Development and application of statistical models for medical scientific researc

A Nehra

CA Vries Feyens De

GN Levine

IB Addis

M Baumhakel

M Doumas

MP Nicolai

PubMed

Nicolai, M.P.J.

Elzevier, H.W.

Leiden University Scholary Publications

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

M. P. J. Nicolai

H. W. Elzevier

Crossref

SHORT COMMUNICATIONDo residents in cardiology need more training to make them talkabout sex?M. P. J. Nicolai & H. W. ElzevierPublished online: 31 January 2014# The Author(s) 2014. This article is published with open access at Springerlink.comKeywords Residents training . Erectile dysfunction .Cardiovascular disease . Quality of careThe editorial comment of last December’s issue of theNetherlands Heart Journal pointed to our paper in that sameissue, in which Dutch cardiologists’ knowledge about theeffects of cardiovascular agents on sexual function wasevaluated (1, 2).Our previous work had already shown that 42 % of cardi-ologists indicated a need for training to increase their knowl-edge about sexual function in patients with cardiovasculardisease (3). Concerning that finding, the editors posed therelevant question whether it was mostly the residents indicat-ing this need for training, or not. If that were the case, thisimplicates that amendments in residents’ training have to bemade.In order to answer this question, we have re-analysed ourdata and present the results here.Of all NVVC members, 414 questionnaires were eligiblefor analysis: 19.1 % were residents in cardiology and 80.9 %were cardiologists. The residents said they discuss sexualfunction significantly less often with their patients than thecardiologists (linear-by-linear association p<0.001) and re-ferred a significantly lower percentage of patients for treat-ment of sexual dysfunction (estimated mean 0.9 % ±1.74compared with cardiologists mean 2.3 % ±4.56; p=0.007).Residents counselled patients with heart failure or after myo-cardial infarction less often about safely restoring sexual ac-tivity (linear-by-linear association p=0.024) or about the useof nitrates when anginal pain occurs during sexual activity(linear-by-linear association p=0.013). Furthermore, residentsspoke significantly less often about PDE-5 inhibitor use com-pared with their bosses (linear-by-linear association p<0.001).The knowledge about sexual health that residents reportedto possess was comparable with that of cardiologists: 71.8 %of the residents said they have sufficient knowledge to be ableto discuss sexual function with patients, versus 70.4 % of thecardiologists. The other 28.2 % of residents said they lackedthis knowledge (compared with 29.6 % of cardiologists; p=0.80).Interestingly, only 21.8 % of the residents stated a need fortraining to be able to provide care for sexual health, comparedwith 78.2 % of the cardiologists (p=0.23). From the aboveresults, we can infer that Dutch cardiology residents are notmotivated to inform patients about sexual function or toprovide treatment options for sexual dysfunction.Yet, our latest study among male patients from four Dutchcardiac clinics indicated that erectile dysfunction (ED) wasprevalent in the majority (70 %) of the men with cardiovas-cular disease; it was the most stated reason not to be sexuallyactive. ED caused significant burden in those affected by it,and 46 % would like to talk about treatment options with thecardiologist. Furthermore, 55 % said it would be helpful ifquestions about sexual health could be asked during consul-tation with a specialised nurse and 58 % would appreciatewritten information (4).These data, in addition to the mounting evidence pub-lished in the last decade (5–7), have shown that ED is avery common problem among men with cardiovasculardisease. In addition, it might be aggravated by insecurityabout the cardiac condition or induced by the antihyperten-sive agents used (8). And, although still understudied,sexual dysfunction has shown to be very prevalent amongwomen as well (9, 10). It is therefore impossible forcardiologists to avoid paying attention to sexual health.More training is mandatory to make sure cardiologists areable to inquire about sexual function, to counsel patientsabout sexual activity after cardiac events, to have thenecessary knowledge about medication-induced sexualM. P. J. Nicolai (*)Department of Surgery, Westfries Gasthuis, PO Box 600,1620 AR Hoorn, the Netherlandse-mail: melianthenicolai@gmail.comH. W. ElzevierDepartment of Urology, Leiden University Medical Center, Leiden,the NetherlandsNeth Heart J (2014) 22:122–123DOI 10.1007/s12471-014-0517-0dysfunction and to prescribe PDE-5 inhibitors. This sub-analysis among Dutch residents in cardiology emphasisedthat care for sexual health should especially get moreattention in residents training.Open Access This article is distributed under the terms of the CreativeCommons Attribution License which permits any use, distribution, andreproduction in any medium, provided the original author(s) and thesource are credited.References1. De Vries Feyens CA, Cramer MJ. Let’s talk about sex. Neth Heart J.2013;12:537–9.2. NicolaiMP, Liem SS, Both S, et al.What do cardiologists know aboutthe effects of cardiovascular agents on sexual function? A surveyamong Dutch cardiologists. Part I. Neth Heart J. 2013;21:540–4.3. Nicolai MP, Both S, Liem SS, et al. Discussing sexual function in thecardiology practice. Clin Res Cardiol. 2013;102:329–36.4. Nicolai MPJ, Bavel J, Somsen GA, et al. Erectile dysfunction in thecardiology practice: a patient’s perspective. AmHeart J. 2014; Ref Type:Generic.5. Baumhakel M, Schlimmer N, Kratz M, et al. Cardiovascular risk,drugs and erectile function–a systematic analysis. Int J Clin Pract.2011;65:289–98.6. Levine GN, Steinke EE, Bakaeen FG, et al. Sexual Activity andCardiovascular Disease: A Scientific Statement From the AmericanHeart Association. Circulation. 2012;125:1058–72.7. Nehra A, Jackson G, Miner M, et al. The Princeton III Consensusrecommendations for the management of erectile dysfunction andcardiovascular disease. Mayo Clin Proc. 2012;87:766–78.8. Nicolai MP, Liem SS, Both S, et al. A review of the positive andnegative effects of cardiovascular drugs on sexual function: aproposed table for use in clinical practice. Neth Heart J.2014;22:11–9.9. Addis IB, Ireland CC, Vittinghoff E, et al. Sexual activity andfunction in postmenopausal women with heart disease. ObstetGynecol. 2005;106:121–7.10. Doumas M, Tsiodras S, Tsakiris A, et al. Female sexual dysfunctionin essential hypertension: a common problem being uncovered. JHypertens. 2006;24:2387–92.Neth Heart J (2014) 22:122–123 123

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

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