Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer Before Robot-Assisted Radical Prostatectomy

The accuracy of multi-parametric MRI (mpMRI) in pre-operative staging of prostate cancer (PCa) remains controversial. Objective: To evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents poorest and 5 represents best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for binary classification of EPE including 95% confidence intervals and area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. 39 men (32.2%), or 43 lobes (18.6%) had EPE. Likert score ≥3 had sensitivity (SE), specificity (SP), NPV, PPV of 90.4%, 52.3%, 96%, 29.9%, respectively, and AUC was 0.82 (95% CI: 0.77-0.86). AUC was 0.63 (95% CI: 0.37-0.9), 0.77 (0.71-0.84) and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3 and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was a) multi-parametric and b) of a higher image quality according to the PI-QUAL scoring system.

The Effectiveness of Industrial Training during Covid- 19 Pandemic: Perspective of Undergraduate Students of Mechanical Engineering

A post-training survey was conducted to all students of Bachelor of Engineering (Hons) Mechanical programme in Universiti Teknologi MARA (UiTM) who completed their industrial training in 2020. The aim of the survey was to overview the effectiveness of industrial training in the perspective of students. This study also was carried out to investigate the effect Covid-19 pandemic on the preparation of companies and students’ perception of their own performance before and after the industrial training. The survey was conducted via online involving 166 respondents. The questions included multiple-choice, 5-score Likert scale and open-ended questions. The results show that the majority of the respondents were satisfied with their selection of placement and achievement during the training with the highest mean Likert score of 4.65. The analysis on the self-evaluation of performance before and after industrial training also revealed a significant increase in generic skills especially personal attitude and professionalism aspects. The finding of this work also concludes that the pandemic has no severe impact on the effectiveness of industrial training in the perspective of the students. This finding will be considered for the development of guidelines of Industrial Training course to fit the demands during the pandemic. Keywords: Industrial Training, Mechanical Engineering, Performance, Survey

Treatment Preferences Among Patients with Diffuse Large B-Cell Lymphoma: A Survey across Western Europe and the United States of America

Introduction: Diffuse large B-cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin's lymphoma (NHL), encompassing 30-58% of all NHL cases and approximately 60,000 cases annually in the United States of America (US) alone (Tilly et al, 2015; Zolkefli, 2017). The treatment (tx) landscape for DLBCL has significantly expanded, with novel targeted therapies, immunotherapies in addition to chemotherapy and chimeric antigen receptor therapy (CAR-T) (Bachanova et al, 2020). The importance of shared decision-making in cancer tx selection is well recognized; yet, we lack data on patient preferences regarding DLBCL tx, and existing research on tx factors in other disease areas, such as regimen intensity, has shown mixed results (Van Hoogdalem et al, 2019; Rummel et al, 2017; Rubin and Peyrot, 1999).Thus, we aimed to examine patient preferences of tx characteristics across the DLBCL landscape. Methods: Data were drawn from the Adelphi DLBCL Disease Specific Programme™, a point-in-time survey of hematologists, hemato-oncologists, oncologists, and their DLBCL patients conducted in France (FR), Germany (DE), Italy (IT), Spain (SP), the United Kingdom and the US between Jan-May 2021. Eligible patients were asked by their consulting physician to voluntarily complete a patient self-completion form (PSC) capturing demographics and preferences encompassing their DLBCL tx options. Patient tx preference questions were presented in a simplified manner to reduce the risk of misinterpretation. Patients' level of acceptance for characteristics of tx options, such as the patients' willingness to "be hospitalized" or "wait longer" for a more effective tx, were rated using a 7-point Likert scale (1=total disagreement; 7=total agreement). A Likert score of 6-7 was considered "agreement", whilst a Likert score of 1-2 was considered "disagreement". Results: Data analysis were conducted on 441 DLBCL patients (FR: n=80, DE: n=150, IT: n=54, SP: n=43, UK: n=34, US: n=80) who completed a PSC (Table 1). At data collection, mean (standard deviation) age was 64.6 (12.4) years, 36% of patients were female, 19% working full- or part-time and 81% were on second line or later. 8%, 24%, 28% and 40% were at Ann Arbor disease stage I, II, III and IV respectively at the time of data collection. Overall, 43% of patients agreed that they would be willing to wait longer (up to 4 weeks) for a more effective tx (e.g. CAR-T) than a tx with no delays (not have to wait 4 weeks), whilst 41% of patients agreed that they would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) if they were less likely to suffer side effects (SEs) than a tx with no delays. 32% and 31% of patients agreed that they would find being hospitalized (for a period of 1-2 weeks) for safety monitoring at the start (first 1-2 months) of their tx acceptable if they did not have to wait longer to start tx (up to 4 weeks) or if they were less likely to suffer SEs respectively. Finally, 37% of patients agreed that they would find being hospitalized (for a period of 1-2 weeks) for safety monitoring acceptable provided the tx was more effective (Table 1). Conversely, 9% of patients disagreed with the statement "I would find taking a continuous tx as an outpatient for my lymphoma acceptable". 20% of patients disagreed with the statement "I would find being hospitalized for monitoring (for a period of 1-2 weeks) at the start (first 1-2 months) of my tx acceptable if it were more effective". 17% of patients disagreed with the statement "I would find being hospitalized for monitoring (for a period of 1-2 weeks) at the start of my tx acceptable if it had less SEs". 9% of patients disagreed with the statement "I would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) that was more effective than a tx with no delays" and 11% of patients disagreed with the statement "I would be willing to wait longer (up to 4 weeks) for a tx (e.g. CAR-T) if I were less likely to suffer SEs than a tx with no delays". Finally, 13% of patients disagreed with the statement "I would find being hospitalized (for a period of 1-2 weeks) for monitoring at the start (first 1-2 months) of my tx acceptable if I did not have to wait longer (up to 4 weeks) to start my tx" (Table 1). Conclusion: A substantial proportion of patients reported that the requirement to wait longer and need for hospitalization were of low concern for their tx selection, often reporting in favor of extended hospitalization if better tx efficacy and SE profile could be achieved. Figure 1 Figure 1. Disclosures Quek: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company. Ma: Regeneron Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company.

SP7.1.14 Our experience of the first 100 cases of prostate biopsy using the Transperineal PrecisionPoint Access system at a hospital in the North West of England

Aims The diagnosis of prostate cancer has evolved over the past 2 decades with rapid changes occurring in the last 5 years. Traditionally transrectal prostate biopsies were the standard. However due to the risk of sepsis and sub optimal diagnostic accuracy, this method has been superseded by biopsies of the prostate now being performed via the transperineal (TP) route more frequently. Our hospital was the first in our region to use the PrecisionPoint Transperineal Access system to perform TP biopsy under local anaesthetic, and here we present our experience of the first 100 cases. Aims of this study included determining cancer detection rate and MRI correlation, as well as looking at rates of complications post procedure. Method This was a retrospective study with 100 patients in our cohort. We assessed MRI and histology correlation and post procedure complication rates. Results Histology in 72% of patients was positive for prostate cancer. Correlation between MRI findings and histology were noted to be high. As Likert score decreased, so did percentage of positive biopsies. Rates of significant complications were low, with no hospital admissions required following the procedure. Conclusion Our study demonstrates TP biopsy using the PrecisionPoint transperineal access system is a safe and effective method of detecting prostate cancer, which is well tolerated by patients.

Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?

Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.

Medical professionalism among medical students: A multifaceted evaluation

Background: Professionalism is one of the five key attributes that the General Medical Council has focused on the guideline of Good Medical Practice. The primary aim of this study is to evaluate how the attributes of professionalism among medical students are perceived by themselves (SG) and patients, parents, carers, junior doctors, nurses, consultants and other allied health professionals (NSG). The secondary aim of this study is to evaluate methods of assessment for professionalism. Methods: This study was carried out for a period of 8 weeks. This was a multifaceted evaluation gathering opinions from SG and NSG. All participants filled-in a questionnaire, using a 5-point Likert score scale satisfaction. Results: In total, we had 185 participants: 88 (SG), and 97 (NSG). The mean score of medical professionalism rated by SG was 3.87 and NSG was 3.95. The top two attributes that scored the highest scores by SG were respectfulness and confidentiality. NSG were confidentiality and appearance. The two attributes that had the lowest score in both groups were attendance and punctuality. One-to-one feedback was the most favorable choice of assessment method among both groups. Conclusion: The level of professionalism among medical students in this study was observed to be positive. There was no significant difference between both groups. Professionalism is a crucial requirement for all medical doctors. It is all educator’s responsibility from all educators to instill medical professionalism from the moment medical school begins.

Diagnostic interpretation of non-contrast qualitative MR imaging features for characterisation of uterine leiomyosarcoma

Objective: To assess the value of non-contrast MRI features for characterisation of uterine leiomyosarcoma (LMS) and differentiation from atypical benign leiomyomas Methods: This study included 57 atypical leiomyomas and 16 LMS which were referred preoperatively for management review to the specialist gynae-oncology multidisciplinary team meeting. Non-contrast MRIs were retrospectively reviewed by five independent readers (three senior, two junior) and a five-level Likert score (1-low/5-high) was assigned to each mass for likelihood of LMS. Evaluation of qualitative and quantitative MRI features was done using uni- and multi variable regression analysis. Inter reader reliability for the assessment of MRI features was calculated by using Cohen’s κ values. Results: In the univariate analysis, interruption of the endometrial interface and irregular tumour shape had the highest Odds ratios (OR) (64.00, p < 0.001 and 12.00, p = 0.002, respectively) for prediction of LMS. Likert score of the mass was significant in prediction (OR, 3.14; p < 0.001) with excellent reliability between readers (ICC 0.86; 95% CI, 0.76–0.92). The post-menopausal status, interruption of endometrial interface and thickened endometrial stripe were the most predictive independent variables in multivariable estimation of the risk of leiomyosarcoma with an accuracy of 0.88 (95%CI, 0.78–0.94). Conclusion: At any level of expertise as a radiologist reader, the loss of the normal endometrial stripe (either thickened or not seen) in a post-menopausal patient with a myometrial mass was highly likely to be LMS. Advances in knowledge: This study demonstrates the potential utility of non-contrast MRI features in characterisation of LMS over atypical leiomyomas and therefore influence on optimal management of these cases.

Correlation of Likert scores III–V with increasingly worse pathology in radical prostatectomy specimens significant only for men aged 0.15, with age <60 as good as PSAD <0.15 at discriminating lower risk in Likert III

Objectives: This study aimed to compare Likert scores with radical prostatectomy specimens. Methods: This study examined 443 men with validated pre-biopsy magnetic resonance imaging results and used cross-tabulation and chi-square significance testing with National Comprehensive Cancer Network risk categories. Results: The mean prostate-specific antigen (PSA) was 10, and the mean age was 64 years. Comparing Likert III to Likert V and Likert IV to Likert V, both (each p=0.02) were significantly associated with higher prostate cancer risk groups, but Likert III versus Likert IV was not ( p=0.1). Within the subgroup PSA density (PSAD) <0.15 ( n=140), the correlation of Likert score and final pathological risk group was lost ( p=0.5), but it was not lost within the subgroup PSAD >0.15 ( n=281; p=0.045 III vs. IV only and p=0.055 overall). Within the subgroup age <60 ( n=104), the correlation of Likert score and final pathological risk group was significant ( p=0.006 for III vs. IV and p=0.04 overall), whereas within the subgroup age >60 ( n=339) this significant difference was lost ( p=0.34). Further subgroup analysis within Likert III ( n=86) found that men <60 ( n=22) had neither high-grade (G3 or G4 or G5) nor very high-risk disease. There were only two high-risk cases, both of which were G2T3a (2/22; 10%). In men with Likert III and PSAD <0.15 ( n=31), there were seven high-risk and two very high-risk cases (9/31; 25%). This difference was not significant ( p=0.31) Conclusion: With these two findings, we recommend that men <60 with Likert III can be counselled like men with Likert III and PSAD <0.15, that they are unlikely to have unfavourable or high-risk disease and that they may wish to avoid biopsy or treatment. Level of evidence: Level 1b.

Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum

Background: Prompt Doppler ultrasonography to aid in diagnosis is often key to managing testicular torsion, but there may be delays in access; a faster, more widely available alternative is point-of-care ultrasonography (POCUS). The purpose of this study was to develop and evaluate a scrotal POCUS curriculum for urology and emergency medicine residents. Methods: Content experts in urology, emergency medicine and diagnostic imaging collaborated in a modified Delphi method to design a practical didactic curriculum for scrotal POCUS for the identification of testicular torsion. Training included 3 online video teaching modules and a 1-hour hands-on teaching session with standardized adult patients. We evaluated participants’ competency in scrotal POCUS using a validated scale. We assessed participants’ knowledge, comfort and confidence in performing scrotal POCUS before and after the intervention and at 3 months. Results: Twenty-four urology (n = 12) and emergency medicine (n = 12) residents participated in the curriculum. After hands-on practice, 23 participants (96%) were deemed competent at scrotal POCUS. Pre–post testing showed significant improvement in knowledge (mean score 63% v. 80%, p < 0.001), comfort (mean Likert score 0.6 v. 3.6, p < 0.001) and confidence (mean Likert score 1.0 v. 2.1, p < 0.001) after the intervention. These effects were maintained at the 3-month assessment. Conclusion: The scrotal POCUS curriculum was effective and acceptable to both urology and emergency medicine residents. The findings suggest that scrotal POCUS can be learned effectively through a short hands-on session and didactic instruction.

Medical School Applicants’ Online Interviews during COVID-19 Epidemic

Background: For many years, the primary criterion used to select medical school applicants worldwide has been cognitive measures of high school educational attainment. Yet academic assessment alone may not necessarily select the candidates who possess the behavioral or non-cognitive attributes thought important in medical students and doctors: honesty, integrity, flexibility, motivation, willingness to cooperate, managing emotions, self-esteem, control, leadership skills, resilience personal values, confidence, empathy, conscientiousness, and social accountability. There is evidence that significant relationship exists between both cognitive and non-cognitive variables and students’ performance in medical school. The challenge posed by the current pandemic of covid19 is that all admission interviews are now carried out via video. Method: In video interviews for admission to our Arabian Gulf University, the applicants were asked standardized questions under four main domains: motivation and commitment to medicine, handling stress and ethical dilemma, social skills, and responsibility as well as self-presentation. Each of these domains was given a Likert score ranging from one to five. Scores 1 and 2 indicated unsatisfactory performance, while scores 3, 4 and 5 indicated fair, good, and excellent, respectively. Each panel member scored each applicant independently. This creates the data bases for statistical analyses. Results and Discussion: The feedback from staff and students was so far positive, however, statistical results need a longitudinal follow-up of at least one decade: we do not have statistics showing to what extent the selection criteria for admission have a predictive validity for successfully completing the MD program and performing as a medical doctor. Conclusions: Transitioning medical school interviews to a virtual setting beyond the restrictions of COVID-19 would allow eliminating travel expenses and cost saving for applicants.