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The Daily Blog from EAU 2013: Day 1 and 2

Saluti di Milano! This week the BJUI team are bringing you live updates from the European Association of Urology Annual Meeting in one of Europe’s most beautiful destinations – Milan. Our team has been Tweeting, Facebooking and now blogging from Europe’s premier urology gathering. In fact, we are the leading influencers in social media at this year’s meeting as shown by the metrics updated at Symplur where we registered the official hashtag #eau13.

 

 

Social media has really taken off at this meeting with the EAU Media team having formalized a strategy to promote social media. By just following #eau13 on your smart device you will receive a constant stream of interesting news and gossip from our team, from the excellent EAU Twitter-feed, and from the increasing number of others who are getting active in social media. One of the features we really like is the live twitter feed running on all the LCD screens detailing sessions around the venue:

 

This is something we first used at the Australasian Prostate Cancer Conference in Melbourne in 2012 and we are presenting outcomes from our social media initiatives at that meeting at the forthcoming BAUS meeting in Manchester.

But back to Milan. You have got to admit that one of the attractions of the EAU Annual Meeting is that it usually takes place in Europe’s favourite cities. – Paris, Milan, Stockholm. In the past ten years the EAU meeting has grown from a relatively modest meeting with variable scientific content, to a truly world-class event with very high-quality plenary sessions, poster presentations, video sessions, courses and satellite events. As of close of business on day two today, there were over 10,000 urologists and health professionals registered (and @benchallacombe was awarded Tweet of the Day by the EAU for letting the world know!), with another couple of thousand industry representatives. This is a big meeting! Over 14,000 delegates are expected before the close of the meeting.

The meeting actually started on Friday with a special all-day International Consensus meeting looking at chemoprevention of prostate cancer and five satellite symposiums. Dr Schroder re-iterated his stand that “PSA screening significantly reduces mortality. Harms are identified and quantified; they do not exceed the benefits”. The panel of experts from around the world intend producing a consensus statement on early detection, prognostic markers to predict high-grade disease, and the most appropriate clinical preventions strategies. There were also the “Urology Beyond Europe” meetings which allow urological associations from 11 other regions to run sessions at EAU. This certainly reflects the fact that the EAU meeting is a truly global event, maybe moreso than the AUA meeting. This year there are delegates from over 100 countries . This year’s meeting kicked off in spectacular style two days ago with a lavish opening ceremony featuring an operatic performance from La Scala in the main auditorium:

As I arrived in Milan at 0700 on Friday, I spent most of the day in a groggy mess trying to shake off the jet lag having spent 24 hours on a plane. I did make it in to hear Dr Urs Studer issue a call to young urologists at the opening session to “widen your interests, be aware of urology’s many aspects and don’t be a keyhole specialist”.

Saturday morning kicked off in the spectacular style we have got used to with the festival of live surgery that is the European Section of Urological Technology (ESUT) Section meeting. The ESUT has consistently been the most-highly attended Section meeting at the EAU for a number of years and this year was convened in conjunction with the new EAU Robotic Urology Section (ERUS) and the Urolithiasis Section. The main eUro auditorium was packed for most of the day as many thousands of delegates watched the live feed from the operating theatres at San Raffaele Hospital.

 

Over the day, there were 20 cases of which ten were live and the remainder pre-recorded the previous day. The technical quality was outstanding with all broadcasts in high-definition and some robotic procedures in 3D. The ESUT along with EAU and ERUS will be announcing the new EAU Guidelines on Live Surgery on the closing day of the meeting which will address concerns about the governance and ethical considerations of live surgery. I have blogged about this previously and we all welcome the leadership that EAU/ESUT and ERUS have demonstrated in this area.

Competing with ESUT for numbers on Saturday were six other section meetings, 22 poster sessions, two video sessions, 12 courses and seven sponsored satellite sessions. Myself and other editorial board members and contributors to the BJUI have been tweeting highlights and photos from these various sessions. Here are a few of the headlines:

  •        PSA screening in men aged 55-69 reduces prostate cancer-specific mortality by 31%. Dr Monique Roobol presented the latest findings from the ERSPC study and also showed no benefit to PSA screening for men aged 70-74 in the world’s largest PSA screening study. In another poster, Dr Roobol also showed the addition of the Prostate Health Index (PHI) to the ERSPC Risk Calculator added a net benefit increasing the area under the curve from 0.56 to 0.73.
  •        MRI guided prostate biopsies: a lively session saw the role of multiparametric MRI being debated by a number of experts. Should we only biopsy patients who have a lesion demonstrable on MRI?? A step too far for now but mpMRI and fusion biopsies will be a hot topic for the next couple of years.
  •        Innovation & Infection: this most-aptly named session addressed the highly-topical area of urological infections which has attracted much media attention in recent times with increasing warnings of antibiotic resistance. This is reaching crisis proportions in some regions and commonly performed procedures such as prostate biopsy are of particular interest.
  •        BPH surgery complications are under-estimated: a large French study has shown that complication rates following TURP and open prostatectomy in real clinical practice compared to clinical trials. A review of over 260,000 patients undergoing BPH surgery revealed a re-operation rate of 4.7%, clot retention in 3.4% of TURPs and urethral stricture in 2.7% of patients. 420 men (0.18%) underwent surgery for urinary incontinence.
  •        Robotic partial nephrectomy – there is clearly increasing adoption of robotic partial nephrectomy with a number of posters and videos featuring already. A key message is that larger, more complex tumours can successfully be managed with this approach in experienced centres. The role of fluoresce-guided robotic surgery is evolving.
  •        From young to old: An interesting theme at this year’s meeting has been an overview of the urologist’s role of managing the ageing urinary tract. A plenary session yesterday was dedicated to this and a particular message was the rising role of surveillance for small renal masses in older patients. More harm can be done from intervention than surveillance in this group
  •        Stone prevention – a packed auditorium at the EULIS section meeting heard that stone prevention strategies instead of treatment modalities should be explored for recurrent stone formers with rapid screening of diet including internet-based approaches. Dr Knoll presented a staggering analysis of 200,000 stones from Germany(!) showing an increase in calcium oxalate composition and surprisingly stable levels of uric acid (considering the rising obesity levels). Newer imaging modalities such as dual-energy CT may help to identify stone composition which may help tailor treatment.

Of course, a lot of other activity goes on around the periphery of meetings like this. Yesterday I attended the Consulting Editors meeting of European Urology where outgoing Editor-in-Chief Francesco Montorsi welcomed newly appointed successor, Jim Catto from Sheffield in the UK. Jim takes over the reins in January 2014 and we look forward to the new ideas he will bring to the Platinum Journal. Today we have the BJUI Editorial Board meeting which is a great opportunity to meet with our friends and colleagues from round the world who are doing a fantastic job under new Editor-in-Chief Prokar Dasgupta.

 These meetings are also a great opportunity to catch up with colleagues from around the world. We are posting pictures on our Facebook site this week and you will see photos on Twitter also.

Pictured at the Duomo – Ben Challacombe (London), Stacy Loeb (New York), Declan Murphy (Melbourne)

Stay following #eau13 and join the conversation!

 

Declan Murphy

T: @declangmurphy

Associate Editor (Social Media) BJUI

Uro-Oncologist, Melbourne

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Social media @BJUIjournal: what a start!

When Prokar Dasgupta assumed the role of new Editor-in-Chief of the BJUI in January 2013, he outlined his vision and some of the major changes that the Journal would make as it transitioned to a new editorial team. After ten years of progress under Professor John Fitzpatrick, it was clear that we are now working in a much-changed publishing landscape, one that will change even more in the next few years. In particular, the way in which medical professionals receive information and interact with colleagues, patients, journals and other professional groups is unrecognizable from what it was just two or three years ago.

Social media is the driver of much of this change. It has transformed the way in which the current generation of trainees interact – Facebook, Twitter, YouTube, LinkedIn, Urban Spoon, Expedia, Trip Advisor, Instagram – all of these platforms are key conduits for how Generation Z experiences life. This generation will find the idea of a printed journal arriving in the post every month to be anathema. In a world with an ever-increasing amount of content being produced, and much competition for our limited attention span, Gen Z live their lives through mobile platforms capable of delivering the precise content they want, immediately to their devices. Not just that, this content, whether that be breaking news via Twitter, friend status updates on Facebook, job opportunities via LinkedIn, is delivered through vibrant media that allows them to engage and respond by liking, sharing, favourite-ing, re-tweeting and commenting even as the content reaches them. All of this activity is done through convenient and increasingly pervasive mobile platforms while on the train to work, while queuing for a coffee, between cases in theatre, during a lecture, first thing in the morning, last thing at night. Gen Z will not seek out this type of content – it will seek them out and be delivered straight to their timeline/twitter-feed.

My role as Associate Editor (Social Media) at BJUI, has been to devise and implement a strategy to ensure that the BJUI evolves in this new world – to ensure that the next generation of trainees find us a meaningful organization to engage with and be informed, educated and entertained by. My fellow Associate Editors, Dr Matt Bultitude (Website), Dr Ben Challacombe (Innovation) and Dr Quoc-Dien Trinh (Health Services Research), play important roles here as do our publishers, our Executive team and Editor-in-Chief at BJUI.

So what have we done? If you are on Twitter or Facebook you will have noticed that BJUI has come to life on these key social media platforms.

 

Since 1st January, our followers on Twitter have grown by over 20% to 1151 and we have generated huge traffic back to our website with over 2000 link clicks from the 500 interactions we have had during this period.

 

Advanced metrics allow us to measure all of this activity against other organisations active in urology. For example our Klout score has increased from 46 to 53 with a corresponding increase in our Peerindex rating. We are leading the field across all of the key domains we have targeted to date and continue to make progress as we introduce further changes at bjui.org in 2013.

Our Facebook site is now highly engaging and is constantly updated with news and content from our website.

 

We have recorded over 73,000 page impressions by 11,000 Facebook visitors in the first two months of 2013, a huge rise from previously, and all of this traffic gets directed back to content at bjui.org, whether that be a Journal article, blog, picture quiz or our new “poll of the week”.

 

Our YouTube site is updated with videos from authors and other multimedia content to complement citable articles published in the Journal. You will see a lot more content added here in coming months.

But perhaps the most talked-about area we have introduced is [email protected]. And although we are the first mainstream urology journal to introduce a blog site, other journals have done so with great success. In September, Matt Bultitude and I visited the social media team at the BMJ to get some tips on how they had developed their social media strategy into the very successful multi-platform spectacular that they now oversee. Juliet Dobson, Blogs Editor and Assistant Web Editor at the BMJ offered some excellent advice to help us get up and running and their former Editor, Richard Smith, remains one of the bloggers I most admire. BMJ Blogs is well worth a visit for aspiring bloggers to read some of the best.

We launched our new website on the 2nd January 2013 to coincide with the new Editor taking the helm, and also published our first blog that day. From then until the 28th February 2013, [email protected] has featured the following:

  • 35 blogs contributed by 25 authors on three continents
  • 133 comments from all over the world
  • 8 editorial blogs from our specialty Associate Editors
  • Multidisciplinary contributions from both authors and comment-leavers

The topics have included everything from urology humour, through the European Working Time Directive, reality TV and an eminent urologist describing his recent personal experience of robotic radical prostatectomy. Our contributors have included many of the key opinion leaders in social media in urology, many of whom are rising stars or already established in academic urology. Also established urology opinion-leaders who are rather new to social media but enjoying the challenge! Other contributors are young trainees who have proved themselves to be talented bloggers already. I am quite pleased that the most-read blogs in January and February were written by two young trainees of mine in Melbourne. But I am sure the self-appointed King of Twitter, Ben Davies, and other established stars of urology social media will be vying for such coveted titles as the months go by.

I had set a target that by the end of the first quarter we would have 1000 readers per month visiting [email protected]. By the end of the February, we had already had over 9000 visits to our blog site! Each reader spent over 3.5 minutes per blog and many of them left comments or pushed out links to our blogs using Twitter or Facebook. We have had many comments posted by readers from every corner of the world and have enjoyed some very humorous posts. For us, social media is all about engagement. We want to use these platforms to allow readers to passively engage with us by liking, sharing, tweeting content that they enjoy whether that is a full paper in the BJUI, a blog post, YouTube video, weekly poll or Picture Quiz of the Week. And for those who want to engage more actively, we strongly encourage you to join the conversation and add a comment to any of our blogs.

So we have had a great start to our social media push at the BJUI. And there will be a lot more to come in the coming months – watch for our activity during the upcoming conference season and look forward to the results of the inaugural BJUI Social Media Awards to be announced at the American Urological Association Annual Meeting. For those of you who are new to social media, I encourage you to dip your toes in by reading a blog or two and adding a comment. Before you know it you will have downloaded the Twitter app to your smartphone and you’ll be off and running! For the Twitterati, I thank you for all your enthusiasm in helping us get social media up and running at the BJUI and I look forward to your blogs, mentions, re-tweets and podcasts over the coming months. Social media is all about engagement – join the conversation @BJUIjournal.

 

Declan Murphy is a uro-oncologist in Melbourne and is Associate Editor of Social Media at the BJUI. Follow him on Twitter @declangmurphy

The X-Factor, Reality TV, and Live Surgery Demonstration

Declan theatreMy first suggestion to my wife was that I enter Pop Idol with my modified, radiation-bashing rendition of American Pie (chorus “bye bye brachytherapy seeds“). She quickly retorted “DIVORCE! YOU CANT SING!” I begrudgingly agreed. Then Britain’s Got Talent came along and I saw an overweight Greek father and son duo, Stavros Flatley, prance around the stage bare-chested, dancing to some traditional Greek music and I thought “YES! There is hope!” I put on Riverdance, grabbed my then three-year-old son and started teaching him the basics of an Irish jig. I pleaded with my wife to allow us enter the X Factor (or whatever reality TV show was auditioning at that time), but she again screamed “DIVORCE!”. It appeared my hopes of finding fame on reality TV were dashed forever (although I expect Masterchef might be interested in my prowess on the BBQ – Murphy’s Marvellous Marinade on a whole eye fillet deserves a wider audience).

At about that time, the vogue of having live surgery demonstrations featuring at clinical meetings was really gaining momentum. The World Robotic Symposium, European Robotic Urology Symposium, European Society for Urological Technology section meeting at the EAU, Challenges in Laparoscopy & Robotics and others, were all featuring live surgery demonstrations as a prominent part of their scientific program. These sessions feature enormous high-definition screens, 3D broadcast in some circumstances, parallel operating rooms, and live interaction with the surgical team, and have proved enormously popular with audiences and sponsors alike. In fact, without live surgery, some of these meetings would be quite dull –there is certainly a commercial value in featuring live surgery as part of the program as is demonstrated by the huge numbers attending these sessions. Whether it is the lure of seeing world-famous surgeons perform robotic prostatectomy, partial nephrectomy or various types of salvage surgery, or the ever-present possibility of seeing a complication and its management, there is a blood-lust which surgical audiences have for this type of entertainment, sorry – education, and which is being met by the organisers of urology conferences. A merry band of surgeon-entertainers roam the world turning up at these conferences with their entourage of assistants and scrub nurses, and turning on the charm for the huge audiences which the big names now attract.

However, some controversy surrounds the ethics and conduct of live surgery. We wrote in the BJUI previously about some concerns we had and questioning the absolute educational value of these demonstrations. Well known leaders such as Dr Arthur Smith have also voiced concerns about live surgery and in some specialties and some countries, live surgery demonstrations are banned. In response, it has been encouraging to see the European Robotic Urology Society (now an official Section of the EAU), whose annual meeting is a live surgery spectacular, work with others to generate guidelines and ethical standards for the conduct of live surgery at scientific meetings. These will be published in the coming months.

So when it dawned on me that the personal price to pay for fame on reality TV was too high, I resigned myself to a life away from the glamour and fame of reality TV. However, I was very interested when Alex Mottrie and Ben Challacombe invited me to do a live robotic radical prostatectomy for the European Robotic Urology Symposium in London a few months ago. I had only ever done live surgery demonstrations for quite small audiences previously (I had done my karaoke version of American Pie to bigger audiences), and I was somewhat daunted and excited by the prospect of doing live surgery for a big audience, especially one full of the “Gods of Robotic Surgery”. The reality TV star inside me was saying ‘YES! I AM GOING TO BE A STAR!!” So I said yes. And the nerves started soon after. By the time it got to the opening morning of ERUS (in stunning post-Olympics London), I was pretty anxious. The case was straight-forward and I had done hundreds already, so why was I nervous? Well the audience was big (>800), and they looked blood-thirsty – I could feel them licking their lips at the prospect of something going badly wrong. I knew that a few of the “good luck mate” wishes that I had received that morning could be interpreted as “I hope you don’t hurt your head when you fall off your pedestal”. And the big guys were all over the place. The live surgery roll included Vip Patel, Richard Gaston, Alex Mottrie, Prokar Dasgupta, James Porter, Ronney Abaza, Mike Stiefleman, Ashok Hemal and Peter Wiklund. Francesco Montorsi was in the operating room next door and we would be operating in parallel. It was somewhat daunting. Even the stars looked nervous before going live with their surgery, some were even quite temperamental as the stress builds, but when they go live to the convention centre, they put on their “TV-face” and the show begins – all sweetness and charm. Quite a show.

Before live surgery at Guy’s

In the “Green Room” before live surgery at Guy’s Hospital in London for ERUS 2012: Ken Palmer, Geoff Coughlin, Jim Porter, Vip Patel, Declan Murphy, Francesco Montorsi and Declan Cahill

For me, I figured out that the reason I was nervous was that I did not want to make a mess of it in front of a big audience. Human nature has a vain streak to it, and much as I am embarrassed to admit it, I realised that some of my anxiety was just that – I wanted to look and sound good on the big screens. There – I’ve said it! Something certainly added a different stress to the normal pressure of wanting to do an excellent job for your patient, and I expect that even the highly experienced live surgery stars who feature at these meetings do feel this extra pressure. Especially when things get a little sticky or you cause some bleeding and someone at the other end is asking “why did you do that?” Thankfully my case went nicely and my patient has done very well – details to be presented at next year’s ERUS as part of their new guidelines which will see feedback from all cases from the previous Symposium – an excellent initiative.

Doing robotic radical prostatectomy at ERUS 2012

Doing robotic radical prostatectomy at ERUS 2012

Doing robotic radical prostatectomy at ERUS 2012

So for now, the reality TV star in me has been sated and life goes on. Although I did hear there may be a new reality TV series in Australia for amateurs who fancy themselves as crocodile hunters. I wonder would she let me do that….

Declan Murphy
@declangmurphy

 

Declan Murphy is Honorary Clinical Associate Professor at the Department of Surgery, University of Melbourne, St Vincent’s Hospital and Director of Robotic Surgery at the Peter MacCallum Cancer Centre. He had previously been consultant urological surgeon at Guys & St Thomas’ NHS Foundation Trust in London.

 

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Twitter: my #eurekamoment #pennydrops #babyvomit

I remember distinctly when the penny dropped for me. It was about 2am on a warm summer’s night in early January 2012 (apologies to those of you shivering in the Northern Hemisphere). I had my one-week old son in one arm, swinging between sleeping and spewing, and an iPad in my other hand, providing distraction between nappy changes and feeds. The sleep-deprivation had dulled my senses considerably and my brain was capable of no more than light reading.

It was then I read a piece in the New York Times online about the power of Twitter in medical communication. Previously, I thought Twitter was the domain of Lady Gaga, Justin Bieber, Kim Kardashian (Kim who?) and various narcissistic cricket and football players. It seemed like puerile nonsense for a generation that I no longer belonged to. However, reading this opinion piece made me think again. It was clear that there is a whole generation of significant academic clinicians, researchers and publishers who have embraced social media and who use Twitter, in particular, to disseminate their work with a speed and reach that is simply unachievable through any other medium. I was struck by various examples of how key scientific publications are first flagged on Twitter and how within hours, responses are made by key opinion leaders and these responses are again disseminated rapidly around the Twittersphere. And although none of the examples were based around urology, it was clear to me that oncologists and surgeons were getting on board the social media rollercoaster.

So between nappy changes and having wiped some baby vomit off my iPad, I logged onto Twitter and created a username. I searched for prostate cancer and urology and quickly found my way to a few key resources and super-users who seemed to have a very active Twitter presence and who were tweeting content that immediately appeared of interest to me. Within a few minutes I had identified a few highly valuable Twitter users to follow and within their lists of followers and those who they were following, I quickly built up a useful stream of tweets dropping into my timeline. And then of course, a few of these Twitterers started following me back, which was mildly exciting. Within a few days and having posted a few tweaks, I began to feel part of the Twittersphere.

As the weeks went by, I continued to be astounded by just how fast information travels on Twitter. While I get emails with the table of contents for the various journals that I subscribe to, these only drop in my inbox every few weeks. Also, because there are a number of significant journals that I do not subscribe to (non-urological mostly), there are many papers published out there that do not come immediately to my attention. Depending on which Twitter sites you follow, all key papers related to your area of interest find their way into your timeline instantaneously as soon as they are published. Not just that, very interesting comment from others also gets to you very quickly. For example, key findings in prostate cancer tend to be picked up by the major US news sites who then invite comment from key leaders in major cancer centres. A typical example is that of the PSA screening recommendations made by the United States Preventive Services Taskforce in June 2012, which provoked huge controversy. Twitter came to life and key opinion leaders such as Matt Cooperberg (@cooperberg_ucsf) helped drive the conversation through Twitter and blogs (e.g.The Huffington Post blog) at lightning speed. These comments get tweeted out and responses to these comments also get blogged and within hours of a paper being published you have news of the paper, expert comment and wider reaction…… all in 140 characters or less!

And while none of us have much time in the day to add an extra task, I find that waiting for my coffee in the morning or while the resident puts an arterial line in my next patient, there are a few spare moments in the day where the Twitter app on my iPhone comes to life. Twitter is perfectly suited to the smart phone user and that is where the majority of tweets around the world are generated from. It is also perfectly suited for one of the other very exciting areas in which I have seen Twitter play a very useful role – that of conferencing. At the EAU in Paris, a small but energetic group of Twitter users started tweeting content from various sessions at this large meeting and started engaging with other Twitter users around the world. For me, I believe conferencing is about to be transformed by the power of social media but more about that soon.

For now, at the new BJUI, we want to grow the audience and get you all to join the conversation. Through Twitter, blogging, Facebook, YouTube and other social media platforms, we are building for the future of communication in urology. The next generation of trainees will be deeply embedded in all of these platforms and will expect to be engaged through them. We are entering a new generation of medical communication – come join the conversation.

Declan Murphy
@declangmurphy

 

Declan Murphy is Honorary Clinical Associate Professor at the Department of Surgery, University of Melbourne, St Vincent’s Hospital and Director of Robotic Surgery at the Peter MacCallum Cancer Centre. He had previously been consultant urological surgeon at Guys & St Thomas’ NHS Foundation Trust in London.

 

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