Telepresence robots in medical education and eye health care delivery

Purpose : Moorfields Eye Hospital, London, is a centre of excellence for ophthalmic research, education and patient care. During the COVID-19 pandemic, medical students' clinical education exposure and patients' multidisciplinary care were greatly affected. Telepresence robots have been suggested as a solution to reduce the impact of COVID-19. We present the results of a trial used to evaluate the capabilities of a telepresence robot in improving clinical education for undergraduate medical students, and the possibility to deliver multidisciplinary clinical patient care via a telepresence robot. Methods : In a two-day trial period, the telepresence robot was used in four tasks: 1) to livestream an adnexal surgery to students off-site;2) autonomously navigating patients from clinic to pharmacy;3) by a clinician to remotely review patients with an ophthalmologist who was consulting the patient face to face;4) and to deliver a teaching session to medical students. Feedback was gathered using a questionnaire and in a group discussion together with clinicians, patients, students, robot specialists and IT specialists. Results : 15 patients of a wide age range and 5 medical students were surveyed. The vast majority of both groups were unaware of telepresence robots. The mean rating given by both groups was 6/10 (with a range of 1-10/10 and 3-8/10) respectively. The groups praised the innovation, felt it could support clinical pressures, and improve their involvement. However, there were concerns about impersonality and technical limitations, and each offered ideas for improvements. All students felt there was potential to improve medical education using the robot. Qualitative feedback during the group discussion highlighted the importance of adapting the currently available hardware and software to enhance its use in education and patient care. Conclusions : This trial provided a greater understanding into the practicalities of incorporating a telepresence robot, in its current form, to clinical medical care and education. While there are challenges with the technical specification of the telepresence robot, the proposition of using such a device has drawn positive engagement from students, patients and clinicians thus validating further research.

Impact of COVID-19 on the management of ureteric stones in the UK: the COVID Stones study

Introduction: In the COVIDStones study, we aimed to determine how management of ureteric stones changed during the COVID-19 pandemic in the United Kingdom. Materials and Methods: The COVID Stones study was a multi-centre retrospective study of consecutive adults diagnosed with CT-proven ureteric stone disease at 19 UK sites. We compared a pre-pandemic period (23/3/19 to 22/6/19) to a period during the pandemic (the 3-month period after the first SARS-CoV-2 case at individual sites). Results: 3755 patients were included (pre-pandemic = 1963 patients;pandemic = 1792 patients). Patients during the pandemic had significantly lower hospital admission rates (pre-pandemic = 54.2% vs pandemic = 46.6%, p<0.001), shorter length of stay (mean = 4.0 vs. 3.2 days, p=0.01), and higher rates of use of alpha-blockers (16.1% vs. 23.3%, p<0.001). In the cohort of patients who received interventional management (n=790 [44.1%] vs. n=686 [34.9%]), rates of ESWL (22.8% vs. 33.9%, p<0.001) were significantly higher;rates of ureteroscopy (56.7% vs. 47.7%, p<0.01) and stent insertion (67.9% vs. 54.5%, p>0.001) were lower;and there was no difference in rates of nephrostomy (p=0.76) during the pandemic. During the pandemic, there was no difference in success of primary treatment overall, including both non-interventional and interventional modalities (prepandemic= 73.8% vs. pandemic=76.2%, p=0.467), nor when stratified by treatment modality or stone size. Conclusions: Despite fewer invasive procedures performed during the pandemic, we demonstrated no difference in success of treatment, without an increase in adverse outcomes. This leads us to question whether the management of ureteric stones can be optimised further.

The COVID stones collaborative: How has the management of ureteric stones changed during and after the COVID-19 pandemic? Rationale and study protocol

Background and objectives The coronavirus disease 2019 (COVID-19) pandemic is having a significant impact on healthcare delivery. As a result, management of patients with ureteric stones has likely been affected. We report our study protocol for the investigation of ureteric stone management during and after the COVID-19 pandemic. Material and methods The COVID Stones study is a multicenter national cohort study of the management and outcomes of patients with ureteric stones before, during, and after the COVID-19 pandemic in the United Kingdom. The study will consist of three data collection periods, pre-pandemic (“pre-COVID”), pandemic (“COVID”), and postpandemic (“post-COVID”). This will allow quantification of what “normal” was, how this has changed, and to capture any persisting changes in management. The primary outcome evaluating the success rate of the initial treatment decision will be assessed following a 6-month follow-up from the time of first presentation and will be performed for each recruited patient from each of the three data collection periods. This will allow comparison between both management and outcomes before, during, and after the pandemic. Conclusions We anticipate that this study will lead to an increased understanding of the impact of the outcomes of emergency management of ureteric stones following changes in clinical practice due to the COVID-19 pandemic health provision restrictions.