International Society for Sexual Medicine`s Guidelines for the Diagnosis and Treatment of Premature Ejaculation

Introduction. Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE. Aim. Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature. Results. This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion. Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years. Althof SE, Abdo CHN, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJG, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, and Tan HM. International Society for Sexual Medicine`s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010;7:2947-2969.

Official Positions for FRAX(®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®).

Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX(®)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX(®) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX(®) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX(®) calculations.

FRAX(®) Clinical Task Force of the 2010 Joint International Society for Clinical Densitometry & International Osteoporosis Foundation Position Development Conference.

The World Health Organization fracture risk assessment tool, FRAX(®), is an advance in clinical care that can assist in clinical decision-making. However, with increasing clinical utilization, numerous questions have arisen regarding how to best estimate fracture risk in an individual patient. Recognizing the need to assist clinicians in optimal use of FRAX(®), the International Osteoporosis Foundation (IOF) in conjunction with the International Society for Clinical Densitometry (ISCD) assembled an international panel of experts that ultimately developed joint Official Positions of the ISCD and IOF advising clinicians regarding FRAX(®) usage. As part of the process, the charge of the FRAX(®) Clinical Task Force was to review and synthesize data surrounding a number of recognized clinical risk factors including rheumatoid arthritis, smoking, alcohol, prior fracture, falls, bone turnover markers and glucocorticoid use. This synthesis was presented to the expert panel and constitutes the data on which the subsequent Official Positions are predicated. A summary of the Clinical Task Force composition and charge is presented here.

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®).

FRAX(®) Bone Mineral Density Task Force of the 2010 Joint International Society for Clinical Densitometry International Osteoporosis Foundation Position Development Conference.

FRAX(®) is a fracture risk assessment algorithm developed by the World Health Organization in cooperation with other medical organizations and societies. Using easily available clinical information and femoral neck bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), when available, FRAX(®) is used to predict the 10-year probability of hip fracture and major osteoporotic fracture. These values may be included in country specific guidelines to aid clinicians in determining when fracture risk is sufficiently high that the patient is likely to benefit from pharmacological therapy to reduce that risk. Since the introduction of FRAX(®) into clinical practice, many practical clinical questions have arisen regarding its use. To address such questions, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundations (IOF) assigned task forces to review the best available medical evidence and make recommendations for optimal use of FRAX(®) in clinical practice. Questions were identified and divided into three general categories. A task force was assigned to investigating the medical evidence in each category and developing clinically useful recommendations. The BMD Task Force addressed issues that included the potential use of skeletal sites other than the femoral neck, the use of technologies other than DXA, and the deletion or addition of clinical data for FRAX(®) input. The evidence and recommendations were presented to a panel of experts at the ISCD-IOF FRAX(®) Position Development Conference, resulting in the development of ISCD-IOF Official Positions addressing FRAX(®)-related issues.

Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues.

Theoretical Referents in Knowledge Organization: A Domain Analysis of the Knowledge Organization Journal

Aiming at contributing to the epistemological characterization of the area of knowledge organization, our goal is to analyze the KO journal, since its creation in 1993, as a knowledge domain, from a nuclear community of the most productive and greater impact authors, analyzing the dialogue among citing authors and cited ones, and also the co-citations established by the citing authors. We worked with a corpus of 310 articles published between 1993 and 2011 produced by a total of 360 authors. The relatively more productive authors, a group geographically concentrated in Europe (37%), North America (44%) and Asia (19%), is clearly explained by the historical European origin of the ISKO and by an increasing North American presence along the years. Of the 33 most cited authors, 22 were co-cited in at least 6 works, which suggests that they are the theoretical referential nucleus of the area, in the studied journal. Finally, we observe that the area reveals theme cohesion and coherence in its production, enabling us to clearly visualize its theoretical referential nucleus and to confirm the role performed by the KO magazine as a catalyzing agent of international theoretical construction in the area.

The Relationship between Authors and Main Thematic Categories in the Field of Knowledge Organization: A Bibliometric Approach

This is a study about the relationships between authors and the main thematic categories in the papers published in the last five International ISKO Conferences, held between 2002 and 2010. The aim is to map the domain as ISKO conferences are considered the most representative forum in the field. The published papers are considered to indicate the relationships between authors and themes. The Classification Scheme for Knowledge Organization Error! Bookmark not defined Literature (CSKOL) was used to categorize the papers. The theoretical and methodological foundations of the study can be found in the concept of domain analysis proposed by Hjorland. The analysis of the papers (n=146) led to the identification of the most productive authors, the networks representing the relationships between the authors as also the categories that constitute the primary areas of research.

The Weight of Language and Action: Epistemic Stance, Methodological Action,and Theoretical Perspective in Knowledge Organization

Knowledge organization (KO) research is a field of scholarship concerned with the design, study and critique of the processes of organizing and representing documents that societies see as worthy of preserving (Tennis, 2008). In this context we are concerned with the relationship between language and action.On the one hand, we are concerned with what language can and does do for our knowledge organization systems (KOS). For example, how do the words NEGRO or INDIAN work in historical and contemporary indexing languages? In relation to this, we are also concerned with how we know about knowledge organization (KO) and its languages. On the other hand, we are concerned with how to act given this knowledge. That is, how do we carry out research and how do we design, implement, and evaluate KO systems?It is important to consider these questions in the context of our work because we are delegated by society to disseminate cultural memory. We are endowed with a perspective, prepared by an education, and granted positions whereby society asks us to ensure that documentary material is accessible to future generations. There is a social value in our work, and as such there is a social imperative to our work. We must act with good conscience, and use language judiciously, for the memory of the world is a heavy burden.In this paper, I explore these two weights of language and action that bear down on KO researchers. I first summarize what extant literature says about the knowledge claims we make with regard to KO practices and systems. To make it clear what it is that I think we know, I create a schematic that will link claims (language) to actions in advising, implementing, or evaluating information practices and systems.I will then contrast this with what we do not know, that is, what the unanswered questions might be (Gnoli, 2008 ; Dahlberg, 2011), and I will discuss them in relation to the two weights in our field of KO.Further, I will try to provide a systematic overview of possible ways to address these open questions in KO research. I will draw on the concept of elenchus - the forms of epistemology, theory, and methodology in KO (Tennis, 2008), and framework analysis which are structures, work practice, and discourses of KO systems (Tennis, 2006). In so doing, I will argue for a Neopragmatic stance on the weight of language and action in KO (Rorty, 1982 ; 2000). I will close by addressing the lacuna left in Neopragmatic thought – the ethical imperative to use language and action in a particular good and moral way. That is, I will address the ethical imperative of KO given its weights, epistemologies, theories, and methods. To do this, I will review a sample of relevant work on deontology in both western and eastern philosophical schools (e.g., Harvey, 1995).The perspective I want to communicate in this section is that the good in carrying out KO research may begin with epistemic stances (cf., language), but ultimately stands on ethical actions. I will present an analysis describing the micro and the macro ethical concerns in relation to KO research and its advice on practice. I hope this demonstrates that the direction of epistemology, theory, and methodology in KO, while burdened with the dual weights of language and action, is clear when provided an ethical sounding board. We know how to proceed when we understand how our work can benefit the world.KO is an important, if not always understood, division of labor in a society that values its documentary heritage and memory institutions. Being able to do good requires us to understand how to balance the weights of language and action. We must understand where we stand and be able to chart a path forward, one that does not cause harm, but adds value to the world and those that want to access recorded knowledge.

A Metadata Thesaurus: Report on the Knowledge Organization of the Dublin Core Metadata Initiative Conference Proceedings

2003 Dublin Core Metadata Initiative Proceedings appear in both print and online form. In order to aid search and retrieval of this growing body of research a researchers at the University of Washington and Siderean Software have started a metadata thesaurus. This poster reports on those efforts.

Extending the Simple Knowledge Organization System for Concept Management in Vocabulary Development Applications

In this article, we describe the development of an exten- sion to the Simple Knowledge Organization System (SKOS) to accommodate the needs of vocabulary devel- opment applications (VDA) managing metadata schemes and requiring close tracking of change to both those schemes and their member concepts. We take a neo- pragmatic epistemic stance in asserting the need for an entity in SKOS modeling to mediate between the abstract concept and the concrete scheme. While the SKOS model sufficiently describes entities for modeling the current state of a scheme in support of indexing and search on the Semantic Web, it lacks the expressive power to serve the needs of VDA needing to maintain scheme historical continuity. We demonstrate prelimi- narily that conceptualizations drawn from empirical work in modeling entities in the bibliographic universe, such as works, texts, and exemplars, can provide the basis for SKOS extension in ways that support more rig- orous demands of capturing concept evolution in VDA.

Form, Intention, and Indexing: The Liminal and Integrated Conceptions of Work in Knowledge Organization

This paper proposes a dual conception of work in knowledge organization. The first part is a conception of work as liminal, set apart from everyday work. The second is integrated, without separation. This talk is the beginning of a larger project where we will characterize work in knowledge organization, both as it is set out in our literature (Šauperl, 2004; Hjørland 2003 Wilson, 1968), and in a philosophical argument for its fundamental importance in the activities of society (Shera, 1972; Zandonade, 2004).But in order to do this, we will co-opt the conception of liminality from the anthropology of religion (Turner, 1967), and Zen Buddhist conceptions of moral action, intention, and integration (Harvey, 2000 and cf., Harada, S., 2008).The goal for this talk is to identify the acts repeated (form) and the purpose of those acts (intention), in knowledge organization, with specific regard to thresholds (liminal points) of intention present in those acts.We can then ask the questions: Where is intention in knowledge organization liminal and where is it integrated? What are the limits of knowledge organization work when considered at a foundational level of the intention labor practices? Answering such questions, in this context, allows us to reconsider the assumptions we have about knowledge organization work and its increasingly important role in society. As a consequence, we can consider the limits of classification research if we see the foundations of knowledge organization work when we see forms and intentions. I must also say that incorporating Zen Buddhist philosophy into knowledge organization research seems like it fits well with ethics and ethical responses the practice of knowledge organization. This is because 20th Century Western interpretations of Zen are often rooted in ethical considerations. This translates easily to work.

The Value Of The 2005 International Society Of Urological Pathology (isup) Modified Gleason Grading System As A Predictor Of Biochemical Recurrence After Radical Prostatectomy.

To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.

[renal Tumors: The International Society Of Urologic Pathology (isup) 2012 Consensus Conference Recommendations].

During the last 30 years many advances have been made in kidney tumor pathology. In 1981, 9 entities were recognized in the WHO Classification. In the latest classification of 2004, 50 different types have been recognized. Additional tumor entities have been described since and a wide variety of prognostic parameters have been investigated with variable success; however, much attention has centered upon the importance of features relating to both stage and grade. The International Society of Urological Pathology (ISUP) recommends after consensus conferences the development of reporting guidelines, which have been adopted worldwide ISUP undertook to review all aspects of the pathology of adult renal malignancy through an international consensus conference to be held in 2012. As in the past, participation in this consensus conference was restricted to acknowledged experts in the field.