ABSTRACT
The COVID-19 pandemic forced civil society and business to face a new reality where much greater reliance needed to be placed on networked devices and internet distributed communications, including the provision of services ranging from medical advice to food, entertainment and even the facility to interact with family. The ability to meet in-person with family, friends, colleagues, business associates or customers was severely restricted leaving internationalisation as a utopian dream as borders were closed, students were denied access to a physical classrooms and businesses had to rapidly "pivot” or fail. These alternatives to real life have seemed less appealing to many, with every aspect of life "going online”, whether virtualectures, exams, meetings, mediations, court appearances, job interviews, shopping for a piece of cheese or starting a new trade relationship. Much innovation over the last two years has been around deploying online business models. There has also been a wider use of artificial intelligence to support "efficient” operations partly stimulated by the falling staffing levels due to the pandemic directly through sickness or forced isolations, or indirectly by a growing sense of the futility of working for a business, known as the Great Resignation ("Over the 12 months ending in January 2022, hires totalled 76.4 million and separations totalled 70.0 million…” indicating a huge refocusing on jobs in the USA) This paper looks at the challenge for legal systems to pivot around the growing trends in deployments of online innovation. Some businesses are now widely deploying software-based analysis systems, such as Airbnb, which is using them to "verify the identity and trustworthiness of a user of an online system” and flag potential guests who may be problematic. Although Airbnb is a multibillion-dollar business, it is a good example of how through using publicly available data, user supplied information, and smart software (artificial intelligence) a business can make predictions on the behaviour of its potential customers. Other AI resources have been creating new gaming scenarios, reporting on the news, and even creating new artworks and music. These kinds of use of AI in the marketplace have challenged the legal frameworks that support individual privacy and also ideas around human creativity. © 2022, Academic Conferences and Publishing International Limited. All right reserved.
ABSTRACT
Introduction: In the UK between the March 23, 2020 and May 10, 2020, the government enforced a lockdown. This, combined with COVID, caused OMFS hospitals across London to experience a change in staffing, resources and patient presentations. This study examines these changes, how patient care was adapted during this period and what can be learnt for the future. Method(s): Data was collected from OMFS units attached to all 4 level 1 trauma centers in London. Prospective data was collected from March 23, 2020-May 10, 2020 (1st period). Retrospective data was collected from hospital coding records for 23rd of March - May 10, 2019 (2nd period). Data was collected on all referrals to the OMFS team including diagnosis, patient demographics and treatment received. Result(s): There was an 84% reduction in patients presenting with mandible fracture. 2 units with dental emergency services experienced no change in dental abscess presentations whilst the other 2 units saw a decrease of 70-75%. There was a trend towards reducing admission and general anaesthetic treatments. Most mandible fractures were treated in the outpatient setting with 1 unit discharging 100% of mandible fractures that presented to A&E. Only 13 of 72 paediatric lacerations were treated with general anaesthetic. Conclusion(s): The COVID lockdown period, like war time, posed great challenges to healthcare provision. This paper presents the changes experienced and how patients were managed. Aiming to allow reflection and learning to guide changes in management to be adopted for the future.Copyright © 2022
ABSTRACT
Lufotrelvir was designed as a first in class 3CL protease inhibitor to treat COVID-19. Development of lufotrelvir was challenged by its relatively poor stability due to its propensity to epimerize and degrade. Key elements of process development included improvement of the supply routes to the indole and lactam fragments, a Claisen addition to homologate the lactam, and a subsequent phosphorylation reaction to prepare the prodrug as well as identification of a DMSO solvated form of lufotrelvir to enable long-term storage. As a new approach to preparing the indole fragment, a Cu-catalyzed C-O coupling using oxalamide ligands was demonstrated. The control of process-related impurities was essential to accommodate the parenteral formulation. Isolation of an MEK solvate followed by the DMSO solvate ensured that all impurities were controlled appropriately. © 2023 American Chemical Society.
ABSTRACT
Purpose: American Indian and Alaska Native (AI/AN) adolescents face significant physical and mental health disparities. These inequities result from historical and intergenerational traumas, which are the cumulative, permeating effects that impact individuals and communities who share a specific identity. Currently there is a paucity of research focusing on the mental health of AI/AN youth as well as the relationship between mental health and cultural connection. This project assesses the relationship between cultural identity (ethnic identity and tribal affiliation) and outcomes associated with mental health (loneliness, friendships, emotional support, and sleep) for AI/AN adolescents. It also aims to understand the impact of the COVID-19 pandemic on stress management for AI/AN adolescents. Methods: 12 to 18 year old adolescents from the Lumbee Tribe of North Carolina participated in this mixed-methods study. The project involved two phases informed by the principles of community-based participatory research. Phase 1, discussed in this , involved surveys using validated instruments to assess cultural connection, mental health outcomes, stress management, and resilience among participants. Phase 2 involves semi-structured interviews with adolescents. Results: Of 123 AI/AN youth who completed the survey, 54.5% (N=67) were 15-18 years old with mean age of 14.9 (SD=2.0). 61% (N=75) were assigned female at birth, 56% (N=70) identified as female, and 4.1% (N=5) identified as non-binary. Mean tribal affiliation (TA) and ethnic identity (EI) scores suggest strong cultural connection among participants (TA: mean 3.1/5, SD 0.6;EI: 3.4/5, SD 0.9). Sleep quality (mean 2.63/5) and positive stress management (mean 2.06/5) were low, suggesting room for improvement. Bivariate analysis and logistic regressions demonstrated moderate positive correlations between ethnic identity and friendship, ethnic identity and emotional support, tribal affiliation and friendship, and tribal affiliation and emotional support. Conclusions: Results highlight that AI/AN adolescents in this sample have a moderate-strong connection with culture, marked by ethnic identity and tribal affiliation. They also demonstrate the impact of cultural connection on mental health for AI/AN adolescents. Phase 2 will draw upon Phase 1 findings to further understand the relationship between cultural connection and mental health outcomes, and to promote community-driven interventions emphasizing inherent strengths and resiliencies identified through qualitative interviews of AI/AN youth. Data related to cultural connection and mental health outcomes may also be used to set the framework for policy formulation which may allow for increased funding and programming addressing mental health for AI/AN youth. Sources of Support: This research received support from the UNC Chapel Hill Office of Global Health.
ABSTRACT
Background. We sought to determine the frequency of asymptomatic SARS-CoV-2 infections, the BNT162b2 mRNA COVID 19 vaccine-related symptoms, and the correlates of immunity in post-vaccination breakthrough infections in a prospective cohort of healthcare workers. Methods. We have been conducting a single-center, observational cohort study of healthcare workers. 271 participants were enrolled since August 25, 2020. Testing for SARS-CoV-2 spike (S)-specific IgG antibodies is conducted using a microspherebased multiplex immunoassay interpolated against an internal standard curve for binding antibody (bAb) units (BAU) and has been performed on serum samples collected at monthly visits between September 2020 to August of 2021, and quarterly since then. Neutralizing antibody titers against wild-type (WT) virus are determined by microneutralization assays and against Delta and Omicron variants by lentiviral pseudovirus neutralization assays. For the first 6 months, participants completed a symptoms questionnaire every day they had any symptoms. Results. 12 participants were diagnosed with SARS-CoV-2, with at least mild symptoms. Of 206 participants evaluated for adverse effects after 1st and 2nd vaccine doses, no relationship was observed between vaccine-associated symptom scores and antibody titers 1 month after the 2nd dose. Longitudinal studies demonstrate that anti-S IgG bAbs decrease from a geometric mean (GM) of 1929 BAU/mL at 1 month post-vaccination to a GM of 442 BAU/mL at 6 months post-vaccination ( P < 0.001, n =187), and that boosting increases S-specific IgG BAU. While only 5 of 39 participants had detectable anti-Omicron neutralizing activity 1 month after 2 vaccinations, booster vaccination resulted in detectable neutralizing activity for all participants. Conclusion. Asymptomatic infection is likely rare, that there is no relationship between vaccine-associated symptom severity and antibody titers 1 month after the 2nd vaccination, and that booster results in better protection against the Omicron variant. Ongoing studies are evaluating serological and cellular immune responses immediately prior to 38 breakthrough infections in an attempt to identify immune correlates of protection and will be reported at the conference.
ABSTRACT
The digitization of financial transactions in both Global North and Global South has led to considerable shifts in how money is used, understood, and processed by users, banks, and fintechs. This shift from physical cash to digital media, accelerated by the COVID-19 push for digital transactions, has impacted how users perceive and use digital money and opened avenues for more data collection. This diverse panel proposes a discussion to understand the set of opportunities and challenges around the design of digital financial services (DFS) and data-driven decision-making in DFS. We will create a live working document starting before the panel to document the discussion, which develops during and after the panel. This live document will enable community to engage with a broader audience of researchers and industry, outlining processes, methods, and tools that researchers and practitioners have created to work with users to develop new equitable DFS and further exploration. © 2022 Owner/Author.
ABSTRACT
OBJECTIVE: Vaccination against the SARS-CoV-2 virus is a primary tool to combat the COVID-19 pandemic. However, vaccination is a common seizure trigger in individuals with Dravet syndrome (DS). Information surrounding COVID-19 vaccine side effects in patients with DS would aid caregivers and providers in decisions for and management of COVID-19 vaccination. METHODS: A survey was emailed to the Dravet Syndrome Foundation's Family Network and posted to the Dravet Parent & Caregiver Support Group on Facebook between May and August 2021. Deidentified information obtained included demographics and vaccination status for individuals with DS. Vaccine type, side effects, preventative measures, and changes in seizure activity following COVID-19 vaccination were recorded. For unvaccinated individuals, caregivers were asked about intent to vaccinate and reasons for their decision. RESULTS: Of 278 survey responses, 120 represented vaccinated individuals with DS (median age = 19.5 years), with 50% reporting no side effects from COVID-19 vaccination. Increased seizures following COVID-19 vaccination were reported in 16 individuals, but none had status epilepticus. Of the 158 individuals who had not received a COVID-19 vaccination, 37 were older than 12 years (i.e., eligible at time of study), and only six of these caregivers indicated intent to seek vaccination. The remaining 121 responses were caregivers to children younger than 12 years, 60 of whom indicated they would not seek COVID-19 vaccination when their child with DS became eligible. Reasons for vaccine hesitancy were fear of increased seizure activity and concerns about vaccine safety. SIGNIFICANCE: These results indicate COVID-19 vaccination is well tolerated by individuals with DS. One main reason for vaccine hesitancy was fear of increased seizure activity, which occurred in only 13% of vaccinated individuals, and none had status epilepticus. This study provides critical and reassuring insights for caregivers and health care providers making decisions about the safety of COVID-19 vaccinations for individuals with DS.
Subject(s)
COVID-19 , Epilepsies, Myoclonic , Status Epilepticus , Adult , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Epilepsies, Myoclonic/etiology , Epileptic Syndromes , Humans , Pandemics , SARS-CoV-2 , Seizures/etiology , Spasms, Infantile , Status Epilepticus/etiology , Vaccination/adverse effects , Young AdultABSTRACT
Background. The Prospective Assessment of SARS-CoV-2 Seroconversion (PASS) study is following over 200 healthcare workers who have received the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. A major aim of the study is to determine whether baseline antibody titers against the seasonal human coronaviruses are associated with altered levels of vaccine-induced antibody responses to SARS-CoV-2. Methods. Serial serum samples obtained pre-vaccination and 1 month after the second dose were tested for IgG antibodies against the full pre-fusion spike protein and the receptor binding domain (RBD) of SARS-CoV-2, as well as the full pre-fusion spike proteins of OC43, HKU1, 229E, and NL63. Antibodies were measured using highly sensitive and specific multiplex assays based on Luminex-xMAP technology. Results. Preliminary analyses of the first 103 subjects in whom we have 1 month post-vaccination serum demonstrate development of high IgG geometric mean titers (GMT) to both the full spike protein (GMT: 13,685, 12,014-15,589, 95% CI) and the RBD (GMT: 19,448, 17,264-21,908, 95% CI) of SARS-CoV-2 after the 2nd vaccine dose. Preliminary analysis demonstrates no association between baseline antibody titers against spike protein of OC43 and antibody titers against SARS-CoV-2 spike protein (Pearson's r-value= 0.13, P-value= 0.21) or RBD (Pearson's r-value= 0.09, P-value= 0.36) one month after vaccination. Future analyses will evaluate whether there is an association with baseline seasonal coronavirus antibody titers and either SARS-CoV-2 neutralization titers or anti-SARS-CoV-2 spike protein titers at 6 months after vaccination. Conclusion. These preliminary results suggest that baseline antibody responses to seasonal coronaviruses neither boost nor impede SARS-CoV-2 vaccine-induced antibody responses. Longitudinal sampling will enable assessment of vaccine durability and determination of whether baseline seasonal coronavirus antibody levels are associated with altered duration of detectable COVID-19 vaccine-induced antibody responses.
ABSTRACT
Objective: Paediatric neurologists are concerned about the risk of COVID-19 in children with demyelinating disorders receiving immunomodulatory treatment. To investigate this, we collected data via the UK Childhood Neuro-Inflammatory Disorders (UK-CNID) network of the British Paediatric Neurology Association (BPNA). Methods: Survey of paediatric neurologists managing unvaccinated UK children (<18 years) with a demyelinating disorder (multiple sclerosis [MS];neuromyelitis optica spectrum disorder [NMOSD] and myelin oligodendrocyte glycoprotein antibody disease [MOGAD]) on immunomodulatory therapy with SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs between March and December 2020. Results: Of 151 UK children (MS 98, MOGAD 37, NMOSD 16) with a median age of 9 years (range 6-18y), with a demyelinating disorder, nine (6.0%) had a positive PCR for SARS-CoV-2. Five had MS and four MOGAD. Four were from south Asian or south-east Asian, four were White and one was mixed White and south Asian. Seven children had COVID-19 symptoms;two were asymptomatic. Two required a brief hospital admission for typical COVID-19 respiratory symptoms and the remaining five had mild symptoms including fever, rash, cough and headache. One with MOGAD, treated with azathioprine, developed transverse myelitis 12 days after COVID-19 onset. She recovered fully with a course of corticosteroids. MS patients were on following disease modifying therapies;dimethylfumarate (n=2), fingolimod (n=1);natalizumab (n=1) and ocrelizumab (n=1). MOGAD cases were on the following immune therapy: combination of oral prednisolone and intravenous immunoglobulin (n=2), prednisolone steroids (n=1) and azathioprine (n=1). Conclusions: In contrast to adult patients, who often have underlying co-morbidities and advanced neurological disabilities, we have identified that children treated for demyelinating disorders appear to have a milder COVID-19 course. Whilst the number of children treated for demyelinating disorders that developed COVID-19 is low, the overall mild course described may provide reassurance to neurologists, patients and family members.
ABSTRACT
In caring for patients during the COVID-19 pandemic, nurses are experiencing a crisis of emotional highs and lows that will have lasting implications for their professional and personal well-being. As a result, much attention has been focused on nurse burnout, but the range of nurses' experiences is more nuanced, complicated, and profound. With the recognition that the nursing workforce was already experiencing burnout before the pandemic, this article explores how individuals respond to disasters and the detrimental effects of the repeated surges of critically ill patients, which have led nurses to experience an extended period of disillusionment that includes secondary traumatic stress, cumulative grief, and moral distress. This article describes the range of psychological responses to the COVID-19 pandemic so that nurse leaders can better identify resources and interventions to support nurses.
Subject(s)
Burnout, Professional , COVID-19 , Compassion Fatigue , Burnout, Professional/psychology , Humans , Job Satisfaction , PandemicsABSTRACT
Background: In-person cooking classes can improve the dietary behaviors of children with obesity. With the COVID-19 pandemic, our pediatric weight management clinic was forced to change our in-person cooking classes to a telehealth format. This quality improvement (QI) project aimed to improve dietary behaviors and family satisfaction with telehealth cooking classes. Methods: Families were recruited from a pediatric weight management clinic to participate in weekly dietitian-led cooking classes using a telehealth platform for 3 weeks. Families completed an electronic survey after each class. Changes were made to the cooking class format after each cycle (for a total of 3 QI cycles) based on survey results, including providing recipes in advance, increasing the amount of nutrition education provided, and encouraging use of the chat feature. Results: 12 children (ages 9-16, 83% female, 17% Black, 17% Hispanic, 58% obesity, 42% severe obesity, 50% public insurance) participated in the cooking classes. 24 total surveys were completed, with only 1 indicating that the class was unhelpful and only 2 indicating that it was difficult to meet online. 9 families reported that telehealth and in-person cooking classes were comparable and 3 families (all from cycle 3) reported that they preferred the telehealth format. Families commented on the convenience and comfort of the telehealth format. There was an increase in the number of days per week the child helped plan a meal across all cycles (mean increase of 1.6 days). However, cycle 3 was the only cycle where there were improvements in all dietary behaviors assessed, including number of days that the family prepared and planned a meal, ate together, and ate fresh food (mean increase of 2.3-3.7 days per week). Conclusions: Telehealth cooking classes are a good substitution to in-person cooking classes and can improve child dietary behaviors with enhanced interactivity.
ABSTRACT
Background: Myocardial injury is associated with adverse outcomes in patients with COVID-19. However, the prognostic role of myocardial injury in COVID-19 compared to other acute illnesses and the underlying mechanisms of injury are poorly understood. Methods: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, all consecutive patients with suspected COVID-19 underwent cardiac troponin (ARCHITECTSTAT highsensitive troponin I (hs-cTnI) assay;Abbott Laboratories) testing in plasma that was surplus to clinical requirements. The results were not reported unless required by the attending clinician. We evaluated the prevalence of myocardial injury, mechanisms and outcomes in all patients. In those with any hs-cTnI concentration above the sex-specific 99th centile the diagnosis was adjudicated according to the 4th Universal Definition of Myocardial Infarction. The primary outcome of all-cause mortality was compared in those with and without myocardial injury and COVID-19 by cox regression adjusted for age, sex, renal function and co-morbidities. Results: A total of 2,916 (median age 69 [interquartile range, IQR 54- 79] years, 53% women) consecutive patients with suspected COVID-19 were followed up for 228 [IQR 203-249] days. Myocardial injury occurred in 26% (750/2,916) with a median troponin concentration of 66 [35-178] ng/L;the prevalence was 41% (46/112) and 25% (704/2,804) in those with and without COVID-19, respectively. The most common mechanism was acute non-ischaemic myocardial injury occurring in 80% (37/46) and 71% (502/704) of patients with and without COVID-19, respectively. Type 1 myocardial infarction (2% and 4%), type 2 myocardial infarction (7% and 14%) and chronic myocardial injury (11% and 11%) were less common and only one patient had confirmed myocarditis. In patients with myocardial injury mortality was increased compared to those without (P<0.001 log rank), whether they had COVID-19 (54% [25/46] versus 26% [17/66]) or not (35% [248/704] versus 14% [294/2100]). Myocardial injury was an independent predictor of death in all patients (adjusted hazard ratio [aHR] 2.04, 95% confidence interval [CI] 1.71 to 2.43), but this excess risk was not higher in patients with COVID-19 (aHR 1.58, 95% CI 0.75 to 3.15) compared to those without the condition (aHR 2.01, 95% CI 1.81 to 2.49). Conclusion: Myocardial injury is common in hospitalised patients with suspected COVID-19 whether or not COVID-19 was the cause of their presentation. The majority of patients had acute non-ischaemic myocardial injury rather than a defined cardiac condition. Despite this the presence of myocardial injury was an independent predictor of death in all hospitalised patients.
ABSTRACT
Introduction & Objectives: The pandemic caused by Covid-19 has caused significant strain on healthcare professionals across the globe. Without downplaying the devastating effects of the virus itself, the collateral damage-specifically in cancer targets-has only compounded an already difficult time in medicine. Therefore, it was of the utmost importance that we: strived to continue to meet our cancer targets, and we analysed our success in addressing this. Materials & Methods: A key factor was the proximity of a private Nuffield hospital (GN) to the primary trust. GN acted as a 'clean site'. From 6th April 2020, 2 Xi Da Vinci robots and dedicated staff were relocated to day surgery theatres with direct: access to GN. Endoscopic procedures occurred in GN theatres. Post-operative recovery happened in GN. National guidelines were followed including COVID-19 symptom screening, isolation and preoperative nasopharyngeal swabs. All theatre staff were swabbed weekly and worked solely at GN. Patients were risk stratified prior to admittance. Cancer features and patient risk factors for COVID-19 were taken into account. Standard enhanced recovery principles were applied throughout the patient's journey. In theatre, we worked to ensure minimal staff numbers for safe practice were present. We reviewed operations performed, alongside cancer (prostate & bladder) pathway data from March to June 2020. For comparison identical data from August to November 2019 was collected. Results: There were a total of 369 cancer operations performed at our Trust from March until June 2020. In comparison, 407 cancer operations were performed in the 4 months from August until November 2019. For both timeframes, a: variety of robotic, endoscopic and open surgeries were carried, with similar numbers seen in each. In total, we received 80 referrals for possible prostate malignancies from March-June 2020, and 150 from August-November 2019. Days to MRI was slightly better in March to June, but we did not find a statistical difference. We: found a statistically significant decrease in the number of days it took for a patient to go from referral to diagnosis. Furthermore, we also improved on the proportion of patients who had their diagnosis told to them within 28 days, from 74% to 87%. In total, we received 134 referrals for possible bladder malignancies from March-June 2020, and 81 from August-November 2019. We improved on days to OPA for patients and time to flexible cystoscopy, with both results carrying statistical significance. We were able to reduce time to OPA from 8 to 6 days, and time to flexible cystoscopy from 26 to 12 days. Conclusions: This study demonstrates that with rapid development of separate 'clean' and 'COVID' sites, we successfully delivered a comparable, safe and effective cancer service. As we potentially face a second wave we share our success to see if these changes can be replicated elsewhere.
ABSTRACT
Background: A 37-year- old man was diagnosed with HIV-1 in November 2018, following a negative test in July 2018. Baseline HIV viral load was 56882 cps/ml and CD4 610 cells/mm3 (32%). HLA B5701 was negative and genotype showed wild-type virus. Baseline ALT was 54 IU/L but this was felt to be related to recent seroconversion. He was commenced on abacavir/lamivudine/dolutegravir (Triumeq) and achieved full viral suppression after 4 weeks. Method: Over the course of 2019, his ALT ranged from 40-150 IU/L with associated occasional rises in AST to around 80 IU/L;bilirubin, ALP and GGT remained within normal limits. He reported no other prescribed or over the counter medication including gym supplements, steroid use or recreational drugs and alcohol consumption was <7 units/week. Extensive investigation for causes of transaminitis were all within normal ranges/negative and hepatic ultrasound was normal. We referred him to hepatology and continued monthly liver tests, pending review. His transaminitis worsened and by Nov 2020 ALT 501 IU/L/ AST 200 IU/L and an urgent liver biopsy was arranged. By Dec 2020 ALT 997 IU/L, AST 316 IU/L and we decided to stop his Triumeq as there was no other explanation for his liver inflammation. Results: The patient later disclosed the use of anabolic steroids during 2020 due to Covid-19 gym closures but he had stopped these in November. His transaminases improved immediately upon cessation of Triumeq and within 14 days ALT was 354 and AST 130. Conclusion: Liver biopsy histopathology showed changes in keeping with drug-induced liver injury (DILI) that was not consistent with typical patterns seen with anabolic steroid use. Given other case reports of INSTI-associated DILI with a possible class effect, as well as omeprazole use, we recommenced ART with TDF/lamivudine/doravirine. The patient continues to use anabolic steroids. ALT/AST continue to fall and the patient remains in follow-up. We report a case of probable delayed hepatotoxicity after 2 years in a patient taking Triumeq. Late ART-associated DILI should be considered in the context of worsening transaminitis.
ABSTRACT
Introduction & Objectives: We present our experience on managing our robotic cancer service during the lock down period of COVID 19 pandemic to ensure safety of both staff and patients, reducing waiting list times and re-initiating robotic training. Materials & Methods: In keeping with government guidance all non-emergent operations were suspended in the Royal Surrey County Hospital (RSCH), Guildford, UK on the 9th April till the 29th July. In collaboration between RSCH and the Nuffield Private Hospital, innovative solutions were proposed and implemented to set up a robotic hub for cancer surgeries in a “clean” area. This included risk assessment, team allocations, moving of equipment, correspondence with various teams, reinstating logistics using remote access, screening and training of staff and patients along with setting a protocol for procedures and emergencies based on national and international guidelines. Results: 76 Robot Assisted Radical Prostatectomy (RARP) and 13 (Robot Assisted Radical Cystectomy (RARC) were performed between 21st April and 29th July at RSCH. After a month of service, when all procedures were conducted by expert surgeons, robotic training was initiated in a phased manner. None of the patients or staff members developed COVID 19 infection or were off sick during this time. Our waiting list at the end of this period was down to single figures for both RARPs and RARCs. Conclusions: With adequate planning, robotic surgery can be safely carried out to confront the barriers for return to pre-pandemic practice, preventing a ripple effect on waiting list times for cancer surgeries. Good patient and trainee satisfaction can also be achieved using this approach.
ABSTRACT
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.