Reflections from “The Boards”

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Every year in February, 250 or so urologists make the pilgrimage to the Dallas airport to take the Urology Certifying Exam (a.k.a. the Oral Boards). This ranks as one of the strangest events in my life. I felt it appropriate to share my experience. My trip to Dallas begins with a very sincere “good luck on your test daddy” from my 5-year old daughter. This makes me feel great, until I realize I am less than 24 hours from actually taking the exam. My stress level now starts to rise. As…

Editorial: Valuing interventions for localised prostate cancer

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Robert Pickard and Luke Vale Governments of all nations struggle to work out how best to use the limited resources available for health care. One key area of uncertainty is long term conditions with multiple therapeutic options including no active treatment, where relative merits of different treatments are unclear and there is associated unexplained variation in use of often expensive interventions such as surgery. The management of localised prostate cancer typifies this situation. The problem…

Error Training: An emerging teaching tool not to be ignored!

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“To err is human, to cover up is unforgivable, to fail to learn is inexcusable” Sir Liam Donaldson, Former Chief Medical Officer As a specialist registrar, I recall operating on a large renal tumour along with my mentor Omer Karim (who is now my colleague). As the mobilization was difficult due to neovascularization, he took over and just as the kidney was about to be delivered out, the adrenal vein was avulsed and there was a gush of blood. A Satinsky clamp was placed and to my surprise, Omer…

Surgery is Not Normal

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The man was unconscious on the operating table, in lithotomy position and fully prepped for the major extirpative surgery which he was about to undergo. Four of us from different surgical specialities stood around his nether regions with arms folded, having all done a very thorough bimanual examination. We were discussing whether his recurrent colorectal cancer felt mobile enough to get away with a posterior exenteration, or if all the pelvic organs had to go. As we considered the physical exam findings…

Editorial: VR simulators can improve patient safety

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You wouldn't expect the pilot of the aeroplane in which you fly to the EAU or AUA meeting to be a novice who was training on the aeroplane that you were being transported in! Similarly, patients undergoing robot-assisted surgery do not expect to be the “guinea pigs” upon which trainee surgeons move up the learning curve of surgical experience. Sometimes, however, they are. Surgical simulators offer the means for surgeons to gain experience before moving to operating on actual patients.…

Twitter Chat Tools for International Urology Journal Club

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Twitter is a great social channel for professionals to exchange ideas. I regularly use Twitter to connect with urologists, health care professionals, patients and thought leaders around the world. I also use Twitter to share my blog posts.   Participating in Twitter Chats One of the many other ways I find value on the platform is by participating in Twitter Chats. Twitter chats are a great way to get people with a common interest into a community. A Twitter Chat can be a one-time event;…

From Famine to Feast. Systemic Therapy for Prostate Cancer Comes of Age.

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OR The Hare Becomes the Tortoise?? When I was a medical oncology trainee in 2001 looking for an area to specialise in my mentors told me prostate cancer was going to be the next big thing. I must admit I was dubious but now more than 10 years later this is amongst the best advice I have ever received. On a par with support Manchester United and buy property in London! Systemic treatment for prostate cancer has well and truly arrived and we are in a position where at times we are spoilt for choice. So…

Editorial: Obesity is associated with worse oncological outcomes in patients treated with radical cystectomy

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Michael R. Abern, Stephen J. Freedland and Brant A. Inman Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA Obesity is a worldwide epidemic: it is estimated over 300 million adults are obese and over 1 billion are overweight. As obesity is a risk factor for cancers and is modifiable, the authors of this report retrospectively analyse the association between body mass index (BMI) and outcomes in a large multinational cohort of bladder cancer patients that underwent…

EWTD: Quantity or Quality?

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The European Working Time Directive (EWTD) was due to be in full implementation from August 2009 limiting junior doctors to a 48-hour week averaged over a 6-month period. The reality of this is somewhat different from the legislation. In truth, the questions needed to be asked were - was it ever feasible? What was the training impact in a craft-based speciality going to be? Where are we now? The detrimental effects to training in a reduced working environment has been documented in both hemispheres.…

Prostate Cancer Outcomes Study Meets Twitter Face to Face

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The International Urology Journal Club on Twitter discussion for February 2103 was based upon the recently published Prostate Cancer Outcomes Study in the New England Journal of Medicine on 31 January 2013. The originally planned discussion paper that was only hours away from being announced when it became apparent through Twitter notification by @NEJM that the PCOS paper was going to be published that day. With this news, ‘urology twitter’ spoke loud and clearly (well, tweeted to be technically…
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