RESUMEN
Advanced practice providers increasingly assume responsibility for prior authorizations (PAs). We hypothesized that the time burden of PAs will be correlated with increased approval. We collected several variables (ie, type, method, time spent, use of peer to peer, and outcome) for all PAs completed by a departmental nurse practitioner in 1 region. Chi-square tests and 2 sample t tests were used to assess significance. There was no significant association between the method of request, the number of attempts, and the time spent to approved PA. Further research is needed to determine ways to decrease the time and opportunity cost associated with PAs.
RESUMEN
OBJECTIVE: To study the factors that influence men's disposition towards post-mortem disposition of their cryopreserved gametes. DESIGN: A retrospective chart review of sperm cryopreservations between June 2016 and January 2020 was performed. All patients ≥ 18 years of age were included. Samples intended for donation or records with an unspecified reason for preservation were excluded. SETTING: A large academic health center. PATIENTS: Participants' (n=217) mean age was 35.8 ± 10.8 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients' reason for undergoing sperm cryopreservation, method of retrieval, and whether they chose to have the sample preserved or discarded post-mortem. RESULTS: A total of 217 men were analyzed; mean age was 35.8 ± 10.8 years. Of those, 176 (81.1%) men decided to preserve their sperm for a spouse and 41 (18.9%) elected to have the sample discarded when choosing the fate of their cryopreserved sample should they die. There was no significant difference in disposition towards sample fate based on age or method of collection. However, there was a significant difference based on the "reason for cryopreservation" (p = 0.001). We found that compared to patients that underwent sperm cryopreservation due to cancer-related treatments, the patients that underwent sperm banking prior to vasectomy were more inclined to discard the sample (OR = 3.45, 95% CI: 1.16 - 10.27, p = 0.026). Men that collected the sperm as an in vitro fertilization backup were less willing to discard the sample (OR = 0.42, 95% CI: 0.18 - 0.97, p = 0.043). CONCLUSIONS: It appears that men's disposition towards post-mortem disposition of their cryopreserved sperm are influenced by their reason for cryopreservation, rather than their age or method used for collection. As cryopreservation has become more common and affordable, understanding the factors that impact men's disposition towards the post-mortem disposition of the cryopreserved gametes is imperative, as this knowledge has the potential to influence institutional policies and legislation, and may help solve future legal conflicts and ethical dilemmas.
RESUMEN
OBJECTIVE: To compare postoperative pain control among men who received different quantities of narcotic prescriptions following scrotal surgery. We hypothesized that men receiving eight vs four pills of acetaminophen 300 mg/codeine 30 mg there would be no significant difference in mean pain following scrotal and inguinal surgery. PATIENTS AND METHODS: In this prospective, open-label study, men who underwent scrotal surgery received eight or four acetaminophen 300 mg/codeine 30 mg pills. Men were encouraged to take scheduled non-steroidal anti-inflammatory drugs (NSAIDs), apply ice on the incision, and take acetaminophen 300 mg/codeine 30 mg as needed for breakthrough pain. Men were evaluated within 1-2 weeks after surgery. Statistical analysis was performed using Microsoft Excel and Stata/IC 15.1. RESULTS: A total of eighty-seven men met inclusion criteria, fifty-four men received eight acetaminophen/codeine pills, and thirty-three men received four pills. There was no significant difference in mean pain score (0-10) of men receiving eight pills vs four pills in the week after surgery (3.6 ± 1.9 vs 3.3 ± 1.8, P = .5004). Of men who used NSAIDs and ice, 93.5% and 92.3% found them to be moderately or very helpful. CONCLUSION: Reducing the total prescription of combined narcotic/non-narcotic medication is not associated with increased postoperative pain in patients undergoing scrotal/inguinal surgery. There was no difference in postoperative pain in men taking eight or four acetaminophen 300 mg/codeine 30 mg pills. A limited prescription of eight or four pills was adequate for pain control in the majority of men who underwent scrotal surgery. NSAIDs and ice were found to be useful adjuncts for pain relief by those who used them.
RESUMEN
Testosterone has a variety of functions and is commonly used in older men to treat symptoms of hypogonadism, such as decreased libido, decreased mood and erectile dysfunction. Despite its positive effects on sexual function, it has a negative effect on fertility. Exogenous testosterone therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone and luteinizing hormone. The purpose of this review is to discuss the contraceptive properties of testosterone therapy and to discuss strategies to increase testosterone in men with the desire to preserve fertility.
RESUMEN
Physician assistants (PA) and nurse practitioners have been moving toward specialty practices, like urology. With increased training and education, they manage more complex conditions independently. Whether they are the primary provider or the follow up to a specialist, physician extenders can play a vital role in managing patients undergoing testosterone therapy. Physician extenders should be able to understand the indications, risks and associated adverse effects of administering testosterone in order to proficiently take care of patients with low testosterone. The goal of this review is to recognize the role and the limits to which physician extenders should manage hypogonadism, and when physician collaboration or referral is necessary.
