Urology Practice最新文献

{"title":"Feasibility of Pay for Performance and Transparency Interventions on the Selection and Quality of Observational Management for Patients With Low-Risk Prostate Cancer in the Community Practice.","authors":"Franklin D Gaylis, Michael S Leapman, Shellie D Ellis, Steven Hu, Matthew R Cooperberg, Stacy Loeb, Ronald C Chen, Edward S Cohen, Paul E Dato, Shahrad Aynehchi, Richard David, Robert Topp, Bianca Santomauro, Kevin Ginsburg, William J Catalona","doi":"10.1097/UPJ.0000000000000745","DOIUrl":"10.1097/UPJ.0000000000000745","url":null,"abstract":"<p><strong>Introduction: </strong>Practice-level strategies to improve the use of conservative management for low-risk prostate cancer have not been rigorously evaluated. We examined the feasibility of implementation and preliminary outcomes of a pay-for-performance (P4P) and a transparency intervention at the practice level.</p><p><strong>Methods: </strong>We conducted a pilot study within a Southern California urology practice network. We developed and implemented a value-based model based on quality metrics for patients with low-risk prostate cancer (LR PCa) consisting of a financial incentive to the urology practice paid by a large commercial payer, as well as performance transparency (audit and feedback) reporting to participating providers. The primary outcome was the increase in use of conservative management (active surveillance or watchful waiting) from baseline to the intervention periods (2019-2022/23). We evaluated conservative therapy among patients for whom financial incentives were eligible as well as noneligible patients.</p><p><strong>Results: </strong>Following the introduction of transparent physician audit and feedback and P4P intervention, adoption of conservative management (active surveillance or watchful waiting) increased from 65.5% (93/142) to 83% (125/150), respectively (<i>P</i> < .001). Increases in conservative management for LR PCa, post intervention, were observed in both patients for whom performance incentives were eligible (94%) as well as noneligible (82%) patients.</p><p><strong>Conclusions: </strong>P4P and transparent audit and feedback collaborative interventions to promote adherence to evidence-based quality measures were both feasible and associated with increased use of conservative management of patients with LR PCa. Physician audit and feedback (transparency) appears to have the strongest influence on physician adoption of conservative management.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"241-248"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Arianna Biasatti, Riccardo Autorino","doi":"10.1097/UPJ.0000000000000747","DOIUrl":"10.1097/UPJ.0000000000000747","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"289-290"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary Sphincters.","authors":"Joon Yau Leong, Paul H Chung","doi":"10.1097/UPJ.0000000000000757","DOIUrl":"10.1097/UPJ.0000000000000757","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"222-223"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of ChatGPT as a Reliable Source of Medical Information on Prostate Cancer for Patients: Global Comparative Survey of Medical Oncologists and Urologists.","authors":"Arnulf Stenzl, Andrew J Armstrong, Eamonn Rogers, Dany Habr, Jochen Walz, Martin Gleave, Andrea Sboner, Jennifer Ghith, Lucile Serfass, Kristine W Schuler, Sam Garas, Dheepa Chari, Ken Truman, Cora N Sternberg","doi":"10.1097/UPJ.0000000000000740","DOIUrl":"10.1097/UPJ.0000000000000740","url":null,"abstract":"<p><strong>Introduction: </strong>No consensus exists on performance standards for evaluation of generative artificial intelligence (AI) to generate medical responses. The purpose of this study was the assessment of Chat Generative Pre-trained Transformer (ChatGPT) to address medical questions in prostate cancer.</p><p><strong>Methods: </strong>A global online survey was conducted from April to June 2023 among > 700 medical oncologists or urologists who treat patients with prostate cancer. Participants were unaware that this was a survey evaluating AI. In component 1, responses to 9 questions were written independently by medical writers (MWs; from medical websites) and ChatGPT 4.0 (AI-generated from publicly available information). Respondents were randomly exposed and blinded to both AI-generated and MW-curated responses; evaluation criteria and overall preference were recorded. Exploratory component 2 evaluated AI-generated responses to 5 complex questions with nuanced answers in the medical literature. Responses were evaluated on a 5-point Likert scale. Statistical significance was denoted by <i>P</i> < .05.</p><p><strong>Results: </strong>In component 1, respondents (N = 602) consistently preferred the clarity of AI-generated responses over MW-curated responses in 7 of 9 questions (<i>P</i> < .05). Despite favoring AI-generated responses when blinded to questions/answers, respondents considered medical websites a more credible source (52%-67%) than ChatGPT (14%). Respondents in component 2 (N = 98) also considered medical websites more credible than ChatGPT, but rated AI-generated responses highly for all evaluation criteria, despite nuanced answers in the medical literature.</p><p><strong>Conclusions: </strong>These findings provide insight into how clinicians rate AI-generated and MW-curated responses with evaluation criteria that can be used in future AI validation studies.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"229-240"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithm-Based Mobile Texting Platform for the Self-Management of Interstitial Cystitis/Bladder Pain Syndrome: Pilot Study Evaluating Feasibility, Usability, and Potential Utility.","authors":"Edward K Kim, Lily A Brown, Denise Hartzell-Leggin, Uduak U Andy, Camryn E Harvie, Kristene E Whitmore, Diane K Newman, Rebecca F Hamm, Lily A Arya","doi":"10.1097/UPJ.0000000000000737","DOIUrl":"10.1097/UPJ.0000000000000737","url":null,"abstract":"<p><strong>Introduction: </strong>We developed an algorithm-based mobile texting platform for promoting self-management in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Our aim was to measure the feasibility, usability, and potential utility of the platform.</p><p><strong>Methods: </strong>A texting platform that delivered 4 treatment modules (education and behavioral modification, cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices) and an automated weekly message over 6 weeks was developed. Feasibility and usability were determined using patient engagement (proportion of platform messages to which patients responded) and System Usability Scale. Satisfaction with patient-physician communication questionnaire, Pain Self-Efficacy Scale, and Interstitial Cystitis Symptom and Problem Index were administered before and after the intervention.</p><p><strong>Results: </strong>Engagement with the platform in 52 female patients with IC/BPS (median age [IQR] 40 [30-48] years) was 76.9%. The commonest module selected by patients was pelvic floor physical therapy (50%) followed by cognitive behavioral therapy (34%) and guided mindfulness (15%). System usability score (median, IQR) was 87 (83-95), indicating high usability. Satisfaction with patient-physician communication improved significantly (median change, 4; IQR, 1-9; <i>P</i> < .001). Pain self-efficacy score improved from moderate impairment at baseline to minimal impairment at 6 weeks (median change, 10; IQR, 2-18; <i>P</i> < .001). Urinary symptoms scores also improved (median change Interstitial Cystitis Symptom Index, -3; IQR, -5 to -1.5; <i>P</i> < .001, Problem Index, -2; IQR, 5.5 to -0.5; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>An automated mobile platform has the potential for improving access to self-management strategies and easing clinicians' challenge of counseling patients with IC/BPS during time-limited in-person visits.</p><p><strong>Trial registration: </strong><b>ClinicalTrials.gov Identifier:</b> NCT05260112.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"203-213"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility Preservation for Iatrogenic Infertility: Patient Barriers and Opportunities for the Reproductive Medicine Workforce.","authors":"Emily Y Huang, Lisa M Shandley, Akanksha Mehta, Kathleen C Kobashi, Akhil Muthigi","doi":"10.1097/UPJ.0000000000000735","DOIUrl":"10.1097/UPJ.0000000000000735","url":null,"abstract":"<p><p>Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential such as gonadotoxic chemotherapy and radiation but also brain and pelvic surgery, biologics for autoimmune disease, and hormone therapy. Fertility preservation (FP) involves freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue for future procreation and may be the only option for some patients who hope to use their autologous gametes for future reproduction. Although there is a growing awareness to refer patients at risk for iatrogenic infertility to reproductive specialists, patients seeking FP continue to face a multitude of barriers. The most prohibitive factor is cost, but poor accessibility to specialty care, lack of education of providers and patients, and stigmatization around reproductive health may all lead to delayed referrals. We discuss several opportunities for the reproductive medicine workforce to help address barriers to FP. One method to make FP more accessible to patients in a shorter time frame would be to make it more affordable through improved insurance coverage. Currently, there is no active federal legislation mandating that insurance plans cover FP; however, there have been several success stories at the state level. In addition, education of providers and patients through multispecialty collaboration and targeted campaigns can have a profound impact on expediting referral for fertility care. Promising new technologies and innovation in health care delivery are also on the horizon. Unaddressed fertility concerns are very distressing to patients and detrimental to their quality of life. Urologists can contribute significantly to improving the care for these patients clinically and through advocacy and education.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"194-201"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply by Authors.","authors":"Anju Murayama, David-Dan Nguyen, Anna-Lisa V Nguyen, Liam Murad, Alan Cheng, Dean S Elterman, Girish S Kulkarni, Naeem Bhojani, Raj Satkunasivam, Quoc-Dien Trinh, Deborah C Marshall, Christopher J D Wallis","doi":"10.1097/UPJ.0000000000000753","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000753","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 2","pages":"290"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is It Time for a Paradigm Shift for the Prevention of the Recurrence of Acute Urinary Retention?","authors":"Steven A Kaplan","doi":"10.1097/UPJ.0000000000000755","DOIUrl":"10.1097/UPJ.0000000000000755","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"191-193"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Thomas M Fitzgibbon, Jay D Raman","doi":"10.1097/UPJ.0000000000000751","DOIUrl":"10.1097/UPJ.0000000000000751","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"262-263"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is Needed to Support Nonurban Urology in the United States? Perspectives From Urologists in Rural and Underresourced Areas.","authors":"Kathleen Kieran, Candace Granberg, Christopher Deibert, Arthur L Burnett, Paul H Chung","doi":"10.1097/UPJ.0000000000000741","DOIUrl":"10.1097/UPJ.0000000000000741","url":null,"abstract":"<p><strong>Introduction: </strong>Twenty percent of Americans live in nonurban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of nonmetropolitan urologists (NMUs) in the United States.</p><p><strong>Methods: </strong>Based on the results of the 2022 AUA Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in nonmetropolitan areas. Multiple choice answers were summarized as proportions, and free-text answers were collected and grouped by theme.</p><p><strong>Results: </strong>One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), older than 55 years (76.1%), in practice > 25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next 5 years. Call burden is the most likely reason to leave practice (40%).</p><p><strong>Conclusions: </strong>Most urologists practicing in nonmetropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within 5 years. Understanding contemporary stressors can inform policies to support current and future NMUs.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"264-273"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}