Guy Martin Nehrenz

The Benefit of Music for the Reduction of Stress and Anxiety in Patients Undergoing Elective Cosmetic Surgery

Stress and anxiety are common responses to illness, hospitalization, and surgery. Increased stress and anxiety during a surgical procedure or recovery can negatively impact health outcomes, leading to longer surgical and recovery times and complications. It is believed that music implementation in the perioperative environment can reduce the stress and anxiety levels of patients. Twenty-six patients electing to have cosmetic surgery participated in this study. Fourteen were provided with preselected music during their preoperative period while 12 were not. Patients receiving the music reported 18% (P 1⁄4 0.002) less anxiety after the intervention. Heart rate and blood pressure were recorded as physiological measures of stress but no significant changes were found. Results suggest that patients waiting for surgery benefit emotionally from hearing music. This low-cost, complementary therapy has the potential to improve the experience and outcomes of patients electing to have cosmetic surgery.

Factors That Influence Physician Assistant Program Graduates to Choose Rural Medicine Practice

Purpose: A shortage of primary care, rural practitioners exists in the United States. The increasing number of physician assistants (PA) in the workforce could be an important resource in improving access to primary care services for rural patients, yet little is known about the specific factors influencing a PA to choose to practice rural medicine. The purpose of this study is to examine the factors that influence PA program graduates to choose rural medicine. Methods: This descriptive study was conducted by electronic survey. Participants were recruited from the membership of the Texas Academy of Physician Assistants (TAPA). Main outcome measures were the correlations between rural clerkships, rural background, and rural practice. Participants were also queried regarding 16 additional factors that might influence practice choice. Results: A relationship exists between rural background and rural practice choice (&khgr;2(4) = 16.08, P = .003). Correlation also was identified between completion of rural clerkships and rural practice choice (&khgr;2(1) = 10.67, P = .001). Factors found to have the most influence on PAs to choose rural practice were (1) desire to serve the needs of the community; (2) type of practice; and (3) supervising physician characteristics. Conclusions: PAs with a rural background and those that completed rural clerkships have a greater propensity toward rural practice after graduation. It is possible, for programs with an interest or a mission of increasing the number of their graduates who choose rural practice, that knowledge of factors that influence their graduates’ practice choices may prove beneficial.

Dancers' perceptions of injuries

Dance socioculture encourages dancers to perform through pain and injury and influences whether dancers will take time off in the event of an injury. The purpose of this study was to examine the impact dancers mind-set and enculturation had on their decision to continue to train and perform through injury. Fifteen trained dancers (5 males and 10 females), age 27.7±14.25 years, completed a survey to determine the dancers perceptions of injury and rehabilitation decisions post-injury. Findings indicate that enculturated perceptions may play a significant role in dancers response to injury. n n xa0 n n Key words:xa0Dancers, injury, perceptions, enculturation, rehabilitation.

Infection control professionals' information-seeking preferences.

OBJECTIVESnThe aims of this study were to: 1) establish whether infection control professionals (ICPs) who had access to and utilised medical librarian services for evidence-based medicine (EBM) research perceived this assistance to be useful and 2) to establish whether ICPs who used electronic or hard copy resources for EBM research perceived that those resources had a significant impact on their work.nnnMETHODSnConvenience sampling was used to collect quantitative data via a questionnaire. Study participants were members of South-west and Western chapters of the Association for Professionals in Infection Control and Epidemiology. There were 264 questionnaires distributed in this study; 179 participants completed the questionnaire. The response rate for eligible respondents was 59.5% (157).nnnRESULTSnResults indicated 56.7% (51) of the ICPs with librarian access reported requesting assistance from their work facility librarian. In reference to locating infection control information, 77.9% (95), 87.3% (124) and 93.3% (138) of ICPs found textbooks, journals and the Internet very useful or useful, respectively.nnnCONCLUSIONnStudy results indicated ICPs who used the assistance of medical librarians and/or hard copy or electronic resources for EBM research perceived such sources to be valuable for obtaining infection control information.

Using Pictograms for Communication

The U.S. Navy sponsors annual Pacific Partnership deployments to provide humanitarian and disaster relief training for the U.S. military, partner nations, nongovernmental organizations, and host nations. Communication between these groups and the local populations receiving medical care is problematic in that sufficient numbers of capable translators are often unavailable or vastly undertrained with respect to medical terminology and practice. In addition, should Pacific Partnership respond to a real disaster, adequate numbers of translators will likely be unavailable as a result of the disaster itself. Consequently, medical providers will require alternate methods of communication previously tested for efficacy and validity. One such method is the use of pictograms designed to represent common medical maladies. To determine whether pictograms meet the 85% congruence level required by the American National Standards Institute, 36 images were provided to English-speaking physician assistants and nurse practitioners for interpretation with three images repeated within the array to assess internal validity of the questionnaire. Of the 33 distinct images, 26 (79%) reached 85% congruence showing that validated images may be a method of communication in circumstances where medical providers and patients speak discordant languages.

Educational debt: does it have an influence on initial job location and specialty choice?

Purpose: This study applied a quantitative design and analyzed the impact of educational debt on initial specialty and location choices for physician assistant (PA) graduates in Indiana. Methods: PAs who graduated between January 1, 2000, and December 31, 2010, and actively practice in Indiana were surveyed. Descriptive statistics and chi‐square analyses were performed to determine whether any significant relationships existed among practice specialty, location, and gender. Results: 157 participants (33%) responded to the survey and were considered in the final analysis. Males were more likely than females to be influenced by debt in choosing their specialty and the location of their initial job. A majority of PAs would have reconsidered rural practice if they had received federal and or state loan forgiveness for educational debt. Conclusion: This study provides evidence that debt may influence practice specialty and location choice. Further studies are needed to determine how gender might account for decisions to practice in certain specialties and location.

Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications

Few studies have examined the roles of dorsal penile nerve block (DPNB) and penile ring block (PRB) in surgery of inflatable penile prosthesis (IPP) placement. We sought to compare the postoperative pain outcomes of two different medications used in DPNB plus PRB. We thus carried out a prospective study of patients with erectile dysfunction who underwent “de novo” IPP placement between January 2013 and June 2013. Patients were divided to one of three groups: 1-DPNB plus PRB with bupivacaine injection; 2-DPNB plus PRB with ropivacaine injection and, 3-Control group without DPNB or PRB injection. Postoperative pain score and pain medication usage were recorded 2u2009h postoperatively, and every 24u2009h, for a week. The Visual Analog Scale (VAS) was used as pain scale measurement. A total of 131 patients were included in this study: 40 to bupivacaine, 47 to ropivacaine, and the rest were controls. Two hours postoperatively, mean VAS was significantly different (pu2009<u20090.0001) between medicated patients and the control group, however, no significant differences were observed between medication groups. Mean VAS was not significantly different among the groups from post-surgical day 2 thru 7. In conclusion, DPNB plus PRB during IPP provided effective analgesia in the immediate post-operative recovery.

A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery

Background With better designed devices and lower infection rates, satisfaction with inflatable penile prosthesis (IPP) placement is increasingly high. However, dissatisfaction is still present and there is disagreement regarding length and sensation changes after the IPP placement. The aim of this study was to evaluate changes in penile length, girth and sensitivity after IPP placement. Methods From August 2012 to January 2013 all patients undergoing “de novo” IPP surgery were invited to participate in this study. Eighty six patients met inclusion criteria while 62 agreed to participate in this observational study. A week before surgery, penile length and circumference, and glans/elbow biothesiometer readings were recorded 15 minutes after Trimix induced erection. Same measures were taken at postoperative week 6 and month 6. Results Amperage from Glans biothesiometer readings showed statistically significant shorter readings than elbow biothesiometer preoperatively, 6 weeks and 6 months after surgery (P<0.001 each). No significant sensory difference in the glans penis after IPP was noted. However, compared to preoperative Trimix induced erections, penile length and circumference were greater after IPP placement (P=0.04 and P=0.001, respectively). Conclusions We observed statistically significant increase in penile length and girth after IPP placement without significant changes in sensory conduction.

Experience With Prophylactic Gentamicin During Penile Prosthesis Surgery: A Retrospective Comparison of Two Different Doses

BACKGROUNDnGentamicin has been determined to be active against a wide range of bacterial infections and has been commonly used as a preoperative antibiotic for inflatable penile prosthesis (IPP) implantation. However, the best dosing regimen to produce the safest optimal prophylactic effect remains to be determined.nnnAIMnTo compare low- and high-dose gentamicin as prophylaxis during IPP implantation.nnnMETHODSnWe retrospectively analyzed two groups of patients who underwent IPP placement from April 14, 2012 through April 13, 2016. Group 1 was composed of 490 patients who underwent IPP placement from April 14, 2012 through April 13, 2014 and received a low dose of preoperative gentamicin at 80 mg every 8 hours for 1 day. Group 2 was composed of 407 patients who underwent IPP placement from April 14, 2014 through April 13, 2016 and received a single high dose of preoperative gentamicin at 5 mg/kg. We compared the infection rates of IPP and any gentamicin-related toxicities. The same surgeon performed all procedures. All patients received additional vancomycin 1 g before incision and at 12 hours postoperatively.nnnOUTCOMEnDemographic data and IPP infection rate were compared and potential toxicities from the higher dose of gentamicin were closely monitored.nnnRESULTSnThere were no significant differences in mean age, mean body mass index, and mean interval for IPP placement and IPP infection between the two groups. No toxicity was seen with the higher gentamicin dose. Six cases in group 1 (five de novo cases and one redo case, infection ratexa0= 1.22%) and three cases in group 2 (two de novo cases and one redo case, infection ratexa0= 0.74%) were found to have IPP infection. The infection rate in group 2 appeared to be lower than that in group 1, although a significant statistical difference was not achieved (Pxa0= .057).nnnCLINICAL IMPLICATIONSnThese findings would help guide urologists in choosing an optimal preoperative gentamicin dose for IPP surgery.nnnSTRENGTHS AND LIMITATIONSnThis is the first study to report on the usage of high-dose preoperative gentamicin for IPP surgery but with limitations as a retrospective study.nnnCONCLUSIONSnAlthough not achieving a statistical difference, there was a trend for patients receiving a higherxa0dose of preoperative gentamicin to have a lower IPP infection rate. No toxicity was encountered from the 5-mg/kg gentamicin dose. We recommend following prophylactic high-dose gentamicin guidelines. Xie D, Gheiler V, Lopez I, etxa0al. Experience With Prophylactic Gentamicin During Penile Prosthesis Surgery: A Retrospective Comparison of Two Different Doses. J Sex Med 2017;14:1160-1164.

Ureterocele: Review of Presentations, Types, and Coexisting Diseases

Introduction: Ureterocele is swelling in one of the ureters that carry urine from the kidney to the bladder, which can block urine flow. An ureterocele usually occurs in the lower part of the ureter, where the ureter enters the bladder. Ureteroceles are equally common in both leftand right-side ureters. Some persons with ureteroceles are asymptomatic. Often, the diagnosis is made later in life due to kidney stones. Materials and methods: A systematic review was accomplished using Medline to obtain articles related to ureteroceles in English, Spanish, Italian, and French. Interests were focused on presentations, types and coexisting diseases for ureterocele. Results: Ureterocele can present with urinary tract infection, urinary retention, urinary incontinence, abdominal or loin pain, abdominal or vulvar mass, abdominal distention, hematuria, or vaginal bleeding. We can type the ureteroceles based on its location (ectopic or intravesicle), its association with triplicate system, duplication system, or single system, prenatal or postnatal, pediatric or adult, female or male, and thick or non-thick. The co-existing diseases include ureteral calculus, tumor, and congenital urinary tract abnormalities. Large ureteroceles are usually diagnosed earlier than smaller ones. An ureterocele may be discovered during a pregnancy ultrasound. Children with this condition often have severe urinary tract infections. Conclusions: The review suggests that there are various presentations, types and coexisting diseases for ureteroceles. Findings implicate the importance of considering these variables when making treatment decision in patients with ureteroceles.