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Review article
Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations
Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología
J. Gómez Rivasa,b,
Corresponding author
juangomezr@gmail.com

Corresponding author.
, A. Rodríguez-Serranoa, S. Loebc, J. Yuen-Chun Teohd, M.J. Ribale, J. Bloembergf, J. Cattog, J. N’Dowh, H. van Poppeli, J. Gonzálezj, M. Estebank, M. Rodriguez Socarrásl
a Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain
b Young Academic Urologist-Urotechnology working party (ESUT-YAU), European Association of Urology, Arnhem, Netherlands
c Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, United States
d S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
e Servicio de Urología, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
f European Association of Urology, Arnhem, Netherlands
g Academic Urology Unit, University of Sheffield, Sheffield, UK
h Academic Urology Unit, University of Aberdeen, Aberdeen, UK
i Department of Urology, Katholieke University, Leuven, Belgium
j Servicio de Urología, Hospital Universitario Gregorio Marañon, Madrid, Spain
k Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain
l Instituto de Cirugía Urológica Avanzada (ICUA), Madrid, Spain
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        "titulo" => "Telemedicina y trabajo inteligente&#58; adaptaci&#243;n al espa&#241;ol de las recomendaciones de la Asociaci&#243;n Europea de Urolog&#237;a"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Telemedicine and telehealth applications in urology&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The current COVID-19 pandemic has put our health system under great pressure&#44; causing dramatic changes in our daily lives&#46; Many countries have imposed restrictions on mobility and social life in an effort to control the virus spread&#46; These protective measures have considerably conditioned the way we are practicing medicine&#46; Health care has been forced to adapt quickly&#44; and recommendations have even been published to help classify urological surgeries according to their priority&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Many centers are rapidly converting their on-site activity into telemedicine&#44; which has become the new reality for most of them&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> It is expected that many patients will spend long periods of confinement at home&#44; and the onset or worsening of urological symptoms or the interruption of follow-up can generate anxiety and feelings of helplessness&#46; Today&#44; one in 10 people in the world are over 60 years old&#59; and this number is expected to double by 2050&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> Although urological diseases affect a wide spectrum of age groups &#40;from prenatal age to advanced age&#41;&#44; many urological diseases are found in patients at high risk of COVID-19 infection&#44; and in those with poor evolution &#40;advanced age&#44; male gender&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> As such&#44; it is desirable to reduce unnecessary face-to-face and emergency room visits in order to avoid unnecessary contacts&#44; thus protecting patients and reducing the burden of health care and resource consumption&#46; It is clear&#44; therefore&#44; that many aspects of health care can be addressed through technology&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As telemedicine has been used in previous epidemic outbreaks&#44; it has been rapidly incorporated as a solution to monitor patients with COVID-19&#44; and to continue with specialized care in several countries&#46; Examples include patients isolated in Taiwan during the SARS epidemic in 2003&#44; the pandemic H1N1 influenza in 2009&#44; and patients infected with H7N9 influenza in 2013 in China&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;6&#44;10&#8211;13</span></a> Many legal&#44; privacy&#44; and billing issues are involved&#44; but these are being rapidly resolved because of the COVID-19 crisis&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is difficult to predict how long will the pandemic last&#44; and social distancing may become the &#8220;new normalcy&#8221; in our society&#46; Even when this pandemic is over&#44; telemedicine offers potential advantages&#44; such as patient convenience and reduced vehicle emissions&#46; It is time to formalize the role of telemedicine in the daily clinical practice of urology&#44; and it is our responsibility to make efforts to adapt and familiarize with all the instruments and possible strategies for its optimal implementation&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#44;17</span></a> Our goal is to provide practical recommendations for an appropriate and effective use of technology tools in virtual medicine&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This review will examine the current scenario in which telemedicine is used for daily urological practice&#46; Extensive literature research has been conducted on original articles and reviews using the Medline database and grey literature up to April 2020&#46; We searched for the following terms&#58; &#8220;COVID-19 outbreak&#8221; and&#47;or &#8220;smart working&#8221; and&#47;or &#8220;telemedicine&#8221; and&#47;or &#8220;telehealth&#8221; and&#47;or &#8220;urology&#8221;&#46; The combination of &#8216;COVID-19 outbreak&#8221; with each of the other terms resulted in 149 related articles&#46; The coherence of these recommendations is affected by the inherent lack of strong evidence in urology&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Characteristics and considerations</span><p id="par0030" class="elsevierStylePara elsevierViewall">Telehealth refers to the use of electronic information and telecommunication tools to provide remote clinical care support&#44; professional and public health education&#44; and health administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;15&#44;18</span></a> Telemedicine is used for remote clinical services such as diagnosis and monitoring&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">19&#44;20</span></a> Smart working is a work model that uses new or existing technologies to improve performance&#58; it is linked to the concepts of flexibility and teleworking&#46; Any innovative idea is applicable and defends the concept of working from any place&#58; cafeterias&#44; coworking spaces and especially&#44; home&#46; Smart working is used by companies in different areas such as finance&#44; support services and consultancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">21&#44;22</span></a> Telehealth &#40;including telemedicine&#41; can be carried out through any communication technology such as email&#44; telephone&#44; messaging&#44; calls&#44; video calls&#44; video transmission&#44; data storage&#44; images&#44; video conferencing and webinars&#46; However&#44; the implementation of these technologies requires addressing issues related to privacy&#44; reimbursement&#44; and other organizational issues&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#44;5&#44;15&#44;18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Benefits of telemedicine during the COVID-19 Pandemic</span><p id="par0035" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Reduces the spread of coronavirus &#40;SARS-CoV-2&#41; from symptomatic or asymptomatic infected patients</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Reduces infection of healthy people</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Reduces contamination to workers and hospital surfaces</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Healthcare professionals who are positive for COVID-19 or at high risk for complicated COVID-19 infection can potentially work while on home confinement</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patient visits to the hospital are those which are really necessary&#44; and their efficiency can possibly increase with time and practice</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Recent data on patient satisfaction show that patients are accepting telemedicine to a surprising degree&#44; particularly for follow-up consultations&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#44;24</span></a></p></li></ul></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Telemedicine and the benefits of smart working beyond the COVID-19 pandemic</span><p id="par0070" class="elsevierStylePara elsevierViewall">Air pollutants emitted by traffic contribute to respiratory diseases&#46; Vehicle emissions contribute to greenhouse gases that lead to climate change&#46; Teleworking avoids commuting&#44; reducing these emissions and helping to improve regional air quality and to protect the environment at the same time&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Buildings use energy to heat&#44; cool and light offices and to run equipment&#46; Office buildings account for almost 1&#47;5 of all commercial energy consumption and almost 3&#47;4 of that amount is used for lighting&#44; heating&#44; cooling and powering office equipment&#46; A reduced amount of office space will probably reduce emissions from electricity use&#46; The net savings depend on changes in the use of space and equipment at the office and telework location&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Teleworking can indirectly increase productivity&#44; as it allows workers to avoid distractions and replace commuting time with working time&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">How to pursue telemedicine and smart working in urology&#63;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Telemedicine is a team effort that includes urologists&#44; nurses&#44; administrative staff&#44; interdisciplinary coordination with other services such as laboratory&#44; radiology and oncology&#44; and health informatics technicians&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Access to patient records and data</span><p id="par0090" class="elsevierStylePara elsevierViewall">Records and data must be electronic in compliance with privacy and data protection regulations&#46; In the European Union &#40;EU&#41;&#44; these processes must be in accordance with the General Regulation of Data Protection &#40;GDPR&#41;&#46; It also addresses the exportation of personal data outside the EU&#46; The GDPR aims to give individuals control over their personal data and simplify the regulatory environment for international business by unifying rules within the EU&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">27</span></a> Each country&#44; region&#44; health system and hospital has its own program to securely manage data from medical records&#44; images&#44; diagnostics and laboratory tests&#46; It is desirable that they can be accessed from any computer&#47;device and location&#44; even from home&#59; if this option is not available&#44; the hospital administration should consider providing remote access to the Virtual Private Network &#40;VPN&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patient scheduling</span><p id="par0095" class="elsevierStylePara elsevierViewall">It is convenient to provide patients with different methods to schedule their visit&#44; including websites&#44; emails&#44; phone numbers or through mobile applications&#46; A prior call&#44; text message or email reminder from the clinic team is recommended to ensure that the patient knows how to access the visit and that the necessary records are available&#46; Patients can upload medical records directly into their file via a phone or computer so that physicians can view their tests or imaging results from other facilities during the visit&#46; A patient appointment must be generated and managed with the help of the tele-nursing team and administrative staff&#44; making your scheduling process more flexible&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">How to contact patients and make a telehealth visit&#63;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Patients can be contacted via a simple phone call&#44; video call&#44; email&#44; text message&#44; specific software or through a mobile application&#46; The most interactive way seems to be a video visit&#44; which allows practitioners to perform a limited physical exam by instructing the patient telematically&#46; However&#44; platforms with the ability to perform video consultations with secure data protection may be limited in many countries due to privacy&#44; billing&#44; and cost issues&#46; In addition&#44; some patients may have difficulty connecting to a video consultation due to technical problems&#46; In such a case&#44; a phone call may be the best option&#46; Available telemedicine applications alone are often less interactive and may not have sufficient support compared to a comprehensive telemedicine platform &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">How to triage patients in telemedicine&#63;</span><p id="par0105" class="elsevierStylePara elsevierViewall">The best way to manage teleconsultation is based on the creation of a good triage process&#46; The classification of patients into groups is crucial&#44; for example&#58; &#40;1&#41; first consultation or follow-up of oncological versus non-oncological diseases&#59; &#40;2&#41; an acute condition for consultation &#40;e&#46;g&#46;&#44; urinary tract infection&#44; costal pain&#44; hematuria&#41;&#59; &#40;3&#41; patients who need a complementary in-person test &#40;e&#46;g&#46;&#44; cystoscopy or imaging tests such as ultrasound or CT&#41;&#59; &#40;4&#41; patients who really need to visit the emergency room or outpatient office for a procedure &#40;e&#46;g&#46;&#44; catheterization for acute urinary retention or renal colic with fever&#41;&#59; and&#44; &#40;5&#41; patients with a diagnosis that would require surgical intervention&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In a globalized world&#44; patients may need translation services&#46; However&#44; this is not directly available on some telemedicine platforms such as EPIC&#174; &#40;EPIC&#44; Verona&#44; USA&#41;&#46; Institutions should make an effort to provide patients with interpreting services to facilitate communication&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Informed consent in the clinical record</span><p id="par0115" class="elsevierStylePara elsevierViewall">It is important to document all data in the clinical record in the way of an on-site medical history&#46; The note should include a disclaimer&#44; such as &#8220;this visit is provided with the patient&#39;s consent&#8221;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Management of complementary diagnostic tests</span><p id="par0120" class="elsevierStylePara elsevierViewall">In a clinical setting&#44; the request for diagnostic laboratory or imaging tests can be managed through the virtual private network&#46; Many patients will need laboratory or imaging test requests&#44; some of them with relative urgency&#46; Files should be safely sent through secure e-mails on a regular basis&#46; One example of a secure encrypted application is Doximity&#44; which offers various ways to reach patients from cell phones while protecting personal number&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The COVID pandemic is limiting patient mobility and health resources&#46; The request for complementary tests must be made in a rational way&#44; considering that many hospital departments and laboratories with diagnostic purposes &#40;e&#46;g&#46; radiology&#41; are working under exceptional conditions and serving primarily COVID-19 patients during this critical time period&#46; Deferring nonurgent laboratory and imaging tests should be considered&#44; depending on the clinical priority of the test&#44; patient age and health status&#44; and the local COVID-19 situation&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;24&#44;29&#44;30</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Follow-up consultation</span><p id="par0130" class="elsevierStylePara elsevierViewall">At the follow-up visit&#44; the telehealth team should make sure that the results of the complementary tests are available to the practitioner&#46; Once results are available and clinical decisions can be made&#44; it is recommended to send the reports to the patient and further appointments should be scheduled&#46; In the current pandemic&#44; it is understandable that follow-up visits for low-risk patients may be scheduled later than usual&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Telemedicine platforms</span><p id="par0135" class="elsevierStylePara elsevierViewall">It is convenient to rely on a platform that combines secured data management&#44; access to electronic records&#44; as well as the ability to allow video visits&#46; There is a need for integrated telehealth platforms in many European countries &#40;within a legal frame&#41;&#46; Currently&#44; there are commercially available platforms such as EPIC&#174; &#40;EPIC&#44; Verona&#44; WI&#44; USA&#41; medical record system and NHS Attend Anywhere&#174;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> During the outbreak&#44; EPIC is being used successfully in the United States&#46; However&#44; the response capacity for rapid implementation of such platforms during a pandemic period is limited in many countries due to costs and regulations &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">How to interact with other members of the telemedicine team&#63;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Continuous communication with the team is crucial&#44; for which regular channels such as calls&#44; emails and messaging are used&#46; Online applications such as Zoom&#174;&#44; Hangouts&#174; and Skype&#174; can be used for video conferencing&#44; although this may depend on country restrictions&#44; and special care should be taken when sharing data&#46; The use of Zoom&#174; has increased during the COVID-19 pandemic&#44; with millions of people teleworking around the world&#46; This has caused us to be concerned about privacy&#46; Currently&#44; the Zoom&#174; service does not support end-to-end encryption for video and audio content&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> Several paid corporate packages&#44; such as Microsoft&#174; Teams&#174; and G Suite&#44; offer email services with business domains&#44; storage capacity and spreadsheets that allow real-time updates&#44; chat channels&#44; agendas&#44; calendars and video conferencing tools for business groups with better performance than free versions with an increasing number of users&#46; It is recommended to use secured applications in terms of privacy&#44; and to create securely encrypted databases for patient follow-up tasks&#44; which can be updated and shared with the entire team&#46; Consult your clinical administrators and familiarize yourself with local regulations before adopting these technologies&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Working from home</span><p id="par0145" class="elsevierStylePara elsevierViewall">Working from home requires self-discipline&#44; order and organization&#46; It is advisable to have scheduled activities&#44; patient agenda and respect time in the same way as in face-to-face visits&#46; Prepare an adequate work area at home that protects patients&#8217; confidentiality and with available technology &#40;computer&#44; internet connection&#44; video camera and microphone&#41;&#44; as well as wearing professional clothing&#46; Maintain good communication and enthusiasm with the team&#44; as well as healthy habits and routines to improve productivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">21&#44;22</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Virtual learning in urology</span><p id="par0150" class="elsevierStylePara elsevierViewall">The year 2020 is an exceptional year&#44; as the annual congresses of the European Association of Urology &#40;EAU&#41;&#44; the American Association of Urology &#40;AUA&#41; and the Spanish Association of Urology &#40;AEU&#41; were physically suspended and have become entirely virtual due to the COVID-19 pandemic&#46; Today&#44; learning and sharing knowledge through virtual platforms is more compelling than ever&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">32&#44;33</span></a> In this sense&#44; several virtual platforms have been created&#44; including social networks such as Twitter&#174;&#44; Facebook&#174; and Instagram&#174;&#44; as well as urological webinars organized by the different associations&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">34&#8211;37</span></a> Several platforms can be used to create webinars and congresses&#46; Among others&#44; LogMeIn &#40;<a href="https://www.logmeininc.com/">https&#58;&#47;&#47;www&#46;logmeininc&#46;com&#47;</a>&#41; offers platforms such as GoToMeeting&#44; GoToWebinar and GoToTraining that allow organizing webinars&#44; meetings and virtual congresses in a relatively easy way&#44; with accessible prices and complying with European regulations on data protection&#46; There are also simpler alternatives&#44; such as live streaming through online applications and platforms such as Facebook&#174;&#44; Instagram&#174; or Zoom&#174;&#44; which can be options for broadcasting video conferences&#46; Privacy must be fully respected within these processes&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Privacy and billing</span><p id="par0155" class="elsevierStylePara elsevierViewall">Adherence to the data protection regulation is essential&#46; It is advisable to use secured communication channels to protect the confidentiality of patient data&#46; Platforms provided by each institution are most recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> Privacy and billing regulations vary across different regions and countries and have complicated after by the rapid evolution of the COVID-19 situation&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">14&#44;15</span></a> Once more&#44; it is strongly advised to check on the local regulations with your clinical administrator&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Limitations and risks</span><p id="par0160" class="elsevierStylePara elsevierViewall">One of the limitations of teleconsultations is that a physical exam cannot be performed in the conventional way&#46; However&#44; a physician-directed self-examination may be a reasonable option&#44; especially in video visits&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#44;14</span></a> Moreover&#44; it is not possible to obtain diagnostic tests &#40;such as urine analysis&#44; post-void residual urine measurement&#44; laboratory tests&#41; during the visit either&#44; and these tests must be conducted independently&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Telemedicine billing conditions vary between countries and are complicated&#59; however&#44; changes in telehealth regulations are being considered&#44; and we should be encouraged to study and adapt them to each country and region&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Confidentiality is another issue&#59; however&#44; it can be solved by following the recommendations&#44; using the appropriate channels and common sense&#46; Regulatory considerations on confidentiality are also being addressed&#58; patients should be notified about the current protections and a disclaimer should be included in clinical documentation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Some urologists may not have previous experience with telework and telehealth&#59; potential challenges include scheduling virtual visits&#44; team meetings&#44; self-discipline&#44; distractions from remote working&#44; feelings of loneliness&#44; loss of motivation&#44; depression&#44; disruptions to family life within the home&#44; and creating a professional distance working environment&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Good practice recommendations on telemedicine and smart working</span><p id="par0180" class="elsevierStylePara elsevierViewall">These recommendations aim to provide best practices for the implementation of telemedicine in urology&#46; The COVID-19 pandemic is changing rapidly&#44; and these recommendations should be constantly updated&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">1&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Stay current on innovative strategies and learn how to manage platforms and tools that enable communication with patients&#44; communication with other team members&#44; and secured data exchange&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">2&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Provide patients with different methods to schedule appointments&#46; Contact them in advance to agree on the date and time and provide them with instructions on how to access the teleconsultation or virtual visit&#46; Provide a telephone number for urgent consultations and alert symptoms and avoid unnecessary visits to the hospital&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">3&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">During video visit&#58; have a calmed and private environment&#44; make sure that the patient does too&#46; Preferably the patient should be alone or with a family member to help with technical issues&#46; Computers are preferable to cell phones&#46; Make sure that the background is quiet and not disturbing&#44; and that there is proper lighting and good quality audio&#46; The camera should be placed at eye level&#46; Wear professional attire as you would in other clinical settings&#46; Manage your body language and analyze the patient&#39;s body language&#46; Offer advice when performing guided physical self-examinations&#46; For patients who cannot set up a video visit for technical reasons&#44; a phone call may be an alternative&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">4&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Not having a specific application is not a reason to avoid telemedicine&#46; Even a simple phone call and access to medical records&#44; managed by a urologist or nurse&#44; can help address urologic issues and concerns during a pandemic emergency&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">5&#46;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Hospital telephones should be used for telephone calls&#46; If you use your personal cell phone&#44; make sure your personal number is not being revealed&#46; There are options for the management of this issue&#44; such as the Doximity application&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">6&#46;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Triage patients using common and clinical sense&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;3</span></a></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">7&#46;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Send reports&#44; prescriptions&#44; perform laboratory tests&#44; imaging tests&#44; and schedule in-person procedures &#40;e&#46;g&#46;&#44; cystoscopies&#41; if necessary&#44; with the support of a nursing and&#47;or administrative telemedicine team&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">8&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Maintain constant communication with the team&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">9&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Become familiar with the available options for email&#44; videoconferencing&#44; calendars&#44; social networks&#44; packages&#44; telehealth platforms&#44; and webinar platforms&#46; Consult with administrators about local regulations before adopting these technologies&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">10&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Follow privacy and billing regulations in your country and region&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">11&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">If you are a healthcare provider&#44; self-discipline is crucial&#46; Set schedules and avoid distractions when you are working&#44; as if you were in an on-site job&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> Create healthy routines and keep motivation high&#46; Find balance with any family member at home&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">12&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">Keep academically current by following the virtual congresses&#44; webinars&#44; guides and articles from the official channels of the urological associations &#40;<a href="https://uroweb.org/">https&#58;&#47;&#47;uroweb&#46;org&#47;</a>&#41; &#40;<a href="http://www.aeu.es/">www&#46;aeu&#46;es</a>&#41;&#46; Exchange knowledge and ideas through social media&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#44;18</span></a></p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">13&#46;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Schedule update scientific meetings by videoconference&#46; Discuss relevant clinical cases and new strategies with novel situations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">14&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Try to generate and share quality content for the population and patients&#46; Remember that you are a health professional and that there is a substantial need to disseminate high quality health information&#44; especially during a public health crisis&#46;</p></li></ul></p><p id="par0255" class="elsevierStylePara elsevierViewall">Try to comply with recommendations&#44; follow your local policies and avoid misconduct &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Challenges and future directions</span><p id="par0260" class="elsevierStylePara elsevierViewall">In the current scenario&#44; we must make efforts to ensure the viability of telemedicine and smart working&#46; These tools are useful during this crisis and are probably here to stay&#46; It is the duty of national and regional associations&#44; as well as the urology departments of each institution&#44; to find strategies adapted to their local situation&#46; We must look for simple and effective strategies in the short term and make plans for the medium and long term&#46; No one currently knows how to return to &#8220;normal clinical practice&#8221; when the incidence of COVID-19 decreases&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Everything seems to indicate that on-site visits are going to be restricted for an indeterminate period of time&#44; and we have to evolve rapidly with telemedicine and virtual medicine&#46; One important issue is access to healthcare&#44; which can be problematic for people in rural areas&#59; this is another population that can benefit in the long term from further expansion of telemedicine&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">Institutions should develop telehealth programs according to the needs of each department&#46; This includes defining the types of services to be offered &#40;e&#46;g&#46;&#44; first consultations&#44; follow-ups&#44; rapid test reading or imaging&#8230;&#41;&#46; The planning phase comes after defining the needs&#44; where deadlines and task lists are created to launch and maintain the telemedicine program&#46; It includes the following steps&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">1&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Defining the objective of the patients and diseases to be included in the program and the timetables to be followed &#40;e&#46;g&#46;&#44; monitoring of low risk prostate cancer&#44; BPH with low to moderate symptoms&#46;&#46;&#46;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">2&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Select enthusiastic and motivated people and provide specific training&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">3&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Determine the hours needed to complete the tasks and create an implementation schedule&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">4&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Discuss and create the materials needed to build the telemedicine program&#46;</p></li></ul></p><p id="par0295" class="elsevierStylePara elsevierViewall">The final phase is implementation and feedback&#46; The implementation of a telemedicine program implies an organizational change in the departments&#44; and as every change&#44; this one involves people&#46; Technology is a cornerstone of telemedicine programs&#59; however&#44; successful implementation requires the ability to build the best team&#46;</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusions</span><p id="par0300" class="elsevierStylePara elsevierViewall">Telemedicine and smart working provide specialized clinical support for urologists at a distance using technological tools as a logistically viable alternative to on-site consultation&#46; This novel medical practice reduces unnecessary visits to medical facilities and is useful for reducing the risk of transmission in the current COVID-19 pandemic&#46; In addition&#44; both personal and social considerations &#40;e&#46;g&#46;&#44; greenhouse gas emissions&#44; greater efficiency&#41; may support the continued use of telemedicine when applicable&#44; even beyond the COVID-19 pandemic&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare having no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Telemedicine provides remote clinical support through technology tools&#46; It can facilitate medical care delivery while reducing unnecessary office visits&#46; The COVID-19 outbreak has caused an abrupt change in our daily urological practice&#44; where teleconsultations play a crucial role&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To provide practical recommendations for the effective use of technological tools in telemedicine&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A literature search was conducted on Medline until April 2020&#46; We selected the most relevant articles related to &#8220;telemedicine&#8221; and &#8220;smart working&#8221; that could provide valuable information&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support&#46; Smart working is a working approach that uses new or existing technologies to improve performance&#46; Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future&#46; It is time for us to officially give telemedicine the place it deserves in clinical practice&#44; and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation&#46; We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer&#44; reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La telemedicina ofrece un soporte cl&#237;nico remoto utilizando herramientas tecnol&#243;gicas&#46; Puede facilitar la atenci&#243;n m&#233;dica al tiempo que reduce las visitas innecesarias a la consulta&#46; La pandemia COVID-19 ha provocado un cambio brusco en nuestra pr&#225;ctica urol&#243;gica diaria convirti&#233;ndose en algo muy necesario el acto de la teleconsulta&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Proporcionar recomendaciones pr&#225;cticas para el uso efectivo de herramientas tecnol&#243;gicas en telemedicina&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda en la literatura en la plataforma Medline hasta abril de 2020&#59; seleccionamos los art&#237;culos m&#225;s relevantes relacionados con &#171;telemedicina&#187; y &#171;trabajo inteligente&#187; que podr&#237;an proporcionar informaci&#243;n &#250;til&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La telemedicina se refiere al uso de la informaci&#243;n electr&#243;nica y a las herramientas de telecomunicaciones para proporcionar apoyo cl&#237;nico remoto a la atenci&#243;n m&#233;dica&#46; El trabajo inteligente es un modelo de trabajo que utiliza tecnolog&#237;as nuevas o existentes para mejorar el rendimiento&#46; La telemedicina se est&#225; convirtiendo en una herramienta &#250;til y necesaria durante la pandemia COVID-19 e incluso m&#225;s all&#225; de la misma&#46; Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra pr&#225;ctica cl&#237;nica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementaci&#243;n de una manera &#243;ptima&#44; garantizar una atenci&#243;n de calidad a los pacientes y que dicha atenci&#243;n sea percibida por pacientes y familiares como de alto nivel&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La telemedicina facilita la atenci&#243;n cl&#237;nica urol&#243;gica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes&#44; reduce las visitas innecesarias a las cl&#237;nicas y es &#250;til para reducir el riesgo de transmisi&#243;n viral de la COVID-19&#46;</p></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Access to medical records&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Connection to the National Health System&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Connection to hospital&#47;clinic VPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Video visit capability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doctor&#39;s access to lab test&#47;images&#47;prescriptions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Safety in compliance with privacy regulations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Billing in compliance with regulations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient consent form&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient information&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Translation services&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Telehealth platforms capabilities&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Misconduct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Example&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not asking for consent to televisit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not informing change from on-site visit to online visit at the beginning of the consultation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Communicating sensitive information through improper channels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Informing a diagnosis of cancer through a text message&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not using proper channels under the privacy and billing laws of the country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Billing a consultation as face-to-face using channels or applications outside of the country&#39;s laws&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not sending reports and prescriptions that have been offered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not sending treatment prescription taken on a regular basis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inappropriate televisit and WFH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wearing informal clothes&#44; and using a nonprivate environment to inform the patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not properly managing a patient who needs face-to-face care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not recommending face-to-face care to a patient with lumbar pain and fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      "titulo" => "References"
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        0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Association of Urology Guidelines Office Rapid Reaction Group&#58; an organisation-wide collaborative effort to adapt the European association of urology guidelines recommendations to the coronavirus disease 2019 Era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Ribal"
                            1 => "P&#46; Cornford"
                            2 => "A&#46; Briganti"
                            3 => "T&#46; Knoll"
                            4 => "S&#46; Gravas"
                            5 => "M&#46; Babjuk"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2020.04.056"
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                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2020"
                        "paginaInicial" => "78"
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              "identificador" => "bib0200"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Considerations in the triage of urologic surgeries during the COVID-19 pandemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;D&#46; Stensland"
                            1 => "T&#46;M&#46; Morgan"
                            2 => "A&#46; Moinzadeh"
                            3 => "C&#46;T&#46; Lee"
                            4 => "A&#46; Briganti"
                            5 => "J&#46;W&#46;F&#46; Catto"
                          ]
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                      ]
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                      "doi" => "10.1016/j.eururo.2020.03.027"
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                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2020"
                        "volumen" => "77"
                        "paginaInicial" => "663"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32279903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endourological stone management in the era of the COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Proietti"
                            1 => "F&#46; Gaboardi"
                            2 => "G&#46; Giusti"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2020.03.042"
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                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2020"
                        "paginaInicial" => "78"
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Telemedicine in the time of coronavirus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Calton"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jpainsymman.2020.03.019"
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                        "tituloSerie" => "J Pain Symptom Manag"
                        "fecha" => "2020"
                        "paginaInicial" => "60"
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806313005094"
                          "estado" => "S300"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic&#58; a call to action"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Ohannessian"
                            1 => "T&#46;A&#46; Duong"
                            2 => "A&#46; Odone"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2196/18810"
                      "Revista" => array:4 [
                        "tituloSerie" => "JMIR Public Heal Surveill"
                        "fecha" => "2020"
                        "volumen" => "6"
                        "paginaInicial" => "e18810"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bolstering the surgical response to COVID-19&#58; how virtual technology will save lives and safeguard surgical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Karim"
                            1 => "N&#46; Hachach-Haram"
                            2 => "P&#46; Dasgupta"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bju.15080"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2020"
                        "volumen" => "125"
                        "paginaInicial" => "E18"
                        "paginaFinal" => "E19"
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ISSN: 21735786
Original language: English
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