Multiple sclerosis and sexual dysfunction: A need for further education and interdisciplinary care.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune condition affecting young women and men, resulting in varied disabilities, including sexual dysfunction. OBJECTIVE: This narrative review aims to describe the prevalence, pathophysiology, and impact of sexual dysfunction in people with MS (PwMS); provide a review of current assessment and treatment strategies; and offer considerations for future care. METHODS: Literature review was performed to identify primary and secondary sources discussing sexual dysfunction in PwMS. RESULTS: Sexual dysfunction is common in PwMS and can occur throughout the disease course. Sexual dysfunction is associated with depression, reduced quality of life, and may have broader implications related to relationships, fertility, pregnancy, and parenting. The etiology is often multifactorial and can be classified as primary, secondary, or tertiary dysfunction. Sexual dysfunction in PwMS is underdiagnosed and undertreated; however, many healthcare providers may already have the skills required to care for PwMS with sexual dysfunction. CONCLUSIONS: Additional education for providers regarding the approach to assessment and management of sexual dysfunction, their potential role in treatment, and available specialized resources is needed. The role of interdisciplinary care with collaboration among providers should be considered. Further research should evaluate the impact of specific assessment tools and treatments on sexual dysfunction in PwMS.

Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two US national samples.

BACKGROUND: The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ≥4 points for men and ≥3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to "gold standard" measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening--positive or negative based on AUDIT-C scores--can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. METHODS: This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results--positive or negative screens based on the AUDIT-C score--that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. RESULTS: Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. LIMITATIONS: This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. CONCLUSIONS: Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C.

Multicenter survey of emergency physician management and referral for hyperglycemia.

BACKGROUND: The Emergency Department (ED), with its high-risk and often disenfranchised patient population, presents a novel opportunity to identify patients as having undiagnosed or uncontrolled diabetes. OBJECTIVE: To evaluate Emergency Physician opinion on management and referral for incidental hyperglycemia and on ED-based diabetes screening. METHODS: We conducted a web-based survey of all attending and resident Emergency Physicians at three academic EDs. We asked for glucose thresholds to treat and refer non-diabetic and diabetic ED patients for hyperglycemia, comparing physicians' ideal and actual practices. We also inquired about interest in and barriers for active ED-based diabetes screening compared to use of blood glucose values obtained during usual ED care. RESULTS: We contacted 185 physicians, and 152 (85%) completed the survey; 75% of respondents reported routine outpatient referral of non-diabetic patients for random glucose values >or= 200 mg/dL. However, a majority (71%) believed that they should use a lower threshold to refer than they currently use. Nearly all (92%) agreed that Emergency Physicians should inform non-diabetic patients of elevated glucose values; 53% supported and 21% opposed active ED-based screening of asymptomatic patients. The most commonly cited barriers were limited follow-up (69%), insufficient time/resources (51%), and outside scope of practice (36%). CONCLUSION: Emergency Physicians support improved recognition of and referral for hyperglycemia, based on glucose values collected during usual ED care. We plan to develop tools to interpret random ED glucose values in the context of undiagnosed and uncontrolled diabetes.

A brief educational intervention may increase public acceptance of emergency research without consent.

OBJECTIVES: We hypothesized that knowing the regulations regarding emergency research without consent would increase public support for this type of research. METHODS: Randomized controlled trial. Consecutive patients presenting during eight 24-h periods received one of two interviews; the intervention interview included an educational paragraph. RESULTS: There were 473 (74% of eligible) patients who participated: 51% (95% confidence interval [CI] 46-55) were willing to be enrolled in a study using exception to informed consent; 84% (95% CI 80-87) believed that current therapy for cardiac arrest offers ≥ 50% chance of full recovery, and these patients were less willing to enroll (odds ratio [OR] 0.5, 95% CI 0.3-0.9). The educational intervention increased willingness to enroll (OR 1.3, 95% CI 1.0-1.6, p = 0.03). CONCLUSIONS: A brief educational intervention had only a modest effect on willingness to participate in emergency research without consent. It may be more important to educate patients on the shortcomings of current therapy than on the ethical and regulatory justifications for such research.

Estimated risk for undiagnosed diabetes in the emergency department: a multicenter survey.

BACKGROUND: One third of the 21 million Americans with diabetes remain undiagnosed. The emergency department (ED) is a novel setting for diabetes screening. OBJECTIVES: To estimate risk factors for undiagnosed diabetes in the ED. METHODS: This was a cross sectional survey in five Boston EDs. The authors enrolled consecutive adults without known diabetes over two 24-hour periods at each site. The focus was on diabetes risk factors and estimated risk for diabetes on the basis of American Diabetes Association (ADA) criteria. The authors also examined prior diabetes testing and willingness to participate in ED-based diabetes screening. RESULTS: Six hundred four patients (70% of eligible) were enrolled. On the basis of ADA risk score, 33% (95% confidence interval [CI] = 29% to 37%) were high risk for undiagnosed diabetes, and an additional 42% (95% CI = 38% to 46%) had elevated risk. For example, 58% (95% CI = 54% to 62%) of participants were overweight or obese (body mass index of > or = 25). Among these at-risk participants without prior diabetes testing, 73% (95% CI = 66% to 80%) reported amenability to having additional blood drawn for ED diabetes screening, and 98% (95% CI = 96% to 100%) indicated that they would follow up for confirmation of abnormal screening. CONCLUSIONS: Many ED patients in the study had risk factors for undiagnosed diabetes. Patient attitudes toward ED-based diabetes screening support further exploration of this important and currently underutilized opportunity for public health intervention.