The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide

A mobile health application for prostate cancer antigen dosage: is it time to say goodbye to classic screening methods?

OBJECTIVE

To evaluate the quality of apps for prostate cancer antigen (PSA) dosage, available for downloading on the iOS and Android platforms, discussing the potential role of mobile health applications (MHAs) in update the screening protocol.

METHODS

An observational cross-sectional descriptive study of all smartphone apps for PSA dosage was performed through the most used platforms (iOS and Android). On 10 February 2023, a total of 457 apps were found according to the search criteria. Mobile Application Rating Scale (MARS) was adopted to assess apps' quality. Then, MARS items were analyzed through descriptive statistics and bivariate correlations between study variables with Pearson's coefficient.

RESULTS

Of all samples, 24 MHAs were included in the final analysis: 12% (n = 3) from the iTunes App Store and 88% (n = 21) from the Google Play Store. According to the MARS quality assessment, the mean values 2.61, 2.94, 3.11, 2.97, 2.94, and 2.63 were measured for the engagement, functionality, aesthetics, information, overall mean score, and subjective quality, respectively.

CONCLUSION

The MHAs for PSA were under the acceptability threshold and future improvements are required. Moreover, MHAs appropriately developed could play an active role in PSA screening campaign and adherence of follow-up regimens. Finally, the virtual instrument could both reduce the social divide of access to care for patients in rural areas and improve PCA detection, speeding up the active treatment.

Practical Strategies for Addressing Video Visit Access Barriers in Urology

Purpose:

Since March 2020, telehealth has been a major part of health care delivery. Observational studies have shown that seniors, minorities, low-income Americans, and rural Americans have proportionally greater challenges in accessing telehealth compared with their counterparts. However, strategies to overcome these challenges have not been fully addressed. The objective of this study was to understand in greater detail the challenges patients face with video visits and introduce specific strategies to address these problems.

Methods:

We collected data on the technical barriers faced by patients through phone calls from a medical student-run volunteer program that assisted patients with telehealth visits through an electronic health record referral system.

Results:

Our study identified 4 main issues faced by patients that prevent successful video visits: (1) completion of registration steps, (2) familiarity with accessing and using video conferencing software, (3) attainment of proxy access for parents of a pediatric patient, and (4) resolution of miscellaneous technical queries. We addressed these issues through a structured workflow algorithm, which provided patients with an opportunity to receive a live walk-through of the steps for registering for a video visit, practice with video conferencing software, and guidance to resources and answers to any issues in the process.

Conclusion:

This study provides practical guidance for overcoming the challenges that patients face with video visits. These strategies can be used in any urology practice to improve video visit adoption and telehealth access in patient populations where challenges may exist.

Effect of COVID-19 on Graduating Urology Resident Case Logs: Analysis of the Accreditation Council of Graduate Medical Education National Data Reports

OBJECTIVE

To assess the national case logs of the first graduating urologic resident cohorts to have trained during the COVID-19 pandemic for effects on surgical volumes.

METHODS

The nationally aggregated Accreditation Council for Graduate Medical Education urology resident case logs were obtained for graduates of academic years (AYs) 2015-2016 through 2020-2021. Case volume differences for tracked index categories were compared between AYs with a 1-way analysis of variance. Data were then combined into pre-COVID and COVID-affected resident cohorts and differences in average cases logged were analyzed with 2-tailed student's t-tests.

RESULTS

Graduating urology residents logged an average of 1322 (SD 24.8) cases over their residency during the examined period. Total cases had multiple statistical differences between AYs but the only index category with a statistically significant decrease for a COVID-affected AY compared to pre-COVID AY was pediatric majors: AY 2020-2021 logged fewer cases than AY 2015-2016 (53.9 vs 63.0, P = .004) and AY 2018-2019 (53.9 vs 61.2, P = .04). When aggregated into pre- and COVID-affected cohorts, both pediatric minor (123.4 vs 117.5, P = .049) and pediatric major (61.4 vs 56.8, P = .003) case averages decreased for the COVID-affected cohort of residents, but no adult index category decreased.

CONCLUSION

National graduating urology resident surgical volume for adult index categories was maintained through the pandemic. Pediatric cases saw a statistical decrease in volume of questionable clinical significance. This does not eliminate concern that individuals may have experienced a detrimental impact on their resident education.

Analysis of quality information provided by "Dr. YouTubeTM" on Phimosis

The objective of the current study was to evaluate the quality of the information provided in YouTube^TM videos on phimosis. The term “phimosis” was searched on YouTube^TM, and the Patient Education Materials Assessment Tool (PEMAT) for Audio/Visual Materials (Understandability and Actionability sections, good-quality score of minimum 70%) and misinformation scale (rated from 1 to 5) were used to assess video quality. Quality assessment was investigated over time. Of all, 60 were eligible for analysis. Healthcare providers were the authors of 75.0% of the videos, and 73.3% of the videos were patient-targeted. The median Understandability score was 42.9% (interquartile range [IQR]:34.5–58.9) and ranged from 28.6 to 42.9% (2013–2020). The median Actionability score was 50.0% (IQR:25.0–56.2) and ranged from 25.0 to 50.0% (2013–2020). The median misinformation score was 2.8/5 (IQR:1.6–3.6), and although the score fluctuated over time, the median score was 2.6 both in 2013 and in 2020. According to our results, although an increase of PEMAT over time was observed, the overall quality of the information uploaded on YouTube^TM is low. Therefore, at present, YouTube^TM cannot be recommended as a reliable source of information on phimosis. Video producers should upload higher-quality videos to help physicians and patients in the decision-making process.