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 4 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: 1679 appointments representing all urological areas were registered. Overall, 67.6 [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). Conclusion: 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 follow-up visit, especially those with geographical, pathological and socioeconomic considerations.
This paper concerns the petrogenesis of the 504 ± 3 Ma Mont Chagnon massif, the southern extension of the Orford ophiolite in the Quebec Appalachians. The evolution of this massif is summarized in three stages marked by different magmatic series. In the Late Cambrian, the onset of southeastern subduction of the Iapetus basin generated an immature oceanic island arc made up of light rare-earth-element-depleted tholeiites, now preserved in the massif as a portion of the intrusive crustal unit, the dyke complex, and part of the lower volcanic unit. A phase of arc splitting, and concomitant partial erosion of the crustal section, was shortly followed by the eruption of rhyolite genetically related to felsic and low-Ti dykes, and trondhjemite. The geochemistry of these magmas bear some similarities with boninitic series. We believe these liquids derived from the partial melting of the Iapetus amphibolitized oceanic crust, with that of its Laurentian-derived sediments and nearby peridotite, either found as a trapped sliver above the subducting slab or as the slab itself. The final stage, preserved in the massif as a part of the intrusive section, the upper volcanic rocks, and the late-stage dykes, represents the back-arc opening. An ocean-island component is involved in the back-arc related petrogenetic processes, producing magmas with compositions intermediate between arc tholeiites and enriched back-arc basin basalts. This is the first report that the Iapetus basin was locally closing as early as Late Cambrian in the southern Quebec area.
Introduction: During the first regional COVID-19 lockdown in March 2020, we conducted a study aimed at evaluating completeness of telemedicine consultation in urology. Of 1679 consultations, 67% were considered completely managed by phone. The aim of the present study was to assess patients’ experience and satisfaction with telemedicine and to compare them with urologists’ perceptions about quality and completeness of the telemedicine consultation. Methods: We contacted a randomly selected sample of patients (n=356) from our previous study to enquire about their experience. We used a home patient experience questionnaire, inspired by the Patient Experiences Questionnaire for Out-of-Hours Care (PEQ-OHC) and the Consumer Assessment Health Profile Survey (CAHPS). Results: Of 356 patients contacted, 315 agreed to complete the questionnaire. Urological consultations were for non-oncological (104), oncological (121), cancer suspicion (41), and pediatric (49) indications. Mean patient satisfaction score after telemedicine consultation was 8.8/10 (median 9/10) and 86.3% of patients rated the quality of the consultation as either excellent (54.6%) or very good (31.7%). Consultations regarding cancer suspicion had the lowest score (8.3/10). Overall, 46.7% of all patients would have preferred an in-person visit outside of the pandemic situation. Among patients whose consultations were rated suboptimal by urologists, almost a third more (31.2%) would have preferred an in-person visit (p=0.03). Conclusions: Despite high reported patient satisfaction rates with telemedicine, it is noteworthy that nearly half of the patients would have preferred an in-person visit. Post-pandemic, it will be important to incorporate telemedicine as an alternative, while retaining and offering in-person visits.
Introduction: Recent literature emphasizes how over-prescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective in-patient surgery. Methods: Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal. Results: Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8–42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was over-prescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids. Conclusions: We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.
IntroductionOptimal analgesia for circumcision is still debated. The dorsal penile nerve block has been shown to be superior to topical and caudal analgesia. Recently, the ultrasound-guided pudendal nerve block (group pudendal) has been popularized. This randomized, blinded clinical trial compared group pudendal with ultrasound-guided dorsal penile nerve block (group penile) under general anesthesia for pediatric circumcision.MethodsPrepubertal males aged 1–12 years undergoing elective circumcision were randomized to either group. The primary outcome was postoperative face, legs, activity, cry, consolability (FLACC) scores. Our secondary outcomes included parent’s postoperative pain measure, analgesic consumption during the first 24 hours, surgeon’s and parent’s satisfaction, time to perform the block, hemodynamic changes intraoperatively and total time in postanesthesia care unit and until discharge.ResultsA total of 155 patients were included for analysis (77 in group pudendal and 78 in group penile). Mean age was 7.3 years old. FLACC scores were not statistically different between groups (p=0.19–0.97). Surgeon satisfaction was higher with group pudendal (90.8% vs 56.6% optimal, p<0.01). Intraoperative hemodynamic changes (>20% rise of heart rate or blood pressure) were higher in group pudendal (33.8% vs 9.0%, p<0.01) as was intraoperative fentanyl use (1.3 vs 1.0 μg/kg, p<0.01). Other secondary outcomes were not statistically different.DiscussionBoth ultrasound-guided blocks, performed under general anesthesia, provide equivalent postoperative analgesia for pediatric circumcision as evidenced by low pain scores and opioid consumption. Surgeon satisfaction was higher in the pudendal group.Trial registration numberNCT03914365.
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