Omissions in care for sexual health in cardiology and gastroenterology : perspectives of physicians and patients

Dit proefschrift toont lacunes in de Nederlandse gezondheidszorg op twee deelgebieden: de cardiologie en de gastroenterologie. Hierbij is 1) zowel onder cardiologen als onder cardiologische pati_nten onderzocht in hoeverre zorg wordt geboden op het gebied van seksualiteit en seksuele disfunctie bij hart- en vaatziekten en in hoeverre er hieraan behoefte is. In het bijzonder op het gebied van erectiele disfunctie, een veel voorkomend probleem bij mannen met hart- en vaatziekten, blijkt een fors tekort te bestaan aan zorg hiervoor binnen de cardiologie. Naar aanleiding van de vergaarde data zijn richtlijnen opgesteld en aanbevelingen gedaan voor het verbeteren van de seksuele gezondheidzorg binnen de cardiologie. 2) Onder maag-darm-leverartsen en pati_nten die een colonoscopie ondergingen werd ge_valueerd in wel mate aandacht wordt besteed aan seksueel misbruik is het verleden. De impact van colonoscopisch onderzoek bij pati_nten met seksueel misbruik in de voorgeschiedenis werd aangetoond. Seksueel misbruik is zeer prevalent en heeft een bijzonder grote impact op de gezondheid en de pijnbeleving. Aanbevelingen worden gedaan voor het verbeteren van de zorg rondom colonoscopisch onderzoek voor pati_nten met seksueel misbruik in het verleden.The studies were initially initiated by the Pelfic Floor & Sexuality Research Group Leiden and where possible thanks to an unrestricted grant of Olympus. Additional financial support was provided by: Astellas Amgen Coloplast Ferring GSK Pfizer RPMedical Olympus Medical BV Janssen-Cilag BVUBL - phd migration 201

An estimation of patients at potential risk for drug-induced sexual dysfunction using pharmacy dispensing data

Background and Objectives: Adverse drug reactions on sexual functioning (sADRs) may seriously decrease a person's quality of life. A multitude of diseases and drugs are known risk factors for sexual dysfunction.To inform patients better about these potential effects, more insight is needed on the estimated number of patients at high risk for sADRs and their characteristics.Methods: This cross-sectional study estimated the number of patients in the Netherlands who were dispensed drugs with a potential very high risk (>10%) or high risk (1-10%) for sADRs as registered in the Summary of Product Characteristics, the official drug information text in Europe.Results: In April 2019, 2.06% of the inhabitants of the Netherlands received drugs with >10% risk for sADRs and 7.76% with 1-10% risk.The majority of these patients had at least one additional risk factor for decreased sexual function such as high age or depression. Almost half of the patients were identified with two or more morbidities influencing sexual functioning. Paroxetine, sertraline and spironolactone were the most dispensed drugs with a potential >10% risk for sADRs. One-third of their first dispenses were not followed by a second dispense, with a higher risk of discontinuation for a decreasing number of morbidities.Conclusion: About 1 in 11 inhabitants of the Netherlands was dispensed a drug with a potential high risk for sADRs, often with other risk factors for sexual complaints. Further research is needed whether these users actually experience sADRs, to understand its impact on multimorbid patients and to provide alternatives if needed.Clinical Pharmacy and Toxicolog

Discussing reproductive health in spinal care, part II: fertility issues

Abstract PURPOSE: Due to advancing insights, discussing fertility in spinal care is an emerging topic. Studies among neurosurgeons to evaluate clinical practice about discussing fertility are non-existent. The aim of this study is to review knowledge, attitude and practice patterns regarding discussing fertility in spinal care. METHODS: Dutch neurosurgeons and residents were sent a mail-based questionnaire addressing attitude, knowledge and practice patterns regarding discussing fertility. RESULTS: Response rate was 62 % (compared to mean of 28 % in similar surveys) with 89 questionnaires suitable for analysis. Mean age was 42 years with 83 % of respondents being male. A quarter of respondents stated neurosurgeons are responsible to discuss fertility, with 12 % indicating to actually do this. Fertility is discussed more often with patients with cauda equina syndrome (70 %) and with men (p = 0.006). Merely 8 % of respondents stated to have adequate knowledge on fertility preservation (FP); this percentage was higher for doctors with spinal surgery as specialty (p = 0.015). In case of cauda equina syndrome, doctors with more knowledge discussed fertility more often (p = 0.002). Fifty-three percent of neurosurgeons wished to enhance their knowledge, in order to feel more comfortable to discuss fertility with their patients. Five percent indicated to have ever referred a patient to a fertility specialist. CONCLUSION: With the exception of cauda equina syndrome, fertility is not routinely discussed in spinal care. Fertility is discussed more often with men. Recent guidelines state that discussing fertility is an essential part of good practice in spinal care. Education on fertility and FP needs to be integrated in the neurosurgical training program to create more awareness, and to enable clinicians to provide adequate information and care to the patient. KEYWORDS: Education; Fertility; Practice patterns; Reproductive health; Spinal care GynecologyCervix cance

An educational need regarding treatment-related infertility and fertility preservation: a national survey among members of the Dutch society for medical oncologists

Cancer diagnosis and treatment may influence reproductive planning and impact fertility in patients of reproductive age. Although guidelines have been established in the past decade, education, practice, and attitudes of medical oncologists regarding fertility preservation remain undecided. A nationwide survey was performed among members of the Dutch Society for Medical Oncology. Demographics, practice, knowledge, and barriers were measured regarding information provision of fertility preservation towards cancer patients of childbearing age. From 392 members, 120 oncologists completed the questionnaire (30.6%). Majority of oncologists was convinced it is their responsibility to discuss impact of cancer treatment to fertility (93.2%), yet 68.3% discussed the subject often or always (n = 82). Oncologists employed in district general hospitals were less likely to discuss fertility (p = 0.033). On average, 44.6% of reproductive men and 28.9% of reproductive women is referred to fertility specialists. Half of the respondents declared to possess sufficient knowledge regarding fertility preservation (n = 57, 47.5%). Poor prognosis (53%), unlikely survival (43.1%), and high chances on fertility recovery (28.7%) were identified as barriers to discussing fertility preservation. Among oncologists, impact of cancer treatment on fertility is a well-accepted responsibility to counsel. Despite, self-reported knowledge regarding fertility preservation is strongly varying. In practice, fertility is discussed to some extent, influenced by several barriers and depending on prognosis and type of hospital. Patients benefit from knowledge improvement among oncology care providers concerning fertility effects of cancer treatment. Education during medical school, residency, and among practicing oncologists may raise awareness, together with enhancement of referral possibilities.Development and application of statistical models for medical scientific researc

The Impact of Sexual Abuse in Patients Undergoing Colonoscopy

Development and application of statistical models for medical scientific researc

Identifying the need to discuss infertility concerns affecting testicular cancer patients: an evaluation (INDICATE study)

Simple SummaryTesticular cancer is the most common malignancy in young males affecting the ability to father children. It's important that effects on fertility are discussed before starting treatment so patients are aware of the risks and their options. The objective of our study was to evaluate the manner in which men with testicular cancer are counselled about implications on fertility and the possibility of semen preservation. Furthermore, we aimed to evaluate satisfaction with provided information and to identify reproductive concerns. In a sample of 201 patients, one out of ten patients reported not to be informed about the risk of subfertility. Sperm banking was performed by 41.3%, of which 13 men made use of preserved sperm, resulting in paternity for 7 men. The subjects fertility and semen preservation need to be broached promptly after diagnosis of testicular cancer because they cause dissatisfaction with care and grief if fertility problems occur afterwards.Men with testicular cancer (TC) risk impaired fertility. Fertility is a major concern for TC patients due to diagnosis in almost always reproductive ages and high overall survival. This study assessed counselling in regards to the risk of impaired fertility and sperm cryopreservation. A cross-sectional survey was performed on 566 TC patients diagnosed between 1995-2015. Of the 566 survivors, 201 questionnaires were completed (35.5%). Eighty-eight percent was informed about possible impaired fertility, 9.5% was not informed. The majority (47.3%) preferred the urologist to provide information. Collecting sperm was troublesome but successful for 25.6%, 4.8% did not succeed in collecting sperm. The reasons were high pressure due to disease, pain after surgery and uncomfortable setting. Due to impaired fertility, 19% of the respondents reported grief and 9.3% stated as being less satisfied in life. Sperm cryopreservation was performed by 41.3% (n = 83). One third (n = 63, 31.3%) had children after treatment, of which 11.1% made use of preserved sperm (n = 7). The results of this survey indicate the importance of timely discussion of fertility issues with TC patients. While being discussed with most men, dissatisfaction and grief may occur as a result of impaired fertility and a lack of counselling. Overall, 6.5% made use of cryopreserved sperm (n = 13). Men prefer their urologist providing counselling on fertility.Development and application of statistical models for medical scientific researc

Patient sexual function and hip replacement surgery: A survey of surgeon attitudes

Neuro-urology: functional disorders in male and female urogenital trac

Do residents in cardiology need more training to make them talk about sex?

Development and application of statistical models for medical scientific researc

response to letter to the editor: Time to integrate sexual function in the health-related quality of life of patients with left ventricular assist devices The problem is the implementation of sexual healthcare in cardiology

Neuro-urology: functional disorders in male and female urogenital trac

Adverse drug reactions on sexual functioning: a systematic overview

Neuro-urology: functional disorders in male and female urogenital trac