PD45-04 IMPROVING QUALITY OF PROSTATE CANCER SURGERY BY PROVIDING FEEDBACK TO SURGEONS: THE SURGICAL REPORT CARD (SUREP) STUDY
Bibliographic record
Abstract
You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD45)1 Apr 2019PD45-04 IMPROVING QUALITY OF PROSTATE CANCER SURGERY BY PROVIDING FEEDBACK TO SURGEONS: THE SURGICAL REPORT CARD (SUREP) STUDY Ravi M. Kumar*, Luke T. Lavallée, Christopher Morash, Ilias Cagiannos, Dean Fergusson, David Sands, Sonya Cnossen, Ranjeeta Mallick, Michael Horrigan, Dawn Stacey, and Rodney H. Breau Ravi M. Kumar*Ravi M. Kumar* More articles by this author , Luke T. LavalléeLuke T. Lavallée More articles by this author , Christopher MorashChristopher Morash More articles by this author , Ilias CagiannosIlias Cagiannos More articles by this author , Dean FergussonDean Fergusson More articles by this author , David SandsDavid Sands More articles by this author , Sonya CnossenSonya Cnossen More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , Michael HorriganMichael Horrigan More articles by this author , Dawn StaceyDawn Stacey More articles by this author , and Rodney H. BreauRodney H. Breau More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556600.95443.98AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Goals of radical prostatectomy include complete tumor resection, optimization of urinary function, and maintenance of erectile function. In this Surgical Report card (SuRep) study, we aimed to closely monitor cancer, urinary, and sexual outcomes and provide surgeons with report cards assessing their performance. METHODS: Prospective radical prostatectomy patients at The Ottawa Hospital were consented for participation in SuRep. All 8 prostate cancer surgeons at The Ottawa Hospital also consented to participation. Feasibility goals for the study were 95% patient enrollment, with 80% participation at 6-months follow-up, and 70% participation at 12-months. At enrollment and follow-up, patient reported outcomes were assessed using validated questionnaires (EPIC and EQ-5D). Patients were defined as potent if they had no erectile dysfunction and continent if they had no incontinence. The patient data was analyzed and report cards were provided to surgeons every 3 months starting approximately 1 year after the first patient was enrolled. RESULTS: During the study period, 422 of 436 (97%) radical prostatectomy patients participated in the study. Follow-up data was available for 358 (85%) patients at 6-months and 356 (84%) patients at 12-months following surgery. Two-hundred and ten (50%) patients were included in the first year (pre-report card) and 212 (50%) patients were included in the second year (post-report card). Baseline characteristics were similar in the pre- and post-report card cohorts. Almost all patients were continent (98%) and the majority were potent (61%) prior to surgery. Nerve sparing surgery increased from 148 (70%) pre-report card to 173 (82%) post-report card. There was a non-statistically significant increase in the proportion of patients with a positive surgical margin post-report cards (32% pre-report card vs 39% post-report card; p=0.09). There was no difference in post-operative erectile function (24% vs 26%; p=0.69) and a decrease in continence (76% vs 63.2%; p=0.01). CONCLUSIONS: A surgical report card program including patient reported outcomes is feasible. The data was used to accurately counsel patients about their expected outcomes following radical prostatectomy. With one year of surgical report cards, overall patient outcomes did not improve. We believe that specific initiatives and longer duration of feedback are needed for positive change to occur. Source of Funding: Funded in part by Prostate Cancer Canada (Discovery 2014 D2014-2), The Ottawa Hospital Academic Medical Organization, and the Prostate Cancer Fight Foundation & TELUS Ride For Dad. All statements in this report are solely those of the authors. Ottawa, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e827-e827 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravi M. Kumar* More articles by this author Luke T. Lavallée More articles by this author Christopher Morash More articles by this author Ilias Cagiannos More articles by this author Dean Fergusson More articles by this author David Sands More articles by this author Sonya Cnossen More articles by this author Ranjeeta Mallick More articles by this author Michael Horrigan More articles by this author Dawn Stacey More articles by this author Rodney H. Breau More articles by this author Expand All Advertisement PDF downloadLoading ...
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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 | 0.009 | 0.042 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.107 | 0.012 |
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".