Ajay K. Nangia

Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction

To digitally model (three‐dimensional, 3D) the course of the pudendal arteries relative to the bony pelvis in the adult male, and to identify sites of compression with different bicycle riding positions as a potential cause of penile hypoxia and erectile dysfunction.

A standardized pain management protocol improves timeliness of analgesia among emergency department patients with renal colic.

Background: Kidney stones are a common, and extremely painful, cause of emergency department (ED) visits. Pain management is a critical component of high-quality patient care. A pilot study at our institution found that only 69% of ED patients with renal colic had evidence of clinically significant analgesia. Objective: In response to these findings, we evaluated the impact of a formalized pain management protocol on timeliness of analgesia among ED patients with renal colic. Subjects and Methods: Using a before and after study design, adult ED patients with renal colic were eligible. In the prospective arm, patients were treated with ketorolac, 30 mg intravenous, and morphine, 0.05-0.1 mg/kg intravenous, according to a standardized protocol. Results were compared with a retrospective chart review of eligible patients treated during a similar preprotocol period. Results: Implementation of the protocol resulted in a significant reduction in time to effective analgesia (72 ± 63 vs 37 ± 42 minutes, P = .003). The protocol did not result in any increase in adverse effects. Conclusion: Implementation of a standardized pain management protocol among ED patients with renal colic resulted in a marked improvement in quality of care as evidenced by a 49% reduction in time to effective analgesia.

Distribution of male infertility specialists in relation to the male population and assisted reproductive technology centers in the United States

OBJECTIVE To describe the spatial distribution of assisted reproductive technology (ART) centers and male infertility specialists by location, driving distance from ART center, and potential male population in need of these resources. DESIGN Cross-sectional study. SETTING Male population in the reproductive years (20-49 years old) based on U.S. Census Bureau data in 2000. Urology male infertility specialists as defined by 2005 specialty society membership directories. ART centers registered with the Society for Assisted Reproductive Technology in 2005. MAIN OUTCOME MEASURE(S) Male population and male infertility specialists within the service area served by in-state and neighboring-state ART centers, as defined by a 60-minute travel time. RESULT(S) One hundred ninety-seven male infertility specialists and 390 ART centers were identified. On a state level, the highest male population in the reproductive years was seen in California, Texas, and Florida. The highest male populations per male specialist were found in Oregon, Tennessee, and Oklahoma. The highest number of ART centers per male specialist was found in Tennessee. The highest proximities of male specialists within the 60-minute driving service area of different ART centers were found in the North East and Southern California. The Midwest to Northwest had the least. CONCLUSION(S) A disparity of urology male infertility specialists exists in the United States, with large areas of the country being underserved and overserved based on the location of ART centers.

Access to assisted reproductive technology centers in the United States.

OBJECTIVE To describe the disparity of assisted reproductive technology (ART) centers in the United States as they relate to residential locations of populations in their reproductive years and state-mandated coverage for infertility services. DESIGN Cross-sectional study. SETTING Population in reproductive years (women 20-44 years; men 20-49 years) based on US Census 2000 data. Assisted reproductive technology centers registered with the Society for Assisted Reproductive Technology (SART) in 2005. MAIN OUTCOME MEASURE(S) Populations within service area served by in-state and neighboring state ART centers as defined by a 60-minute travel time along road networks from each center. RESULT(S) Service areas for 387 of 390 ART centers were calculated. Fourteen states had some form of mandated coverage. Underserved states included Alaska, Montana, Wyoming, and West Virginia. The northeastern United States had the greatest percentage of overserved population with 66%-100% study population within 60 minutes of an ART center. Female age stratification showed the highest age group (35-44 years) per state in northern New England and the youngest in Utah and District of Columbia. Median total study population within 60 minutes of an ART center in their own state was higher in mandated versus nonmandated states. CONCLUSION(S) Disparity of access to care for infertility services exists from the standpoint of population service areas for ART centers and state-mandated coverage. Female age stratification may help anticipate future need for services with existing resource distribution.