ABSTRACT
Objective: The use of Quick Response (QR) codes has the potential to overcome some of the healthcare challenges we currently face, especially those presented by the COVID-19 pandemic. The aim of this research was to evaluate the use of QR codes poster in delivering patient information effectively in a Urology Outpatient department. Methods: A national online survey of Urologists was distributed, and leaflet costs were estimated. QR codes for the British Association of Urological Surgeons (BAUS) patient information leaflets were incorporated into a poster for the Urology Outpatient department. Feedback on the poster was sought from patients. Results: Overall, 108 Urologists responded to the initial survey;44% were consultants. However, 54% provided > 50% of patients with an information leaflet during face-to-face clinics prior to the Covid-19 pandemic, decreasing to 33% during COVID-19. Using departmental outgoings, a cost of (sic)3120 was calculated for printed leaflets per year normally. Rise in telephone clinics during the pandemic meant 47% of patients were provided an Internet link or asked to use Google in the clinical letter, up from 17% prior to the pandemic. In response to the QR codes poster, in a patient population, mostly male (82%) and older people(60% between 60 and 80 years of age), 40% were familiar with QR codes, 73% could access Internet and 53% used it to find information, 46% found the poster easy to use or follow and 61% found it informative. Conclusion: QR codes offer benefits, including capability for touch-free access, cost-effectiveness, potential to increase engagement and understanding, enable user-initiated learning and improve adherence. Patient perception varies with age group and smartphone access and usage.
ABSTRACT
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
ABSTRACT
OBJECTIVES: To determine the safety of urological admissions and procedures during the height of the COVID-19 pandemic using "hot" and "cold" sites. The secondary objective is to determine risk factors of contracting COVID-19 within our cohort. PATIENTS AND METHODS: A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high-volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a "cold" site requiring a negative COVID-19 swab 72-hours prior to admission and patients were required to self-isolate for 14-days preoperatively, while all acute admissions were admitted to the "hot" site.Complications related to COVID-19 were presented as percentages. Risk factors for developing COVID-19 infection were determined using multivariate logistic regression analysis. RESULTS: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the urology team; 101 (16.5%) on the "cold" site and 510 (83.5%) on the "hot" site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID-19 postoperatively with one (0.2%) postoperative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). CONCLUSIONS: Continuation of urological procedures using "hot" and "cold" sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a postoperative mortality.