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Who can use the content that a library licenses? What are e-rights? Can licensed digital content be distributed through interlibrary loan? The digital revolution has altered how libraries acquire and distribute content to patrons. Gone are the days in which libraries primarily purchased and owned physical materials. In the internet era, content can be temporarily leased electronically, which has led to unexpected legal issues for librarians and other non-lawyers to navigate (1). In Licensing Digital Content: A Practical Guide for Librarians, Harris provides a plain-language crash course in digital licensing intended to give inexperienced librarians the skills necessary to negotiate a digital license. The guide provides readers with a detailed description of the licensing experience from the development of a licensing needs assessment to the negotiation of the final agreement.

Importance Procedures for stress urinary incontinence and benign gynecologic surgery are often performed concurrently, and associated complication rates have previously been unexplored. Objective The aim of this study was to compare postoperative complication rates between women undergoing midurethral sling (MUS) placement at the time of benign gynecologic surgery and those undergoing MUS alone. Study Design This was a retrospective matched cohort study of women undergoing MUS with or without concurrent minimally invasive benign gynecologic surgery from January 2010 through December 2020. Eligible women undergoing concurrent surgery were matched to a cohort of women undergoing MUS placement alone. The electronic medical record was queried for demographic and perioperative/postoperative data up to 12 months after surgery. Results Thirty-eight women met inclusion criteria for the concurrent group, and 152 women were matched accordingly. The overall adverse event rate was 39.5% (95% confidence interval [CI], 0.25–0.55) for the concurrent group and 24.3% (95% CI, 0.18–0.32) for the MUS-only group (P = 0.05). Adverse events with Clavien-Dindo grade ≤ 2 were higher in the concurrent group (Clavien-Dindo Grade 1: 5% vs 0%, P = 0.04; Clavien-Dindo Grade 2: 16% vs 6%, P = 0.04), as was composite postoperative resource utilization (76% vs 49%, P = 0.003). Mesh exposure (P = 0.03) and sling lysis/excision rates (P = 0.02) were higher in the concurrent group. On logistic regression, concurrent surgery cases remained significantly associated with sling mesh erosion (adjusted odds ratio, 12.6; 95% CI, 1.4–116.4). Conclusions Midurethral sling placement at the time of minimally invasive benign gynecologic surgery is safe but is associated with a higher incidence of postoperative hospital resource utilization and sling mesh extrusion, and a need for revision.

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