Video-consultation in the Emergency Department: An Assessment of the Potential Benefit for a UK District General Hospital (Preprint)

BACKGROUND DGH Emergency department referrals to a tertiary centre depend on information available from a ‘generalist’ clinician in discussion with a specialist team. If there is uncertainty, the lowest risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient whilst still in the Emergency department could improve decision making about patient transfer. OBJECTIVE This study assessed the potential benefit of real time video consultation between remote specialist and Emergency department patient across all specialities. METHODS Detailed patient data was collected prospectively for 6 months on all patients presenting to a DGH Emergency department who required input from a specialist team in the nearest tertiary centre. These patients were discussed retrospectively with the specialist teams to determine whether video conferencing could have benefited the patient’s management. The logistics for use of videoconferencing were explored. RESULTS 18,799 patients were seen in the Emergency department during the study period. 413 referrals were made to the tertiary centre specialist teams. Review of patients transferred indicated 193 might have benefited from video consultation. If the specialist team could be accessed via video conferencing only whilst a senior member was available in hospital (0800-2200hr) then a maximum of only 5 patients per week across all specialities would use the equipment. If 24hr specialist access was available this would increase to 7 patients per week. CONCLUSIONS Video consultation between emergency department patient and specialist has limited potential to improve patient management.

Inclusive curriculum and BAME student advocacy in a business school: reflections on three years of inclusive module reviews

This article presents a case study of BAME (Black, Asian and minority ethnic) student advocacy and its impact upon the curriculum of a large business school within a post-92 UK university. Learning from the University of Birmingham's (2017) ‘BME Ambassador Scheme’ and the ‘Curriculum Consultants’ model at Kingston University (2017), a programme of BAME Student Advocates was established in 2018 across this university, to raise issues of race equity with staff in positions of power. The scheme has grown from 10 BAME Student Advocates in 2018 to 14 in 2020, offering student advocacy on many aspects of university life, including employability services, the learning environment, academic skills workshops, student community and belonging, and the undergraduate curriculum. The role-holder is employed by the central Student Success Team, and partners with a senior member of staff in each academic school (and several other business functions) to collaborate on specific race equity objectives each year. One recurring aspect of the role involves offering diverse student perspectives on module content, delivery and assessment to achieve a more inclusive curriculum design for programmes with the largest awarding gaps. This article reflects upon the outcomes and lessons learned through conducting 24 such module reviews over a three-year period within a business school and proposes potential future developments.

Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit—Impact on Mortality and Clinical Outcomes

Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010–2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). Results: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6–4.3) h] compared to the resident period [0.5 (0.3–1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.

Evaluation of the Review Models and Approval Timelines of Countries Participating in the Southern African Development Community: Alignment and Strategies for Moving Forward

Introduction: Regulatory reliance, harmonization and work sharing have grown over the last few years, resulting in greater sharing of work and information among regulators, enabling efficient use of limited resources and preventing duplication of work. Various initiatives on the African continent include ZaZiBoNa, the Southern African Development Community (SADC) collaborative medicines registration initiative. ZaZiBoNa has resulted in great savings in time and resources; however, identified challenges include lack of clear information regarding the participating countries registration processes and requirements as well as lengthy registration times. The aim of this study, therefore, was to compare the data requirements and review models employed in the assessment of applications for registration, the target timelines for key milestones and the metrics of applications received and approved in 2019 and 2020 by Mozambique, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe.Methods: A senior member of the division responsible for issuing marketing authorisations completed an established and validated questionnaire, which standardizes the review process, allowing key milestones, activities and practices of the six regulatory authorities to be identified and compared. The completed questionnaires were validated by the heads of the respective agencies.Results: The majority of applications received and approved by all six agencies in 2019 and 2020 were for generics. The mean approval times for generics varied across the countries, with ranges of 218–890 calendar days in 2019 and 158–696 calendar days in 2020. All three types of scientific assessment review models were used by the six agencies and data requirements and extent of scientific assessment were similar for five countries, while one conducted full reviews for new active substances. A large variation was observed in the targets set by the six agencies for the different milestones as well as overall approval times.Conclusions: The study identified the strengths of the countries as well as opportunities for improvement and alignment. Implementation of the recommendations made as in this study will enhance the countries' individual systems, enabling them to efficiently support the ZaZiBoNa initiative.

Evaluation of the Good Review Practices of Countries Participating in the Southern African Development Community: Alignment and Strategies for Moving Forward

Introduction: National medicines regulatory agencies are faced with challenges including limited resources and technical capacity, resulting in countries collaborating and sharing resources to improve efficiency of the review process to facilitate access to quality-assured medicines by their populations. One such collaboration is the Southern African Development Community (SADC) medicines registration collaborative initiative, ZaZiBoNa. Countries participate in the initiative by contributing to regulatory reviews and good manufacturing practices inspections. The aim of this study was to review and compare the registration processes of regulatory authorities of Mozambique, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe to identify strategies for better alignment.Methods: A senior member of the division responsible for issuing marketing authorisations completed an established and validated questionnaire, which standardises the review process, allowing key milestones, activities and practices of the six regulatory authorities to be identified and compared. The completed questionnaires were validated by the heads of the respective agencies.Results: The six countries vary in population and in the size of their respective regulatory agency and the resources allocated to regulatory reviews. The review processes of the six agencies were similar; however, differences were noted in the milestones recorded; for example, two of the countries did not record the start of the scientific assessment. Additionally, decisions for marketing authorisation were made by an expert committee in four of the countries and by the head of the agency and the Minister of Health in two countries. All six agencies implemented the majority of good review practices; however, the need for improvement in the areas of transparency and communication and quality decision making practices was a common finding for all six countries.Conclusions: Participation in the ZaZiBoNa initiative has improved the way in which the six agencies perform regulatory reviews in their countries, highlighting the realisation of one of the key objectives of the initiative, which was building the expert capacity of member countries. Other agencies in the SADC region and beyond can use the results of this study to identify best practices, which in turn, could improve their regulatory performance.

Honorary authorship in high-impact journals in anaesthesia and pain medicine

Enlisting an author on a published paper, whose input was insufficient, is called honorary authorship. The aim of this study is to assess the proportion of honorary authorship in the field of pain medicine. Data were collected from seven high-impact journals. Corresponding authors were sent a survey regarding their awareness on authorship guidelines, the decision-making in authorship and specific contributions made to the surveyed article. We identified two types of honorary authorship: (1) self-perceived honorary authorship, which is measured by asking the corresponding author if honorary authorship was present according to their opinion and (2) International Committee of Medical Journal Editors (ICMJE)-defined honorary authorship, which is honorary authorship based on the guidelines. In total, 1051 mails were sent and 231 responded, leading to a response rate of 22.0%. 81.3% of the respondents were familiar with the ICMJE authorship guidelines, while 59.6% were aware of the issue of honorary authorship. 13.3% of the respondents were employed at a department in which the senior member is automatically included on all manuscripts. The ICMJE-defined honorary authorship was 40%, while self-perceived honorary authorship was 13.5%. There seems to be a high awareness of the ICMJE guidelines among corresponding authors in the field of Pain Medicine. Despite this high awareness, a high proportion of journal articles had honorary authorship, suggesting that authorship guidelines fail to be applied in a significant proportion of the literature.

“Strokes to the portrait”: the senior member of the Moscow City Duma N. P. Vishnyakov (1844–1927) on his contemporaries and himself (based on the materials of the personal archive)

This article examines the informative capabilities of the body of materials from the personal archive of N. P. Vishnyakov for reconstructing the history of the senior member of the Moscow City Duma. Leaning on the historiography dedicated to the work with personal archive collections, as well as determining lacunas in the scientific literature, assessment is given to composition of the fund with emphasis on one of the varieties of sources stored therein &ndash; &ldquo;Reminiscences of the Duma&rdquo;, internal and external criticism of these materials. The example of N. P. Vishnyakov's &ldquo;Reminiscences of the Duma&rdquo; demonstrated the experience of development of the methods of archival studies, source studies, historiographical and specific-historical approaches towards examination of personal and family archives. Work with the body of materials from personal archive collections allows introducing the new historical sources into the scientific discourse. Based on the substantive analysis of the texts that comprise the source base of the article, the author attempts to reconstruct the everyday activity of the Moscow Duma, which draws interest of the historians in the context of sociopolitical history, as well as micro-historical analysis. The sources of N. P. Vishnyakov's personal archive bear the imprint of ego-documents, which allow reconstructing the actions &ldquo;behind the scene&rdquo; through the prism of personal relations and contracts of the founder, as well as direct participants of the historical process, including the figure of N. P. Vishnyakov.

The Academy and the Tsugaru Disciples

This chapter chronicles the formation of the Tsugaru group of posthumous Hirata disciples and highlights Tsuruya Ariyo's efforts as a leader. This circle was devoted to poetry composition, the study of the Ancient Way, and worship of their late teacher's spirit, while retaining some scholarly autonomy. It explores the local intellectuals' association of their own “country” of Tsugaru to a larger nation of Japan by both engaging Hirata kokugaku and joining a national network. The chapter also details Ariyos' debate with Kikuchi Masahisa, a senior member of the academy from the neighboring rival domain of Morioka, on how to correctly interpret Japan's myths and Master Hirata Atsutane's teachings. Ultimately, the chapter explains how Ariyo was regarded within the Hirosaki domain as a townsperson of relatively low social standing, albeit, one of considerable cultural achievement.

Intra-household Bargaining, Son Preference and the Status of Women in India

Son preference prevails among Indian families. We test the hypothesis that women who bear sons experience an elevated status within the household, which translates into their increased role in decision-making. Using data from the Indian Human Development Survey, we find that women who have given birth to at least one son show greater participation in the household’s financial decisions as well as other decisions on a regular basis. After analysing 13 decision variables, we find that women who have given birth to at least one son enjoy higher overall bargaining power in the household. For example, in decisions concerning what to spend money on, having a son is equivalent to 6 years of formal education. We also show that the presence of a senior member in the household, however, often reduces the women’s household bargaining strength. JEL Classification Codes: J11, J12, J13, D190