PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Delphi”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,369 records · Page 76Linked to original sources

The complete amino acid sequence of the major component myoglobin of Amazon river dolphin (Inia geoffrensis).

The complete amino acid sequence of the major component myoglobin from Amazon River dolphin, Inia geoffrensis, was determined by specific cleavage of the protein to obtain large peptides which are readily degraded by the automatic sequencer. Three easily separable peptides were obtained by cleaving the protein with cyanogen bromide at the methionine residues and four peptides were obtained by cleaving the methyl-acetimidated protein with trypsin at the arginine residues. From these peptides over 85% of the sequence was completed. The remainder of the sequence was obtained by fragmentation of the large cyanogen bromide peptide with trypsin. This protein differs from that of the common porpoise, Phocoena phocoena, at seven positions, from that of the common dolphin, Delphinus delphis, at 11 positions, and from that of the sperm whale, Physeter catodon, at 15 positions. By comparison of this sequence with the three-dimensional structure of sperm whale myoglobin it appears that those residues close to the heme group are most conserved followed by those in nonhelical regions and lastly by those in the helical segments. All of the substitutions observed in this sequence fit easily into the three-dimensional structure of the sperm whale myoglobin.

Amino Acid Sequence↗

Redox properties of mesophilic and hyperthermophilic rubredoxins as a function of pressure and temperature.

The formal equilibrium reduction potentials of recombinant electron transport protein, rubredoxin (MW = 7500 Da), from both the mesophilic Clostridium pasteurianum (Topt = 37 degrees C) and hyperthermophilic Pyrococcus furiosus (Topt = 95 degrees C) were recorded as a function of pressure and temperature. Measurements were made utilizing a specially designed stainless steel electrochemical cell that easily maintains pressures between 1 and 600 atm and a temperature-controlled cell that maintains temperatures between 4 and 100 degrees C. The reduction potential of P. furiosus rubredoxin was determined to be 31 mV at 25 degrees C and 1 atm, -93 mV at 95 degrees C and 1 atm, and 44 mV at 25 degrees C and 400 atm. Thus, the reduction potential of P. furiosus rubredoxin obtained under standard conditions is likely to be dramatically different from the reduction potential obtained under its normal operating conditions. Thermodynamic parameters associated with electron transfer were determined for both rubredoxins (for C. pasteurianum, DeltaV degrees = -27 mL/mol, DeltaS degrees = -36 cal K-1 mol-1, and DeltaH degrees = -10 kcal/mol, and for P. furiosus, DeltaV degrees = -31 mL/mol, DeltaS degrees = -41 cal K-1 mol-1, and DeltaH degrees = -13 kcal/mol) from its pressure- and temperature-reduction potential profiles. The thermodynamic parameters for electron transfer (DeltaV degrees, DeltaS degrees, and DeltaH degrees ) for both proteins were very similar, which is not surprising considering their structural similarities and sequence homology. Despite the fact that these two proteins exhibit dramatic differences in thermostability, it appears that structural changes that confer dramatic differences in thermostability do not significantly alter electron transfer reactivity. The experimental changes in reduction potential as a function of pressure and temperature were simulated using a continuum dielectric electrostatic model (DELPHI). A reasonable estimate of the protein dielectric constant (epsilonprotein) of 6 for both rubredoxins was determined from these simulations. A discussion is presented regarding the analysis of electrostatic interaction energies of biomolecules through pressure- and temperature-controlled electrochemical studies.

Clostridium↗

Identification by integrated computer modeling and light scattering studies of an electrostatic serum albumin-hyaluronic acid binding site.

Dynamic light scattering and turbidimetry, carried out on solutions of hyaluronic acid (HA) and bovine or human serum albumin (SA) at fixed ionic strength (I), revealed a critical pH corresponding to the onset of HA-SA soluble complex formation. Subsequent reduction of pH below pH(c), corresponding to an increase in protein net positive charge, results in phase separation of the complex. The sensitivity of pH(c) to I indicated the primacy of electrostatic interactions in this process. Since pH(c) was always above the pK(a) of HA, these effects could be attributed to the influence of protein charge. The electrostatic potential around HSA was modeled using DelPhi (MSI) under pH, I conditions corresponding to incipient binding, phase separation, and noninteraction. At all incipient binding conditions (i.e., pH(c), at varying I), an identical region of positive potential 5 A from the protein van der Waals surface appeared. This unique domain intensified with a decrease in pH or I (corresponding to stronger binding), and diminished with an increase in pH or I (i.e., at noninteracting conditions). The size and low curvature of this domain could readily accommodate a 12 nm (decamer) sequence of HA. Simple electrostatic considerations indicate an electrostatic binding energy for the formation of this complex of ca. 1 kT, consistent with the condition of incipient complex formation. We suggest that such weak electrostatic binding may characterize nonspecific interactions for other protein-gylcosaminoglycan pairs.

Animals↗

Ionic strength dependence of protein-polyelectrolyte interactions.

The effect of univalent electrolyte concentration on protein-polyelectrolyte complex formation has been measured by frontal analysis continuous capillary electrophoresis (FACCE) and turbidimetry for the interaction of bovine serum albumin (BSA) with a synthetic hydrophobically modified polyacid, for BSA with (porcine mucosal) heparin (Hp), a highly charged polyanion, and for Hp and insulin. All three highly diverse systems display maxima or plateaus in complex formation in the range of ionic strength 5 < I < 30 mM, confirmed in the case of BSA-Hp by multiple techniques. Similar maxima are reported in the literature, but with little discussion, for BSA-poly(dimethyldiallylammonium chloride), lysozyme-hyaluronic acid, and lysozyme-chondroitin sulfate, always in the I range 5-30 mM. While inversion of salt effect has been discussed specifically for the interaction of gelatin and sodium polystyrenesulfonate with gelatin(28) and with beta-lactoglobulin,(10) the general nature of this phenomenon, regardless of polyelectrolyte origin, molecular weight, and charge sign has not been recognized. The position of the maxima and their occurrence when protein and polyelectrolyte have the same net charge imply that they arise when Debye lengths extend, at low I, beyond half the protein diameter so that addition of salt screens repulsions, as well as attractions. This appears to be a general effect caused by electrostatic repulsions that can coexist simultaneously with hydrophobic interactions. Modeling of protein electrostatics via Delphi is used to visualize this effect for BSA, lysozyme, insulin, and beta-lactoglobulin.

Electrolytes↗

Perfluorooctanesulfonate and related fluorinated hydrocarbons in marine mammals, fishes, and birds from coasts of the Baltic and the Mediterranean Seas.

Perfluorooctanesulfonate (PFOS; C8F17SO3-), perfluorooctanesulfonamide (FOSA; C8F17SO2NH2), perfluorohexanesulfonate (PFHxS; C6F13SO3-), and perfluorooctanoate (PFOA; C7F15CO2-) were detected in 175 samples of liver and blood of bluefin tuna (Thunnus thynnus), swordfish (Xiphias gladius), common cormorants (Phalacrocorax carbo), bottlenose dolphins (Tursiops truncatus), striped dolphins (Stenella coeruleoalba), common dolphins (Delphinus delphi), fin whales (Balenoptera physalus), and long-finned pilot whales (Globicephala melas) from the Italian coast of the Mediterranean Sea and in livers of ringed seals (Phoca hispida), gray seals (Halichoerus grypus), white-tailed sea eagles (Haliaeetus albicilla), and Atlantic salmon (Salmo salar) from coastal areas of the Baltic Sea. PFOS was detected in all of the wildlife species analyzed. Concentrations of PFOS in blood decreased in order of bottlenose dolphins > bluefin tuna > swordfish. Mean PFOS concentrations (61 ng/ g, wet wt) in cormorant livers collected from Sardinia Island in the Mediterranean Sea were less than the concentrations of PFOA (95 ng/g, wetwt). PFOS concentrations in cormorant livers were significantly correlated with those of PFOA. FOSA was found in 14 of 19 livers or blood samples of marine mammals from the Mediterranean Sea. The highest concentration of 878 ng FOSA/g, wet wt, was found in the liver of a common dolphin. Livers of ringed and gray seals from the Bothnian Bay in the Baltic Sea contained PFOS concentrations ranging from 130 to 1,100 ng/g, wet wt. No relationships between PFOS concentrations and ages of ringed or gray seals were observed. Concentrations of PFOS in livers of seals were 5.5-fold greater than those in corresponding blood. A significant positive correlation existed between the PFOS concentrations in liver and blood, which indicates that blood can be used for nonlethal monitoring of PFOS. Trend analysis of PFOS concentrations in livers of white-tailed sea eagles collected from eastern Germany and Poland since 1979 indicated an increase in concentrations during the 1990s. Livers of Atlantic salmons did not contain quantifiable concentrations of any of the fluorochemicals monitored. PFOS is a widespread contaminant in wildlife from the Baltic and the Mediterranean Seas, while FOSA and PFOA were detected only in certain locations indicating their sporadic spatial distribution.

Alkanesulfonic Acids↗

Individual Reduction Potentials of the Iron Ions in Fe(2)S(2) and High-Potential Fe(4)S(4) Ferredoxins.

The DelPhi program package has been used to confirm that the span in reduction potentials among high-potential Fe(4)S(4) ferredoxins must be mainly ascribed to the net protein charges arising from acidic and basic residues. Subsequently, the order of the individual reduction potentials of the iron ions in Fe(2)S(2) ferredoxins as found from NMR spectroscopy was explained mainly on the basis of different solvation contributions to the electrostatic potential. The individual reduction potentials of the iron ions in high-potential Fe(4)S(4) ferredoxins, again available from NMR spectroscopy, are only qualitatively reproduced. It is proposed that the protein triggers a distortion in the cluster which would be a further contribution to the electrochemical inequivalence of the individual iron ions.

Journal Article↗

Theoretical study of the unusual protonation properties of the active site cysteines in thioredoxin.

The thiol/disulfide oxidoreductases of the thioredoxin family have, in the active site, two cysteines that can be in a reduced or an oxidized form. One of the cysteines in the reduced state is deprotonated, and it is called nucleophilic cysteine. The pK(a) of this cysteine is different from that of a normal cysteine and varies widely among the different enzymes of this family. However, the factors responsible for the different degrees of stabilization of nucleophilic cysteine thiolate are not fully understood. Here, we have studied the well-known hypothesis of proton sharing between the active site thiols by performing a linear transit scan for the transfer of the proton between the active site cysteines. We used a two-layered (DFT/MM) ONIOM formalism, with the active site region treated at the B3LYP/6-31+G(d) level and the remains of the protein treated with the Amber Parm94 force field. The solvation free energy was accounted for with a continuum solvent model, by solving the Poisson-Boltzmann equation using the program Delphi. We have obtained excellent agreement with the experimental data available in the literature. Besides refuting the proton sharing hypothesis, our results include a value of 14.0 for the pK(a) of the buried cysteine, a quantity that has not been possible to obtain experimentally but which has been proven to be higher than 11. Additionally, this study also provides detailed information on the very interesting and so far unknown fact that the contribution of the enzymatic structure (8.3 kcal/mol) prevails in relation to that of the solvent (0.60 kcal/mol) concerning the differential stabilization of the active site thiolates.

Binding Sites↗

Electrostatics of ligand binding: parametrization of the generalized Born model and comparison with the Poisson-Boltzmann approach.

An accurate and fast evaluation of the electrostatics in ligand-protein interactions is crucial for computer-aided drug design. The pairwise generalized Born (GB) model, a fast analytical method originally developed for studying the solvation of organic molecules, has been widely applied to macromolecular systems, including ligand-protein complexes. However, this model involves several empirical scaling parameters, which have been optimized for the solvation of organic molecules, peptides, and nucleic acids but not for energetics of ligand binding. Studies have shown that a good solvation energy does not guarantee a correct model of solvent-mediated interactions. Thus, in this study, we have used the Poisson-Boltzmann (PB) approach as a reference to optimize the GB model for studies of ligand-protein interactions. Specifically, we have employed the pairwise descreening approximation proposed by Hawkins et al.(1) for GB calculations and DelPhi for PB calculations. The AMBER all-atom force field parameters have been used in this work. Seventeen protein-ligand complexes have been used as a training database, and a set of atomic descreening parameters has been selected with which the pairwise GB model and the PB model yield comparable results on atomic Born radii, the electrostatic component of free energies of ligand binding, and desolvation energies of the ligands and proteins. The energetics of the 15 test complexes calculated with the GB model using this set of parameters also agrees well with the energetics calculated with the PB method. This is the first time that the GB model has been parametrized and thoroughly compared with the PB model for the electrostatics of ligand binding.

Ligands↗

Electrostatically driven protein aggregation: beta-lactoglobulin at low ionic strength.

The aggregation of beta-lactoglobulin (BLG) at ambient temperature was studied using turbidimetry and dynamic light scattering in the range 3.8<pH<5.2 in 0.0045 M NaCl, and in the ionic strength range 0.0045-0.5 M at fixed pH=5.0. The initial rate of aggregation, taken as the initial slope of turbidity vs time, (dtau/dt)0, indicated maximum aggregation near pH 4.6 (below the isoelectric point of 5.2), but the dependence of the initial rate of aggregation on pH was highly asymmetric. At pH 5.0, (dtau/dt)0 strongly increased with a decrease in ionic strength I from 0.1 to 0.0045 M and was found to be nearly linear with 1/I. DLS measurements revealed an increase in particle size with time, with the appearance of bimodal distributions in which the fast and slow modes corresponded, respectively, to a BLG dimer and to larger aggregates in the 100-800 nm range. At conditions of slower aggregation, DLS revealed the consumption of dimers to form higher order aggregates with no intermediate species. Computer modeling (Delphi) was used to visualize the electrostatic potential around the dimer to elucidate the pH and ionic strength dependence of the initial aggregation rates. The aggregation process appears to comprise an initial fast consumption of the dimer, whose dependence on pH and I arises from the interaction of the positive and negative domains of interacting dimers, followed by the slow formation of much larger aggregates with relatively little sensitivity to pH and I. The open-ended nature of BLG aggregation is thought to arise from the asymmetry of the dimer charge distribution.

Hydrogen-Ion Concentration↗

Identifying Opportunities for Vertical Integration of Biochemistry and Clinical Medicine.

Objectives: Retention of basic science knowledge, as judged by National Board of Medical Examiners' (NBME) data, suffers due to lack of apparent relevance and isolation of instruction from clinical application, especially in biochemistry. However, the literature reveals no systematic process for identifying key biochemical concepts and associated clinical conditions. This study systematically identified difficult biochemical concepts and their common clinical conditions as a critical step towards enhancing relevance and retention of biochemistry.Methods: A multi-step/ multiple stakeholder process was used to: (1) identify important biochemistry concepts; (2) determine students' perceptions of concept difficulty; (3) assess biochemistry faculty, student, and clinical teaching scholars' perceived relevance of identified concepts; and (4) identify associated common clinical conditions for relevant and difficult concepts. Surveys and a modified Delphi process were used to gather data, subsequently analyzed using SPSS for Windows.Results: Sixteen key biochemical concepts were identified. Second year medical students rated 14/16 concepts as extremely difficult while fourth year students rated nine concepts as moderately to extremely difficult. On average, each teaching scholar generated common clinical conditions for 6.2 of the 16 concepts, yielding a set of seven critical concepts and associated clinical conditions.Conclusions: Key stakeholders in the instructional process struggle to identify biochemistry concepts that are critical, difficult to learn and associated with common clinical conditions. However, through a systematic process beginning with identification of concepts and associated clinical conditions, relevance of basic science instruction can be enhanced.

Journal Article↗

Low-cost instrumentation for the diagnosis of Hirschsprung's disease.

In Hirschsprung's disease, the internal anorectal sphincter fails to relax in response to rectal distension, which strongly indicates the absence of rectoanal inhibitory reflex (RAIR). Hirschsprung's disease is a very common case particularly encountered in the newborns in our region. Development of a manometric system targeted specifically for the diagnosis of this disease at a reasonable cost is an urgent need identified by our regional colorectal surgeons. These surgeons indicated that commercially available anorectal manometers are too expensive to acquire. Therefore, in our research we tried to develop a low-cost single balloon-transducer system, which only provides information about RAIR, and hence diagnoses the Hirschsprung's disease. The hardware part of our instrumentation is made of a latex balloon, pressure transducer, amplifier, and A/D converter circuits, which all collects the pressure readings and sends the data to the computer. The manometer system software, programmed based on Delphi, displays these readings and patient information on a computer screen. This designed system was successful enough to perform manometric recording of RAIR in the anorectal ampulla of rabbits and rats.

Anal Canal↗

Critical ingredients of consumer run services: results of a national survey.

Fidelity criteria are increasingly used in program monitoring and evaluation, but are difficult to derive for emerging models (i.e., those not based on theory or a research demonstration project). We describe steps used to develop and operationalize fidelity criteria for consumer-run (CR) mental health services: articulating and operationalizing criteria based on published literature, then revising and validating the criteria through expert judgments using a modified Delphi method. Respondents rated highest those structural and process components emphasizing the value of consumerism: consumer control, consumer choices and opportunities for decision-making, voluntary participation (and the absence of coercion), and respect for members by staff.

Community Mental Health Services↗

Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?

BACKGROUND: The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport. METHODS: The anesthesiologist-manned helicopter and rapid response car service at Rogaland Central Hospital assisted 1106 patients at the scene during the 18-month study period. Two expert panels assessed patients with a potential health benefit for life years gained (LYG) using a modified Delphi technique. The probability of survival as a result of the studied EMS was multiplied by the life expectancy of each patient. The benefit was attributed either to the anesthesiologist, the rapid transport or a combination of both. RESULTS: The expert panels estimated a benefit of 504 LYG in 74 patients (7% of the total study population), with a median age of 54 years (range 0-88). The cause of the emergency was cardiac diseases (including cardiac arrest) in 61% of the 74 patients, trauma in 19%, and cardio-respiratory failure as a result of other conditions in 20%. The LYG were equally divided between air and ground missions, and the majority (88%) were attributed solely to ALS by the anesthesiologist. CONCLUSION: The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.

Adolescent↗

Effectiveness of interventions to promote continuing professional development for dentists.

BACKGROUND: Continuing education is incumbent upon dentists as health professionals, but its promotion may be required, particularly in order to ensure regular professional updating. Continuing professional development may be delivered in a variety of ways, and new strategies and techniques must be evaluated for effectiveness. AIM: To evaluate the effectiveness of two interventions utilizing the philosophies and techniques of the discipline of Quality Improvement. METHOD: A self-assessment instrument (a manual) for quality dental practice was developed using the Delphi technique. A randomized, controlled trial of the interventions was conducted under field conditions for dental practice in Victoria, Australia. Dentists in Test Groups 1 and 2 completed the self-assessment manual, and received relevant references and their own scores for the manual in comparison with empirical standards. Dentists in Test Group 1 also attended a continuing education course on Quality Improvement. Dentists in Control Group 1 completed the manual only and received feedback of their scores. Dentists in Test Groups 1 and 2, and in Control Group 1 completed the manual again after 1 year as a post-intervention follow-up. Dentists in Control Group 2 completed the manual only at 1 year. RESULTS: The intervention involving self-assessment, receipt of scores and references for the manual resulted in modest improvements in total scores for dentists after 1 year, although a response bias was apparent. CONCLUSION: An effective method of facilitating change in quality dental practice was identified. Assessment of strategies and techniques for professional development of dentists should include observation of patterns of participation.

Attitude of Health Personnel↗

Providing cancer services to remote and rural areas: consensus study.

There is controversy about how cancer care should be provided to patients in remote and rural areas. The aim of this project was to measure consensus among health professionals who treat rural patients with cancer about priorities for cancer care. A modified Delphi process was used. Of 78 health professionals in Grampian, 62 responded (79%). Of 49 items suggested, there was agreement on 26 (53%), encompassing fast access to diagnosis, high-quality specialist treatment, and well-coordinated delivery of care with good and fast communication and effective team working between all health professionals involved. Specialist oncology nurses in local hospitals were considered a priority along with good facilities, accommodation, and transport for patients. There was no agreement on the best location for chemotherapy (local or central). The only large difference of opinion between participants based in primary and secondary care concerned chemotherapy provision at local community hospitals (primary care was in favour, hospital practitioners against, P&<0.001). In making their decisions, participants took problems of access into account, but were also concerned with quality of care and feasibility in the current health service. Our findings show that more evidence is needed regarding the balance of risks and benefits of local chemotherapy provision. Overall, however, there is agreement on many principles for cancer care that could be translated into practice.

Attitude of Health Personnel↗

The process of care model for evaluation and treatment of erectile dysfunction. The Process of Care Consensus Panel.

This paper addresses pertinent issues concerning the role of physicians in the assessment and treatment of men with complaints of erectile dysfunction. With the availability of safe and effective oral drug therapy, the field of erectile dysfunction has expanded rapidly to encompass multiple disciplines and specialties. Recognizing the need for evidence-based standards and guidelines in the management of this common disorder, a multidisciplinary panel of experts was convened to examine existing literature and practice standards. This panel employed a modified Delphi methodology to develop consensus on definition and classification, rational utilization of diagnostic and therapeutic options, and clinical guidelines for the management of erectile dysfunction in a primary care setting. A 'Process of Care Model for Erectile Dysfunction' was thus developed, incorporating a step-wise decision making approach, defined in terms of relevant processes, actions and outcomes. According to this method, initial assessment should include a careful clinical history, focused physical examination and selected laboratory tests. Subsequent management should be goal-oriented, taking into account patient and partner needs and preferences. The step-wise treatment algorithm is based on the selection criteria of ease of administration, reversibility, relative invasiveness and cost. In addition, common referral indications for specialized diagnostic testing and treatment are provided. By assisting the primary physician in selecting appropriate assessment tools and treatment interventions, the proposed guidelines are intended to optimize care of the patient with erectile dysfunction. The panel strongly recommends further research into the causes and associated risk factors for erectile dysfunction, prevention and the role of lifestyle modification, and the critical issue of partner-related sexual dysfunction. Considering the strong relationship between sexual dysfunction and overall quality of life, it is incumbent upon physicians to address the sexual needs of their patients in a sensitive and informed manner.

Adult↗

Diagnostic and treatment strategies for erectile dysfunction: the 'Process of Care' model. [University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School].

The new era of erectile dysfunction medicine ushered in by the availability of an effective and safe oral medication paves the evolution of the field toward a multi-disciplinary and primary care setting. There exists a paucity of guidelines regarding the assessment and management of the patient with erectile dysfunction in the primary care arena. The 'Process of Care' model for the evaluation and treatment of erectile dysfunction has been developed to advance new guidelines for the diagnosis and management of erectile dysfunction in the primary care and multi-disciplinary setting. This model was developed under the auspices of the University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School (chairman: R Rosen) with input from a multi-disciplinary group of experts including representation from primary care, internal medicine, endocrinology, psychiatry, psychology and urology. The methodology employed was a modified delphi-technique (RAND method). The key components of the model are: 1)a rational approach to diagnosis and treatment, 2) emphasis on clinical history-taking and a focused physical examination 3) specialized testing and referral in pre-defined situations 4) step-wise management approach with ranking of treatment options and 5)incorporation of patient and partner needs and preferences in the decision making process when possible (a goal-directed approach). The management algorithm is conceptually organized into progressive stages from Process--> Action--> Outcome. International Journal of Impotence Research (2000) 12, Suppl 4, S119-S121.

Erectile Dysfunction↗

Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism.

PURPOSE: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. MATERIALS AND METHODS: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. RESULTS: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. CONCLUSIONS: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi-institutional trials to objectively assess safety and efficacy in the various treatment modalities.

Humans↗