An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study.

BackgroundThe evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care.MethodsWe developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date.DiscussionUse of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts.Trial registrationClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018

Qualitative Analysis of the Content Found in Online Discussion Boards for Urethral Stricture Disease and Urethroplasty.

ObjectiveTo describe the patient experience and chief concerns with urethroplasty to improve physician understanding and patient education. Online discussion boards allow patients with urethral stricture disease (USD) to connect with other USD patients. It is unknown how men use these web resources and what information is available about urethroplasty.MethodsThree online forums featuring urethroplasty were identified by Google search. Thematic analysis categorized the content of posts using manually applied codes, with inter-rater reliability and descriptive statistics generated by Dedoose (Los Angeles, CA).ResultsA total of 140 unique posters contributed 553 posts to the forums. Posts were categorized as information support (n = 651), issues posturethroplasty (n = 470), own experience preurethroplasty (n = 336), feelings towards other posters (n = 312), what to expect posturethroplasty (n = 265), feelings after urethroplasty (n = 228), and considerations before urethroplasty (n = 134). Experience navigating the healthcare system with USD (n = 141) and weak urine stream (n = 70) were the most frequent preurethroplasty complaints. Postoperative pain (n = 164) was the most frequent issue. Patients expressed more positivity (n = 126) and satisfaction (n = 120) than negativity (n = 33) with urethroplasty.ConclusionPatients participated in online discussions to share experiences with USD and urethroplasty, receive emotional support, and find answers. Men were more often satisfied than not with their urethroplasty outcomes, with 88% of postoperative feelings coded as positive or satisfied compared to negative. This study provides physicians with insight into the experiences of patients and how to best educate them

Large-scale sequencing identifies multiple genes and rare variants associated with Crohn’s disease susceptibility

peer reviewe

An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study.

BackgroundThe evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care.MethodsWe developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date.DiscussionUse of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts.Trial registrationClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018

Retinal Ganglion Cell Injury In Early Pediatric Onset MS

"We sought to document retinal ganglion cell injury in a pediatric onset multiple sclerosis (MS) cohort and evaluate if differences in neuronal levels of injury can be seen by sex in eyes with or without history of optic neuritis (ON).

Risk Factors for Sexual Pain Among Physically Active Women.

INTRODUCTION:Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM:To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS:This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE:Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS:A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION:Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509