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.

Transconjunctival XEN45 implantation for secondary open-angle glaucoma management in a pediatric patient with WAGR syndrome.

Purpose: To report a case of XEN45 gel stent implantation in a pediatric patient with WAGR syndrome as a successful surgical intervention in the management of multifactorial secondary open-angle glaucoma. Observations: A 6-year-old female with a history of WAGR syndrome, bilateral congenital aniridia, pseudophakia OD and glaucoma OD, was referred for a XEN45 gel stent OD. IOP was persistently elevated at 24 mm Hg despite two glaucoma medications. Implantation of the XEN45 gel stent was performed using a transconjunctival ab externo approach. There were no significant intra-or-postoperative adverse events associated with the stent. The patient achieved good IOP-lowering control without glaucoma medications across the 18-month follow-up period. Conclusions: A XEN45 stent through a transconjunctival ab externo approach may be an effective surgical intervention in pediatric patients with secondary open-angle glaucoma associated with aniridia and aphakia.

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.

Bilateral Purtscher-Like Retinopathy Associated With COVID-19 Infection.

This case report describes a 37-year-old female individual who presented with sudden-onset blurred vision in both eyes 4 days after testing positive for COVID-19.

Comparison of pre-formalin fixation and postfixation temporal artery biopsy lengths.

OBJECTIVE: To evaluate the difference in temporal artery biopsy length before and after formalin fixation and identify any correlations with pathologic diagnosis. DESIGN: Prospective case series. PARTICIPANTS: Patients undergoing temporal artery biopsy between June 2020 and October 2021. METHODS: The pre- and postfixation biopsy lengths were compared. The primary outcome was the difference in temporal artery length as measured before fixation by the surgeon versus the postfixation measurement by the pathologist. RESULTS: Forty-seven consecutive biopsies in 46 patients were included. One patient had a repeat biopsy. Mean age was 75.3 ± 8.4 years (range, 49-94 years); 74% of patients (34 of 46 patients) were female. Mean prefixation biopsy length was 2.36 ± 0.58 cm (range, 1.1-4.5 cm). Mean postfixation biopsy length was 2.09 ± 0.59 cm (range, 0.6-3.8 cm). Mean difference (postfixation shrinkage) was 0.27 ± 0.24 cm (p = 0.0298), and 36% of biopsies (17 of 47 biopsies) were positive. There was no significant difference in prefixation temporal artery biopsy length (p = 0.38) or postfixation shrinkage (p = 0.24) between positive and negative biopsies. In a univariate analysis, elevated erythrocyte sedimentation rate was 31.3 mm/h (range, 4-88 mm/h) in negative biopsies versus 54.5 mm/h (range, 29-98 mm/h) in positive biopsies (p = 0.01), C-reactive protein was 17.4 mg/L (range, 0.2-145 mg/L) in negative biopsies versus 78.56 mg/L (range, 5-244.4 mg/L) in positive biopsies (p = 0.003), and platelets were 254.9 × 109/L (range, 134-570 × 109/L) in negative biopsies versus 393.8 × 109/L (range, 210-593 × 109/L) in positive biopsies (p < 0.001), all associated with a positive pathologic diagnosis. CONCLUSIONS: The average temporal artery biopsy was approximately 0.27 cm shorter on pathologic reports compared with before fixation measurements. Surgeons should account for this shrinkage with a buffer of at least 0.3 cm, aiming for excision of at least 2.3 cm, if they desire a postfixation size of 2 cm.

Short-Term Efficacy and Safety of Open Conjunctiva Ab Externo XEN45 Gel Stent Implantation in Glaucoma Patients.

PRCIS: We examined the safety and efficacy of the open conjunctiva ab externo approach for XEN45 gel stent implantation. There was a significant reduction in intraocular pressure (IOP) and number of glaucoma medications at 12 months follow-up. PURPOSE: This study aims to determine the safety and efficacy of the open conjunctiva ab externo approach to XEN45 stent implantation. MATERIALS AND METHODS: Retrospective chart review of all patients between July 2018 and March 2020 who underwent XEN45 implantation. IOP and the number of glaucoma medications were measured at the preoperative, 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperative appointments. The primary outcome of this study is the number of cases achieving complete success at 12 months postoperatively. RESULTS: Forty-four eyes of 44 patients were included. Mean preoperative IOP was 26.2±8.7 mm Hg on 3.2±0.7 IOP-lowering medications. At 12 months postoperative, mean IOP was 18.9±9.1 mm Hg (n=35, P <0.0001; mean reduction of 27.9%) on 0.9±1.4 (n=35, P <0.0001) IOP-lowering medications. Postoperative needling was performed in 5 cases (11.4%). Of the 35 cases with a postoperative visit at 12 months, complete success was achieved in 14 cases (40.0%) and qualified success in 3 cases (8.6%). Eighteen cases (51.4%) were recorded as failures at 12 months, comprised of 4 cases requiring reoperation for glaucoma (2 XEN45 implants, 1 trabeculectomy, and 1 Baerveldt implant), and 14 cases that did not meet the IOP-lowering criteria for success. During the postoperative course, there was 1 case of self-limited hypotony, 2 self-resolving choroidal effusions, and 3 cases of bleb leakage. CONCLUSIONS: The open conjunctiva ab externo approach to XEN45 implantation achieved successful levels of IOP reduction in 48.6% of glaucoma cases within the first year. The most common adverse events included the need for additional glaucoma surgery (excluding needling procedures), transient hypotony, and bleb leak.

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.