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The purpose of the study was to explore attitudes/beliefs in men attending an urban health fair to explore barriers to prostate cancer (PCa) screening. Five hundred and forty-four men attending the PCa booth at the fair in 2014 or 2015 completed questionnaires about PCa. Data were examined using Pearson’s χ2, Fisher’s Exact, and Wilcoxon rank tests after grouping men by African American (AA) and non-African American ethnicity. Three hundred and twenty-six (60%) men were AA and two hundred and eighteen (40%) were non-AA (89% white). Median age (54 vs. 56 years) and prior PCa screening were similar between AA and non-AA; income (p = .044) and education (p = .0002) differed. AA men were less likely to have researched prostate-specific antigen (PSA) on the internet (p = .003), but more used TV (p = .003) and media (p = .0014) as information sources. Family members had a stronger influence over screening decisions for AA men (p = .005). After reading PSA information, AA men were more likely to still be confused (p = .008). A higher proportion of AA men were less worried about dying from PCa (p = .0006), but would want treatment immediately instead of watchful waiting (p < .0001). Interestingly, a higher proportion of AA men indicated that they would prefer not to know if they had PCa (p = .001). Ultimately, more AA men had a PSA done (98.4% vs. 95.1%; p = .031). When considering screening eligible men, a higher proportion of AA men had an abnormal PSA (13.1% vs. 5.3%; p = .037). AA men’s beliefs surrounding PCa differ from non-AA men, and should be considered when developing culturally appropriate education, screening, and treatment strategies for this group.

Facilitated percutaneous coronary intervention for ST-segment-elevation myocardial infarction (STEMI) is defined as the use of pharmacological substances before a planned immediate intervention, to improve coronary patency. We undertook a meta-analysis of randomised controlled trials (published and unpublished) to compare facilitated and primary percutaneous coronary intervention. We identified 17 trials of patients with STEMI assigned to facilitated (n=2237) or primary (n=2267) percutaneous coronary intervention. We identified short-term outcomes (up to 42 days) of death, stroke, non-fatal reinfarction, urgent target vessel revascularisation, and major bleeding. Grade 3 flow rates for prethrombolysis and post-thrombolysis in myocardial infarction (TIMI) were also analysed. The facilitated approach resulted in a greater than two-fold increase in the number of patients with initial TIMI grade 3 flow, compared with the primary approach (832 patients [37%] vs 342 [15%], odds ratio 3·18, 95% CI 2·22–4·55); however, final rates did not differ (1706 [89%] vs 1803 [88%]; 1·19, 0·86–1·64). Significantly more patients assigned to the facilitated approach than those assigned to the primary approach died (106 [5%] vs 78 [3%]; 1·38, 1·01–1·87), had higher non-fatal reinfarction rates (74 [3%] vs 41 [2%]; 1·71, 1·16–2·51), and had higher urgent target vessel revascularisation rates (66 [4%] vs 21 [1%]; 2·39, 1·23–4·66); the increased rates of adverse events seen with the facilitated approach were mainly seen in thrombolytic-therapy-based regimens. Facilitated intervention was associated with higher rates of major bleeding than primary intervention (159 [7%] vs 108 [5%]; 1·51, 1·10–2·08). Haemorrhagic stroke and total stroke rates were higher in thrombolytic-therapy-containing facilitated regimens than in primary intervention (haemorrhagic stroke 15 [0·7%] vs two [0·1%], p=0·0014; total stroke 24 [1·1%] vs six [0·3%], p=0·0008). Facilitated percutaneous coronary intervention offers no benefit over primary percutaneous coronary intervention in STEMI treatment and should not be used outside the context of randomised controlled trials. Furthermore, facilitated interventions with thrombolytic-based regimens should be avoided.

Many trials have been done to compare primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy for acute ST-segment elevation myocardial infarction (AMI). Our aim was to look at the combined results of these trials and to ascertain which reperfusion therapy is most effective. We did a search of published work and identified 23 trials, which together randomly assigned 7739 thrombolytic-eligible patients with ST-segment elevation AMI to primary PTCA (n=3872) or thrombolytic therapy (n=3867). Streptokinase was used in eight trials (n=1837), and fibrin-specific agents in 15 (n=5902). Most patients who received thrombolytic therapy (76%, n=2939) received a fibrin-specific agent. Stents were used in 12 trials, and platelet glycoprotein IIb/IIIa inhibitors were used in eight. We identified short-term and long-term clinical outcomes of death, non-fatal reinfarction, and stroke, and did subgroup analyses to assess the effect of type of thrombolytic agent used and the strategy of emergent hospital transfer for primary PTCA. All analyses were done with and without inclusion of the SHOCK trial data. Primary PTCA was better than thrombolytic therapy at reducing overall short-term death (7% [n=270] vs 9% [360]; p=0·0002), death excluding the SHOCK trial data (5% [199] vs 7% [276]; p=0·0003), non-fatal reinfarction (3% [80] vs 7% [222]; p<0·0001), stroke (1% [30] vs 2% [64]; p=0·0004), and the combined endpoint of death, non-fatal reinfarction, and stroke (8% [253] vs 14% [442]; p<0·0001). The results seen with primary PTCA remained better than those seen with thrombolytic therapy during long-term follow-up, and were independent of both the type of thrombolytic agent used, and whether or not the patient was transferred for primary PTCA. Primary PTCA is more effective than thrombolytic therapy for the treatment of ST-segment elevation AMI.

Sexuality is an important, yet often overlooked, aspect of successful aging. The current article explores potential relationships between sexual activity in older adults and marital status, health, mobility, urinary incontinence, and caffeine and alcohol use, as well as sexual desire and erectile function in women and men, respectively. A survey was mailed to community-dwelling older adults 60 and older. Of 242 respondents (79% ages 60 to 74, 53% male), 159 (65.7%) were sexually active. A higher proportion of sexually active adults were married (Sexuality is an important, yet often overlooked, aspect of successful aging. The current article explores potential relationships between sexual activity in older adults and marital status, health, mobility, urinary incontinence, and caffeine and alcohol use, as well as sexual desire and erectile function in women and men, respectively. A survey was mailed to community-dwelling older adults 60 and older. Of 242 respondents (79% ages 60 to 74, 53% male), 159 (65.7%) were sexually active. A higher proportion of sexually active adults were married ( p = 0.0005), had better health ( p = 0.0003), and drank alcohol ( p = 0.007). A lower proportion of sexually active adults had urinary incontinence ( p = 0.006). Similar proportions of men and women were sexually active (62.8% and 68.2%, respectively; p = 0.38). Sexually active women had better sexual desire scores ( p < 0.0001) and more drank alcohol ( p = 0.0013). Sexually active men had better mobility ( p = 0.012) and erectile function ( p < 0.0001). Fewer sexually active men had incontinence ( p < 0.0001). Only alcohol use and no urinary incontinence were predictors unique to women and men, respectively. Health care providers must be aware of factors that may impact sexual health in older adults. [Res Gerontol Nurs. 2014; 7(6):256–263.]

Introduction and hypothesis Key differences between interstitial cystitis/bladder pain syndrome (IC/BPS) subtypes (with and without Hunner’s ulcer) have been noted. We hypothesized that pain characteristics in women grouped by IC/BPS subtype would differ. Methods A survey was mailed to 749 women to assess IC/BPS pain and other characteristics. Cystoscopy/hydrodistention reports were reviewed for presence/absence of Hunner’s ulcer. The McGill Pain Questionnaire Short Form© (MPQ-SF), Brief Pain Inventory (BPI), and Interstitial Cystitis Symptom and Problem Indices (ICSI-PI) assessed symptoms. Data were analyzed with Pearson’s chi-square, Fisher’s exact, t tests, and Wilcoxon rank tests. Results Of the 214 women that returned a survey (36 ulcerative and 178 non-ulcerative IC/BPS), similar proportions in each group reported that certain foods, exercise, and/or stress triggered symptoms. Fewer ulcerative patients reported pain with vaginal penetration than non-ulcerative (5/33, 15.2 % vs 76/160, 47.5 %; p  = 0.0006). On the BPI, the ulcerative and non-ulcerative groups reported similar numbers of painful areas (mean 4.1 ± 6.1 and 4.1 ± 3.8; p  = 0.33), and lower abdominal/pelvic pain was reported most (13/35, 37 % vs 79/172, 46 %; p  = 0.34) followed by lower back pain (12/35, 34 % vs 69/172, 40 %; p  = 0.52). Even though ICSI-PI, MPQ-SF, and BPI scores/responses did not differ, on the MPQ-SF the three words most frequently used by ulcerative patients to describe their pain were sharp, stabbing, and hot burning, and in non-ulcerative were aching, cramping, and tender. Conclusions These measures did not reveal any significant differences in pain between subtypes. More research is needed in larger samples to determine whether differences exist.

Objective To survey Urologists and Radiation Oncologists in Metropolitan Detroit regarding practice patterns in managing non-metastatic prostate cancer during the pandemic.  Methods An online survey was created to capture the perspective of the impact the COVID-19 restrictions have on the management of prostate cancer by Urologists and Radiation Oncologists in the Detroit Metropolitan area.  Results While most physicians felt that their facilities had adequate quantities of personal protective equipment (PPE), one in four offices reported that they did not have sufficient access to PPE. Urologists surveyed indicated that most of the low risk prostate cancer surgeries were cancelled and 56.2% had half or more of intermediate and high risk disease prostatectomies cancelled as well. Treatment options were then shifted towards either temporary surveillance or hormone therapy. Radiation Oncologists indicated that prostate cancer patients ready to start treatment were mostly delayed with temporary surveillance or hormone therapy depending on risk category (60% indicated they delayed low risk and favorable intermediate risk cases, 56% unfavorable intermediate risk cases, and 44% high risk cases). More than 80% of patients already undergoing treatment continued radiation.  Conclusion In the setting of this pandemic, the management of prostate cancer has shifted to a much more conservative approach. While the response to the crisis has not been uniform, the majority of the practitioners followed newly established guidelines. The long-term outcomes of delays and deviations from standard treatment approaches will remain to be seen.

The 5-Meter Walk Test (5MWT) has been recommended for use by the Society of Thoracic Surgeons as an outcome measure in the Adult Cardiac Surgery Database to predict frailty in individuals who are candidates for cardiac surgery. However, there are no published reports of performance on this test in the literature. Therefore, the purpose of this study was to provide descriptive analysis of the 5MWT for individuals who were candidates for cardiac surgery. Retrospective analysis of 113 preoperative cardiac surgery candidates who underwent a 5MWT. Gait speed calculated from the test was completed as part of preoperative testing administered by physical therapists. Three trials were performed with up to a one minute rest between trials. Differences by trial, gender, use of assistive device, and gait or postural deviations were determined using t-tests. Mean gait speed was 1.05 (SD 0.26) m/s for the subjects. There was a statistically significant increase in gait speed from trial 1 to trial 3 by 0.05 (0.08) m/s (p < 0.0001). There were no significant differences in gait speed between males and females. Participants using assistive devices displayed a significantly slower mean gait speed of 0.70 (0.27) than those who walked unaided, with a mean gait speed of 1.08 (0.24) m/s (p < 0.0001). Participants with noted gait or postural deviations also walked significantly slower (mean 0.84, SD 0.22) than those without deviations (mean 1.15, SD 0.21) (p < 0.0001). Subjects displayed a slight increase in speed from trial 1 to trial 3, reinforcing a cited benefit of the shorter distance of the 5MWT that may limit fatigue. Although statistically significant, the increase in speed from trial 1 to 3 may not be clinically significant in relation to the intent of the test. Significantly slower gait speeds were noted when a subject had an observable gait or postural deviation or used an assistive device.

Purpose To examine dosimetric and clinical outcomes for Cs-131 radioactive seed implant compared to Pd-103 and I-125.  Background/Significance Cs-131 is a novel isotope with relatively short half-life (9.7 days) that may have clinical advantages in seed implant treatments of prostate cancers. There may be a shorter duration of symptoms and increased PSA control rates. Methods We performed a retrospective study in which clinical and dosimetric outcomes were compared for 186 prostate implants performed over a ten-year time period at three different Ascension hospitals. Isotopes that were used included Cs-131 (n=66; half-life 9.7 days), I-125 (n=60; half-life 60 days), and Pd-103 (n=60; half-life 17 days) Results The implants used standard radiation dosages. These were 145 Gy for I-125 alone or 109 Gy when combined with external beam radiation. In the case of Cs-131 used alone, the dose was 115 Gy or 85 Gy when combined with an external beam. For Pd-103, 125 Gy was used for monotherapy and 90 Gy when combined with an external beam. The Cs-131 dosimetry was found to be similar to I-125 and Pd-103 on a quantitative basis. However, there was better homogeneity, and the delivered activity per seed and the number of seeds employed were greater compared to other isotopes. We compared the corrected total source strengths (i.e. normalized to sample mean values) and were able to demonstrate similar distributions for the three isotopes. Dosimetric analysis also suggested there was superior homogeneity with Cs-131. The median PSA value at 60 months was 0.11 ng/ml. There were only a few PSA failures in the three groups of cases, nonetheless, the Cs-131 had the fewest.  Conclusions One attractive option for men with early-stage prostate cancer is interstitial brachytherapy. The use of the shorter-acting Cs-131 isotope may be expected to have dose-related side effects that resolve more rapidly. This series suggests a trend for improved PSA control outcomes for Cs-131 patients compared with I-125 and Pd-103.

ObjectivesTo evaluate additional treatments, symptoms, satisfaction and quality of life 1 year after vaginal and abdominal pelvic organ prolapse (POP) repair.MethodsAdult women enrolled in a prospective POP database were reviewed. Baseline and outcomes data 1 year after surgery were collected including the Pelvic Floor Distress Inventory (PFDI) and mailed surveys. Data were analyzed with descriptive statistics, Fisher’s exact tests and t tests.ResultsOf 222 women, 147 (66%) had vaginal and 75 (34%) had abdominal repair. Vaginal group patients were older (64.1 vs. 59.7 years; p = 0.003), but other demographic characteristics did not differ. Vaginal group patients had lower baseline anterior and apical prolapse grades (anterior 2.7 vs. 3.1, p = 0.003; apical 2.1 vs. 3.1, p < 0.001). Baseline PFDI scores were similar. Scores improved significantly for both groups after 1 year, but 1-year PFDI scores were significantly higher in the vaginal group (45.6 vs. 32.6, p = 0.032). Scores were not different when adjusted for age and prolapse grade (p = 0.24). At 1 year, most patients in the vaginal and abdominal groups reported moderately/markedly improved overall symptoms (72/108 vs. 50/60, p = 0.030) and quality of life (89/101 vs. 54/59, p = 0.601). Most were satisfied with surgery (68/101 vs. 48/59, p = 0.067). Retreatment rates (pelvic floor physical therapy, medications, coping strategies, surgical procedures) were similar (34/109 vs. 15/62, p = 0.381). Vaginal mesh use did not affect additional treatments, patient satisfaction or symptoms.ConclusionsAlthough symptoms improve and most women are satisfied with surgery, about one in four women have additional therapy in the first year after POP repair.

AimsTo evaluate whether baseline symptoms and outcomes are influenced by gender in a matched cohort undergoing neuromodulation.MethodsPatients in our prospective neuromodulation database that had a tined lead placed were reviewed. Those that had implantable pulse generator (IPG) placed were matched on age and urologic diagnosis. History, voiding diaries, satisfaction, Interstitial Cystitis Symptom/Problem Index (ICSIPI), and overactive bladder symptom severity (OABq ss)/health-related quality of life (HRQOL) preimplant and over 3 years were evaluated using descriptive statistics, repeated measures, and matched pair GEE or mixed analyses.ResultsOf 590 patients in the database, more women than men received an IPG (450/488; 92.2 vs. 84/102; 82.4%; p = 0.0011). Eighty matched pairs (n = 160; 81% ≥ 50 years old; 56.25% had urgency/frequency with urge incontinence—UI) were identified and evaluated. On voiding diaries, volume/void was greater in women only at baseline (p = 0.040); both groups improved over time (p < 0.0001). Urinary frequency improved in both women and men (p = 0.0010; p = 0.0025). Over 3 years, UI episodes/day improved only in men (p = 0.017) and UI severity improved only in women (p < 0.0001). ICSIPI, OABq ss, and HRQOL scores improved similarly in both groups (p < 0.0001 for all measures in both groups), and although more women were satisfied at 3 months (p = 0.027), groups did not differ at other time points.ConclusionsMore women undergo neuromodulation and have initial success and subsequent IPG implantation. UI episodes improved only in men, and UI severity improved only in women. Both women and men experienced similar levels of symptom improvement on other measures.