Family Medicine and Primary Care

Post-COVID healthcare reform in India: What to expect? Soham D Bhaduri Journal of Family Medicine and Primary Care 2020 9(11):5427-5431 COVID-19 has exposed the fault lines of India's public health system. The pandemic can be a useful window of opportunity to undertake public healthcare reforms that are long due. Such reforms are, however, constrained by the path-dependent characteristics of private healthcare in India. Measures taken to expand healthcare during the pandemic appear unlikely to sow the seeds of successful path transformation, and may rather reinforce the private sector dominated trajectory. Policymakers must introduce a bold set of pro-public healthcare reforms during the pandemic, which can then be incrementally built upon through securing legitimacy and support.

Why COVID-19 pandemic builds a convincing case for investing in 'Young Physician Leaders (YPL)' Paramdeep Singh Journal of Family Medicine and Primary Care 2020 9(11):5432-5434 There are pressing issues that are plaguing healthcare systems across the world (especially in the lower-middle-income countries), which comprise low-quality care, affordability, accessibility, poor infrastructure, violence against healthcare personnel, deficiency of physicians and healthcare staff. COVID-19 has put an immense physical and mental strain on the young physicians who are at the forefront in fighting this pandemic. This has lead to an increase in incidences of burnout among young doctors, which adversely impacts the quality of healthcare, patient well-being and satisfaction. The present-day medical training typically creates solo medical experts; but, modern-day management of patients and organisations require team-work and leadership. To profoundly alter the way the young physicians work and for creating physician leaders for the future, leadership training ought to commence during the medical school.

A low-cost solution for converting existing stethoscope into tele-stethoscope in resource-constrained setting for COVID-19 pandemic Sumit Kalra, Preeti Mutreja, Amit Goyal, Abhinav Dixit Journal of Family Medicine and Primary Care 2020 9(11):5435-5436 In the present scenario of COVID-19, there has been a sudden surge in demand for tele- consultancy. Such measures require resources to support the system. Replacement of conventional equipment used in a clinic with digital equipment is not feasible due to their cost and scalability issues. The authors developed a simple low-cost (almost zero cost) method to convert a conventional stethoscope into a tele-stethoscope. Such a simple modification can be useful in periphery wherein doctors are still not available and the growing number of patients would require a diagnosis of the chest conditions.

COVID-19: Lab medicine expect due respect Amrita Ghosh Journal of Family Medicine and Primary Care 2020 9(11):5437-5438

Preparing for a COVID-19 pandemic: Redefining roles of multidisciplinary team in a large tertiary hospital in Rajasthan Abhay Elhence, Binit Sureka, Mahendra Kumar Garg, Pankaj Bhardwaj, Tanuj Kanchan, Arvind Sinha, Pradeep Kumar Bhatia, Vijaya Lakshmi Nag, Nikhil Kothari, Naveen Dutt, Suryanarayanan Bhaskar, Vibhor Tak, NR Bishnoi, Sanjeev Misra Journal of Family Medicine and Primary Care 2020 9(11):5439-5444 Through this manuscript, we would like to share our experience with building a COVID hospital, allocating duties, planning and managing supplies during COVID-19 pandemic. This manuscript is prepared by the Doctors of various specialties with vast experience involved in actual planning of the infrastructure and resources. This comprehensive manuscript will help teams to prepare and train, stockpile necessary equipment and prepare their staff to deal with current crisis if there is a surge in infected cases.

COVID-19 reinfection: Linked possibilities and future outlook Ekta Krishna, Vineet Kumar Pathak, Reshma Prasad, Hannah Jose, M Mohan Kumar Journal of Family Medicine and Primary Care 2020 9(11):5445-5449 SARS-CoV-2 is the third major coronavirus epidemic to affect humans. There had been multiple instances of patients turning positive after recovering from SARS-2-CoV infection. Though many different theories emerge, false positive RT-PCR is logically the foremost cause and there is a general consensus that during quarantine re-infection from outside seems unlikely when strictly adhered to. As many new strains emerge worldwide during the course of on-going pandemic, the chances of re-infection cannot be ignored as it may contribute to false negative RT-PCR test results. SARS-2-CoV though a novel virus, is phylogenetically similar to SARS-like CoV with around 79% similarity. Studies on immunological response to these infections suggest that antibodies formed after infection confers immunity only for a short period of time before it starts to wane. Also studies on SARS-CoV-2 suggest that antibody formation and longevity of immunity in an individual is dependent on the strain of coronavirus, its severity and age of the person infected. All these considerations demand reviewing the treatment duration, discharge criteria, appropriate use of imaging techniques and importance of risk communication and health education to those recovered.

Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel Sanjay Kalra, AK Das, G Priya, S Ghosh, RN Mehrotra, S Das, P Shah, S Bajaj, V Deshmukh, D Sanyal, S Chandrasekaran, D Khandelwal, A Joshi, T Nair, F Eliana, H Permana, MD Fariduddin, PK Shrestha, D Shrestha, S Kahandawa, M Sumanathilaka, A Shaheed, AA Rahim, A Orabi, A Al-ani, W Hussein, D Kumar, K Shaikh Journal of Family Medicine and Primary Care 2020 9(11):5450-5457 Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.

Mapping of Health Technology Assessment (HTA) teaching and training initiatives: Landscape for evidence-based policy decisions in India Rinshu Dwivedi, Ramesh Athe, Sanghamitra Pati, Krushna C Sahoo, Debdutta Bhattacharya Journal of Family Medicine and Primary Care 2020 9(11):5458-5467 Demographic transitions accompanied with epidemiological shifts are affecting many countries around the globe. These apprehensions have raised the concern for constructing and sustaining healthcare systems especially among resource-constrained low- and middle-income-countries (LMICs) such as India. Introducing Health-Technology-Assessment (HTA) in the educational initiatives could support planners and policy-makers in formulating evidence-based-decision-making along with tackling inequalities/inefficiencies and promoting cost-effectiveness in resource allocation. A mapping exercise has been undertaken for examining the feasibility and implementation of HTA curriculum in the existing courses in India. To gain best possible insight on HTA curriculum, a situational analysis was conducted using systematic search strategy through search engines such as Google, Google Scholar, ProQuest and PubMed. Currently, seventy-one institutes in India are offering one or more courses through regular mode at undergraduate/postgraduate/diploma-certificate/doctorate-level pertaining to Medical-technology (MT), Biostatistics (BS), and Health-economics (HE). MT was offered in 37 institutes (52.12%), followed by BS in 23 (32.39%), and HE in nine (12.67%). Only two institutes (2.81%) are offering certificate-courses on HTA, mainly confined in virtual modules. This review reveals noticeable gaps in the existing curriculum in India and necessitates a novel academic initiative by introducing HTA in a full-fledged manner. Reforms in the research and educational initiatives need to be brought for promoting awareness regarding HTA. The application of domain needs to be widened from the field of health-policy formulators to research and teaching. This should be further strengthened with the strong academic collaborations to generate replicable findings, address challenges, and offer solutions for existing threats to HTA.

Managing pregnancy in COVID-19 pandemic: A review article Vinita Singh, Pragati Trigunait, Sagarika Majumdar, Rajeshwari Ganeshan, Rajshree Sahu Journal of Family Medicine and Primary Care 2020 9(11):5468-5473 The outbreak Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a highly contagious and lethal beta coronavirus SARS-CoV-2, which has spread fast to encroach the entire globe and hence declare pandemic. Pregnancy alters body physiology and immune systems, can have worse effects of some respiratory infections and due to limited research and published data we still are in dilemma of appropriate management guidelines This article covers the updated guidelines for infection prevention and control (IPC), screening, sampling, antenatal visit schedules, risk scoring, triaging, supportive care, delivery, postpartum care and care of the newborn. This article aims to provide up-to-date information as per recent guidelines of various association which would serve as guidance in managing pregnant women and newborn with suspected or confirmed COVID-19. All the published papers till date, NCPRE, WHO Interim guidelines, RCOG, FOGS GCPRI, Medical Council of India, ICMR, MOFHW, CDC, ACOG guidelines are referred to compile this article to reach to a conclusion of evidence based management of pregnant ladies during COVID-19 pandemic. This article covers the not only infection prevention and control (IPC) guidelines, but also screening and sampling guidelines, antenatal visit schedules, risk scoring, triaging but also in-patient supportive care, delivery, postpartum care and care of the newborn. Data are very limited and hence very difficult to accurately define clinical management strategies and needs to be constantly updated.

Novel coronavirus (COVID-19) and its potential G.I. manifestation: A review Amar Deep, Kamlendra Verma, Suchit Swaroop, Ajay Kumar, Sumit Rungta Journal of Family Medicine and Primary Care 2020 9(11):5474-5479 The outbreak of the new coronavirus in Wuhan, Chinese Hubei City (COV-2) was also known as COVID-19 and has spread to more than 213 countries, zones or territories worldwide, and is an emergency of international public health with no antiviral drugs or vaccines; and, also, the presencouragement of the disease has become a global public health emergency. This novel coronavirus is now the seventh member of the coronaviridae family, known for infecting humans and showing evidence of causing gastric symptoms, and has the potential to be transmitted through the fecal-oral route according to a new report published online by physicians at Shanghai Jiao Tong University (Gastroenterology. 2020 March 3. doi: 10.1053/j.gastro. 2020.02.054). Here we identify the efforts to compile and disseminate the COVID-19 epidemiological information on Its potential G.I. Demonstration of news media and social networks, and few newspapers recently published. Physicians should know, how GI manifestation discussed in different publications to suspect CORONA virus infection in that patients who does not have any upper and lower respiratory tract symptom and intervein to discuss the disease severity and duration. It will increase the threshold of suspicion of physician toward Covid-19 disease.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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