Jonathan Bergman

CSU Mentor, Long Beach, California, United States

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Publications (30)103.19 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze whether ereferral is associated with decreased time to completion of hematuria workup. We included 100 individuals referred to Olive View-UCLA Medical Center for urologic consultation for hematuria. Half were referred before implementation of ereferral, and half were referred after the system was implemented. We performed bivariate analysis to assess correlations of baseline subject sociodemographic and clinical characteristics with ereferral status. We also created a multivariate linear regression model for log days to completion of hematuria workup, with ereferral as the main predictor and subject sociodemographic and clinical characteristics as covariates. Excluding cases with an infectious cause, the mean number of days from urinalysis documenting hematuria to completed hematuria workup was 404 days before ereferral and 192 days after implementation of ereferral (median 239 vs 170; 2-sample median P = .0013). Upper tract imaging was obtained at a median of 76 days after initial positive urinalysis in the absence of infection, 122 days before ereferral, and 41 days after implementation of ereferral (2-sample median P = .1114). In all cases, lower tract evaluation was completed after upper tract imaging. Our multivariable model evaluating factors associated with time to hematuria workup demonstrated that ereferral use was independently associated with shorter time to hematuria workup (P = .006). Electronic consultations can significantly shorten the time to work-up of hematuria in the safety net.
    Urology 10/2013; · 2.42 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine urology trainees' views about the quality and current practices of end-of-life care and to explore strategies for improving integration and quality of care. METHODS: We conducted semi-structured interviews with 20 trainees from 4 institutions in different regions of the United States. Open-ended questions allowed participants to express themselves independently, and follow-up discussions explored their perception of current end-of-life practices, as well as avenues for future integration and improvement. We analyzed transcripts using a multistage, cutting-and-sorting technique in an inductive approach based on grounded theory analysis. RESULTS: Clinicians agreed that their patients do not currently receive ideal care and were interested in joining a team geared towards improving care at the end of life. They expressed a preference for a multidisciplinary team, although the precise role each wanted to play within the team varied. Better identification of depression, pain, and patient-centered goals to allow value-congruent care were high in priorities for improvement. Trainees cited the lack of an educational curriculum on end-of-life care as a barrier to improving care and expressed a desire for formal education on this topic. CONCLUSION: Urology trainees believe that end-of-life care can be improved and are interested in participating as part of a multidisciplinary team to better care for these individuals. There was consensus that end-of-life care should be formally taught to all intern and resident physicians and care at the end of life should be integrated to pursue value-congruent care for each patient.
    Urology 05/2013; · 2.42 Impact Factor
  • Jonathan Bergman, Mark S Litwin
    European Urology 04/2013; · 10.48 Impact Factor
  • Jonathan Bergman, Robert H Brook, Mark S Litwin
    JAMA surgery. 03/2013; 148(3):215-6.
  • Jonathan Bergman, Mark S Litwin
    European Urology 12/2012; · 10.48 Impact Factor
  • Jonathan Bergman, Mark S Litwin
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    ABSTRACT: Active surveillance is an important arrow in the quiver of physicians advising men with prostate cancer. Quality-of-life considerations are paramount for patient-centered decision making. Although the overall deleterious impact on health is less dramatic than for those who pursue curative treatment, men on active surveillance also suffer sexual dysfunction and distress. Five-year outcomes revealed more erectile dysfunction (80% vs 45%) and urinary leakage (49% vs 21%) but less urinary obstruction (28% vs 44%) in men undergoing prostatectomy. Bowel function, anxiety, depression, well-being, and overall health-related quality of life (HRQOL) were similar after 5 years, but at 6-8 years, other domains of HRQOL, such as anxiety and depression, deteriorated significantly for those who chose watchful waiting. Further research is needed to compare prospectively HRQOL outcomes in men choosing active surveillance and those never diagnosed with prostate cancer, in part to help weigh the potential benefits and harms of prostate cancer screening.
    JNCI Monographs 01/2012; 2012(45):242-9.
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    ABSTRACT: Despite the positive influence of spiritual coping on the acceptance of a cancer diagnosis, higher spirituality is associated with receipt of more high intensity care at the end of life. The purpose of our study was to assess the association between spirituality and type of end-of-life care received by disadvantaged men with prostate cancer. We studied low-income, uninsured men in IMPACT, a state-funded public assistance program, who had died since its inception in 2001. Of the 60 men who died, we included the 35 who completed a spirituality questionnaire at program enrollment. We abstracted sociodemographic and clinical information as well as treatment within IMPACT, including zolendroic acid, chemotherapy, hospice use, and palliative radiation therapy. We measured spirituality with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire (FACIT-Sp) and compared end-of-life care received between subjects with low and high FACIT-Sp scores using chi-squared analyses. A higher proportion of men with high (33%) versus low (13%) spirituality scores enrolled in hospice, although our analysis was not adequately powered to demonstrate statistical significance. Likewise, we saw a trend toward increased receipt of palliative radiation among those with higher spirituality (37% vs. 25%, P=0.69). The differences in end-of-life care received among those with low and high spirituality varied little by the FACIT-Sp peace and faith subscales. End-of-life care was similar between men with lower and higher spirituality. Men with higher spirituality trended toward greater hospice use, suggesting that they redirected the focus of their care from curative to palliative goals.
    World Journal of Urology 02/2011; 29(1):43-9. · 2.89 Impact Factor
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    ABSTRACT: We evaluated the outcome in 19 patients who underwent bladder neck reconstruction by lengthening, narrowing and tightening the bladder neck with a combined tubularized posterior urethroplasty and circumferential fascial wrap. We reviewed the records of all patients who underwent bladder neck lengthening, narrowing and tightening between April 1996 and November 2002. Preoperative urodynamic and radiographic data were available on all patients. The surgical technique involved retroperitoneal exposure of the bladder neck with a tubularized posterior urethroplasty over a urethral catheter. The reconstructed urethra was then circumferentially wrapped with a fitted piece of cadaveric fascia. Of the 19 patients 15 remain completely continent at a mean ± SD followup of 35.5 ± 29.1 months. Three patients underwent secondary reconstruction, including bladder neck ligation in all 3 and secondary enterocystoplasty in 2. No patient experienced difficult intermittent catheterization via the urethra postoperatively. Bladder neck lengthening, narrowing and tightening is effective for managing neurogenic sphincteric incontinence. Outcomes are comparable with those of other reconstructive procedures.
    The Journal of urology 10/2010; 184(4 Suppl):1763-7. · 4.02 Impact Factor
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    ABSTRACT: Hospice programs improve the quality of life and quality of death for men dying of cancer. We sought to characterize hospice use by men dying of prostate cancer and to compare the use of high-intensity care between those who did or did not enroll in hospice. We used linked Surveillance, Epidemiology, and End Results-Medicare data to identify a cohort of Medicare beneficiaries who died of prostate cancer between 1992 and 2005. We created 2 multivariable logistic regression models, one to identify factors associated with hospice use and one to determine the association of hospice use with the receipt of diagnostic and interventional procedures and physician visits at the end of life. Of 14,521 men dying of prostate cancer, 7646 (53%) used hospice for a median of 24 days. Multivariable modeling demonstrated that African American ethnicity (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.68-0.88) and higher Charlson comorbidity index (OR, 0.49; 95% CI, 0.44-0.55) were associated with lower odds of hospice use, while having a partner (OR, 1.23; 95% CI, 1.14-1.32) and more recent year of death (OR, 1.12; 95% CI, 1.11-1.14) were associated with higher odds of hospice use. Men dying of prostate cancer who enrolled in hospice were less likely (OR, 0.82; 95% CI, 0.74-0.91) to receive high-intensity care, including intensive care unit admissions, inpatient stays, and multiple emergency department visits. The proportion of individuals using hospice is increasing, but the timing of hospice referral remains poor. Those who enroll in hospice are less likely to receive high-intensity end-of-life care.
    Archives of internal medicine 10/2010; 171(3):204-10. · 11.46 Impact Factor
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    ABSTRACT: We determined factors associated with bother, the distress patients experience as a result of functional detriments after treatment for localized prostate cancer. A prospective cohort of men treated for clinically localized prostate cancer completed a questionnaire comprising the UCLA-PCI, Medical Outcomes Study Short Form-36, American Urological Association Symptom Index and Memorial Anxiety Scale for Prostate Cancer fear of recurrence subscale. We used nonlinear mixed models to identify factors associated with severe urinary, sexual and bowel bother. Worse function scores were associated with severe urinary, sexual and bowel bother following treatment (OR 0.88-0.94, p <0.001). Worse American Urological Association Symptom Index score was associated with severe urinary bother (OR 1.22, 95% CI 1.16-1.28). Time since treatment was inversely associated with urinary (OR 0.68, 95% CI 0.54-0.83) and bowel bother (OR 0.63, 95% CI 0.47-0.80) early after treatment but not for the entire 48-month study period. Receipt of concomitant androgen deprivation therapy was not associated with bother 48 months after radiation. Addressing functional detriment may confer improvement in urinary, sexual and bowel bother. Patient distress related to dysfunction improves with time. Measuring health related quality of life after prostate cancer treatment should incorporate functional and bother assessments.
    The Journal of urology 10/2010; 184(4):1309-15. · 4.02 Impact Factor
  • Jonathan Bergman, Lorna Kwan, Mark S Litwin
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    ABSTRACT: We established a method to present a health related quality of life instrument in a format more readily interpretable by men with prostate cancer. Men with clinically localized prostate adenocarcinoma treated with radical prostatectomy (220), external beam radiotherapy (56) or interstitial seed brachytherapy (60) were prospectively recruited into the study. We assessed health related quality of life outcomes prospectively at baseline and 24 months after treatment using validated instruments. We defined good, intermediate and poor function for sexual, urinary and bowel domains, including good-the best response for all items in that scale, poor-the worst response for any item and intermediate-all others. We then compared bother scores in men at each symptom level. Men with good baseline urinary and bowel function had almost no related bother (mean +/- SD UCLA-PCI 98 +/- 9 and 99 +/- 8, respectively). Those with poor function had significant distress (mean UCLA-PCI 60 +/- 30 and 64 +/- 34) and those with intermediate function had moderate distress (mean UCLA-PCI 84 +/- 20 and 83 +/- 24, respectively). Effect size was clinically and statistically significant across groups for urinary and bowel function. Men with poor baseline sexual function had much more distress than those with intermediate function (mean UCLA-PCI 44 +/- 37 vs 71 +/- 26). To enhance the clinical relevance of outcome analysis we grouped men by baseline function to help discern their likely levels of bother and function after treatment.
    The Journal of urology 06/2010; 183(6):2186-92. · 4.02 Impact Factor
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    ABSTRACT: The average American adult reads at a fifth to eighth-grade level, with wide variability, presenting challenges for the assessment of self-reported health related quality of life. We identified the health related quality of life instruments used in patients with urological diseases and evaluated their readability. We focused on the most burdensome urological diseases, based on total expenditures in the United States. We then identified disease specific instruments by systematically searching PubMed, the Cochrane Database of Systematic Reviews, Google, Google Scholar, the Patient Reported Outcome and Quality of Life Instruments Database (Mapi Research Institute, Lyon, France) and Yahoo! for health related quality of life studies in patients with these urological conditions. Where disease specific instruments were lacking, we noted the general health related quality of life measures most commonly used. For each instrument, we calculated the median Flesch-Kincaid grade level, the proportion of questionnaire items below an eighth-grade reading level, the mean Flesch Reading Ease, and the mean number of words per sentence and characters per word, all of which are validated measures of readability. The average +/- SD of the median Flesh-Kincaid reading levels was 6.5 +/- 2.1 (range 1.0 to 12.0). Of the 76 instruments 61 (80%) were at or below an eighth-grade reading level. The mean reading ease was greater than 30 for each of the 76 questionnaires and greater than 60 for 66 (87%). Urinary tract infection, the costliest urological disease, has only 1 disease specific health related quality of life measure. Urolithiasis, the second costliest, has none. The reading level of health related quality of life questionnaires in urology is appropriate for the reading ability of most adults in the United States. However, the most burdensome urological diseases lack disease specific health related quality of life instruments.
    The Journal of urology 03/2010; 183(5):1977-81. · 4.02 Impact Factor
  • Jonathan Bergman, Amanda C Chi, Mark S Litwin
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    ABSTRACT: The quality of end-of-life care was assessed in disadvantaged men prospectively enrolled in a public assistance program. That end-of-life care would be aggressive, more so than recommended by quality-of-care guidelines, was hypothesized. Included in the study were all 60 low-income, uninsured men in a state-funded public assistance program who had died since its inception in 2001. To measure quality of end-of-life care, information was collected regarding timing of the institution of new chemotherapeutic regimens, time from administration of last chemotherapy dose to death, the number of inpatient admissions and intensive care unit stays made in the 3 months preceding death, and the number of emergency room visits made in the 12 months before dying. Also noted were hospice use and the timing of hospice referrals. Eighteen men (30%) enrolled in hospice before death and the average hospice stay lasted 45 days (standard deviation, 32; range, 2-143 days; median, 41 days). Two patients (11%) were enrolled for fewer than 7 days, and none were enrolled for more than 180 days. The average time from administration of the last dose of chemotherapy to death was 104 days. Chemotherapy was never initiated within 3 months of death, and in only 2 instances (6%) was the final chemotherapeutic regimen administered within 2 weeks of dying. Use of hospital resources (emergency room visits, inpatient admissions, and intensive care unit stays) was uniformly low (mean, 1.0 +/- 1.0, 0.65 +/- 0.82, and 0.03 +/- 0.18, respectively). End-of-life care in disadvantaged men dying of prostate cancer, who enroll in a comprehensive statewide assistance program, is high-quality.
    Cancer 03/2010; 116(9):2126-31. · 5.20 Impact Factor
  • Journal of Urology - J UROL. 01/2010; 183(4).
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    ABSTRACT: The IMPACT Program seeks to improve access to prostate cancer care for low-income, uninsured men. The objective of the current study was to compare the cost-effectiveness of four policy alternatives in treating this population. We analyzed the cost-effectiveness of four policy alternatives for providing care to low-income, uninsured men with prostate cancer: (1) IMPACT as originally envisioned, (2) a version of IMPACT with reduced physician fees, (3) a hypothetical Medicaid prostate cancer treatment program, and (4) the existing county safety net. We calculated cost-effectiveness based on incremental cost-effectiveness ratios (ICERs) with the formula ICER = (Cost(alternative strategy) - Cost(baseline strategy)) / (QALY(alternative strategy) - QALY(baseline strategy)). We measured outcomes as quality-adjusted life years (QALYs). "Best-case" scenarios assumed timely access to care in 50% of cases in the county system and 70% of cases in any system that reimbursed providers at Medicaid fee-for-service rates. "Worst-case" scenarios assumed timely access in 35 and 50% of corresponding cases. In fiscal year 2004-2005, IMPACT allocated 11% of total expenditures to administrative functions and 23% to fixed clinical costs, with an overall budget of $5.9 million. The ICERs ($/QALY) assuming "best-case" scenarios for original IMPACT, modified IMPACT, and a hypothetical Medicaid program were $32,091; $64,663; and $10,376; respectively. ICERs assuming "worst-case" scenarios were $27,189; $84,236; and $10,714; respectively. County safety net was used as a baseline. In conclusion, IMPACT provides underserved Californians with prostate cancer care and value-added services with only 11% of funds allocated to administrative fixed costs. Both the original IMPACT program and the hypothetical Medicaid prostate cancer program were cost-effective compared to the county safety net, while the reduced-fees version of IMPACT was not.
    Journal of Community Health 11/2009; · 1.28 Impact Factor
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    ABSTRACT: Being in a supportive relationship may have improved the health-related quality of life (HRQOL) of men with prostate cancer, if the support was strong and positive. In the current study, the authors sought to examine the impact of partnership status on the mental health of men treated for localized prostate cancer. Participants had clinically localized prostate cancer and chose treatment with radical prostatectomy (n=307), external-beam radiotherapy (n=78), or brachytherapy (n=91). The authors prospectively assessed subject characteristics and HRQOL outcomes and evaluated associations between partnership outcomes and HRQOL measures. Two multivariate linear regression models were then created, 1 for baseline HRQOL outcomes and 1 for change in HRQOL from baseline to 12 months, with partnership status as the main predictor and subject characteristics as covariates. Partnership status was not found to be associated with either baseline physical or mental health, but partnered participants had less bowel bother (P=.02) and a lower fear of recurrence (P=.03) at baseline than did unpartnered subjects. Men with fewer comorbid conditions scored better across almost all baseline HRQOL domains. Primary treatment type was significantly associated with changes in physical HRQOL, with men undergoing radical prostatectomy describing better changes in physical health than those treated with brachytherapy (P=.04) or those receiving external-beam radiotherapy (P<or=.01). Physical and mental health was found to be comparable in the study cohort of partnered and unpartnered men treated for prostate cancer. The universally high socioeconomic status of the current study cohort may mitigate differences in HRQOL by partnership status.
    Cancer 08/2009; 115(20):4688-94. · 5.20 Impact Factor
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    ABSTRACT: We evaluated associations between demographic and clinical characteristics, quality of life outcome measures and erectile aids in men treated for localized prostate cancer. Patients had clinically localized prostate cancer, were not using erectile aids at baseline and chose treatment with radical prostatectomy (275), external beam radiotherapy (70) or brachytherapy (80). Patient characteristics and health related quality of life outcomes were prospectively assessed at baseline and at regular intervals up to 48 months after treatment. Outcomes were assessed with SF-36, the American Urological Association symptom index and UCLA-PCI. We categorized use of a phosphodiesterase type 5 inhibitor, urethral alprostadil suppositories, penile injection therapy or a vacuum erection device after treatment as erectile aid use. We created a multivariate model examining baseline demographic, clinical and health related quality of life covariates associated with erectile aid use. Of the 425 patients 237 (56%) used an erectile aid at some point during the posttreatment period. In our multivariate model patients treated with external beam radiation were less likely to use an aid (OR 0.34, 95% CI 0.16-0.69) and men with significant sexual bother (OR 2.68, 95% CI 1.37-5.23), or with 1 or more comorbidities (OR 1.80, 95% CI 1.08-2.93) were more likely to use an aid. Patient demographic characteristics were not associated with erectile aids. After treatment for localized prostate cancer more than half of men use erectile aids, especially when they are significantly bothered by dysfunction. This is most pronounced after radical prostatectomy and in men with significant comorbidity.
    The Journal of urology 07/2009; 182(2):649-54. · 4.02 Impact Factor
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    ABSTRACT: To determine the responsiveness of the University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) by studying its sensitivity to clinically perceptible changes in health over time in men treated for localized prostate cancer. All subjects underwent radical prostatectomy (n=253), external beam radiotherapy (n=66), or interstitial seed brachytherapy (n=73). We assessed health-related quality of life (HRQOL) outcomes using the UCLA-PCI to capture disease-specific outcomes and the Medical Outcomes Study Short Form-36 to study general HRQOL. We assessed the UCLA-PCI's responsiveness to change by comparison with the health change item of the Medical Outcomes Study Short Form-36. We measured responsiveness by calculating effect sizes and Guyatt statistics when comparing UCLA-PCI scores between baseline and 1 year and between 1 and 2 years. Of the 475 men who completed all baseline questionnaires, 392 (83%) completed all surveys at 12-month follow-up. Although sexual function decreased from baseline to 12 months in all groups, the magnitude of the negative change was inversely proportional to general health. For those whose general health worsened, effect sizes were >0.50 across all 6 domains. Effect sizes and Guyatt statistics were lowest (<0.25) for urinary bother, bowel function, and bowel bother in the groups demonstrating either no change or improvement in general health. Responsiveness of the UCLA-PCI in the short-term recovery period (12 months post-treatment) was better than in the chronic recovery phase (12-24 months) across almost all domains. The UCLA-PCI is responsive to change in assessing HRQOL in men treated for prostate cancer.
    Urology 07/2009; 75(6):1418-23. · 2.42 Impact Factor
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    ABSTRACT: Hospice care has been found to improve symptom management, quality of death and quality of life at the end of life. We describe hospice use by a cohort of low income, uninsured men with prostate cancer enrolled in a public assistance program. We ascertained whether hospice enrollment was associated with a decrease in the number of prostate cancer related emergency room visits made before death. We studied all 57 low income, uninsured men in a public assistance program who had died since its inception in 2001. The association between sociodemographic and clinical data, and hospice enrollment data were evaluated. The overall rate of hospice use was 28% (16 of 57 patients). The mean +/- SD duration of hospice enrollment before death was 44 +/- 43 days (median 34, range 2 to 143). Two patients (12%) were enrolled fewer than 7 days and none were enrolled more than 180 days. Prostate cancer related emergency room visits, adjuvant chemotherapy treatment, evidence of metastasis at initial presentation and death from prostate cancer were significantly associated with hospice use (p <0.05). We noted a trend toward fewer mean emergency room visits made by men enrolled in hospice care than by those not enrolled (0.7 +/- 1.3 vs 1.1 +/- 0.9, p = 0.15). Hospice use and the duration of enrollment by low income, uninsured men dying of prostate cancer was comparable to previously reported hospice use by insured individuals. Hospice enrollment was associated with fewer prostate cancer related emergency room visits.
    The Journal of urology 04/2009; 181(5):2084-9. · 4.02 Impact Factor
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    ABSTRACT: Our goal was to evaluate the utility of the pelvic ring stability examination for detection of mechanically unstable pelvic fractures in blunt trauma patients. Retrospective chart review. We enrolled 1,502 consecutive blunt trauma patients and found 115 patients with pelvic fractures including 34 patients with unstable pelvic fractures (Tile classification B and C). Unstable pelvic ring on physical examination had a sensitivity and specificity of 8% (95% CI 4-14) and 99% (95% CI 99-100), respectively, for detection of any pelvic fracture and 26% (95% CI 15-43) and 99.9% (95% 99-100), respectively, for detection of mechanically unstable pelvic fractures. The sensitivity and specificity of pelvic pain or tenderness in patients with Glasgow Coma Scale >13 were 74% (95% CI 64-82) and 97% (95% CI 96-98), respectively for diagnosing any pelvic fractures, and 100% (95% CI 85-100) and 93% (95% CI 92-95), respectively for diagnosing of mechanically unstable pelvic fractures. The sensitivity and specificity of the presence of pelvic deformity were 30% (95% CI 22-39) and 98% (95% CI 98-99), respectively for detection of any pelvic fracture and 55% (95% CI 38-70) and 97% (95% CI 96-98), respectively for detection of mechanically unstable pelvic fractures. The presence of either pelvic deformity or unstable pelvic ring on physical examination has poor sensitivity for detection of mechanically unstable pelvic fractures in blunt trauma patients. Our study suggests that blunt trauma patients with Glasgow Coma Scale >13 and without pelvic pain or tenderness are unlikely to suffer an unstable pelvic fracture. A prospective study is needed to determine whether a set of clinical criteria can safely detect or exclude the presence of an unstable pelvic fracture.
    The Journal of trauma 03/2009; 66(3):815-20. · 2.35 Impact Factor

Publication Stats

186 Citations
103.19 Total Impact Points

Institutions

  • 2013
    • CSU Mentor
      Long Beach, California, United States
  • 2012–2013
    • Robert Wood Johnson Foundation
      Princeton, New Jersey, United States
  • 2005–2013
    • University of California, Los Angeles
      • • Department of Urology
      • • Department of Emergency Medicine
      • • Jonsson Comprehensive Cancer Center
      Los Angeles, California, United States
    • University of Southern California
      Los Angeles, California, United States
  • 2010
    • University of Washington Seattle
      • Department of Urology
      Seattle, WA, United States
  • 2009
    • Hartford Hospital
      Hartford, Connecticut, United States