Website Transparency and Information Dissemination among Urology Residency Programs

INTRODUCTION AND OBJECTIVE: Due to the COVID-19 pandemic, urology residency programs have had to adjust their typical practices, including the adoption of virtual recruiting and interviewing. Such efforts have included utilizing social media and improving program websites, which are often the starting point for potential applicants to obtain information about a program. We sought to evaluate the transparency and quality of information dissemination among urology residency program websites. METHOD(S): The websites of all 143 non-military, accredited United States urology residency programs were evaluated for various measures grouped into distinct categories including program priorities, program curriculum, program profiles, program quality of life, medical student opportunities, interview process, selection/exclusion criteria, and social media. Programs that have yet to graduate residents were excluded. Programs were separated based on American Urological Association (AUA) section. Percentage values were determined by the number of programs reporting information on a particular measure. RESULT(S): The most reported category was program profiles (84%), with many programs providing details such as resident hometowns, faculty research interests, and alumni fellowship matches. The least reported category was selection/exclusion criteria (32%), with 8% of programs discussing a minimum/preferred Step 1 score and 23% discussing osteopathic applicants. Program mission/objective statements, training site locations, and current resident and faculty profiles were subcategories reported by greater than 90% of programs. DEI and wellness initiatives/statements were discussed by 45% and 36% of programs, respectively. For virtual opportunities, 21% of programs provided online open house information, and 85% had an active Twitter account with 34% providing direct links. Average AUA overall transparency was 53.7%, with the Northeastern Section highest at 62.4%. CONCLUSION(S): The importance of transparency and quality of information dissemination is greater than ever with the increasing utilization of virtual formats in the residency application process. Our results indicate several areas of improvement that urology residency programs can amend to provide improved transparency for applicants during the application process. (Figure Presented).

Opportunistic Infections in Post Renal Transplant Patients Treated With Dexamethasone for COVID-19

Background: Dexamethasone, a common treatment regimen for COVID-19, may mitigate inflammation-mediated lung injury in immunocompromised patients who have COVID-19 with severe disease. However, it comes with the cost of further suppressing the immune system, increasing the risk for opportunistic infections. This study looked at various post renal transplant patients on immunosuppression who contracted COVID-19, their treatment with or without dexamethasone, and their subsequent development of opportunistic infections that necessitated readmission. Method(s): We identified index hospitalization for COVID-19 amongst kidney transplant recipients between 2020 and 2022 at our institution. Local electronic medical record review was utilized for demographics, vaccination status, readmissions for opportunistic infections, and dexamethasone treatment characteristics for COVID-19 infection. Result(s): Of the 33 patients included in the analyses, 14 (42.4%) were readmitted at least once for opportunistic infections. Those readmissions included 5 cases of viral infection, 14 bacterial infection, and 4 fungal infection. For treatment of COVID-19, 18/33 patients (54.5%) received at least 1 dose of dexamethasone. Of the 18 patients given dexamethasone, 8 (44.4%) were found to be among the 14 readmitted patients with opportunistic infection. Of the 33 patients, 25 (75.8%) had received at least one dose of the COVID-19 vaccine at the time of COVID-19 diagnosis. Amongst the 14 readmitted patients, 8 (57.1%) had received at least one dose of COVID-19 vaccine at time of COVID diagnosis and 6 (42.9%) had not received any vaccine. Conclusion(s): In this single cohort, readmission rate after COVID-19 hospitalization for kidney transplant recipient was 42%, higher than the average rate for all COVID-19 cases readmission rate (12% per CDC, 27% per National Veterans Affairs). Glucocorticoid use should be done with extreme caution in immunocompromised patients due to the increased risk for opportunistic infections. Opportunistic infections were associated with corticosteroids use in 44% of COVID-19 patients in this group. Another risk factor for opportunistic infection following COVID-19 in immunosuppressed patients may be vaccination status at the time of COVID-19 diagnosis.

Undergraduate Surveys Reveal That Instructors Are Key in Students Overcoming Classroom Struggles During the COVID-19 Pandemic

Many undergraduate students encounter struggle as they navigate academic, financial, and social contexts of higher education. The transition to emergency online instruction during the Spring of 2020 due to the COVID-19 pandemic exacerbated these struggles. To assess college students’ struggles during the transition to online learning in undergraduate biology courses, we surveyed a diverse collection of students (n = 238) at an R2 research institution in the Southeastern United States. Students were asked if they encountered struggles and whether they were able to overcome them. Based on how students responded, they were asked to elaborate on (1) how they persevered without struggle, (2) how they were able to overcome their struggles, or (3) what barriers they encountered that did not allow them to overcome their struggles. Each open-ended response was thematically coded to address salient patterns in students’ ability to either persevere or overcome their struggle. We found that during the transition to remote learning, 67% of students experienced struggle. The most reported struggles included: shifts in class format, effective study habits, time management, and increased external commitments. Approximately, 83% of those struggling students were able to overcome their struggle, most often citing their instructor’s support and resources offered during the transition as reasons for their success. Students also cited changes in study habits, and increased confidence or belief that they could excel within the course as ways in which they overcame their struggles. Overall, we found no link between struggles in the classroom and any demographic variables we measured, which included race/ethnicity, gender expression, first-generation college students, transfer student status, and commuter student status. Our results highlight the critical role that instructors play in supporting student learning during these uncertain times by promoting student self-efficacy and positive-growth mindset, providing students with the resources they need to succeed, and creating a supportive and transparent learning environment. Copyright © 2022 Cannon, Clance, Correia, Morrison, Nelson and Henning.

Parenting through the COVID-19 pandemic

The COVID-19 pandemic has significantly altered the experiences of individuals the world over-without precedent. Its impact has been especially harsh for parents. This chapter considers the impacts of COVID-19 through a family systems lens, which highlights the importance of recognizing that a parent is part of a “family unit” and so their experiences of the pandemic are felt directly, from the world around them, and through indirect pathways via the other members of their family. This chapter will explore the stressors grounded in the pandemic that uniquely impact parents and the ways that parents seek to adapt and cope with these stressors in a landscape where many of their pre-COVID coping strategies and supports are rendered inaccessible or untenable. This chapter also explores the various psychosocial outcomes that may eventuate as parents attempt to balance these imposing stressors with their coping resources with varying levels of success including parental burnout, family violence, and posttraumatic growth. Critical during this ongoing pandemic is that negative outcomes are not an inevitability and that growth for individuals, and the family unit, is entirely possible. However, parents must be equipped with strategies to minimize the stressors impacting their family, afforded the capacity to develop new coping mechanisms, have access to new support pathways, embrace psychological flexibility, and to experience perceived control in theirs, and their families, lives. Each family will face this pandemic period differently and it is therefore parents who must navigate the pathway forward on behalf of their family’s unique experiences. © 2021 Elsevier Inc. All rights reserved.

Successful introduction of the methoxyflurane inhaler, Penthrox®, to brachytherapy for post-irradiation implant removal analgesia during the COVID-19 pandemic

Methods We planned to introduce the Penthrox® methoxyflurane inhaler device into brachytherapy and started prospectively collecting peri-procedure pain scores (using the 10-point visual analogue scale) whilst the processes of training and drug approval were completed. After which, peri-procedure pain scores were collected prospectively. We also recorded drug idiosyncrasies and patient feedback. Results Data were collected before introducing Penthrox from 10 patients and from 16 patients after introduction. Pre-Penthrox pain scores during needle removal demonstrated a mean score of 8/10, despite pre-procedure administration of intravenous analgesia including morphine. The mean pain score with Penthrox and without any other analgesia was 0.6/10. Penthrox has been well tolerated with patients reporting few adverse side effects. Discussion Pre-COVID-19, patients attending our brachytherapy suite for gynaecological malignancy would have sufficient analgesia for needle insertion and removal with a single-shot intrathecal anaesthetic. The pandemic necessitated the decision to administer two treatments within 1 day, reducing the need to attend hospital on multiple separate visits. This meant the intrathecal analgesia would be less effective by the time of needle removal, thus necessitating other methods of analgesia for the procedure. This included intravenous morphine, Entonox® and, at times, midazolam. Using Penthrox to reduce pain during needle removal was discussed and, following local approval, was introduced to brachytherapy. Penthrox (methroxyflurane) is a halogenated ether with a UK license for emergency relief of moderate to severe pain in adult patients with trauma. It provides generally well-tolerated analgesia, which may negate the need for procedural sedation. Associated potential risks are nephrotoxicity, hepatotoxicity and it is an enzyme inducer. It is well tolerated in suitable patients [1]. The introduction of Penthrox to the brachytherapy service has been successful in significantly reducing the reported pain scores during removal of needles. This has in turn improved procedural conditions through providing a calmer atmosphere in theatre and better operating conditions for the oncologists. Patient satisfaction was also high. To our knowledge, this is the first time Penthrox has been used for this indication outside Australasia.

What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemic.

OBJECTIVES: This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations. METHOD: A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital. RESULTS: Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required. CONCLUSION: Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.