Incidence Of ED Research Articles

DISCREPANCY BETWEEN PATIENT VERSUS PROVIDER ASSESSMENT OF ERECTION QUALITY

ObjectiveTo characterize the discrepancy between patients’ and providers’ assessments of erection rigidity and its association with patient characteristics and penile ultrasound parameters. MethodsPatients presenting for penile doppler ultrasound between July 2022 and October 2023 were reviewed retrospectively. After intracavernosal injection, patients and providers independently rated erection rigidity from 1 to 10 prior to ultrasound. We defined discrepancy as a difference of 2 out of 10 or greater between the two assessments. Chi-squared and Mann Whitney U tests were used for hypothesis testing. Results65/297 (22%) of patients demonstrated a discrepancy in perceived erection quality. 58/65 (89%) of these patients rated their erections lower than their providers. There was a higher incidence of ED as the primary diagnosis in the discrepant group as compared to the concordant group (p=0.01). The discrepant group also showed a higher resistive index on penile ultrasound (p=0.04), with no difference in peak systolic velocity, end diastolic velocity, or other clinical variables between the two groups. ConclusionDiscrepancy in perceived erection rigidity was mainly driven by lower patient perception, although these patients had noninferior penile hemodynamics to their peers. These findings underscore the influence of subjective perception of virility on sexual function. It is critical for clinicians to identify patients with poor perception of erectile function out of proportion to physiologic abnormalities. Thoughtful counseling about treatment goals and expectations, emphasizing functional outcomes, and adjunctive treatments such as sex therapy or psychotherapy are critical to therapeutic success in this population.

Immersive Virtual Reality Versus Video Distraction for the Management of Emergence Delirium in Children: A Randomized Controlled Study

PurposeEmergence delirium (ED) presents challenges for both parents and health care providers in pediatric surgical settings. This study aims to evaluate the effectiveness of immersive virtual reality (VR) distraction and video distraction combined with parental presence in reducing ED in preschool-aged children undergoing elective surgery. DesignA prospective, randomized, controlled clinical trial was conducted with 90 children ages 4 to 7. Participants were randomly assigned to three groups: VR distraction (group V), tablet video distraction with parental presence (group T), and standard care (group C). The primary endpoints were the incidence of ED and Pediatric Anesthesia Emergence Delirium Scale scores, with secondary measures encompassing scores from the Parental Separation Anxiety Scale and the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. MethodsParticipants were assigned to one of the three intervention groups, and relevant scales were used to assess ED, parental separation anxiety, and postoperative pain. The immersive VR distraction and video distraction with parental presence interventions were compared against standard care. FindingsImmersive VR distraction significantly reduced the incidence of ED (6.67% in group V vs 40% in group T and 60% in group C), and the incidence of ED in group V was notably lower than in the other groups (P = .023 vs group T and P = .004 vs group C). Children in group V displayed significantly lower FLACC compared with the other groups as well (P < .05). However, no significant differences between the 3 groups were observed in perioperative anxiety as assessed by the Parental Separation Anxiety Scale scores (P = .27). ConclusionsThis study underscores the potential of immersive VR distraction as an effective intervention for mitigating ED in pediatric surgical patients. The findings suggest that incorporating VR technology during the perioperative period can positively impact postoperative outcomes. Further research in diverse surgical contexts is recommended to validate these findings and explore the broader applicability of VR distraction in pediatric health care settings.

Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study

BackgroundErectile dysfunction (ED) is a prevalent condition that is thought to be significantly impacted by oxidative stress. The oxidative balance score (OBS) has been built to characterize the state of antioxidant/pro-oxidant balance. There is less known regarding the relationship of OBS with ED.MethodsThis study conducted cross-sectional analyses on 1860 males who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. OBS was constructed by the 16 dietary components and 4 lifestyle factors. Self-reported ED was defined as men who indicated that they “never” or “sometimes” could achieve or keeping an erection adequate for satisfactory intercourse. Multivariate logistic regression models were applied to examine the association between OBS and the risk of ED.ResultsAmong 1860 participants, the median OBS was 20 (IQR 15–26), and OBS was lower in males with ED vs. those without ED (P = 0.001). The results of our analyses indicated a negative correlation between OBS and ED among male subjects. Specifically, each one-unit increase in the continuous OBS was relate to 3% reduction in the odds of ED after full adjustment. Moreover, when extreme OBS quartiles were compared, the adjusted odds ratio (95% confidence interval) for the 4th OBS category was 0.53 (0.32 to 0.88) after full adjustment (P for trend < 0.05). There was also statistical significance in the relationships between dietary/lifestyle OBS with ED, and the association between lifestyle OBS and ED may be even tighter. For each unit increase in lifestyle OBS, the odds of ED decreased by 11% after full adjustment.ConclusionHigher OBS was associated with reduced risk of ED in U.S. males. These findings suggested that adopting an antioxidant-rich diet and engaging in antioxidant-promoting lifestyle behaviors may contribute to a lower incidence of ED. These results provided recommendations for a comprehensive dietary and lifestyle antioxidants for ED patients.

Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi

Amaç: Derlenme deliryumu etiyolojisi tam olarak bilinmeyen, çoğunlukla küçük çocuklarda görülen, agresif davranışlar, göz teması eksikliği ve çevrenin farkında olmamakla karakterize bir fenomendir. Birçok sebepten kaynaklanabileceği gösterilmiş ancak en çok baş-boyun cerrahisi, inhaler ajanlar ve postoperatif ağrı suçlanmaktadır. Değerlendirmek için bazı skalalar kullanılır. Duyarlılığı en yüksek olan Pediyatrik Anestezi Deliryum Skalası olan "PAED" (Pediatric Anesthesia Delirium Scale)'dir. Preemptif analjezi, ağrı yolaklarının henüz ağrılı uyaran oluşmadan kesilerek engellenmesidir ve postoperatif analjezi için etkinliği birçok çalışma ile doğrulanmıştır. Bu çalışma: preemptif analjezi yöntemi ile azaltılan postoperatif ağrının derlenme deliryumunu azaltacağı hipotez edilerek planlanmıştır.&#x0D; Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra adenotonsillektomi ve tonsillektomi operasyonu geçirecek, 2-7 yaş arası 96 hasta iki gruba randomize edildi. Analjezikler preemptif gruba indüksiyondan önce, intraoperatif gruba ise operasyonun başlamasından 15 dakika sonra uygulandı. Derlenme ünitesinde derlenme deliryumu PAED skalası ile, ağrı skorları çocuğun yüz ifadesi, bacakların pozisyonu, hareketleri, ağlaması ve avutulabilmesi değerlendirilerek yapılan “FLACC” (Face, Legs, Activity, Cry, Consolability) ağrı değerlendirme skalası ile değerlendirildi. FLACC&gt;7 ağrı ve PAED&gt; 10 derlenme deliryumu kabul edildi.&#x0D; Bulgular: Preemptif grupta PAED ve FLACC skorları istatistiksel olarak anlamlı düşük bulundu ancak derlenme deliryum gelişme insidansı açısından iki grup arasında sadece 5.dakikada anlamlı fark saptandı (p

Efficacy of angiotensin receptor blockers for erectile dysfunction in hypertensive men: A systematic review

Abstract Erectile dysfunction (ED) is a condition that affects many men, especially as they age, and is an indicator of an underlying health condition and is a risk factor for cardiovascular disease. ED also causes significant psychological distress due to stress, anxiety, and low self-esteem related to reduced sexual activity and satisfaction. A high incidence of ED is known to be associated with men with hypertension and diabetes. Angiotensin receptor blockers (ARBs) are newer-generation antihypertensive drugs elucidating a beneficial effect on erectile function compared to older-generation drugs. This study aimed to systematically review the literature to investigate the efficacy of ARBs compared to other classes of antihypertensive drugs in improving ED-related outcomes. A literature search was carried out in Medline, Embase, the Cochrane Library databases, and other relevant sources to select clinical studies that compared the efficacy of ARBs with other antihypertensive drugs in men with concomitant hypertension and ED. Overall, twelve clinical studies comprising 11,672 hypertensive patients with ED were included. Analyses of the outcomes show that ARBs significantly reduce arterial pressure and improve erectile function, frequency of sexual activity, and overall satisfaction in patients. ARBs depress the process of oxidative stress and thus increase sexual desire among the patients with ED patients. Both monotherapy and combination therapies are beneficial for improving erectile function and compliance among patients.

Relationship between Age, Hypertension, and Type-2 Diabetes Mellitus in Benign Prostatic Hyperplasia Patients with Erectile Dysfunction

Based on epidemiological data, the incidence of ED and BPH increases with the same risk factors, such as age, metabolic disease, and others. Aim: This study aimed to determine the prevalence of ED and its relationship to age and the presence of hypertension (HT) and type-2 diabetes mellitus (T2DM) comorbid in BPH patients. This is a cross-sectional study conducted at RSUD Dr. Saiful Anwar and Hermina Hospital Tangku-banprahu Malang utilizes two questionnaires, including the translated version of The Interna-tional Index of Erectile Function (IIEF-5) and Erectile Hardness Score (EHS) in Indonesian. There were 44 research subjects with only 21 respondents to the IIEF-5 question-naire, while the EHS questionnaire was given to all subjects. The prevalence of ED was found to reach 100.0% at the age of 70-79 years through the IIEF-5 questionnaire and aged ³ 80 years through the EHS questionnaire. The prevalence of ED in BPH patients with HT was found to be higher than non-HT patients through both questionnaires. The prevalence of ED in BPH patients with T2DM was found to be higher through the IIEF-5 questionnaire and slight-ly lower through the EHS questionnaire than non-T2DM patients. Age had a significant rela-tionship with ED through the EHS questionnaire (p = 0.006), while no significant relationship was found through the IIEF-5 questionnaire (p = 1.000). HT and T2DM did not have a signif-icant relationship with ED (IIEF-5: p = 0.229 and 0.526; EHS: p = 0.518 and 1.000). The prevalence of ED in BPH patients increases with age and the presence of comorbid HT and T2DM. Even so, there was no significant relationship between HT and T2DM with ED in BPH patients. A significant relationship between age and ED was only found in the EHS questionnaire but not in the IIEF-5 questionnaire.

Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial

ObjectiveEmergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DesignRandomized, prospective, and double-blind. SettingPatients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PatientsA total of 163 patients of both sexes aged 3–8 years were enrolled over 18 months. InterventionsImmediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient’s forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40–60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MeasurementsThe primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. Main results86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). ConclusionIndividualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. Clinical trial registrationNCT04466579.

(389) Highlighting the Necessity of Cancer Survivorship Clinics in Rural America: Urologic Malignancy as an Independent Risk Factor of ED

Abstract Introduction Erectile dysfunction (ED) affects up to 30 million men in the United States and as many as 150 million men worldwide. Although the most common contributing factors such as cardiovascular disease, obesity, and diabetes currently receive the most attention, cancer diagnosis as an independent risk factor deserves further scrutiny. Prior studies have shown increased incidence of ED in cancer patients with both direct and indirect pathways postulated. Despite this, documentation of a history of ED before and after cancer treatment remains understudied. Objective To document the difference in SHIM scores between a group of patients carrying a urologic malignancy diagnosis and a second group of general urologic patients. Secondary endpoints included prevalence of several comorbid conditions and descriptive statistics of ED prevalence and both desire for and treatment of ED. Methods A standardized questionnaire was prospectively administered at a tertiary care academic urology clinic which treats all forms of urologic malignancy in a rural population of about 2 million. The survey included the validated Sexual Health Inventory for Men (SHIM), information regarding oncologic diagnosis, and comorbid medical conditions including BPH, tobacco use disorder, alcohol consumption, diabetes, depression, hypertension, and high cholesterol. Surveys were administered pre- and post-treatment to all consenting patients. The control group consisted of male urologic patients with no present or past diagnosis of urologic malignancy (UM). Mann-Whitney U tests were used to compare means for continuous variables and chi-squared tests for categorical variable comparison. Results A total of 762 patients completed the entire survey, with 214 (28.1%) patients reporting a history of UM. Sixty-one (28.1%) were bladder cancer diagnoses with an additional 83 (38.8%) renal cancer and 125 (58.4%) prostate cancer. Analysis revealed a statistically significant difference in mean SHIM scores between patients with UM and without UM (p &amp;lt;0.05), with SHIM total mean 15.478 +/− 7.823 in UM patients while non-oncologic patients scored 17.598 +/− 7.574. There were no significant differences in the prevalence of 7 of the 8 studied comorbid conditions (HTN p=0.007). Only 2.8% of oncology patients reported receiving treatment for ED while 64% reported interest in receiving treatment for ED. Conclusions Urologic malignancy is significantly associated with lower SHIM scores. More striking however is the large discrepancy between those interested in treatment and those receiving it, especially at a tertiary care academic center. As a result, our institution is working towards a urologic cancer survivorship protocol involving evaluation by a sexual dysfunction specialist within one year of treatment or earlier. The present study emphasizes the need for physician vigilance and both physician and patient education to improve outcomes in a distressed population. Disclosure No

A Novel Risk Calculator to Predict Erectile Dysfunction in HIV-Positive Men.

HIV infection is considered to be a lifelong medical condition, requiring follow-up and treatment for decades. HIV-positive men are reported to have erectile dysfunction more often than age-matched healthy controls, and improving sexuality is known to potentially improve overall health-related quality of life. The aim of this paper is to evaluate the presence of ED in HIV-positive men and the associated contributing factors and to create a statistical model to assess the risk to develop ED in this population. In a prospective study, we analyzed a group of HIV-positive men in a cross-sectional manner, looking at demographics, blood test results, and smoking habits. Data were statistically analyzed using the Kruskal-Wallis test. In our series, the overall incidence of ED was 48.5%, increasing with age. Our analysis showed no correlation with blood sugar level, but a very strong correlation with total serum lipids. We were able to develop and validate a risk calculator for ED in HIV-positive men.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

BackgroundEmergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. MethodsA prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. ResultsOne hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. ConclusionIn this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Frequency of Erectile Dysfunction after Transurethral Resection of Prostate

Background: The most effective treatment for symptomatic benign prostatic hyperplasia is surgery. When a patient is diagnosed with BPH and surgery is scheduled, the urologist will usually do transurethral resection of the prostate (TURP) to alleviate symptoms due to its positive results. The effect of TURP on sexual function, on the other hand, is yet unknown and debated.Objective: The purpose of this study was to determine the incidence of ED in sexually active adult males.Materials and Methods: The following are the materials and procedures that were used to complete this project. A total of 165 individuals between the ages of 40 and 65 years old with LUTS symptoms were included in the study. Patients with uncontrolled diabetes, a big prostate, bladder stones, or complicated urethral illness, such as corrected hypospadia or repaired urethral stricture disease, were excluded from the study. Every patient had TURP surgery and was cared for according to our ward routine until he was discharged. Results: The study's participants ranged in age from 40 to 65, with a mean age of 57.50 3.10 years. The majority of the 114 patients (69.09%) were between the ages of 56 and 65. Pre-operative IIEF-5 scores were 18.53 5.24, while post-operative IIEF-5 scores were 15.06 2.50. Patients with ED following TURP were observed in 29 (17.58%) of sexually active adult males, with mild ED in 13 (44.83%), moderate ED in 09 (31.03%), and severe ED in 07 (24.14%).Keywords: benign prostatic hyperplasia, transurethral resection of prostate, erectile dysfunction.

Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database.

BackgroundErectile dysfunction (ED) is an adverse effect of many medications.AimWe used a national pharmacovigilance database to assess which medications had the highest reported frequency of ED.MethodsThe Food and Drug Administration Adverse Event Reporting System (FAERS) was queried to identify medications with the highest frequency of ED adverse event reports from 2010 to 2020. Phosphodiesterase-5 inhibitors and testosterone were excluded because these medications are often used as treatments for men with ED. The 20 medications with the highest frequency of ED were included in the disproportionality analysis.OutcomesProportional Reporting Ratios (PRRs) and their 95% confidence intervals were calculated.ResultsThe 20 medications accounted for 6,142 reports of ED. 5-α reductase inhibitors (5-ARIs) and neuropsychiatric medications accounted for 2,823 (46%) and 2,442 (40%) of these reports respectively. Seven medications showed significant levels of disproportionate reporting with finasteride and dutasteride having the highest PRRs: 110.03 (103.14–117.39) and 9.40 (7.83–11.05) respectively. The other medications are used in a wide variety of medical fields such as cardiology, dermatology, and immunology.Clinical ImplicationsPhysicians should be familiar with these medications and understand their respective mechanisms of action, so that they may counsel patients appropriately and improve their quality of life.Strengths and LimitationsThe strength of the study is its large sample size and that it captures pharmacologic trends on a national level. Quantitative and comparative “real-world” data is lacking for the most common medications associated with ED. The limitation is that the number of reported events does not establish causality and cannot be used to calculate ED incidence rates.ConclusionIn a national pharmacovigilance database, 5-ARIs and neuropsychiatric medications had the highest reports of ED adverse effects. There were many other medications used in a variety of medical fields that were also associated with ED.Kaplan-Marans E, Sandozi A, Martinez M, et al. Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Sex Med 2022;10:100543.

Emergency Department Presentations of Acute Primary Angle Closure in the United States from 2008 to 2017.

PurposeAcute primary angle closure (APAC) is an ophthalmologic emergency. Nationwide data on the epidemiology and clinical characteristics of APAC are lacking despite the associated visual morbidity.Patients and MethodsA retrospective cross-sectional study using the Nationwide Emergency Department Sample (NEDS). The NEDS was queried by ICD-9/10 code for cases of APAC presenting to the United States emergency departments over a ten-year period from 2008 to 2017. All identified cases were included to produce nationally representative estimates. Linear regression and seasonality tests were used to identify trends. Reported outcomes include the incidence, demographics, seasonality, and economic impact of APAC regionally and nationwide.ResultsA total of 23,203 APAC-related ED visits were identified. The mean (SD) and median ages were 58.8 (16.2) and 60 years, respectively. Females (59.4%, p < 0.01), those in the lowest income quartile (6983, 30.1%, p < 0.01), and those in the seventh decade of life (5599, 24.1%) presented more frequently with APAC. The incidence of ED presentations within each age group rose with age and increased significantly over the study period (p < 0.01). The Northeast region had the highest average incidence (0.93 per 100,000 population). Significant seasonal variation was seen regionally and nationally (p < 0.01), with the highest average incidence in December and lowest in April. Median inflation adjusted charge per ED visit was $2496.10, and the total inflation adjusted charges equaled $101.5 million.ConclusionThe incidence of APAC-related ED visits continues to rise in the United States. High-risk groups include women, individuals of low socioeconomic status, and those between ages 50 and 70. Significant seasonal and regional trends were observed in ED presentations of APAC.

Trends in emergency department visits due to back pain and spine surgeries during the COVID-19 pandemic in Finland.

We aim to report the incidences of ED visits due to back pain, hospitalizations, and urgent spine surgeries during the first and second waves of COVID-19 in Finland. The number of emergency department visits and hospitalizations due to back pain as well as urgent spine surgeries in the adult population was collected from hospital discharge registers for the years 2017 through 2019 (reference years) and 2020.This study was conducted at three large Finnish hospitals. The monthly incidence with 95% confidence intervals (CI) of emergency department visits and hospitalizations due to back pain and spine surgeries in the three participating hospitals were calculated and compared by incidence rate ratios (IRR).Visits to ED due to back pain decreased during the pandemic. The incidence of ED visits due to back pain was similar in February (IRR 0.95, CI: 0.82-1.10), but a decrease was seen after lockdown began (March IRR 0.67, CI: 0.57-0.78; April IRR 0.65, CI: 0.56-0.76) compared to the reference years. A second decrease in visits was seen after regional restrictions were implemented in October (IRR 0.88, CI: 0.76-1.02). The most common diagnoses were non-specific back pain, lumbar disk herniation, and back contusion. Incidence of non-specific back pain decreased during the lockdown (March IRR 0.65, CI: 0.55-0.78) and regional restrictions (October IRR 0.83, CI: 0.70-0.98), whereas the rates of other diagnoses remained unchanged, and incidences of hospitalizations and urgent spine surgeries remained stable.A clear decrease in ED visits due to back pain was seen during the first and second waves of the pandemic. This decrease was mainly the result of patients with non-specific back pain avoiding visits to the ED. The incidence of specific back pain, hospitalizations, and urgent spine surgeries remained unchanged during the pandemic.

Assaults in schools: Findings using a national data base

BackgroundAssaults can occur at schools/educational facilities involving students, teachers and other school employees. It was the purpose of this study to correlate injury patterns with patient demographics in school assault victims. Understanding injury patterns with their associated demographics will not only be useful for health care providers but can also assist in proposing prevention strategies for both students and school employees. MethodsEmergency department data from the National Electronic Injury Surveillance System All Injury Program data for the years 2005 through 2015 were used in this study. Statistical analyses were performed with SUDAAN software to account for the weighted, stratified nature of the data. ResultsThere were an estimated 852,822 ED visits for school assaults. The median age was 13.8 years with 81.3% between 5 and 19 years old; 64.4% were male. After age 4, the number of females proportionately increased with increasing age. The most common diagnosis was a contusion/abrasion (38.6%). The injuries occurred in the head/neck (63.9%), upper extremity (19.0%), upper trunk (6.6%), lower trunk (5.5%), and lower extremity (4.9%). Firearm violence accounted for 0.1% of the assaults. Human bites occurred in 3.7%. Sexual assault was rare and proportionally the highest in those ≤4 years of age. Internal organ injuries were more common in females (13.1% vs 3.55) and for those admitted to the hospital (29.9% vs 19.9%). The incidence of ED visits for school assault decreased 50% from 2005 to 2015. ConclusionsThis study analyzed ED visits due to assaults occurring in schools. Firearm violence accounted for only 0.1% of the injuries, in contrast to media coverage regarding school assaults. The most common injury location was the head/neck (63.9%) and the most common diagnosis was a contusion/abrasion. This data can also serve as a baseline for further studies and the impact of potential reduction strategies.

Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

BackgroundEmergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery.MethodsThis clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores.ResultsOf the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients.ConclusionIn conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required.Trial registrationThis study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017.

Incidence, risk factors, and consequences of emergence delirium after elective brain tumor resection

BackgroundEmergence delirium (ED) is a common phenomenon occurring in the recovery period. The aim of this study was to investigate the incidence, risk factors, and consequences of ED in adults after elective brain tumor resection. MethodsWe retrospectively analyzed the data of a prospective cohort performed in a tertiary university hospital. Adult patients admitted to the intensive care unit (ICU) immediately after elective brain tumor resection were consecutively enrolled. Level of consciousness was assessed using the Richmond Agitation–Sedation Scale and ED was assessed using the Confusion Assessment Method for the ICU. Risk factors for ED were determined by multivariable logistic regression. ResultsA total of 659 patients met the inclusion criteria, of which 41 patients with coma were excluded. Among the remaining 618 patients, 131 (21.2%) developed ED. Independent risk factors for ED were: age, education level, use of anticholinergic and mannitol, Glasgow Coma Score and arterial partial pressure of oxygen postoperatively, postoperative pain, malignant tumor, and frontal approach craniotomy. ED was associated with increased postoperative delirium, longer length of hospital stay, and higher hospitalization costs. There was no significant difference in the neurological function deficits (modified Rankin Scale score) between ED and non-ED groups. ConclusionsED has a high incidence and is associated with poor outcomes in adults after elective brain tumor resection. Early screening and prevention for ED should be established in perioperative management of this population.

Sexual Function Outcomes After Surgical Treatment of Penile Fracture.

IntroductionPenile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection.AimOur study aims to evaluate patients with penile fracture and to identify the factors that may influence the sexual function after surgical repair.MethodsA total of 138 patients who were diagnosed with penile fracture between January, 1999 and December, 2018 were reviewed. Clinical features, perioperative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed.Main Outcome MeasuresSexual function was evaluated by three parameters six months after surgical repair: International Index of Erectile Function-5 (IIEF-5) questionnaire, penile curvature and the presence of a painful intercourse. All factors that could potentially influence these parameters were analyzed.ResultsThe mean age was 31.2 years (19-55). Presentation delay ranged from 1 to 5 days (mean = 16.8 hours) while surgery delay was 14.3 hours ().The most common cause of penile fracture in our patients was forcefully bending of the erect penis to achieve detumescence in 62 cases (44.9%). On multivariate analysis, we found that the presentation delay and the fracture site located in the proximal shaft of the penis showed significant difference in the occurrence of postoperative ED (P = 0.03 and P = 0.015 respectively). Presentation delay, elective incision and tuncial leak located in the proximal shaft (P = 0.045; P = 0.018 and P = 0.022 respectively) were associated with higher penis curvature.ConclusionImmediate surgical repair and circumferential degloving incision for tunical leaks located in the proximal shaft of the penis are recommended in order to decrease the incidence of ED after surgical repair of penile fractures. Ouanes Y, Saadi MH, Alouene HH, et al. Sexual Function Outcomes After Surgical Treatment of Penile Fracture. Sex Med 2021;9:100353.

Improving Care Delivery for Young Adults With Type 1 Diabetes via a Multi-Faceted Quality Improvement Interdisciplinary Intervention

Abstract Background: The transition from pediatric to adult type 1 diabetes (TID) care represents a vulnerable period for young adults (YA), and many are eventually lost to follow up. This can result in lost opportunities for patient education, worsened glycemic control and increased rates of acute diabetes complications. To address this, a multi-faceted quality improvement (QI) intervention was implemented at a YA T1D program with the goal of improving patient attendance and care delivery amongst YA with T1D. Methods: The intervention consisted of three main components: a transitional navigator, an interdisciplinary diabetes assessment flowsheet and virtual care via phone or video conference. These components were implemented at the YA T1D program using a stepwise approach beginning in 2019. The attendance of all patients seen between January 2017 and August 2020 were tracked monthly on a run chart to identify any shifts after each component was implemented. A pre-post analysis was also performed in new patients with a minimum follow up period of 12 months to compare secondary outcomes including A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations, incidence of severe hypoglycemia and psychosocial counselling rates. Results: A total of 2240 scheduled appointments was included in the primary analysis. Patient attendance improved from 59% to 79% (p&amp;lt;0.01) with virtual care, demonstrated by a shift in attendance sustained over 6 months after its implementation. Virtual care was utilized in 81.3% of appointments in the post-intervention period. Subgroup analysis showed the improvement in attendance was significant in follow up appointments (80% vs 59%, p&amp;lt;0.01), but there was no difference in attendance for initial consultations (67% vs 58%, p=0.45). Forty-two patients were included in the pre-post analysis (n=27 in the pre-intervention and n=15 in the post-intervention period). There were with no significant difference in baseline characteristics of the two groups. Mean patient age was 20.2±2.9 years. Males comprised of 28.5% of the study population. Mean duration of diabetes was 11.1±5.3 years, and baseline average A1c was 8.6±1.7%. Preliminary analysis demonstrated there was significant improvement in preconception counselling rate (76% vs 100%, p=0.048) following the intervention. There was no significant difference in A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations or incidence of severe hypoglycemia. Conclusion: Virtual care was effective in improving attendance for follow up appointments at a YA T1D clinic. Further data analysis for patients assessed in September to December 2020 is currently underway.

PROLONGED OBSERVATION OF SEXUAL DISORDERS BY HYPERTONIC PATIENTS AFTER NURSING INTERVENTION

Objective: Objective of this prolonged work was to observe progress in severity of erectile dysfunction as an expression of endothelial damage) by hypertensive patients with or without cardiovascular organic changes after one year nursing intervention on modifiable lifestyle risk factors in half of recruited probands. Design and method: Method: The presence and severity of ED in the group of 200 hypertensive patients, aged 40–70 years, were studied in the beginning and after one year. With half of the enrolled patients was performed periodic targeted nursing intervention (one year duration), focused on respect of the life style principles. Questionnaire method was used for data collection at the beginning and at the end of the annual reporting period, as well as after next 4 years. Questionnaires were focused on antropometric dates, lifestyle, QoL and ED. Results: Results: The research results showed that by hypertensive patients with organic CV changes is a higher incidence of moderate and severe ED than in hypertensive patients without organ changes. Those result were similar at start, as well as on the end of monitoring after 4 years. At the same time, a higher incidence of ED in the group of patients with organic complications than without them. In groups without nursing intervention was an increase in the number of patients with severe ED by 18% (group without organic complications), respectively 37% (with organic complications). The severity of ED by groups without intervention increased also, bud less intensive. The differences have been statistically significant. After 4 years monitoring – worsening of ED was observed, more intensive (statistically significant) by group of patients with cardiovascular organic changes. Conclusions: Conclusions: The results confirmed the assumption of a positive effect of targeted and repeated nursing interventions aimed at compliance with healthy lifestyle and quality of life on ED by hypertensive patients. In the end, paper makes recommendations regarding the highlighting of motivational factors affecting the adoption of healthy lifestyle and explains the role of nurses in applying the principles of secondary prevention of CV disease.