Palliative care on Twitter: who to follow to get started.

Palliative care on Twitter: who to follow to get started.

The 9th Palliative Care Congress: one attendee's highlights.

The 9th annual Palliative Care Congress, organised by the Palliative Care Research Society and the Association of Palliative Medicine, took place in Gateshead, England, on 14-16 March at the impressive The Sage Gateshead on the bank of the river Tyne. Proceedings got under way in dramatic fashion with a production of the Nell Dunne play Home Death, which International Journal of Palliative Nursing part-sponsored. The play was well received by the early comers to the Congress, as evidenced by the comment that it was interesting to experience the very familiar event of a patient's death from the unfamiliar perspective of the person's relatives. This refreshingly alternative start to the Congress continued into the official opening next morning, with a vibrant and humorous performance from the Newcastle Sword Dancers that no doubt helped to cast off the last traces of sleep for many a delegate.

Bringing death further into the open.

This month, BBC1 screened a television programme, Inside the Human Body: First to Last, in which a man's death was shown. This event was apportioned only a fraction of the total running time, but it garnered a lot of attention in the media. What did the programme, and the reactions of the national press and general public, tell us about current attitudes towards death and dying?

Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists.

Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice. Herein, we describe the positive margin rates of two non-fellowship-trained private-practice urologists who converted from open radical retropubic prostatectomy to robot-assisted radical prostatectomy. The margin positivity data from two non-fellowship-trained private-practice urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy from each surgeon were compared with the first 50 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive surgical margin was defined as tumor present at the inked margin of the prostate. There was a significant decrease in the overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for surgeon 1 dropped from 44 to 20% and from 37 to 5.7%, respectively, after changing from open to robotic prostatectomy. For surgeon 2, the overall positive margin rate changed from 26 to 18% and the pT2 positive margin rate changed from 27.5 to 7% after converting. Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain negative surgical margins. With proper training this phenomenon does seem to apply to non-fellowship-trained urologists in private practice and can be realized within the first 50 cases performed.

The use of robotically assisted surgery for treating urachal anomalies.

OBJECTIVE: To report the management of urachal anomalies using a robotically assisted approach. PATIENTS AND METHODS: Between January 2005 and February 2006, five patients (mean age 51 years, range 24-68) were diagnosed with urachal anomalies. Two basic robot-assisted surgical approaches were used for excising the urachal anomalies: excision of the urachal remnant via partial cystectomy, and radical cystectomy for excision of urachal adenocarcinoma. RESULTS: All five cases were successful and the excised specimens were assessed histologically. The short-term oncological outcome in the three patients with histologically confirmed moderately differentiated adenocarcinoma showed no evidence of recurrent disease within a median interval of 8 months. Surveillance follow-up cystoscopy in the patients who had a partial cystectomy showed a well-healed bladder mucosa with no evidence of recurrence. CONCLUSIONS: Radical excision of the urachal tract with partial cystectomy or radical cystectomy using the da Vinci robot is safe, effective and technically feasible.

Secondary polycythemia caused by ureteropelvic junction obstruction successfully treated by laparoscopic nephrectomy.

Secondary polycythemia is a condition that causes an increase in red blood cell count either because of the physiologic response to stress or inappropriate secretion of erythropoietin. We report a case of a secondary polycythemia caused by ureteropelvic junction obstruction that was successfully treated by laparoscopic nephrectomy.

Medical knowledge: the importance of faculty involvement and curriculum in graduate medical education.

PURPOSE: The Accreditation Council for Graduate Medical Education requires that each residency program must demonstrate and document actual accomplishments through objective measures. At University of Washington we identified deficiencies in resident medical knowledge and designed interventions that would assist in improving resident AUA IS scores, using this as a metric to document the outcomes. MATERIALS AND METHODS: In 2001 the University of Washington syllabus and faculty precepted chapter review sessions were formally established. The national AUA IS was used as an objective standardized examination to determine an annual group percentile score. RESULTS: We noted a gradual and consistent increase in the average percentile group score on the national annual AUA IS examinations of our residents. A generalized estimating equation model demonstrated a significant difference between pre-intervention and post-intervention average percentile resident AUA IS scores (p <0.001). Average resident percentile rankings in 2001 to 2004 were 25.6 points higher than the average rankings of residents tested in 1997 to 2000. CONCLUSIONS: We developed and evaluated a cohesive core curriculum designed to improve resident knowledge in urology, as measured by the AUA IS metric. With the active participation of faculty the curriculum enhanced resident education.