2024

Antibiotic Stewardship for Procedures and Patients with Recurring Infections

Antibiotic Stewardship for Procedures and Patients with Recurring Infections

Posted by | Mar 2024

Brian J. Flynn, MD, presents guidance on effective UTI management while minimizing antibiotic resistance. Dr. Flynn begins with an overview of recurring UTI pathogenesis and diagnosis.

Dr. Flynn then addresses common treatment options for recurrent UTI management, like Fosfomycin. He reviews the common first-line antibiotics, highlighting the importance of short-duration antibiotics after non-antibiotic treatments have failed.

Dr. Flynn then delves into other prophylactic strategies for treating recurrent UTIs. He discusses prophylactics relating to cleanliness, specific cranberry products, water intake, and methanamine hippurate.

Dr. Flynn concludes by addressing the social and psychological impact of recurrent UTIs, particularly in post-menopausal women. He stresses the importance of discussing contributing factors frankly, but empathetically, with patients to achieve the desired treatment outcome.

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Optimizing Perioperative Nutrition and Assessing Frailty

Optimizing Perioperative Nutrition and Assessing Frailty

Posted by | Mar 2024

Jennifer M. Taylor, MD, MPH, discusses interventions for optimizing perioperative outcomes surrounding patient frailty and nutrition. Dr. Taylor begins by defining the causes of frailty and acknowledging that most cancer patients will have a certain level of frailty.

Dr. Taylor presents tools for the assessment of frailty that medical practitioners can use to evaluate frailty-based risks of invasive treatments. She notes that frail patients have a higher risk of mortality after surgery, and demonstrates a prototype of a Risk Analysis Index that is currently being trialed at multiple VA hospitals.

Dr. Taylor concludes by discussing the importance of having a multidisciplinary team that includes a dietician to support the frail patient pre- and post-operatively. She highlights that preoperative nutritional interventions, particularly in malnourished patients, are effective in reducing frailty in a short amount of time.

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Integrated Diagnostics (Radiogenomics) and Patient Selection and Monitoring for Active Surveillance, Surgical, and Radiation Treatment

Integrated Diagnostics (Radiogenomics) and Patient Selection and Monitoring for Active Surveillance, Surgical, and Radiation Treatment

Posted by | Mar 2024

Sanoj Punnen, MD, MAS, discusses the use and benefits of integrated diagnostics for monitoring prostate cancer during Active Surveillance (AS). He begins by noting that AS is becoming a popular treatment for a wide range of low-risk prostate cancers, thanks to more granular risk-stratification methods and an increasing clinical emphasis on lowering patient burden during treatment.

Dr. Punnen then discusses lowering the frequency of serial biopsies as a means of lowering patient burden during treatment. He explores studies which indicate that MRI and Gleason scoring alone are insufficient for monitoring prostate cancer progression.

Dr. Punnen concludes with an exploration of the ongoing Miami MRI-Guided Active Selection for Treatment of Prostate Cancer (MAST) trial examining the use of MRI, 4Kscore, and Decipher scores during AS. The data thus far indicates that MRI alone is not predictive of progression, and that clinicians should consider integrating other prognostic data into their AS treatment protocols.

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Construction and Multi-Center Validation of the Radiomics Model for Non-Invasive Identification of Active Surveillance Candidates

Construction and Multi-Center Validation of the Radiomics Model for Non-Invasive Identification of Active Surveillance Candidates

Posted by | Mar 2024

Liang Wang, MD, PhD, presents current data on the use of noninvasive approaches with radiomics models to identify prostate cancer in active surveillance (AS) patients. Dr. Wang begins by sharing data on the risk reduction that early detection provides, but notes risks of overdiagnosis and overtreatment. He then addresses the role of magnetic resonance imaging (MRI) in prostate cancer management, noting improved techniques and better image interpretation by the Prostate Imaging Reporting & Data System (PI-RADS). However, Dr. Wang highlights that other biomarkers along with MRI must guide further diagnosis and treatment.

Dr. Wang discusses the rapidly evolving field of radiomics, explaining it enables the digital decoding of images into quantitative features that may uncover disease characteristics unseen by the naked eye. Further, it assesses a broad set of predefined features to define patterns relevant to pathology using statistical methods.

Dr. Wang concludes by cautioning that current data on the use of radiomics were from single-institution retrospectives with small cohort sizes and an absence of independent, external validation. Dr. Wang mentions broader, ongoing research which may lead to a non-invasive, radiomics-based tool that may be used to identify AS candidates with prostate cancer in the future.

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Physician Coaching and Embracing QI

Physician Coaching and Embracing QI

Posted by | Mar 2024

Ryan P. Terlecki, MD, FACS, presents a model for quality improvement for healthcare providers, drawing from professional sports coaching. He begins by articulating the professional parallels between physicians and quarterbacks, noting that the best performers in each field have strong professional support networks and constant performance evaluation.

Dr. Terlecki then discusses how quality improvement measures used in professional sports apply to medical practice. He supports his points by presenting data from studies where “playbacks” of urologic surgeries were used to effectively improve surgeon performance.

Dr. Terlecki concludes by emphasizing the benefits of being open to feedback and making efforts to improve for both healthcare professionals and patients. He encourages healthcare professionals to be open to both giving and receiving coaching in their practices, and provides actionable advice for implementing these quality improvement measures.

Dr. Terlecki provides guidance on tailoring patient intake questionnaires to keep the focus on the patient’s issue and possible approaches. He gives examples of open and closed questions for male genital pain.

Dr. Terlecki then discusses the importance of setting patient expectations regarding diagnoses and what they should expect from the provider, particularly when the provider does not specialize in pain management. He then discusses common, uncommon, and overlooked causes of male genital pain.

Dr. Terlecki concludes by walking through this algorithm from intake to assessment to diagnosis and treatment. He emphasizes the importance of not dismissing patient input on treatment, but still strictly adhere to evidence-based treatment over unproven or alternative treatments.

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