Faculty Bibliography

BACKGROUND:Social media coverage is increasingly used to spread the message of scientific publications. Traditionally, the scientific impact of an article is measured by the number of citations. At a journal level, this conventionally matures over a 2-year period, and it is challenging to gauge impact around the time of publication. OBJECTIVE:We, therefore, aimed to assess whether Web-based attention is associated with citations and to develop a predictive model that assigns relative importance to different elements of social media coverage: the #SoME_Impact score. METHODS:We included all original articles published in 2015 in a selection of the highest impact journals: The New England Journal of Medicine, The Lancet, the Journal of the American Medical Association, Nature, Cell, and Science. We first characterized the change in Altmetric score over time by taking a single month's sample of recently published articles from the same journals and gathered Altmetric data daily from the time of publication to create a mixed effects spline model. We then obtained the overall weighted Altmetric score for all articles from 2015, the unweighted data for each Altmetric component, and the 2-year citation count from Scopus for each of these articles from 2016 to 2017. We created a stepwise multivariable linear regression model to develop a #SoME_Score that was predictive of 2-year citations. The score was validated using a dataset of articles from the same journals published in 2016. RESULTS:0.19 vs 0.09; P<.001). Articles in the upper quantile of #SoME_Score were more than 5 times more likely to be among the upper quantile of those cites (odds ratio 5.61, 95% CI 4.70-6.73). CONCLUSIONS:Social media attention predicts citations and could be used as an early surrogate measure of scientific impact. Owing to the cross-sectional study design, we cannot determine whether correlation relates to causation.

BACKGROUND:The World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on urological services in different geographical areas is unknown. OBJECTIVE:To investigate the global impact of COVID-19 on urological providers and the provision of urological patient care. DESIGN, SETTING, AND PARTICIPANTS/METHODS:A cross-sectional, web-based survey was conducted from March 30, 2020 to April 7, 2020. A 55-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of urological services. Target respondents were practising urologists, urology trainees, and urology nurses/advanced practice providers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/UNASSIGNED:The primary outcome was the degree of reduction in urological services, which was further stratified by the geographical location, degree of outbreak, and nature and urgency of urological conditions. The secondary outcome was the duration of delay in urological services. RESULTS AND LIMITATIONS/CONCLUSIONS:A total of 1004 participants responded to our survey, and they were mostly based in Asia, Europe, North America, and South America. Worldwide, 41% of the respondents reported that their hospital staff members had been diagnosed with COVID-19 infection, 27% reported personnel shortage, and 26% had to be deployed to take care of COVID-19 patients. Globally, only 33% of the respondents felt that they were given adequate personal protective equipment, and many providers expressed fear of going to work (47%). It was of concerning that 13% of the respondents were advised not to wear a surgical face mask for the fear of scaring their patients, and 21% of the respondents were advised not to discuss COVID-19 issues or concerns on media. COVID-19 had a global impact on the cut-down of urological services, including outpatient clinic appointments, outpatient investigations and procedures, and urological surgeries. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak. On average, 28% of outpatient clinics, 30% of outpatient investigations and procedures, and 31% of urological surgeries had a delay of >8 wk. Urological services for benign conditions were more affected than those for malignant conditions. Finally, 47% of the respondents believed that the accumulated workload could be dealt with in a timely manner after the COVID-19 outbreak, but 50% thought the postponement of urological services would affect the treatment and survival outcomes of their patients. One of the limitations of this study is that Africa, Australia, and New Zealand were under-represented. CONCLUSIONS:COVID-19 had a profound global impact on urological care and urology providers. The degree of cut-down of urological services increased with the degree of COVID-19 outbreak and was greater for benign than for malignant conditions. One-fourth of urological providers were deployed to assist with COVID-19 care. Many providers reported insufficient personal protective equipment and support from hospital administration. PATIENT SUMMARY/UNASSIGNED:Coronavirus disease-19 (COVID-19) has led to significant delay in outpatient care and surgery in urology, particularly in regions with the most COVID-19 cases. A considerable proportion of urology health care professionals have been deployed to assist in COVID-19 care, despite the perception of insufficient training and protective equipment.

The #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology. According to the 2018 American Urological Association census, only 9.2% of practicing urologists are female and 16% are non-Caucasian. Social media have been used in other medical disciplines to promote diversity and form networks for gender and racial minorities. We studied the hashtag #ILookLikeAUrologist, started to promote diversity and inclusion in urology, to determine if it had any signs of a community of practice. Over the 4 yr since its inception, there have been 3694 tweets using the hashtag #ILookLikeAUrologist. The discussion had 1348 unique contributors, hailing from 35 countries on six continents. There were 8,156,051 impressions, highlighting a wide potential reach for the discussion. In a random 25% sample of original tweets, the main themes were gender representation, followed by personal narratives and camaraderie. Most contributors were practicing urologists, followed by urology trainees, other physicians, and professional organizations. Although most posts were authored by women, men represented nearly a quarter of individual contributors. The #ILookLikeAUrologist hashtag has been widely used by a large global audience in urology. Future research is warranted to examine the impact of digital communities of practice on outcomes such as fostering collaboration, providing mentorship, and reducing burnout.
Patient Summary: The #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology.
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OBJECTIVES/OBJECTIVE:To compare both the concordance between the 4Kscore® and SelectMDx® for informing decision to perform prostate biopsy (PB) and the performance of these tests for detecting clinically significant prostate cancer (csPCa). Several biomarkers were developed to inform decisions whether to perform a PB based on the probability of detecting csPCa. There is a paucity of studies directly comparing them METHODS: Between 11/2018 and 4/2019, all new referrals with the diagnosis of elevated PSA were advised to undergo 4Kscore® and SelectMDx® in order to guide the selection of candidates for PB. Men were advised to undergo PB if the reported biomarker risk for detecting csPCA was ≥7.5%, or if they presented a PI-RADS ≥1 MRI. Cohen's Kappa was used to assess the concordance between the binary 4Kscore® and SelectMDx® results using externally validated cutoffs of 7.5% and 12%. Receiver operating characteristics curve and area under the curve (AUC) assessed the performance of each biomarker for predicting csPCa. RESULTS:Of 128 consecutive patients referred, 114 (89.1%) underwent 4Kscore® and SelectMDx®, The kappa coefficient between the biomarkers using the 7.5% cutoff was 0.184 (poor concordance) and 0.22 using the 12% cutoff. The two biomarkers yielded discordant guidance whether to proceed with PB in 46% and 38% of cases, respectively. csPCa was found in 22 of the 50 patients who underwent PB (44%). The AUC for 4Kscore® and SelectMDx® was 0.830 (95%CI: 0.710 - 0.949) and 0.672 (95%CI: 0.517 - 0.828) (p=0.036), respectively. CONCLUSION/CONCLUSIONS:The discordance observed between the 4Kscore® and SelectMDx® is disconcerting. The 4Kscore® when combined with MRI was superior to the SelectMDx® for detecting csPCa. Prospective comparative studies must be performed to optimize implementation of biomarkers for selecting candidates for PB.

Current guidelines recommend conservative management as the preferred option for most low-risk prostate cancer cases, with certain possible exceptions (age <55yr, African Americans, and high-volume grade group 1). Although previous studies have documented substantial heterogeneity in the uptake of conservative management, less is known about the underlying reason for this variation and whether it is due to guideline-concordant factors (age, race, and biopsy cancer volume). We explored variation in the use of conservative management for low-risk prostate cancer among 20 597 men diagnosed in the US Veterans Affairs health care system from 2010 to 2016. Conservative management increased substantially over this time from 51% to 76% (p< 0.001). However, there was substantial variation by facility (35-100%). Multivariable analysis revealed that patient factors included in the guidelines (e.g., age and biopsy cores), other patient factors (eg, marital status and PSA) and non-patient factors (eg, geographic region, case volume, year) were associated with conservative management use. In conclusion, even within an integrated health care system, there remains significant heterogeneity in the uptake of conservative management for low-risk prostate cancer. Both guideline-concordant factors and other factors not discussed in the guidelines were associated with conservative management use. PATIENT SUMMARY: In the US Veterans Affairs health care system the vast majority of men with low-risk prostate cancer were managed conservatively by 2016, although there was significant variation by facility. Patient factors specifically mentioned in guidelines had the greatest impact on prediction of conservative management.