Improving documentation of vaccinations for patients with rheumatologic diseases

Purpose of Study: Vaccinations are an essential part of preventative medicine and provide for the improvement of public health by preventing the spread of infectious diseases. Patients with autoimmune rheumatic diseases have chronic illnesses that often require prolonged or lifelong immunosuppression or immunomodulation therapy to promote both quality-of-life and survival. Less than half of these patients receive the most common vaccinations despite having a higher risk of vaccine-preventable infections than the general population. The evaluation of immunization status and discussion of vaccines have remained under-prioritized in the medical community due to a wide variety of factors. The use of smart phrases has been shown in previous studies to positively affect clinical outcomes. Improvement in the documentation rate with this method can prompt discussion of immunizations and reduce the rate of suboptimal vaccination coverage in this high-risk patient population. We aimed to increase documentation of vaccinations by ten percent over four weeks using a novel vaccine smart phrase. This will prompt the provider to discuss patient-specific vaccination strategies and has the potential to improve vaccination rates in UMMC rheumatology patients. Methods Used: A baseline assessment through chart review was performed for four weeks immediately prior to implementation (March 14, 2022). Then, educational material on dot phrase implementation was provided electronically to four rheumatology fellows and a two week adjustment period was allowed. The impact of the smart phrase intervention was defined as the difference in the frequency of discussion (via documentation) of vaccinations (COVID, influenza, pneumococcal, and zoster) per clinical in-person encounter four weeks before and four weeks after implementation. Inclusion criteria were any patient with a rheumatology fellow provider seen in adult rheumatology clinic at UMMC. A total of 345 patient encounters were evaluated. Summary of Results: Results showed that implementation of the dot phrase was unable to meet our goal of increased vaccination documentation by 10%. In fact, a 5% overall decrease in the frequency of vaccine documentation was observed. [Figure presented] Conclusion(s): We suspect that an increased patient-to-provider ratio may have pressured the system and led to decreased discussion of vaccinations. Additionally, while we were careful to choose a time for assessment which avoided COVID-19 peaks, proximity to a recent spike may have artificially increased baseline vaccination discussion relative to post-implementation. Lastly, patient charts were not reviewed from prior to the pre-intervention assessment period in an effort to prioritize sample size. It is possible that a discussion on vaccination status was not repeated in subsequent clinic visits. Future studies seek to increase the length of time of the assessment in order to minimize these effects. Additionally, fellow education should be provided in person with the opportunity for further discussion and fellow input. Copyright © 2023 Southern Society for Clinical Investigation.

Knowledge and impact of COVID 19 pandemic on residents of Batu Gajah township

Introduction: Since the COVID-19 outbreak in Malaysia, the government had introduced measures to reduce the number infected including lockdowns, wearing facial masks, frequent hand washing and social distancing. Everyone had to follow and cope with this new lifestyle which affected them socio-economically and mentally. Objective(s): To determine the level of knowledge and impact of Covid-19 on residents of Batu Gajah township. Material(s) and Method(s): This cross-sectional study was conducted in February 2021 on Batu Gajah Township residents in Kinta District, Perak, Malaysia. The sample size calculated was 96 with a precision of 10% for 95% confidence interval, assuming 50% of respondents will have socio economic and mental health issues. As only one week was allotted for data collection, the sample size of 96 was chosen. Prior ethical approval and consent of respondents were obtained. Batu Gajah residents were invited to participate via WhatsApp and Facebook groups. They answered a pre-tested questionnaire (online using google form) which had 12, 10 and 16 questions respectively on knowledge, socioeconomic status and mental health. Result(s) and Conclusion(s): In total 109 responded and most of them 104 (95%) had good knowledge on COVID-19. Socioeconomic impact in terms of problem in paying bills was 40 (36.7%);whilst 53 (48.6%) stated they had no other resources to support themselves and 44 (40.4%) had to use their savings to make ends meet. Forty-five respondents (41.2%) stated they were worrying too much;34 (31.2%) had trouble relaxing, 37 (37%) had trouble sleeping and 14 (12.8%) had thoughts about ending their lives. Overall, 20% had poor psychological health. The association between the socioeconomic status and mental health was statistically significant with p-value = 0.00896. Most of the respondents had good knowledge of COVID-19 with a substantial number affected financially and psychologically by the COVID-19 pandemic.

Post-mRNA vaccine flares in autoimmune inflammatory rheumatic diseases: Results from the COronavirus national vaccine registry for ImmuNe diseases Singapore (CONVIN-SING)

Background Studies of flares of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination are limited by small sample size, short follow up or at risk of selection bias. Methods A national retrospective cohort study of consecutive AIIRD patients ≥12 years old, across 8 hospitals who received at least one dose of a COVID-19 mRNA vaccine. Patients were included from the date of 1st vaccine dose and censored at the time of flare or on the date of the clinic visit at least 3 months from cohort entry, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis. Findings 4627 patients (73% Chinese, 71% female) of median (IQR) age 61 (48, 70) years were included;42% Rheumatoid arthritis, 14% Systemic lupus erythematosus and 11% Psoriatic arthritis. 47% were in remission, 41% low disease activity, 10% moderate disease activity and 1% in high disease activity. 18% patients flared, of which 11.7% were within the 3-month period of interest. 11.8% patients improved. Median (IQR) time-to-flare was 60 (30, 114) days. 25% flares were self-limiting, 61% mild-moderate and 14% severe. Older patients (53–65 years and >66 years) had a lower risk of flare [HR 0.6 (95% CI 0.5–0.8) and 0.7 (0.6–0.8) respectively]. Patients with inflammatory arthritis and with active disease had a higher risk of flare [HR 1.5 (1.2–2.0) and 1.4 (1.2–1.6), respectively]. Treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), immunosuppression and prednisolone was also associated with an increased risk of flare [HR 1.5 (1.1–2), 1.2 (1.1–1.4) and 1.5 (1.2–1.8) for prednisolone ≤7.5 mg respectively]. Interpretation There was a moderately high rate of AIIRD flares after mRNA vaccination but also improvement in several patients. Severe flares and hospitalisation were rare. Thus, vaccination remains safe and highly recommended.

Incidence of proteinuria and microscopic hematuria in hospitalised COVID-19 infected patients: A single centre experience

Introduction: The outbreak of COVID-19 has rapidly evolved to global pandemic since December 2019. Kidney injury is commonly associated with COVID-19 infection. The majority of reports strongly support that acute tubular injury is the primary lesion driving AKI in COVID-19. Our objective of this study is to identify the incidence of proteinuria and microscopic hematuria in COVID-19 patients admitted to Hospital Sultanah Bahiyah, Alor Setar. Material(s) and Method(s): This is a single centred, retrospective cross-sectional study examining the records of patients infected with COVID-19 admitted to Hospital Sultanah Bahiyah from September 13 till December 28, 2020. We excluded patients with pre-existing medical illnesses. These patients had urine dipstick tests done upon admission. Result(s): A total of 160 patients were included in this study. The mean age was 34.6 years, 43.8% were male and 56.2% were female patients. The median serum creatinine level was 68 mumol/L. Patients were categorised into different severity of COVID-19 infection on admission, 46% category 1, 22% category 2, 18% category 3, 13 % category 4, 1% category 5. The incidence of proteinuria and microscopic hematuria were 20.3% and 14.4% respectively on admission. The incidence of combined proteinuria and microscopic hematuria was 5.0%. Conclusion(s): In our study, proteinuria and microscopic hematuria were relatively common in different categories of COVID-19 infection even without preexisting chronic illnesses.The incidence of proteinuria and microscopic hematuria in our study are comparable to other studies. More data is needed to distinguish patients who had preexisting proteinuria and microscopic hematuria prior to presentation from those developed denovo in hospital.

Retrospective Analysis on Implementation of Kangaroo Mother Care in Hospital Miri Nicu

Aims Hospital Miri is a district hospital with NICU that caters neonatal care service in Northern Sarawak. Preterm birth rate in our centre makes up of 10% (n=487) in 2019 and 11% (n=491) in 2020 of the live births, with mortality rate of 3% for preterm infants less than 33 weeks. According to WHO and Cochrane review (2016), Kangaroo mother care helps to reduce mortality, nosocomial infection, hypothermia, and improved growth and exclusive breastfeeding. Methods This is a retrospective observational study. Kangaroo Mother Care (KMC) Project was introduced in 2020 in Hospital Miri NICU as part of quality improvement project. Stable preterm infants with postmenstrual age 30 weeks to 34 weeks 6 days were enrolled with mother's consent into the project. It was carried out in 3 phases, with phase 1 of stable infants under room air or HFNC, phase 2 of stable infants on NIV and phase 3 with intubated infants. As COVID-19 endemic encroached, the project was put on hold at phase 2. Infants' demographic data was analysed using frequency and percentage. Outcomes were measured in mean, frequency and percentage. Maternal mental health score, knowledge score were taken prior to implementation of KMC and upon discharge. The mental health score is described as median and knowledge score is compared by wincoxon signed-rank test. Overall experience score was taken as median and mean. Results A total of 41 infants with the gestation of 32 to 34 weeks 6 days participated, 22 (53.7%) with majority of 41.5% aged 34 to 34 weeks 6 days post menstrual age at the time of enrolment. Mean length of stay was 38.34 days (SD:24.4), time taken to achieve birth weight was 11.4 days (SD: 4.05). Time taken to initiate breastfeeding range from 8 to 14 days to >22 days of life, mean: 24.78. Eighteen infants (43.9%) achieved exclusive breastfeeding on discharge. Mother's mental health, knowledge and experience were measures using Likert scale with the total score of 15 for mental health and 18 for knowledge and experience. For mental health score, pre-KMC median score:14, post-KMC median score was 15. There was improvement in the mother's experience upon discharge (p-value: <0.001). For overall experience, median was 18 with the mean score of 16.88 (SD:1.56). Conclusion Our study was suspended prematurely as per local pandemic control guideline. Knowing about the benefit of KMC to both mother and infants, we suggest that it should be encouraged and continued with adaptation and modification of the procedure during COVID-19 pandemic.

OUT-OF-HOSPITAL SUPPORT FOR PREPARATION OF RADIOTHERAPY IN PEDIATRIC PATIENTS DURING COVID-19

Introduction Child Life Specialists (CLS) cannot support pediatric cancer patients (PCPs) in hospitals during COVID-19 to minimize infection risk. We have recently developed an out-of-hospital radiotherapy (RT) preparatory workshop for PCPs and their carers, providing multidisciplinary support before the actual radiation treatment. Methods 6 PCPs were referred by the Hong Kong Children's Cancer Foundation (Table 1). RT undergraduates and practising radiotherapists hosted individualized, 2-hour simulation workshop for PCPs with a theme featuring PCP's favorite game or cartoon character. The Virtual Environment for Radiotherapy Training system realistically mimics the RT environment. The workshop included treatment preparation and delivery simulation to improve PCP's compliance with daily RT. Carer's queries were addressed by our professional workers. Evaluative questionnaires were given to participating families and CLS, with 6 questions to assess if the workshop addressed the needs of relevant stakeholders. Results The carers opined that the workshops eased their concerns and helped PCPs comply with daily RT (Figure 1). The CLS found the workshop was as effective as hospital visits, and should be continued after COVID19 (Table 2). The workshop allowed more time and multidisciplinary resources than hospital visits. Conclusions The proposed workshop provides better support for PCPs and their carers compared to conventional in-hospital counseling and should be recommended as a standard service provision beyond COVID-19.

THE PROJECTED IMPACT OF COVID-19 ON GLOBAL HEALTH SERVICES: TAXING AN ALREADY CRITICALLY LIMITED RESOURCE

INTRODUCTION AND OBJECTIVE: Prior to the COVID-19 pandemic, an estimated 4.8 billion individuals lacked access to basic surgical care worldwide, with near absence in many low-income/ middle-income countries (LMICs). Global health programs work to advance universal health coverage. The COVID-19 pandemic eliminated in-person surgical care and local training to LMICs provided by these programs. The objective of this study was to project a calculated impact of interrupted International Volunteers in Urology (IVUmed) global health surgical workshops since the start of the COVID-19 pandemic on patient care and training provided to partner LMIC sites. METHODS: Data from the 5 fiscal years (FY - April to March) prior to the COVID-19 pandemic was reviewed. This included metrics of number patients seen and surgical cases performed, local surgeons trained, countries visited, and estimated value of service provided as part of financial impact reporting. The last IVUmed workshop was March 5-15, 2020 and concludes the FY 2020. No surgical workshops were performed for FY 2021 and FY 2022 (through October 31, 2021). The projected FY loss of productivity for each metric was calculated by averaging the 5 FYs prior to FY 2021. The total loss since the COVID-19 pandemic was then calculated by the sum of the projected FY 2021 (this value) and that of FY 2022 thus far (7/12ths of this value). RESULTS: Averaging IVUmed surgical workshops over FY 2016-2020, 23 trips were taken each year to 13 countries. The average number of patients seen was 812, with an average of 564 surgical cases performed. The average number local surgeons involved in each workshop was 296. The FY average value of service was US$4,204,217.60. Projected losses for FY 2021 through October 31, 2021 (FY 2022 thus far) would be in the form of 36 trips to 21 countries. This has impacted 1,286 patients and meant the loss of 893 surgical cases. 469 local surgeons have been impacted by lost in-person training. The estimated value of service lost is US$6,656,677.86. CONCLUSIONS: COVID-19 has negatively impacted the already critically limited global surgical volume in LMICs. A simple calculation of lost surgical workshops thus far attempts to put a number on the impact this pandemic has had on the IVUmed program. This is the estimate of the impact of COVID-19 on only a single global health program, with the impact likely nearly immeasurable with the universal loss of global health services being provided during the pandemic. Such estimates can try to help global health programs prepare for the potential backlog of care and training that will be faced when workshops resume.

REINTEGRATING A GLOBAL HEALTH PROGRAM TO ON-SITE VISITS DURING THE COVID-19 PANDEMIC

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic limited global surgical missions. As a vaccine has been developed and deployed with low-/middle-income countries (LMICs) adjusting to a post-pandemic landscape, the question remains of how and when to restart surgical missions to these locations. This study reports the experience of International Volunteers in Urology (IVUmed) with identifying metrics of “readiness” for return to global health surgical workshops. METHODS: A survey was created and emailed in September 2021 to LMIC international partners where IVUmed has previously performed or is planning surgical workshops. The survey queried if international sites were ready for the return of surgical workshops, the timing of readiness, type workshop requested first, challenges faced including equipment limitations, and vaccination status. Results were tabulated. RESULTS: Of 30 emails sent, there were 12 responses. This represented 11 unique hospitals in 10 unique cities in 9 countries. The majority of respondents were from the continent of Africa (n=9) while the others were from Asia (n=2) and the Caribbean (n=1). Most respondents lived in countries where vaccines were available (75%) with all respondents stating they were vaccinated and are required to wear masks out in public. Most sites (66.7%) responded being ready for IVUmed workshops, with a start date of February 2022 (55.6%). 83% of respondents stated their hospital infrastructure could support a workshop, with 75% stating good access to personal protective equipment;58%, however, noted difficulty obtaining surgical supplies. Two respondents stating their hospitals continue to only perform emergent surgical cases. The most popular first workshops requested were pediatric urology and laparoscopy/endourology (30% each). Themes of the biggest challenge noted since the start of COVID-19 included 7 comments on performing operations, 4 about lack of supplies, and 2 about lost learning opportunities. CONCLUSIONS: It is unclear how and when to restart global health surgical mission programs since the start of the COVID-19 pandemic, which impacted the already critically limited global surgical volumes in LMICs. While LMIC partners queried report a high vaccination status, the vaccination status of the general population in surveyed countries has not been established. While this is an ongoing research project, important considerations for resumption of surgical missions must include careful assessment of timeliness, surgical and anesthetic capacity, facility resources, and safety. Direct communication with local sites is imperative.

THE IVU VIRTUAL VISITING PROFESSORSHIP PROGRAM: YOUTUBE AND ITS IMPACT ON GLOBAL HEALTH EDUCATION

INTRODUCTION AND OBJECTIVE: Like many global health organizations, International Volunteers in Urology (IVU) had to adjust to limitations on international travel during the COVID-19 pandemic that eliminated in-person surgical workshops. IVU turned to a completely virtual presence through the expansion of a visiting professorship program (VVP) of lectures given to international partner sites on requested topics via live video conference. These lectures were recorded and subsequently posted on YouTube, and promoted through social media, to increase accessibility. We reviewed the use of YouTube as an educational platform. METHODS: YouTube analytics of the IVU VVP program viewed after the live presentation from February 2020 through October 2021 were reviewed. We categorized the lectures by urology topic and evaluated them by the watch time in hours, the total number of views, and the number of channel subscribers. We then calculated an interest score, represented by the ratio of the number of views to the total number of videos under a specific topic, and a value score, represented by a ratio of total watch hours to the total number of videos. RESULTS: 68 lectures have been given over 20 months with 10,941 total views, 873.4 total hours of watch time, and 259 channel subscribers. The top three video categories by watch time and number of views included endourology (215.2 hours, 2,006 views), oncology (169.1 hours, 1,868 views), and pediatrics (164.9 hours, 3,453 views). “Ultrasound basics for urologists” was watched the most with 104.4 hours (1,000 views), while “Complex hypospadias” had the highest number of views at 1,200 (25.4 hours). The top three video categories by interest scores were endourology (287), pediatrics (247), and voiding dysfunction (189), while the top three by value scores were endourology (31), voiding dysfunction (18), and sexual health (15). For all videos, direct YouTube searches were the most common means of viewership (representing 41.7% of views), while external traffic sources represented 13.9% of views. Of the external traffic sources, the most common was from Google (14.2%). CONCLUSIONS: The COVID-19 pandemic led IVU to create a well-received VVP program, archived through YouTube to enable sustained remote education and outreach to international sites. Review of YouTube trends provided feedback on didactic topics. The difference in views and watch time highlight topics of higher educational value to international sites and may suggest areas of focus in future virtual and in-person didactics when they resume.

Pulmonary Complications of COVID-19: A case report.

Rapid evolution of pulmonary complications associated with severe COVID-19 pneumonia often pose a management challenge to clinicians especially in the critical care setting. Serial chest imaging enable clinicians to better monitor disease progression and identify potential complications early which may decrease the mortality and morbidity associated with COVID-19. We report a 69-year-old male patient with severe COVID-19 pneumonia who presented to a tertiary referral centre in Kuala Lumpur, Malaysia, in 2020 with multiple pulmonary complications including lung cavitation, bronchopleural fistula, pneumothorax, pneumomediastinum, subcutaneous emphysema and acute pulmonary embolism. Unfortunately, the patient died one month after admission. COVID-19 patients may develop pulmonary complications due to a combination of direct viral lung damage, hypoxaemia and high stress ventilation. Awareness of COVID-19 complications can prompt early diagnosis and timely management to reduce morbidity and mortality.

POS-677 COMPARISON BETWEEN SINGLE AND DOUBLE CUFFED TENCKHOFF CATHETER IN EARLY ONSET EXIT SITE INFECTION AND PERITONITIS - SINGLE CENTER EXPERIENCE

Introduction: In Malaysia, the overall prevalence of Chronic Kidney Disease (CKD) is 15.48%1. The incidence of patients with end-stage renal disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (PMP) in 1993 to 231 PMP in 20132. From 2007 to 2016, the acceptance rate for both hemodialysis and peritoneal dialysis nearly doubled while the prevalence rate had increased by more than two-fold.3Early observational studies reported lower peritonitis rates with double versus single-cuffed catheters.4However, Eklund B et al. showed that there is no significant difference in terms of catheter survival, exit site infection and peritonitis.5Exit-site infection (ESI) is a common complication of peritoneal dialysis (PD) and is one of the important risk factors in PD-related peritonitis and technical failure.6In addition, exit site infection is an independent risk factor for early onset peritonitis. Early onset peritonitis on the other hand, is identified as an independent risk factor for mortality and technique failure in PD patients.7 Our objective of this study is to identify the incidence of exit site infection and early onset peritonitis among patients whom had their tenckhoff catheter inserted in Hospital Sultanah Bahiyah from January 2021 till June 2021. Methods: This is a single centered, retrospective observational study which examines the incidence of early onset exit site infection in the first 3 months and early onset peritonitis in the first 3 months for patients on newly inserted single or double cuffed tenckhoff catheters. All patients had their tenckhoff catheter inserted from 1stof January 2021 till 31stof June 2021 were recruited. The catheters are inserted by Nephrologists under Y-Tech peritoneoscope guidance in the operation theatre. Coiled Dacron cuffed catheters were used. I-series coiled PD catheter from MEDCOMP USA was used for single cuffed catheter while Argyle Curl Cath Peritoneal Catheters from MEDTRONIC USA was used for double cuffed catheter. Results: A total of 62 patients were included, 35 patients had double cuffed catheter inserted while 27 patients had single cuffed catheter inserted. One patient who had single cuffed catheter inserted was excluded from this study due to malfunctioning of tenckhoff catheter postoperatively. The mean age for single cuffed catheter and double cuffed catheter patients were 50.3 and 55.8 years old respectively. Among the single cuffed catheter patients, 12(44%) were female while 15(56%) were male. Among the double cuffed catheter patients, 19(54%) were female while 16(46%)were male. The incidence of exit site infection for single cuffed catheter was 2(8%) while double cuffed catheter was 6(17%) The incidence of early onset peritonitis for single cuffed catheter and double cuffed catheter were 4(15%) and 11(31%) respectively. Conclusions: There is a higher incidence of early onset exit site infection and early onset peritonitis among patients with double cuffed tenckhoff catheter. Our study has limitation due to small sample size as the study being conducted during the height of COVID19 pandemic. Further study would be needed to recruit more patients over longer duration to ascertain late onset exit site infection, peritonitis and the long term catheter survival among single and double cuffed tenckhoff catheter. No conflict of interest

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units☆ Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Redirecting a global health surgical program to remote support during a pandemic: the IVU virtual visiting professorship program

INTRODUCTION AND OBJECTIVE: Global health surgical programs generally provide support through hands on surgical workshops. The COVID-19 pandemic has significantly impacted domestic and international travel, virtually eliminating the ability of such programs to provide in person care. International Volunteers in Urology (IVU) has developed a virtual visiting professorship (VVP) program out of necessity to redirect in person support to virtual support. METHODS: The VVP program was established in February 2020 when the decision was being made to suspend surgical mission trips. The program consists of hour long lectures provided to established international sites at which IVU has previously held global health surgical workshops on topics requested by those sites after solicitation by IVU. Lecturers are IVU volunteers. We report the experience of the IVU VVP program from February 2020 through January 2021. We evaluated the number and timing of VVPs, as well as topics, locations served, and volunteers engaged. We also report the results of a basic survey from participants evaluating the program. RESULTS: 42 lectures have been given over 12 months. Topics included those in General Urology (n=9), Oncology (n=20), Female Urology (n=2), Reconstruction (n=2), and Pediatrics (n=9). Lectures have been given to sites in 11 countries outside of the US, mainly in Africa, with 10 lectures given to the Pan-African Urological Surgeon's Association. A total of 2,149 persons registered for the VVPs;1,094 (51%) participated. While participation initially was proportionate to the number lectures given, there has been some decrease since September 2020 (Figure 1). The lectures have been given by 31 IVU volunteers, of which for 12 (39%), the VVP was their first experience with IVU. Participants ranked presentations on Likert Scale (0 poor-100 excellent) a median of 98. CONCLUSIONS: The COVID-19 pandemic has required global health surgical programs to significantly rethink their support of others. IVU has created a well-received VVP program that enables remote education during a time when it has been necessary for more selfisolation. Such a program enables maintained connectivity in this altered landscape of global health programs and has increased IVU participation.

Early perceptions of COVID-19 significantly differed between low-/lower-middle income countries and high-income countries

INTRODUCTION AND OBJECTIVE: While the response of certain countries to the COVID-19 pandemic was well publicized, the response of others, particularly less resourced, was not. We compared the personal response of individuals in low-/lower-middle income countries (LLMIC) to high-income countries (HIC) and what they witnessed by their establishments. METHODS: In May 2020, a survey was emailed to surgeons associated with the International Volunteering in Urology program. Responding participants were grouped into LLMIC or HIC. The survey questioned patient care and operating practice during the pandemic and personal attitudes regarding COVID-19, including personal risk of contraction and transmission. Results were compared by student's t-test, Mann-Whitney U, or chi-square test with p<0.05 being significant. RESULTS: 103 surveys were sent with 40 responses: 17 from LLMIC and 23 from HIC. The groups did not differ for age (p=0.13) or having children (p=0.06). Significantly more LLMIC respondents were male (p=0.03). HICs reported higher rates of COVID testing (83% vs. 6%;p<0.001). Groups had similar reports of operating per normal routine, having cared for or operated on COVID positive patients, and having personal patients die from COVID (p>0.05). Groups similarly had hospital guidelines on the care of COVID patients (p>0.05). Despite significantly more HICs performing telemedicine (87% vs. 18% p=0.0007), groups did not differ regarding working remotely (p=0.24). LLMICs expressed stronger concern regarding personal and family risk of contracting COVID, as well as being a possible vector of transmission (Figure 1). A Likert scale ranking of the pandemic (1 being unremarkable and 100 the worst seen) did not significantly differ between LLMIC and HIC (median 72.5 vs. 88.0;p=0.11). CONCLUSIONS: Early in the pandemic, there were significant differences in attitudes regarding personal risk of COVID-19 upon survey of LLMIC and HIC surgeons despite seemingly little difference in impact on clinical practice. This may come from LLMICs having more personal experience with prior pandemics. Follow-up studies are needed to evaluate if attitudes have changed as the pandemic has progressed.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures. Resumen La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios.