Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound.

OBJECTIVE: Dextranomer-hyaluronic acid (Deflux(®)), the most widely used compound in the endoscopic treatment of vesico-ureteric reflux (VUR) today, is believed to provoke only minimal inflammation. Reports of calcification of Deflux(®) are increasing. We ascertain the incidence of Deflux(®) calcification appearing as distal ureteric calculi on ultrasound. METHODS: Three cases (2 external patients) of ureteroscopy for calcified submucosal Deflux(®) prompted a retrospective review of the notes and imaging of all children treated with Deflux(®) for VUR between December 2000 and January 2011 at Great Ormond Street Hospital. RESULTS: 232 children (M:F = 5:3) received Deflux(®) for VUR at median age 2 years (range 2 months-12 years). Follow-up annual ultrasound, performed in all, identified calcification in 2. The interval between Deflux(®) injection and presentation of its calcification was 4 years. 104 of the 232 children had been followed up for 4-10 years. Considering the observed lag-period, after 4 years the incidence of calcification of Deflux(®) on ultrasound was 2% (2/104). CONCLUSIONS: Patients should be warned that calcification of Deflux(®) can occur. Misinterpretation as ureteric stones is common and may lead to unnecessary ureteroscopy. In this series, the incidence of calcification of Deflux(®) on ultrasound after 4 years was 2%.

Training on bench models improves dexterity in ureteroscopy.

INTRODUCTION: There is a need for alternative training in endourology. Computerised simulators have been introduced but have, so far, not been compared to real surgery. Bench models have proved to be comparable to real surgery when performing standard procedures in the upper urinary tract. OBJECTIVE: To validate training on bench models as a tool to improve dexterity in semi-rigid ureteroscopy. METHODS: Urology residents were tested when performing semi-rigid ureteroscopy on a bench model (Mediskills), before and after training. All standard equipment and instruments, including fluoroscopy, were available. For the test procedure we used a task-specific checklist and a global score (maximum score 10 + 9 = 19). After base line assessment, the participants practised under supervision. After training they were reassessed, using the same procedure as previously. RESULTS: The performance was significantly better after the training. Results before/after were: 5.1/9.2, 2.6/7.8 and 7.7/17.2 for task-specific checklist, global score and total score respectively. All residents felt more familiar with the instruments and the procedure after the training. CONCLUSION: Training on bench models for ureteroscopy enhanced the manual dexterity as well as familiarity with the method and is recommendable before operating on patients.

Implementing a community education program on stroke for health care providers and consumers.

Stroke remains a leading killer and cause of disability in the United States. The incidence of stroke appears to be increasing while new advances in the management of stroke continue to emerge. These realities emphasize the need to communicate advances to health care providers and consumers. However, educating health care providers and consumers in rural states is often difficult due to dispersed geographic distribution and lack of resources. This project, utilizing teleconferencing technology, brought an educational program on stroke management for providers and consumers into rural communities. Community hospitals, with teleconferencing capability, were identified throughout Vermont. Community providers and consumers were invited to participate in educational sessions using a variety of marketing methodologies. A multidisciplinary team designed two curricula (one for providers and one for health care consumers) on the management of stroke. A total of 211 health care professionals and 122 consumers participated in the program. Education session evaluations suggested that the program either met or exceeded participants' expectations for the majority of programs. This project demonstrated that academic centers can provide quality continuing medical education for their rural communities using teleconferencing technology. Experience with this program suggests that there are three key elements for success: adequate planning time, communication on multiple levels, and strong marketing strategies.