Jonathan Kam

The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.

To determine if portable video media (PVM) improves patients knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process.

Retrograde Ejaculation: A Rare Presenting Symptom of Type 1 Diabetes Mellitus.

A 19 year old presented with a progressive decline in ejaculate volume over 2 weeks, followed by a complete absence of ejaculate emission. A post-ejaculatory urine specimen demonstrated spermatozoa confirming a diagnosis of retrograde ejaculation. Investigations revealed a raised blood glucose level of 24.5 mmol/L and HbA1c >15%, with positive tests for anti-GAD antibodies and anti-IA2 antibodies consistent with a diagnosis of Type 1 diabetes mellitus. Retrograde ejaculation in diabetes is associated with autonomic neuropathy and is a late feature of the disease. This case is unique with retrograde ejaculation being the primary presenting symptom of Type 1 diabetes mellitus.

Does magnetic resonance imaging–guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy

Background The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB. Methods Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management. Results A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4–5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB. Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone. There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%). Conclusions This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.

Rare case of a massive staphylococcal prostatic abscess presenting as an ischio‐rectal abscess

associated valvular disease. Chest 1991; 99: 538–45. 3. Reber D, Birnbaum DE, Tollenaere P. Heart diseases following mediastinal irradiation: surgical management. Eur. J. Cardiothorac. Surg. 1995; 9: 202–5. 4. Smedira NG. Mitral valve replacement with a calcified annulus. Operat. Tech. Thorac. Cardiovasc. Surg. 2003; 8: 2–13. 5. Guerrero M, Dvir D, Himbert D et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: results from the first multicenter global registry. JACC Cardiovasc. Interv. 2016; 9: 1361–71. Tanveer Ahmad,* MCh Prakash M. Ludhani,* MCh Ronen Gurvitch,† FRACP John Goldblatt,* FRACS James Tatoulis,* FRACS *Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia and †Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Portable Video Media Versus Standard Verbal Communication in Surgical Information Delivery to Nurses: A Prospective Multicenter, Randomized Controlled Crossover Trial

Background Continuing education of health professionals is important for delivery of quality health care. Surgical nurses are often required to understand surgical procedures. Nurses need to be aware of the expected outcomes and recognize potential complications of such procedures during their daily work. Traditional educational methods, such as conferences and tutorials or informal education at the bedside, have many drawbacks for delivery of this information in a universal, standardized, and timely manner. The rapid uptake of portable media devices makes portable video media (PVM) a potential alternative to current educational methods. Objective To compare PVM to standard verbal communication (SVC) for surgical information delivery and educational training for nurses and evaluate its impact on knowledge acquisition and participant satisfaction. Design Prospective, multicenter, randomized controlled crossover trial. Setting Two hospitals: Gosford District Hospital and Wyong Hospital. Participants Seventy-two nursing staff (36 at each site). Intervention Information delivery via PVM––7-minute video compared to information delivered via SVC. Outcome Measures Knowledge acquisition was measured by a 32-point questionnaire, and satisfaction with the method of education delivery was measured using the validated Client Satisfaction Questionnaire (CSQ-8). Results Knowledge acquisition was higher via PVM compared to SVC 25.9 (95% confidence interval [CI] 25.2-26.6) versus 24.3 (95% CI 23.5-25.1), p = .004. Participant satisfaction was higher with PVM 29.5 (95% CI 28.3-30.7) versus 26.5 (95% CI 25.1-27.9), p = .003. Following information delivery via SVC, participants had a 6% increase in knowledge scores, 24.3 (95% CI 23.5-25.1) versus 25.7 (95% CI 24.9-26.5) p = .001, and a 13% increase in satisfaction scores, 26.5 (95% CI 25.1-27.9) versus 29.9 (95% CI 28.8-31.0) p < .001, when they crossed-over to information delivery via PVM. Linking Evidence to Action PVM provides a novel method for providing education to nurses that improves knowledge retention and satisfaction with the educational process.BACKGROUND Continuing education of health professionals is important for delivery of quality health care. Surgical nurses are often required to understand surgical procedures. Nurses need to be aware of the expected outcomes and recognize potential complications of such procedures during their daily work. Traditional educational methods, such as conferences and tutorials or informal education at the bedside, have many drawbacks for delivery of this information in a universal, standardized, and timely manner. The rapid uptake of portable media devices makes portable video media (PVM) a potential alternative to current educational methods. OBJECTIVE To compare PVM to standard verbal communication (SVC) for surgical information delivery and educational training for nurses and evaluate its impact on knowledge acquisition and participant satisfaction. DESIGN Prospective, multicenter, randomized controlled crossover trial. SETTING Two hospitals: Gosford District Hospital and Wyong Hospital. PARTICIPANTS Seventy-two nursing staff (36 at each site). INTERVENTION Information delivery via PVM--7-minute video compared to information delivered via SVC. OUTCOME MEASURES Knowledge acquisition was measured by a 32-point questionnaire, and satisfaction with the method of education delivery was measured using the validated Client Satisfaction Questionnaire (CSQ-8). RESULTS Knowledge acquisition was higher via PVM compared to SVC 25.9 (95% confidence interval [CI] 25.2-26.6) versus 24.3 (95% CI 23.5-25.1), p = .004. Participant satisfaction was higher with PVM 29.5 (95% CI 28.3-30.7) versus 26.5 (95% CI 25.1-27.9), p = .003. Following information delivery via SVC, participants had a 6% increase in knowledge scores, 24.3 (95% CI 23.5-25.1) versus 25.7 (95% CI 24.9-26.5) p = .001, and a 13% increase in satisfaction scores, 26.5 (95% CI 25.1-27.9) versus 29.9 (95% CI 28.8-31.0) p < .001, when they crossed-over to information delivery via PVM. LINKING EVIDENCE TO ACTION PVM provides a novel method for providing education to nurses that improves knowledge retention and satisfaction with the educational process.

Structured Preoperative Phone Counseling by Junior Medical Staff for Improving the Consent Process for Tonsillectomy

Objective To assess the effectiveness of preoperative phone counseling by junior medical staff for improving the standard of informed consent for tonsillectomy. Study Design Prospective randomized controlled trial. Setting District general hospital. Subjects and Methods A total of 43 patients undergoing tonsillectomy were randomly allocated to 2 groups. Group A (n = 25) underwent the conventional consent process by the consultant ear, nose, and throat surgeon at the time of assessment (which generally takes place 6 to 12 months prior to surgery due to wait-list times). Group B (n = 18) underwent this same consent process but received a structured preoperative phone call 2 to 3 weeks prior to the day of surgery. A preoperative questionnaire assessing the knowledge of tonsillectomy, perioperative course, and risks was completed on the day of surgery. Results Group B had a better recall of the risks of tonsillectomy, recalling 7.1 of the 10 most significant risks, as compared with 4.6 for group A (P = .017). Group B had a better awareness of tooth damage (78% vs 30% of patients, P ≤ .001), voice change (61 vs 19%, P = .005), and burns to lips and mouth (44% vs 8%, P = .005). Finally, 35% more patients from group B rated their understanding of tonsillectomy as good or very good (P = .017). Conclusion Preoperative phone counseling by junior medical staff closer to the time of surgery reinforces and clarifies the information previously provided by senior consultants at the time of initial consent for tonsillectomy.

Portable Video Media Versus Standard Verbal Communication in Surgical Teaching: A Prospective, Multicenter, and Randomized Controlled Crossover Trial

OBJECTIVE This study aims to evaluate the effectiveness of portable video media (PVM) compared to standard verbal communication (SVC) as a novel adjunct for surgical education of junior medical officers and medical students, in terms of knowledge acquisition and participant satisfaction. BACKGROUND The effective, continued education of final year medical students and junior doctors is the foundation of quality healthcare. The development of new media technologies and rapid internet streaming has resulted in an opportunity for the integration of PVM into medical education. PVM is an educational platform with the advantage of being standardized, efficient, and readily available. DESIGN This is a multicenter, prospective, and randomized controlled crossover study. Participants completed a preintervention knowledge test and were then randomized in an allocation ratio of 1:1 to receive surgical education regarding cystoscopy and ureteric stenting for acute renal colic via either PVM or SVC. A 32-point knowledge test and a modified Client Satisfaction Questionnaire-8 were then administered and the participants were then crossed over to the other educational method. The knowledge and satisfaction tests were then readministered. RESULTS Fifty-four participants were recruited for this study with 27 participants in each group. Both groups had a 18% to 20% increase in knowledge scores following the first intervention p < 0.001 and on crossover there was a further 4% increase in knowledge scores, p < 0.01. There was no significant difference between the groups in knowledge scores before intervention, p = 0.23 after first intervention p = 0.74 or following crossover p = 0.09. After first intervention, participants in the group receiving PVM education first had a significant 8% higher satisfaction score compared to the SVC group, p = 0.023. CONCLUSIONS Our study has shown that PVM shows similar efficacy in information uptake to traditional forms of education. Furthermore, PVM was shown to have higher satisfaction scores compared to SVC. Further studies will need to evaluate the use of PVM for education in other surgical and medical domains and assess the long-term knowledge retention.

Red hot chilli pepper! Intralingual dermoid cyst: a rare cause of neck swelling

gastrocutaneous fistulas, ranging from conservative management, endoscopic techniques and surgical closure. This is the first case of such a long delay in the presentation of a gastrocutaneous fistula due to a gunshot wound. In this setting, due to the acute change in condition and deterioration of the patient, surgery was the only appropriate management to definitively cease the haemorrhage and close the fistula.

Rapidly growing massive pleomorphic rhabdomyosarcoma of the bladder presenting with bladder outlet obstruction

A 76-year-old man presented with significant lower urinary tract symptoms, macroscopic haematuria and recurrent urinary tract infections. Initial investigations were consistent with bladder outlet obstruction secondary to an enlarged prostate. Digital rectal examination revealed a grossly enlarged, benign prostate. His urine peak flow was poor at 8 mL/s and he had a post-void residual of 160 mL. A renal tract ultrasound showed a 150-cc prostate protruding into the bladder (Fig. 1). His prostate-specific antigen level was 1.4 ng/mL and other investigations wereunremarkable.His relevantpasthistory includemyelofibrosis, open cholecystectomy and rivaroxaban therapy for atrial fibrillation. Cystoscopically, there appeared to be a massively enlarged middle lobe of a benign prostate and he underwent a transurethral resection (TUR) of the prostate with 105 g resected. Histopathology showed a high-grade stromal tumour, favouring leiomyosarcoma of the prostate (this diagnosis was later amended following additional staining of the pathological specimen). Positron emission tomography/computed tomography imaging was performed for staging 4 weeks postoperatively, which showed a 4-cm prostatic mass (Fig. 2a) and no evidence of metastatic disease. His urinary symptoms initially improved, but he represented on three occasions with clot retention. On the third presentation, due to his significant suprapubic pain and ongoing haematuria requiring blood transfusion, he was taken emergently to operating theatres where cystoscopy revealed significant obstructive regrowth of the tumour with a large intravesical component. A large debulking TUR of the prostate and bladder tumour was performed 6 weeks after the initial TUR of the prostate, with 150 g resected. He underwent further magnetic resonance imaging for local staging of his disease showing significant regrowth almost completely occupying the bladder despite the second resection (Fig. 2b). He underwent cystoprostatectomy, bilateral pelvic lymphadenectomy and ileal conduit 2 weeks following the second TUR (Fig. 3). Operating time was 5 h and 10 min, and he had an uneventful post-operative course. Histopathology revealed a 16-cm tumour with spindle cells displaying marked nuclear pleomorphism and areas of bizarre multinucleated giant cells. This was reviewed by a specialist soft-tissue tumour pathologist and additional stains performed (myogenin and myoD1) were positive, identifying the cellular differentiation of the tumour as skeletal muscle. The final histopathological diagnosis was a pleomorphic rhabdomyosarcoma of bladder origin infiltrating the deep muscularis propria (pT2) and contiguous involvement of the prostate with clear surgical margins and negative lymph nodes. Fig. 1. Longitudinal view of the bladder on ultrasound showing an enlarged 150-cc prostatic mass (*) protruding into the bladder (arrow).

Multi-centre, prospective evaluation of the Seldinger technique for difficult male urethral catheter insertions by non-urology trained doctors

To evaluate the safety and effectiveness of the Seldinger technique by non‐urology trained (NUT) doctors for difficult male indwelling urinary catheter (IDC) insertions.