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Minerva Urology and Nephrology 2021 October;73(5):662-7

DOI: 10.23736/S2724-6051.20.03747-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Exploratory analysis on the usage of Pi-score algorithm over endoscopic stone treatment step 1 protocol

Domenico VENEZIANO 1, 2, 3 , Giulio PATRUNO 4, Michele TALSO 5, Theodore TOKAS 6, Silvia PROIETTI 7, Angelo PORRECA 8, Guido KAMPHUIS 9, Shekhar BIYANI 10, Esteban EMILIANI 11, Marcos CEPEDA DELGADO 12, Lopez M. de MAR PEREZ 13, Roberto MIANO 14, Stefania FERRETTI 15, Nicola MACCHIONE 16, Panagiotis KALLIDONIS 17, Emanuele MONTANARI 18, Giovanni TRIPEPI 19, Achilles PLOUMIDIS 20, Giovanni CACCIAMANI 21, Estevao LIMA 1, 2, Bhaskar SOMANI 22

1 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; 2 ICVS/3B’s Associate Laboratory, Braga, Portugal; 3 Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy; 4 Department of Urology, San Giovanni Addolorata Hospital, Rome, Italy; 5 Department of Urology, ASST Vimercate, Vimercate, Monza-Brianza, Italy; 6 Department of Urology and Andrology, General Hospital, Hall in Tirol, Austria; 7 Department of Urology, San Raffaele-Turro Hospital, Milan, Italy; 8 Department of Urology, Policlinico Abano Terme, Abano Terme, Padua, Italy; 9 Department of Urology, AMC University Hospital, Amsterdam, The Netherlands; 10 Department of Urology, St. James’s University Hospital Leeds Teaching Hospitals NHS, Leeds, UK; 11 Department of Urology, Fundaciò Puigvert, Barcelona, Spain; 12 Department of Urology, Rio Hortega University, Valladolid, Spain; 13 Department of Urology, Jesús Usón Center of Minimally Invasive Surgery, Caceres, Spain; 14 Department of Urology, University of Rome Tor Vergata, Rome, Italy; 15 Department of Urology, Parma University Hospital, Parma, Italy; 16 Department of Urology, San Paolo Hospital, Milan, Italy; 17 Department of Urology, University of Patras, Patras, Greece; 18 Department of Urology, University Polyclinic Hospital, Milan, Italy; 19 Institute of Clinical Physiology (IFC), National Research Council (CNR), Reggio Calabria, Italy; 20 Department of Urology, Athens Medical Centre, Athens, Greece; 21 USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 22 Department of Urology, University of Southampton, Southampton, UK



BACKGROUND: The Performance Improvement score (Pi-score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training.
METHODS: The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of ‘ART in Flexible Course’, during four courses in Barcelona and Milan. Collected data were independently analyzed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa statistics were used for comparison analysis.
RESULTS: Sixteen hands-on training expert tutors and 47 3rd-year residents in Urology were involved. Concordance found between the 16 proctors’ scores was the following: Task 1=0.30 (“fair”); Task 2=0.18 (“slight”); Task 3=0.10 (“slight”); Task 4=0.20, (“slight”). Concordance between Pi-score results and proctor average scores per-participant was the following: Task 1=0.74 (“substantial”); Task 2=0.71 (“substantial”); Task 3=0.46 (“moderate”); Task 4=0.49 (“moderate”).
CONCLUSIONS: Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.


KEY WORDS: Endoscopy; Urology; Algorithms

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