Urological Complaints Research Articles

Comparison of anatomical changes in computed tomography CT scan in supine position and prone position with respect to percutaneous nephrolithotomy PCNL.

Objective To compare the anatomical organ positional changes renal access tract length and maximum renal access angle in relation to the kidney in supine and prone positions through CT scan images. Methods CT Urography was performed in 52 patients with various urological complaints in supine and delayed images in prone position. A comparison in both supine and prone position was done to analyse the organ interposition pleural interposition, mean access tract length, maximum renal access angle for PCNL.

Effect of Private Equity Ownership on Access to Outpatient Urologic Cancer Care in Medicare Recipients

To compare appointment availability and wait times between private equity-owned and non-private equity-owned urology clinics for 2 common urologic complaints. We identified all PE-owned urology clinic locations as of June 2022 (n=390). For each PE-owned location, a geographically matched, non-PE-owned clinic was identified. Each office was called using a "secret shopper" method with a standardized script, requesting an appointment on behalf of their Medicare-aged father for evaluation of gross hematuria or elevated prostate-specific antigen (PSA). The primary outcome was appointment availability, and the secondary outcome was wait time until soonest appointment. PE-owned and non-PE-owned clinics treated the presenting complaints with similar frequency (gross hematuria: 85% vs88%, P=.3, elevated PSA: 93% vs94%, P=.5). Wait time in days until the next available appointment was similar for PE-owned clinics compared to non-PE clinics for both complaints (gross hematuria: 16 vs13, P=.06, elevated PSA: 18 vs19, P=.7). If available, the time in days until the soonest next appointment with an advanced practice provider was also similar between PE-owned and non-PE clinics (gross hematuria: 13 vs11, P=.07, elevated PSA: 13 vs12, P=.6). Overall, there were no large-scale differences in access to outpatient urologic care between PE-owned clinics and non-PE-owned clinics. Access to care in PE-owned clinics is likely clinically similar to geographic-matched controls for Medicare patients with gross hematuria or elevated PSA.

Upper airway obstruction and nocturnal enuresis in children: Why is it important?

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children. Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope. Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173). Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Rise of The Hot Clinic

Abstract Introduction The surgical hot clinic was opened in December 2019 as part of our emergency surgical service. Despite initially poor uptake, the clinic has demonstrated its resilience through two national lockdowns and continuing pressures within the NHS. We report a two-month snapshot of activity in the unit. Methods Between June 1st and 1st August 2023, 299 patients were seen in the clinic. We analysed the data for patient demographics referral source and presenting complaint. Outcome measures included inpatient admission and patient discharge. Results 299 patients attended the clinic during the study period. The number of patients seen each day varied between 4 and 12 (median 5). Of these, 147 (49.1%) were male and 152 (50.9%) were female. The referral source was primary care in 28%, Emergency Department in 37.2% and ward discharges accounted for 34.8%. Abdominal pain accounted for the majority of presentations (39.5%,), abscesses (22.4%), urological complaints (17%) complex wounds (5%), rectal bleeding (3.4%), hernial disease in 2%. Miscellaneous conditions accounted for the remainder (10.7%). 279 patients were discharged from the clinic, the admission rate from the clinic 6.7% Conclusions The surgical hot clinic has become an invaluable for patient assessment and emergency surgical care, remaining open even when other areas of the trust have been closed due to the pandemic or NHS pressures. We recommend an emergency surgical ‘hot clinic’ as part of the framework in the provision of emergency surgical services.

Urological manifestations of obstructive sleep apnoea and their clinical utility in screening.

The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential to impact quality of life and patient outcomes. This article aims to strengthen the connection between OSA and urological complaints, summarise their response to CPAP treatment and discuss their clinical utility in OSA. Common urological complaints associated with OSA are nocturnal polyuria, overactive bladder symptoms and erectile dysfunction. Urinary symptoms are thought to be related to recurrent hypoxic episodes and have a significant impact on quality of life. Multiple studies report that urological symptoms and quality of life improve with CPAP treatment. However, current OSA screening questionnaires rely heavily on cardiorespiratory symptoms and specific risk factors that are not present in all OSA population subgroups. We review data that support clinicians incorporating urological symptoms when screening for OSA.

The Effect of Pregnancy on Urinary Symptoms.

Background Urinary incontinence is a condition that causes social, medical, or hygienic problems. The increase in the incidence of stress incontinence, particularly with increasing parity, emphasizes the role of pregnancy on the etiology of incontinence and other urinary symptoms. This study aimed to estimate the effect of pregnancy on urinary incontinence and other urinary symptoms with history and urodynamic data. Methodology This study was conducted at Mustafa Kemal University, Medical Faculty, Obstetrics and Gynecology Department. A total of 72 pregnant primigravid women without any urinary problems were included in the study. Patients with severe chronic disease, neurological disorders, antepartum hemorrhage, multiple pregnancies, younger than 18, and those with physical and mental disabilities were excluded. All patients were initially evaluated in the first trimester and finally in the sixth week of the postpartum period. Demographic and obstetric data, including urological complaints and urodynamic findings, were recorded. Results There were significant increases in nocturia, frequency, dysuria, urgency, and stress urinary incontinence complaints in pregnant women. Urge incontinence was not significantly different after pregnancy. In the postpartum urodynamic studies, nine (12.5%) patients with stress urinary incontinence and six (8.3%) patients with detrusor instability were detected. There was no significant difference between cesarean section and vaginal delivery regarding incontinence. Conclusions According to the study findings, pregnant women who were continent before pregnancy could become incontinent after birth according to urodynamic data. However, long-term studies are needed to determine whether this incontinence is temporary. Additionally, according to our results, cesarean section should not be recommended over vaginal delivery only to prevent incontinence.

Quality of information and appropriateness of ChatGPT outputs for urology patients.

The proportion of health-related searches on the internet is continuously growing. ChatGPT, a natural language processing (NLP) tool created by OpenAI, has been gaining increasing user attention and can potentially be used as a source for obtaining information related to health concerns. This study aims to analyze the quality and appropriateness of ChatGPT's responses to Urology case studies compared to those of a urologist. Data from 100 patient case studies, comprising patient demographics, medical history, and urologic complaints, were sequentially inputted into ChatGPT, one by one. A question was posed to determine the most likely diagnosis, suggested examinations, and treatment options. The responses generated by ChatGPT were then compared to those provided by a board-certified urologist who was blinded to ChatGPT's responses and graded on a 5-point Likert scale based on accuracy, comprehensiveness, and clarity as criterias for appropriateness. The quality of information was graded based on the section 2 of the DISCERN tool and readability assessments were performed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKGL) formulas. 52% of all responses were deemed appropriate. ChatGPT provided more appropriate responses for non-oncology conditions (58.5%) compared to oncology (52.6%) and emergency urology cases (11.1%) (p = 0.03). The median score of the DISCERN tool was 15 (IQR = 5.3) corresponding to a quality score of poor. The ChatGPT responses demonstrated a college graduate reading level, as indicated by the median FRE score of 18 (IQR = 21) and the median FKGL score of 15.8 (IQR = 3). ChatGPT serves as an interactive tool for providing medical information online, offering the possibility of enhancing health outcomes and patient satisfaction. Nevertheless, the insufficient appropriateness and poor quality of the responses on Urology cases emphasizes the importance of thorough evaluation and use of NLP-generated outputs when addressing health-related concerns.

Pathogenetic Effects of Global Stress on the Dynamic Component of Benign Prostatic Hyperplasia in Men in Ukraine

The military situation in Ukraine significantly worsened the quality of medical care for the population. Of all Ukrainian men the age category from 30 to 60 years old who take part in military operations is the most effective one. Another, no less important part of the male population is the old persons, who, as a result of military operations, have limited opportunities to receive medical care. Currently, observing by urologist, required for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) due to combat operations in the country, is often performed via distance curation. The doctor needs a clear understanding of the patient’s medical history, taking into account his psychological and somatic status, the use of medicines. Stress negatively affects men’s health, worsening the hormonal background, mental state and aggravating problems of the genital and urinary systems. Psychological stress is a factor in the exacerbation or occurrence of urological complaints, which can lead to the pathological activation of certain parts of the sympathetic nervous and hormonal systems, the development of LUTS by BPH. Tamsulosin is considered to be the most recognized and widely used treatment for LUTS in patients with BPH. The classic medicament approach of BPH monotherapy is the use of Serenoa repens extract. The distance appointment of selective α-adrenoblockers, both in monotherapy and in combinations, is an important measure of providing specialized urological care to the population.

A Rare Case of Incidentally Detected Urinary Bladder Lipoma

Urinary bladder lipomas are rare benign neoplasm. These are fatty tumors made of adipose tissue. Very few cases has been documented in literature. Hence, it necessary to be know the typical imaging finding when incidentally detected in imaging. We report a case of 70 year who presented with complaints of loose stool and right iliac fossa pain. Patient gives no history of any recent urinary tract complaints or previous history of urinary tract infection or any previous urological complaint.

Evaluation of the results of perioperative surgical robots in urology - literature review

Introduction: Operations with the use of surgical robots have become an acceptable method of treating urological complaints. The question remains what the perioperative results look like compared to other methods, such as classical surgery or laparoscopy. The aim of the study is to summarize the current state of knowledge about the use of surgical robots in urology, provide information on the types of procedures that can be performed with their help, safety and results Materials and methods: Literature review in databases: [Pubmed; science direct; google scholar]; searched using the words: [robotic surgery, surgical robots, BPH, robot, cystectomy, nephrectomy, retroperitoneal lymphadenectomy, prostatectomy,]. Publications from 2016 to 2023 were reviewed. Results: Data from multiple publications were collected. Promising perioperative results of surgical robots have been shown. Blood loss, length of hospital stay, and complication rate are lower compared to other methods. Positive surgical margins occur with a similar frequency. The safety of performing operations with the use of surgical robots in patients after previous chemotherapy or radiotherapy has been proven. The duration of the operation is usually longer compared to other methods. Conclusions: Performing surgery with the use of surgical robots is a promising method in urology. In many cases, perioperative outcomes are better. However, there is a lack of good quality studies conducted over a long period of time.

MP25-03 IN-DEPTH ANALYSIS OF UWORLD TM USMLE STEP 3 UROLOGY QUESTION BANK TOPICS WITH COMPARISON TO AUA MEDICAL STUDENTS CURRICULUM

You have accessJournal of UrologyCME1 Apr 2023MP25-03 IN-DEPTH ANALYSIS OF UWORLDTM USMLE STEP 3 UROLOGY QUESTION BANK TOPICS WITH COMPARISON TO AUA MEDICAL STUDENTS CURRICULUM Rohan Sawhney, Vinay Patel, Maya Srinath, and Jessica Kreshover Rohan SawhneyRohan Sawhney More articles by this author , Vinay PatelVinay Patel More articles by this author , Maya SrinathMaya Srinath More articles by this author , and Jessica KreshoverJessica Kreshover More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic education in U.S. medical schools has steadily declined despite the known increasing burden of urological disease complaints in our aging population. The AUA created a medical student curriculum to codify the urologic topics graduating medical students should know. We sought to identify the urologic topics deemed relevant to all physicians as defined by board exams (USMLE Step 3) and further, to compare these to the AUA curriculum. METHODS: The UWorld™ Step 3 question bank was queried on June 20th, 2022. Questions were categorized as urologic and non-urologic by two independent reviewers and a third reviewer to resolve discrepancies. Inter-rater reliability testing was performed. Urologic questions were categorized by topic (Table 1) and then compared to the AUA medical student curriculum (Tables 2, 3) to determine if topics were covered. RESULTS: A total of 82 urology questions (4.44%) were identified within the UWorldTM question bank. A majority (63.4%) were covered within the AUA medical student curriculum. Topics not covered in the curriculum can mainly be categorized into GU oncology (non-prostate cancer) and pediatric urology. Inter-rater reliability was high (91.89% with a Cohen’s kappa coefficient of 0.46). CONCLUSIONS: Despite waning urologic education in medical school, this knowledge is required for all practicing physicians with over 4% of Step 3 practice questions being urologic. While the AUA medical student curriculum covers the majority of necessary urologic education, there are gaps, especially within oncology and pediatric urology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e342 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Sawhney More articles by this author Vinay Patel More articles by this author Maya Srinath More articles by this author Jessica Kreshover More articles by this author Expand All Advertisement PDF downloadLoading ...

Determination of Women and Reproductive Health Awareness in Emergency Department: A Descriptive Cross-Sectional Study

Aim: Emergency departments (EDs) are units in which acute management of traumatic and medical emergencies are provided; but also guidance on public health is provided as well as ensuring personal health and awareness. In this study, it was aimed to determine the level of knowledge about women’s and reproductive health and possible disease symptoms in female patients aged 18 years and older who applied to the emergency department, regardless of the complaint of admission. We also aimed to determine the role of EDs in contributing to the correct referral of these patients. Material and Methods: This was a descriptive cross-sectional study which took place in a tertiary care center. Women aged 18 years and older who applied to the emergency department with any complaint were assessed with a structured questionnaire consisting of 18 questions and multiple-choice options about women’s health. Participants' sociodemographic characteristics, fertility, menstrual cycle and contraception patterns, their knowledge about cancer prevention, gynecological and urological complaints were asked. It was also asked whether the ED physician gave any guidance on issues related to women's health, before discharge from ED. Results: Totally 523 women were included in the study. The mean age was 38.89±14.32 years. Most of them (91.6%) were lived in city center, 63.3% were married and 60% were high school and university graduates. The ratio of not using any contraceptive method and total number of pregnancies were higher at the lower education levels (p=0.003 and 0.004, respectively). The knowledge of women about cancer screening was low and 42.4% of them did not have information about screening issues. In comparison according to educational status, it was seen that the ratio of screening awareness, breast self-examination, HPV test, and mammography were higher and statistically significant in university graduates (p=0.000). ED physicians conducted appropriate outpatient clinic referral for screening and follow-up in 53.6% of 114 patients with gynecological complaints. Conclusion: The level of knowledge about women’s health is still not at the desired level. Although there are a wide variety of effective and modern methods available, not to use a contraceptive method is still common. With the increase, dissemination and continuity of reproductive health education and consultancy services, the lack of information on this subject will be eliminated to a large extent and wrong practices will be prevented. Emergency departments are places for preventing public health, besides managing acute conditions.

Acil Servise Başvuran Ürolojik Acil Olgularin Değerlendirilmesi

Aim: Especially in recent years, with the increase in the number of patients admitted to the emergency services the number of urological emergencies is increasing. Some of these require immediate attention. There are not enough studies on urological emergencies in our country. In this study, we aimed to investigate the demographic data of patients over the age of 18 who presented to the emergency department with non-traumatic urological emergency complaints. Materials and Methods: This study was designed based on a 6-month prospective, cross-sectional study. After obtaining the approval of the ethics committee, patients over the age of 18 with urological emergency complaints were examined between 06.11.2019 and 06.05.2020. Results: The ratio of urological emergencies to all patients was found to be 1.5%. 56.76% (n: 231) of the patients were male and 43.24% (n = 176) were female. In the study was found 44.7% of the patients to be urinary tract infection, 31.45% renal colic, 8.8% hematuria, 6.88% acute urinary retention. In our study, urology consultation was requested for 19% of urological emergency patients. Emergency intervention was applied to 21.13% of all urological emergency cases. Emergency operation was required for 1.47% of the patients. 10.81% of the patients required hospitalization. Conclusion: As a result, urological emergencies are common. Among these cases, there may be diseases that require urgent intervention or surgery. It is very important for the patients the emergency physicians who evaluate the patient first to make a careful and meticulous evaluation and to make a urology consultation if necessary.

Urological Education in United States Medical Schools: Where Are We Now and How Can We Do Better?

While urological complaints increase in aging populations and conditions commonly require management by multiple physician specialty types, exposure to formal urological education in United States medical schools is limited and has been decreasing over time. We aim to update the current status of urological education in the United States curriculum and delve further into the subject matter being taught and the type and timing of this education. An 11-question survey was developed to describe the current status of urological education. The survey was distributed using Survey Monkey to the American Urological Association's medical student listserv in November 2021. Descriptive statistics were used to summarize survey findings. Of 879 invitations sent, 173 responded (20%). Most (112/173, 65%) of respondents were in their fourth year. Only 4 (2%) reported that their school had a required clinical urology rotation. Kidney stones (98%) and urinary tract infections (100%) were the most frequent topics taught. The least exposure included infertility (20%), urological emergencies (19%), bladder drainage (17%), and erectile dysfunction (13%). Videos and case vignettes were the preferred learning modalities and the majority (84%) of respondents were familiar with the American Urological Association's medical student curriculum material. The majority of United States medical schools do not have a required clinical urology rotation and some core urological topics are not taught at all. Future incorporation of urological educational material through video and case vignette learning may be the best opportunity to provide exposure to clinical topics that will commonly be encountered regardless of chosen medical discipline.

Venlafaxine-induced spontaneous ejaculation: Case report and literature review

IntroductionVenlafaxine is a serotonin-norepinephrine reuptake inhibitor and its extensive use for major depressive disorder and anxiety disorders. Although it has been reported that venlafaxine may have various side effects, as far as we know, spontaneous ejaculation(SE) has not been reported yet.ObjectivesWe aim to describe this clinical case with venlafaxine-induced SE and to discuss the possible etiological factors.MethodsCase report and literature review.ResultsA 53-year-old male with generalized anxiety disorder was initiated venlafaxine treatment with 75 mg/day. After two months patient’s complaints partially regressed and the dose of venlafaxine treatment was increased to 150 mg/day. 10 days after the dose increase, the patient applied with the complaint of SE 2-3 times a day. No urological etiology was found. During outpatient follow-ups, after the 5 days from reducing the daily dose to 75 mg/day, SE complaint completely regressed. After following couple of months, the patient by himself, increased the dose of venlafaxine to 150 mg/day without consulting a psychiatrist. Then SE recurred approximately 15 days later. Venlafaxine treatment dose was reduced again to 75 mg/day and urological complaints spontaneously regressed.ConclusionsSE, a rare sexual side effect, represents ejaculation that occurs involuntarily and in the absence of any sexual stimuli. The possible mechanism of SE, detected as a side effect in our case, may be that increased adrenergic activity reduces ejaculatory latency and triggers spontaneous ejaculation. Antidepressant-associated sexual dysfunction could be a dose-dependent adverse event. Therefore, reducing the dosage of the treatment to a minimum effective dose could be an option.DisclosureNo significant relationships.

Impact of COVID-19 Pandemic on Emergency Department Referrals with Urologic Complaints; a Retrospective Cross-Sectional Study

Introduction:Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint. Method:This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era).Results:480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p <0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p < 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001).Conclusion:During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment.

External Genital Revisions after Gender-Affirming Penile Inversion Vaginoplasty: Surgical Assessment, Techniques, and Outcomes.

Following gender-affirming penile inversion vaginoplasty or vulvoplasty, patients may seek vulvar revision procedures for a variety of common aesthetic and functional concerns. These indications for revision and accompanying techniques are not well-described in the literature. Patients who underwent vulvar revision surgery at the authors' institution were identified, and patient demographics, surgical indications, operative details, and complications were described. Common complaints requiring external genital revision were sorted into four categories: clitoral, labial, introital, and urethral. Thirty-five patients with a history of vaginoplasty underwent vulvar revision between May of 2017 and December of 2019. The mean age at surgical correction was 38.9 years. Ten patients (28.6 percent) had undergone prior secondary procedures (range, 1 to 3). Mean follow-up after revision surgery was 10.7 ± 8.7 months (range, 0 to 30.6 months). The majority of patients underwent concurrent revisions in multiple "categories". Labial aesthetic concerns were most common (n = 27, 77.1 percent), followed by clitoral (n = 20, 57.1 percent), urologic (n = 17, 48.6 percent), and introital complaints (n = 12, 34.3 percent). Twelve patients (34.3 percent) had canal stenosis requiring concurrent robot-assisted canal revision with peritoneal flaps. Complications included labial abscess (n = 1) and deep vein thrombosis (n = 1). Three patients (8.6 percent) underwent subsequent external genital revisions. Management approaches and surgical techniques for each of these common revision categories are provided. As more individuals seek vaginoplasty and vulvoplasty, surgeons must be prepared to address a range of common aesthetic and functional complaints requiring vulvar revision. Therapeutic, IV.

The growing need for reliable online health information during lockdown in Europe: An infodemiologic analysis of myocardial infarction management in the COVID-19 era.

I n t r o d u c t i o n: The COVID-19 pandemic has put healthcare systems worldwide under huge strain, resulting in a significant loss of their capacity and availability. Patients have become more reluctant to contact their doctors or call an ambulance in case of myocardial infarction (MI) symptoms onset. It has been accompanied by a significant decrease in the number of coronary angiography and PCI procedures performed. O b j e c t i v e s: The aim of the study is to evaluate the role of online health information in the patient- dependent phase of MI management during the COVID-19 lockdown in Europe. Methods: We analyzed Google Trends data on the popularity of phrases related to MI symptoms, respiratory tract infection, urological complaints, and terms unrelated to health, for the period of the first COVID-19 lockdown, along with the data from the corresponding weeks from 2017-2019 in seven European countries. R e s u l t s: The search volume for particular symptoms of myocardial infarction increased in all studied countries, compared to the analogous period from 2017-2019, with a significant increase in for chest pain, shortness of breath, fear, and palpitations in most countries. These changes have not been accompanied by increased interest in terms related to respiratory tract infection symptoms and urological complaints. C o n c l u s i o n s: Our findings suggest that during lockdown, patients with MI symptoms may have tried to manage their complaints on their own, using information from the Internet. This demonstrates the growing role of the Internet in the patient's decision-making process in the emergency situation, indicating a growing need for reliable and freely available online information provided by healthcare professionals.

Overactive Bladder Symptoms Within Nervous System: A Focus on Etiology.

Overactive bladder (OAB) is a common debilitating condition characterized by urgency symptoms with detrimental effects on the quality of life and survival. The exact etiology of OAB is still enigmatic, and none of therapeutic approaches seems curative. OAB is generally regarded as a separate syndrome, whereas in clinic, OAB symptoms could be found in numerous diseases of other non-urogenital systems, particularly nervous system. The OAB symptoms in neurological diseases are often poorly recognized and inadequately treated. This review provided a comprehensive overview of recent findings related to the neurogenic OAB symptoms. Relevant neurological diseases could be mainly divided into seven kinds as follows: multiple sclerosis and related neuroinflammatory disorders, Parkinson’s diseases, multiple system atrophy, spinal cord injury, dementia, peripheral neuropathy, and others. Concurrently, we also summarized the hypothetical reasonings and available animal models to elucidate the underlying mechanism of neurogenic OAB symptoms. This review highlighted the close association between OAB symptoms and neurological diseases and expanded the current knowledge of pathophysiological basis of OAB. This may increase the awareness of urological complaints in neurological disorders and inspire robust therapies with better outcomes.

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

BackgroundInternationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls.In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service.MethodsThe APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service.A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database.ResultsTwo thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations.ConclusionIncreased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.