ABSTRACT
Daily healthcare is becoming increasingly costly and resource-intensive, requiring vast human and financial resources. The primary aim of the present study was to present the initial findings regarding the diagnostic accuracy of a novel telemedicine platform, DermaCheckup, when compared with face-to-face clinical appointments. The secondary aim was to assess whether patient management plans produced via this telemedicine platform differ from those decided upon following a face-to-face dermatological consultation. The difference in time to diagnosis between the tele-dermatology platform and standard care was also assessed. The DermaCheckup teledermatology service was implemented in March, 2020 as the COVID-19 pandemic emerged in the UK. The present study assessed patients who underwent a face-to-face clinical consultation, who, prior to visiting the clinic, used the teledermatology platform; thus, the diagnosis made via teledermatology was able to be compared to that made following standard care. Comparisons were made between diagnosis, process of diagnosis and the time to diagnosis. A total of 29 consecutive patients entering one UK dermatology clinic were included in the study. The COVID-19 pandemic resulted in face-to-face visits being challenging, owing to the risk of transmission of SARS-CoV-2. This limited the number of patients recruited into the study. The DermaCheckup application exhibited a very good level of agreement in terms of diagnosis with traditional face-to-face appointments. In the present study cohort, 93% of the patients could have been managed safely or referred immediately for a biopsy, thus avoiding a visit to the hospital. A substantial important improvement was also observed in the efficiencies that can be potentially achieved; the time to manage a patient decreased between 46-22-fold without considering the waiting time required between the time of organizing an appointment to the actual appointment.
ABSTRACT
BACKGROUND: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.
