A dynamic risk management approach to reduce harm in hypertrophic cardiomyopathy

Building local decision-making competencies during COVID-19: Accelerating the transition from learning healthcare systems to learning health communities

Introduction

The persisting and evolving COVID-19 pandemic has made apparent that no singular policy of mitigation at a regional, national or global level has achieved satisfactory and universally acceptable results. In the United States, carefully planned and executed pandemic policies have been neither effective nor popular and COVID-19 risk management decisions have been relegated to individual citizens and communities. In this paper, we argue that a more effective approach is to equip and strengthen community coalitions to become local learning health communities (LLHCs) that use data over time to make adaptive decisions that can optimize the equity and well-being in their communities.

Methods

We used data from the North Carolina (NC) county and zip code levels from May to August 2020 to demonstrate how a LLHC could use statistical process control (SPC) charts and simple statistical analysis to make local decisions about how to respond to COVID-19.

Results

We found many patterns of COVID-19 progression at the local (county and zip code) levels during the same time period within the state that were completely different from the aggregate NC state level data used for policy making.

Conclusions

Systematic approaches to learning from local data to support effective decisions have promise well beyond the current pandemic. These tools can help address other complex public health issues, and advance outcomes and equity. Building this capacity requires investment in data infrastructure and the strengthening of data competencies in community coalitions to better interpret data with limited need for advanced statistical expertise. Additional incentives that build trust, support data transparency, encourage truth-telling and promote meaningful teamwork are also critical. These must be carefully designed, contextually appropriate and multifaceted to motivate citizens to create and sustain an effective learning system that works for their communities.

Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory

The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.