end of the session to measure confidence and desire to incorporate gamification into instruction and as a formative feedback indicator for instructors. Participants reported increased confidence and desire to use games for library instruction after participating in the session. A selection of games was uploaded to a shared content folder designed for course participants as an ongoing repository for ideas and communication. CONCLUSIONS: For librarians who are interested in incorporating principles of gamification into library instruction, attending a relatively short hands-on workshop can facilitate learning and confidence around prototyping and creating games for use in library instruction. We intend to improve upon the workshop and offer it again in additional contexts, based on direct observations of the session and participant feedback.

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review.

CONTEXT: Racial and ethnic disparities in health outcomes of newborns requiring care in the NICU setting have been reported. The contribution of NICU care to disparities in outcomes is unclear. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. DATA SOURCES: Medline/PubMed, Scopus, Cumulative Index of Nursing and Allied Health, and Web of Science were searched until March 6, 2018, by using search queries organized around the following key concepts: "neonatal intensive care units," "racial or ethnic disparities," and "quality of care." STUDY SELECTION: English language articles up to March 6, 2018, that were focused on racial and/or ethnic differences in the quality of NICU care were selected. DATA EXTRACTION: Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Information extracted focused on racial and/or ethnic disparities in quality of care and potential mechanism(s) for disparities. RESULTS: Initial search yielded 566 records, 470 of which were unique citations. Title and abstract review resulted in 382 records. Appraisal of the full text of the remaining 88 records, along with the addition of 5 citations from expert consult or review of bibliographies, resulted in 41 articles being included. LIMITATIONS: Quantitative meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Overall, this systematic review revealed complex racial and/or ethnic disparities in structure, process, and outcome measures, most often disadvantaging infants of color, especially African American infants. There are some exceptions to this pattern and each area merits its own analysis and discussion.

A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds.

The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.

A scoping review of military veterans involved in the criminal justice system and their health and healthcare.

BACKGROUND: In the criminal justice system, special populations, such as older adults or patients with infectious diseases, have been identified as particularly vulnerable to poor health outcomes. Military veterans involved in the criminal justice system are also a vulnerable population warranting attention because of their unique healthcare needs. This review aims to provide an overview of existing literature on justice-involved veterans' health and healthcare to identify research gaps and inform policy and practice. METHODS: A systematic search was conducted to identify research articles related to justice-involved veterans' health and healthcare that were published prior to December 2017. Study characteristics including healthcare category, study design, sample size, and funding source were extracted and summarized with the aim of providing an overview of extant literature. RESULTS: The search strategy initially identified 1830 unique abstracts with 1387 abstracts then excluded. Full-text review of 443 articles was conducted with 252 excluded. There were 191 articles included, most related to veterans' mental health (130/191, 68%) or homelessness (24/191, 13%). Most studies used an observational design (173/191, 91%). CONCLUSIONS: Knowledge gaps identified from the review provide guidance on future areas of research. Studies on different sociodemographic groups, medical conditions, and the management of multiple conditions and psychosocial challenges are needed. Developing and testing interventions, especially randomized trials, to address justice-involved veterans care needs will help to improve their health and healthcare. Finally, an integrated conceptual framework that draws from diverse disciplines, such as criminology, health services, psychology, and implementation science is needed to inform research, policy and practice focused on justice-involved veterans.

The physical deterioration of dialysis patients-Ignored, ill-reported, and ill-treated.

The progressive physical deterioration of dialysis patients is apparent to all who are involved in their care. Exercise can help stem this decline, yet exercise uptake in chronic and end-stage kidney disease is low. The involvement of exercise professionals has been shown to significantly increase patients' physical function and improve their quality of life. However, exercise professionals are scarce in renal programs, far less than dietetic and social work services. A review of 10 years of renal exercise publications in the physical therapy and rehabilitation literature found that only 0.4% (7 out of a total of 1763) of all published articles were focused on people with kidney disease. This compared with stroke (44%, n=883), arthritis/bone (29%, n=458), cancer (9%, n=168), respiratory (8%, n=106), cardiac (5%, n=82), and diabetes (3%, n=45). These results reflect the low emphasis placed on renal rehabilitation by the physical therapy professions and the low renal content in physical therapy tertiary education programs. This is likely to have an impact on the level of involvement of physical therapists in renal programs leading to lower physical function and poorer quality of life for renal patients.

Practising evidence-based medicine (EBM): a descriptive analysis of medical students' whole-task EBM assignments.

Researchers have suggested whole-task learning activities to practice and teach evidence-based medicine (EBM); however, limited description exists of their use in EBM curricula. This article describes medical students' execution of a whole-task EBM assignment and characterises themes emerging from assignment submissions. Between 2013 and 2015, Stanford University's paediatric clerkship students completed a whole-task EBM assignment based on a patient encounter. The assignment captured students' efforts to perform all EBM steps and describe their patient scenario and future knowledge needs strategies. Assignments were analysed using descriptive statistics and qualitative description. 123 students completed the assignment. Students formulated therapy (n=76), prognosis (n=18), diagnosis (n=15), harm (n=9) and aetiology (n=2) questions, and used a single (n=58) or multiple information resources (n=57). Based on evidence appraisal, 95 students indicated that the found evidence would inform future practice while 16 were sceptical of its conclusivity. 65 learners wanted to share evidence with colleagues; 33 with patients and families. To meet future knowledge needs, learners suggested using a structured approach (eg, PICO (patient, intervention, comparison and outcome); n=58), reading more primary literature (n=22) and creating question logs (n=21). This article provides a glimpse into students' EBM process and demonstrates the feasibility of whole-task activities for use in EBM training. Findings related to students' clinical uncertainty and information sharing raise questions about coverage of these topics in current EBM training and suggest that further investigation is warranted.

Extensor tendon gap reconstruction: a review.

BACKGROUND: The extensor tendons of the hand are located in a superficial position on the dorsal aspect of the hand and are highly susceptible to injury. Laceration, crush and avulsion injuries are common extensor tendon injuries presenting for acute care. Such injuries that involve tendon loss or gaps in the extensor tendons require specialised attention and can be some of the most challenging to repair, as extensor tendons have less excursion than flexor tendons. Reconstructive techniques for such defects may differ according to the location of the defect, especially in Verdan's extensor zones 1-5. Adequate repair of extensor tendon defects in zones 1-5 is especially important because (a) even a 1 mm tendon gap in those zones may cause 20° extension loss, and (b) shortening of the extensor tendon by as little as 1 mm may cause decreased finger flexion. REVIEW: This article reviews and discusses the literature on the various approaches and techniques for extensor tendon reconstruction, delineated by zone of injury (zones 1-8). CONCLSIONS: Awareness of the various techniques available to repair defects in each zone of injury is important so that surgeons can choose the technique most in alignment with the type of injury, the surgeon's skills, and patient characteristics, and optimise the repair of such injuries.

Deepithelized posterior interosseous artery flap for 3-dimensional defect coverage in the hand.

The posterior interosseous artery (PIA) flap is a pedicle flap that can be harvested at the posterior forearm based on blood supply from the PIA and its concomitant veins. The flap can be used for posttrauma coverage of exposed bones, tendons, and defects; for treatment of a surgical wound; or as a spacer in congenital or burn-related contracture releases. The surgical technique has been reported with limited donor morbidity and few complications to cover exposed structures. In this article, we present our methods and experience using a modification of the posterior interosseous flap that was deepithelized to fill a 3-dimensional cavity in the hand. This method has been successfully used, and the example of the patient shows good outcome, function, and range of motion with no significant complications. The deepithelized PIA flap is a technique that surgeons may add to their toolbox for 3-dimensional defect coverage in the hand. It offers the following advantages: (a) technically uncomplicated; (b) does not create significant donor site morbidity; (c) does not sacrifice any major vessels; and (d) provides good cosmetic appearance, especially in the dorsum of the hand.

Hand infections: a retrospective analysis.

Purpose. Hand infections are common, usually resulting from an untreated injury. In this retrospective study, we report on hand infection cases needing surgical drainage in order to assess patient demographics, causation of infection, clinical course, and clinical management. Methods. Medical records of patients presenting with hand infections, excluding post-surgical infections, treated with incision and debridement over a one-year period were reviewed. Patient demographics; past medical history; infection site(s) and causation; intervals between onset of infection, hospital admission, surgical intervention and days of hospitalization; gram stains and cultures; choice of antibiotics; complications; and outcomes were reviewed. Results. Most infections were caused by laceration and the most common site of infection was the palm or dorsum of the hand. Mean length of hospitalization was 6 days. Methicillin-resistant Staphylococcus aureus, beta-hemolytic Streptococcus and methicillin-susceptible Staphylococcus aureus were the most commonly cultured microorganisms. Cephalosporins, clindamycin, amoxicillin/clavulanate, penicillin, vancomycin, and trimethoprim/sulfamethoxazole were major antibiotic choices. Amputations and contracture were the primary complications. Conclusions. Surgery along with medical management were key to treatment and most soft tissue infections resolved without further complications. With prompt and appropriate care, most hand infection patients can achieve full resolution of their infection.

Zone I extensor reconstruction with tendon salvaged from another finger.

Laceration, crush, and avulsion injuries are common acute extensor tendon injuries. Simple lacerations may often be repaired in the emergency room, but crush or avulsion injuries may involve tendon loss and gaps in the extensor tendons. Reconstruction can be difficult. The purpose of this article is to present a salvage technique for reconstruction of large extensor tendon gaps in extensor zone I in patients with severe injuries to multiple fingers. This technique, in which a tendon is transplanted from an unsalvageable finger to another with a terminal tendon gap in the same patient, may be a reasonable remedy for reconstruction of tendon loss or gaps and may offer advantages over other traditional reconstructive techniques in certain cases.

Hypotheses for ongoing evolution of muscles of the upper extremity.

There are organs and muscles in the human body that may be considered rudimentary in that they have insignificant or undetermined function. Several such muscles are found in the upper extremity. In this review, four muscles that appear to be undergoing evolutionary changes are discussed: flexor digitorum superficialis to the fifth finger, anconeus, palmaris longus, and anconeus epitrochlearis. The present study synthesizes, advances and extends previously described work about these muscles and extends the hypotheses and concludes that: (a) the flexor digitorum superficialis to the fifth finger is currently under adaptive evolution, (b) the anconeus has currently stabilized its evolution and is serving as a transient stability augmenter during a short portion of the human lifespan, and (c) the entire distal upper extremity is currently in the process of undergoing evolutionary change. Understanding of these muscles and their evolutionary context is important for understanding of impact on function, dysfunction, treatment and future research.

Management of gunshot wounds to the hand: a literature review.

Hand trauma resulting from firearms is becoming more common in civilian life. In the past, as in wartime, infection was a main source of concern following firearm-related hand injuries, whereas in current civilian life with modern medical care, infection rates are actually low for such injuries. As infection is now of lesser concern, the focus should shift to improve functional outcomes. This review summarizes available literature regarding the management of gunshot wounds to the hand, with particular focus on functional outcomes. In conducting this review, we found that there is not comprehensive information regarding management of gunshot wounds to the hand, and literature discussing functional recovery of the hand is limited. Given the current evidence related to management of gunshot wounds to the hand, we believe that early debridement, antibiotic treatment, reconstruction, and rehabilitation offer patients the best chance for full functional recovery.