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Research vibrations

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Here is a randomised trial from Denmark to uplift your mood this European summer. Penile vibratory stimulation may help with the recovery of erectile function after nerve-sparing radical prostatectomy [1]. However, it does not hasten recovery of continence. Building on the European theme, we were discussing alternative ways of influencing research communities and colleagues during the European Association of Urology (EAU) meeting in Stockholm. One obvious rising star is ResearchGate (Fig. 1).

ResearchGate (https://www.researchgate.net/) is a social networking site for scientists and researchers that allows them to share papers, exchange questions and find collaborators. ResearchGate has won the digital innovation of the year award from Focus Magazine in 2014. An important accolade in a world increasingly influenced and greatly amplified by the web and social media.

For a generation of scientists using Facebook, Twitter and similar social networks, ResearchGate has become a familiar site to exchange data and knowledge related to research. Similar to the other social network sites people can post comments, form groups, have profile pages and can ‘like’, ‘endorse’ and ‘follow’ other members. One can use it as an online bibliography and can even deposit published papers on the site. Members can also share negative results or experiments that are difficult to publish in peer-reviewed journals.

There is also a project section where groups can work together on projects in a secure environment. Forget Skype meetings at the last minute!

ResearchGate also introduces a new way of measuring the impact of a certain researcher on a scientific community. The ResearchGate score (RG score) is a new bibliometric tool that combines traditional parameters, such as the impact factor, with the user’s activity on the site, like posting or answering questions or the number of people that follow them. Also, the RG score of the peers that follow you will have an impact on your own RG score: the more influential your followers are, the higher your personal RG score will get.

Just as the Klout score is measuring the influence that one has in social media, ResearchGate could become an alternative measure not only of the scientific importance of a certain researcher but also of his or her interactivity. It is a measure for ‘scientific social network reputation’.

At the moment the relationship between impact factor, citation index and the RG score is difficult to establish, as the algorithm that is used to calculate the RG score is not widely known. If ResearchGate wants to establish the RG score as a respected measurement tool, some transparency will be helpful in future.

Since ResearchGate was founded in 2008 by Dr Ijad Madisch, Dr Sören Hofmayer and computer scientist Horst Fickensher, >4 million members have joined and the numbers are steadily increasing. Several other exchange platforms exist on the internet, but ResearchGate is certainly the most widespread at the moment. We think it is here to stay and claim a role as one of the tools to measure one’s scientific reputation.

Dirk De Ridder† and Prokar Dasgupta*
†BJUI Associate Editor, University Hospitals Leuven, Leuven, Belgium, and *Guy’s Hospital, KCL and Editor-in-Chief, BJUI

Reference

  1. Fode M, Borre M, Ohl DA, Lichtbach J, Sønksen J. Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve-sparing radical prostatectomy: a randomised, controlled trial. BJU Int 2014; 114: 111–7

 

The Big Data challenge: amplify your content using video and maximise your impact

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It remains a great achievement for an author to have his or her work published in a peer-reviewed journal such as the BJUI. There is a tremendous sense of fulfilment when the e-mail from the Editor-in-Chief includes ‘accept’ in the subject heading. What may have been a long period from study design, through ethics approval, patient recruitment, intervention, data collection, statistical analysis, manuscript preparation, to final revisions, finally comes to an end – chapter closed, move on.

However, in this era of ‘Big Data’, we are now confronted with new challenges with respect to getting our content noticed. It is estimated that of all the data created in the history of mankind, from early cave drawings to medieval manuscripts and modern web 2.0 communication, >90% has been created in the past 2 years alone [1]. Two thousand years ago, 90% of the world’s content was thought to be archived in just one place, the Library of Alexandria in Egypt, and all of that content would easily fit on a flash drive today. With this massive amount of new data emerging, the current challenge is not just to get published, but also to get your work noticed. Are you always looking out for new methods of approaching potential customers? If the answer is yes, then you should definitely try out a geocoding service. Just imagine, you will have a large map in front of you, where the locations of all your customers are marked. You will know exactly where your customers live, and in which regions your products and services are most popular. Just think of what you can do with this knowledge. For starters, how about running some location based targeted marketing campaigns? These campaigns are sure to bring in lots of new customers, if you can fine-tune these properly. Geoparsing API by Geocodeapi.io can be done simply through address interpolation, which uses data from a street GIS where the street network is already inputted within the geographic coordinate space. Attributed in each street segment are address ranges, such as house numbers from one segment to another. Here is what geocoding does: (1) It takes an address, (2) matches it to a street and particular segment (e.g. a block), and (3) interpolates the address position. However, issues may arise in the geocoding process. What happens is that you have to distinguish between ambiguous addresses (say, “43 Hampton Drive” and “43E Hampton Drive”). It’s also a challenge when you geocode new addresses for a street that is not yet added to the GIS database. Using interpolation also entails a number of caveats, including the fact that it assumes that the parcels are evenly spaced along the length of the segment. This is quite unlikely in reality – it can be that a geocode address is off by a number of thousand feet. A more sophisticated geocoding application will match geocode information to the property level, using such tools as USPS address data, and cascade out to block, track or other levels depending on data matching accuracy.

This is where social media can help your content to rise above the morass and get into the mind of your target audience. At the BJUI, we have integrated social media into every aspect of the Journal [2], as it is clear that this is important for our readers [3]. The use of popular platforms, e.g. Twitter, YouTube, Facebook and Instagram, as well as our own blog site, allows us to greatly amplify the reach of our content, at lightning speed, and allows us to engage with our readers in a way that traditional print publishing never could.

In the video accompanying this editorial, we offer some practical advice to help our authors create high-quality video to augment their content. This advice includes:

  • Capture at the highest quality possible – digital video recorders outperform DVDs and are essential for laparoscopic and robotic work. For open surgery, a GoPro is our preferred capture device but an iPhone can also provide good footage.
  • Editing brings the video to life: video editing software is widely available and can transform your video from a dull procession into a vivid story. Add in additional footage (e.g. operating room footage to go with your laparoscopic video), still pictures, graphs, imaging etc, and add titles to help illustrate your key messages.
  • Output for social – your video-editing software will allow you to export your movie in a format optimised for YouTube (e.g. FLV file), or to upload directly to YouTube. Or just export it in a high-quality format and we will upload to YouTube for you.

We encourage the use of video to accompany any type of publication at BJUI, including web-only content such as blogs, and we require it for featured content such as the ‘Article of the Week’, ‘Article of the Month and Step by Step articles’. Videos in a surgical specialty like urology are often focused on procedural technique, but they do not have to be this limited and we encourage all other types of BJUI content to also be supplemented with video. Our BJUI Tube site and YouTube site contain good examples of how authors can describe their content with video by using figures and tables in an interview-style format. This latest video addresses issues around the capture and editing of videos to optimally complement your published work. These videos are then disseminated to a wider audience through our large social media network. All of our videos are ≈3 min in duration, as our analytics demonstrate that viewers ‘switch off’ when videos run for much longer.

We therefore encourage you to think social, think video, and help your content reach its maximum audience. We are here to help you!

Declan G. Murphy*†‡, Wouter Everaerts† and Stacy Loeb§
*Peter MacCallum Cancer Centre, University of Melbourne, †The Royal Melbourne Hospital, ‡Epworth Prostate Centre, Epworth Hospital, Melbourne, Australia, and §New York University, New York, USA

References

  1. IBM. What is big data? 2013. Available at: https://www-01.ibm.com/software/data/bigdata/what-is-big-data.html. Accessed April 2014
  2. Murphy DG, Basto M. Social media @BJUIjournal – what a start! BJU Int 2013; 111: 1007–1009
  3. Loeb S, Bayne CE, Frey C et al. Use of social media in urology: data from the American Urological Association. BJU Int 2014; 113: 993–998

Flying high as a kite

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Some of my happiest memories are from my childhood. Part of it was spent in Lucknow where my mother had her ancestral home. An important city in Northern India, Lucknow was the seat of the Nawabs who built many beautiful palaces. One of these has a labyrinth, which many have entered only to get lost within its many chambers. Another, the Chhota Imambara is pictured on the cover. Lucknow is also famous for its cuisine with street vendors selling tasty kebabs. Above all, I remember many hours perched on the roof top of our home in the old town, flying kites, with my family. The sky above became a riot of colours. Today there is even a touring company offering nostalgic kite flying holidays in this ancient city.

In May, our Article of the Month comes from the King George Medical University, Lucknow. In a prospective, longitudinal comparison over six years, of a large number of patients undergoing urinary diversion after radical cystectomy, the authors demonstrate better quality of life after orthotopic neobladder rather than ileal conduit formation [1]. The mean age of the patients was in the mid 50s, which is perhaps why a significant number underwent neobladder formation. This article and the accompanying editorial from Urs Studer [2] are must reads for anyone involved in the management of bladder cancer. In the UK many of our patients are generally older with multiple co-morbidities and end up having ileal conduits. For the younger patients it is perhaps time for a rethink?

We also feature an excellent multi-institutional collaboration reporting on PCNL outcomes in England from the Hospital Episode Statistics (HES) database over a five year period. Mortality is rare after this procedure but 9% of patients have a readmission within 30 days [3]. While the HES like most other databases has its inherent limitations, the authors should be congratulated for analysing complex outcomes on nearly 6000 patients; in particular John Withington who is writing his thesis on the subject.

And finally – an invitation. If you are attending the AUA, we are again having a BAUS–BJUI–USANZ session on the afternoon of the 18 May. The faculty is international and the program even more exciting than it was last year. This is a further testament to the strong friendship that exists between our organisations and the AUA. The Coffey–Krane prize for the best paper published in the BJUI by a trainee, will be presented at the end of this session followed by the BJUI reception.

Many of you have loved our new design, layout and quality although this has led to a precipitous drop in our acceptance rate in favour of only the very best papers. Thank you for your support, which has given us the strength and resolve to fly high. The sky is the limit.

Prof. Prokar Dasgupta
Editor-in-Chief, BJUI
King’s College London, Guy’s Hospital#

References

  1. Singh V, Yadav R, Sinha RJ, Gupta DK. Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder reconstruction after radical cystectomy: a statistical model. BJU Int 2014; 113: 726–732
  2. Studer UE. Life is good with orthotopic bladder substitutes! BJU Int 2014; 113: 686–687
  3. Armitage JN, Withington J, van der Meulen J, et al. Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database. BJU Int 2014; 113: 777–782

 

Engaging responsibly with social media: the BJUI Guidelines

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  • The final, peer-reviewed version of this paper has been accepted for publication in BJUI.
    You can find it here. Please cite this article as doi: 10.1111/bju.12788

    The social media revolution is well underway. Facebook, Twitter, YouTube, Instagram, Weibo, Blogger, LinkedIn, and many other social media platforms, have now penetrated deeply into our lives and have transformed the way in which we communicate and engage with society. The statistics are staggering. As of mid-2014, the total number of global users of the following platforms has exceeded billions of people from every nation in the world:

    • Facebook – over 1.3 billion users
    • Twitter – over 280 million active users
    • YouTube – over 1 billion people view YouTube each month
    • Instagram – over 200 million users
    • LinkedIn – over 270 million users

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Social media has also become very popular among-st healthcare professionals both on a personal and professional basis. The reach and engagement which social media enables, along with the incredible speed with which information is disseminated, clearly creates opportunities for advances in healthcare communication. However, because healthcare professionals also have serious professional responsibilities which extend to their communication with others, there are dangers lurking in social media due to the inherent lack of privacy and control.

As a result, major professional bodies have now issued guidance for their members regarding their behaviour using social media. These include bodies representing medical students, general practitioners, physicians, oncologists, the wider medical community, as well as major regulatory bodies such as the Federation of State Medical Boards and the General Medical Council (GMC) in the UK, whose role is to licence medical practitioners. The guidance from the latter, part of the GMC’s Good Medical Practice policy, has significant implications as failure to comply with this guidance could impact a doctor’s licence to practice. All health care providers engaging in social media need to familiarize themselves with the relevant institutional, local, and national guidelines and policies.

There are many examples of healthcare providers who have faced disciplinary action following content posted on social media platforms. For example, posting photos of a drunk patient to Instagram and Facebook [1] is likely to result in serious disciplinary and legal action. In another case, a doctor in the USA was dismissed from her hospital and censured by the State Medical Board when she posted online details of a trauma patient [2]. Although her posting did not reveal the patient’s name, enough information was posted for others in the community to identify the patient. Furthermore, a review of physician violations of online professionalism and disciplinary action taken by State Medical Boards in the USA demonstrated that this case was not isolated [3]. Over 90% of State Medical Boards reported that at least one of several online professionalism violations had been reported to each of them. The most common violations were inappropriate patient communication online, often of a sexual nature. While the most frequent plaintiffs were patients and their families, it is noteworthy that complaints by other physicians were reported in half of State Medical Boards. Overall, serious disciplinary action including licence restriction, suspension or revocation occurred in over half of cases. There is clearly a need for healthcare professionals to be aware of their responsibility when communicating online.

So what of urology and social media? There is no doubt that many urologists have embraced social media with great enthusiasm, and urology has been one of the specialties leading the way [4-7]. The BJUI has been at the forefront of this enthusiasm as we have implemented a wide-ranging and evolving social media strategy including an active presence on the main social media platforms, a popular blog site, and a strategy to integrate our journal content across these platforms [8]. We now also recognise achievements in social media in urology through our annual Social Media Awards and by introducing a formal teaching course at the 2013 British Association of Urological Surgeons (BAUS) Annual Meeting, the first such course at a major urology meeting. While continuing to encourage the development of social media in urology as one of our key strategies, we also recognise that there are risks inherent in engaging in social media and that clinicians must be aware of these risks.

We therefore propose the following guidelines for healthcare professionals to ensure responsible engagement with social media. Much of this content is in alignment with advice issued by the other bodies listed above.

 

  1. Always consider that your content will exist forever and be available to everyone. Although some social media platforms have privacy settings, these are not foolproof and one should never presume that a post on a social media platform will remain private. It should instead be assumed that all social media platforms lack privacy and that content will exist forever.
  2. If you are posting as a doctor, you should identify yourself. The GMC guidance has specifically commented on anonymity. They advise that if you are identifying yourself as a doctor then you should also give your name, as a certain level of trust is given to advice from a doctor. People posting anonymously should be very careful in this regard as content could always be traced back to its origins, particularly if it became a matter for complaint.
  3. State that your views are your own if your institutions are identifiable. It is commonplace for clinicians to identify their institutional affiliation in their social media profile. While not an excuse for unprofessional activity, it is good practice to state that your views are your own, particularly if you occupy leadership positions within that institution.
  4. Your digital profile and behaviour online must align with the standards of your profession. Whatever standards are expected of the licencing body for your profession must be upheld in all communications online. You should also be aware that what you post, even in a perceived personal environment such as Facebook, is potentially accessible by your employers. As employers they will have a certain standard of behaviour that they expect. For example, use of inappropriate language or images of drunkenness could result in disciplinary action.
  5. Avoid impropriety – always disclose potential conflicts of interest. The American Society of Clinical Oncology (ASCO) includes this important point in their guidance. Influencers in social media can hold powerful sway and clinicians have a responsibility to use this influence responsibly and manage any potential conflicts.
  6. Maintain a professional boundary between you and your patient. It is not unusual for patients to be interested in their doctor’s social network. While most people do not restrict their Twitter and instagram followers for public profiles (and therefore all tweets must uphold professional standards), it is reasonable to politely decline a friend request on Facebook by stating that you keep your personal and professional social networks separate. The BMA guidance specifically advises against patients and doctors becoming friends on Facebook and advises that they politely refuse giving the reasons why.
  7. Do not post content in anger and always be respectful. It is considered inappropriate to post personal or derogatory comments about patients OR colleagues in public. Defamation law could apply to any comment made in the public domain.
  8. Protect patient privacy and confidentially at all times. There is an ethical and legal duty to protect patient confidentiality at all times, and this equally applies to online communication including social media. If posting a video or image, consent needs to be obtained for this even if the patient is not directly identifiable. Content within a post or image, including its date and location and your own identity, may indirectly identify a patient to others. The GMC guidance also states that you must not ‘discuss individual patients or their care with those patients or anyone else’. Thus posting about a case you have just seen could be in breach of these recommendations.
  9. Alert colleagues if you feel they have posted content which may be deemed inappropriate for a doctor. Quite unintentionally, colleagues may post content which may be regarded as unprofessional for any of the reasons listed above. Although a digital shadow may always persist, deleting the online content before it becomes more widely disseminated may help mitigate the damage.
  10. Always be truthful and strive for accuracy. All online content in social media should be considered permanent. It should also be considered that anyone in the world could potentially access this content. Therefore, truthfulness and accuracy are simple standards which should be upheld as much as possible.

Social media is a very exciting area of digital communication and is full of opportunities for clinicians to engage, to educate and to be educated. However, risks exist and an understanding of the boundaries of professional responsibility is required to avoid potential problems. Adherence to simple guidelines such as those proposed here may help clinicians achieve these aims.

Declan G Murphy1-2, Stacy Loeb3, Marnique Y Basto1, Benjamin Challacombe4, Quoc-Dien Trinh5, Mike Leveridge6, Todd Morgan7, Prokar Dasgupta4, Matthew Bultitude4

1University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia, 2Epworth Prostate Centre, Epworth Healthcare Richmond, Melbourne, Australia, 3New York University, USA, 4Guy’s Hospital, King’s College London, UK, 5Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA, 6Department of Urology, Queen’s University, Kingston, ON, Canada, 7Department of Urology, University of Michigan, Ann Arbor, MI, USA

References

  1. ABC News. Chicago doctor allegedly posted photos of drunk patient on social media. Available at: https://jobs.aol.com/articles/2013/08/21/chicago-doctor-drunk-patient-photos-facebook/
  2. Above the Law. ER doc forgets patient info is private, gets fired for facebook overshare. Available at: https://abovethelaw.com/2011/04/er-doc-forgets-patient-info-is-private-gets-fired-for-facebook-overshare/.
  3. Greysen SR, Chretien KC, Kind T, Young A, Gross CP. Physician violations of online professionalism and disciplinary actions: a national survey of state medical boards. JAMA 2012; 307: 1141-1142.
  4. Prabhu V, Lee T, Loeb S et al. Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen. BJU Int 2014; doi: 10.1111/bju.12748
  5. Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. Eur Urol 2014; doi: 10.1016/j.eururo.2014.02.048
  6. Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: data from the American Urological Association. BJU Int 2013; doi: 10.1111/bju.12586
  7. Matta R, Doiron C, Leveridge MJ. The dramatic rise of social media in urology: trends in Twitter use at the American and Canadian Urological Association Annual Meetings in 2012 and 2013. J Urol 2014; doi: 10.1016/j.juro.2014.02.043
  8. Murphy DG, Basto M. Social media @BJUIjournal – what a start! BJU Int 2013; 111: 1007-1009

The final, peer-reviewed version of this paper has now been accepted for publication in BJUI. You can find it here. Please cite this article as doi: 10.1111/bju.12788

 

Quality matters most where the BJUI and stone disease are concerned

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Size (and shape) is important and sometimes strings should be attached, but quality matters most where the BJUI and stone disease are concerned …

The Editor-in-chief of the BJUI has consolidated the journal’s commitment to accepting only the highest quality papers, and this is certainly evident in the upper urinary tract section of this edition, where two studies demonstrate what it takes to be published in the journal nowadays.

In the first article, Kerri Barnes and colleagues from University of Iowa Department of Urology [1] have followed their own department’s earlier retrospective analysis of the benefit of “tethered stents” [2], by analysing the safety and effectiveness of this approach in a prospective, randomised controlled trial. It is often stated that randomised controlled trials are difficult in surgical disciplines, but this study affirms the proverb that “where there’s a will, there’s a way”. Although there was a substantial drop out in the number of patients that could have been included (three quarters of the patients approached for the study declined to be involved as they wished to determine the nature of the stent left in situ), statistical significance was not approached for any of the key concerns that leaving a stent on a string might cause for either the patient or their surgeon.

Furthermore, they have shown that that leaving the strings in place allowed patients to remove their stents significantly earlier (and in the convenience of their own home), than if they had to return to hospital for cystoscopic removal a week or so post-operatively. Despite the established knowledge that stents contribute to postoperative morbidity and can adversely affect quality of life, and the increasing evidence that stents are not required in “uncomplicated” ureteroscopy, it is clear that most urologists continue to leave a stent for a sense of security after performing ureteroscopic stone surgery. Shorter stent dwell times may help reduce the overall burden of stent related symptoms, and it is worth emphasising that none of the patients whose stent was removed at 7 days post operatively had any adverse consequences; neither did the 15% of this group whose stents fell out even earlier. As Fernando and Bultitude [3] comment in the associated editorial, the next question is: “If you are going to place a stent, how long does the stent need to stay for?” Perhaps, in order to emphasise that, where stent bother is concerned, shorter is better, this should be re-phrased as “how little time is enough time for a stent to stay in”…

In the second, Will Finch, from Norfolk and Norwich University Hospital, and his colleagues from Addenbrooke’s Hospital, Cambridge [4], have shown that stone size assessments from CT are most reliably calculated by a 3D-reconstructed stone volume. They have demonstrated that the maximum diameter of a stone tends to predict its overall shape such that a rugby ball-shaped stone (a “prolate ellipsoid”) has the polar diameter as the major axis, whereas a disc-shaped stone (an “oblate ellipsoid”) has the equatorial diameter as its major axis. Stones less than 9mm in diameter tended to be prolate, whilst those of 9–15 mm in diameter tended to be oblate; stones larger than 15 mm in diameter approach the more “random” shape of a scalene ellipsoid, for which the formula used to calculate stone volume (length (l) × width (w) × depth (d) × π × 0.167, which is often simplified to (l × w × d) / 2 in clinical practice) can be used.

However, if this is used for all stones regardless of their size and shape, rugby-ball and disc-like stones of less than 15mm in size are likely to have their volume over-estimated. Accordingly, the authors challenge the guidance of the EAU regarding stone volume calculations [5] to recommend that formulae based on the shape of the stone (π/6*a*a*c* for an oblate and π/6*a*b*b* for a prolate stone – see the paper itself to make sense of this) offer a more accurate assessment of stone volume.

Whilst these formulae are recommended for day-to-day calculations to guide treatment choices, they emphasise that 3D-reconstructed stone volumes should be used to report stone volume in research papers. In an age of stone surgery where CTKUB is so widely used in patients’ imaging assessment, and accepting that stone volume is the key determinant of achieving a stone free patient, this would allow the most accurate comparisons between the effectiveness of different surgical treatments.

Both articles are simple, straightforward, and well conducted studies that apply to the every-day practice of stone surgery. High quality papers are, of course, only really of benefit if they change practice for the better. So why not speak to your radiologist today about adding stone volume assessments to CTKUB reports (and point them to Finch et al. for the evidence) or even do it yourself! And the next time you put in a stent, reassure yourself, and the patient,

that there is no harm, and many benefits, in having some strings attached …

Daron Smith
University College Hospital, London, United Kingdom

Read the April issue

References

  1. Barnes KT, Bing MT, Tracy CR. Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial. BJU Int 2014; 113: 605–609
  2. Bockholt N, Wild T, Gupta A, Tracy CR. Ureteric stent placement with extraction strings: no strings attached? BJU Int 2012; 110 (11 Pt C): E1069–1073
  3. Fernando A, Bultitude M. Tether your stents! BJU Int 2014; 113: 517–518
  4. Finch W, Johnston R, Shaida N, Winderbottom A, Wiseman O. Measuring stone volume – three-dimensional software reconstruction or an ellipsoid algebra formula? BJU Int 2014; 113: 610–614
  5. Tiselius HG, Alken P, Buck C et al. European Association of Urology 2008 Guidelines on Urolithiasis. Available at: https://www.uroweb.org/fileadmin/user_upload/Guidelines/Urolithiasis.pdf. Accessed 17 June 2012
 

Future Proofing Urology – Conference Highlights from the USANZ ASM 2014

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Dr Marnique Basto (@DrMarniqueB) 

 

 

Delegates of #USANZ14 received a sunny welcome at this year’s 67th annual scientific meeting in Brisbane, affectionately coined by Aussies as ‘Bris-vegas’ attributed to a love of Elvis and the city’s growing live music scene. The reins were passed from Professor Damien Bolton and A/Professor Nathan Lawrentschuk (@lawrentschuk) who convened last year’s ASM in Melbourne to Greg Malone (@DrGregJMal) and Eric Chung. @BJUIjournal Editor-in-chief Prokar Dasgupta (@prokarurol) praised the USANZ organising committee for their tremendous hospitality.

A star studded international faculty made the long-haul down under including Shahrokh Shariat, Alan Partin, Gerry Andriole, James Eastham, Rainy Umbas, Per-Anders Abrahamsson, Monique Roobol, Hein Van Poppel, Jean de la Rosette, Gerald Brock, Brad Leibovich, Gary Lemack, Tom Lue, Jonathan Coleman, Michael Jewett, Oliver Traxer, Eric Small, Adrian Joyce, Roger Kirby, Gopal Badlani, Sunil Shroff, Eila Skinner, Jaspreet Sandhu, Matthew Rettig, Pilar Laguna, Jaime Landman, Irwin Goldstein, Todd Morgan and Gregor Goldner.

The hype around #USANZ14, however, had kicked off well before conference doors opened with @USANZUrology mounting the largest pre-conference social media (SoMe) campaign of any Urology conference internationally to date. Over 200 tweets were generated in the five-day lead-up from the @Urologymeeting account, doubling last year’s efforts of the social media team at the Prostate Cancer World Congress in Melbourne. It’s fair to say Australia is setting a blazing pace in the use of SoMe to amplify the Urology conference experience and generate international engagement and global reach.

“Future proofing urology” was the conference theme this year to promote and foster multidisciplinary collegiality and evidenced urological practice. The theme was entwined throughout the four-day conference with the final day showcasing a multidisciplinary forum with international experts discussing complex cases. Additionally the Australian and New Zealand Urological Trials (@ANZUPtrials) session highlighted the interplay between urology, radiation and medical oncology and the current trials underway. 

USANZ president David Winkle officially opened conference proceedings and we had the honour of Scottish-born Australian Scientist Professor Ian Frazer AC, the mastermind behind the Human Papilloma Virus vaccine and the fight against cervical cancer, deliver the Harry Harris oration. Professor Frazer’s ongoing dedication to implementing vaccination programs in low GDP countries such as Vanuatu and Butan was truly inspirational. Harry Harris was the first full time Urology specialist in Australia, and suitably the award of the seven newest fellows of the USANZ collegiate followed. Congratulations to all.

A lively point-counterpoint debate on the viability of prostate cancer prevention then ensued between Shahrokh Shariat (@DrShariat) on the negative and Gerald Andriole (@uropro) on the affirmative. Interestingly both parties used the same sets of data to reach opposite conclusions. The ability to use the opposition’s prior publications against them became the clincher in several of the debates throughout the conference; however, it was the ‘no show’ of hands from the audience when asked “who currently uses chemoprevention?” that reinforced the inevitable conclusion.

The BJUI session was then underway and A/Prof Nathan Lawrentschuk, Associate Editor of the BJUI USANZ supplement, outlined his vision for the journal going forward. The winner of the BJUI Global Prize awarded to a trainee who significantly contributed to the best international article went to Dr. Ghalip Lidawi for his paper titled ‘High detection rate of significant prostate tumours in anterior zones using transperineal template saturation biopsy’. In an Oscar-style award ceremony Dr Lidawi was broadcast from Tel Aviv. Professor Alan Partin (@alan_partin) went on to deliver a brilliant and balanced rationale behind why Gleason 6 IS prostate cancer and potentially coined the alternative name PENIS (‘Prostatic epithelial neoplasm of indeterminate significance’).  News of ‘PENIS of the prostate’ hit social media channels instantly with Urologists chiming in from the US to give their opinion within minutes and before Dr Partin had even stepped down from the podium.

Dr. Ghalip Lidawi accepting his BJUI Global Prize via video message (photo courtesy of Imogen Patterson).

After the opening plenary each morning, the 950 delegates were treated to a range of concurrent sessions from the faculty, which included localised prostate cancer, endourology, andrology/prostheses, high risk prostate cancer, LUTS/BPH, prostate cancer multidisciplinary forum, urology general, bladder cancer, kidney cancer and abstract poster presentations. There was a concurrent nursing program also running during the USANZ schedule that proves year after year to be a huge success.

A stand out session of the meeting was on high-risk prostate cancer section on Monday afternoon. Professor James Eastham (who is rumoured to have just joined twitter!) discussed the role of pelvic lymph node dissection (PLND) for diagnostic and therapeutic purposes with reference to the Memorial Sloan Kettering (MSK) experience and the role of salvage PLND after radical prostatectomy for choline PET detected retroperitoneal or pelvic node recurrence. Professor Hein van Poppel went on to support the role of surgery in high-risk disease in this session, while Drs Shariat and Per Anders Abrahamsson discussed the latest in hormonal adjuvant therapy. 

What makes USANZ special?

The abstract submissions this meeting far superseded last year in volume and quality requiring two concurrent poster presentation sessions running most of the conference. The use of transperineal template biopsy was a prominent theme again in the abstract series, as was active surveillance for low risk prostate cancer. Pleasingly we saw the development of large international collaborations involving Australia such as the Vattikuti Global Quality Initiative on Robotic Urologic Surgery where Mr Daniel Moon has collaborated with nine hospitals throughout Europe, North America and India on their growing robotic partial nephrectomy series. 

Each year a select group of our young talented trainees compete for the prestigious Keith Kirkland (KK) clinical and Villis Marshall (VM) basic science prizes. This year Dr Kenny Rao (@DrKennyRao) was awarded the VM prize from a field of five candidates for his work titled ‘Zinc preconditioning protects the rat kidney against ischaemic injury’. Dr Helen Nicholson (@DrHLN) took out the KK prize over 10 other candidates for her work; ‘Does the timing of intraoperative non-steroidal anti-inflammatory analgesia affect pain outcomes in ureteroscopy? A prospective, single-blinded, randomised controlled trial’. These were awarded at the gala ball located at the Brisbane townhall, a venue soon to be filled by some of the most prominent in the world for the G20 summit. Other awards on the night included the Alban Gee for best poster to Shomik Sengupta (@shomik_s), the BAUS trophy (@BAUSUrology) to Michael Holmes and the Abbvie Platinum award to Niall Corcoran.

Unlike any other Urology meetings worldwide, the USANZ ASM is compulsory for all trainees from their third year on and is encouraged in the first two years. Trainees were treated to a breakfast meeting with Dr Shahrokh Shariat who imparted 14 career tips and then assisted @lawrentschuk in grilling trainees on difficult case studies in preparation for their fellowship exams. A brilliant learning opportunity! Trainees also got to meet one-on-one with international faculty members of their choice to facilitate potential future fellowships in somewhat of a staged ‘speed-dating’ affair – 10 minutes chat, then move on. To top off the trainee program, the @BJUIjournal delivered an extremely practical and useful workshop focussed on getting published in the digital and social media era where blogs are encouraged, tweets are citable and your CV now contains a social media section.

A SoMe session attracted a lot of attention from international delegates and twitter activity on the #USANZ14 hashtag skyrocketed as we were joined by Stacy Loeb (@LoebStacy) in Moscow, Alexander Kutikov (@uretericbud) in the US and Rajiv Singal (@DrRKSingal) in Canada. Declan Murphy (@declangmurphy), Henry Woo (@DrHWoo) and Todd Morgan (@wandering_gu) put on a masterful (and non-nauseating) prezi display with the audience taken on an e-health journey of novel gadgets and devices including one that measured tumescence and sends the file automatically to the physician records. The possibilities are endless! Twitter boards were back in force; a sign of a quality and successful conference according to @declangmurphy. The wifi at the conference venue could not be faulted!

Controversial areas of SoMe were also broached including the APRAH Advertising Guidelines that came into effect this week, Monday March 17. Australian Plastic surgeon Jill Tomlinson (@jilltomlinson) has actively opposed the guidelines that will see physicians responsible for all testimonials associated with them on the internet. The policy mandates this information be removed otherwise a fine of up to $5000 is possible, many feel this places an unreasonable burden on health practitioners to be responsible for content that they may potentially be unaware of. Read Jill Tomlinson’s letter to APRAH here.

The @BJUIJournal and its editors @prokarurol, @lawrentschuk, @declangmurphy and @alan_partin (left to right below) and off screen @drHwoo were prominent SoMe influencers of the meeting two years running. We were also delighted to have Mike Leveridge (@_theurologist) from Canada attending, one of the pioneering uro-twitterati. A mention goes out to fellow countryman @drrksingal who was again mistaken for being at the conference due to his strong SoMe presence from afar. The twitter activity for the conference period March 16 (00:00) to March 19 (23:59) generated nearly 1.4 million impressions and 2,326 tweets or approximately 344K impressions and 581 tweets per day. Based on the study conducted by our team examining metrics of all eight major urological conferences of 2013, #USANZ14 would comparatively rate second only to the AUA in the international engagement and global reach attained. Congratulations to @USANZUrology and @Urologymeeting for enhancing our conference experience and sending our message out to almost 1.4 million potential viewers in just a 4-day period. 

The BJUI Workshop featured Editor-in-Chief Prokar Dasgupta and Associate Editors Nathan Lawrentschuk, Declan Murphy and Alan Partin.

In 2015 we take a trip to Adelaide for the 68th Annual Scientific Meeting of USANZ with experts already confirmed including Steven Kaplan, Martin Koyle, Morgan Rupert, Matthew Cooperberg and Glenn Preminger. See you all there!

 

Dr Marnique Basto (@DrMarniqueB) is a USANZ trainee from Victoria who has recently completed a Masters of Surgery in the health economics of robotic surgery and has an interest in SoMe in Urology.

Check out the new BJUI Instagram feed for more photos from #usanz14 www.instagram.com/bjui_journal

 

 

Text and the city

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From the spectacular rise of bitcoin to the passing of Mandela and Thatcher, the horrors of Boston and Nairobi to the resignation of the Pope, the breakthroughs in human stem cell cloning [1] to the promise of medical three-dimensional printing [2] – our personal and professional lives are influenced by global and technological events in a way that seemed unimaginable just a few decades ago.

The clinical and scientific research community has never been more international as it is now. Publications of researchers from China and India in prestigious Science Citation Index (SCI – maintained by Thomson Reuters) journals has increased steadily, with Chinese papers accounting for 9.5% of all published in 2011 from a negligible figure a decade ago, second only to America [3].

At the BJUI, we are proud to be able to facilitate and receive the best high-quality research from any part of the world. Recent efforts in developing our print, online and social media channels have allowed us to disseminate this work to a greater worldwide audience than ever before. We are affiliated with the Urological Associations in Britain, Ireland, the Caribbean, India, Hong Kong and Australia and New Zealand. The ‘I’ in BJUI is something we work hard to foster.

In celebration of the global reach of the BJUI, all our 2014 covers will showcase the city or country of origin of our key feature within the issue. We wanted to reflect the sense of community that runs through the competitive, yet closely linked international network of research teams that are published within the BJUI. We hope that you will appreciate the stunning visual impact that complements the topical diversity, superlative quality and intellectual rigour of each new issue of the BJUI in 2014.

The article of the month in this issue features the androgen receptor and prostate cancer – a reflection of a life time of translational research from David Neal’s group at Cambridge [4]. Our Editor-in-Chief was inspired by the Zacchary Cope lecture at The Royal Society of Medicine, London and convinced David to send his paper to the BJUI. Furthermore during the annual meeting of the BAUS section of Academic Urology this January in Cambridge, it became obvious that punting was just as iconic as the awe inspiring university buildings in this beautiful city.

Tet Yap
Royal College of Surgeons of England, London, UK
Director of Glass Magazine

References

  1. Tachibana M, Amato P, Sparman M et al. Human embryonic stem cells derived by somatic cell nuclear transfer. Cell 2013; 153: 1228–1238
  2. Fischer S. The body printed. IEEE Pulse 2013; 4: 27–31
  3. Scientific Research: Looks good on paper. © The Economist Newspaper Ltd, London (28 September 2013)
  4. Lamb AD, Massie CE, Neal DE. The transcriptional programme of the androgen receptor (AR) in prostate cancer. BJU Int 2014; 113: 361–369
 

Digital Doctor Conference 2013

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Digital consumerism is progressing relentlessly and whilst the advantages of new technology are evident in our personal lives, there is a palpable air of concern amongst the medical profession. “The Digital Doctor” team are positively embracing the benefits of moving healthcare into a new era and hope to direct the use of new technology in a constructive manner that will benefit both healthcare professionals and patients. To achieve these aims the “Digital Doctor Conference 2013”, was held for its second year last November, again kindly sponsored by the British Computer Society and held at their excellent headquarters in Covent Garden, London. The conference was attended by IT professionals, doctors, medical students and patients; thus group sessions contained some perspective on every aspect of healthcare technology. The organisers are also an eclectic mix of doctors and IT professionals, united by their interest in improving Health IT.

The conference included plenary talks, interactive group sessions and workshops. Eminent plenary speakers included Martin Murphy, Clinical Director at NHS Wales Information Service.

Martin challenged us to redefine our relationship with our patients in a new era where clinical information will be in control of patients and access to healthcare professionals can be as easy as a click away. Currently, services like those at rocketdoctor.ca are now properly stablished and operating everyday. Adapting to this change works the same way as medicine has always done. Implementing new technologies to improve medicine is and always has been a top priority, looking only to more effectively save or better lives.

Software mediated care – implications for our patients and ourselves from Digital Doctor on Vimeo.

Popular teaching sessions at the conference were daily life IT tools, including the “Inbox Zero” philosophy, how to collaborate online, keeping up to date with RSS readers and Stevan Wing gave an introduction to the open-source “R project” for statistics. Other sessions focused on how to develop IT systems. This insight is useful both to allow healthcare professionals to construct their own IT solutions but also to help translate ideas to IT professionals. One such example being Sarah Amani, who used her experience as a mental health nurse to develop a mental health app for young people, called “My Journey”. In her inspiring plenary, co-presented with Annabelle Davis who developed the Mind of my Own app, she makes the point that the vast majority of young people rely on email, social media and online services therefore this is the best place to reach them. A session giving the methods and practicalities of developing IT systems was given by Rob Dyke, Product Development Manager of Tactix4. To help delegates get their ideas to reality Ed Wallitt, one of the organisers and the founder of Podmedics, built on earlier sessions about how to code, how a website works and information design, explaining how to use wireframes and prototypes, to achieve professional design of websites and apps.

Existing NHS IT systems were explained using the example of an emergency patient admission. Tracking the patient journey from home to hospital, via A+E, then transfer to ward, rehab back home, with GP clinic the final destination. At each stage a different IT system is employed such as the emergency 999 network and the N3 private network. Concepts such as the NHS spine were introduced and explained. A complex web of systems were shown to be in use, with numerous safety mechanisms; providing some explanation as to the difficulties faced by employees in the NHS.

Delegates were able to implement this teaching in the “App factory”, to solve problems they face in daily life or work. Three app ideas were created and presented by separate teams. These were a teaching log for doctors to record teaching sessions and simultaneously get feedback from students, a productivity app to provide useful information for new doctors to know about any hospital, however the winning idea was a patient facing app for use in hospital, to track updates in ongoing care.

In another session Matthew Bultitude, an Associate Editor of BJUI, was invited by Nishant Bedi (another organiser) for his vision of the future of medical journals. Journals are key in shaping the way medical practice is conducted and the dissemination of information is as important as ever in the digital age. Paperless journals may be the future however traditional business models rely on paper journals for revenue and many journals have yet to feel confident in moving all of their content exclusively online. Yet there are signs of change with European Urology adopting a paperless format for members from Jan 2014, now surely others will follow?

Under new leadership, the BJUI has recently focused on revolutionising its online presence, starting with a complete website overhaul. Amongst many changes to its design, the website now hosts an article of week, user poll, blogs and picture quiz. Numerous metrics for the website now show significant improvement in website visitors, duration of visit (1 to 3 min) and “bounce” rate. The increasing importance of social media for health professionals is demonstrated by the fact that more than ¼ of website traffic now arrives from Twitter and Facebook, having previously been dominated by search engines. Matthew finished by discussing alternatives to impact factor, such as the journal’s “Klout” score or “individual article” metrics, which are likely to be increasingly important as medical journals develop more web and social media presence. Extremely accurate individual “article level metrics” are calculated by checking number of views, tweets and re-tweets, and mentions in review sites (such as F1000 Prime). It is clear to see how powerful this could be, for example when discussing viewing numbers and duration of reading, Matthew can inform us that currently BJUI Blog articles are each read for a total of 5 min, with even the 15th most popular article receiving almost 500 views.

This talk was paired with one from the futuristic journal “F1000 Prime”. This journal provides an extra layer of expert peer review, using scientific articles that are already published in other journals. Thus articles selected by F1000 Prime direct users to the most significant developments in their chosen field, the expert reviews of the articles include an article rating, relevance to practice and whether there are any new findings. Research has shown that selection of an article by F1000 Prime, is an accurate indicator of future impact factor. Users may also receive email alerts of recommended relevant papers and they are able to nominate articles, follow the recommendations of an expert reviewer. Also refreshingly, any submissions to the journal, receive a completely transparent peer review process, openly available to any user.

Conference attendees were given the patients’ perspective of Health IT, by a panel chaired by Anne-Marie Cunningham (another organiser). These real life stories, gave insight into the mindset of people suffering from demanding chronic disease, both at home and in the hospital. Importance is given to people taking ownership of their health; both rare and common diseases were mentioned including Addison’s disease, asthma and mental health issues, where 24 hour support is an unfulfilled requirement and there is a need for a more integrated approach. Positive examples were given with one patient gaining reassurance by regular home peak-flow monitoring that can be reviewed remotely by her respiratory consultant. This helps to determine optimal timing for clinic review, with other similar examples seen in home blood pressure or blood sugar monitoring. Importantly social media and support groups can provide 24 hour advice and connect patients with expert doctors or similar sufferers all over the world. It was clear that the lack of hospital WiFi disconnects some patients from their online support networks, when they are actually most vulnerable. Other complaints centred around the underuse of email appointments and text alerts, which could empower patients to chase their own appointments or scans. 

Delegate feedback suggests this conference is unique and covers a rapidly expanding area of Medicine. We look forward to the next conference in 2014. The Digital Doctor 2013 conference program and highlights are available from the website or directly on our vimeo chanel. For updates and upcoming events follow us on Twitter @thedigidoc and the podcast is available from iTunes or our website. 

Mr. Nishant Bedi
Core Surgical Trainee (Urology), West Midlands Deanery

Dr Stevan Wing
Academic Neurology Registrar, East of England and The University of Cambridge 

 

Annabelle Davis

Out with the old; In with the new. Stats and metrics: The BJUI website 2013

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Is it already over twelve months since the new Editor took over and the new BJUI web journal was launched? The old one had served its purpose well but the editorial board had decided the change of leadership dictated a clean new website would be launched in January 2013. Decisions were hard. Out went non-journal content such as case reports and in its place we created four main content areas with the aim of maintaining fresh, regularly changing content. These (article of the week; BJUI blogs; picture quiz of the week; BJUI poll) you will by now be familiar with, but how has the new web journal performed? Let’s look at the metrics over the last year.


The BJUI website prior to 2013

Firstly, most of the figures referred to in this article are for the www.bjui.org site only. They do not include direct access to the journal articles in the Wiley Online Library where the issues are stored. Thus analysing overall visitor numbers is not that valid and doesn’t allow for meaningful comparison. However, it appears there has been an increase in web visits of at least 10%. When we drill deeper, this is where we really notice a change. Readers now spend on average over 3 minutes on the site per visit. This is a dramatic change from previously – in 2012 the mean visit duration was just 87 seconds!

More and more people today decide to get involved with an online business, due to the fact that having a business operated through the internet offers a lot of advantages over doing it the traditional way. Online business means that you can do business right at the comforts of your own home. Thus, there is no need for you to get dress and step out of your house to earn a living. However, there are many important things that you need to learn more about in getting your online business off the ground. One of which is the creation of your own website, and the need to obtain hosting, in order to get it launched onto the World Wide Web. With so many employees working from home it’s understandable that so many businesses are now using software to monitor online activity as this means that staff can be easily managed.

Knownhost web hosting can be obtained through a company who have its own servers, where websites are hosted. In other words, a hosting service is one of the necessities in getting your own website visible through the internet. For sure, there are many ways that you can have your own web page today, such as creating a free blog or a free website. However, in most cases, these types of services are limited and having one of those pages does not mean that you entirely own them, since another website is actually hosting it.

In a nutshell, website hosting is very important because you simply could not launch your own website without having it. The hosting service provider is the one that will provide you with the space where you can upload your files that are related to your site, and they are also the ones who will ensure that your website is visible to people when they type your site’s address on their favorite web browsers.

Since there are a lot of web hosting service providers available in the market today, selection is very important in order to get associated with a reliable one. When you are able to obtain a hosting account from a reliable provider, you will be able to avoid loss of sales caused by downtimes. There are actually hosting service providers, which do not have reliable servers. In other words, they encounter a lot of downtimes, and because of that, your business would lose a lot of sales opportunities. This is because server downtimes mean that your website would not be visible on the net during those times. Thus, people who are suppose to make certain purchases, may decide to buy the items from your competitors.

In relation to that, aside from the importance of hosting for your online business, you should also become more aware of the importance of selecting a reliable web host; and one of the best ways to do that is by learning about the features of the hosting account that they can offer to you.

Geographically, the top country by visit is the United States with 22% of all visits, closely followed with the UK (21.6%) with Australia third. In total there were visits from 189 countries with both India and Japan making the top 10 (numbers of visitors) emphasising the journal’s global reach. This is truly an international journal.

 
Global subscriptions to BJUI represented as a “heat map”

Another major difference we have noticed is in bounce rate. This refers to the percentage of people who leave immediately after visiting the page they landed on i.e. if everyone only looks at the first page they come to then the bounce rate would be 100%. In 2012 the bounce rate was 66% – and this has improved significantly to 50% in 2013. This rate is never going to be very low – people come directly to a blog, quiz or just go straight onto the author guidelines or an article on Wiley Online Library. But to see such a reduction is encouraging and vindicates the approach we have taken with the web.

When we look at traffic sources, again we see another big change. This is how the visitor came to the site i.e. do they type in the web address, use a search engine or get driven to the site by social media. As you might expect, the largest single source of traffic (45%) is from Google – these visitors also spend over 3 minutes on the site with a bounce rate of 40% – so the site is not being found by accident and readers move onto other pages. 24% of traffic is direct but what is new behaviour is that 12% is from Twitter and 6% from Facebook – so social media is now driving nearly 20% of all website traffic. Facebook visitors also spend over 4 minutes on the site – they come for a reason! Of course there are the quirks – a men’s health magazine drove 1% of visits to a specific article on penis extenders! Those readers aren’t urologists as they only spend 16 seconds on the site with a bounce rate of 99.4% – this, however, does give credibility to the use of these statistics.

Apart from the homepage, the majority of social media-driven traffic is to the blogs. This has been highly successful with regular topical blogs and comments. Blog traffic has been high with the most popular (Melbourne Consensus Statement) receiving over 6500 views and 58 comments. Whilst this is clearly the highest, the top 8 blogs all have over 1000 views. Time spent on these blogs is high with several being read for an average of over 6 minutes. In January 2014 we added widgets to our blogs that allow you to see the number of reads each blog has received, and also  to allow tweeting and Facebook liking directly from the blog. Blogs posted prior to this time also have these features but the number of reads prior to January 2014 are not displayed. With this section being so popular are Letters to the Editor dead?

In a recent poll, we asked you what single feature you had liked best. Exactly equal with 34% were the blogs and the free Articles of the Week (which have also been popular in the web metrics with over 13,000 views). Picture quizzes have been successful with over 10,000 views. These demonstrate a shorter time on the page as one would expect (100 secs) but also a lower bounce rate (48%) – these readers often go elsewhere on the site. The video section has also been popular with over 2000 views although obtaining good quality videos is challenging and we encourage authors to submit video with their articles to further drive this section.

 

How does this translate to actual journal article downloads? Interestingly our approach has led to an increase of over 35% in full text downloads from Wiley Online Library compared with 2012. This is exciting and shows the web journal has been very successful not only in driving website activity as described above but also in promoting core journal content.

So for 2014 we have a new App to view the journal. Currently only on the Apple platform (80% of mobile devices used in 2013 to view the website were Apple), this is free to download although requires a log-in to view full content (available via your institutional subscription, from Wiley or from your society). It works really well on the iPhone as well as the iPad and allows access to not only the monthly journal but ‘Early View’ articles as well. This is already my preferred method for reading the journal and I highly recommend trying it.

With high-quality web and mobile interfaces, the question has to be are we ready to go paperless? As the Web Editor I should of course say yes. We discussed this at length at our first board meeting in November 2012. Due to our diverse international readership it was felt to be too early for such innovation. This will inevitably happen and another major urology journal has taken this step in 2014 (€60 supplement for the print version of European Urology). It is surely only a matter of time until digital is the standard platform. Hopefully you, the readers, will tell us when the time is right.

Matthew Bultitude
Associate Editor, Web

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