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BJU International ; 09:09, 2022.
Article in English | MEDLINE | ID: covidwho-2019160

ABSTRACT

OBJECTIVES: To determine if management of ureteric stones in the United Kingdom changed during the COVID-19 pandemic and whether this affected patient outcomes. PATIENTS AND METHODS: We conducted a multicentre retrospective study of adults with CT-proven ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/19 to 22/6/19) and a period during the pandemic (the 3-month period after the first SARS-CoV-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection. RESULTS: A total of 3735 patients were included (pre-pandemic=1956 patients;pandemic=1779 patients). Stone size was similar between groups (p>0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic=54.0% vs pandemic=46.5%, p<0.001), shorter length of stay (mean=4.1 vs. 3.3 days, p=0.02), and higher rates of use of medical expulsive therapy (17.4% vs. 25.4%, p<0.001). In patients who received interventional management (pre-pandemic n=787 vs. pandemic n=685), rates of ESWL (22.7% vs. 34.1%, p<0.001) and nephrostomy were higher (7.1% vs. 10.5%, p=0.03);and rates of ureteroscopy (57.2% vs. 47.5%, p<0.001), stent insertion (68.4% vs. 54.6%, p<0.001), and general anaesthetic (92.2% vs. 76.2%, p<0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic=73.8% vs. pandemic=76.1%, P=0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and readmission and renal function at 6 months did not differ between the data collection periods. CONCLUSIONS: During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community.

2.
Journal of Clinical Urology ; 15(1):72, 2022.
Article in English | EMBASE | ID: covidwho-1957024

ABSTRACT

Introduction: The COVID-19 pandemic has disrupted surgical services. We aimed to assess 30-day post-operative outcomes following urological cancer surgery during the COVID-19 pandemic. Patients and Methods: All bladder, kidney, UTUC and prostate cancer patients from the COVIDSurg-Cancer Study who underwent elective, potentially-curative surgery during the COVID-19 pandemic until July 2020 were included. Univariable and multivariable logistic regression was performed to assess the association of patient factors with mortality, respiratory complications, and operative complications. Results: 1,902 patients from 36 countries were included. 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed;of those, 8 (38.1%) were diagnosed with COVID-19. Mortality was more likely with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4- 81.4, p<0.001), age >80 years, ASA grade ≥3 and ECOG Grade ≥1. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.4-144.5, p<0.001), age >70 years, from an area with high community risk, or with a revised cardiac risk index ≥1. There were 84 (4.4%) major complications (Clavien-Dindo ≥3). Patients with a concurrent COVID-19 infection (OR 7.5, 95%CI 2.7-20.3, p<0.001), or aged ≥80 years were more likely to experience major complications. Conclusions: Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.

3.
Journal of Clinical Urology ; 15(1):8-9, 2022.
Article in English | EMBASE | ID: covidwho-1957015

ABSTRACT

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.

4.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927852

ABSTRACT

Rationale: 'Cardiac Effort' (CE), the total number of heart beats used during the 6-minute walk test (6MWT) divided by walk distance (beats/m), improves reproducibility in the 6MWT and correlates with right ventricular function in pulmonary arterial hypertension (PAH). The SARS-CoV-2 pandemic made in-office 6MWT challenging. We aimed to determine 1) whether a chestbased accelerometer could estimate 6MWT distance in the clinic and remotely;2) the reproducibility of CE measured during a remote 6MWT;and 3) the safety of remote 6MWT. We also compared measures of heart rate (HR) derived from electrocardiogram (ECG) and wrist-based photoplethysmography (PPG) during the 6MWT in PAH. Methods: This was a singlecenter, prospective observational study with IRB approval completed October 2020-April 2021. Group 1 PAH subjects on stable therapy for >90 days completed 4-6 total 6MWT during a 2 week period to assess reproducibility;we anticipated no clinical change during this short interval. The first and last 6MWT were performed in the clinic;2-4 remote 6MWT were completed at participant's discretion. Participants did not wear masks but did wear the MC10 Biostamp nPoint sensors to measure ECG HR and accelerometry. Two blinded readers estimated 6MWT distance using raw accelerometry data. We measured PPG HR with a wrist Nonin 3150 pulse oximeter during clinic 6MWT only. Averages of clinic variables and remote variables were used for paired Student's t test, Bland-Altman Plot, or Pearson correlation. Results: We enrolled 20 participants: 80% female;60% connective tissue disease;and 65% on initial combination therapy with ambrisentan and tadalafil. There was a wide range in baseline, clinicperformed 6MWT distance (220 -570 m). The median length of the remote 'hallway' was 40 ft. For clinic walks, there was 0.10% average difference between the directly observed and Biostamp accelerometry-estimated 6MWT distance with a strong correlation of r=0.99, p<0.0001 (figure 1). The 6MWT distance estimated using Biostamp in the clinic was greater than what was estimated remotely, 405 m vs. 389 m, p=0.007. There was no clear difference between clinic or remote CE, 1.83 beats/m vs 1.93 beats/m, p=0.14, or Borg Dyspnea Index, 3.5 vs 3.4, p=0.35. There were no safety concerns. PPG undercounted total HR expenditure during 6MWT compared to Biostamp (629 vs 719, p<0.0001). Conclusion: Remote 6MWT was feasible, appeared safe, and 6MWT distance was shorter than clinic distance. CE calculated by ECG HR and accelerometer-estimated distance provides a reproducible remote assessment of exercise tolerance, comparable to the clinic measured value. (Figure Presented).

8.
BMJ Innovations ; 2020.
Article in English | Scopus | ID: covidwho-901352

ABSTRACT

Following the outbreak of the novel SARS-CoV-2 (COVID-19), the World Health Organization made a number of recommendations regarding the utilisation of healthcare services. In general, there has been a reduction in elective healthcare services including outpatient clinics, diagnostic services and elective surgery. Inevitably these reductions for all but the most urgent clinical work will have a detrimental impact on patients, and alternative ways of working including the use of telemedicine may help to mitigate this. Similarly, electronic solutions may enable clinicians to maintain inter and intra-professional working in both clinical and academic settings. Implementation of electronic solutions to minimise direct patient contact will be new to many clinicians, and the sheer number of software solutions available and varying functionality may be overwhelming to anyone unfamiliar with â virtual communication'. In this article, we will aim to summarise the variety of electronic communication platforms and tools available for clinicians and patients, detailing their utility, pros and cons, and some 'tips and tricks' from our experience through our work as an international research collaborative. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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