The spatio-temporal dynamics of an outbreak provide important insights to help direct public health resources intended to control transmission. They also provide a focus for detailed epidemiological studies and allow the timing and impact of interventions to be assessed.

A common approach is to aggregate case data to administrative regions. Whilst providing a good visual impression of change over space, this method masks spatial variation and assumes that disease risk is constant across space. Risk factors for COVID-19 (e.g. population density, deprivation and ethnicity) vary from place to place across England so it follows that risk will also vary spatially. Kernel density estimation compares the spatial distribution of cases relative to the underlying population, unfettered by arbitrary geographical boundaries, to produce a continuous estimate of spatially varying risk.

Using test results from healthcare settings in England (Pillar 1 of the UK Government testing strategy) and freely available methods and software, we estimated the spatial and spatio-temporal risk of COVID-19 infection across England for the first 6 months of 2020. Widespread transmission was underway when partial lockdown measures were introduced on 23 March 2020 and the greatest risk erred towards large urban areas. The rapid growth phase of the outbreak coincided with multiple introductions to England from the European mainland. The spatio-temporal risk was highly labile throughout.

In terms of controlling transmission, the most important practical application of our results is the accurate identification of areas within regions that may require tailored intervention strategies. We recommend that this approach is absorbed into routine surveillance outputs in England. Further risk characterisation using widespread community testing (Pillar 2) data is needed as is the increased use of predictive spatial models at fine spatial scales.

Patient and public involvement in Health Technology Assessment (HTA) is gaining increased interest among research and policy communities. Patients’ organizations represent an important link between individual patients and the health system. Social theories are increasingly being used to explain doctor–patient–system interactions, expanding understanding beyond the mere clinical perspective. In this sense, patient involvement in HTA can also be considered through the Habermas’s theory of communicative action. From a Habermasian perspective, HTA as part of the instrumental rationality contributes to an increased efficiency of resource use within the system; however, such rationalization threatens to colonize the lifeworld by making it “increasingly state administered with attenuated possibilities for communicative action as a result of the commercialization and rationalization in terms of immediate returns.” Using Habermasian system/lifeworld framework, this paper explores opportunities and obstacles to patient involvement in HTA, whereby trying to understand current and possible roles of patients’ organizations as a mediating force between HTA as a function of the system and the lifeworld represented by patients.

Current international experience has shown the vulnerability of health-care systems of developed nations, and of developing nations such as India, to coronavirus disease 2019 (COVID-19). COVID-19 pandemic is a disaster with mass casualties. International experience has revealed that, even in the countries where mass disasters are less frequent and not involved in conflicts, they are overwhelmed with COVID-19 deaths. Although, in the current scenario with fewer deaths, India’s health-care system can handle the situation of COVID-19 but should be prepared for the worst in terms of appropriate management, and adequate infection prevention measures including handling the dead without hampering the dignity of the deceased and of the surviving family. Before any crisis overwhelms responders and resources, emergency response plans should be established and activated to ensure the reliable identification and documentation of the dead. The current review was carried out to recommend the proper management of dead bodies in the COVID-19 mass disaster with a particular focus on resource-poor countries, such as India.

This article examines two current debates in Denmark—assisted suicide and the prioritization of health resources—and proposes that such controversial bioethical issues call for distinct philosophical analyses: first-order examinations, or an applied philosophy approach, and second-order examinations, what might be called a political philosophical approach. The authors argue that although first-order examination plays an important role in teasing out different moral points of view, in contemporary democratic societies, few, if any, bioethical questions can be resolved satisfactorily by means of first-order analyses alone, and that bioethics needs to engage more closely with second-order enquiries and the question of legitimacy in general.

Objective: To undertake a postal survey of cancer networks to define the services available for the diagnosis, treatment and support of patients with head and neck cancer in England.

Findings: Thirty-four cancer networks are now responsible for the delivery of head and neck cancer services in England and 52 cancer units responded to our questionnaire. Multidisciplinary team working was evident in all centres. However such team working was not always fully staffed, especially in areas of national staff shortages such as pathology, radiology, dietetics and speech therapy. Rapid referral pathways were present for initial assessment of patients but clinically significant delays were identified in the provision of complex investigations, in access to intensive care beds and for oncological care – especially radiotherapy.

Conclusions: Major changes in service configuration are likely to be required if the current national targets of time to diagnosis and treatment are to be met.

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures.

We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period.

MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by £2470 per patient because of MRSA.

The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit.

MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.

Background and objective: The study evaluated the manpower requirements in anaesthesia in Belgium until 2020. The basic intent was to estimate the need for anaesthesiologists in different hospitals because the number of medical students will be reduced to 700 in 2004 and to 600 in 2007 (numerus clausus), and the number of trainees in anaesthesia from 110 to 42 (best scenario) or to 21 (worst scenario). Simultaneous anaesthesia (more than one patient at the same time) is not allowed by our professional safety rules or by the Belgian Ministry of Public Health. The questions are: will we have enough anaesthesiologists in the next 20 years, and is there a need for nurses to administer anaesthesia? This professional title of nurse anaesthetist does not presently exist in Belgium.

Methods: Every registered anaesthesiologist in Belgium received a questionnaire about the manpower requirements in his or her institution expected over the next 20 years. The workload in the specialty was also considered.

Results: We received 154 replies from 186 different hospitals. The workload is definitely high: 10 h per day was devoted to clinical work and 4.6 h per week to administration. Belgium will need 51 anaesthesiologists each year after 2004, and 58 each year from 2010 to 2020.

Conclusions: Will anaesthesiologists accept their present high workload for the next 20 years? If not, the consequences will be serious. Three-quarters (75.4%) of the replies identified a need for more anaesthesiologists and considered that an anaesthesiologist supervising anaesthesia nurses for a number of patients simultaneously was a possible solution.