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Brajcich BC, Johnson JK, Holl JL, Bilimoria KY, Ager MS, Chung J, Joung RHS, Iroz CB, Odell DD, Bentrem DJ, Yang AD, Franklin PD, Slota JM, Silver CM, Skolarus T, Merkow RP. Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery. J Surg Oncol 2023. [PMID: 37126379 DOI: 10.1002/jso.27292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Emergency department (ED) utilization after gastrointestinal cancer operations is poorly characterized. Our study objectives were to determine the incidence of, reasons for, and predictors of ED treat-and-release encounters after gastrointestinal cancer operations. METHODS Patients who underwent elective esophageal, hepatobiliary, gastric, pancreatic, small intestinal, or colorectal operations for cancer were identified in the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The primary outcomes were the incidence of ED treat-and-release encounters and readmissions within 30 days of discharge. RESULTS Among 51 527 patients at 406 hospitals, 4047 (7.9%) had an ED treat-and-release encounter, and 5573 (10.8%) had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. ED treat-and-release encounters were most frequently for pain (12.0%), device/ostomy complaints (11.7%), or wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.12-1.37) and Medicare (OR 1.27, 95% CI 1.16-1.40) or Medicaid (OR 1.82, 95% CI 1.62-2.40) coverage. CONCLUSIONS ED treat-and-release encounters are common after major gastrointestinal operations, making up nearly half of postdischarge ED encounters. The reasons for ED treat-and-release encounters differ from those for ED encounters with readmissions.
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Affiliation(s)
- Brian C Brajcich
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Julie K Johnson
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Karl Y Bilimoria
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jeanette Chung
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel Hae Soo Joung
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cassandra B Iroz
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D Odell
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Surgical Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Anthony D Yang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer M Slota
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Casey M Silver
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Ted Skolarus
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Ryan P Merkow
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
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Herr D, Elliott D, Stensland K, Caram MV, Burns J, Hollenbeck B, Sparks J, Shin C, Zaslavsky A, Tsodikov A, Skolarus T. National population-based survival estimates after definitive radiation therapy for prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
395 Background: Understanding contemporary radiation therapy outcomes for prostate cancer (i.e., metastasis, death) is important for shared decision-making and setting expectations for patients and providers. Unfortunately, long-term outcome estimates are often derived from meta-analyses of outdated prospective clinical trials or population-based data lacking reliable clinical details (e.g., incident metastatic disease). For these reasons, we used a recently validated, natural language processing algorithm to identify incident metastatic prostate cancer within the electronic medical records of men treated with radiation therapy for localized prostate cancer in order to conduct an innovative and contemporary population-based survival outcomes study. Methods: We used national administrative, cancer registry, and electronic health record data for patients undergoing definitive radiation therapy with or without concurrent androgen deprivation therapy (ADT) within the Veterans Health Administration from 2005 to 2015. We used National Death Index data through 2019 for overall and prostate cancer-specific survival, and identified the date of incident metastatic prostate cancer using a validated natural language processing algorithm. We estimated metastasis-free, prostate cancer-specific, and overall survival using Kaplan-Meier methods. Results: We identified 41,876 patients treated with definitive radiation therapy for prostate cancer from 2005 through 2015, and followed them for over 8 years (follow up, median, 8.7 years, age at diagnosis, median, 65 years). Most patients had intermediate (42%) and high risk (33%) disease, with nearly half treated with ADT as part of initial therapy (44%). Unadjusted 10-year metastasis-free survival was 96%, 92%, and 80% for low, intermediate, and high risk disease. Similarly, unadjusted 10-year prostate cancer-specific survival was 98%, 97%, and 90% for low, intermediate, and high risk disease. Unadjusted overall survival was lower across disease risk categories at 77%, 71%, and 62% for low, intermediate, and high risk disease. Conclusions: These data provide population-based benchmarks for clinically relevant endpoints, including metastasis-free survival, among patients with low, intermediate, and high risk prostate cancer undergoing radiation therapy using contemporary techniques. The survival rates for high risk disease, in particular, compare favorably with historical outcomes.
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Affiliation(s)
- Daniel Herr
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - David Elliott
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | | | | | - Jennifer Burns
- HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Jordan Sparks
- HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Chris Shin
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | | | - Alexander Tsodikov
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Ted Skolarus
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
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Wang T, Bredbeck BC, Sinco B, Shubeck S, Baskin AS, Skolarus T, Dossett LA. Variations in Persistent Use of Low-Value Breast Cancer Surgery. JAMA Surg 2021; 156:353-362. [PMID: 33533894 DOI: 10.1001/jamasurg.2020.6942] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. Objective To identify variation and determinants of persistent use of low-value breast cancer surgical care. Design, Setting, and Participants Retrospective cohort study in which reliability-adjusted facility rates of each procedure were calculated using random-intercept hierarchical logistic regression before and after evidence demonstrated that each procedure was unnecessary. The National Cancer Database is a prospective cancer registry of patients encompassing approximately 70% of all new cancer diagnoses from more than 1500 facilities in the United States. Data were analyzed from November 2019 to August 2020. The registry included women 18 years and older diagnosed as having breast cancer between 2004 and 2016 and meeting inclusion criteria for each Choosing Wisely recommendation. Main Outcomes and Measures Rate of each low-value breast cancer procedure based on facility type and breast cancer volume categories before and after the release of data supporting each procedure's omission. Results The total cohort included 920 256 women with a median age of 63 years. Overall, 86% self-identified as White, 10% as Black, 3% as Asian, and 4.5% as Hispanic. Most women in this cohort were insured (51% private and 47% public), were living in a metropolitan or urban area (88% and 11%, respectively), and originated from the top half of income-earning households (65.5%). While there was significant deimplementation of axillary lymph node dissection and lumpectomy reoperation in response to guidelines supporting omission of these procedures, rates of contralateral prophylactic mastectomy and sentinel lymph node biopsy in older women increased during the study period. Academic research programs and high-volume facilities overall demonstrated the greatest reduction in use of these low-value procedures. There was significant interfacility variation for each low-value procedure. Facility-level axillary lymph node dissection rates ranged from 7% to 47%, lumpectomy reoperation rates ranged from 3% to 62%, contralateral prophylactic mastectomy rates ranged from 9% to 67%, and sentinel lymph node biopsy rates ranged from 25% to 97%. Pearson correlation coefficient for each combination of 2 of the 4 procedures was less than 0.11, suggesting that hospitals were not consistent in their deimplementation performance across all 4 procedures. Many were high outliers in one procedure but low outliers in another. Conclusions and Relevance Interfacility variation demonstrates a performance gap and an opportunity for formal deimplementation efforts targeting each procedure. Several facility-level characteristics were associated with differential deimplementation and performance.
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Affiliation(s)
- Ton Wang
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brooke C Bredbeck
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brandy Sinco
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Sarah Shubeck
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison S Baskin
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor.,University of Michigan School of Medicine, Ann Arbor
| | - Ted Skolarus
- Department of Urology, Michigan Medicine, Ann Arbor.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
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Stensland K, Kaffenberger S, Canes D, Galsky M, Skolarus T, Moinzadeh A. Assessing Genitourinary Cancer Clinical Trial Accrual Sufficiency Using Archived Trial Data. JCO Clin Cancer Inform 2020; 4:614-622. [DOI: 10.1200/cci.20.00031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Clinical trials often fail to reach their anticipated end points, most frequently because of poor accrual. Prior studies have analyzed trial termination, but it has not been easy to assess accrual estimates using international databases such as ClinicalTrials.gov because of limitations in accessing accrual information. Specifically, it is not easy to extract both anticipated and actual accrual of clinical trials. We designed a new algorithmic approach to extracting trial accrual data from ClinicalTrials.gov and used it to estimate the sufficiency of patient accrual onto genitourinary (GU) cancer trials. METHODS We queried ClinicalTrials.gov for completed/terminated phase II and III clinical trials for prostate, bladder, kidney, testicular, and ureteral cancers registered after 2007. We extracted trial characteristics from available XML files. We then used a Python algorithm to access prior trial registrations on the ClinicalTrials.gov archive site and extract both anticipated and actual accrual numbers. We then compared the actual accrual of each trial to its anticipated accrual and defined sufficient accrual as 85% of anticipated accrual. RESULTS The algorithm was 100% accurate compared with hand extraction in a small validation subset. A total of 925 trials were included, of which 840 (91%) had both anticipated and actual accrual. Only 418 (50%) trials had sufficient accrual (≥ 85% of anticipated). Considering only trials marked as successfully completed, 395/597 (66%) reached sufficient accrual. CONCLUSION GU cancer trials often do not meet their anticipated accrual goals. New approaches to trial conduct are direly needed. Our reproducible and scalable approach to extracting accrual information can be applied to analysis of ClinicalTrials.gov in future analyses in the hope of improving the efficiency of the clinical trials enterprise.
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Affiliation(s)
| | | | - David Canes
- Lahey Hospital and Medical Center, Burlington, MA
| | - Matthew Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Parry M, Nossiter J, Cowling T, Sujenthiran A, Berry B, Aggarwal A, Cathcart P, Payne H, Clarke N, Skolarus T, Van Der Meulen J. Patient-reported urinary incontinence following radical prostatectomy for prostate cancer and its association with undergoing incontinence surgery: A national population-based study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chapman C, Burns J, Tsodikov A, Chang M, Deville C, Hollenbeck B, Skolarus T. Clinical Predictors and Disparities in Surveillance PSA Utilization after Prostate Cancer Treatment. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sessine M, Borza T, Weizer A, Kirk P, Liu X, Li B, Hollenbeck B, Qin Y, Jacobs B, Urish K, Helm J, Lavieri M, Skolarus T. MP71-02 REFRAMING READMISSION REDUCTION INCENTIVES AFTER RADICAL CYSTECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fam M, Yabes J, Hale N, Turner R, Bandari J, Macleod L, Hugar L, Gingrich J, Borza T, Skolarus T, Davies B, Jacobs B. MP71-20 COMPARATIVE EFFECTIVENESS OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN THE MEDICARE BLADDER CANCER POPULATION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Fam M, Yabes J, Hale N, Turner R, Yu M, Macleod L, Hugar L, Gingrich J, Borza T, Skolarus T, Davies B, Jacobs B. MP44-02 CHANGING TRENDS IN THE USE OF CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER IN THE UNITED STATES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee M, Hollenbeck B, Oerline M, Skolarus T, Jacobs B, Jen R, Luckenbaugh A, Shahinian V, Borza T. MP86-16 SPILLOVER EFFECTS OF THE HOSPITAL READMISSION REDUCTION PROGRAM ON RADICAL CYSTECTOMY READMISSIONS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ginossar T, Heckman CJ, Cragun D, Quintiliani LM, Proctor EK, Chambers DA, Skolarus T, Brownson RC. Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education. J Med Educ Curric Dev 2018; 5:2382120518761875. [PMID: 29707648 PMCID: PMC5892792 DOI: 10.1177/2382120518761875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity. METHODS We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education. RESULTS Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges. CONCLUSIONS Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication & Journalism and the Comprehensive Cancer Center, The University of New Mexico, Albuquerque, NM, USA
| | - Carolyn J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Deborah Cragun
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lisa M Quintiliani
- School of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ted Skolarus
- Section Chief, Urology, VA Ann Arbor Healthcare System Associate Professor, Department of Urology, University of Michigan VA Ann Arbor HSR&D Center for Clinical Management Research
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Wittmann D, Mehta A, Northouse L, Dunn R, Braun T, Duby A, An L, Arab L, Bangs R, Bober S, Brandon J, Coward M, Dunn M, Galbraith M, Garcia M, Giblin J, Glode M, Koontz B, Lowe A, Mitchell S, Mulhall J, Nelson C, Paich K, Saigal C, Skolarus T, Stanford J, Walsh T, Pollack CE. TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial. BMC Cancer 2017; 17:664. [PMID: 28969611 PMCID: PMC5625773 DOI: 10.1186/s12885-017-3652-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 09/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. METHODS The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. DISCUSSION The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.
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Affiliation(s)
- D Wittmann
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA.
| | - A Mehta
- Emory University, Atlanta, GA, USA
| | - L Northouse
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - R Dunn
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - T Braun
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - A Duby
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L An
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L Arab
- University of California-Los Angeles, California, Los Angeles, USA
| | - R Bangs
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - S Bober
- Dana Farber Cancer Center and Harvard University, Boston, MA, USA
| | - J Brandon
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - M Coward
- University of North Carolina, Chapel Hill, NC, USA
| | - M Dunn
- University of North Carolina, Chapel Hill, NC, USA
| | - M Galbraith
- University of Colorado-Denver, Denver, CO, USA
| | - M Garcia
- University of California-San Francisco, San Francisco, CA, USA
| | - J Giblin
- Emory University, Atlanta, GA, USA
| | - M Glode
- University of Colorado-Denver, Denver, CO, USA
| | - B Koontz
- Duke University, Durham, NC, USA
| | - A Lowe
- Prostate Cancer Foundation-Australia, St Leonards, Australia
| | - S Mitchell
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - J Mulhall
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - C Nelson
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - K Paich
- TrueNTH Movember Foundation, Michigan, USA
| | - C Saigal
- University of California-Los Angeles, California, Los Angeles, USA
| | - T Skolarus
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
- VA Ann Arbor Healthcare System, HSRD Center for Clinical Management Research, Ann Arbor, USA
| | - J Stanford
- Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - T Walsh
- University of Washington, Seattle, Washington, USA
| | - C E Pollack
- Johns Hopkins University, Baltimore, MD, USA
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Daskivich T, Thomas IC, Skolarus T, Leppert J. PD03-05 EXTERNAL VALIDATION OF THE AGE-ADJUSTED PROSTATE CANCER-SPECIFIC COMORBIDITY INDEX (PCCI), A CLAIMS-BASED TOOL FOR PREDICTION OF LIFE EXPECTANCY IN MEN WITH PROSTATE CANCER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Auffenberg G, Dunn R, Qin Y, Winkelman T, Dupree J, Hollenbeck B, Skolarus T, Miller D, Borza T. PD58-05 CONTRIBUTING TO A CRISIS? DEFINING NATIONAL PATTERNS IN OPIOID PRESCRIBING AFTER OUTPATIENT VASECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goldfarb R, Brandes S, Kirk P, Borza T, Qin Y, Skolarus T. PD60-11 POPULATION-BASED MANAGEMENT OF MALE URETHRAL STRICTURE DISEASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kirk P, Borza T, Dupree J, Wei J, Ellimoottil C, Caram M, Hollenbeck B, Skolarus T. PD14-05 ECONOMIC IMPLICATIONS OF UROLOGIST PRESCRIPTION PRACTICES AMONG MEDICARE PART D BENEFICIARIES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Guo D, Thomas IC, Mittakanti H, Shelton J, Makarov D, Skolarus T, Cooperberg M, Sonn G, Chung B, Brooks J, Leppert J. PD47-10 THE RESEARCH IMPLICATIONS OF PSA REGISTRY ERRORS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ellimoottil C, Skolarus T, Gettman M, Boxer R, Kutikov A, Lee BR, Shelton J, Morgan T. Telemedicine in Urology: State of the Art. Urology 2016; 94:10-6. [PMID: 27109596 DOI: 10.1016/j.urology.2016.02.061] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
Whereas telemedicine is recognized as one of the fastest-growing components of the healthcare system, the status of telemedicine use in urology is largely unknown. In this narrative review, we detail studies that investigate the use of televisits and teleconsultations for urologic conditions. Moreover, we discuss current regulatory and reimbursement policies. Finally, we discuss the significant barriers to widespread dissemination and implementation of telemedicine and reasons why the field of urology may be positioned to become a leader in the provision of telemedicine services.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
| | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Matthew Gettman
- Department of Urology, Mayo Clinic College of Medicine, Rochester, MN
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, CA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Benjamin R Lee
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jeremy Shelton
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Todd Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
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Tracey J, Ambani S, Osawa T, Skolarus T, He C, Borza T, Weizer A, Montgomery J, Hafez K, Hollenbeck B, Lee C, Morgan T. MP63-17 WEEKEND DISCHARGE AFTER RADICAL CYSTECTOMY AND THE RISK OF READMISSION. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Paich K, Dunn R, Skolarus T, Montie J, Hollenbeck B, Palapattu G, Wood D, Mitchell S, Hola V, Erickson K, Shifferd J, Wittmann D. Preparing Patients and Partners for Recovery From the Side Effects of Prostate Cancer Surgery: A Group Approach. Urology 2015; 88:36-42. [PMID: 26541826 DOI: 10.1016/j.urology.2015.07.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/06/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the acceptance and knowledge attained in a preoperative psychoeducational group seminar for patients and partners. Education before radical prostatectomy (RP) helps patients set appropriate expectations for functional recovery. We hypothesized that the seminar would be acceptable and would facilitate learning. MATERIALS AND METHODS Men scheduled for RP from March 1, 2012, to July 31, 2013, were eligible, and partners were invited. The 2.5-hour interactive seminar included multidisciplinary presentations about surgery-related urinary and sexual outcomes, rehabilitation, and couples' work toward recovering sexual intimacy. A satisfaction and knowledge survey was administered immediately afterward. We analyzed demographic and satisfaction data with descriptive statistics and evaluated congruence of patients' and partners' knowledge responses using nonparametric statistics. RESULTS Of 618 patients scheduled, 426 patients and 342 partners attended; 323 couples provided complete data. Over 90% of participants found the seminar informative and 74% found a group setting comfortable; 84% found travel to the seminar burdensome. Most patients and partners (84% and 90%, respectively) expected some urinary incontinence and understood rehabilitation strategies to regain bladder control; 84% of patients and 78% of partners expected postsurgery sexual activity to be different and 73% of patients and 65% of partners expected surgery to make erections worse. Couples were incongruent regarding frequency of incontinence, likelihood of erectile dysfunction, and sex being different after surgery: patients were more realistic. CONCLUSION A preoperative psychoeducational group seminar on the recovery from RP side effects promotes realistic expectations and is acceptable to patients and partners. Incongruent couples may need further instruction after surgery. Web-based methodology could improve access and should be studied in future research.
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Affiliation(s)
- Kellie Paich
- Department of Urology, University of Michigan, Ann Arbor, MI; Division TrueNTH-USA, Movember Foundation, Culver City, CA
| | - Rodney Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; VA Ann Arbor Healthcare System, HSRD Center for Clinical Management Research, University of Michigan, Ann Arbor, MI
| | - James Montie
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | | | | | - Staci Mitchell
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Victor Hola
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Kim Erickson
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Jennifer Shifferd
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- Department of Urology, University of Michigan, Ann Arbor, MI; School of Social Work, University of Michigan, Ann Arbor, MI.
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Shelton JB, Ochotorena L, Bennett C, Shekelle P, Kwan L, Skolarus T, Goldzweig C. Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support. J Gen Intern Med 2015; 30:1133-9. [PMID: 25740462 PMCID: PMC4510234 DOI: 10.1007/s11606-015-3249-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/10/2014] [Accepted: 02/10/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In 2012, the Veterans Health Administration (VHA) implemented guidelines seeking to reduce PSA-based screening for prostate cancer in men aged 75 years and older. OBJECTIVES To reduce the use of inappropriate PSA-based prostate cancer screening among men aged 75 and over. SETTING The Veterans Affairs Greater Los Angeles Healthcare System (VA GLA) PROGRAM DESCRIPTION: We developed a highly specific computerized clinical decision support (CCDS) alert to remind providers, at the moment of PSA screening order entry, of the current guidelines and institutional policy. We implemented the tool in a prospective interrupted time series study design over 15 months, and compared the trends in monthly PSA screening rate at baseline to the CCDS on and off periods of the intervention. RESULTS A total of 30,150 men were at risk, or eligible, for screening, and 2,001 men were screened. The mean monthly screening rate during the 15-month baseline period was 8.3%, and during the 15-month intervention period, was 4.6%. The screening rate declined by 38% during the baseline period and by 40% and 30%, respectively, during the two periods when the CCDS tool was turned on. The screening rate ratios for the baseline and two periods when the CCDS tool was on were 0.97, 0.78, and 0.90, respectively, with a significant difference between baseline and the first CCDS-on period (p < 0.0001), and a trend toward a difference between baseline and the second CCDS-on period (p = 0.056). CONCLUSION Implementation of a highly specific CCDS tool alone significantly reduced inappropriate PSA screening in men aged 75 years and older in a reproducible fashion. With this simple intervention, evidence-based guidelines were brought to bear at the point of care, precisely for the patients and providers for whom they were most helpful, resulting in more appropriate use of medical resources.
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Affiliation(s)
- Jeremy B Shelton
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA,
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Chu S, Boxer R, Madison P, Kleinman L, Skolarus T, Altman L, Bennett C, Shelton J. Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics. Urology 2015; 86:255-60. [PMID: 26168998 DOI: 10.1016/j.urology.2015.04.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/24/2015] [Accepted: 04/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the use of telemedicine to deliver general urologic care to remote locations within the Veterans Affairs Greater Los Angeles Healthcare System. We describe the diagnoses managed, patient satisfaction, safety, and benefit to patients in terms of saved travel time and expense. METHODS We conducted a retrospective chart review examining care delivered through urology telemedicine clinics over a 6-month period. We examined the urologic conditions, patient satisfaction, and emergency department visits within 30 days of the visit. We estimated patient benefit by calculating travel distance and time and the saved travel-associated costs using Google Maps and US Census income data. RESULTS Ninety-seven unique telemedicine visits were conducted and a total of 171 urologic diseases were assessed. The most common conditions were lower urinary tract symptoms (35%), elevated prostate-specific antigen level (15%), and prostate cancer (14%). One patient was seen in the emergency department within 30 days with an unpreventable urologic complaint. Patient satisfaction was "very good" to "excellent" in 95% of cases, and 97% would refer another veteran to the urology telemedicine clinic. Patients saved an average of 277 travel miles, 290 minutes of travel time, $67 in travel expenses, and $126 in lost opportunity cost. CONCLUSION Telemedicine was successfully and safely used to evaluate and treat a wide range of urologic conditions within the Veterans Affairs Greater Los Angeles Healthcare System, and saves patients nearly 5 hours and up to $193 per visit. Further investigation of the potential of telemedicine for the delivery of urologic care in a cost-effective manner is warranted.
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Affiliation(s)
- Stephanie Chu
- Department of Urology, University of California, Los Angeles, CA.
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | | | | | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; HSR&D Center for Health Communications Research, Veterans Affairs Ann Arbor, Ann Arbor, MI
| | - Lisa Altman
- Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Carol Bennett
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Jeremy Shelton
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
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Singhal U, Lu L, Skolarus T, Palapattu G, Montgomery J, Weizer A, Hollenbeck B, Miller D, Chan J, Mehra R, Tomlins S, Hamstra D, Feng F, Morgan T. MP56-12 THE ROLE OF PERINEURAL INVASION AS A PROGNOSTIC TOOL IN PROSTATE CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jacobs B, He C, Li B, Hu M, Helfand A, Krishnan N, Hollenbeck B, Helm J, Lavieri M, Skolarus T. MP32-15 READMISSION INTENSITY AFTER HIGH-RISK SURGERY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bernat J, Wittmann D, Hawley S, Haggstrom D, Darwish-Yassine M, Skolarus T. MP27-12 DETERMINANTS OF INFORMATION NEEDS IN LONG-TERM PROSTATE CANCER SURVIVORS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schroeck F, Kaufman S, Jacobs B, Skolarus T, Hollingsworth J, Miller D, Suskind A, Hollenbeck B. 424 REGIONAL VARIATION IN THE QUALITY OF PROSTATE CANCER CARE. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ambani S, Weizer A, Montgomery J, Miller D, He C, Dailey S, Crossley H, Hafez K, Hollenbeck B, Skolarus T, Lee C, Montie J, Palapattu G, Morgan T. 1766 LENGTH OF STAY FOLLOWING RADICAL CYSTECTOMY: HOW LONG IS LONG ENOUGH? J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wittmann D, Skolarus T, Montie J. 1489 COUPLES' EXPECTATIONS OF ERECTILE RECOVERY AFTER RADICAL PROSTATECTOMY FOCUS ON SELF- AND SURGEON EFFICACY, NOT ON NERVE DAMAGE. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shelton J, Skolarus T, Malin J, Antonio AL, Saigal C. 82 SPECIFICATION AND VALIDATION OF PROSTATE CANCER QUALITY OF CARE E-MEASURES IN THE VETERANS HEALTH ADMINISTRATION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zhang S, Skolarus T, Hollenbeck B. 336 SHIFTING INPATIENT TO OUTPATIENT CARE FOR PROSTATE CANCER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Skolarus T, Zhang S, Miller D, Wei J, Hollenbeck B. 337 THE ECONOMIC BURDEN OF PROSTATE CANCER SURVIVORSHIP CARE. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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