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Parveen S, Amjad M, Rauf SA, Arbab S, Jamalvi SA, Saleem SEUR, Ali SK, Bai J, Mustansir M, Danish F, Khalil MA, Haque MA. Surgical decision-making in the digital age: the role of telemedicine - a narrative review. Ann Med Surg (Lond) 2025; 87:242-249. [PMID: 40109606 PMCID: PMC11918621 DOI: 10.1097/ms9.0000000000002874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 12/07/2024] [Indexed: 03/22/2025] Open
Abstract
This narrative review delves into the transformative role of telemedicine in the realm of surgical decision-making. Telemedicine, a significant innovation in healthcare services, leverages electronic information and communication technologies to provide healthcare services when distance separates the participants. It addresses the challenges of increased healthcare demands, an aging population, and budget constraints. Telemedicine technologies are employed for pre- and postoperative consultations, monitoring, and international surgical teleconferencing and education. They enhance healthcare access, particularly in remote areas, and facilitate knowledge sharing among healthcare professionals. The review also provides a historical context and discusses the technological advancements in telemedicine, including the rise of digital health technologies and the integration of artificial intelligence and machine learning in healthcare. It delves into the details of telemedicine technologies such as telesurgery, telerobotics, telepathology, teleimaging, remote patient monitoring, and virtual and augmented reality. Despite the numerous benefits, the implementation of telemedicine is often hindered by various complex and diverse ethical and legal concerns, including privacy and data security. The review highlights the need for further evidence on health outcomes and cost savings, bridging the digital divide, and enacting policies to support telemedicine reimbursement. It also emphasizes the need for incorporating telemedicine modules in medical education. It recommends that policy-making bodies consider utilizing telemedicine to address healthcare coverage gaps, particularly in rural areas.
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Affiliation(s)
| | - Maryam Amjad
- Liaquat National Medical College, Karachi, Pakistan
| | | | | | | | | | | | - Jaiwanti Bai
- Liaquat National Medical College, Karachi, Pakistan
| | | | - Fnu Danish
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Md Ariful Haque
- Department of Public Health, Atish Dipankar University of Science and Technology, Dhaka, Bangladesh
- Voice of Doctors Research School, Dhaka, Bangladesh
- Department of Orthopaedic Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China
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Kazeem AO, Hasken W, Sims T, Culp SH, Krupski TL, Lobo JM. Patient Satisfaction with a Novel Tele-Cystoscopy Model: Expanding Access to Bladder Cancer Surveillance for Rural Patients. TELEMEDICINE REPORTS 2024; 5:229-236. [PMID: 39143957 PMCID: PMC11319854 DOI: 10.1089/tmr.2024.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/16/2024]
Abstract
Background Tele-cystoscopy involves trained advanced practice providers performing cystoscopy with real-time interpretation by an urologist. The goal of this externally validated care model is to expand the availability of cystoscopy to underserved rural areas. Herein we report on population demographics and describe the socioeconomic benefits of tele-cystoscopy for bladder cancer surveillance. Methods Using an IRB-approved protocol, patients were consented for dual, sequential cystoscopy wherein they experienced a standard-of-care cystoscopy along with tele-cystoscopy. Patients completed a questionnaire that contained both subjective and objective health and socioeconomic-related questions as well as a satisfaction survey. Patients were also probed about factors associated with transportation to their cystoscopy appointments including gasoline costs, travel time, and time off work. Using the Distressed Community Index, patients were ascribed an economic resource category ranging from prosperous to distressed. Results In total, 48 patients with a mean age of 55 completed surveys after completing dual cystoscopies. Thirteen patients (27%) were uninsured and 10 patients (20%) had Medicaid as primary insurance. The tele-cystoscopy clinic saved patients an average of 235 miles and 434 min of travel time. In total, 82% of patients resided in a distressed community indicating fewer economic resources. Satisfaction results showed a mean score of 31.38 (out of 32). Conclusions Patients were satisfied with tele-cystoscopy, noting increased access to health care and fewer disruptions impacting bladder cancer surveillance. Tele-cystoscopy may be a viable option to expand access and improve adherence to guidelines for bladder cancer surveillance, particularly benefiting patients in rural areas and those of lower socioeconomic status.
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Affiliation(s)
- Aisha O. Kazeem
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - William Hasken
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Terran Sims
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen H. Culp
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Tracey L. Krupski
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer M. Lobo
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Pilone G, Hentrich T, Schnieders J, Jakubek F, Prugger V, Glasberger M, Mangler M. Prospective Randomized Study on the Use of Robot-Assisted Postoperative Visits. Telemed J E Health 2024; 30:2363-2372. [PMID: 38966967 DOI: 10.1089/tmj.2023.0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Introduction: Robot-assisted visits, as part of telemedicine, can offer doctors the opportunity to take care of patients. Due to the COVID-19 pandemic, there has been an increase in telemedicine. The use of teleconsultations, for example, has found its way into the German health care system. However, the practicability and the benefit of robot-assisted postoperative visits have not been systematically investigated in any study worldwide. Methods: Patients were enrolled in a prospective randomized study comparing the standard postoperative visit with the doctor on call and the digital visit through the Double robot between December 2019 and April 2022. All patients and doctors completed a survey after the visit. The primary outcome was patient satisfaction. Secondary outcomes included patients' pain, hospitalization time, and patients' opinions about the usefulness of the robot. Likert scales of arithmetic mean, standard deviation, and subgroup analyses with the Mann-Whitney U test and the Fisher's exact test were used to compare outcomes. Results: We enrolled a total of 106 patients: 54 (50.9%) of them underwent the robot visit and 52 (49.1%) underwent the conventional visit. Baseline demographic and clinical characteristics were similar between groups. Our primary outcome was the same in both arms. Similar results were obtained for the secondary endpoints. Conclusion: Robot-televisits were comparable with standard visits including satisfaction, usefulness, and time of hospitalization. Digitalization in medicine is an irreversible process, especially after the COVID-19 pandemic. We hope that our study will provide concrete help to encourage the allocation of funds for telemedicine in Germany's health care system.
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Affiliation(s)
- Giordana Pilone
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Tino Hentrich
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Jutta Schnieders
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Farnaz Jakubek
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Vera Prugger
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Marit Glasberger
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Mandy Mangler
- Department of Obstetrics and Gynecology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
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Koumpias AM, Fleming O, Lin LA. Association of licensure and relationship requirement waivers with out-of-state tele-mental health care, 2019-2021. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae026. [PMID: 38756180 PMCID: PMC11034529 DOI: 10.1093/haschl/qxae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 05/18/2024]
Abstract
During the COVID-19 public health emergency, states waived in-state licensure and pre-existing patient-physician relationship requirements to increase access to care. We exploit this state telehealth policy variation to estimate the association of in-state licensure requirement waivers and pre-existing patient-physician relationship requirement waivers with out-of-state tele-mental health care utilization of patients diagnosed with COVID-19. Using claims from January 2019 until December 2021 of 2 037 977 commercially insured individuals in 3 metropolitan statistical areas (MSAs) straddling Midwestern state borders, we found increased out-of-state telehealth utilization as a share of out-of-state mental health care by 0.1411 and 0.0575 visits per month or 1679.76% and 467.48% after licensure and relationship waivers, respectively. Within-MSA analyses illustrate an urban-rural digital divide in out-of-state utilization as a share of total or telehealth mental health care. Our findings indicate waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state health care online. Interstate medical licensure compact participation may provide broader access to out-of-state tele-mental health care than emergency waivers.
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Affiliation(s)
- Antonios M Koumpias
- Department of Social Sciences, University of Michigan-Dearborn, Dearborn, MI 48128, United States
| | - Owen Fleming
- Department of Economics, Wayne State University, Detroit, MI 48202, United States
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, United States
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, United States
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5
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Duong T, Kieran K. Comparing Telemedicine and In-Person Clinical Evaluations for Pediatric Urology Concerns. J Surg Res 2024; 295:281-288. [PMID: 38056354 DOI: 10.1016/j.jss.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Telemedicine may promote equitable health care delivery, particularly in rural and underserved regions. While patient and provider satisfaction with telemedicine appear to be high, it remains unclear if telemedicine accomplishes the same clinical goals as in-person clinic visits. We undertook this study to compare the differences in history-taking, physical examination, and recommended follow-up in new pediatric urology patients seen via telemedicine and in-person. METHODS This cross-sectional study was performed by retrospectively reviewing the charts of all new patients visiting the general pediatric urology clinic at a single freestanding children's hospital in January and April of three consecutive years (2019, 2020, 2021). Data were abstracted on patient demographics, comprehensiveness of history of present illness, completeness of physical examination, and recommended follow-up. Patients seen by telemedicine and in-person were compared. RESULTS Of 1354 patients, 1244 (91.9%) had in-person and 110 (8.1%) telemedicine visits. Telemedicine patients had a median of 4 history of present illness components recorded; in-person patients had 3 (P < 0.0001). Patients seen in-person had a more comprehensive physical examination recorded compared with telemedicine patients (median 12 vs 2 systems, P < 0.0001). Significantly fewer telemedicine patients were discharged from clinic after the initial visit (2.7% vs 16.5%), and significantly more were asked to return for additional evaluation (39.1% vs 23.2, P < 0.0001). CONCLUSIONS Initial pediatric urology telemedicine consultations gathered more historical and fewer physical examination components and were more likely to require an additional clinic visit for evaluation. Goals of care should be considered when selecting a visit modality.
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Affiliation(s)
- Trang Duong
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington; Department of Urology, University of Washington, Seattle, Washington.
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Zeng N, Liu MC, Zhong XY, Wang SG, Xia QD. Knowledge mapping of telemedicine in urology in the past 20 years: A bibliometric analysis (2004-2024). Digit Health 2024; 10:20552076241287460. [PMID: 39421308 PMCID: PMC11483830 DOI: 10.1177/20552076241287460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/10/2024] [Indexed: 10/19/2024] Open
Abstract
Telemedicine refers to the process of utilizing communication technologies to exchange disease information, perform surgery and educate care providers remotely, breaking through the distance limit and promoting the health of individuals and communities. The fifth-generation (5G) technology and the COVID-19 pandemic have greatly boosted studies on the application of telemedicine in urology. In this study, we conduct a comprehensive overview of the knowledge structure and research hotspots of telemedicine in urology through bibliometrics. We searched publications related to telemedicine in urology from 2004 to 2024 on the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace and R package "bibliometrix" were employed in this bibliometric analysis. A total of 1,357 articles from 97 countries and 2,628 institutions were included. The number of annual publications on telemedicine in urology witnessed a steady increase in the last two decades. Duke University was the top research institution. Urology was the most popular journal, and Journal of Medical Internet Research was the most co-cited journal. Clarissa Diamantidis and Chad Ellimoottil published the most papers, and Boyd Viers was co-cited most frequently. Effectiveness evaluation of telemonitoring, cost-benefit analysis of teleconsultation and exploration of telesurgery are three main research hotspots. As the first bibliometric analysis of research on telemedicine in urology, this study reviews research progress and highlights frontiers and trending topics, offering valuable insights for future studies.
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Affiliation(s)
- Na Zeng
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei-Cheng Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-Yu Zhong
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-Gang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi-Dong Xia
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Leslie K, Myles S, Schiller CJ, Alraja AA, Nelson S, Adams TL. Protecting the public interest while regulating health professionals providing virtual care: A scoping review. PLOS DIGITAL HEALTH 2023; 2:e0000163. [PMID: 37115785 PMCID: PMC10146454 DOI: 10.1371/journal.pdig.0000163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. After screening, 59 academic articles and 18 grey literature sources were included for analysis. We identified five key findings: the public interest when regulating health professionals providing virtual care was only implicitly considered in most of the literature; when the public interest was discussed, the dimension of access was emphasized; criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care; subnational licensure was viewed as a barrier; and the demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Overall, virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness.
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Affiliation(s)
| | - Sophia Myles
- Athabasca University, Athabasca, Alberta, Canada
- University of Toronto, Toronto, Ontario, Canada
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Symeonidis EN, Veneziano D, Borgmann H, Zapała Ł, Zachariou A, Brenneis H, Haensel SM, Haas H, Dimitriadis F. Telemedicine in Urology: Where Have We Been and Where Are We Heading? EUR UROL SUPPL 2023; 50:106-112. [PMID: 36910337 PMCID: PMC9999165 DOI: 10.1016/j.euros.2023.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
CONTEXT Humanity is facing significant challenges, and in 2019, a new coronavirus caused an unprecedented global disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic vastly impacted health care delivery, generating devastating economic, social, and public health disruption. Although previously underutilized, it was not until recently that telemedicine emerged and amassed tremendous popularity. OBJECTIVE To examine and assess telemedicine's past, present, and future roles in urology. EVIDENCE ACQUISITION We queried relevant literature investigating the role of telemedicine in urology using the electronic PubMed database and mainly focused on English-language studies of any design. EVIDENCE SYNTHESIS Growing attention has been paid to the widespread adoption of novel telehealth technologies for managing various diseases. Meanwhile, solid evidence supports the meaningful use of telemedicine for most urological diagnoses. Existing literature delineates telemedicine as a viable, safe, and convenient alternative to in-person clinical visits. CONCLUSIONS The present article overviews the evolution of telemedicine in urology, and discusses its application in outpatient and physician's office settings. In addition, it highlights the technical, legal, ethical, and financial aspects of telemedicine while providing valuable insights and practical considerations for the future of telehealth in urology. PATIENT SUMMARY Urologists must adopt telemedicine carefully in daily practice, always adhering to predefined regulatory frameworks.
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Affiliation(s)
- Evangelos N. Symeonidis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | | | - Hendrik Borgmann
- Department of Urology, University Hospital Medical School Brandenburg, Brandenburg an der Havel, Germany
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Horst Brenneis
- Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan M. Haensel
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | | | - Fotios Dimitriadis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Teplitsky SL, Bylund J, Bettis A, Pearson K, Waters T, Harris AM. An analysis of state-reported hospital transfer data of urology patients. Curr Urol 2023. [DOI: 10.1097/cu9.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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10
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Lindenfeld Z, Berry C, Albert S, Massar R, Shelley D, Kwok L, Fennelly K, Chang JE. Synchronous Home-Based Telemedicine for Primary Care: A Review. Med Care Res Rev 2023; 80:3-15. [PMID: 35510736 DOI: 10.1177/10775587221093043] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Synchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.
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Affiliation(s)
- Zoe Lindenfeld
- New York University School of Global Public Health, New York City, USA
| | | | | | | | - Donna Shelley
- New York University School of Global Public Health, New York City, USA
| | | | | | - Ji Eun Chang
- New York University School of Global Public Health, New York City, USA
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Abstract
Bladder cancer as one of the main comorbid diseases might be more susceptible to develop COVID-19 infection with a higher mortality risk during the COVID-19 pandemic. The European Association of Urology (EAU) recommended a comprehensive panel for bladder cancer diagnosis and treatment during this global health problem. The urgent need for treatments of COVID-19 during the pandemic has persuaded researchers to evaluate the different medications, which may lead to drug shortages. Therefore, in this review paper, we have focused on the least recommendations of EAU about bladder cancer during of COVID-19 pandemic to provide a comprehensive panel for high-risk patients.
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Affiliation(s)
- Shahede Khansary
- Department of Gynecology, Faculty of Medicine, Hamadan university of Medical Sciences, Hamadan, Iran
| | - Heidar Tavilani
- Department of Clinical Biochemistry, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hadi Ghasemi
- Autophagy Research Center, Department of Biochemistry, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
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Calleja Hermosa P, Campos-Juanatey F, García-Baquero R, Ponce de Leon Roca J, Martínez-Salamanca JI. The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey. Actas Urol Esp 2022; 46:640-645. [PMID: 36216766 PMCID: PMC9334879 DOI: 10.1016/j.acuroe.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as "non-urgent" (andrology and reconstructive surgery) were postponed or even unattended. MATERIAL AND METHODS In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. RESULTS We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). CONCLUSIONS The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.
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Affiliation(s)
- P Calleja Hermosa
- Unidad de Urología Reconstructiva y Andrología, Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - F Campos-Juanatey
- Unidad de Urología Reconstructiva y Andrología, Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - R García-Baquero
- Unidad de Andrología y Cirugía Reconstructiva Urogenital, Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - J Ponce de Leon Roca
- Unidad Urología Reconstructiva de Fundació Puigvert, Coordinador nacional del Grupo de Cirugía Reconstructiva Urológica de la Asociación Española de Urología, Barcelona, Spain
| | - J I Martínez-Salamanca
- Servicio de Urología, Hospital Puerta de Hierro, Lyx Instituto de Urología, Universidad Francisco de Vitoria, Coordinador Nacional del Grupo de Andrología de la Asociación Española de Urología, Madrid, Spain
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13
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Paesano N, Carrion DM, Autrán Gomez AM. Telemedicine use in current urologic oncology clinical practice. Front Surg 2022; 9:885260. [PMID: 36338631 PMCID: PMC9629354 DOI: 10.3389/fsurg.2022.885260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the last fifteen years, there have been important technological advances in telehealth systems and urology, along with other specialties, has been a pioneer in the successful use of this medical care modality. Due to the COVID-19 pandemic, the use of telemedicine has been rapidly embraced by the urology community around the world. A review of the most relevant and updated articles on telemedicine and telehealth in urology has been carried out with the aim of better understanding how it has been implemented to date, as well as reviewing concepts, current regulations, health policies and recommendations for its implementation. METHODS A narrative review of the current literature published up to April 2022 on the use of telemedicine in urology was performed. From the search results, 42 publications were obtained for analysis. RESULTS Telemedicine in urology has been shown to be useful in a variety of clinical scenarios within urological practice, from benign diseases to advanced cancers. This is due to the positive impact on medical consultation times, lower patient mobility costs, less work absenteeism and greater protection for both the patient and the doctor. The main limitations for the use of telemedicine lie in the impossibility of a correct physical examination, which is essential in certain situations, as well as the lack of accessibility to technology in disadvantaged populations and in elderly patients who have not adapted to the use of technology, as well as the lack of development of health policies to establish their implementation in some countries. CONCLUSION Telemedicine is in full growth. There is much information in the current literature on the successful adoption of telemedicine for patients suffering from urological diseases. While the use and implementation of these new practices has been rapid in the urology community, more work is needed to bring more accessible specialty care to underserved and underdeveloped areas. Health policies must promote its development to reduce costs and increase access.
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Affiliation(s)
- Nahuel Paesano
- Department of Urology, Instituto Médico Tecnológico, Prostate Institute Barcelona, CIMA—SANITAS Hospital, Barcelona, Spain,Office of Residents and Young Urologists, Office of Residents and Young Urologists of the American Confederation of Urology (CAU), Barcelona, Spain,Correspondence: Nahuel Paesano
| | - Diego M. Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain,Department of Urology, Instituto de Cirugía Urologica Avanzada (ICUA), Clínica CEMTRO, Madrid, Spain
| | - Ana María Autrán Gomez
- Department of Urology, Lyx Urology, Madrid, Spain,Office of Research, Office of Research of the American Confederation of Urology (CAU), Madrid, Spain
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Naik N, Hameed BMZ, Nayak SG, Gera A, Nandyal SR, Shetty DK, Shah M, Ibrahim S, Naik A, Kamath N, Mahdaviamiri D, D'costa KK, Rai BP, Chlosta P, Somani BK. Telemedicine and Telehealth in Urology-What Do the 'Patients' Think About It? Front Surg 2022; 9:863576. [PMID: 35495745 PMCID: PMC9051070 DOI: 10.3389/fsurg.2022.863576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023] Open
Abstract
Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
| | - B. M. Zeeshan Hameed
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Sanjana Ganesh Nayak
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Anshita Gera
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | | | - Dasharathraj K. Shetty
- Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Milap Shah
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Sufyan Ibrahim
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aniket Naik
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Nagaraj Kamath
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Delaram Mahdaviamiri
- Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kenisha Kevin D'costa
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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15
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Calleja Hermosa P, Campos-Juanatey F, García-Baquero R, Ponce de Leon Roca J, Martínez-Salamanca JI. Impacto De La Pandemia En La Actividad De Las Unidades De Cirugía Reconstructiva Urológica Y De Andrología En España Durante El Estado De Alarma (Covid-19) En 2020: Resultados De Una Encuesta Nacional. Actas Urol Esp 2022; 46:640-645. [PMID: 35765673 PMCID: PMC9225932 DOI: 10.1016/j.acuro.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Introducción El estado de alarma debido a la COVID-19 revolucionó la actividad asistencial y quirúrgica. Dentro de la enfermedad urológica, aquellas consideradas «demorables» como la andrológica y la reconstructiva sufrieron un retraso considerable en su atención. Material y métodos En mayo de 2020, tras haber superado casi la primera ola de la pandemia y en pleno estado de alarma, se envió una encuesta con 24 ítems a 120 urólogos integrados en los Grupos de Cirugía Reconstructiva Urológica y Andrología de la Asociación Española de Urología (AEU) para conocer la repercusión asistencial sobre la actividad clínica y quirúrgica en ambas subespecialidades. Resultados Se alcanzó una tasa de respuesta del 75,8% con 91 encuestas recibidas. Previo al estado de alarma, el 49,5% disponía de uno a 2 quirófanos semanales, el 71,4% afrontaba una lista de espera quirúrgica de entre 3 y 12 meses, y el 39,6% atendía entre 20 y 40 pacientes semanales en consulta. Durante el estado de alarma, el 95,6% recibió directrices sobre cirugías a realizar, priorizando la cirugía urgente y la oncológica. En el 85,7% de los centros no se realizó ninguna cirugía andrológica ni reconstructiva. Alrededor del 50% de las consultas no fueron presenciales, recurriendo a la telemedicina (teléfono o e-mail) en la mayoría de los casos. Conclusiones Las repercusiones de la pandemia sobre las enfermedades andrológicas y las candidatas a cirugía reconstructiva fueron muy importantes. Tras casi 2 años del inicio de la pandemia, aún queda por determinar el verdadero impacto final en nuestro sistema sanitario.
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Affiliation(s)
- P Calleja Hermosa
- Unidad de Urología Reconstructiva y Andrología, Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, España
| | - F Campos-Juanatey
- Unidad de Urología Reconstructiva y Andrología, Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, España
| | - R García-Baquero
- Unidad de Andrología y Cirugía Reconstructiva Urogenital, Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - J Ponce de Leon Roca
- Unidad Urología Reconstructiva de Fundació Puigvert, Coordinador nacional del Grupo de Cirugía Reconstructiva Urológica de la Asociación Española de Urología, Barcelona, España
| | - J I Martínez-Salamanca
- Servicio de Urología, Hospital Puerta de Hierro, Lyx Instituto de Urología. Universidad Francisco de Vitoria. Coordinador Nacional del Grupo de Andrología de la Asociación Española de Urología, Madrid, España
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16
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On the use of telemedicine in the context of COVID-19: legal aspects and a systematic review of technology. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC7954684 DOI: 10.1007/s42600-021-00133-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose The aim of this study was to carry out a systematic review of telemedicine technology and to discuss the role of legislation in the application of telemedicine technology within the scope of COVID-19. Methods The search for papers was conducted in the databases Cochrane Central, MEDLINE, and Embase. The keywords considered for this systematic review were (coronavirus OR “2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19” OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*))) AND ((telemedicine OR telehealth OR “remote assessment” OR telemonitoring)). The review process was carried out by six independent reviewers, using the PRISMA-P method. Results As a result, a total of 34 papers were selected, which addressed the study of telemedicine technologies used in times of endemics, epidemics, and pandemics, focusing on COVID-19. Conclusion Telemedicine allows for care in remote areas and at a lower cost to the patient and, in the current situation, it can reduce the number of contagions as well as the occupation of beds in health facilities. Telemedicine may suffer from limitations, mainly due to current legislation, but in this pandemic era of COVID-19, several countries around the world have made their laws more flexible to allow more widespread use of telemedicine.
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17
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Ayoub CH, El-Asmar JM, Abdulfattah S, El-Hajj A. Telemedicine and Telementoring in Urology: A Glimpse of the Past and a Leap Into the Future. Front Surg 2022; 9:811749. [PMID: 35273996 PMCID: PMC8901873 DOI: 10.3389/fsurg.2022.811749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Telemedicine is the process of utilizing telecommunications and digital relay to perform, teach, or share medical knowledge. The digital era eased the incorporation of telemedicine to different areas of medical care, including the surgical care of Urologic patient mainly through telementoring, telesurgery, and telerobotics. Over the years, Telemedicine has played an integral part in a physicians' ability to provide high quality medical care to remote patients, as well as serve as an educational tool for trainee physicians, in the form of telementoring. During the COVID-19 pandemic, telemedicine has played a vital role in combatting the health implications of confinements. Challenges of telemedicine implementation include cost, ethical considerations, security, bandwidth, latency, legal, and licensure difficulties. Nevertheless, the future of telemedicine, specifically telementoring, promises several improvements and innovative advancements that aim to bridge the gap in technological divides of urologic care. In this review, we build on what is already known about telemedicine focusing specifically on aspects related to telementoring, telestration, and telesurgery. Furthermore, we discuss its historical role in healthcare with a special emphasis on current and future use in urology.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M. El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Albert El-Hajj
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18
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Bodle L, Hunger RE, Seyed Jafari SM. Comparison of teledermatological examinations with conventional office visits in management of acne vulgaris: A review of current literature. J Cosmet Dermatol 2021; 21:3292-3299. [PMID: 34859946 DOI: 10.1111/jocd.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Acne vulgaris is the most common skin disease in the world, particularly affecting adolescents and young adults. Telemedicine has grown rapidly in the past few years and represents a new simplification in modern medicine. The aim of this literature review is to provide an overview of acne vulgaris in teledermatology and to identify the differences between teledermatological examinations and face-to-face consultations. For this purpose, a systematic literature search of the PubMed database was performed, up to the end of 2019. The content of 109 studies matching the keywords acne, acne vulgaris, teledermatology, telehealth, or telemedicine was screened, and 13 studies were systematically reviewed and compared. The analysis of the studies shows that patients living in remote areas benefit greatly from online visits since it is less time consuming and financially favorable, which is also associated with higher patient satisfaction. In addition, the satisfaction of doctors, the main safety concerns of patients, and a brief insight into telemedicine in other specialties are discussed. Taking the results of the different studies into account, the conclusion is that telemedicine is well accepted and often even desired by most patients and will likely become a very important part of modern medicine in the future.
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Affiliation(s)
- Lukas Bodle
- Department of Dermatology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, University Hospital Bern, Bern, Switzerland
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19
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García Rodríguez J, González Ruiz de León C, Sacristán González R, Méndez Ramírez S, Modrego Ulecia L, Fernández-Gómez JM. Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care. Actas Urol Esp 2021; 45:530-536. [PMID: 34531161 PMCID: PMC8302855 DOI: 10.1016/j.acuroe.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVE The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer. The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 h and considered very preferential. CONCLUSIONS Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.
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Affiliation(s)
- J García Rodríguez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - R Sacristán González
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - S Méndez Ramírez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - L Modrego Ulecia
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J M Fernández-Gómez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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20
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García Rodríguez J, González Ruiz de León C, Sacristán González R, Méndez Ramírez S, Modrego Ulecia L, Fernández-Gómez JM. [Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care]. Actas Urol Esp 2021; 45:530-536. [PMID: 34127282 PMCID: PMC8084619 DOI: 10.1016/j.acuro.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 hours and considered very preferential. CONCLUSIONS Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.
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Affiliation(s)
- J García Rodríguez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - R Sacristán González
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - S Méndez Ramírez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - L Modrego Ulecia
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - J M Fernández-Gómez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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21
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Troesch VL, Juhr D, Pearlman A. Barriers to receiving testosterone replacement therapy in the community during COVID-19 pandemic. Transl Androl Urol 2021; 10:3312-3316. [PMID: 34532255 PMCID: PMC8421835 DOI: 10.21037/tau-21-350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Background While the etiology for the upsurge in testosterone testing and prescriptions is likely multifactorial, increased direct-to-consumer marketing and the expansion of clinical care centers devoted to testosterone treatment likely play a role. Many of these centers require patients to report, in-person, on a regular basis for their injectable therapy and/or lab studies. The purpose of our study was to investigate barriers of care that patients receiving treatment for testosterone deficiency may be experiencing in the setting of COVID-19. Methods Our survey was posted on a closed Facebook support page for males currently receiving testosterone treatment and members of the group were invited to participate. The survey asked participants several questions related to how they received their injections, if they've experienced difficulties obtaining their injections due to COVID-19 restrictions, and about their interest in telemedicine services for their care. Results The majority of patients were able to receive their treatment despite barriers enforced by the pandemic. Of the 104 participants, almost half received their testosterone prescriptions from an outpatient clinic dedicated to testosterone replacement, while the other half received their therapy from a PCP, endocrinologist, or urologist. Only 5 patients (4.8%) noted difficulties obtaining their injections during this pandemic, 4 of which received their prescriptions from dedicated testosterone clinics, and the other from a PCP. Nearly 90% of respondents self-administered their testosterone therapy. With regards to telemedicine, 57.8% of patients have utilized the technology in some capacity, however 74.4% said that they would prefer to use telemedicine video services with a urologist or APP with expertise in andrology over in-person services. Conclusions In our survey, the majority of the respondents have been able to receive their injectable testosterone therapy despite the ongoing pandemic. The majority of respondents self-administer their treatments, which may explain the lack of barriers. This study is the first of its kind to investigate the effect of a pandemic on the receipt of care for those being treated for testosterone deficiency with injectable testosterone.
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Affiliation(s)
- Victoria L Troesch
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Denise Juhr
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Amy Pearlman
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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22
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Shiff B, Frankel J, Oake J, Blachman-Braun R, Patel P. Patient Satisfaction With Telemedicine Appointments in an Academic Andrology-focused Urology Practice During the COVID-19 Pandemic. Urology 2021; 153:35-41. [PMID: 33450281 PMCID: PMC9754887 DOI: 10.1016/j.urology.2020.11.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction with telemedicine appointments as an alternative to in-person appointments at an Andrology-focused academic urology practice during the coronavirus disease 2019 pandemic. METHODS Between March and June 2020, all appointments at the practice of a single Andrology-focused academic urologist were conducted by telephone. Consecutive patients were contacted by telephone following their appointment to complete a telephone questionnaire. Baseline demographic information was obtained, and perceptions regarding telephone appointments were assessed using a Likert scale. RESULTS Ninety-six patients completed the telephone questionnaire. Median age was 48.5 years (interquartile range 37.3-62.8 years) with 55 of 96 (57.3%) of the appointments Andrology-focused. Mean distance of residence from the hospital was 8.4 km (interquartile range 4.7-25.2 km). Only 9 of 96 (9.3%) of the patients felt that the telephone format did not adequately address their needs. However, 26 of 96 (27.1%) of patients said they would prefer an in-person appointment. On multivariable analysis adjusting for age, gender, presenting complaint, type of appointment, education level, and employment status, no factors were associated with feeling that the telephone appointment adequately addressed needs or preference for an in-person appointment in the future. CONCLUSION Patients were generally satisfied with telephone appointments as an alternative to in-person appointments during the coronavirus disease 2019 pandemic. Nonetheless, a substantial portion of patients said they would prefer in-person appointments in the future.
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Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jed Frankel
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Oake
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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23
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Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health 2021; 42:463-481. [PMID: 33798406 DOI: 10.1146/annurev-publhealth-090519-093711] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that (a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; (b) telemedicine in select circumstances has demonstrated improved health outcomes; and (c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.
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Affiliation(s)
- William Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
| | - Kina Zhou
- School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA; .,Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
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The role of technology in the perioperative management of bladder cancer patients. Urol Oncol 2021; 40:466-473. [PMID: 34154900 DOI: 10.1016/j.urolonc.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Consumer technology in the form of personal computers, mobile devices, and wearable technology, despite current underutilization, has the potential to greatly enhance the practice of urologic oncology and the surgical care of bladder cancer patients, particularly through the dissemination of educational videos, telemedicine, and the use of wearable technology for patient monitoring. A comprehensive healthcare application can unite all of these features, providing curated educational videos at different timepoints in surgical care, facilitating communication between the patient and the care team, and interfacing with wearable technology and other peripherals to allow for nonintrusive patient monitoring to help facilitate early identification of complications and to follow post-operative patient progress. Here we seek to review the available literature on this topic, discuss our institutional experience, and provide future perspectives in the perioperative management of bladder cancer patients.
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25
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Margolin EJ, Pina Martina LA, Miles CH, Wenske S, McKiernan JM, DeCastro GJ, Hyams ES, Drake CG, Lim EA, Stein MN, Deutsch I, Anderson CB. Telemedicine in management of genitourinary malignancies: Patient and physician perspectives. Urol Oncol 2021; 39:480-486. [PMID: 34092480 DOI: 10.1016/j.urolonc.2021.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The rapid expansion of telemedicine has presented a challenge for the care of patients with genitourinary malignancies. We sought to assess patient and physician perspectives on the use of telemedicine for genitourinary cancer care. METHODS We conducted a prospective cross-sectional study of patients who had telemedicine visits with urology, medical oncology, or radiation oncology for management of genitourinary malignancies from July-August 2020. Patients and physicians each received a questionnaire regarding the telemedicine experience. Responses were scored on a 5-point Likert scale. The primary outcomes of the study were patient and physician satisfaction. RESULTS Of the 115 patients who enrolled, we received 96 patient responses and 46 physician responses. Overall, 77% of patients and 70% of physicians reported being "extremely satisfied" with the telemedicine encounter. Satisfaction was high among all components of the encounter including patient-physician communication, counseling, shared decision making, time spent, timeliness and efficiency, and convenience. Additionally, 78% of patients and 85% of physicians "strongly agreed" that they were able to discuss sensitive topics about cancer care as well as they could at an in-person visit. Nine telemedicine visits (9%) encountered technological barriers. Technological barriers were associated with lower overall satisfaction scores among both patients and physicians (p ≤ 0.01). CONCLUSION We observed high levels of patient and physician satisfaction for telemedicine visits for management of genitourinary malignancies. Technological barriers were encountered by 9% of patients and were associated with decreased satisfaction.
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Affiliation(s)
- Ezra J Margolin
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Luis A Pina Martina
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Sven Wenske
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - G Joel DeCastro
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Elias S Hyams
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Charles G Drake
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Emerson A Lim
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Mark N Stein
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Israel Deutsch
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
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Winter M, Patel MI. Difficulties of delivering urological care to remote areas. ANZ J Surg 2021; 91:483-484. [PMID: 33847058 DOI: 10.1111/ans.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.,Department of Urology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Manish I Patel
- Specialty of Surgery, Sydney Medical School, Sydney, New South Wales, Australia.,Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
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Rodler S, Schütz JM, Styn A, Weinhold P, Casucelli J, Eismann L, Bauer RM, Staehler M, Stief C, Buchner A, Mumm JN. Mapping Telemedicine in German Private Practice Urological Care: Implications for Transitioning beyond the COVID-19 Pandemic. Urol Int 2021; 105:650-656. [PMID: 33951666 PMCID: PMC8247820 DOI: 10.1159/000515982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
Background There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications. Methods An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ<sup>2</sup> test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis. Results 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations. Conclusion Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.
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Affiliation(s)
- Severin Rodler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
| | - Julius M Schütz
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Amelie Styn
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Philipp Weinhold
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Jozefina Casucelli
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Lennert Eismann
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Ricarda M Bauer
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Michael Staehler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Christian Stief
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany
| | - Alexander Buchner
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
| | - Jan-Niclas Mumm
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, Munich, Germany.,Arbeitsgruppe für Anwendung von künstlicher Intelligenz und digitalen Gesundheits-anwendungen in der Urologie, Klinikum der Universität München, Munich, Germany
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Nicholson KJ, Rosengart MR, Watson AR. Telerounding Has Clinical Value and Enables the Busy Surgeon: A Colorectal Surgeon's Ten-Year Experience. Am Surg 2021; 88:2923-2927. [PMID: 33866864 DOI: 10.1177/00031348211011131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Study of telemedicine and telerounding in surgical specialties is limited. The push for telemedicine during the COVID-19 pandemic has challenged the face-to-face rounding paradigm and creates an opportunity for reflection on the benefits of telemedicine, especially for balancing competing corporate and clinical demands. METHODS The 117-month video-based inpatient telerounding experience of a colorectal surgeon in an academic medical system was recorded, including patient characteristics, diagnoses, technology, content of telerounding encounters, and logistical considerations. Data were analyzed using descriptive statistics. RESULTS 163 patients were seen in 201 telerounding encounters, primarily for routine postoperative care (90.5%). Most were admitted for inflammatory bowel disease (63.2%). Changes were made to plans of care during 28.9% of encounters, and discharge planning was part of 26.4%. Encounters were conducted primarily from the surgeon's administrative office (68.7%) or other work-related locations (10.9%), while 6.5% originated from the surgeon's home. Technologic issues occurred in 5.5% of encounters. 89.1% of patient feedback was positive and none was negative. CONCLUSION Telerounding is technologically feasible and has clinical value, including for patients with complex surgical problems. Technologic problems are rare and patient satisfaction is high. Surgeons should consider telerounding as a means to balance competing demands.
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Affiliation(s)
| | | | - Andrew R Watson
- Department of Surgery, 6595University of Pittsburgh, Pittsburgh, PA, USA
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Charnell AM, Hoen L', Sforza S, Spinoit AF, Radford A. Remote consultations in paediatric urology-Not just for pandemics? J Pediatr Urol 2021; 17:260-262. [PMID: 33478900 DOI: 10.1016/j.jpurol.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/24/2020] [Accepted: 01/01/2021] [Indexed: 11/15/2022]
Abstract
Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which conditions may be suitable for remote consultations. These guidelines have been appraised by the European Association of Urology Young Academic Urologists paediatric working group. Through practical experience and anticipated difficulties, we have discussed considerations that paediatric urology departments should ponder when integrating remote clinics into their practice as we move forward from the pandemic.
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Affiliation(s)
- Aimee M Charnell
- Department of Paediatric Surgery, Leeds Children's Hospital NHS Trust, Leeds, UK; Leeds Institute of Medical Education, University of Leeds, UK
| | - Lisette 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands.
| | - Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Anne-Françoise Spinoit
- Pediatric and Reconstructive Urology, Robotics, Department of Urology, Ghent University Hospital, Belgium
| | - Anna Radford
- Department of Paediatric Surgery, Leeds Children's Hospital NHS Trust, Leeds, UK; Hull York Medical School, York, UK
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Brimley S, Natale C, Dick B, Pastuszak A, Khera M, Baum N, Raheem OA. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021; 9:289-295. [PMID: 33752994 PMCID: PMC9585225 DOI: 10.1016/j.sxmr.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 01/23/2023]
Abstract
Introduction Although telemedicine (TM) has been available for several decades, the recent increase in its acceptance due to the COVID-19 pandemic has emerged as a valuable solution for the delivery of health care that provides easy, affordable, and convenient communication with urologic patients. Objectives The objective of this study was to highlight limiting factors and provide successful practical solutions to assist urologists in incorporating and maintaining TM in their practices. Methods A thorough literature review was conducted utilizing PubMed, Cochrane library, clinicaltrials.gov, Google Scholar, and Web of Science. Search terms and keywords included “telemedicine” and “urology.” Only articles written or translated into the English language were included. Results A total of 12 peer-reviewed articles were identified that discussed barriers for incorporation of TM in urology. Articles exclusive to the use of TM during the COVID-19 pandemic were also included, as well as American Urological Association and European Urological Association guidelines and Centers for Medicare & Medicaid Services statements and policies regarding TM pertinent to urological practice. Conclusion TM is currently a viable option and fills an unmet need for most practicing urologists, especially during the COVID-19 pandemic, offering insight to the relative ease of transition to online clinical practice. OA Raheem, S Brimley, C Natale, et al. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021;9:289–295.
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Affiliation(s)
- Scott Brimley
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Mohit Khera
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Neil Baum
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
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El-Asmar JM, Labban M, El-Hajj A. Integration of aquablation through telemetry: an alternative to onsite proctoring? World J Urol 2021; 39:3473-3479. [PMID: 33547926 PMCID: PMC7866960 DOI: 10.1007/s00345-021-03603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the feasibility of telementoring for aquablation by comparing the outcomes of onsite versus telemetry proctoring. METHODS The telemetry device of choice was Proximie, an innovative digital platform that uses live video stream with an augmented reality technology. Our study retrospectively reviewed outcomes from our IRB approved prospective Aquablation database from March 2018 till October 2019. Procedures were guided by a proctor either onsite or remotely through telemetry. One-way ANOVA or Chi-square was used to compare perioperative parameters and mixed model ANOVA was used to compare functional outcomes. RESULTS Our data included 59 patients who underwent a proctored-based Aquablation of which 21 were telementor guided and 38 were onsite guided. The initial ten procedures were done with the latter approach. There was no statistical difference in age, comorbidities, prostate size, and baseline serum markers amongst the two groups. In contrast, telementor guidance was associated with increased general anaesthesia use (76.2% vs. 21.1%) and haemostatic cauterization (81.0% versus 47.4%) with a p value < 0.00001 and 0.004 respectively. However, the main procedure outcomes: operative time, time to Foley catheter removal, haemoglobin drop, urinary retention, and adverse events were statistically insignificant (p value > 0.05). CONCLUSION Following an initial phase of onsite proctoring, telementoring can be safely used in the adoption phase of a new robotic technology. This approach allowed more flexibility in patient scheduling and reduced travel costs with similar surgical outcomes.
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Affiliation(s)
- Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Ong CSH, Lu J, Tan YQ, Tan LGL, Tiong HY. Implementation of a Ureteric Colic Telemedicine Service: A Mixed Methods Quality Improvement Study. Urology 2021; 147:14-20. [PMID: 33091386 PMCID: PMC7573635 DOI: 10.1016/j.urology.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.
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Affiliation(s)
- Chloe Shu Hui Ong
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Jirong Lu
- Department of Urology, National University Hospital, National University Health System, Singapore.
| | - Yi Quan Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore
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Almallah YZ, Doyle DJ. Telehealth in the time of Corona: 'doctor in the house'. Intern Med J 2020; 50:1578-1583. [PMID: 33354885 DOI: 10.1111/imj.15108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic has led to many physicians working from home whenever possible. Although the concept of 'remote' patient care has been around for decades, present circumstances have provided a grand impetus in that direction with a view to protecting both patient and caregiver. In this article, we discuss some of the various challenges to moving forward with telemedicine, drawing in part on our own experiences in dealing with the COVID-19 pandemic. Clinical, technical, financial and cultural barriers to telemedicine are identified, along with a discussion concerning anticipated benefits. We conclude that the COVID-19 pandemic will likely forever change how healthcare is conducted as telemedicine figures increasingly prominently in the clinical landscape.
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Affiliation(s)
- Yahia Zaki Almallah
- Department of Urology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE
| | - Daniel John Doyle
- Department of Urology, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE
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Leibar Tamayo A, Linares Espinós E, Ríos González E, Trelles Guzmán C, Álvarez-Maestro M, de Castro Guerín C, Fernández-Pascual E, Girón de Francisco M, Gómez de Vicente J, Gómez Rivas J, Mainez Rodriguez J, Pérez-Carral J, Garcia-Matres M, Martinez-Piñeiro L. Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2020. [PMCID: PMC7585720 DOI: 10.1016/j.acuroe.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. Objective To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. Material and methods Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. Results Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period;18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1%, had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI 8−10), and 61.5% of respondents consider teleconsultation as a "health care option" after the healthcare crisis. Conclusion Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.
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Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. Actas Urol Esp 2020; 44:617-622. [PMID: 32650954 PMCID: PMC7301061 DOI: 10.1016/j.acuro.2020.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option» after the healthcare crisis. CONCLUSION Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.
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Abstract
STUDY DESIGN This was a prospective cohort study. OBJECTIVE The objective of this study was to design and test a novel spine neurological examination adapted for telemedicine. SUMMARY OF BACKGROUND DATA Telemedicine is a rapidly evolving technology associated with numerous potential benefits for health care, especially in the modern era of value-based care. To date, no studies have assessed whether. METHODS Twenty-one healthy controls and 20 patients with cervical or lumbar spinal disease (D) were prospectively enrolled. Each patient underwent a telemedicine neurological examination as well as a traditional in-person neurological examination administered by a fellowship trained spine surgeon and a physiatrist. Both the telemedicine and in-person tests consisted of motor, sensory, and special test components. Scores were compared via univariate analysis and secondary qualitative outcomes, including responses from a satisfaction survey, were obtained upon completion of the trial. RESULTS Of the 20 patients in the D group, 9 patients had cervical disease and 11 patients had lumbar disease. Comparing healthy control with the D group, there were no significant differences with respect to all motor scores, most sensory scores, and all special tests. There was a high rate of satisfaction among the cohort with 92.7% of participants feeling "very satisfied" with the overall experience. CONCLUSIONS This study presents the development of a viable neurological spine examination adapted for telemedicine. The findings in this study suggest that patients have comparable motor, sensory, and special test scores with telemedicine as with a traditional in-person examination administered by an experienced clinician, as well as reporting a high rate of satisfaction among participants. To our knowledge, this is the first telemedicine neurological examination for spine surgery. Further studies are warranted to validate these findings.
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Andino JJ, Lingaya MA, Daignault-Newton S, Shah PK, Ellimoottil C. Video Visits as a Substitute for Urological Clinic Visits. Urology 2020; 144:46-51. [PMID: 32619595 PMCID: PMC7834609 DOI: 10.1016/j.urology.2020.05.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers. METHODS We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome ("revisit rate") as the proportion of additional healthcare evaluation (ie, office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter. RESULTS Patients seen by video visit tended to be younger (51 vs 61 years, P <.001), would have to travel further for a clinic appointment (82 vs 68 miles, P <.001), and were more likely to be female (36 vs 28%, P = .001). The most common diagnostic groups evaluated through video visits were nephrolithiasis (40%), oncology (18%) and andrology (14.3%). While the 30-day revisit rates were higher for clinic visits (4.3% vs 7.5%, P = .01) primarily due to previously scheduled appointments, revisits due to medical concerns were similar across both groups (0.5% vs 0.67%; P = .60). CONCLUSIONS Video visits can be used to deliver care across a broad range of urologic diagnoses and can serve as a substitute for clinic visits.
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Affiliation(s)
- Juan J Andino
- Department of Urology, Michigan Medicine, Ann Arbor, MI.
| | | | | | - Parth K Shah
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Chad Ellimoottil
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Turcotte B, Paquet S, Blais AS, Blouin AC, Bolduc S, Bureau M, Caumartin Y, Cloutier J, Deschênes-Rompré MP, Dujardin T, Fradet Y, Lacombe L, Moore K, Morin F, Nadeau G, Simonyan D, Soucy F, Tiguert R, Toren P, Lodde M, Pouliot F. A prospective, multisite study analyzing the percentage of urological cases that can be completely managed by telemedicine. Can Urol Assoc J 2020; 14:319-321. [PMID: 33275552 DOI: 10.5489/cuaj.6862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has accelerated the development of telemedicine due to confinement measures. However, the percentage of outpatient urological cases that could be managed completely by telemedicine outside of the COVID-19 pandemic remains to be determined. We conducted a prospective, multisite study involving all urologists working in the region of Quebec City. METHODS During the first four weeks of the regional confinement, 18 pediatric and adult urologists were asked to determine, after each telemedicine appointment, if it translated into a complete (CCM), incomplete (ICM), or suboptimal case management (SCM, adequate only in the context of the pandemic). RESULTS A total of 1679 appointments representing all urological areas were registered. Overall, 67.6% (95% confidence interval [CI] 65.3; 69.8), 27.1% (25.0; 29.3), and 4.3% (3.5; 5.4) were reported as CCM, SCM, and ICM, respectively. The CCM ratio varied according to the reason for consultation, with cancer suspicion (52.9% [42.9; 62.8]) and pediatric reasons (38.0% [30.0; 46.6]) showing the lowest CCM percentages. CCM percentages also varied significantly based on the setting where it was performed, ranging from 61.1% (private clinic) to 86.8% (endourology and general hospital). CONCLUSIONS We show that two-thirds of all urological outpatient cases could be completely managed by telemedicine outside of the pandemic. After the pandemic, it will be important to incorporate telemedicine as an alternative for a patient's first or followup visit, especially those with geographical, pathological, and socioeconomic considerations.
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Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Sophie Paquet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anne-Sophie Blais
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Annie-Claude Blouin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Bolduc
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Michel Bureau
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Yves Caumartin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Jonathan Cloutier
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Thierry Dujardin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Louis Lacombe
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Katherine Moore
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Fannie Morin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Geneviève Nadeau
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Research Centre, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Frédéric Soucy
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Rabi Tiguert
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Michele Lodde
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
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Demaerschalk BM, Cassivi SD, Blegen RN, Borah B, Moriarty J, Gullerud R, TerKonda SP. Health Economic Analysis of Postoperative Video Telemedicine Visits to Patients' Homes. Telemed J E Health 2020; 27:635-640. [PMID: 32907513 DOI: 10.1089/tmj.2020.0257] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract Importance: A postoperative video telemedicine follow-up program was introduced by the Mayo Clinic. An attempt was made to understand the potential cost savings to patients before contemplating full-scale expansion across all potentially eligible surgical patients and practices. Objective: The primary purpose was to estimate potential cost savings to patients with video telemedicine follow-up to home compared with face-to-face follow-up in a standard clinic setting. Design: The research was designed collaboratively by the Center for Connected Care and the surgical practice to address the question of estimated cost savings of postoperative video telemedicine visits. The intervention arm is the postoperative video telemedicine follow-up visit to home setting and the comparator is the face-to-face visit at Mayo Clinic. Setting: Large, integrated, academic multispecialty practice supporting patient care delivery, research, and education. Participants: The population under study comprised routine uncomplicated postoperative patients who underwent video telemedicine or face-to-face follow-up visits that fell within the 90-day global period across multiple (general, neurosurgery, plastic, thoracic, transplant, and urology) surgical specialties. Main Outcome(s) and Measure(s): Economic outcomes were cost of travel, accommodations, meals, and missed work. Additional outcomes included time expenditure and patient satisfaction. Cost/benefit analysis unit was US dollars (USD). All costs were inflated to 2018 USD, using the Gross Domestic Product Implicit price deflator. Results: Patients who utilized video telemedicine rather than face-to-face clinic visit for postoperative follow-up were estimated to save $888 per visit on average. More specifically, patients residing more than 1,635 miles round trip from clinic saved an estimated $1,501 per visit and patients not needing accommodation still saved an estimated $256 per visit. Patient satisfaction over video telemedicine postoperative follow-up visits remained high over the 6-year period of study. Conclusions and Relevance: The use of video telemedicine for routine uncomplicated postoperative follow-up visits to replace face-to-face follow-up visits has the potential to be financially advantageous for patients. Key points Question: For postoperative patients, what are the health economic outcomes associated with video telemedicine follow-up to home compared with face-to-face follow-up in a standard clinic setting? Findings: Video telemedicine offers a cost benefit for patients through avoidance of travel costs and missed work. Meaning: For uncomplicated routine postoperative follow-up visits, video telemedicine is a less costly alternative for most patients.
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Affiliation(s)
- Bart M Demaerschalk
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA.,Clinical Neurological Sciences, Neurology & Neurosurgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Stephen D Cassivi
- Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca N Blegen
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan Borah
- Healthcare and Policy Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James Moriarty
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Gullerud
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarvam P TerKonda
- Center for Connected Care, Mayo Clinic, Rochester, Minnesota, USA.,Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA.,Plastic Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Early Experience With Telemedicine in Patients Undergoing Otologic/Neurotologic Procedures. Otol Neurotol 2020; 41:e1154-e1157. [DOI: 10.1097/mao.0000000000002774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Torremade J, Martínez-Salamanca JI. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in Spain. J Sex Med 2020; 17:1220-1221. [PMID: 32493601 PMCID: PMC7245267 DOI: 10.1016/j.jsxm.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Jose Torremade
- Hospital Universitari de Bellvitge, Urology Department, Hospitalet de Llobregat, Spain
| | - Juan Ignacio Martínez-Salamanca
- Hospital Universitario Puerta de Hierro, Urology Department, Majadahonda, Spain; Lyx Instituto de Urología, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain.
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Khor V, Arunasalam A, Azli S, Khairul-Asri MG, Fahmy O. Experience from Malaysia During the COVID-19 Movement Control Order. Urology 2020; 141:179-180. [PMID: 32339556 PMCID: PMC7195371 DOI: 10.1016/j.urology.2020.04.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Vincent Khor
- Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia; Hospital Serdang, Ministry of Health Malaysia, Selangor, Malaysia.
| | - Arun Arunasalam
- Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia; Hospital Serdang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Saiful Azli
- Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia; Hospital Serdang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Mohd Ghani Khairul-Asri
- Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia; Hospital Serdang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Omar Fahmy
- Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia; Hospital Serdang, Ministry of Health Malaysia, Selangor, Malaysia
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43
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Dobbs RW, Nguyen TT, Shahait M, Lee DJ, Kim JL, El-Fahmawi A, Lee DI. Outpatient Robot-Assisted Radical Prostatectomy: Are Patients Ready for Same-Day Discharge? J Endourol 2020; 34:450-455. [PMID: 31973590 DOI: 10.1089/end.2019.0796] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: Several case series have demonstrated the safety and feasibility of outpatient robot-assisted radical prostatectomy (RARP) in well-selected patients; however, the patient perspective of this practice has not been well explored. In this study, we explored patients' perspectives on the potential barriers and benefits of outpatient RARP. Materials and Methods: We developed a multidimensional questionnaire to assess socioeconomic status, presence of caretaker at home, preferred transportation to the emergency room in case of chest pain or postsurgical complications, readiness for discharge at postanesthesia care unit (PACU), and potential barriers for discharge. In addition, patients were asked to provide an estimate of overnight hospitalization costs and their willingness to pay out-of-pocket expenses for their overnight stay. Patients who underwent RARP between August 1, 2018, and April 30, 2019, were asked to fill the questionnaire within the first week following their operation. Results: During our study, 157/292 (53.8%) of men undergoing RARP from a single high-volume robotic surgeon completed the survey. Patients who completed <80% of the survey (n = 5) were excluded from the final analysis. Thirty-seven (24.3%) patients felt that they would have been ready for discharge immediately from PACU, and 48 (31.6%) patients after extended recovery and before midnight. Only 17.8% (n = 27) of the patients claim that they experienced a medical intervention in the hospital that could not have been managed at home. The main barriers for same-day discharge were pain (55.9%, 80/143), catheter discomfort (44.7%, 64/143), insufficient education about catheter care (31.4%, 45/143), postoperative nausea and vomiting (15.3%, 22/143), and medical complications (13.2%, 19/143). Conclusions: Two-thirds of patients following RARP did not feel ready to be discharged on the day of their surgery. Further research is necessary to identify patients who may benefit from this approach to reduce health care costs while minimizing patient postoperative morbidity.
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Affiliation(s)
- Ryan W Dobbs
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thanh-Tuan Nguyen
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohammed Shahait
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica L Kim
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ayah El-Fahmawi
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David I Lee
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Men’s health is a unique field that requires a multi-disciplinary approach to appropriately treat the full spectrum of men’s health needs. Given that interest in men’s health is relatively new, the definition of a men’s health clinic continues to evolve. Originally conceived as testosterone replacement centers, men’s health clinics are increasingly understood to encompass male endocrine, surgical, urologic, physical performance, and psychological issues. As interest in men’s health continues to grow, it is important to focus on the field’s future, including pharmacies, telemedicine, and the diffusion of healthcare.
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Affiliation(s)
- Justin J Houman
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sriram V Eleswarapu
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jesse N Mills
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Michael P, Tran VT, Hopkins M, Berger I, Ziemba J, Bansal UK, Balasubramanian A, Chen J, Mayer W, Fang A, Rais-Bahrami S, James A, Harris A. Comparison of Urologic Transfers to Academic Medical Centers: A Multi-institutional Perspective. Urology 2019; 136:100-104. [PMID: 31751623 DOI: 10.1016/j.urology.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/25/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers. METHODS Four academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories. RESULTS Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302). CONCLUSION Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
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Affiliation(s)
- Patrick Michael
- Department of Urology, University of Kentucky, Lexington, KY
| | - Vi T Tran
- Department of Urology, University of Kentucky, Lexington, KY.
| | - Marilyn Hopkins
- Department of Urology, University of Kentucky, Lexington, KY
| | - Ian Berger
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Justin Ziemba
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Utsav K Bansal
- Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Jessie Chen
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Wesley Mayer
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Andrew Fang
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Andrew James
- Department of Urology, University of Kentucky, Lexington, KY
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, KY
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Tapiero S, Yoon R, Jefferson F, Sung J, Limfueco L, Cottone C, Lu S, Patel RM, Landman J, Clayman RV. Smartphone technology and its applications in urology: a review of the literature. World J Urol 2019; 38:2393-2410. [PMID: 31598754 DOI: 10.1007/s00345-019-02960-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/13/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Smartphone technology has propelled the evolution of health-related mobile technology, referred to as mobile health (mHealth). With the rise of smartphone ownership and the growing popularity of health-related smartphone usage, mHealth offers potential benefits for both patients and health care providers. The objective of this review is to assess the current state of smartphone technology in urology. METHODS A literature search of PubMed database was conducted to identify articles reporting on smartphone technology in urology. Publications were included if they focused on smartphone mHealth technology pertinent to the field of urology or included an evaluation of urological applications in digital stores. RESULTS We identified 50 publications focused on the use of smartphones in urology. Studies were then grouped into the following categories: smartphones employing the built-in camera and light source, applications specific to prostate cancer, urolithiasis, pediatric urology, and as educational tools for urologists. In 23/50 (46%) studies, smartphone technology/intervention was compared to a control group or to standard of care. In this regard, smartphone technology did not demonstrate benefit over standard of care in 13 studies. In contrast, in 10 studies, smartphone interventions were proven beneficial over current practice. CONCLUSIONS Smartphone technology is constantly evolving and has the potential to improve urological care and education. Of concern to consumer and urologist alike is that these downloadable programs are limited due to the accuracy of their content, risk of confidentiality breach, and the lack of central regulation and professional involvement in their development.
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Affiliation(s)
- Shlomi Tapiero
- Department of Urology, University of California, Irvine, USA
| | - Renai Yoon
- Department of Urology, University of California, Irvine, USA
| | | | - John Sung
- Department of Urology, University of California, Irvine, USA
| | - Luke Limfueco
- Department of Urology, University of California, Irvine, USA
| | | | - Sherry Lu
- Department of Urology, University of California, Irvine, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, USA.
| | - Jaime Landman
- Department of Urology, University of California, Irvine, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, USA
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Abstract
PURPOSE OF REVIEW Telehealth, or the remote delivery of healthcare services using telecommunications technology, has the potential to revolutionize the delivery of healthcare and contribute to ongoing efforts to provide high-value care. RECENT FINDINGS We discuss several categories of telehealth that have been applied to healthcare. Several of these approaches, in particular video visits and teleconsultations, have promising early data demonstrating the significant benefits of telehealth technology with respect to the quality of care, access, cost savings, and patient experience. Nonetheless, considerable knowledge gaps still exist regarding how and for which patients and diseases telehealth modalities should be applied. Finally, we discuss the barriers to widespread adoption at the institutional, state, and federal levels. SUMMARY Maximizing the value of healthcare is an important goal for hospitals, physicians, and policymakers. Telehealth leverages advances in technology and the widespread availability of telecommunications devices to make healthcare communication more available, more convenient, and more efficient for patients and providers. With appropriate policies and incentives, telehealth initiatives can improve the value of urologic care and smooth the transition to a value-based healthcare system.
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Current use of telehealth in urology: a review. World J Urol 2019; 38:2377-2384. [PMID: 31352565 DOI: 10.1007/s00345-019-02882-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Applications of telehealth have been growing in popularity. However, there is little information on how telehealth is being used in Urology. In this review, we examine current applications of telehealth in urological practices as well as barriers to implementation. METHODS A review was conducted of original research within the past 10 years describing telehealth applications in urology. Articles on telehealth as applied to other specialties were reviewed for discussion on real or perceived barriers to implementation. RESULTS Twenty-four articles met the inclusion criteria. The most common application of telehealth was using a video visit to assess or follow-up with patients. The second most commonly described applications of telehealth were telementorship, or the use of telehealth technology to help train providers, and telemedicine used in diagnostics. Studies consistently stated the effectiveness of the telehealth applications and the high level of patient and provider satisfaction. CONCLUSIONS Telehealth is sparingly used in urology. Barriers to implementation include technological literacy, reimbursement uncertainties, and resistance to change in workflow. When used, telehealth technologies are shown to be safe, effective, and satisfactory for patients and providers. Further investigation is necessary to determine the efficacy of telehealth applications.
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Berger I, Hopkins M, Ziemba J, Skokan A, James A, Michael P, Harris A. Comparison of Interhospital Urological Transfers between a Metropolitan and Rural Tertiary Care Institution. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ian Berger
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marilyn Hopkins
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Justin Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alexander Skokan
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Andrew James
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Patrick Michael
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
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50
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Cohen AJ, Ndoye M, Fergus KB, Lindsey J, Butler C, Patino G, Anger JT, Breyer BN. Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census. J Rural Health 2019; 36:300-306. [DOI: 10.1111/jrh.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew J. Cohen
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Medina Ndoye
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Kirkpatrick B. Fergus
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - John Lindsey
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Christi Butler
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - German Patino
- Department of UrologyUniversity of California‐San Francisco San Francisco California
| | - Jennifer T. Anger
- Cedars‐Sinai Department of SurgeryDivision of Urology Los Angeles California
| | - Benjamin N. Breyer
- Department of UrologyUniversity of California‐San Francisco San Francisco California
- Department of Biostatistics and EpidemiologyUniversity of California‐San Francisco San Francisco California
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