Initial Experience and Clinical Assessment of the Karl Storz FLEX-XC1 Single-Use Flexible Ureteroscope.

INTRODUCTION: The Karl Storz FLEX-XC1 is a novel single-use flexible ureteroscope that uses the same videographics platform as its reusable digital counterpart. We evaluated the technical performance of the FLEX-XC1 in its initial clinical use. METHODS: We reviewed a series of consecutive ureteroscopy procedures performed by 2 endourologists using the FLEX-XC1 for indications for which we typically use a single-use device: total stone burden > 15 mm or > 10 mm in the lower pole, anticipated case duration > 60 minutes, bilateral procedure, or upper tract urothelial cancer procedures. We assessed device tip deflection, intraoperative mechanical failure, and clinical outcomes for each case. Surgeons rated visual clarity, image quality, and maneuverability on a 1 to 5 Likert scale. RESULTS: Of 29 procedures using FLEX-XC1, 27 (93%) were successfully completed. Preoperative upward deflection was < 270° in 6 (21%) cases, and downward deflection was < 270° in 9 (31%) cases. Three types of intraoperative malfunctions occurred: rotational twisting of deflectable tip (4 cases, 13%), device not advancing through distal ureter (1 case, 3%), and working channel not accommodating a 365-µm laser (1 case, 3%). Visual clarity, image quality, and maneuverability were rated as 5 "very good" or 4 "good" in 100%, 100%, and 97% of cases, respectively. No device-specific or general 30-day complications were observed. CONCLUSIONS: The FLEX-XC1 showed comparable image quality and maneuverability to reusable digital devices. We observed incomplete deflection in up to 31% of cases and mechanical failure in 2 cases. The FLEX-XC1 may be advantageous in prolonged cases where maintaining visual clarity is paramount.

"IAmSizeSexy": A health communication body image study.

OBJECTIVE: The aim of this study was to formatively evaluate a health communication campaign on body image targeting undergraduate female students. PARTICIPANTS: A total of 331 students at a large public Midwestern university participated in the study. METHODS: Researchers used central intercept procedures to recruit students from residence halls. After viewing the campaign materials, students completed an online survey assessing their message endorsement and level of eating disorder symptomology and provided open-ended comments. RESULTS: Students appreciated the message and thought it was effective, though students with greater body image concerns were less receptive to the message. Thematic analysis indicated students perceive body image to be a relevant issue, yet they want the university to provide more attention to, and information on, the topic. CONCLUSIONS: Overall, students understood the message and found it helpful. Nevertheless, students with body image issues responded less favorably, warranting the need for secondary and tertiary prevention.

Impact of Body Weight Perceptions and Electronic Bullying on Suicide-Related Risk Behaviors among Youth: Results from Youth Risk Behavior Surveillance System, 2015.

BACKGROUND: For youth between the ages of 10 and 24, suicide is the third leading cause of death, and results in approximately 4600 lives lost each year. Body weight status and bullying is associated with increase mental health disorders. METHODS: We analyzed data from the 2015 Youth Risk Behavior Survey, consisting of 15,506 students in grades 9-12. Logistic regression analysis was performed using STATA13 to estimate the independent association of perceived weight status and bullying experienced at school and electronically to suicidal behaviors measured as-considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt, after controlling for socio-demographics. RESULTS: Considered suicide and attempted suicide were significantly associated with very overweight, slightly overweight, very underweight, and slightly underweight weight perceptions. Made suicide plan was significantly associated with slightly and very overweight perceptions. Injurious suicide attempt was significantly associated with very underweight or very overweight perceptions. Bullying, at school and electronically was significantly associated with all suicidal behaviors. CONCLUSIONS: Examination of not just body weight status but body weight perceptions held by adolescent students, and the experience of not just in-person bullying but also electronic bullying on youth suicidal behaviors is crucial.

Barriers to access and utilization of eating disorder treatment among women.

Anorexia, bulimia, and other specified feeding or eating disorders (OSFED) are psychiatric disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). One difference of eating disorders compared to other psychiatric disorders is the physical effects of the disease. Although anorexia is easier to physically detect than bulimia and OSFED, many women remain undiagnosed and untreated. Even if an eating disorder is recognized by the individual, barriers to clinical diagnosis and treatment persist. This study examines the barriers to treatment among women with anorexia, bulimia, and OSFED using Andersen's Behavioral Model. The physical, psychological, and personality trait differences among the eating disorder subgroups may affect treatment utilization and access.

Randomized trials stopped early for benefit: a systematic review.

CONTEXT: Randomized clinical trials (RCTs) that stop earlier than planned because of apparent benefit often receive great attention and affect clinical practice. Their prevalence, the magnitude and plausibility of their treatment effects, and the extent to which they report information about how investigators decided to stop early are, however, unknown. OBJECTIVE: To evaluate the epidemiology and reporting quality of RCTs involving interventions stopped early for benefit. DATA SOURCES: Systematic review up to November 2004 of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify RCTs stopped early for benefit. STUDY SELECTION: Randomized clinical trials of any intervention reported as having stopped early because of results favoring the intervention. There were no exclusion criteria. DATA EXTRACTION: Twelve reviewers working independently and in duplicate abstracted data on content area and type of intervention tested, reporting of funding, type of end point driving study termination, treatment effect, length of follow-up, estimated sample size and total sample studied, role of a data and safety monitoring board in stopping the study, number of interim analyses planned and conducted, and existence and type of monitoring methods, statistical boundaries, and adjustment procedures for interim analyses and early stopping. DATA SYNTHESIS: Of 143 RCTs stopped early for benefit, the majority (92) were published in 5 high-impact medical journals. Typically, these were industry-funded drug trials in cardiology, cancer, and human immunodeficiency virus/AIDS. The proportion of all RCTs published in high-impact journals that were stopped early for benefit increased from 0.5% in 1990-1994 to 1.2% in 2000-2004 (P<.001 for trend). On average, RCTs recruited 63% (SD, 25%) of the planned sample and stopped after a median of 13 (interquartile range [IQR], 3-25) months of follow-up, 1 interim analysis, and when a median of 66 (IQR, 23-195) patients had experienced the end point driving study termination (event). The median risk ratio among truncated RCTs was 0.53 (IQR, 0.28-0.66). One hundred thirty-five (94%) of the 143 RCTs did not report at least 1 of the following: the planned sample size (n = 28), the interim analysis after which the trial was stopped (n = 45), whether a stopping rule informed the decision (n = 48), or an adjusted analysis accounting for interim monitoring and truncation (n = 129). Trials with fewer events yielded greater treatment effects (odds ratio, 28; 95% confidence interval, 11-73). CONCLUSIONS: RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism.