Obviously you girls must have been partying when the immunology class was explaining the concept of adjuvants. 

Dear Dr.Pai,

I read your article with great interest. 

I  really like your idea of convening all  x-ray hardware makers to get a discount pricing for NTP in high TB burden countries. However, if I may add,  this agenda, making x-ray accessible to high burden countries, should be raised to the overall UHC agenda beyond TB field. X-ray is a multi disease a platform, than can be used for TB, other lung infectious diseases as well as for NCDs such as lung cancer. We are all aware that chest x-ray is one of the essential health services in high income countries.   It's unfortunate that the recently published WHO list of essential diagnostics did not include diagnostic imaging withing the scope. Chest x-ray is often considered a barrier in resource limited settings and people try to think about strategies without using it. I believe it's time to seriously think about how to break that barrier instead of getting away from it and taking a detour.

Dear Madhukar and Authors,

Thank you for this! You've raised some important points and as an editor, I value feedback.  I hope you don't mind, but I have taken the liberty of responding to your issues, most of which I agree with. Some answers are a little tongue in cheek...

All I can say is that if you have taken the time to write a paper, be it an opinion piece, guest editorial, or recording your life's research, it is up to us to make sure the process of publication is as painless as possible.

1. I agree – most electronic manuscript systems require some level of rocket-scientist understanding to simply send a paper. I like receiving articles via email (or in the post, because I am that old).

Referencing styles are a curse; academics use Harvard because it bulks out the article. Real people use Vancouver - easier to read, less messy in text. Let’s criminalise Harvard referencing.

I agree - the fewer forms the better.

And here’s something radical…

COPYRIGHT SHOULD REMAIN WITH THE AUTHOR(S)!

They have done the work they should be able to share it (with appropriate acknowledgement to the journal in which it was published). 

  2. I agree; an editor should read through all manuscripts upon receipt in order to determine if it is suitable for that particular journal and if so, which reviewers to send it to. I aimed to send such letters within the first week of receipt. Also important to give feedback in such letters and where possible, suggest alternative journals to which they could submit their paper.

  3. I have received some of my best articles from such countries. However, I also had one or two members of an EAB who baldly told me not to accept any articles unless they were written by them, other members of the EAB, or ‘approved’ authors… Needless to say, I ignored that ‘advice’.

  4. I don’t see the point of such commentaries, but agree with the sentiment (see previous point about authors).

  5. I think the concept of payment for publication/processing is almost immoral. It creates vast income for the publisher and has the potential to stymie the publication of good research (especially from the LMICs), or indeed the ‘lower paid’ professions. Fees to publish are around £2k, which is ridiculous. The argument that this allows open access to the reader is spurious. If authors cannot afford to pay to get their research published, there won’t be anything for the reader to read, free or otherwise.

It also calls into question the objectivity of peer-review. If a journal has ‘x’ number of pages to fill, will poor articles be used? And if as an author, I have paid to be published, I would expect to be published at a date and time convenient for me.

  6.  Never! It is essential that the ‘negative’ findings, or those that didn’t quite demonstrate that ‘this dressing was the greatest thing since sliced bread’, findings are published. This is where the ethics of company sponsored studies/product reviews become tricky. If company has given your department a sum of money to trial a product, how much say do they have on a0 the results and b) the final paper?

  7. Most editors would never find eight reviewers to comment! However, editors should collate reviewer comments and soften them as necessary. In my mind, editors should do as much as possible to help and encourage authors, particularly novice writers.

  8.  Could not agree more – see point 7! 

  9.  Yes

  10. Four weeks is ample; reviewers, paid or not, make a commitment to the journal, and by extension, authors. If they are too busy to undertake reviewers within a reasonable time-frame they should withdraw their services, or the editor should be having a word…

  11.  Agree – to be honest, if it requires that many reviews, perhaps it shouldn’t have gone to review in the first place. Or, if at second review, more changes are required, ask the author to withdraw paper and either submit elsewhere or resubmit after complete revision. That way, it isn’t going back and forth. Also, editors should read revisions to ensure that all reviewer comments have been addressed before going to another review. That saves both author and reviewer time.

  12.  See point above – should not happen

  13. I agree – although sometimes spelling and grammar need to be addressed, and sometimes we change a few paragraphs around to make it flow better.

  14.  We do where possible! However, need to take into account frequency of publication – if submitting to a monthly or bi-monthly journal, it may take longer to get into the next issue, whereas this will not be the case for a weekly/fortnightly journal.

15. Always! I used to send progress reports, even if it was just a line to say that it was still out for review. We would not exist without authors, so it makes sense to work with them, not against them.

Thank you!

Deborah Glover MBE

Independent Medical Editor/Writer

Madhu,

I would remiss if I did not also highlight the digitization of diagnostic tests themselves (e.g. GxAlert) as part of that optimal lab vision. Simply by digitizing existing diagnostics, countries have saved millions in supply chain, improved case notifications, reduced diagnostic errors, assisted in getting patients enrolled onto treatment, and many other benefits. 

More importantly, in addition to the individual digital tools you mention -- and most of them have generated fantastic results and evidence in their own right -- is the tremendous potential of connecting digital systems together, which results in incredible benefits. For example, by combining Riders4Health's digital specimen transport app/data with GxAlert's diagnostic results, one is able to track the whole clinic-to-lab-back-to-clinic TB testing process from start to finish. Such data was previously available only after conducting a 6-month study of paper logbooks riddled with errors, missing data, and partial entries. By connecting systems, you can see interim processes (e.g. delivery time, time in depot, lab turnaround time, results reporting time) and improve what you measure. Partial implementations of such connections led to quadrupling the test volumes in Ethiopia, cutting results delivery from 61 days down to <1 hour in Malawi, and saving $1m or more in supply chain optimization in Nigeria.

It's time for digital diagnostics to be connected with digital treatment, adherence, and patient benefits. It's time for digital triage (e.g. CAD4TB) to refer high-risk patients directly into digital diagnostics (GxAlert), and so on. And, it's time for funders and ministries to view these interventions as part of a connected whole and both execute as such. There is an opportunity for a visionary country to take the lead and implement against the strategy you lay out above. All of the interventions exist today and the benefits will compound immediately.

Best
Jeff Takle
Co-founder of GxAlert (SystemOne) 

Hi,

I am Bijay Maharjan from Nepal and work for TB patients in Nepal. We are carrying out nutritional supplement program to TB patients. I have used N TB app and its quiet helpful for the health worker. Can we start the N TB app in Nepal as a pilot study? It will be great that we can work together.

thank you for developing such a wonderful app

Thanks for sharing here, really interesting and a useful perspective for those working overseas from their homeland.