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Background Magnesium sulphate is widely used in antenatal mothers for various indications such as neuroprotection, tocolysis and preeclampsia. Some studies suggest that there is alteration in intestinal motility and blood flow in preterm neonates as a result of exposure to Magnesium sulphate. Objective To evaluate the effect of antenatal magnesium Sulphate (MgSO ) on mortality and morbidity outcomes related to the gastrointestinal system (GI) in preterm infants. Search strategy PubMed, CINAHL, Embase, and CENTRAL were searched through up to November 2022. Data collection and Analysis Two authors independently conducted data extraction. A random-effects model meta-analysis was performed. All included studies were assessed for methodological quality using appropriate quality assessment tool. The GRADE approach was used to assess the overall certainty of evidence. Main Results A total of thirty-eight observational and six RCTs involving 51,466 preterm infants were included. There were no increased odds of stage ≥2 NEC, (n= 50,727, OR:1.0; 95% CI: 0.89-1.12, I - 7%), SIP ( n= 34,186, OR: 1.22, 95% CI: 0.94-1.58, I -30% ), feed intolerance (n= 414, OR: 1.06, 95% CI: 0.64-1.76, I -12%) in infants exposed to antenatal MgSO . On the contrary, the incidence of surgical NEC was significantly lower in MgSO exposure infants (n= 29,506 OR:0.74; 95% CI: 0.62-0.90, ARR: 0.47%). Studies assessing the effect on GI-related mortality were sparse to make any conceivable conclusion. GRADE certainty of findings were ‘very low’. Conclusion Antenatal MgSO did not increase the incidence of gastrointestinal-related morbidities or mortality in preterm infants.

We sought data on the validity, reliability, responsiveness, and feasibility of the coefficient of fat absorption (CFA) as a measure of pancreatic enzyme replacement therapy (PERT) efficacy in people with cystic fibrosis (pwCF) and reviewed the literature for alternative measures.We searched PubMed for the Medical Subject Heading cystic fibrosis and the key words cystic fibrosis, fat absorption, CFA, and fecal fat imbalance; historical articles; and citations in bibliographies.The lower the CFA, the greater its variability; thus, it is less variable in healthy individuals who have higher CFA than pwCF. In addition, the test-retest values for CFA are more variable in pwCF than the general population. There is no correlation between CFA and body mass index or PERT dose but CFA is related to gastrointestinal signs and symptoms. Research-quality CFA studies are expensive, time consuming, and odious to pwCF and research staff. Sparse stool tests, breath tests, and blood tests of fat absorption have been studied as potential alternatives to CFA to measure PERT efficacy.Based on the evidence, we conclude that CFA as a measure of the efficacy of PERT is more of a "coal standard" than a gold standard; developing suitable alternatives should be a priority.

Evidence-based practice (EBP) is the standard approach used by healthcare practitioners to provide high quality, patient-centered healthcare. Given that all health professions students require education in both EBP and interprofessional collaboration, we used the advantages of a flipped classroom instructional strategy to provide an interprofessional EBP instruction program. Health professions students who had a clear understanding of their professional roles and had engaged in some clinical experience participated in this pilot program. The program consisted of three online learning modules (3.5 h) and one in-person faculty facilitated interprofessional case-based EBP learning activity (2 h). This program was designed with the following objectives (and assessments): develop students' foundational EBP knowledge and skills (module quizzes); increase students' understanding of health professionals' roles and responsibilities (module quiz); and improve students' attitudes toward interprofessional teamwork and communication (Readiness for Interprofessional Learning Scale). Program feasibility was also assessed. Student evaluations of the program indicated they learned skills they felt contributed to their successful participation in the in-person activity. Additionally, students reported a better understanding of the benefits and challenges of working in interprofessional teams. Students preferred the flipped classroom approach to a more traditional approach and favored learning in an interprofessional group. The major impact of this program is the potential for health professions students to gain foundational EBP knowledge and skills and experience in interprofessional teams by transitioning uni-professional, traditional EBP instruction to a flipped classroom educational strategy with students from multiple health professions programs.

OBJECTIVE: Intra-cranial pressure (ICP) after mild traumatic brain injury (mTBI) is poorly studied due to lack of sensitive non-invasive methods. The purpose of this review was to summarize the existing knowledge of changes in ICP after mTBI. LITERATURE SELECTION: PubMed, Embase, CINAHL, and Scopus were searched by 3 reviewers independently up to December 2016. Inclusion criteria: animal and human studies measuring ICP and brain oedema after an mTBI. Exclusion criteria: Moderate and severe forms of traumatic brain injury, repeat samples, and studies that measured ICP at the time of impact but not after. Study quality was assessed using Downs and Black criteria. RESULTS: Of 1067 papers, 9 studies were included. In human studies, 1 provided direct evidence on increased, 1 provided indirect evidence of increased, and 2 provided indirect evidence of decreased ICP. In animal studies, 3 studies provided direct evidence of increased, 1 provided indirect evidence of increased, and 1 provided indirect evidence of no change in ICP. CONCLUSION: The existing research suggests that there may be increased ICP after mTBI and animal studies suggest an elevation for days which returns to baseline, which corresponds with functional and symptomatic recovery. Future human studies using sensitive indirect methods to measure ICP longitudinally after mTBI are needed.

Objective: The research assessed online learning modules designed to teach health professions students evidence-based practice (EBP) principles in an interprofessional context across two institutions.Methods: Students from nine health professions at two institutions were recruited to participate in this pilot project consisting of two online learning modules designed to prepare students for an in-person case-based interprofessional activity. Librarians and an instructional designer created two EBP modules. Students’ competence in EBP was assessed before and after the modules as well as after the in-person activity. Students evaluated the online learning modules and their impact on the students’ learning after the in-person session.Results: A total of 39 students from 8 health professions programs participated in the project. Average quiz scores for online EBP module 1 and module 2 were 83% and 76%, respectively. Following completion of the learning modules, adapted Fresno test of competence in EBP scores increased (p=0.001), indicating that the modules improved EBP skill competence. Student evaluations of the learning modules were positive. Students indicated that they acquired new information skills that contributed to their ability to develop a patient care plan and that they would use these information skills in their future clinical practice.Conclusions: Online EBP learning modules were effective in developing EBP knowledge and skills for health professions students. Using the same modules ensured that students from different health professions at different stages of their professional programs had consistent knowledge and enabled each student to fully engage in an interprofessional evidence-based activity. Student feedback indicated the modules were valued and beneficial.

Summary Background Tissue expanders (TEs) can be used to assist primary closure of complicated hernias and large abdominal wall defects. However, there is no consensus regarding the optimal technique, use, or associated risk of TE in abdominal wall reconstruction. Methods A systematic search of PubMed and Embase databases was conducted to identify articles reporting abdominal wall reconstruction with TE techniques. English articles published between 1980 and 2016 were included on the basis of the following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of postoperative complications, hernia recurrence, and patient-based clinical data. Results Fourteen studies containing 103 patients (85 adults and 18 children) were identified for analysis. Most patients presented with a skin-grafted ventral hernia (n = 86). The etiology of the hernia was from trauma or prior abdominal surgery. The remaining patients had TE placed before organ transplantation (n = 12) or for congenital abdominal wall defects (n = 5). The location for expander placement was subcutaneous (n = 74), between the internal and external obliques (n = 26), posterior to the rectus sheath (n = 2), and intra-peritoneal (n = 1). Postoperative infections and implant-related problems were the most commonly reported complications after Stage I. The most common complication after Stage II was recurrent hernia, which was observed in 12 patients (11.7%). Five patients with TE died. Complications and mortality were more prevalent in children, immunosuppressed patients, and those with chronic illnesses. Conclusions Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and risk profile.

Rising textbook costs are a concern for students, instructors, and educational institutions. In an effort to address this concern, the University at Buffalo Libraries administered a student-based e-textbook pilot program in the spring and summer of 2013. The study was designed to assess students' evolving attitudes toward e-textbooks and to explore more sustainable e-textbook implementation models. A total of 314 students across courses, grade levels, and disciplines were provided with free access to CourseSmart's e-book platform. Usage data and attitudinal data were collected and analyzed. Library insights into student-based e-textbook implementation programs are also discussed.

In spring 2015, a 45-question survey was e-mailed to 585 medical students at the University at Buffalo (UB) in order to gauge their use of library spaces, resources, equipment, and services at UB's Health Sciences Library and plan for a library space located within a new medical school building. Students' self-reported use of the library during the academic year is presented along with the features they would like to see in their ideal library space. The responses generated in the survey are a barometer of current use and will be used in the planning process.

Objectives To review oncology nurses role of informational continuity in regards to nutrition and hydration to ensure continuity of care from one care center to another. Data Sources Peer-reviewed literature, PubMed, CINAHL, EMBASE, and web-based resources. Conclusion Optimal nutrition and hydration during cancer treatment and survivorship requires assessment and preplanning of needs. Oncology nurses play a vital role in preparing patients and caregivers for optimal nutrition during the surgical treatment trajectory. Implications for Nursing Practice Oncology nurses should emphasize nutrition planning during the surgical treatment trajectory to enhance survivorship and quality of life of the cancer patient. Educational resources exist for both nursing and cancer patients.

Summary Background Free vascularized lymph node transfer (VLNT) is a relatively novel technique for treatment of lymphedema. The purpose of this systematic review was to evaluate the current evidence on VLNT and to determine if there is objective data concerning improved outcomes. Methods A literature search of PubMed, EMBASE and CENTRAL electronic databases was conducted to identify articles written in the English language on VLNT for treatment of lymphedema. Publications were selected according to inclusion criteria. Papers reporting adjunct techniques and those that did not describe outcomes were excluded. Data including patient demographics, surgical technique, complications and outcomes were extracted. A quality score was calculated for each article. Results Eighteen studies were included with an overall study population of 305 patients. Mean quality score of articles was 5.3 with levels of evidence range from II to IV. Among 182 patients who underwent limb circumference assessment, 165 (91%) showed postoperative improvement. Reduction of limb volume was noted in 98 of 114 (86%) patients. Ninety two patients underwent lymphoscintigraphy/lymphangiography and 55 (60%) demonstrated moderate or significant improvement of flow. Patient satisfaction was questioned in 105 patients and with exception of 7 patients, all reported a high satisfaction level with significant relief in symptoms and improved quality of life. Publications also reported a reduction in infectious episodes. Conclusion VLNT appears to provide improvement in lymphedema. More studies with standardized methods for reporting outcomes and uniform patient selection are needed to evaluate this technique thoroughly.