The Use of Clips to Prevent Post-Polypectomy Bleeding: A Clinical Review.

GOALS: The goal of this clinical review is to provide an overview of the current literature regarding the utility of prophylactic clips in reducing postpolypectomy bleeding and to provide an expert statement regarding their appropriateness in clinical practice. BACKGROUND: Colonoscopy enables the identification and removal of premalignant and malignant lesions through polypectomy, yet complications including postpolypectomy bleeding (PPB) can arise. While various studies have explored applying clips prophylactically to prevent PPB, their effectiveness remains uncertain. STUDY: A literature search conducted in PubMed and Embase identified 671 publications discussing clip use postpolypectomy; 67 were found to be relevant after screening, reporting outcomes related to PPB. Data related to clip utilization, polyp characteristics, and adverse events were extracted and discussed. RESULTS: The current literature suggests that prophylactic clipping is most beneficial for nonpedunculated polyps ≥20 mm, especially those in the proximal colon. The utility of clipping smaller polyps and those in the distal colon remains less clear. Antithrombotic medication usage, particularly anticoagulants, has been linked to an increased risk of bleeding, prompting consideration for clip placement in this patient subgroup. While cost-effectiveness analyses may indicate potential savings, the decision to clip should be tailored to individual patient factors and polyp characteristics. CONCLUSIONS: Current research suggests that the application of prophylactic clips can be particularly beneficial in preventing delayed bleeding after removal of large nonpedunculated polyps, especially for those in the proximal colon and in patients on antithrombotic medications. In addition, for large pedunculated polyps prophylactic clipping is most effective at controlling immediate bleeding.

How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take.

TOPIC: Understanding approaches to sustainability in cataract surgery and their risks and benefits. CLINICAL RELEVANCE: In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS: We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS: Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke-style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS: Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Recognizing the value of meta-research and making it easier to find.

Meta-research is a bourgeoning field studying topics with significant relevance to health sciences librarianship, such as research reproducibility, peer review, and open access. As a discipline that studies research itself and the practices of researchers, meta-research spans disciplines and encompasses a broad spectrum of topics and methods. The breadth of meta-research presents a significant challenge for identifying published meta-research studies. Introducing a subject heading for meta-research in the controlled vocabularies of literature databases has the potential to increase the visibility of meta-research, further advance the field, and expand its impact on research practices. Given the relatively recent designation of meta-research as a field and its expanding use as a term, now is the time to develop appropriate indexing vocabulary. We seek to call attention to the value of meta-research for health sciences librarianship, describe the challenges of identifying meta-research literature with currently available key terms, and highlight the need to establish controlled vocabulary specific to meta-research.

Mapping the pathways to health sciences librarianship: reflections and future implications from an immersion session.

Objective: Many health sciences librarians enter the profession without specific health sciences training. Some LIS programs have health sciences courses or tracks, but health sciences training within an LIS program is only one path to entering health sciences librarianship. To develop a map of pathways into health sciences librarianship, an immersion session at the Medical Library Association conference in 2022 asked health sciences librarians to share how they entered the profession. Methods: The immersion session was structured in three parts: facilitator introductions, small group discussions, and a whole group summary discussion. Guided by questions from the facilitators, small groups discussed what pathways currently exist, how to promote existing pathways, what new pathways should be created, and how to develop and promote pathways that make the profession more equitable, diverse, and inclusive. Results: Through in-the-moment thematic analysis of the small group discussions, the following emerged as key pathways: library school education; internships and practica; the Library and Information Science (LIS) pipeline; on-thejob training; mentoring; self-teaching/hands-on learning; and continuing education. Themes of equity, diversity, and inclusion arose throughout the session, especially in the concluding whole group discussion. Conclusion: Small group discussions in a conference immersion session showed the value of community building in a profession that has multiple pathways for entrance, highlighting the importance of unearthing hidden knowledge about avenues for exploring and enhancing career pathways. The article seeks to address barriers to entry into the profession and adds to the literature on strengthening the field of health sciences librarianship.

Responding to a new generation of proprietary study resources in medical education.

Traditionally, health sciences libraries have supported patrons who are preparing for medical licensure examinations by collecting and making accessible board exam preparation resources, such as question banks and study guides. However, when online board exam preparation resources are not available for licensing, providing equitable access to all library users can be a challenge. In recent years, a new generation of online study resources has emerged. Sites such as SketchyMedical and Picmonic use visual learning mnemonics, while resources such as Quizlet leverage crowd-sourcing to generate study content. While some of the content from these resources is made freely available, these resources are often limited to paid individual subscribers. This new generation of study resources, thus, presents a conundrum for health sciences librarians. On the one hand, these innovative resources offer new insights into how students learn and study, reflecting pedagogical trends in self-directed learning. On the other hand, the proprietary individual subscription-based model of these resources can widen the achievement gap between students who can afford to pay subscription costs and those who cannot. This commentary provides an overview of some of the most popular medical board examination preparation resources that have emerged in recent years. The authors suggest that health sciences librarians collaborate with medical students and educators to better understand and evaluate these resources.

Identifying meta-research with researchers as study subjects: Protocol for a scoping review.

BACKGROUND: Meta-research in which researchers are the study subjects can illuminate how to better support researchers and enhance the development of research capacity. Comprehensively compiling the literature in this area can help define best practices for research capacity development and reveal gaps in the literature. However, there are challenges to assessing and synthesizing the breadth of the meta-research literature produced. METHODS: In this article, we discuss the current barriers to conducting literature reviews on meta-research and strategies to address these barriers. We then outline proposed methods for conducting a scoping review on meta-research with researchers as study subjects. DISCUSSION: Due to its interdisciplinary nature, broad scope, and difficult to pinpoint terminology, little is known about the state of meta-research with researchers as the study subjects. For this reason, there is a need for a scoping review that will identify research performed in which researchers were the study subjects.

Complications of Nasal Tip Stabilizing Grafts with Autologous Versus Irradiated Homologous Costal Cartilage in Septorhinoplasty: A Systematic Review.

Background: Complications associated with the use of autologous and homologous costal cartilage for nasal tip stabilizing grafts in septorhinoplasty are not well understood. Objective: The authors review current literature to evaluate complications associated with autologous and irradiated homologous costal cartilage (IHCC) used for septal extension and columellar strut grafts in rhinoplasty. Method: A comprehensive literature search was conducted in PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Articles that used autologous or IHCC for either septal extension or columellar strut grafts in patients undergoing septorhinoplasty were included. The primary outcomes analyzed were postoperative complications. Results: A total of 14 studies representing 1358 patients were included. The pooled complication rate was 4.7%. IHCC grafts were associated with a higher incidence of complications (n = 21, 5.0% vs. n = 44, 4.6%, p = 0.01). Resorption was the most common complication in the IHCC group and occurred significantly more frequently than in the autologous costal cartilage (ACC) group (n = 10, 2.4% vs. n = 5, 0.49%, p = 0.002). Deviation/warping was the most common complication in the ACC group (n = 16, 1.7%). Conclusion: Autologous and irradiated homologous costal rhinoplasties remain safe procedures. The increased incidence of resorption associated with IHCC grafts should be considered during preoperative planning.

Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocol.

This protocol outlines a proposed scoping review to characterize evidence on implementation and quality improvement (QI) strategies that aim to improve equitable, evidence-informed care delivery for pregnant and birthing people with substance use disorder (SUD) in acute care. Untreated SUD during pregnancy is associated with an increased risk of overdose and severe maternal morbidity. Acute care settings are one important place to deliver equitable, evidence-informed clinical care. While clinical practice guidelines for substance use treatment and care of pregnant and birthing people with SUD exist, there are gaps in implementation. Our population of interest is pregnant and birthing people with SUD in an acute care setting. We will include US-based studies that describe or evaluate implementation or QI strategies, including experimental, observational, and descriptive studies published from 2016 to 2023. The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews and registered at OSF (registration number: BC4VZ). We will search MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsychInfo (Ovid) for published studies. Conference proceedings and Perinatal Quality Collaborative websites will be searched for grey literature. Two reviewers will independently screen then extract studies that meet inclusion criteria using a data extraction tool. The completion of this scoping review will help illuminate strengths and gaps in research and practice that aim to inform substance use treatment and care in acute care settings for pregnant and birthing people with SUD.

Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol.

INTRODUCTION: Research on effectively navigating older adults into primary care is urgently needed. Community-clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order to improve patients' access to healthcare and, ultimately, population health. However, research on community-based points of entry linking adults with untreated medical needs into the healthcare sector is nascent. CCLMs implemented for the general adult population are not necessarily accessible to older adults. Given the recency of the CCLM literature and the seeming rarity of CCLM interventions designed for older adults, it is appropriate to employ scoping review methodology in order to generate a comprehensive review of the available information on this topic. This protocol will inform a scoping review that reviews characteristics of community-based programmes that link older adults with the healthcare sector. METHODS AND ANALYSIS: The present protocol was developed as per JBI Evidence Synthesis best practice guidance and reporting items for the development of scoping review protocols. The proposed scoping review will follow Levac and colleagues' update to Arksey and O'Malley's scoping review methodology. Healthcare access at the system and individual levels will be operationalised in data extraction and analysis in accordance with Levesque and colleagues' Conceptual Framework of Access to Health. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Beginning in August 2023 or later, citation databases (AgeLine (Ebsco); CINAHL Complete; MEDLINE (PubMed); Scopus Advanced (Elsevier); Social Services Abstracts (ProQuest); Web of Science Core Collection (Clarivate)) and grey literature (Google; American Public Health Association Annual Meeting Conference Proceedings; SIREN Evidence & Resource Library) will be searched. ETHICS AND DISSEMINATION: The authors plan to disseminate their findings in conference proceedings and publication in a peer-reviewed journal and deposit extracted data in the Figshare depository. The study does not require Institutional Review Board approval. REGISTRATION DETAILS: Protocol registered in Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2EF9D).

A Prioritized Patient-Centered Research Agenda to Reduce Disparities in Telehealth Uptake: Results from a National Consensus Conference.

Introduction: We hosted a national consensus conference with a diverse group of stakeholders to develop a patient-centered research agenda focused on reducing disparities in telehealth use. Methods: Attendees were purposively invited to participate in a 2-day virtual conference. The group developed a prioritized research agenda focused on reducing disparities in telehealth uptake, with discussion informed by findings from a scoping review. All work was conducted in partnership with a Steering Committee of national experts in telehealth and patient-centered care (n = 5) and a community-based Telehealth Advisory Board with experience with telehealth use and barriers (n = 8). Results: Sixty individuals participated in the conference and discussion resulted in a final list of 20 questions. Fifty-two attendees voted on the final prioritization of these questions. Results were aggregated for all voters (n = 52) and patient-only voters (n = 8). The top question identified by both groups focused on patient and family perspectives on important barriers to telehealth use. The entire group voting identified telehealth's impact on patient outcomes as the next most important questions, while the patient-only group identified trust-related considerations and cultural factors impacting telehealth use as next priorities. Conclusions: This project involved extensive patient and stakeholder engagement. While voting varied between patients only and the entire group of conference attendees, top identified priorities included patient and family perspectives on important barriers to telehealth, trust and cultural barriers and facilitators to telehealth, and assessment of telehealth's impact on patient outcomes. This research agenda can inform design of future research focused on addressing disparities in telehealth use.

Developing Pathways to Health Sciences Librarianship with an Introductory Course and Mentoring Program.

Because of gaps in the offerings of Library and Information Science programs and librarian continuing education programs, library students and early-career librarians may not be aware of opportunities in health sciences librarianship. There is a need for introductory educational offerings on the foundations of health sciences librarianship. There is also a need to address barriers that may obstruct members of underrepresented groups from becoming health sciences librarians. The article explores the possibility that online education and mentoring can address gaps in introductory educational offerings in health sciences librarianship. The article describes the development of a pilot program for an online Introduction to Health Sciences Librarianship course and mentoring program, reflects on results from a survey of program participants, and identifies areas for further research and program development. The article also discusses the potential implications the program may have for addressing equity, diversity, and inclusion in health sciences librarianship.

Continuous glucose monitoring metrics for earlier identification of pre-diabetes: protocol for a systematic review and meta-analysis.

INTRODUCTION: Glycaemic variability and other metrics are not well characterised in subjects without diabetes. More comprehensive sampling as obtained with continuous glucose monitoring (CGM) may improve diagnostic accuracy of the transition from health to pre-diabetes. Our goal is to investigate the glycaemic system as it shifts from health to pre-disease in adult patients without diabetes using CGM metrics. New insights may offer therapeutic promise for reversing dysglycaemia more successfully with dietary, nutritional and lifestyle change before progression occurs to pre-diabetes and diabetes. METHODS AND ANALYSIS: This systematic review will include comprehensive searches of the PubMed, Scopus, Cochrane Library and ClinicalTrials.gov databases, with restrictions set to studies published in the last 10 years in English and planned search date 10 March 2022. Reference lists of studies that meet eligibility criteria in the screening process will subsequently be screened for the potential inclusion of additional studies. We will include studies that examine CGM use and report diagnostic criteria such as fasting glucose and/or haemoglobin A1c such that we can assess correlation between CGM metrics and established diagnostic criteria and describe how CGM metrics are altered in the transition from health to pre-diabetes. The screening and data extraction will be conducted by two independent reviewers using Covidence. All included papers will also be evaluated for quality and publication bias using Cochrane Collaboration risk of bias tools. If there are two or more studies with quantitative estimates that can be combined, we will conduct a meta-analysis after assessing heterogeneity. ETHICS AND DISSEMINATION: The systematic review methodology does not require formal ethical review due to the nature of the study design. Study findings will be publicly available and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022308222.