Optimizing and validating the technical infrastructure of a novel tele-cystoscopy system

Hougen, Helen Y.; Lobo, Jennifer M.; Corey, Thomas; Jones, Randy; Rheuban, Karen S.; Schenkman, Noah S.; Krupski, Tracey L.

doi:10.1177/1357633x15610040

Cited by 19 publications

(11 citation statements)

References 20 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…40,41 Some innovative groups go so far as to propose that registered nurses could perform "tele-cystoscopies" interpreted real time by board-certified urologists; the feasibility, safety, and legal implications of this approach are unknown and it remains an area of research. 42 Telesurgery may reduce geographic disparities to complex care in the far future, but legal, financial, and security concerns need to be addressed as well as making such a system palatable to a patient. 43 Where technology cannot penetrate, certainly outreach to rural environments in the form of a visiting consultant clinic may be of benefit in rural areas.…”

Section: Discussionmentioning

confidence: 99%

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

Cohen

Fergus

Lindsey

et al. 2019

The Journal of Rural Health

View full text Add to dashboard Cite

Objective: To assess an aging subspecialty workforce and growing population that portends challenges in meeting patient care needs. We hypothesized that rural physicians are retiring at higher rates than their urban counterparts in the United States and that this represents a bellwether for workforce challenges at large. Methods: We analyzed data from the 2014-2016 American Urological Association Census, a sample-weighted representative survey of urologists, as a case study for subspecialists. We compared urologists who work in rural regions to nonrural regions on available characteristics. Results: In 2016, rural urologists accounted for 2.4% of 12,186 practicing urologists in the United States. General urology remained the focus of 90% of rural urologists, compared to 59% of nonrural urologists (P = .03). Alarmingly, 48% of rural physicians were >65 years old in 2016 compared to 29% in 2014, and 33% of rural urologists were solo practitioners compared to 9% of nonrural urologists (P < .01). The planned retirement age for rural physicians increased from 68 in 2014 to 73 in 2016 (P trend = .02). The percentage of rural practice urologists has remained stable since 2014. Conclusions: Rural urologists are older and provide more general urological care than their nonrural counterparts. Rural urologists are postponing retirement. Although this might be due to personal desires and financial goals, it may also be due to a relative absence of potential junior partners. Given that almost 50% of rural urologists were older than 65 in 2016, this is not a sustainable solution to an impending shortage of physicians. Greater innovation in telemedicine or alternative care models will soon be needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

Cohen

Fergus

Lindsey

et al. 2019

The Journal of Rural Health

View full text Add to dashboard Cite

show abstract

“…Furthermore, our findings may help to increase access to surveillance cystoscopies interpretation in rural areas performed by a physician or even a registered nurse without any additional live video system. 12 In conclusion, when photos of a UBC exist, a team of senior urologists can make an excellent decision about the type and extent of surgical treatment and plan ahead postsurgical management of the patient.…”

Section: Discussionmentioning

confidence: 99%

Can urologists accurately stage and grade urothelial bladder cancer by assessing endoscopic photographs?

2017

View full text Add to dashboard Cite

Introduction Assessment of urothelial bladder cancer during cystoscopy or transurethral resection of bladder tumour has a significant impact on the urologist's decision-making: treatment with simple outpatient fulguration, required depth of resection, and need of immediate post-surgical intravesical therapy. These choices depend heavily on the urologist's ability to accurately assess pre-biopsy tumour stage and grade. The aim of the study was to determine whether evaluation of photographs taken during transurethral resection of bladder tumour can reliably characterize a tumour's stage and grade. Methods Smartphone photographs of 50 urothelial bladder cancer cases were taken at the beginning of transurethral resection of bladder tumour and individually presented to seven senior urologists. All urologists were blinded to the final pathological report and to any other urological evaluation. Each one was asked to rate the tumour as low vs high grade and noninvasive Ta vs noninvasive T1 or muscle invasive. Results were compared with final pathology. Individual appraisal and the majority's opinion were evaluated. Results Urologists have correctly predicted tumour stage and grade in 63.5% of cases (222 of 350, average of 32 out of 50 accurate assessments). The final majority assessment was correct in 40 of 50 cases (80%). Sensitivity and specificity of the final results for the diagnosis of T1 or higher were 80% and 88.6%, respectively. Sensitivity and specificity for Ta low grade were 83.3% and 80%, respectively. Conclusions To the best of our knowledge, this is the first documented attempt to evaluate urologists' ability to assess urothelial bladder cancer stage and grade using endoscopic photographs. Urologists can usually identify stage and grade of urothelial bladder cancer but accuracy increases when multiple senior urologists examine the same photographs and achieve majority consensus. Presenting photographs of urothelial bladder cancer to a team of urologists may lead to an excellent decision regarding type and extent of surgical treatment and substantiate appropriate post-surgical management.

show abstract

“…We found strong concordance between expert urologists and workers in their rating of video quality and corresponding medical appropriateness (R = 0.932). 14…”

Section: What Is Known About the Topicmentioning

confidence: 99%

Adapting nurse‐led cystoscopy experience to the United States: Tele‐cystoscopy a possible compromise?

Beller

Lobo

Horton

et al. 2019

Int J of Uro Nursing

Self Cite

View full text Add to dashboard Cite

Urology workforce shortages in rural areas limit access to diagnostic cystoscopy for hematuria or surveillance cystoscopy for patients with bladder cancer. To address this, we developed a tele‐cystoscopy model in which urologic advanced practice professionals (APPs) perform cystoscopies that are interpreted in real‐time by board‐certified urologists at their home institution. This collaborative model allows the cystoscopic interpretation to be performed by a board‐certified urologist. This model may both improve access for patients in remote locations and may lead to greater acceptance of nurse‐led cystoscopy in the medical legal environment found in the United States.

show abstract

Optimizing and validating the technical infrastructure of a novel tele-cystoscopy system

Abstract: We created and tested the feasibility of a tele-cystoscopy system that was deemed suitable for medical diagnosis by a group of experts. We further validated tele-cystoscopy video quality using both experts and recently validated crowd-sourcing.

Cited by 19 publications

References 20 publications

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

Can urologists accurately stage and grade urothelial bladder cancer by assessing endoscopic photographs?

Adapting nurse‐led cystoscopy experience to the United States: Tele‐cystoscopy a possible compromise?

Contact Info

Product

Resources

About