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Objective: The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development.Methods: Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model.Results: A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years.Conclusions: The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl. [ABSTRACT FROM AUTHOR]

Introduction: Libraries have provided mediated search services for more than forty years without a practice standard to guide the execution of searches, training of searchers, or evaluation of search performance. A pan-Canadian group of librarians completed a study of the literature on mediated search practices from 2014-2017 as a first step in addressing this deficit. Methods: We used a three-phase, six-part content analysis process to examine and analyze published guidance on literature searching. Card sorting, Delphi methods, and an online questionnaire were then used to validate our findings and build a code of practice. Results: Our code of practice for mediated searching lists eighty-five search tasks arranged in performance order, within five progressive levels of search complexity. A glossary of 150 search terms supports the code of practice. Discussion: The research literature on mediated search methods is sparse and fragmented, lacking currency and a shared vocabulary. A code of practice for mediated searching will provide clarity in terminology, approach, and methods. This code of practice will provide a unified and convenient reference for training a new hire, upholding standards of search service delivery, or educating the next wave of health library professionals. [ABSTRACT FROM AUTHOR]

Background There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin. Methods We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017. Studies evaluating stroke and bleeding outcomes with DOAC use in CKD and dialysis patients were included. Results From 8008 studies, 10 met the inclusion criteria. For moderate CKD patients (estimated glomerular filtration rate  <60 mL/min/1.73 m2), there was no difference in stroke outcomes between dabigatran 110 mg [hazard ratio (HR) 0.78, 95% confidence interval (95% CI) 0.51–1.21], rivaroxaban (HR 0.82–0.84, 95% CI 0.25–2.69) and edoxaban (HR 0.87, 95% CI 0.65–1.18) versus warfarin. Dabigatran (150 mg twice daily) and apixaban reduced risk of stroke or systemic embolism significantly more than warfarin for moderate CKD patients (HR 0.55, 95% CI 0.34–0.89 and HR 0.61, 95% CI 0.39–0.94, respectively). Edoxaban and apixaban were associated with reduced major bleeding events (HR 0.50–0.76) compared with warfarin. Rivaroxaban and dabigatran 110 mg and 150 mg showed no significant difference in major bleeding versus warfarin. In hemodialysis (HD) patients, there was no difference in stroke outcomes between apixaban, dabigatran [relative risk (RR) 1.71, 95% CI 0.97–2.99] or rivaroxaban (RR 1.8, 95% CI 0.89–3.64) versus warfarin. In HD patients, rivaroxaban and dabigatran were associated with an increased major bleeding risk (RR 1.45–1.76), whereas there was no major bleeding difference with apixaban compared to warfarin. Limitations The heterogeneity of major bleeding and stroke definitions of the 10 included studies. Conclusions Clinicians should continue to weigh the risk of stroke versus bleeding before prescribing DOACs in the CKD and dialysis population. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impact of literature searching services on patient care, and to create a validated quick-assessment tool to be used by other libraries to assess their own literature searching services. Methods: All users of the Regina Qu’Appelle Health Region Health Sciences Library who requested a literature search for the purposes of patient care were emailed a link to a short survey as a preamble to search results sent using LibAnswers. A reminder was sent one week after the initial invitation. Responses were collected using FluidSurveys. Face and content validation of the survey were conducted with prospective respondents, librarians, and research support staff followed by a short pilot phase to assess reliability. Results: Fifty-four responses were received for a response rate of 57.5%. Immediate impacts of the information provided included confirming, changing, or determining a diagnosis (7.1%) or treatment plan (64.3%); avoiding adverse events (9.5%); and preventing (4.8%) or initiating (2.4%) a referral or consultation to another department. Future uses for the information provided include changing the approach to particular (27.8%) or future (55.6%) patients, sharing with colleagues (68.5%), and teaching (42.6%). Conclusions: Libraries do effect change in patient care. It is possible for hospital libraries to assess the impact a service such as literature searching has on patient care without requiring a major time investment from library users. Librarians in similar settings are encouraged to further validate and use this tool to more easily compare the impact hospital libraries have on patients. [ABSTRACT FROM AUTHOR]

The article offers information on "VisualDx," by Visual Diagnostic Decision Support Logical Images, to help primary care clinicians quickly diagnose conditions of the skin.

The article offers information on the 37th annual Canadian Health Libraries Association conference to be held in Saskatoon, Saskatchewan on May 22-25, 2013.

The article focuses on the need for standards for literature searching in health libraries in Canada.

We performed a systematic review on the agreement and reproducibility of 3 advanced imaging methods, 3-dimensional echocardiography (3DE), cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR), for quantifying aortic regurgitation (AR) severity. Medline, Embase, and Cochrane databases were systematically searched using the PICO model from inception to February 4, 2022, for publications that quantified AR severity with 3DE, CCT, or CMR. Measurement agreement and intraobserver and interobserver reproducibility results were extracted from each study. Study quality was assessed using the QUADAS-2 tool. Forty-two publications with 2176 patients with AR were identified. For 3DE, vena contracta (VC) width, VC area, and effective regurgitant orifice area had higher correlations with AR volume than the 2-dimensional echocardiography (2DE)-derived VC width. CCT-derived regurgitant volume had moderate-to-good correlations with 2DE. CMR regurgitant volume measurements had lower intraobserver and interobserver variabilities because of improved endocardial definition, fewer geometric assumptions, and less angle dependence for flow measurements when compared with 2DE. 3DE color flow convergence methods used to quantify AR severity were superior to 2DE methods and could be used in patients with adequate echocardiographic windows. CCT methods also demonstrated improvements over 2DE methods. Although this method is limited due to the radiation exposure, it could play a role in patients with poor echocardiographic windows unable to tolerate CMR. CMR demonstrated the smallest intraobserver and interobserver variability in evaluating AR severity and is a reasonable option for those where the echocardiographic results are mixed and for clinical trials., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is a lack of clear benefit and a potential risk of bleeding with direct oral anticoagulant (DOAC) use in chronic kidney disease (CKD) and dialysis patients with atrial fibrillation. The objective of this study was to evaluate how treatment with DOACs affects stroke and bleeding outcomes compared with warfarin or aspirin., Methods: We conducted a systematic review of randomized controlled trials, cohort studies and case series, and searched electronic databases from 1946 to 2017. Studies evaluating stroke and bleeding outcomes with DOAC use in CKD and dialysis patients were included., Results: From 8008 studies, 10 met the inclusion criteria. For moderate CKD patients (estimated glomerular filtration rate  <60 mL/min/1.73 m2), there was no difference in stroke outcomes between dabigatran 110 mg [hazard ratio (HR) 0.78, 95% confidence interval (95% CI) 0.51-1.21], rivaroxaban (HR 0.82-0.84, 95% CI 0.25-2.69) and edoxaban (HR 0.87, 95% CI 0.65-1.18) versus warfarin. Dabigatran (150 mg twice daily) and apixaban reduced risk of stroke or systemic embolism significantly more than warfarin for moderate CKD patients (HR 0.55, 95% CI 0.34-0.89 and HR 0.61, 95% CI 0.39-0.94, respectively). Edoxaban and apixaban were associated with reduced major bleeding events (HR 0.50-0.76) compared with warfarin. Rivaroxaban and dabigatran 110 mg and 150 mg showed no significant difference in major bleeding versus warfarin. In hemodialysis (HD) patients, there was no difference in stroke outcomes between apixaban, dabigatran [relative risk (RR) 1.71, 95% CI 0.97-2.99] or rivaroxaban (RR 1.8, 95% CI 0.89-3.64) versus warfarin. In HD patients, rivaroxaban and dabigatran were associated with an increased major bleeding risk (RR 1.45-1.76), whereas there was no major bleeding difference with apixaban compared to warfarin., Limitations: The heterogeneity of major bleeding and stroke definitions of the 10 included studies., Conclusions: Clinicians should continue to weigh the risk of stroke versus bleeding before prescribing DOACs in the CKD and dialysis population.