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Objective: To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. Design: Service evaluation involving descriptive cross-sectional questionnaire. Setting: Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. Participants: Patients and clinicians involved in video consultations. Methods: Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations. Results: A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future. Conclusion: The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.

The development of a second-generation process for the synthesis of eletriptan via a Fischer indole cyclisation is described. The finalised process offers several potential advantages over the current route of manufacture including cost, throughput, and safety.Eletriptan (R)-7 belongs to the class of drugs known as triptans and was approved in the United States in December 2002. It is a potent and selective 5-HT agonist and is marketed as Relpax for the treatment of migraine. It is currently a low volume product; however, at the time the research was started, the development of novel formulations and drug delivery systems could have significantly increased bulk demand for the drug. The current manufacturing route 1 to eletriptan 7 is well developed and robust, but does suffer some limitations (scheme 1). The key starting material 5 is extremely expensive and contributes approximately 50% of the total cost of manufacture. It uses the costly, unnatural isomer of proline as well as the highly noxious and sensitizing reagent phenyl vinyl sulfone. The synthesis also incorporates a lithium aluminium hydride reduction, generating large waste aqueous streams. Thus an alternative route of manufacture was sought that would be able to deliver this increase in bulk demand.During the assessment of alternative routes to eletriptan, the Fischer indole synthesis was highlighted as a particularly attractive way to build up the molecule. It had the potential to deliver a convergent, highly efficient synthesis (scheme 2), as well as being a well understood and reliable transformation. The Fischer indole reaction was discovered in 1883 by Hermann Emil Fischer, 2 and despite its age, is still one of the most commonly used methods to synthesise indole containing molecules. Indeed several other members of the Triptan family of drugs are manufactured via this method. 3 If this approach were successful, then many of the issues associated with the current route of manufacture could be avoided.The Fischer reaction proceeds via condensation of an aryl hydrazine with a carbonyl compound, followed by a 1,3-sigmatropic rearrangement and subsequent elimination of ammonia. 4 In order to prove that the Fischer reaction was viable for the preparation of eletriptan (R)-7, the synthesis of either aldehyde 8 or a suitably protected form would be required, together with the hydrazine 10. Formation of 8 or 9 and indeed 10 however, proved to be quite challenging. The first successful synthesis (scheme 3) of 9 was via lithiation of N-methylpyrolle 5 11 and subsequent alkylation with 2-(2-bromoethyl)-1,3-dioxolane, followed by hydrogenation of the pyrrole to yield the racemic pyrrolidine 9a.This synthesis was not amenable to further scale up, due to the low yields, cryogenic reaction conditions and chromatography. However sufficient material was isolated to validate the use of 9a in the Fischer indole reaction by condensation with commercially available 4-bromophenyl hydrazine. This delivered rac-5, a racemic form of an intermediate in the original synth...

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