Notice bibliographique
Résumé
ashing down a couple of ballpark franks means a trip to the gents after the home half of the sixth inning.Bladder bursting, I find myself at the wall of urinals with 31 fellow Jays fans (and one burly Minnesotan with a well-worn Kirby Puckett jersey).Easy enough, 700cc's on deck, but then the familiar feeling.There's not a chance on this earth I'm peeing here.A shuffle of the feet, eyes dead ahead, a centering breath, some imagined pelvic floor relaxation.Nothing.A flush nearby means go time, valsalva time!All this produces is a tiny, sour bleat and inguinal canals straining like Dizzy Gillespie's cheeks.The Ballad of the Shy Bladder is sung again as the crowd attenuates and the dam finally bursts.This is a glib paruresis anecdote, but it is the thin edge of the wedge of a glaring care gap in the urology clinic.The impact of cognition, mood, anxiety, and mental health in the etiology and treatment of our patients' problems is enormous, and the median urologist is, at best, marginally trained to stickhandle these issues.Anxiety and adjustment disorders are woven into oncology; we are trained to break bad news and to empathize with time, tone, and tissues.Social workers stand ready in cancer centers.Multidisciplinary pain clinics have long brought psychologists into the public system; sure, we recognize the impact of coping and catastrophizing, but we rely on expert colleagues to help tackle that part.In these cases, the issue may become that the expected psychological reactions to cancer and pain reach escape velocity and wreak havoc.Where we are lacking is most conspicuous when disordered thinking may be etiologic, as so often in patients with voiding or sexual dysfunction.A social life addled by the prospect of incontinence.Elaborate rituals and mantras to find the peace to empty one's bladder.An urge and ache to void that never abates.A 40-year-old athlete in knots about erections that simply stopped working.Urine normal.Anatomy normal.Cystoscopy normal.It's here we see our patients ensnared in cognitive short-circuits, an answer to the diagnostic puzzle resolving.We've written about it and even named it."Uropsychiatry" first showed up in 1964, and dozens of low-fidelity expositions on "neuroses" and "psychosomatics" followed, but these buds never bloomed into a therapeutic field. 1 We know of the Hinman "non-neurogenic neurogenic bladder" in kids, 2 but when we reach back into our clinical toolkit, we find only a crude glossary of terms and a list of care providers, who are not us, best suited to help.And so, we deploy the tools we have.Manage your fluids and triggers, a β3 or PDE-5i, hoping to start a positive cascade or exploit a placebo effect, rooting in earnest and feeling impotent ourselves.Sometimes we shrug and dig up a card or number for a colleague psychologist, social worker, or physiotherapist outside of the public system.We silo our specialties in medicine as a means of categorizing disorders and to provide some order in how to train ourselves to manage them.Diseases, though, don't care about our taxonomies as they smatter themselves about our bodies and minds.This leaves urologists as gatekeepers for vexing pain, voiding and sexual issues that have often already eluded our toolkits before we've laid eyes.Patients have taken their concerns to their primary care team, and when referred to us, have every reason to believe we are the experts in their issue; however pridefully we cling (or fall back?) to our status as surgeons of the genital and urinary tract, we are also the medical doctors for the same (remember your personal letter and interviews?;).You may think this is not a problem, or at least not our problem, but that's a shortcut to unburdening ourselves of the care of our patients.If you believe undermanagement of the cognitive and psychological aspects of urologic disease is a real issue, how might we tackle it?
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,004 | 0,002 |
| Communication savante | 0,008 | 0,006 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,015 | 0,027 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,030 | 0,018 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».