Search

In this article, Kwok, Muntean and Mallen argue that patient pathways can be a useful indicator of care quality, and should be incorporated into quality evaluations of NHS services.

A shared goal of patients, providers, and the companies that produce new therapies is to have these therapies used according to guidelines. Health services specialize in patient care and may lack the capabilities to take a product from conception through to everyday use. This results in a mutually beneficial relationship between health services and industry. The market for cardiovascular drugs is significant, which results in competition between companies. While traditional methods of observational analysis may be able to determine to what extent drugs and devices are being prescribed or implanted by health providers, there is less real-world patient level insight as to why patients are taking (or not taking) these treatments and why one agent is chosen over another. Considering patient pathways is a novel approach that can be utilized to understand real-world patient activities. This approach focuses on the patient flow across the healthcare system and barriers at each stage including identification of patients, diagnostic testing, the decisions on treatment, and prescribing can help identify ways of improving the utilization based on guidelines. It overcomes several assumptions related to patient and clinician decision-making and practical considerations such as geography and availability of health services. In this article, we introduce the concept of patient pathways and why considering them maybe of interest to companies. As significant resources are invested to bring a product to market, this approach can help define if there are missed opportunities for their products to be utilized and potential barriers to implementation.

The spread of COVID-19 infection has changed the world. Population-based studies of COVID-19 are limited because it is unknown why events happen or why certain outcomes occur. An alternative approach called the patient pathway review evaluates what happens to individuals in detail. In the "ideal" pathway patients with COVID-19 will seek medical attention and COVID-19 will be identified and they will either be admitted to hospital, managed in the community or they will self-care. However, in the "real-world" pathway, patients may delay seeking medical attention and it is variable who the patient decides to seek help from and some patients may be initially misdiagnosed. The eventual outcome will be recovery from the acute infection or death but there may be a spectrum of healthcare needs for patients from those who care for themselves in the community to those who are hospitalized and require intensive care. The patients may or may not have short- and long-term adverse effects. People infected with COVID-19 can take on different paths which depend on the patient's decision making, clinical decision making, and the patient's response to the infection. Desirable pathways are those where patients have good outcomes and also limit the transmission of the virus.

Background: Cleaning is a major control component for outbreaks of infection. However, for the SARS-CoV-2 pandemic, there is limited specific guidance regarding the proper disinfection methods that should be used. Methods: We conducted a systematic review of the literature on cleaning, disinfection or decontamination methods in the prevention of SARS-CoV-2. Results: A total of 27 studies were included, reporting a variety of methods with which the effectiveness of interventions were assessed. Virus was inoculated onto different types of material including masks, nasopharyngeal swabs, serum, laboratory plates and simulated saliva, tears or nasal fluid and then interventions were applied in an attempt to eliminate the virus including chemical, ultraviolet (UV) light irradiation, and heat and humidity. At body temperature (37°C) there is evidence that the virus will not be detectable after 2 days but this can be reduced to non-detection at 30 min at 56°C, 15 min at 65°C and 2 min at 98°C. Different experimental methods testing UV light have shown that it can inactivate the virus. Light of 254–365 nm has been used, including simulated sunlight. Many chemical agents including bleach, hand sanitiser, hand wash, soap, ethanol, isopropanol, guandinium thiocynate/t-octylphenoxypolyethoxyethanol, formaldehyde, povidone-iodine, 0.05% chlorhexidine, 0.1% benzalkonium chloride, acidic electrolysed water, Clyraguard copper iodine complex and hydrogen peroxide vapour have been shown to disinfect SARS-CoV-2. Conclusions: Heating, UV light irradiation and chemicals can be used to inactivate SARS-CoV-2 but there is insufficient evidence to support one measure over others in clinical practice.

Background The 2019 coronavirus disease (COVID-19) has become a global pandemic and the published literature describing the virus has grown exponentially. Methods We conducted a systematic review of the literature to identify the symptoms, comorbidities present, radiological features and outcomes for adults testing positive for COVID-19 admitted to hospital. The results across multiple studies were numerically pooled to yield total estimated. Results A total of 45 studies were included in this review with 14 358 adult participants (average age 51 years, male 51%). The pooled findings suggest that the most common symptom among patients was fever (81.2%) followed by cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%). The comorbidities that were most prevalent among patients with the virus were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%). Abnormal chest X-ray findings were present in 27.7% of patients and ground-glass opacity was demonstrated on chest computerized tomography in 63.0% of patients. The most frequent adverse outcomes were acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%). Death occurred in 8.2% of patients and 16.3% required intensive care admission and 11.7% had mechanical ventilation. Bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock. Conclusions COVID-19 most commonly presents with fever, cough, fatigue and anorexia and among patients with existing hypertension and cardiovascular disease. It is important as serious adverse outcomes can develop such as acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and death.

Water ice covers the surface of various objects in the outer Solar system. Within the heliopause, surface ice is constantly bombarded and sputtered by energetic particles from the solar wind and magnetospheres. We report a laboratory investigation of the sputtering yield of water ice when irradiated at 10 K by 4 keV singly (13C+, N+, O+, Ar+) and doubly charged ions (13C2+, N2+, O2+). The experimental values for the sputtering yields are in good agreement with the prediction of a theoretical model. There is no significant difference in the yield for singly and doubly charged ions. Using these yields, we estimate the rate of water ice erosion in the outer Solar system objects due to solar wind sputtering. Temperature-programmed desorption of the ice after irradiation with 13C+ and 13C2+ demonstrated the formation of 13CO and 13CO2, with 13CO being the dominant formed species., Comment: 10 pages, 7 figures, 3 tables, accepted for publication at MNRAS