To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. Subjects and MethodsThe uroLogical tEAching in bRitish medical schools Nationally (LEARN) study was a national multicentre cross-sectional evaluation. Year 2 to Year 5 medical students and Foundation Year (FY) 1 doctors were invited to complete a survey between 3 October and 20 December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). ResultsIn all, 7063/8346 (84.6%) responses from all 39 UK medical schools were included; 1127/7063 (16.0%) were from FY1 doctors who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory-based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and

Here, we report a case of malignant psoas syndrome presented to us during the second peak of the COVID-19 pandemic. Our patient had a medical history of hypertension, recently diagnosed with left iliac deep vein thrombosis and previous breast and endometrial cancers. She presented with exquisite pain and a fixed flexion deformity of the left hip. A rim-enhancing lesion was seen within the left psoas muscle and was initially deemed to be a psoas abscess. This failed to respond to medical management and attempts at drainage. Subsequent further imaging revealed the mass was of a malignant nature; histology revealing a probable carcinomatous origin. Following diagnosis, palliative input was obtained and, unfortunately, our patient passed away in a hospice shortly after discharge. We discuss the aetiology, radiological findings and potential treatments of this condition and learning points to prompt clinicians to consider this diagnosis in those with a personal history of cancer.

Aims We evaluated the outcomes of patients treated with laparoscopic cholecystostomy versus percutaneous (IR) cholecystostomy during the COVID-19 pandemic. Methods Electronic records of patients undergoing cholecystostomy during the COVID-19 peak in 2020 were analysed. Our primary outcomes were the number of readmissions and subsequent completion of laparoscopic cholecystectomy. Results 6 patients underwent laparoscopic cholecystostomy between January and December. 3 were performed following failure of cholecystectomy, 2 were unfit for cholecystectomy and one underwent surgery due to lack of radiologist availability. 9 IR cholecystostomies occured between March and July. 4 were unfit surgical candidates, 5 were due to COVID related restrictions on operating. 6 readmissions came from the surgical cohort, 4 for infection compared to 3 from the IR cohort with only 1 for infection. Notably, of the 4 IR-drained patients deemed unfit, only one had a subsequent gallbladder related admission. 3 surgical patients underwent definitive surgery, 2 subtotal and 1 total cholecystectomy with a mean time to definitive treatment of 27.5 weeks. 4 IR patients underwent surgery with 1 abandoned, 1 subtotal and 2 total cholecystectomies with a mean time to definitive management of 20.25 weeks. Conclusions IR cholecystostomy showed reduced readmission rates compared to laparoscopic cholecystostomy, especially related to infection with rates of 11% and 66%, respectively. More patients underwent total laparoscopic cholecystectomy following IR drainage. However, adhesion formation proved troublesome in both methods. IR cholecystostomy showed a reduced time to definitive surgery. Finally, most high-risk patients undergoing IR cholecystostomy had no further gallbladder related admissions therefore proving its utility in such groups.

Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

Aims Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Methods At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.