Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

INTRODUCTION: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. MATERIALS AND METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient). CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. LEVEL OF EVIDENCE: 3.

EEMCO guidance for the in vivo assessment of skin surface pH.

The pH of the skin follows a sharp gradient across the stratum corneum (SC), which is suspected to play an important role in controlling the enzymatic activities involved in cellular metabolism and renewal. This gradient is maintained by several systems, such as sweat and sebum secretion and degradation as well as cellular metabolism. At the surface of the skin, what is measured is in fact an apparent skin pH due to extracted material from the SC diffusing into water applied at the surface. pH values recorded at the surface of a semi hydrophobic milieu such as the SC should be interpreted with great caution because it is obvious that hydrogen ions are not in a pure solution at the surface of the skin. For a correct measurement of skin surface pH, it is recommended to follow all practical operating conditions. Care must be taken in identifying the skin site, healthy controls (age, gender, skin type), the time of day of the measurement and the environmental conditions. Also, subjects should receive precise instructions before the test, mainly in terms of hygiene procedure or use of topical products. The interpretation of data should not overlook the fact that even small differences in pH may reflect significant modifications at the molecular level. Although it is usually agreed that the pH of the skin surface may influence the cutaneous microflora, much remains to be learnt about the role of the acid mantle of the skin with regard to defensins and other protective mechanisms.

[Relationship between primary care and neurological care]. / Interrelación entre atención primaria y asistencia neurológica.

The problems posed by health care are related to health service structure and development. The transformation of a three level care structure into one of just two levels, primary care and specialized care, plays its part. With the aim of analyzing the importance these factors might have in present-day health care, we carried out an aleatoric study of all those patients who attended our neurological service in the years 1992 and 1993. We obtained two sample groups consisting of 921 and 849 patients respectively through interconsultatory requests from practitioners within a limited health care area. We studied the patient's background, the requesting practitioner, diagnosis obtained and complementary tests used. Patients from individual practitioners varied in number from 4 to 38, with some 20% of all patients having been referred by just six practitioners. 20% of the patients we studied showed no neurological pathology. Complementary tests used in all diagnoses sent to us amounted to less than half the number of patients studied. We analyzed the importance these factors have in the present delay in health care services.

Intraoperative assessment of carotid endarterectomy.

In our experience intraoperative arteriography in carotid endarterectomy is very effective in detecting residual small lesions after surgery. There were no neurosurgical complications due to arteriography. The interpretation of the surgical results is objective since the criteria are the same as those used to assess preoperative arteriography. Different intraoperative assessment methods to control carotid endarterectomy are also analysed.