Adopting Telehealth During The COVID-19 Era: The Urologist's Perspective.

OBJECTIVE: To evaluate the urology providers' (through a range of training levels) experience utilizing telemedicine given the rapid nationwide implementation of telemedicine in urology practices due to COVID-19. Several studies focusing on the patient's perspective have illustrated that telemedicine is comparable to traditional office visits in terms of cost, communication, and overall satisfaction. However, there is sparse data on the provider's experience. METHODS: With IRB approval, we assessed provider satisfaction with telemedicine at Urology programs in the U.S. through an electronic survey. The 25-question survey was based on the Patient Assessment of Communication of Telehealth which is a validated 33 question instrument that has been utilized to assess the quality of patient-provider communication in telemedicine. Experience with telemedicine was assessed in 2 categories: technical aspects and communication with patients. Variables were rated using a 5-point Likert Scale. RESULTS: There were 144 responses to the survey. 50% of providers reported not receiving any formal training in using telemedicine. This differed significantly by training level with 55% of attendings having had received training vs 20% of residents. Providers felt they would most benefit from training in billing (52%) rather than equipment use (33%) or communication (28%). 87% of providers felt comfortable discussing sensitive topics while only 55% felt comfortable using telehealth to schedule surgery (P < .001). CONCLUSION: Urology providers are generally satisfied with their experience communicating with patients via telemedicine and the majority would opt to continue utilizing telemedicine. Nevertheless, many providers are hesitant to schedule surgery via telemedicine. Providers would benefit from formal training in telemedicine.

Persistent Dysuria in a Young Male.

A Cowper's Duct syringocele is a rare diagnosis and currently there exists no clinical guidelines for evaluation and management. This clinical challenge illustrates the case presentation, evaluation, diagnosis, and treatment options for of a newly diagnosed Cowper's Duct syringocele.

Analyzing Spatial Learning and Prosocial Behavior in Mice Using the Barnes Maze and Damsel-in-Distress Paradigms.

The Barnes maze is a reliable measure of spatial learning and memory that does not require food restriction or exposure to extremely stressful stimuli. The Barnes maze can also assess other mouse behaviors, such as general motivation to escape from the maze platform and exploratory behavior. The Barnes maze can measure whether a genetic mutation or environmental variable can impact the acquisition and retention of spatial memories, as well as provide information about the search strategy employed by the mice. Here we use the Barnes maze to detect a memory deficit in adult mice following a single developmental ethanol exposure event. The newly described Damsel-in-Distress paradigm exposes a male mouse to a female mouse trapped in a chamber in the open center field of the arena. It provides an opportunity for the mouse to socially respond to the trapped female and exhibit prosocial behavior. The Damsel-in-Distress paradigm can also be used to examine mouse behavior in a novel arena and measure locomotor activity. Both the Barnes Maze and the Damsel-in-Distress protocols require minimal financial investment and most aspects of the tests can be constructed from common lab supplies. These flexible and accessible tools can also be used to detect behavioral changes over the course of development.

Acute ethanol exposure during late mouse neurodevelopment results in long-term deficits in memory retrieval, but not in social responsiveness.

OBJECTIVE: Prenatal alcohol exposure can result in neurological changes in affected individuals and may result in the emergence of a broad spectrum of neurobehavioral abnormalities termed fetal alcohol spectrum disorders (FASD). The effects of ethanol exposure during development are both time and dose dependent. Although many animal models of FASD use more chronic ethanol exposure, acute developmental alcohol exposure may also cause long-lasting neuronal changes. Our research employed behavioral measures to assess the effects of a single early postnatal ethanol intoxication event in mice. MATERIALS AND METHODS: Mice were dosed at postnatal day 6 (a 2.5 g/kg dose of ethanol or a saline control administered twice, 2 hr apart) as a model of third trimester binge drinking in humans. This exposure was followed by behavioral assessment in male mice at 1 month (1M) and at 4 months of age (4M), using the Barnes maze (for learning/memory retrieval), exploratory behavior, and a social responsiveness task. RESULTS: Ethanol-exposed mice appeared to be less motivated to complete the Barnes maze at 1M, but were able to successfully learn the maze. However, deficits in long-term spatial memory retrieval were observed in ethanol-exposed mice when the Barnes maze recall was measured at 4M. No significant differences were found in open field behavior or social responsiveness at 1M or 4M of age. CONCLUSIONS: Acute ethanol exposure at P6 in mice leads to mild but long-lasting deficits in long-term spatial memory. Results suggest that even brief acute exposure to high ethanol levels during the third trimester equivalent of human pregnancy may have a permanent negative impact on the neurological functioning of the offspring.

Implementation of a Phase I Caregiver Visitation Program for a Specialized Pediatric Population.

Phase I caregiver visitation practice has been endorsed and encouraged by the American Society of PeriAnesthesia Nurses, yet implementation has not been widespread. Literature has described benefits of visitation for patients and their caregivers. This article reports on a Phase I caregiver visitation program at a specialty care hospital. The steps of implementation and guidelines for both the health care team and the patient's caregivers are outlined. Visitation is recognized as promoting patient safety during Phase I recovery. A discussion of additional benefits and obstacles is addressed.

Advanced practice registered nurse certification.

Advanced practice registered nurses (APRNs) in nephrology began to be certified through the Nephrology Nursing Certification Commission (NNCC) in 2006. Since that time, the APRN Consensus Model has been developed, which addresses licensure, accreditation, certification, and education and which strongly recommends specialty certification for advanced practice nurses. This article discusses NNCC certification for advanced practice in nephrology nursing and describes the major components of the APRN Consensus Model.

Innovative use of perianesthesia nurses in imaging services: meeting the needs of children with disabilities.

A new imaging center was established within a children's specialty hospital that provides services for children and adults with childhood-onset disabilities. New services in this advanced imaging center include computed tomography, magnetic resonance imaging, fluoroscopy, and ultrasound. Individuals with disabilities are particularly at risk for complications during procedures requiring sedation and anesthesia. The perianesthesia nurses' role was developed to support the sedation needs of this population during imaging services. Perianesthesia nurses developed an advanced imaging screening process to prepare patients for sedation during imaging services. With these processes, the new Advanced Imaging Center is providing timelier and better coordinated imaging services.

Hemodialysis vascular access: upper extremity graft versus anterior chest wall graft.

The primary goal of this study was to compare two types of grafts used for vascular access in patients on chronic hemodialysis. The population of interest includes patients on chronic hemodialysis who have had both an upper extremity arteriovenous graft and an anterior chest wall arteriovenous graft (n = 23). In addition to comparing the time to first intervention, the primary and secondary patency rates of the two types of grafts were evaluated. Medical record review was used to gather information related to the placement of the vascular access. The correlated t-test was utilized to analyze the data. Although the trend towards longer time to first intervention with the chest wall grafts was demonstrated numerically, significance was not reached statistically. However, analysis of the secondary findings revealed that both the primary and secondary patency rates were longer in the anterior chest wall graft group. The chi square test was used to analyze the patency rates and statistical significance was reached for secondary patency rate at 3 months with chi2 (1) = 10.1, p < .01. The findings of this study are promising in regards to the patency rates of the anterior chest wall grafts. Future research should include an expanded study of both primary and secondary patency rates in the chest wall graft looking at their patency at 6, 12, and 18 months. Because of the aging population on hemodialysis and the higher acuity of these patients, alternate vascular access sites are going to be a priority.