Radiation Safety Education and Practices in Urology: A Review.

Introduction: Radiation safety education is important as fluoroscopy is commonly used for diagnostic and therapeutic purposes. Exposure to high levels of ionizing radiation is associated with an increased risk of cancer and other adverse health effects; therefore, it is essential that urologists and trainees are educated on the safe use of radiation. Unfortunately, radiation education and occupational safety is not standardized for this group and there are currently no review studies examining radiation safety for urologists in the clinical setting. This review aims at investigating the various levels of radiation safety education and practices used in urology. Methods: MEDLINE and EMBASE databases were searched for relevant publications reporting on radiation knowledge and randomized controlled trials, non-randomized comparative studies, and observational studies were included. Reviews, abstracts, editorial comments, non-urologic studies, and incomplete articles were excluded. Results: Within these articles, there were 16 observational studies. Frequency of radiation exposure ranged from <1 × to >15 × /week. There were higher rates of adherence to use of lead aprons and thyroid shields than lead eyeglasses and gloves. Radiation safety education was infrequent. Radiation safety knowledge was especially low for the risks of radiation exposure. Most studies highlight the need for increased awareness and training on radiation safety for both urology trainees and consultants. Conclusions: Radiation safety education and practices are an important issue in urology. Improvements to education and compliance to radiation safety practices are critical to ensuring urologists and trainees use ionizing radiation in a safe and responsible manner.

Scholarly Opportunities for Medical Students and Residents in Canadian Medical Professional Organizations.

Objectives: Participation in medical specialty organizations can provide medical students and residents with additional research, advocacy, networking, and leadership opportunities. Although past research has looked at individual specialties in the United States, little is known about trainee involvement in Canadian organizations. Therefore, the aim of this study is to review the opportunities available for medical students and residents within Canadian medical specialty organizations. Methods: The websites of 71 Canadian medical specialty organizations were reviewed to assess levels of trainee participation. Results: Of the 71 organizations reviewed, 42 (59%) allow medical students and 67 (94%) allow residents to become members. Most organizations allow trainees to attend their annual conference (83% for students and 93% for residents), and the mean cost of attending the most recent virtual conference was $114 (range: $0-$475) for students and $142 (range: $0-$475) for residents. Twenty-two organizations (31%) have travel awards for students and 37 (52%) have awards for residents. Research grants are available in 41 (58%) of organizations for students and 56 (79%) for residents. Formal mentorship programs exist in 16 (23%) organizations for students and 25 (35%) for residents. Conclusion: To our knowledge, this study highlights for the first time the scholarly opportunities available to trainees within Canadian medical specialty organizations.

X-ray therapy safety and awareness education for medical trainees and attending physicians.

INTRODUCTION: Medical imaging involving ionizing radiation is common in the clinical setting. Little is known about the level of radiation safety training for medical trainees and attending physicians. We sought to identify the level of radiation safety knowledge and training at the undergraduate, postgraduate, and attending physician level. METHODS: A 29-question survey was sent by email to two sites in Canada. We pooled the results of medical students, residents, and attending physicians. The primary outcome was to describe the amount of radiation safety training among these groups. The secondary outcomes were to describe the frequency of radiation exposure, level of radiation knowledge, and preferred training method for radiation safety. RESULTS: Of 115 surveys that were properly completed, 31 (26.9%) medical students, 17 (14.7%) residents, and 67 (58.3%) attending physicians responded. A greater number of medical students (41.9%) reported they had zero hours of training time for radiation safety compared to attending physicians (14.9%) (p<0.05). A higher number of attending physicians (47.8%) and residents (64.7%) participated in patient care involving fluoroscopy daily or at least several times per week compared to medical students (3.2%) (p<0.001). Attending physicians had the greatest number of correct responses to radiation safety questions. Online courses and workshops were the preferred training methods. CONCLUSIONS: Radiation safety training is an important component of medical education for medical trainees and attending physicians. Current radiation safety training requirements and procedures at various levels of medical training in Canada should be addressed. Implementing radiation safety education may improve adherence to the radiation safety principles.

Utility of head computed tomography for older adults with suspected delirium in the emergency department: A retrospective observational study.

BACKGROUND: Delirium in older people is associated with significant morbidity and mortality and has life-threatening etiologies making prompt recognition essential. Computed tomography of the head (CT-head) may have a role in determining the cause of delirium; however, inpatient studies suggest it is overused. There is a paucity of emergency department (ED)-based research surrounding the use of CT-head in delirium. This study aims to describe the utility of CT-head in older patients presenting to the ED with symptoms of delirium. METHODS: We conducted a retrospective chart review of patients 65 years and older with symptoms of delirium who visited local EDs over a 3.5-year period (2016-2020). We compared patients who did and did not receive CT-head. Our primary objective was to determine the proportion of acute findings in patients who received CT-head. Our secondary objectives were to describe the proportions of patients who did and did not receive CT-head in terms of their demographics, presenting symptoms, disposition, and indications for and results of CT-head scans. Chi-square tests were utilized for comparisons. RESULTS: A total of 630 encounters were identified through database searching; 526 met inclusion criteria. Thirty-four were excluded for presenting directly to consultants, leaving 492 included encounters. Of those who received a CT-head (n = 279), 13 (4.7%) had acute findings. Of the encounters with acute findings, four (30.77%) had focal neurological deficits (FND), and two (15.38%) had Glasgow Coma Scale (GCS) score < 14. Patients without CT-head (n = 213) were more likely to be discharged (p < 0.01) and less likely to have a FND (p < 0.01). CONCLUSIONS: CT-head is ordered for over half of older ED patients with symptoms of delirium despite infrequent acute findings. Acute findings typically occur in the context of symptoms suggestive of intracranial abnormalities such as FND or GCS < 14. This suggests physicians should be more selective when ordering CT-heads in patients with symptoms of delirium.

Opportunity costs of attending surgical clinic appointments and experiences with telemedicine for follow-up care.

OBJECTIVES: Telemedicine has been rapidly implemented in orthopedics during the coronavirus (COVID-19) pandemic. The purpose of this study was to quantify opportunity costs for patients attending typical in-person appointments and understand their perceptions of telemedicine for follow-up care. METHODS: A cross-sectional study was performed by surveying patients who had elective orthopedic surgery and attended at least one in-person and one phone call appointment. The survey assessed opportunity costs associated with in-person appointments, experience with telemedicine, and preferred type of future appointment. RESULTS: Of the 49 eligible patients, 41 (83.7%) completed the survey. The median travel distance to the clinic was 108 km, and the time spent in the clinic was 60 min. Participants responded "yes" to various forms of opportunity costs associated with attending in-person appointments, including missed work (46.3%), lost income (34.1%), recreational activities (26.8%), home or yard care (14.6%), socializing with friends or family (12.2%), school (2.4%), and childcare (2.4%). In addition, elements of the telemedicine appointment were rated from 1 (least favorable) to 10 (most favorable), and averages were calculated for ease of use (9.2), convenience (8.4), confidence in the doctor's diagnostic ability (8.2), likelihood of using the service again (6.4), and overall satisfaction (8.2). Preferred future appointment types included having the first visit in-person and subsequent visits via telephone (61.0%), in-person only (36.6%), and unsure (2.4%). CONCLUSION: This study identifies various opportunity costs associated with in-person orthopedic appointments and a favorable view toward telemedicine for follow-up care.