Search

The article focuses on examining the discrepancies in remuneration for urologic services across different provinces in Canada, particularly within the fee-for-service model commonly practiced by urologists. Topics include the analysis of provincial remuneration for various urologic procedures, the identification of significant variations in payment rates between provinces, and the factors contributing to these differences, such as physician demand and medical overhead.

Introduction: Radiation safety education is important as fluoroscopy is commonly used for diagnostic and therapeutic purposes. Exposure to high levels of ionizing radiation is associated with an increased risk of cancer and other adverse health effects; therefore, it is essential that urologists and trainees are educated on the safe use of radiation. Unfortunately, radiation education and occupational safety is not standardized for this group and there are currently no review studies examining radiation safety for urologists in the clinical setting. This review aims at investigating the various levels of radiation safety education and practices used in urology. Methods: MEDLINE and EMBASE databases were searched for relevant publications reporting on radiation knowledge and randomized controlled trials, non-randomized comparative studies, and observational studies were included. Reviews, abstracts, editorial comments, non-urologic studies, and incomplete articles were excluded. Results: Within these articles, there were 16 observational studies. Frequency of radiation exposure ranged from <1 × to >15 × /week. There were higher rates of adherence to use of lead aprons and thyroid shields than lead eyeglasses and gloves. Radiation safety education was infrequent. Radiation safety knowledge was especially low for the risks of radiation exposure. Most studies highlight the need for increased awareness and training on radiation safety for both urology trainees and consultants. Conclusions: Radiation safety education and practices are an important issue in urology. Improvements to education and compliance to radiation safety practices are critical to ensuring urologists and trainees use ionizing radiation in a safe and responsible manner. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Pathology is the property of Canadian Association of Pathologists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two female patients aged 70 and 72 with video‐urodynamics‐confirmed detrusor overactivity and detrusor underactivity (DO‐DU) were treated. Patients were refractory to medical therapies and had previously failed intravesical botulinum toxin type A (BoNT‐A) at other centers secondary to urinary retention and difficulty with self‐catheterization. Placement of an Interstim II device (Medtronic, Minneapolis, Minnesota) for sacral neuromodulation (SNM) as alternative third‐line treatment partially improved overactive bladder (OAB) symptoms while significantly improving voiding symptoms. Postvoid residual (PVR) of patients improved from a median of 118 mL (110‐125 mL) to 20 mL (18‐26 mL) and 213 mL (195‐230 mL) to 70 mL (60‐73 mL), respectively. Addition of medical therapies post SNM failed to modify OAB symptoms further and a rechallenge with dose‐reduced BoNT‐A was undertaken.OAB symptoms were significantly improved by addition of BoNT‐A, while urinary retention was avoided (median PVR post BoNT‐A 38 mL [34‐40 mL] and 185 mL [150‐205 mL], respectively). Reduction in incontinence pad use as well as resolution of nighttime incontinence in both patients and daytime incontinence in one patient was achieved. DO‐DU patients treated by SNM who have improved bladder emptying (PVR <100 mL) but incomplete resolution of OAB symptoms should be trialed on adjunct medical therapies to improve OAB symptoms. If OAB symptoms are still inadequately controlled, consideration of a rechallenge with BoNT‐A, particularly with dose reduction, appears to be efficacious and avoids symptomatic retention in this challenging cohort. [ABSTRACT FROM AUTHOR]

Introduction: Today's surgical practice has evolved, with increasing emphasis on quality assurance. Many forms of quality-control monitoring have been suggested, but they are often impractical or difficult to implement. Cumulative summation (CUSUM) is a simple method to provide visual feedback before significant quality issues arise. We present our initial use and practical application of CUSUM in a surgical practice. Methods: A retrospective analysis was applied to a prospectively collected database of 577 sequential patients who have undergone robot-assisted radical prostatectomy from a single surgeon over a 10-year period. Outcome measures were analyzed with CUSUM, which included a composite complication score, continence rates, length of hospital stay, biochemical recurrence, and need for adjuvant radiation. If any outcomes were out of control, they would cross the CUSUM failure line. Results: CUSUM chart-plotting for incontinence demonstrated an initial upward slope followed by trending to a new safety limit. Additionally, outcomes in complications and biochemical recurrence did not reach the established safety boundaries. Length of stay and radiation outcomes did initially cross the safety line, but were improved over time. Conclusions: The use of CUSUM in clinical practice can fulfill the need for quality assurance. CUSUM plotting in our practice reflected the initial learning curve, followed by ongoing maintenance and improvement in performance. These changes were consistent with the implementation of changes in surgical techniques. Although this tool was used retrospectively, this strengthens our argument to implement the tool prospectively and assess real-time refinement of surgeon skill. We have demonstrated that CUSUM can be appropriately used to assure quality control in a surgical practice. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Medical imaging involving ionizing radiation is common in the clinical setting. Little is known about the level of radiation safety training for medical trainees and attending physicians. We sought to identify the level of radiation safety knowledge and training at the undergraduate, postgraduate, and attending physician level. METHODS: A 29-question survey was sent by email to two sites in Canada. We pooled the results of medical students, residents, and attending physicians. The primary outcome was to describe the amount of radiation safety training among these groups. The secondary outcomes were to describe the frequency of radiation exposure, level of radiation knowledge, and preferred training method for radiation safety. RESULTS: Of 115 surveys that were properly completed, 31 (26.9%) medical students, 17 (14.7%) residents, and 67 (58.3%) attending physicians responded. A greater number of medical students (41.9%) reported they had zero hours of training time for radiation safety compared to attending physicians (14.9%) (p<0.05). A higher number of attending physicians (47.8%) and residents (64.7%) participated in patient care involving fluoroscopy daily or at least several times per week compared to medical students (3.2%) (p<0.001). Attending physicians had the greatest number of correct responses to radiation safety questions. Online courses and workshops were the preferred training methods. CONCLUSIONS: Radiation safety training is an important component of medical education for medical trainees and attending physicians. Current radiation safety training requirements and procedures at various levels of medical training in Canada should be addressed. Implementing radiation safety education may improve adherence to the radiation safety principles. [ABSTRACT FROM AUTHOR]

Competing Interests: There is no conflict of interest or funding provided for this research.

Introduction: Patients in search of answers to health-related questions often seek out information on the internet. The current study aimed to evaluate the quality of videos on the topic of mesh pertaining to its use in the treatment of stress urinary incontinence or pelvic organ prolapse., Methods: A total of 100 videos on the topic of mesh on YouTube TM were screened in this study. From that, a further 30 were selected for review. Five experts in the medical field reviewed each video anonymously, using two video assessment tools. Video characteristics were collected and evaluated. Videos were assessed based on a Global Assessment Score (GAS) and Patient Education Tool for Audiovisual Materials (PEMAT-A/V) scale for ease of patient access and comprehension. The overall correlation between raters and videos was also compared., Results: The GAS and PEMAT-A/V ratings correlation across multiple raters demonstrated excellent inter-rater reliability. We found that the overall GAS score and recommendation was substandard, and the median PEMAT-A/V understandability score was 70% (poorly understandable). Most videos contained some form of marketing, and a scarce number had reliable sources of information. Evidence of neutrality was low., Conclusions: Through the expert assessment of videos using quality assessment tools, this study demonstrated the overall variable quality of mesh videos on YouTube TM and the need for further education regarding patient resources.