Use of electronic health record best practice alerts to improve adherence to American Urological Association vesicoureteral reflux guidelines.

PURPOSE: To evaluate the effect of a guidelines-based best practice alerts (BPA) in the electronic health record (EHR) on adherence to American Urological Association (AUA) vesicoureteral reflux (VUR) guidelines. METHODS: Retrospective cohort study of patients aged 0-17 years old with primary VUR with an initial urology clinic visit the year before or year after BPA implementation was done. Primary outcomes include obtaining vital signs, urinalysis, and ultrasound at initial and 1-year follow-up visit. RESULTS: We identified 123 patients with initial visits during the study period, 58 of whom returned for 1-year follow-up visits. Patients seen post-BPA were more likely to have height measured at initial visit than those seen pre-BPA (47.3% vs. 11.8%, p < 0.001). The majority of patients were screened with weight (98.3%) and ultrasound (87.9%) at 1-year follow-up both before and after BPA implementation. Neither blood pressure measurements (59.1% vs. 55.6%, p > 0.5) nor urinalysis orders (23.8% vs. 19.4%, p > 0.05) significantly increased post-BPA. CONCLUSION: The use of an EHR-based BPA increased the likelihood of obtaining height measurements by clinic intake staff but did not significantly affect provider adherence to other practice guideline recommendations. Our findings suggest that BPA implementation alone is not sufficient to impact provider uptake of VUR guideline recommendations.

Single-Use Grasper Integrated Flexible Cystoscope for Stent Removal: A Micro-Costing Analysis-Based Comparison.

Background: A single-use flexible cystoscope with integrated grasper (Isiris; Coloplast, Denmark) has recently become commercially available. The objective of our study is to compare the costs of stent removal in an outpatient clinical environment between the single-use Isiris system (Coloplast) to our existing approach using a reusable cystoscope and stent grasper. Materials and Methods: The number of stent removal procedures at our tertiary center was recorded as a proportion of all cystoscopic procedures performed between February 2016 and February 2017. Elements in the micro-cost assessment included original purchasing price of an Olympus digital reusable cystoscope, repair fee (based on a 1-year contract), sterilization equipment and accessory costs, reprocessing costs of the cystoscope, and labor costs. The costs were estimated on a per-use basis and compared to the purchasing price of Isiris. Results: A total of 1775 cystoscopic procedures were performed, and the reusable cystoscope was used for stent removal in 871 (49%) cases. The per-use cost for stent removal procedures using the reusable cystoscope was estimated to be $161.85. The single per-use purchasing price for the Isiris device is $200. Based on the current volume, the break-even point was calculated to be 704 stent pulls. After 704 stent pulls, the cost benefit favors the reusable cystoscope. Conclusion: Based on this micro-cost analysis, per-use costs appear to favor the reusable cystoscope for stent removal. It appears that centers with high volumes of stent pulls may find the reusable cystoscope and stent grasper more cost beneficial than the single-use system.

Using Scent Detection Dogs in Conservation Settings: A Review of Scientific Literature Regarding Their Selection.

Dogs are widely used for scent detection work, assisting in searches for, among other things, missing persons, explosives, and even cancers. They are also increasingly used in conservation settings, being deployed for a range of diverse purposes. Although scent detecting dogs have been used in conservation roles for over 100 years, it is only recently that the scientific literature has begun to document their effectiveness and, importantly, how suitable dogs should initially be selected by organizations wanting to develop a detection program. In this paper, we review this literature, with the aim of extracting information that might be of value to conservation groups considering whether to invest in the use of dogs. We conclude that selection of appropriate dogs is no easy task. While olfactory ability is critical, so also are a range of other characteristics. These include biological, psychological, and social traits. At present, no validated selection tools have been published. Existing organizations have adapted selection instruments from other contexts for their use, but very little published information is available regarding the effectiveness of these instruments in a conservation setting. In the absence of clear guidelines, we urge those wanting to invest in one or more dogs for conservation purposes to proceed with extreme caution and, preferably, under the watchful eyes of an experienced professional.