Cisplatin-based chemotherapy has long been the standard first-line treatment for metastatic urothelial carcinoma (mUC). However, owing to comorbidities, up to 50% of patients are ineligible for cisplatin, necessitating alternative primary treatment options. Immune checkpoint inhibitors (ICIs) have emerged as a vital alternative for those unable to receive cisplatin. However, the prognosis for advanced urothelial carcinoma remains grim, with challenges persisting in optimizing first-line therapy. Recent advancements have redirected attention towards innovative combinations in primary treatment. The combination of enfortumab vedotin (EV) and pembrolizumab has significantly improved overall and progression-free survival compared to chemotherapy alone. This marks a critical shift in first-line treatment options for patients who are cisplatin-ineligible or require alternatives to standard chemotherapy. While platinum-based chemotherapy continues to be essential for many patients, the approval of EV and pembrolizumab as first-line treatments for cisplatin-ineligible patients signifies a significant breakthrough in primary care. These therapies offer new options and enhance outcomes in terms of survival and response rates, highlighting the increasing relevance of ICI-containing regimens in frontline care. This review provides an exhaustive overview of the current frontline treatment landscape for mUC, incorporating clinical trial evidence and exploring investigational agents to aid in clinical decision-making and guide future therapeutic strategies.

Background: Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic. Methods: A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27th August and 23rd October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking. Results: The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups. Conclusions: Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

The unsafe behavior of frontline workers at construction sites is the most important cause of construction accidents. This study proposed a comprehensive model of frontline workers' unsafe behaviors based on a systems perspective and used structural equation modeling (SEM) to explore the influence mechanisms between Objective Conditions (e.g., work environment, work climate, task complexity), Safety Management (e.g., safety education and training, safety reward and punishment regulations, safety inspection, safety technology disclosure, safety warning signs), Group Influence (propagation of unsafe behaviors among workers), Personal Perception (subjective judgment of operators on their safety knowledge and skills), and Unsafe Behaviors. Data from 460 frontline workers were collected through questionnaires and the correlation hypotheses were tested using SPSS 26.0 and Amos 26.0 software. The following conclusions were obtained: (1) Objective Conditions directly positively influence Safety Management, Group Influence, and Personal Perception, but indirectly negatively influence Unsafe Behavior; (2) Safety Management not only directly positively affects Personal Perception but also directly negatively affects Unsafe Behavior. However, the direct effect of Safety Management on Group Influence is not significant; (3) Group Influence has a direct positive effect on Unsafe Behavior, but the direct effect on Personal Perception is not significant; (4) The direct effect of Personal Perception on Unsafe Behavior is insignificant. These findings can be used as preliminary data to guide decision-makers or managers in construction companies to develop reasonable management plans to curb unsafe behaviors of frontline workers.

COVID-19 has brought unprecedented challenges and exacerbated existing work-related struggles resulting in heightened occupational stress and impacted work performance among health caregivers. This study utilised the transactional model of stress and coping to explore the coping strategies adopted by radiology health caregivers during the pandemic with the aim to provide baseline data for enhancing preparedness and development of interventions to support staff during future health crises. A qualitative, interpretative phenomenological analysis (IPA) methodology coupled with constructivist and interpretivist philosophical views were utilised in a multi-method context to conduct semi-structured interviews and focus group discussions among 24 radiology health caregivers in the eThekwini district of KwaZulu-Natal, South Africa. Data were transcribed verbatim and manually analysed using the IPA framework. The radiology health caregivers highlighted resilience, adaptability and identified emotion-focused and problem-focused coping as their mostly preferred strategies of dealing with COVID-19 related mental distress. These included accepting professional responsibilities and duties, social coping, spiritual therapy, adaptive behavioural coping, escape-avoidance and solution-oriented approaches. The findings can guide radiology departments in developing bespoke mental health interventions to support radiology health caregivers during any future health crises.

Background: Over 900,000 cases of COVID-19 and 23,000 deaths have been reported till 13 July in India. Preserving the limited healthcare workforce is part of the strategy against the pandemic. Mortality and morbidity data have a role in customising this strategy. At this time, there is no published study on COVID-related mortality among doctors or other healthcare workers in India. Methods: A multi-pronged search was made for all reported deaths linked with COVID-19 among doctors in India. Details of COVID-linked deaths reported by mainstream media and by multiple professional social media sources were collected, screened, verified and analysed. Violent deaths occurring in the setting of pandemic-related work were separately listed. Deaths from other diseases were excluded. Results: Among 108 COVID-linked deaths among doctors, there were four pandemic-related violent deaths including three road accidents and a suicide. Of the 104 non-violent deaths, 55.5% were below 60 years of age, while 29.6% and 21% were below the age of 50 and 40 respectively. The average age at death was 56.3 (range 22 - 96). Over half of the deaths occurred among general practitioners, while surgical specialties accounted for 27% of the mortality. The geographic distribution of deaths of doctors correlated with the reported number of COVID-19 patients in each state. The total number of COVID-related healthcare worker deaths was 136, out of which eight (5.8%) were violent, and occurred in young individuals with an average age of 27.8 years. Conclusions: The majority of the 104 COVID-related non-violent deaths among doctors (55.5%) occurred below the age of 60. The average at death was 56.6 years. The states with highest number of COVID-19 cases had greater number of doctor deaths. Violent deaths among young healthcare workers in the setting of the pandemic requires special attention.