8 results on '"Rosen, Geoffrey H."'
Search Results
2. Re: Jim C. Hu, Melissa Assel, Mohamad E. Allaf, et al. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial. Eur Urol. 2024;86:61-68.
- Author
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Rosen GH, Chakiryan NH, and Murray KS
- Subjects
- Humans, Male, Magnetic Resonance Imaging, Perineum, Rectum, Prostatic Neoplasms pathology, Prostate pathology, Image-Guided Biopsy methods, Randomized Controlled Trials as Topic
- Published
- 2024
- Full Text
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3. Within State Variability of Antimicrobial Susceptibility: Missouri as an Archetype to Assess Guidelines for Antimicrobial Prophylaxis for Transurethral Procedures.
- Author
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Wright CC, Kanake S, Golzy M, Malm-Buatsi E, Murray KS, and Rosen GH
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- Humans, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Cefazolin therapeutic use, Escherichia coli, Missouri, Drug Resistance, Bacterial, Gentamicins therapeutic use, Microbial Sensitivity Tests, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents pharmacology, Urinary Tract Infections microbiology, Anti-Infective Agents therapeutic use
- Abstract
Objective: To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines., Methods: Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), third-generation cephalosporins, cefazolin, penicillin combinations, gentamicin, and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities., Results: Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for third-generation cephalosporins for E. coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E. coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E. coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%)., Conclusion: Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
- Full Text
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4. AUTHOR REPLY.
- Author
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Golzy M, Rosen GH, Kruse RL, Hooshmand K, Mehr DR, and Murray KS
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- 2023
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5. Holistic Assessment of Quality of Life Predicts Survival in Older Patients with Bladder Cancer.
- Author
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Golzy M, Rosen GH, Kruse RL, Hooshmand K, Mehr DR, and Murray KS
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- Humans, United States epidemiology, Aged, Adult, Retrospective Studies, Cross-Sectional Studies, Medicare, Quality of Life, Urinary Bladder Neoplasms surgery
- Abstract
Objective: To determine if clustering methods can use a holistic assessment of health-related quality-of-life after bladder cancer diagnosis to predict survival outcomes independent of clinical characteristics. In the United States, an estimated 81,180 cases of bladder cancer will be diagnosed in 2022. We aim to help address the knowledge gap concerning the impact of patient functional status on outcomes., Materials and Methods: This is a cross-sectional, retrospective cohort study of patients in the End Results-Medicare Health Outcomes Survey Registry. Age and 36-Item Short Form Survey (SF-36) responses were used as K-means inputs to identify homogenous clusters of older patients with bladder cancer. We analyzed the association between the identified clusters, patient and disease characteristics, and outcomes. We used Cox proportional hazard regression to compare overall survival., Results: We identified 5 homogenous clusters that exhibited differences in patient characteristics and survival. There was no significant difference in cancer stage or surgery type among the clusters. The Cox proportional hazard regression demonstrated significant associations of cluster with gender, age, education, marital status, smoking status, type of surgery, and cancer stage on overall survival. Cluster independently predicted overall survival., Conclusion: Using unsupervised machine learning, we identified clusters of patients with bladder cancer who had similar mental and physical function scores. Cluster grouping suggests that patients' mental and physical function may not be based on disease or treatment. There are significant survival differences between all clusters, demonstrating that a holistic assessment of patient-reported health-related quality-of-life has the potential to predict survival and possible modifiable risk factors in older patients with bladder cancer., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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6. EDITORIAL COMMENT.
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Rosen GH, Badalato GM, and Murray KS
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- 2023
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7. Antimicrobial Selection for Transurethral Procedures Across the United States: A State-by-State Antibiogram Evaluation.
- Author
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Rosen GH, Kanake S, Golzy M, Malm-Buatsi E, and Murray KS
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- Drug Resistance, Bacterial drug effects, Humans, Risk Factors, United States epidemiology, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents classification, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis methods, Bacteria classification, Bacteria drug effects, Bacteria isolation & purification, Microbial Sensitivity Tests methods, Microbial Sensitivity Tests statistics & numerical data, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications microbiology, Postoperative Complications prevention & control, Urethra microbiology, Urethra surgery, Urinary Tract Infections epidemiology, Urinary Tract Infections etiology, Urinary Tract Infections microbiology, Urinary Tract Infections prevention & control, Urologic Surgical Procedures adverse effects, Urologic Surgical Procedures methods
- Abstract
Objective: To evaluate optimal regimens for perioperative antimicrobial prophylaxis in transurethral procedures by examining antimicrobial susceptibility patterns in the United States., Materials and Methods: Through several methods, we attempted to attain an antibiogram for each state. We focused on microbes known to cause infections after transurethral surgeries and antibiotics referred to in current or prior recommendations and compared susceptibility rates across states using Kruskal Walis tests and the Dwass, Steel, Critchlow-Fligner tests. We also examined susceptibility to (non-ceftazidime) third generation cephalosporins., Results: Data is included from 40 states. For each microbe studied, there was significant variability in sensitivity to antibiotics studied. Current first line recommendations for antimicrobial prophylaxis include first generation cephalosporins with 82%, 80%, and 87% mean coverage for E coli, Proteus, and Klebsiella respectively and trimethoprim-sulfamethoxazole with 74%, 80%, and 93% coverage, respectively. Susceptibility to aminoglycosides is 91%, 92%, and 96%, respectively and to third generation cephalosporin, it is 92%, 99%, and 94%., Conclusion: Current first line recommended antimicrobials for prophylaxis in transurethral procedures provide overall poor predicted coverage based on our database of antibiograms. Alternatives exist that have higher predicted susceptibility, though clinical significance of this and risk of resultant antimicrobial resistance is unknown. Urologists should consider local patterns when selecting antimicrobial prophylaxis for their patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
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8. Straight-Up Approach to Bedside Ureteral Stents.
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Bailey J, Rosen GH, and Murray KS
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- Humans, Point-of-Care Systems, Prosthesis Implantation methods, Stents, Ureter surgery
- Abstract
Objective: To demonstrate placement of bedside double-j ureteral stents in an Emergency Department or hospital floor setting., Background: Ureteral stent placement is a potentially lifesaving intervention and is one of the most common procedures performed by urologists. Although this procedure is typically performed in the operating room, studies have shown placing ureteral stents at the bedside could potentially decrease delay in stent placement, alleviate financial burdens of operating room use, decrease radiation exposure, and avoid general anesthesia risks
1-5 . We demonstrate a safe and efficacious method for bedside ureteral stent placement without fluoroscopic guidance., Materials and Methods: In the setting of the Emergency Department we use ketamine for conscious sedation and local anesthesia while on the wards, we utilize just local anesthesia. After the patient has been sterilely prepped and draped, the operator passes the flexible cystoscope into the bladder in the standard fashion. The obstructed ureteral orifice is identified, and an extra-long guidewire is used to place a 4.8-French ureteral stent through the scope and beyond the obstruction. A post-operative plain film x-ray of the abdomen confirms proper placement. If significant issues are encountered, the procedure is abandoned, and standard operating room stent placement is undertaken., Results: The technique is simple and reproducible for placing double-j ureteral stents outside of the operating room environment without general anesthesia., Conclusion: In select patients, bedside double-j ureteral stent placement using our method is a safe and reproducible way to avoid the costs and risks associated with general anesthesia and to optimize utilization of scarce operating room resources., (Copyright © 2021 Elsevier Inc. All rights reserved.)- Published
- 2021
- Full Text
- View/download PDF
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