scholarly journals Consensus-based perioperative protocols during the COVID-19 pandemic

2021 ◽  
Vol 34 (1) ◽  
pp. 13-21
Author(s):  
Praveen V. Mummaneni ◽  
John F. Burke ◽  
Andrew K. Chan ◽  
Julie Ann Sosa ◽  
Errol P. Lobo ◽  
...  
Keyword(s):  
San Francisco ◽  
Delphi Method ◽  
Resource Constraints ◽  
Healthcare Providers ◽  
Medical Officer ◽  
Invasive Procedures ◽  
Chief Operating Officer ◽  
Nursing Leaders ◽  
Significance Threshold ◽  
Significant Disagreement

OBJECTIVEDuring the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints.METHODSA multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95% consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion.RESULTSOverall, 15 of 18 statements achieved consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus. Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery.CONCLUSIONSUrgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic.

scholarly journals Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

2020 ◽  
Author(s):  
Joshua P Murphy ◽  
Aneesa Moolla ◽  
Sharon Kgowedi ◽  
Constance Mongwenyana ◽  
Sithabile Mngadi ◽  
...  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Policy Implementation ◽  
Community Health ◽  
Resource Constraints ◽  
Health Workers ◽  
Healthcare Providers ◽  
Successful Implementation ◽  
Programme Implementation ◽  
Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

scholarly journals Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

2015 ◽  
Vol 42 (4) ◽  
pp. 682-689 ◽  
Author(s):  
Shirley L. Chow ◽  
J. Carter Thorne ◽  
Mary J. Bell ◽  
Robert Ferrari ◽  
Zarnaz Bagheri ◽  
...  
Keyword(s):  
Literature Review ◽  
Delphi Method ◽  
Antinuclear Antibodies ◽  
Quality Care ◽  
Healthcare Providers ◽  
Potential Effect ◽  
Survey Results ◽  
Bone Scans ◽  
Bone Density Testing ◽  
Perceived Relevance

Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

scholarly journals Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study

2020 ◽  
Vol 11 ◽  
pp. 215013272095647
Author(s):  
Zalilah Abdullah ◽  
Siti Hajar Abdul Aziz ◽  
Nur Aliyah Sodri ◽  
Ainul Nadziha Mohd Hanafiah ◽  
Nor Idawaty Ibrahim ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Resource Constraints ◽  
Clinical Skill ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Care Coordinator ◽  
Good Communication ◽  
Increasing Demand ◽  
The Individual ◽  
Inner Setting

Background: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. Methods: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. Results: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting. Conclusion: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

scholarly journals Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

2019 ◽  
Author(s):  
Kah Mun Foo ◽  
Meena Sundram ◽  
Helena Legido-Quigley
Keyword(s):  
Qualitative Study ◽  
Waiting Time ◽  
Chronic Conditions ◽  
Resource Constraints ◽  
Healthcare Providers ◽  
Policy Formulation ◽  
Care Quality ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Facilitators And Barriers

Abstract Background About one-third of all adults worldwide were diagnosed with multiple chronic conditions (MCCs). Literature had found several challenges of providers and patients coping with managing MCCs in the community, and yet limited research studies that consider their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods This involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provides subsidised primary care services. Topic guides were developed with reference from literature review, Chronic Care Model (CCM) and Framework for patient-centred access to healthcare. Results Despite perceived affordable charges and availability of support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of the healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those that did not turn up might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges of delivering safe and quality care with limited consultation duration due to the need to manage waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle related guidelines, patients’ actions are influenced by multiple factors including work nature, beliefs and environment. Conclusions There were barriers on care access, delivery and self-management as reported. It is crucial to adopt whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCCs management. This study has also highlighted the importance to consider different viewpoints of healthcare providers and users in policy formulation and community care planning.

scholarly journals Trotting down the memory lane

2017 ◽  
Vol 20 (2) ◽  
pp. 1-3
Author(s):  
Ishwar Lohani
Keyword(s):  
Los Angeles ◽  
Plastic Surgery ◽  
San Francisco ◽  
General Surgery ◽  
Medical Center ◽  
Medical Officer ◽  
Chief Editor ◽  
Senior Resident ◽  
Medical College ◽  
International College

Born on 1962 at Kamaladi, Kathmandu, Prof Ishwar Lohani completed School Leaving Certificate from St. Xavier’s School. Lalitpur. followed by Senior Cambridge ‘O’ Level from Cambridge University 1980 and Proficiency Certificate Level from Amrit Science Campus. 1984. He did B. Muse. (Sangeet Prabhakar) in Tabala from Kalanidhi Sangit Manavidyalaya under Prayag Sangit Samiti, Allahabad. 1983. He completed M.B.B.S Degree from Madurai Medical College under Madurai Kamaraj University, Madurai, Tamilnadu, India. 1991 and MS General Surgery from PGIMER, Chandigarh, India. 1994. After completion of M.Ch. Plastic Surgery from PGIMER, Chandigarh, India in 1997, he worked initially as a Senior Medical Officer for few months and later as Senior Resident in the Dept. of Surgery, Chandigarh Medical College. He completed fellowship in Plastic Surgery as PSEF International fellow from University of Southern California, Los Angeles and California Pacific Medical Center, San Francisco May 2001 to Feb 2002 under Dr. Randy Sherman and Dr. Bryant Toth. He later did fellowship in Plastic Surgery through the Scottish Foundation for Surgery in Nepal at St. John’s Hospital, Livingstone and Canniesburn Hospital Glasgow, England from Jan 17, 2003 to Feb 28, 2003 under Dr. Auf Quaba and Dr. David Soutar. Presently working as Professor and Head of Department, Dept. of Plastic Surgery and Burns at the T.U. Teaching Hospital, Maharajgunj, Kathmandu, Nepal. He has been involved in the training of MBBS, MS (General Surgery) and MCh Plastic surgery graduates at the Maharajgung Medical Campus. He served as the President of the International College of Surgeons (ICS) Nepal Section; General Secretary of Association of Plastic Surgeons of Nepal (APSON). He has been member of Society of Surgeons of Nepal since 1996 and has contributed a lot in the activities of the society. He has presented in numerous National and International conferences and has numerous publications in international and national journals as well. He served as the Chief Editor of the Journal of Society of Surgeons of Nepal 2008 – 2014.  

scholarly journals “Side effects-part of the package” – A mixed methods approach to adverse events among patients with DR-TB under RNTCP Gujarat, India

2020 ◽  
Author(s):  
Arjunkumar Hardas Jakasania ◽  
Kalpita shringarpure ◽  
Dixit Kapadia ◽  
Radhika Sharma ◽  
Kedar Mehta ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Adverse Events ◽  
Healthcare Providers ◽  
Medical Officer ◽  
Treatment Seeking ◽  
Tb Treatment ◽  
Program Manager ◽  
Resistant Tuberculosis ◽  
Unsuccessful Treatment ◽  
Poor Treatment

Abstract Background Unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB) are associated with poor treatment adherence due to high rates of adverse events (AEs). However, AEs are not systematically collected and managed under programmatic setting. The present study aims to assess the a) incidence and pattern of adverse events in first three months of DR-TB treatment; b) treatment seeking behaviour for AE management; and c) explore the challenges perceived by patients and healthcare providers in seeking treatment/reporting AEs. Methods This mixed methods study included all patients diagnosed and initiated on treatment during July-September 2018 at Ahmedabad DR-TB centre under RNTCP. The patients were interviewed telephonically and assessed for all AEs experienced by them during first three months of DR-TB treatment initiation. In-depth interviews and key-informant interviews were conducted among patients and DOTS supervisors, and programme staff (treatment supervisors, Medical Officer and District Program Manager). Results Total 207 AEs were reported by the 74 DR-TB patients who were interviewed. All patients experienced at least one AE during treatment. Incidence rate of AEs (experienced) was 3.11 (1 st month-4.6, 2 nd month-2.7, 3 rd month-2.02) per 100 person days of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and subthemes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, past treatment experience; 2) Health system related- lack of guideline and training for AE management, poor coordination between hospital and tuberculosis centre.Conclusion The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient should be done at initiation of treatment. An efficient real-time reporting and management of AE can be developed and tested for effective DR-TB control.

Case study

Kybernetes ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 637-649 ◽  
Author(s):  
Tsung-Han Yang ◽  
Cheng-Yuan Ku ◽  
Man-Nung Liu
Keyword(s):  
Delphi Method ◽  
Medical Information ◽  
Healthcare Providers ◽  
Medical Information System ◽  
Assessment Procedure ◽  
Practical Case ◽  
Negative Consequences ◽  
Medical Systems ◽  
Self Assessment ◽  
Content Type

Purpose – In recent years, many development projects of the medical systems encounter difficulties and eventually fail. Failure is often due to very complicated and changeable medical procedures and the inconsistent understanding between system stakeholders, especially the healthcare providers, and information technology staff. Many research results also indicate that poor communication easily results in negative consequences during the implementation of the medical information system. To effectively overcome this obstacle, the purpose of this paper is to propose an enhanced Delphi method to assist in reaching consensus during the software development with some additional steps. Design/methodology/approach – As an alternative to the traditional way to elicit pertinent feedback from respondents, the enhanced Delphi method stresses the systematic, flexible, and cyclic stages to construct a questionnaire with viewpoints from different types of panelists and a self-assessment procedure as a validating step to measure the improvements in the system implementation. Findings – The better communication between the members of project team does increase the comprehensive assessment of a project. Originality/value – Based on a practical case, the enhanced Delphi method really demonstrates good performance and effectiveness.

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