Virtual Urology Clinics: Impact on Patients, Clinicians, Environment and Economy

Objectives: The SARS-CoV-2 pandemic necessitated restructuring of outpatient services with increased reliance on telemedicine. Greater use of virtual clinics (VCs) is expected to continue;However, patient and clinician satisfaction with these are poorly understood, as are their environmental and fiscal impact. Methods: The first, middle and last patients from various Urological subspeciality VC lists over a 30-day period at the peak of the pandemic were contacted. Healthcare professionals independent of initial care evaluated patient satisfaction using a custom questionnaire. Environmental and fiscal cost analyses were calculated using patient addresses, NHS tariff data and Gross Value Added (GVA) per head. Simultaneously, an online survey exploring changes to outpatient practices and clinician satisfaction with VC was distributed to UK Urologists. Results: 1146 patients underwent VC (30th March - 30th April 2020). 99 patients were contacted. 55 (56%) completed all survey questions (male: 78%, age >65: 60%, follow up: 78%). 49 (89%) were satisfied/very satisfied, with reduced time and travel having the strongest influence on responses. Approximately 5.31 tonnes of C02 emissions were avoided. Estimated cost-savings were £42,714.55 to the NHS and £62,078.82 to the economy. 86 Urologists completed the clinician survey. 83 (97%) switched some/all outpatient activity to virtual, with 69 (80%) using telephone. 24 (28%) felt satisfied/very satisfied for new referrals. 81% (70) felt satisfied/very satisfied for follow up consultations. 61 (71%) would use VC regularly. There were notable variations by subspeciality. Conclusions: VC use should be strongly considered beyond the pandemic, but may not suitable for every patient or subspeciality.

A systematic review of low-cost simulators in ENT surgery.

BACKGROUND: Simulation training has become a key part of the surgical curriculum over recent years. Current trainees face significantly reduced operating time as a result of the coronavirus disease 2019 pandemic, alongside increased costs to surgical training, thus creating a need for low-cost simulation models. METHODS: A systematic review of the literature was performed using multiple databases. Each model included was assessed for the ease and expense of its construction, as well as its validity and educational value. RESULTS: A total of 18 low-cost simulation models were identified, relating to otology, head and neck surgery, laryngeal surgery, rhinology, and tonsil surgery. In only four of these models (22.2 per cent) was an attempt made to demonstrate the educational impact of the model. Validation was rarely formally assessed. CONCLUSION: More efforts are required to standardise validation methods and demonstrate the educational value of the available low-cost simulation models in otorhinolaryngology.

Has the sars-cov-2 pandemic improved the management of acute ureteric colic?

Objective The WHO declared SARS-CoV-2 a pandemic on 11th March 2020 prompting a rapid change to surgical practice. This study focuses on how the management of ureteric colic has adapted in a major tertiary referral unit during the peak of the pandemic so that lessons be can be learned in case a second wave occurs. Materials and Methods We compared admission rates and treatment patterns against national and European guidelines in 20 weeks, divided into pre-and peri-pandemic. Results A total of 72 patients were admitted during the study period. 64% (46/72) were admitted pre-pandemic. 22% (10/46) of these were septic (5 stented, 5 nephrostomized) while 20% (9/46) were managed conservatively. 59% (27/46) of pre-pandemic admissions were suitable for active treatment, of which 48% (13/27) received definitive treatment (11 ureteroscopy (URS), 2 shockwave lithotripsy (SWL)) all within 48 hours of admis-sion. 52% (14/27) had temporising procedures (11 stented, 3 nephrostomized) and underwent definitive treatment within 63 days. Of the total patients, 36% (26/72) were admitted peri-pandemic. 23% (6/26) were septic (1 stent, 5 nephrostomized), while 31% (8/26) were managed conservatively. 46% (12/26) were suitable for active treatment. 75% (9/12) received definitive treatment (4 URS, 5 SWL) of which 33% (4/12) within 48 hours and the remaining treated and stone free within 12 days. 25% (3/12) had temporising procedures (2 stented, 1 nephrostomized), with the definitive treatment provided within 17 days. Conclusion Ureteric colic admissions were reduced by almost half during the pandemic. There has been increased primary treatment with a reduction in temporising procedures and time to receiving definitive treatment. In the ‘new normal,’ lessons learned must be carried forward to maintain high rates of definitive treatments.