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Dubin JM, Aguiar JA, Lin JS, Greenberg DR, Keeter MK, Fantus RJ, Pham MN, Hudnall MT, Bennett NE, Brannigan RE, Halpern JA. The broad reach and inaccuracy of men's health information on social media: analysis of TikTok and Instagram. Int J Impot Res 2024; 36:256-260. [PMID: 36402921 PMCID: PMC9676765 DOI: 10.1038/s41443-022-00645-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
Social media (SoMe) offers great potential to expand access to health information, but a significant proportion of users consume its content instead of consulting a physician. We sought to quantify the volume and characterize the accuracy of men's health-related content on TikTok and Instagram. We searched TikTok and Instagram for the terms: testosterone, erectile dysfunction, male infertility, semen retention, Peyronie's disease, and vasectomy. The top 10 hashtags for each term were used to estimate the total impressions for each term on each platform, and posts were then characterized by creator type, content type, and accuracy (1 to 5 scale). TikTok had 2,312,407,100 impressions and Instagram had 3,107,300 posts across all topics. Semen retention had the most impressions on TikTok (1,216,074,000) and posts on Instagram (1,077,000). Physicians created only a small portion of total TikTok and Instagram posts (10.3% and 12.9%, respectively). Across all topics, the accuracy of content was poor (2.6 ± 1.7), however, physician posts were more accurate than non-physician posts (mean 4.2 ± 1.2 vs 2.3 ± 1.6, p < 0.001, respectively). Men's health content is popular on TikTok and Instagram but is not accurate. We recommend that physicians actively engage in SoMe to address misinformation.
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Affiliation(s)
- Justin M Dubin
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jonathan A Aguiar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jasmine S Lin
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mary Kate Keeter
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard J Fantus
- Division of Urology, Department of Surgery, Northshore University Health System, Evanston, IL, USA
| | - Minh N Pham
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew T Hudnall
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nelson E Bennett
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Joshua A Halpern
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Hudnall MT, Ambulkar SS, Lai JD, Pham MN, Fantus RJ, Keeter MK, Wren J, Bennett NE, Brannigan RE, Halpern JA. Characteristics of men who use direct-to-consumer men's health telemedicine services. Int J Impot Res 2023; 35:753-757. [PMID: 36310185 PMCID: PMC9618023 DOI: 10.1038/s41443-022-00635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
The characteristics of men who use direct-to-consumer (DTC) men's health services are not well understood. We conducted an online survey of adult men via ResearchMatch, assessing sociodemographic data, health behaviors, and concern for low testosterone and infertility. Logistic regression estimated the association between participant characteristics and familiarity with and reported use of DTC services such as Hims® and Roman®. Among 1276 men surveyed, 62.2% were concerned about low testosterone. While almost half (48.5%) were familiar with men's DTC health services, only 37 (2.9%) reported using these services. On multivariable analysis, men who used DTC men's health services were more likely to be younger (age 18-39: odds ratio [OR] 2.94, 95% confidence interval [CI] 1.03-8.38, p = 0.04; age 40-59: OR 3.26, CI 1.17-9.10, p = 0.02; referent age ≥60), have annual income between $75k and $100k (OR 5.25, CI 1.39-19.87.45, p = 0.02), and be concerned about low testosterone (OR 3.81, CI 1.46-9.96, p = 0.01). In conclusion, younger men and those with mid-range incomes were more likely to use online DTC men's health services compared to older or wealthier men. Likewise, men with concerns about low testosterone were more likely to use DTC services, but other health-conscious behaviors and frequency of doctor visits did not predict use.
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Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Siddhant S Ambulkar
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - James Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Greenberg DR, Hudnall MT, Goyette BN, Lai JD, Hayon S, Bennett NE, Brannigan RE, Halpern JA. Assessing the Prevalence of Low Testosterone and Elevated Follicle Stimulating Hormone Among Men Presenting for Fertility Evaluation Without Oligospermia. Urology 2023; 180:130-134. [PMID: 37482101 DOI: 10.1016/j.urology.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To compare the prevalence of abnormal hormone parameters among men with and without oligospermia to determine the value of universal hormonal screening during initial fertility evaluation. MATERIALS AND METHODS We retrospectively evaluated men who underwent semen analysis and hormonal evaluation (morning testosterone [T] and follicle-stimulating hormone [FSH]) between January 2002 and May 2021. Sperm concentration was dichotomized at 15 million/mL according to World Health Organization (WHO) criteria. We compared median and interquartile range (IQR) T and FSH levels according to sperm concentration using Kruskal-Wallis test. Differences in prevalence of low testosterone (<300 ng/dL) and abnormal FSH (>7.6mIU/mL) were determined using chi-square test. RESULTS 1164 men had a morning serum T. There was no difference in median T among men with normal vs abnormal sperm concentration (316 ng/dL, IQR 250-399 vs 316 ng/dL, IQR 253-419; P = .52). FSH was measured in 1261 men. Median FSH was higher among men with sperm concentration <15 million/mL (6.0IU/mL, IQR 3.9-10.7 vs 3.8IU/mL, IQR 2.7-5.7; P < .001). Among men with ≥15 million/mL concentration, 44.1% were found to have low T (P = .874) and 10.8% had an FSH ≥7.6 mIU/mL (P < .001). Among men with ≥15 million/mL sperm concentration who underwent both T and FSH evaluation, 43.6% had at least 1 hormonal abnormality. CONCLUSION Almost half of men with normal sperm concentration had low T. As low T may have long-term implications for both fertility and overall health, providers should consider universal T screening in men presenting for fertility evaluation.
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Affiliation(s)
- Daniel R Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bailey N Goyette
- Department of Urology, University of Missouri School of Medicine, Columbia, MO
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Solomon Hayon
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Logan CD, Hudnall MT, Schlick CJR, French DD, Bartle B, Vitello D, Patel HD, Woldanski LM, Abbott DE, Merkow RP, Odell DD, Bentrem DJ. Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery. JAMA Netw Open 2023; 6:e2335311. [PMID: 37768664 PMCID: PMC10539988 DOI: 10.1001/jamanetworkopen.2023.35311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/06/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Venous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA). Objective To determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA. Design, Setting, and Participants This retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023. Exposures Inpatient surgery for cancer with general surgery, thoracic surgery, or urology. Main Outcomes and Measures Rates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty. Results Overall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty. Conclusions and Relevance These findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.
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Affiliation(s)
- Charles D. Logan
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Matthew T. Hudnall
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cary Jo R. Schlick
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Dustin D. French
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Department of Ophthalmology, Northwestern University, Chicago, Illinois
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois
- Veterans Affairs Health Services Research and Development Service, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Brian Bartle
- US Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Hines VA Medical Center, Chicago, Illinois
| | - Dominic Vitello
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Hiten D. Patel
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Lauren M. Woldanski
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- William S. Middleton VA Medical Center, Madison, Wisconsin
| | - Daniel E. Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- William S. Middleton VA Medical Center, Madison, Wisconsin
| | - Ryan P. Merkow
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David D. Odell
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David J. Bentrem
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois
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Greenberg DR, Hudnall MT, Goyette BN, Fantus RJ, Dubin JM, Brannigan RE, Halpern JA. Predictors of Semen Parameters Decline Following the Microsurgical Varicocelectomy. Cureus 2023; 15:e45061. [PMID: 37829944 PMCID: PMC10567203 DOI: 10.7759/cureus.45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective Varicocele is considered the most common reversible cause of male infertility. However, some men do not clinically improve after surgical repair. We aimed to identify preoperative factors associated with decreased semen parameters and clinical "downgrading" of total motile sperm count (TMSC) following varicocelectomy. Methods We examined men with preoperative laboratory testing and pre- and postoperative semen analyses (SA) who underwent varicocelectomy between 2010 and 2020. Ejaculate volume, sperm motility, sperm concentration, TMSC, and clinical grade of TMSC (in vitro fertilization: <5M sperm, intrauterine insemination: 5-9M sperm, natural pregnancy: >9M sperm) were used to determine postoperative outcomes. Demographic and clinical factors were compared between cohorts. Results Among 101 men who underwent varicocelectomy, 35 (34.7%) had decreased postoperative TMSC with a median follow-up of 6.6 months (interquartile range 3.9-13.6 months). Eleven (10.9%) men experienced TMSC clinical "downgrading" following surgery. Clinical grade III varicocele was significantly associated with decreased sperm motility on postoperative SA (OR 4.1, 95% CI 1.7-10.0, p=0.002), and larger left testicle volume (OR 1.4, 95% CI 1.1-1.8, p=0.02) was associated with clinical "downgrading" after varicocelectomy. Conclusion A small but significant proportion of men experienced a "downgrading" of semen parameters after varicocelectomy. Larger left testis size was associated with clinical downgrading, whereas clinical grade III varicoceles were associated with lower post-treatment sperm motility. These data are critical for preoperative patient counseling.
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Affiliation(s)
- Daniel R Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | - Justin M Dubin
- Department of Urology, Memorial Healthcare, Aventura, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Greenberg DR, Stanisic AV, Pham MN, Hudnall MT, Ambulkar SS, Brannigan RE, Fantus RJ, Halpern JA. Factors associated with undergoing microdissection testicular sperm extraction among men with non-obstructive azoospermia following evaluation by a reproductive urologist. Transl Androl Urol 2023; 12:1062-1070. [PMID: 37554532 PMCID: PMC10406537 DOI: 10.21037/tau-23-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/02/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Microdissection testicular sperm extraction (mTESE) is the gold standard treatment for men with non-obstructive azoospermia (NOA). However, many men do not elect to pursue this surgical intervention. We aimed to identify factors associated with NOA patients undergoing mTESE after initial evaluation by a reproductive urologist (RU) through a retrospective cohort study. METHODS We retrospectively reviewed NOA patient who underwent evaluation by a RU between 2002-2018. Demographic and clinical data were collected. Our primary outcome was electing to undergo mTESE. RESULTS 44.4% (75/169) of NOA men underwent mTESE. These patients earned significantly higher median neighborhood income ($133,000 vs. $97,000, P<0.001), spent fewer years trying to conceive before seeking care {1.3 [interquartile range (IQR): 1-3] vs. 2.3 (IQR: 1-5), P=0.012}, and were more likely to be married (79.7% vs. 53.9%, P=0.001). On univariate analysis, married men [odds ratio (OR) 3.37, 95% confidence interval (CI): 1.67-6.79, P=0.001] and men with higher neighborhood income (OR 1.14, 95% CI: 1.06-1.21, P<0.001) were more likely to undergo mTESE, while couples attempting to conceive for a longer period of time prior to initial evaluation were less likely to undergo mTESE (OR 0.79, 95% CI: 0.68-0.92, P=0.003). On multivariable regression analysis, marital status and years attempting to conceive remained significantly associated with NOA patients undergoing mTESE (OR 4.61, 95% CI: 1.16-18.25, P=0.03; OR 0.67, 95% CI: 0.52-0.88, P=0.003, respectively). CONCLUSIONS Higher neighborhood income and marital status were positively associated with patients undergoing mTESE, while couples who attempted to conceive for a longer period of time before seeking infertility care were less likely to undergo mTESE.
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Affiliation(s)
- Daniel R. Greenberg
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA
| | | | - Minh N. Pham
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA
| | - Matthew T. Hudnall
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA
| | | | - Robert E. Brannigan
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA
| | - Richard J. Fantus
- The University of Kansas Hospital, Department of Urology, Overland Park, KS, USA
| | - Joshua A. Halpern
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL, USA
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Logan CD, Mahenthiran AK, Siddiqui MR, French DD, Hudnall MT, Patel HD, Murphy AB, Halpern JA, Bentrem DJ. Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy. J Surg Oncol 2023. [PMID: 37036165 DOI: 10.1002/jso.27274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. STUDY DESIGN The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. RESULTS Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. CONCLUSION Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.
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Affiliation(s)
- Charles D Logan
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Ashorne K Mahenthiran
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mohammad R Siddiqui
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Matthew T Hudnall
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hiten D Patel
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua A Halpern
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Hudnall MT, Greenberg D, Logan C, Schaeffer EM, Brannigan RE, Bentrem DJ, Halpern JA. Association between frailty and low testosterone among men undergoing oncologic surgery. J Surg Oncol 2023; 127:501-503. [PMID: 36190426 DOI: 10.1002/jso.27114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Logan
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Jesse Brown VAMC, Veterans Affairs Chicago Healthcare System, Chicago, Illinois, USA.,Veterans Affairs Health Services Research and Development, Chicago, Illinois, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Jesse Brown VAMC, Veterans Affairs Chicago Healthcare System, Chicago, Illinois, USA
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Pham MN, Ko OS, Huang R, Vo AX, Tsai KP, Lai JD, Hudnall MT, Halpern JA, Meeks JJ, Benson J, Soares R, Kim R, Bilimoria KY, Stulberg JJ, Auffenberg GB. An Evaluation of Peer-Rated Surgical Skill and its Relationship With Detrusor Muscle Sampling in Transurethral Resection of Bladder Tumor. Urology 2022; 169:134-140. [PMID: 36049631 PMCID: PMC10099284 DOI: 10.1016/j.urology.2022.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess the reliability of peer-review of TURBT videos as a means to evaluate surgeon skill and its relationship to detrusor sampling. METHODS Urologists from an academic health system submitted TURBT videos in 2019. Ten blinded peers evaluated each surgeon's performance using a 10-item scoring instrument to quantify surgeon skill. Normalized composite skill scores for each surgeon were calculated using peer ratings. For surgeons submitting videos, we retrospectively reviewed all TURBT pathology results (2018-2019) to assess surgeon-specific detrusor sampling. A hierarchical logistic regression model was fit to evaluate the association between skill and detrusor sampling, adjusting for patient and surgeon factors. RESULTS Surgeon skill scores and detrusor sampling rates were determined for 13 surgeons performing 245 TURBTs. Skill scores varied from -6.0 to 5.1 [mean: 0; standard deviation (SD): 2.40]. Muscle was sampled in 72% of cases, varying considerably across surgeons (mean: 64.5%; SD: 30.7%). Among 8 surgeons performing >5 TURBTs during the study period, adjusted detrusor sampling rate was associated with sending separate deep specimens (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.02-3.81, P = .045) but not skill (OR: 0.81; 95% CI: 0.57-1.17, P = .191). CONCLUSION Surgeon skill was not associated with detrusor sampling, suggesting there may be other drivers of variability of detrusor sampling in TURBT.
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Affiliation(s)
- Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Oliver S Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reiping Huang
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Amanda X Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyle P Tsai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonas Benson
- Northwestern Medicine Central DuPage Hospital, Winfield, IL; Northwestern Medicine Delnor Hospital, Geneva, IL; UroPartners LLC, Winfield, IL
| | - Ricardo Soares
- Department of Urology, Northwestern Medicine Kishwaukee Hospital, DeKalb, IL
| | - Ronald Kim
- Northwestern Medicine Lake Forest Hospital, Lake Forest, IL; UroPartners LLC, Lake Forest, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Chicago, IL
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX
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10
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Lai JD, Fantus RJ, Meza JA, Hudnall MT, Pham M, Brannigan RE, Ghomrawi HMK, Halpern JA. Cost-effectiveness of early screening home semen analysis in couples attempting to conceive. Urology 2022; 170:104-110. [PMID: 36115433 DOI: 10.1016/j.urology.2022.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the cost-effectiveness of incorporating home semen analysis in screening for oligospermia and expediting time to evaluation. METHODS A decision analytic model was built using inputs from the medical literature. The index patient is the male partner in a couple seeking fertility, and entry into the model was assumed to be at the inception of the couple's attempts to conceive via natural means. Three main strategies are described and analyzed: 1) baseline strategy of no testing; 2) utilization of a home semen testing kit; 3) universal testing via a clinic visit and gold standard lab semen analysis. The primary outcome was detection of oligospermia (defined as sperm concentration < 15mil/mL). Strategies were ranked by months to evaluation by a male infertility specialist saved. Costs were considered from the patient perspective and were incorporated to determine the incremental cost per month saved to evaluation (ICMS) per 100,000 patients. RESULTS Compared to a baseline strategy of no screening, utilizing a home test would save 89,000 months at the incremental cost of $7,418,000 for an ICMS of $45.51. Shifting to a strategy of universal gold standard clinic and lab testing saves an additional 3,000 months but at an ICMS of $17,691 compared to the home testing strategy. CONCLUSIONS Widespread adoption and early usage of home semen analysis may be a cost-effective method of screening for oligospermia and facilitating further evaluation with an andrology specialist.
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Affiliation(s)
- Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL,.
| | | | - Julio A Meza
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Minh Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Hassan M K Ghomrawi
- Departments of Surgery; Department of Pediatrics; Department of Medicine (Rheumatology); Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago IL
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11
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Pham MN, Siebert AL, Faw CA, Dubin JM, Hudnall MT, Lai JD, Wren JM, Bennett NE, Brannigan RE, Halpern JA. Selective Serotonin Reuptake Inhibitor (SSRI) Use is Not Associated With Impaired Semen Parameters. Urology 2022; 164:140-144. [PMID: 35093399 DOI: 10.1016/j.urology.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine the association between selective serotonin reuptake inhibitor (SSRI) use and semen quality. METHODS We performed a retrospective review of all men undergoing semen analysis (SA) for fertility evaluation from 2002-2020 at a single academic medical center. Men were excluded if they had prior exposure to spermatotoxic medications, clomiphene citrate, gonadotropins, selective estrogen receptor modulators, or medical conditions known to impact male fertility. SSRI exposure was defined by an outpatient prescription within 90 days prior to any semen test. Differences between men with and without SSRI exposure were assessed with Wilcoxon rank sum for continuous variables and chi-squared testing for proportions. Univariable and multivariable linear regression models were fit to evaluate the relationship between SSRI use and individual semen parameters, controlling for age at the time of the semen analysis and non-SSRI drug use. RESULTS A total of 8861 men were identified, of whom 153 men (1.7%) were exposed to SSRIs prior to SA. Median age was 35 years (interquartile range: 32-39) and was similar between groups (P = .999). Non-SSRI medication use was significantly higher in men taking SSRIs (78.4% vs 23.3%, < .001). On univariable and multivariable analyses, SSRI exposure was not associated with differences in semen volume, sperm concentration, motility, total motile sperm count, or normal morphology. CONCLUSION In adult men undergoing fertility evaluation, SSRI exposure was not associated with impaired semen parameters. These data may help inform reproductive counseling and medical decision-making regarding SSRI use in men seeking paternity.
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Affiliation(s)
- Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aisha L Siebert
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cory A Faw
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin M Dubin
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James M Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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12
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Pham MN, Hudnall MT, Fantus RJ, Lai JD, Ambulkar SS, Wren JM, Bennett NE, Auffenberg GB, Chu DI, Brannigan RE, Halpern JA. The adverse association between stimulant use for attention deficit hyperactivity disorder (ADHD) and semen parameters. Andrologia 2022; 54:e14315. [PMID: 34816465 PMCID: PMC8844090 DOI: 10.1111/and.14315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 12/01/2022] Open
Abstract
This study examined the relationship between stimulant medications used for the treatment of attention deficit hyperactivity disorder and semen parameters. We performed a retrospective cohort study at a large, academic institution between 2002 and 2020. We included men with a semen analysis without prior spermatotoxic medication use, empiric medical therapy exposure or confounding medical diagnoses (varicocele, Klinefelter's syndrome, cryptorchidism, cystic fibrosis, diabetes, cancer or cancer-related treatment, and azoospermia). Men were stratified by stimulant exposure (methylphenidate or amphetamines). A multivariable linear regression was fit to assess the association between individual semen parameters, age, stimulant exposure and non-stimulant medication use. Of 8,861 men identified, 106 men had active prescriptions for stimulants within 90 days prior to semen testing. After controlling for age and exposure to non-stimulant medications, stimulant use was associated with decreased total motile sperm count (β: -18.00 mil/ejaculate and standard error: 8.44, p = 0.033) in the setting of decreased semen volume (β: -0.35 ml, and standard error: 0.16, p = 0.035), but not sperm concentration, motility and morphology. These findings suggest a role for reproductive physicians and mental health providers to consider counselling men on the potential negative impact of stimulants prescribed for attention deficit hyperactivity disorder on semen volume during fertility planning.
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Affiliation(s)
- Minh N. Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew T. Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard J. Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremy D. Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James M. Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nelson E. Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - David I. Chu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Robert E. Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua A. Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Pham MN, Ambulkar SS, Fantus RJ, Joshi T, Hudnall MT, Lai JD, Wren JM, Bennett NE, Jungheim ES, Brannigan RE, Halpern JA. Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing. Fertil Steril 2022; 117:489-496. [DOI: 10.1016/j.fertnstert.2021.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
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14
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Hudnall MT, Greene LI, Pham MN, Lai JD, Fantus RJ, Keeter MK, Wren J, Bennett NE, Brannigan RE, Halpern JA. Perceptions of Infertility and Semen Analysis Testing Among American Men Without Children. Urology 2021; 158:95-101. [PMID: 34537196 DOI: 10.1016/j.urology.2021.07.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether health-conscious men are more likely to be concerned about infertility and self-initiate semen analysis at a laboratory/clinic or through a direct-to-consumer at-home product without a health care provider recommendation. METHODS Cross-sectional survey conducted online via ResearchMatch.org between November 2019 and January 2020. Men age 18 and older without children (n = 634) were included for analysis. Outcomes were likelihood of self-initiating a semen analysis, prevalence of infertility concern. RESULTS Of the 634 participants, 186 expressed concern about infertility but only 29% were likely to discuss these concerns with a health care provider. More men would self-initiate a semen analysis using an at-home product than through a traditional laboratory/clinic (14.2% vs 10.4%, P = .04). Odds of self-initiating a traditional semen analysis were higher for men concerned about low testosterone (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.12-4.74, P = .023) and infertility (OR 3.91, 95% CI 2.14-7.15, P <.001). Self-initiating an at-home semen analysis was associated with concern for low testosterone and infertility as well as middle age (age 40-59: OR 3.02, 95% CI 1.16-7.88, P = .024) and fitness tracker use (OR: 1.95, 95% CI 1.12-3.39, P = .018). CONCLUSION Many men were unlikely to discuss infertility concerns with a health care provider. Middle aged men and those who used fitness trackers were more likely to self-initiate fertility evaluation through at-home semen analysis. Concern about low serum testosterone was pervasive and strongly associated with concern for being infertile and self-initiating a semen analysis of any kind.
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Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Lisa I Greene
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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15
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Dubin JM, Fantus R, Pham MN, Hudnall MT, Lai JD, Wren J, Bennett NE, Brannigan RE, Halpern JA. ASSOCIATION BETWEEN FOLLICLE STIMULATING HORMONE (FSH) AND BASELINE SEMEN PARAMETER ABNORMALITIES IN MEN PRESENTING FOR FERTILITY EVALUATION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Lai JD, Fantus RJ, Cohen AJ, Wan V, Hudnall MT, Pham M, Brannigan RE, Halpern JA. Unmet financial burden of infertility care and the impact of state insurance mandates in the United States: analysis from a popular crowdfunding platform. Fertil Steril 2021; 116:1119-1125. [PMID: 34246467 DOI: 10.1016/j.fertnstert.2021.05.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine infertility-related fund-raising campaigns on a popular crowdfunding website and to compare campaign characteristics across states with and without legislative mandates for insurance coverage for infertility-related care. DESIGN Retrospective cohort study. SETTING Online crowdfunding platform (GoFundMe) between 2010 and 2020. PATIENT(S) GoFundMe campaigns in the United States containing the keywords "fertility" and "infertility." INTERVENTION(S) State insurance mandates for infertility treatment coverage. MAIN OUTCOME MEASURE(S) Primary outcomes included fund-raising goals, funds raised, campaign location, and campaigns per capita. RESULT(S) Of the 3,332 infertility-related campaigns analyzed, a total goal of $52.6 million was requested, with $22.5 million (42.8%) successfully raised. The average goal was $18,639 (standard deviation [SD] $32,904), and the average amount raised was $6,759 (SD $14,270). States with insurance mandates for infertility coverage had fewer crowdfunding campaigns per capita (0.75 vs. 1.15 campaigns per 100,000 population than states without insurance mandates. CONCLUSION(S) We found a large number of campaigns requesting financial assistance for costs associated with infertility care, indicating a substantial unmet financial burden. States with insurance mandates had fewer campaigns per capita, suggesting that mandates are effective in mitigating this financial burden. These data can inform future health policy legislation on the state and federal levels to assist with the financial burden of infertility.
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Affiliation(s)
- Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew J Cohen
- Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Vivian Wan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Minh Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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17
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Hudnall MT, Desai AS, Tsai KP, Weiner AB, Vo AX, Ko OS, Jan S, Schaeffer EM, Kundu SD. It's all in the name: Does nomenclature for indolent prostate cancer impact management and anxiety? Cancer 2021; 127:3354-3360. [PMID: 34081322 DOI: 10.1002/cncr.33621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite consensus guidelines, many men with low-grade prostate cancer are not managed with active surveillance. Patient perception of the nomenclature used to describe low-grade prostate cancers may partly explain this discrepancy. METHODS A randomized online survey was administered to men without a history of prostate cancer, presenting a hypothetical clinical scenario in which they are given a new diagnosis of low-grade prostate cancer. The authors determined whether diagnosis nomenclature was associated with management preference and diagnosis-related anxiety using ratings given on a scale from 1 to 100, adjusting for participant characteristics through multivariable linear regression. RESULTS The survey was completed by 718 men. Compared with Gleason 6 out of 10 prostate cancer, the term grade group 1 out of 5 prostate cancer was associated with lower preference for immediate treatment versus active surveillance (β = -9.3; 95% CI, -14.4, -4.2; P < .001), lower diagnosis-related anxiety (β = -8.3; 95% CI, -12.8, -3.8; P < .001), and lower perceived disease severity (β = -12.3; 95% CI, -16.5, -8.1; P < .001) at the time of initial diagnosis. Differences decreased as participants received more disease-specific education. Indolent lesion of epithelial origin, a suggested alternative term for indolent tumors, was not associated with differences in anxiety or preference for active surveillance. CONCLUSIONS Within a hypothetical clinical scenario, nomenclature for low-grade prostate cancer affects initial perception of the disease and may alter subsequent decision making, including preference for active surveillance. Disease-specific education reduces the differential impact of nomenclature use, reaffirming the importance of comprehensive counseling and clear communication between the clinician and patient.
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Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuj S Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kyle P Tsai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda X Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Oliver S Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Jan
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Hudnall MT, Halpern JA, Bentrem DJ, French DD. Defining the mission of the MISSION Act. J Surg Oncol 2021; 123:1363-1364. [PMID: 33621352 DOI: 10.1002/jso.26427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew T Hudnall
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua A Halpern
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Jesse Brown VAMC, Chicago, Illinois, USA
| | - David J Bentrem
- Jesse Brown VAMC, Chicago, Illinois, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Feinberg School of Medicine, Northwestern University and VA Health Services Research and Development, Chicago, Illinois, USA
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19
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Pham MN, Hudnall MT, Nadler RB. Marijuana, Lower Urinary Tract Symptoms, and Pain in the Urologic Patient. Urology 2020; 139:8-13. [PMID: 32027882 DOI: 10.1016/j.urology.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe marijuana's clinical role for urologic symptoms. METHODS Studies related to marijuana, voiding dysfunction, lower urinary tract symptoms (LUTS), and pain through January 2019 from PubMed were evaluated for relevance and quality. RESULTS Forty-eight studies were reviewed. Cannabinoids have mixed efficacy for neurogenic LUTS and little evidence for non-neurogenic LUTS, chronic non-cancer-related and perioperative pain. For cancer-related pain, high-level studies demonstrate cannabinoids are well-tolerated with unclear benefit. CONCLUSION Cannabinoids appear well-tolerated in the short-term, but their efficacy and long-term impact is unproven and unknown in urologic discomfort. Cannabinoids for urologic symptoms should be further explored with well-designed randomized controlled trials.
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Affiliation(s)
- Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert B Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Tsai KP, Hudnall MT, Weiner AB, Keeter MK, Meeks JJ. Willingness to Participate in Home Screening for Urologic Cancers in the General Population: An Online Survey of Over 1400 Adults. Urology 2020; 136:35-40. [DOI: 10.1016/j.urology.2019.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/10/2019] [Accepted: 11/19/2019] [Indexed: 12/24/2022]
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21
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Desai AS, Roston A, Wren J, Keeter MK, Patel MS, Hudnall MT, Pham MN, Cooley LF, Bennett NE, Brannigan RE. MP51-07 CONTRACEPTION IN THE ERA OF THE AFFORDABLE CARE ACT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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