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Author(s): Chung, Paul H; Vanni, Alex J; Breyer, Benjamin N; Erickson, Bradley A; Myers, Jeremy B; Alsikafi, Nejd; Buckley, Jill; Elliott, Sean P; Zhao, Lee C; Voelzke, Bryan B; Trauma and Urologic Reconstructive Network of Surgeons (TURNS) | Abstract: ObjectiveTo compare the utility of generic health quality of life (QOL) and condition specific indicators as patient reported outcomes measures for urethral stricture surgery.Materials and methodsPatient data were obtained from the Trauma and Urologic Reconstructive Network of Surgeons collaborative database. Patients who underwent any successful urethroplasty and completed both pre- and postoperative generic and condition-specific questionnaires were included.ResultsA total of 201 patients met inclusion criteria. Urethral-stricture specific measures improved after surgery: mean LUTS score (13.1-4.0, pl0.05), Peeling curve (3.1-1.7, p l 0.05), and overall interference of urinary symptoms on life (3.0-1.6, p l 0.05). Mean overall health status visual analog scale (74.2-80.0, p l 0.05) and generic health QOL EQ-5D index scores (0.90-0.95, p l 0.05) also improved; however, individual EQ-5D measures assessing mobility, self-care, and activity level did not change. EQ-5D measures for pain/discomfort (1.48-1.23, p l 0.05) and anxiety/depression (1.33-1.21, p l 0.05) improved, but not to the same extent as stricture-specific measures. More patients reported improvement in condition-specific urethra/penis pain and bladder pain compared to improvement in generic EQ-5D pain/discomfort (p l 0.001).ConclusionGeneric health QOL indicators are less meaningful in the assessment of urethral stricture surgery and should be replaced with condition-specific outcomes measures. It is important to ensure that appropriate condition-specific outcomes measures are utilized as patient reported outcomes measures become more prevalent in medicine and potentially become utilized to evaluate surgeon outcomes and determine surgeon reimbursement.

Objective To evaluate the current antimicrobial administration practice patterns for urethroplasty among genitourinary reconstruction experts. Improper use of antimicrobials is a global concern. The American Urological Association suggests that for perioperative antimicrobial prophylaxis, a single dose of intravenous cephalosporin be administered for open surgery involving the urinary system. No specific guidelines exist for urethral reconstruction. Subjects and Methods A 27-question survey was designed to assess antimicrobial practice patterns and was administered to 40 international members of the Society of Genitourinary Reconstructive Surgeons who commonly perform urethroplasty. Results The response rate was 85% (n = 34). Preoperative: Seventy-one percent order a urine culture preoperatively despite urine analysis result, and 32% do so 1 week prior. Regardless of catheter status, 41.8% use a urine bacteria threshold of 10K colony-forming units/mL to initiate treatment and ideal duration was 7 days in 35%. Meanwhile, 58.8% would not postpone surgery if preferred duration was not met, and 35% would empirically treat with antimicrobials if a urine culture was not performed. Perioperative: The majority administer 2 antimicrobials intraoperatively with 42% preferring aminoglycoside + penicillin regardless of. Postoperative: Eighteen percent to 24% of respondents continue intravenous antimicrobials for longer than 24 hours. Sixty-one percent administer oral antimicrobials until postoperative catheter removal (2-4 weeks), and the majority give additional antimicrobials at catheter removal. Conclusion There is substantial variability and likely overuse of preoperative, perioperative, and postoperative antimicrobial administration for urethroplasty. Extended prophylactic duration is common postoperatively. Antimicrobial stewardship is our responsibility, and opportunity exists for improvement in antibiotic administration in urethral reconstruction. Prospective trials are requisite to establish guidelines for judicious yet effective regimens.

HealthInsite is the Australian Government's Internet gateway to reliable health information online, providing access to over 15,000 information items on the websites of more than 80 approved information partners. The gateway provides a variety of searching and browsing options to assist users to find information on a wide range of health topics. It relies heavily on subject and other metadata associated with each information resource to provide relevance-ranked search results lists. Subject metadata terms are selected from the Health and Ageing Thesaurus which was developed by the Department of Health and Ageing Library. All of the HealthInsite search and browse options have been successively improved over the eight years since HealthInsite was launched, but the need for significant enhancements to the search engine and search results displays prompted a major upgrade. The upgrade also presents an opportunity to better integrate the Health and Ageing Thesaurus into the search engine to provide support for topic page authoring and searches on non-preferred terms, synonyms and related terms.

The objective of this study was to evaluate the HealthInsite topic query technique, which uses a dynamic database search to assign resources to a topic. It is an alternative to the explicit classification technique, which relies on the classification of each resource using a predefined classification scheme. We performed a recall-precision analysis on all topics within the broad topic area of Child Health. Recall and precision errors were checked to determine which part of the information retrieval process was at fault. We then compared the topic query technique with the explicit classification technique. The results show errors or problems at every stage of the information retrieval process. This has initiated a review of all the tools used in the process, from indexing guidelines to the search engine. While many errors could be corrected, there were still features of the explicit classification technique that could not be achieved by the topic query technique. In conclusion, the topic query technique has the advantage of flexibility, but close co-operation between the different information retrieval specialists is needed to get the best results. The HealthInsite topic navigation structure should be regarded as an organized set of predefined searches rather than a full classified listing.