Evidence-based Assessment Research Articles

The Biosafety Research Road Map: The Search for Evidence to Support Practices in the Laboratory-Zoonotic Avian Influenza and Mycobacterium tuberculosis.

The Biosafety Research Road Map reviewed the scientific literature on a viral respiratory pathogen, avian influenza virus, and a bacterial respiratory pathogen, Mycobacterium tuberculosis. This project aims at identifying gaps in the data required to conduct evidence-based biorisk assessments, as described in Blacksell et al. One significant gap is the need for definitive data on M. tuberculosis sample aerosolization to guide the selection of engineering controls for diagnostic procedures. The literature search focused on five areas: routes of inoculation/modes of transmission, infectious dose, laboratory-acquired infections, containment releases, and disinfection and decontamination methods. The available data regarding biosafety knowledge gaps and existing evidence have been collated and presented in Tables 1 and 2. The guidance sources on the appropriate use of biosafety cabinets for specific procedures with M. tuberculosis require clarification. Detecting vulnerabilities in the biorisk assessment for respiratory pathogens is essential to improve and develop laboratory biosafety in local and national systems.

The Biosafety Research Road Map: The Search for Evidence to Support Practices in the Laboratory-Shigella spp.

Shigella bacteria cause shigellosis, a gastrointestinal infection most often acquired from contaminated food or water. In this review, the general characteristics of Shigella bacteria are described, cases of laboratory-acquired infections (LAIs) are discussed, and evidence gaps in current biosafety practices are identified. LAIs are undoubtedly under-reported. Owing to the low infectious dose, rigorous biosafety level 2 practices are required to prevent LAIs resulting from sample manipulation or contact with infected surfaces. It is recommended that, before laboratory work with Shigella, an evidence-based risk assessment be conducted. Particular emphasis should be placed on personal protective equipment, handwashing, and containment practices for procedures that generate aerosols or droplets.

Generic Workflow to Predict Medicine Concentrations in Human Milk Using Physiologically-Based Pharmacokinetic (PBPK) Modelling-A Contribution from the ConcePTION Project.

Women commonly take medication during lactation. Currently, there is little information about the exposure-related safety of maternal medicines for breastfed infants. The aim was to explore the performance of a generic physiologically-based pharmacokinetic (PBPK) model to predict concentrations in human milk for ten physiochemically diverse medicines. First, PBPK models were developed for "non-lactating" adult individuals in PK-Sim/MoBi v9.1 (Open Systems Pharmacology). The PBPK models predicted the area-under-the-curve (AUC) and maximum concentrations (Cmax) in plasma within a two-fold error. Next, the PBPK models were extended to include lactation physiology. Plasma and human milk concentrations were simulated for a three-months postpartum population, and the corresponding AUC-based milk-to-plasma (M/P) ratios and relative infant doses were calculated. The lactation PBPK models resulted in reasonable predictions for eight medicines, while an overprediction of human milk concentrations and M/P ratios (>2-fold) was observed for two medicines. From a safety perspective, none of the models resulted in underpredictions of observed human milk concentrations. The present effort resulted in a generic workflow to predict medicine concentrations in human milk. This generic PBPK model represents an important step towards an evidence-based safety assessment of maternal medication during lactation, applicable in an early drug development stage.

Traumatic Brain Injury Intensive Evaluation and Treatment Program: Protocol for a Partnered Evaluation Initiative Mixed Methods Study.

The traumatic brain injury (TBI) Intensive Evaluation and Treatment Program (IETP) is an innovative modality for delivering evidence-based treatments in a residential, inpatient format to special operational forces service members and veterans with mild TBI. IETPs provide bundled evidence-based assessment, treatment, referral, and case management in concordance with the existing guidelines for mild TBI and commonly co-occurring comorbidities. To date, there has been no formal characterization or evaluation of the IETP to understand the determinants of implementation across the system of care. The goal of our partnered evaluation initiative (PEI) with an operational partner, the Physical Medicine and Rehabilitation National Program Office, is to facilitate the full implementation of the IETP across all 5 Veterans Health Administration TBI-Centers of Excellence (TBI-COE) and to inform minimum standards while supporting the unique characteristics of each site. This IETP partnered evaluation will describe each of the 5 TBI-COE IETP services and state of implementation to identify opportunities for adaptation and scale, characterize the relationship between patient characteristics and clinical services received, evaluate the outcomes for participants in the IETP, and inform ongoing implementation and knowledge translation efforts to support IETP expansion. In alignment with the goals of the protocol, ineffective treatment components will be targeted for deimplementation. A 3-year concurrent mixed methods evaluation using a participatory approach in collaboration with the operational partner and TBI-COE site leadership will be conducted. Qualitative observations, semistructured focus groups, and interviewing methods will be used to describe IETP, stakeholder experiences and needs, and suggestions for IETP implementation. Quantitative methods will include primary data collection from patients in the IETP at each site to characterize long-term outcomes and patient satisfaction with treatment and secondary data collection to quantitatively characterize patient-level and care system-level data. Finally, data sets will be triangulated to share data findings with partners to inform ongoing implementation efforts. Data collection began in December 2021 and is currently ongoing. The results and deliverables will inform IETP characterization, evaluation, implementation, and knowledge translation. The results of this evaluation seek to provide an understanding of the determinants affecting the implementation of IETPs. Service member, staff, and stakeholder insights will inform the state of implementation at each site, and quantitative measures will provide options for standardized outcome measures. This evaluation is expected to inform national Physical Medicine and Rehabilitation Office policies and processes and knowledge translation efforts to improve and expand the IETP. Future work may include cost evaluations and rigorous research, such as randomized controlled trials. DERR1-10.2196/44776.

Promoting breast health awareness: Can a sensor-enabled training system for patient education help?

IntroductionAccording to a 2009 study published in the Journal of Clinical Oncology, 79% of women (N = 222) diagnosed with breast cancer reported that they identified their cancers through breast self-exam (BSE). However, the U.S. Preventative Services Task Force does not require clinicians to teach women how to perform BSE. MethodsTo address this grave challenge, our team at the Technology Enabled Clinical Improvement (TECI) Center has developed a mobile, sensor-enabled haptic training system to teach women proper BSE technique. To validate the efficacy of the training system, our team deployed a data collection at the 2019 Breast Cancer and African Americans (BCAA) event where survey, sensor, and anecdotal data were collected from 61 participants. The custom-built breast model used in this study had a single, hard mass embedded in it. ResultsParticipants at the BCAA event were able to successfully identify the mass 65% of the time and used an average force of 7.2 N. When looking at participants’ confidence in their abilities to perform BSE, only 10% of respondents answered “very confident” pre-training whereas post-training, the reporting for “very confident” jumped to 66% (p < 0.01). ConclusionBy comparison, our previous work revealed that practitioners who use less than 10 N of force are 70% more likely to miss a lesion. The integration of sensors into the BSE haptic training system allowed for objective, evidence-based assessment of hands-on skill. In addition to teaching women proper BSE technique, this training empowered women to be informed advocates in their breast health journey. Future community-based training/feedback sessions will allow for continuous advancement of the training system.

Using ecosystem health and welfare assessments to determine impacts of wild collection for public aquariums.

Aquatic ecosystems are currently facing a multitude of stressors from anthropogenic impacts, including climate change, pollution, and overfishing. Public aquariums positively contribute to ecosystems through conservation, education, and scientific advancement; but may also negatively detract from these systems through collection of animals from the wild and sourcing from commercial suppliers. Changes within the industry have occurred, although evidence-based assessments of 1) how aquariums collect and maintain their populations to determine sustainability of the environment they have harvested; and 2) the welfare of these harvested animals once within the aquariums are still needed. The objectives of this study were to assess the ecosystem health of locations aquariums frequently visit to collect fish from the wild, and then evaluate the wellbeing of fishes at aquariums after extended periods in captivity. Assessments included use of chemical, physical, and biological indicators at field sites, and use of a quantitative welfare assessment at aquariums for comparison to species reared through aquaculture. Anthropogenic pressures at field sites were observed, but no evidence of high degradation or compromised health of animals were found. Welfare assessments of aquarium exhibit tanks produced high-positive scores overall (> 70/84), demonstrating that both wild collected (avg. score 78.8) and aquaculture fishes (avg. score 74.5) were coping appropriately within their environments. Although findings indicated that fish can be taken from the wild at low-moderate rates without any deleterious impact on the environment and cope equally well in aquarium settings, alternatives such as aquaculture should be considered as a strategy to reduce pressure on known stressed aquatic environments or where significant numbers of fishes are being taken.

Management of Prostate Cancer in Older Adults.

The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.

Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials.

Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2=0%, n=1722, k=10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2=0%, n=934, k=6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2=0%, n=203, k=2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2=0% n=1109, k=7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2=0% n=1110, k=13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. There was no funding for this study.

Formal evaluation of construction safety performance metrics and a case for a balanced approach

Introduction: Measuring safety performance is crucial to making informed decisions that improve construction safety management. Traditional approaches to construction safety performance measurement primarily focus on injury and fatality rates, but researchers have recently proposed and tested alternative metrics such as safety leading indicators and safety climate assessments. Although researchers tend to extol the benefits of alternative metrics, they are studied in isolation and the potential weaknesses are rarely discussed, leaving a critical gap in knowledge. Method: To address this limitation, this study aimed to evaluate existing safety performance against a set of pre-determined criteria and explore how multiple metrics may be used together to optimize strengths and offset weaknesses. For a well-rounded evaluation, the study included three evidence-based assessment criteria (i.e., the extent to which the metric is predictive, objective, and valid) and three subjective criteria (i.e., the extent to which each metric is clear, functional, and important). The evidence-based criteria were evaluated using a structured review of existing empirical evidence in literature, while the subjective criteria were evaluated using expert opinion solicited through the Delphi method. Results: The results revealed that no construction safety performance measurement metric is strong in all evaluation criteria, but many weaknesses may be addressed through research and development. It was also demonstrated that combining multiple complementary metrics may result in a more complete evaluation of the safety systems because multiple metrics offset respective strengths and weaknesses. Practical Applications: The study provides a holistic understanding of construction safety measurement that may guide safety professionals in their selection of metrics and assist researchers who seek more reliable dependent variables for intervention testing and safety performance trending.

Evidence-based disaster risk assessment in Southeast Asian countries

This paper aims to provide an overview of the risks and trends of natural disasters in Southeast Asian countries and discuss necessary future countermeasures. Quantitative analysis of natural disasters was performed using data collected from EM-DAT. The disaster risk assessment for countries and disaster types was conducted using a frequency-impact risk matrix and risk ranking identification, which is a novel approach based on actual disaster data. The findings suggest that Indonesia, the Philippines, and Thailand face the highest mortality, affected population, and economic damage risks, respectively. Moreover, the study reveals that Southeast Asian countries are vulnerable to climate-related disasters. This risk assessment gives us a comprehensive understanding of natural disaster risks in Southeast Asian countries, enabling us to identify the most vulnerable countries in the region and determine the most significant disaster-type countermeasures for each country.

The effect of evidence-based pain assessment protocol in pediatric emergency department on nurses' knowledge, attitudes, and practices towards pain

PurposeThis study aimed to determine the effect of the “Evidence-Based Pain Assessment Protocol in Pediatric Emergency Department” on nurses' knowledge, attitudes, and practices towards pain. MethodA pretest–posttest quasi-experimental study was conducted with 11 nurses. Before the protocol was applied, 337 nurses' records were assessed for one month. Subsequently, the nurses were educated in the Evidence-Based Pain Assessment Protocol in the Pediatric Emergency Department. After the education, the researchers assessed 315 nurses' records for one month to evaluate the protocol's effect on the nurses' clinical practice. ResultsThe study found no significant difference in the mean scores of nurses' Pediatric Pain Knowledge and Attitude Scale between the pre-and post-education periods (p > 0.05). However, there was a significant difference in the types of pain assessment tools used between these two periods (p < 0.001). In the post-education period, the frequency of both pharmacological and non-pharmacological interventions implemented increased significantly compared to the pre-education period (p < 0.001). Additionally, the study found that the frequency of nurses describing pain and reassessing pain increased significantly in the post-education period compared to the pre-education period (p < 0.001). ConclusionsThe study found that there was no significant change in the nurses' Pediatric Pain Knowledge and Attitude Scale scores before and after the training. However, it was observed that the frequency of nurses reassessing pain, using non-pharmacological interventions, and describing pain increased after the protocol was applied in the emergency department. In particular, therapeutic communication and the walking method were used more frequently in the post-training period among the non-pharmacological interventions applied by the nurses for pain.

Adherence to a lifestyle monitoring system in patients with heart disease: protocol for the care-on prospective observational trial

BackgroundLifestyle factors such as physical fitness, dietary habits, mental stress, and sleep quality, are strong predictors of the occurrence, clinical course, and overall treatment outcomes of common cardiovascular diseases. However, these lifestyle factors are rarely monitored, nor used in daily clinical practice and personalized cardiac care. Moreover, non-adherence to long-term self-reporting of these lifestyle factors is common. In the present study, we evaluate adherence to a continuous unobtrusive and patient-friendly lifestyle monitoring system using evidence-based assessment tools.MethodsIn a prospective observational trial (N = 100), the project investigates usability of and adherence to a monitoring system for multiple lifestyle factors relevant to cardiovascular disease, i.e., daily physical activity levels, dietary habits, mental stress, smoking, and sleep quality. Patients with coronary artery disease, valvular disease and arrhythmias undergoing an elective intervention are asked to participate. The monitoring system consists of a secured online platform with a custom-built conversational interface—a chatbot—and a wrist-worn wearable medical device. The wrist-worn device collects continuous objective data on physical activity and the chatbot is used to collect self-report data. Participants collect self-reported lifestyle data via the chatbot for a maximum of 4 days every other week; in the same week physiological data are collected for 7 days for 24 h. Data collection starts one week before the intervention and continues until 1-year after discharge. Via a dashboard, patients can observe their lifestyle measures and adherence to self-reporting, set and track personal goals, and share their lifestyle data with practitioners and relatives. The primary outcome of the trial is adherence to using the integrated platform for self-tracking data. The secondary outcomes include system usability, determinants of adherence and the relation between baseline lifestyle behaviour and long-term patient-relevant outcomes.DiscussionSystematic monitoring during daily life is essential to gain insights into patients’ lifestyle behaviour. In this context, adherence to monitoring systems is critical for cardiologists and other care providers to monitor recovery after a cardiac intervention and to detect clinical deterioration. With this project, we will evaluate patients’ adherence to lifestyle monitoring technology. This work contributes to the understanding of patient-centered data collection and interpretation, to enable personalized care after cardiac interventions in order to ultimately improve patient-relevant outcomes and reduce health care costs.Trial registrationNetherlands Trial Registry (NTR) NL9861. Registered 6th of November 2021.

Assessing the speech production of multilingual children: A survey of speech-language therapists in French-speaking Belgium.

Assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English-speaking countries. This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French-speaking Belgium. An online survey was completed by 134 SLTs in French-speaking Belgium. SLTs predominantly used norm-referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French-speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French. Action is required to improve clinical practice in assessing the speech production of multilingual children in French-speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers. What is already known on this subject Existing research indicates that assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English-speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French-speaking regions are scarce. What this study adds The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French-speaking Belgium. The norm-referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion-referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French-speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context- and/or language-specific solutions-and ultimately improve clinical practice. What are the clinical implications of this work? SLTs in French-speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French-speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence-based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English.

The digital layer: alternative data for regional and innovation studies

ABSTRACT The lack of large-scale data revealing the interactions among firms has constrained empirical studies. Utilizing relational web data has remained unexplored as a remedy for this data problem. We constructed a Digital Layer by scraping the inter-firm hyperlinks of 600,000 German firms and linked the Digital Layer with several traditional indicators. We showcase the use of this developed dataset by testing whether the Digital Layer data can replicate several theoretically motivated and empirically supported stylized facts. The results show that the intensity and quality of firms’ hyperlinks are strongly associated with the innovation capabilities of firms and, to a lesser extent, with hyperlink relations to geographically distant and cognitively close firms. Finally, we discuss the implications of the Digital Layer approach for an evidence-based assessment of sectoral and place-based innovation policies.

Mobile DMA testing for leakage assessment: perspectives from Ontario, Canada

Abstract The formation of discrete regions in a water distribution system, referred to as district metered areas (DMAs), can be a pragmatic approach to diagnose both system and leakage characteristics. Their application, however, has historically been limited in the North American context owing in part to their costly implementation and operational challenges. Both to overcome these barriers and to demonstrate the benefits of DMAs, a leakage testing programme was undertaken in Ontario, Canada. Novelty arises from the development and deployment of a mobile testing unit specifically designed to collect minimum night flow (MNF) and pressure data into temporarily configured DMAs. Moreover, activation of a pressure reducing valve facilitated the direct testing of pressure modulation on leakage reduction. The mobile unit was deployed in 22 DMAs across eight water systems with results indicating a clear relationship between MNFs and system characteristics for well-performing DMAs. MNF benchmarks were quantified to enable an evidence-based assessment of leakage performance at the DMA level in typical Canadian water systems. This project established the proof-of-concept of the mobile unit for providing both accurate and reliable measurements of key leakage performance characteristics and for predicting leakage reduction following system interventions.

Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection.

Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.

PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND

You have accessJournal of UrologyCME1 Apr 2023PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND Laura Geldmaker, Daniela Haehn, Sarah Hampton, Christopher Walker, Colleen Ball, and Gregory Broderick Laura GeldmakerLaura Geldmaker More articles by this author , Daniela HaehnDaniela Haehn More articles by this author , Sarah HamptonSarah Hampton More articles by this author , Christopher WalkerChristopher Walker More articles by this author , Colleen BallColleen Ball More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s Disease (PD) can coexist with erectile dysfunction (ED). International guidelines recommend that PD management includes an assessment of each patient’s ability to initiate and sustain erection, by intracavernosal injection (ICI) test with or without duplex Doppler ultrasound. Distress caused by PD may limit a patient’s ability to assess adequacy of penile rigidity. Our objective was to assess vascular erectile integrity non-invasively in the setting of PD. METHODS: Consecutive patients who underwent ICI followed by Color Doppler Duplex Ultrasound (CDDU) at our institution were retrospectively reviewed. CDDU findings were recorded following injection of alprostadil and again after a period of privacy and visual sexual stimulation (VSS). Erectile re-observations were made with patient standing after VSS. Erectile rigidity was assessed by one physician and all patients were asked to compare to their best quality home erection. CDDU findings including peak systolic velocities, end diastolic velocities, and resistive indices were recorded. Among patients diagnosed with PD, comparisons of patient characteristics between those with and without a diagnosis of ED were made using a Wilcoxon rank sum test (continuous characteristics) or Fisher’s exact test (categorical characteristics). RESULTS: Our assessment of 1853 men using CDDU found 1239 were diagnosed with PD by CDDU. Among those with PD, 353 (28.5%) were diagnosed with PD only (vascular normal) and 886 (71.5%) were diagnosed with PD+ED. Patients with a CDDU diagnosis of PD only were younger [median: 57 (49, 62) vs. 61 (55, 67) years, p<0.001], less likely to have hypertension [119/349 (34.1%) vs. 424/885 (47.9%), p<0.001], less likely to have used PDE-5 inhibitor [243/348 (69.8%) vs. 692/882 (78.5%), p=0.002], and less likely to have failed to a PDE-5 inhibitor [150/243 (61.7%) vs. 531/691 (76.8%), p<0.001] compared to men with PD+ED. Mean SHIM scores were not normal in either group. SHIM scores were higher among those with PD only [median (interquartile range): 14 (8–20) vs. 10 (6–18), p<0.001]. CDDU diagnoses for men with PD+ED were AI 284/886 (32.1%), CVOD 371/886 (41.9%), mixed vascular ED 231/886 (26.1%). CONCLUSIONS: In our practice more than 90% of men undergo history and physical examination with same day CDDU for the evaluation of PD. In this series, Doppler analysis found that 71.5% of PD patients have some form of vascular ED. We recommend an evidence-based assessment of vascular erectile integrity before any patient is triaged to medical or surgical intervention. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e739 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Geldmaker More articles by this author Daniela Haehn More articles by this author Sarah Hampton More articles by this author Christopher Walker More articles by this author Colleen Ball More articles by this author Gregory Broderick More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment and Treatment of Childhood-Onset Conduct Disorder: A Literature Review

Introduction: Conduct disorder (CD) is among the most highly represented diagnostic issues in child psychiatry. Current research suggests that early-onset CD is predictive of a worse prognosis and trajectory than other CD subtypes if not subsequently met with appropriate psychological assessment and symptom management. This paper aims to provide an overview of the literature from 2014 to 2021 in assessment and intervention protocols that target childhood-onset type specific CD, and appraise associated barriers implicated by the findings. Methods: This review involved a thorough literature search in electronic databases to extract empirical studies directly related to childhood-onset CD. The review was performed on PsycINFO and PubMed using the following search words: “conduct disorder(s)” OR “CD” OR “conduct disordered”, AND “child(hood)-onset” OR “elementary-onset” OR “early-onset”, AND “assessment” OR “evaluation” OR “examination”, AND “intervention” OR “treatment” OR “symptom management”. Results: Based on trends, articles were sorted into three common topics: assessment, treatment, and barriers to psychological services. The studies demonstrated the importance of sensitive and specific assessment tools, neural measures, behavioural markers, and the limited prosocial emotions (LPE) specifier. The results indicated that comorbidities, tailored school- and family-based intervention, parent-child conflict, and the LPE specifier in addition to the age-of-onset subtype is an area of research for clinicians. Discussion: Research has shown that childhood-onset CD, compared to other age-of-onset subtypes, is associated with individual risk factors such as neurological and cognitive deficits, poor emotion regulation, familial maladaptive parenting styles, and evocative family instability. While research has focused on dispositional risk factors for this heterogenous disorder, it is important to shift the focus to evidence-based clinical assessment and treatment strategies tailored to the poor prognosis of this subtype. Future research should examine current assessment sensitivity and appraise key stakeholders in early identification and treatment. Conclusion: Early detection and intervention will increase the chances of a positive outcome for all parties, which includes reducing emotional strain and internalizing thoughts of caregivers and teachers and preventing antisocial personality disorder in adulthood. Normative treatment options for childhood-onset CD coincides with individual risk factors, further research will have implications in identifying and providing early care to at-risk children.

Evidence-Based Medicine: Facial Reanimation.

This article provides a brief historical overview of the assessment instruments that have been developed to categorize the severity of disease in patients with facial palsy. Important advances in the quality of these instruments are discussed. The modern-day instruments that are commonly required for evidence-based patient assessment are then presented, with emphasis on the level of evidence of the studies that describe these instruments.

Upper Blepharoplasty: An Evidence-Based Assessment of Preoperative Considerations and Surgical Techniques.

Upper blepharoplasty is one of the most common facial plastic surgical procedures performed. Due to its growing popularity, an abundance of articles is available describing variations in the surgical technique and outcomes. As a result, it has become increasingly difficult to identify appropriate surgical literature validated by a high level of evidence. The purpose of this review is to identify and describe specific evidence-based components of the preoperative evaluation and surgical approach in upper blepharoplasty surgery.