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Objective: This study explored dietetic interns’ perceptions and knowledge of evidence-based practice (EBP), their use and observation of EBP principles during their clinical rotations, and their intentions to use EBP in their careers.Methods: A mixed methods design combining a survey and focus group was employed. Dietetic interns (n=16) from a large Midwestern university were recruited in person and via email to participate in the survey, focus group, or both. Perceptions and experiences of EBP were analyzed through the focus group (qualitative), and EBP knowledge and clinical practice behaviors were analyzed through the survey (quantitative). The focus group discussion was recorded, transcribed, and analyzed using thematic analysis.Results: Four major themes emerged from the focus group data: (1) observations of EBP in clinical practice, (2) use of EBP during clinical rotations, (3) barriers to EBP, and (4) perceived use of EBP as future registered dietitians. Interns considered EBP important for their profession and future careers. They struggled, however, with the discrepancies between current research and practice, and highlighted differences that they observed and barriers that they experienced across different clinical settings.Conclusions: This exploratory study is the first to examine dietetic interns’ perceptions of and experiences with EBP in the clinical setting. Future research is needed to identify how dietetics educators, librarians, and preceptors can address the barriers that interns perceive in applying EBP in their internships.

Background Previous narrative reviews have concluded that dietary nitrate (NO 3 − ) improves maximal neuromuscular power in humans. This conclusion, however, was based on a limited number of studies, and no attempt has been made to quantify the exact magnitude of this beneficial effect. Such information would help ensure adequate statistical power in future studies and could help place the effects of dietary NO 3 − on various aspects of exercise performance (i.e., endurance vs. strength vs. power) in better context. We therefore undertook a systematic review and individual participant data meta-analysis to quantify the effects of NO 3 − supplementation on human muscle power. Methods The literature was searched using a strategy developed by a health sciences librarian. Data sources included Medline Ovid, Embase, SPORTDiscus, Scopus, Clinicaltrials.gov , and Google Scholar. Studies were included if they used a randomized, double-blind, placebo-controlled, crossover experimental design to measure the effects of dietary NO 3 − on maximal power during exercise in the non-fatigued state and the within-subject correlation could be determined from data in the published manuscript or obtained from the authors. Results Nineteen studies of a total of 268 participants (218 men, 50 women) met the criteria for inclusion. The overall effect size (ES; Hedge’s g) calculated using a fixed effects model was 0.42 (95% confidence interval (CI) 0.29, 0.56; p  = 6.310 × 10 − 11 ). There was limited heterogeneity between studies (i.e., I 2  = 22.79%, H 2  = 1.30, p  = 0.3460). The ES estimated using a random effects model was therefore similar (i.e., 0.45, 95% CI 0.30, 0.61; p  = 1.064 × 10 − 9 ). Sub-group analyses revealed no significant differences due to subject age, sex, or test modality (i.e., small vs. large muscle mass exercise). However, the ES in studies using an acute dose (i.e., 0.54, 95% CI 0.37, 0.71; p  = 6.774 × 10 − 12 ) was greater ( p  = 0.0211) than in studies using a multiple dose regimen (i.e., 0.22, 95% CI 0.01, 0.43; p  = 0.003630). Conclusions Acute or chronic dietary NO 3 − intake significantly increases maximal muscle power in humans. The magnitude of this effect–on average, ~ 5%–is likely to be of considerable practical and clinical importance.

Objective: We sought to determine how many abstracts presented at the 2012 and 2014 Medical Library Association (MLA) annual conferences were later published as full-text journal articles and which features of the abstract and first author influence the likelihood of future publication. To do so, we replicated a previous study on MLA conference abstracts presented in 2002 and 2003. The secondary objective was to compare the publication rates between the prior and current study.Methods: Presentations and posters delivered at the 2012 and 2014 MLA meetings were coded to identify factors associated with publication. Postconference publication of abstracts as journal articles was determined using a literature search and survey sent to first authors. Chi-squared tests were used to assess differences in the publication rate, and logistic regression was used to assess the influence of abstract factors on publication.Results: The combined publication rate for the 2012 and 2014 meetings was 21.8% (137/628 abstracts), which is a statistically significant decrease compared to the previously reported rate for 2002 and 2003 (27.6%, 122/442 abstracts). The odds that an abstract would later be published as a journal article increased if the abstract was multi-institutional or if it was research, specifically surveys or mixed methods research.Conclusions: The lower publication rate of MLA conference abstracts may be due to an increased number of program or nonresearch abstracts that were accepted or a more competitive peer review process for journals. MLA could increase the publication rate by encouraging and enabling multi-institutional research projects among its members.

Legal problems encompass issues requiring resolution through the justice system. This social risk factor creates barriers in accessing services and increases risk of poor health outcomes. A systematic review of the peer-reviewed English-language health literature following the PRISMA guidelines sought to answer the question, how has the concept of patients’ “legal problems” been operationalized in healthcare settings? Eligible articles reported the measurement or screening of individuals for legal problems in a United States healthcare or clinical setting. We abstracted the prevalence of legal problems, characteristics of the sampled population, and which concepts were included. 58 studies reported a total of 82 different measurements of legal problems. 56.8% of measures reflected a single concept (e.g., incarcerated only). The rest of the measures reflected two or more concepts within a single reported measure (e.g., incarcerations and arrests). Among all measures, the concept of incarceration or being imprisoned appeared the most frequently (57%). The mean of the reported legal problems was 26%. The literature indicates that legal concepts, however operationalized, are very common among patients. The variation in measurement definitions and approaches indicates the potential difficulties for organizations seeking to address these challenges.

Objective: This study assessed health sciences librarians’ attitudes toward interprofessional collaboration using the Interdisciplinary Education Perception Scale (IEPS) and gathered information on their involvement with interprofessional activities.Methods: The authors sent a survey to librarians in the Medical Library Association’s (MLA’s) Interprofessional Education Special Interest Group and Research Section consisting of the IEPS and questions about their prior and current experiences with interprofessional practice and education (IPE). We compared mean IEPS scores between each MLA group and several other demographic factors to assess differences in attitudes. We also compared librarians’ IEPS scores with those of previously published health professional students’ IEPS scores and thematically analyzed two open-ended questions.Results: Health sciences librarians’ scores on the IEPS indicated positive attitudes toward IPE. There were no statistically significant differences between any group. Health sciences librarians’ mean IEPS score was similar to the mean score of health professions students from a prior study. The most commonly reported interprofessional activity was teaching or facilitating learning activities for health professions students; fewer served on committees or engaged in non-curricular activities such as grand rounds and book clubs.Conclusion: Health sciences librarians in this study reported positive attitudes toward IPE, in line with the majority of other previously studied health professionals. Years of experience, previous health professional careers, and experience supporting IPE as a librarian had little bearing on the responses to the survey. This suggests that health sciences librarians have positive attitudes toward IPE, regardless of whether they directly support IPE programs or participate in interprofessional activities. This article has been approved for the Medical Library Association’s Independent Reading Program.

Background: To support evidence synthesis and clinical searching, a team of librarians developed and validated infant age (birth to 23 months) search hedges for PubMed (National Library of Medicine) and Medline (OVID). Methods: We developed four sensitive hedges by selecting terms that refer to infants. Three of the hedges had identical MeSH terms and keywords but used different field tags, and the fourth was a simple keyword hedge. We compared our hedges to the built-in MeSH-based infant filter. We used relative recall calculations to validate each hedge’s performance against a gold standard reference set. Results: In PubMed the similarly structured hedges performed in a range of 83.2%-83.8% sensitivity and 88.2%-89.7% specificity. The simple keyword hedge performed with an 83.5% sensitivity and 89.7% specificity. The filter generated a 70.1% sensitivity and 96.2% specificity. Similarly, in Ovid Medline, the set of similar hedges performed in a range of 82.9%-83.6% sensitivity and 88.1%-89.4% specificity. The simple keyword hedge performed with an 82.9% sensitivity and 90.8% specificity. The filter generated a 69.6% sensitivity and 96.2% specificity. Discussion: The variation in field tags did not provide a significant difference in the areas of sensitivity and specificity. The filter performed as expected with higher specificity rather than sensitivity. The simple keyword hedge performed better than anticipated with comparable sensitivity and specificity of the more complex hedges. When searching for infant population articles, the simple keyword search and filter work well for quick, clinical searching. For evidence synthesis, we recommend using one of the more sensitive infant hedges.

Background: Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective: This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods: We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results: A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions: A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.

To support evidence synthesis and clinical searching, a team of librarians developed and validated infant age (birth to 23 months) search hedges for PubMed (National Library of Medicine) and Medline (OVID). We developed four sensitive hedges by selecting terms that refer to infants. Three of the hedges had identical MeSH terms and keywords but used different field tags, and the fourth was a simple keyword hedge. We compared our hedges to the built-in MeSH-based infant filter. We used relative recall calculations to validate each hedge's performance against a gold standard reference set. In PubMed the similarly structured hedges performed in a range of 83.2%-83.8% sensitivity and 88.2%-89.7% specificity. The simple keyword hedge performed with an 83.5% sensitivity and 89.7% specificity. The filter generated a 70.1% sensitivity and 96.2% specificity. Similarly, in Ovid Medline, the set of similar hedges performed in a range of 82.9%-83.6% sensitivity and 88.1%-89.4% specificity. The simple keyword hedge performed with an 82.9% sensitivity and 90.8% specificity. The filter generated a 69.6% sensitivity and 96.2% specificity. The variation in field tags did not provide a significant difference in the areas of sensitivity and specificity. The filter performed as expected with higher specificity rather than sensitivity. The simple keyword hedge performed better than anticipated with comparable sensitivity and specificity of the more complex hedges. When searching for infant population articles, the simple keyword search and filter work well for quick, clinical searching. For evidence synthesis, we recommend using one of the more sensitive infant hedges.

Patients with chronic kidney disease (CKD) are often regarded as experiencing wasting of muscle mass and declining muscle strength and function, collectively termed sarcopenia. The extent of skeletal muscle wasting in clinical and preclinical CKD populations is unclear. We evaluated skeletal muscle atrophy in preclinical and clinical models of CKD, with multiple sub‐analyses for muscle mass assessment methods, CKD severity, sex and across the different preclinical models of CKD. We performed a systematic literature review of clinical and preclinical studies that measured muscle mass/size using the following databases: Ovid Medline, Embase and Scopus. A random effects meta‐analysis was utilized to determine standard mean difference (SMD; Hedges' g) between healthy and CKD. Heterogeneity was evaluated using the I2 statistic. Preclinical study quality was assessed via the Systematic Review Centre for Laboratory Animal Experimentation and clinical studies quality was assessed via the Newcastle‐Ottawa Scale. This study was registered in PROSPERO (CRD42020180737) prior to initiation of the search. A total of 111 studies were included in this analysis using the following subgroups: 106 studies in the primary CKD analysis, 18 studies that accounted for diabetes and 7 kidney transplant studies. Significant atrophy was demonstrated in 78% of the preclinical studies and 49% of the clinical studies. The random effects model demonstrated a medium overall SMD (SMD = 0.58, 95% CI = 0.52–0.64) when combining clinical and preclinical studies, a medium SMD for the clinical population (SMD = 0.48, 95% CI = 0.42–0.55; all stages) and a large SMD for preclinical CKD (SMD = 0.95, 95% CI = 0.76–1.14). Further sub‐analyses were performed based upon assessment methods, disease status and animal model. Muscle atrophy was reported in 49% of the clinical studies, paired with small mean differences. Preclinical studies reported significant atrophy in 78% of studies, with large mean differences. Across multiple clinical sub‐analyses such as severity of CKD, dialysis modality and diabetes, a medium mean difference was found. Sub‐analyses in both clinical and preclinical studies found a large mean difference for males and medium for females suggesting sex‐specific implications. Muscle atrophy differences varied based upon assessment method for clinical and preclinical studies. Limitations in study design prevented conclusions to be made about the extent of muscle loss with disease progression, or the impact of dialysis. Future work would benefit from the use of standardized measurement methods and consistent clinical staging to improve our understanding of atrophy changes in CKD progression, and analysis of biological sex differences.

Background. The current West Africa Ebola virus disease (EVD) outbreak has resulted in multiple individuals being medically evacuated to other countries for clinical management. Methods. We report two patients who were transported from West Africa to the United States for treatment of EVD. Both patients received aggressive supportive care measures, as well as an investigational therapeutic (TKM-100802) and convalescent plasma. Results. While one patient experienced critical illness with multi-organ failure requiring mechanical ventilation and renal replacement therapy, both patients recovered without serious long-term sequelae to date. Conclusions. It is unclear what role the experimental drug and convalescent plasma had in the recovery of these patients. Prospective clinical trials are needed to delineate the role of investigational therapies in the care of patients with EVD.