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Ng A, Chan VWS, Asif A, Lam CM, Light A, Jayaraajan K, Cambridge WA, Matthew MG, Clement KD, Kulkarni M, Bhatt NR, Khadhouri S, Kasivisvanathan V. 1160 LEARN (Urological Teaching in British Medical Schools Nationally): A Multicentre Cross-Sectional Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Urology is a common rotation for UK Foundation Year (FY) doctors, and accounts for >25% of acute surgical referrals. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology to be covered during medical school. However, its national uptake remains unknown. LEARN aims to assess undergraduate urology teaching across UK medical schools.
Method
LEARN is the largest ever multicentre cross-sectional study of undergraduate urology teaching. Year 2-5 medical students and FY1 doctors were invited to complete a survey between 3rd October-20th December 2020. The primary objective is to compare current undergraduate urology teaching against the BAUS syllabus. Secondary objectives investigate the type and quantity of teaching provided, the reported performance rate of GMC mandated urological procedures, and the proportion of those considering urology as a career.
Results
A total of 7,611/8,346 (91.2%) responses from 39 medical schools that met the inclusion criteria were analysed. 16.5% of responses were newly appointed FY1 doctors. In their undergraduate training, the most commonly taught topics were urinary tract infection, acute kidney injury and haematuria; the least taught topics were male urinary incontinence, male infertility and erectile dysfunction. 90.6% and 86.3% had reported performing catheterisation as undergraduates on male and female patients respectively, and 16.9% had considered a career in urology.
Conclusion
LEARN provides the largest evaluation of any undergraduate specialty teaching. It has identified areas to improve teaching, to equip the future workforce with the competencies to manage urological pathology, irrespective of future career choice.
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Affiliation(s)
- A Ng
- UCL Medical School, University College London, London, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - V W S Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - A Asif
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - C M Lam
- Bronglais Hospital, Aberystwyth, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - A Light
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - K Jayaraajan
- Imperial College London, London, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - W A Cambridge
- University of Edinburgh, Edinburgh, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - M G Matthew
- Hull York Medical School, York, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - K D Clement
- Royal Alexandra Hospital, Paisley, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - M Kulkarni
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - N R Bhatt
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - S Khadhouri
- Health Science Research Unit, The School of Medicine, Medical Sciences and Nutrition, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
| | - V Kasivisvanathan
- Division of Surgery and Interventional Science, UCL, London, United Kingdom
- British Urology Researchers in Surgical Training (BURST), London, United Kingdom
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Ng A, Cambridge WA, Jayaraajan K, Lam CM, Light A, Asif A, Chan VWS, Matthews MG, Clement K, Kulkarni M, Bhatt NR, Khadhouri S, Kasivisvanathan V. P73 LEARN: uroLogical tEAching in bRitish medical schools Nationally - a national retrospective multi-centre audit of urology teaching across British medical schools. BJS Open 2021. [PMCID: PMC8030194 DOI: 10.1093/bjsopen/zrab032.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Urological conditions account for approximately 25% of acute surgical referrals and 10-15% of general practitioner appointments. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology that must be covered during undergraduate medical training. However, its uptake nationally remains unknown. This project aims to assess undergraduate urology teaching across UK medical schools.
Methods
A targeted advertising drive using social media, medical school societies, websites and newsletters was performed over 4 weeks. Collaborators are responsible for recruiting survey respondents (year 2 medical students to foundation year 1 (FY1) doctors). Survey respondents will complete a REDCap survey retrospectively assessing their urology teaching to date. The primary objective is to compare current urology teaching in medical schools across the United Kingdom with the BAUS undergraduate syllabus.
Results
Currently, 522 collaborators have registered from 36 medical schools nationally. Of these collaborators, 6.32% (33/522) are FY1s and 93.68% (489/522) are medical students. Each collaborator will be responsible for recruiting at least 15 survey respondents to be eligible for PubMed-indexed collaborator authorship.
Conclusion
LEARN has recruited successfully to date, with all collaborators from the medical student and FY1 cohort. With the role of collaborators to further recruit survey respondents, LEARN will provide the most representative and thorough evaluation of UK undergraduate urological teaching to date. It will provide evidence to support changes in the medical school curriculum, and allow re-evaluation of the current national undergraduate BAUS syllabus.
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Affiliation(s)
- A Ng
- University College London
| | | | | | | | | | - A Asif
- University College London
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O'Meara S, Bhatt NR, Flynn RJ, Manecksha RP, Thomas AZ. Bladder cancer in Ireland: a 21-year review. Ir J Med Sci 2020; 190:531-538. [PMID: 32725349 DOI: 10.1007/s11845-020-02318-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Bladder carcinoma is one of the most commonly diagnosed cancers worldwide; however, various studies have reported on marked international variation in incidence and mortality rates. The aim of this study was to report national figures on incidence, survival and risk factors of bladder cancer. This retrospective review is the first to offer a comprehensive analysis of incidence rates, mortality and potential risk factors in the Irish population from 1994 to 2015. METHODS This was a retrospective study of incidence and survival trends in bladder cancer in the Irish population from 1994 to 2014 based on data from the National Cancer Registry of Ireland (NCRI). Patient demographics, pathology and survival data, as well as potential contributing factors, were studied. RESULTS A total of 9656 cases of bladder cancer were diagnosed from 1994 to 2015, with majority of cases occurring in males (71%). Survival decreased with increasing age, higher grade and higher stage. Bladder cancer is more common in those with a smoking history and with a higher deprivation score. Urothelial cell carcinoma was the most common pathology (95%), with the majority of patients being stage 1 or 2 (44.7%). CONCLUSION The overall incidence of bladder cancer in Ireland has fallen, in line with reducing smoking rates. Our data reflects international trends in incidence, survival and contributing risk factors.
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Affiliation(s)
- S O'Meara
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.
| | - N R Bhatt
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - R J Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - A Z Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, Dublin, Ireland
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Boland MR, Ryan ÉJ, Dunne E, Aherne TM, Bhatt NR, Lowery AJ. Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer. Br J Surg 2019; 107:33-43. [PMID: 31755998 DOI: 10.1002/bjs.11347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assessment of the oestrogen receptor (ER) provides important prognostic information in breast cancer. The impact of progesterone receptor (PgR) status is less clear. Standardization of immunohistochemical analysis of these receptors has reduced interstudy heterogeneity. The aim of this meta-analysis was to evaluate the impact of PgR negativity on outcomes in ER-positive (ER+) breast cancer. METHODS This study was performed according to PRISMA and MOOSE guidelines. PubMed, Embase and the Cochrane Library were searched systematically to identify studies comparing disease-free survival as the primary outcome and overall survival as secondary outcome between PgR-positive (PgR+) and PgR-negative (PgR-) status in ER+ breast cancer. A meta-analysis of time-to-effect measures from included studies was undertaken. RESULTS Eight studies including 13 667 patients, 11 838 in the ER+PgR+ group and 1829 in the ER+PgR- group, met the inclusion criteria. Treatment characteristics did not differ significantly between the two groups. Patients in the ER+PgR- group had a higher risk of disease recurrence than those who had ER+PgR+ disease (hazard ratio (HR) 1·57, 95 per cent c.i. 1·38 to 1·79; P < 0·001). This hazard was increased in patients with human epidermal growth factor receptor 2-negative tumours (HR 1·62, 1·37 to 1·93; P < 0·001). A similar result was observed for overall survival (HR 1·69, 1·33 to 2·14; P < 0·001). CONCLUSION PgR negativity is associated with significant reductions in disease-free and overall survival in ER+ breast cancer. Treatment and surveillance strategies in these patients should be tailored accordingly.
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Affiliation(s)
- M R Boland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - É J Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Dunne
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T M Aherne
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - N R Bhatt
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Davis NF, Bhatt NR, MacCraith E, Flood HD, Mooney R, Leonard G, Walsh MT. Long-term outcomes of urethral catheterisation injuries: a prospective multi-institutional study. World J Urol 2019; 38:473-480. [PMID: 31020421 DOI: 10.1007/s00345-019-02775-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE There are no prospective data describing the incidence and spectrum of long-term complications associated with traumatic urethral catheterisation (UC). We prospectively monitored the long-term clinical outcomes and complications of patients with traumatic UC injuries. METHODS A prospective study at two tertiary university hospitals was performed to record all referrals for iatrogenic urethral injuries caused by UC. Long-term follow-up was prospectively maintained by regular outpatient department visits and by monitoring all urological interventions and their outcomes from urinary catheter-related injuries. RESULTS The incidence of traumatic UC was 13.4 per 1000 catheters inserted in male patients and 37 iatrogenic urethral injuries were recorded. The mean age was 74 ± 12 years and the mean length of follow-up was 37 ± 3.7 months. Urethral injuries were caused by inflating the catheter anchoring balloon in the urethra (n = 26) or by creating a false passage with the catheter tip (n = 11). In total, 29 patients (78%) developed urethral stricture disease during their follow-up; of which 11 have required at least one urethral dilation and two have required one urethrotomy. Three patients required long-term indwelling suprapubic catheter placement and seven patients opted for a long-term indwelling urethral catheter. There were eight patient mortalities; one of which was due to severe urosepsis resulting from catheter balloon inflation in the urethra. CONCLUSION Catheter-related injuries are associated with significant long-term complications in this vulnerable patient cohort. In future, such injuries may be preventable if the safety profile of the urinary catheter is modified.
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Affiliation(s)
- N F Davis
- Department of Urology, Beaumont and Connolly Hospitals, Dublin, Ireland. .,Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. .,Department of Urology, The Austin Hospital, Heidelberg, Melbourne, VIC, 3084, Australia.
| | - N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - E MacCraith
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - H D Flood
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - R Mooney
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - G Leonard
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
| | - M T Walsh
- School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
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Bhatt NR, Dunne E, Faraz M, Gillis AE, Conlon KC, Paran S, Ridgway PF. Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey. World J Surg 2018; 42:3792-3802. [PMID: 29855686 DOI: 10.1007/s00268-018-4688-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls. METHODS A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons. RESULTS Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg. CONCLUSION The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
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Affiliation(s)
- N R Bhatt
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - E Dunne
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - M Faraz
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - A E Gillis
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - K C Conlon
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - S Paran
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - P F Ridgway
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
- Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin 24, Ireland.
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Davis NF, Quinlan MR, Browne C, Bhatt NR, Manecksha RP, D'Arcy FT, Lawrentschuk N, Bolton DM. Single-use flexible ureteropyeloscopy: a systematic review. World J Urol 2017; 36:529-536. [PMID: 29177820 DOI: 10.1007/s00345-017-2131-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Data assessing the effectiveness of single-use flexible ureteropyeloscopy (FURS) are limited. This study evaluates and compares single-use FURS with conventional reusable FURS. METHODS A systematic search using electronic databases (Pubmed and Embase) was performed for studies evaluating single-use FURS in the setting of urinary tract stone disease. Outcome measures included a comparative evaluation of their mechanical, optical and clinical outcomes. RESULTS Eleven studies on 466 patients met inclusion criteria. In vitro comparative data were available on three single-use flexible ureteropyeloscopes (LithoVue™, Polyscope™ and SemiFlex™) and clinical data were available on two (LithoVue™ and Polyscope™). The overall stone-free rate and complication rate associated with single-use FURS was 87 ± 15% and 9.3 ± 9%, respectively. There were no significant differences in procedure duration, stone size, stone clearance and complication rates when single-use FURS and reusable FURS were compared (duration: 73 ± 27 versus 74 ± 13 min, p = 0.99; stone size: 1.36 ± 0.2 versus 1.34 ± 0.18 cm, p = 0.93; stone-free rate: 77.8 ± 18 versus 68.5 ± 33%, p = 0.76; complication rate 15.3 ± 10.6 versus 15 ± 1.6%, p = 0.3). CONCLUSIONS Single-use FURS demonstrates comparable efficacy with reusable FURS in treating renal calculi. Further studies on clinical efficacy and cost are needed to determine whether single-use FURS will reliably replace its reusable counterpart.
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Affiliation(s)
- N F Davis
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - M R Quinlan
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - C Browne
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - F T D'Arcy
- Department of Urology, University Hospital Galway, Galway, Ireland
| | - N Lawrentschuk
- Department of Urology, Austin Hospital, Melbourne, Australia
| | - D M Bolton
- Department of Urology, Austin Hospital, Melbourne, Australia.
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Bhatt NR, Boland MR, McGovern R, Lal A, Tormey S, Lowery AJ, Merrigan BA. Upper limb lymphedema in breast cancer patients in the era of Z0011, sentinel lymph node biopsy and breast conservation. Ir J Med Sci 2017; 187:327-331. [DOI: 10.1007/s11845-017-1658-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
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Davis NF, Quinlan MR, Bhatt NR, Browne C, MacCraith E, Manecksha R, Walsh MT, Thornhill JA, Mulvin D. Incidence, Cost, Complications and Clinical Outcomes of Iatrogenic Urethral Catheterization Injuries: A Prospective Multi-Institutional Study. J Urol 2016; 196:1473-1477. [PMID: 27317985 DOI: 10.1016/j.juro.2016.05.114] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Data on urethral catheter related injuries are sparse. To highlight the dangers inherent in traumatic urethral catheterization we prospectively monitored the incidence, cost and clinical outcomes of urethral catheter related injuries. MATERIALS AND METHODS This prospective study was performed during a 6-month period at 2 tertiary referral teaching hospitals. Recorded data included method and extent of urethral catheterization injury, setting and time of injury, number of catheterization attempts, urological management provided, additional bed days due to urethral injury and clinical outcomes after followup. The additional cost of managing urethral injuries was also calculated. RESULTS A total of 37 iatrogenic urethral injuries were recorded during the 6-month period. The incidence of traumatic urethral catheterization was 6.7 per 1,000 catheters inserted. Thirty (81%) patients sustained a complication Clavien-Dindo grade 2 or greater. The additional length of inpatient hospital stay was 9.4 ± 10 days (range 2 to 53). Of these patients 9 (24%) required an indwelling suprapubic catheter and 8 (21%) have an indwelling transurethral catheter. In addition, 9 (24%) are performing self-urethral dilation once weekly and 4 (11%) have required at least 1 urethral dilation due to persistent urethral stricture disease. The additional cost of managing iatrogenic urethral injuries was €335,377 ($371,790). CONCLUSIONS Iatrogenic urethral catheterization injuries represent a significant cost and cause of patient morbidity. Despite efforts to educate and train health care professionals on urethral catheterization insertion technique, iatrogenic urethral injuries will continue to occur unless urinary catheter safety mechanics are altered and improved.
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Affiliation(s)
- N F Davis
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland.
| | - M R Quinlan
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - C Browne
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - E MacCraith
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - R Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - M T Walsh
- Centre for Applied Biomedical Engineering Research, Materials and Surface Science Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - J A Thornhill
- Department of Urology, Tallaght Hospital, Dublin, Ireland
| | - D Mulvin
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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Bhatt NR, Collins D, Crotty P, Ridgway PF. Prognosis and management of adult wild type gastrointestinal stromal tumours (GISTs): A pooled analysis and review of literature. Surg Oncol 2016; 25:152-7. [PMID: 27566016 DOI: 10.1016/j.suronc.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 03/28/2016] [Accepted: 05/08/2016] [Indexed: 02/06/2023]
Abstract
A pooled review was performed to determine survival in adult WT GIST (Wild Type GastroIntestinal Stromal Tumours) and compare the same with pediatric WT GISTs. Electronic databases were searched using the terms "Wild type" AND "GIST". Eighty-two adult patients from 14 studies were included in the pooled analysis. Cumulative survival was greater than 50% in both age groups, hence medial survival could not be computed. Mean survival in adults was 15.7 years ± 0.78 and in children was 18.8 years ± 1.3 (p = 0.241). Median disease free survival in adults was 10 years while 5-year overall survival was 88%. There was no statistically significant difference in the survival between the two groups (p = 0.241). Overall survival in adults with WT GISTs is favourable compared to other adult GIST subtypes likely reflects a common molecular pathway similar to pediatric GIST.
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Affiliation(s)
- N R Bhatt
- Department of Surgery, Tallaght Hospital, Dublin, Ireland
| | - D Collins
- Department of Surgery, Tallaght Hospital, Dublin, Ireland
| | - P Crotty
- Department of Pathology, Tallaght Hospital, Dublin, Ireland
| | - P F Ridgway
- Department of Surgery, Tallaght Hospital, Dublin, Ireland.
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Bhatt NR, Davis NF, Addie D, Flynn R, McDermott TED, Manecksha RP, Thornhill JA. Evaluating the cost of iatrogenic urethral catheterisation injuries. Ir J Med Sci 2016; 186:1051-1055. [PMID: 27052967 DOI: 10.1007/s11845-016-1451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/21/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Technique is vital to prevent urethral trauma during urethral catheterisation (UC). Education programmes are helpful but are not compulsory and safe UC remains operator dependent. Traumatic UC is associated with increased morbidity, length of stay, resource utilisation and surgical intervention. AIM To determine the cost of iatrogenic urethral injuries managed in a tertiary referral centre over a 6-month period. METHODS A 6-month prospective study monitored iatrogenic urethral injuries secondary to traumatic UC. Included were referrals from district hospitals and inpatient consultations relating to urethral injury caused by traumatic UC. The added cost of management was estimated. RESULTS Thirteen iatrogenic urethral injuries were recorded in 6 months. Management included open surgery for a ruptured bladder (n = 1), flexible cystourethroscopy (n = 10), suprapubic catherisation (n = 4), 3-way catheterisation (n = 4) and catheter re-insertion under direct vision (n = 6). The cost of acute management of these injuries was approximately €50,000 including theatre costs, ambulance transfer, hospital stay, procedural and equipment costs and short-term follow-up care. CONCLUSION Iatrogenic injuries during UC represent a significant cost burden to the healthcare system. Training programmes should be compulsory for all healthcare professionals routinely involved in catheterisation procedures.
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Affiliation(s)
- N R Bhatt
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland.
| | - N F Davis
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - D Addie
- Finance Department, Tallaght Hospital, Dublin 24, Ireland
| | - R Flynn
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - T E D McDermott
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
| | - J A Thornhill
- Department of Urology, Tallaght Hospital, Dublin 24, Ireland
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Bhatt NR, Morris M, O'Neil A, Gillis A, Ridgway PF. When should surgeons retire? Br J Surg 2015; 103:35-42. [PMID: 26577951 DOI: 10.1002/bjs.9925] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/30/2015] [Accepted: 07/31/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age. METHODS A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance. RESULTS The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world. CONCLUSION Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons.
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Affiliation(s)
- N R Bhatt
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Ireland
| | - M Morris
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Ireland.,Education Division, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A O'Neil
- Education Division, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A Gillis
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Ireland
| | - P F Ridgway
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Ireland.,Education Division, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Dosi RV, Bhatt NR, Patell RD, Raj RR. Recurrent hypoglycemia…: A less well-known presentation of Sheehan′s syndrome. J Postgrad Med 2013; 59:318-20. [DOI: 10.4103/0022-3859.123167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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