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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation.

Introduction: There is concern that surgical quality initially declines during the learning phase of robotic surgery. At our institution, we used a multi-surgeon programmatic approach to the introduction of robotic surgery. The purpose of this study was to evaluate outcomes of patients treated during the first year of our program.

Oxidation of Selected Phenothiazine Drugs During Sample Preparation: Effects of Varying Extraction Conditions on the Extent of Oxidation.

Characterization of degradation products formed from selected phenothiazine drugs during standard solid-phase extraction (SPE) approaches is described. An analytical method for promethazine (PMZ), chlorpromazine (CPZ) and their respective N-desmethyl and sulfoxide metabolites in biological samples (bone tissue extract and blood) by ultra performance liquid chromatography-photodiode array detection, using mixed-mode SPE for basic drugs was developed. When ethyl acetate:isopropanol:ammonium hydroxide (80:17:3) was used as the elution solvent during method development, extraneous peaks were observed that were absent in the negative controls.

Analysis of Dextromethorphan and Dextrorphan in Skeletal Remains Following Differential Microclimate Exposure: Comparison of Acute vs. Repeated Drug Exposure.

Analysis of dextromethorphan (DXM) and its metabolite dextrorphan (DXT) in skeletal remains of rats following acute (ACU, 75 mg/kg, IP, n = 10) or three repeated (REP, 25 mg/kg, IP, n = 10, 40-min interval) doses of DXM is described. Following dosing and euthanasia, rats decomposed outdoors to skeleton in two different microclimate environments (n = 5 ACU and n = 5 REP at each site): Site A (shaded forest microenvironment) and Site B (rocky substrate exposed to direct sunlight, 600 m from Site A). Two drug-free rats at each site served as negative controls.

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.

Should surgeons control fluoroscopy during urology procedures?

Introduction: Our study explored the impact of switching from surgeon- to radiation technologist (RT)-controlled fluoroscopy on fluoroscopy and operative times. We also identified factors impacting fluoroscopy and operative times for ureteroscopy (URS) with laser lithotripsy.

Methods: Patients undergoing urological procedures requiring fluoroscopy six months before and after the change from surgeon- to RT-controlled fluoroscopy were identified.

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.

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.

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.

Development and incorporation of hybrid simulation OSCE into in-training examinations to assess multiple CanMEDS competencies in urologic trainees.

Introduction: As residency training requirements increasingly emphasize a competency-based approach, novel tools to directly evaluate Canadian Medical Education Directives for Specialists (CanMEDS) competencies must be developed. Incorporating simulation allows residents to demonstrate knowledge and skills in a safe, standardized environment. We describe a novel hybrid simulation station for use in a urology resident in-training Objective Structured Clinical Exam (OSCE) to assess multiple CanMEDS competencies.