Quality of reporting for qualitative studies in pediatric urology-A scoping review.

INTRODUCTION: Qualitative research has gained popularity in pediatric urology due to rich data and insights about quantitative results. To date, there has been no study evaluating the comprehensiveness of the reporting of these studies based on established guidelines. OBJECTIVE: The objective of this study is to perform a scoping review of the quality of reporting in recent qualitative studies in pediatric urology based on a predominant checklist, the 21-item Standards of Reporting Qualitative Research (SRQR) and identify areas for improvement. STUDY DESIGN: In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we performed a systematic literature search to identify qualitative studies on pediatric urology topics published from 2015 to 2021. We used clustering technology to eliminate articles with unrelated keywords. Articles not in English and those published prior to 2015 were excluded. Two reviewers performed title/abstract screening and full text review and resolved discrepancies by consensus. We reported the median and interquartile range of total SRQR scores (maximum: 21). SRQR-reported items were summarized; overall proportion of reported items for each article was estimated. Bivariate analyses examined the association between study characteristics and SRQR tertile. Simple linear regression was performed to examine the relationship between year and SRQR score. RESULTS: Of the 2562 titles/abstracts screened, 26 studies were included. The most common topics were hypospadias and congenital adrenal hyperplasia (Summary Figure). The median total score was 18.0 of 21 possible items (interquartile range: 3). All studies reported an abstract, problem formulation, purpose/context of the study, data collection methods, integration with prior work, limitations, and ethics review board approval. Most (25/26; 96.2%) reported sampling strategy, data analysis, synthesis/interpretation of findings and links to empirical data. Less fulfilled items included: a title identifying the study as qualitative (11/26, 42.3%), qualitative approach & research paradigm (11/26, 42.3%) and researcher characteristics & reflexivity (9/26, 34.6%). There was no association between study characteristics and SRQR score. There was a statistically significant increase in the SRQR score during the study period (ß = 1.0, p < 0.0001). DISCUSSION: Studies fulfilled most SRQR checklist items. There was significant improvement in quality during the study period. Limitations include possible recency bias and exclusion of articles due to inconsistent categorizations in Pub Med. CONCLUSION: The quality and trajectory of qualitative study reporting in pediatric urology is encouraging. SRQR standards should be implemented by journals to continue improving the robustness and transparency of future qualitative manuscripts in pediatric urology.

Qualitative research in pediatric urology.

INTRODUCTION: Qualitative studies have become increasingly common in the pediatric urology literature due to their ability to enhance our understanding of physicians' and patients' preferences, attitudes, and beliefs. The pediatric urology literature currently lacks clear guidelines for reporting qualitative research. In their absence, it is challenging to judge the quality of these studies. OBJECTIVES: The objectives of this educational article are to define what is involved in rigorous qualitative research studies, help readers recognize high-quality qualitative research, and provide practical skills in designing and implementing qualitative research. RESULTS: Acknowledging researcher biases, taking steps to reduce bias and increase reflexivity, and clear descriptions of research and data collection methods all contribute increased rigor and trustworthiness of qualitative studies. Proper selection of qualitative methodology, derived from the research question to be answered, establishes a foundation for reliable and meaningful data. CONCLUSION: As the field continues to grow, the standardization of reporting of these essential parameters becomes paramount so readers can gauge how findings can be appropriately applied to clinical practice.

Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review.

Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.

Complete Pathologic Response to Pembrolizumab and Axitinib in a Patient With Sarcomatoid RCC and Ocrelizumab-Treated Multiple Sclerosis.

Non-clear cell renal cell carcinoma (RCC) is a heterogeneous disease. We report a case of sarcomatoid non-clear cell RCC in a patient with underlying multiple sclerosis (MS) on immunosuppression with a complete pathologic response to pembrolizumab and axitinib. Comprehensive genomic profiling revealed pathogenic mutations in SETD2 and TP53 with high RNA expression levels of immune checkpoint proteins. Our case illustrates the importance of treatment selection based on presence of sarcomatoid features, underlying autoimmune disease, and genomic profiling.

Influence of Clinical and Sociodemographic Factors on the Management, Costs and Outcomes of Acute Urinary Retention in the Acute Care Setting.

INTRODUCTION: We evaluated clinical and sociodemographic factors that influence care pathways following acute urinary retention with attention to subsequent bladder outlet procedures. METHODS: This was a retrospective cohort study examining patients who presented for emergent care with concomitant diagnoses of urinary retention and benign prostatic hyperplasia in New York and Florida in 2016. Using Healthcare Cost and Utilization Project data, patients were followed throughout a calendar year across subsequent encounters for recurrent urinary retention and bladder outlet procedures. Multivariable logistic and linear regression were utilized to identify factors associated with recurrent urinary retention, subsequent outlet procedures and the cost of retention-related encounters. RESULTS: Among 30,827 patients, 12,286 (39.9%) were ≥80 years of age. Though 5,409 (17.5%) experienced multiple retention-related encounters, only 1,987 (6.4%) received a bladder outlet procedure within the calendar year. Covariates associated with repeat urinary retention included older age (OR 1.31, p <0.001), Black race (OR 1.18, p=0.001), Medicare insurance (OR 1.16, p=0.005) and lower education level (OR 1.13, p=0.03). Age ≥80 years (OR 0.53, p <0.001), Elixhauser Comorbidity Index score ≥3 (OR 0.31, p <0.001), Medicaid status (OR 0.52, p <0.001) and lower education level were associated with lower odds of receiving a bladder outlet procedure. Episode-based costs favored single retention encounters vs repeat encounters ($15,285.96 vs $28,451.21, p <0.001) and undergoing an outlet procedure vs foregoing one ($16,223.38 vs $17,690.54, p=0.002). CONCLUSIONS: Sociodemographic factors are associated with recurrent retention episodes and the decision to undergo a bladder outlet procedure following an episode of urinary retention. Despite the cost benefits associated with preventing repeated episodes of urinary retention, merely 6.4% of patients presenting with acute urinary retention underwent a bladder outlet procedure during the study period. Our findings suggest that early intervention among individuals experiencing urinary retention may confer cost and duration of care benefits.

Race disparities in genetic alterations within Wilms tumor specimens.

BACKGROUND: Wilms tumor (WT) affects Black children disproportionately. Genetic aberrations within WT specimens that contribute to this disparity have not been reported. METHODS: The Therapeutically Applied Research to Generate Effective Treatments (TARGET) database was queried for WT patient and genomic features. Clinical and genetic variables were compared by race. RESULTS: Within the discovery set (enriched for adverse events; N = 94 White, 19 Black, 14 Other/unreported patients), Black children were more likely to present with advanced stage disease (p = 0.019). Within the validation set (primarily a random sampling of NWTS-5; N = 360 White, 92 Black, 72 Other/Unreported), Black children appeared older at diagnosis (p = 0.050), had decreased median follow-up time (p<0.0005) and were over-represented (17.4%) relative to the concurrent U.S. Census (12.8%). Among the 37 target genes sequenced, ACTB (p = 0.030) and DICER1 (p = 0.026) mutations were more common in Black patient specimens, whereas DGCR8 (p = 0.041) mutations were more common in White patient specimens. White patient specimens were more likely to contain one or multiple targeted mutations (p = 0.026). CONCLUSION: Within the TARGET database, Black children were over-represented and harbored WT specimens containing more frequent ACTB and DICER1 mutations. In contrast, WT from White children contained overall more mutations in targeted genes and specifically in DGCR8. LEVEL OF EVIDENCE: III.

Influenza vaccine community outreach: Leveraging an interprofessional healthcare student workforce to immunize marginalized populations.

Vulnerable populations such as the uninsured, unemployed, and unhoused face significant morbidity and mortality from influenza but are less likely to receive the annual vaccine and have limited access to medical care. We describe an interprofessional, student-run vaccine outreach program (VOP) in Davidson County, Tennessee that lowers barriers to vaccination through free vaccination events in nontraditional community locations. We provide this framework as a model to expand novel, seasonal, or outbreak-oriented vaccine outreach to resource-poor populations. Demographic data were collected from the patients who received an influenza vaccine between 2015 and 2019 through an optional survey to determine whether these events were reaching unhoused, uninsured, and/or unemployed individuals. Of 1,803 patients, 1,733 (96.1%) completed at least one field of the demographic form. Overall, 481 (27.8%) were individuals without homes or living in temporary housing and 673 (38.8%) were unemployed. Most patients, 1,109 (64.0%), did not have health insurance at any point during the prior two years. With the addition of a nurse practitioner student to VOP leadership, the 2018-2019 VOP reached the most unhoused or temporarily-housed (228, 32.3%), unemployed (313, 18.5%), and disabled (60, 8.5%) patients. The VOP can be adapted to meet community needs, funding, and volunteer interest. The VOP model may be applicable to a SARS-CoV-2 vaccine, especially since the economic impact of COVID-19 has increased unemployment rates and housing instability. Healthcare students serve as an eager, underutilized resource who can be leveraged to disseminate vaccines to individuals with limited access to care.

Intravesical Anti-PD-1 Immune Checkpoint Inhibition Treats Urothelial Bladder Cancer in a Mouse Model.

PURPOSE: Nonmuscle-invasive bladder cancer is treated by resection within the bladder and bladder instillment with bacillus Calmette-Guérin or chemotherapy. For bacillus Calmette-Guérin-refractory disease, systemic anti-PD-1 (programmed cell death protein 1) immune checkpoint inhibition is a treatment. Our aim is to test whether intravesical instillment with anti-PD-1 inhibitor treats localized bladder cancer as effectively as systemic administration. MATERIALS AND METHODS: We investigated an orthotopic mouse model of urothelial bladder cancer using MBT2 cells instilled into the bladders of syngeneic, wild-type C3H mice. Groups of 10 mice received each treatment for comparison of intravesical anti-PD-1, intraperitoneal anti-PD1, and intravesical chemotherapy. The primary outcome was overall survival and secondary outcomes included long-term immunity and toxicity. RESULTS: Anti-PD-1 administered by bladder instillment (intravesical route) successfully treats localized bladder cancer and has similar overall survival to anti-PD-1 by systemic route. Anti-PD-1 by either route provides a significant survival advantage over control antibody. Anti-PD-1 increases CD8+ cell infiltration in tumors, particularly when administered intravesically. Antibody treatment avoids toxicity observed for intravesical chemotherapy. Mice who cleared their tumors after initial treatment were rechallenged with tumor engraftment 3-9 months later without any additional treatment. Initial anti-PD-1-treated mice did not grow tumors when rechallenged, which suggests long-term immunity exists, but initial mitomycin-treated mice readily grew tumors indicating no immunity occurred by chemotherapy treatment. CONCLUSIONS: Intravesical administration of anti-PD-1 is a promising treatment route for localized bladder cancer, with comparable overall survival to systemic anti-PD-1 in this mouse model. Intravesical anti-PD-1 increases CD8+ T cells in treated tumors and long-term immunity was seen to tumor rechallenge.

Global Surgery Electives: A Strategy to Improve Care to Domestic Underserved Populations?

BACKGROUND: In the United States, a shortage of general surgeons exists, primarily in rural, poor, and minority communities. Identification of strategies that increase resident interest in underserved regions provides valuable information in understanding and addressing this shortage. In particular, surgical experience abroad exposes residents to practice in low-resource and rural settings. As residency programs increasingly offer global surgery electives, we explore whether the presence of an international surgical rotation affects graduates' future practice patterns in underserved communities domestically. METHODS: We surveyed general surgery residency graduates at a single academic institution. Those who finished general surgery residency from 2001 to 2018 were included. Participant demographics, current practice demographics, and perceptions related to global surgery and underserved populations were collected. Respondents were stratified based on whether they did ("after") or did not ("before") have the opportunity to participate in the Kijabe rotation (started in 2011), defined by graduation year. RESULTS: Out of 119 eligible program graduates, 64 (53.7%) completed the survey, and 33 (51.6%) of the respondents graduated following the implementation of the Kijabe rotation. Two participants defined their primary current practice location as international. Fifteen (45.5%) in the "After" group indicated an interest in working with underserved populations following residency, compared to 5 (17.8%) of the "Before" group (P = 0.074). Furthermore, 20 (60.6%) respondents in the "After" group expressed interest in working with underserved populations even if it meant making less money. In the "Before" group, only 13 (46.4%) responded similarly (P = 0.268). Eleven (9.2%) residents rotated at Kijabe. Those who participated in the Kijabe rotation reported an uninsured rate of 36.7% for their current patient population, compared to rate of 13.9% in those who did not rotate there (P = 0.22). CONCLUSIONS: At a single institution, our results suggest that participation in an international surgical rotation in a resource-constrained setting may be associated with increased care for underserved populations in future clinical practice. These results could be due to self-selection of residents who prioritize global surgery as part of their residency experience, or due to increased exposure to underserved patients through global surgery.

Health disparities among tennessee pediatric renal tumor patients.

BACKGROUND/PURPOSE: Wilms tumor (WT) poses a cancer health disparity to black children globally, which has not been evaluated thoroughly for other pediatric renal cancers. We aimed to characterize health disparities among Tennessee children treated for any renal cancer. METHODS: The Tennessee Cancer Registry (TCR) was queried for patients ≤18 years having any renal cancer (n = 160). To clarify treatment and outcomes, we performed a retrospective cohort study of pediatric renal cancer patients in our institutional cancer registry (ICR; n = 121). Diagnoses in both registries included WT, Sarcoma/Other, and Renal Cell Carcinoma. Wilcoxon/Pearson, Kaplan-Meier, and logistic regression were completed. RESULTS: In both registries, WT comprised the most common renal cancer and youngest median age. Sarcoma was intermediate in frequency and age, and RCC was least common, having the oldest age (p < 0.001). In the TCR, black patients comprised 26% of all patients, presented more commonly with distant disease than white patients (37% v. 16%; p = 0.021), and showed worse overall survival (73% v. 89%; p = 0.018), while the ICR showed similar survival between race groups (92% v. 93%, p = 0.868). Sarcoma and metastases were independent predictors of death in both registries (p ≤ 0.002). CONCLUSIONS: Black children in Tennessee presented with more advanced disease and experienced worse survival when combining all renal cancer types, particularly RCC and Sarcoma. When treated at a comprehensive pediatric cancer center, these survival disparities appear diminished. TYPE OF STUDY: Prognostic study. LEVEL OF EVIDENCE: Level II (retrospective cohort).

Peer-led Surgical Clerkship Programming Support Through the General Surgery Interest Group at the Vanderbilt University School of Medicine.

OBJECTIVE: We present a systematic, sustainable, student-led model for supporting the Surgical Clerkship experience. DESIGN: Our model includes student-led suturing and knot-tying classes, operating room tours, skills sessions, and shelf review sessions provided systematically for each of 5 Surgical Clerkship blocks in the 2017 to 2018 academic year. SETTING: Vanderbilt University School of Medicine. PARTICIPANTS: Vanderbilt University School of Medicine Surgical Clerkship students and senior medical student instructors. RESULTS: Successful implementation of a peer-led support program for the Surgical Clerkship with a majority of students rating the helpfulness of both the operating room tours and the skills sessions a 4 or 5 on a Likert scale. CONCLUSION: Our student-led model for a Surgical Clerkship support program can be successfully implemented and demonstrates positive initial indicators of effectiveness.

Early network activity propagates bidirectionally between hippocampus and cortex.

Spontaneous activity in the developing brain helps refine neuronal connections before the arrival of sensory-driven neuronal activity. In mouse neocortex during the first postnatal week, waves of spontaneous activity originating from pacemaker regions in the septal nucleus and piriform cortex propagate through the neocortex. Using high-speed Ca(2+) imaging to resolve the spatiotemporal dynamics of wave propagation in parasagittal mouse brain slices, we show that the hippocampus can act as an additional source of neocortical waves. Some waves that originate in the hippocampus remain restricted to that structure, while others pause at the hippocampus-neocortex boundary and then propagate into the neocortex. Blocking GABAergic neurotransmission decreases the likelihood of wave propagation into neocortex, whereas blocking glutamatergic neurotransmission eliminates spontaneous and evoked hippocampal waves. A subset of hippocampal and cortical waves trigger Ca(2+) waves in astrocytic networks after a brief delay. Hippocampal waves accompanied by Ca(2+) elevation in astrocytes are more likely to propagate into the neocortex. Finally, we show that two structures in our preparation that initiate waves-the hippocampus and the piriform cortex-can be electrically stimulated to initiate propagating waves at lower thresholds than the neocortex, indicating that the intrinsic circuit properties of those regions are responsible for their pacemaker function.