Search

Objectives To perform a survey assessing the use of, attitudes towards, and perceived utility of social media (SoMe) in the 2021 urology residency match. Methods We distributed surveys to urology residency applicants and program directors (PDs) via the Urology Match 2021 Google Spreadsheet and email. The survey collected demographic information as well as SoMe activity, perceived pressure to use SoMe, match results, and attitudes regarding the utility of SoMe in the match process. Results A total of 108/528 (20%) applicants registered for the 2021 match and 61/142 (43%) PDs completed the survey. More applicants than PDs felt that SoMe helped them gain better insight into residency programs or applicants, respectively. Fewer applicants than PDs felt that SoMe activity provided a benefit to them in the match process. No significant relationship was found between SoMe viewing frequency, posting frequency, or tweetorial use with match outcomes. The majority of PDs believed that SoMe played a more important role in the 2021 match process than previous years while 15% and 12% reported that an applicant's SoMe activity helped or hurt the chances of matching to their program respectively. Conclusions SoMe, particularly Twitter, was widely used in the 2021 match by both applicants and PDs. A majority of applicants and PDs believed that SoMe use aided them in some way in the match process, yet there was no relationship between the volume or type of applicant SoMe activity and match outcomes.

Introduction : Inflammatory conditions affecting the heart and surrounding tissues have been recently reported following mRNA vaccination. Evaluating trends in the epidemiology of these events and possible mechanisms related to vaccination will enhance vaccine safety surveillance and inform best practices for future vaccine campaigns. Areas covered : Epidemiology of the burden of vaccine-associated myocarditis are reviewed. Key summaries of available data from public health advisory bodies and vaccine safety surveillance databases are critically reviewed. The possible biological pathways for vaccine-associated heart inflammations are introduced. A critical synthesis of available information to inform vaccine recommendations and best practices is provided. The citations were selected by the authors based on PubMed searches of the literature, national vaccine safety surveillance databases and summaries from national public health bodies. Expert opinion : Myocarditis may be associated with vaccination, through several biological mechanisms. Studies have shown that live viral vaccinations can act as a trigger for hypersensitivity inflammatory reactions, but further work is required to examine how the mRNA formulation may induce these autoimmune responses. Given that the risk of these adverse events is low, and the benefit of protection against disease is so great, the receipt of mRNA vaccines is recommended.

Purpose It has been well documented that a significant number of children with developmental language disorders (DLDs) also exhibit challenging behaviors. In this study, a new intervention (Play and Language [PAL]) was developed through a research collaboration between a speech-language pathologist and a play therapist. The purpose of this clinical focus article is to describe child play therapy techniques and how these, along with early language intervention techniques, may positively impact preschool children's general communication and behavior. Method Students in a communication sciences and disorders program were trained to use a combination of child therapy techniques and language facilitation procedures in the PAL approach. Five preschool children, who displayed DLD and challenging behaviors, participated in a 2-week daily intensive intervention. Pre- and postintervention data for general communication and behavior skills were collected through parent report and language sample data. Student clinician and parent surveys were collected to assess the feasibility of conducting the new intervention and the parent-observed outcomes and satisfaction. Results A majority of the children who participated in the study increased their intelligibility and number of different words. Fewer than half increased their sentence length. These same children decreased their challenging behaviors, with 11 of 14 behaviors being reduced to normal levels. All parents reported satisfaction with their child's results. In addition, students trained to provide the intervention reported high levels of satisfaction with the training to implement PAL and that they were confident in providing the intervention techniques. Conclusion Together, our exploratory data provide preliminary and limited evidence that combining play therapy and language facilitation techniques may improve general communication skills and decrease challenging behaviors within the same intervention. Supplemental Material https://doi.org/10.23641/asha.16840459

Background A question frequently raised in the field is whether evidence-based interventions have adequate translational capacity for delivery in real-world settings where patients are presumed to be more complex, clinicians less specialized, and multidisciplinary teams less coordinated. The dual purpose of this article is to (a) outline a model for implementing evidence-driven, outpatient treatments for eating disorders in a non-academic clinical setting, and (b) report indicators of feasibility and quality of care. Main Body Since our inception (2015), we have completed nearly 1000 phone intakes, with first-quarter 2021 data suggesting an increase in the context of COVID-19. Our caseload for the practice currently consists of approximately 200 active patients ranging from 6 to 66 years of age. While the center serves a transdiagnostic and trans-developmental eating disorder population, modal concerns for which we receive inquiries are Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder, with the most common age range for prospective patients spanning childhood through late adolescence/emerging adulthood; correspondingly, the modal intervention employed is Family-based treatment. Our team for each case consists, at a minimum, of a primary internal therapist and a physician external to the center. Short Conclusion We will describe our processes of recruiting, training and coordinating team members, of ensuring ongoing fidelity to evidence-based interventions, and of training the next generation of clinicians. Future research will focus on a formal assessment of patient outcomes, with comparison to benchmark outcomes from randomized controlled trials., Plain English summary A question frequently raised in the eating disorders field is whether treatments that were developed and tested in research environments can achieve the same results in real-world clinical settings, where patients’ diagnoses are presumed to be more complex, clinicians less specialized, and multi-professional care teams less coordinated. The purpose of this article is to outline a model for implementing evidence-driven, outpatient treatments for eating disorders in non-academic clinical settings, specifically private practices and specialty programs. We describe the philosophy, infrastructure, training processes, personnel, and procedures utilized to optimize care delivery and to create accountability for both scientifically-adherent practice and positive patient outcomes. We also outline ways to be producers—not just consumers—of research in the private sector, and to train the next generation of scientifically-informed eating disorder specialists, all with the goal to bridge the research-practice divide.

PURPOSE: We examined the demographic and clinicopathological parameters associated with the time to convert from active surveillance to treatment among men with prostate cancer. MATERIALS AND METHODS: A multi-institutional cohort of 7,279 patients managed with active surveillance had data and biospecimens collected for germline genetic analyses. RESULTS: Of 6,775 men included in the analysis, 2,260 (33.4%) converted to treatment at a median followup of 6.7 years. Earlier conversion was associated with higher Gleason grade groups (GG2 vs GG1 adjusted hazard ratio [aHR] 1.57, 95% CI 1.36–1.82; ≥GG3 vs GG1 aHR 1.77, 95% CI 1.29–2.43), serum prostate specific antigen concentrations (aHR per 5 ng/ml increment 1.18, 95% CI 1.11–1.25), tumor stages (cT2 vs cT1 aHR 1.58, 95% CI 1.41–1.77; ≥cT3 vs cT1 aHR 4.36, 95% CI 3.19–5.96) and number of cancerous biopsy cores (3 vs 1–2 cores aHR 1.59, 95% CI 1.37–1.84; ≥4 vs 1–2 cores aHR 3.29, 95% CI 2.94–3.69), and younger age (age continuous per 5-year increase aHR 0.96, 95% CI 0.93–0.99). Patients with high-volume GG1 tumors had a shorter interval to conversion than those with low-volume GG1 tumors and behaved like the higher-risk patients. We found no significant association between the time to conversion and self-reported race or genetic ancestry. CONCLUSIONS: A shorter time to conversion from active surveillance to treatment was associated with higher-risk clinicopathological tumor features. Furthermore, patients with high-volume GG1 tumors behaved similarly to those with intermediate and high-risk tumors. An exploratory analysis of self-reported race and genetic ancestry revealed no association with the time to conversion.

Background Numerous statistical methods can be used to calculate the confidence interval (CI) of risk differences. There is consensus in previous literature that the Wald method should be discouraged. We compared five statistical methods for estimating the CI of risk difference in terms of CI width and study conclusion in antibiotic non-inferiority trials. Methods In a secondary analysis of a systematic review, we included non-inferiority trials that compared different antibiotic regimens, reported risk differences for the primary outcome, and described the number of successes and/or failures as well as patients in each arm. For each study, we re-calculated the risk difference CI using the Wald, Agresti-Caffo, Newcombe, Miettinen-Nurminen, and skewness-corrected asymptotic score (SCAS) methods. The CIs by different statistical methods were compared in terms of CI width and conclusion on non-inferiority. A wider CI was considered to be more conservative. Results The analysis included 224 comparisons from 213 studies. The statistical method used to calculate CI was not reported in 134 (59.8%) cases. The median (interquartile range IQR) for CI width by Wald, Agresti-Caffo, Newcombe, Miettinen-Nurminen, and SCAS methods was 13.0% (10.8%, 17.4%), 13.3% (10.9%, 18.5%), 13.6% (11.1%, 18.9%), 13.6% (11.1% and 19.0%), and 13.4% (11.1%, 18.9%), respectively. In 216 comparisons that reported a non-inferiority margin, the conclusion on non-inferiority was the same across the five statistical methods in 211 (97.7%) cases. The differences in CI width were more in trials with a sample size of 100 or less in each group and treatment success rate above 90%. Of the 18 trials in this subgroup with a specified non-inferiority margin, non-inferiority was shown in 17 (94.4%), 16 (88.9%), 14 (77.8%), 14 (77.8%), and 15 (83.3%) cases based on CI by Wald, Agresti-Caffo, Newcombe, Miettinen-Nurminen, and SCAS methods, respectively. Conclusions The statistical method used to calculate CI was not reported in the majority of antibiotic non-inferiority trials. Different statistical methods for CI resulted in different conclusions on non-inferiority in 2.3% cases. The differences in CI widths were highest in trials with a sample size of 100 or less in each group and a treatment success rate above 90%. Trial registration PROSPERO CRD42020165040. April 28, 2020.

Summary Background The WHO Model List of Essential Medicines classified antibiotics into Access, Watch, and Reserve (AWaRe) categories for the treatment of 31 priority bacterial infections as a tool to facilitate antibiotic stewardship and optimal use. We compared the listing of antibiotics on national essential medicines lists (NEMLs) to those in the 2019 WHO Model List and the AWaRe classification database to determine the degree to which NEMLs are in alignment with the AWaRe classification framework recommended by WHO. Methods In this cross-sectional study, we obtained up-to-date (data after 2017) NEMLs from our Global Essential Medicines (GEM) database, WHO online resources, and individual countries' websites. From the 2019 WHO Model List we extracted, as a reference standard, a list of 37 antibiotics (44 unique antibiotics after accounting for combination drugs or therapeutically equivalent drugs as specified by WHO) that were considered essential in treating 31 of the most common and severe clinical infectious syndromes (priority infections). From the WHO AWaRe Classification Database, which contains commonly used antibiotics globally, we extracted a list of 122 AWaRe antibiotics listed by at least one country in the GEM database. We then assessed individual countries' NEMLs for listing of the 44 essential and 122 commonly used antibiotics, overall and according to AWaRe classification group. We also evaluated and summarised the listing of both first-choice and second-choice treatments for the 31 priority infections. A total coverage score was calculated for each country by assigning a treatment score of 0–3 for each priority infection on the basis of whether first-choice and second-choice treatments, according to the 2019 WHO Model List, were included in the country's NEML. Coverage scores were then compared against the score of the 2019 WHO Model List and across World Bank income groups and WHO regions. Findings As of July 7, 2020, we had up-to-date NEMLs for 138 countries. Of the 44 unique essential antibiotics, 24 were Access, 15 were Watch, and five were Reserve. The median number of total essential antibiotics listed across the 138 NEMLs was 26 (IQR 21–32). 102 (74%) countries listed at least 22 (50%) of the 44 essential antibiotics. The median number of total AWaRe antibiotics listed by the 138 countries was 35 (IQR 29–46), of Access antibiotics was 18 (16–21), of Watch antibiotics was 16 (11–22), and of Reserve antibiotics was one (0–2). 56 (41%) countries did not list any essential Reserve antibiotics. 131 (95%) countries had coverage scores of at least 60, equivalent to at least 75% of the score of the 2019 WHO Model List, which was 80. Nine (7%) countries listed fewer than 12 of 24 essential Access antibiotics, and seven (5%) did not list sufficient first-choice and second-choice treatments for priority infections (ie, they had coverage scores lower than 60). Of the 31 priority infections, acute neonatal meningitis and high-risk febrile neutropenia did not have enough listed treatments, with 82 (59%) countries listing no treatment for acute neonatal meningitis and 84 (61%) countries listing only a first-choice treatment, only a second-choice treatment, or no treatment for high-risk febrile neutropenia. Coverage scores differed between countries on the basis of World Bank income groups (p=0·025). Interpretation Our findings highlight potential changes to the antibiotics included in NEMLs that would increase adherence to international guidance aimed at effectively treating infectious diseases while addressing antimicrobial resistance. Funding Canadian Institutes of Health Research and Ontario Strategy for Patient Oriented Research Support Unit.

Background. Tobacco and alcohol are two main risk factors associated with head and neck squamous cell carcinoma (HNSCC). Studies showed that human papillomavirus (HPV) plays a role in the etiology of this cancer. HPV-positive oropharyngeal squamous cell carcinoma (OSCC) patients present in general a better response to conventional therapy and better overall survival (OS). However, OSCC is a heterogeneous disease regarding treatment. This study aimed to identify more effective prognostic factors associated with a poor clinical outcome for OSCC patients to improve treatment selection. Materials and Methods. OSCC patients diagnosed between 2007 and 2017, in two Belgian hospitals, were included. Demographic and clinicopathologic data were extracted from medical records. HPV status was determined through p16 immunohistochemistry. Univariable and multivariable Cox proportional hazard regression analyses allowed to identify variables prognostic for OS and recurrence-free survival (RFS). Kaplan–Meier survival curves have been assessed for survival. Results. The study included 131 patients. Statistics showed that monotherapies were significantly associated with a shorter OS; p16 overexpression was significantly associated with a weak consumption of tobacco or alcohol, and a high p16 expression was significantly associated with both longer RFS and OS. The study validated that tobacco and alcohol consumption were significantly correlated with poorer RFS and poorer OS. Only p16 expression trended to be significant for RFS when compared to smoking and drinking habits, while p16 upregulation and alcohol use were both vital for OS indicating that p16 is an independent and significant prognostic factor in OSCC patients. Finally, a scoring system combining p16, tobacco, and alcohol status was defined and was significantly associated with longer RFS and longer OS for nonsmoker and nondrinker p16-positive OSCC patients. Conclusions. This study confirmed that the overexpression of the p16 protein could be viewed as a factor of good prognosis for RFS and OS of OSCC patients. The prognostic significance of a scoring system combining p16 expression, smoking, and drinking status was evaluated and concluded to be a more effective tool to determine therapeutic orientations based on the risk factors for better treatment relevance and survival.

Background The World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on urological services in different geographical areas is unknown. Objective To investigate the global impact of COVID-19 on urological providers and the provision of urological patient care. Design, setting, and participants A cross-sectional, web-based survey was conducted from March 30, 2020 to April 7, 2020. A 55-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of urological services. Target respondents were practising urologists, urology trainees, and urology nurses/advanced practice providers. Outcome measurements and statistical analysis The primary outcome was the degree of reduction in urological services, which was further stratified by the geographical location, degree of outbreak, and nature and urgency of urological conditions. The secondary outcome was the duration of delay in urological services. Results and limitations A total of 1004 participants responded to our survey, and they were mostly based in Asia, Europe, North America, and South America. Worldwide, 41% of the respondents reported that their hospital staff members had been diagnosed with COVID-19 infection, 27% reported personnel shortage, and 26% had to be deployed to take care of COVID-19 patients. Globally, only 33% of the respondents felt that they were given adequate personal protective equipment, and many providers expressed fear of going to work (47%). It was of concerning that 13% of the respondents were advised not to wear a surgical face mask for the fear of scaring their patients, and 21% of the respondents were advised not to discuss COVID-19 issues or concerns on media. COVID-19 had a global impact on the cut-down of urological services, including outpatient clinic appointments, outpatient investigations and procedures, and urological surgeries. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak. On average, 28% of outpatient clinics, 30% of outpatient investigations and procedures, and 31% of urological surgeries had a delay of >8 wk. Urological services for benign conditions were more affected than those for malignant conditions. Finally, 47% of the respondents believed that the accumulated workload could be dealt with in a timely manner after the COVID-19 outbreak, but 50% thought the postponement of urological services would affect the treatment and survival outcomes of their patients. One of the limitations of this study is that Africa, Australia, and New Zealand were under-represented. Conclusions COVID-19 had a profound global impact on urological care and urology providers. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak and was greater for benign than for malignant conditions. One-fourth of urological providers were deployed to assist with COVID-19 care. Many providers reported insufficient personal protective equipment and support from hospital administration. Patient summary Coronavirus disease-19 (COVID-19) has led to significant delay in outpatient care and surgery in urology, particularly in regions with the most COVID-19 cases. A considerable proportion of urology health care professionals have been deployed to assist in COVID-19 care, despite the perception of insufficient training and protective equipment., Take Home Message The coronavirus disease-19 (COVID-19) pandemic has imposed great challenges to the urological community globally. The impact of COVID-19 on urological services increased with the degree of outbreak, and resulted in significant delay in the delivery of urological care.

Supplemental Digital Content is available in the text., Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. Methods: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. Results: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. No recommendation was provided for six questions. The topics were: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy. Conclusion: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines.

Objective To evaluate the readability, quality, and accuracy of pelvic organ prolapse (POP) YouTube transcripts. Methods We analyzed the readability of written transcripts for the first 100 YouTube videos about “Pelvic Organ Prolapse.” Transcripts were excluded if they lacked narration in English or contained both no text and no audio. Readability was evaluated using an online software ( www.readabilityformulas.com ) to determine reading grade levels. The quality of videos was scored using the DISCERN quality criteria and the Patient Education Materials Assessment Tool. Accuracy was assessed by comparing content to accepted POP treatment guidelines. Results The median grade level of all 100 videos was 12.6. High quality transcripts or transcripts that discuss the benefits, risk, alternative treatments, and quality of life had a median readability score of 12.5. Transcripts with low misinformation (85%) had a higher median readability index (12.6), than transcripts containing high misinformation (12.2). More than 20% of transcripts discussed shared decision-making. The median readability index for videos with a high Patient Education Materials Assessment Tool score (>75%) for understandability and actionability were both 12.6. Conclusion Transcripts of POP YouTube videos are written at difficult levels with many transcripts exceeding the reading capabilities of the American population. The majority of good transcripts or transcripts with high quality content, low misinformation, shared decision-making, no commercial bias, and understandable and actionable content were written at a high school level or above. Efforts should be made to avoid complex terms when creating patient focused content and helping patients navigate to content of appropriate literacy online.

According to the 2018 American Urological Association census, only 9.2% of practicing urologists are female and 16% are non-Caucasian. Social media have been used in other medical disciplines to promote diversity and form networks for gender and racial minorities. We studied the hashtag #ILookLikeAUrologist, started to promote diversity and inclusion in urology, to determine if it had any signs of a community of practice. Over the 4 yr since its inception, there have been 3694 tweets using the hashtag #ILookLikeAUrologist. The discussion had 1348 unique contributors, hailing from 35 countries on six continents. There were 8,156,051 impressions, highlighting a wide potential reach for the discussion. In a random 25% sample of original tweets, the main themes were gender representation, followed by personal narratives and camaraderie. Most contributors were practicing urologists, followed by urology trainees, other physicians, and professional organizations. Although most posts were authored by women, men represented nearly a quarter of individual contributors. The #ILookLikeAUrologist hashtag has been widely used by a large global audience in urology. Future research is warranted to examine the impact of digital communities of practice on outcomes such as fostering collaboration, providing mentorship, and reducing burnout. PATIENT SUMMARY: The #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology.

BACKGROUND Studies have demonstrated that Black men may undergo definitive prostate cancer (CaP) treatment less often than men of other races, but it is unclear whether they are avoiding overtreatment of low-risk disease or experiencing a reduction in appropriate care. The authors' aim was to assess the role of race as it relates to treatment benefit in access to CaP treatment in a single-payer population. METHODS The authors used the Veterans Health Administration (VHA) Corporate Data Warehouse to perform a retrospective cohort study of veterans diagnosed with low- or intermediate-risk CaP between 2011 and 2017. RESULTS The authors identified 35,427 men with incident low- or intermediate-risk CaP. When they controlled for covariates, Black men had 1.05 times the odds of receiving treatment in comparison with non-Black men (P < .001), and high-treatment-benefit men had 1.4 times the odds of receiving treatment in comparison with those in the low-treatment-benefit group (P < .001). The interaction of race and treatment benefit was significant, with Black men in the high-treatment-benefit category less likely to receive treatment than non-Black men in the same treatment category (odds ratio, 0.89; P < .001). CONCLUSIONS Although race does appear to influence the receipt of definitive treatment in the VHA, this relationship varies in the context of the patient's treatment benefit, with Black men receiving less definitive treatment in high-benefit situations. The influence of patient race at high treatment benefit levels invites further investigation into the driving forces behind this persistent disparity in this consequential group.

Intensity in adolescent romantic relationships was examined as a long-term predictor of higher adult blood pressure in a community sample followed from age 17 to 31 years. Romantic intensity in adolescence – measured via the amount of time spent alone with a partner and the duration of the relationship – was predicted by parents’ psychologically controlling behavior and was in turn found to predict higher resting adult systolic and diastolic blood pressure even after accounting for relevant covariates. The prediction to adult blood pressure was partially mediated via conflict in nonromantic adult friendships and intensity in adult romantic relationships. Even after accounting for these mediators, however, a direct path from adolescent romantic intensity to higher adult blood pressure remained. Neither family income in adolescence nor trait measures of personality assessed in adulthood accounted for these findings. The results of this study are interpreted both as providing further support for the view that adolescent social relationship qualities have substantial long-term implications for adult health, as well as suggesting a potential physiological mechanism by which adolescent relationships may be linked to adult health outcomes.

Objective:Public health and emergency management agencies play a critical role in addressing the needs of vulnerable populations in preparation for and in response to emergencies. Identifying and leveraging community assets is a way to address such needs. This study focuses on the development of a process and tools to engage community leaders in sharing their knowledge about their community characteristics and assets useful for emergency planning.Methods:We conducted interviews with community leaders across five study sites with the goal of understanding what type of local knowledge community leaders are able to share in regard to emergency preparedness. Based on the interview results we developed and tested a mobile application as a mobile friendly directory of community assets.Results:We identified two main types of local knowledge about community assets for emergency preparedness: communication-based and trust-based local knowledge. We created an application to facilitate the sharing of such knowledge. Community leaders were able to share local knowledge across four areas: communication-based assets, trust-based assets, spatial-based assets and personal-preparedness assets.Conclusion:Community leaders’ engagement in preparedness efforts is important to identify community assets that can be leveraged to address the needs of the most vulnerable segments of a community.

Background: A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention. We aimed to examine the link between vitamin D supplementation and prevention of ARIs in an updated meta-analysis. Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and the ClinicalTrials.gov registry for studies listed from database inception to May 1, 2020. Double-blind RCTs of vitamin D3, vitamin D2, or 25-hydroxyvitamin D (25[OH]D) supplementation for any duration, with a placebo or low-dose vitamin D control, were eligible if they had been approved by a research ethics committee, and if ARI incidence was collected prospectively and prespecified as an efficacy outcome. Studies reporting results of long-term follow-up of primary RCTs were excluded. Aggregated study-level data, stratified by baseline 25(OH)D concentration and age, were obtained from study authors. Using the proportion of participants in each trial who had one or more ARIs, we did a random-effects meta-analysis to obtain pooled odds ratios (ORs) and 95% CIs to estimate the effect of vitamin D supplementation on the risk of having one or more ARIs (primary outcome) compared with placebo. Subgroup analyses were done to estimate whether the effects of vitamin D supplementation on the risk of ARI varied according to baseline 25(OH)D concentration (vs 25·0–49·9 nmol/L vs 50·0–74·9 nmol/L vs >75·0 nmol/L), vitamin D dose (daily equivalent of vs 400–1000 IU vs 1001–2000 IU vs >2000 IU), dosing frequency (daily vs weekly vs once per month to once every 3 months), trial duration (≤12 months vs >12 months), age at enrolment (vs 1·00–15·99 years vs 16·00–64·99 years vs ≥65·00 years), and presence versus absence of airway disease (ie, asthma only, COPD only, or unrestricted). Risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool. The study was registered with PROSPERO, CRD42020190633. Findings: We identified 1528 articles, of which 46 RCTs (75 541 participants) were eligible. Data for the primary outcome were obtained for 48 488 (98·1%) of 49 419 participants (aged 0–95 years) in 43 studies. A significantly lower proportion of participants in the vitamin D supplementation group had one or more ARIs (14 332 [61·3%] of 23 364 participants) than in the placebo group (14 217 [62·3%] of 22 802 participants), with an OR of 0·92 (95% CI 0·86–0·99; 37 studies; I2=35·6%, pheterogeneity=0·018). No significant effect of vitamin D supplementation on the risk of having one or more ARIs was observed for any of the subgroups defined by baseline 25(OH)D concentration. However, protective effects of supplementation were observed in trials in which vitamin D was given in a daily dosing regimen (OR 0·78 [95% CI 0·65–0·94]; 19 studies; I2=53·5%, pheterogeneity=0·003), at daily dose equivalents of 400–1000 IU (0·70 [0·55–0·89]; ten studies; I2=31·2%, pheterogeneity=0·16), for a duration of 12 months or less (0·82 [0·72–0·93]; 29 studies; I2=38·1%, pheterogeneity=0·021), and to participants aged 1·00–15·99 years at enrolment (0·71 [0·57–0·90]; 15 studies; I2=46·0%, pheterogeneity=0·027). No significant interaction between allocation to the vitamin D supplementation group versus the placebo group and dose, dose frequency, study duration, or age was observed. In addition, no significant difference in the proportion of participants who had at least one serious adverse event in the vitamin supplementation group compared with the placebo group was observed (0·97 [0·86–1·07]; 36 studies; I2=0·0%, pheterogeneity=0·99). Risk of bias within individual studies was assessed as being low for all but three trials. Interpretation: Despite evidence of significant heterogeneity across trials, vitamin D supplementation was safe and overall reduced the risk of ARI compared with placebo, although the risk reduction was small. Protection was associated with administration of daily doses of 400–1000 IU for up to 12 months, and age at enrolment of 1·00–15·99 years. The relevance of these findings to COVID-19 is not known and requires further investigation. Funding: None.

Introduction Depression is one of the most common mental illnesses in the United States and is often treated in primary care settings. Despite its prevalence, depression remains underdiagnosed and undertreated for a variety of reasons, including stigma. This may result in suboptimal management of depression. Studies evaluating stigma in US primary care providers (PCP) are scarce. The main objective of this study was to describe stigma in a cohort of PCPs. Methods We utilized a validated questionnaire to measure stigma (score range 15 to 75 with lower scores indicating lower stigma levels). PCPs in 2 academic internal medicine clinics were sent an electronic questionnaire and received a small monetary incentive for responding. In addition to the stigma survey, we collected demographic data, including age, provider type, gender, and other data related to social proximity to mental illness. To describe stigma, differences in stigma between provider characteristics were evaluated using t tests and ANOVA tests as appropriate. Results Of 107 PCPs, 71 responded (66.4% response rate). Male responders displayed higher stigma scores than females (31.8 vs 27.4, P = .0021). Medical residents displayed higher stigma scores than nonresidents (31.3 vs 27.2, P = .0045). Providers with personal exposure to mental illness and those who reported they frequently treated depression had less stigma. Discussion Overall, a range of stigma was present among PCPs surveyed. Higher levels of stigma were found in men, medical residents, those without personal exposure to mental illness, younger PCPs, and those who reported treating depression less frequently. Future studies should utilize larger sample sizes and focus on the impact of stigma on quality of care.

Objectives To determine the wait times to see an academic Female Pelvic Medicine and Reconstructive Surgery (FPMRS) urologist or gynecologist and to identify factors that may impact these wait times. Methods We reviewed all Accreditation Council for Graduate Medical Education accredited urology and gynecology residency programs. Offices of FPMRS providers were called to ascertain the earliest available new patient visit for a fictional female patient with “urine leakage.” Programs without FPMRS faculty (18.7%) were excluded. FPMRS providers that did not accept Medicaid (15.6%) were also excluded. Negative binomial regression was performed using SPSS v24. Results Final analysis included 362 FPMRS providers. Median wait time for a patient with Medicaid was 30 days (interquartile range [IQR] 15-51) and 26 days (IQR 14-42) for Medicare. The median wait time to see an FPMRS-trained gynecologist was 28 days (IQR 15-50) while FPMRS-trained urologists had a median wait time of 25 days (IQR 13.8-43.3). Female providers had longer median wait times when compared to male providers (30 vs 25 days). On regression analysis, only female gender of the provider was significant (P Conclusion Our study found that nearly 1 in 5 academic departments did not have an FPMRS-trained provider. We found that new patients with urinary incontinence encountered substantial wait times to see FPMRS providers at academic institutions. As we project increased demand for the FPMRS workforce, our findings reflect a challenging landscape where training additional FPMRS providers may be needed to meet demand.

Alpha-1 antitrypsin deficiency; Circulating polymers; Emphysema Deficiència d'alfa-1 antitripsina; Polímers circulants; Emfisema Deficiencia de alfa-1 antitripsina; Polímeros circulantes; Enfisema Background Alpha-1 antitrypsin deficiency (AATD) is considered one of the most common genetic diseases and is characterised by the misfolding and polymerisation of the alpha-1 antitrypsin (AAT) protein within hepatocytes. The relevance of circulating polymers (CP) of AAT in the pathogenesis of lung and liver disease is not completely understood. Therefore, the main objective of our study was to determine whether there is an association between the levels of CP of AAT and the severity of lung and liver disease. Method This was a cross-sectional study in patients with different phenotypes of AATD and controls. To quantify CP, a sandwich ELISA was performed using the 2C1 monoclonal antibody against AAT polymers. Sociodemographic data, clinical characteristics, and liver and lung parameters were collected. Results A cohort of 70 patients was recruited: 32 Pi*ZZ (11 on augmentation therapy); 29 Z-heterozygous; 9 with other genotypes. CP were compared with a control group of 47 individuals (35 Pi*MM and 12 Pi*MS). ZZ patients had the highest concentrations of CP (p

In addition to systemic gender disparities, women in surgery encounter interpersonal microaggressions. The objective of this study is to describe the most common forms of microaggressions reported by women in surgery. We conducted a scoping review using PubMed/MEDLINE, Ovid, and Web of Science to describe the international, indexed English-language literature on gender-based microaggressions experienced by female surgeons, surgical trainees, and medical students in surgery. After screening by title, abstract, and full-text, 37 articles were retained for data extraction and analysis. Microaggressions were analyzed using the Sexist Microaggression Experience and Stress Scale (MESS) framework and stratified by country of origin. Gender-based microaggression publications most commonly originated from the United States (n = 27 articles), Canada (n = 3), and India (n = 2). Gender-based microaggressions were classified into environmental invalidations (n = 20), being treated like a second-class citizen (n = 18), assumptions of traditional gender roles (n = 12), sexual objectification (n = 11), assumptions of inferiority (n = 10), being forced to leave gender at the door (n = 8), and experiencing sexist language (n = 6). Additionally, attendings were more frequently reported to experience microaggressions than surgical trainees and medical students, but more articles reported data on attendings (n = 16) than surgical trainees (n = 10) or students (n = 4). While recent advancements have opened the field of surgery to women, there is still a lack of female representation, and persistent microaggressions may perpetuate this gender disparity. Addressing microaggressions against female surgeons is essential to achieving gender equity in surgical practice.

Context Germline testing (GT) is increasingly impacting prostate cancer (PCa) management and screening, with direct effects in urology, medical oncology, and radiation oncology. The majority of testing indications and recommendations center on men with metastatic disease, although guidelines now encompass newly diagnosed, early-stage PCa and entail assessment of personal history, pathologic features, and family history to determine eligibility for testing. Objective To describe current guidelines on GT for men with PCa and the impact on management. An additional objective was to review the literature on current uptake of GT across practice settings. Evidence acquisition A nonsystematic review was performed of current guidelines on GT in PCa from professional societies and consensus conferences, detailing supporting evidence for these recommendations. This was supplemented by a literature review of uptake of GT and precision medicine in practice. Evidence synthesis Multiple guidelines and consensus panels recommend GT for men with metastatic PCa. Guidelines endorse BRCA2 testing in metastatic PCa because of strong evidence for PCa risk, aggressiveness, and PARP inhibitor candidacy. Testing of additional DNA repair genes in metastatic disease is also endorsed across guidelines. Immunotherapy with pembrolizumab is an option in some guidelines for men with DNA mismatch repair deficiency. In localized disease, GT is recommended on the basis of histologic features and family history; criteria vary between guidelines. GT for localized disease informs hereditary cancer risk and will probably impact future PCa management. Practice gaps exist regarding utilization of GT. Conclusions Germline evaluation is increasingly important in the management of men with metastatic PCa and may also affect the prognosis for men with localized disease. The presence of germline mutations has important hereditary cancer implications for men and their families. Uptake of germline evaluation may be underutilized in some practice settings, so strategies for optimization are required. Patient summary Patients with prostate cancer should talk to their doctor about the pros and cons of genetic testing, with attention to family history and cancer features. Genetic testing can have important implications for treatment, cancer screening, and family cancer risk.

Tests for Coronavirus disease 2019 (COVID-19) are intended for a disparate and shifting range of purposes: (1) diagnosing patients who present with symptoms to inform individual treatment decisions; (2) organizational uses such as "cohorting" potentially infected patients and staff to protect others; and (3) contact tracing, surveillance, and other public health purposes. Often lost when testing is encouraged is that testing does not by itself confer health benefits. Rather, testing is useful to the extent it forms a critical link to subsequent medical or public health interventions. Such interventions might be individual level, like better diagnosis, treatment, isolation, or quarantine of contacts. They might aid surveillance to understand levels and trends of disease within a defined population that enables informed decisions to implement or relax social distancing measures. In this article, we describe the range of available COVID-19 tests; their accuracy and timing considerations; and the specific clinical, organizational, and public health considerations that warrant different testing strategies. Three representative clinical scenarios illustrate the importance of appropriate test use and interpretation. The reason a patient seeks testing is often a strong indicator of the pretest probability of infection, and thus how to interpret test results. In addition, the level of population spread of the virus and the timing of testing play critical roles in the positive or negative predictive value of the test. We conclude with practical recommendations regarding the need for testing in various contexts, appropriate tests and testing methods, and the interpretation of test results.

BACKGROUND Pleraxifor for peripheral blood stem cell (PBSC) mobilization in children with malignancies is often given following failure of standard mobilization (SM) rather than as a primary mobilizing agent. STUDY DESIGN AND METHODS In this retrospective multicenter study, we report the safety of plerixafor-based PBSC mobilization in children with malignancies and compare outcomes between patients who received plerixafor upfront with SM (Group A) with those who received plerixafor following failure of SM (Group B). In the latter pleraxifor was given either following a low peripheral blood (PB) CD34 (

Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.

Context Telemedicine provides remote clinical support using technological tools. It may facilitate health care delivery while reducing unnecessary visits to the clinic. The coronavirus disease 2019 (COVID-19) outbreak has caused an abrupt change in our daily urological practice, converting many of us to be reliant on telehealth. Objective To provide practical recommendations for effective use of technological tools in telemedicine. Evidence acquisition A Medline-based and gray literature search was conducted through April 2020. We selected the most relevant articles related to “telemedicine” and “smart working” that could provide important information. Evidence synthesis Telemedicine refers to the use of electronic information and telecommunications tools to provide remote clinical health care support. Smart working is a model of work that uses new or existing technologies to improve performance. Telemedicine is becoming a useful invaluable tool during and even beyond the COVID-19 pandemic. It is time for us to formalize the place of telemedicine in routine urological practice, and it is our responsibility to adapt and learn about all the tools and possible strategies for their optimal implementation during the pandemic to ensure that the quality of care received by patients and the outcomes of patients and their families are of the highest standard. Conclusions Telemedicine facilitates specialized urological clinical support at a distance, solves problems of limitations in mobility, reduces unnecessary visits to clinics, and is useful for reducing the risk of viral transmission in the current COVID-19 outbreak. Furthermore, both personal and societal considerations may favor continued use of telemedicine, even beyond the COVID-19 pandemic. Patient summary Telemedicine in urology offers specialized remote clinical support to patients, similar to face-to-face visits. It is very useful for reducing unnecessary visits to the clinic, as well as reducing the risk of contagion in the current coronavirus disease 2019 (COVID-19) pandemic., Take Home Message Telemedicine facilitates specialized urological clinical support at a distance, solves problems of limitations in mobility, reduces unnecessary visits to clinics, and is useful for reducing the risk of viral transmission in the current coronavirus disease 2019 (COVID-19) outbreak.

OBJECTIVES The purpose of this study was to determine the outcome of head and neck squamous cell carcinoma (HNSCC) patients developing lung metastasis. DESIGN Retrospective study. PARTICIPANTS HNSCC patients with lung metastasis treated between 2001 and 2018 were included. MEAN OUTCOMES MEASURES Statistical analyses described the relationship between patient survival, treatment efficacy and pulmonary metastasis occurrence. RESULTS One hundred HNSCC patients were included in the study. The median overall survival (OS) was 21 months. The median recurrence-free survival (RFS) was seven months. Patient survival with only lung metastases was significantly longer compared to patients with lung metastases and lymph nodes involvement or other metastases. Moreover, patients with a single metastasis had longer post-RFS and OS than patients with multiple metastases. The local control of metastasis was better when patients presented only lung metastases, and it was more effective in single metastasis. The surgery allowed better metastases local control than supportive care or radio and/or chemotherapy. In case of specific therapy, pulmonary resection was associated with a longer post-RFS and a longer OS compared to supportive care or radio and/or chemotherapy. CONCLUSIONS We confirmed, in the current study, the significant survival benefit for HNSCC patients treated by surgery for their pulmonary metastasis. While treatment of multiple metastases required palliative chemotherapy or best supportive care in most of the cases, specific surgical treatment in selected HNSCC patients should be considered.

CONTEXTE: On ne connait pas encore avec certitude l’innocuite et l’efficacite du plasma de convalescent comme traitement de la forme grave de la maladie a coronavirus 2019 (COVID-2019). Afin d’appuyer la conception de lignes directrices sur la prise en charge de la COVID-19, nous avons effectue une revue systematique et une meta-analyse sur l’utilisation du plasma de convalescent pour le traitement de cette maladie et d’autres formes graves d’infections respiratoires virales. METHODES: En mars 2020, nous avons effectue des recherches dans des bases de donnees biomedicales internationales et chinoises, des registres d’essais cliniques et des sources prepubliees afin de recenser des essais randomises et controles (ERC) et des etudes non randomisees comparant les issues de patients ayant recu du plasma de convalescent a celles de patients n’en ayant pas recu. Ont ete inclus les patients ayant une infection aigue attribuable a un coronavirus, au virus de l’influenza ou au virus Ebola. Nous avons egalement realise une meta-analyse a l’aide d’un modele a effets aleatoires et evalue la qualite des donnees probantes au moyen de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTATS: Sur les 1099 etudes uniques initialement reperees, 6 etaient admissibles, et aucune d’entre elles ne portait sur des patients atteints de la COVID-19. Une etude non randomisee (n = 40) sur l’administration de plasma de convalescent a des patients atteints du coronavirus du syndrome respiratoire aigu severe (SRAS-CoV) a fourni des donnees peu concluantes sur le taux de mortalite (risque relatif [RR] 0,10; intervalle de confiance [IC] de 95 % 0,01 a 1,70). Des estimations regroupees provenant de 4 ERC sur l’influenza (n = 572) n’ont pas montre d’effet manifeste sur le taux de mortalite (4 ERC; RR 0,94; IC de 95 % 0,49 a 1,81), le retablissement complet (2 ERC; rapports de cotes [RC] 1,04; IC de 95 % 0,69 a 1,64) et la duree d’hospitalisation (3 ERC; difference moyenne [DM] −1,62; IC de 95 % −3,82 a 0,58 jours). La qualite des donnees etait tres faible pour tous les parametres relatifs a l’efficacite. Dans les ERC sur l’influenza, aucun ou peu d’evenements indesirables graves ont ete associes au plasma de convalescent (RR 0,85; IC de 95 % 0,56 a 1,29; donnees de faible qualite). INTERPRETATION: Les etudes portant sur des formes graves d’infections respiratoires virales autres que la COVID-19 ont fourni des donnees indirectes de tres faible qualite semblant indiquer que le plasma de convalescent n’offre aucun benefice ou offre des benefices minimes pour le traitement de la COVID-19, de meme que des donnees de faible qualite montrant qu’il n’entraine pas d’evenements indesirables graves.

Objective To understand how to potentially improve inappropriate prostate cancer imaging rates we used National Comprehensive Cancer Network's guidelines to design and implement a Clinical Reminder Order Check (CROC) that alerts ordering providers of potentially inappropriate imaging orders in real-time based on patient features of men diagnosed with low-risk prostate cancer. Methods We implemented the CROC at VA New York Harbor Healthcare System from April 2, 2015 to November 15, 2017. We then used VA administrative claims from the VA's Corporate Data Warehouse to analyze imaging rates among men with low-risk prostate cancer at VA New York Harbor Healthcare System before and after CROC implementation. We also collected and cataloged provider responses in response to overriding the CROC in qualitative analysis. Results Fifty seven percent (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. Conclusion While the decrease in inappropriate imaging during our study window was almost certainly due to many factors, a Computerized Patient Record System-based CROC intervention is likely associated with at least moderate improvement in guideline-concordant imaging practices for Veterans with low-risk prostate cancer.

An infant’s risk of developing neuromotor impairment is primarily assessed through visual examination by specialized clinicians. Therefore, many infants at risk for impairment go undetected, particularly in under-resourced environments. There is thus a need to develop automated, clinical assessments based on quantitative measures from widely-available sources, such as video cameras. Here, we automatically extract body poses and movement kinematics from the videos of at-risk infants (N=19). For each infant, we calculate how much they deviate from a group of healthy infants (N=85 online videos) using Naïve Gaussian Bayesian Surprise. After pre-registering our Bayesian Surprise calculations, we find that infants that are at higher risk for impairments deviate considerably from the healthy group. Our simple method, provided as an open source toolkit, thus shows promise as the basis for an automated and low-cost assessment of risk based on video recordings.

Objective Women are highly underrepresented among leadership positions within radiology research, disproportionate to their underrepresentation in radiology overall. We sought to identify the causes and solutions of such disparity at the personal, organizational, and institutional levels among female radiology researchers who are leaders in the field. Subjects and methods We used purposive sampling to identify nationally recognized female leaders in radiology research. We developed a semistructured interview guide and conducted in-depth one-on-one telephone interviews with participants (n = 16) that ranged from 36 to 65 min. All interviews were recorded and transcribed. Data were analyzed by two researchers trained in qualitative methods using Saldana’s first- and second-cycle coding method. Themes were identified using a grounded theory approach to identify meaningful patterns that addressed the research question. Results Participants identified barriers to their professional development and success, including personal and professional obstacles often associated with work-life balance and the nonlinear nature of women’s careers because of caregiving responsibilities. Participants also identified facilitators of success that operated at the individual, organizational, and institutional level, such as purposeful networking, having an advocate, and participating in leadership events. Conclusion This study represents the first effort to qualitatively capture the facilitators of success for nationally recognized female radiology researchers. Findings suggest that synergistic efforts can be undertaken by early-career female radiologists and their colleagues, national radiology organizations, and academic institutions to systematically enable the inclusion and participation of women. The field of radiology should consider how to work dynamically at multiple levels to implement the identified potential changes.

Purpose On March 16, 2020, the Spanish government declared a state of alarm due to the rapid spread of coronavirus disease 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) were restricted to remain confined at home, and medical visits were cancelled for 3 months. The impact of this lockdown on the manifestations of COPD and the quality-of-life of these patients has not been explored. Patients and methods One hundred patients with COPD were interviewed by telephone from May 2-18, 2020. The interviews included questions about the lockdown, missed medical appointments, fears of the disease, possible COVID-19 infection, and exacerbations of COPD suffered during this period and their management. In addition, the COPD Assessment Test, the Hospital Anxiety and Depression, and the 5-Dimension Euro Quality-of-Life questionnaires were administered. Results Sixty-four (64%) patients claimed to have strictly complied with the lockdown, and only 42 (42%) stated they had left home at least once during lockdown. Only one patient (1%) was hospitalized due to COVID-19, and 13 (13%) patients presented an exacerbation of COPD self-managed at home with no admissions due to exacerbation of COPD during this period. A medical consultation or complementary test was cancelled in 90% of the patients, but 61% had a medical telephone visit with a high degree of satisfaction (mean 9.3/10). Most patients declared that their feeling regarding lung disease and general health was similar or even better during lockdown (82% and 81%, respectively). Conclusion Our results indicate that in general lockdown had a low impact on COPD patients. Only one patient was affected by COVID-19, but moderate exacerbations of COPD were not infrequent. Although many medical visits and test were cancelled, patients were very satisfied with the medical telephone visits.

Context The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. Objective To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. Evidence acquisition Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. Evidence synthesis Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). Conclusions To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. Patient summary We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care., Take Home Message We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provides guidance on prioritizing the timing for different types of urological care.

Background In 2012, the United States Preventative Services Task Force (USPSTF) formally recommended against all prostate-specific antigen (PSA) screening for prostate cancer. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation and to determine if PSA screening was more likely to be ordered based on a veteran’s race or age. Methods Using the VA Corporate Data Warehouse, we created 10 annual groups of PSA-eligible men covering 2009-2018. We identified all PSA tests performed in the VA to determine yearly rates of PSA screening. All statistical tests were 2-sided. Results The overall rate of PSA testing in the VA decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 years having the highest initial rate and greatest decline (70.6% in 2009 to 48.4% in 2018, P < .001). Men aged 55-69 years had a smaller decline (65.2% in 2009 to 58.9% in 2018, P < .001) whereas the youngest men, aged 40-54 years, had an increase in PSA screening (26.2% in 2009 to 37.8% in 2018, P < .001). Conclusions In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than one-half of the men in our study. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying ages experienced statistically significantly differences in PSA screening trends.

Guidelines recommend oral vancomycin as first-line therapy for Clostridioides difficile infection. Guideline recommendations vary regarding dosing of vancomycin. Our aim was to summarize the curren...

Emerging disease threats are on the rise. Risk communication in an emerging threat is used by public health officials to reach the population in a timely and effective manner. However, limited rese...

Scant attention has been paid to intersecting vulnerabilities experienced by Black, Latinx, and older adults of color (BLOAC) that increase COVID-19 related risks. Structural inequities have resulted in disproportionate rates of chronic conditions and limited access to care. Media coverage, focused on COVID-19 mortality among institutionalized older adults (OA), has overlooked community-dwelling OA, leaving their unique risks unaddressed in research and intervention efforts. Key vulnerabilities impacting noninstitutionalized BLOAC exacerbating adverse health outcomes during COVID-19 are discussed, and recommendations are given for gerontological social work (GSW) education, training, and practice to meet the needs of BLOAC during the COVID-19 pandemic.

BackgroundNitric oxide synthase (NOS) activity, an enzyme potentially involved in the major depressive episodes (MDE), could be indirectly measured by the L-Citrulline/L-Arginine ratio (L-Cit/L-Arg). The aim of this study was: (1) to compare the NOS activity of patients with a MDE to that of healthy controls (HC); (2) to assess its change after antidepressant treatment.MethodsA total of 460 patients with a current MDE in a context of major depressive disorder (MDD) were compared to 895 HC for NOS activity (L-Cit/L-Arg plasma ratio). L-Arg and L-Cit plasma levels were measured using a MS-based liquid chromatography method. Depressed patients were assessed at baseline, and after 3 and 6 months of antidepressant treatment for depression severity and clinical response.ResultsDepressed patients had a lower NOS activity than HC at baseline [0.31 ± 0.09 v. 0.38 ± 0.12; 95% confidence interval (CI) −0.084 to −0.062, p < 0.0001]. Lower NOS activity at baseline predicted a higher response rate [odds ratio (OR) = 29.20; 95% CI 1.58–536.37; p = 0.023]. NOS activity in depressed patients increased significantly up to 0.34 ± 0.08 after antidepressant treatment (Est = 0.0034; 95% CI 0.0002–0.0067; p = 0.03).ConclusionsDepressed patients have a decreased NOS activity that improves after antidepressant treatment and predicts drug response. NOS activity may be a promising biomarker for MDE in a context of MDD.

Purpose The purpose of this study was to examine the language, motor, and cognitive abilities of children born preterm in four categories: (a) healthy preterm infants, (b) infants of diabetic mothers, (c) infants with respiratory distress syndrome, and (d) infants with chronic lung disease when the children were 30 months, uncorrected age. Comorbidity of language, motor, and cognitive skills was examined, along with predictor variables. Method A total of 148 children who were born preterm participated and were assessed using bivariate tests and logistic regression on standardized assessment scores. Results Controlling for the children's gestational age (GA), overall language ability was significantly lower in the infants of diabetic mothers group compared to the healthy preterm infant group, and expressive language skills were significantly lower for the chronic lung disease group than the respiratory distress syndrome group. The children with language delays on at least one measure were significantly more likely to have cognitive, motor, or both delays. Lower maternal education was a significant predictor for language and cognitive delays, and younger GA was a significant predictor for language, motor, and cognitive delays. Conclusion Assessment of the preterm infant from a biosystems approach allows the speech-language pathologist to take into consideration maternal education, diagnosis at preterm birth, and GA, which were found to impact the language, motor, and cognitive outcomes of children born preterm. Our findings further reinforce the concept of the whole child in that children born preterm who display language delays should be screened for co-occurring motor and/or cognitive delays.

The use of social media is growing rapidly in health care. The purpose of this study was to provide updated data on utilization of social media in urology. A survey was emailed to 19 840 American Urological Association (AUA) members in September 2017, and responses were compared to our previous survey in 2013. Overall, 74% of 1731 respondents have a social media account. Facebook and YouTube were the platforms most commonly used. However, use of Instagram, LinkedIn, Twitter, and Pinterest significantly increased. Among social media users, 33% agreed that it has impacted their practice, and one-third have followed a medical conference remotely. At the 2018 AUA meeting (#AUA18), there were 18,863 tweets from 3887 contributors, which achieved 73,878 million impressions, a significant increase since 2013. More than half of users were not familiar with professional guidelines on social media. The most common reasons for non-use were not seeing any value and not wanting invasion of privacy. In conclusion, social media use has increased substantially in urology, providing opportunities for global conference participation and influencing clinical practice for a substantial proportion of users. Professional standards for online conduct should be integrated into medical education as use of social media continues to increase. PATIENT SUMMARY: The use of social media in urology has increased over time. Although Facebook and YouTube are the platforms most commonly used, use of Instagram, LinkedIn, Twitter, and Pinterest has significantly increased over time. Use of social media at medical conferences has increased over time, and a substantial proportion of urologists reported that social media influenced their clinical practice.

KEY POINTS On Mar. 11, 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic. The worldwide spread of COVID-19 represents a profound threat to human health. Patients with COVID-19 present primarily with fever, cough, and myalgia or fatigue, and sometimes

Objectives: African Americans face chal­lenges in accessing services for sexually transmitted infections (STIs). From 2012- 2016, the EBAN II intervention was funded by the NIH to test the effectiveness of implementing a culturally congruent, evidence-based HIV/AIDS prevention program in Los Angeles and Oakland, California. This study examined the impact of personal characteristics and experiences of discrimination on the likelihood of being tested for STIs. Method: Participants (N=91) completed a baseline survey. Descriptive statistics were used to test for differences between those who did and did not obtain STI testing. Factors included HIV serostatus, sociodemo­graphic variables, STI history, the presence of outside partners, and discrimination ex­periences. Multiple logistic regressions were conducted for men and women separately. Results: Participants with no recent experi­ences of discrimination were more than 3 (3.4) times more likely to obtain a baseline STI test than those who reported discrimina­tion experiences. HIV-positive women with no recent experiences of discrimination were 11 times more likely than those with reports of recent discrimination to obtain STI tests. Conclusions: It is often women who are the gatekeepers for health seeking in families and the same may be for these couples. Ex­periences of discrimination may impede STI testing, and heighten several health risks, particularly among HIV-positive African American women in HIV-serodiscordant relationships. Addressing the impact of dis­crimination experiences may be important for STI prevention and treatment efforts in interventions promoting health care utilization. Ethn Dis. 2020;30(2):261-268; doi:10.18865/ed.30.2.261

Background In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is acute coronary artery occlusion. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation. Hypothesis Performing an immediate CAG after an OHCA without ST segment elevation on the post-resuscitation ECG and no obvious non-cardiac cause of arrest could lead to a better 180-day survival rate with no or minimal neurological sequel as compared with a delayed CAG performed 48 to 96 hours after the arrest. Design The EMERGE trial is a prospective national, randomized, open and parallel group trial, in which 970 survivors of OHCA will be randomized (1:1) to either immediate (as soon as possible after return of spontaneous circulation) or delayed (48 to 96 h) CAG. Participants will be OHCA patients with no ST segment elevation on the post resuscitation ECG and no obvious non-cardiac cause of arrest. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel corresponding to Cerebral Performance Category (CPC) 1 or 2. The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC score at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay. Summary The EMERGE trial is a prospective, multicenter, randomized, controlled trial that will assess the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST segment elevation and who will be managed with either immediate or delayed CAG.

Several guidelines recommend pelvic lymph node dissection (PLND) at robot-assisted radical prostatectomy (RARP) only when lymph node involvement (LN+) is2%. Individual surgeon use of PLND is not well-known. We sought to examine variability in PLND performance and detection of LN+ across the Michigan Urological Surgery Improvement Collaborative.Data regarding all RARP (3/2012-9/2018) were prospectively collected, including patient and surgeon characteristics. Univariable and multivariable analyses of PLND rate and LN+ rate were performed.Among 9,751 men undergoing RARP, 79.8% had PLND performed (n = 7,781), of which 5.2% were LN+ (n = 404). In univariate and multivariable analyses, predictors of PLND included higher Prostate-Specific Antigen (PSA), biopsy Gleason grade (bGG), number of positive cores, and maximum core involvement at P0.05 for each. Higher PSA, cT stage, bGG, number of positive cores, and maximum core involvement predicted LN+ when PLND was performed (P0.05 for each). There was significant surgeon variation in the proportion of PLND performed at RARP, yet neither surgeon-annualized RARP volume nor % of PLND performed was associated with LN+ disease (P0.05). Grade was associated with PLND (60.0%, 77.6%, 91.0%, 97.3%, and 98.5%; P0.001) and LN+ (0.7%, 2.5%, 5.8%, 8.6%, and 19.9%; P0.001) for bGG 1,2,3,4,5, respectively. Maximum core involvement also strongly predicted LN+ with rates of 1.5%, 3.8%, and 9.4% for35%, 35% to 65%, and65%, respectively (P0.001).Nearly 80% of RARP in Michigan Urological Surgery Improvement Collaborative were performed with PLND, including 60% of bGG1 patients (with LN+ in only 0.7%), but significant variability exists between surgeons. Our data indicate limited benefit for favorable-risk CaP patients and support efforts to decrease PLND use going forward.

Conducting research in corrections can contribute to improved individual and public health. Challenges to gaining entry to correctional settings to conduct research can impede research productivity, delay the launch of studies and inhibit researchers from proposing health research in corrections. The purpose of this paper is to share lessons learned from a large-scale corrections research project designed to develop computer-based learning modules to train front-line corrections personnel about geriatric and end-of-life care. Key lessons learned include the importance of building a team of experts, planning and punting, coordinating with institutional review boards and examining denied applications to inform future planning. To be effective in a correctional setting, leaders in nursing research and corrections nursing must work together within the contextual nature of prisons and jails to advance evidence-based practices for this vulnerable population. These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.

Lessons from extinction can be used in trials designed to pursue a cure for cancer. When cancer cannot be cured, similar strategies may be unwise, and strategies that leverage the adaptations of cancer to therapy should be considered.

Medial patellar instability, in both noniatrogenic and iatrogenic settings, is rare compared with lateral patellar instability. Although iatrogenic medial patellar dislocation is most often considered a complication of a lateral retinacular release, improperly performed patellofemoral procedures such as tibial tubercle osteotomy and medial patellofemoral ligament reconstruction can also be contributing factors. As a result, a thorough history and physical examination are paramount. Because of the sparse evidence for medial patellar instability treatment, management should follow that of lateral patellar instability: first-time dislocators without significant risk of recurrence or osteochondral fracture should initially be managed nonoperatively, whereas recurrent dislocators and those having failed conservative treatment are surgical candidates. Treatment is empiric at this point and is directed at contributing pathological conditions; most commonly, that is reversal of iatrogenic pathological conditions such as repair or reconstruction of a prior excessive lateral release. In this chapter we highlight what is understood about the unusual pathological condition of medial patellar instability, both in the noniatrogenic and iatrogenic settings.

Background: Adults are at risk of being exposed to influenza from many sources. Healthcare personnel (HCP) have the additional risk of being exposed to ill patients.Objective:To determine whether HCP were at higher risk than adults working in nonhealthcare roles (non-HCP).Design:Prospective cohort study.Setting:Acute-care hospitals and other businesses in Toronto, Ontario, Canada.Methods:Adults aged 18–69 years were enrolled for 1 or more of the 2010/2011, 2011/2012, and 2012/2013 influenza seasons. Swabs collected during acute respiratory illnesses were tested for influenza and pre- and postseason blood samples were tested for influenza-specific immune response.Results:The adjusted odds of influenza were similar for HCP and non-HCP (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.63–2.63). Older adults and those vaccinated against influenza had lower odds, and those who shared their workspace and who used corrective eyewear had higher odds of influenza.Conclusions:HCP and other working adults are at similar risk of influenza infection.

BACKGROUND: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU. METHODS: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning. CONCLUSION: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.

PURPOSE: Ejaculatory dysfunction (EjD) and erectile dysfunction after cancer treatment are clinically important complications, but their exact prevalence by various kinds of cancer site and type of treatment is unknown. The aim of this systematic review and meta-analysis was to examine the available evidence and provide pooled estimates for prevalence of EjD and erectile dysfunction in relation to all cancer sites and identify characteristics associated with EjD in cancer patients. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of cross-sectional and case-control studies. We searched 4 electronic databases (Medline®, CINAHL, PsychInfo and Embase®) until July 22, 2020. All retrospective or prospective studies reporting the prevalence of EjD in male patients with cancer were included in this review. A random effects meta-analysis was conducted calculating prevalence proportions with 95% confidence intervals. Prevalence proportions were calculated for the incidences of EjD by cancer site and type of treatment. RESULTS: A total of 64 studies (a total of 10,057 participants) were included for analysis. The most common cancer sites were bladder, colon, testis and rectum. The prevalence rates of EjD after surgical intervention ranged from 14.5% (95% CI 2.2-56.3) in colon cancer to 53.0% (95% CI 23.3-80.7) in bladder cancer. The prevalence rates of erectile dysfunction ranged from 6.8% (95% CI 0.8-39.1) in bladder cancer to 68.7% (95% CI 55.2-79.6) in cancer of the rectum. CONCLUSIONS: In a large study-level meta-analysis, we looked at a high prevalence of EjD and erectile dysfunction at various cancer sites and across different treatment types. Prospective studies of EjD and erectile dysfunction after various kinds of cancer treatments are warranted.