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Nabavizadeh B, Hakam N, Holler JT, Namiri NK, Sadighian MJ, Rios N, Enriquez A, Amend GM, Breyer BN. Epidemiology of child playground equipment-related injuries in the USA: Emergency department visits, 1995-2019. J Paediatr Child Health 2022; 58:69-76. [PMID: 34245468 DOI: 10.1111/jpc.15644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/14/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022]
Abstract
AIM To analyse the most recent trends and characteristics of playground equipment-related injuries in children. METHODS We used the National Electronic Injury Surveillance System database to acquire cases of playground equipment-related injuries in children ≤17 years old between 1995 and 2019. A total of 184 580 unweighted cases met our study inclusion criteria. RESULTS A total of 5 356 703 (95% confidence interval 4 235 530-6 477 876) emergency department visits for playground-related injuries in the USA were estimated during the study period which was equal to an average of 29.4 annual injuries per 10 000 US population ≤17 years. The mean age was 6.5 (standard error 0.049) years. School-aged (42.7%) and pre-school children (35.3%) accounted for most playground injuries. More than half of the injuries were reported in males (53.6%). Most injuries occurred with climbing apparatuses (36%), followed by swings (25.9%) and slides (20.9%). Overall number of injuries (∆ - 22.3%, P = 0.01) and incidence (∆ - 21.6%, P = 0.01) had a declining trend after 2012. However, reported concussion injuries showed an increasing trend during the study (∆ + 28.3%, P < 0.001). A marked seasonal variation in number of injuries existed with most injuries in May and September. CONCLUSIONS Although injuries arising from playground equipment have decreased during the past 8 years, there was an increase in number of reported concussions. The outcomes of this study suggested that further efforts should be directed towards such serious injuries.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Nikan K Namiri
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Natalie Rios
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Anthony Enriquez
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, United States.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States
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Holler JT, Hakam N, Nabavizadeh B, Sadighian MJ, Shibley WP, Li KD, Weiser L, Rios N, Enriquez A, Leapman MS, Amend GM, Breyer BN. Characteristics of Online Crowdfunding Campaigns for Urological Cancers in the United States. Urol Pract 2022; 9:56-63. [PMID: 37145560 DOI: 10.1097/upj.0000000000000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We examined the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S. METHODS This cross-sectional study analyzed publicly available data from GoFundMe, the largest online medical crowdfunding service, via automated web scraping. Online campaigns from 2010 to 2018 with the following primary cancer types were included: kidney, prostate, bladder and testicular. Financial outcomes were compared using Kruskal-Wallis and Wilcoxon rank-sum tests. Multivariable analyses were utilized to identify predictors of campaign financial outcomes. RESULTS Kidney cancers were the most frequent online campaign type (478), followed by prostate (379), bladder (202) and testicular (175) malignancies. Urological cancer campaign recipients frequently requested funding for medical expenses (71%) during active treatment (57%). After adjustment, testicular cancer and children's cancer campaigns generated more donations than other urological and adult cancer campaigns (p <0.05). Family and friend-authored campaigns generated more donations and average donation amounts than self-authored campaigns (p <0.05). Campaign narratives focused on disheartening circumstances received fewer donations than narratives focused on the recipient's high moral character or contributions to society (p <0.05), and unclear narratives received the smallest donation amounts (p <0.05). CONCLUSIONS Urological cancer crowdfunding in the U.S. is primarily used to finance uncovered costs associated with medical care during active treatment. Crowdfunding financial outcomes are likely related to the campaign recipient's age, malignancy type, social network and primary appeal of the narrative. Urologists should be aware of trends in medical crowdfunding in order to better understand the financial burden this patient population faces.
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Affiliation(s)
- Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, California
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, California
| | - William P Shibley
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Lucas Weiser
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Natalie Rios
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Anthony Enriquez
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California
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Li KD, Hakam N, Low P, Lui J, Sadighian MJ, Nabavizadeh B, Shaw NM, Breyer BN. A Legal Database Review of Circumcision Related Litigation in the United States. Urology 2021; 160:94-101. [PMID: 34788667 DOI: 10.1016/j.urology.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To characterize circumcision-related litigation in the United States (US) and factors predictive of lawsuit outcome. Circumcision is a common urologic procedure with medical and ethical nuances. METHODS We reviewed the Nexis Uni legal database for state and federal cases using the term "circumcision" in combination with "medical malpractice" or "negligence" or "medical error" or "complication" or "malpractice" or "tort". Litigation primarily related to circumcision from 1939 to 2021 were reviewed for medical and legal details. RESULTS We identified 77 unique cases. Most cases were processed in state (87%) or appellate (59%) court systems with negligent surgical performance as the most common lawsuit reason (49%). Of reported specialties, urology was the highest proportion represented among named physicians (29%) and most patients were minors at time of circumcision (64%) and lawsuit (59%). Common complications included aesthetic dissatisfaction (20%), pain (19%), impaired sexual function (17%) and surgical trauma/injury (16%). Most verdicts favored physicians (59%), but when against physicians, the median indemnity was $175,000. Lawsuits due to negligent informed consent were significantly more likely to result in verdict favoring the physician compared to those due to negligent surgical performance. CONCLUSIONS Circumcision-related litigation in the US is rare and trial verdicts favor physicians, particularly in federal court cases or when parties allege negligent informed consent. Cases that favored plaintiffs successfully alleged negligent surgical technique. We recommend physicians performing circumcisions receive proper training, clearly communicate potential complications, and ensure appropriate indications for adult patients to reduce malpractice risk.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jason Lui
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Nabavizadeh B, Hakam N, Sadighian MJ, Holler JT, Amend GM, Hampson LA, Penson DF, Breyer BN. Characterizing Standardized Letters of Recommendation in Urology Residency Applications. Urology 2021; 158:18-25. [PMID: 34547345 DOI: 10.1016/j.urology.2021.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify the current formats of standardized letters of recommendation (SLORs) and evaluate their characteristics, the distribution of applicants' ratings, correlation between SLOR domain ratings and conventional application metrics, and potential biases. METHODS We evaluated all applications submitted to our residency program for the 2020-2021 urology match. Two main formats of SLOR were identified. We extracted application characteristics and SLOR domain ratings. RESULTS Ninety SLORs from 82 applicants were reviewed. Applicants were highly rated among top tiers in both formats. Some correlations were observed between domain ratings and application metrics such as Step 1 and Step 2 Clinical Knowledge scores, and percentage of Honors in core clinical clerkships. No statistically significant differences were found between female and male applicants in terms of domain ratings. Alpha Omega Alpha members received higher ratings in "urology resident potential," "academic urologist potential," and "performance as a sub-intern" domains. Applicants from top 40 US medical schools performed better as sub-interns, and were more likely to be ranked higher. Letters from home institutions were associated with higher ratings in several domains. In-person vs virtual interactions received similar ratings except for "communication". CONCLUSION While it is promising to observe such number of SLORs submitted for the first time in urology, the current formats could benefit from further refinement in their structures and domains to distinguish between highly qualified urology applicants more efficiently. Given the transition in Step 1 score reporting to pass/fail outcome, the need for a reliable urology-specific SLOR will be critical.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Lindsay A Hampson
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Li KD, Hakam N, Sadighian MJ, Holler JT, Nabavizadeh B, Amend GM, Fang R, Meeks W, Makarov D, Breyer BN. Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census. Urology 2021; 156:117-123. [PMID: 34331999 DOI: 10.1016/j.urology.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/17/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Raymond Fang
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - William Meeks
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - Danil Makarov
- Population Health and Health Policy, New York University School of Medicine Veterans Affairs New York Harbor Healthcare System-Brooklyn, Brooklyn, NY
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Sadighian MJ, Allen IE, Quanstrom K, Breyer BN, Suskind AM, Baradaran N, Copp HL, Hampson LA. Caregiver Burden Among Those Caring for Patients With Spina Bifida. Urology 2021; 153:339-344. [PMID: 33812880 DOI: 10.1016/j.urology.2021.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE 1) To identify baseline characteristics of caregivers of school-aged children with spina bifida; 2) To identify independent predictors of caregiver burden in this population. MATERIALS AND METHODS A survey was distributed via Facebook advertising to caregivers of patients with congenital genitourinary anomalies from May to September 2018. Eligible participants (n = 408) entailed English-speaking adults who are involved in the patient's care and attend ≥50% of their medical appointments. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI), where higher scores indicate higher burden. CBI ≥24 indicates need for respite and CBI ≥36 indicates high risk of burnout. Bivariate analyses (t-tests and chi-square tests) were conducted using STATA software. RESULTS Our analysis includes 408 caregivers caring for patients with spina bifida. In our study population, 59.3% of caregivers were in need of respite due to caregiver burden and 26.7% of caregivers were so burdened that they are at risk of burning out (CBI score ≥36). Bivariate analysis showed that caregiver gender and number of tasks performed by the caregiver were significantly associated with risk of burnout (CBI ≥ 36). Multivariable analysis of overall caregiver burden showed increased risk of burnout (CBI ≥ 36) among older caregivers, female caregivers, and those performing more caregiving tasks. CONCLUSION Caregiver burden is common among caregivers of patients with spina bifida, and further research is needed to identify strategies and resources for mitigating caregiver burden.
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Affiliation(s)
- Michael J Sadighian
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Isabelle E Allen
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Kathryn Quanstrom
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; University of Michigan, Ann Arbor, MI
| | - Benjamin N Breyer
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Anne M Suskind
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, Ohio State University, Columbus, OH
| | - Hillary L Copp
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Lindsay A Hampson
- School of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
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