Evaluation of Laparoscopic Curricula in American Urology Residency Training: A 5-Year Update.

INTRODUCTION/PURPOSE: Medical simulation offers the advantage of improving resident skill and comfort without impacting patient care. Five years ago, we identified trends in the use of robotic and laparoscopic simulation in 2008 and 2009 at American urology residency training programs. We seek to identify the changes in the use of simulators and the presence of formal curricula in the wake of technological advances and changes in graduate medical education. METHODS: Attendees of the American Urological Association (AUA) Basic Sciences Course, mostly in their second or third year of residency, were surveyed on the availability and use of laparoscopic/robotic simulators at their program, the presence of a formal curriculum, and a Likert scale questionnaire regarding face and content validity. RESULTS: Over a 5-year period, the availability of virtual reality robotic simulators substantially increased from 14% to nearly 60% availability in 2013. Despite this increase, the frequency of simulator use remained unchanged (p = 0.40) and the reported presence of formal curricula decreased from 41% to 34.8%. There was no significant difference in simulator use between residents in programs with or without laparoscopic/robotic curricula (p = 0.95). There was also a decrease in the percentage of residents who felt official laparoscopic curricula (93%-81%) and simulators (82%-74%) should be involved in resident education. CONCLUSIONS: In the past 5 years, despite evidence supporting benefits from simulator use and increasing availability, self-reported resident use has remained unchanged and the reporting of presence of laparoscopic/robotic curricula has decreased. With more dedicated investment in formal curricula, residency training programs may receive greater returns on their simulator investments, improve resident skills and comfort, and ultimately improve the quality of patient care.

Pain management practice patterns for common pediatric urology procedures.

OBJECTIVE: To characterize practice patterns among members of the Society for Pediatric Urology. METHODS: A survey instrument assessing pain management was e-mailed to all members of the Society for Pediatric Urology. Five hundred fifteen invitations were sent, 134 were included, for a 26% response rate. Pain management strategies were assessed for 7 case scenarios. Surveys were included if the responder answered a minimum of 2 case scenarios. Question Pro survey engine was used to process the survey. RESULTS: Local/regional block was the most frequent intraoperative anesthesia (54%-90%). Epidural/caudal use varied from 19% to 42%. For postop opioids, a dichotomy exists between those without age restriction and those who wait until the patient is 6 months old. Sixty three percent responded that ketorolac was prescribed only if the patient had normal renal function, 20% after confirmation of adequate urine output for bilateral procedures, 3% when postoperative creatinine was normal, and 14% did not use ketorolac at all. In regards to age limitations, most did not indicate a limit (53%), whereas a large number required the child to be older than 6 months (26%). Regarding local blocks, most urologists perform the block themselves (61%) for simple/complex penile surgery or inguinal surgery. Of this group, only 33% actually bill for the administration of the block. After a caudal block, a minority (26%) of respondents require the patient to void before discharge for ambulatory procedures. CONCLUSION: There is no clear consensus in pain management for common pediatric urologic procedures. These disparities should be the aim of future studies.

The deposition of C5b-9 complexes and its precursors on E. coli J5 during complement activation enhances uptake and toxicities of gentamicin.

The complement system provides the host with protection against pathogenic agents and in some cases can result in damage to host tissue. However, the exact mechanism of how complement kills gram-negative bacteria in lysozyme-neutralized and or lysozyme-depleted serum is still under active investigation. In previous studies, it has been demonstrated that inner membrane damage by the membrane attack complex contributes to depolarization and the subsequent collapse of the membrane potential. In these studies we have shown that the membrane attack complex and its precursors provide additional protective effect by the enhanced uptake of antibiotics in the death of E. coli J5. Specifically, the deposition of C5b fragments from C6 neutralized Pooled Normal Human Serum (PNHS) and C5b6 complexes from C7 neutralized PNHS on E. coli J5 contribute to antibiotic uptake and killing. Since C5b and C5b6 do not form pores, we suggest that disturbances and or cracks in the outer membrane by the deposited complexes accelerates uptake of the antibiotics and enhanced killing of E. coli J5 employed in these studies.