A Cost, Time, and Demographic Analysis of Participant Recruitment and Urine Sample Collection Through Social Media Optimization.

INTRODUCTION: Clinical research can be expensive and time consuming due to high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social medial has the potential to reach a large population in a small timeframe, at a reasonable cost. METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics. RESULTS: Each sample collection kit contained 3 urine cups, 1 for the disease sample and 2 for control samples. Out of the 3,576 (1,192 disease + 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the 2 clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $81.45 compared to $398.14 for clinic sample. CONCLUSIONS: We conducted a nationwide, contactless, urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic, and without risk of COVID-19 exposure.

The Impact of Holistic Review of Urology Residency Applications on Selection for Interview During the COVID-19 Pandemic.

OBJECTIVE: To investigate the impact of a holistic review of urology residency applications on interview selection at our institution during the COVID-19 pandemic. METHODS: In the 2019-2020 cycle, applicants were filtered by a Step 1 score of 230 and whether they applied from selected east coast medical schools. For the 2020-2021 and 2021-2022 cycles, we implemented a scoring system which focused on desirable attributes based on our program training needs and resources. We compared applicant and interviewee demographics and United States Medical Licensing Examination (USMLE) scores using descriptive statistics and 1-way analysis of variance tests. RESULTS: A total of 282, 300, and 367 students applied to our residency program with 50, 45, and 52 selected for interviews during the 2019-2020, 2020-2021, and 2021-2022 cycles, respectively. Compared to 2019-2020, the 2020-2021 and 2021-2022 interviewee cohorts comprised of more non-tri-state applicants (36%, 55.6%, and 46.2%, respectively). Underrepresented minority representation increased for the 2020-2021 interviewee cohort; however, this was not observed in 2021-2022 (16%, 24.4%, 15.4%, respectively). Additionally, USMLE Step 1 and 2 scores were similar between interviewee cohorts in 2019-2020, 2020-2021 and 2021-2022, respectively (Step 1: 244.2 ± 8.8, 242 ± 12.1, 242.8 ± 12.4, P = .624) (Step 2: 249.1 ± 11.5, 251.5 ± 10.5, 254.4 ± 10.8, P = .143). CONCLUSION: Utilizing a comprehensive review resulted in a geographically diverse interview pool and no significant difference in academic performance among interviewees. Holistic review provides an alternative, balanced evaluation of residency applicants which may increase diversity in urology.

Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center.

AIM: To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. METHODS: A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. RESULTS: One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. CONCLUSION: Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.

Analysis of Twitter Engagement in a Progressively More Competitive Urology Match: A Mixed Methods Study.

OBJECTIVE: To analyze Twitter engagement in response to the urology match during the COVID-19 pandemic. METHODS: Tweets containing the hashtags "#uromatch" or "#AUAmatch" during the 2021 and 2022 Match Week were reviewed. Date, author type and number of followers, general content, and engagement with each Tweet was collected. Differences in engagement between author type and content were analyzed using the Kruskal-Wallis H test. Tweet characteristics were compared between the 2021 and 2022 Match Cycles using the Chi-Square test. RESULTS: There were 656 Tweets in total, with 272 (43.5%) from 2021 and 353 (56.5%) from 2022. Medical students' and residency programs' posts received significantly more Tweet engagement than those by residents/fellows, attendings, or the AUA (P <.05). Tweets focusing on announcing a new residency class and personal announcements of match results received significantly more engagements than other content categories (P <.05). In 2022, there was a significantly higher percentage of Tweets about advice for unmatched applicants (2.2 vs 12.5; P <.001), match statistics (0.4 vs 2.9; P = .028) and focus on underrepresented groups in urology (0.7 vs 3.4; P = .029). CONCLUSION: The Twitter response to the urology match between 2021 and 2022 mirrored the increase in competitiveness, with greater participation and an increasing focus on the difficulty of matching. During Match Week, Twitter is a readily available source of information for programs, matched students, and unmatched students alike. As we continue to embrace virtual platforms, we believe that Twitter will remain a major source of match-related information and can be an instrumental tool for broader networking in our field.

Patient Satisfaction with Telephone Versus Video-Televisits: A Cross-Sectional Survey of an Urban, Multiethnic Population.

OBJECTIVE: To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. METHODS: A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. RESULTS: A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. CONCLUSION: Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.

Implementation of the telephone montreal cognitive assessment in a telemedicine based pre-admission testing clinic during COVID-19.

Introduction: Postoperative delirium (POD) affects 10-70% of patients 60 years or older and has been linked to increasing length of hospitalization, mortality, and morbidity. Pre-existing cognitive impairment is a predictor of POD. COVID-19 restricted use of in-person cognitive screens. The Telephone Montreal Cognitive Assessment (T-MoCA) can screen for cognitive dysfunction remotely. We evaluated the feasibility of administering T-MoCA in a multiethnic population during pre-operative testing televisits. Methods: Patients scheduled for surgery between July 2020 and August 2020 were asked to participate in the T-MoCA at the end of their preadmission testing (PAT) televisit. A retrospective chart review was conducted to collect patient comorbidities and demographics. Patients were stratified by negative (T-MoCA≥19) or positive (T-MoCA<19) for mild cognitive impairment (MCI) and compared using 2-tailed χ2-tests. Univariate logistic regression was used to identify associations between patient characteristics and positive T-MoCA result. Results: Fifty out of 65 (77%) patients who consented to the T-MoCA completed the test. The average time to complete the assessment was 10.5 mins. Twenty two (44%) had a negative score and 28 (56%) had a positive score. Patients who had a positive T-MoCA were older (70.04±7.61 yrs) compared to those with a negative T-MoCA (67.68±4.69 yrs, p=0.007), although the distribution of patients above and below age 65 was not different (p=0.243). The two groups did not vary by gender, race/ethnicity, obesity, surgery type, or medical co-morbidities. When we examined our population for predictors of a positive T-MoCA, we found a trend toward men being less likely to score positive on T-MoCA (OR=0.33, 95% CI: 0.10-1.10, p=0.07) compared to women; and that patients with Hispanic race/ethnicity were more likely to test positive on the T-MoCA (OR=4.13, 95% CI: 0.84-20.28, p=0.08) compared to Non-Hispanic Whites. Conclusions: Implementation of the T-MoCA in a telemedicine-based PAT setting is feasible. In our cohort, most people who consented to the assessment completed it, and more than half scored positively, which may have important implications on the surgical plan and post-operative recovery. There may be limitations in using T-MoCA in certain populations, such as non-English preferred language, hearing difficulties, lack of focus, and use of external aids, which would need to be explored in a larger sample size.