Top 100 Urology Influences on Twitter: Is Social Media Influence Associated with Academic Impact?

Introduction: The purpose of this cross-sectional study is to identify and describe the top 100 urology influencers on the social media platform Twitter. Furthermore, we aim to correlate each individual\u27s Twitter influence with academic impact in urology. Materials and Methods: Twitter influence scores for the topic search “urology” were collected in April 2022 using the Right Relevance software, which accounts for the individual\u27s connections (followers/following) to other influencers in urology as well as engagement (likes, retweets, and views) on the platform. The top 100 personal accounts with the highest computed scores were linked to individuals’ names, all-time h-index, geographic location, specialty, sex, and board certification. We examined the Pearson correlation coefficient between influence rank and h-index. Results: We identified the top 100 Twitter influencers on the topic of “urology.” The majority are from the United States (63%), male (85%), and are practicing urologists (93%). Ninety-three percent (93%) of U.S. urology influencers are board certified. Only 22 out of the 50 states are represented. The second most common country is the United Kingdom with 11 urology influencers. The median all-time h-index is 41.5 (IQR: 27 – 55.5). There is a weak positive coefficient (r=0.26) between the influence rank and h-index (p=0.021). Conclusions: The top Twitter influencers in urology are mostly Board-certified U.S. urologists. Collectively, influencers have a relatively greater academic impact compared to the average urologist, although there is a weak positive correlation between Twitter influence and h-index among top Twitter influencers

Long-term risk of recurrence in surgically treated intermediate-high risk renal cell carcinoma: a post-hoc analysis of the Eastern Cooperative Oncology Group - American College of Radiology Imaging Network E2805 Trial cohort

Background: Surgical resection remains the gold standard treatment modality for clinically localized renal cell carcinoma (RCC). However, the optimal follow-up period in these individuals is controversial, and the current recommendations are based on retrospective data, which inevitably contain attrition bias. Our objective was to re-visit the recurrence rate of surgically treated intermediate-high risk RCC patients using randomized clinical trial data. MethodsWe performed a post-hoc analysis of all the patients that were included in the ECOG-ACRIN E2805 Trial. We assessed post-operative recurrence rates using the cumulative incidence method. Conditional estimates of a 36-month recurrence for patients whom did not have recurrence at set intervals following surgery was performed. Assessment of routinely available clinical and pathological features in predicting disease recurrence at time 0-months after surgery was compared it to that of the same features at 60-months after surgery.ResultsThe original cohort consisted of 1943 patients . Median follow-up for the 1508 patients whom were alive at the end of the study was 67.9 months (IQR 56.7 – 82.0). 730 patients developed disease recurrence. The 36-month cumulative incidence of recurrence was found to be 31.1% (IQR 29.3 – 33.6) for the entire cohort at 0-months from surgery. The rate changed to 26.0% (IQR 23.7 – 28.2), 18.8% (IQR 16.5 – 21.1), 16.1% (IQR 13.6 – 18.8), 18.9% (IQR 15.0 – 23.1) and 20.3% (IQR 12.5 – 28.1) for patients whom did not have recurrence at 12-, 24-, 36-, 48- and 60-months from surgery, respectively. At time 0-month from surgery, age (hazard ratio [HR]: 1.01, 95% confidence interval [CI]: 1.00-1.02), pathologic T3/4 stage (HR: 1.557, 95%CI: 1.17 - 2.07), pathologic N1/2 stage (HR: 2.38, 95%CI: 1.85 - 3.07), Fuhrman grade 3 (HR: 1.36, 95%CI: 1.14 - 1.62) and Fuhrman grade 4 (HR: 2.41, 95%CI: 1.96 - 2.96) were independent predictors of recurrence. Conversely, none of the aforementioned covariates were predictors of disease recurrence at 60-months following surgery. Conclusions: Long-term follow-up, beyond 5-years, is supported by the findings within the present study. Also, the usual independent predictors that are frequently used to guide patient follow-up demonstrated validity immediately following surgery however lose their predictive power at 5 years from surgery.https://scholarlycommons.henryford.com/merf2019clinres/1028/thumbnail.jp

Disparities in selective referral for cancer surgeries: implications for the current healthcare delivery system

Objectives: Among considerable efforts to improve quality of surgical care, expedited measures such as a selective referral to high-volume institutions have been advocated. Our objective was to examine whether racial, insurance and/or socioeconomic disparities exist in the use of high-volume hospitals for complex surgical oncological procedures within the USA. Design, setting and participants Patients undergoing colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy or prostatectomy were identified retrospectively, using the Nationwide Inpatient Sample, between years 1999 and 2009. This resulted in a weighted estimate of 2 508 916 patients. Primary outcome measures Distribution of patients according to race, insurance and income characteristics was examined according to low-volume and high-volume hospitals (highest 20% of patients according to the procedure-specific mean annual volume). Generalised linear regression models for prediction of access to high-volume hospitals were performed. Results: Insurance providers and county income levels varied differently according to patients’ race. Most Caucasians resided in wealthier counties, regardless of insurance types (private/Medicare), while most African Americans resided in less wealthy counties (≤$24 999), despite being privately insured. In general, Caucasians, privately insured, and those residing in wealthier counties (≥$45 000) were more likely to receive surgery at high-volume hospitals, even after adjustment for all other patient-specific characteristics. Depending on the procedure, some disparities were more prominent, but the overall trend suggests a collinear effect for race, insurance type and county income levels. Conclusions: Prevailing disparities exist according to several patient and sociodemographic characteristics for utilisation of high-volume hospitals. Efforts should be made to directly reduce such disparities and ensure equal healthcare delivery

Low CAIX expression and absence of VHL gene mutation are associated with tumor aggressiveness and poor survival of clear cell renal cell carcinoma.

International audienceWe attempted to describe, in a series of clear cell renal cell carcinoma (RCC), the relationship between CAIX expression, VHL gene mutations, tumor characteristics and outcome. Radical nephrectomy was performed in 100 patients. Genomic DNA was extracted from frozen tumor samples. Four amplimers covering the whole coding sequence of the VHL gene were synthesized by PCR and sequenced. The monoclonal antibody M75 was used to evaluate CAIX protein expression immunohistochemically. VHL mutations were identified in 58 patients (58%) and high CAIX expression (>85%) was observed in 78 (78%). Tumors with VHL mutation showed higher CAIX expression than those without (p = 0.02). Low CAIX expression and absence of VHL mutation were associated with a more advanced tumors e.g., higher T stages and presence of metastases. VHL mutation and high CAIX expression predicted longer progression-free survival (p = 0.037) and disease-specific survival (p = 0.001), respectively. In combination, they defined three prognostic groups (p = 0.002): (i) good prognosis, defined as VHL mutation and high CAIX (2-year survival: 86%), (ii) intermediate prognosis with either VHL mutation or high CAIX (69%), and (iii) poor prognosis with no VHL mutation and low CAIX (45%, median survival 18 months). CAIX expression, but not VHL mutational status, was an independent prognostic factor in multivariate analysis. Taken together, CAIX expression and VHL mutational status are able to stratify patients with clear cell RCC into distinct groups with regards to clinicopathological variables and prognosis, with low CAIX expression and absence of VHL mutation being associated with a poor clinicopathological phenotype and diminished survival

Admission Rates, Healthcare Utilization, and Economic Burden of Radiation Cystitis (RC) in the United States

INTRODUCTION AND OBJECTIVES: Radiation cystitis (RC) is a major cause of morbidity after radiotherapy for pelvic cancers. In the absence of a definite cure, patients may require repeated admissions, undergoing multiple - often morbid - urological procedures. Our aim was to study the inpatient economic burden and healthcare utilization associated with RC in the United States (US). METHODS: We focused on 13,272 records of adult (age \u3e= 18) patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008- 2014. Patients with a concurrent diagnosis of other bladder conditions (n=914) were excluded. Due to a change in NIS sampling methodology in 2012, trend of RC-associated admissions was analyzed for 2012-2014. ICD-9 diagnosis and procedure codes were used to study inpatient procedures performed during admission. Complex survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission. Inflation- adjusted cost for each admission and cumulative annual cost of RC-associated admissions were calculated for the study period. RESULTS: The 12,358 assessable patients represented 61,346 admissions for RC nationally per NIS survey weights. The number of admissions increased gradually from 1681 (weighted 8405) in 2012 to 1803 (weighted 9015) in 2014. Overall 84% of all RC-associated admissions were non-elective. 74% of the patients were males. A vast majority (82%) of the patients had Medicare/Medicaid insurance. The admissions were equally distributed between teaching (49%) and non-teaching (51%) hospitals, however, 90% of the admissions were in hospitals located in urban areas. Any RC-directed procedure code was recorded in 62% admissions. Of these, 3,331 (43%) admissions recorded more than one procedure code. Blood transfusion was the most frequently recorded code (33%), followed by transurethral procedures (28%) and cystoscopy (12.6%). Radical cystectomy was done in 1.3% of the admissions. The median length of stay was 4.4 days (IQR 2.2-8.4).The inflation-adjusted cost per admission was 9207 US dollars (IQR 5275 -17,573) overall, being higher in teaching hospitals (median 9802 vs 8463 US dollars in non-teaching hospitals. The cumulative cost of inpatient treatment of radiation cystitis was 63.5 million US dollars per year, amounting to a total of 952.2 million over the study period. CONCLUSIONS: The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.https://scholarlycommons.henryford.com/merf2019qi/1020/thumbnail.jp

Gender Gap in Industry Payments to Urologists

Background: The Open Payments Program (OPP) was established in 2013 under the Sunshine Act, which mandated that medical device and pharmaceutical manufacturers submit public records of any financial incentive given to physicians. The study aim is to characterize the gap in general and research payments between male and female urologists over the past 7 years. Methods: The study sample included all urologists in the US who received at least one general (GP) or research payment from 2015 to 2021. In order to identify urologists’ genders, the OPP was matched with the National Provider Index dataset. Payments to male versus female urologists were analyzed by geography, year, payment type, subspecialty, and industry payer with nominal payments adjusted to the base year’s US dollar using the Bureau of Labor Statistics’ Consumer Price Index – Urban (CPI-U). Results: 1,351,533 payments to 13,678 urologists were analyzed. Of them, 11,926 urologists were male, and 1,752 were female with an average general payment of $17,683.18 to male urologists compared to$5,825.09 to female urologists. Women not only received fewer consultant, royalty/license, speaker, and equity payments, but also received less per transaction in these categories. Conclusions: This study is the first to characterize differences in both research and general payments between male and female urologists. Further studies are needed to understand and interpret the unequal relationships between male and female urologists with industry. Industry should actively work to equitably engage female urologists in consultancies, speaking engagements, and research

National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA

Objectives: While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national trends after major cancer surgery. Design: Retrospective, cross-sectional analysis of a weighted-national estimate from the Nationwide Inpatient Sample (NIS) undergoing major oncological procedures (colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy and prostatectomy). The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were utilised to identify trends in hospital-acquired adverse events. Setting: Secondary and tertiary care, US hospitals in NIS Participants: A weighted-national estimate of 2 508 917 patients (>18 years, 1999–2009) from NIS. Primary outcome measures Hospital-acquired adverse events. Results: 324 852 patients experienced ≥1-PSI event (12.9%). Patients with ≥1-PSI experienced higher rates of in-hospital mortality (OR 19.38, 95% CI 18.44 to 20.37), prolonged length of stay (OR 4.43, 95% CI 4.31 to 4.54) and excessive hospital-charges (OR 5.21, 95% CI 5.10 to 5.32). Patients treated at lower volume hospitals experienced both higher PSI events and failure-to-rescue rates. While a steady increase in the frequency of PSI events after major cancer surgery has occurred over the last 10 years (estimated annual % change (EAPC): 3.5%, p<0.001), a concomitant decrease in failure-to-rescue rates (EAPC −3.01%) and overall mortality (EAPC −2.30%) was noted (all p<0.001). Conclusions: Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required

Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro‐ureterectomy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99046/1/bju11649.pd