Jonathan Bergman

University of California, Los Angeles, Los Ángeles, California, United States

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Publications (44)185.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe guideline adherence for patients with suspected upper tract stones. We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (ED component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider or facility characteristics. Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 08/2015; DOI:10.1016/j.urology.2015.07.040 · 2.19 Impact Factor
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    ABSTRACT: Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p < .01) were all associated with linking to auxiliary resources via hyperlinks. When adjusting for confounders, β coefficient estimates and least squares estimation demonstrated that participants clicking on both hyperlink types were more likely to score higher on all knowledge and attitude items, and demonstrate increased score improvements. Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care. © The Author(s) 2015.
    The American journal of hospice & palliative care 08/2015; DOI:10.1177/1049909115598741 · 1.38 Impact Factor
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    Aaron Laviana · Carol Bennett · Josemanuel Saucedo · Jonathan Bergman ·

    The Journal of Urology 04/2015; 193(4):e936-e937. DOI:10.1016/j.juro.2015.02.2693 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e368-e369. DOI:10.1016/j.juro.2015.02.1408 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e503. DOI:10.1016/j.juro.2015.02.1638 · 4.47 Impact Factor
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    ABSTRACT: Background: We built a web-based, interactive, self-directed learning module about end-of-life care. Objective: The study objective was to develop an online module about end-of-life care targeted at surgeons, and to assess the effect of the module on attitudes towards and knowledge about end-of-life care. Methods: Informed by a panel of experts in supportive care and educational assessment, we developed an instrument that required approximately 15 minutes to complete. The module targets surgeons, but is applicable to other practitioners as well. We recruited general surgeons, surgical subspecialists, and medical practitioners and subspecialists from UCLA and the GLA-VA (N=114). We compared pre- and post-intervention scores for attitude and knowledge, then used ANOVA to compare the pre- and postmodule means for each level of the covariate. We performed bivariable analyses to assess the association of subject characteristic and change in score over time. We ran separate analyses to assess baseline and change scores based on the covariates we had selected a priori. Results: Subjects improved meaningfully in all five domains of attitude and in each of the six knowledge items. Individuals younger than 30 years of age had the greatest change in attitudes about addressing pain, addressing end-of-life goals, and being actively involved as death approached; they also had the most marked improvement in total knowledge score. Having a family member die of cancer within the last five years or a personal experience with palliative care or hospice were associated with higher change scores. Conclusions: A web-based education module improved surgical and medical provider attitudes and knowledge about end-of-life care.
    Journal of Palliative Medicine 03/2015; 18(5). DOI:10.1089/jpm.2014.0349 · 1.91 Impact Factor
  • Jonathan Bergman · Christopher S Saigal · Mark S Litwin ·

    JAMA Internal Medicine 12/2014; 175(2). DOI:10.1001/jamainternmed.2014.6397 · 13.12 Impact Factor
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    ABSTRACT: Background: We partnered with patients, families, and palliative care clinicians to develop an integrated urology-palliative care clinic for patients with metastatic cancer. We assessed clinician satisfaction with a multidisciplinary palliative care clinic model. Methods: We conducted semi-structured interviews with 18 clinicians who practice in our integrated clinic. We analyzed transcripts using a multistage, cutting-and-sorting technique in an inductive approach based on grounded theory analysis. Finally, we administered a validated physician job satisfaction survey. Results: Clinicians found that referring a patient to palliative care in the urology clinic was feasible and appropriate. Patients were receptive to supportive care, and clinicians perceived that quality of care improved following the intervention. Conclusion: An integrated, patient-centered model for individuals with advanced urologic malignancies is feasible and well received by practitioners.
    The American journal of hospice & palliative care 10/2014; DOI:10.1177/1049909114555156 · 1.38 Impact Factor
  • Jonathan Bergman · Aaron Laviana ·
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    ABSTRACT: Quality-of-life assessment tools for men with prostate cancer have given patients and health-care providers a nuanced understanding not only of how long patients will survive, but also how well they will live. Health-related quality of life (HRQOL) addresses the entire spectrum of human experience, including daily necessities, interpersonal relationships, physical and mental health, illness, and professional and personal happiness. Developing an HRQOL instrument is a methodologically rigorous process that requires fastidious attention to detail if the product is to be useful for patients and populations, and responsive to change over time. HRQOL instruments must be psychometrically sound, but also readily used by the target population. Instruments should ideally be administered by a neutral third party, to avoid bias of patients wanting to 'please' their physicians by masking underlying problems. The instruments used in HRQOL assessment can be general or specific to a particular disease process. General HRQOL domains assess overall well-being, typically with instruments that address general health perceptions, and social, emotional, and physical function. Disease-specific instruments might focus on how dysfunction in a particular organ or disease affects overall HRQOL. Several instruments specific to prostate cancer have been used on their own or in conjunction with more generic tools to assess HRQOL in men with prostate cancer.
    Nature Reviews Urology 05/2014; 11(6). DOI:10.1038/nrurol.2014.101 · 4.84 Impact Factor
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    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; 82(6). DOI:10.1016/j.urology.2013.08.015 · 2.19 Impact Factor
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    ABSTRACT: The average American adult reads below the eighth-grade level. To determine whether self-reported health-related quality-of-life questionnaires used for pelvic floor disorders are appropriate for American women, we measured reading levels of questionnaires for urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI). An online literature search identified questionnaires addressing UI, POP, and FI. Readability was assessed using Flesch-Kincaid reading level and ease formulas. Flesch-Kincaid grade level indicates the average grade one is expected to completely and lucidly comprehend the written text. Flesch-Kincaid reading ease score, from 0 to 100, indicates how easy the written text can be read. Questionnaires were categorized by UI, POP, FI, and combined pelvic floor symptoms. The median Flesch-Kincaid reading level was 7.2, 10.1, 7.6, and 9.7, for UI, POP, FI, and combined pelvic floor symptoms, respectively. Reading levels varied greatly between questionnaires, with only 54% of questionnaires written below the eighth-grade level. We identified significant variation in reading levels among the questionnaires and found the 2 most commonly used questionnaires per survey in 2008 at Society of Urodynamics and Female Pelvic Medicine and Urogenital Reconstruction were above the recommended eighth-grade reading level. As specialty societies focus on standardizing questionnaires for research, reading levels should be considered so they are generalizable to larger populations of women with pelvic floor disorders.
    Journal of Pelvic Medicine and Surgery 08/2013; 19(5):293-7. DOI:10.1097/SPV.0b013e31828ab3e2 · 1.09 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; 82(1). DOI:10.1016/j.urology.2013.01.040 · 2.19 Impact Factor
  • Jonathan Bergman · Mark S Litwin ·

    European Urology 04/2013; 64(6). DOI:10.1016/j.eururo.2013.03.048 · 13.94 Impact Factor
  • Charles Scales · Jonathan Bergman · Christopher Saigal · Mark Litwin ·

    The Journal of Urology 04/2013; 189(4):e52. DOI:10.1016/j.juro.2013.02.1508 · 4.47 Impact Factor
  • Jonathan Bergman · Robert H Brook · Mark S Litwin ·

    JAMA SURGERY 03/2013; 148(3):215-6. DOI:10.1001/jamasurg.2013.1568 · 3.94 Impact Factor
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    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 12/2012; 2012(45):242-9. DOI:10.1093/jncimonographs/lgs026
  • Jonathan Bergman · Mark S Litwin ·

    European Urology 12/2012; 65(1). DOI:10.1016/j.eururo.2012.12.021 · 13.94 Impact Factor
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    Jonathan Bergman · Arlene Fink · Lorna Kwan · Sally Maliski · Mark S Litwin ·
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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. DOI:10.1007/s00345-010-0610-y · 2.67 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. DOI:10.1016/j.juro.2010.06.012 · 4.47 Impact Factor
  • Bernard M Churchill · Jonathan Bergman · Blaine Kristo · John L Gore ·
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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. DOI:10.1016/j.juro.2010.03.080 · 4.47 Impact Factor

Publication Stats

355 Citations
185.77 Total Impact Points


  • 2007-2015
    • University of California, Los Angeles
      • Department of Urology
      Los Ángeles, California, United States
  • 2010-2014
    • VA Greater Los Angeles Healthcare System
      Los Ángeles, California, United States
  • 2005
    • CSU Mentor
      Long Beach, California, United States