Familiarity Trends of Successful Urology Residency Match Applicants.

INTRODUCTION: We sought to determine if training program "familiarity" played a role in the successful match of urological surgery residents. METHODS: We analyzed information from successful urology match participants in the United States between 2015 and 2020. Data were collected from the Association of American Medical Colleges applications, UrologyMatch.com and SurveyMonkey®. Information recorded included each candidate's name, hometown, undergraduate institution, graduate or research program (if applicable), medical school, location of visiting subinternships in urological surgery and urology residency training program. RESULTS: Overall, 1,080 of 1,451 successful urology match candidates (74.4%) met 1 or more "familiarity" criteria. Specifically, 329 (22.7%) and 508 (35.0%) students successfully matched into their home and visiting urology training programs, respectively. Of the remaining applicants 153 (10.5%) and 90 (6.2%) matched into training programs <150 miles from their hometowns and within institutions of previous academic pursuits, respectively. South Central section programs were most likely to match students into their home programs (p=0.010). Visiting students were most and least likely to match at programs from Western (p=0.044) and Northeastern (p=0.001) sections, respectively. The New York section matched more candidates from hometowns within 150 miles compared to other sections of the American Urological Association (p=0.0003). CONCLUSIONS: Student and program "familiarity" may play a role in residency match success. Our study demonstrated nearly 75% of urology applicants matched into either their home institutions, visiting subinternship programs, sites of previous undergraduate/graduate studies or training programs <150 miles from their hometowns.

Childhood adversity, mental health and suicide (CHASE): a methods protocol for a longitudinal case-control linked data study.

INTRODUCTION: Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness.Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. METHODS: This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother's linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. RESULTS: ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. 'Clinical Classifications Software' ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. CONCLUSION: There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. KEY WORDS: Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol.

Exploring the psychology of suicidal ideation: A theory driven network analysis.

Two leading theories within the field of suicide prevention are the interpersonal psychological theory of suicidal behaviour (IPT) and the integrated motivational-volitional (IMV) model. The IPT posits that suicidal thoughts emerge from high levels of perceived burdensomeness and thwarted belongingness. The IMV model is a multivariate framework that conceptualizes defeat and entrapment as key drivers of suicide ideation. We applied network analysis to cross-sectional data collected as part of the Scottish Wellbeing Study, in which a nationally representative sample of 3508 young adults (18-34 years) completed a battery of psychological measures. Network analysis can help us to understand how the different theoretical components interact and how they relate to suicide ideation. Within a network that included only the core factors from both models, internal entrapment and perceived burdensomeness were most strongly related to suicide ideation. The core constructs defeat, external entrapment and thwarted belonginess were mainly related to other factors than suicide ideation. Within the network of all available psychological factors, 12 of the 20 factors were uniquely related to suicide ideation, with perceived burdensomeness, internal entrapment, depressive symptoms and history of suicide ideation explaining the most variance. None of the factors was isolated, and we identified four larger clusters: mental wellbeing, interpersonal needs, personality, and suicide-related factors. Overall, the results suggest that relationships between suicide ideation and psychological risk factors are complex, with some factors contributing direct risk, and others having indirect impact.

Correction to: The help for people with money, employment or housing problems (HOPE) intervention: pilot randomised trial with mixed methods feasibility research.

[This corrects the article DOI: 10.1186/s40814-018-0365-6.].

The help for people with money, employment or housing problems (HOPE) intervention: pilot randomised trial with mixed methods feasibility research.

BACKGROUND: Job loss, austerity measures, financial difficulties and house repossession contribute to the risk of self-harm and suicide during recessions. Navigating the benefits system and accessing sources of welfare and debt advice is a difficult experience for vulnerable people, further contributing to their distress. Whilst there is some evidence that advice-type interventions can lead to financial gain, there is mixed evidence for their effectiveness in improving mental health in those experiencing financial difficulties. There have been no interventions targeting those who have self-harmed due to economic hardship. METHODS: Our aim was to determine the feasibility and acceptability of a brief psychosocial intervention (the 'HOPE' service) for people presenting to hospital emergency departments (ED) following self-harm or in acute distress because of financial, employment or welfare (benefit) difficulties. Nineteen people consented to random allocation to the intervention or control arm on a 2:1 basis. Participants randomised to the intervention arm (n = 13) received up to six sessions of 1:1 support provided by community support staff trained in Motivational Interviewing (MI). Control participants (n = 6) received a one-off session signposting them to relevant support organisations. Fourteen participants were followed up after 3 months. Participants and mental health workers took part in qualitative interviews. The acceptability of outcome measures including the PHQ-9, GAD-7, repeat self-harm, EQ5D-5 L and questions about debt, employment and welfare benefits were explored. RESULTS: Interviews indicated the main benefits of the service as the resolution of specific financial problems and receiving support when participants were feeling most vulnerable. Randomisation was acceptable to most participants although not always fully understood and control participants could be disappointed. Recruitment was slow (1-2 per month). The outcome measures were acceptable and appeared sensitive to change. DISCUSSION: The HOPE intervention is feasible and acceptable. There was evidence of need and it is a relatively inexpensive intervention. Refining aspects of the intervention would be straightforward. A full-scale RCT would be feasible, if broadened eligibility criteria led to increased recruitment and improvements were made to staff training and support. TRIAL REGISTRATION: ISRCTN58531248.

The Impact of Age and Deprivation on NHS Payment Claims for Domiciliary Dental Care in England.

Domiciliary dental care provides care to patients who are unable to attend dental clinics for a variety of reasons. OBJECTIVE: This research analyses NHS payment claim data for domiciliary dental care in England to identify any variations by area and determine whether age or deprivation are associated with levels of domiciliary care provided. METHODS: Publicly available data from the NHS Business Services Authority and demographic data from additional public datasets were linked to assess the variation in claims made for NHS domiciliary activity across England. Associations with factors such as the proportion of older people and deprivation were investigated using correlation, univariable and multivariable regression models. RESULTS: There was substantial variation by area in the number of NHS payment claims made for domiciliary activity and a statistically significant but very weak positive correlation between the population of each area and the number of domiciliary payment claims made. Correlation, univariable and multivariable analyses demonstrated positive but weak associations between area deprivation measures and the number of claims per population. There was little evidence of an association between proportions of older adults and numbers of domiciliary claims per population. CONCLUSION: As older and more deprived populations are those most likely to require domiciliary dental care, these results suggest that access to services is variable and not always based upon need. This highlights a potential need to reconsider the criteria upon which this type of dental care is offered and the commissioning of these services in different localities.

HOPE: Help fOr People with money, employment, benefit or housing problems: study protocol for a randomised controlled trial.

BACKGROUND: Self-harm and suicide increase in times of economic recession. Factors including job loss, austerity measures, financial difficulties and house repossession contribute to the risk. Vulnerable individuals commonly experience difficulties in navigating the benefits system and in accessing the available sources of welfare and debt advice, and this contributes to their distress. Our aim is to determine the feasibility and acceptability of a brief psychosocial intervention (the "HOPE" service) for people presenting to hospital emergency departments (ED) following self-harm or in acute distress because of financial, employment, or welfare (benefit) difficulties. METHOD: A pilot study including randomisation will be employed to determine whether it is possible to undertake a full-scale trial. Twenty people presenting to the ED who have self-harmed, have suicidal thoughts and depression and/or are in crisis and where financial, employment or benefit problems are cited as contributory factors will be asked to consent to random allocation to the intervention or control arm on a 2:1 basis. People who require secondary mental health follow-up will be excluded. Those randomised to the intervention arm will receive up to six sessions with a mental health worker who will provide practical help with financial and other problems. The mental health worker will use the motivational interviewing method in their interactions with participants. Control participants will receive one session signposting them to existing relevant support organisations. Participants will be followed up after 3 months. Participants and the mental health workers will take part in qualitative interviews to enable refinement of the intervention. The acceptability of outcome measures including the PHQ-9, GAD-7, repeat self-harm, EQ5D-5L and questions about debt, employment and welfare benefits will be explored. DISCUSSION: This study will assess whether a full-scale randomised trial of this novel intervention to prevent self-harm among those distressed because of financial difficulties is feasible, including the acceptability of randomisation, potential rate of recruitment and the acceptability of outcome measures. TRIAL REGISTRATION: ISRCTN58531248.

Comparison of clinical outcomes between "ideal" and "nonideal" transobturator male sling patients for treatment of postprostatectomy incontinence.

OBJECTIVE: To review the clinical outcomes of "ideal" vs "nonideal" postprostatectomy stress urinary incontinence (PPI) patients who underwent male sling placement. METHODS: The medical records of 95 consecutive patients with PPI who underwent male sling insertion (AdVance male sling, American Medical Systems, Minnetonka, MN) were reviewed. Patients were divided into "ideal" vs "nonideal" cohorts. The ideal group consisted of patients with mild to moderate incontinence (<4 pads/day or <300 g daily pad weight), ability to volitionally contract the external urinary sphincter, no history of pelvic radiation or cryotherapy, no history of previous anti-incontinence surgical procedures, the ability to generate a volitional detrusor contraction when voiding, and a postvoid residual urine volume <100 mL. Patients in the nonideal group did not satisfy all these criteria. RESULTS: Significant reductions in daily pad usage and weight were noted in both cohorts. In the ideal patient group, 66 of 72 patients (92%) would undergo the procedure again. Conversely, only 7 of 23 nonideal men (30%) would undergo the procedure again. CONCLUSION: Preoperative patient selection can influence favorable outcomes after the treatment of PPI with AdVance male slings. Attention to ideal vs nonideal patient characteristics should be used when counseling men considering male sling surgery.

Intimate partner abuse and suicidality: a systematic review.

Research has demonstrated an association between intimate partner abuse and suicidality, presenting a serious mental health issue. However, studies have differed widely in the samples and methods employed, and in the depth of the investigation. Given the level of heterogeneity in the literature, this systematic review examines, for the first time, the nature of the relationship between intimate partner abuse and suicidality. The three main psychological and medical databases (PsychInfo 1887-March 2011; Medline, 1966-March 2011; Web of Knowledge 1981-March 2011) were searched. Thirty-seven papers on the topic of intimate partner abuse and suicidality were found. With only one exception, all of the studies found a strong and consistent association between intimate partner abuse and suicidality. Significantly, this relationship held irrespective of study design, sample and measurement of abuse and suicidality, thus demonstrating a consistently strong relationship between intimate partner abuse and suicidality. This review highlights that intimate partner abuse is a significant risk factor for suicidal thoughts and behaviours, which has important clinical implications.

Review of female stress urinary incontinence.

Stress urinary incontinence (SUI) is a common problem affecting up to 35% of the female population. SUI results from a laxity of the pelvic floor anatomy, neuromuscular injury of the external urinary sphincter mechanism or both. Evaluation of the condition includes careful history, physical examination and urine analysis. Additional tests such as urodynamic studies and cystoscopic inspection are determined on a case by case basis. Treatment options range from behavior modification to medications to surgery. We present a review of the incidence, pathophysiology, evaluation and medical/surgical treatment options for SUI.

Long-term results of suprapubic bladder neck closure for treatment of the devastated outlet.

OBJECTIVES: To assess the long-term success of suprapubic bladder neck closure in patients with irreparably damaged bladder outlets. METHODS: A cohort of 35 patients with intractable urinary incontinence secondary to severe posterior urethral/bladder neck damage underwent suprapubic bladder neck closure. Patients were assessed with regard to the success of procedure, as well as early and late complications. RESULTS: With a mean follow-up of 79 months (range 12 to 164), suprapubic bladder neck closure was successful in 29 (83%) of 35 patients. One revision of the bladder neck improved the success rate to 94% (33 of 35). Early and late complications, excluding bladder neck fistula, were reported in 3 (9%) and 5 (14%) of 35 patients, respectively. CONCLUSIONS: High success and acceptable complication rates can be achieved with suprapubic bladder neck closure for the treatment of severe urinary incontinence secondary to a devastated bladder outlet.

Long-term results of antegrade endoureterotomy using the holmium laser in patients with ureterointestinal strictures.

OBJECTIVES: To investigate the effectiveness and morbidity of percutaneous laser endoureterotomy in the management of ureterointestinal anastomotic strictures after radical cystectomy and urinary diversion. METHODS: Between May 1997 and August 2000, 19 percutaneous endoureterotomy incisions, including 3 repeated incisions, were performed on 15 patients with a mean age of 61 years (range 41 to 80) to treat ureterointestinal strictures. A total of 16 renal units were treated (9 left, 7 right), including one bilateral procedure. All procedures were performed using a 200-micrometer holmium laser fiber in antegrade fashion with a 7.5F flexible ureteroscope. A nephroureteral stent was left in place for 4 to 6 weeks postoperatively. Success was defined as radiologic improvement and/or the ability to return to full activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes. RESULTS: With a median follow-up of 20.5 months (range 9 to 41), the overall success rate was 57% (8 of 14 renal units). Two patients were lost to follow-up. The mean operative time was 91 minutes, and no perioperative complications occurred. Three patients required repeated endoureterotomies, with two requiring open reimplantation. Overall, the endoureterotomy failed in 6 patients in the series, with five of the six failures involving left-sided strictures. CONCLUSIONS: Percutaneous endoureterotomy is an effective, minimally invasive treatment option for patients with ureterointestinal strictures after urinary diversion. Better visualization and a more precise incision may make the holmium laser a safer cutting modality than alternative methods in patients with ureteroenteric strictures. Patients with left-sided ureterointestinal strictures should be cautioned that endourologic management might have a lower success rate.

Intravesical valrubicin in the treatment of carcinoma in situ of the bladder.

The propensity of patients with carcinoma in situ (CIS) of the bladder to progress to invasive and metastatic disease is clearly established. Today, the standard therapy in treating patients with CIS of the bladder is intravesical bacillus Calmette-Guerin (BCG). Nevertheless, patients who fail intravesical BCG have few viable options except to undergo a radical cystectomy. Valrubicin (N-trifluoroacetyladriamycin-14-valerate) is a new semisynthetic derivative of the anthracycline antibiotic doxorubicin that has been shown to benefit patients with BCG-refractory CIS of the bladder. Intravesical instillation of valrubicin is well-tolerated, safe and can be durable. Early non-randomised studies show promise and the current utilisation of this drug is limited to patients with BCG-refractory CIS of the bladder who are not good surgical candidates. Randomised studies of intravesical valrubicin for the treatment of superficial bladder cancer are ongoing.

Are occupational stress levels predictive of ambulatory blood pressure in British GPs? An exploratory study.

BACKGROUND: Occupational stress has been implicated as an independent risk factor in the aetiology of coronary heart disease and increased hypertensive risk in a number of occupations. Despite the large number of studies into GP stress, none have employed an objective physiological stress correlate. OBJECTIVES: We conducted an exploratory study to investigate whether self-reported occupational stress levels as measured by the General Practitioner Stress Index (GPSI) were predictive of ambulatory blood pressure (ABP) using a Spacelabs 90207 in a sample of British GPs. METHOD: Twenty-seven GPs (17 males, 10 females) participated in the study. Each GP wore an ABP monitor on a normal workday and non-workday. All GPs completed the GPSI before returning the ABP monitors. Demographic data were also collected. RESULTS: Stress associated with 'interpersonal and organizational change' emerged from the stepwise multiple regression analysis as the only significant predictor of ABP, explaining 21% of the variance in workday systolic blood pressure, 26% during the workday evening and 19% during the non-workday. For diastolic blood pressure, the same variable explained 29% of the variability during the workday and 17% during the non-workday. No significant gender differences were found on any of the ABP measures. CONCLUSIONS: For the first time in GP stress research, our findings established that higher levels of self-reported occupational stress are predictive of greater ABP in British GPs. More detailed psychophysiological research and stress management interventions are required to isolate the effects of occupational stress in British GPs.

Therapeutic options and treatment of muscle invasive bladder cancer.

Carcinoma of the bladder is the second most common genitourinary malignancy. Although several treatments exist, the gold standard therapy for muscle invasive bladder cancer (> or = stage T2) is cystectomy with urinary diversion. We review various surgical treatments for muscle invasive bladder cancer, focusing on the reported survival rates, complications, advantages and disadvantages of each therapeutic modality.

Management of entrapped ureteral stone baskets.

Entrapped stone baskets can occur and can lead to significant ureteral injury and long-term morbidity. We describe two patients in whom semirigid ureteroscopy was used to facilitate safe removal of impacted baskets from the ureter.

Hopelessness: The role of depression, future directed thinking and cognitive vulnerability.

Previous research has suggested that parasuicides are impaired in their ability to generate positive future experiences. This study aimed to look at the relationship between future experiences, cognitive vulnerability and hopelessness in parasuicides and matched hospital controls. Parasuicides ( N = 20) and matched hospital controls ( N = 20) were assessed the day following an episode of deliberate self-harm on measures of hopelessness, depression, anxiety, cognitive vulnerability and future directed thinking. The parasuicides differed from hospital controls on measures of depression, hopelessness and negative cognitive style in the predicted direction. Future positive thinking, depression and negative cognitive style explained 70.5% of the hopelessness variance. Future positive thinking was not correlated with either depression or negative cognitive style, whereas negative cognitive style was correlated with depression and hopelessness. Future directed thinking contributes to hopelessness independently of depression and does not seem to be associated with cognitive vulnerability.

A thematic analysis of suicide notes.

The analysis of suicide notes is an integral part of understanding suicidal behaviour. To this end, Leenaars (1996, 1992) has developed the Thematic Guide to Suicide Prediction (TGSP) for profiling the psychological correlates of suicide. The utility of this tool in suicide prevention, however, is not known. This study applied the TGSP to suicide notes (n = 45), interpreted in the light of coroner's inquest papers, drawn from a Northern Irish population. The results yielded support for the existence of psychological suicidal correlates. Moreover, qualitative differences between depressed and not depressed notewriters and those with and without a previous suicidal attempt were identified. For example, depressed suicides were more likely to communicate difficulties in developing attachments, or to exhibit cognitive constriction than nondepressed notewriters. Analysis of age differences was limited because of the paucity of suicide notes (in this sample, written by individuals aged 65 years or older). This research has further helped to identify psychological differences that should be beneficial in the prevention of suicide. Such differences should be integrated into existing risk assessment schedules. It is also argued that the analysis of suicide notes should form one strand in an integrated research framework.

Human performance with a seventeen-arm radial maze analog.

Results using radial mazes suggest rats may have a greater short-term memory (STM) capacity than the human "magical number seven." We examined spatial STM in humans using a radial maze analog drawn on paper. Subjects were instructed to lift, in "random" order, each of 17 cardboard flaps arranged radially around a center point. Fifteen undergraduate subjects, tested seven trials a day on 2 consecutive days, averaged 15.4 correct choices per trial. Thus, humans perform equally well on a 17-arm radial maze analog as rats do on a 17-arm radial maze, suggesting comparable spatial STM capacities, and perhaps homologous brain substrates for these tasks, in these two species.