What has changed during the state of emergency due to COVID-19 on an Academic Urology Department of a Tertiary Hospital in Portugal

A MULTINATIONAL STUDY OF THE IMPACT OF COVID-19 ON UROLOGIC SURGERY RESIDENCY AND WELLBEING

OBJECTIVE

To assess changes to the experiences and wellbeing of urology trainees in the United States(US) and European Union (EU) during the COVID-19 pandemic.

METHODS

A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions.

RESULTS

Two hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (p<0.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research.

CONCLUSIONS

The COVID-19 pandemic has resulted in significant restructuring of residents' educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.

Impact of the COVID-19 Pandemic on the Intensity of Health Services Use in General Practice: A Retrospective Cohort Study

Objectives: We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use in general practice.

Methods: Based on an electronic medical records database, we built one patient cohort each for January-June 2019 (control, 173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts per 100 patients and predicted non-shutdown values. Analyses were repeated for selected at-risk groups and different age groups.

Results: During the shutdown, weekly consultation counts were lower than predicted by −17.2% (total population), −16.5% (patients with hypertension), −17.5% (diabetes), −17.6% (cardiovascular disease), −15.7% (patients aged <60 years), −20.4% (60–80 years), and −14.5% (>80 years). Weekly BP counts were reduced by −35.3% (total population) and −35.0% (hypertension), and HbA1c counts by −33.2% (total population) and −29.8% (diabetes). p-values <0.001 for all reported estimates.

Conclusion: Our results document consequential decreases in consultation counts and chronic disease monitoring during the shutdown. It is crucial that health systems remain able to meet non-COVID-19-related health care needs.

Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases

Introducción

La pandemia por SARS-CoV-2 ha cambiado la práctica urológica a nivel mundial. Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urología de un hospital terciario, a lo largo de diferentes fases epidemiológicas.

Métodos

Estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo. Según la organización hospitalaria, distinguimos 3 periodos: durante las primeras 2 semanas no hubo cambios (1.^er periodo), en las 7 semanas siguientes solo se realizaron intervenciones urgentes previa extracción de exudado nasofaríngeo (2.^o periodo), y tras el 4 de mayo se reanudó la cirugía electiva aplicando un protocolo de cribado multidisciplinar (3.^er periodo).

Las variables demográficas y basales, las quirúrgicas y perioperatorias, así como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3). El seguimiento telefónico se realizó al menos 3 semanas tras el alta hospitalaria.

Resultados

Se realizaron 103 cirugías urológicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1.^er periodo. El diagnóstico era conocido en un paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 días tras la intervención y 16,6 días tras el alta. Cuatro de 7 pacientes trasplantados resultaron afectados. Se registraron 3 muertes por la enfermedad: una mujer de 69 años trasplantada y 2 varones mayores de 80 años con comorbilidades y alto riesgo anestésico a los que se realizó drenaje de absceso retroperitoneal y cirugía retrógrada intrarrenal, respectivamente.

Conclusiones

La infección por SARS-CoV-2 afectó principalmente a trasplantados renales o pacientes añosos con alto riesgo anestésico, durante las 2 primeras semanas de la pandemia. Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad.

Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases

Introduction

Methods

Results

Conclusions