Browsing by Author "Blevins, Amy E."
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Item Assessment of Service Desk Quality at an Academic Health Sciences Library(Taylor & Francis, 2016) Blevins, Amy E.; DeBerg, Jen; Kiscaden, Elizabeth; Ruth Lilly Medical LibraryDue to an identified need for formal assessment, a small team of librarians designed and administered a survey to gauge the quality of customer service at their academic health sciences library. Though results did not drive major changes to services, several important improvements were implemented and a process was established to serve as a foundation for future use. This article details the assessment process used and lessons learned during the project.Item Courting Apocalypse: Creating a Zombie-Themed Evidence-Based Medicine Game(Taylor & Francis, 2017) Blevins, Amy E.; Kiscaden, Elizabeth; Bengtson, Jason; Ruth Lilly Medical Library, School of MedicineIn 2015, two librarians at the Hardin Library for the Health Sciences at the University of Iowa turned their dreams into a reality and secured funding to build a zombie-themed evidence-based medicine game. The game features a “choose your own adventure” style that takes students through a scenario where a disease outbreak is taking place and a resident is asked to use evidence-based medicine skills to select a screening and diagnostic tool to use on potentially infected patients. Feedback on the game has been positive, and future plans include building additional modules on therapy, harm, and prognosis.Item Creating a curriculum based library instruction plan for medical students(Rowman & Littlefield, 2014) Blevins, Amy E.[Excerpt] There are multiple situations in which a librarian may find themselves creating a multi-session or longitudinal curriculum-based library instruction program. Maybe you’ve been hoping to do just this very thing for a while, or you stepped into the shoes of a librarian that did this before you, or possibly you’re finding your motivation from an external force. You might be facing this challenge with years of teaching experience or not. No matter what the situation, this chapter will provide tips and strategies for developing a well-rounded library instruction program that focuses on the use of both information literacy skills and evidence based practice principles.Item Developing a Best Practices Plan for Tutorials in a Multi-Library System(Taylor and Francis, 2014-07-14) Blevins, Amy E.; Deberg, Jennifer; Childs, ChrisIn 2010, the University of Iowa's library system administration created a task force to conduct a reevaluation of tools and spaces used for video tutorial creation across a multi-library system. Following this effort, a working group was charged with improving documentation and staff awareness of resources for developing video tutorials. The group observed that librarians were often independently creating videos that were variable in quality, lacked consistent branding, and were not often shared with others. This article will describe experiences at the Hardin Library for the Health Sciences at the University of Iowa in selecting video tutorial software, and striving to establish a more structured process, including team-developed guidelines, for tutorial creation in a multi-library system. Project limitations and areas for future work will also be presented.Item Early coronary angiography and survival after out-of-hospital cardiac arrest: a systematic review and meta-analysis(BMJ Publishing Group, 2018-10-19) Khera, Rohan; CarlLee, Sheena; Blevins, Amy E.; Schweizer, Marin; Girotra, Saket; Ruth Lilly Medical Library, School of MedicineBackground: Although acute myocardial infarction is a common cause of out-of-hospital cardiac arrest (OHCA), the role of early coronary angiography in OHCA remains uncertain. We conducted a meta-analysis of observational studies to determine the association of early coronary angiography with survival in OHCA. Methods: We searched multiple electronic databases for published studies on early coronary angiography in OHCA between 1 January 1990 and 18 January 2017. Studies were included if (1) restricted to only OHCA, (2) included an exposure group that underwent early coronary angiography within 1 day of arrest onset and a concurrent control group that did not undergo early coronary angiography, and (3) reported survival outcomes. We used a random-effects model to obtain pooled OR. I2 statistics and Cochran's Q test were used to determine between-study heterogeneity. Results: A total of 17 studies with 14 972 patients were included, of whom 6424 (44%) received early coronary angiography. Early coronary angiography was associated with higher odds of survival (pooled OR 2.54 (95% CI 1.94 to 3.33)) and survival with favourable neurological outcome (pooled OR 2.37 (95% CI 1.71 to 3.28)). However, there was substantial heterogeneity in our pooled estimate (I2=88% and p value for Cochran's test <0.0001 for both outcomes). The large heterogeneity in pooled estimates was reduced after including adjusted estimates when available, and was explained by differences in methodological rigour and characteristics of included studies. Conclusion: Among patients resuscitated from OHCA, early coronary angiography is associated with increased survival to discharge and favourable neurological outcome.Item How Do Medical Students Approach Critical Appraisal? Results from a Mixed-Methods Study(2023-05-19) Menard, Laura M.; Blevins, Amy E.; Vetter, Cecelia J.; Trujillo, Daniel J.OBJECTIVES: Our research team wanted to find out what principles and best practices medical students use when prompted by a clerkship assignment to complete a critical appraisal of an article of their choosing. Our hypothesis was that, outside of a structured classroom environment, many students would default to more basic literature evaluation strategies or even apply proxies for methodological rigor such as journal reputation or peer review status of a study. METHODS: All first-year clerkship students at the School of Medicine are required to complete a patient-focused evidence-based medicine (EBM) assignment during their Internal Medicine clerkship. A team of three librarians and one statistician undertook a mixed-methods approach to identify and quantify themes that emerged in the text of one year's worth of these assignments (n=343). A mixed method research approach was implemented to gain a greater understanding of the EBM principles and best practices that students reference in their assignments. Within this approach a qualitative content analysis was conducted, followed by a quantitative analysis of patterns within the sample. The research team used first- and second cycle coding and a collaboratively developed code list of nine major codes to ensure accuracy and standardization. Additionally, the research team's statistician implemented an inter-rater reliability plan and examined inter-class correlations to ensure grading consistency across team members and student assignments. Once all assignments had been coded, the team used statistical analysis to find correlations between codes as well as frequency of code application within the sample in order to identify five major critical appraisal themes which emerged in the students' assignments. RESULTS: After a rigorous coding process, several codes and related themes emerged. The research team identified nine main codes and five major themes. These themes are as follows: Theme 1: Comparing the study population to the patient being treated and recommending a course of action Theme 2: Identifying study type and position in hierarchy of evidence Theme 3: Identifying proxies for study quality, including provenance and timeliness of chosen study Theme 4: Summarizing study methodology and results Theme 5: Attempting a critical appraisal of chosen study Additionally, we identified correlations between themes as well as frequency of application in the sample. CONCLUSIONS: A few notable results from our analysis of this sample are the frequency with which students were able to summarize the results of their chosen study and apply what they had learned to patient care (54.5% and 46.9% of all assignments, respectively). However, a notable number of students (35.2%) incorrectly used journal reputation, peer review status, h-index, impact factor, or similar metric, as a proxy for critical appraisal without engaging with the study methodology. This indicates that there is a need for further education and engagement with clerkship directors regarding the utility and application of EBM skills in the clinical curriculum.Item Incidence and Outcomes Associated With Clostridium difficile Infections: A Systematic Review and Meta-analysis(JAMA Network, 2020-01-03) Marra, Alexandre R.; Perencevich, Eli N.; Nelson, Richard E.; Samore, Matthew; Khader, Karim; Chiang, Hsiu-Yin; Chorazy, Margaret L.; Herwaldt, Loreen A.; Diekema, Daniel J.; Kuxhausen, Michelle F.; Blevins, Amy E.; Ward, Melissa A.; McDanel, Jennifer S.; Nair, Rajeshwari; Balkenende, Erin; Schweizer, Marin L.; Ruth Lilly Medical Library, School of MedicineImportance: An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. Objective: To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. Data Sources: MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. Study Selection: Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. Data Extraction and Synthesis: Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019. Main Outcomes and Measures: Incidence of CDI and CDI-associated hospital LOS in the United States. Results: When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). Conclusions and Relevance: Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.Item Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis(Cambridge, 2017-02) Chiang, Hsiu-Yin; Perencevich, Eli N.; Nair, Rajeshwari; Nelson, Richard E.; Samore, Matthew; Khader, Karim; Chorazy, Margaret L.; Herwaldt, Loreen A.; Blevins, Amy E.; Ward, Melissa A.; Schweizer, Marin L.; Department of Medicine, School of MedicineInformation about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.Item Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment(BMJ Evidence Based Medicine, 2020-10-22) Menard, Laura M.; Blevins, Amy E.; Trujillo, Dan; Lazarus, KennethObjectives: This research project aims to determine the potential differential impact of two curricular approaches to teaching evidence-based medicine (EBM) on student performance on an EBM assignment administered during the first year of clerkship. A meaningful result would be any statistically significant difference in scores on the assignment given to measure student performance. Design: In order to assess and compare student learning under the different curricula, the PI and a team of five faculty members blinded to assignment date and other possibly identifying details used a modified version of the previously validated Fresno rubric to retrospectively grade three years’ worth of EBM assignments given to students in clerkship rotations 1-3 (n = 481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts were examined. Setting: The study took place at a large Midwestern medical school with nine campuses across the state of Indiana. Participants: Study participants were four hundred eighty-one students who attended the medical school and completed the Internal Medicine clerkship between 2017-2019. Interventions: Prior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students’ first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of two years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first two years of medical school. Main Outcome Measures: We used clerkship-level EBM assignment grades to determine whether there was a difference in performance between those students who experienced the old versus the new instructional model. Clerkship EBM assignments given to the students used identical questions each year in order to have a valid basis for comparison. Additionally, we analyzed average student grades across the school on the EBM portion of Step 1. Results: Four hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch ANOVA test. Overall, students performed .99 of a point better on the assignment from Year One (Y1), prior to EBM curriculum integration, to Year Three (Y3), subsequent to EBM integration (p= <.001). Statistically significant improvement was seen on questions measuring students’ ability to formulate a clinical question and critically appraise medical evidence. Additionally, on USMLE Step 1, we found that student scores on the EBM portion of the exam improved from Y1 to Y3. Conclusions: Results of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the pre-clinical years increases, or at the very least does not lessen, student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students’ retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format. Overall, this study provides a foundation for new research and practice seeking to improve EBM instruction. Trial Registration: IRB approval (Protocol #1907054875) was obtained for this study.Item Introducing First Year Medical Students to Personalized Medicine Concepts in a Small Group Activity(2020-03-06) Harrington, Maureen A.; Blevins, Amy E.; Foster, Erin D.; Pratt, Vickie; Sharpe, StephanieAn individuals’ genetic profile is becomingly an increasingly important parameter in healthcare decisions. This small group activity was developed to introduce first year medical students in the Molecules to Cells and Tissues course to the concept and significance of Pharmacogenomics and personalized medicine. Additionally, this activity provided students with an opportunity to work with a large dataset and use the information to impact clinical decision making. This activity has two cases, takes student groups approximately 2 hours to complete, and requires internet access. Case materials are available through the learning management system Canvas, and include open-ended questions to guide students through the cases. In these cases students explore the functional significance of different alleles of a panel of cytochrome P450 genes. The group activity has the students examine a large data set of cytochrome P450 genes and cognate alleles to determine their prevalence in the local population and calculate the individuals’ gene scores. The students are then asked to explain the impact of the genotype (or gene score) on the resulting patient phenotype (i.e. the functional significance of the genotype). The first case involves a breast cancer survivor support group in which patients taking Taxol discuss lack of adequate pain relief from opioids and the potential impact of concomitant use of natural compounds/supplements on drug metabolism. The second case involves a patient presenting with recurrent stroke-like symptoms despite being on the anticoagulant medication clopidogrel. The patient is initially suspected to be non-compliant, but is later determined to be a poor metabolizer of the anticoagulant clopidogrelto its active form thus decreasing its efficacy. The expertise of the IUSM Medical Genetics research faculty was leveraged to provide a large data set of cytochrome P450 genes and cognate alleles. The selection of cytochrome P450 was based upon delivering content focused on the biochemistry of the enzyme system and provided an opportunity to highlight the drug interaction database available through IUSM Clinical Pharmacology (The FlockhartTable™ ; https://drug-interactions.medicine.iu.edu/). The addition of natural compounds was to draw students’ attention to the Natural Medicines database, which is the recommended source for evidence-based data on complementary and alternative medicine. Natural Medicines is available through the Ruth Lilly Medical Library and can be searched by substance or condition. It provides both a summary of the literature available on substances as well as the level of evidence or quality of studies done on the substance.