查看更多>>摘要：Cost-Effective Strategies for Small Renal Masses Active surveillance (AS) for small renal masses has emerged as a reasonable management option for many patients. Initial AS, followed by delayed intervention depending on subsequent tumor growth and patient choice, appears safe given low rates of early metastatic potential. Su et al (page 794) report on a cost-effectiveness model assessing different treatment options for incidental masses less than 2 cm, including AS or immediate ablation/surgery, in a multicenter center study.1 The main finding is AS followed by delayed intervention is most cost-effective compared to up-front surgery or thermal ablation. Clinical decision analyses show age, individual preferences, and health status were important factors shaping optimal management. Although some of the conclusions become limited when considering somewhat larger renal masses, the authors conclude that as the probability of metastatic progression decreases (ie ≤2 cm) AS will realize higher health utilities than the other approaches.
查看更多>>摘要：Before hypotheses could be generated, observation and data were needed. These conjectures could then be tested and their results collated. The interpretation of these new data restarts the cycle; hypotheses are discarded, revised, and reformulated. New tests are run and so on and so forth. Arthur Conan Doyle’s Sherlock Holmes, the famous fictional detective notable for his deductive acumen, identified a key weakness to this method: it needed reliable observations. In “The Adventure of the Copper Beeches,” he exclaims “Data! Data! Data! . I can’t make bricks without clay.”1 The near ubiquity of the computers, the Internet, and electronic medical records offer the hope that data could be gathered from vast physical and virtual networks. Reports of rare and unusual conditions that would take hundreds of years to collate by any single practitioner or institution could be gathered easily. Common conditions could likewise be accumulated and subjected to new analysis.
查看更多>>摘要：In 2019 the American Urological Association (AUA) released the evidence-based guideline “Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.” Information supporting the guideline came from a 2019 systematic evidence review prepared for the AUA by the Pacific Northwest Evidence-Based Practice Center (EPC). The AUA used evidence found in the EPC’s report to derive the 16 guideline statements that make up the 2019 guideline. In 2021 the EPC conducted an updated search to identify potentially relevant studies published since the original 2019 systematic review. A subset of 11 studies were identified as warranting further review to support potential changes to the 2019 guideline. The Panel utilized this updated report to determine whether the data supported, challenged, complemented, or did not add to the current body of evidence for each guideline statement. Following review, all statements were deemed current; however, relevant supporting text was updated based on the findings discussed below.
查看更多>>摘要：The recent SCOTUS (Supreme Court of the United States) decision to overturn Roe v. Wade has had a seismic effect on the medical community. We witnessed an outpouring of shock and disappointment from doctors, nurses, and health care workers who decried the undeniable harmful effects of this decision on the physician-patient relationship and women’s health. Our urological community will be irreversibly shaped by this new medicolegal landscape. For most surgical trainees, residency falls during prime childbearing years. The ability to choose when to have children, “family planning,” is crucial. For several reasons, many students, residents, and fellows delay child rearing until later in their career. Even though the current training environment is more favorable toward parental leave and work-life integration, this does not negate the central importance that “choice” is imperative to the women and pregnant people who elect to pursue a career in urology.
Rutul D. PatelJustin LoloiKevin LabagnaraKara L. Watts...
3页
查看更多>>摘要：The Supreme Court of the United States’ (SCO-TUS) decision to overrule Roe vs. Wade has rendered abortion illegal across a multitude of states. While this decision primarily impacts the management of women’s reproductive health, urologists around the country may feel the rippling effect as more men start seeking options for contraception. Although the number of vasectomies performed in the United States has steadily declined across all age groups over the last decade,1 urologists may see a sudden reversal of this trend, particularly in states that are disproportionately affected by the SCOTUS decision. As a surrogate measure for public interest in vasectomies, we conducted an analysis of Google Trends TM’s relative search volume (RSV) by individual state for the topic “vasectomy.” RSV is measured on a scale from 0-100 and is normalized to the time and location of a query. We compiled search data from 3 months prior to the SCOTUS decision to establish a baseline and quantified the immediate change by comparing to the values from 3 days after the decision. For each state, we calculated the ratio of licensed urologists to adult men (per 100,000) using data from the American Urological Association’s 2021 census and the United States’ 2020 census.
查看更多>>摘要：To perform surgery is to experience adverse surgical events. The frequency of such events is so high that no surgeon can avoid them—it will happen.1 Surgeons generally prepare well for things that might happen: scenarios are anticipated and contingencies are rehearsed. Lack of preparation for something that will happen is, therefore, all the more surprising—not least because of the potential for adverse events to cause harm. Such harm is likely to be most pertinent, most profound, and most prolonged for the affected patient, or for their loved ones. Any discussion of the impact of adverse events must recognize this. But health care providers are affected, too. Wu articulated this in coining the term “second victim” in 2000.2 The term has become controversial.3 On reflection, perhaps “second casualty” is better—it’s free of any implication of intent to harm and perhaps of an individual perpetrator. Whatever the terminology, evaluation of this harm in the existing literature often groups doctors together. Yet surgeons are worthy of particular focus: the link between an individual’s action or inaction is perceived by patient, press, and practitioners (quite reasonably so) as more direct in surgery than in other branches of medicine.
查看更多>>摘要：In 2021, Vice Admiral Dr. Vivek Murthy released a report titled, “Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment.” In his report, Dr. Murthy discusses not only the dangers of medical misinformation, but also the value of medically exact information both online and on social media. Within the specialty of urology, a growing number of studies have reported misleading medical information on the Internet and “fake news” on popular social media platforms. Inaccurate medical information has the potential to lead to ineffective, costly, and even potentially harmful outcomes for our patients. In addition, medically inaccurate information can complicate the patient-physician relationship by causing confusion, misunderstandings, and potentially even distrust. Fortunately for our patients, medically correct information also exists on the Internet.8 Over the years, the Urology Care Foundation? (the Official Foundation of the American Urological Association) has created over 600 pieces of physician-vetted, guidelines-based patient education materials. These materials include fact sheets, patient guides, and posters.
Zoe GuckienNikhi P. SinghCarter J. BoydSoroush Rais-Bahrami...
3页
查看更多>>摘要：Historically, urology ranks among the most competitive specialties. The Urology Match cycles in 2021 and 2022 saw significant growth coupled with a scarcity of available positions resulting in the match rate of 65.6% in 2022, the lowest since 2014.1 Applicants continue to outnumber available residency positions with only 365 positions offered for a record 556 applicants submitting rank lists to the American Urological Association (AUA) Residency Match in 2022, leaving 191 applicants unmatched.1 The increased number of applications per applicant and overall applicants places an intensified burden on both applicants and residency programs. The COVID-19 pandemic created unforeseeable changes in medical education and the Residency Match process including limitations on clinical rotations, delays in USMLE? (United States Medical Licensing Examination?) scheduling, restrictions on away rotations, and transition to virtual in-terviews.3 To our knowledge, no studies have analyzed trends in the Match including the 2022 cycle. The purpose of this article is to explore longitudinal trends in the Urology Residency Match and the cost burden of application fees on urology applicants.
查看更多>>摘要：Although the urology residency application process has recently undergone several promising changes—the transition to virtual interviews in 2020, the introduction of “preference signaling” in 2021—the persistent and widening disparity between per-applicant application volumes and available training positions warrants concern and attention. Since the 2019 AUA Match, when applicants averaged 71 applications and nearly $1,500 in submission fees,1 applicants have continued to submit more applications each subsequent year despite minimal change in the average number of interviews per applicant. The financial impact of rising application volumes and associated expenses is not theoretical; the present report estimates the future value of loan debt due to 2022 submissions fees at more than $1.68 million. The mounting costs associated with the de facto system of virtually unlimited application volumes are problematic because costs are neither equally distributed among applicants nor shouldered by applicants alone. First, while application fees may in theory discourage or deter excessive submissions, not only do applicants appear unlikely to curb scattershot submission based primarily on the ability to pay, but furthermore those who are least able to absorb the expense of both the rising floor and ceiling of submissions are frequently the ones most disadvantaged in the application process, whether due to structural, demographic, or educational barriers.
Zoe GuckienNikhi P. SinghCarter J. BoydSoroush Rais-Bahrami...
1页
查看更多>>摘要：We appreciate the insights regarding the disproportionate burden placed on certain disadvantaged applicants and the effect of the increasing application volume on residency programs, which are both perspectives that are often overlooked. Our analysis focused solely on application costs, but as the current study showed, application-related fees comprise only a small portion of the financial responsibility. In a study from 2014, up to 95% of urology applicants completed at least 1 away rotation and attended an average of 14 interviews with an added cost in excess of $8,000 in current dollar value estimates. These fees are not allocated to programs, making additional application fees beneficial to neither applicants’ financial wellness nor programs’ ability to cover the added time required to thoroughly review the increasing volume of applications. While virtual interviews and open houses have their own inherent drawbacks, they can aid in minimizing travel costs, serving as an added equalizer to curb the financial limitations for some applicants and programs alike. In combination with continued progress toward a more equitable, holistic review of residency applicants (preference signaling, secondary applications, etc), it will be interesting to observe how virtual residency recruitment activities continue to evolve as the pandemic catalyst, which gave rise to their widespread implementation, dissipates.
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