Androgen deprivation therapy and excess mortality during the COVID-19 pandemic

Introduction & Objectives: Men have a higher risk of death from COVID-19 than women and androgens facilitate entrance of the SARS-CoV-2 virus into respiratory epithelial cells. Thus, androgen deprivation therapy (ADT) may mitigate the course of COVID-19. The aim of the study was to estimate the impact of ADT on mortality from COVID-19 in men with prevalent prostate cancer by comparing all-cause mortality in the spring of 2020 to the same time period in previous years. Materials & Methods: All men with prevalent prostate cancer in Prostate Cancer data Base Sweden (PCBaSe) on March 1 each year in 2015-2020 were followed until June 30 the same year. Exposure to ADT was ascertained from filled prescriptions for bicalutamide, Gonadotropin Releasing Hormone agonists and antagonists (GnRH), and from The Patient Registry data on orchidectomy. The mortality rates by calendar day for each exposure group and calendar time period were calculated and plotted with locally weighted smoothing. Using Poisson regression, the rate of death was compared between 2020 and the average in previous years. Results: 9,822 men with Pca died in March-June in the years 2015-2020, of whom 5,034 men were on ADT. There was an excess mortality in 2020 vs previous years in men on GnRH, bicalutamide and men not on ADT (Figure). The crude relative mortality rate ratio in men on ADT in 2020 vs 2015-2019 was 0.86 (95% confidence interval 0.78 to 0.95). After multivariable adjustment this ratio was attenuated to 0.96 (95% CI 0.87 to 1.06). When restricting the analysis to regions with the highest incidence of COVID-19 and to the two months when mortality in 2020 was highest, the results were similar to those in the main analysis. Conclusions: We found little support for the hypothesis that androgen deprivation therapy mitigates the disease course of COVID-19. (Figure Presented)

Academic urology tweet performance dashboard

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has limited in-person opportunities such as away rotations and residency interviews within academic urology. Twitter may serve as a vital tool mitigating these barriers and expanding the field. Our study aims to re-evaluate Twitter usage among academic urology programs in 2020 compared to 2009-2019. METHODS: We evaluated 83,000 tweets from 113/133 U.S. academic urology program twitter accounts during 2009-2020 through the Application Programming Interface on April 2, 2021. Text patterns were interpreted as positive, neutral, or negative via sentiment analysis. Tweets, number of followers, @mentions, hashtags, and account creations were analyzed. We captured word cloud (visualization of most frequent words) and trigram (most frequent three-word combinations) analysis. RESULTS: Our data revealed that 2020 depicted a record number of tweets (22,544) and account creations (23). For all programs, the median (IQR) number of tweets and followers was 1,748 (872- 3,051) and 2,201 (1,509-3,956). The University of North Carolina (8,707) tweeted the most. However, Johns Hopkins (5,365) had the most followers. The most frequently mentioned account in both 2009- 2019 and 2020 was the American Urological Association (@americanurological). @uro-res and @uroresidency ranked higher in 2020 than previously. Compared to 2009-2019, positive sentiment increased by 3%, while negative decreased by 2%. Word cloud analysis identified urology and resident as the most prominent words in 2020, shifting from urology and cancer (2009-2019). Trigram analysis revealed 2009-2019 tweets pertained around (risk, prostate, cancer) whereas 2020 tweets revolved around (virtual, open, house), suggesting a context shift to program recruitment. CONCLUSIONS: Our novel findings reveal that urology programs are capitalizing Twitter to promote residency recruitment and education via increased tweets and account creations, which will have far-reaching implications on urology's future.

Does social media play a role in the urology match?

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic forced many changes to the urology residency match process, including limits on in-person sub-internships and interviews. As a result, social media (SoMe) was poised to play an increased role as a mechanism for virtual interaction and information sharing. In this study we sought to better understand how SoMe was utilized by both urology residency applicants (RA) and program directors (PD), attitudes toward SoMe use, and whether SoMe use had actual benefits or harms in the match process. METHODS: Following IRB approval, surveys were sent to RA and PD via email and posted on the Google Spreadsheet “Urology Match 2021”. The survey collected demographic information as well as SoMe activity, attitudes regarding the utility of SoMe in the match, and match outcomes including interview offer rate (IOR, number of interview offers received / number of programs applied) and rank list position of the matched program. Statistical analysis was performed using SPSS 27. RESULTS: Of 528 registered RAs for the 2021 match and 142 PDs, 108 (21%) and 64 (45%) completed the survey, respectively. SoMe was used by 99% of RAs, but only 75% used it in the match. 78% of PDs use SoMe regularly. Both RAs and PDs indicated they feel pressure to use SoMe for professional purposes, 70% vs 50% respectively. Twitter was the most popular platform, used by 93% of RAs and 74% of PDs using SoMe. 37% of RAs and 58% of PDs felt that SoMe activity provided benefit to the applicant or program in the match process, respectively. Most RAs (59%) felt that SoMe helped them gain better insight into urology programs while only 27% of PDs believed SoMe provided them better insight into RAs. A significant correlation was found between RA perceived insight into programs and their frequency of both viewing and posting on SoMe (p = 0.00012, p = 0.004). Neither relationship was observed for PD. No significant relationship was found between SoMe viewing frequency, posting frequency or tweetorial use and the match outcomes of IOR and rank list position of matched program. Although only 5% of PD reported incorporating SoMe as part of their assessment of RA, 14% said an applicant's activity on SoMe helped their chances of matching to their program while 11% said an applicant's activity hurt their chances. CONCLUSIONS: SoMe, particularly Twitter, was widely used in the 2021 match by both RAs and PDs. A majority of RAs and PDs believed that SoMe use aided them in some way in the match process. Although PDs reported that RA activity influenced match outcomes in some cases, in the overall sample we did not find a relationship between the volume or type of RA SoMe activity with match outcomes.

Exploring the Residents' Perspective on Smart learning Modalities and Contents for Virtual Urology Education: Lesson Learned During the COVID-19 Pandemic. / Explorando la perspectiva de los residentes sobre las modalidades y contenidos de aprendizaje inteligente para la educación virtual de urología: lección aprendida durante la pandemia de la COVID-19.

PURPOSE: The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS: A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS: Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION: Our study provides the first global «big picture¼ of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.

Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. / Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología.

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.