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Jefferson FA, Fadel A, Findlay BL, Robinson MO, Seyer AK, Koo K, Granberg CF, Boorjian SA, Anderson KT. The prevalence of impostor phenomenon and its association with burnout amongst urologists. BJU Int 2024; 133:579-586. [PMID: 38378021 DOI: 10.1111/bju.16301] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout. SUBJECTS AND METHODS A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America. RESULTS A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001). CONCLUSION Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.
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Affiliation(s)
| | - Anthony Fadel
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Amanda K Seyer
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Ryu JH, Kim YB, Jung TY, Ko WJ, Kim SI, Kwon D, Kim DY, Oh TH, Yoo TK. Practice Patterns of Korean Urologists Regarding Positive Surgical Margins after Radical Prostatectomy: a Survey and Narrative Review. J Korean Med Sci 2021; 36:e256. [PMID: 34697927 PMCID: PMC8546307 DOI: 10.3346/jkms.2021.36.e256] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is no clear consensus on the optimal treatment with curative intent for patients with positive surgical margins (PSMs) following radical prostatectomy (RP). The aim of this study was to investigate the perceptions and treatment patterns of Korean urologists regarding the resection margin after RP. METHODS A preliminary questionnaire was prepared by analyzing various studies on resection margins after RP. Eight experienced urologists finalized the 10-item questionnaire. In July 2019, the final questionnaire was delivered via e-mail to 105 urologists in Korea who specialize in urinary cancers. RESULTS We received replies from 91 of the 105 urologists (86.7%) in our sample population. Among them, 41 respondents (45.1%) had performed more than 300 RPs and 22 (24.2%) had completed 500 or more RPs. In the question about whether they usually performed an additional biopsy beyond the main specimen, to get information about surgical margin invasion during surgery, the main opinion was that if no residual cancer was suspected, it was not performed (74.7%). For PSMs, the Gleason score of the positive site (49.5%) was judged to be a more important prognostic factor than the margin location (18.7%), multifocality (14.3%), or margin length (17.6%). In cases with PSMs after surgery, the prevailing opinion on follow-up was to measure and monitor prostate-specific antigen (PSA) levels rather than to begin immediate treatment (68.1%). Many respondents said that they considered postoperative radiologic examinations when PSA was elevated (72.2%), rather than regularly (24.4%). When patients had PSMs without extracapsular extension (pT2R1) or a negative surgical margin with extracapsular extension (pT3aR0), the response 'does not make a difference in treatment policy' prevailed at 65.9%. Even in patients at high risk of PSMs on preoperative radiologic screening, 84.6% of the respondents said that they did not perform neoadjuvant androgen deprivation therapy. Most respondents (75.8%) indicated that they avoided nerve-sparing RP in cases with a high risk of PSMs, but 25.7% said that they had tried nerve-sparing surgery. Additional analyses showed that urologists who had performed 300 or more prostatectomies tended to attempt more nerve-sparing procedures in patients with a high risk of PSMs than less experienced surgeons (36.6% vs. 14.0%; P = 0.012). CONCLUSION The most common response was to monitor PSA levels without recommending any additional treatment when PSMs were found after RP. Through this questionnaire, we found that the perceptions and treatment patterns of Korean urologists differed considerably according to RP resection margin status. Refined research and standard practice guidelines are needed.
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Affiliation(s)
- Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Dongdeuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk Yoon Kim
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Tae Hee Oh
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
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Gomes CM, Favorito LA, Henriques JVT, Canalini AF, Anzolch KMJ, de Carvalho Fernandes R, Bellucci CHS, Silva CS, Wroclawski ML, Pompeo ACL, de Bessa J. Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists. Int Braz J Urol 2020; 46:1042-1071. [PMID: 32539253 PMCID: PMC7527096 DOI: 10.1590/s1677-5538.ibju.2020.99.15] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
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Affiliation(s)
- Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - João Victor T Henriques
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alfredo F Canalini
- Divisão de Urologia, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Karin M J Anzolch
- Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Carlos H S Bellucci
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Caroline S Silva
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | - Marcelo L Wroclawski
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Departamento de Urologia, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | | | - José de Bessa
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
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Ghayad T, Mekhael M, Gebara N, Eid R, Kourié HR, Haddad F, Nemr E. [Lebanese physicians' attitude towards prostate cancer screening]. Bull Cancer 2020; 107:1199-1201. [PMID: 32977939 DOI: 10.1016/j.bulcan.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Toni Ghayad
- Université Saint-Joseph de Beyrouth, faculté de médecine, Beyrouth, Liban
| | - Mario Mekhael
- Université Saint-Joseph de Beyrouth, faculté de médecine, Beyrouth, Liban
| | - Nicole Gebara
- Université Saint-Joseph de Beyrouth, faculté de médecine, département de médecine de famille, Beyrouth, Liban.
| | - Roland Eid
- Université Saint-Joseph de Beyrouth, département d'hématologie et d'oncologie médicale, faculté de médecine, Beyrouth, Liban
| | - Hampig Raphael Kourié
- Université Saint-Joseph de Beyrouth, département d'hématologie et d'oncologie médicale, faculté de médecine, Beyrouth, Liban
| | - Fady Haddad
- Université Saint-Joseph de Beyrouth, département de médecine interne, Beyrouth, Liban
| | - Elie Nemr
- Université Saint-Joseph de Beyrouth, faculté de médecine, département d'urologie, Beyrouth, Liban
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Harke NN, Radtke JP, Hadaschik BA, Bach C, Berger FP, Blana A, Borgmann H, Distler FA, Edeling S, Egner T, Engels CL, Farzat M, Haese A, Hein R, Kuczyk MA, Manseck A, Moritz R, Musch M, Peters I, Pokupic S, Rocco B, Schneider A, Schumann A, Schwentner C, Sighinolfi CM, Buse S, Stolzenburg JU, Truß MC, Waldner M, Wülfing C, Zimmermanns V, Witt JH, Wagner C. To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic. PLoS One 2020; 15:e0239027. [PMID: 32931510 PMCID: PMC7491711 DOI: 10.1371/journal.pone.0239027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. Material and methods An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. Results 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers–however, the number of COVID-19 patients and urologists did not reach double digits. Conclusion The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.
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Affiliation(s)
- Nina N Harke
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Jan P Radtke
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | | | - Christian Bach
- Department of Urology, RWTH Aachen University, Aachen, Germany
| | - Frank P Berger
- Department of Urology, University of Jena, Jena, Germany
| | - Andreas Blana
- Department of Urology, Fürth Hospital, Fürth, Germany
| | - Hendrik Borgmann
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Florian A Distler
- Department of Urology, Paracelsus Medical University, Nuremberg, Germany
| | | | - Tobias Egner
- Department of Urology, Klinikum Würzburg Mitte, Würzburg, Germany
| | | | - Mahmoud Farzat
- Department of Urology, Diakonie Klinikum, Siegen, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Hein
- Department of Urology, Klinikum Magdeburg, Magdeburg, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Andreas Manseck
- Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Rudolf Moritz
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Michael Musch
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Inga Peters
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Sasa Pokupic
- Department of Urology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andreas Schneider
- Department of Urology, Main-Kinzig-Kliniken Standort Gelnhausen, Gelnhausen, Germany
| | - André Schumann
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | | | - Chiara M Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephan Buse
- Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Michael C Truß
- Department of Urology, Klinikum Dortmund, Dortmund, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Krankenhaus Köln-Hohenlind, Köln, Germany
| | | | | | - Jörn H Witt
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital Gronau, Gronau, Germany
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Castro EIB, Secchi GL, Gómez CD, Gómez JT, Clark O, Alonso IAM, Salcedo JGC. COVID-19: Measures to prevent hospital contagion. What do urologists need to know? Int Braz J Urol 2020; 46:113-119. [PMID: 32550704 PMCID: PMC7719994 DOI: 10.1590/s1677-5538.ibju.2020.s117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
A new outbreak of respiratory infection caused by the novel coronavirus in late December 2019 in China caused standards of medical care to change not only for related areas but for the entire healthcare system, and when the WHO declared COVID-19 a pandemic new strategies of patient care had to be defined initially to optimize resources to confront the pandemic and then to protect healthcare personnel. As urologists, we must be involved in these new standards, since without an effective vaccine the risk of contagion is high; thus, the purpose of this review is to have orientation on the measures urologists should take in their everyday clinical practice.
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Affiliation(s)
- Edgar Ivan Bravo Castro
- Department of Urology Hospital Central MilitarMéxicoDFMéxicoDepartment of Urology Hospital Central Militar, México DF, México
| | - Gerardo López Secchi
- Department of Urology Mutualista Asociación EspañolaMontevideoUruguayDepartment of Urology Mutualista Asociación Española, Montevideo Uruguay
- Department of Urology Hospital Francisco SocaCanelonesUruguayDepartment of Urology Hospital Francisco Soca, Canelones, Uruguay
| | - Cristobal Díaz Gómez
- Department of Urology Hospital Central MilitarMéxicoDFMéxicoDepartment of Urology Hospital Central Militar, México DF, México
| | - Javier Torres Gómez
- Department of Urology Hospital Central MilitarMéxicoDFMéxicoDepartment of Urology Hospital Central Militar, México DF, México
| | - Omar Clark
- Department of Urology Mutualista Asociación EspañolaMontevideoUruguayDepartment of Urology Mutualista Asociación Española, Montevideo Uruguay
| | - Ivan Azael Martinez Alonso
- Department of Urology Hospital Central MilitarMéxicoDFMéxicoDepartment of Urology Hospital Central Militar, México DF, México
| | - José Gadu Campos Salcedo
- Department of Urology Hospital Central MilitarMéxicoDFMéxicoDepartment of Urology Hospital Central Militar, México DF, México
- Hospital Central MilitarUrology SectionMexicoDFMéxicoChief of the Urology, Urology Section, Hospital Central Militar, Mexico, DF, México
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Krasavtseva YV, Kiseleva MG, Kasyan GR, Pushkar DY. [Assessment of the psychological status of urologists during the COVID-19 pandemic]. Urologiia 2020:5-9. [PMID: 32597578] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED The aim of this study was to analyze the symptoms of depression, anxiety, and stress in urologists during the COVID-19 pandemic. MATERIALS AND METHODS 90 urologists aged 25 to 60 years (M=37.27, S.D.=9.53), 93% of them were men, participated in the online survey. They answered questions about their attitude to their job as doctors and the impact of COVID-19. They filled out the Depression, Anxiety and Stress Scales (DASS-21), the Ten Item Personality Inventory (TIPI) and answered questions assessing their sense of control. RESULTS The greatest concern among urologists is the risk of getting infected with COVID-19 (for 30% of the doctors). 43% of urologists state that their profession interesting. A positive attitude to work, as well as the Big Five traits (Conscientiousness, Emotional Stability and Agreeableness) are associated with lower levels of depression, anxiety, stress and lack of control. Working with COVID-19 patients reduces stress and increases the sense of control. Age and high levels of Emotional Stability predicted lower levels of anxiety, depression and stress. DISCUSSION Working with COVID-19 patients allows doctors to feel more control over what is happening. A sense of control, in turn, and a positive attitude towards work are associated with a lower levels of depression, anxiety and stresssymptoms. CONCLUSION The results of this study can be used in selection of therapeutic targets for psychotherapy, administered to doctors; in prevention of symptoms of anxiety, stress and depression among doctors; and in professional selection of doctors for working in crisis situations.
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Affiliation(s)
- Yu V Krasavtseva
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
| | - M G Kiseleva
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
| | - G R Kasyan
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
| | - D Yu Pushkar
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
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Tandogdu Z, Kakariadis ETA, Naber K, Wagenlehner F, Bjerklund Johansen TE. Appropriate empiric antibiotic choices in health care associated urinary tract infections in urology departments in Europe from 2006 to 2015: A Bayesian analytical approach applied in a surveillance study. PLoS One 2019; 14:e0214710. [PMID: 31022187 PMCID: PMC6483335 DOI: 10.1371/journal.pone.0214710] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background Health care associated urinary tract infections (HAUTI) is a common complicating factor of urological practice. It is unclear what the appropriate empirical antibiotic choices are and how infection control policies (ICP) influence this. The aim of this study is to use probabilistic approaches towards the problem. That is to determine the chances of coverage of empirical antibiotic choices in HAUTIs and their annual trends in Europe. In addition, the impact of departmental self-reported compliance with catheter management and regulated usage of prophylactic antibiotics policies was tested. The estimated chances of coverage of antibiotics and further probabilistic calculations are carried out using the Global Prevalence of Infections in Urology (GPIU) annual surveillance study European data. Methods GPIU is a multi-state annual prevalence study conducted in urology departments to detect patients with HAUTIs, using the Center for Disease Control (CDC) definitions and antimicrobial resistance (AMR). In this analysis; the European cohort from 2005 to 2015 was used. The estimated chance of coverage for each antibiotic choice in HAUTIs was calculated using the Bayesian Weighted Incidence Syndromic Antibiogram (WISCA) approach. Annual trend of the overall cohort and number of appropriate antibiotic choices were estimated. Departments were compared according to their self-reported compliance to ICPs to determine if there was an impact on chances of coverage and appropriate antibiotic choices. Results We estimated that in most study years less than half of the single agent antibiotics and all combination options were appropriate for empirical treatment of HAUTIs. Departments with compliance to both ICPs were estimated to have 66%(2006) to 44% (2015) more antibiotic choices compared to departments with complete lack of compliance to the ICPs. In our estimates departments with adherence to a single policy was not superior to departments with complete lack of adherence to ICPs. Conclusions Most single agent choices had limited coverage for HAUTIs and combination choices had improved chance of coverage. Optimal antibiotic selection decision should be part of decision experiments and tested in local surveillance studies. Departments with self-reported compliance to ICPs have more antibiotic choices and details of the compliance should be evaluated in future studies. The analysis herein showed that over the 10-year course there was no clear time trend in the chances of coverage of antibiotics (Bayesian WISCA) in European urology departments.
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Affiliation(s)
- Zafer Tandogdu
- Institute for Clinical Medicine, Oslo University, Oslo, Norway
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| | | | - Kurt Naber
- Munich Technical University, Munich, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Truls Erik Bjerklund Johansen
- Institute for Clinical Medicine, Oslo University, Oslo, Norway
- Department of Urology, Oslo University Hospital, Oslo, Norway
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Capitanio U, Larcher A, Kriegmair MC, Bertolo R, Salagierski M, Campi R, Klatte T, Trevisani F, Montorsi F, Mir MC, Ouzaid I. Do We Truly Care About the Functional Outcomes for Renal Cancer Patients? Multidisciplinarity Is Still Far Away. Eur Urol 2018; 75:349-350. [PMID: 30237026 DOI: 10.1016/j.eururo.2018.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Umberto Capitanio
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Larcher
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Maciej Salagierski
- Faculty of Medicine and Health Science, University of Zielona Góra, Zielona Góra, Poland
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Francesco Trevisani
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Onologia, Valencia, Spain
| | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, Paris-Didert University, Paris, France
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Adsul P, Wray R, Boyd D, Weaver N, Siddiqui S. Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients. J Cancer Educ 2017; 32:580-588. [PMID: 27029194 DOI: 10.1007/s13187-016-1025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists' perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30-60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members' involvement in discussions about treatment, especially patients' spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient's condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient's practical, emotional, and social experiences. Their styles to elicit the patient's preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists' routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.
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Affiliation(s)
- Prajakta Adsul
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA.
| | - Ricardo Wray
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
| | - Danielle Boyd
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Nancy Weaver
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Sameer Siddiqui
- Department of Surgery, School of Medicine, Saint Louis University, 3635 Vista Ave, St. Louis, MO, 63110, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
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