From travel to virtual work: The transitional experiences of global workers during Covid-19.

The Covid-19 pandemic has transformed how global work is conducted in multinational enterprises. There has been a rapid and forced shift from global mobility to global virtual work. Taking a transition perspective and drawing on event system theory, this paper examines the transitional working experiences of global workers amid a global health pandemic. Through 32 in-depth interviews (pre- and in-Covid-19), our findings reveal how this exogenous event has transformed previously unquestioned and enshrined global work routines. By unpacking the transition process, we find that global workers were challenged to reconfigure the structural and relational dimensions of their global work. We disentangle the strategic and sustainable lessons learnt on the future of global working for multinational enterprises.

Costing malaria interventions from pilots to elimination programmes.

BACKGROUND: Malaria programmes in countries with low transmission levels require evidence to optimize deployment of current and new tools to reach elimination with limited resources. Recent pilots of elimination strategies in Ethiopia, Senegal, and Zambia produced evidence of their epidemiological impacts and costs. There is a need to generalize these findings to different epidemiological and health systems contexts. METHODS: Drawing on experience of implementing partners, operational documents and costing studies from these pilots, reference scenarios were defined for rapid reporting (RR), reactive case detection (RACD), mass drug administration (MDA), and in-door residual spraying (IRS). These generalized interventions from their trial implementation to one typical of programmatic delivery. In doing so, resource use due to interventions was isolated from research activities and was related to the pilot setting. Costing models developed around this reference implementation, standardized the scope of resources costed, the valuation of resource use, and the setting in which interventions were evaluated. Sensitivity analyses were used to inform generalizability of the estimates and model assumptions. RESULTS: Populated with local prices and resource use from the pilots, the models yielded an average annual economic cost per capita of $0.18 for RR, $0.75 for RACD, $4.28 for MDA (two rounds), and $1.79 for IRS (one round, 50% households). Intervention design and resource use at service delivery were key drivers of variation in costs of RR, MDA, and RACD. Scale was the most important parameter for IRS. Overall price level was a minor contributor, except for MDA where drugs accounted for 70% of the cost. The analyses showed that at implementation scales comparable to health facility catchment area, systematic correlations between model inputs characterizing implementation and setting produce large gradients in costs. CONCLUSIONS: Prospective costing models are powerful tools to explore resource and cost implications of policy alternatives. By formalizing translation of operational data into an estimate of intervention cost, these models provide the methodological infrastructure to strengthen capacity gap for economic evaluation in endemic countries. The value of this approach for decision-making is enhanced when primary cost data collection is designed to enable analysis of the efficiency of operational inputs in relation to features of the trial or the setting, thus facilitating transferability.

Efficient Delivery of Investigational Antibacterial Agents via Sustainable Clinical Trial Networks.

The economics of antibiotics can be improved by infectious diseases-specific clinical trial networks. While developers would still need to implement an independent phase 1 program as well as studies focused on highly resistant pathogens, standardized procedures in a network focused on usual drug resistance phenotype isolates would permit sharing of controls and would predictably generate high-quality pivotal data for product registration while creating cost and time savings in the range of 30%-40%. This would reduce economic barriers to antibiotic development and contribute to public health.

Hospital doctor turnover and retention: a systematic review and new research pathway.

PURPOSE: Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research. DESIGN/METHODOLOGY/APPROACH: Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science. FINDINGS: We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover. RESEARCH LIMITATIONS/IMPLICATIONS: Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results. PRACTICAL IMPLICATIONS: Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting "stay interviews" with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts. SOCIAL IMPLICATIONS: Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees. ORIGINALITY/VALUE: The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study.

OBJECTIVE: To create a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the life of current last-line treatments. DESIGN: Modelling study. SETTING: England. POPULATION: Patients accessing sexual health services. INTERVENTIONS: Incremental impact of introducing a hypothetical AMR POCT that could detect susceptibility to previous first-line antibiotics, for example, ciprofloxacin or penicillin, so that patients are given more tailored treatment, compared with the current situation where all patients are given therapy with ceftriaxone and azithromycin. The hypothetical intervention was assessed using a mathematical model developed in Excel. The model included initial and follow-up attendances, loss to follow-up, use of standard or tailored treatment, time taken to treatment and the costs of testing and treatment. MAIN OUTCOME MEASURES: Number of doses of ceftriaxone saved, mean time to most appropriate treatment, mean number of visits per (infected) patient, number of patients lost to follow-up and total cost of testing. RESULTS: In the current situation, an estimated 33 431 ceftriaxone treatments are administered annually and 792 gonococcal infections remain untreated due to loss to follow-up. The use of an AMR POCT for ciprofloxacin could reduce these ceftriaxone treatments by 66%, and for an AMR POCT for penicillin by 79%. The mean time for patients receiving an antibiotic treatment is reduced by 2 days in scenarios including POCT and no positive patients remain untreated through eliminating loss to follow-up. Such POCTs are estimated to add £34 million to testing costs, but this does not take into account reductions in costs of repeat attendances and the reuse of older, cheaper antimicrobials. CONCLUSIONS: The introduction of AMR POCT could allow clinicians to discern between the majority of gonorrhoea-positive patients with strains that could be treated with older, previously abandoned first-line treatments, and those requiring our current last-line dual therapy. Such tests could extend the useful life of dual ceftriaxone and azithromycin therapy, thus pushing back the time when gonorrhoea may become untreatable.

Funding Antibiotic Innovation With Vouchers: Recommendations On How To Strengthen A Flawed Incentive Policy.

A serious need to spur antibiotic innovation has arisen because of the lack of antibiotics to combat certain conditions and the overuse of other antibiotics leading to greater antibiotic resistance. In response to this need, proposals have been made to Congress to fund antibiotic research through a voucher program for new antibiotics, which would delay generic entry for any drug, even potential blockbuster lifesaving generics. We find this proposal to be inefficient, in part because of the mismatch between the private value of the voucher and the public value of the antibiotic innovation. However, vouchers have the political advantage in the United States of being able to raise sufficient amounts of money without annual appropriations from Congress. We propose that if antibiotic vouchers are to be considered, the design should include dollar and time caps to limit their volatility, sufficient advance notice to protect generic manufacturers, and market-based linkages between the value of the voucher and the value of the antibiotic innovation. We also explore a second option: The federal government could auction vouchers to the highest bidders and use the money to create an antibiotics innovation fund.