ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures.

A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.

A Scoping Review of Simulation-Based Training Paradigms for Carotid Artery Endarterectomy and Carotid Artery Stenting.

BACKGROUND: Surgical simulation has come to the forefront to enhance the training of residents. The aim of our scoping review is to analyze the available simulation-based carotid revascularization techniques, including carotid endarterectomy (CEA) and carotid artery stenting (CAS) and suggest critical steps for evaluating competency in a standardized fashion. METHODS: A scoping review of all reports on simulation-based carotid revascularization techniques including CEA and CAS was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane, Science Citation Index Expanded, Emerging Sources Citation Index, and Epistemonikos databases. Data were collected according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The English language literature was searched from January 1, 2000 to January 9, 2022. The outcomes evaluated included measures of assessment of operator performance. RESULTS: Five CEA and 11 CAS manuscripts were included in this review. The methods of assessments employed by these studies to judge performance were comparable. The 5 CEA studies sought to validate and demonstrate improved performance with training or distinguish surgeons by their experience level, either through assessing operative performance or end-product results. The 11 CAS studies used 1 of 2 types of commercial simulators and focused on determining the efficacy of simulators as teaching tools. By examining the steps of the procedure associated with preventable perioperative complications, it provides a reasonable framework for determining which elements of the procedure should be emphasized most. Furthermore, using potential errors as a basis for assessment of competency could reliably distinguish operators based on level of experience. CONCLUSIONS: Competency-based simulation training is becoming more relevant as our surgical training paradigm shifts with the increased scrutiny within training programs of work-hour regulations and the need to develop a curriculum to assess our trainees' ability to perform specific operations competently during their stipulated training period. Our review has given us an insight into the current efforts in this space regarding 2 specific procedures that are key for all vascular surgeons to master. Although many competency-based modules are available, there is a lack of standardization in the grading/rating system of what surgeons consider vital steps of each procedure to assess these simulation-based modules. Therefore, the next steps of curriculum development should be based on standardization efforts for the different protocols available.

Listening to Learners to Prepare for the Future: A Mayo Clinic College of Medicine and Science Benchmarking Survey.

In 2022, a benchmarking survey was completed to gage learner satisfaction with library services, spaces, and resources across 10 Mayo Clinic Libraries. The discussion for this project began around a previously published survey of what medical students wanted from their library. Librarians were asked if Mayo Clinic Libraries could do a similar survey, as a full survey of the Mayo Clinic College of Medicine and Science had not been done. Overall, the findings were positive and provide a baseline for future surveys.

Preoperative echocardiography as a prognostic tool for liver transplant in patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) presents with a hypertrophied left ventricle (LV). It is often associated with LV outflow tract obstruction (LVOTO) and a risk for sudden death. This study aimed to describe outcomes of patients with HCM who underwent liver transplant (LT). METHODS: A retrospective review was conducted for patients diagnosed with HCM undergoing LT. Patient characteristics, preoperative echocardiography results, HCM risk of sudden cardiac death prediction model score, and 5-year mortality were examined. A univariable Cox proportional hazards model was used to evaluate the association between risk factors and 5-year mortality. All tests were two-sided with the alpha level set at .05. RESULTS: Twenty-nine patients were included in the analysis. Six patients (21%) had a perioperative cardiopulmonary complication. The 5-year survival rate was 61% (95% CI, 45-82). The analyzed risk factors showed that 5-year post-LT survival was significantly predicted by maximal LV outflow tract gradient at rest > 60 mmHg (hazard ratio, 1.04 [95% CI, 1.01-1.06]). CONCLUSIONS: Preoperative LV outflow tract resting gradient > 60 mmHg was associated with 5-year post-LT mortality. The results suggest the severity of LVOTO identified by echocardiography is a prognostic tool for patients with HCM after LT.

Higher Risk for Reintervention in Patients after Stenting for Radiation-Induced Internal Carotid Artery Stenosis: A Single-Center Analysis and Systematic Review.

BACKGROUND: This study aimed to review short- and long-term outcomes of all carotid artery stenting (CAS) in patients with radiation-induced (RI) internal carotid artery (ICA) stenosis compared with patients with atherosclerotic stenosis (AS). METHODS: We performed a single-center, multisite case-control study of transfemoral carotid artery intervention in patients stented for RI or AS. Cases of stented RI carotid arteries were identified using a CAS database covering January 2000 to December 2019. These patients were randomly matched 2:1 with stented patients because of AS by age, sex, and year of CAS. A conditional logistic regression model was performed to estimate the odds of reintervention in the RI group. Finally, a systematic review was performed to assess the outcomes of RI stenosis treated with CAS. RESULTS: There were 120 CAS in 113 patients because of RI ICA stenosis. Eighty-nine patients (78.8%) were male, and 68 patients (60.2%) were symptomatic. The reasons for radiation included most commonly treatment for diverse malignancies of the head and neck in 109 patients (96.5%). The mean radiation dose was 58.9 ± 15.6 Gy, and the time from radiation to CAS was 175.3 ± 140.4 months. Symptoms included 31 transient ischemic attacks (TIAs), 21 strokes (7 acute and 14 subacute), and 17 amaurosis fugax. The mean National Institutes of Health Stroke Scale in acute strokes was 8.7 ± 11.2. In asymptomatic patients, the indication for CAS was high-grade stenosis determined by duplex ultrasound. All CAS were successfully completed. Reinterventions were more frequent in the RI ICA stenosis cohort compared with the AS cohort (10.1% vs. 1.4%). Reinterventions occurred in 14 vessels, and causes for reintervention were restenosis in 12 followed by TIA/stroke in two vessels. On conditional regression modeling, patients with RI ICA stenosis were at a higher risk for reintervention (odds ratio = 7.1, 95% confidence interval = 2.1-32.8; P = 0.004). The mean follow-up was 33.7 ± 36.9 months, and the mortality across groups was no different (P = 0.12). CONCLUSIONS: In our single-center, multisite cohort study, patients who underwent CAS for RI ICA stenosis experienced a higher rate of restenosis and a higher number of reinterventions compared with CAS for AS. Although CAS is safe and effective for this RI ICA stenosis cohort, further data are needed to reduce the risk of restenosis, and close patient surveillance is warranted. In our systematic review, CAS was considered an excellent alternative option for the treatment of patients with RI ICA stenosis. However, careful patient selection is warranted because of the increased risk of restenosis on long-term follow-up.

Evaluating Scholars' Impact and Influence: Cross-sectional Study of the Correlation Between a Novel Social Media-Based Score and an Author-Level Citation Metric.

BACKGROUND: The development of an author-level complementary metric could play a role in the process of academic promotion through objective evaluation of scholars' influence and impact. OBJECTIVE: The objective of this study was to evaluate the correlation between the Healthcare Social Graph (HSG) score, a novel social media influence and impact metric, and the h-index, a traditional author-level metric. METHODS: This was a cross-sectional study of health care stakeholders with a social media presence randomly sampled from the Symplur database in May 2020. We performed stratified random sampling to obtain a representative sample with all strata of HSG scores. We manually queried the h-index in two reference-based databases (Scopus and Google Scholar). Continuous features (HSG score and h-index) from the included profiles were summarized as the median and IQR. We calculated the Spearman correlation coefficients (ρ) to evaluate the correlation between the HSG scores and h-indexes obtained from Google Scholar and Scopus. RESULTS: A total of 286 (31.2%) of the 917 stakeholders had a Google Scholar h-index available. The median HSG score for these profiles was 61.1 (IQR 48.2), and the median h-index was 14.5 (IQR 26.0). For the 286 subjects with the HSG score and Google Scholar h-index available, the Spearman correlation coefficient ρ was 0.1979 (P<.001), indicating a weak positive correlation between these two metrics. A total of 715 (78%) of 917 stakeholders had a Scopus h-index available. The median HSG score for these profiles was 57.6 (IQR 46.4), and the median h-index was 7 (IQR 16). For the 715 subjects with the HSG score and Scopus h-index available, ρ was 0.2173 (P<.001), also indicating a weak positive correlation. CONCLUSIONS: We found a weak positive correlation between a novel author-level complementary metric and the h-index. More than a chiasm between traditional citation metrics and novel social media-based metrics, our findings point toward a bridge between the two domains.

An Evidence-Based Approach to Casting and Orthosis Management of the Pediatric, Adolescent, and Young Adult Population for Injuries of the Upper Extremity: A Review Article.

OBJECTIVE: Review the use of upper-extremity orthoses and casts after injuries to the wrist and hand in the pediatric, adolescent, and young adult population. The common injuries reviewed include pediatric distal radius fractures, scaphoid fractures, metacarpal fractures, mallet fingers, volar plate injuries of the proximal interphalangeal (PIP) joint, and ulnar collateral ligament (UCL) tears of the thumb metacarpophalangeal (MCP) joint. DATA SOURCES: We conducted a literature review from 1985 to 2016 of upper-extremity orthotic interventions. Non-English language citations and animal studies were excluded. Citations from retrieved studies were used to identify other relevant publications. This review included cases of common injuries to the upper extremity, which required orthotic intervention. MAIN RESULTS: Immobilization recommendations for nonsurgical pediatric distal radius fractures, nonsurgical metacarpal fractures, mallet fingers, and UCL tears of the thumb MCP include a removable orthosis. Nondisplaced scaphoid fracture orthosis recommendations include initial immobilization in a nonremovable short-arm thumb spica cast. Volar plate injuries of the PIP joint require buddy straps for healing. CONCLUSIONS: The literature demonstrates the effectiveness of removable orthoses in healing, patient satisfaction, and time to return to activity after many common upper-extremity injuries. Removable orthoses should be considered an equal or superior treatment method to cast immobilization, immobilization of additional joints, or longer periods of immobilization.

COVID-19 - Background and Health Sciences Library Response during the First Months of the Pandemic.

COVID-19, a novel respiratory disease caused by the SARS-CoV-2 coronavirus, was first recognized in Wuhan, China in December 2019 and declared a pandemic by the World Health Organization in March 2020. Health science librarians continue to navigate the global health crisis while providing critical information services to their institutions. An informal survey was conducted to obtain some general information on the types of responses by health science librarians to this event. Among the findings is an opportunity for librarians to strengthen interdepartmental relationships and disaster response plans in preparation for future pandemics and disaster events.

Awake vs. asleep motor mapping for glioma resection: a systematic review and meta-analysis.

BACKGROUND: Intraoperative stimulation (IS) mapping has become the preferred standard treatment for eloquent tumors as it permits a more accurate identification of functional areas, allowing surgeons to achieve higher extents of resection (EOR) and decrease postoperative morbidity. For lesions adjacent to the perirolandic area and descending motor tracts, mapping can be done with both awake craniotomy (AC) and under general anesthesia (GA). OBJECTIVE: We aimed to determine which anesthetic protocol-AC vs. GA-provides better patient outcomes by comparing EOR and postoperative morbidity for surgeries using IS mapping in gliomas located near or in motor areas of the brain. METHODS: A systematic literature search was carried out to identify relevant studies from 1983 to 2019. Seven databases were screened. A total of 2351 glioma patients from 17 studies were analyzed. RESULTS: A random-effects meta-analysis revealed a trend towards a higher mean EOR in AC [90.1% (95% C.I. 85.8-93.8)] than with GA [81.7% (95% C.I. 72.4-89.7)] (p = 0.06). Neurological deficits were divided by timing and severity for analysis. There was no significant difference in early neurological deficits [20.9% (95% C.I. 4.1-45.0) vs. 25.4% (95% C.I. 13.6-39.2)] (p = 0.74), late neurological deficits [17.1% (95% C.I. 0.0-50.0) vs. 3.8% (95% C.I. 1.1-7.6)] (p = 0.06), or in non-severe [28.4% (95% C.I. 0.0-88.5) vs. 20.1% (95% C.I. 7.1-32.2)] (p = 0.72), and severe morbidity [2.6% (95% C.I. 0.0-15.5) vs. 4.5% (95% C.I. 1.1-9.6)] (p = 0.89) between patients who underwent AC versus GA, respectively. CONCLUSION: Mapping during resection of gliomas located in or near the perirolandic area and descending motor tracts can be safely carried out with both AC and GA.

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Exploring interprofessional collaboration and attitudes of health sciences librarians.

OBJECTIVE: This study assessed health sciences librarians' attitudes toward interprofessional collaboration using the Interdisciplinary Education Perception Scale (IEPS) and gathered information on their involvement with interprofessional activities. METHODS: The authors sent a survey to librarians in the Medical Library Association's (MLA's) Interprofessional Education Special Interest Group and Research Section consisting of the IEPS and questions about their prior and current experiences with interprofessional practice and education (IPE). We compared mean IEPS scores between each MLA group and several other demographic factors to assess differences in attitudes. We also compared librarians' IEPS scores with those of previously published health professional students' IEPS scores and thematically analyzed two open-ended questions. RESULTS: Health sciences librarians' scores on the IEPS indicated positive attitudes toward IPE. There were no statistically significant differences between any group. Health sciences librarians' mean IEPS score was similar to the mean score of health professions students from a prior study. The most commonly reported interprofessional activity was teaching or facilitating learning activities for health professions students; fewer served on committees or engaged in non-curricular activities such as grand rounds and book clubs. CONCLUSION: Health sciences librarians in this study reported positive attitudes toward IPE, in line with the majority of other previously studied health professionals. Years of experience, previous health professional careers, and experience supporting IPE as a librarian had little bearing on the responses to the survey. This suggests that health sciences librarians have positive attitudes toward IPE, regardless of whether they directly support IPE programs or participate in interprofessional activities.

Elevating Evidence-Based Practice: A Multi-Site Workshop Pilot for Nurses.

Leveraging an established evidence-based practice (EBP) workshop at the Mayo Clinic campus in Arizona, the manager of Nursing Research asked local library staff to discuss the research process and to demonstrate to the attendees how to use literature databases to support their research projects and EBP practices on their units. The EBP workshop was presented via video conference from the originating location to two remote locations within the organization. Each remote site had a librarian in attendance to support the librarian at the originating campus. This method allowed the librarians at each site to guide and assist patrons and establish a face-to-face connection with attendees.

Reality Check: Basics of Augmented, Virtual, and Mixed Reality.

Augmented, virtual, and mixed reality applications all aim to enhance a user's current experience or reality. While variations of this technology are not new, within the last few years there has been a significant increase in the number of artificial reality devices or applications available to the general public. This column will explain the difference between augmented, virtual, and mixed reality and how each application might be useful in libraries. It will also provide an overview of the concerns surrounding these different reality applications and describe how and where they are currently being used.

Merging Technology and Emotions: Introduction to Affective Computing.

Affective computing technologies are designed to sense and respond based on human emotions. This technology allows a computer system to process the information gathered from various sensors to assess the emotional state of an individual. The system then offers a distinct response based on what it "felt." While this is completely unlike how most people interact with electronics today, this technology is likely to trickle into future everyday life. This column will explain what affective computing is, some of its benefits, and concerns with its adoption. It will also provide an overview of its implication in the library setting and offer selected examples of how and where it is currently being used.

Feast for the Eyes: An Introduction to Data Visualization.

Data visualization is defined as the use of data presented in a graphical or pictorial manner. While data visualization is not a new concept, the ease with which anyone can create a data-drive chart, image, or visual has encouraged its growth. The increase of free sources of data and need for user-created content on social media has also led to a rise in data visualization's popularity. This column will explore what data visualization is and how it is currently being used. It will also discuss the benefits, potential problems, and uses in libraries. A brief list of visualization guides is included.

Online Professional Profiles: Health Care and Library Researchers Show Off Their Work.

In an increasingly digital world, online profiles can help health care and library professionals showcase their research and scholarly work. By sharing information about their investigations, studies, and projects, health care and library researchers can elevate their personal brand and connect with like-minded individuals. This column explores different types of online professional profiles and addresses some of the concerns that come with using them. A list of online professional profile and platform examples is also provided.

An Introduction to Gamification: Adding Game Elements for Engagement.

Gamification is defined as the use of game design elements in a nongame context. While gamification is not a new concept, new dynamics are unfolding that may cause more businesses, educators, and librarians to consider the use of game-like elements into future endeavors. In addition to more generation Y or millennials entering higher education and the workplace, there has been a significant acceptance of routinely using smartphones and playing games. This column will explain what gamification is, provide an overview of the benefits and concerns surrounding gamification, and describe how and where it is currently being used.

Presenting your best: web-based applications for library instruction.

Library instruction in academic, health sciences, and hospital libraries is an evolving concept. Content, the intended learner, and various teaching models influence the creation of library instructional tutorials and presentations. Standard programs such as PowerPoint and Keynote are often used to generate these instructional materials. However, new and dynamic web-based presentation applications have the potential to improve the learning experience for patients and health care professionals. This column will briefly touch on library instruction and standard presentation creators, but will mainly concentrate on six web-based applications that can be used for the creation of library instructional presentations.

An introduction to altmetrics.

Altmetrics, or alternative metrics, are forging a new way to capture the impact of not only articles, but also scholarly or research "products" by tracking them when they are mentioned online, such as in blogs or social media platforms. While altmetrics have a lot of potential, there are also some limitations preventing their full acceptance alongside traditional citation metrics. This column will explain the basics of altmetrics and altmetric tools, discuss some of the ways they can be used in libraries, and explore some possible concerns with this new metric. A list of resources for additional information is also included.

Taking advantage of Google's Web-based applications and services.

Google is a company that is constantly expanding and growing its services and products. While most librarians possess a "love/hate" relationship with Google, there are a number of reasons you should consider exploring some of the tools Google has created and made freely available. Applications and services such as Google Docs, Slides, and Google+ are functional and dynamic without the cost of comparable products. This column will address some of the issues users should be aware of before signing up to use Google's tools, and a description of some of Google's Web applications and services, plus how they can be useful to librarians in health care.