PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Detection and Screening II1 Apr 2015PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY Derek Bos, Christopher Allard, Shawn Dason, Vladimir Ruzhynsky, Anil Kapoor, and Bobby Shayegan Derek BosDerek Bos More articles by this author , Christopher AllardChristopher Allard More articles by this author , Shawn DasonShawn Dason More articles by this author , Vladimir RuzhynskyVladimir Ruzhynsky More articles by this author , Anil KapoorAnil Kapoor More articles by this author , and Bobby ShayeganBobby Shayegan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1659AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of bladder tumor (TURBT) specimens lacking detrusor muscle are associated with clinical upstaging and the need for additional procedures which may delay curative treatment. We evaluated whether resident involvement in TURBTs is associated with adequacy of pathology specimens and time to cystectomy at a single academic centre in Ontario, Canada. METHODS We identified all TURBTs performed at St. Joseph's Healthcare Hamilton from November 2011 to June 2014. Charts were reviewed to determine baseline characteristics, resident involvement, and pathologic findings including presence of detrusor muscle. Logistic regression was used to assess associations between resident involvement and adequacy of tumor specimens. Among patients who underwent cystectomy, we assessed the time to cystectomy from initial high risk TURBT (high grade, ≥T1, or CIS), excluding patients with subsequent low risk TURBTs, BCG, or neoadjuvant chemotherapy. Associations between resident involvement with pathologic outcomes and time to cystectomy were determined with Chi−square and log rank tests, respectively. RESULTS A total 664 TURBTs were performed on 471 patients during the study period. Patient and tumor characteristics were comparable for TURBTs performed by attendings and residents. Attendings were more likely to obtain muscle in specimens for all TURBTs (OR1.68 [95%CI 1.09, 2.59], p=0.018) and for the subset of 275 high risk TURBTs (OR1.99 [95%CI 1.11, 3.55], p=0.019). Senior residents (PGY3−5) had higher odds of muscle in all (OR1.91 [95%CI 1.12, 3.25], p=0.017) and high risk (OR2.9 [95%CI 1.43, 5.9], p=0.003) specimens compared with juniors. In multivariate analysis adjusting for covariates patient age, sex, and tumor size, resident involvement was associated with inadequate tumor specimens among all patients (p=0.032) and only high risk tumors (p=0.049). Resident involvement was associated with a non-significant increased need for repeat TURBT. The median time from initial high risk TURBT to cystectomy was 73.3 (IQR 51.8, 131.4) and 49.4 (IQR 31.4, 65.7) days for residents and attendings, respectively (p=0.024). CONCLUSIONS Resident involvement during TURBTs is associated with inconclusive pathology and delayed time to cystectomy. Future studies should assess educational tools to improve endoscopic surgical training techniques minimizing effects of resident learning on patient outcomes. Further studies are needed to clarify the impact of resident involvement on long-term patient outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e564 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Derek Bos More articles by this author Christopher Allard More articles by this author Shawn Dason More articles by this author Vladimir Ruzhynsky More articles by this author Anil Kapoor More articles by this author Bobby Shayegan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".