Neuromuscular Paralysis is not a Barrier to Same Day Catheter Removal After HoLEP.

OBJECTIVE: To determine if same day catheter removal is feasible in a population of holmium laser enucleation of the prostate patients who received paralysis and if bladder pressure monitoring could predict successful catheter removal. METHODS: From February 2021 to February 2022, we evaluated same day catheter removal for patients undergoing holmium laser enucleation of the prostate. Criteria for proceeding with same day catheter removal included: an uncomplicated procedure, continuous bladder irrigation weaned within 120 minutes of arrival to PACU, minimal postoperative hematuria and a bladder pressure over 30 cmH20 as measured using the VP Test device (SRS Medical). RESULTS: One hundred and eight patients were enrolled, with a median age of 68 years (IQR: 62.0-73.0) and prostate volume 80.8cc (IQR: 64.8-112.3). Criteria for catheter removal was met by 83/108 (76.9%) patients. Of those that attempted a trial of void, 69/83 passed for an effective pass rate of 83.1%. Median maximum detrusor pressure for those that passed and failed were 51.0 cmH20 (IQR: 40.5 -68.0) and 48.0 cmH20 (IQR: 38.8-61.8) [P = .53], respectively. Intraoperative Lasix administration was associated with a higher rate of trial of void (TOV) success and preoperative PVR was associated with lower TOV success, with OR (95%CI) of 5.8 (1.4, 29.5) [P = .02] and 0.6 (0.4, 0.9) [P = .01], respectively. CONCLUSION: Same day catheter removal is feasible in those who receive neuromuscular paralysis, with a success rate >80%. Bladder pressure monitoring did not assist with differentiating which patients will pass or fail a trial of void. Intraoperative Lasix administration may be helpful in increasing success for same day catheter removal while elevated preoperative PVR was associated with TOV failure.

Analysis of Gender-Based Authorship Trends in Leading Pain-Medicine Journals Over 10 Years.

Authorship of peer-reviewed publications is important for academic rank, promotion, and national reputation. In pain medicine, limited information is available for authorship trends for women as compared with men. The objective of this study was to describe trends of female authorship data in the 5 pain journals with the highest impact factors over a 10-year period. We analyzed data for January, April, and October in 2009, 2014, and 2019. For each article, the following information was recorded: journal name, journal month, journal year, article title or article PMCID, total authors, total female authors, total male authors, total authors of unknown gender, presence or absence of a female first author, and presence or absence of a female last/senior author. Authorship for 924 articles was reviewed. When a man was senior author, women were first author on only 27.9% of articles (P<.001). A woman was 2 times as likely (57.2%) to be first author when a woman was the senior author (P<.001), pointing to the potential impact of female senior authors. An article with 50% or more female authors was 76.4% more likely to have a female senior author (P<.001). The results demonstrate the influence of a senior female author on the likelihood of an article's having a female first author. When men were the senior authors, women were half as likely to be first authors. The total number of female authors changed very little between 2009 and 2019.

A Case of COVID-19 Vaccine Associated New Diagnosis Myasthenia Gravis.

An 82-year-old man presented with intermittent episodes of slurred speech during his evening meals after receiving the BNT162b2 COVID-19 vaccine. Thorough evaluation was conducted including lab work and EMG confirming a new diagnosis of late-onset myasthenia gravis. Despite treatment, the patient progressed rapidly to severe exacerbation requiring intubation and placement of a PEG tube. Infections provoking new diagnosis and exacerbations of myasthenia gravis have been reported. New diagnosis of myasthenia gravis associated with the COVID-19 vaccine is rarely reported. This case highlights the need for clinicians to be aware of the uncommon presenting symptoms in late-onset myasthenia gravis and the possibility of vaccine provoked diagnoses of immune mediated diseases.

Review of Published Curriculum on Sex Trafficking for Undergraduate Medical Trainees.

Educational councils and medical societies recommend that medical students learn to recognize and care for victims of sex trafficking. Previous research has found that healthcare providers are one of the few professionals to interact with sex trafficking victims during exploitation. This review evaluates currently published curricular and extracurricular U.S. medical education resources. A literature review of MEDLINE, PubMed, Embase, MedEdPORTAL, Google Scholar, and Google was conducted in December 2018 to January 2019 using the search terms: human trafficking OR sex traffic OR sex violence OR sex work OR sex exploitation OR child prostitution AND education, medical, undergraduate OR students, medical OR medical student or medical education OR education, medical. The inclusion criteria included informational educational materials for medical students on sex trafficking. Studies were excluded for: non-English language, empirical research on sex trafficking, nonhealth or nonundergraduate medical students, and resources focused on other sexual health topics. The database literature search uncovered 64 scholarly articles. Inclusion criteria were met by 4 articles; 2 articles were added from a reference review, and an additional 5 articles were found from an Internet search. These 11 resources provided educational materials relevant to medical students on sex trafficking themes, including scope, consequences, identification, treatment, referral, legal, security, and prevention. The curricula demonstrated a wide variability in delivery method, length, and scope. A limited published sex trafficking curriculum exists for medical student learners. Future research evaluating unpublished curricula within U.S. medical schools is necessary to coordinate efforts for standardized and robust sex trafficking education.