The evolution and integration of a patient-centric mapping tool (patient journey value mapping) in continuous quality improvement

The need to improve a healthcare system that too frequently fails to deliver benefits of care, even resulting in harm to patients, has been well established. The resulting era of quality improvement has aimed to improve the delivery of care by increasing quality while reducing cost. One approach to improving how healthcare is delivered is the application of Lean management strategies. Despite widespread investment in Lean approaches to improve healthcare delivery, evidence supports a deficiency of this approach to improve patient satisfaction with care. Identifiable operational tension between quality improvement efforts designed to streamline care processes and those targeting improvement of the patient care experience existed. We set out to address this deficiency by embedding the patient experience into improvement efforts through the introduction of a patient-centric value stream mapping approach

Visualising Viruses

Viruses pose a challenge to our imaginations. They exert a highly visible influence on the world in which we live, but operate at scales we cannot directly perceive and without a clear separation between their own biology and that of their hosts. Communication about viruses is therefore typically grounded in mental images of the virus particles that transmit viral genomes from one host cell to the next. Virus particles are an important entry point in discussing viruses. The ability to form them is characteristic of all viruses. They can, as the infectious stage of the viral replication cycle, be used to explain many directly observable properties of transmission, infection and immunity. Finally, and importantly, virus particles are often strikingly beautiful and can stimulate further interest in viruses. The structures of some virus particles have been determined experimentally in great detail, but for many important viruses a detailed description of the virus particle is lacking. This can be because they are challenging to describe with a single experimental method, or simply because of a lack of data. In these cases, methods from medical illustration can be applied to produce detailed visualisations of virus particles which integrate information from multiple sources. Here, we demonstrate how this approach was used to visualise the highly variable virus particles of influenza A viruses and, in the early months of the COVID-19 pandemic, the virus particles of the then newly-characterised and poorly described SARS-CoV-2. We show how constructing integrative illustrations of virus particles can challenge our thinking about the biology of viruses as well as providing tools for science communication, and we provide a set of science communication resources to help in visualising two viruses whose effects are extremely apparent to all of us

Characterising Long Covid: a living systematic review update with controlled studies

The authors have withdrawn their manuscript owing to a reporting error that we have identified in the conduct of this updated systematic review

What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review

Although the majority of patients with COVID-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for weeks or months after the acute phase of the illness. These symptoms include, among others, fatigue, problems in breathing, lack of smell and taste, headaches, and also depression and anxiety. It has also become clear that the virus has lasting effects not only on the respiratory system but also on other parts of the body, including the heart, liver, and the nervous system. In this paper we present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and duration of symptoms and clinical features of post-acute COVID-19 and its long-term complications. The living systematic review will be updated regularly, initially monthly with update cycles under continuous review as the pace of new evidence generated develops through the pandemic. We will include studies that follow up with COVID-19 patients who have experienced persistent mild, moderate or severe symptoms, with no restrictions regarding country, setting, or language. We will use descriptive statistics to analyse the data and our findings will be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from COVID-19. The protocol has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211131, CRD42020211131, 25/09/2020)

Long COVID: tackling a multifaceted condition requires a multidisciplinary approach.

This is the final version. Available from Elsevier via the DOI in this record.

Characterising long COVID: a living systematic review

BACKGROUND: While it is now apparent clinical sequelae (long COVID) may persist after acute COVID-19, their nature, frequency and aetiology are poorly characterised. This study aims to regularly synthesise evidence on long COVID characteristics, to help inform clinical management, rehabilitation strategies and interventional studies to improve long-term outcomes. METHODS: A living systematic review. Medline, CINAHL (EBSCO), Global Health (Ovid), WHO Global Research on COVID-19 database, LitCovid and Google Scholar were searched till 17 March 2021. Studies including at least 100 people with confirmed or clinically suspected COVID-19 at 12 weeks or more post onset were included. Risk of bias was assessed using the tool produced by Hoy et al. Results were analysed using descriptive statistics and meta-analyses to estimate prevalence. RESULTS: A total of 39 studies were included: 32 cohort, 6 cross-sectional and 1 case-control. Most showed high or moderate risk of bias. None were set in low-income countries and few included children. Studies reported on 10 951 people (48% female) in 12 countries. Most included previously hospitalised people (78%, 8520/10 951). The longest mean follow-up time was 221.7 (SD: 10.9) days post COVID-19 onset. Over 60 physical and psychological signs and symptoms with wide prevalence were reported, most commonly weakness (41%; 95% CI 25% to 59%), general malaise (33%; 95% CI 15% to 57%), fatigue (31%; 95% CI 24% to 39%), concentration impairment (26%; 95% CI 21% to 32%) and breathlessness (25%; 95% CI 18% to 34%). 37% (95% CI 18% to 60%) of patients reported reduced quality of life; 26% (10/39) of studies presented evidence of reduced pulmonary function. CONCLUSION: Long COVID is a complex condition with prolonged heterogeneous symptoms. The nature of studies precludes a precise case definition or risk evaluation. There is an urgent need for prospective, robust, standardised, controlled studies into aetiology, risk factors and biomarkers to characterise long COVID in different at-risk populations and settings. PROSPERO REGISTRATION NUMBER: CRD42020211131

Ativismo ou altivez judicial: análise postural do Supremo Tribunal Federal

Analisa a postura do Supremo Tribunal Federal após a redemocratização brasileira de 1988. Empreende uma reflexão sobre a conduta da Corte Constitucional face aos problemas enfrentados nos últimos anos. A Constituição Federal de 1988 incorporou amplo rol de direitos e garantias fundamentais a serem guardados, promovidos e concretizados, inclusive via prestação jurisdicional. Dessarte, incumbiu ao STF o mister de dar significado e alcance as normas constitucionais. Contudo, é no cumprimento deste poder-dever, que a Suprema Corte pode vir a se posicionar de modo: ativista, autocontido ou altivo. Concluímos que o STF tem uma postura altiva e dentro das suas competências constitucionais, assim como, não há retrocesso democrático no Brasil, pelo contrário, há um avanço institucional, mesmo diante de crises de representatividade pontuais