Management of breast incidentalomas: A closed loop audit experience at royal surrey foundation trust

Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic. Methods: Pre-pandemic analysis of practice (November 2019 - January 2020) led us to the intervention of all referrals straight to MDT without an unnecessary prior clinical encounter, with secondary planned investigations and clinical assessment thereafter. Completion of audit loop and analysis included referral information, MDT outcome, imaging, and clinical correspondence with descriptive analysis. Results: Post-intervention 61 patients were referred to the MDT over an 18-month period (February 2020 - October 2021). 90% of patients were referred following CT scans. Median age 71 (range 32-93), 38% of patients had no additional breast imaging and 74% of patients did not require a tissue biopsy. 15% (n=9) were diagnosed with new breast cancer, 36% were new benign, with 34% already known lesions. 16% of patients required no further intervention. Conclusion: 15% of incidentalomas were diagnosed as malignancies, compared to local 3-4% from one stop clinics. Prompt referral to MDT accelerates triple assessment and tissue diagnosis. Streamlining of patient care optimised appropriate clinical encounters for vulnerable patients. Early senior radiological assessment at the MDT of incidentalomas during COVID-19 provided confirmation of benign features and therefore no further intervention and reassurance for 16% of patients.

AWS CORD-19 Search: A Neural Search Engine for COVID-19 Literature

Coronavirus disease (COVID-19) has been declared as a pandemic by WHO with thousands of cases being reported each day. Numerous scientific articles are being published on the disease raising the need for a service which can organize, and query them in a reliable fashion. To support this cause we present AWS CORD-19 Search (ACS), a public, COVID-19 specific, neural search engine that is powered by several machine learning systems to support natural language based searches. ACS with capabilities such as document ranking, passage ranking, question answering, knowledge graph based ranking and biomedical topic classification provides a scalable solution to COVID-19 researchers and policy makers in their search and discovery for answers to high priority scientific questions. We present a quantitative evaluation and qualitative analysis of the system against other leading COVID-19 search platforms. ACS is top performing across these systems yielding quality results which we detail with relevant examples in this work. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Site monitoring and site management during COVID-19-a contract research organization's experience

The challenges brought by the COVID-19 pandemic have forced us all to change our routine practices in drastic ways. The routines of a contract research organization are no exception. These challenges were the catalyst that invigorated Westat to rethink procedures, consider new tools, and strengthen risk assessment protocols that would benefit any kind of clinical trial in the future. When the COVID-19 pandemic struck, clinical sites restricted access and in-person visits were halted. Before the pandemic, Westat had been conducting intermittent remote monitoring visits in between on-site visits where adequate electronic technologies existed. Exclusive remote site monitoring was not a routine practice and not conducted at sites without remote access to medical records. Now, remote access to medical records is required, although some sites did not have the technology to accomplish this task. Westat worked with information technology departments and worked through contract issues. In its monitoring and site management roles, Westat found ways to enhance the infrastructure to ensure that trial sites continued to adhere to protocols, ICH-GCP Guidelines, and regulatory requirements, ultimately to protect the safety of research participants and the integrity of data. As a starting point, Westat developed a guideline for conducting remote monitoring visits. Table 1 shows a list of the immediate high-level challenges identified and a sample of Westat's responses. This poster will present overviews of the various tools developed, additional considerations while implementing responses, and lessons learned.

Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK.

AIMS: In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020. MATERIALS AND METHODS: Lung Radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression. RESULTS: In total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease. CONCLUSIONS: The COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.

A novel use for routine CBCT imaging during radiotherapy to detect COVID-19.

INTRODUCTION: Thoracic CT is a useful tool in the early diagnosis of patients with COVID-19. Typical appearances include patchy ground glass shadowing. Thoracic radiotherapy uses daily cone beam CT imaging (CBCT) to check for changes in patient positioning and anatomy prior to treatment through a qualitative assessment of lung appearance by radiographers. Observation of changes related to COVID-19 infection during this process may facilitate earlier testing improving patient management and staff protection. METHODS: A tool was developed to create overview reports for all CBCTs for each patient throughout their treatment. Reports contain coronal maximum intensity projection (MIP's) of all CBCTs and plots of lung density over time. A single therapeutic radiographer undertook a blinded off-line audit that reviewed 150 patient datasets for tool optimisation in which medical notes were compared to image findings. This cohort included 75 patients treated during the pandemic and 75 patients treated between 2014 and 2017. The process was repeated retrospectively on a subset of the 285 thoracic radiotherapy patients treated between January-June 2020 to assess the efficiency of the tool and process. RESULTS: Three patients in the n = 150 optimisation cohort had confirmed COVID-19 infections during their radiotherapy. Two of these were detected by the reported image assessment process. The third case was not detected on CBCT due to minimal density changes in the visible part of the lungs. Within the retrospective cohort four patients had confirmed COVID-19 based on RT-PCR tests, three of which were retrospectively detected by the reported process. CONCLUSION: The preliminary results indicate that the presence of COVID-19 can be detected on CBCT by therapeutic radiographers. IMPLICATIONS FOR PRACTICE: This process has now been extended to clinical service with daily assessments of all thoracic CBCTs. Changes noted are referred for oncologist review.

Was trade openness with China an initial driver of cross-country human coronavirus infections?

Purpose: This paper aims to consider if an initial driver of the cross-country global coronavirus pandemic was trade openness with China. Design/methodology/approach: The authors estimate simple, seemingly unrelated and zero-inflated count data specifications of a gravity model of trade between China and its trading partners, where the number of human coronavirus infections in a country is a function of the number of distinct good/services exported and imported from China. Findings: Parameter estimates reveal that the number of early cross-country human coronavirus infections increased with respect to trade openness with China, as measured by the number of distinct Chinese exported and imported goods/services, and can account for approximately 24% of early infections among China's trading partners. The findings suggest that one of the costs of trade openness and globalization is that they can be a driver of cross-country human disease pandemics. Originality/value: This inquiry constitutes a first approach at embedding the possible disease pandemic costs of free trade, trade openness and globalization within a trade gravity model. © 2020, Emerald Publishing Limited.

Comprehensive assessment of COVID-19 impact on Saskatchewan power system operations

This paper presents lessons learned to date during the coronavirus disease 2019 (COVID-19) pandemic from the viewpoint of Saskatchewan power system operations. A load estimation approach is developed to identify how the closures affecting businesses, schools, and other non-critical businesses due to COVID-19 changed the electricity consumption. Furthermore, the impacts of COVID-19 containment measures and re-opening phases on load uncertainty are examined. Changes in CO2 emissions resulting from an increased proportion of renewable energy generation and the change in load pattern are discussed. In addition, the influence of COVID-19 on the balancing authority's power control performance is investigated. Analyses conducted here are based on data from SaskPower Corporation, which is the principal electric utility in Saskatchewan, Canada. Some recommendations for future power system operation and planning are developed.