Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital.

BACKGROUND: Frequent pages can disrupt workflow, interrupt patient care, and may contribute to physician burnout. We hypothesized that paging volumes followed consistent temporal trends, regardless of the medical or surgical service, reflecting systems based issues present in our hospitals. METHODS: A retrospective review of the hospital paging systems for 4 services at The Ottawa Hospital was performed. Resident paging data from April 1 to July 31, 2018 were collected for services with a single primary pager number including orthopaedic surgery, general surgery, neurology, and neurosurgery. Trends in paging volume during the 4-month period were examined. Variables examined included the location of origin of the page (emergency room vs. inpatient unit), and day/time of the page. RESULTS: During the study period, 25,797 pages were received by the 4 services, averaging 211 (± Standard Deviation (SD) 12) pages per day. 19,371 (75%) pages were from in-patient hospital units, while 6426 (24%) were pages from the emergency room. The median interval between pages across all specialties was 22:30 min. Emergency room pages peaked between 16:30 and 20:00, while in-patient units peaked between 17:30 and 18:30. CONCLUSIONS: Each service experienced frequent paging with similar patterns of marked increases at specific times. This study identifies areas for future study about what the factors are that contribute to the paging patterns observed.

Primary amyloidosis of the bladder; a mimicker of bladder cancer.

Amyloidosis is a protein folding disorder characterized by the deposition of fibrillar proteins into solid organs or tissues. Primary localized amyloidosis of the bladder is very rare and can mimic bladder cancer in its presentation with hematuria, lower urinary tract symptoms or a mass on imaging. A case of localized amyloidosis of the bladder in a 48-year-old man with painless gross hematuria and evidence of bladder mass on ultrasound is presented. Amyloidosis is a rare but important non-malignant process of the bladder. We present a review of the literature and suggestions for management of this rare bladder disease.

Influence of dose-death interval on colchicine and metabolite distribution in decomposed skeletal tissues.

The semi-quantitative analysis of decomposed bone of rats exposed to colchicine and euthanized following different time intervals postexposure (i.e., dose-death interval, DDI) is described. Rats received colchicine (50 mg/kg, i.p.) and were euthanized 30 min (DDI1; n = 4), 60 min (DDI2; n = 4), or 180 min (DDI3; n = 4) postdose. Drug-free animals (n = 3) served as negative controls. Perimortem heart plasma was collected. Remains were decomposed to skeleton outdoors and then collected and sorted (skull, vertebrae, rib, pelvis, femur, tibia). Bones were dried, pulverized, and prepared by microwave-assisted extraction and microplate solid-phase extraction (MAE-MPSPE), followed by analysis for colchicine, 3-demethylcolchicine (3DMC), and 2-demethylcolchicine (2DMC) by ultra-high-performance liquid chromatography with photodiode array detection (UHPLC-PDA) at 350 nm. Bone type was a main effect (Kruskall-Wallis, p < 0.05) with respect to drug level (expressed as mass-normalized response ratio, RR/m) for each analyte, at each DDI. For all samples, DDI was a main effect (Kruskall-Wallis, p < 0.05) with respect to analyte level, and the ratio of analyte levels (RR3DMC/RRCOLCH, RR2DMC/RRCOLCH, and RR2DMC/RR3DMC). Bone COLCH levels varied by 19-fold, 12-fold, and 60-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Bone 3DMC levels varied by 12-fold, 11-fold and 17-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Bone 2DMC levels varied by 20-fold, 14-fold, and 14-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Values of RR3DMC/RRCOLCH varied by 16-fold, 5-fold, and 5-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Values of RR2DMC/RRCOLCH varied by 10-fold, 6-fold, and 12-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Values of RR2DMC/RR3DMC varied by 3-fold, 5-fold, and 2-fold across all bone types in the DDI1, DDI2, and DDI3 groups, respectively. Measured analyte levels in bone correlated poorly with corresponding levels in blood (r = -0.65-+0.31). Measured values of RR2DMC/RRCOLCH and RR2DMC/RR3DMC in bone also correlated poorly with corresponding values in blood. Measured values of RR3DMC/RRCOLCH were well correlated with corresponding blood levels for all bone types except skull (r = 0.91-0.97).

Recurrent nephrolithiasis associated with keratinizing desquamative squamous metaplasia.

Keratinizing desquamative squamous metaplasia (KDSM) in the renal pelvis is a rare condition with unclear malignant potential. Recent reports suggest it is likely benign and favor endoscopic treatment approaches. Medical record review was completed on two cases at our center to obtain history, physical examination, radiographic findings, and management. A literature review was completed to identify all published cases of KDSM. Both patients at our center suffered recurrent urolithiasis, hypothesized to be secondary to KDSM. Both were managed with a percutaneous approach to ensure complete stone and KDSM plaque removal. Our cases highlight that percutaneous surgery is an excellent management option for stone and KDSM eradication from the collecting system. This approach also allows adequate oncologic surveillance of the underlying urothelium.

Ultrasonography for the prediction of urological surgical intervention in patients with renal colic.

CONTEXT: There are no clear indicators of which ultrasound findings in an emergency department (ED) renal colic population are predictive of urological surgical intervention. OBJECTIVE: To determine the sonographic findings of renal colic that predict surgical intervention. METHODS: We conducted a retrospective cohort study of 500 consecutive ED patients with a diagnosis of renal colic that had ultrasonography (performed by radiology) during their ED visit. Our main outcome was urological surgical intervention. This was defined as extracorporeal shock wave lithotripsy, percutaneous nephrostomy or ureteroscopy performed within 16 weeks of the initial ED presentation. RESULTS: Of the 500 identified patients, 483 met our eligibility criteria. Of this group, 67 (13.9%) received a surgical intervention. Ultrasound (US) findings were 97% (95% CI 88.7% to 99.5%) sensitive and 28.1% (23.9% to 32.8%) specific in 'diagnosing' the requirement for surgery when the ultrasound (US) showed either at least a stone present or showed moderate to severe hydronephrosis. The presence of stone and moderate to severe hydronephrosis had a + likelihood ratio (LR) 3.86 (2.46 to 6.07) and a -LR 0.72 (0.60 to 0.86). Having a stone ≥6 mm had a sensitivity of 77.6% (65.5% to 86.5%), a specificity of 73.6% (69.0% to 77.7%), a +LR of 2.94 (2.39 to 3.6) and a -LR 0.30 (0.19 to 0.48). CONCLUSIONS: Radiology performed ultrasonography is a valuable tool for identifying renal colic that will go on to receive a surgical intervention in the 16 weeks following an ED visit. Further studies are needed to confirm the utility of ultrasound findings of stone visualisation, stone size and moderate to severe hydronephrosis in determining which patients need outpatient urology follow-up.

A two-year review of cocaine findings in impaired driving investigations in Ontario, Canada.

Drug-impaired driving is an increasing public safety concern across Canada, particularly due to the demonstrated increase in use of recreational drugs such as cocaine. Cocaine is a central nervous system stimulant drug; however, it can impair an individual's driving ability in both the stimulant and crash phases. Despite the scientific consensus regarding cocaine's potential for driving impairment, there is relatively little information available regarding blood concentrations and associated observations of impairment in suspected impaired drivers. Retrospective data analysis was performed to evaluate suspected impaired driving cases in which cocaine and/or benzoylecgonine were detected alone, or in combination with other drugs, in blood and urine samples submitted to the Toxicology Section of the Centre of Forensic Sciences with incident dates between 2021 and 2022. Cocaine and/or benzoylecgonine were detected in 46% (blood) and 66% (urine) of the total impaired driving samples submitted. In 41 cases where cocaine and/or benzoylecgonine were the only drug finding in blood, concentrations of cocaine and benzoylecgonine ranged from 0.0073 to 0.26 mg/L (mean 0.096 mg/L) and 0.13 to 5.3 mg/L (mean 2.1 mg/L), respectively. Driving observations reported by the arresting officer in cases where cocaine and/or benzoylecgonine were the only drug finding in blood and urine included the driver being involved in a collision, the vehicle leaving the roadway, erratic driving and the driver being asleep at the wheel; observations of drug impairment reported by the drug recognition expert at the time of driver evaluation included abnormal speech patterns, poor balance/incoordination, abnormal body movements and the individual falling asleep. The results provide concentrations of cocaine and benzoylecgonine observed in suspected impaired drivers, insight into observations that may be associated with prior cocaine use and additional information to inform on the effects of cocaine on driving.

Micro cost-effectiveness analysis of standard vs. mini percutaneous nephrolithotomy A single Canadian institution's experience.

INTRODUCTION: Mini-percutaneous nephrolithotomy (mPCNL ) has been described as an alternative to standard nephrolithotomy (sPCNL ) for select stones. Studies suggest that mPCNL has comparable stone-free rates, with potential for decreased complications and shorter hospital stay. Costs associated with both procedures present a challenge to Canadian institutions due to capital acquisitions of equipment and ongoing disposables. The objective of this study was to compare the cost-effectiveness of both procedures at our institution. METHODS: A decision tree analytic model was developed to compare costs and outcomes of both procedures. Primary outcomes included assessment of total capital, operative, and hospitalization costs. Cost and outcome of peri- and postoperative parameters were obtained using a retrospective analysis of 20 mPCNL and 84 sPCNL procedures on 1-2.5 cm stones between January 2020 and June 2022, and supplemented with internal hospital expenditure records and literature outcome data. Descriptive statistics and regression models were performed. RESULTS: The estimated total cost-per-patient was $7427.05 and $5036.29 for sPCNL and mPCNL, respectively, resulting in cost-savings of $2390.76 in favor of mPCNL, with a comparable stone-free rate. The savings were due to lower costs associated with complications and hospital stay. mPCNL had higher capital costs ($95 116.00) compared to sPCNL ($78 517.00), but per-procedure operative costs were lower for mPCNL ($2504.48) compared to sPCNL ($3335.72). Cost-per-case regression of total costs intersected at 5.51 cases when accounting for operative and hospitalization costs, and at 20 cases when only considering operative costs. CONCLUSIONS: Despite higher upfront costs, mCPNL may represent a valid, cost-effective alternative to sPCNL for select stones due to clinical and economic benefits in Canadian institutions.

Hemorrhaging laparoscopic partial nephrectomy - feasibility of a novel simulation model.

INTRODUCTION: Intraoperative surgical complications pose significant potential risks to patients. Uncontrolled bleeding during laparoscopic partial nephrectomy is one such event that requires collaboration and communication between surgical team members. We developed and evaluated a multidisciplinary surgical simulation scenario and model of intraoperative hemorrhage during a laparoscopic partial nephrectomy to facilitate the practice of these crucial non-technical skills. METHODS: A simulation scenario using a novel, titratable, bleeding partial nephrectomy model was developed. The operating room simulation consisted of an intubated mannequin placed in the lateral decubitus position and laparoscopic renal model. The multidisciplinary simulation scenario included anesthesia and urology residents and progressed from bleeding to a pulseless electrical activity arrest. The degree of renal model bleeding was modified based on the progression of the urology resident. After the scenario, participants were debriefed and completed a post-simulation survey assessing: 1) their perception of the simulated scenario; and 2) their teaching of non-technical skills in their residency training. RESULTS: The porcine model was successfully reproduced for nine consecutive weeks and functioned well to simulate bleeding from a laparoscopic partial nephrectomy site; the bleeding was able to be titrated based on resident progression and excision of the simulated tumor. All residents stated the scenario was valuable to assess and improve non-technical surgical skills and that their exposure to practice non-technical skills in their existing curriculum could be improved. CONCLUSIONS: Simulating an intraoperative bleeding partial nephrectomy, combined with an intraoperative crisis scenario, is a feasible, immersive, and reproducible model and can challenge residents' non-technical skills.

Development, implementation, and uptake of a novel Canadian Resident Matching Service (CaRMS) residency recruitment committee strategy in the era of COVID-19.

INTRODUCTION: Given restrictions on electives outside of medical students' home institutions during the COVID-19 pandemic, the objective of this study was to create a novel recruitment strategy for the University of Ottawa's (uOttawa) urology residency program. METHODS: A steering committee was formed and created a three-part recruitment strategy that included a new uOttawa urology website, a residency program social media campaign (Twitter and Instagram), and a virtual open house (VOH). Descriptive data from the website and Instagram and Twitter accounts were collected. Attendees of the VOH completed a mixed-methods survey, which collected quantitative and qualitive responses assessing aspects of the VOH and virtual resource use. RESULTS: From August 1 to December 31, 2020, the uOttawa urology website had 1707 visits. The Twitter account had a total of 29 000 views with 1000-5000 views per tweet. Thirty-one candidates attended the VOH. Survey responders reported that the most frequently used resources to gain knowledge of the program were the website (81%) and Twitter account (71%). The most helpful and informative resources were the uOttawa urology website, the VOH, and direct conversations with residents arranged through the website. Despite not having completed an elective, 26 students (84%) felt they had an understanding of what it might feel like to train in the program. Suggestions by students for future initiatives included one-on-one virtual meetings, another VOH, and more information on selection processes. CONCLUSIONS: A multifaceted, virtual recruitment strategy can be implemented to improve candidate understanding and engagement with residency programs while visiting elective opportunities remain limited.

Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation.

OBJECTIVE: Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties. DESIGN: In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016). SETTING: Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada. PARTICIPANTS: Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female). RESULTS: Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11). CONCLUSIONS: Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

Stereotactic Radiotherapy in the Treatment of Paraneoplastic Vasculitis in Oligometastatic Renal Cell Carcinoma.

Approximately 20% of renal cell carcinoma (RCC) is diagnosed because of paraneoplastic manifestations. RCC has been associated with a large variety of paraneoplastic syndromes (PNS), but it is rarely associated with PNS vasculitis. We present a case of a previously healthy male who presented with systemic vasculitis; bitemporal headaches, diplopia, polyarthritis, palpable purpura, tongue lesion, peri-orbital edema, scleritis, chondritis and constitutional symptoms. He was subsequently found to have oligometastatic RCC. Both his primary lesion and site of oligometastasis were treated with stereotactic radiotherapy (SBRT) and resulted in the resolution of his vasculitis, as well as sustained oncologic response. This is the first case to demonstrate that effective sustained treatment for PNS vasculitis due to oligometastatic RCC is possible with SBRT.

Reporting of harm in randomized controlled trials published in the urological literature.

PURPOSE: Evidence-based decision making seeks to balance potential benefits and harms (adverse effects) of health care interventions for an individual patient. We determined the prevalence and completeness of harm reporting in randomized controlled trials in the urological literature. MATERIALS AND METHODS: We performed a systematic literature search of all randomized controlled trials of therapeutic interventions published in The Journal of Urology, Urology, European Urology and BJU International in 1996 and 2004. Each article was reviewed by 2 independent investigators for 10 harm reporting criteria recommended by the CONSORT group. Discrepancies were settled by discussion and consensus. RESULTS: A total of 152 randomized controlled trials met the inclusion criteria, of which 109 (72%) reported adverse event outcomes. The median number of harm reporting criteria satisfied improved marginally from 1996 to 2004 (2.8 to 3.3, p = 0.36). A large proportion of studies failed to address harm in the abstract (55, 36%), introduction (71, 47%) and discussion (52, 34%). Few studies specified which adverse events were evaluated (21, 14%), when harm information was collected (32, 21%) or how the harm was attributed to the intervention (5, 3%). Only 48 (32%) articles provided reasons for patient withdrawal and 1 in 5 (33, 22%) reported the severity of adverse events. CONCLUSIONS: Randomized controlled trials published in the urological literature contain significant deficiencies in adverse event reporting. These findings suggest the need for reporting standards for harm in urological journals. Improvements in adverse event reporting would permit a more balanced assessment of interventions and would enhance evidence-based urological practice.

"Between a Rock and a Hard Place": A Case Report of Stone Fragment Impaction Causing a Retained Ureteroscope Requiring Open Surgical Intervention.

Background: Ureteroscopy is frequently used for small renal and ureteral calculi. Rarely cases have been reported of retained ureteroscopes as a complication. With the limited number of cases, it is important to add these to the literature to mitigate the future risk from this complication that can lead to significant morbidity. We present our unique experience with a retained ureteroscope requiring open surgical intervention. Case Presentation: Our case is a 65-year-old female undergoing ureteroscopy for a 2 cm right ureteropelvic junction obstructing stone. After laser lithotripsy, there was significant buildup of stone debris distally along the ureteroscope. Conservative measures failed to remove the ureteroscope, so an open surgical approach was taken. The ureteroscope was removed, and a ureteral reimplant was performed. Postoperative CT shows residual hydronephrosis, but there is no obstruction seen on renal Lasix scan. Conclusions: This is a rare, but real, complication that urologists must be aware of. Preventive measures with pre-stenting early intraoperative stenting, using a ureteral access sheath, or using a single-use flexible ureteroscope could be considered especially when treating larger stones endoscopically.

Assessment of response of the Intoxilyzer 8000C to volatiles of forensic relevance in vitro, part I: acetone, isopropanol, and methanol.

The response of the Intoxilyzer 8000C (version approved for evidentiary breath alcohol testing in Canada) to volatile solvents in vitro is described. Acetone, isopropanol, and methanol were prepared as aqueous solutions or dilutions of standard alcohol solution (SAS; 1.21 mg ethanol/mL) to generate apparent blood ethanol concentrations (aBEC) of 50 or 80 mg/dL. Solvent concentrations examined were relevant to clinical or impaired driving scenarios. Replicates of 20 aBEC measurements were made for each mixture and the actuation of the "INTERFERANT DETECT" message (IDM) was noted. Measurements of aqueous acetone (0-40 mg acetone/dL), isopropanol (0-100 mg isopropanol/dL), and methanol (0-100 mg methanol/dL) yielded aBECs of 0, 0-43, and 0-55 mg/dL, respectively. The minimum concentration examined at which the IDM was actuated in 100% of replicates was 25, 30, and 100 mg/dL for acetone, isopropanol, and methanol, respectively. The maximum concentration examined at which the IDM was actuated in none of the replicates was 5, 10, and 50 mg/dL for acetone, isopropanol, and methanol, respectively. In examinations of acetone/isopropanol mixtures in diluted SAS where the IDM was not always actuated, the maximum BEC overestimation was 10 mg/dL. Overall, the potential for significant undetected BEC overestimation is low and may be further reduced through truncation of test results and subject observation.

Analysis of Dextromethorphan and Three Metabolites in Decomposed Skeletal Tissues by UPLC-QToF-MS: Comparison of Acute and Repeated Drug Exposures.

Ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-QToF-MS) analysis of dextromethorphan (DXM) and its metabolites-dextrorphan, 3-methoxymorphinan (3-MEM) and 3-hydroxymorphinan-in skeletal remains of rats exposed to DXM under different dosing patterns is described. Rats (n = 20) received DXM in one of four dosing patterns: acute (ACU1 or ACU2-100 or 200 mg/kg, i.p.; n = 5, respectively) or repeated (REP1 or REP2-3 doses of 25 or 50 mg/kg, i.p., 30 min apart; n = 5, respectively). Drug-free animals (n = 5) served as negative controls. Following euthanasia, the animals decomposed to skeleton outdoors. Bones were sorted by animal and skeletal element (vertebra, femur, pelvis, tibia, rib and skull), washed, air-dried and pulverized prior to dynamic methanolic drug extraction, filtration/pass-through extraction and analysis by UPLC-QToF-MS in positive electrospray ionization mode. Analyte levels (expressed as mass-normalized response ratios, RR/m) differed significantly between ACU1 and ACU2 (Mann-Whitney (MW), P < 0.05) in all skeletal elements for all analytes investigated, and between REP1 and REP2 in most skeletal elements for 3-MEM and 3-HOM, but in all skeletal elements for DXM. Between ACU1 and ACU2, and between REP1 and REP2, analyte level ratios (RRi/RRj) differed significantly (MW, P < 0.05) in 3/6 to 6/6 skeletal elements, depending on the ratios concerned, with no analyte level ratio differing significantly between both ACU1 vs ACU2 and REP1 vs REP2. Kruskal-Wallis (KW) analysis showed skeletal element to be a main effect for all analyte levels and analyte level ratios in all ACU and REP groups examined (P < 0.05). For data pooled only according to exposure pattern, KW analysis showed dose pattern to be a main effect for both analyte levels and analyte level ratios (P < 0.05). These data illustrate a dependence of these measures on dose, dose pattern and skeletal element, suggesting that some exposure patterns may be distinguished by toxicological analysis of bone.

Development and implementation of a mobile version of the O-SCORE assessment tool and case log for competency-based assessment in urology residency training: An initial assessment of utilization and acceptance among residents and faculty.

INTRODUCTION: In competency-based models of residency training, work-based assessments of residents' technical skills are essential both for providing formative feedback and for assessing surgical competence. The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) is a previously validated paper-based evaluation tool created to assess a surgical trainees' operative competence. To address some of the barriers to assessment, we developed and implemented a mobile application that combines the O-SCORE with a surgical case log. METHODS: A description of the development implementation process for the mobile O-SCORE and case log is provided. Following implementation, a survey was developed and administered electronically to all faculty and residents within the University of Ottawa's Division of Urology to assess user perceptions and utilization of the application. The survey was administered and data collected via Survey Monkey. RESULTS: The overall response rate was 94%. The majority of residents (94%) reported that it was easy to log cases with the application and 81% felt that it had a positive impact on their training; 75% of faculty were willing or very willing to complete evaluations when assigned and 66% felt that the application had a positive effect on the quality of feedback they provided. CONCLUSIONS: Overall, faculty and residents felt that our mobile O-SCORE application was user-friendly and valuable as both a surgical log and assessment tool. With surgical programs moving towards competency-based models of training and assessment, the O-SCORE mobile application represents a practical electronic surgical log and work-based assessment instrument that can be easily adopted into any surgical training program.

Perceptions and Practice Patterns of Holmium Laser Goggles in Endourological Procedures: An Unnecessary Evil?

PURPOSE: The holmium laser is used increasingly for a wide array of urological procedures. Laser safety goggles are mandatory at many centers for individuals within the nominal hazard zone, as set out by the institution. Recent ex vivo studies suggest standard eye wear may be equally as protective. We sought to evaluate the perceptions and practice patterns of laser safety goggles in urology. MATERIALS AND METHODS: A 24-question survey was sent out through e-mail to an international e-mail list of ∼2000 urologists that were members of the Endourological Society. Data were collected anonymously using Survey Monkey. RESULTS: A total of 264 (14%) urologists completed the survey. Thirty-four percent worked in the community, whereas 63% worked at an academic institution. Ninety-seven percent routinely used the holmium laser. The most common uses were lithotripsy (99%), tissue incision (71%), tumor ablation (58%), and prostate ablation (26%). Formal laser training and institutional laser safety policies were reported in 76% and 64%, respectively. Forty percent of respondents routinely wore laser safety goggles. Laser adverse events were witnessed by 19%, but there were no eye injuries reported. Seventy percent of surgeons felt that laser safety goggles may impair their vision. When presented with the information that regular eye glasses may be as effective as laser goggles for preventing harm, the majority (86%) would opt for regular eye wear. CONCLUSIONS: Laser safety eyewear practice patterns vary greatly. Many centers have adopted policies for universal mandatory laser goggles in the operating room. With over two thirds of surgeons suggesting laser goggles impair their vision, and recent literature suggesting regular eye wear is equivalent in preventing laser-associated eye injuries, laser goggle safety policies should be updated to better match the potential hazards inherent to the device.

Laparoscopic pyeloplasty practice patterns in Canada.

INTRODUCTION: Ureteropelvic junction obstruction (UPJO) is a condition characterized by partial or complete obstruction of urine transport from the renal pelvis to the ureter and can present with intermittent flank pain, recurrent urinary tract infections, renal stones, or renal dysfunction. While historically, open pyeloplasty was the gold standard for surgical management, laparoscopic methods to repair UPJO have largely taken over as the preferred approach for adolescent and adult patients. Despite near universal adoption of laparoscopic pyeloplasty among Canadian urologists, it remains a technically complex procedure and considerable variability exists in the procedural steps performed. METHODS: An online survey was distributed to all urologists registered with the Canadian Urology Association (CUA). Participants were asked to describe their training background, comfort level with laparoscopic pyeloplasty, positioning preferences, procedural steps, and stenting practices. RESULTS: A total of 100 board-certified urologists completed our survey, with approximately half from a community setting and half with academic affiliations (56% and 43%, respectively). The vast majority (98%) reported preferring the Anderson-Hynes (dismembered) pyeloplasty technique. Other technical steps of the procedure were variable among respondents, with no discernable pattern. Those who felt most comfortable with the procedure tended to perform a larger volume of laparoscopic pyeloplasties annually or work at higher-volume institutions. CONCLUSIONS: Laparoscopic pyeloplasty remains a technically challenging procedure that many Canadian urologists are uncomfortable performing. With this publication, we hope to create discussion among urologists and to reveal procedural tips that may improve comfort in tackling these complex cases.

Effects of tissue type and the dose-death interval on the detection of acute ketamine exposure in bone and marrow with solid-phase extraction and ELISA with liquid chromatography-tandem mass spectrometry confirmation.

Ketamine exposure was detected in skeletal tissues by ELISA and liquid chromatography-tandem mass spectrometry (LC-MS-MS). Rats (n = 9) received ketamine hydrochloride acutely (75 mg/kg, i.p.) and were euthanized within 15, 30, or 90 min. Drug-free control animals (n = 3) were also euthanized. Extracted femora were separated into epiphyseal and diaphyseal fragments, with marrow isolated from the medullary cavity. Bone was ground and incubated in methanol. Extracts were dried and reconstituted in phosphate buffer (0.1 M, pH 7.3), and marrow was homogenized in alkaline solution. Both then underwent solid-phase extraction. Extracts were assayed by ELISA, with data expressed in terms of relative decrease in absorbance (%DA, drug-positive tissues vs. matrix-matched drug-free controls) and binary classification test sensitivity (S). Generally, %DA decreased in the order of marrow > epiphyseal bone > diaphyseal bone, and was negatively correlated with dose-death interval (DDI). Measured S values were 100% in ELISA analysis of extracts of all tissue types. Sensitivity values were computed from LC-MS-MS data using a 5 ng/mL cutoff. Sensitivity values for ketamine detection were 100%, 0-100% and 0%, at the 15, 30, and 90 min DDI, respectively, and sensitivity values for norketamine detection were 0-66%, 0-66%, and 0% at the 15, 30, and 90 min DDI, respectively. These results suggest that the tissue type sampled and DDI may influence the sensitivity of detection of ketamine exposure in skeletal tissues.

Formic acid and methanol concentrations in death investigations.

Methanol ingestion results in the formation of formic acid, a toxic metabolite that can cause metabolic acidosis. Methanol toxicity is therefore dependent on the amount of methanol ingested, the nature of treatment received, elapsed time since ingestion, and the accumulation of formic acid. Both methanol and formic acid concentrations are determined at this laboratory using headspace gas chromatography. An examination of 12 fatalities attributed to methanol poisoning is presented. Six individuals were found deceased, and their postmortem methanol and formic acid concentrations ranged from 84 to 543 mg/dL and 64 to 110 mg/dL, respectively. In the other six individuals, hospital treatment such as bicarbonate, ethanol infusion, and hemodialysis was administered. Antemortem methanol and formic acid concentrations ranged from 68 to 427 mg/dL and 37 to 91 mg/dL, respectively, whereas corresponding postmortem methanol and formic acid levels ranged from undetectable to 49 mg/dL and undetectable to 48 mg/dL, respectively. Hospital treatment of formic acid toxicity resulted in significantly reduced postmortem methanol and formic acid concentrations. Furthermore, the toxicological relevance of nine methanol-positive cases where postmortem methanol concentrations ranged from 3 to 142 mg/dL, with corresponding formic acid levels of less than 10 mg/dL, is discussed.