Years of life lost estimates cannot always be taken at face value: Response to “COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study”

In their recent analysis, Hanlon et al. estimated the years of life lost (YLL) in people who have died with COVID-19 by following and expanding on the WHO standard approach. We welcome this research as an attempt to draw a more accurate picture of the mortality burden of this disease which has been involved in the deaths of more than 300,000 people worldwide as of May 2020. However, we argue that obtained YLL estimates (13 years for men and 11 years for women) are interpreted in a misleading way. Even with the presented efforts to control for the role of multimorbidity in COVID-19 deaths, these estimates cannot be interpreted to imply “how long someone who died from COVID-19 might otherwise have been expected to live”. By example we analyze the underlying problem which renders such an interpretation of YLL estimates impossible, and outline potential approaches to control for the problem.

25. Conditions, warranties, and innominate terms

If a party fails to perform a promise in a contract, it is in breach and liable to pay damages. But some breaches of contract not only entitle the injured party to claim damages, but also to put an end to the contract. The nature of the term becomes important when considering the right to terminate. This chapter discusses the meaning and scope of conditions, warranties, and innominate terms. A party may terminate a contract for breach of condition, but never for breach of warranty. Terms that are neither conditions nor warranties are called ‘innominate’ terms. It may be possible to terminate a contract for breach of an innominate term if the breach is sufficiently serious. Breaches which justify termination are often called ‘repudiatory breaches’. The chapter also considers express termination clauses and another difficult sense in which the term ‘condition’ is used, namely to denote an ‘entire obligation’.

Effectiveness and perceptions of using templates in long-term condition reviews: a systematic synthesis of quantitative and qualitative studies

Background: Review templates are commonly used in long-term condition (LTC) consultations to standardise care for patients and promote consistent data recording. However, templates may affect interactions during the review and potentially inhibit patient-centred care. Aim: To systematically review literature on the impact of LTC review templates on process and health outcomes, and the views of healthcare professionals and patients on using review templates in consultations. Design and setting: Parallel qualitative and quantitative systematic reviews. Method: Following Cochrane methodology, we searched nine databases (1995-2019; updated July 2020) for clinical trials and qualitative studies of LTC templates in healthcare settings. We performed duplicate selection, risk-of-bias assessment and data extraction. The quantitative and qualitative analyses were conducted in parallel and findings synthesised narratively. Results: We included 12 qualitative and 14 quantitative studies (two studies reported both qualitative and quantitative data and were included in both analyses). Review templates were well used, but the only study to assess health outcomes showed no effect. Templates can improve documentation of key measures, and act as a reminder tool; however, this can restrict the review process, and risks prioritising healthcare professional agendas over patients. Templates may also limit opportunities to discuss individuals’ concerns about living with their condition, and act as a barrier to providing patient-centred care. Conclusion: Future research should evaluate health as well as process outcomes. The potential benefits of templates in improving documentation should be balanced against concerns that ‘tick boxes’ may override patient agendas unless templates are designed to promote patient-centred care.