Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre.

PURPOSE: Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. METHODS: Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. RESULTS: Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. CONCLUSION: Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

The Irish experience of kidney transplantation among recipients with prior non-renal solid organ transplants: A retrospective study on short- and long-term outcomes.

BACKGROUND: This study aims to evaluate allograft and patient outcomes among recipients of kidney transplants after non-renal solid organ transplants. We also aim to compare our findings with recipients of a repeat kidney transplant. METHODS: We performed an analysis on kidney transplant recipients who underwent kidney transplantation after a non-renal solid organ transplant. Survival data were stratified into 2 groups: Group A (n = 37) consisted of recipients of a kidney transplant after prior non-renal solid organ transplant, and Group B (n = 330) consisted of recipients of a repeat kidney transplant. RESULTS: The 1-,5-, and 10-year graft survival (death-censored) for recipients of a kidney transplant post-non-renal solid organ transplant (Group A) were 97.3%, 91.5%, and 86.9%, compared with 97.9%, 90.2%, and 83.4% for recipients of a repeat kidney transplant (Group B) (p = .32). The 1-, 5-, and 10-year patient survival rates were 97.3%, 82.7%, and 79.1% in Group A compared to 97.9%, 90.2%, and 83.4% in Group B. Unadjusted overall patient survival was significantly lower for Group A (p = .017). CONCLUSION: Kidney transplant recipients who have undergone a previous non-renal solid organ transplant have similar allograft survival outcomes, but higher long-term mortality rates compared to repeat kidney transplant recipients.

Designing and assessing a urethral catheter skills workshop for intern doctors in a university teaching hospital.

BACKGROUND: Urethral catheterisation (UC) is a frequently performed medical procedure and catheter-related injuries can lead to significant morbidity for patients. The aims of this study are to assess interns' exposure to UC and to design, implement and assess a structured UC skills workshop for hospital interns. METHODS: A 10-item anonymous questionnaire on UC was distributed to interns in two university teaching hospitals. Respondents were invited to participate in a skills workshop. Teaching methods for correct UC technique included a lecture, a video tutorial and a simulated patient model. Participants' catheter insertion skills were assessed using a 20-item OSCE checklist when the UC workshop concluded. RESULTS: In total, 40 interns completed the initial questionnaire of whom 26 (65%) had not received any dedicated catheter skills training prior to commencing internship. Fourteen (35%) were unsupervised during their first UC. Fifteen (37%) interns attended the dedicated skills workshop. All interns found the workshop beneficial and 12 (80%) reported an improvement on confidence afterwards. Following the workshop, the mean (± standard deviation) catheter insertion OSCE score was 92% (± 14.1). CONCLUSIONS: Interns have a lack of knowledge, experience and confidence with catheter insertion. Current training models are deficient. The introduction of a structured skills workshop may help to improve catheter insertion skills among interns.

The aesthetic and cultural pursuits of patients with stroke.

BACKGROUND: There has been an increasing interest in the arts in health care, with a suggestion that the arts and aesthetics can augment patient outcomes in stroke and other illnesses. Designing such programmes requires better knowledge of the artistic, aesthetic, and cultural pursuits of people affected by stroke. The aim of this study was to obtain the insights of this group about the profile of art and aesthetic activities in their lives and the influence of stroke on these aspects. METHODS: Patients attending a stroke service were administered questions adapted from the Irish Arts Council's 2006 questionnaire on participation in aesthetics and cultural pursuits. Information was also collected on stroke type and present functional and cognitive status. Thirty-eight patients were interviewed. Of these, 20 were inpatients in hospital at the time of the interview and 18 were interviewed in an outpatient setting. RESULTS: Popular activities included mainstream cinema, listening to music, dancing, attending plays or musicals, and being outdoors. Many patients ceased these activities after their stroke, mostly because of health issues and inaccessibility. Most of the patients valued the importance of the arts in the health-care setting. CONCLUSIONS: This study gives a perspective for the first time on the aesthetic and cultural pursuits of stroke patients before their stroke. It portrays a wide variety of cultural and leisure activities and the cessation of these poststroke. It revealed the restrictions patients felt on gaining access to leisure pursuits both while in hospital and following discharge.

Focus groups with people with learning disabilities.

Focus groups are a widely accepted method in qualitative research. While there is a burgeoning literature on the methodology of focus groups, using focus groups with people with learning disabilities has received less attention so far. The article serves two purposes: (1) to review the current literature on focus groups in learning disability research and (2) to sketch four aspects that may impact on the usefulness of the focus group method with respondents with learning disabilities. Some comments on the role of focus groups in qualitative research start the article before we outline the emancipatory and participatory context of research with people with learning disabilities.

Changes in QT interval with exercise in elite male rowers and controls.

BACKGROUND: QT interval prolongation occurs at rest and during exercise in pathological left ventricular hypertrophy. However, athletes with physiological hypertrophy have normal QT at rest. The aim of this study was to compare the effect of exercise on QT in athletes with echocardiographic left ventricular hypertrophy and normal controls, and explore differences in their response. METHODS: Elite male rowers (n=15) with echocardiographic left ventricular hypertrophy, and normal volunteers (n=15) underwent 15 min of a Bruce protocol treadmill test. Electrocardiograms (ECGs) were recorded during each stage and every minute during recovery for 3 min. QT was measured at each stage. Corrected QT (QTc) was calculated using Bazett's formula. RESULTS: QT at rest was significantly greater than QT after 3 min of recovery in the controls (0.36+/-0.02 vs. 0.32+/-0.04 s; P=0.001) but not in the athletes (0.36+/-0.03 vs. 0.34+/-0.02 s; P=0.05). Regression lines for QT versus heart rate showed a strongly negative correlation in both athletes and controls (y=0.463-0.0013x (r=0.91; P<0.0001) and y=0.461-0.0013x (r=0.93; P<0.0001), respectively), but greater individual homogeneity in the athletes. CONCLUSIONS: training-induced hypertrophy does not affect the heart rate/QT relationship. The more rapid recovery in QT and homogeneity of the heart rate/QT relationship in athletes compared to controls is likely to be a benign effect of myocardial fitness, but it is hypothesised that it may contribute to arrhythmias in the unfit individual after vigorous exertion.