Efficacy of EMLA for Office-based Andrology Procedures Under Local Anesthesia: A Randomized Control Trial.

OBJECTIVE: To evaluate the effectiveness of Eutectic Mixture of Local Anesthetic (EMLA), a topical anesthetic cream, in office-based invasive andrological procedures such as hydrocelectomy, spermatocelectomy, and others, aimed at minimizing pain perception and enhancing the overall patient experience. METHODS: A double-blinded randomized controlled trial was conducted for patients undergoing scrotal andrology surgeries under LA. Power calculation was performed with an estimated sample size of 72. Participants were randomly assigned in a 1:1 ratio to topical EMLA + LA versus LA alone. In the post-operative recovery area, patient will be asked to complete a VAS questionnaire rating pain with LA administration and pain with procedure. Analysis comparing VAS pain scores of both groups was performed using the independent sample t-test method. RESULTS: Seventy-two patients were included in our analysis, with 36 in the control and 36 in the intervention arm. For patient pain with administration of LA, the control arm reported an average VAS pain score of 4.31, compared to 3.72 in the intervention arm (P = .319). For patient pain with procedure, patients in the control arm reported a median VAS pain score of 3.47 compared to 3.03 (P = .432) in the intervention arm. Overall, 86% (62/72) of patients reported that they would either be "very likely" (4/5) or "highly likely" (5/5) to undergo future procedures under local anesthetic. CONCLUSION: While performing scrotal surgeries under LA appears to be well tolerated and a feasible option, the application of EMLA cream does not appear to significantly alter patient-reported outcomes.

Do you want to be a urologist? Gender differences for medical student perception of urology.

INTRODUCTION: Gender inequality has been prevalent in the history of medicine, specifically within surgical specialties. Though there have been advances, urology has remained overwhelmingly male-dominant, with slow growth in female recruitment. This survey study evaluated whether gender-related differences in the perception of urology are present among future applicants that could account for gender disparity seen in recruitment. METHODS: An anonymized, online survey was distributed to medical students enrolled at the Max Rady College of Medicine during the 2022-2023 semester. Attracting and deterring survey statements were created using current literature to guide topics of interest. Participants rated each statement using a five-point Likert scale with optional supplemental qualitative responses. Likert ratings were compared using a Mann-U-Whitney calculation between self-identifying male and female participants. RESULTS: We received 90 responses over six weeks, achieving a response rate of 23%. Female students, compared to their male peers, were deterred by factors such as working in a male-dominated specialty (p<0.001) and working with primarily male patients (p<0.001). There were no significant gender-related differences for statements pertaining to interest in surgery, work-life balance, or exposure to urology. CONCLUSIONS: In this survey study, the biggest deterrents reported by female medical students to entering urology were working in a male-dominated profession and seeing primarily male patients. There were no significant gender-related differences for questions relating to interest in surgery, work-life balance, and exposure to urology.

Cognitive load and processes during chest radiograph interpretation in the emergency department across the spectrum of expertise.

BACKGROUND: In the emergency department (ED), chest radiographs (CXRs) provide essential information for clinical diagnostic reasoning. Errors in interpretation by emergency physicians can lead to negative patient outcomes. To aid in teaching this important skill, an understanding of cognitive processes and cognitive load (CL) in CXR interpretation in emergency medicine (EM) personnel is warranted. METHODS: This study adopted a concurrent mixed-methods research design. Participant groups included medical students (M), junior (J) and senior (S) EM residents, and attending emergency physicians (P) in the ED at an academic hospital. To elucidate cognitive processes, a real-time cognitive task analysis during CXR interpretation was performed. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. The interview was followed by a questionnaire, where participants rated their CL, stress, and confidence level. RESULTS: Levels of CL (M vs. S and M vs. P, p = 0.002; J vs. S, p = 0.004; J vs. P, p = 0.005) and stress (J vs. P, p = 0.002) decreased, while confidence levels increased (M vs. S, p = 0.006; J vs. S, p ≤ 0.001; J vs. P, p = 0.003) as experience level increased. Qualitative analysis of interviews revealed four themes: checking behavior, information reduction, pattern recognition versus systematic viewing, and recognizing scope of practice. Experts commonly utilized checking behavior (e.g., comparison to prior radiographs) and deprioritized task irrelevant data. Experts used a general overview technique as their initial approach as opposed to a systematic viewing approach, and they more readily recognized an EM physicians' scope of practice in this task. CONCLUSION: This study characterized differences in cognition that led to increased CL, stress, and lower level of confidence in EM learners during CXR interpretation and provided insight into expertise development in this important skill.