Nonclinical Barriers to Care for Neurogenic Patients Undergoing Complex Urologic Reconstruction

Understanding the prevalence and distribution of fellowship trained female and male genitourinary reconstruction and men's health/andrology academic faculty in the United States

Background

We evaluated the prevalence, distribution, and specialist to population ratio of male and female reconstruction and andrology/prosthetics faculty within United States urologic training programs. Our objective was to help determine the current need/demand for reconstructive fellowship trained faculty for necessary clinical exposure during residency in the midst of a nationwide residency expansion.

Methods

All non-military urology residency programs were evaluated. Programs were sorted into their American Urologic Association Sections and websites were analyzed for evidence of fellowship training and/or clinical expertise/interest: (I) male genitourinary reconstruction (MGR); (II) female genitourinary reconstruction (FGR) and (III) infertility/andrology/men's health (AMH). The 2020 US Census data was used to determine specialist to population ratios by sections.

Results

Of 137 evaluated programs, FGR had the highest percentage of fellowship-trained faculty (76%) followed by AMH (66%) and MGR (61%). Clinical/surgical interest was noted in pelvic organ prolapse (88%), inflatable penile prosthesis (79%) and urethral stricture disease (75%). Over 10% of training programs had two or more faculty with MGR, FGR and AMH fellowship training. Significant geographic variation amongst academic programs exists with the South and Southeastern parts of the US being relatively underserved, both in percentage of programs with fellowship-trained faculty, and by faculty per 1,000,000 inhabitants.

Conclusions

The majority of US urology residencies have faculty with fellowship training and/or stated clinical interest in MGR, FGR and AMH. Still, many programs remain without these faculty while others have two or more in their respective fields. The geographic trends noted here have both educational and recruitment significance.

Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden

OBJECTIVE

To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood.

METHODS

The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden.

RESULTS

The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects).

CONCLUSION

NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.

Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review

Introduction

Health literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings.

Methods

PubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.

Results

Five studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs).

Conclusion

This review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.