Outcomes of Head and Neck Free Tissue Transfer Requiring Vein Grafting: Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the literature to determine the prevalence of free flap failure in head and neck free flaps requiring vein grafting.

DATA SOURCES

Search strategies created in collaboration with a medical librarian were implemented using PubMed, Cochrane, Scopus, Web of Science, and Google Scholar from inception to August 2022.

REVIEW METHODS

The population of interest included adult and pediatric patients undergoing reconstruction of oncologic or traumatic head and neck defects with a free flap requiring a vein graft that presents the success/failure rate. The primary outcome was the flap failure rate, and the secondary outcome was the flap compromise/revision rate. Inclusion and exclusion criteria were designed to capture all study designs. Initially, 2778 articles were identified by the search strategy. Two reviewers independently performed the review, data extraction for analysis, and a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Meta-analysis was performed using a random effects model.

RESULTS

Eleven studies of 789 flaps were included for data extraction. Random effects meta-analysis resulted in an estimated prevalence of free flap failure of 12.30% (95% confidence interval: 6.39%-19.49%, I2 = 77.4%).

CONCLUSION

Taking into account that head and neck free tissue transfers that require a vein graft are typically associated with more challenging reconstructions and the lack of a suitable alternative, vein grafts appear to be a reliable method for bridging the gap between the flap and recipient vessels in head and neck free tissue transfer when indicated.

Vaccines for Respiratory Syncytial Virus Prevention in Older Adults

OBJECTIVE

This review evaluates the efficacy and safety of novel respiratory syncytial virus (RSV) vaccines approved for adults aged 60 years and older.

DATA SOURCES

A literature search through February 27, 2024 was conducted using search terms, such as RSV, viral respiratory illness, vaccine, RSVpreF, RSVpreF3, Prefusion F, Abrysvo, and Arexvy.

STUDY SELECTION AND DATA EXTRACTION

Data from primary literature and vaccine prescribing information were reviewed, encompassing evaluations of clinical pharmacology, efficacy, safety, adverse events, warnings, and precautions.

DATA SYNTHESIS

The literature review process resulted in 10 articles included within this article's scope, including the results of 2 major phase III trials presented in detail. Two RSV vaccines, Respiratory Syncytial Virus Vaccine (recombinant [adjuvanted]; RSVpreF3-ASO1E, Arexvy) and Respiratory Syncytial Virus Vaccine (recombinant; RSVpreF, Abrysvo), approved for preventing RSV-associated lower respiratory tract disease (LRTD) in adults aged 60 years or older in the United States are discussed. Results from Phase III trials have demonstrated the efficacy of 1 dose of these vaccines in preventing RSV-associated LRTD across 2 RSV seasons.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

The Advisory Committee on Immunization Practices currently recommends use of these vaccines under shared clinical decision-making for adults aged 60 years or older. Most common adverse effects include injection site reactions (eg, site pain, redness, and swelling). Administration requires a single intramuscular injection of 0.5 mL, reconstituted prior to administration.

CONCLUSIONS

The RSVpreF3-ASO1E and RSVpreF vaccines effectively prevent RSV-associated LRTD in adults aged 60 years and older.

Trends In... Librarians and Faculty Status

Within academic libraries there are a variety of models for faculty status or classification applicable to librarians within their institutions. Some librarian positions are tenure track, some are non-tenure track, and some are classified as non-faculty administrative staff roles. This column will outline things to consider when a librarian classified as staff, professional or non-faculty is approached to take on a faculty role in an academic department outside of the library or is presented with the opportunity to pursue faculty status as a librarian. Having these statuses has benefits as well as challenges which should be considered before taking on such a role.

Miscommunication and Employee Power Dynamics May Affect Student Navigation of Library Resources

A Review of: Almeida, N., & Tidal, J. (2022). Library wayfinding and ESOL students: Communication challenges and empathy-based intervention. portal: Libraries and the Academy, 22(2), 453–474. https://doi.org/10.1353/pla.2022.0025   Objective – To map the experiences of students of English for speakers of other languages (ESOL) navigating an academic library. Design – A wayfinding study to evaluate how students navigate a library. Setting – An urban-based academic library at an institution of higher education. Subjects – Students of English for speakers of other languages (ESOL). Methods – A mixed methods study including visual recordings, web screen capture, interviews, and surveys. Subjects were recruited through email. Twelve participants were selected and given an initial screening survey. They were given four tasks to complete: Find a book in the stacks, find a book in the reserves, find a DVD in media, and find a database. They were equipped with a GoPro camera and were given a think-aloud protocol (TAP). They were then given a post-task debriefing interview. Qualitative data were analyzed and coded. Quantitative data like success of task and time to completion were also recorded. Main Results – Success rate varied among tasks: Finding a book in reserves had the highest rate at 75%, while finding a database had the lowest at 50%. Time also varied from 12 minutes to find a book in the stacks to just under 6 minutes to find a database. Seven of the 12 participants indicated they had prior library experience; however, they still encountered skill gaps. They lacked familiarity with the space, policies, website, and terminology. Participants also struggled with library jargon and inconsistent use of jargon among staff and librarians. Conclusion – The researchers discovered there were discrepancies between language used in signs, directions provided by staff, and information provided on the website. Signage was important because several participants made remarks on lack a familiarity with the library space. They would get lost and anxious. In addition, the video recordings and subsequent discussions among the staff and librarians showed issues arising from the power dynamics in the library organization. Staff felt pressured to provide reference services when librarians were unavailable due to staffing shortages, which led to miscommunication. These conclusions lead to empathy-based training to address language discrepancies and experiences among staff. It also provided additional rationale for hiring.

The Use of Search Request Forms Can Identify Gaps in a Consumer Health Library Collection

A Review of: Giannopoulos, E., Snow, M., Manley, M., McEwan, K., Stechkevich, A., Giuliani, M. E., & Papadakos, J. (2021). Identifying gaps in consumer health library collections: A retrospective review. Journal of the Medical Library Association: JMLA, 109(4), 656–666. https://doi.org/10.5195/jmla.2021.895 Abstract Objective – The objective of this study was to determine if search request forms, which are used when a patron’s request for information cannot be fulfilled at the time of contact with the library team, can be used to identify gaps in consumer health library collections while offering some explanation for the gaps. Design – Retrospective case study of search request forms. Setting – A consumer health library at an academic cancer center in Canada. Subjects – Library patrons: Patients, Patient family, other members of the center, and unspecified. Methods – The researchers reviewed 260 search request forms submitted between 2013 and 2020. Of those, 249 records met inclusion criteria and were analyzed and coded. Coding included patron type, cancer diagnosis, information delivery, and content themes. This information was then used to identify gaps in the library collection and the reasons for the gaps. Main Results – Patients were the primary patrons, asking 62.9% of the questions, followed by family members at 22.5%. The most common cancer type researched was breast at 23.3%, then hematology at 16.5%. gynecology, gastrointestinal, genitourinary, and sarcoma were next between 10% and 8.4%. The remaining cancer types ranged between 6.0 % and 2.0%, with brain being the lowest. Of the questions asked, 60% revealed a gap in the collection. The gaps included rare cancer diagnosis, treatment options, and prognosis. There were data collected on why the information was unavailable. While 53% of the gaps were a result of limited health consumer information, 25% were a result of paywall restrictions or content restricted to members. Conclusion – Search request forms can be an effective tool in evaluating gaps in collections. In this study, the researchers were able to identify that breast cancer patients made up the most significant proportion of patrons, and the biggest gaps in the collection were related to their treatment decisions. One opportunity to bridge this gap is through collaboration with clinical teams in developing patient friendly resources on this topic. In addition, inter-institutional collaboration between libraries may also help. Continued review of forms can help inform collection decisions to better meet the needs of patrons.

Fertility preservation in transgender men and the need for uniform, comprehensive counseling

Objective

To review the literature to assess best practices for counseling transgender men who desire gender-affirming surgery on fertility preservation options.

Design

A scoping review of articles published through July 2021.

Setting

None.

Patient(s)

Articles published in Cochrane, Web of Science, PubMed, Science Direct, SCOPUS, and Psychinfo.

Intervention(s)

None.

Main Outcome Measure(s)

Papers discussing transgender men, fertility preservation (FP), and FP counseling.

Result(s)

The primary search yielded 1,067 publications. After assessing eligibility and evaluating with a quality assessment tool, 25 articles remained, including 8 reviews, 5 surveys, 4 consensus studies, 3 retrospective studies, 3 committee opinions, and 2 guidelines. Publications highlighted the importance of including the following topics during counseling: (1) FP and family building options; (2) FP outcomes; (3) effects of testosterone therapy on fertility; (4) contraception counseling; (5) attitudes toward family building; (6) consequences of transgender parenting; and (7) barriers to success.

Conclusion(s)

Currently, there is a lack of standardization for comprehensive counseling about FP for transgender men. Standardized approaches can facilitate conversation between physicians and transgender men and ensure patients are making informed decisions regarding pelvic surgery and future family building plans.

A Case Study on How Reference Staffing and Visibility Models Impact Patron Behaviors

A Review of: Holm, C.E. & Kantor, S. (2021). Reference is not dead: A case study of patron habits and library staffing models. Portal: Libraries and the Academy, 21(2), 299–316. https://doi.org/10.1353/pla.2021.0017 Abstract Objective – To determine if reference staffing models are a predictor of reference question rates and if academic library patrons’ reference behaviors are linked to reference staffing models and desk visibility. Design – A retrospective case study. Setting – Two academic libraries at a large R3 public university in the state of Georgia, United States of America. Subjects – 10,295 service transactions (chat and in-person, including non-reference transactions related to directional and technology questions) from the 2016 fiscal year and 6,568 service transactions (chat and in-person, including only chat non-reference transactions) from FY 2017. Methods – Analysis of two years of service transaction data (July 2015 to June 2017) recorded by librarians using the reference analytics module of Springshare’s LibAnswers at three locations (virtual 24/7 chat and two libraries with different physical locations, such as centrally-located or harder-to-find service points) for three kinds of reference service modes: chat, fully-staffed in-person services, and occasional “on-call” services. “Reference” transactions were classified using the Reference & User Services Association (RUSA) definition. Email, SMS/text, and Facebook inquiries were excluded from this study. One library, which had the same service model for the 2016-2017 fiscal years, served as the study’s “control” so that an analysis of service model alterations could be conducted.Main Results – The rate of chat reference remained steady, independent from the desk model employed. There was also an overall decline in reference questions from FY 2016 to FY 2017. For FY 2016, the average daily chat transaction rate was 16.1 inquiries (range: 0 inquiries for some days and up to 51 for others) compared to an average 20.5 inquiries at the two physical service locations (range: 0 to 95 inquiries per day). In FY 2017, the average daily chat transaction rate was 13.9 inquiries (range: 0 to 46 inquiries per day) compared to 6.8 transactions for the physical locations (range: 0 to 19 inquiries per day). For FY 2016, when the model shifted to on-call, the average daily chat transaction rate was 14 inquiries compared to the physical locations with 0 and .67 inquires per day. In FY 2017, the averages were 19.33 for chat compared to .33 and .33 for the physical locations. Conclusion – For the two fiscal years studied here, question rates and reference behaviors seemed to be linked to staffing models. Patrons in this study preferred a staffed and visible desk and 24/7 chat, while “on-call” services were not favored. By replacing the visible desk with an on-call model, the library created a situation where chat was the only consistent reference service offering. As a result, patrons may have viewed the visible desk as being unreliable. The on-call service model appears to have negatively affected patron behavior since, according to the data presented, patrons’ reference needs were best met by chat and a visibly staffed desk service model.

The Rutgers University Libraries Open and Affordable Textbook (OAT) Program

The Rutgers University (RU) Open and Affordable Textbooks (OAT) Program provides $1,000 incentive awards to faculty who commit to redesigning or developing a course to use open or affordable course materials. This can include replacing a traditional textbook with open educational resources (OER), library-licensed materials, course reserves, self-developed materials, or a combination of these. It is a university-wide initiative, but this paper will focus on the impact on students in the health science programs. In many cases Health Sciences faculty went beyond using open educational resources by developing their own and making them freely available to their students and others. As of 2020 it is estimated students in the health sciences have saved $285,218 through the use of open materials and sustainable course design.

Two populations in need. The Metropolitan Elder Care Alliance

The elderly population in the Chicago area benefits from an unusual home care aide program--one in which the aides also benefit: aides are drawn from the population receiving public assistance and given training that offers them a career ladder and opportunity they might otherwise not have had, all while helping others.