Internet Transparency of Local Men’s Health Clinics in Nebraska

An overview of Men’s Health Clinics offering Testosterone Therapy in a Midwest State. Introduction/ Background – Since 2001, there has been a 300% increase in the use of Testosterone therapy. However, there remains limited published data on the demographics of facilities and providers that advertise this service. This study aims to look at such demographics of advertised Men’s health clinics in Nebraska. Methods/ Materials – An internet search was conducted with the phrases “Nebraska Male health clinics, Nebraska Low T/testosterone, Nebraska Hormone Replacement Therapy”. All clinics that were found offering Testosterone therapy with Men’s health in their mission statement were included. Data was gathered using 6 questions, with answers obtained from the public website or by calling the office. Results – 19 different facilities were found that self-identified as Men’s Health clinics. 5/19 facilities were nationally corporate owned, 13/19 were individually owned, and 1 was an academic university. All offered Testosterone Therapy. Of the 19 facilities, 10/19 branded themselves primarily as Men’s Health Clinics. 6/10 out of those offered testosterone therapy, Plasma infusion, and Penile Shockwave Therapy. Those that offered services other than Men’s health were marketed as Medical Spas and Aesthetic centers, offering hormone replacement therapy, aesthetics, and anti-aging treatments. 10/19 Clinics had no MD listed and visits would be with a mid-level provider (NP or PA). Only 1/19 provided prices online, others required consultation before prices would be given. Of the 19 facilities, only 6 accept insurance and the rest are cash-pay clinics only. Conclusions – Of the Nebraska clinics that self-identify as men’s health clinics, many are individually owned clinics with a focus on hormone replacement or aesthetics. Of those clinics, many were run entirely by mid-levels or with a supervising MD overseeing mid-levels. Less than 1/3rd of facilities accept insurance and there is a lack of price transparency

A Glimpse Into Urology Medical School Education: A Multi-Institutional Medical Student Survey

Introduction: Urological education and exposure for medical students is imperative as we face a growing geriatric population with increased urological needs. Previous research has examined American Urological Association (AUA) program director opinions of student exposure, but no surveys have been directed at current medical students. The purpose of this study is to quantify student exposure to and opinions of urology to determine precipitating factors that lead students towards or away from urology as a specialty of choice. Methods: A 14 question (11 multiple choice and 3 fill-in-the blank) Google Survey was developed. Questions ranged from student exposure to urology, consideration of urology as a specialty, to opinions of positive/negative aspects of urology. After receiving IRB approval, the survey was distributed to the deans and student affair offices of 156 AAMC medical schools. Results: Twenty medical schools (13%) disseminated the survey, contributing to 147 student responses with an even gender split. The percentage of MS4s that applied to urology was 9%. Of all the respondents, 11% did not have a urology rotation, and 25% had no exposure throughout medical school. A large proportion of students (54%) felt the urology exposure to be inadequate. The majority of respondents had either a positive (43%) or neutral (48%) perception towards urology. The positive aspects of urology included perceptions of salary (87%), lifestyle (62%), focalized specialization (54%) and use of technology (49%). The negative aspects of urology included competitiveness (75%), resident workload (33%), and focalized specialization (29%). Conclusions: Urological education opportunities during medical school appear to be limited. Many students do not have any exposure to urology, let alone opportunities to experience a clinical rotation in the field. Although the specialization and lifestyle of urology are attractive, the competitiveness of the field seems to have dissuaded many possible applicants. However, with the increased need for urologists and the decreasing supply, future work should focus on increasing medical student exposure to urology

The Financial Burden of the Urology Match: Room for improvement

Abstract Introduction/ Background – The Urology match remains highly competitive, but there is limited published data on the costs of the application process for contemporary applicants. This study aims to determine the financial burden of the Urological match and the effect it has on applicants. Methods/ Materials – All applicants to the University of Nebraska Medical Center (UNMC) Urology Residency in the 2019 Urology match were invited to complete an anonymous, IRB approved online survey containing 16 questions on interview travel and costs, financial aid, and debt burden. Results – Thirty-nine out of 183 (21%) applicants responded to the survey. The median number of programs applied to was 87 (range 26 - 100). The median number of interviews offered was 17 (range 0 - 51) and the median number of interviews attended was 14 (range 0 - 27). The median interview expense was $6,0000 (range 0 – 10,000). Applicants reported the money came from a combination of medical student loans (43$57,500. Conclusions – At UNMC, applicants for the 2019 Urology interview cycle incurred a median monetary cost of $6,000. With 18Abstract Introduction/ Background – The Urology match remains highly competitive, but there is limited published data on the costs of the application process for contemporary applicants. This study aims to determine the financial burden of the U[A1] rological match and the effect it has on applicants. Methods/ Materials – All applicants to the University of Nebraska Medical Center (UNMC) Urology Residency in the 2019 Urology match were invited to complete an anonymous, IRB approved online survey containing 16 questions on interview travel and costs, financial aid, and debt burden. Results – Thirty-nine out of 183 (21$6,0000 (range 0 – 10,000). Applicants reported the money came from a combination of medical student loans (43%), family and friends (43%), or from personal savings (41%). To save money, 64% of applicants reported staying with family and friends on at least 1 interview and about 43% [A2] of applicants reported sharing a room with another applicant. Notably, 18%[A3] of applicants surveyed stated that they declined interviews due to cost. The median medical school debt of those surveyed was $57,500[A4] . Conclusions – At UNMC, applicants for the 2019 Urology interview cycle incurred a median monetary cost of$6,000 . With 18% of applicants stating that they declined interviews due to financial cost, there should be reform to the interview process to help lower costs to applicants and promote a successful match. Limiting total applications or coordinating same city interviews are two[A5] options to reduce cost. [A1]Check throughout – sometimes you capitalize Urology or Urological and other times you do not. Be consistent throughout entire paper. Either way is fine. [A2]Don’t start a sentence with a numeral – either spell it out or add to the previous sentence. [A3]Change – you can also start a sentence with a transition like “Notably, 18%...” [A4]This seems low. Double check [A5]Typically spell out numbers one-nine and then use numerals for 10 and up (except for measurements, dollar amounts, and others)

Online health information for penile prosthesis implants lacks quality and is unreadable to the average US patient

BACKGROUND: Online health information (OHI) has become widely accessible and affects patient decisions regarding their healthcare. The purpose of this study was to assess the readability, quality, and accuracy of information available to patients online about penile prosthesis implants (PPIs). METHODS: We performed a Google search using the keywords penile implant and penile prosthesis. The first 30 search results for both terms were analyzed, and advertisements, news articles, duplicates, and videos were excluded. Websites were categorized as institutional, commercial, and personal/patient support. Readability of each website was determined using the Flesch-Kincaid grade level (FKGL) readability formula within the readable tool. Quality was measured by Health On the Net (HON) certification status and the DISCERN scoring method. For website accuracy, a score of 1-4 (1=0-25%, 2=25-50%, 3=50-75%, and 4=75-100%) was assigned. RESULTS: Forty-four websites met the criteria (23 institutional, 12 commercial, and 9 personal/patient support). The mean total FKGL score was 9.55. No statistical difference was detected between mean FKGL for each website category (p=0.69). Only eight websites (18%) scored ≤8th-grade reading level (average US adult level), while 36 (82%) were \u3e8th-grade level. Mean total DISCERN sum score was 39.74/75, with no statistical difference in mean DISCERN score between website types (p=0.08). Over half (55%) of the websites were defined as very poor or poor quality by DISCERN scoring. Mean total overall quality rating was 2.67/5. HON certification was verified for only nine websites (20%). Twenty-five percent of websites were classified as 0-25% accurate, 23% were 25-50% accurate, 30% were 50-75% accurate, and 23% were 75-100% accurate. CONCLUSION: Most information on the Internet about PPIs is reasonably accurate; however, the majority of websites are deficient in quality and unreadable to the average patient, irrespective of website type

Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors

<title>ABSTRACT</title><sec><title>Objective:</title><p>To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.</p></sec><sec><title>Methods:</title><p>From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated.</p></sec><sec><title>Results:</title><p>14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs.$44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p<0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p<0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes.</p></sec><sec><title>Conclusions:</title><p>More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.</p></sec

Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database

Long-term use of testosterone can be associated with mood destabilizing effects. Most studies investigating psychiatric complications of anabolic steroids have used small samples, but a comprehensive assessment of the risk of developing mental health disorders after testosterone use has not been performed at the population level. To determine whether testosterone therapy is associated with major depressive disorder or suicide attempts in men. We conducted a retrospective cohort study of 70.3 million electronic health records collected from 46 healthcare organizations encompassing flagship hospitals, satellite hospitals, and outpatient clinics since 2008 to determine whether testosterone use is associated with major depressive disorder and suicide attempts in a large population. We included men 18 or older who either used testosterone or did not, defined by reported use, insurance claim, or prescription use of testosterone documented in the electronic health record. We propensity-score matched by age, race, ethnicity, obesity, and alcohol-related disorder. Additionally, a sub-group analysis was performed in testosterone deficient (<300 ng/dL) men comparing those with TD on testosterone therapy to a control group of men with TD who are not using testosterone. We determined measures of association with a new diagnosis of major depressive disorder and suicide attempt or intentional self-harm following testosterone use within 5 years. A total of 263,579 men who used testosterone and 17,838,316 men who did not were included in the analysis. Testosterone use was independently associated with both Major Depressive Disorder (OR 1.99, 95% CI 1.94–2.04, P < .0001) and Suicide Attempt/Intentional Self-Harm (OR 1.52, 95% CI 1.40-1.65, P < .0001). Results remained significant in testosterone deficient sub-group analysis. Men who use testosterone should be screened for and counseled about risks of depression and suicidality. Strengths of this study include a large sample size, the ability to account for chronology of diagnoses, the use of propensity score matching to control for potentially confounding variables, and the consistency of results with sub-group analyses. Limitations include the potential for incorrect coding within the electronic health record, a lack of granular information regarding testosterone therapy adherence, the possibility that unrecorded testosterone or anabolic steroid use were prevalent but not captured within the control group, and a lack of data regarding testosterone withdrawal. Testosterone use is independently associated with new-onset mental health disorders. Future studies are necessary to elucidate the role that androgen withdrawal plays and whether a causal relationship exists. Nackeeran S, Patel MS, Nallakumar DT, et al. Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database. J Sex Med 2022;19:933–939