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A set of 300 vaginal smears was interpreted by 13 cytologists from six European laboratories, who were requested to report inadequate and suboptimal smears. The set had been appropriately seeded to reach approximately 10% inadequate and 20% suboptimal smear frequency. According to the majority report, 230 smears were classified as adequate (76.7%), 43 as inadequate (14.3%), and 27 as suboptimal (9.0%). Agreement with the majority report ranged from 52% to 91% (average 78%). Kappa statistics for reporting inadequate smears showed a high level of agreement for five cytologists, and fair to good agreement for eight. In contrast, kappa statistics for reporting suboptimal smears showed fair to good agreement with the majority report only in five instances, whereas agreement was poor for eight cytologists. 'Inadequate smear' rates may be used to compare the quality of smears received in different laboratories, as there is a high level of agreement among cytologists as to what constitutes an inadequate smear. However, this is not true for "suboptimal smear" rates, and more precise reporting criteria must be defined and tested if an intermediate category is to be retained to report poor quality smears: more precise reporting criteria must be defined and tested if an intermediate category is to be retained to report poor quality smears.

Increasing diversity in the nursing workforce has been cited as key to decreasing long-standing health disparities in the United States. [1][2][3] Yet, Black, Hispanic/ Latinx, Native American, and Asian American nurses remain inadequately represented in the health care workforce. 4 Most recent data from the 2018 National Sample Survey of Registered Nurses (RNs) show that White, non-Hispanic RNs accounted for 73.3% of the RN workforce, followed by Hispanic/Latinx (10.2%), Black non-Hispanic/Latinx (7.8%), Asian non-Hispanic/Latinx (5.2%), and American Indian or Alaska Native non-Hispanic/Latinx (0.3%) RNs. 5 Although the number of underrepresented minority (URM) nurses in the US workforce has increased over time, these figures are not reflective of the demographic characteristics of the US population. 4,6,7 Mounting evidence shows that nursing workforce diversity is essential to the provision of high-quality care and culturally effective care. 1,8,9 This is particularly important in light of the coronavirus disease-2019 (COVID-19) pandemic, which has disproportionately impacted Black, Hispanic/Latinx, and Native American communities-further magnifying existing health disparities among these groups. 5,[10][11][12] Therefore, assessing factors associated with success for URM students in nursing is an essential step toward removing barriers that hinder nursing workforce diversity and developing interventions that enhance successful academic outcomes (eg, retention) for this group.Graham et al 13 conducted an integrative literature review from 1985 to 2015 that focused on examining facilitators and barriers to success among URMs and highlighted academic factors that may affect retention in the nursing program. The authors identified specific barriers to students' success, including faculty practices and interaction with peers. To expand on this body of literature, our systematic review sought to appraise the current literature to provide a more current understanding of barriers and facilitators to

This article describes the development of a flipped classroom instructional module designed by librarians to teach first- and second-year medical students how to search the literature and find evidence-based articles. The pre-class module consists of an online component that includes reading, videos, and exercises relating to a clinical case. The in-class sessions, designed to reinforce important concepts, include various interactive activities. The specifics of designing both components are included for other health sciences librarians interested in presenting similar instruction. Challenges encountered, particularly in the live sessions, are detailed, as are the results of evaluations submitted by the students, who largely enjoyed the online component. Future plans are contingent on solving technical problems encountered during the in-class sessions.

Background and Purpose: Dynamic susceptibility contrast (DSC) MR imaging is commonly used to estimate penumbra size in acute ischemic stroke; this technique relies on the administration of gadolinium contrast, which has limited use in certain populations, such as those with impaired renal function or allergies. Arterial spin labeling (ASL) is a relatively new technique that can provide information on cerebral perfusion without need for exogenous contrast agents. This systematic review examines published studies that specifically compared ASL to DSC for assessment of ischemic penumbra. Methods:We searched PubMed, Embase, Web of Science, and the Cochrane Library for papers which compared ASL with DSC for assessment of ischemic penumbra in acute ischemic stroke among adult human populations. Two independent reviewers screened studies using predefined inclusion and exclusion criteria. Study characteristics and findings regarding the utility of ASL compared to DSC for identification of penumbra were then extracted and anlyzed for results and risk of bias. Results: Seventeen articles met inclusion and exclusion criteria. Studies compared ASLwith DSC on a range of metrics (hypoperfusion, hyperperfusion, mismatch, and reperfusion). Most studies concluded that agreement of ASL with DSC was moderate to very high.A small subset of studies found discrepancy in agreement of ASL with DSC for size or location of perfusion abnormalities. A heterogeneity of perfusion parameters studied for DSC was noted, along with the need for more standardization of research methods. Conclusion:ASL shows moderate to high agreement with DSC for detection of penumbra among ischemic stroke patients.

n 2020, approximately 241 million cases of malaria occurred in 85 countries with endemic malaria. Travelers to these regions are at risk for infection. 1 The number of people with malaria who arrive in the US has increased each year since 1972, from approximately 614 cases in 1972 to an 2161 cases in 2017. 2 Patients with malaria typically present to frontline US health care workers, who need to diagnose and manage this infection. This Review summarizes current evidence regarding the prevention, diagnosis, and treatment of malaria. MethodsWe searched the PubMed and Cochrane Library databases for English-language randomized clinical trials, meta-analyses, systematic reviews, and observational studies of the epidemiology, diagnosis, and treatment of malaria, published from January 2016 to March 2022. References were searched manually for additional relevant publications, including World Health Organization IMPORTANCE Malaria is caused by protozoa parasites of the genus Plasmodium and is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria. The mortality rate from malaria is approximately 0.3% in the US and 0.26% worldwide. OBSERVATIONS In the US, most malaria is diagnosed in people who traveled to an endemic region. More than 80% of people diagnosed with malaria in the US acquired the infection in Africa. Of the approximately 2000 people diagnosed with malaria in the US in 2017, an estimated 82.4% were adults and about 78.6% were Black or African American. Among US residents diagnosed with malaria, 71.7% had not taken malaria chemoprophylaxis during travel. In 2017 in the US, P falciparum was the species diagnosed in approximately 79% of patients, whereas P vivax was diagnosed in an estimated 11.2% of patients. In 2017 in the US, severe malaria, defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia, occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died. P falciparum has developed resistance to chloroquine in most regions of the world, including Africa. First-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin. If P falciparum was acquired in a known chloroquine-sensitive region such as Haiti, chloroquine remains an alternative option. When artemisinin-based combination therapies are not available, atovaquone-proguanil or quinine plus clindamycin is used for chloroquine-resistant malaria. P vivax, P ovale, P malariae, and P knowlesi are typically chloroquine sensitive, and treatment with either artemisinin-based combination therapy or chloroquine for regions with chloroquine-susceptible infections for uncomplicated malaria is recommended. For severe malaria, intravenous artesunate is first-line therapy. Treatment of mild malaria due to a chloroquine-resistant parasite consists ...

Due to the proliferation of electronic resources, fewer users visit the library. Traditional classroom instruction and in-person consultations are no longer sufficient in assisting library users. Librarians are constantly seeking new ways to interact with patrons and facilitate efficient use of electronic resources. This article describes the development, implementation, and evaluation of a project in which desktop-sharing software was used to reach out to users at remote locations. Various ways of using this tool are described, and challenges and implications for future expansion are discussed.

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