Abstract Purpose The COVID-19 pandemic led to delays in urologic cancer treatment. We sought the patient perspective on these delays. Methods We conducted a mixed methods study with an explanatory-sequential design. Survey findings are presented here. Patients from a Midwestern Comprehensive Cancer Center and the Bladder Cancer Advocacy Network provided demographic and clinical data and responded to statements asking them to characterize their experience of treatment delay, patient-provider communication and coping strategies. We quantified patient distress with an ordinal scale (0-10), based on the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT). Results Forty-four consenting patients responded to the survey. Most were older than 61 years (77%) and male (66%). Their diagnoses included bladder (45%), prostate (30%) and kidney (20%) cancers. Median time since diagnosis was 6 months, 95% had plans for surgical treatment. Dominant reactions to treatment delay included fear that cancer would progress (50%) and relief at avoiding COVID-19 exposure (43%). Most patients reported feeling that their providers acknowledged their emotions (70%), yet 52% did not receive follow up phone calls and only 55% felt continually supported by their providers. Patients’ median distress level was 5/10 with 68% of patients reaching a clinically significant level of distress (≥4). Thematically grouped suggestions for providers included better communication (18%), more personalized support (14%), and better patient education (11%). Conclusion During the COVID-19 pandemic, a high proportion of urologic cancer patients reached a clinically significant level of distress. While they felt concern from providers, they desired more engagement and personalized care.
Abstract Vacuum erection devices (VEDs) are commonly recommended by urologists to treat erectile dysfunction. We explored consumer views on VED use through a qualitative analysis of 1,500 Amazon.com reviews for 21 of the most popular VED products. Reviews were analyzed using GPT-4, identifying common themes and subthemes. Electric and manual VEDs were compared, and a multivariable ordinal regression was built to identify factors linked to higher product ratings. The most common themes were efficacy (1,375/1,500, 92%) and user experience (82%). Electric VEDs compared to manual devices had more frequently mentions of ease of use (46% vs. 34%) and better design features (26% vs. 17%). A 5/5 rating was linked to fewer mentions of deficiencies, malfunctions, warnings, and desired changes compared to 1/5 rating. Each 1 USD increase was linked to an average 0.10-point drop in ratings (95% CI: -0.12 to -0.08). Compared to non-electric, non-sex toy products, those with electric features and additional sex toy functions had average rating increases of 0.72 points (95% CI: 0.44 to 1.00) and 0.40 points (95% CI: 0.13 to 0.67), respectively. Amazon reviews generally show positive sentiment towards VEDs, with electric models favored for ease of use, though patient education is essential for safe use.
Flint Lockwood est inventeur. Jusqu'ici, toutes ses inventions bizarres, depuis les chaussures que l'on se pulverise sur les pieds jusqu'au traducteur de pensees pour singe, ont ete des echecs spectaculaires qui ont cause d'innombrables problemes a sa petite ville, Swallow en Château. Cette fois, Flint est bien decide a inventer quelque chose qui rendra les gens heureux. Pourtant, lorsque sa nouvelle creation, la machine a transformer l'eau en nourriture, detruit la grand-place avant de disparaitre dans les nuages, il pense que sa carriere d'inventeur est definitivement fichue. Jusqu'a ce que l'incroyable se produise : il se met a pleuvoir des cheeseburgers ! Sa machine marche ! Les averses de nourriture connaissent un instantane, et Flint se fait vite une nouvelle amie : Sam Sparks, la presentatrice meteo qui arrive a Swallow en Château pour couvrir ce qu'elle appelle le plus formidable phenomene meteo de l'histoire ... Bonus : Editions pret et consultation : - Commentaire audio - Scenes supplementaires et etendues - La recette du succes : making of - Les voix de Tempete de boulettes geantes - Coulisses de la video musicale Raining Sunshine - Karaoke et video musicale Raining Sunshine - 5 documentaires sur la creation des effets visuels et de l'animation - Jeux.
We investigated the influence of patient age on sacral nerve stimulation trial outcomes, device implantation and treatment durability.We analyzed a database of all sacral nerve stimulation procedures performed between 2012 and 2014 at a high volume institution for associations of patient age with sacral nerve stimulation indication, trial stimulation success, device revision and device explantation.In a cohort of 356 patients those with nonobstructive urinary retention and urgency-frequency were younger than patients with urgency urinary incontinence. Trial stimulation success did not differ by age in stage 1 and percutaneous nerve evaluation trials (p = 0.51 and 0.84, respectively). Logistic regression identified greater odds of trial success in females compared to males (OR 2.97, 95% CI 1.32-6.04, p = 0.009) and for urgency urinary incontinence compared to urgency-frequency (OR 3.02, 95% CI 1.39-6.50, p = 0.006). In analyzed patients there were 119 surgical revisions, including battery replacement, and 53 explantations. Age was associated with a decreased risk of revision with 3% lower odds per each additional year of age (OR 0.97, 95% CI 0.95-0.98, p <0.0001). While age did not influence explantation, for each body mass index unit there was a 5% decrease in the odds of explantation (OR 0.95, 95% CI 0.91-0.98).In contrast to previous studies, older patients experienced no difference in the sacral nerve stimulation response in stimulation trials and no difference in the implantation rate. Furthermore, age was modestly protective against device revision. This suggests that age alone should not negatively predict sacral nerve stimulation responses.
