Management of erectile dysfunction post-radical prostatectomy

© 2015 Saleh et al.Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients

Primary renal embryonal rhabdomyosarcoma in adults: a case report and review of the literature.

Adult renal rhabdomyosarcoma is a rare subtype of renal sarcoma. We present a case of a renal mass treated with radical nephrectomy that subsequently was shown to be renal rhabdomyosarcoma. We discuss the clinical presentation, imaging findings, and histology for this case and review the available literature

Challenges and recommendations for high quality research using electronic health records

Harnessing Real World Data is vital to improve health care in the 21st Century. Data from Electronic Health Records (EHRs) are a rich source of patient centred data, including information on the patient's clinical condition, laboratory results, diagnoses and treatments. They thus reflect the true state of health systems. However, access and utilisation of EHR data for research presents specific challenges. We assert that using data from EHRs effectively is dependent on synergy between researchers, clinicians and health informaticians, and only this will allow state of the art methods to be used to answer urgent and vital questions for patient care. We propose that there needs to be a paradigm shift in the way this research is conducted - appreciating that the research process is iterative rather than linear. We also make specific recommendations for organisations, based on our experience of developing and using EHR data in trusted research environments

The self-management abilities test (SMAT): a tool to identify the self-management abilities of adults with bronchiectasis

AbstractBronchiectasis is an increasingly common chronic respiratory disease which requires a high level of patient engagement in self-management. Whilst the need for self-management has been recognised, the knowledge and skills needed to do so— and the extent to which patients possess these—has not been well-specified. On one hand, understanding the gaps in people’s knowledge and skills can enable better targeting of self-management supports. On the other, clarity about what they do know can increase patients’ confidence to self-manage. This study aims to develop an assessment of patients’ ability to self-manage effectively, through a consensus-building process with patients, clinicians and policymakers. The study employs a modified, online three-round Delphi to solicit the opinions of patients, clinicians, and policymakers (N = 30) with experience of bronchiectasis. The first round seeks consensus on the content domains for an assessment of bronchiectasis self-management ability. Subsequent rounds propose and refine multiple-choice assessment items to address the agreed domains. A group of ten clinicians, ten patients and ten policymakers provide both qualitative and quantitative feedback. Consensus is determined using content validity ratios. Qualitative feedback is analysed using the summative content analysis method. Overarching domains are General Health Knowledge, Bronchiectasis-Specific Knowledge, Symptom Management, Communication, and Addressing Deterioration, each with two sub-domains. A final assessment tool of 20 items contains two items addressing each sub-domain. This study establishes that there is broad consensus about the knowledge and skills required to self-manage bronchiectasis effectively, across stakeholder groups. The output of the study is an assessment tool that can be used by patients and their healthcare providers to guide the provision of self-management education, opportunities, and support.</jats:p

30 days wild: development and evaluation of a large-scale nature engagement campaign to improve well-being

There is a need to increase people’s engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature

Video recording patients for direct care purposes: a systematic review and narrative synthesis of international empirical studies and UK professional guidance

Background: Technological advances have allowed for a variety of videorecording applications in healthcare but in practice these have largely been confined to training, research, and quality improvement. Video recordings of patients embedded as part of the electronic health record may offer advantages over text-based documentation to supplement patient assessment and clinical decision-making. However, little is about the application, acceptability, and impact of video recording patients to support their care. Objectives: Synthesise the academic literature to explore the extent to which video-based patient records are acceptable and effective in supporting direct patient care and summarise the ethico-legal considerations and guidance of professional and regulatory bodies in the United Kingdom. Methods: Five electronic databases (Medline, Embase, PsycInfo, Cochrane, HMIC) were searched from 2012 to 2022. Studies were eligible if they recruited patients ≥ 18 years and evaluated an intervention involving videorecording individual patients to support diagnosis, care, and/or treatment. All study designs and countries of publication were included. Websites of professional and regulatory bodies in the UK were searched to identify relevant guidance and recommendations. Study quality was assessed using published tools and guidance. Acceptability was evaluated using recruitment and retention rates and framework-based synthesis of patients’ and professionals’ perspectives based on Sekhon’s Theoretical Framework of Acceptability of Healthcare Interventions. To evaluate effectiveness, clinically relevant, objective measures of impact were extracted and tabulated according to study design. The framework approach was applied to synthesise reported ethico-legal considerations and recommendations of professional and regulatory bodies were extracted and tabulated. Results: Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Thirteen guidance documents were retrieved, of which seven were retained for the review. Mean recruitment rate was 68.2% (range 34.2% - 100.0%); mean retention rate was 73.3% (range 16.7% - 100.0%). Regarding acceptability, the views of patients and clinical staff were predominantly positive though some concerns were expressed about privacy, technical problems, and integrating videorecording into clinical workflows; some patients were anxious about their physical appearance. Patients and professionals perceived video-based patient records to be valuable in supporting clinical assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies provided evidence favouring video-based records but there was no convincing evidence of effectiveness from randomised controlled trials. Reported ethico-legal considerations addressed professional and regulatory guidance including informed consent, protecting privacy, and secure storage and transmission of videos. Conclusions: Video recording patients for direct care purposes may be acceptable to patients and professionals, providing the benefits are clear, and risks are properly mitigated, but evidence of effectiveness remains uncertain. Implementation of video-based patient records must adhere to national legislation and professional guidance on consent, privacy, and data protection

Assessment of patients' ability to review electronic health record information to identify potential errors: cross-sectional web-based survey

Background: Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective: The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods: A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results: A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions: While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care

Early Gas Stripping as the Origin of the Darkest Galaxies in the Universe

The known galaxies most dominated by dark matter (Draco, Ursa Minor and Andromeda IX) are satellites of the Milky Way and the Andromeda galaxies. They are members of a class of faint galaxies, devoid of gas, known as dwarf spheroidals, and have by far the highest ratio of dark to luminous matter. None of the models proposed to unravel their origin can simultaneously explain their exceptional dark matter content and their proximity to a much larger galaxy. Here we report simulations showing that the progenitors of these galaxies were probably gas-dominated dwarf galaxies that became satellites of a larger galaxy earlier than the other dwarf spheroidals. We find that a combination of tidal shocks and ram pressure swept away the entire gas content of such progenitors about ten billion years ago because heating by the cosmic ultraviolet background kept the gas loosely bound: a tiny stellar component embedded in a relatively massive dark halo survived until today. All luminous galaxies should be surrounded by a few extremely dark-matter-dominated dwarf spheroidal satellites, and these should have the shortest orbital periods among dwarf spheroidals because they were accreted early.Comment: Published in Nature (15 February 2007), 28 pages, 8 figures, Supplementary Information include

Modeling the influence of open water surfaces on the summertime temperature and thermal comfort in the city

Due to the combination of rapid global urbanization and climate change, urban climate issues are becoming relatively more important and are gaining interest. Compared to rural areas, the temperature in cities is higher (the urban heat island effect) due to the modifications in the surface radiation and energy balances. This study hypothesizes that the urban heat island can be mitigated by introducing open surface water in urban design. In order to test this, we use the WRF mesoscale meteorological model in which an idealized circular city is designed. Herein, the surface water cover, its size, spatial configuration, and temperature are varied. Model results indicate that the cooling effect of water bodies depends nonlinearly on the fractional water cover, size, and distribution of individual lakes within the city with respect to wind direction. Relatively large lakes show a high temperature effect close to their edges and in downwind areas. Several smaller lakes equally distributed within the urban area have a smaller temperature effect, but influence a larger area of the city. Evaporation from open water bodies may lower the temperature, but on the other hand also increases the humidity, which dampens the positive effect on thermal comfort. In addition, when the water is warmer than the air temperature (during autumn or night), the water body has an adverse effect on thermal comfort. In those cases, the water body eventually limits the cooling and thermal comfort in the surrounding city, and thus diverges from the original intention of the intervention

Academic Performance and Behavioral Patterns

Identifying the factors that influence academic performance is an essential part of educational research. Previous studies have documented the importance of personality traits, class attendance, and social network structure. Because most of these analyses were based on a single behavioral aspect and/or small sample sizes, there is currently no quantification of the interplay of these factors. Here, we study the academic performance among a cohort of 538 undergraduate students forming a single, densely connected social network. Our work is based on data collected using smartphones, which the students used as their primary phones for two years. The availability of multi-channel data from a single population allows us to directly compare the explanatory power of individual and social characteristics. We find that the most informative indicators of performance are based on social ties and that network indicators result in better model performance than individual characteristics (including both personality and class attendance). We confirm earlier findings that class attendance is the most important predictor among individual characteristics. Finally, our results suggest the presence of strong homophily and/or peer effects among university students