Health-related Quality of Life in Patients With Urethral Stenosis After Radiation Treatment for Prostate Cancer.

OBJECTIVE: To evaluate patient-reported quality of life (PRQoL) in patients presenting with membranous urethral stenosis after prostate radiotherapy. Urethral stenosis is an under-reported complication after prostate radiotherapy with a particular deficiency in PRQoL. METHODS: Patients presenting with urethral stenosis after radiotherapy were retrospectively reviewed from 2004 to 2022. PRQoL was assessed via patient survey using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). RESULTS: Two hundred thirty patients were identified at a mean age of 67.7years and mean time to stricture diagnosis of 63.6months' postradiotherapy. Of 87 patients completing the survey, 29.9% recalled being aware of urethral stenosis as a potential complication and 51.7% had documentation of urethral stenosis as a potential complication. 33.5% of patients underwent urethroplasty, 59.6% repeat endoscopic treatment and 6.1% an indwelling catheter. 64.4% of patients reported urinary dysfunction as a "moderate" or "big" problem, 66.7% reported frequent or total incontinence, 64.4% required daily pad use and 50.6% reported incontinence as either a "moderate" or "big" problem. 85.0% reported poor or absent orgasmic dysfunction and 88.5% reported erections insufficient for sexual activity. Additionally, 47.1% of patients reported rectal pain and 31.0% reported dysuria. Depressive symptoms and fatigue were reported by 41.4% and 60.9% of patients respectively. CONCLUSION: Urethral stenosis after radiotherapy is a clinically complex entity with a broad scope of associated symptoms including high rates of patient-reported incontinence, voiding dysfunction, sexual dysfunction, pain, bowel dysfunction and depression. This multifocal nature combined with often insidious presentation and patient unawareness creates a uniquely challenging condition to treat.

Exercise and Executive Function during Follicular and Luteal Menstrual Cycle Phases.

PURPOSE: A single bout of aerobic or resistance exercise improves executive function. We sought to determine whether menstrual cycle variations in ovarian hormone concentrations differentially influence the expression and/or magnitude of a postexercise executive benefit. METHODS: Eumenorrheic female participants completed 20-min single bouts of aerobic exercise (via cycle ergometer) at a moderate intensity (i.e., 80% of estimated lactate threshold) during the early follicular and midluteal phases of their menstrual cycle. Pre- and postexercise executive function was examined via antisaccades-an executive task requiring a saccade mirror-symmetrical to a visual stimulus. Antisaccades are an ideal tool for examining postexercise executive changes because the task is mediated via the same frontoparietal networks as modified following single-bout and chronic exercise. RESULTS: Antisaccade reaction times decreased from the pre- to postexercise assessments by an average of 22 ms (P = 0.003), and this benefit was independent of changes in directional errors or end point accuracy (P's > 0.26). In other words, participants did not decrease their postexercise reaction times at the cost of increased planning times or execution errors. Most notably, the postexercise antisaccade benefit did not vary in magnitude across follicular or luteal phases (P = 0.33) and a two one-sided test statistic (i.e., equivalence testing) provided support for the null hypothesis (P = 0.008). CONCLUSIONS: A postexercise executive benefit is independent of hormonal variations in the menstrual cycle. Further, our results evince that the phase of a female participant's menstrual cycle should not be a limiting factor in determining their inclusion in exercise neuroscience research.

Pain Assessment for Nursing Home Residents: A Systematic Review Protocol.

BACKGROUND: The burden of pain in nursing homes is substantial; however, pain assessment for both acute and chronic conditions remains inadequate, resulting in inappropriate or inadequate treatment. Complexities in assessing resident pain have been attributed to factors (barriers and facilitators) arising at the resident, healthcare provider, and healthcare system levels. OBJECTIVES: In this systematic review protocol, we identify our research approach that will be used to critically appraise and synthesize data in order to assess barriers and facilitators to pain assessment in nursing home residents aged ≥65 years. METHODS: This is a Cochrane style systematic review protocol adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols reporting standards. This review will include primary (original) qualitative literature concerning either barriers or facilitators to pain assessment in older adult nursing home residents. A thematic analysis approach will be employed in collating and summarizing included data and will be categorized into resident, healthcare provider, and system-level factors. Database searches will include Abstracts in Social Gerontology, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and Web of Science. DISCUSSION: The identification of barriers and facilitators to pain assessment in older adult nursing home residents may assist healthcare providers across all platforms and levels of education to improve pain assessment among nursing home residents. Improving the assessment of pain has the potential to improve quality of care and ultimately quality of life for older adult nursing home residents.

Factors Associated With Pain Assessment for Nursing Home Residents: A Systematic Review and Meta-Synthesis.

OBJECTIVES: The burden of pain in nursing home residents is substantial; unfortunately, many times it goes undiagnosed and is inadequately treated. To improve identification of pain in this population, we aimed to review and synthesize findings from qualitative studies that report primary barriers and facilitators to pain assessment in nursing home residents. DESIGN: This is a Cochrane-style systematic review and narrative synthesis of qualitative evidence adhering to PRISMA guidelines. Databases were searched from inception to June 2018, supplemented by hand searching of references. We assessed the quality of included studies using the Critical Appraisal Skills Program Quality Appraisal Checklist. SETTING AND PARTICIPANTS: We included studies conducted in nursing homes. Studies focused on nursing home residents, nursing home staff, or both. MEASURES: Extracted data were subject to thematic analyses and were collated and summarized into 3 groups: resident, health care provider, and health care system factors. RESULTS: Thirty-one studies met our inclusion criteria. Resident factors had 3 subthemes: physical or cognitive impairments, attitudes and beliefs, and social/cultural/demographic characteristics. Health care provider factors had 3 subthemes: knowledge and skills, attitudes and beliefs, and social/cultural/demographic characteristics. Health care system-level factors had 3 subthemes: interpersonal factors, resources, and policy. Key barriers to pain assessment included the presence of resident cognitive impairment, health care providers' lack of knowledge, and the breakdown of communication across organizational hierarchies. Key facilitators to pain assessment included the identification of pain-related behaviors in residents, the experience and skills of health care providers, and establishing facility-level pain assessment protocols and guidelines. CONCLUSION AND IMPLICATIONS: Findings from this review identify primary barriers and facilitators to pain assessment in nursing home residents, highlighting key considerations for stakeholders, including health care providers, and health care policy decision makers. These efforts have the potential to improve the identification of pain in residents, and may ultimately improve pain management and residents' quality of life.