Establishing a national high fidelity cadaveric emergency urology simulation course to increase trainee preparedness for independent on-call practice: a prospective observational study.

BACKGROUND: Whilst competence in the management of a wide range of urological emergencies is a requirement for certification in urology, many conditions are uncommon and exposure during training may be limited. This prospective observational study sought to evaluate the feasibility and effectiveness of a standardised cadaveric emergency urology simulation course aimed at improving operative confidence and competence prior to independent on-call practice in the United Kingdom. METHODS: A two-day cadaveric emergency urology simulation course supported by the British Association of Urological Surgeons (BAUS) was implemented at two pilot centres. All delegates that undertook one of the initial series of courses were invited to complete online pre- and post-course questionnaires relating to prior operative experience, documented competence and perceived confidence in being able to perform specific emergency procedures independently. Primary outcome was a self-reported 'confidence score' selected from a linear numeric scale ranging from 1 (not at all confident to perform a given procedure independently) to 10 (fully confident). Statistical analysis was undertaken using SPSS Statistics for Mac Version 25 and the paired student's t-test used to compare mean pre- and post-course scores. RESULTS: One hundred and four delegates undertook the course during the study period. Of these, 85 (81.7%) completed the pre-course survey and 67 (64.4%) completed the post-course survey, with 61 (58.7%) completing both. The greatest proportion of respondents were Speciality Trainees in Urology of ST5 level or higher (equivalent of Resident/Fellows with 4 or more years of surgical training; n = 31, 36.5%). Delegates reported variable pre-course exposure, with most experience reported in loin approach to the kidney (median 10) and least in exploration and packing of a transurethral resection cavity and emergency nephrectomy (median 0). Following course completion, a statistically significant increase in confidence score was observed for each procedure, with the greatest increases seen for shunt for priapism (4.87 to 8.80, p < 0.001), ureteric reimplantation (3.52 to 7.33, p < 0.001) and primary ureteric anastomosis (3.90 to 7.49, p < 0.001). CONCLUSIONS: A standardised high fidelity cadaveric simulation course is feasible and significantly improves the confidence of trainees in performing a wide range of emergency procedures to which exposure is currently limited.

The 100 most influential manuscripts in andrology: a bibliometric analysis.

BACKGROUND: As the specialty of Andrology expands it is important to establish the most important studies that have shaped, and continue to shape, current research and clinical practice. Bibliometric analysis involving a citation rank list is an established means by which to identify the published material within a given field that has greatest intellectual influence. This bibliometric analysis sought to identify the 100 most influential manuscripts in Andrology, as well as the key research themes that have shaped contemporary understanding and management of andrological conditions. METHODS: The Thompson Reuters Web of Science citation indexing database was interrogated using a number of search terms chosen to reflect the full spectrum of andrological practice. Results were ranked according to citation number and further analysed according to subject, first and senior author, journal, year of publication, institution and country of origin. RESULTS: The Web of Science search returned a total of 24,128 manuscripts. Citation number of the top 100 articles ranged from 2819 to 218 (median 320). The most cited manuscript (by Feldman et al., The Journal of Urology 1994; 2819 citations) reported the prevalence and risk factors for erectile dysfunction (ED) in the Massachusetts Male Ageing Study. The Journal of Urology published the highest number of manuscripts (n = 11), followed by the New England Journal of Medicine (n = 10). The most common theme represented within the top 100 manuscripts was erectile dysfunction (n = 46), followed jointly by hypogonadism and male factor infertility (n = 24 respectively). CONCLUSION: Erectile dysfunction should be considered the most widely researched, published and cited field within andrological practice. This study provides a list of the most influential manuscripts in andrology and serves as a reference of what comprises a 'highly citable' paper for both researchers and clinicians.

CONTEXTE: Etant donné que la spécialité Andrologie se développe, il est important de dresser un inventaire des études les plus importantes qui ont façonné, et qui continuent à façonner, la recherche actuelle et la pratique clinique. L'analyse bibliométrique, qui inclue une liste de rang de citations, est un moyen bien établi pour identifier le matériel publié, dans un champ donné, qui a la plus grande influence intellectuelle. La présente analyse bibliométrique cherche à identifier les 100 manuscrits les plus influents en Andrologie, ainsi que les principaux thèmes de recherche qui ont façonné la compréhension et la prise en charge contemporaines des situations andrologiques. MÉTHODES: La base de données d'indexation des citations du Web of Science de Thompson Reuters a été interrogée en utilisant un nombre de termes de recherche choisis pour refléter l'éventail complet de la pratique andrologique. Les résultats ont été classés selon leur nombre de citations, puis ensuite analysés en fonction du sujet, des premier et dernier auteurs, du journal, de l'année de publication, de l'institution et du pays d'origine. RÉSULTATS: La recherche sur le Web of Science a rapporté un total de 24 128 manuscrits. Le nombre de citations des 100 premiers articles va de 2 819 à 218 (médiane 320). L'article le plus cité (de Feldman et al., The Journal of Urology 1994 ; 2 819 citations) rapportait la prévalence et les facteurs de risque de la dysfonction érectile (DE) dans l'étude du Massachusetts menée chez l'homme vieillissant. The Journal of Urology a publié le plus grand nombre de manuscrits (n=11), suivi du New England Journal of Medicine (n=10). Le thème le plus souvent représenté dans les manuscrits du top 100 était la dysfonction érectile (n=46), suivi conjointement par l'hypogonadisme et l'infertilité d'origine masculine (respectivement n=24). CONCLUSION: La dysfonction érectile devrait être considérée comme le champ de la pratique andrologique qui a le plus largement fait l'objet de recherches, de publications et de citations. La présente étude fournit une liste des manuscrits les plus influents en andrologie, et constitue une référence sur ce que signifie un article 'fortement cité' à la fois pour les chercheurs et pour les cliniciens.

The 100 most cited manuscripts in emergency abdominal surgery: A bibliometric analysis.

BACKGROUND: The number of citations a scientific article receives provides a good indication of its impact within any given field. This bibliometric analysis aimed to identify the 100 most cited articles in Emergency Abdominal Surgery (EAS), to highlight key areas of interest and identify those that have most significantly shaped contemporary clinical practice in this newly evolving surgical specialty. This is of increasing relevance as concerns grow regarding the variable and suboptimal outcomes in Emergency General Surgery. MATERIALS AND METHODS: The Thomson Reuters Web of Science database was used to search using the terms [Emergency AND Abdom* AND Surg*] to identify all English language, full manuscripts. Results were ranked according to citation number. The top 100 articles were further analysed by subject, author, journal, year of publication, institution, and country of origin. RESULTS: The median (range) citation number of the top 100 out of 7433 eligible papers was 131 (1569-97). The most cited paper (by Goldman et al., Massachusetts General Hospital, New England Journal of Medicine; 1569 citations) focused on cardiac risk stratification in non-cardiac surgery. The Journal of Trauma, Injury, Infection and Critical Care published the most papers and received most citations (n = 19; 2954 citations. The majority of papers were published by centres in the USA (n = 52; 9422 citations), followed by the UK (n = 13; 1816 citations). The most common topics of publication concerned abdominal aneurysm management (n = 26) and emergency gastrointestinal surgery (n = 26). CONCLUSION: Vascular surgery, risk assessment and gastrointestinal surgery were the areas of focus for 59% of the contemporary most cited emergency abdominal surgery manuscripts. By providing the most influential references this work serves as a guide to what makes a citable emergency surgery paper.

Spontaneous gastric perforation in an 11-year-old boy with anorexia nervosa: rare presentation with right iliac fossa pain.

Spontaneous gastric perforation is rare in children. It is usually associated with prematurity, foreign bodies and trauma. Anorexia nervosa (AN) can be an underlying condition although no cases are reported in the literature. We are reporting a rare case of 1-year-old boy with AN who presented with right iliac fossa (RIF) pain mimicking acute appendicitis. Intraoperative findings proved a gastric perforation. Pathophysiology of this condition in AN is poorly understood. Gastric smooth muscle atrophy and ischaemia can be the possible underlying mechanisms. The case discussed here highlights the fact that any abdominal pain in patients with underlying eating disorders (EDs) should raise suspicion of perforation as diagnosis can be far more complicated.