Paralyzed Veterans Of America Research Articles

V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY

You have accessJournal of UrologyCME1 Apr 2023V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY Emad Ibrahim Emad IbrahimEmad Ibrahim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal cord injury (SCI) is the leading cause of anejaculation in young men. After SCI 90% of men with SCI will need a method of assisted ejaculation to achieve biological fatherhood. Penile vibratory stimulation (PVS) was popularized in 1994 after the production of the first vibrator specifically designed for semen retrieval in men with SCI. The success of this device was based on a calculated amplitude of 2.5 mm which was proven to be optimal for successfully producing an ejaculate. PVS is safe, reliable, can be performed by the male partner at home after an initial evaluation by a health care provider and yields the best sperm quality.A newly designed vibrator was produced in 2019 and was tested by a group of international experts for safety and efficacy. The study concluded the device was safe and effective in inducing ejaculation in men suffering from anejaculation after SCI. METHODS: Initial encounter: standard history, physical exam and level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury were performed. In addition, assessment of Hip Flexor Reflex and Bulbocavernosus Reflex was performed. Procedure: Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to mange autonomic dysreflexia. The patient lied supine on the exam table and the vibrator was applied to the dorsum or frenulum of the glans penis. Stimulation was delivered in 2-minute increments to a maximum of 10 minutes per visit. Stimulation using 2 vibrators (Sandwich technique) or with abdominal electrical stimulation can be performed in select patients. Semen: Ejaculated semen was collected in a sterile cup and a semen analysis was performed after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of having retrograde ejaculation. RESULTS: PVS was successful in 86% of men whose level of injury was T10 or rostral. A total of 3,698 PVS procedures were successfully performed by our group. The total motile sperm count in antegrade ejaculates produced by PVS was >5 million (lower limit considered for IUI) in 71% of ejaculates. CONCLUSIONS: PVS is a safe and effective method to manage anejaculation in men with SCI. Sperm can be obtained non surgically from most men with SCI. Sufficient sperm are available for simple insemination procedures. PVS should be considered as the method of choice for semen retrieval in this patient population. Source of Funding: Paralyzed Veterans of America (PVA) Educational Grant #877 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emad Ibrahim More articles by this author Expand All Advertisement PDF downloadLoading ...

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Critical Appraisal of Paralyzed Veterans of America Guidelines in Spinal Cord Injury: An International Collaborative Study Using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II).

Spinal cord injuries (SCI) in military personnel, veterans, and others require an evidence-based, multidisciplinary approach to their care. This appraisal used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to evaluate the methodological quality of clinical guidelines for the management of SCI published by the Paralyzed Veterans of America (PVA) organization. We searched clinical guidelines on SCI published by PVA until December 2019. Four appraisers across three international centers independently evaluated the quality of eligible clinical guidelines using AGREE II. Mean AGREE II scores for each domain were calculated. In higher quality domains, scores for individual items were analyzed. A total of 12 guidelines published by PVA on SCI were assessed. Mean scores for all six domains were as follows: Scope and Purpose (78.8%), Stakeholder Involvement (63.7%), Rigor of Development (68.4%), Clarity of Presentation (80.1%), Applicability (53.0%), and Editorial Independence (28.5%). The mean score for the overall quality of all PVA guidelines was 71.9% (95% CI: 69.7-74.1). No guideline was assessed as "not recommended" by any appraiser. Overall quality was significantly associated with year of publication (rs = 0.754, P = 0.0046). Overall agreement among appraisers was excellent (intraclass correlation coefficients for each guideline ranged from 0.96 to 0.99). PVA guidelines for the management of SCI demonstrated acceptable or good quality across most domains. We recommend the use of PVA guidelines for the assessment and treatment of SCI and related disorders. The quality of PVA guidelines for the management of SCI have improved over time.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Identification and Management of Cardiometabolic Risk after Spinal Cord Injury

Administrative and financial support provided by Paralyzed Veterans of AmericaReprinted with permission from the Paralyzed Veterans of America (PVA) Consortium for Spinal Cord Medicine Clinical Pra...

Paralympics and veterans

Sports and recreation are essential components of medical rehabilitation. Through these, people with disability learn to adjust to a new self-image; build strength, stamina, and coordination; and learn adaptive skills that help them throughout their life. Sports are also an important means for helping society at large learn about disability and removing some of the stigma associated with having a disability. The pinnacle of many adaptive sports is the Paralympic Games. The Paralympic Games have their origin both in medical rehabilitation and in association with veterans. Although the first Paralympic Games are credited with being held in Rome in 1960, their early beginnings start in 1948 [1]. Shortly after the end of World War II, Sir Ludwig Guttmann recognized the need to provide sport and recreation outlets for the cadre of wounded, injured, or ill British soldiers under his care at the Stoke Mandeville Hospital in Aylesbury, England [2]. In 1948, he organized the first Stoke Mandeville Games (SMG), and the participants were patients at the hospital. Most of them had incurred spinal cord injuries during the war. The SMG were very popular among the staff and participants, and news spread quickly to continental Europe. In 1952, the first International SMG was held with several more participating countries [2]. Simultaneously, restless American veterans receiving care in Department of Veterans Affairs (VA) hospitals were developing wheelchair basketball. Around the time that the Paralyzed Veterans of America (PVA) was formed in 1946, wheelchair basketball also began to grow as a sport [3]. Since its origin, the PVA has supported sports and recreation as important modalities for the health and well-being of its members and all veterans with disabilities. In 1960, 400 athletes from 23 countries around the world started a truly international Olympic-style competition [1]. The Paralympic Games continue to grow and evolve. The numbers of athletes and the types of disabilities have expanded to become more inclusive. In 1976, the Paralympic Games family included individuals with major limb amputations and those with visual impairments [2]. Expanding populations also increased the number of sports. In 1980, athletes with cerebral palsy were invited to participate in the Paralympic Games [2]. The 1984 Paralympic Games were held in both New York City, New York, and at Stoke Mandeville Hospital. This was because of fund raising and organizational challenges that caused an organizational and financial rift between the organizing committees. This set back the Paralympic Games movement and sounded an alarm for change. That change took place when the International Coordinating Committee for World Sports Organizations for the Disabled (ICCWSOD) officially formed the Paralympic Games and retroactively included events back to 1960 [2]. The Paralympic Games were established to parallel the Olympic Games, and from 1988 forward, the Paralympic Games and Olympic Games have been held in the same city in the same year, sharing many of the same venues [1]. In 1989, the ICCWSOD was retired and the International Paralympic Committee was established with 160 member countries headquartered in Bonn, Germany [1]. The Paralympic movement is greater than the Paralympic Games. The motto for the Paralympics is Spirit in Motion [1]. The following driving principles of the Paralympics demonstrate that the movement extends beyond sports and seeks to achieve equality and independence for all people with disability around the globe [1]: * Transcendence: Courage and achievements of the athletes participating to go beyond their limitations. * Equality: Both a statement of fact and an aspiration, encouraging people with disabilities and of different cultures to be viewed as equal. * Integration: Reflects the pursuit of providing equal access to all. The Paralympic movement has paralleled the disability rights movements, and both have contributed greatly toward creating opportunities for people with disability and changing societal perceptions. …

Guidelines for the treatment of pressure ulcers

1. Co-chaired this panel 2. University of Washington, Seattle, WA 3. University of Texas Medical Branch Galveston, Galveston, TX 4. Sinai Hospital, Baltimore, MD 5. Johns Hopkins Medical Institutions, Baltimore, MD 6. University of Southern Denmark, Odense University Hospital, Odense, Denmark 7. University of South Florida, Tampa, FL 8. University of Virginia Health System, Charlottesville, VA 9. St. Louis Medical Center, St. Louis, MO, and 10. University of San Francisco, San Francisco, CA

Civil Rights - Americans with Disabilities Act - Ninth Circuit Holds That Movie Theaters Must Provide Comparable Viewing Angles for Patrons in Wheelchairs. - Oregon Paralyzed Veterans of America v. Regal Cinemas, Inc., 339 F.3d 1126 (9th Cir. 2003)

Civil Rights - Americans with Disabilities Act - Ninth Circuit Holds That Movie Theaters Must Provide Comparable Viewing Angles for Patrons in Wheelchairs. - Oregon Paralyzed Veterans of America v. Regal Cinemas, Inc., 339 F.3d 1126 (9th Cir. 2003)

The Importance of a Nurse Case Manager, a Personal Assistant, and a Strong Support System: A Case Scenario

We are members of the social work profession. The lead author, Gordon, directs the social work case management program for Paralyzed Veterans of America (PVA). Ellen is a social work educator whose most recent research has focused on professional roles and relationships in geriatric health care. Both of us believe that social workers have vital roles to play in community-based case management. That is our bias. This article, however, takes a different focus. For in the process of Gordon's having been case managed through a very complicated series of medical episodes, we recognized the pivotal role played by the nurse case manager representing his health plan. In addition, Gordon copublished an article in The Journal of Case Management on personal assistance services (Gilson & Casebolt, 1997) which was published in the spring of 1997. He had no idea that when that article would appear in print, he would actually be engaged in a scenario that would lead to his hiring a personal assistant for himself. Our support systems are already full of social workers and they brought a strength of professional and personal skills to the drama that unfolded. Our spouses (a social work educator/administrator and a hospice chaplain) and a host of other persons were engaged during the process, and when we could stop to look back we felt that what we had learned, both personally and professionally, was important to share with others. The combination of nurse case manager, personal assistant, and a strong social support system made a difference in what happened to Gordon. The roles and relationships of this vital combination is the subject of this article. The Hospital After much deliberation and given tremendous pain in his right leg, Gordon decided to have an elective operation. He entered an acute care hospital in April 1997 for the purpose of a routine knee replacement. The evening following surgery, Gordon reclined in bed. Our spouses, Ann and Karl, and we shared light conversation in a private hospital room as the newly reconstructed right knee was exercised mechanically. The plan was for a routine discharge home in 5 days after aggressive and immediate rehabilitation. The four of us were going to celebrate Gordon's birthday with dinner on Sunday night, the day after discharge. It was a plan. The following day, following extreme bouts with nausea, at first attributed to a reaction to pain medication, things were not going as planned. By 2:00 a.m. the following morning, Ellen and Karl received a call from Ann. They met in the family waiting room for the intensive care unit (ICU). Gordon had been transferred to ICU and the prognosis was frightening. The on-call physician feared that he had a clot in his lung. By noon the next day, it was determined that he had sustained a heart attack and an angioplasty was performed that afternoon. The results revealed serious blockage in four arteries, necessitating emergency surgery. But there was a problem. He now had pneumonia and his lungs needed to be clear before going to surgery. This was Friday. By Monday, a quadruple bypass was performed. Before anyone could fully feel relieved that this surgery had been successful, Gordon was wheeled back into the operating room. A blood clot had formed in the balloon pump which was designed to enhance poor circulation in his left leg. The clot had restricted circulation and a bilateral fasciotomy was performed, literally fileting his leg on both sides. This was his good left leg, and the knee replacement on his right leg had become an aside amid the more serious life-threatening scenario that was occurring. By this time, Gordon was on a ventilator. Thankfully he does not remember these events. Throughout this process, a nurse case manager representing Gordon's health plan worked with Ann and a multitude of professionals at the hospital. Beginning with a primary care physician and an orthopedist, by the time Gordon was ready to leave the hospital he had an entourage of physicians and assorted other professional staff engaged in his care. …