Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom

Background and aims Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. Methods and results A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. Conclusions Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.

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Breaking the bottle neck to enhance pediatrics renal transplantation at Soba university hospital: Role of a non-governmental organization

Healthcare in Low-resource Settings ◽

10.4081/hls.2019.7930 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Ihab B. Abdalrahman ◽

Shaima N. Elgenaid ◽

Rashid Ellidir ◽

Asma Nizar Mohammed Osman Abdallah ◽

Safa Ahmed Hassan Hamid ◽

...

Keyword(s):

Renal Transplant ◽

Quality Care ◽

Healthcare Delivery ◽

University Hospital ◽

Healthcare Delivery System ◽

Governmental Organization ◽

Low Resource ◽

Number Of Patients ◽

Stage Renal Disease ◽

The Impact

High cost and limited resources of pediatrics renal transplant in low-resource countries limits the number of transplants. However, the collaboration between government and community sector provided high quality care for these patients. Here we highlight the impact of a non-governmental organization in facilitating pediatrics renal transplant. Data was collected from files of all pediatric patients withend stage renal disease who received renal transplant between January 2010 and December 2017 at Soba University Hospital (77 patients). The 8-year period was divided into 16 intervals of 6 months each. The number of patients who received renal transplant ranged from 1 to 12 patients in each interval. There was a rise in 2017 when 21 (28.7%) patients received kidney transplant. In the last 6 months in 2017 there was a significant reduction in duration of hospital stay compared to the rest of the period; it dropped from 16.36 to 9.92 days (P=0.003). Partnership between governmental and non-governmental sectors is a good strategy in low resource area to bridge some of the gaps of healthcare delivery system.

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Impact of telephone triage in managing patient demand for same-day appointments? A before-after study in a UK general practice

British Journal of General Practice ◽

10.3399/bjgp18x697361 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697361

Author(s):

Jeffrey Chirk Fan Lau ◽

Sadia Rashid

Keyword(s):

Retrospective Cohort ◽

System Change ◽

Urgent Care ◽

Inclusion Criteria ◽

Telephone Triage ◽

Face To Face ◽

Care Services ◽

Before And After ◽

The Impact ◽

Patient Episode

BackgroundTelephone consultations are increasingly being utilised to manage patient demand for GP appointments. It’s true impact on patient care remains to be answered as existing evidence has shown mixed results.AimTo report the impact of telephone triage on: number of face-to-face (F2F) appointments offered; unplanned re-consultations with GP or urgent care services within 24 hours; and total consultation duration per patient episode.MethodA retrospective cohort study in a single suburban practice in Kent, comparing outcomes between the new telephone triage and old walk-in F2F appointment systems in managing patient requests for same-day appointments. Data was sampled across 1 week, at 3-monthly intervals over each 12-month period before and after the system change-over in April 2016.Results1198 patient encounters matched the inclusion criteria. F2F appointments were offered to 34.7% of patients after telephone triage. Although unplanned re-consultations were four times more prevalent since the system changed compared to the previous year (P<0.001), no difference was seen between those consulted by telephone only, or offered a F2F appointment after telephone triage. Overall, patient consultations by telephone triage were 2.37 minutes shorter than consultations under its predecessor (P <0.001).ConclusionTelephone triage was able to manage majority of patient problems by telephone alone, with significant reduction in consulting time per patient episode. Telephone consulting was not shown accountable for the increase in unplanned re-consultations.

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The Impact of the First Wave of the COVID-19 Pandemic on Providing Special Care Dentistry: A Survey for Dentists

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062970 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2970

Author(s):

Jacobo Limeres Posse ◽

Maria T. van Harten ◽

Caoimhin Mac Giolla Phadraig ◽

Márcio Diniz Freitas ◽

Denise Faulks ◽

...

Keyword(s):

Online Survey ◽

Geographical Area ◽

Special Care ◽

Urgent Care ◽

Professional Activity ◽

Clinical Activity ◽

Protective Measures ◽

Geographical Regions ◽

The Impact ◽

Area Of Origin

This study aimed to investigate the impact of COVID-19 on the experiences of special care dentistry providers worldwide. An online survey was administered from 10 to 31 July 2020. Age, sex, years of professional activity, COVID-19 status, geographical area of origin and length of lockdown period were recorded for all participating dentists. The relationships between these variables and the changes in clinical activity, the treated patients’ COVID-19 status and the implementation of protective measures in the dental clinic were analyzed. A total of 436 (70.6% women) dentists from 59 countries responded to the survey. Clinical activity was reduced or stopped for 79.1% of respondents. The most common change was to limit treatment to urgent care only (53.7%). Treatment under general anesthesia or deep sedation was discontinued (51.0%) or reduced (35.8%) for the majority of respondents. Male dentists were more likely to maintain their clinical activity than female dentists (p < 0.001), and respondents from North America were more likely to do so than participants from other geographical regions (p < 0.001). Dentists from Latin America and the Caribbean were more likely to report treatment of confirmed cases of COVID-19 than those from Europe (p < 0.001). The implementation of protective measures in the dental office was determined by the survey participant’s sex, intensity of clinical activity and geographical area of origin. To conclude, the provision of special care dentistry was considerably reduced in response to the pandemic. Service maintenance was mainly related to the geographical area in which the surveyed dentists worked, further exacerbating pre-existing inequalities.

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AB0904-HPR RHEUMATOLOGY NURSING AND COVID19: FIRST WAVE EXPERIENCES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1923 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1474.2-1475

Author(s):

L. Cano Garcia ◽

S. Garcia Diaz ◽

S. P. Fernandez-Sanchez ◽

C. Domínguez-Quesada ◽

M. D. C. Ordoñez Cañizares ◽

...

Keyword(s):

Nursing Education ◽

Nursing Care ◽

Day Care ◽

Work Load ◽

Clinical Activity ◽

Telephone Consultation ◽

Face To Face ◽

Audiovisual Aids ◽

The Impact ◽

Rheumatic Patients

Objectives:To know the impact of the first wave of COVID19 (March to June 2020) in the nursing activity in rheumatology and explore improvements in patient care during the pandemic situation.Methods:2 surveys were sent to nurses working in the rheumatology area (Both in the Outpatient department and day care unit) during October 2020 in Spain. The first survey had 10 questions about what happened in the rheumatology units in the first wave of the COVID19 pandemic (March to June of 2020) and the second survey had 10 questions about the standards of quality of nursing care in times of pandemic. Google forms were used to collect and analyze data.Results:32 nurses completed the survey (30 women (93.8%)) with an average age of 49.6 ± 10.2 years. 93.8% work in the outpatient clinics and 2(6.2%) in day care units. The main results of the effects of the first wave of the pandemic are as follow: 4(12.5%) nurses were transferred to other areas of the hospital, 27(84.4%) showed changes in their care activity; and in 12(37,5%) of the surveyed centers, (slightly less than half of the medical staff) left their usual activity to care for covid-19 patients. In June 2020, at the end of the first wave, 17(53.1%) reported more decompensated patients and 22(68.8%) reported that they had both telephone and face-to-face consultations; 15(46.9%) reported that their clinical activity had increased.Regarding the standards of quality during the pandemia: 27(84.4%) believed that rheumatology units should be strengthened,31(96.9%) reported the need to carry out COVID educational campaigns in rheumatic patients and 30(100%) stated that nursing education should lead that education; 31(96.7%) believed that telephone consultation should be on demand and by telephone, 25 (78.1%) considered it necessary to include video calls and the possibility of receiving reports in non-face to face care and photos. Finally, 23(71.9%) centers recorded nursing and medical telephone consultations in their medical records.Conclusion:The pandemic had a huge impact on nursing care for rheumatic patients, with difficulties associated with extra work load and changes in the dynamics of care. A readjustment of assistance has been necessary and audiovisual aids were necessary to improve telephone (non face to face) service.Disclosure of Interests:None declared

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P132 Research in the time of COVID-19: Recruitment to a clinical trial comparing models of NIV implementation in people with MND

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.173 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A64-A64

Author(s):

N Sheers ◽

M Howard ◽

L Hannan ◽

S Retica ◽

D Berlowitz

Keyword(s):

Controlled Trial ◽

Healthcare Delivery ◽

Pilot Randomised Controlled Trial ◽

Face To Face ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Participant Screening ◽

Randomised Controlled ◽

The Impact ◽

Function Testing

Abstract Introduction A pilot randomised controlled trial (RCT) examining the feasibility of a new model of non-invasive ventilation (NIV) implementation was due to commence in early 2020. Based on previous research, it was anticipated that 100% of people with motor neurone disease (MND) would be eligible, 60% would consent to participate and 20 people would be randomised in five months. The aim of this report is to describe the impact of COVID-19 pandemic contingencies on trial recruitment. Methods Report of project progress, participant screening and recruitment. Results First reports of COVID-19 coincided with study commencement and changed usual healthcare delivery. Lockdowns meant telehealth substituted for face-to-face assessment, respiratory function testing was limited and/or patients were reluctant to seek medical treatment. This modified pathway impacted evaluation of diagnosis, timing of need for NIV and procedural safety, with patients then referred specifically for a single-day hospital NIV implementation to enable face-to-face multidisciplinary assessment to aid decisions. Of 81 potential participants screened in an 8-month period, 64% were ineligible for the RCT. Despite this shift in eligibility rate, 16 people with MND have been recruited as of May 2021. Conclusion The current climate has amplified the significance of this research trial; people with MND have had reduced access to face-to-face services globally and clinicians have had to quickly adapt to a changing landscape of telemedicine and remote monitoring of patients. This trial’s screening data suggest that COVID-19 hasn’t stopped people with MND being implemented on NIV, but it has altered assessment pathways.

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O36 The impact of the COVID-19 pandemic on undergraduate medical education: a survey of students’ safety and satisfaction during breast surgery clinical placement

British Journal of Surgery ◽

10.1093/bjs/znab282.041 ◽

2021 ◽

Vol 108 (Supplement_5) ◽

Author(s):

Rehab Gasiea ◽

Rayhan Gasiea ◽

Christina Yip

Keyword(s):

Medical Education ◽

Clinical Teaching ◽

Breast Surgery ◽

Clinical Placement ◽

Clinical Activity ◽

Face To Face ◽

Team Meetings ◽

Medical Education And Training ◽

The University ◽

The Impact

Abstract Introduction COVID-19 is affecting all medical education and training. The University used in the collection of data suspended all clinical placement from mid-March 2020, resuming in-person teaching from September. To enable social distancing, the medical school and Breast Unit introduced: 1. one student per clinician per clinical activity (3-hours), 2. online learning (1-hr) and patient exposure (2 hours) in some clinical activities, 3. remote learning via Teams, and 4. personal protective equipment. Method We sent a 24-question survey to 31, 3rd and 4th year, students, who had breast surgery clinical placement between 07/09/20 and 18/12/20. The aim was to assess whether clinical activities could still feasibly be carried out, the effectiveness of COVID-19 protection, and students’ learning satisfaction. Result Our survey achieved a 65% response-rate. Over two-thirds of students had at least 3 days’ clinical placement, attending clinics, theatre, mammography, multidisciplinary team meetings and a 3-hr lecture via Teams. 90% of students had face-to-face patient interaction and 70% conducted physical examinations. All students were provided with hand-gel and masks and, at clinics, 35% of students were provided with face-shields. None of the students reported COVID-19 related symptoms during or after placement. 85% of students felt safe during their clinical placement and 95% reported satisfaction with the quality of teaching. Conclusion Notwithstanding COVID-19 restrictions, a blend of face-to-face with online clinical teaching can be safely delivered. Take-home Message Notwithstanding COVID-19 restrictions, a blend of face-to-face with online clinical teaching can be safely delivered.

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Embedding Supervised Exercise Training for Men on Androgen Deprivation Therapy Into Standard Prostate Cancer Care: A Feasibility and Acceptability Study

10.21203/rs.3.rs-133211/v1 ◽

2021 ◽

Author(s):

Sophie Reale ◽

Rebecca Turner ◽

Eileen Sutton ◽

Liz Steed ◽

Stephanie Taylor ◽

...

Keyword(s):

Prostate Cancer ◽

Exercise Training ◽

Androgen Deprivation Therapy ◽

Cancer Care ◽

Professional Training ◽

Androgen Deprivation ◽

Face To Face ◽

Supervised Exercise ◽

Rate Maximum ◽

The Impact

Abstract Lifestyle interventions involving exercise training offset the adverse effects of androgen deprivation therapy in men with prostate cancer (PCa). Yet provision of integrated exercise pathways in cancer care is sparse. This study assessed the feasibility and acceptability of an embedded supervised exercise training intervention into standard PCa care in a single-arm, multicentre prospective cohort study. Feasibility included recruitment, retention, adherence, fidelity and safety. Acceptability of behaviourally informed healthcare and exercise professional training was assessed qualitatively. Despite the imposition of lockdown for the COVID-19 pandemic, referral rates into and adherence to, the intervention was high. Of the 45 men eligible for participation, 79% received the intervention. Patients completed a mean of 27 minutes of aerobic exercise per session (SD=3.48), at 77% heart rate maximum (92% of target dose), and 3 sets of 10 reps of 3 resistance exercises twice weekly for 12 weeks, without serious adverse event. The intervention was delivered by healthcare and exercise professionals with moderate to high fidelity and the intervention was deemed highly acceptable to patients. The impact of societal changes due to the pandemic on the delivery of this face-to-face intervention remain uncertain but positive impacts of embedding exercise provision into PCa care warrant long-term investigation.

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The impact of the creation of a venous surgical centre within the department of cardiovascular surgery at a university hospital

Phlebology The Journal of Venous Disease ◽

10.1258/026835507780346150 ◽

2007 ◽

Vol 22 (2) ◽

pp. 70-74 ◽

Cited By ~ 2

Author(s):

J T Christenson

Keyword(s):

Surgical Procedures ◽

Cardiovascular Surgery ◽

Physician Satisfaction ◽

University Hospital ◽

Treatment Modalities ◽

Clinical Activity ◽

Patient Volume ◽

The Creation ◽

New Treatment ◽

The Impact

Background: The establishment of specialty vein clinics has proven beneficial in terms of expansion of clinical volume. Depending on the local situation, the creation of a venous surgical centre may, in addition, result in better collaboration between various specialties, enable active participation in the development and evaluation of new treatment modalities, offer better training/education and provide venues for more complex treatment modalities such as reconstructive surgery of the deep venous system. Objectives: The aim of this study was to analyse the impact of the creation of a venous surgical centre under the auspices of a department of cardiovascular surgery at a university hospital. Methods: A venous surgical centre was established on 1 October 2003, under the direction of one senior surgeon. The impact on clinical activity was measured in terms of patient volume, percentage distribution between venous and arterial surgery and surgical procedures performed, complications following venous surgery as well as evaluation of patient and referring physician satisfaction. Data, from the department's databank, on all patients evaluated and surgically treated for venous and arterial problems from 1 January 2000 to 30 June 2006 were analysed. Number of outpatient clinic visits and operations (patients and surgical procedures) were calculated. Results: The establishment of the venous surgical centre, without additional funding, led to a significant increase in clinical volume. There was a 433% increase in vein surgical procedures and a 774% increase in outpatient clinic visits (comparing 2002 with 2004). Endovenous laser treatment of varicose veins and reconstructive surgery for the deep venous system was started, and a program for training surgeons was established. Complication rate following varicose vein surgery decreased from 5.8% to 1.2% (hematomas and groin infection). Patient and referring physician satisfaction was documented in 2004 and 2006 using questionnaires. Conclusions: The establishment of an academic venous surgical centre has proven useful in increasing clinical activity in terms of patient volume, providing more efficient and better continuity of care, ensuring less complications following varicose vein surgery, allowing the introduction of new treatment modalities, and resulting in overwhelming patient and treating physician satisfaction.

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Web-Based Activity Within a Sexual Health Economy: Observational Study (Preprint)

10.2196/preprints.8101 ◽

2017 ◽

Author(s):

Katy ME Turner ◽

Adam K Zienkiewicz ◽

Jonathan Syred ◽

Katharine J Looker ◽

Joia de Sa ◽

...

Keyword(s):

Sexual Health ◽

Service Use ◽

Total Activity ◽

Health Economy ◽

Clinical Activity ◽

Web Based ◽

Face To Face ◽

Sti Testing ◽

The Impact ◽

The Web

BACKGROUND Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need. OBJECTIVE The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead. METHODS Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other. RESULTS Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period—2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses. CONCLUSIONS This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion.

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Impact of the COVID-19 pandemic on new starts to oral oncology medications in the US

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211073778 ◽

2022 ◽

pp. 107815522110737

Author(s):

Lynn Neilson ◽

Monal Kohli ◽

Kiraat D Munshi ◽

Samuel K Peasah ◽

Rochelle Henderson ◽

...

Keyword(s):

Prostate Cancer ◽

Drug Users ◽

Healthcare Delivery ◽

Cancer Drug ◽

Prescription Data ◽

Cancer Disease ◽

The Us ◽

Oral Oncology ◽

The Impact ◽

Post Period

Introduction The COVID-19 pandemic has had a significant impact on healthcare delivery. Although others have documented the impact on new cancer diagnoses, trends in new starts for oncology drugs are less clear. We examined changes in new users of oral oncology medications in the US following COVID-19 stay-at-home orders in 2020 compared to prior years. Methods We examined prescription data for members enrolled with a national pharmacy benefits manager in the US from January 1-October 31 of 2018, 2019, and/or 2020. This is a retrospective, observational study comparing new users per 100,000 members per month for all oral oncology drugs, and separately for breast, lung, and prostate cancer, leukemia, and melanoma oral drugs. We performed a difference-in-differences analysis for change in new users from pre-period (prior to pandemic-induced disruption, January-March), to post-period (following pandemic-induced disruption, April-October), between 2020 and 2019, and 2020 and 2018. Results New oral oncology drug users per 100,000 members per month declined by an additional 11.3% in the 2020 post-period compared to 2019 ( p = 0.048). New oral breast cancer drug starts declined by an additional 14.0% in the 2020 post-period compared to 2019 ( p = 0.040). Similar but non-significant trends were found between 2020 and 2018. No significant differences were found between post-period monthly new starts of leukemia, melanoma, lung or prostate cancer disease-specific oral medications. Conclusions Long-term implications of delays in cancer treatment initiation are unclear, although there is concern that patient outcomes may be negatively impacted.

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