Kathleen Kan

All Publications

• Creating a community advisory board for pediatric bladder health. Frontiers in pediatrics Teehan, E., Phord-Toy, A., Venkatapuram, P., Kan, K. M. 2024; 12: 1396003

  Abstract

  Pediatric lower urinary tract symptoms (LUTS) are highly prevalent in neurologically healthy school-aged children. However, no evidence-based programs exist to prevent or treat LUTS in the community setting. To address this, we established the first community advisory board (CAB) that aims to identify individual and societal structures impacting pediatric bladder health in Northern California's Bay Area and co-design culturally relevant bladder health interventions.Probability and non-probability sampling methods were used to recruit community stakeholders to the CAB. Our final CAB comprised of two parents, two community health workers, one educator, one pediatric urology registered nurse, and one pediatrician. The CAB met quarterly during the 1-year study period.Bi-directional feedback identified community-level barriers to bladder health, particularly in the school environment, and the need for tailored resources to teach children and families about healthy bladder behaviors.The CAB co-designed school-based bladder health interventions, including bladder health posters, and provided feedback on three school-based research study proposals. The CAB will continue to guide and inform future community-engaged research efforts.

  View details for DOI 10.3389/fped.2024.1396003

  View details for PubMedID 39081924

  View details for PubMedCentralID PMC11287218

• Parental Knowledge, Beliefs, Practices, and Barriers Related to Children's Bladder Health in the School Environment. The Journal of school health Venkatapuram, P., Angulo-Lozano, J. C., Spinzi, S., Brown-Johnson, C., Phord-Toy, A., Kan, K. M. 2024

  Abstract

  Pediatric lower urinary tract symptoms (LUTS) are a set of common childhood problems. Community-level interventions that target behavioral change among children with LUTS can improve symptoms outside of the clinic environment. Parents, navigating the home and school environments, are key in supporting healthy bladder behaviors. Thus, we asked parents about their perceptions and barriers related to pediatric bladder health.English-speaking parents (n = 30) of children ages 5-10 years with and without LUTS were interviewed. Transcripts were coded iteratively by two independent coders using deductive and inductive approaches that emphasized consensus coding and peer debriefing.Ninety-three percent of participants were women, 50% were 30-39 years old, and 60% held a graduate degree. Parents identified school-, classroom-, and child-based barriers to bladder health. These included the bathroom environment, restrictive policies for bathroom use, and anxiety on how and when to use the bathroom.Addressing school-, classroom-, and child-based barriers is necessary to promote healthy bladder habits among children in the school environment and beyond. Recommended school-based interventions include bathroom use and sanitation policies that support students' voiding needs, teachers' professional development, and school readiness initiatives. Limitations include participation of English-speaking parents only.

  View details for DOI 10.1111/josh.13456

  View details for PubMedID 38711264

• Paediatricians' perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study. BMJ paediatrics open Spinzi, S., Agrawal, G., Sharma, A., Venkatapuram, P., Sharma, K., Brown-Johnson, C., Kan, K. M. 2024; 8 (1)

  Abstract

  Paediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these bothersome symptoms, yet there is no formal resource to support them with the treatment of LUTS. Evaluating paediatricians' experiences is an important step in informing health promotion efforts to improve health outcomes in children. This study aims to explore paediatricians' knowledge, beliefs, practice patterns, and perceived barriers and facilitators in providing LUTS care.In this qualitative study, we conducted semistructured focus groups of paediatricians within California. Focus groups were conducted via Zoom, and participants were enrolled until thematic saturation was reached. Participants were asked about their current practices, knowledge and beliefs, barriers and facilitators to care, training and education, and responsibility for behaviour and action. Thematic analysis was performed using deductive and inductive approaches; themes were mapped through an iterative, team-based process.15 paediatricians, aged 30-69 years, with 13 (86.7%) women, were interviewed. Most (11, 73.3%) practised in general outpatient settings. Interviewed paediatricians recognised paediatric LUTS as a common problem that can significantly impact children's well-being. In practice, paediatricians did not actively screen for LUTS beyond the potty-training milestone due to short visit duration and competing healthcare demands. Lack of guidelines, parental mistrust and inadequate clinical education were barriers identified by paediatricians.Paediatricians expressed a willingness to help patients but indicated several limitations to providing adequate LUTS care. Future professional development work can emphasise guideline development, early screening strategies to support timely intervention and better education for clinicians.

  View details for DOI 10.1136/bmjpo-2023-002372

  View details for PubMedID 38569740

  View details for PubMedCentralID PMC10989118

• Prevalence of pediatric lower urinary tract symptoms in a national claims database of privately insured patients, 2003-2014. International urology and nephrology Kan, K. M., Agrawal, G., Brosula, R., Venkatapuram, P., Chen, A. L., Zhang, C. A. 2024

  Abstract

  BACKGROUND: We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately insured pediatric population who are 6-20 years old by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature.METHODS: We retrospectively reviewed Optum's de-identified Clinformatics Data Mart Database between 2003-2014. A pLUTS patient was defined by the presence of≥1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period.RESULTS: We identified 282,427 unique patients with≥1 claim for pLUTS between the ages of 6-20 years from 2003 to 2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. The median age group of patients was 6-10 years. More patients were female (59.80%), white (65.97%), between 6 and 10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported≤2 children, and 65.53% reported≥3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting.CONCLUSIONS: Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly insured populations.

  View details for DOI 10.1007/s11255-023-03913-6

  View details for PubMedID 38289544

• Distinguishing characteristics of pediatric patients with primary hyperoxaluria type 1 in PEDSnet. Journal of pediatric urology Tasian, G. E., Dickinson, K., Park, G., Marchesani, N., Mittal, A., Cheng, N., Ching, C. B., Chu, D. I., Walton, R., Yonekawa, K., Gluck, C., Muneeruddin, S., Kan, K. M., DeFoor, W., Rove, K., Forrest, C. B. 2023

  Abstract

  Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inborn error of metabolism that causes oxalate deposition, leading to recurrent calcium oxalate kidney stones, chronic kidney disease and systemic oxalosis, which produces a broad range of serious life-threatening complications. Patients with PH1 have delayed diagnosis due to the rarity of the disease and the overlap with early-onset kidney stone disease not due to primary hyperoxaluria.The objective of this study was to determine the clinical features of individuals <21 years of age with PH1 that precede its diagnosis. We hypothesized that a parsimonious set of features could be identified that differentiate patients with PH1 from patients with non-primary hyperoxaluria-associated causes of early-onset kidney stone disease.We determined the association between clinical characteristics and PH1 diagnosis in a case-control study conducted between 2009 and 2021 in PEDSnet, a clinical research network of eight US pediatric health systems. Each patient with genetically confirmed PH1 was matched by sex and PEDSnet institution to up to 4 control patients with kidney stones without PH of any type. We obtained patient characteristics and diagnostic test results occurring before to less than 6 months after study entrance from a centralized database query and from manual chart review. Differences were examined using standardized differences and multivariable regression.The study sample included 37 patients with PH1 and 147 controls. Patients with PH1 were younger at diagnosis (median age of 3 vs 13.5 years); 75 % of children with PH1 were less than 8 years-old. Patients with PH1 were more likely to have combinations of nephrocalcinosis on ultrasound or CT (43 % vs 3 %), lower eGFR at diagnosis (median = 52 mL/min/1.73 m2 vs 114 mL/min/1.73 m2), and have normal mobility. Patients with PH1 had higher proportion of calcium oxalate monohydrate kidney stones than controls (median = 100 % vs 10 %). There were no differences in diagnosis of failure to thrive, stone size, or echocardiography results.Children with PH1 are characterized by presentation before adolescence, nephrocalcinosis, decreased eGFR at diagnosis, and calcium oxalate monohydrate stone composition. If externally validated, these characteristics could facilitate earlier diagnosis and treatment of children with PH1.

  View details for DOI 10.1016/j.jpurol.2023.10.001

  View details for PubMedID 37848358

• Utilization and safety of telemedicine for pediatric lower urinary tract symptoms before and during the COVID-19 pandemic. Lower urinary tract symptoms Chen, A. L., Spinzi, S., Agrawal, G., Kan, K. M. 2023

  Abstract

  OBJECTIVES: Telemedicine for pediatric lower urinary tract symptoms (pLUTS) is a relatively new mode of delivering bladder health education with scant evidence supporting current practice. We aim to examine the safety of pLUTS-related telemedicine visits surrounding the COVID-19 pandemic.METHODS: We conducted a retrospective cohort study of new pLUTS referral diagnoses to our institution's pediatric urology clinics. Demographics, wait times, and referral diagnoses were captured and compared before and after March 2020 using chi2 /Fisher exact tests and t-tests. A retrospective chart review was performed for an initial telemedicine visit followed by an in-person visit to identify missed radiology, lab, or physical exam findings.RESULTS: Six hundred twelve patients were included from September 2018 to August 2021. Most were 5-10years old (62.3%), female (56.2%), English speaking (86.5%), White (39.4%), and had private insurance (67.2%). Wait times were shorter for telemedicine versus in-person visits (t190 =-3.56, p<.001). After March 2020, patients with a urinary tract infection (UTI) and females utilized in-person visits more often (p<.001). After chart review (11 patients, mean=10.4years), 9 (81.8%) had comorbid conditions and/or family history of lower urinary tract symptoms. None had missed clinical findings that changed management.CONCLUSIONS: pLUTS care can be delivered via telemedicine without a significant change in patient volume and population, though additional investigations will clarify the needs of patients with specific referral diagnoses and comorbid conditions. The in-person exam can be omitted safely with proper clinical history taking, supporting future virtual programs that address delays in care within local communities.

  View details for DOI 10.1111/luts.12496

  View details for PubMedID 37448183

• Assessment of readability and quality of patient education materials specific to nocturnal enuresis. Journal of pediatric urology Mohile, J. M., Luzon, J. B., Agrawal, G., Malhotra, N. R., Kan, K. M. 2023

  Abstract

  BACKGROUND: Bedwetting, or nocturnal enuresis (NE), is a common childhood disease. Families increasingly turn to free online resources for health education in order to navigate treatment options.OBJECTIVE: We aim to determine the readability and quality of online health information that families may encounter when searching for information on pediatric NE.STUDY DESIGN: The search term 'bedwetting' was queried in commonly used search engines. Included articles were further categorized as institutional/reference, commercial, non-profit/charitable, or personal. An online readability platform calculated 3 commonly used readability assessments as well as a consensus score. Quality was assessed by two independent pediatric urologists using a validated DISCERN instrument. Differences in readability were further assessed by article category type.RESULTS: 36 websites were reviewed, 3 did not include treatment options and were not included in quality assessment. 55.6% of the articles were categorized as institutional/reference, 27.8% as non-profit/charitable, 11.1% as personal, and 5.6% as commercial. The average, standard deviation, and range of readability level were as follows: overall consensus score=9.56±2.09, FK Grade Level Formula score=9.38±2.17 (range 5.8-14.1), SMOG Index score=8.89±1.79 (range 6.4-12.9), and the GF Index score=11.86±2.34 (range 8.4-16.9). The overall consensus score, 9.56, correlates to a 9th-grade reading level. 16 articles were considered to be of 'good' quality, 12 of 'fair' quality, and 5 of 'poor' quality; according to the DISCERN scoring. There was no statistically significant difference in readability scores across website categories. Two articles included the outdated treatment option of intranasal DDAVP.DISCUSSION: These findings are concordant with the increasing body of literature demonstrating that patient education materials are too difficult to read. Pediatric urologists should be aware of the readability and quality of available online content for common clinical presentations. They can ensure that institutional articles online are useful to patients by participating in the development and design of these materials.CONCLUSION: We demonstrated that online articles that families encounter via a search engine query for bedwetting are written at a higher level than recommended and the majority are of 'fair' quality. There is much room for improvement for institutions to provide high quality, readable content that supports the needs of families seeking information on NE.

  View details for DOI 10.1016/j.jpurol.2023.05.001

  View details for PubMedID 37248162

• EVALUATING THE REACH AND IMPLEMENTATION OF A BLADDER HEALTH EDUCATION PROGRAM USING AN IMPLEMENTATION SCIENCE FRAMEWORK Chu, J., Sharma, A., Kan, K. M. LIPPINCOTT WILLIAMS & WILKINS. 2023: E934

  View details for Web of Science ID 000994549503087

• Reply by Authors. The Journal of urology Kan, K. M., Tin, A. L., Stearns, G. L., Eastham, J. A., Sjoberg, D. D., Sandhu, J. S. 2021: 101097JU000000000000231202

  View details for DOI 10.1097/JU.0000000000002312.02

  View details for PubMedID 34875871

• De Novo Urinary Storage Symptoms are Common after Radical Prostatectomy: Incidence, Natural History and Predictors. The Journal of urology Kan, K. M., Tin, A. L., Stearns, G. L., Eastham, J. A., Sjoberg, D. D., Sandhu, J. S. 2021: 101097JU0000000000002312

  Abstract

  INTRODUCTION: After RP, clinical complaints of new onset storage symptoms may be related to anastomotic strictures or as accommodation for stress urinary incontinence; however, a subgroup of men will experience de novo storage symptoms in the absence of stricture or stress urinary incontinence. As therapies for OAB have improved, we sought to assess the prevalence, natural history, and risk factors of de novo storage dysfunction in continent men.METHODS: We retrospectively analyzed urinary symptom questionnaires completed by patients who were continent prior to RP and did not have post-operative anastomotic strictures at our institution from 2002-2019. De novo storage dysfunction, assessed as new onset or worsening urgency or frequency was assessed at 6, 12, 18 and 24 months after RP and association between it and patient and preoperative factors determined.RESULTS: A total of 2619 patients were included in the final analysis. An initial 34% of patients reported de novo storage symptoms at 6 months, which decreased to 26% at later follow-up. We found evidence that minimally invasive surgery and nonwhite race were associated with reporting worsening symptoms. The association between post-operative hematoma and worsening symptoms was less conclusive but was of clear clinical relevance (OR 3.15; 95% CI 1.04, 9.54; p-value=0.042).CONCLUSION: A significant number of RP patients experience de novo storage symptoms. Patients who underwent MIS surgery are at higher risk. At risk patients should be counseled on the incidence of de novo storage symptoms and offered early treatment per OAB guidelines.

  View details for DOI 10.1097/JU.0000000000002312

  View details for PubMedID 34694923

• TIME TO SPONTANEOUS RESOLUTION IN INFANT STONE DISEASE Berquist, S., Agrawal, G., Dela Cruz, J., Kan, K. LIPPINCOTT WILLIAMS & WILKINS. 2021: E831

  View details for Web of Science ID 000693689000163

• Comparison of orthogonal NLP methods for clinical phenotyping and assessment of bone scan utilization among prostate cancer patients JOURNAL OF BIOMEDICAL INFORMATICS Coquet, J., Bozkurt, S., Kan, K. M., Ferrari, M. K., Blayney, D. W., Brooks, J. D., Hernandez-Boussard, T. 2019; 94

  View details for DOI 10.1016/j.jbi.2019.103184

  View details for Web of Science ID 000525692600015

• Comparison of Orthogonal NLP Methods for Clinical Phenotyping and Assessment of Bone Scan Utilization among Prostate Cancer Patients. Journal of biomedical informatics Coquet, J. n., Bozkurt, S. n., Kan, K. M., Ferrari, M. K., Blayney, D. W., Brooks, J. D., Hernandez-Boussard, T. n. 2019: 103184

  Abstract

  Clinical care guidelines recommend that newly diagnosed prostate cancer patients at high risk for metastatic spread receive a bone scan prior to treatment and that low risk patients not receive it. The objective was to develop an automated pipeline to interrogate heterogeneous data to evaluate the use of bone scans using a two different Natural Language Processing (NLP) approaches.Our cohort was divided into risk groups based on Electronic Health Records (EHR). Information on bone scan utilization was identified in both structured data and free text from clinical notes. Our pipeline annotated sentences with a combination of a rule-based method using the ConText algorithm (a generalization of NegEx) and a Convolutional Neural Network (CNN) method using word2vec to produce word embeddings.A total of 5,500 patients and 369,764 notes were included in the study. A total of 39% of patients were high-risk and 73% of these received a bone scan; of the 18% low risk patients, 10% received one. The accuracy of CNN model outperformed the rule-based model one (F-measure = 0.918 and 0.897 respectively). We demonstrate a combination of both models could maximize precision or recall, based on the study question.Using structured data, we accurately classified patients' cancer risk group, identified bone scan documentation with two NLP methods, and evaluated guideline adherence. Our pipeline can be used to provide concrete feedback to clinicians and guide treatment decisions.

  View details for PubMedID 31014980

• Clinical and Metabolic Correlates of Calcium Oxalate Stone Subtypes: Implications for Etiology and Management. Journal of endourology Bamberger, J. N., Blum, K. A., Kan, K. M., Parkhomenko, E. n., Gallante, B. n., Gupta, M. n. 2019

  Abstract

  Calcium oxalate (CaOx) is the predominate component within renal calculi and can be divided into two subtypes: CaOx-monohydrate (COM) and CaOx-dihydrate (COD). COM and COD form in differing urinary environments which suggest differential underlying metabolic abnormalities associated with each subtype. We compared clinical and metabolic findings in CaOx stone-formers to delineate factors differentiating COD and COM stone formers and the implication this holds in terms of etiology and treatment.We identified CaOx stone-formers that had passed their stones or had undergone endoscopic extraction between October 2014 and December 2018. Only patients who had a predominant subtype (≥ 80% COM or COD) and who had a 24-hour urine evaluation prior to medical management were included. Clinical and metabolic factors were compared in the two subgroups.Out of 157 stone-formers, 121 were COM and 36 were COD. COD formers were younger than COM formers with a mean age of 53±16 vs 59±15, respectively (p=0.038). There were no observable differences in gender, BMI, HTN, DM, or HLD. COM formers exhibited higher rates of hypocitraturia and hyperoxaluria, p= 0.022 and p=0.018, respectively. Conversely, COD formers had significantly higher rates of hypercalciuria (47% vs. 28%, p=0.012). Multivariate analysis found hypercalciuria to independently predict COD (p=0.043) and hyperoxaluria to predict COM stones (p=0.016).COM formers are more likely to have hyperoxaluria, hypocitraturia, and elevated urinary oxalate levels compared to COD formers. COD formers exhibited higher incidence of hypercalciuria. These data suggest that all CaOx stones are not alike, and that distinct metabolic and clinical etiological differences exist that may guide future management and prevention.

  View details for DOI 10.1089/end.2019.0245

  View details for PubMedID 31154910

• Is it possible to automatically assess pretreatment digital rectal examination documentation using natural language processing? A single-centre retrospective study. BMJ open Bozkurt, S. n., Kan, K. M., Ferrari, M. K., Rubin, D. L., Blayney, D. W., Hernandez-Boussard, T. n., Brooks, J. D. 2019; 9 (7): e027182

  Abstract

  To develop and test a method for automatic assessment of a quality metric, provider-documented pretreatment digital rectal examination (DRE), using the outputs of a natural language processing (NLP) framework.An electronic health records (EHR)-based prostate cancer data warehouse was used to identify patients and associated clinical notes from 1 January 2005 to 31 December 2017. Using a previously developed natural language processing pipeline, we classified DRE assessment as documented (currently or historically performed), deferred (or suggested as a future examination) and refused.We investigated the quality metric performance, documentation 6 months before treatment and identified patient and clinical factors associated with metric performance.The cohort included 7215 patients with prostate cancer and 426 227 unique clinical notes associated with pretreatment encounters. DREs of 5958 (82.6%) patients were documented and 1257 (17.4%) of patients did not have a DRE documented in the EHR. A total of 3742 (51.9%) patient DREs were documented within 6 months prior to treatment, meeting the quality metric. Patients with private insurance had a higher rate of DRE 6 months prior to starting treatment as compared with Medicaid-based or Medicare-based payors (77.3%vs69.5%, p=0.001). Patients undergoing chemotherapy, radiation therapy or surgery as the first line of treatment were more likely to have a documented DRE 6 months prior to treatment.EHRs contain valuable unstructured information and with NLP, it is feasible to accurately and efficiently identify quality metrics with current documentation clinician workflow.

  View details for DOI 10.1136/bmjopen-2018-027182

  View details for PubMedID 31324681

• An Automated Feature Engineering for Digital Rectal Examination Documentation using Natural Language Processing. AMIA ... Annual Symposium proceedings. AMIA Symposium Bozkurt, S., Park, J. I., Kan, K. M., Ferrari, M., Rubin, D. L., Brooks, J. D., Hernandez-Boussard, T. 2018; 2018: 288–94

  Abstract

  Digital rectal examination (DRE) is considered a quality metric for prostate cancer care. However, much of the DRE related rich information is documented as free-text in clinical narratives. Therefore, we aimed to develop a natural language processing (NLP) pipeline for automatic documentation of DRE in clinical notes using a domain-specific dictionary created by clinical experts and an extended version of the same dictionary learned by clinical notes using distributional semantics algorithms. The proposed pipeline was compared to a baseline NLP algorithm and the results of the proposed pipeline were found superior in terms of precision (0.95) and recall (0.90) for documentation of DRE. We believe the rule-based NLP pipeline enriched with terms learned from the whole corpus can provide accurate and efficient identification of this quality metric.

  View details for PubMedID 30815067