Men being treated for prostate cancer (PCa) commonly report a diminished sense of their masculinity, but it is not clear what contributes to that perception. Here we examined the literature to explore the characteristics most commonly used to describe diminished masculinity in PCa patients. Data were extracted from 42 peer-reviewed articles that referenced both PCa and terms associated with masculinity. We then ranked the terms by frequency and evaluated whether each reflected a biological feature (e.g., ability to achieve an erection) or a social norm (e.g., being a protector/breadwinner). We also recorded whether patient reports were self-generated or elicited through existing psychological assessment instruments chosen by researchers. We found notable differences between what patients perceived as a decline in their masculinity when spontaneously self-reported, and when elicited through preexisting measures. Patients most often reported changes in bodily function (e.g., reduced erectile function, libido, and physical strength), whereas their responses on formalized measures reflected social and psychological concepts (e.g., self-reliance and stoicism). Our results suggest that loss of masculinity experienced by PCa patients is largely experienced biologically as opposed to socially. Moving forward, interdisciplinary collaboration between those in biomedicine and psychosocial fields will be crucial for improving the quality of life of PCa patients.

Purpose. Delirium frequently affects critically ill patients in the intensive care unit (ICU). The purpose of this study is to evaluate the impact of delirium on ICU and hospital length of stay (LOS) and perform a cost analysis. Materials and Methods. Prospective studies and randomized controlled trials of patients in the ICU with delirium published between January 1, 2015, and December 31, 2020, were evaluated. Outcome variables including ICU and hospital LOS were obtained, and ICU and hospital costs were derived from the respective LOS. Results. Forty-one studies met inclusion criteria. The mean difference of ICU LOS between patients with and without delirium was significant at 4.77 days ( p < 0.001 ); for hospital LOS, this was significant at 6.67 days ( p < 0.001 ). Cost data were extractable for 27 studies in which both ICU and hospital LOS were available. The mean difference of ICU costs between patients with and without delirium was significant at $3,921 ( p < 0.001 ); for hospital costs, the mean difference was $5,936 ( p < 0.001 ). Conclusion. ICU and hospital LOS and associated costs were significantly higher for patients with delirium, compared to those without delirium. Further research is necessary to elucidate other determinants of increased costs and cost-reducing strategies for critically ill patients with delirium. This can provide insight into the required resources for the prevention of delirium, which may contribute to decreasing healthcare expenditure while optimizing the quality of care.

IntroductionTestosterone is known to regulate male sexual interest, but the exact way that androgens influence men's sexual cognition remains unclear.AimTo investigate the influence of androgen deprivation (AD) on visual responses to sexually suggestive stimuli in men treated for prostate cancer with AD therapy.MethodsPatients with AD-treated prostate cancer, patients with prostate cancer not on AD therapy, and age-matched healthy control participants were exposed to images of male and female runway models fully or minimally clothed. Eye tracking was used to compare looking behavior among groups.Main Outcome MeasuresProportion of fixations on fully clothed vs minimally clothed models and proportion of fixations on target areas of interest (ie, legs, chest, pelvis, and face) of fully clothed and minimally clothed models were analyzed and compared among groups.ResultsAlthough men not on AD exhibited a larger proportion of fixations on the minimally clothed compared with the fully clothed images, there was no difference between the 2 image types for men on AD. This was true regardless of whether the images depicted male or female models. Groups did not differ in their fixations to target areas of interest.ConclusionThese results suggest that testosterone can influence men’s visual attention to sexual stimuli; specifically, AD can attenuate the time spent fixated on sexualized targets.Palmer-Hague JL, Tsang V, Skead C, et al. Androgen Deprivation Alters Attention to Sexually Provocative Visual Stimuli in Elderly Men. Sex Med 2017;5:e245–e254.

231 Background: Eye-tracking research has demonstrated that heterosexual men with normal testosterone levels attend visually to features of women associated with fertility, notably their breast size and waist to hip ratio. As such, eye-tracking data can serve as an implicit measure of a man’s libido. Many treatments for prostate cancer (PCa)—in particular androgen deprivation therapy (ADT)—depress sexual interest in men, but there is no objective measure of the intensity of this effect. Here we explore whether eye-tracking can be used to quantify the impact of PCa treatments on men’s libido. Methods: We used an IRB-approved deception protocol to explore the validity of eye-tracking technology for assessing the level of sexual interest of PCa patients and normal controls. Three age-matched groups of heterosexual men aged 50 years and older were recruited. They were: PCa patients using ADT, PCa patients not using ADT, and healthy controls. Unaware that their eye movements were being tracked, all were exposed to photographs of female models, either fully clothed (neutral) or minimally clothed (sexy). Number and duration of eye fixations on target areas of the female models’ bodies were recorded. Results: Trends observed in our preliminary data suggest that men on ADT exhibit differential patterns of visual attention to sexual stimuli compared to men in the other two groups. Although confirmation with a larger sample size is required, such shifts in attention may provide an objective measure of the influence of cancer treatments on the libido of PCa patients. Conclusions: Eye-tracking technology may provide a reliable and objective technique for measuring the libido of cancer patients. Such data could help patients be better informed about psychological side effects when making treatment decisions. They could also lead to ways to both study and reduce the impact of PCa treatments on men’s sexual interest.

Background. Nighttime and weekends in hospital and intensive care unit (ICU) contexts are thought to present a greater risk for adverse events than daytime admissions. Although some studies exist comparing admission time with patient outcomes, the results are contradictory. No studies currently exist comparing costs with the time of admission. We investigated the differences in-hospital mortality, ICU length of stay, ICU mortality, and cost between daytime and nighttime admissions. Methods. All adult patients (≥18 years of age) admitted to a large academic medical-surgical ICU between 2011 and 2015 were included. Admission cohorts were defined as daytime (8:00–16:59) or nighttime (17:00–07:59). Student’s t-tests and chi-squared tests were used to test for associations between days spent in the ICU, days on mechanical ventilation, comorbidities, diagnoses, and cohort membership. Regression analysis was used to test for associations between patient and hospitalization characteristics and in-hospital mortality and total ICU costs. Results. The majority of admissions occurred during nighttime hours (69.5%) with no difference in the overall Elixhauser comorbidity score between groups ( p = 0.22 ). Overall ICU length of stay was 7.96 days for daytime admissions compared to 7.07 days ( p = 0.001 ) for patients admitted during nighttime hours. Overall mortality was significantly higher in daytime admissions (22.5% vs 20.6, p = 0.012 ); however, ICU mortality was not different. The average MODS was 2.9 with those admitted during the daytime having a significantly higher MODS (3.0, p = 0.046 ). Total ICU cost was significantly higher for daytime admissions ( p = 0.003 ). Adjusted ICU mortality was similar in both groups despite an increased rate of adverse events for nighttime admissions. Daytime admissions were associated with increased cost. There was no difference in all hospital total cost or all hospital direct cost between groups. These findings are likely due to the higher severity of illness in daytime admissions. Conclusion. Daytime admissions were associated with a higher severity of illness, mortality rate, and ICU cost. To further account for the effect of staffing differences during off-hours, it may be beneficial to compare weekday and weeknight admission times with associated mortality rates.

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