Clinical and Demographic Factors Linked to Low-Value Emergency Department Visits in Pediatric Patients With Spina Bifida.

Purpose: Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida.

Materials And Methods: Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit.

Obstetrics and Gynecology Residency Geographic Match Location Patterns: Comparison of Pre and Post Virtual Interviews.

Objective: To evaluate the impact of virtual interviews on geographic trends for applicants and programs in the obstetrics and gynecology (OBGYN) resident match.

Design: Cross-sectional study of a random 50% sample of all OBGYN residency programs listed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2023 to 2024 academic year. Data collected from each program included geographic location, number of residents per year, and total number of residents.

Evaluation of bi-layer silk fibroin grafts for onlay urethroplasty in a rabbit model of urethral stricture disease.

Autologous tissues such as buccal mucosa (BM) are widely used for reconstruction of urethral strictures; however, limitations such as donor site morbidity and scarce tissue supply require the development of alternative biomaterials for urethral repair. The goals of this study were to determine the safety and efficacy of bi-layer silk fibroin (BLSF) matrices for urethral stricture repair and compare histological and functional outcomes to the standard approach, BM urethroplasty under good laboratory practices. A total of 13 rabbits exhibiting urethral stricture formation following electrocoagulation injury were treated with onlay urethroplasty with either acellular BLSF (N = 7) or autologous BM (N = 6) grafts for 3 months.

Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals.

Introduction: Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida.

Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective.

Purpose: A robotic-assisted laparoscopic approach to appendicostomy offers the benefits of a minimally invasive approach to patients who would typically necessitate an open procedure, those with a larger body habitus, and those requiring combined complex colorectal and urologic reconstructive procedures. We present our experience performing robotic-assisted appendicostomies with a focus on patient selection, perioperative factors, and functional outcomes.

Methods: A retrospective review of patients who underwent a robotic-assisted appendicostomy/neoappendicostomy at our institution was performed.

Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study.

Purpose: This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD.

Methods: A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics.

Results: Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%).

Characterizing psychosocial services in a pediatric urology practice.

Introduction: Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families.

Objective: To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital.

Categorization of a Universal Coding System to Distinguish Use of Durable Medical Equipment and Supplies in Pediatric Patients.

Importance: Although durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES.

Objective: To categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence and related spending of DMES in pediatric patients using Medicaid.

Design, Setting, And Participants: This study is a cross-sectional analysis of the 2018 Merative Medicaid Database and included 4 569 473 pediatric patients aged 0 to 21 years enrolled in Medicaid in 12 US states from January 1 to December 31, 2018.

Gender Affirmation-Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study.

Background: Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition.

Barriers and Facilitators for Under-Represented in Medicine (URiM) Medical Students Interested in Surgical Sub-specialties.

Background: Little is known on drivers and detractors underrepresented in medicine (URiM) medical students face.

Methods: Using the nominal group technique (NGT), we explored experiences that strengthen or weaken the enthusiasm to pursue a career in surgery among URiM medical students (October 2021- April 2022); participants voted on the three most important experiences (weight of 3= top rated, = 1 for the lowest rated). Responses from NGT with at least one vote were weighted, ranked, and categorized.

Cost analysis for mirabegron use in the treatment of children with neurogenic bladder.

Introduction: Mirabegron is a beta-3 adrenergic receptor agonist that received FDA approval in 2021 to treat neurogenic detrusor overactivity (NDO) in children ages three years and older. Despite its safety and efficacy, access to mirabegron frequently remains restricted by payor coverage policies.

Objective: This cost minimization study sought to determine the cost implications from a payor perspective of mirabegron use at different points in the treatment pathway for pediatric NDO.

Implementation of a Problem-Based Presentation Format to Improve Residents' Ambulatory Patient Presentations.

Background: The format for residents to present hospitalized patients to teaching faculty is well defined; however, guidance for presenting in clinic is not uniform.

Objective: We report the development, implementation, and evaluation of a new standardized format for presenting in clinic: the Problem-Based Presentation (PBP).

Methods: After a needs assessment, we implemented the format at the teaching clinics of our internal medicine residency program.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness.

Introduction: The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties.

Methods: We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space.

High-performance pediatric surgical risk calculator: A novel algorithm based on machine learning and pediatric NSQIP data.

Backgrounds: New methods such as machine learning could provide accurate predictions with little statistical assumptions. We seek to develop prediction model of pediatric surgical complications based on pediatric National Surgical Quality Improvement Program(NSQIP).

Methods: All 2012-2018 pediatric-NSQIP procedures were reviewed.

False-positive urine pregnancy screening tests are uncommon in the hospital setting among patients with bowel-containing urinary tract reconstruction.

Purpose: False-positive urine pregnancy screening tests (UPST) have been reported among patients with bowel-containing urinary reconstruction (BCUR). However, the true frequency of such inaccurate results, which have been attributed to urinary mucous or other proteins interfering with or mimicking the binding of beta-HCG in the assay, is unknown in this population. We sought to determine the incidence of false-positive pregnancy screening tests among this patient population at our institution.

Patient Experience with Virtual Preoperative Consultations in Pediatric Surgical Specialties.

Background: A cross-sectional study was conducted to assess the comparative effectiveness of virtual visits for preoperative evaluation and surgical decision-making in three pediatric surgical subspecialties.

Methods: Patients who underwent surgical procedures in the departments of Urology, Ophthalmology, and Plastic and Oral Surgery at a tertiary care pediatric hospital over a one-year period during the COVID-19 pandemic were included. Patients were assigned to one of three clinical pathways based on their preoperative visit(s): only in-person visit(s) (IP), a combination of in-person and virtual visit(s) (IP/VV), and only virtual visit(s) (VV).