Evaluation of Different Surgical Techniques for Revision Cubital Tunnel Release: A Meta-Analysis of Patient-Reported Symptoms.

PURPOSE: Controversy exists regarding the best option for revision surgery in refractory cubital tunnel syndrome (CuTS). The purpose of this systematic review was to evaluate the effectiveness of revision surgery and determine the optimal surgical approach for patients requiring revision surgery for CuTS. METHODS: A literature search was conducted. Characteristics of the included studies were summarized descriptively. The risk ratio between patient-reported preoperative and postoperative outcomes relating to pain, motor, and sensory deficits was calculated. A meta-regression analysis was performed to evaluate the postoperative symptom improvements based on the type of secondary surgery. Random-effects meta-analysis and descriptive statistics were used when appropriate. RESULTS: A total of 471 patients were evaluated in 20 studies. In total, 254 (53.9%) male and 217 (46.1%) female patients, with an average age of 49.2 ± 14.1 years, were included in this study. Pain was the most common symptom (n = 346, 81.6%), followed by sensory and motor dysfunction in 342 (80.6%) and 223 (52.6%) patients, respectively. Meta-analysis comparing preoperative and postoperative symptoms between patients who had submuscular transposition (SMT), subcutaneous transposition (SCT), and neurolysis showed that a significant subgroup difference exists between the types of revision surgery in sensory and motor improvements. Meta-regression showed that SMT was associated with better outcomes compared with SCT in motor and sensory improvements. CONCLUSIONS: Revision surgery for CuTS can be useful for addressing recurrent and persistent symptoms. Compared with neurolysis and SCT, SMT seems to be the superior option for revision surgery, demonstrating substantial improvement in all symptom domains. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Racial and Ethnic Demographic Reporting in Phase 2 Proton Therapy Clinical Trials: A Review.

Purpose: Equitable inclusion of racial and ethnic participation in clinical trials is crucial to improving disparities in health care, especially for historically marginalized populations. Our study aims to describe the racial and ethnic demographics of patients enrolled in published phase 2 clinical trials involving proton therapy in the United States. Materials and Methods: Published manuscripts were identified in PubMed, Embase, World of Science, and Cochrane. Phase 2 trials evaluating proton therapy for US patients were included. For each article in the study, data were collected comprising authors, title, and publication year, and clinical trial numbers were verified. Additional data included tumor site, primary institution, sample size, reported race/ethnicity, and raw number/percentile of race/ethnicity. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Results: Overall, 970 titles were identified; 636 remained after duplicate screening, and 75 full-text articles were assessed. We identified 38 eligible manuscripts for inclusion comprising 2648 patients. Only 15 (39%) of the publications reported race/ethnicity. Of these, 8 (21%) and 10 (26%) documented Hispanic or Black trial participants, respectively; however, only 6 (16%) documented trial participation for both Hispanic and Black patients. Of the 1409 patients with a documented race/ethnicity, 89.0% (n = 1254) were non-Hispanic white, 5.3% (n = 75) were Black, and 2.2% (n = 31) were Hispanic. Other and unknown race/ethnicity comprised the remaining patients (3.5%; n = 49). Conclusion: We identified underreporting of demographic data in published phase 2 proton therapy trials, which unfortunately mirrored underreporting for cancer drug clinical trials. We also noted dramatic Black and Hispanic patient underrepresentation across the trials in which race and ethnicity are reported. Findings highlight the urgent need to identify and address barriers to proton therapy trials for Black and Hispanic patients ensuring clinical trials in radiation oncology are representative of the patients seen in clinical practice.

Assessing Health Students' Knowledge of and Perceived Utility and Effectiveness of Graphic Medicine Materials.

Librarians can participate in the innovative field of graphic medicine by developing a collection of this genre. To assess the appropriateness of a graphic medicine collection in a university health science library, this study assessed knowledge of and usage of graphic medicine materials, as well as the materials' perceived utility and effectiveness. Given that responses suggested that graphic medicine resources can be useful to educational and clinical initiatives, it is reasonable for health science libraries to collect in this area. Further research in a practical setting can help illuminate the true effectiveness of graphic medicine materials in these realms.

Characteristics and Treatment of Patients Diagnosed With Paradoxical Adipose Hyperplasia After Cryolipolysis: A Case Series and Scoping Review.

BACKGROUND: Paradoxical adipose hyperplasia (PAH), a rare side effect of CoolSculpting (cryolipolysis), is characterized by fatty enlargement of the treatment area occurring months after the procedure. OBJECTIVES: The purpose of this study was to report a retrospective case series of patients diagnosed with PAH at the authors' institution, increase the collective understanding of this complication and subsequent management, and raise the question of who should ethically perform cryolipolysis. METHODS: All participants diagnosed with PAH by a plastic surgeon at a large academic medical center were identified. Demographic information, medical history, procedure details, time to PAH diagnosis, and corrective surgical intervention details were collected. Mean duration of time from cryolipolysis treatment to diagnosis of PAH was calculated, along with other descriptive statistics. A scoping review of all PAH literature published in PubMed, Embase, and Web of Science was also conducted. RESULTS: Four patients diagnosed with PAH after cryolipolysis were identified for inclusion in this study. The calculated incidence of PAH at our center was 0.67%. All patients requested therapy for PAH and subsequently underwent either liposuction, abdominoplasty, or both. The mean duration of in-person follow-up time after final surgical treatment of PAH was 13.8 + 19.8 months (range, 2.8-43.5). Fortunately, no patients showed signs of PAH recurrence, and 3 out of 4 patients did not show signs of residual deformity. CONCLUSIONS: Findings from this patient cohort and scoping review provide evidence that although revisions may be required, conventional body contouring methods, not in the armamentarium of non-plastic surgeon practitioners, effectively alleviated PAH.

Updating the landmark literature for the practice of geriatrics: Notable articles from 2012-2019.

BACKGROUND: Remaining current on the latest advances in the peer-reviewed literature is a basic tenant of medical education and evidence-based practice. We updated an important prior publication (Vaughan, et al.) identifying landmark articles in geriatric medicine by considering the influence of altmetrics and updating the list with notable articles published between 2012 and 2019. METHODS: Articles were identified by searching Web of Science and Scopus for highly cited articles clinically relevant to geriatrics or gerontology and by searching the Altmetric Explorer database for relevant articles with high altmetric scores. The results of the literature search were screened and evaluated using a bibliometric score consisting of an adjusted journal impact factor, citation count, and altmetric score. RESULTS: The top 12 notable articles in geriatrics were selected by a consensus panel and ranked using an expert opinion survey. This process reinforces the concept of combining subjective and objective measures to identify notable articles to be used for the education of healthcare professionals in geriatrics principles of care for older adults. CONCLUSIONS: While our update was performed approximately 9 years after the initial identification of landmark articles, we propose that future updates are conducted at an interval of every 5 years by the governance of a national professional society.

Viewing Victor McKusick's legacy through the lens of his bibliography.

Victor McKusick's contributions to the field of medical genetics are legendary and include his contributions as a mentor, as creator of Mendelian Inheritance in Man (now Online Mendelian Inheritance in Man [OMIM®]), and as a leader in the field of medical genetics. McKusick's full bibliography includes 772 publications. Here we review the 453 papers authored by McKusick and indexed in PubMed, from his earliest paper published in the New England Journal of Medicine in 1949 to his last paper published in American Journal of Medical Genetics Part A in 2008. This review of his bibliography chronicles McKusick's evolution from an internist and cardiologist with an interest in genetics to an esteemed leader in the growing field of medical genetics. Review of his bibliography also provides a historical perspective of the development of the discipline of medical genetics. This field came into its own during his lifetime, transitioning from the study of interesting cases and families used to codify basic medical genetics principles to an accredited medical specialty that is expected to transform healthcare. Along the way, he helped to unite the fields of medical and human genetics to focus on mapping the human genome, culminating in completion of the Human Genome Project. This review confirms the critical role played by Victor McKusick as the founding father of medical genetics.

Juvenile idiopathic arthritis, gait characteristics and relation to function.

BACKGROUND: Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance. METHODS: Six databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582) RESULTS: The search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway. CONCLUSIONS: Key features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.

Compassionate Computing in the Time of COVID-19: Interview with Laurie N. Taylor.

When COVID-19 was recognized as a global pandemic and offices, clinics, and academic centers closed in the spring of 2020, many librarians found themselves answering reference questions, teaching, meeting, facilitating access to information resources, and organizing resources remotely. In the transition from traditional offices and workspaces to work from home, librarians and their administrations faced many challenges and adapted to a variety of new technologies. Video-conferencing and phone-forwarding tools were being used in new ways or for the first time. Instead of addressing technology that librarians adopted or adapted in greater numbers during the global pandemic, this column will examine an attitude of care and approach to technology called "compassionate computing" that helped ease the transition to work from home during an unprecedented time.

Assistive Technology and Software to Support Accessibility.

Since the implementation of the Americans with Disabilities Act (ADA), efforts have been made to increase access to public services, businesses, education, and public spaces for all members of the community. However, digital accessibility to information online is regularly an afterthought or applied retroactively, rather than a standard consideration integrated into the creation, instruction, and dissemination of information resources. Libraries can serve as advocates for increasing digital accessibility to information resources. This column will investigate what technologies are currently being utilized for digital accessibility, discuss concerns related to digital accessibility, and consider methods for libraries to become more involved with supporting and integrating digital accessibility into online library services.

Putting Misinformation Under a Microscope: Exploring Technologies to Address Predatory False Information Online.

The dissemination of misinformation in health care and the sciences has become a growing concern over the last five years. Whether the false information is spread with malice or merely ignorance, researchers, providers, librarians, regulatory bodies, and internet platform providers have all begun taking steps to identify false information and halt its proliferation online. Some companies have begun looking at ways to apply artificial intelligence and machine learning to timely and widespread identification efforts. This column will investigate what technologies are currently being considered for addressing the misinformation crisis, discuss concerns over the application of such technologies, and consider methods for libraries to become more involved with the technological side of the issue.

Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection: A Meta-Analysis with Trial Sequential Analysis.

INTRODUCTION: Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections. METHODS: We performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias. RESULTS: After performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56-0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41-0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16-0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04-1.93, p = 0.03, I2 = 0%). CONCLUSION: This meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence. FUNDING: University of Florida Open Access Publishing Fund funded the Rapid Service Fees. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442).

Can You Hear Me Now? Social Listening as a Strategy for Understanding User Needs.

Maintaining regular engagement with audiences through various forms of social media is becoming more important as library users and the general public increasingly rely on social media for news, updates, and feedback. While large corporations have been monitoring social media for more than a decade, libraries have recently begun to use social listening to stay abreast of trends and assess user needs as voiced directly by their communities. This column will explain what social listening is, explore concerns over its widespread application, consider examples of social media listening software currently available, and offer an overview of its application in library settings.

HIV/AIDS information promotion at the library: creative campaigns for young adults.

BACKGROUND: While rates of new HIV diagnoses have gone down nationally, Florida's HIV-positive population is growing and remains one of the largest in the country. Given this landscape, it is clear that diverse, creative, and collaborative efforts are needed to better inform the public about HIV risks, prevention, and treatment and to encourage healthy behaviors. CASE PRESENTATION: Building on previous work, librarians at the University of Florida engaged in a yearlong project to raise awareness about HIV/AIDS risks, prevention, and treatment among university students and to improve their information-seeking behaviors related to this disease. The "Creative Campaigns" project included 3 distinct elements of activity and engagement, designed to complement one another: a graphic novel contest, a social media campaign, and training for campus health care providers. The contest yielded 4 high-quality submissions, and the month long social media campaign garnered over 50,000 views and utilized Facebook ads to extend beyond the library's typical audience. The instruction proved useful to campus counseling and wellness staff. CONCLUSIONS: Overall, the team considered the project a success in terms of reaching new audiences in new ways, and several of its components have been integrated into subsequent projects and regular operations. Exploring new methods of outreach through social media and creative formats required careful planning and the development of new skill sets amongst project team members but proved to be a rewarding way to generate engagement in the local community.

Minimally invasive interval cytoreductive surgery in ovarian cancer: systematic review and meta-analysis.

The introduction of minimally invasive surgery in other gynecologic cancers has shown benefits with similar oncologic outcomes. However, the biology and complexity of surgery for ovarian cancer may preclude this approach for ovarian cancer patients. Our objective is to assess feasibility to achieve complete cytoreductive surgery after neoadjuvant chemotherapy for stage IIIC-IV ovarian cancer patients via minimally invasive surgery. Our data sources include PubMed, Embase, Scopus, Biosis, Clinicaltrials.gov, and the Cochrane Library. Meta-analysis was performed using the random-effects model with DerSimonian and Laird estimator for the amount of heterogeneity to estimate the pooled outcomes. A funnel plot and Egger's regression test were used to test publication bias. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies. There were 6 studies (3 prospective, 3 retrospective) that met the criteria for meta-analysis with a total of 3231 patients, 567 were in the minimally invasive group and 2664 in the laparotomy group. Both groups were similar in stage and serous histology. Complete cytoreductive surgery was achieved in 74.50% (95% CI 40.41-97.65%) and 53.10% (95% CI 4.88-97.75%) of patients in the minimally invasive and laparotomy groups, respectively. There was no statistical significant difference between these 2 pooled proportions (p = 0.52). Three studies compared minimally invasive surgery vs laparotomy. No significant difference was observed between the 2 groups in obtaining complete cytoreductive surgery [OR = 0.90 (95% CI 0.70-1.16; p = 0.43)]. A symmetrical funnel plot indicated no publication bias. The pooled proportion for grade > 2 postoperative complications was not significant among the laparoscopy group [3.11% (95% CI 0.00-10.24%; p = 0.15)]. Complete cytoreductive surgery appears feasible and safe with minimally invasive surgery in selected advanced ovarian cancer patients after neoadjuvant chemotherapy.

The (Un)Common Instructor: A New Role for Medical Librarians Beyond Information Literacy.

University common reading programs provide a shared experience as students transition into college life and develop critical thinking skills. Typically in such programs, all students in an incoming class read and discuss the same book. Conversely, the University of Florida Honors Program's (un)common reads facilitates the same skills development through multiple small sections, each focusing on a different book and each with flexible and innovative assignments and activities. Health Science Center librarians have taught in these (un)common reads since the spring semester 2010-2011. This article describes librarian involvement in this program as well as the ensuing benefits for students, librarians, and the university at large.

Use of annual surveying to identify technology trends and improve service provision.

OBJECTIVE: At an academic health sciences library serving a wide variety of disciplines, studying library users' technology use provides necessary information on intersection points for library services. Administering a similar survey annually for five years generated a holistic view of users' technology needs and preferences over time. METHODS: From 2012 to 2016, the University of Florida Health Science Center Library (HSCL) annually administered a sixteen-to-twenty question survey addressing health sciences users' technology awareness and use and their interest in using technology to engage with the library and its services. The survey was distributed throughout the HSC via email invitation from liaison librarians to their colleges and departments and advertisement on the HSCL home page. RESULTS: Smartphone ownership among survey respondents was nearly universal, and a majority of respondents also owned a tablet. While respondents were likely to check library hours, use medical apps, and use library electronic resources from their mobile devices, they were unlikely to friend or follow the library on Facebook or Twitter or send a call number from the catalog. Respondents were more likely to have used EndNote than any other citation management tool, but over 50% of respondents had never used each tool or never heard of it. CONCLUSIONS: Annual review of survey results has allowed librarians to identify users' needs and interests, leading to incremental changes in services offered. Reviewing the aggregate data allowed strategic consideration of how technology impacts library interactions with users, with implications toward library marketing, training, and service development.

Mind over Matter: Using Technology to Improve Wellness.

Wellness-the balance of mental, emotional, spiritual, and physical health for the overall health benefit of the individual-is a growing concern, particularly for professionals in the medical field. Although wellness is usually viewed in opposition to technology, more digital devices and mobile applications are emerging to support wellness for health consumers. This wellness technology seeks to improve the overall health of the user through increasing calm and decreasing stress. This column will explain what wellness technology is, concerns over its widespread application, examples of wellness devices on the market currently, and an overview of where it is being applied in libraries.

A Review of Two-Factor Authentication: Suggested Security Effort Moves to Mandatory.

Two-factor authentication has been available to technology consumers for a long time, and a few years ago businesses and institutions began implementing optional two-factor authentication to improve digital security. Now more universities and hospitals are moving from optional to mandatory two-factor authentication, and employees used to two-factor authentication for their personal digital life must adjust to using two-factor authentication in their work flow. This column will review some of the ongoing and emergent aspects of two-factor authentication to enhance security in an ever-changing digital landscape.