Performance Characteristics of a Rule-Based Electronic Health Record Algorithm to Identify Patients with Gross and Microscopic Hematuria.

BACKGROUND: Two million patients per year are referred to urologists for hematuria, or blood in the urine. The American Urological Association recently adopted a risk-stratified hematuria evaluation guideline to limit multi-phase computed tomography to individuals at highest risk of occult malignancy. OBJECTIVES: To understand population-level hematuria evaluations, we developed an algorithm to accurately identify hematuria cases from electronic health records (EHRs). METHODS: We used International Classification of Diseases (ICD)-9/ICD-10 diagnosis codes, urine color, and urine microscopy values to identify hematuria cases and to differentiate between gross and microscopic hematuria. Using an iterative process, we refined the ICD-9 algorithm on a gold standard, chart-reviewed cohort of 3,094 hematuria cases, and the ICD-10 algorithm on a 300 patient cohort. We applied the algorithm to Geisinger patients ≥35 years (n = 539,516) and determined performance by conducting chart review (n = 500). RESULTS: After applying the hematuria algorithm, we identified 51,500 hematuria cases and 488,016 clean controls. Of the hematuria cases, 11,435 were categorized as gross, 26,658 as microscopic, 12,562 as indeterminate, and 845 were uncategorized. The positive predictive value (PPV) of identifying hematuria cases using the algorithm was 100% and the negative predictive value (NPV) was 99%. The gross hematuria algorithm had a PPV of 100% and NPV of 99%. The microscopic hematuria algorithm had lower PPV of 78% and NPV of 100%. CONCLUSION: We developed an algorithm utilizing diagnosis codes and urine laboratory values to accurately identify hematuria and categorize as gross or microscopic in EHRs. Applying the algorithm will help researchers to understand patterns of care for this common condition.

Bladder Leiomyoma presenting as urinary retention: A case report.

Leiomyoma of the bladder is a rare diagnosis and accounts for 0.43% of all bladder tumors. We herein present a case of a thirty-nine-year-old female diagnosed with bladder leiomyoma presenting with urinary retention. Workup of her urinary retention revealed a midline bladder neck mass. Transurethral resection of her tumor revealed pathology consistent with bladder leiomyoma. Surgical resection is generally the recommended management of this lesion to make a histopathological diagnosis despite low potential of malignant transformation. Although these tumors are benign, they can cause severe obstructive or irritative symptoms. Further research is needed to determine the pathophysiology of these tumors.

Analysis of the top 100 most influential papers in benign prostatic hyperplasia.

INTRODUCTION: The fund of knowledge on benign prostatic hypertrophy (BPH) has been growing since the 1970s. Citation analysis is a tool by which we can quantify influence of specific articles and assess the growth of a certain topic. This paper seeks to identify trends, as well as draw attention to the most influential papers, authors, and journals. Many analogous studies have been done, but none have been done in the field of BPH. METHODS: We used Thomson Reuters Web of Science to collect articles pertaining to BPH in a two-step fashion. We identified 117 keywords relevant to BPH and using these 117 words, we were able to identify 7302 total articles. These articles were organized by number of citations. Of the top 200 articles, 100 articles were excluded based on title and abstract analysis. One hundred articles were included for final analysis, as this is the standard of citation analysis. RESULTS: Overall, total citations were slightly correlated with journal impact factor. Author analysis revealed no significant difference between authorship and average citations. Topic analysis showed the most cited topic was surgical management with 657.35 citations per year. Study design analysis showed the predominant study design was the randomized control trial. CONCLUSIONS: By using the two-step methodology, we were able to create a list of the top 100 most influential articles in the field of BPH. In doing so, we illustrated the growth of the field over time and paid tribute to the myriad of papers, authors, and journals that have shaped the field to this day.

Functional MRI of Sensory Substitution in the Blind.

Visual cortex functionality in the blind has been shown to shift away from sensory networks toward task-positive networks that are involved in top-down modulation. However, how such modulation is shaped by experience and reflected behaviorally remains unclear. This study evaluates the visual cortex activity and functional connectivity among congenitally blind, acquired blind, and sighted subjects using blood-oxygenation-level-dependent functional MRI during sensory substitution tasks and at rest. We found that primary visual cortex activity due to active interpretation not only depends on the blindness duration, but also negatively associates with behavioral reaction time. In addition, alterations in visual and task-positive functional connectivity progress over the duration of blindness. In summary, this work suggests that functional plasticity in the primary visual cortex can be reshaped in the blind over time, even in the adult stage. Furthermore, the degree of top-down activity in the primary visual cortex may reflect the speed of performance during sensory substitution.