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INTRODUCTION: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 (STOP-VIRUS) Collaborative was a virtual adaptation to healthcare collaboration and quality improvement during COVID-19 pandemic. The learning that happens in this space is complex, nuanced, and multi-dimensional, best explained using Wenger's social learning theory of the Landscape of Practice, where one needs knowledgeability and the ability to identify and cross the boundaries to achieve learning. METHOD(S): We conducted a qualitative study using thematic analysis to explore STOP-VIRUS participants' perspective on their experience. We used identified themes to inform the creation of the continuum of readiness for change to better characterize common challenges that institutions face at different QI readiness stages. We used a blended framework of the ADKAR model for changes start at the individual level, McKinsey's 7S framework to focus our efforts on different components necessary for change at the organizational level, and the overarching theory of landscape of practice to guide analysis and development of our conceptual framework. RESULT(S): We constructed a blended conceptual framework based on the ADKAR stages of change and the necessary components for successful change implementation based on the McKinsey's 7S framework. The 7S framework effectively demonstrates a systematic and comprehensive approach to change on an organizational level, including the 7 constructs: staff, style/culture, skills, strategy, systems, structure, with shared culture at the center of change. However, change starts at the individual level. Within the STOP-VIRUS Collaborative, the participants from each site are the catalyst for change. As a result, this is reflected through the stages of change embodied in the ADKAR model: awareness, desire, knowledge, ability, and reinforcement. Together, they provided a continuum that enable individual healthcare providers to impact change on an organization level. CONCLUSION(S): STOP-VIRUS collaborative was a multicenter, interprofessional, and diverse learning environment that re-emphasized best-practice guidelines. It provides valuable support to institutions at various stages of readiness for quality improvement initiatives, with important lessons that can be applied to future virtual collaboratives.
ABSTRACT
Background. Nasal and oral application of topical antiseptics such as povidone iodine could potentially reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited information is available on the efficacy of such agents in reducing the burden of SARS-CoV-2. Methods. We conducted a pilot non-blinded, randomized trial to compare the effectiveness of 3 doses of povidone iodine (each dose with 10% intranasal and 1% gargle) administered every 8 hours versus the control with phosphate-buffered saline in reducing the burden of SARS-CoV-2 RNA in the nares and oropharynx of patients with COVID-19. Swabs were used to collect anterior nares and oropharynx samples before the first and second doses and 8 hours after the final dose (24 hours after the initial dose). Real-time polymerase-chain reaction (RT-PCR) was used to assess the burden of viral RNA. Analysis of variance was used to compare cycle threshold values for povidone iodine versus control patients. Subjects were surveyed about adverse reactions to treatment. Results. As shown in the figure, SARS-CoV-2 cycle thresholds were similar in the povidone iodine (N=10 subjects) and control (N=8 subjects) groups prior to treatment. After initiation of treatment, there was no significant difference in cycle thresholds for the povidone iodine versus control subjects (P >0.05). No adverse effects of treatment were reported. Effect of intranasal and oral application of povidone iodine versus phosphate-buffered saline on nasal and oropharyngeal SARS-CoV-2 RNA. Error bars show standard error. Conclusion. Our findings suggest that that nasal and oral application of povidone iodine have limited effectiveness in reducing the burden of SARS-CoV-2. Future studies are needed to assess for effectiveness of more frequent dosing intervals and to determine if povidone iodine reduces recovery of viable virus by culture.
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Purpose: Tto estimate how many independent optical practices in the Republic of Ireland (ROI) are offering myopia control options to patients and parents. Method(s): 346 independent optical practices were identified in the ROI using a listing provided on the Association of Optometrists Ireland website. All practices identified were emailed to ask if they practised any myopia control. Practice websites (where available) were examined to see if myopia control was mentioned as a service offered. Some practices believed to be offering myopia control were phoned directly to ascertain if they were practising myopia control. This research was carried out between Feb and March 2019 (i.e. pre-covid restrictions in the ROI). Result(s): 17 independent practices in the ROI were identified as having fitted patients with contact lenses for myopia control. Five of the 17 were not advertising myopia control on their websites. Several practitioners who were not advertising myopia control on their websites reported that they still felt that they were in the early stages of learning about myopia control and were therefore only offering it to patients and parents who enquired about it directly. Conclusion(s): In spite of the increase in licensed contact lens options for myopia control in the ROI and the relative ease with which suitable patients could be fitted with myopia control lenses, practitioners still appear reluctant to engage in the practice. Copyright © 2022
ABSTRACT
Background: Acute coronary syndrome (ACS) and heart failure (HF) are frequent causes of hospitalisation and readmissions. A novel smartphone app-based model of care (TeleClinical Care-TCC) was developed to support patients after ACS or HF admission. Purpose: This randomised control trial aimed to characterise both the intervention and clinical outcomes. The primary endpoint was the incidence of 30-day readmissions. Secondary endpoints included six-month cardiac and all-cause readmissions, mortality, major adverse cardiovascular events (MACE), cardiac rehabilitation (CR) completion, medication adherence, serum low-density lipoprotein (LDL-C), quality of life, blood pressure, body mass index, waist circumference and six-minute walk distance. Additionally, cost-effectiveness and user satisfaction were evaluated. Methods: Patients were randomised 1:1 to either TCC plus usual care or usual care alone and were followed-up at six months. Intervention arm participants received the TCC app and were asked to use Bluetooth-enabled devices for measuring weight, heart rate, blood pressure and physical activity daily. Readings were automatically transmitted to the patient's smartphone and a secure web-server (KIOLA). Customisable thresholds for each parameter were defined at discharge. Abnormal readings were flagged by email to a monitoring team, who discussed management with the patient's usual healthcare providers. The app also provided educational push notifications. Results: 164 patients from two hospitals in Sydney, Australia were enrolled between February 2019 and March 2020 (TCC n=81, control n=83). Recruitment ceased during the COVID-19 pandemic. The mean age was 61.5 years. 79% of patients were male. The per-patient mean percentage of days with data transmission was 64.2±27.5%. 565 alerts were received, 16% of which resulted in additional investigations, healthcare consultation or a change in management. There was no difference in 30-day readmission rate (11 readmissions in each arm). There was a significant difference in six-month readmissions, favouring the intervention (21 vs. 41 readmissions, HR=0.40, 95% CI 0.16-0.95, P=0.03), driven by a reduction in cardiac readmissions (11 vs. 25, HR=0.51, 95% CI 0.27-0.94, P=0.03). Use of TCC was associated with improved CR completion (39% vs. 18%, P=0.025) and medication adherence (75% vs. 50%, P=0.002). There was no significant difference in mortality, MACE, LDL-C, quality of life or any of the physical parameters. The average user rating was 4.56 out of 5. The study cost EUR 4015 per readmission saved. Upon modelling, it was calculated that if the number of enrolled patients exceeds 243, total expenditure will be overcome by cost savings from reducing readmissions. Conclusion: The TCC model of care was feasible and safe. In this study, clinical benefits were demonstrated including a reduction in six-month readmissions, improved CR completion and improved medication adherence.