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Background Tumor necrosis factor-alpha inhibitors (anti-TNFs) are a primary treatment for inflammatory bowel disease. Pharmaceutical expenditures and usage of specialty drugs are increasing. In the United States, biosimilars continue to be underutilized, despite opportunities for health care cost savings. Through quality improvement (QI) methodology, we aimed to increase biosimilar utilization among eligible patients initiating intravenous (IV) anti-TNF therapy and describe patient outcomes and associated cost savings. Methods Beginning in July 2019, all patients initiating IV anti-TNF therapy were identified and tracked. Using the Institute of Healthcare Improvement Plan-Do-Study-Act cycle, a four-stage problem-solving model used for carrying out change, we trialed interventions to increase biosimilar utilization, including provider, staff, and family education, and utilization of a clinical pharmacist and insurance specialist. Statistical process control charts were used to show improvement over time. Patients’ clinical outcome and cost savings were reviewed. Results Using QI methodology, we increased biosimilar utilization from a baseline of 1% in June 2019 to 96% by February 2021, with sustained improvement. The originator (infliximab) was the insurance company’s preferred product for 20 patients (20%). Patient outcomes (IV anti-TNF levels, absence of antidrug antibodies, and physician global assessment) between biosimilars and originators were similar. Estimated cost savings over the project duration were nearly $381,000 (average sales price) and $651,000 (wholesale acquisition cost). Conclusions Through QI methodology, we increased biosimilar utilization from 1% to 96% with sustained improvement, without compromising patient outcomes or safety. Estimated cost savings were substantial. Similar methodology could be implemented at other institutions to increase biosimilar utilization and potentially decrease health care costs.

Mediation is one form of dispute resolution used in resolving commercial disputes in New Zealand. Lawyers play a key role as gatekeepers to commercial mediation. This article explores the role that these gatekeepers are playing in the New Zealand private commercial mediation market. The findings are based on a survey and interviews carried out in late 2015 and early 2016. Prior to this study there was no comprehensive information on the attitude of New Zealand commercial lawyers to mediation. The evidence reported in this article suggests that lawyers are very aware of commercial mediation, and support it, but largely on their own terms. They are not undermining it. In fact, lawyers believe they are contributing positively to the mediation process. Clients have a more limited knowledge of mediation but usually follow their lawyer’s recommendations. Thus lawyers play a key role as gatekeepers to commercial mediation. The main reason lawyers recommend mediation is cost (i.e. it is cheaper than litigation). Lawyers prefer legally trained mediators with experience and a good reputation. Lawyers report high mediation settlement rates and high overall quality of mediations. Overall, the ‘gatekeepers’ are generally happy with the standard of commercial mediation in New Zealand. However, mediation exists to serve the clients, not the gatekeepers. The views of actual users are necessary to complete the picture of the New Zealand commercial mediation market.

This report outlines the findings of a research project that was co-funded by the Resolution Institute as part of Victoria University’s 2018/19 Summer Scholarship programme. It forms part of the New Zealand Commercial Mediation Study (NZCMS). This report aims to provide insight into the practice of commercial mediation in New Zealand and builds on the previous studies: the first examining the nature of private commercial mediation in New Zealand (as this does also), the second examining the perspectives of commercial lawyers, the ‘gatekeepers’ of mediation, and the third examining the perspectives of ‘users’ of commercial mediation, (more specifically in the insurance sector). The longitudinal nature of this research allows readers to see the differences in the private mediation market from early 2015 to early 2019. Investigation into the private mediation market is necessary for its growth and development as a form of alternative dispute resolution.

The results of this survey provide an understanding of users’ perspectives on mediation. The respondents reported a good knowledge of mediation. They also indicated that the insurance industry as a whole is aware of mediation and supports the use of it. Users report they are using mediation often and believe that it is well utilised in the insurance sector. However, most estimate that the organisations they work for use mediation less than 25 times in any given year. Respondents’ main reason for using mediation is its cost-effectiveness. Respondents’ main reason for not using mediation is the other party’s unwillingness. This indicates the party on the other side of a dispute may be a barrier to using mediation. Respondents also noted that the other party having a weak case or unrealistic expectations were reasons not to use mediation.

Sophisticated fictional portrayals of lawyers facing ethical dilemmas can provide important insights into the nature of legal ethics and morality in the New Zealand legal profession. These insights can assist the legal community in addressing complex issues surrounding professional regulation. This article reveals legal characters who act contrary to legal ethics but with moral justifications and characters who act ethically but in a way that laypeople may view as amoral or immoral. While the depictions of lawyers are generally negative, a close analysis reveals that this is partly a result of confusion over what Dare has termed the standard conception of a lawyer's role. Fewer insights can be gained from superficial characterisations. While much has been written on this topic in other jurisdictions, more light can be shed on New Zealand's ethical landscape through the study of New Zealand's fictional texts. This article exposes a rich resource for the legal community because as Economides and O'Leary have argued in relation to legal ethics, stories matter. This dictum should apply to works of non-fiction and fiction.

This report contains follow on research from the 2015 study examining the nature of private commercial mediation in New Zealand. The aim of this research project is to examine gatekeepers’ perspectives on commercial mediation. There is a lack of empirical information on the nature and use of commercial mediation in New Zealand. This project aimed at gathering empirical data from lawyers working within this field to gain a picture of the current market. Overall conclusions include:• Lawyers know about commercial mediation and support it, but largely on their own terms. They are not undermining it. Lawyers believe they are contributing positively to the mediation process.• Clients have a more limited knowledge of mediation but usually follow their lawyer’s recommendations. Thus lawyers play a key role as gatekeepers to commercial mediation.• The main reason lawyers recommend mediation is cost ie it is cheaper than litigation.• Lawyers prefer legal trained mediators with experience and a good reputation. • Lawyers report high mediation settlement rates and high overall quality of mediation. Lawyers are generally happy with the standard of commercial mediation in New Zealand.• It appears that while mediators believe it would be advantageous to expand commercial mediation in NZ, lawyers are generally satisfied with the level and quality of commercial mediation. The group that has not yet been surveyed is clients and potential clients of commercial mediation.

This report delivers the results from the first project to systematically explore commercial mediation in NZ. A key aim of this project is to move the study of commercial mediation in NZ from anecdote to evidence. There has been a lot of talk about the growing importance of commercial mediation in NZ but no empirical evidence to support the claims. This information vacuum weakens the mediation profession’s efforts to effectively promote mediation for commercial disputes. It also leaves the profession vulnerable to criticism from those suspicious of mediation i.e. it is difficult to rebut criticism without convincing evidence.Specific research questions covered in the project include:How much commercial mediation is taking place?What styles of mediation are being used in commercial disputes?How effective is this mediation?Who is carrying out commercial mediation? Where is it happening?How can the use of commercial mediation be increased and encouraged?What are the key challenges facing commercial mediation?Relevant written sources have been analysed and individual mediators surveyed and interviewed regarding the nature of their work. Along with providing an overview of NZ’s commercial mediation landscape the project will hopefully stimulate further research into this area of mediation practice. This report assesses the current state of commercial mediation in NZ and offer predictions for the future.

E-learning’ can be defined as a method of learning that is supported by the use of information technology (‘IT’). It is believed that e-learning has the power to transform the way we teach and that it may improve learning. However, when designing an online environment, lecturers do not always take into consideration certain crucial elements of teaching — including the motivation of their students. Similarly, the research has largely ignored the role of motivation in the online learning environment due to the assumption that e-learners are self-motivated and active learners. This article looks at certain elements that can be used to foster the motivation of students in the online environment.

Clinical issues related to informed consent and competency are present in all areas of medicine and are, quite possibly, the most relevant in the disciplines of psychiatry and neurology. The very nature of the specialty (involving disease of mind or brain) often calls into question the ability of the patient to understand the medical procedures or treatment that are being proposed.