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Rai E, Varghese E, Yaddanapudi S, Iyer RS. Advancing pediatric perioperative care in India: A contemporary overview. Paediatr Anaesth 2024. [PMID: 38462924 DOI: 10.1111/pan.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND In the last 30 years, significant advances have been made in pediatric medical care globally. However, there is a persistent urban-rural gap which is more pronounced in low middle-income countries than high-income countries, similar urban-rural gap exists in India. While on one hand, health care is on par or better than healthier nations thriving international medical tourism industry, some rural parts have reduced access to high-quality care. AIM With this background, we aim to provide an overview of the present and future of healthcare in India. METHODOLOGY With the cumulative health experience of the authors or more than 100 years, we have provided our experience and expertise about healthcare in India in this narrative educational review. This is supplemented by the government plans and non government plans as appropriate. References are used to justify as applicable. RESULTS With the high percentage of pediatric population like other low to middle-income countries, India faces challenges in pediatric surgery and anesthesia due to limited resources and paucity of specialized training, especially in rural areas. Data on the access and quality of care is scarce, and the vast rural population and uneven resource distribution add to the challenges along with the shortage of pediatric surgeons in these areas of specialized care . Addressing these challenges requires a multi faceted strategy that targets both immediate and long-term healthcare needs, focusing on improving the facilities and training healthcare professionals. Solutions could include compulsory rural service, district residency programs, increasing postgraduate or residency positions, and safety courses offered by national and international organizations like Safer Anesthesia from Education Pediatrics, Vital Anesthesia Simulation Training, and World Federation of Society of Anesthesiologists pediatric fellowships. CONCLUSION India has achieved great strides in perioperative health care and safety. It has become the major international medical industry due to high-quality care, access and costs. Crucially, India needs to establish local hubs for pediatric perioperative care training to enhance healthcare delivery for children.
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Affiliation(s)
- Ekta Rai
- Department of Anaesthesiology, Christian Medical College, and Hospital, Vellore, India
| | - Elsa Varghese
- Department of Anesthesiology, Kasturba Medical College, and Hospital, Manipal, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev S Iyer
- Associate Division Chief for Quality and Safety, General Anesthesiology, Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Kumar M, Puri M, Suka M, Chawla N, Kaur GP, Yadav R, Agrawal K, Biswas R. Impact of Action Taken in Response to Stillbirth Audit: A Success Story. J Obstet Gynaecol India 2023; 73:61-68. [PMID: 37916007 PMCID: PMC10616033 DOI: 10.1007/s13224-023-01808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/07/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology. Material and Methods Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions. Results The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (p = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (p = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (p < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48). Conclusion Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.
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Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Millo Suka
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Nupur Chawla
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Gagan Preet Kaur
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Reena Yadav
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Kiran Agrawal
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Ratna Biswas
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
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Deorari AK, Kumar P, Chawla D, Thukral A, Goel S, Bajaj R, Singh M, Gilbert C, Shukla R. Improving the Quality of Health Care in Special Neonatal Care Units of India: A Before and After Intervention Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200085. [PMID: 36316137 PMCID: PMC9622290 DOI: 10.9745/ghsp-d-22-00085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/13/2022] [Indexed: 07/27/2023]
Abstract
BACKGROUND We evaluated the efficacy of training health care workers (HCWs) in point-of-care quality improvement (POCQI) and a preterm newborn health care package (PHCP), followed by remote mentoring and supportive supervision in improving health care practices, neonatal survival, and morbidities in special neonatal care units (SNCUs). METHODS This pre- and postintervention quality improvement study was conducted at 3 SNCUs in Madhya Pradesh, India from February 2017 to February 2019. Clinical care teams comprising doctors and nurses from the study sites were trained in POCQI and the PHCP. The teams identified, prioritized, and analyzed problems and designed quality improvement initiatives at their respective health facilities. Change ideas were tested by the local teams using sequential plan-do-study-act cycles. Facilitators maintained contact with the teams through quarterly review meetings, fortnightly videoconferencing, on-demand phone calls, and group chat service. State SNCU coordinators made follow-up visits to supplement coaching. Study research staff independently collected data on admissions, health care practices, and outcomes of neonates. FINDINGS A total of 156 HCWs were trained in the POCQI methodology and PHCP. Sixteen quality improvement projects were formulated and implemented. Among 13,821 enrolled neonates (birth weight 2275±635 g; gestation: 35.8±2.8 weeks), improvement was seen in reduction of use of oxygen (36.1% vs. 48.0%; adjusted odds ratio [aOR]=0.60, 95% confidence interval [CI]=0.55, 0.66), antibiotics (29.4% vs. 39.0%; aOR=0.76, 95% CI=0.68, 0.85), and dairy milk (33.8% vs. 49.4%; aOR=0.34, 95% CI=0.31 to 0.38). Enteral feeds were started within 24 hours of admission in a larger number of neonates, resulting in fewer days to reach full feeds. There was no effect on survival at discharge from the hospital (aOR=0.93; 95% CI=0.80, 1.09). CONCLUSION A collaborative cross-learning quality improvement approach with remote mentoring, coaching, and supportive supervision was successful in improving the quality of care at SNCUs.
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Affiliation(s)
- Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sonika Goel
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School Hygiene & Tropical Medicine, London, United Kingdom
| | - Rajan Shukla
- MCH and Health Care Quality Group, Indian Institute of Public Health, Hyderabad, India
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Taneja G, Sarin E, Bajpayee D, Chaudhuri S, Verma G, Parashar R, Chaudhry N, Mohanty JS, Bisht N, Gupta A, Tomar SS, Patel R, Sridhar VS, Joshi A, Rathi C, Baswal D, Gupta S, Gera R. Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:590-610. [PMID: 34593584 PMCID: PMC8514027 DOI: 10.9745/ghsp-d-20-00368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the highest risk of maternal and newborn mortality occurring during the period around birth, quality of care during the intrapartum and immediate postpartum periods is critical for maternal and neonatal survival. METHODS The United States Agency for International Development's Scaling Up Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions project, also known as the Vriddhi project, collaborated with the national and 6 state governments to design and implement the Care Around Birth approach in 141 high caseload facilities across 26 high-priority districts of India from January 2016 to December 2017. The approach aimed to synergize evidence-based technical interventions with quality improvement (QI) processes, respectful maternity care, and health system strengthening efforts. The approach was designed using experiential training, mentoring, and a QI model. A baseline assessment measured the care ecosystem, staff competencies, and labor room practices. At endline, the approach was externally evaluated. RESULTS Availability of logistics, recording and reporting formats, and display of protocols improved across the intervention facilities. At endline (October-December 2017), delivery and newborn trays were available in 98% of facilities compared to 66% and 55% during baseline (October-December 2015), respectively. Competency scores (> 80%) for essential newborn care and newborn resuscitation improved from 7% to 70% and from 5% to 82% among health care providers, respectively. The use of partograph in monitoring labor improved from 29% at the baseline to 61%; administration of oxytocin within 1 minute of delivery from 35% to 93%; newborns successfully resuscitated from 71% to 96%; and postnatal monitoring of mothers from 52% to 94%. CONCLUSION The approach successfully demonstrated an operational design to improve the provision and experience of care during the intrapartum and immediate postpartum periods, thereby augmenting efforts aimed at ending preventable child and maternal deaths.
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Affiliation(s)
- Gunjan Taneja
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Enisha Sarin
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
- IPE Global, New Delhi, India
| | - Devina Bajpayee
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Saumyadripta Chaudhuri
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Geeta Verma
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Rakesh Parashar
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Nidhi Chaudhry
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Jaya Swarup Mohanty
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Nitin Bisht
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Anil Gupta
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Shailendra Singh Tomar
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | | | - V S Sridhar
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Anurag Joshi
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Chitra Rathi
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
| | - Dinesh Baswal
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sachin Gupta
- Maternal and Child Health, United States Agency for International Development-India, New Delhi, India
| | - Rajeev Gera
- United States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India
- IPE Global, New Delhi, India
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Satija A, Lorenz K, DeNatale M, Mickelsen J, Deo SS, Bhatnagar S. Early Referral to Palliative Care for Advanced Oral Cancer Patients: A Quality Improvement Initiative in Oncology Center at All India Institute of Medical Sciences. Indian J Palliat Care 2021; 27:230-234. [PMID: 34511789 PMCID: PMC8428875 DOI: 10.25259/ijpc_367_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/20/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Oral cancers have high epidemiologic burden in India, and most oral cancer patients at the All India Institute of Medical Sciences present in advanced stages. Their symptomatic needs are often not adequately addressed and the referrals to palliative medicine clinic are for severe pain or terminal stages. Using quality improvement methods, we aimed to provide early referral to palliative care for advanced oral cancer patients. Materials and Methods: Duration (number of days) between registration at the head-and-neck cancer clinic and referral to palliative medicine clinic at baseline and postinterventions. Interventions: Understanding current perceptions of oncologists for referral to palliative medicine clinic, educating them through departmental meetings, fostering clinician and patient-family awareness through pamphlets, defining process and screening guidelines for referral, including symptom burden charts in head-and-neck cancer clinic notes, soliciting regular feedback from oncologists at review meetings. Results: The number of days for the referral to the palliative medicine clinic decreased from an average of 48 days to 13 days in 6 months. Conclusion: A multicomponent intervention included oncologists and patients and families, education, workflow modification, standardized assessment, documentation, and clinician feedback, and succeeded in improving the timeliness of palliative care referrals of advanced oral cancer patients.
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Affiliation(s)
- Aanchal Satija
- Departments of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Karl Lorenz
- VA Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - Sv Suryanarayana Deo
- Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Departments of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
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Giannitrapani KF, Satija A, Ganesh A, Gamboa R, Fereydooni S, Hennings T, Chandrashekaran S, Mickelsen J, DeNatale M, Spruijt O, Bhatnagar S, Lorenz KA. Barriers and Facilitators of Using Quality Improvement To Foster Locally Initiated Innovation in Palliative Care Services in India. J Gen Intern Med 2021; 36:366-373. [PMID: 32901438 PMCID: PMC7878595 DOI: 10.1007/s11606-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 08/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Quality improvement (QI) methods represent a vehicle for fostering locally initiated innovation cycles. We partnered with palliative care services from seven diverse practice settings in India to foster locally initiated improvement projects. OBJECTIVE To evaluate the implementation experiences of locally initiated palliative care improvement projects at seven diverse sites and understand the barriers and facilitators of using QI to improve palliative care in India. PARTICIPANTS We use a quota sampling approach to capture the perspectives of 44 local stakeholders in each of the following three categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide informed by the consolidated framework for implementation research (CFIR). We use standard qualitative methods to identify facilitators and barriers to using QI methods in seven diverse palliative care contexts. RESULTS Across all sites, respondents emphasized the following factors important in the success of quality improvement initiative: leveraging clinic level data, QI methods training, provider buy-in, engaged mentors, committed leadership, team support, interdepartmental coordination, collaborations with other providers, local champions, and having a structure for accountability. Barriers to using QI methods to improve palliative care services included lack of designated staff, high patient volume, resources, patient population geographic constraints, general awareness and acceptance of palliative care, and culture. CONCLUSIONS Empowering local leaders and medical personnel to champion, design, and iterate using QI methods represents a promising powerful tool to spread palliative care services in developing countries.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Aanchal Satija
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Archana Ganesh
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raziel Gamboa
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Soraya Fereydooni
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Taylor Hennings
- University of California Berkeley School of Public Health, Berkeley, CA, USA
| | | | | | | | - Odette Spruijt
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Sushma Bhatnagar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karl A Lorenz
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Primary Care and Populaiton Health, Stanford University School of Medicine, Palo Alto, CA, USA
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Kumar P, Chawla D, Thukral A, Deorari A, Shukla R, Gilbert C. Development of a quality improvement package for reducing sight-threatening retinopathy of prematurity. Indian J Ophthalmol 2020; 68:S115-S120. [PMID: 31937745 PMCID: PMC7001182 DOI: 10.4103/ijo.ijo_2087_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: With improving survival of preterm neonates, retinopathy of prematurity (ROP) is emerging as a major cause of childhood blindness. Incidence of sight-threatening ROP can be reduced by improving the quality of care provided to preterm neonates. Methods: This before-and-after study was designed to develop a need-based intervention package to improve knowledge, skills, and practices of those providing care for preterm neonates, and to evaluate the effectiveness of this package when combined with point-of-care quality improvement (POCQI) in improving survival of preterm neonates without sight-threatening ROP. The study had a formative component to assess baseline knowledge, skills, practices and attitudes, and to assess the needs of the healthcare staff to improve the care of preterm neonates. It was conducted in four special care neonatal units (SCNU) in the state of Madhya Pradesh in India. Results: A theory of change was developed to guide the development of study tools including needs assessment and educational package development. The educational package thus developed has been tested at the study sites in combination with POCQI projects driven by local teams of healthcare providers. The effectiveness of the interventions has been evaluated by collection of individual-level data on neonates admitted at the study sites. Conclusion: A multidimensional educational package integrated with system changes in the form of quality improvement (QI) endeavours driven by local context and needs were developed and evaluated in the project.
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Affiliation(s)
- Praveen Kumar
- Neonatal Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Quality Care: Need of the Hour. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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What do perioperative national clinical audits tell us? The evolving role of national audits in changing practice and improving outcomes. BJA Educ 2019; 19:334-341. [DOI: 10.1016/j.bjae.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/20/2022] Open
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Chawla D, Deorari A. Retinopathy of prematurity prevention, screening and treatment programmes: Progress in India. Semin Perinatol 2019; 43:344-347. [PMID: 31174875 DOI: 10.1053/j.semperi.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
India is home to largest number of preterm births and neonates at risk of developing retinopathy of prematurity. Being a large heterogenous country, different approaches including training of local ophthalmologists, tele-screening by ophthalmic technicians carrying wide-angle retinal cameras and use of low-cost retinal cameras by neonatal unit healthcare providers are being tested to expand the coverage of screening.
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
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