Rhino-orbital mucormycosis: Our experiences with clinical features and management in a tertiary care center

Objective: To determine the prevalence, risk factors, and elaborate our experiences with diagnosis and treatment of patients with mucormycosis, enabling a better understanding of the disease and its management. Methods: This is a case series of patients with Covid-19 associated with Rhino-orbital-cerebral mucormycosis, managed in our tertiary care center from April 2021 to June 2021. Results: Six cases of Covid-19 associated with Rhino-orbital-cerebral mucormycosis have been analyzed in the study. The mean age of patients was 40.67 years with a male preponderance (83.3%). The most common complaint was headache (100%), while a minority (33%) came with ocular complaints. All the patients either had a previous history of diabetes mellitus or developed increased blood sugar levels following Covid infection, and were kept on insulin to control their blood sugar levels. 4 patients (66.67%) had a history of corticosteroid use during Covid-19 hospitalization. Treatment included intravenous liposomal Amphotericin B (100%), functional endoscopic sinus surgery (66.67%), maxillectomy (33.33%) and transcutaneous retrobulbar liposomal Amphotericin B (33.33%). Amphotericin B induced nephrotoxicity, which was seen in 1 patient (16.67%). Mortality occurred in only one patient (16.67%), 25 days following successful surgery. Conclusion: Diabetes Mellitus is the most important predisposing factor for the development of Covid-19 associated Rhino-orbital-cerebral mucormycosis. Early presentation, prompt diagnosis and timely initiation of treatment with liposomal Amphotericin B and surgical debridement along with strict blood sugar control can lead to a favorable outcome. However, regular follow-up and monitoring of serum electrolytes and kidney profile must be ensured for such patients.

Mayflower group benchmark on changes in work due to COVID-19: Now and in the future

See PDF] Defining benchmarks Organizations and institutions are constantly striving to gather more data to determine how successful their current practices are. [...]organizations rely on benchmarking to compare their current thinking and metrics with other companies’ thinking and metrics so they can determine whether their organizational practices are “best in class” as well as determine what the industry best practices are (Camp, 1989;Hiltrop & Despres, 1994). [...]benchmarking can help set priorities for organizations (Ulrich etal., 1989). [...]one caveat to address concerns the use of a ranking methodology. To illustrate, organizations may be addressing teleworking while also including the various factors affiliated with virtual teams. [...]given the novel circumstances (i.e., COVID-19), research that includes

Leadership in the time of COVID: Should we really throw the baby out with the bathwater?

[...]we contend that how corporations define great leadership in their company need not change for the sake of change itself based on COVID-19, particularly if the models are based on theory, research, and detailed validation efforts. [...]one could argue everything we do, from a human resource (HR) and TM perspective, has been targeted for review and change. Because the nature of the pandemic is so unique to our current experience, senior leaders and HR professionals are looking to external sources of information to help guide their decision-making. [...]recent internal employee surveys show positive employee responses to the pandemic around PepsiCo values and the shift to remote work. [...]we encourage our colleagues to apply a broader systems thinking lens (e.g., Katz & Kahn, 1978) to their HR and TM efforts in light of the pandemic, considering what we already know about existing constructs and phenomena (including their stability across time and circumstance) as well as what practices we already implement.

From the Editorial Board: Sachin H. Jain, MD, MBA

For years, health care leaders convey that one day, digital health would become a dominant mode of health care delivery. Now, in large part due to the coronavirus disease 2019 pandemic, that day has come. In Dec 2020, 20% of physician visits were via telehealth--down from 50% in April, but up from 1% before the pandemic. Further adoption of telehealth will require not just its widespread acceptance as a viable way to deliver care, but also changes in payment models and regulatory frameworks. The growth in telehealth visits among older adults has largely paralleled that among other age groups. An Aug 2020 study conducted by the University of Michigan found that telehealth visits among US adults over 50 jumped from 4% in May 2019 to 30% in June 2020. This situation presents both an opportunity and a dilemma for patients and providers alike. Telehealth and, indeed, a whole suite of virtual tools allow us to provide better, more comprehensive care to our patients in ways that are far more convenient for them.

Implementing a targeted approach to social determinants of health interventions.

The scale of the coronavirus disease 2019 pandemic and its disproportionate impact on vulnerable populations has spurred unprecedented focus on and investment in social determinants of health (SDOH). Although the greater focus on social determinants is laudable and necessary, there is a tendency for health care organizations to implement SDOH programs at scale without rigorous evidence of effect, rather than targeting interventions to specific patients and assessing their impact. This broad, and sometimes blind, application of SDOH interventions can be costly and wasteful. We argue for rejecting the "more is better" mindset and specifically targeting patients who truly need and would substantially benefit from SDOH interventions. Matching interventions to the most appropriate patients involves screening for social needs, developing rigorous evidence of effect, and accompanying policy reform.

Health Costs And Financing: Challenges And Strategies For A New Administration.

It is likely that 2021 will be a dynamic year for US health care policy. There is pressing need and opportunity for health reform that helps achieve better access, affordability, and equity. In this commentary, which is part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on our collective backgrounds in health financing, delivery, and innovation to offer consensus-based policy recommendations focused on health costs and financing. We organize our recommendations around five policy priorities: expanding insurance coverage, accelerating the transition to value-based care, advancing home-based care, improving the affordability of drugs and other therapeutics, and developing a high-value workforce. Within each priority we provide recommendations for key elected officials and political appointees that could be used as starting points for evidence-based policy making that supports a more effective, efficient, and equitable health system in the US.