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Testicular torsion is a known cause of morbidity in pediatric patients, but the burden in the adult population is poorly understood. We sought to determine the incidence of testicular torsion and risk factors for orchiectomy in a population encompassing all ages. A cohort analysis of 1625 males undergoing surgery for torsion was performed using the 2011 and 2012 Healthcare Cost and Utilization Project Nationwide Emergency Departments Sample. Patient and hospital factors were examined for association with orchiectomy vs. testicular salvage. The estimated yearly incidence of testicular torsion was 5.9 per 100,000 males ages 1-17 years and 1.3 per 100,000 males ≥18 years. Among those undergoing surgical intervention, orchiectomy was performed in 33.6%. The risk of orchiectomy was highest in patients 1-11 years of age and patients over 50 years of age (46.0% and 69.7% of patients, respectively). Orchiectomy was also associated with public insurance (Medicaid/Medicare) or self-pay as primary payer. While testicular torsion is less common in the adult population, the rate of orchiectomy is high. Those with disadvantaged payer status are also at increased risk for testicular loss.

Over the past century, retroperitoneal lymph node dissection (RPLND) for patients with non-seminomatous germ cell tumors has evolved to become an indispensable diagnostic and therapeutic procedure. Bilateral RPLND with inclusion of the suprahilar regions initially established therapeutic efficacy but was associated with significant ejaculatory morbidity. Decades later, multiple anatomic mapping studies demonstrated a predilection for low-volume retroperitoneal metastases to be ipsilateral and infrahilar, leading to the introduction and popularity of several modified templates. By minimizing contralateral dissection and avoiding essential neural pathways, coordinated antegrade ejaculation rates improved considerably. Simultaneously, prospective nerve-sparing techniques were developed to preserve sympathetic nerve function, allowed for modified or bilateral templates, and resulted in minimal ejaculatory morbidity. The primary oncologic concern with modified templates remains the potential for unresected 'extra-template' disease leading to retroperitoneal or systemic recurrences requiring additional therapy. While modified templates continue to be widely used, larger scale and longer-term studies are essential to fully elucidate their appropriate application and therapeutic efficacy.

The goal of this work was to identify methods of clinician-patient cancer-related communication that may impact patient outcomes associated with distress at critical points in the course of cancer care.A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines for quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Instrument, and the contributive value for recommendations was assessed. Systematic reviews and randomized trials were also evaluated for methodological rigor.Four existing guidelines, eight systematic reviews and nine randomized trials were identified. Two of the guidelines were of high quality, and all systematic reviews reported clear search criteria and support for their conclusions; the randomized trials were of modest or low quality. For all situations and disease stages, guidelines consistently identified open, honest, and timely communication as important; specifically, there was evidence for a reduction in anxiety when discussions of life expectancy and prognosis were included in consultations. Techniques to increase patient participation in decision-making were associated with greater satisfaction but did not necessarily decrease distress. Few studies took cultural and religious diversity into account.There is little definitive evidence supporting the superiority of one specific method for communicating information compared to another. Evidence regarding the benefit of decision aids or other strategies to facilitate better communication is inconsistent. Since patients vary in their communication preferences and desire for active participation in decision making, there is a need to individualize communication style.

This article compares Moscow’s and Washington’s foreign policies toward the Middle East in 1982 and 2008. In 1982, Moscow and Washington each had a distinct set of friends and foes. In 2008, Washington still has a distinct set of friends and foes, but Moscow has relatively good relations with all governments and most major opposition movements in the region—the only exceptions being Al Qaeda and its affiliates. It is argued that Putin’s policy toward the Middle East is not really aimed at displacing the U.S. in the region, but protecting Russia and Russian interests from Al Qaeda and its allies. Indeed, a continued American presence in the region serves to protect Russian interests in the region.

Background Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. We analyzed data from population-based infectious disease surveillance for severe acute respiratory illness (SARI) among children 20% additional cases. Conclusions Influenza viruses and RSV (and possibly PIV, hMPV and adenoviruses) are important pathogens to consider when developing technologies and formulating strategies to treat and prevent SARI in children.

To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations.The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in cancer patients were selected for review by two group members based on predefined criteria.Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression, two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual care.There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence from the general population and other medically ill populations, combined approaches to the treatment of depression may be the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial, pharmacological, and combined treatments.

To examine the influence of initial interest, pre-clerkship experiences, clerkship experiences, and enrichment activities on choosing a career in psychiatry. Residents in psychiatry at the authors’ medical school completed a survey that examined each of these factors in relation to career choice. Thirty participants ranked initial interest as the most influential factor. Thirteen residents with low initial interest ranked clerkship experiences and negative experiences in other specialties as more influential than the 17 residents with high initial interest. Twelve residents who had attended the authors’ medical school rated enrichment activities, particularly psychiatry electives, as more influential than the remaining 18 from other medical schools did. Although limited by small sample size and potential recall biases, this study suggests that positive clerkship experiences and participation in psychiatry electives may be modifiable programmatic factors that could enhance recruitment to psychiatry.

Background For disease surveillance, manual data collection using paper-based questionnaires can be time consuming and prone to errors. We introduced smartphone data collection to replace paper-based data collection for an influenza sentinel surveillance system in four hospitals in Kenya. We compared the quality, cost and timeliness of data collection between the smartphone data collection system and the paper-based system. Methods Since 2006, the Kenya Ministry of Health (MoH) with technical support from the Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC) conducted hospital-based sentinel surveillance for influenza in Kenya. In May 2011, the MOH replaced paper-based collection with an electronic data collection system using Field Adapted Survey Toolkit (FAST) on HTC Touch Pro2 smartphones at four sentinel sites. We compared 880 paper-based questionnaires dated Jan 2010-Jun 2011 and 880 smartphone questionnaires dated May 2011-Jun 2012 from the four surveillance sites. For each site, we compared the quality, cost and timeliness of each data collection system. Results Incomplete records were more likely seen in data collected using pen-and-paper compared to data collected using smartphones (adjusted incidence rate ratio (aIRR) 7, 95% CI: 4.4-10.3). Errors and inconsistent answers were also more likely to be seen in data collected using pen-and-paper compared to data collected using smartphones (aIRR: 25, 95% CI: 12.5-51.8). Smartphone data was uploaded into the database in a median time of 7 days while paper-based data took a median of 21 days to be entered (p

The definitive version of this document can be found here: http://www.springerlink.com/content/b0qvjvke6428b5dr/ This document was created using OCR technology, and may contain minor discrepancies from the published document.

Definitions of revolution have strongly influenced theorization about it. We argue here that revolution is a highly variable phenomenon. Rigid definitions of revolution do not allow for theorizing which explains this variability. Revolution can occur to various degrees along various dimensions. These include the political, international, economic, cultural, ethnic, and gender dimensions. Revolutions do not necessarily affect all these dimensions equally. Revolutions that have led to great change along some of these dimensions have also led to little or no change along others. We further argue that an understanding of revolution requires an understanding of what maintains social order.

Accurate staging of clinically localized prostate cancer is crucial to ensure patients receive optimal management and counseling. Despite the growing number of diagnostic modalities, however, accurate staging remains a challenge. In this Viewpoint, Mitchell et al. discuss the relative merits of tried and tested and newly emerging staging techniques.