Search

BACKGROUND Carcinoma cervix is one of the leading causes of death among women worldwide. The World Health Organization has put forth the 90-70-90 global strategy for the elimination of cervical cancer as a public health problem. It calls for 70% women to be screened at least once in their lifetime. However, this rate is as low as 1.9% for India and even lower for many other countries, making the target insurmountable, especially in resource-constrained settings. The COVID-19 pandemic made this even more challenging. OBJECTIVE This study aimed to identify bottlenecks and high leverage points and propose a technology-driven, national-level program for improving the screening of carcinoma cervix. METHODS Detailed process mapping was done to identify potential bottlenecks. A counterfactual approach was used to identify high leverage points for impact using “What if” scenarios. These findings were used to build program theory–based logic models to propose a national-level program for carcinoma cervix prevention. RESULTS Availability, accessibility, affordability, skewed distribution of infrastructure, cost implications, and limited specialist workforce were identified as bottlenecks. The COVID-19 pandemic put a strain on existing resources and worsened the situation. The existing network of primary health care workers, changes in health-seeking behavior due to COVID-19 with the increasing role of tele-health, conducive political milieu with initiatives such as Digital India Mission, and a booming start-up ecosystem were identified as high leverage points through the counterfactual approach. Using these findings, a national program was designed with program theory–based logic modeling. CONCLUSIONS The journey from

Background Carcinoma cervix is one of the leading causes of death among women worldwide. The World Health Organization has put forth the 90-70-90 global strategy for the elimination of cervical cancer as a public health problem. It calls for 70% women to be screened at least once in their lifetime. However, this rate is as low as 1.9% for India and even lower for many other countries, making the target insurmountable, especially in resource-constrained settings. The COVID-19 pandemic made this even more challenging. Objective This study aimed to identify bottlenecks and high leverage points and propose a technology-driven, national-level program for improving the screening of carcinoma cervix. Methods Detailed process mapping was done to identify potential bottlenecks. A counterfactual approach was used to identify high leverage points for impact using “What if” scenarios. These findings were used to build program theory–based logic models to propose a national-level program for carcinoma cervix prevention. Results Availability, accessibility, affordability, skewed distribution of infrastructure, cost implications, and limited specialist workforce were identified as bottlenecks. The COVID-19 pandemic put a strain on existing resources and worsened the situation. The existing network of primary health care workers, changes in health-seeking behavior due to COVID-19 with the increasing role of tele-health, conducive political milieu with initiatives such as Digital India Mission, and a booming start-up ecosystem were identified as high leverage points through the counterfactual approach. Using these findings, a national program was designed with program theory–based logic modeling. Conclusions The journey from Conflicts of Interest None declared.

The primary purpose of medical records is to support patient care. It is a means of communication and secondarily, it is an important medicolegal document. Current standards of clinical records are variable. The aim of this study was to assess the adequacy of case notes in a tertiary care hospital and compare it with that of world standards. 231 case records of inpatients in the general surgery department who were discharged were audited retrospectively. Out of 53 standards analyzed, 7 had 100% compliance. More than 75% of compliance was achieved in 30/53 standards. A significant lapse in record keeping was found in daily entries by doctors, the timing of entries, details of initial assessment, and daily progress notes. Maintaining high-quality clinical record is an important part of our responsibility. Deficiencies show up in formal audits of case records. Regular orientation programs to improve the quality of clinical records and regular auditing of case notes are required to ensure adequacy.