The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

The linguistic status of Isotype

It is ironic that Otto Neurath, one of those responsible for the ‘linguistic turn’ in philosophy of the twentieth century, should have been concerned during the last twenty years of his life with developing a ‘pictorial language’. By using simplified pictograms as components, the Wiener Methode der Bildstatistik (later called Isotype) bypassed verbal language to a great extent, creating the potential for universal understanding of biological, social and economic correlations. However, despite its consistency and rigour, Isotype was not a complete language, and Neurath knew that it never could be. This paper will examine the linguistic characteristics of Isotype and describe the deliberate resistance on the part of its creators to develop a full theory behind it.

Developing consensus on hospital prescribing indicators of potential harms amenable to decision support

Aim: To develop a list of prescribing indicators specific for the hospital setting that would facilitate the prospective collection of high severity and/or high frequency prescribing errors, which are also amenable to electronic clinical decision support (CDS). Method: A three-stage consensus technique (electronic Delphi) was carried out with 20 expert pharmacists and physicians across England. Participants were asked to score prescribing errors using a 5-point Likert scale for their likelihood of occurrence and the severity of the most likely outcome. These were combined to produce risk scores, from which median scores were calculated for each indicator across the participants in the study. The degree of consensus between the participants was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or more was achieved. Results: A total of 80 prescribing errors were identified by consensus as being high or extreme risk. The most common drug classes named within the indicators were antibiotics (n=13), antidepressants (n=8), nonsteroidal anti-inflammatory drugs (n=6), and opioid analgesics (n=6).The most frequent error type identified as high or extreme risk were those classified as clinical contraindications (n=29/80). Conclusion: 80 high risk prescribing errors in the hospital setting have been identified by an expert panel. These indicators can serve as the basis for a standardised, validated tool for the collection of data in both paperbased and electronic prescribing processes, as well as to assess the impact of electronic decision support implementation or development.

Challenges in conducting and publishing research on the Middle East and Africa in leading journals

Purpose – The purpose of this paper is to examine the reasons for the lack of research attention paid to the Middle East (ME) and Africa regions. In particular, this study seeks to identify the reasons for and implications of the paucity of ME- and Africa-based studies in high-quality international journals in the marketing field with a specific focus on the challenges in conducting and publishing research on these regions. Design/methodology/approach – The authors conducted a systematic review of the literature on the ME and Africa regions to identify papers published in 23 high-quality marketing, international business, and advertising journals. This search resulted in 301 articles, among which 125 articles were based on primary or secondary data collected from a local source in those regions. The authors of these 125 articles constitute the Delphi study sample. These academics provided input in an effort to reach a consensus regarding the two proposed models of academic research in both regions. Findings – This paper differs from previous studies, where academic freedom emerged as the most important inhibitor to conducting and publishing research. The most frequently mentioned challenges in conducting research in Africa were access to data, data collection issues, diversity of the region, and lack of research support infrastructure. For the ME, the most often described challenges included validity and reliability of data, language barriers, data collection issues, and availability of a network of researchers. Editors’ and reviewers’ low interest and limited knowledge were ranked high in both regions. South Africa, Israel, and Turkey emerged as outliers, in which research barriers were less challenging than in the rest of the two regions. The authors attribute this difference to the high incidence of US-trained or US-based scholars originating from these countries. Originality/value – To the best of the knowledge, no marketing studies have discussed the problems of publishing in high-quality international journals of marketing, international business, and advertising for either region. Thus, most of the issues the authors discuss in this paper offer new insightful results while supplementing previous research on the challenges of conducting and publishing research on specific world regions.