Outcomes of Cryopreserved Vs Fresh Haploidentical Allogeneic Donor Grafts Using Post-Transplant Cyclophosphamide (PTCy) for Gvhd Prophylaxis

The World Health Organization (WHO) declared COVID-19 a pandemic in March 2020. Since then, logistical challenges arose regarding the procurement of allogeneic (allo) hematopoietic stem cell (HSC) donor grafts. Little data was available on transplant outcomes using cryo haploidentical (haplo) HSC grafts with post-transplant cyclophosphamide (PTCy) for GVHD prophylaxis. We retrospectively analyzed patients who received a first PTCy-based haplo hematopoietic stem cell transplant (Haplo HCT) at a single outpatient transplant center between January 2015 and December 2021. We identified 294 patients, 179 received a fresh graft and 115 received a cryo graft (Table 1). Both cohorts were similar in terms of median age, diagnoses, HCT-CI score and DRI. Out of 179 fresh haplo grafts, 160 (89.4%) were from peripheral blood stem cells (PBSC) and 19 (10.6%) were bone marrow grafts (BM). There were no cryo BM grafts used. Conditioning intensity were similar amongst both cohorts, with 43% myeloablative, 41.9% non-myeloablative and 15.1% RIC regimens used for fresh Haplo HCT and 39.1% myeloablative, 42.6% non-myeloablative and 18.3% RIC cryo Haplo HCT. Median time to engraftment was 16 days for fresh Haplo HCT and 17 days for cryo HCT (p=0.18). Median time to platelet engraftment was 27 days for fresh Haplo HCT and 27.5 days for cryo HCT (p=0.96). Since March 2020, only 8 transplants performed at our institution were from fresh haplo HSC grafts. Cryo grafts performed after March 2020 accounted for 73 (63.5%) of 115 total cryo Haplo HCT performed in the period reviewed. Using a Cox model to evaluate the effect of graft type and adjusting for significant variables, we found no difference in overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse rates between fresh and cryo Haplo HCT performed (Figure 1). While we found no difference in grades III-IV aGVHD (Table Presented) (Figure Presented) between fresh vs cryo Haplo HCT, we found a statistically significant higher incidence of grades II-IV aGVHD (p=0.033). There was no difference in all-grade cGVHD (p=0.53) or moderate- severe cGVHD (p=0.86) (Figure 2).(Figure Presented) The National Marrow Donor Program (NMDP) released a statement requiring cryopreservation of unrelated donor grafts at the start of the COVID-19 pandemic. The cryopreservation of all types of allo HSC grafts has been adopted by many transplant programs including ours. Our results mimic a CIBMTR analysis published at the start of the pandemic, where survival outcomes using fresh vs cryo haplo HSC grafts with PTCy as GVHD prophylaxis were similar. Contrary to other reports, we did not see differences in graft failure or rates of cGVHD between fresh and cryo Haplo HCT. The use of cryopreserved HSC grafts for Haplo HCT with PTCy results in favorable outcomes in an outpatient transplant setting. Further studies are needed to determine the cost-effectiveness of this practice in the post-pandemic era.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Post COVID-19 recovery personalised care

The impact of the pandemic shifted the focus of global healthcare systems to treating and preventing COVID-19 infection. In October 2021 the World Health Organisation published a clinical case definition of Post COVID syndrome which included symptoms of post viral infection that had lasted for over 3 months which followed the work of patient led groups naming this condition Long Covid (Callard and Perego 2021). Globally more than 100 million people are living with prolonged symptoms of COVID-19 infection which is creating a huge demand on clinical services. Impact of Post COVID Syndrome: The symptoms of Post COVID syndrome are extensive, can fluctuate, be relapsing - remitting and can have a significant impact on an individuals activities of daily living including work. It was recognised by Greenhalgh et al (2020) that people with prolonged symptoms will require an interprofessional holistic assessment and a paced approach to recovery embracing self-management and peer support strategies. Personalised care approaches to Post COVID Care: The universal personalised care model embeds six evidencebased components of personalised care with well documented benefits in many conditions including asthma and COPD. These approaches must be embedded for people with Post COVID Syndrome and involve people with lived experience. Conclusion(s): Post COVID Syndrome can be a debilitating multisystem relapsing condition which needs a holistic, individualised, personalised approach to care.

Day case thoracoscopy in a UK district general hospital

Background: Day case local anaesthetic thoracoscopy (LAT) with indwelling pleural catheter (IPC) insertion is currently being advocated to mininize length of stay in the Covid pandemic. As part of this innovation, continuous service reviews are warranted. All local procedures are performed in theatre. Rapid pleurodesis with talc is not performed due to staffing problems. All patients receive erector spinae catheters to control post-op pain. Method(s): All patients undergoing day case LAT between Dec 2019-Jan2022 were analysed. Basic demographics and outcomes were collected for a descriptive analysis of data. Result(s): 32 patients underwent day case LAT. All had negative pre-op Covid-19 swabs: mean age 72.4 years (range 34-83);22M/10M. Diagnoses were 9 lung cancers, 11 mesotheliomas and 9 fibrinous pleuritis (1 of those went for VATS and proved mesothelioma). The lung did not deflate, not enabling biopsies in 3 (Non-malignant diagnoses). 28 IPCs and 2 large bore drains were inserted due to surgical emphysema. 1 patient developed an empyema and 1 had cellulitis within 30 days. 28 IPCs have already been removed due to pleurodesis (median 54 range 21-197). All were discharged the same day except the 2 requiring a large bore drains. Mean length of stay is 0 days. Diagnostic sensitivity of LAT is 96.5%. Pain scores at day 0,1,2 of surgery were consistently low. No patient caught Covid in the 30 days post surgery. Conclusion(s): Day case LAT is feasible with our current set up and should be widely adopted. The health economics of preventing admission are considerable.

Holistic Online Learning, in a Post COVID-19 World

In August of 2020, the United Nations reported that the COVID-19 pandemic had affected 1.6 billion learners, in more than 190 countries and on all continents [1]. The closing of schools and other learning spaces impacted an astonishing 94% of the world's student population. These sudden school closures, at all levels, had the immediate and unprecedented effect of triggering a mass migration to emergency remote teaching. While mass vaccinations have enabled educational institutions to reopen and students to return to classrooms in the Fall of 2021, the educational disruption caused by the COVID-19 pandemic is far from over. Higher education must now permanently transition from reductionist, emergency remote learning systems to permanent, holistic online learning platforms. In order to better understand this transition, an online survey was delivered to diverse groups of international students attending Corvinus University and ESSCA School of Management, at the beginning and end of the Spring 2021 semester. The analysis of this survey, strongly indicates that the home and social environments of University, had a significant impact on the student's learning aptitudes.

Holistic Online Learning, in a Post COVID-19 World

In August of 2020, the United Nations reported that the COVID-19 pandemic had affected 1.6 billion learners, in more than 190 countries and on all continents [1]. The closing of schools and other learning spaces impacted an astonishing 94% of the world's student population. These sudden school closures, at all levels, had the immediate and unprecedented effect of triggering a mass migration to emergency remote teaching. While mass vaccinations have enabled educational institutions to reopen and students to return to classrooms in the Fall of 2021, the educational disruption caused by the COVID-19 pandemic is far from over. Higher education must now permanently transition from reductionist, emergency remote learning systems to permanent, holistic online learning platforms. In order to better understand this transition, an online survey was delivered to diverse groups of international students attending Corvinus University and ESSCA School of Management, at the beginning and end of the Spring 2021 semester. The analysis of this survey, strongly indicates that the home and social environments of University, had a significant impact on the student's learning aptitudes.

A Case of Beriberi After MIS-C

Introduction: As of June 2021, 4 million children have tested positive for COVID-19 in the US. In contrast to adults, children are often hospitalized with gastrointestinal symptoms including persistent vomiting. Pancreatitis has also been seen in MISC, which can lead to malnutrition. Most physician learn about thiamine deficiency and Wernicke Encephalopathy in patients with severe alcoholism or in low-income settings. We cared for a child with Wernicke Encephalopathy due to subacute malnutrition and weight loss after pancreatitis secondary to MISC in the US. Case Description: A 13-year-old female presented to Levine Children's Hospital with weight loss. She was diagnosed with COVID on 1/23/21 with 1 week of URI symptoms, with baseline weight 165 pounds (BMI 31.1). She was seen in an Emergency Department (ED) on 3/1/21 for vomiting with lipase 350u/L;she received fluids and was discharged. She represented on 3/7/21 with persistent symptoms weighing 135.5 pounds (BMI 25.6) with lipase 790u/L. She was discharged after three days with a diagnosis of post-COVID pancreatitis and lipase 600u/L. After discharge, she continued losing weight despite ondansetron. She followed up with GI on 3/15, weighing 130 pounds (BMI 24.5). An abdominal MRI and endoscopy were normal. She was started on omeprazole and cyproheptadine. She presented to Levine Children's Hospital on 3/24/21 for a second opinion. Upon admission, her serum lipase was 895u/L and she weighed 115 pounds (BMI 21.7). She was started on dextrose-containing fluids and developed seizures on 3/27/21. MRI brain was normal. Ophthalmology noted bilateral abducens nerve palsy. She developed worsening mental status and respiratory failure, so was intubated. A repeat MRI brain revealed posterior reversible encephalopathy syndrome and findings specific for Wernicke Encephalopathy. Thiamine level was low, and empiric thiamine was initiated. She was started on feeds and clinically improved. She was then extubated and showed improvements in her motor function and ability to follow commands. She transferred to inpatient rehab and continues to make progress. Discussion: Identification of the degree of malnutrition for this patient was difficult to obtain due to non-communicating EMRs. This limited the providers' ability to accurately quantify the degree of weight loss and the potential for Thiamine deficiency. The combination of limited body storage and short half-life can result in total depletion of thiamine stores within 2 weeks leading to altered mental status. Unfortunately, stigmatization of obesity in children has been well documented and malnutrition may be overlooked due to a normal BMI. Conclusion: Obtaining growth charts for patients presenting with weight loss is important as they provide objective data and help prevent obesity bias. If a child has a history of weight loss and develops altered mental status, vitamin B deficiencies should be considered in the differential. Pancreatitis associated with MIS-C can cause significant malnutrition leading to Wernicke Encephalopathy.

Strategies to Reduce Mortality Among Children Living With HIV and Children Exposed to HIV but Are Uninfected, Admitted With Severe Acute Malnutrition at Mulago Hospital, Uganda (REDMOTHIV): A Mixed Methods Study.

Background: Children living with HIV (CLHIV) and children who are exposed to HIV but uninfected (CHEU) are at increased risk of developing malnutrition. Severely malnourished children have high mortality rates, but mortality is higher in CLHIV/CHEU. This study aims to investigate whether empiric use of an antibiotic with greater antimicrobial sensitivity (ceftriaxone) than standard-of-care (ampicillin plus gentamicin) will reduce mortality among CLHIV/CHEU admitted with severe acute malnutrition. Methods: This is an open label randomized controlled trial involving 300 children; 76 CLHIV and 224 CHEU. The participants are being randomized to receive 1 week of ceftriaxone (n = 150) or standard-of-care (ampicillin/gentamicin) (n = 150), in addition to other routine care. The trial's primary outcome is in-hospital mortality. Secondary outcomes are: length of hospitalization; weight-for-height, weight-for-age and height-for-age z-scores; and pattern/antimicrobial sensitivity of pathogens. In addition, 280 severely malnourished children of unknown serostatus will be tested for HIV at admission to determine the prevalence and factors associated with HIV-infection. Furthermore, all the CLHIV on LPV/r will each provide sparse pharmacokinetic (PK) samples to evaluate the PK of LPV/r among malnourished children. In this PK sub-study, geometric means of steady-state LPV PK parameters [Area Under the Curve (AUC) 0-12h , maximum concentration (Cmax) and concentration at 12 h after dose (C12h)] will be determined. They will then be put in pharmacokinetic-pharmacodynamic (PK-PD) models to determine optimal doses for the study population. Discussion: This study will ascertain whether antibiotics with higher sensitivity patterns to common organisms in Uganda and similar settings, will produce better treatment outcomes. The study will also provide insights into the current pattern of organisms isolated from blood cultures and their antimicrobial sensitivities, in this population. In addition, the study will ascertain whether there has been a significant change in the prevalence of HIV-infection among children presenting with severe malnutrition in the WHO recommended option B plus era, while determining the social/structural factors associated with HIV-infection. There will also be an opportunity to study PK parameters of antiretroviral drugs among severely malnourished children which is rarely done, and yet it is very important to understand the dosing requirements of this population. Trial Registration: ClinicalTrials.gov, identifier: NCT05051163.

Meeting the expectations of those undergoing elective Caesarean sections during the pandemic

Objective: To assess whether changes in procedure implemented at the QEUH during the pandemic have impacted the experience of elective Caesarean sections for patients and birth partners. Design: Two questionnaires were produced: one for patients, one for birth partners. These included a scale for participants to record how strongly they agreed with 12 statements addressing core expectations. Statements from a 2018 patient satisfaction audit were repeated allowing comparison. Five free text questions were developed to encourage reflection on positive or negative aspects and address the impact of the pandemic. Method: Questionnaires were offered to all patients undergoing elective Caesarean sections over three weeks in October 2021. They were distributed to 30 pairs ahead of theatre;38 responses were collected from 19 patients and birth partners post-delivery. Qualitative data was collated. Categorical variables were analysed by percentage allowing comparison with 2018 findings. Free text responses were reviewed on an individual basis. Results: 68% agreed with every statement. The statements with which patients and birth partners most strongly agreed were regarding feeling treated with respect (97%);feeling safe (95%);feeling comfortable with staff communication (97%);and feeling supported (95%). Notable improvement since 2018 was identified in respondents agreeing their partners were supported (95% from 54%), they were involved in decisions in theatre (79% from 46%), and they were supported to make decisions regarding their baby (79% from 62%). The lowest level of agreement was with the statement 'I feel the information provided in advance prepared me well for what to expect on the day': 50% strongly agreed demonstrating improvement from 48% in 2018;42% felt COVID-19 restrictions had impacted on their experience: 50% explained this was significant in limiting time spent together prior to delivery (partners can only join patients once they reach recovery ahead of their section);19% felt the impact was minimal;84% of the free text responses expressed gratitude and offered positive comments. Conclusions: The QEUH maternity department has achieved overall higher levels of satisfaction than in 2018 despite pandemic driven procedural changes. The greatest impact was limitation on time spent together prior to delivery. The area with most scope for improvement remains the provision of clear advance information, while satisfaction has increased, improvement efforts have been hindered by the reduction in F2F appointments. The volume of positive feedback provided exceeded the expectations of this study, reflecting the positive impact of this team on patients and birth partners.

Race, SpO2, and SaO2 in Critically Ill Adults

Rationale: For critically ill adults, oxygen saturation is continuously monitored using pulse oximetry (SpO2) as a surrogate for arterial oxygen saturation (SaO2). Skin pigmentation may affect accuracy of pulse oximetry by introducing error due to statistical bias (e.g., consistently lower SaO2 at a given SpO2), variance (e.g., wider range of SaO2 values at a given SpO2), or both. We evaluated relationships between patient race, SpO2, SaO2, and likelihood of hypoxemia or hyperoxemia. Methods: We analyzed prospectively collected data from all adults receiving mechanical ventilation in a single ICU from July 2018 to February 2021, excluding patients with Covid-19. Race was reported by patients or their surrogates in routine care;we included those with race documented as Black or White. Values for SpO2 were recorded from bedside monitors every 1 minute. Values for SaO2 from all arterial blood gas measurements were collected. First, we analyzed all pairs of SpO2 and SaO2 values obtained within 1 minute of each other in a generalized linear mixed-effects model with SaO2 as the dependent variable, a random effect for patient, and fixed effects for race, SpO2, and their interaction. Second, we compared the unadjusted incidence of hypoxemia (SaO2<88%) and hyperoxemia (PaO2>150 mmHg) by race, with SpO2 values 92-96% within 10 minutes of SaO2 measurement. Results:This analysis included 994 patients with 5,989 paired measurements of SpO2 and SaO2 collected within 10 minutes, of which 4,211 were within 1 minute. Of 5,989 SpO2-SaO2 pairs, 792 (13%) were from Black patients and 5,194 (87%) from White patients. In mixed-effects model analysis, the mean difference in SaO2 between White patients and Black patients was -0.1 (95% CI, -1.3 to 1.2) at SpO2 of 88%, 0.4 (-0.6 to 1.3) at SpO2 of 90%, 0.8 (0.0 to 1.6) at SpO2 of 92%, 1.1 (0.24 to 1.9) at SpO2 of 95%, and 1.0 (0.3 to 1.8) at SpO2 of 96% (Figure 1). Among patients with an SpO2 of 92-96%, Black patients were more likely than White patients to have hypoxemia (4.3% vs 1.4%) and hyperoxemia (5.1% vs 2.1%). Conclusions:At SpO2 values of 92-98%, the associated SaO2 value was 1 percentage point lower on average for Black patients compared to White patients, consistent with statistical bias in pulse oximetry. Additionally, greater variation in SaO2 values at a given SpO2 resulted in a higher incidence of both hypoxemia and hyperoxemia for Black patients with SpO2 values of 92-96%, compared to White patients.

Creating a Dedicated Pandemic Ambulatory Clinic: Lessons Learned From COVID-19.

BACKGROUND AND OBJECTIVES: COVID-19 is highly infectious and the pandemic requires many adaptations to how we deliver medical care. Early in the pandemic, much of this focus was on hospital and emergency department care delivery models to ensure the safety of non-COVID-19 patients and health care workers. However, providing much needed outpatient assessments for COVID-19 patients during a pandemic is also fraught with challenges. From our review of the literature, best practices for a dedicated pandemic ambulatory outpatient clinic have not previously been described. We present a model for creating a dedicated ambulatory pandemic clinic at our institution for the acute care needs of COVID-19 patients. METHODS: To address the current pandemic, the Mayo Acute Symptoms of COVID-19 Clinic was implemented on April 13, 2020, with the aims of providing a stand-alone location for COVID-19 patients to have acute outpatient evaluations as well as diagnostics. RESULTS: Recognized challenges addressed included consideration of airflow recirculation patterns in standard medical office buildings, optimization of protocols to conserve personal protective equipment (PPE), limiting total exposure time during patient flow, and reducing surfaces and spaces that patients would physically contact. To this end, unique methods of patient scheduling, patient flow process, staff training, and PPE protocols were developed and are explained in detail in this article. CONCLUSION: In the COVID-19 pandemic, as well as inevitably in future pandemics, outpatient medical facilities need to be prepared to care for nonhospitalized and nonemergent pandemic patients. We offer a practical approach that has been successful at our institution, with opportunity for local adaptation based on need and resources.

Characterizing the nature of professional training and practice of psychologists in South Africa

Psychology in South African has a contentious history owing to its alignment with apartheid era ideologies of racial segregation. Although the profession has undergone significant transformation since democracy in 1994, almost three decades later less than a quarter of professional psychologists in the country are black African. Structured psychology training programmes select an average of 8 candidates per year, which has promoted criticism and scrutiny of recruitment and selection procedures that may be more oriented towards those from privileged educational backgrounds. In this interview with Jean-Pierre Bouchard, psychology researchers Anita Padmanabhanunni, Kyle Jackson, Zorina Noordien and Tyrone Pretorius from the University of the Western Cape provide a critical overview of the training and practice of professional psychology in South Africa, selection and recruitment processes, the relevance of the profession, impact of telepsychology and the implications of COVID-19 for professional training and practice.

Grasping the nettle of private finance will be essential to rebuilding the UK after Covid-19

The Covid-19 pandemic has resulted in Britain's biggest debt in over 60 years. But the country also needs to spend over £600 billion to stimulate economic recovery as well as meet its target of net zero greenhouse gas emissions by 2050. While the UK government's private finance initiative model for procuring public infrastructure has fallen out of favour, private investment can deliver major public benefits if properly managed. This paper highlights both good and bad outcomes of private finance initiatives around the world and suggests how they can best be used to support the UK government's long-term aspirations to 'build back better' and meet its climate targets. The key is to focus on specific projects and to structure deals to provide quality, value for money and longevity. © 2022 ICE Publishing: All rights reserved.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE: College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency. METHOD: A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]). RESULTS: Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition. CONCLUSIONS: Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Chest trauma: an experience of a Respiratory Support Unit with level 2 care in the North East of England

IntroductionFalls cause 75% of trauma in patients above 65 years of age and thoracic trauma is the second commonest injury;rib fractures are the commonest thoracic injury. There is wide variation in care. Older trauma patients are less likely to have trauma assessments. Rib fractures carry up to 12% mortality with up to 31% developing pneumonia.1 The number of fractures correlates with morbidity. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anaesthetists for rib fracture management on a respiratory support unit.MethodsWith Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between Aug 20-Apr 21 were analysed. Descriptive statistical methodology was applied.Results119 patients were identified. Mean age was 71.1 years (range 23–97). 53 were male, 66 female. Mechanism of injury were falls from standing (65), falls down stairs/bed or in the bath (18), ladders (4), cycling (12), assault (3), road accidents (8) and 9 others (for example off horses). LOS was 7.3 days (range 1–54). 85 patients had more than 1 co-morbidity. 26 had a full trauma assessment and 75 had pan CTs. Mean number of rib fractures was 3.6. 31 (26%) had a pneumothorax and/or haemothorax. 18 chest drains were inserted (all small bore) and 1 needle aspiration done. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All had pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. 20 (17%) developed pneumonias.16 (14%) deaths occurred within 30 days (1 heart failure and cancer progression, 2 Covid and 14 pneumonias)- all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality.ConclusionsHigh level care for thoracic trauma can be performed by the respiratory team with analgesia managed by the pain team. 42% of pneumothoraces/haemothoraces were observed. Falls from standing are associated with significant mortality and morbidity. The service is now complemented by a frailty assessment service.Referencehttps://academic.oup.com/ageing/article/49/2/161/5673134

Day Case Thoracocoscopy With IPC Insertion

Introduction: Northumbria Healthcare NHS Foundation Trust runs a large pleural service. Local anaesthetic medical thoracoscopy (LAT) is a well-established procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT with pleurodesis. The Covid-19 pandemic has forced day case LAT provision with IPC placement without pleurodesis to minimise transmission risk. We describe our experience. LAT is performed in theatre under conscious sedation. Methods: All notes of patients requiring day case LAT between July 2020-Feb 2021 were analysed. Basic demographics and outcomes were collected. A descriptive analysis of the data was performed. Results: 17 patients underwent day case LAT. All had negative pre-operative Covid-19 swabs: mean age 70.8 years (range 34-82), 12 male,5 female. Diagnoses included 5 lung cancers, 6 mesotheliomas and 4 fibrinous pleuritis. The lung did not deflate, not enabling biopsies in 2. Non-malignant diagnoses are currently presumed. 14 IPCs and 2 large bore drain were inserted due to 2 immediate complication (surgical emphysema). 1 patient developed an empyema within 30days. 9 out of the 11 IPCs have already been removed due to pleurodesis occurring (mean number days 60. All were discharged on the same day except the two requiring further drain insertion. Conclusion: We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients. Keywords: medical thoracoscopy, lung cancer, covid-19