Browsing by Author "Menard, Laura M."
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Item Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis(American Medical Association, 2020-07-01) Turner, Joseph S.; Bucca, Antonino W.; Propst, Steven L.; Ellender, Timothy J.; Sarmiento, Elisa J.; Menard, Laura M.; Hunter, Benton R.; Emergency Medicine, School of MedicineImportance: The ε4 allele of the apolipoprotein E (APOE) gene and lower apolipoprotein E (apoE) protein levels in plasma are risk factors for Alzheimer disease, but the underlying biological mechanisms are not fully understood. Half of plasma apoE circulates on high-density lipoproteins (HDLs). Higher apoE levels in plasma HDL were previously found to be associated with lower coronary heart disease risk, but the coexistence of another apolipoprotein, apoC3, modified this lower risk. Objective: To investigate associations between the presence of apoE in different lipoproteins with cognitive function, particularly the risk of dementia. Design, Setting, and Participants: This prospective case-cohort study embedded in the Ginkgo Evaluation of Memory Study (2000-2008) analyzed data from 1351 community-dwelling participants 74 years and older. Of this group, 995 participants were free of dementia at baseline (recruited from September 2000 to June 2002) and 521 participants were diagnosed with incident dementia during follow-up until 2008. Data analysis was performed from January 2018 to December 2019. Exposures: Enzyme-linked immunosorbent assay–measured concentration of apoE in whole plasma, HDL-depleted plasma (non-HDL), HDL, and HDL subspecies that contain or lack apoC3 or apoJ. Main Outcomes and Measures: Adjusted hazard ratios for risk of dementia and Alzheimer disease during follow-up and adjusted differences (β coefficients) in Alzheimer Disease Assessment–Cognitive Subscale (ADAS-cog) and Modified Mini-Mental State Examination scores at baseline. Results: Among 1351 participants, the median (interquartile range) age was 78 (76-81) years; 639 (47.3%) were women. The median (interquartile range) follow-up time was 5.9 (3.7-6.5) years. Higher whole plasma apoE levels and higher apoE levels in HDL were associated with better cognitive function assessed by ADAS-cog (whole plasma, β coefficient, −0.15; 95% CI, −0.24 to −0.06; HDL, β coefficient, −0.20; 95% CI, −0.30 to −0.10) but were unassociated with dementia or Alzheimer disease risk. When separated by apoC3, a higher apoE level in HDL that lacks apoC3 was associated with better cognitive function (ADAS-cog per SD: β coefficient, 0.17; 95% CI, −0.27 to −0.07; Modified Mini-Mental State Examination score per SD: β coefficient, 0.25; 95% CI, 0.07 to 0.42) and lower risk of dementia (hazard ratio per SD, 0.86; 95% CI, 0.76 to 0.99). In contrast, apoE levels in HDL that contains apoC3 were unassociated with any of these outcomes. Conclusions and Relevance: In a prospective cohort of older adults with rigorous follow-up of dementia, the apoE level in HDL that lacked apoC3 was associated with better cognitive function and lower dementia risk. This finding suggests that the cardioprotective associations of this novel lipoprotein extend to dementia.Item Critical Appraisal Calculations: One Guide to Rule Them All(2021-06-14) Menard, Laura M.Item Defining a project proposal to enhance the Medical Library Association’s annual meeting through Session-level assessment: The exploration of the 2017-2018 Rising Star cohort(Hypothesis: Journal of the Research Section of MLA, 2018) Theis-Mahon, Nicole; Menard, Laura M.; Schmillen, Hanna; Stark, RachelObjectives: Associations and organizations rely on feedback from membership to assess conferences, programs, and meetings. The Medical Library Association (MLA) utilizes post-conference assessment to get an overall evaluation of the meeting. While this informs future meeting planning, it does not provide targeted assessment data about the perceived quality and relevance of sessions, papers, or posters. Incorporating session-level, just-in-time feedback would further engage meeting attendees and ensure relevance of the meeting to the membership. Methods: The 2017-2018 MLA Rising Star cohort investigated the interest in and use of session level, just-in-time feedback at conferences of seven peer associations. A five-question survey to gauge MLA member interest in session-level feedback was distributed in February 2018. The survey was only available to current MLA members and advertised on the MLA blog, distributed to Section and SIG, state, and select MLA Chapter lists. Live polling was also conducted at the May 22, 2018, MLA Rising Star project proposal presentation. Results: The cohort received responses from five peer associations and only three are using some form of session-level, just-in-time assessment at their conferences. The February 2018 MLA membership survey yielded 157 responses. 94% of respondents (n=147) had attended a MLA meeting and 72% of respondents agreed that they would find session-level assessment valuable. Respondents indicated that they would be interested in receiving feedback from attendees about the application of their session’s content, whether attendees learned something new, and if their session met expectations. Of attendees at this May 22, 2018, project proposal presentation, 97% agreed that they would value the opportunity to provide session-level, and 91% indicated that as a presenter would find attendee feedback useful. Conclusion: The investigation by the 2017-2018 MLA Rising Star Cohort indicated an interest in session-level, just-in-time feedback for MLA’s annual meetings.Item Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo: A Systematic Review and Meta-analysis(American Medical Association, 2022) Hunter, Benton R.; Wang, Alfred Z.; Bucca, Antonino W.; Musey, Paul I., Jr.; Strachan, Christian C.; Roumpf, Steven K.; Propst, Steven L.; Croft, Alexander; Menard, Laura M.; Kirschner, Jonathan M.; Emergency Medicine, School of MedicineImportance: Acute vertigo can be disabling. Antihistamines and benzodiazepines are frequently prescribed as "vestibular suppressants," but their efficacy is unclear. Objective: To assess the efficacy of antihistamines and benzodiazepines in the treatment of acute vertigo from any underlying cause. Data sources: We searched the PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and ClinicalTrials.gov databases from inception to January 14, 2019, without language restrictions. Bibliographies of the included studies and relevant reviews were also screened. Study selection: We included randomized clinical trials (RCTs) comparing antihistamine or benzodiazepine use with another comparator, placebo, or no intervention for patients with a duration of acute vertigo for 2 weeks or less. Studies of healthy volunteers, prophylactic treatment, or induced vertigo were excluded, as were studies that compared 2 medications from the same class. Data extraction and synthesis: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, data were extracted and risk of bias was assessed by 2 authors independently for each study. Data were pooled using a random-effects model. Main outcomes and measures: The predefined primary outcome was change in 10- or 100-point vertigo or dizziness visual analog scale (VAS) scores at 2 hours after treatment. Secondary outcomes included change in nausea VAS scores at 2 hours, use of rescue medication at 2 hours, and improvement or resolution of vertigo at 1 week or 1 month. Results: Of the 27 trials identified in the systematic review, 17 contributed to the quantitative meta-analysis and involved a total of 1586 participants. Seven trials with a total of 802 participants evaluated the primary outcome of interest: single-dose antihistamines resulted in significantly more improvement on 100-point VAS scores compared with benzodiazepines (difference, 16.1 [95% CI, 7.2 to 25.0]) but not compared with other active comparators (difference, 2.7 [95% CI, -6.1 to 11.5]). At 1 week and 1 month, neither daily benzodiazepines nor antihistamines were reported to be superior to placebo. RCTs comparing the immediate effects of medications (at 2 hours) after a single dose generally had a low risk of bias, but those evaluating 1-week and 1-month outcomes had a high risk of bias. Conclusions and relevance: Moderately strong evidence suggests that single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines. Furthermore, the available evidence did not support an association of benzodiazepine use with improvement in any outcomes for acute vertigo. Other evidence suggested that daily antihistamine use may not benefit patients with acute vertigo. Larger randomized trials comparing both antihistamines and benzodiazepines with placebo could better clarify the relative efficacy of these medications.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 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 It’s Not the Upside Down: Creating a Flipped Classroom Experience for Critical Appraisal(2019-10-06) Menard, Laura M.; Blevins, Amy E.OBJECTIVE: Critically appraising medical literature is a skill that every medical student needs, however, finding experienced instructors and time in the curriculum can be challenging – especially with multiple campuses. An assistant director worked with an associate director to design a flipped classroom model for teaching critical appraisal skills to medical students. In addition, the assistant director designed an in-house training program and facilitator guides to ensure that librarians had the skills to deliver the sessions to campuses around the state. METHODS: Using Kaltura, the assistant director designed and recorded short video tutorials with embedded formative assessments for prognosis, harm, and diagnosis. Librarians attended a “teach through” where they were introduced to the material. Students completed the video tutorials and a summative quiz within a course management system ahead of a facilitated small group session. The summative quiz included questions to assess satisfaction and comprehension. All librarians reviewed the summative quiz data to customize the sessions. RESULTS: Summative quiz feedback was positive. The data provided by the embedded formative assessments showed that students were able to answer questions based on the information provided in the tutorials. In addition, anecdotal evidence from the course director shows that students were satisfied with the new modality. Librarians used both the summative and formative quiz results to tailor the sessions to individual campus needs. This also allowed for scaffolding and reinforcement of instruction across the three sessions. CONCLUSIONS: The flipped classroom model allowed librarians to maximize critical appraisal instruction while minimizing face-to-face classroom time. In addition, librarians felt comfortable serving as facilitators rather than lecturers for material that librarians had not previously taught. We will continue to use this model since it provides the students with self-directed learning opportunities with minimal disruption to course and librarian schedules.Item Medical Student Responses in Critical Appraisal: A Qualitative Analysis(2022-05-06) Vetter, Cecelia J.; Menard, Laura M.; Blevins, Amy E.; Trujillo, Daniel J.Title: Medical Student Responses in Critical Appraisal: A Qualitative Analysis Objectives: To identify themes in medical student critical appraisal skills when asked to complete an evidence-based medicine (EBM) assignment. Researchers will analyze identified themes to find common approaches used by medical students when critically appraising a research article. Methods: Our team (three medical librarians and a statistician) will conduct a qualitative analysis of first year clerkship (third year of medical school) students’ responses to an EBM assignment wherein students are asked to critically appraise a research article and apply it to patient care. Previously, we noted that many students use factors such as journal reputation or impact factor as proxies for critically appraising study methodology and results. The librarian team is conducting a qualitative analysis of textual responses by gathering one years’ worth of quiz responses. Each team member is individually reviewing each response for general themes. After this open coding is completed, librarian team members will collaboratively develop a code list. Each team member will then code each assignment individually. Statistics will be run for inter-rater reliability and discrepancies will be resolved by librarian group consensus. Results: The team will present main and secondary themes. Commentary and examples will be provided by the librarian team on trends seen in medical student critical appraisal. Conclusions: This project is ongoing. However, we anticipate that our results will inform EBM instruction by identifying common themes in medical trainees' early attempts to apply critical appraisal skills to a clinical scenario.Item Ocular Point-of-Care Ultrasonography to Diagnose Posterior Chamber Abnormalities: A Systematic Review and Meta-analysis(AMA, 2020-02-05) Propst, Steven L.; Kirschner, Jonathan M.; Strachan, Christian C.; Roumpf, Steven K.; Menard, Laura M.; Sarmiento, Elisa J.; Hunter, Benton R.; Emergency Medicine, School of MedicineImportance: Diagnosing posterior chamber ocular abnormalities typically requires specialist assessment. Point-of-care ultrasonography (POCUS) performed by nonspecialists, if accurate, could negate the need for urgent ophthalmologist evaluation. Objective: This meta-analysis sought to define the diagnostic test characteristics of emergency practitioner-performed ocular POCUS to diagnose multiple posterior chamber abnormalities in adults. Data sources: PubMed (OVID), MEDLINE, EMBASE, Cochrane, CINAHL, and SCOPUS were searched from inception through June 2019 without restrictions. Conference abstracts and trial registries were also searched. Bibliographies of included studies and relevant reviews were manually searched, and experts in the field were queried. Study selection: Included studies compared ocular POCUS performed by emergency practitioners with a reference standard of ophthalmologist evaluation. Pediatric studies were excluded. All 116 studies identified during abstract screening as potentially relevant underwent full-text review by multiple authors, and 9 studies were included. Data extraction and synthesis: In accordance with PRISMA guidelines, multiple authors extracted data from included studies. Results were meta-analyzed for each diagnosis using a bivariate random-effects model. Data analysis was performed in July 2019. Main outcomes and measures: The outcomes of interest were diagnostic test characteristics of ocular POCUS for the following diagnoses: retinal detachment, vitreous hemorrhage, vitreous detachment, intraocular foreign body, globe rupture, and lens dislocation. Results: Nine studies (1189 eyes) were included. All studies evaluated retinal detachment, but up to 5 studies assessed each of the other diagnoses of interest. For retinal detachment, sensitivity was 0.94 (95% CI, 0.88-0.97) and specificity was 0.94 (95% CI, 0.85-0.98). Sensitivity and specificity were 0.90 (95% CI, 0.65-0.98) and 0.92 (95% CI, 0.75-0.98), respectively, for vitreous hemorrhage and were 0.67 (95% CI, 0.51-0.81) and 0.89 (95% CI, 0.53-0.98), respectively, for vitreous detachment. Sensitivity and specificity were high for lens dislocation (0.97 [95% CI, 0.83-0.99] and 0.99 [95% CI, 0.97-1.00]), intraocular foreign body (1.00 [95% CI, 0.81-1.00] and 0.99 [95% CI, 0.99-1.00]), and globe rupture (1.00 [95% CI, 0.63-1.00] and 0.99 [95% CI, 0.99-1.00]). Results were generally unchanged in sensitivity analyses of studies with low risk of bias. Conclusions and relevance: This study suggests that emergency practitioner-performed ocular POCUS is an accurate test to assess for retinal detachment in adults. Its utility in diagnosing other posterior chamber abnormalities is promising but needs further study.Item One School: Using Teach-Throughs to Ensure Consistency(2020-03-06) Blevins, Amy E.; Menard, Laura M.