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2.
Am J Surg ; 223(1): 176-181, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1568479

ABSTRACT

OBJECTIVES: Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. METHODS: First case vascular surgeries from July 2019-January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. RESULTS: 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. CONCLUSIONS: Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care.


Subject(s)
Cost Savings/statistics & numerical data , Efficiency, Organizational/economics , Medical Informatics , Operating Rooms/organization & administration , Vascular Surgical Procedures/organization & administration , Academic Medical Centers/economics , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Efficiency, Organizational/standards , Efficiency, Organizational/statistics & numerical data , Health Plan Implementation/organization & administration , Health Plan Implementation/statistics & numerical data , Humans , Operating Rooms/economics , Operating Rooms/standards , Operating Rooms/statistics & numerical data , Practice Guidelines as Topic , Program Evaluation , Quality Improvement , Retrospective Studies , Root Cause Analysis/statistics & numerical data , Vascular Surgical Procedures/economics , Vascular Surgical Procedures/statistics & numerical data , Workflow
6.
Sex Health ; 18(1): 41-49, 2021 03.
Article in English | MEDLINE | ID: covidwho-1174747

ABSTRACT

The 2016 global commitments towards ending the AIDS epidemic by 2030 require the Asia-Pacific region to reach the Fast-Track targets by 2020. Despite early successes, the region is well short of meeting these targets. The overall stalled progress in the HIV response has been further undermined by rising new infections among young key populations and the unprecedented COVID-19 pandemic. This paper examines the HIV situation, assesses the gaps, and analyses what it would take the region to end AIDS by 2030. Political will and commitments for ending AIDS must be reaffirmed and reinforced. Focused regional strategic direction that answers the specific regional context and guides countries to respond to their specific needs must be put in place. The region must harness the power of innovative tools and technology in both prevention and treatment. Community activism and meaningful community engagement across the spectrum of HIV response must be ensured. Punitive laws, stigma, and discrimination that deter key populations and people living with HIV from accessing health services must be effectively tackled. The people-centred public health approach must be fully integrated into national universal health coverage while ensuring domestic resources are available for community-led service delivery. The region must utilise its full potential and draw upon lessons that have been learnt to address common challenges of the HIV and COVID-19 pandemics and achieve the goal of ending AIDS by 2030, in fulfillment of the United Nations' Sustainable Development Goals.


Subject(s)
Acquired Immunodeficiency Syndrome/prevention & control , Epidemics/prevention & control , Acquired Immunodeficiency Syndrome/transmission , Asia , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Goals , Health Plan Implementation/organization & administration , Humans , International Cooperation , Pacific Islands , Politics , Sustainable Development , Universal Health Insurance/organization & administration
7.
Sex Health ; 18(1): 41-49, 2021 03.
Article in English | MEDLINE | ID: covidwho-1114755

ABSTRACT

The 2016 global commitments towards ending the AIDS epidemic by 2030 require the Asia-Pacific region to reach the Fast-Track targets by 2020. Despite early successes, the region is well short of meeting these targets. The overall stalled progress in the HIV response has been further undermined by rising new infections among young key populations and the unprecedented COVID-19 pandemic. This paper examines the HIV situation, assesses the gaps, and analyses what it would take the region to end AIDS by 2030. Political will and commitments for ending AIDS must be reaffirmed and reinforced. Focused regional strategic direction that answers the specific regional context and guides countries to respond to their specific needs must be put in place. The region must harness the power of innovative tools and technology in both prevention and treatment. Community activism and meaningful community engagement across the spectrum of HIV response must be ensured. Punitive laws, stigma, and discrimination that deter key populations and people living with HIV from accessing health services must be effectively tackled. The people-centred public health approach must be fully integrated into national universal health coverage while ensuring domestic resources are available for community-led service delivery. The region must utilise its full potential and draw upon lessons that have been learnt to address common challenges of the HIV and COVID-19 pandemics and achieve the goal of ending AIDS by 2030, in fulfillment of the United Nations' Sustainable Development Goals.


Subject(s)
Acquired Immunodeficiency Syndrome/prevention & control , Epidemics/prevention & control , Acquired Immunodeficiency Syndrome/transmission , Asia , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Goals , Health Plan Implementation/organization & administration , Humans , International Cooperation , Pacific Islands , Politics , Sustainable Development , Universal Health Insurance/organization & administration
8.
J Prev Med Hyg ; 61(4): E508-E519, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1102691

ABSTRACT

BACKGROUND: The role of health systems in the management of disasters, including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the World Health Organization (WHO) to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran's health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak. METHODS: The present investigation was designed as a qualitative study. We utilized the "COVID-19 Strategic Preparedness and Response Plan" devised by WHO as a conceptual framework. RESULTS: The dimension/pillar which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillars/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry. DISCUSSION: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face possible future crises.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/organization & administration , Disaster Planning/organization & administration , Disease Outbreaks/prevention & control , Infection Control/organization & administration , COVID-19/epidemiology , Community Health Workers/organization & administration , Health Plan Implementation/organization & administration , Health Policy , Humans , Public Health/statistics & numerical data , Research Design , World Health Organization
9.
Lancet ; 397(10279): 1151-1156, 2021 03 20.
Article in English | MEDLINE | ID: covidwho-1087331

ABSTRACT

With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.


Subject(s)
Epidemics/prevention & control , HIV Infections/epidemiology , Health Plan Implementation/organization & administration , Public Health Administration , Epidemiological Monitoring , HIV Infections/therapy , Health Status Disparities , Humans , Minority Groups/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , Social Stigma
10.
Arch Dis Child ; 106(6): 548-557, 2021 06.
Article in English | MEDLINE | ID: covidwho-1054629

ABSTRACT

OBJECTIVE: To describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic. DESIGN: Descriptive study. SETTING: Seven PICUs in England. MAIN OUTCOME MEASURES: (1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs. RESULTS: Seven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280-307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50-62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%). CONCLUSION: In a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.


Subject(s)
COVID-19/therapy , Critical Care/organization & administration , Health Plan Implementation/organization & administration , Intensive Care Units, Pediatric/organization & administration , Adult , Child , England , Forecasting , Health Plan Implementation/trends , Humans , Intensive Care Units, Pediatric/trends
11.
Eur J Ophthalmol ; 31(2): 321-327, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-939985

ABSTRACT

The COVID-19 pandemic has altered the clinical landscape immeasurably. The need to physical distance requires rethinking how we deliver ophthalmic care. Within healthcare, we will need to focus our resources on the five T's: Utilising technology, multidisciplinary clinical teams with wide professional talents need to work efficiently to reduce patient contact time. With regular testing, this will allow us to reduce the risk further. We also must acknowledge the explosion of different modalities to train our future ophthalmologists and the global challenges and advantages that these bring. Finally, we must not forget the psychological impact that this pandemic will have on ophthalmologists and ancillary staff, and need to have robust mechanisms for support.


Subject(s)
COVID-19/transmission , Communicable Disease Control/methods , Delivery of Health Care/organization & administration , Health Plan Implementation/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ophthalmology/organization & administration , SARS-CoV-2 , Humans , Telemedicine/methods
12.
Urology ; 147: 14-20, 2021 01.
Article in English | MEDLINE | ID: covidwho-880619

ABSTRACT

OBJECTIVE: To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS: A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS: Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION: The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.


Subject(s)
Quality Improvement , Remote Consultation/organization & administration , Renal Colic/diagnosis , Ureteral Calculi/diagnosis , Urology/organization & administration , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Plan Implementation/organization & administration , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Safety/standards , Patient Satisfaction , Pilot Projects , Prospective Studies , Qualitative Research , Remote Consultation/standards , Renal Colic/etiology , Renal Colic/therapy , Singapore/epidemiology , Telephone , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Tomography, X-Ray Computed , Ureter/diagnostic imaging , Ureteral Calculi/complications , Ureteral Calculi/therapy , Urology/methods , Urology/standards
13.
Glob Heart ; 15(1): 63, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-869209

ABSTRACT

In response to the Covid-19 pandemic, many low- and middle-income countries (LMICs) expanded access to telemedicine to maintain essential health services. Although there has been attention to the accelerated growth of telemedicine in the United States and other high-income countries, the telemedicine revolution may have an even greater benefit in LMICs, where it could improve health care access for vulnerable and geographically remote patients. In this article, we survey the expansion of telemedicine for chronic disease management in LMICs and describe seven key steps needed to implement telemedicine in LMIC settings. Telemedicine can not only maintain essential medical care for chronic disease patients in LMICs throughout the Covid-19 pandemic, but also strengthen primary health care delivery and reduce socio-economic disparities in health care access over the long-term.


Subject(s)
COVID-19/therapy , Chronic Disease/therapy , Disease Management , Health Services Accessibility/organization & administration , Poverty , Telemedicine/organization & administration , Delivery of Health Care/organization & administration , Health Plan Implementation/organization & administration , Healthcare Disparities/organization & administration , Humans , Primary Health Care/organization & administration , Workflow
14.
Future Oncol ; 16(31): 2551-2567, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-680035

ABSTRACT

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.


Subject(s)
Breast Neoplasms/therapy , COVID-19/prevention & control , Continuity of Patient Care/organization & administration , Health Resources/economics , Medical Oncology/organization & administration , Breast Neoplasms/diagnosis , Breast Neoplasms/economics , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Clinical Decision-Making , Communicable Disease Control/standards , Developing Countries , Female , Health Plan Implementation/economics , Health Plan Implementation/organization & administration , Humans , Medical Oncology/economics , Medical Oncology/standards , Pandemics/prevention & control , Patient Selection , SARS-CoV-2/pathogenicity , Triage/organization & administration , Triage/standards , Workforce/economics , Workforce/organization & administration
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