Bladder Cancer Survivors Who Do Not Smoke Have Better Longitudinal Health-Related Quality of Life Measures: An Assessment of the Comparative Effectiveness and Survivorship Health in Bladder Cancer (CEASE-BC) Study.

PURPOSE: Cigarette smoking is the most common risk factor for the development of bladder cancer (BC), yet there is a paucity of data characterizing the relationship between smoking status and longitudinal health-related quality of life (HRQoL) outcomes in patients with BC. We examined the association between smoking status and HRQoL among patients with BC. MATERIALS AND METHODS: Data were sourced from a prospective, longitudinal study open between 2014 and 2017, which examined HRQoL in patients aged ≥ 18 years old diagnosed with BC across North Carolina. The QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core instrument) was administered at 3, 12, and 24 months after BC diagnosis. Our primary exposure of interest was current smoking status. Linear regression using generalized estimating equations was used to analyze the relationship between smoking status and various domains of the QLQ-C30. RESULTS: A total of 154 patients enrolled in the study. Eighteen percent were classified as smoking at 3 months from diagnosis, and packs per day ranged from < 0.5 to 2. When controlling for time from diagnosis, demographic covariates, cancer stage, and treatment type, mean differences for physical function (7.4), emotional function (5.6), and fatigue measures (-8.2) were significantly better for patients with BC who did not smoke. CONCLUSIONS: Patients with BC who do not smoke have significantly better HRQoL scores in the domains of physical function, emotional function, and fatigue. These results underscore the need to treat smoking as an essential component of BC care.

The Objective Structured Teaching Encounter (OSTE) in health professions education: A systematic review.

PURPOSE: New emphasis on the assessment of health professions educators' teaching competence has led to greater use of the Objective Structured Teaching Encounter (OSTE). The purpose of this study is to review and further describe the current uses and learning outcomes of the OSTE in health professions education. MATERIALS AND METHODS: PubMed, MEDLINE, and CINAHL (March 2010 to February 2022) were searched for English-language studies describing the use of an OSTE for any educational purpose within health professions education. RESULTS: Of the 29 articles that met inclusion criteria, over half of the studies (17 of 29, 58.6%) were published during or after 2017. Seven studies described OSTE use outside of the traditional medical education context. These new contexts included basic sciences, dental, pharmacy, and Health Professions Education program graduates. Eleven articles described novel OSTE content, which included leadership skills, emotional intelligence, medical ethics, inter-professional conduct, and a procedural OSTE. There is increasing evidence supporting the use of OSTEs for the assessment of clinical educators' teaching skills. CONCLUSIONS: The OSTE is a valuable tool for the improvement and assessment of teaching within a variety of health professions education contexts. Further study is required to determine the impact of OSTEs on teaching behaviors in real-life contexts.

Delayed Upper Aerodigestive Tract Perforation from Anterior Cervical Spine Hardware: Treatment and Swallowing Outcomes.

Delayed upper aerodigestive tract (UADT) perforation is a rare complication of anterior cervical spinal hardware. The purpose of this study was to investigate swallowing outcomes between treatment approaches for delayed UADT perforation. A retrospective chart review was performed on patients with anterior cervical hardware and delayed UADT perforation who were treated at a single tertiary care center between 2000 and 2020. Of the twelve patients identified, most patients presented with dysphagia (n = 9, 75%) and/or neck pain (n = 7, 58%). Perforations generally occurred at the level of C6 (n = 6, 50%) and C7 (n = 4, 33%) and spanned only one spinal level (n = 8, 67%). The majority (n = 8, 67%) of patients were past or current cigarette users. Operative approaches included primary repair (n = 5, 42%) and rotational flap (n = 4, 33%); the rotational flap harvest sites included supraclavicular fasciocutaneous (n = 2), infrahyoid muscle (n = 1), and sternocleidomastoid muscle (n = 1). While most patients demonstrated penetration and/or aspiration on first post-operative swallow study (n = 6), this resolved completely within a median time of 31 days. There were no differences in swallowing outcomes between repair approaches. Patient smoking history appears to be a clear risk factor for the development of delayed UADT perforation from anterior cervical spine hardware. A variety of techniques can be used to repair these perforations, and there were no differences in swallowing outcomes between repair approaches.

Patterns of Smoking Cessation Strategies and Perception of E-cigarette Harm Among Bladder Cancer Survivors.

BACKGROUND: Cigarette smoking is the leading preventable cause of bladder cancer (BC). Some proponents of e-cigarettes describe their use as a risk mitigation strategy despite potential carcinogen exposure and uncertain long-term risks. OBJECTIVE: We assessed smoking cessation strategies, including e-cigarette use, and harm perception among patients with BC. METHODS: We performed a cross-sectional study on a convenience sample of patients with BC at a single institution from August 2021 - October 2022. The survey instrument was sourced from the Cancer Patient Tobacco Use Questionnaire (C-TUQ) from the American Association for Cancer Research with standardized questions on tobacco use, cessation questions, and e-cigarette harm perceptions. RESULTS: Of the 104 surveyed BC patients (mean age: 72 years; 27% female; 55% with muscle-invasive disease), 20% were current smokers (median pack years: 40) and 51% were former smokers (median pack years: 20). A minority (9%) had quit smoking at the time of diagnosis. Pharmacotherapy for smoking cessation included nicotine patches (25%), gum (21%), lozenges (8%), e-cigarettes (8%), and Varenicline/Bupropion (4%). Notably, 43% of patients who continued to smoke expressed willingness to switch to e-cigarettes as a cessation aid. E-cigarette users (11%) more commonly perceived e-cigarettes as non-harmful compared to former (4%) and non-smokers (4%) (P = .048), though all groups regarded e-cigarettes as equally addictive as traditional cigarettes. CONCLUSIONS: Despite the prevalence of BC survivors who continue to smoke, a significant proportion perceive e-cigarettes as a viable and less harmful cessation aid. The infrequent use of FDA-approved pharmacotherapies underscores potential implementation gaps. These findings highlight the need for further research and targeted interventions in addressing smoking cessation among BC survivors.

Association of USMLE Step 1 Pass/Fail Reporting with Interview and Match Outcomes.

OBJECTIVE: To investigate interview and match outcomes of medical students who received pass/fail USMLE reporting vs medical students with numeric scoring during the same period. DESIGN: Retrospective analysis of a cross-sectional survey-based study. SETTING: United States 2023 residency match. PARTICIPANTS: Medical student applicants in the 2023 residency match cycle who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey. RESULTS: Among 6756 applicants for the 2023 match, 496 (7.3%) took USMLE Step 1 with pass/fail reporting. Pass/fail reporting was associated with lower USMLE Step 2-CK scores (245.9 vs 250.7), fewer honored clerkships (2.4 vs 3.1), and lower Alpha Omega Alpha membership (12.5% vs 25.2%) (all p < 0.001). Applicants with numeric USMLE Step 1 scores received more interview offers after adjusting for academic performance (beta coefficient 1.04 (95% CI 0.28-1.79); p = 0.007). Numeric USMLE Step 1 scoring was associated with more interview offers in nonsurgical specialties (beta coefficient 1.64 [95% CI 0.74-2.53]; p < 0.001), but not in general surgery (beta coefficient 3.01 [95% CI -0.82 to 6.84]; p = 0.123) or surgical subspecialties (beta coefficient 1.92 [95% CI -0.78 to 4.62]; p = 0.163). Numeric USMLE Step 1 scoring was not associated with match outcome. CONCLUSIONS: Applicants with numeric USMLE Step 1 scoring had stronger academic profiles than those with pass/fail scoring; however, adjusted analyses found only weak associations with interview or match outcomes. Further research is warranted to assess longitudinal outcomes.

Comparison of Cost and Perioperative Outcomes Among Patients Undergoing Simple Prostatectomy and Laser Enucleation of the Prostate.

Introduction: Simple prostatectomy (SP) and laser enucleation of the prostate (LEP) are treatments for symptomatic benign prostatic hyperplasia (BPH) in men with large glands (e.g., >80 g). The decision between the two operations is often dependent on surgeon preference/experience and equipment availability. As the use of minimally invasive techniques, such as robotic-assisted simple prostatectomy, has increased for the treatment of large gland BPH, studies comparing the outcomes and cost of these modalities in a contemporary cohort are lacking. Methods: All-payer data from Healthcare Cost and Utilization Project State Databases from Florida, New York, California, and Maryland from 2016 to 2018 were used to identify adults who underwent SP or LEP for BPH. Patient demographics, facility characteristics, revisit rates, and cost of the index hospitalization were examined. Multivariable logistic and gamma generalized linear regression models were utilized to compare predictors of the operation performed, 30-day revisits, and index hospitalization cost among the two operations. Results: Of the 2032 patients in the cohort, 1067 (46.4%) underwent LEP and 965 (41.9%) underwent SP. On multivariable logistic regression analysis, SP patients were younger, had higher comorbidity scores, and were more likely to be uninsured compared with LEP patients. Thirty-day revisit rates among the operations were equivalent (odds ratio 0.89, 95% confidence interval 0.63-1.27, p = 0.05). The mean adjusted cost of the index hospital stay for LEP was significantly greater than that of SP ($7291 vs $6442, p = 0.04). However, our sub-group analysis examining high-volume centers revealed no significant differences in cost ($6184 vs $5353, p = 0.1). Conclusions: Across the four states examined, SP and LEP were performed with comparable volume and had similar rates of 30-day revisits. The SP was less expensive than LEP overall; however, among high-volume facilities, the cost of both operations was reduced, such that they were equivalent.

Otolaryngology Program Director, House-Staff, and Student Opinions: Step 1 Pass/Fail Score Reporting.

OBJECTIVE(S): To compare otolaryngology program director, house-staff, and medical student perspectives on the score reporting change of USMLE Step 1 to pass/fail. METHODS: Separate electronic surveys were sent to program directors of ACGME-accredited otolaryngology programs (Cronbach's alpha = .87), otolaryngology house-staff (Cronbach's alpha = .91), and medical students interested in otolaryngology (Cronbach's alpha = .76). RESULTS: Among the 51 otolaryngology program directors that completed the survey (response rate of 46.8%), 17.6% favored reporting USMLE Step 1 as pass/fail. A majority believed the reporting change would make it more difficult to screen (74.5%) and objectively compare applicants (82.4%). Step 2 CK scores will be more important to most program directors due to the reporting change (83.7%). Of the 93 house-staff that completed surveys, most did not favor the reporting change (61.3%). Over half (54.0%) of the 87 medical students that completed surveys did not support the scoring change, and most (65.5%) did not feel that it would decrease anxiety around residency applications (65.5%). Most house-staff and medical students felt that the scoring change would put non-U.S. MD students at a disadvantage (65.6% of house-staff, 69.8% of medical students). CONCLUSION: Most survey respondents do not agree with the decision to report Step 1 as pass/fail. Despite its intended goals, most do not believe pass/fail Step 1 reporting will improve medical student well-being and believe it will put certain student populations at a greater disadvantage.

Electronic cigarette, or vaping, product use-associated lung injury (EVALI) in a patient with testicular cancer: A case report.

Electronic cigarette, or vaping, product use-associated lung injury (EVALI) is an increasingly recognized entity with the potential for severe pulmonary toxicity. We present the case of a young man first evaluated at a tertiary care center in the United States in 2019 with newly diagnosed testicular cancer with acute respiratory failure, which was initially attributed to possible metastatic disease but eventually determined to be related to EVALI. This case highlights the clinical features of EVALI, the potential diagnostic dilemma that can arise with EVALI when occurring in the setting of malignancy and the importance of inquiring about vaping use among patients with malignancy, especially in adolescents and young adults.

Linguistic Differences Based on Gender and Race in Urology Application Personal Statements: A Comparison of 2017 and 2023 Applications.

While diversity and inclusion efforts have increased in urology, comparative analysis of personal statements from 2016-2017 and 2022-2023 residency applications showed few linguistic changes over time by gender or race/ethnicity. These results suggest the need for directed efforts to engage, mentor, and coach females and underrepresented minorities during medical school and the urology application process.

Utilization of part C early intervention services for patients with cleft palate.

OBJECTIVES: To investigate the utilization of early intervention services under Part C of the 2004 Individuals with Disabilities Educational Act for children with cleft palate and to better understand barriers these patients encounter when receiving services. METHODS: A retrospective chart review was performed on children under the age of 18 who were treated for cleft palate at a single tertiary care center and referred to Tennessee's Early Intervention System (TEIS) between January 2007 and December 2018. RESULTS: For the 61 patients included, developmental therapy was the most common TEIS referral made (n = 408, 28%), followed by speech therapy (n = 371, 26%). Most of these services were delivered as scheduled (n = 513, 80%); some families missed appointments without notifying the provider (i.e., family no-show)(n = 101, 2%). Children referred at a younger age were more likely to receive developmental therapy (p = 0.012) and to attend their services (p = 0.027). Patients with Medicaid were more likely to have absences with prior notification (p = 0.05) and without prior notification (i.e., family no-show)(p = 0.009) than patients with other types of health insurance. CONCLUSIONS: Patients with cleft palate often have complex needs; earlier referral to ancillary services may improve attendance at appointments and impact the services they receive. Socioeconomic factors may hinder patients from accessing these services even once they are referred.

The Use of Crowdfunding to Support Radiation Therapy Cancer Treatments.

BACKGROUND/AIM: The purpose of this study was to assess patients' use of a crowdfunding platform to raise funds for radiation treatment and to better understand the direct and indirect costs associated with treatments. MATERIALS AND METHODS: The GoFundMe crowdfunding database was queried for four unique categories related to radiation treatment campaigns. Covariates identified included clinical and demographic variables, and associations between amount raised and these predictors were analyzed using a generalized linear model. RESULTS: While 56% percent of campaigns cited direct costs associated with treatment, 73.4% of campaigns cited indirect costs related to treatment. Indirect expenses related to travel (31.7%) as well as living expenses (29.2%) were cited most often across all four treatment categories. CONCLUSION: This study enhances understanding regarding patients use of crowdfunding for radiation treatment. Increased focus should be placed on discussing the indirect costs of care with patients and their families.

Communicating uncertainty in cancer prognosis: A review of web-based prognostic tools.

Objective To review how web-based prognosis tools for cancer patients and clinicians describe aleatory (risk estimates) and epistemic (imprecision in risk estimates) uncertainties. Methods We reviewed prognostic tools available online and extracted all uncertainty descriptions. We adapted an existing classification and classified each extracted statement by presentation of uncertainty. Results We reviewed 222 different prognostic risk tools, which produced 772 individual estimates. When describing aleatory uncertainty, almost all (90%) prognostic tools included a quantitative description, such as "chances of survival after surgery are 10%", though there was heterogeneity in the use of percentages, natural frequencies, and use of graphics. Only 14% of tools described epistemic uncertainty. Of those that did, most used a qualitative prefix such as "about" or "up to", while 22 tools described quantitative descriptions using confidence intervals or ranges. Conclusions Considerable heterogeneity exists in the way uncertainties are communicated in cancer prognostic tools. Few tools describe epistemic uncertainty. This variation is predominately explained by a lack of evidence and consensus in risk communication, particularly for epistemic uncertainty. Practice Implications As precision medicine seeks to improve prognostic estimates, the community may not be equipped with the tools to communicate the results accurately and effectively to clinicians and patients.

Tolerance of uncertainty: A systematic review of health and healthcare-related outcomes.

BACKGROUND: Uncertainty tolerance (UT) is thought to be a characteristic of individuals that influences various outcomes related to health, healthcare, and healthcare education. We undertook a systematic literature review to evaluate the state of the evidence on UT and its relationship to these outcomes. METHODS: We conducted electronic and bibliographic searches to identify relevant studies examining associations between UT and health, healthcare, or healthcare education outcomes. We used standardized tools to assess methodological quality and analyzed the major findings of existing studies, which we organized and classified by theme. RESULTS: Searches yielded 542 potentially relevant articles, of which 67 met inclusion criteria. Existing studies were heterogeneous in focus, setting, and measurement approach, were largely cross-sectional in design, and overall methodological quality was low. UT was associated with various trainee-centered, provider-centered, and patient-centered outcomes which were cognitive, emotional, and behavioral in nature. UT was most consistently associated with emotional well-being. CONCLUSIONS: Uncertainty tolerance is associated with several important trainee-, provider-, and patient-centered outcomes in healthcare and healthcare education. However, low methodological quality, study design limitations, and heterogeneity in the measurement of UT limit strong inferences about its effects, and addressing these problems is a critical need for future research.