Cribriform prostate cancer: Morphologic criteria enabling a diagnosis, based on survey of experts.

Among four sub-patterns of Gleason grade 4 prostate cancer, voluminous evidence supports that the cribriform pattern holds an unfavorable prognostic impact, as compared with poorly-formed, fused, or glomeruloid. The International Society of Urological Pathology (ISUP) recommends specifying whether invasive grade 4 cancer is cribriform. Recently, ISUP experts published a consensus definition of cribriform pattern highlighting criteria that distinguish it from mimickers. The current study aimed to analyze morphologic features separately to identify those that define the essence of the cribriform pattern. Thirty-two selected photomicrographs were classified by 12 urologic pathologists as: definitely cribriform cancer, probably cribriform, unsure, probably not cribriform, or definitely not cribriform. Consensus was defined as 9/12 agree or disagree, with ≤1 strongly supporting the opposite choice. Final consensus was achieved in 21 of 32 cases. Generalized estimating equation (GEE) model with logit link was fitted to estimate effect of multiple morphologic predictors. Fisher exact test was used for categorical findings. Presence of intervening stroma precluded calling cribriform cancer (p = 0.006). Mucin presence detracted (p = 0.003) from willingness to call cribriform cancer (only 3 cases had mucin). Lumen number was associated with cribriform consensus (p = 0.0006), and all consensus cases had ≥9 lumens. Predominant papillary pattern or an irregular outer boundary detracted (p = NS). Invasive cribriform carcinoma should have absence of intervening stroma, and usually neither papillary pattern, irregular outer boundary, nor very few lumens. Setting the criteria for cribriform will help prevent over- or undercalling this important finding.

Online Ratings of Urologists: Comprehensive Analysis.

BACKGROUND: Physician-rating websites are being increasingly used by patients to help guide physician choice. As such, an understanding of these websites and factors that influence ratings is valuable to physicians. OBJECTIVE: We sought to perform a comprehensive analysis of online urology ratings information, with a specific focus on the relationship between number of ratings or comments and overall physician rating. METHODS: We analyzed urologist ratings on the Healthgrades website. The data retrieval focused on physician and staff ratings information. Our analysis included descriptive statistics of physician and staff ratings and correlation analysis between physician or staff performance and overall physician rating. Finally, we performed a best-fit analysis to assess for an association between number of physician ratings and overall rating. RESULTS: From a total of 9921 urology profiles analyzed, there were 99,959 ratings and 23,492 comments. Most ratings were either 5 ("excellent") (67.53%, 67,505/99,959) or 1 ("poor") (24.22%, 24,218/99,959). All physician and staff performance ratings demonstrated a positive and statistically significant correlation with overall physician rating (P<.001 for all analyses). Best-fit analysis demonstrated a negative relationship between number of ratings or comments and overall rating until physicians achieved 21 ratings or 6 comments. Thereafter, a positive relationship was seen. CONCLUSIONS: In our study, a dichotomous rating distribution was seen with more than 90% of ratings being either excellent or poor. A negative relationship between number of ratings or comments and overall rating was initially seen, after which a positive relationship was demonstrated. Combined, these data suggest that physicians can benefit from understanding online ratings and that proactive steps to encourage patient rating submissions may help optimize overall rating.

Leveraging the clinical collaborative model to drive value improvement.

PURPOSE OF REVIEW: Physician-led quality improvement collaboratives have emerged across surgical disciplines as a means to measure and subsequently improve the quality and cost of care. In this review, we will provide an overview of recent successes within quality improvement collaboratives, as well as discuss future opportunities for such initiatives. RECENT FINDINGS: Successful quality improvement collaboratives have coupled data registries with a collegial environment to achieve data-driven improvements in care across diverse practice settings. Such efforts have a track record for accomplishing specific patient safety gains, and have more recently addressed complex care scenarios where data and consensus building have been leveraged to clarify optimal care pathways. Collaboratives are currently exploring mechanisms to meaningfully impact increasingly complex elements of care delivery, such as individual surgeon performance. SUMMARY: Quality improvement collaboratives are in a unique position to understand patterns in care across populations, lead evidence-based assessments of variation in quality, and to attempt to intervene to improve outcomes based on the data they accumulate. As healthcare increasingly shifts to emphasize quality of care, physician-led collaboratives represent an important mechanism to drive improvement.

Collaboration is Key - Bridging the Gap and Building an IR Endoscopy Practice.

While the tools and techniques employed by interventional radiologists on a day-to-day basis translate well to learning the skills required to perform basic endoscopic interventions, collaboration with other specialties is crucial to the success of an interventional radiology endoscopy program. As in any field in medicine, the paramount goal is to improve patient care. Adding the ability to directly visualize structures through an endoscope to certain interventional radiologic procedures may greatly augment the efficacy, safety, and success of interventional radiology procedures. Colleagues in urology, gastroenterology, and surgery should be involved in decision-making and treatment planning to ensure that a shared vision for optimal patient care is achieved.