While progress has been made on communication skills training for clinicians, gaps exist in how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting and provide timely feedback about effectiveness and quality. This 1-year, multi-phase, proof-of-concept study aims to design and pilot test ‘CommSense,’ a novel wearable sensing system and associated natural language processing algorithms. Our team leverages disciplinary expertise from nursing, engineering, medicine, and library science. CommSense will be deployed on mobile devices (e.g., smartwatches) with the goal to reliably extract key markers of communication quality from real-time patient-clinician palliative care interactions. In Phase 1 (completed) we conducted a thorough review of the literature to develop an evidence-based list of quality communication metrics and determined how these metrics could be best operationalized. Phases 2 and 3 (in-progress) will involve design of the CommSense system and pilot testing with simulated clinical scenarios to assess fidelity of data capture and extraction of desired metrics. We identified 96 articles from relevant databases in consultation with a health sciences librarian; 18 articles were added based on expert opinion. After screening article titles and abstracts (n=114) for relevance, 72 articles were selected for full-text extraction and independently reviewed by 2 members of our clinical team. We used a ‘talk-aloud’ thematic analysis approach to develop a list of 7 core communication metrics (5 verbal; 2 non-verbal) with associated strategies for operationalization. Clinician-patient communication is complex and determining appropriate metrics for evaluation is challenging. We propose a core set of communication ‘best practices’ that can be extracted from conversations using the CommSense technology. The long-term goal of this research is to deploy CommSense in a variety of healthcare contexts to provide real-time feedback to end-users to improve communication and patient-centered health outcomes.

Purpose Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions. Methods We conducted a scoping review using the Arksey and O’Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016. Results Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience. Conclusion Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.

Background: Human papillomavirus infection, a causative agent of cervical cancer, is of great concern, more so in populations with high HIV prevalence, such as South Africa. Aim: This review aimed to examine the prevalence and distribution of selected cervical human papillomavirus (HPV) types in HIV infected and HIV uninfected women in South Africa. Methods: PubMed and Web of Science databases were searched using key words. For data integrity, data was assessed by two authors independently. The study inclusion criteria comprised records on cervical HPV, HPV genotyping and HPV type distribution among South African women. Statistical analysis was performed using Social Science Statistics. Results: Sixty-nine articles met the inclusion criteria for analysis. Data on cervical HPV prevalence and type distribution was available only for five of the nine provinces of South Africa. Only 4/69 studies used sequencing as an approach to identify HPV types. In a general population, HPV type 16 was the most frequent (8.80%), followed by types 35 (4.86%), 18 (4.14%), 58 and 52 with the frequency of 3.65% and 3.62%, respectively. Furthermore, the least frequent type was HPV 70 (0.74%). Both HIV infected and HIV uninfected populations had a higher prevalence of high-risk human papillomavirus (hrHPV) types 16, 18 and 35 than other HPV types; while HPV types 6, 11 and 70 were the least frequent types from these populations. Lastly, HPV 16 was the most predominant type among women with normal (2.03%) and abnormal cervical cytology (6.60%). Conclusion: Expanding on HPV genotyping will improve the knowledge in patterns of HPV type distribution in South Africa that will further help in decision making to improve current diagnostics, and future vaccine development and assessment.

To fill the gap in health research capacity-building efforts, we created the 'Virtual Library' (VL) - a web-based repository of context-relevant resources for health researchers in low- and middle-income countries (LMICs). This paper describes the participatory process used to systematically develop the VL, and describes how our interprofessional team - representing both an LMIC (Nepal) and a high-income country (HIC) (USA, US) - engaged in shared meaning-making. A team of researchers and clinicians representing a range of subdisciplines from Nepal and the US created a replicable search strategy and standardized Resource Screening Guide (RSG) to systematically assess resources to be included within the VL. Descriptive methods were used to summarize findings from the RSG and lessons learned from the collaborative process. Collectively, 14 team members reviewed 564 potential resources (mean = 40, SD = 22.7). Mean RSG score was 7.02/10 (SD = 2). More than 76% of resources met each of the four quality criteria (relevant; reputable, accessible; understandable). Within the published VL, 298 resources were included, organized by 15 topics and 45 sub-topics. Of these, 223 resources were evaluated by the RSG; 75 were identified by team member expertise. The collaborative process involved regular meetings, iterative document revisions, and peer review. Resource quality was better than expected, perhaps because best practices/principles related to health research are universally relevant, regardless of context. While the RSG was essential to systematize our search and ensure reproducibility, team member expertise was valuable. Pairing team members during peer-review led to bi-directional knowledge sharing and was particularly successful. This work reflects a highly collaborative global partnership and offers a model for future health research capacity-building efforts. We invite engagement with the Virtual Library as one supportive pillar of infrastructure to develop individual and institutional research capacity.

BACKGROUND:Inclusivity, the intentional incorporation of practices that foster a sense of belonging by promoting meaningful interactions among persons and groups representing different traits, perceptions and experiences, is a prerequisite for excellence in nursing education. Nevertheless, many faculty struggle to create an inclusive learning experience for baccalaureate nursing students.PURPOSE:The purpose of this scoping study was to explore and summarize the extant literature on inclusivity, identify evidence-based strategies to promote inclusivity, and provide directions for further research on inclusivity in baccalaureate nursing education.RESULTS:Thirty studies, conducted in English-speaking countries, from 2001 through 2016, were included in the final analysis. Results from the mostly descriptive studies were organized into 3 themes. 1) Nursing students from underrepresented minority groups experience discrimination from peers, faculty, and clinicians in the classroom, the clinical setting and/or the larger institution. 2) The cumulative effect of discrimination is a lack of belongingness, which is associated with adverse outcomes. 3) All aspects of the undergraduate nursing students' learning community act as facilitators or barriers to inclusivity or a sense of belongingness.CONCLUSIONS:This study provided a deeper understanding of underrepresented minority nursing students' experiences and perspectives related to inclusivity. This, in turn, can inform future action.

Background: Smoking cessation and relapse prevention represent an important opportunity to improve cancer survival rates, reduce the risk of cancer treatment complications, and improve quality of life.. Unfortunately, about half of cancer patients continue to smoke despite smoking being a known and often reversible cause of premature death.. We have previously shown that repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) decreases cue craving, reduces cigarette consumption and increases quit rate in nicotine dependent smokers. Thus, we hypothesize that 5 sessions of rTMS can be safely used in cancer patients and that multiple rTMS sessions can aid smoking cessation.

Data Synthesis: Various technologies were used, including videoconferencing, videophone, and commercially available modalities such as Skype, FaceTime, AngelEye, and NICView Webcams. In the 11 studies, three main outcomes were evaluated: parents’ perception of technology use, health care providers’ perceptions of technology use, and objective outcomes, such as parental anxiety or stress or infant length of stay. Overall, parents and health care providers perceived the varied interventions quite favorably, although a few significant differences were found for the objective measures.

OBJECTIVE:To synthesize findings from the published literature on the use of technology in the NICU to improve communications and interactions among health care providers, parents, and infants.DATA SOURCES:Electronic databases including Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar were searched for related research published through May 2016. The reference lists of all studies were reviewed, and a hand search of key journals was also conducted to locate eligible studies.STUDY SELECTION:Eleven studies (five quantitative, two qualitative, and four mixed methods) were identified that met the inclusion criteria. Only studies published in English were included.DATA EXTRACTION:Whittemore and Knafl's methodology for conducting integrative reviews was used to guide data extraction, analysis, and synthesis. Data were extracted and organized according to the following headings: author, year, and location; study purpose and design; sample size and demographics; technology used; study findings; and limitations.DATA SYNTHESIS:Various technologies were used, including videoconferencing, videophone, and commercially available modalities such as Skype, FaceTime, AngelEye, and NICView Webcams. In the 11 studies, three main outcomes were evaluated: parents' perception of technology use, health care providers' perceptions of technology use, and objective outcomes, such as parental anxiety or stress or infant length of stay. Overall, parents and health care providers perceived the varied interventions quite favorably, although a few significant differences were found for the objective measures.CONCLUSION:Several interventions have been tested to improve communications and promote interactions among NICU health care team members, parents, and infants. Although initial findings are positive, research in this area is quite limited, and the reviewed studies had several limitations. There is a significant need for further rigorous research to be conducted with diverse samples.

A library service model that provides reference and instructional services by summoning reference librarians from a single service point is described. The system utilizes Libraryh3lp, an open-source, multioperator instant messaging system. The selection and refinement of this solution and technical challenges encountered are explored, as is the design of public services around this technology, usage of the system, and best practices. This service model, while a major cultural and procedural change at first, is now a routine aspect of customer service for this library.

Much of traditional library disaster planning focuses on recovery of facilities and collections, while relatively little planning focuses on preparing libraries to continue to offer selected services to their patrons throughout a disaster [1]. This article reports about a service continuity plan developed by two academic health sciences libraries' interlibrary loan (ILL) departments, who have established an effective partnership for continuing selected services when normal functioning is compromised. Corporations have long prepared for disasters by implementing what is referred to as business continuity planning (BCP), and libraries can benefit by taking a lesson from the corporate sector in this area. While corporate BCP is driven by basic cost-benefit principles (e.g., the longer a company is shut down, the less revenue is generated), a service continuity plan among libraries can ensure that core services remain available to patrons during times of emergency or disaster, perhaps when they are needed most. In an academic health sciences library environment, ILL services can be essential. Whether the patron is a health care professional in a hospital, medical school, or private practice, the need for information can be urgent, especially during a disaster when normal health care staffing routines are disrupted. Yet ILL services are more vulnerable to disruption than some other library services. Two factors that contribute to this vulnerability are a lack of depth of coverage in many ILL departments and the high level of expertise required to effectively access and transmit information across the various platforms used in ILL procedures. Recently, the National Network of Libraries of Medicine (NN/LM) developed its National Emergency Preparedness & Response Plan to address preparedness and response, specifically service continuity, among its members. The NN/LM plan strongly encouraged its network members to seek out and establish partnerships, or “back-up” relationships, with other members: “Network members are encouraged to partner with a back-up library and to develop a Memorandum of Understanding (MOU), specifying services that would be provided by the back-up library to the affected Network member in the event of a disaster” [2]. In the spirit of the NN/LM plan, the Claude Moore Health Sciences Library at the University of Virginia (CMHSL at UVA) and the Health Sciences Library at the University of North Carolina at Chapel Hill (HSL at UNC-CH) have collaborated to establish procedures for continuing each others' essential ILL services in the event of some type of service disruption. For the purposes of this initial phase of a possibly ongoing project, the two libraries have defined “essential ILL services” as requests for materials not owned by the borrowing library for its patrons from another library. The scenario of an influenza pandemic was one of the driving forces behind developing the partnership between the two ILL departments. The prospect of an avian influenza pandemic has been looming for the past several years and is being monitored closely by the Centers for Disease Control and Prevention . Three influenza pandemics occurred in the last century (1918, 1957, and 1968), and public health experts generally agree that another is likely in the near future. Although no one can predict when the next pandemic might happen, some experts believe we are already living on borrowed time [3]. A pandemic is likely to occur during a typical flu season, fall through early spring, and the likely scenario for a pandemic presents some special problems for service continuity. To reduce the spread of the pandemic, public health officials might request that universities, businesses, and other institutions take social distancing measures, such as suspending classes and closing areas that are open to the public, to reduce the spread of disease. Social distancing strategies may cause classes to be suspended for seven to ten weeks and would likely close libraries, which offer space to students, employees, and the public. During this time, health sciences libraries would strive to continue to provide services to their patrons, whether the physical building is open or closed. Localized emergencies—such as wildfires, storms, or flooding—might also cause library buildings to be closed or staff to be evacuated to other locations. Contingency plans that have been developed in advance can lead to a seamless transition in providing services from off-site.

Enabling health sciences libraries to face emergencies with minimal loss of service continuity for their library patrons is a key initiative of the National Network of Libraries of Medicine (NN/LM). Dan Wilson and Susan Yowell from the University of Virginia Claude Moore Health Sciences Library were funded by NN/LM to coordinate the development of resources and training materials that could be used to assist network member libraries nationwide with planning for emergency preparedness and recovery. This article describes key results of the development, including the "10 Steps to Service Continuity" plan and the accompanying online toolkit. KEYWORDS: disaster planningemergency preparednesshospital librariansNational Library of MedicineNational Network/Libraries of Medicineservice continuity This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-LM-6-3502 with the University of Maryland Baltimore. The authors would like to thank the NN/LM Network Office, Directors, and Associate Directors, the NN/LM Outreach Evaluation Resource Center, and all the NN/LM staff and network members who contributed valuable knowledge and insight in the development of the NN/LM Emergency Preparedness & Response plan.

In an effort to help raise awareness about the need for disaster planning in health sciences libraries, emergency response planners at the Claude Moore Health Sciences Library at the University of Virginia considered how best to promote the idea and provide a forum for gathering and exchanging information, while maintaining control over content in order to keep the focus and the quality of the entries consistent. The blog they created has been successful in providing much-needed assistance to hospital libraries and other libraries, both large and small, as well as for individuals and other organizations worldwide.

Abnormal growth in Down syndrome (DS) is reflected by variable reduction in size and simplification in form of many physical traits. This study aimed to compare the thickness of enamel and dentine in deciduous and permanent mandibular incisor teeth between DS and non‐DS individuals and to clarify how these tissues contribute to altered tooth size in DS. Sample groups comprised 61 mandibular incisors (29 permanent and 32 deciduous) from DS individuals and 55 mandibular incisors (29 permanent and 26 deciduous) from non‐DS individuals. Maximum mesiodistal and labiolingual crown dimensions were measured initially, then the crowns were sectioned midsagittally and photographed using a stereomicroscope. Linear measurements of enamel and dentine thickness were obtained on the labial and lingual surfaces of the crowns, together with enamel and dentine–pulp areas and lengths of the dentino‐enamel junction. Reduced permanent crown size in DS was associated with a reduction in both enamel and dentine thickness. After adjustments were made for tooth size, DS permanent incisors had significantly thinner enamel than non‐DS permanent teeth. The DS permanent teeth also exhibited significant differences in shape and greater variability in dimensions than the non‐DS permanent teeth. Crown dimensions of deciduous incisors were similar in size or larger in DS compared with non‐DS deciduous teeth. Enamel and dentine thicknesses of the deciduous teeth were similar in DS and non‐DS individuals. The findings indicate that growth retardation in DS reduces both enamel and dentine deposition in the permanent incisors but not in the earlier‐forming deciduous predecessors. The results are also consistent with the concept of amplified developmental instability for dental traits in DS. Am. J. Hum. Biol. 13:690–698, 2001. © 2001 Wiley‐Liss, Inc.

The finding of pale or clear cells in ameloblastomas is an exceptionally rare--but not unreported--phenomenon. The diagnostic implications of the presence of such cells in ameloblastomas are several and relate mainly to the question of histopathologic differential diagnosis. Although mucous cells in ameloblastomas are an accepted phenomenon, their occurrence has been reported only infrequently. This report describes a case of ameloblastoma exhibiting histopathologic evidence of focal mucous cell differentiation. Issues relating to the differential diagnosis of this lesion are discussed.