Gregory W Hruby

New York Presbyterian Hospital | NYP · Quality and Patient Safety

This paper describes our considerations and methods for implementing an open-source centralized research data repository (CRDR) and reports its impact on retrospective outcomes research capacity in the urology department at Columbia University. We performed retrospective pretest and post-test analyses of user acceptance, workflow efficiency, and pu...

Electronic health records (EHR) are a vital data resource for research uses, including cohort identification, phenotyping, pharmacovigilance, and public health surveillance. To realize the promise of EHR data for accelerating clinical research, it is imperative to enable efficient and autonomous EHR data interrogation by end users such as biomedica...

Many academic medical centers have aggregated data from multiple clinical systems into centralized repositories. These repositories can then be queried by skilled data analysts who act as intermediaries between the data stores and the research teams. To obtain data, researchers are often expected to complete a data request form. Such forms are mean...

To most medical researchers, databases are obscure black boxes. Query analysts are often indispensable guides aiding researchers to perform mediated data queries. However, this approach does not scale up and is time-consuming and expensive. We analyzed query mediation dialogues to inform future designs of intelligent query mediation systems. Thirty...

Introduction: Our goal was to determine if board certification status was associated with improved postoperative outcomes for certain urologic oncology operations. Methods: We performed a retrospective cohort study of patients aged 65 and over having radical prostatectomy (RP), radical cystectomy (RC), and radical or partial nephrectomy (RPN) by...

Value-based care initiatives require accurate quantification of resource utilization. This study explores hospital resource documentation performance for total knee and hip arthroplasty (TKA, THA) implants and how this may differ between hospitals. This retrospective study utilized the Premier discharge database, years 2006 to 2020. TKA/THA cases w...

Introduction: Disposable single-use cystoscopes have become increasingly available, demonstrating comparable quality to reusable cystoscopes while eliminating the need for reprocessing and repairs. However, high costs remain a concern. To clarify the role for these scopes, we performed a cost analysis comparison between the single-use Ambu® aScope...

Cohort identification for clinical studies tends to be laborious, time-consuming, and expensive. Developing automated or semi-automated methods for cohort identification is one of the “holy grails” in the field of biomedical informatics. We propose a high-throughput similarity-based cohort identification algorithm by applying numerical abstractions...

ABSTRACT Objective To develop an open-source information extraction system called EliIE (Eligibility Criteria Information Extraction) for parsing and formalizing free-text clinical research eligibility criteria following the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) version 5.0. Materials and methods EliIE parses eligi...

Objective: To apply cognitive task analyses of the Biomedical query mediation (BQM) processes for EHR data retrieval at multiple sites towards the development of a generic BQM process model. Materials and methods: We conducted semi-structured interviews with eleven data analysts from five academic institutions and one government agency, and perf...

Purpose The analysis of exosome/microvesicle (extracellular vesicles (EVs)) and the RNA packaged within them (exoRNA) has the potential to provide a non-invasive platform to detect and monitor disease related gene expression potentially in lieu of more invasive procedures such as biopsy. However, few studies have tested the diagnostic potential of...

Box plot Analysis of Prostate Cancer Related Gene delta Ct Expression in Urinary EVs. Box plot analysis demonstrating the Delta Ct spread of prostate cancer related genes AR, BIRC5, ERG, PCA3, T:E, and TMPRSS in Bx Pos and Bx Neg patients. Delta Ct was determined as Ct gene of interest − Ct KLK3. AR (Bx Neg n = 38, Bx Pos n = 47), BIRC5 (Bx Neg n =...

Cartoon of Prostate Tissue Sections Taken for Comparative Analysis of TMPRSS2:ERG Gene Expression in Tissue Versus Urinary exoRNA. Cartoons showing benign (blue) and cancer (pink) regions from a radical prostatectomy that were selected for RNA extraction and gene expression analysis. Tumor and benign regions positive for TMPRSS2:ERG expression are...

Detection of mRNA Transcripts in FFPE Tissue. Agilent bioanalyzer DNA chip analysis of amplicons generated via PCR in no template control (NTC) and samples with reverse transcriptase reaction (RT) and without reverse transcriptase (No RT) reaction. The ‘No RT’ samples failed to generate amplicons consistent with the RNA specific primers and probe f...

Representative H&E Stained Tissue of the Various Benign and Tumor Areas Surveyed for TMPRSS2:ERG Expression. Prostatectomy tissue (5um) was stained with H&E to demonstrate the morphology of each area. Analysis of sections serial to those originally analyzed by the pathologist revealed in some cases micro foci of tumor (see section C12), which may e...

Box plot Analysis of TMPRSS2:ERG delta Ct Expression in Urinary EVs. Box plot analysis demonstrating the spread of TMPRSS2:ERG delta Ct in Bx Neg, Bx Pos, Cont, No Bx and RP groups. Delta Ct was determined as Ct TMPRSS2:ERG − Ct KLK3. Bx Neg—biopsy negative (n = 39), Bx Pos—biopsy positive (n = 47), Cont—control males <35 years old (n = 40), No Bx—...

The lack of understanding of user experience with self-service query tools is a barrier to designing effective query tools and is what propelled this study. User actions were documented and transformed into networks of actions for qualitative analysis. Proficient use of self-service query tools requires significant technical experience. To decrease...

BACKGROUND We sought to determine maximum wait times between biopsy diagnosis and surgery for localized prostate cancer, beyond which the rate of adverse pathologic outcomes is increased.METHODS We retrospectively reviewed 4,610 patients undergoing radical prostatectomy between 1990 and 2011. Patients were stratified by biopsy Gleason score and PSA...

Purpose To describe the clinical course of patients that achieved a clinical complete response (cT0) following neoadjuvant chemotherapy (NC) for muscle-invasive bladder cancer (MIBC), as there is no established treatment paradigm for management of these patients. Materials and Methods We performed a retrospective review of 109 patients with MIBC (...

In many institutions, data analysts use a Biomedical Query Mediation (BQM) process to facilitate data access for medical researchers. However, understanding of the BQM process is limited in the literature. To bridge this gap, we performed the initial steps of a cognitive task analysis using 31 BQM instances conducted between one analyst and 22 rese...

Involvement of the prostatic urethra by bladder cancer directly impacts prognosis, risk of urethral recurrence, and timing of radical cystectomy (RC); it also affects the type of urinary diversion chosen. Both cold cup biopsies and transurethral (TUR) loop biopsies have been used to evaluate the status of the prostatic urethra. We report our 20 yea...

We describe a clinical research visit scheduling system that can potentially coordinate clinical research visits with patient care visits and increase efficiency at clinical sites where clinical and research activities occur simultaneously. Participatory Design methods were applied to support requirements engineering and to create this software cal...

Introduction: Intraoperative biopsy of the apical margin during radical prostatectomy has been recommended as a way to reduce the positive margin rate at this location. However, the enhanced visibility of the apex during robot-assisted radical prostatectomy (RARP) may obviate this need, allowing for the preservation of maximal urethral length. We...

We examined the effects of neoadjuvant chemotherapy (NC) in the treatment of muscle invasive urothelial carcinoma of the bladder in those with mixed histology (MH) versus those with pure urothelial carcinoma (UC). Between 2000-2012, 195 patients were identified with clinical stage T2-T4, N0-Nx, M0-Mx UCB who had either NC (+/- radical cystectomy) (...

Various definitions of biochemical failure (BF) have been used to predict cancer recurrence following prostate cryoablation. However to date, none of these definitions have been validated for this use. We have reviewed several definitions of BF to determine their accuracy in predicting biopsy-proven local recurrence following prostate cryoablation....

What's known on the subject? and What does the study add? It is known that men of African descent in the USA and Jamaica have both a higher incidence of prostate cancer and higher mortality than Caucasian men, but it is unclear whether they have worse pathological and biochemical recurrence (BCR) outcome than their Caucasian counterparts after radi...

Study Type – Therapy (evaluation of information materials) Level of Evidence 3b What's known on the subject? and What does the study add? Patients are highly likely to access the Internet for health information, and studies have reported that inaccurate or low-quality information may alter patients’ expectations and negatively impact informed decis...

Perioperative blood transfusion (PBT) has been shown to contribute to cancer progression and mortality. This study sought to determine the impact of PBT during radical cystectomy on cancer-specific survival (CSS) and overall survival (OS). The Columbia University Urologic Oncology Database was reviewed for patients who underwent a RC from 1989 to 2...

It is becoming increasingly evident that microRNAs (miRNAs) are associated with the development and progression of prostate cancer (PCa). We examined the hypothesis that plasma miRNA levels can differentiate patients by aggressiveness in 82 PCa patients. Taqman based quantitative RT-PCR assays were performed to measure copy number of target miRNAs....

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Incremental nerve-sparing techniques (NSTs) improve postoperative erectile function after robot-assisted radical prostatectomy (RARP). However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confi...

e15019 Background: Urothelial carcinoma of the bladder (UCB) with mixed histological features (MH) is thought to portend a worse prognosis when compared to pure UC, based on reports of decreased survival for pure non-UC tumors. While patients with muscle-invasive UCB have been shown to derive a survival benefit from treatment with neoadjuvant chemo...

e15021 Background: Studies in breast and prostate surgery show reduced cancer recurrence after regional (RA) versus general anesthesia (GA). Mechanisms include RAÕs reduced post-operative opioid use and cortisol-mediated immunosuppression. RA may be used alone during transurethral resection of bladder tumors (TURBT) and in combination with GA durin...

The da Vinci Surgical System (dVSS) has been reported to eliminate innate hand dominance of the surgeon. There are no studies to date, however, that specifically address whether the dVSS has its own inherent "handedness" resulting from the fixed left-right preference of specific instrument docking and assistant positioning. We identified the pelvic...

Study Type – Aetiology (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? For patients with high grade (HG) non-muscle invasive urothelial cell cancer (UCC) of the bladder, transurethral resection of bladder tumor (TURBT) in conjunction with induction and maintenance intravesical therapy is a commonly...

African-Americans (AA) are at risk for benign ethnic neutropenia (BEN), which has been implicated as a potential source of disparity in cancer outcomes among AAs. Since AAs with prostate cancer (PCa) are more likely to have aggressive pathological features, this investigation sought to determine if absolute neutrophil count (ANC) is associated with...

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? In an array of urological and non-urological malignancies, lymphovascular invasion (LVI) is a pathological feature known to be associated with adverse outcomes for recurrence and survival. For some cancers, LVI has therefore been incor...

Purpose: Many patients and their parents utilize the Internet for health-related information, but quality is largely uncontrolled and unregulated. The Health on the Net Foundation Code (HONcode) and DISCERN Plus were used to evaluate the pediatric urological search terms 'circumcision,' 'vesicoureteral reflux' and 'posterior urethral valves'. Mat...

Background: Despite evidence supporting perioperative chemotherapy, few randomized studies compare neoadjuvant and adjuvant chemotherapy for bladder cancer. Consequently, the standard of care regarding the timing of chemotherapy for locally advanced bladder cancer remains controversial. We compared patient outcomes following neoadjuvant or adjuvan...

To compare the outcomes of patients treated in the perioperative setting with methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) versus gemcitabine and cisplatin (GC). Systemic cisplatin-based chemotherapy regimens are the mainstay of treatment for patients with advanced bladder cancer. GC has often been used interchangeably with MVAC in n...

We determined the total amount of diagnostic radiation that a patient with testicular cancer receives during the course of treatment and the associated risk of secondary malignancy. At a single institution 119 men with seminomatous and nonseminomatous germ cell tumors of the testis were retrospectively identified. Annual and lifetime exposure to ra...

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men w...

Background: Prostate cancer studies have used urine as a non-invasive source of nucleic acids for biomarker analysis. These studies have been limited by the need for a digital rectal exam (DRE) or prostate massage prior to urine collection to enable enough cellular material for RNA analysis. Such manipulations can potentially lead to variability in...

Cryoablation is an acceptable treatment option for small renal cortical neoplasms (RCN). Unlike extirpative interventions, intraoperative needle biopsy is the only pathologic data for ablated tumors. It is imperative that sampled tissue accurately captures pathology. We studied the optimal intraoperative needle core biopsy protocol for small RCN du...

This study sought to evaluate cancer-specific outcomes among patients who received perioperative mitomycin C (MMC) prior to induction BCG versus those who received induction BCG alone. Between January 2000 and August 2010, 260 patients were identified who underwent a course of induction BCG with or without concomitant perioperative MMC. Specificall...

• The incidence of venous thromboembolism (VTE) after robotic-assisted laparoscopic prostatectomy (RALP) in patients receiving perioperative heparin prophylaxis was compared with those who did not receive such prophylaxis. • Between July 2007 to February 2010, a total of 307 RALPs were performed at our institution by two surgeons. A total of 187 pa...

To examine the relationship between tumour diameter and estimated GFR (eGFR) in patients with renal cell carcinoma (RCC). In total, 1009 patients undergoing partial or radical nephrectomy for unilateral RCC were identified in the Columbia Urologic Database. eGFR was calculated using the modification of diet in renal disease equation using demograph...

Vitamin D has a well-known role in calcium metabolism and bone health. It may also help prevent a number of chronic diseases, including cardiovascular disease, diabetes and malignancies such as breast, colorectal and prostate cancer. To our knowledge the prevalence of vitamin D deficiency has never been reported in the general urological population...

DNA methylation, a widely used epigenetic mark, has been associated with many tumors. However, few studies have addressed the role of cell-free plasma DNA methylation in discriminating aggressive prostate cancer (PCa) from indolent cases. We conducted a case series and a case-control study among histologically confirmed stage II/III cases and match...

Obesity has been identified as a limitation of extracorporeal shockwave lithotripsy (SWL). The obesity metrics of body mass index (BMI) and skin-to-stone distance (SSD) have been evaluated as predictors of SWL success. While SSD has demonstrated a strong correlation with success, BMI has not. Bioimpedance analysis (BIA) is an accurate way of determ...

In addition to their lipid lowering effects, HMG-CoA reductase inhibitors (statins) have been shown to exert antithrombotic effects through downregulation of the coagulation cascade. Because statin use is widespread, it is important to understand the impact of these drugs on blood loss (BL) during surgery. We studied the impact of statin use on BL...

The optimal approach for management of the distal ureter and bladder cuff (DUBC) during laparoscopic nephroureterectomy (LNU) for upper-tract transitional-cell carcinoma (TCC) is controversial. We describe our contemporary experience with LNU and compare several approaches to the DUBC. A retrospective analysis was performed on 36 patients undergoin...

With low life expectancy rates in hemodialysis patients, the preservation of renal parenchyma must be weighed against the oncological outcomes in considering partial nephrectomy (PN) in solitary kidneys. The main objective of this study was to assess the oncologic and functional outcomes after PN in patients with solitary kidneys. A retrospective a...

4616 Background: African Americans (AA) are known to have a phenomenon called “benign ethnic neutropenia (BEN).” This is well described in both the hematology and oncology literature and has been implicated as a source of disparity in cancer outcomes among AAs. Since AA are more likely to have pathological subtypes of prostate cancer, this investig...

e15018 Background: This study sought to evaluate cancer-specific outcomes among patients who received perioperative mitomycin C (MMC) prior to induction BCG versus those who received induction BCG alone. Methods: Between January 2000 and August 2010, 260 patients were identified who underwent a course of induction BCG with or without concomitant pe...

• Gleason sum from prostate biopsy (bGS) is an important tool in classifying severity of disease, ultimately influencing clinical management. • Commonly, pathology specimens are re-evaluated internally prior to surgery. • We evaluate agreement of bGS with prostatectomy Gleason sum (pGS) and the impact of re-grading on prediction of true underlying...

Neurovascular bundle preservation generally results in good postoperative sexual function after radical prostatectomy. However, erectile function (EF) after radical prostatectomy is still a significant concern. The same surgical technique often results in different EF outcomes. We evaluated factors that correlate with recovery of EF within 1 year a...

•To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). •A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. •Exclusion criteria were neo-adjuvant or adjuvant therapy, follow-up <2 years, and insufficient pathological or prostate-specific antigen (PSA) da...

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Preoperative platelet count (PLT), which reflects the systemic inflammatory response, has been previously identified in several small studies as useful prognostic factor in a number of cancers including renal cell carcinoma. This study...

OBJECTIVE • To determine how the presence of MP on T1 biopsy specimens affects the outcome of patients undergoing RC as compared to when no MP is identified in the TURBT specimen. • Patients were retrospectively identified from the Columbia University Urologic Oncology Database. • From January 1986 to October 2009, 114 patients diagnosed with cT1N0...

To investigate the relationship between diabetes and metformin use with outcomes after radical prostatectomy (RP) for clinically localized cancer. A total of 112 diabetic metformin users and 98 diabetic non-metformin users treated with RP from 1990 to 2009 were identified. Nondiabetic controls were match using their 5-year risk of biochemical recur...

Contemporary cryoablation technology utilizes the Joule-Thomson effect, defined as a change in temperature that results from expansion of a nonideal gas through an orifice or other restriction. We evaluated the effect of initial gas tank pressures on freezing dynamics in a single-probe model and in a multiprobe model using contemporary cryoablation...