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BMJ Open Qual ; 10(Suppl 1)2021 07.
Article in English | MEDLINE | ID: covidwho-1341330


BACKGROUND: Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020. METHODS: A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites. RESULTS: Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region. CONCLUSION: The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.

Delivery of Health Care/standards , Patient Care/standards , Point-of-Care Systems , Quality Improvement , Quality of Health Care , COVID-19 , Health Facilities , Health Personnel , Humans , Implementation Science , India , Pandemics
J Appl Lab Med ; 6(4): 953-961, 2021 07 07.
Article in English | MEDLINE | ID: covidwho-1147984


BACKGROUND: Numerous studies have documented reduced access to patient care due to the COVID-19 pandemic, including access to diagnostic or screening tests, prescription medications, and treatment for an ongoing condition. In the context of clinical management for venous thromboembolism, this could result in suboptimal therapy with warfarin. We aimed to determine the impact of the pandemic on utilization of International Normalized Ratio (INR) testing and the percentage of high and low results. METHODS: INR data from 11 institutions were extracted to compare testing volume and the percentage of INR results ≥3.5 and ≤1.5 between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (January-June 2020, period 2). The analysis was performed for inpatient and outpatient cohorts. RESULTS: Testing volumes showed relatively little change in January and February, followed by a significant decrease in March, April, and May, and then returned to baseline in June. Outpatient testing showed a larger percentage decrease in testing volume compared to inpatient testing. At 10 of the 11 study sites, we observed an increase in the percentage of abnormal high INR results as test volumes decreased, primarily among outpatients. CONCLUSION: The COVID-19 pandemic impacted INR testing among outpatients which may be attributable to several factors. Increased supratherapeutic INR results during the pandemic period when there was reduced laboratory utilization and access to care is concerning because of the risk of adverse bleeding events in this group of patients. This could be mitigated in the future by offering drive-through testing and/or widespread implementation of home INR monitoring.

Anticoagulants/therapeutic use , COVID-19/complications , International Normalized Ratio/methods , Patient Care/statistics & numerical data , Patient Care/standards , SARS-CoV-2/isolation & purification , Venous Thromboembolism/drug therapy , Warfarin/therapeutic use , COVID-19/virology , Humans , Venous Thromboembolism/virology
Best Pract Res Clin Anaesthesiol ; 35(3): 461-475, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1103745


In 2019, a novel coronavirus called the severe acute respiratory syndrome coronavirus 2 led to the outbreak of the coronavirus disease 2019, which was deemed a pandemic by the World Health Organization in March 2020. Owing to the accelerated rate of mortality and utilization of hospital resources, health care systems had to adapt to these major changes. This affected patient care across all disciplines and specifically within the perioperative services. In this review, we discuss the strategies and pitfalls of how perioperative services in a large academic medical center responded to the initial onset of a pandemic, adjustments made to airway management and anesthesia specialty services - including critical care medicine, obstetric anesthesiology, and cardiac anesthesiology - and strategies for reopening surgical caseload during the pandemic.

Airway Management/standards , COVID-19/epidemiology , COVID-19/therapy , Clinical Decision-Making , Critical Care/standards , Patient Care/standards , Airway Management/methods , Clinical Decision-Making/methods , Critical Care/methods , Humans , Pandemics , Patient Care/methods
Best Pract Res Clin Anaesthesiol ; 35(3): 415-424, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-938789


The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Reopening of the economy and the return to ambulatory surgery and OBS and procedures have created a challenge due to COVID-19 and the infectious disease precautions that must be taken. Patients may be more apt to return to the outpatient setting to avoid the hospital, especially with the resurgence of COVID-19 cases locally, nationally, and worldwide. This review provides algorithms for screening and testing patients, selecting patients for procedures, choosing appropriate procedures, and selecting suitable personal protective equipment in this unprecedented period.

Ambulatory Surgical Procedures/standards , Anesthesia/standards , COVID-19/prevention & control , Patient Care/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Ambulatory Surgical Procedures/trends , Anesthesia/trends , COVID-19/epidemiology , Humans , Patient Care/trends , Personal Protective Equipment/trends
Arq. bras. cardiol ; 114(5): 805-816, maio 2020. tab, graf
Article in Portuguese | LILACS (Americas) | ID: covidwho-910581


Resumo Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos.

Abstract In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.

Humans , Pneumonia, Viral/complications , Cardiovascular Diseases/virology , Health Personnel/standards , Coronavirus Infections/complications , Betacoronavirus , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cardiovascular Physiological Phenomena , Risk Factors , Cardiopulmonary Resuscitation/standards , Practice Guidelines as Topic , Coronavirus Infections , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Ventricular Dysfunction/etiology , Pandemics , Patient Care/standards , Heart/physiopathology
Cancer Med ; 9(24): 9205-9218, 2020 12.
Article in English | MEDLINE | ID: covidwho-880259


Coronavirus disease-2019 (COVID-19) has emerged as a novel infection which has spread rapidly across the globe and currently presents a grave threat to the health of vulnerable patient populations like those with malignancy, elderly, and immunocompromised. Healthcare systems across the world are grappling with the detrimental impact of this pandemic while learning about this novel disease and concurrently developing vaccines, strategies to mitigate its spread, and treat those infected. Cancer patients today face with a unique situation. They are susceptible to severe clinically adverse events and higher mortality from COVID-19 infection as well as morbidity and mortality from their underlying malignancy. Conclusion: Our review suggests increased risk of mortality and serious clinical events from COVID-19 infection in cancer patients. However, risk of adverse events does not seem to be increased by cancer therapies. True impact of COVID-19 on cancer patients will unravel over the next few months. We have also reviewed clinical features of COVID-19, recent recommendations from various medical, surgical, and radiation oncology societies for major solid tumor types like lung, breast, colorectal, and prostate cancer during the duration of this pandemic.

COVID-19/prevention & control , Medical Oncology/methods , Neoplasms/therapy , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Humans , Medical Oncology/standards , Neoplasms/classification , Neoplasms/diagnosis , Pandemics , Patient Care/methods , Patient Care/standards , Practice Guidelines as Topic , Public Health/methods , SARS-CoV-2/physiology , Telemedicine/methods
Int J Med Inform ; 144: 104291, 2020 12.
Article in English | MEDLINE | ID: covidwho-808519


OBJECTIVE: The coronavirus pandemic has highlighted the need to simplify data collection for critically-ill patients, particularly for physicians relocated to the ICU setting. Herein we present a simple, reproducible, and highly-customizable manual-entry tool to track ICU patients using new HIPAA-compliant Google Big Query technology for parsing large datasets. This innovative flow chart is useful and could be modified to serve the particular needs of different sub-specialists, particularly those that either rely heavily on hand-written notes or experience poor electronic medical record (EMR) penetration. METHODS: The tool was developed using a combination of three Google Enterprise features: Google Forms for data input, Google Sheets for data output, and Google Big Query for data parsing. Code was written in SQL. Sheets functions were used to transpose and filter parsed data. White and black box tests were performed to examine functionality. RESULTS: Our tool was successfully able to collect and output fictional patient data across all 57 data points specified by the intensivists and surgeons of Cardiovascular Department of Mt. Sinai Morningside Hospital. CONCLUSION: The functional tests performed demonstrate use of the tool. Though originally conceived to simplify patient data collection for newly relocated physicians to the ICU, our tool also overcomes financial and technological barriers previously described in low-income countries that could dramatically improve patient care and provide data to power future studies in these regions. With the original code provided, implementers may adapt our tool to best meet the requirements of their clinical setting and protocols during this very challenging time.

Critical Illness/therapy , Data Accuracy , Data Management/statistics & numerical data , Electronic Health Records/statistics & numerical data , Health Information Exchange/statistics & numerical data , Intensive Care Units/statistics & numerical data , Patient Care/standards , Physicians/statistics & numerical data , Delivery of Health Care/standards , Humans
Oncologist ; 25(10): e1562-e1573, 2020 10.
Article in English | MEDLINE | ID: covidwho-745074


BACKGROUND: The COVID-19 outbreak has resulted in collision between patients infected with SARS-CoV-2 and those with cancer on different fronts. Patients with cancer have been impacted by deferral, modification, and even cessation of therapy. Adaptive measures to minimize hospital exposure, following the precautionary principle, have been proposed for cancer care during COVID-19 era. We present here a consensus on prioritizing recommendations across the continuum of sarcoma patient care. MATERIAL AND METHODS: A total of 125 recommendations were proposed in soft-tissue, bone, and visceral sarcoma care. Recommendations were assigned as higher or lower priority if they cannot or can be postponed at least 2-3 months, respectively. The consensus level for each recommendation was classified as "strongly recommended" (SR) if more than 90% of experts agreed, "recommended" (R) if 75%-90% of experts agreed and "no consensus" (NC) if fewer than 75% agreed. Sarcoma experts from 11 countries within the Sarcoma European-Latin American Network (SELNET) consortium participated, including countries in the Americas and Europe. The European Society for Medical Oncology-Magnitude of clinical benefit scale was applied to systemic-treatment recommendations to support prioritization. RESULTS: There were 80 SRs, 35 Rs, and 10 NCs among the 125 recommendations issued and completed by 31 multidisciplinary sarcoma experts. The consensus was higher among the 75 higher-priority recommendations (85%, 12%, and 3% for SR, R, and NC, respectively) than in the 50 lower-priority recommendations (32%, 52%, and 16% for SR, R, and NC, respectively). CONCLUSION: The consensus on 115 of 125 recommendations indicates a high-level of convergence among experts. The SELNET consensus provides a tool for sarcoma multidisciplinary treatment committees during the COVID-19 outbreak. IMPLICATIONS FOR PRACTICE: The Sarcoma European-Latin American Network (SELNET) consensus on sarcoma prioritization care during the COVID-19 era issued 125 pragmatical recommendations distributed as higher or lower priority to protect critical decisions on sarcoma care during the COVID-19 pandemic. A multidisciplinary team from 11 countries reached consensus on 115 recommendations. The consensus was lower among lower-priority recommendations, which shows reticence to postpone actions even in indolent tumors. The European Society for Medical Oncology-Magnitude of Clinical Benefit scale was applied as support for prioritizing systemic treatment. Consensus on 115 of 125 recommendations indicates a high level of convergence among experts. The SELNET consensus provides a practice tool for guidance in the decisions of sarcoma multidisciplinary treatment committees during the COVID-19 outbreak.

COVID-19/epidemiology , Medical Oncology/organization & administration , Medical Oncology/standards , Sarcoma/therapy , COVID-19/prevention & control , Consensus , Europe/epidemiology , Humans , Latin America/epidemiology , Patient Care/standards , Practice Guidelines as Topic , SARS-CoV-2 , Sarcoma/diagnosis
Endocr Relat Cancer ; 27(9): R357-R374, 2020 09.
Article in English | MEDLINE | ID: covidwho-693491


Substantial management changes in endocrine-related malignancies have been required as a response to the COVID-19 pandemic, including a draconian reduction in the screening of asymptomatic subjects, delay in planned surgery and radiotherapy for primary tumors deemed to be indolent, and dose reductions and/or delays in initiation of some systemic therapies. An added key factor has been a patient-initiated delay in the presentation because of the fear of viral infection. Patterns of clinical consultation have changed, including a greater level of virtual visits, physical spacing, masking, staffing changes to ensure a COVID-free population and significant changes in patterns of family involvement. While this has occurred to improve safety from COVID-19 infection, the implications for cancer outcomes have not yet been defined. Based on prior epidemics and financial recessions, it is likely that delayed presentation and treatment of high-grade malignancy will be associated with worse cancer outcomes. Cancer patients are also at increased risk from COVID-19 infection compared to the general population. Pandemic management strategies for patients with tumors of breast, prostate, thyroid, parathyroid and adrenal gland are reviewed.

Coronavirus Infections/prevention & control , Endocrine Gland Neoplasms/therapy , Infection Control/organization & administration , Pandemics/prevention & control , Patient Care/standards , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Disease Management , Endocrine Gland Neoplasms/virology , Female , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2