Jennifer A. Lyon

Sathianathen NJ, et al. World J Mens Health. 2022 Jan;40:e16. https://doi.org/10.5534/wjmh.210155

Objectives: To assess the effects of phosphodiesterase inhibitors ( PDEI ) compared to placebo and other standard of care drugs i.e alpha blockers ( AB ) and 5‐alpha reductase inhibitors (5‐ ARI ) in men with LUTS consistent with benign prostatic hyperplasia ( BPH ). Methods: We conducted a systematic search of the Cochrane Central Register of Controlled Trials ( CENTRAL ), MEDLINE , EMBASE , Web of Science, and clinical trials registries of the World Health Organization ( WHO ) and the National Institutes of Health ( NIH ) (updated 2 August 2018). Citation tracking and hand‐searching of abstracts and conference proceedings was done. We also attempted to contact the study authors in case additional information was needed. Randomised controlled trials ( RCT ) comparing PDEI versus placebo, AB , or 5‐ ARI used for at least four weeks in men with BPH ‐ LUTS were included. Three review authors independently screened the literature and extracted data. Primary outcomes were effects on urinary symptoms as assessed by the International Prostate Symptom Score ( IPSS ‐total; score ranging from 0 to 35, with higher values reflecting more symptoms), urinary bother as assessed by the Benign Prostatic Hyperplasia Impact Index ( BPHII ; score ranging from 0 to 13, with higher values reflecting more bother), and adverse events ( AE ). We used GRADE to rate the quality of evidence. We considered short‐term (up to 12 weeks) and long‐term (12 weeks or longer) results separately. Results: We included a total of 16 randomised trials in this review. Primary outcomes: PDEI versus placebo: PDEI may result in a small improvement in IPSS ‐total score (mean difference ( MD ) 1.89 lower, 95% confidence interval ( CI ) 2.27 lower to 1.50 lower; n = 4293; low‐quality evidence) compared to placebo, and may reduce the BPHII score slightly ( MD 0.52 lower, 95% CI 0.71 lower to 0.33 lower; n = 3646; low‐quality evidence). Rates of AE s may be increased (risk ratio ( RR ) 1.42, 95% CI 1.21 to 1.67; n = 4386; low‐quality evidence). This corresponds to 95 more AE s per 1000 participants (95% CI 47 more to 151 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI versus AB : PDEI and AB probably provide similar improvement in IPSS ‐total score ( MD 0.22 higher, 95% CI 0.49 lower to 0.93 higher; n = 933; moderate‐quality evidence) and may have a similar effect on BPHII score ( MD 0.03 higher, 95% CI 1.10 lower to 1.16 higher; n = 550; low‐quality evidence) and AE ( RR 1.35, 95% CI 0.80 to 2.30; n = 936; low‐quality evidence). This corresponds to 71 more AE s per 1000 participants (95% CI 41 fewer to 264 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI and AB versus AB : The combination of PDEI and AB may provide a small improvement in IPSS ‐total score ( MD 2.56 lower, 95% CI 3.92 lower to 1.19 lower; n = 193; low‐quality evidence) compared to AB alone. We found no evidence for BPHII scores. AE may be increased ( RR 2.81, 95% CI 1.53 to 5.17; n = 194; moderate‐quality evidence). This corresponds to 235 more AE per 1000 participants (95% CI 69 more to 542 more per 1000). Study results were limited to treatment duration of four to 12 weeks. PDEI and AB versus PDEI alone: The combination of PDEI and AB may provide a small improvement in IPSS ‐total ( MD 2.4 lower, 95% CI 6.47 lower to 1.67 higher; n = 40; low‐quality evidence) compared to PDEI alone. We found no data on BPHII or AE . Study results were limited to a treatment duration of four weeks. PDEI and 5‐ ARI versus 5‐ ARI alone: in the short term (up to 12 weeks), the combination of PDEI and 5‐ ARI probably results in a small improvement in IPSS ‐total score ( MD 1.40 lower, 95% CI 2.24 lower to 0.56 lower; n = 695; moderate‐quality evidence) compared to 5‐ ARI alone. We found no evidence on BPHII scores or AE . In the long term (13 to 26 weeks), the combination of PDEI and 5‐ ARI likely results in a small reduction in IPSS ‐total score ( MD 1.00 less, 95% CI 1.83 lower to 0.17 lower; n = 695; moderate‐quality evidence). We found no evidence about effects on BPHII scores. There may be no difference in rates of AE ( RR 1.07, 95% CI 0.84 to 1.36; n = 695; low‐quality evidence). This corresponds to 19 more AE per 1000 participants (95% CI 43 fewer to 98 more per 1000). We found no trials comparing other combinations of treatments or comparing different PDEI for BPH ‐ LUTS . Conclusions: Compared to placebo, PDEI likely leads to a small reduction in IPSS ‐total and BPHII sores, with a possible increase in AE . There may be no differences between PDEI and AB with regards to improvement in IPSS ‐total, BPHII , and incidence of AE . There appears to be no added benefit of PDEI combined with AB compared to PDEI or AB or PDEI combined with 5‐ ARI compared to ARI with regards to urinary symptoms. Most evidence was limited to short‐term treatment up to 12 weeks and of moderate or low certainty.

Background Benign prostatic hyperplasia (BPH) refers to non‐malignant enlargement of the prostate gland that may cause bothersome lower urinary tract symptoms (LUTS). Alpha‐blockers (ABs) and 5‐alpha reductase inhibitors (5‐ARIs) are the mainstay of medical treatment. Recently, phosphodiesterase inhibitors (PDEIs) that so far have been used mainly to treat erectile dysfunction were introduced to treat male LUTS. Objectives To assess the effects of PDEIs compared to placebo and other standard of care drugs (ABs and 5‐ARIs) in men with LUTS consistent with BPH. Search methods We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and clinical trials registries of the World Health Organization (WHO) and the National Institutes of Health (NIH) (updated 2 August 2018). We performed citation tracking and handsearching of abstracts and conference proceedings. We also contacted study authors to ask for additional information. Selection criteria We considered for inclusion in this systematic review randomised controlled trials (RCTs) comparing PDEIs versus placebo, ABs, or 5‐ARIs for at least four weeks in men with BPH‐LUTS. Data collection and analysis Three review authors independently screened the literature and extracted data. Primary outcomes were effects on urinary symptoms as assessed by the International Prostate Symptom Score (IPSS‐total; score ranging from 0 to 35, with higher values reflecting more symptoms), urinary bother as assessed by the Benign Prostatic Hyperplasia Impact Index (BPHII; score ranging from 0 to 13, with higher values reflecting more bother), and adverse events (AEs). We used GRADE to rate the quality of evidence. We considered short‐term (up to 12 weeks) and long‐term (12 weeks or longer) results separately. Main results We included a total of 16 randomised trials in this review. The results for primary outcomes are as follows. PDEI versus placebo: PDEIs may result in a small improvement in IPSS‐total score (mean difference (MD) 1.89 lower, 95% confidence interval (CI) 2.27 lower to 1.50 lower; n = 4293; low‐quality evidence) compared to placebo, and may reduce the BPHII score slightly (MD 0.52 lower, 95% CI 0.71 lower to 0.33 lower; n = 3646; low‐quality evidence). Rates of AEs may be increased (risk ratio (RR) 1.42, 95% CI 1.21 to 1.67; n = 4386; low‐quality evidence). This corresponds to 95 more AEs per 1000 participants (95% CI 47 more to 151 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI versus AB: PDEIs and ABs probably provide similar improvement in IPSS‐total score (MD 0.22 higher, 95% CI 0.49 lower to 0.93 higher; n = 933; moderate‐quality evidence) and may have a similar effect on BPHII score (MD 0.03 higher, 95% CI 1.10 lower to 1.16 higher; n = 550; low‐quality evidence) and AEs (RR 1.35, 95% CI 0.80 to 2.30; n = 936; low‐quality evidence). This corresponds to 71 more AEs per 1000 participants (95% CI 41 fewer to 264 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI and AB versus AB alone: the combination of PDEI and AB may provide a small improvement in IPSS‐total score (MD 2.56 lower, 95% CI 3.92 lower to 1.19 lower; n = 193; low‐quality evidence) compared to AB alone. We found no evidence for BPHII scores. AEs may be increased (RR 2.81, 95% CI 1.53 to 5.17; n = 194; moderate‐quality evidence). This corresponds to 235 more AEs per 1000 participants (95% CI 69 more to 542 more per 1000). Study results were limited to treatment duration of four to 12 weeks. PDEI and AB versus PDEI alone: the combination of PDEI and AB may provide a small improvement in IPSS‐total (MD 2.4 lower, 95% CI 6.47 lower to 1.67 higher; n = 40; low‐quality evidence) compared to PDEI alone. We found no data on BPHII or AEs. Study results were limited to a treatment duration of four weeks. PDEI and 5‐ARI versus 5‐ARI alone: in the short term (up to 12 weeks), the combination of PDEI and 5‐ARI probably results in a small improvement in IPSS‐total score (MD 1.40 lower, 95% CI 2.24 lower to 0.56 lower; n = 695; moderate‐quality evidence) compared to 5‐ARI alone. We found no evidence on BPHII scores or AEs. In the long term (13 to 26 weeks), the combination of PDEI and 5‐ARI likely results in a small reduction in IPSS‐total score (MD 1.00 less, 95% CI 1.83 lower to 0.17 lower; n = 695; moderate‐quality evidence). We found no evidence about effects on BPHII scores. There may be no difference in rates of AEs (RR 1.07, 95% CI 0.84 to 1.36; n = 695; low‐quality evidence). This corresponds to 19 more AEs per 1000 participants (95% CI 43 fewer to 98 more per 1000). We found no trials comparing other combinations of treatments or comparing different PDEI agents. Authors' conclusions Compared to placebo, PDEI likely leads to a small reduction in IPSS‐total and BPHII sores, with a possible increase in AEs. There may be no differences between PDEI and AB with regards to improvement in IPSS‐total, BPHII, and incidence of AEs. There appears to be no added benefit of PDEI combined with AB compared to PDEI or AB alone or PDEI combined with 5‐ARI compared to ARI alone with regards to urinary symptoms. Most evidence was limited to short‐term treatment up to 12 weeks and of moderate or low certainty.

Laparoscopic surgical procedures (LSP) have grown in popularity due to their purported benefits of improved effectiveness and efficiency. This study summarizes the Cochrane systematic reviews’ (CSRs’) evidence comparing the use of LSP versus open procedures used for surgical patient management and comparing the CSRs’ quality and consistency of LSP evidence reported across time and different surgical specialties.

Limited health literacy is a common but often unrecognized problem associated with poor health outcomes. Well-validated screening tools are available to identify and provide the opportunity to intervene for at-risk patients in a resource-efficient manner. This is a multimethod study describing the implementation of a hospital-wide routine health literacy assessment at an academic medical center initiated by nurses in April 2014 and applied to all adult inpatients. Results were documented in the electronic health record, which then generated care plans and alerts for patients who screened positive. A nursing survey showed good ease of use and adequate patient acceptance of the screening process. Six months after hospital-wide implementation, retrospective chart abstraction of 1,455 patients showed that 84% were screened. We conclude that a routine health literacy assessment can be feasibly and successfully implemented into the nursing workflow and electronic health record of a major academic medical center.

This cross-sectional survey focused on faculty use and knowledge of author identifiers and researcher networking systems, and professional use of social media, at a large state university. Results from 296 completed faculty surveys representing all disciplines (9.3% response rate) show low levels of awareness and variable resource preferences. The most utilized author identifier was ORCID while ResearchGate, LinkedIn, and Google Scholar were the top profiling systems. Faculty also reported some professional use of social media platforms. The survey data will be utilized to improve library services and develop intra-institutional collaborations in scholarly communication, research networking, and research impact.

This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics.