bluuebunny/crossref_metadata_2025_split huggingface dataset:
108 Impact of Health Literacy on Satisfaction Following Inflatable Penile Prosthesis Surgery
Authors: Bhalla R , Furuyama W , Calvert J , Ball M , Dropkin B , Milam D , Kaufman M , Johnsen N 
Published: April 2022

ABSTRACT

Introduction
Health literacy - the ability to obtain, comprehend, and act on basic medical information - can impact surgical outcomes and patient quality of life (QOL). Urologic prosthetic surgery aims to improve a patient's QOL, therefore patient satisfaction is a fundamental measure of success.

Objective
We sought to determine whether health literacy impacts patient satisfaction following inflatable penile prosthesis (IPP) surgery for erectile dysfunction.

Methods
We performed a single-institution retrospective study of patients who underwent IPP insertion between January 1st 2016 and July 31st 2020. A patient satisfaction phone questionnaire was administered between October 2020 and January 2021 to measure: (1) overall satisfaction with IPP surgery on a Likert scale and (2) if patients would undergo IPP surgery again. Baseline health literacy was measured using the Brief Health Literacy Screen (BHLS) – a validated 3-item questionnaire. Ordinal logistic regression was used to assess the association between health literacy and patient satisfaction, adjusting for the predetermined covariates of patient age, marital status, preoperative Sexual Health Inventory for Men (SHIM) scores, time from surgery to phone questionnaire, and device functionality.

Results
A total of 162 IPP patients met study inclusion criteria. The cohort consisted of primarily Caucasian (81.5%) and married (74.7%) men with a median age of 64.5 years and an interquartile range (IQR) of 57.5-69.5 years. The median (IQR) BHLS score was 15 (13-15) and the median (IQR) time from the index surgery to phone questionnaire administration was 2.41 (1.39-3.98) years. 69.8% of men were either very satisfied or satisfied with their procedure, and 74.1% of men would again undergo IPP surgery. After adjustment for potential confounders, BHLS score was significantly associated with patient satisfaction after IPP surgery (OR 1.31, 95% CI 1.11-1.54; p=0.001) and was positively associated with likelihood of again undergoing IPP surgery (OR 1.53, 95% CI 1.25-1.87; p&lt;0.001) (Table 1).

Conclusions
Patients with lower health literacy are less likely to be satisfied following IPP placement. The BHLS score is an important tool that can be used to identify patients who may benefit from increased preoperative counseling and education to further improve patient expectations and QOL following IPP surgery.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific
109 Caprini Risk Score is Shockingly High in Penile Prosthesis Surgery Patients
Authors: Habashy E , Hebert K , Helo S , Ziegelmann M , Collins S , Trost L , Kohler T 
Published: April 2022

ABSTRACT

Introduction
The significant overlap of risk factors for erectile dysfunction and venous thromboembolism (VTE) may disproportionally increase the risk of VTE in men undergoing inflatable penile prosthesis (IPP) surgery. Owing to the absence of available literature, AUA and EAU perioperative VTE guidelines do not address VTE risk with IPP surgery and generally recommend against pharmacologic prophylaxis with outpatient surgery. The Caprini Score is a validated scoring system to estimate VTE risk in the perioperative period.

Objective
We sought to assess the risk of VTE by calculating Caprini Scores in men undergoing IPP surgery.

Methods
We retrospectively reviewed and calculated Caprini Scores for patients undergoing IPP surgery at our institution between July 2017 and June 2019.

Results
215 patients undergoing IPP surgery were identified with a mean and median Caprini score of 5.96 (SD, 1.63) and 6 (IQR 5,7), respectively. 84% of the cohort was classified as high or highest risk for VTE (Figure 1). This is in part due to our cohort's mean age of 64, mean BMI of 31 and history of prostate cancer treatment as the cause of ED. Prior history of VTE (deep vein thrombosis(DVT) or pulmonary embolism (PE)was identified in 17 (8%) patients with 5 (2%) have a history of both DVT and PE.

Conclusions
Men undergoing IPP surgery are high risk for VTE based on Caprini score assessment. VTE prophylaxis should be considered in men undergoing penile implant surgery. Before widespread application, long-term data is necessary to assess safety and efficacy of VTE prophylaxis in the IPP surgery population.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast
111 Decreasing Intraoperative Narcotic Use: Pudendal Nerve Block Prior to Inflatable Penile Prosthesis Implantation
Authors: Sayyid R , Owens-Walton J , Taylor N , Oberle M , Fratino K , King S 
Published: April 2022

ABSTRACT

Introduction
The opioid epidemic has proven to be a public health crisis in the United States over the past two decades and efforts to decrease opioid exposure, and thus risk of dependence, are sorely needed.

Objective
To determine whether pudendal nerve block (PNB) utilization in the immediate pre-operative setting decreases intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis (IPP) implantation.

Methods
A retrospective cohort analysis of all patients undergoing a primary IPP implantation between January 2017 and July 2020 at the Charlie Norwood VA Medical Center in Augusta, GA were included. Patients undergoing implant revisions or concurrent procedures were excluded. PNBs were performed in the standard fashion bilaterally with 10 cc of combination 0.25% Marcaine without epinephrine and Solu-Medrol (Methylprednisolone sodium succinate). Univariable and multivariable gamma regression analyses were performed to evaluate the association between PNB utilization and intra-operative opioid analgesic requirements, abstracted from individual patient's anesthesia provider medication administration record. The primary study outcome was intra-operative opioid analgesic requirements, quantified in morphine milligram equivalents (MME), and the secondary outcome was post-operative opioid analgesic requirements.

Results
The study cohort consisted of 122 patients, 35 (28.7%) of whom underwent a PNB. Twelve (34.3%) and 17 (19.5%) patients in the PNB and non-PNB groups had an active opioid analgesic prescription at the time of their pre-operative visit. Median intra-operative opioid analgesic requirements were significantly lower in the PNB group (16.3 versus 26.0 MME, p=0.036). Receipt of an immediate pre-operative PNB was significantly associated with lower intra-operative opioid analgesic requirements on multivariable (coefficient 0.84, p=0.038) regression analysis. There was no significant difference in post-operative opioid analgesic requirements (37.5 MME in both groups, p=0.15).

Conclusions
Immediate pre-operative pudendal nerve blocks decrease intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation, and should be considered to decrease intra-operative opioid analgesic requirements.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific
114 Patient Risk Factors for Prolonged Opioid Dependence Following Primary Inflatable Penile Prosthesis Placement Managed with Multimodal Analgesia
Authors: Braun A , Sudhakar A , Lucas J , Patel R , Gross M , Simhan J 
Published: April 2022

ABSTRACT

Introduction
Multimodal analgesia (MMA) following inflatable penile prosthesis (IPP) placement has previously demonstrated substantially improved pain control with reduced opioid burden both in the acute and prolonged postoperative period. However, some patients receiving MMA still require opioid pain management beyond the immediate postoperative recovery, placing them at risk for developing prolonged opioid dependence.

Objective
In this analysis, we examine patient-specific and perioperative factors predicting increased pain and prolonged use of opioids in the recovery period following primary IPP surgery in those managed with MMA only.

Methods
This is a multicenter retrospective review of 165 primary three-piece IPP recipients from 12/2018 to 12/2020 managed with a standardized MMA protocol. Patients on narcotics preoperatively were excluded. Prolonged opioid dependence was defined as active opioid prescriptions in the Prescription Drug Monitoring Program (PDMP) 90 days after surgery in previously opioid-naïve patients. Preoperative, intraoperative and immediate postoperative factors were analyzed to assess correlative risk for increased pain and development of opioid dependence in the MMA cohort.

Results
The prolonged opioid use group (2/165) demonstrated substantially higher Visual Analog Scale (VAS) pain scores in PACU (p=0.014) with trends towards higher total morphine equivalents (TME) in PACU (p=0.076). Also seen were higher total morphine equivalents (TME) in postoperative day 0 (p=0.0425), while VAS scores on POD1 (p=0.123) and total TME prescribed at discharge (p=0.646) did not reach statistical significance. In assessing preoperative factors associated with developing opioid-dependence, age (p=0.194), race (p=0.414), BMI (p=0.202) and prevalence of diabetes (p=0.656) and chronic pain (p=0.291) did not demonstrate statistical significance. Intraoperative factors analyzed including operative time (p=0.719), surgical approach (p=1.00), cylinder size (p=0.938), use of rear-tip extenders (p=1.00), reservoir size (p=0.346) and use of drain (p=1.00) also did not yield significance.

Conclusions
Patients who developed prolonged postoperative opioid dependence tended to experience higher PACU VAS scores and increased TME requirements throughout their hospitalization. MMA appears to reduce risk of prolonged postoperative opioid dependence in this series. We found no clear preoperative or operative trends for prolonged opioid dependence in MMA patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
115 Two Cases of “Drained and Retained” Inflatable Penile Prosthesis and Artificial Urinary Sphincter Reservoirs causing Small Bowel Obstruction
Authors: Loloi J , Davila J , Matloubieh J , Gottlieb J , Maria P , Donnelly J , Small A 
Published: April 2022

ABSTRACT

Introduction
Inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) are the most common surgical implants in the field of men's health. Infected or defective implants can be removed or replaced. The “drain and retain” strategy has been described as generally safe when prosthetic reservoirs are not easily retrieved. However, case reports of complications related to retained balloons have been described including erosion into the bowel and bladder, intraperitoneal migration and vascular compression. Here we describe two rare cases of reservoir-induced small bowel obstruction (SBO) from IPP and AUS reservoirs.

Objective
Describe two rare cases of retained IPP and AUS reservoirs causing SBO.

Methods
Single institutional retrospective case series.

Results
Case 1: 75 year old male who underwent IPP placement in 2001. Due to device malfunction, IPP cylinders were removed and replaced with 2-piece device in 2017, and the reservoir was “drained and retained.” The patient presented 4 years later with abdominal pain, nausea/vomiting, and right lower quadrant (RLQ) feculent cutaneous drainage. CT scan showed SBO with a transition within the terminal ileum due and an endoluminal foreign body in the cecum (consistent with the retained reservoir) (Figure 1A). Additionally, a contained bowel perforation with entero-cutaneous fistula tract to the skin was identified. Diagnostic laparoscopy revealed a thickened terminal ileum, walled-off perforation in the RLQ (Figure 1B) thought to be due to reservoir entry into the bowel, and a fistula to the right abdominal wall. The bowel was resected, thorough investigation including right-sided colonoscopy was unable to identify the reservoir, and primary anastomosis was performed. Follow up CT scan 3 days later showed passage of reservoir, presumably in the patient's bowel movements. Case 2: 81 year old male with a history of AUS placement in 2016. The device was removed for infection 5 years later. The reservoir was “drained and retained” given difficult access and no sign of reservoir infection. One month later, he presented with abdominal distention, nausea and vomiting. A CT scan revealed dilated loops of small bowel with an abrupt transition point in the RLQ adjacent to the retained reservoir (Figure 1C). Exploratory laparotomy showed SBO with the reservoir and tubing embedded into the small bowel wall (Figure 1D). The foreign bodies were successfully retrieved and the affected bowel was resected and repaired with a primary anastomosis.

Conclusions
These two cases of SBO due to IPP and AUS reservoirs show a potential danger of the “drain and retain” strategy, especially when reservoirs are placed intraperitoneal. These cases may be helpful to inform patient counseling on the rare risks of implant revision surgery. Innovative means of reservoir retrieval at explantation are needed to mitigate these risks.

Disclosure
No
116 Dorsal Artery Branches to the Corpora Cavernosa
Authors: Trussler J , Aponte-Colon D , Alnammi M , Flacke S , McCullough A 
Published: April 2022

ABSTRACT

Introduction
Understanding the penile arterial anatomy and its preservation is of interest to reconstructive and oncologic surgeons. The predominant cavernosal arterial supply is provided by the cavernous artery (CA) as it branches from the internal pudendal artery (IPA). Penile ultrasound and cavernosography have demonstrated the existence of accessory arteries originating from the dorsal artery of the penis (DA). Assessment of the arterial anatomy has largely been limited to imprecise ultrasound or invasive angiography.

Objective
To describe the anatomic findings relating to DA branching patterns in the penis among men undergoing CT cavernosography for evaluation of sexual dysfunction.

Methods
Images from CT cavernosography were reviewed in a sequential cohort of men. Imaging was reviewed to delineate the arterial anatomy with respect to the CA and DA branches distal to the pubic symphysis as noted by an absence of contrast in a linear hiatus within the corpora cavernosa. Data included the presence of an identifiable CA or DA branch, their diameters, the number of DA branches, distance from the pubic symphysis, and the approximate branching angle.

Results
68 men had imaging available for analysis, 57 of whom underwent evaluation for ED and 37 for penile curvature. At least one CA was identifiable in 88% of men with a mean diameter of 1.66mm (Median 1.40, [IQR 1.30, 1.90]). DA perforating branches were identified in 90.8% of men, with a mean of 2.1 discrete branches per patient (Median 2, [IQR 1,3]). 26 men had penile doppler data available for comparison. Among those men, the mean CA diameter after injection was 1.51mm and the ratio between diameter measured on doppler and CT was 1.0. 4 patients had a DA branch identified on penile doppler and all had at least one DA branch identified on CT. 19 patients had at least one DA branch identified on CT which was not seen on penile doppler. In a subset of 33 patients with further CT data available for review, the mean number of DA branches identified was 2.24 (Median 2, [IQR 1,3]), with a mean DA branch diameter of 1.39mm (Median 1.40, [IQR 1, 1.70]). The first branch was identified at a mean of 2.06cm distal to the pubic symphysis with a branching angle of approximately 49.75 degrees, and the second branch was identified at a mean of 3.4cm distal to the pubic symphysis with a branching angle of approximately 50.62 degrees.

Conclusions
Dorsal artery contribution to the cavernosal blood supply may be more variable than previously thought. This is of interest to those performing penile doppler for assessment of blood flow given that it may be difficult to delineate the CA and DA in some patients. The impact of these DA branches on sexual function is not clear and warrants further investigation.

Disclosure
No
Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers
Authors: Chen Daniel L. , Meyers Rachel N. , Provance Aaron J. , Zynda Aaron J. , Wagner K. John , Siegel Shannon R. , Howell David R. , Miller Shane M. 
Published: April 2022

Introduction Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers. Methods Climbers (ages 8–18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as “lifetime” injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y-1, prior to age 12 y (late specialization if after age 12 y). Results Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1–2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1–2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups. Conclusions Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.
Self-Explanation and Empty-Base Explanation
Authors: KAPPES YANNIC 
Published: April 2022

AbstractThis paper explores a novel notion of self-explanation that combines ideas from two sources: (1) the tripartite account of explanation, according to which a proposition can help explain another either in the capacity of a reason why the latter obtains or in the capacity of an explanatory link, and (2) the notion of an empty-base explanation, which generalizes the ideas of explanation by zero-grounding and explanation by status. After having introduced these ideas and the novel notion of self-explanation, I argue that the latter has the potential to resist extant arguments against the possibility of self-explanation. In the remainder of the paper, I discuss candidates for such self-explanatory propositions and suggest possible applications for Humeanism about laws of nature, the debate on the grounds of ground, the rationalist tradition, and philosophical theology.
A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units
Authors: Mantadakis Elpis , Kopsidas Ioannis , Coffin Susan , Dimitriou Gabriel , Gkentzi Despoina , Hatzipantelis Emmanouel , Kaisari Aikaterini , Kattamis Antonis , Kourkouni Eleni , Papachristidou Smaragda , Papakonstantinou Evgenia , Polychronopoulou Sophia , Roilides Emmanuel , Spyridis Nikos , Tsiodras Sotirios , Tsolia Maria N. , Tsopela Grammatiki-Christina , Zaoutis Theoklis , Tragiannidis Athanasios 
Published: April 2022

Abstract

Objective:
We surveyed antimicrobials used in Greek pediatric hematology–oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients.

Design:
Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017.

Intervention:
In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated.

Setting:
Five of the 6 PHO units in Greece and the single pediatric BMT unit participated.

Participants:
Admitted children in each unit who received the first 15 new antibiotic courses each month.

Results:
Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children’s hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008).

Conclusions:
We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.
Non-Association Conditions among Released Women: Implications for Successful Community Reintegration
Authors: McKendy Laura , Ricciardelli Rosemary 
Published: April 2022

AbstractIn addition to standard parole conditions, parolees under federal community supervision may be subject to special conditions as determined by the Parole Board of Canada; such conditions are intended to manage factors associated with criminogenic risk and need. One set of special conditions places restrictions on parolees’ social relationships and associations, which can include general restrictions (e.g., non-association with individuals involved in crime) or specific restrictions (e.g., no contact with one’s victim or co-accused). Drawing on case files of women under community supervision (n= 43), we explore how non-association and no contact orders shape community release experiences. We suggest that such conditions can have wide-reaching effects on women’s social lives and reintegration (e.g., in the areas of social support, employment, and housing), thereby, at times, complicating women’s attempts to construct post-institutional lives and identities. We consider how association conditions illustrate the broader tension between parole requirements and reintegration.
Public Support for Canadian Courts: Understanding the Roles of Institutional Trust and Partisanship
Authors: Crandall Erin , Lawlor Andrea 
Published: April 2022

AbstractPublic support is a critical component of any court’s institutional legitimacy. Understanding the roots and durability of such support is therefore crucial. This article uses survey data to explore public attitudes towards Canadian courts from 2008 to 2019. This time period is especially relevant given the comparatively tumultuous relationship between the Supreme Court and the Conservative government of Prime Minister Stephen Harper (2006–2015). Notably, partisanship now appears to be a defining characteristic of court support in Canada, with Conservative Party supporters being less likely to support the courts. While institutional trust is also found to be a strong predictor of court support, this suggests public attitudes towards Canadian courts may no longer be as well shielded from the effects of changing political circumstances as they once were.