Matthew Winter

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.

Box, cable and smartphone: a simple laparoscopic trainer

Laparoscopic surgery requires different abilities to open surgery, and is challenging to learn within the confines of the operating theatre. With the development of laparoscopic surgery in modern surgery, the importance in improving these skills is becoming an increasing focus of surgical training programmes.

Incidence of facial fractures in the Australian Football League

The incidence of facial injuries within the Australian Football League (AFL) raises concern and can cause the temporary or permanent loss of function thereby threatening a players earning potential and length of playing career. The purpose of this study was to identify all facial fractures occurring within the AFL over a 17‐season period from 1992 to 2008. We aimed to detail injury trends and possible factors that correlate to a players risk of sustaining a facial fracture.

Penile Abscess: A Case Report and Review of Literature

A case of penile abscess after amphetamine injection into the penis is reported. A 45-year-old male patient was successfully treated with surgical drainage and antibiotics. There were no 3-month consequences of treatment at follow-up, and the patient maintained potency, without any penile deformity. The aetiology, diagnosis, and management of penile abscesses are discussed.

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.

Adult bipolar diathermy circumcision and related procedures in adults - a safe and efficient technique.

Objectives To present our novel technique and step-by-step approach to bipolar diathermy circumcision and related procedures in adult males. Methods We reviewed our technique of bipolar circumcision and related procedures in 54 cases over a 22-month period at our day procedure center. Bipolar diathermy cutting and hemostasis was performed using bipolar forceps with a Valleylab machine set at 15. Sleeve circumcision was used. A dorsal slit was made, followed by frenulum release and ventral slit, and was completed with bilateral circumferential cutting. Frenuloplasties released the frenulum. Preputioplasties used multiple 2–3 mm longitudinal cuts to release the constriction, with frenulum left intact. All wounds were closed with interrupted 4/0 Vicryl Rapide™. Results A total of 54 nonemergency bipolar circumcision procedures were carried out from November 2010–August 2012 (42 circumcisions, eight frenuloplasties, and four preputioplasties). Patients were aged 18–72 years (mean, 34 years). There was minimal to no intraoperative bleeding in all cases, allowing for precise dissection. All patients were requested to attend outpatient reviews; three frenuloplasty and two circumcision patients failed to return. Of the remaining 49, mean interval to review was 49 days, with a range of 9–121 days. Two circumcision patients reported mild bleeding with nocturnal erections within a week postoperatively, but they did not require medical attention. Two others presented to family practitioners with possible wound infections which resolved with oral antibiotics. All 49 patients had well-healed wounds. Conclusion The bipolar diathermy technique is a simple procedure, easily taught, and reproducible. It is associated with minimal bleeding, is safe and efficient, uses routine operating equipment and is universally applicable to circumcision/frenuloplasty/preputioplasty. In addition, it has minimal postoperative complications, and has associated excellent cosmesis.

A limb threatening complication of intravenous fluid resuscitation.

We report a case of compartment syndrome of the hand with associated bullous eruption secondary to extravasation of intravenous fluid. A 28-year-old male with quadriplegic cerebral palsy presented to the emergency department (ED) via ambulance with septic shock secondary to aspiration pneumonia. The patient had a large bore intravenous (IV) cannula inserted in the dorsum of his right hand by paramedics prior to arrival to the ED. Fluid resuscitation had been commenced en route to hospital. In the ED, fluid resuscitation was continued and 1 gram of ceftriaxone was also administered through the cannula. Over the course of the next 30 minutes, the patient’s hand was noted to become swollen and ischaemic with newly formed bullae (Fig. 1). The classic signs of disproportionate pain, paraesthesia and paresis were not present due to the patient’s obtunded mental state and pre-existing hand contractures. An urgent duplex Doppler ultrasound of the upper limb was performed in the ED to exclude an embolic cause for the ischaemia. This demonstrated pulsatile flow in the radial artery to the level of the wrist. A superficial dorsal fasciotomy of the hand was performed in the ED under local anaesthesia, which resulted in immediate revascularization of the hand (Fig. 2). The significant oedema within the superficial space of the hand had compromised blood flow causing a compartment syndrome (CS). CS of the hand is a well-documented clinical entity. There are a small number of case reports of hand and forearm CS secondary to extravasation of IV fluid. Bullous eruption with CS secondary to extravasation of IV fluid has also been reported. This case highlights the risks associated with IV fluid resuscitation in patients who cannot communicate pain or discomfort. Vigilance is required when caring for anaesthetized, obtunded or paediatric patients with IV fluids running, as extravasated fluid can cause a CS if not recognized early. The consequences of a missed CS can be devastating, with permanent loss of function.

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.

Retro-ureteral Small Bowel Herniation After Radical Cystectomy

Small bowel obstruction caused by internal herniation under ureteric bands is a rare occurrence. Only 6 previous cases have been documented. This case report reviews the case of a 79-year-old male who presented to emergency with abdominal pain requiring subsequent laparotomy and release of internal herniation of bowel under ureter.

PD10-01 THE USE OF PORTABLE VIDEO MEDIA VERSUS STANDARD VERBAL COMMUNICATION IN THE UROLOGICAL CONSENT PROCESS: A RANDOMISED CONTROLLED CLINICAL TRIAL

INTRODUCTION AND OBJECTIVES: Technology can be used to improve patient care, especially regarding informed consent. The aim of our study is to determine patient satisfaction and knowledge acquired during the consent process for cystoscopy and insertion of a ureteric stent, comparing the use of standard verbal communication (SVC) to portable video media (PVM). METHODS: A randomized controlled cross-over trial was performed enrolling patients presenting with acute colic requiring a ureteric stent. Patients were randomised to receive either SVC or PVM prior to procedure. A validated questionnaire (CSQ-8 max score 32) assessing patient satisfaction and a 28-point questionnaire assessing understanding of the critical components of the procedure was then completed. The groups were then crossed over and questionaries retested. Patients were asked to give their overall preference at the conclusion of both delivery methods. SVC involved the typical verbal interaction required for consent. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. RESULTS: Eighty patients were randomly assigned and completed the trial. 36 patients received PVM as the first intervention and 44 patients received SVC as the first intervention and then crossover was performed according to protocol. Recruitment was completed over two sites over a 15-month period (July 2014 to Oct 2015). Mean age of participants was 54 years old. 21 (26%) patients were female and 59 (74%) male. Mean SVC time was 4.34min. The patient satisfaction as measured by CSQ-8 was the same between groups (mean PVM 30.30 v SVC 29.1, p1⁄40.119). A 15.2% increase in understanding, as assessed by the 28-point questionnaire, was demonstrable favouring the use of PVM (mean PVM 23.06 v SVC 20.02, p1⁄40.001). Upon group crossover analysis, a 18.5% increase in MCQ score was seen when the SVC group were crossed over to the PVM arm (p<0.001). No increase in MCQ score was seen when crossover from PVM to SVC was performed (p1⁄40.893). A total of 81% (n1⁄465) patients preferred PVM and 19% (n1⁄415) preferred SVC. CONCLUSIONS: This study demonstrates patient preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM appears to be a more effective means of content delivery to patients, in the acute hospital setting, in terms of overall preference andknowledgegained.PVMisauseful adjunct toSVCfor informedconsent and could be extended to many other procedural consents.