ABSTRACT
I argue that Covid-19 is likely to impact current models of internationalisation of higher education. This is because of the difficulties in physical movement of students, of a greater recognition of the potential of technology, and of greater demand for sustainable ways of educating. At present internationalisation in the Global North has too often been confused with recruitment of high-paying students. In the wake of this crisis, understanding of the term itself must be revisited in light of the purpose of universities. Another risk post Covid-19 is the risk of retreat into narrow nationalism and nationally bound perspectives on law. Exchanges of staff and students are therefore needed more than ever. Covid-19 has positively revealed the potential for transformation of international legal education and exchanges between law schools. The current model is for student exchanges to happen as parallel physical moves of students between universities, rather than direct intellectual exchange between students. Technology has enabled virtual intellectual and cultural exchange which mirrors peer work in class: online collaborative writing;breakout rooms. This new form of exchange offers access to students who might not be able to afford physical travel to access a fuller comparative conversation on law. I will draw on my own experience teaching during the pandemic. Finally, I will acknowledge that law students should expand physical horizons in study and later, work, but suggest that initial virtual cross-border intellectual exchange enhances that journey and is, of itself, a journey worth making. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
ABSTRACT
BACKGROUND: Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care. METHODS: Interviews were conducted with 40 staff delivering hip fracture care in four UK hospitals. Twenty-three anonymised British Orthopaedic Association reports addressing under-performing hip fracture services were analysed. Following Thematic Analysis of both data sources, themes were transposed onto domains both along and across the hip fracture care pathway. RESULTS: Effective pre-operative care required early alert of patient admission and the availability of staff in emergency departments to undertake assessments, investigations and administer analgesia. Coordinated decision-making between medical and surgical teams regarding surgery was key, with strategies to ensure flexible but efficient trauma lists. Orthogeriatric services were central to effective service delivery, with collaborative working and supervision of junior doctors, specialist nurses and therapists. Information sharing via multidisciplinary meetings was facilitated by joined up information and technology systems. Service provision was improved by embedding hip fracture pathway documents in induction and training and ensuring their consistent use by the whole team. Hospital executive leadership was important in prioritising hip fracture care and advocating service improvement. Nominated specialty leads, who jointly owned the pathway and met regularly, actively steered services and regularly monitored performance, investigating lapses and consistently feeding back to the multidisciplinary team. CONCLUSION: Findings highlight the importance of representation from all teams and departments involved in the multidisciplinary care pathway, to deliver integrated hip fracture care. Complex, potentially modifiable, barriers and facilitators to care delivery were identified, informing recommendations to improve effective hip fracture care delivery, and assist hospital services when re-designing and implementing service improvements.
Subject(s)
Delivery of Health Care , Hip Fractures , Humans , Hip Fractures/surgery , HospitalsABSTRACT
Patients with immune-mediated inflammatory diseases (IMIDs) and acquired and genetic immunodeficiencies receiving therapeutic infusions are considered high risk for SARS-CoV-2 infection. However, the seroprevalance in this group and the safety of routine administrations at outpatient infusion centers are unknown. To determine the infection rate and clinical-social factors related to SARS-CoV-2 in asymptomatic patients with IMIDs and immunodeficiencies receiving routine non-cancer therapeutic infusions, we conducted a seroprevalence study at our outpatient infusion center. We report the first prospective SARS-CoV-2 sero-surveillance of 444 IBD/IMID, immunodeficiency, and immune competent patients at an outpatient infusion center in the U.S. showing lower seroprevalence in patients compared with the general population and provide clinical and social characteristics associated with seroprevalence in this group. These data suggest that patients can safely continue infusions at outpatient centers.