Individual Practitioners Research Articles

"Digital Health Earth": towards a global healthcare management geolocating human health condition by means of space technology

Healthcare providers such as the World Health Organization, transnational and global health initiatives, the national healthcare systems, down to the smallest villages and individual practitioners and professionals could benefit from geo referential data and metadata and 3D digital assets provided by space technology. Health prevention and literacy programs, mortality and morbidity rates, including contextual statistical data about populations and territories are being already produced and accessible. The hypothetical frame of a Digital Health Earth hereto presented could be performed as the interoperability of 3D representations of sectors of territories and geolocalized layers about health and environment. SDG Goals crossed with WHO programs and available data can become the premises for the design and development of a global representation of healthcare situations, highlighting priorities and disseminating data by intuitive and interactive modes of visualization as it is already happening with 2D dashboards about COVID-19 pandemic. Healthcare practitioners, professionals, health managers, but also patients, proxy, social workers, laypeople, stakeholders and media could benefit from visualizing and comparing Digital Earth health data. Concerns about privacy, digital divide and social exclusion from primary care services and how quality of lives might occur are considered here. As a consequence of Space Technology, especially for its connection with the Satellite industry, Digital Health Earth, will contribute to the development of a new added value economic branch inside the increasing market of the Space Economy Revolution.

193. quality Improvement Initiative for Non-purulent Cellulitis Management in Urgent care setting: provider-level Performance Feedback

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs). This has resulted in an 88% increase in MRSA-directed antibiotic use in emergency departments. However, the majority of cellulitis presents as non-purulent due to Group A streptococci. An unintended consequence is that many with non-purulent cellulitis receive sub-optimal antibiotics and unnecessary diagnostics. Clinical guidelines at our institution recommend beta-lactam antibiotics and discourage empiric MRSA coverage for non-purulent cellulitis. The aim of this study is to use an audit-feedback intervention to optimize urgent care providers management of mild/moderate non-purulent cellulitis.MethodsWe identified all consecutive patients presenting to our urgent care with a diagnosis of lower extremity non-purulent cellulitis using ICD coding. We conducted a prospective pre and post-intervention study from 10/2018-3/2019 and 11/2019-4/2020 respectively. Intervention included review of practice guidelines with providers and feedback from pre-intervention phase. To assess individual practitioners’ prescribing habits, a comprehensive scoring system focused on empiric antibiotic selection, antibiotic duration, and diagnostics was combined with patient demographics. Scores classified non-purulent SSTI treatment as follows: 0–2 = good, 2.5–5 = fair, and >5.5 = poor (Figure 1).Figure 1: Provider Cellulitis Management Scoring Sheet ResultsThere was statistically significant provider score improvement in the post-intervention phase with greater percentage of good cases (40% to 69%) and no poor cases (Figure 2). For IV antibiotics for mild and moderate cellulitis, there was decreased use of overly broad antibiotics (Figure 3). Antibiotic duration of greater than 7 days decreased from 68% to 52%. Combination antibiotic therapy decreased from 12% to 4%. There was also a statistically significant decrease in use of wound cultures but no change in ultrasound use.Figure 2: Overall Provider Scores Figure 3: IV Antibiotic Use ConclusionAudit-feedback intervention was effective for improving antibiotic usage and decreasing treatment duration. Providing physicians with data on their practice patterns relative to those of their peers and clinical practice guidelines can improve management of non-purulent cellulitis.Disclosures All Authors: No reported disclosures

Crime detection – russian and foreign experience

The article discusses the issues of crime detection as one of the criteria for the effectiveness of the law enforcement agencies. Every year the number of undetected crimes remains at a consistently high level. This confirms the relevance of the problem under consideration and indicates the need for further developments in this direction. The authors managed to conclude that the full definition of the term “crime detection” is not presented in any legislative act, i.e. this scientific category has actually always been outside the legal field, which led to its arbitrary interpretation by individual scientists and practitioners. Also, the authors concluded that there is a close relationship between the concepts of "crime detection" and "countering detection", which was the basis of this article. The article was prepared considering foreign experience. In general, this approach allows using the effective means and methods in the fight against crime, as well as modern technologies in crime detection.

Therapeutic relationships in aphasia rehabilitation: Using sociological theories to promote critical reflexivity.

BackgroundTherapeutic relationships are fundamental in aphasia rehabilitation, influencing patient experience and outcomes. While we have good understandings of the components of therapeutic relationships, there has been little exploration of how and why therapists construct and enact relationships as they do. Sociological theories may help develop nuanced understanding of the values, assumptions and structures that influence practice, and may facilitate critical reflexivity on practice.AimsTo explore the potential for theoretical approaches from outside speech–language therapy to enable a deeper understanding of the nature and enactment of therapeutic relationships in aphasia rehabilitation.Methods & ProceduresAn explanatory single case study of one speech–language therapist–patient dyad in an in‐patient stroke rehabilitation setting. Data included observations of five interactions, two interviews with the client and three interviews with the speech–language therapist. Analysis was guided by analytical pluralism that applied aspects of three sociological theories to guide data analysis and make visible the contextual factors that surround, shape and permeate the enactment of therapeutic relationships.Outcomes & ResultsThe analysis of this dyad made visible individual, interactional and broader structural features that illustrate the dynamic processes that practitioners and patients undertake to enact therapeutic relationships. Clinical practice could be viewed as a performance with each person continually negotiating how they convey different impressions to others, which shapes what work is valued and foregrounded. The patient and therapist took up or were placed in different positions within the interactions, each with associated expectations and rights, which influenced what types of relationships could, or were likely to, develop. Organizational, rehabilitation and individual practitioner structures assigned rules and boundaries that shaped how the therapist developed and enacted the therapeutic relationship. Whilst the therapist had some agency in her work and could resist the different influencing factors, such resistance was constrained because these structures had become highly internalized and routinized and was not always visible to the therapist.Conclusions & ImplicationsWhile therapists commonly value therapeutic relationships, social and structural factors consciously and unconsciously influence their ability to prioritize relational work. Sociological theories can provide new lenses on our practice that can assist therapists to be critically reflexive about practice, and to enact changes to how they work to enhance therapeutic relationships with clients. What this paper addsWhat is already known on the subject Therapeutic relationships are critical in aphasia rehabilitation. We have a good understanding of the different components of therapeutic relationships and how relationships are perceived by patients and practitioners. What this paper adds to existing knowledge This study is novel in its use of sociological lenses to explore contexts and complexities inherent in building and maintaining therapeutic relationships. These are often invisible to the practitioner but can have a significant impact on how relational work is enacted and what forms of relationship are possible. What are the potential or actual clinical implications of this work? This study will support clinicians to critically reflect on how they enact therapeutic relationships and may enhance awareness of the often‐hidden factors which influence the ways in which they work.

Working with/in institutions: how policy enactment in widening participation is shaped through practitioners’ experience

Widening participation in higher education is driven by policy that is then enacted by individual practitioners. Practitioners bring with them a wealth of personal and employment experiences which shape their interpretations and enactments. Drawing on 16 in-depth semi structured interviews with practitioners across seven universities in England, a classification is developed in order to conceptualise their orientations to policy enactment. Whilst nationally focused, this study has international resonance especially in marketised higher education systems where policies are similarly enacted. The model developed within the article proposes that personal and professional experience can cause practitioners to orient towards the interests of the institution or the individuals they work with. This orientation can be in compliance with institutional policy or adopt a more transgressive stance. Through deeper theorisation of practitioner positions, we can better understand how to ensure work in this area better serves the individuals whom it is targeted at.

Shared resonances: Cham Bani conceptions of divinities in contemporary Vietnam

ABSTRACT Recent studies of Cham Bani religious communities in what is now the Socialist Republic of Vietnam have highlighted that these communities are particularly ‘unorthodox,’ concerning ‘normative’ Islam or that they are ‘syncretic.’ Drawing upon a combination of anthropological and historical methods, we suggest that the concept of shared resonances is helpful for scholars in the field of Religious Studies. The existence of shared resonances describes why Cham Bani conceptions of divinities may resemble those of other communities, ranging from Animist (Cham Jat) to Cham particularist Hinduism (Cham Ahiér), while still leaving space for conceptions of divinities to be articulated by individual practitioners.

Surgical Re-entry Strategy Following COVID-19 Pandemic: A Tiered and Balanced Approach.

Following the Presidential declaration of a national emergency, many health care organizations adhered to recommendations from the Centers for Medicare and Medicaid (CMS) as well as the American College of Surgeons (ACS) to postpone elective surgical cases. The transition to only emergent and essential urgent surgical cases raises the question, how and when will hospitals and surgery centers resume elective cases? As a large health care system providing multispecialty tertiary/quaternary care with across the Southeast United States, a collaborative approach to resuming elective surgery is critical. Numerous surgical societies have outlined a tiered approach to resuming elective surgery. The majority of these guidelines are suggestions which place the responsibility of making decisions about re-entry strategy on individual health care systems and practitioners, taking into account the local case burden, projected case surge, and availability of resources and personnel. This paper reviews challenges and solutions related to the resumption of elective surgeries and returning to the pre-COVID-19 surgical volume within an integrated health care system that actively manages 18 facilities, 111 operating rooms, and an annual operative volume exceeding 123,000 cases. We define the impact of COVID-19 across our surgical departments and outline the staged re-entry approach that is being taken to resume surgery within the health care system.

Emancipatory knowledge and epistemic reflexivity: The knowledge and practice for change?

This State of the Science issue invites us to ponder "solution-ism," echoing scholars throughout history who have questioned the technical rationalities that tend to accompany its logic.1 Diverse thinkers have expressed concern for understanding the complexity of our social worlds2-4 while also expressing a healthy caution against the potential unintended effects of even the most well-intended "solutions." In this sense, the papers in this special issue help to add complexity to our collective thinking within the field of health professional education, providing nuance in how we might approach some of our most cherished intentions for positive change. The papers by Nerland and HasuREF and Gordon and Cleland,REF do so while sharing a particular focus, each drawing connections between change at the level of individual professionals and broader change at the level of entire professions, organizations, or systems. Nerland and Hasu connect individual practitioners with systems of knowledge production through the concept of epistemic reflexivity. Gordon and Cleland draw from three different social theories to connect micro (individual) and macro (organizational) change.

Co-Creating and Implementing Quality Criteria for Citizen Science

Citizen science is increasingly recognized as a valid research methodology by the research community and policy makers alike. In our experience, however, citizen science is sometimes used as a catchall term for activities that involve scientific and democratic innovation, resource efficiency in scientific processes, outreach, and education. We fear that this use of the term citizen science risks undermining the recognition of citizen science in academia as well as among citizen scientists and the general public in the longer term. Informed by these concerns, we report on a transdisciplinary attempt to establish quality criteria to decide in a transparent manner which citizen science projects are listed on Osterreich forscht, an Austrian citizen science platform that is based on an established network of citizen scientists, academic researchers, funding institutions, and research institutions. We present 20 quality criteria and their relationship to existing literature, and describe the process by which they were formulated over a one-year period: a series of transdisciplinary exchanges, concerning what shape citizen science should take in the particular context of Austria, and the potential implications of certain quality criteria for individual disciplines and practitioners. While we realize that any demarcation process is bound to produce exclusionary effects, we argue that the bottom-up, transdisciplinary nature of our working group was a necessary step for Osterreich forscht to strengthen its identity and purpose.

Beyond the Rhetoric

Culturally effective practice remains elusive within child welfare agencies. Recognizing the hierarchical nature of becoming culturally competent, this article presents specific strategies that enhance cultural effectiveness at the individual, interprofessional, middle management, and upper management levels. The approaches evolve from a five-stage model of change: precontemplation, contemplation, preparation, action, and maintenance. Becoming culturally competent requires a clear assessment of where the individual practitioner and agency are on the change continuum. The article also explores barriers to culturally competent practice, with a focus on multilevel strategies that work within child welfare agencies.

Enabling positive practice improvement through data-driven feedback: A model for understanding how data and self-perception lead to practice change.

This article aims to identify the factors that affect physicians' experiences of receiving practice data and to use these data to develop a model describing how individuals interact with the data. We designed an interview guide to study physicians' perspectives on audit and feedback. By intentional sampling, we recruited 15 physicians amongst gender groups, types of practice (academic vs community), and durations of practice. The interviews were conducted by a single author and transcribed without identifiers. We then began with an open coding analysis for all of the transcripts, and thereafter conducted axial coding to group the data into larger themes. Several attributes were identified as either enabling or counterproductive attributes for participant improvement. The final proposed model identifies different zones of engagement on the basis of both the individual practitioner's growth mindset and the quality of the existing data system. In the highest engagement zone, the mindset of the collective leadership is one of growth. Systemic supports are in place, which potentiates learning that may come from an individual motivated to use their own data. Our novel model depicts the relationship between data feedback systems and individuals' mindsets interact to augment or hinder clinical practice improvement. This model may provide leaders with a framework to examine their academic and administrative structures and how they might interface with performance feedback systems with clinicians.

Nurses’ experiences of compassionate care in the palliative pathway

Aims and objectivesThe aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway.BackgroundCompassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway.DesignThis study employed a qualitative design using focus groups and a hermeneutic approach.MethodsFour focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28–60 years (mean age = 45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines.ResultsThree themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) creating a space for dying and (c) family caregivers’ acceptance of death.ConclusionsThis study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief and the absence of noise and conflict.Relevance to clinical practiceThe quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.

ABA Finding Its Heart During a Pandemic: An Exploration in Social Validity.

The COVID-19 pandemic has presented practitioners of applied behavior analysis (ABA) with new and uncharted challenges. Upholding ethical responsibilities while navigating an international public health crisis has opened areas of uncertainty that have no precedent. Although there is general guidance on how to respond ethically from the Behavior Analyst Certification Board (BACB) in their publication specific to the COVID-19 crisis (BACB, 2020, March 29, Ethics Guidance for ABA Providers During COVID-19 Pandemic, retrieved from https://www.bacb.com/ethics-guidance-for-aba-providers-during-covid-19-pandemic-2/), there remains a huge responsibility on the individual practitioner to make potentially life-changing decisions. In that regard, practitioners are urged to ensure that they rely on socially significant and valid decision-making processes. The goal of this article is to provide an exercise in accounting for stakeholder feedback and connecting with patients and families regarding their input on the acceptability of treatment during the COVID-19 pandemic. The exercise is in the form of a structured parent interview to help practitioners account for the setting variables and social validity of treatment during a crisis. It is our ethical responsibility to remember this critical dimension of our science and practice.

Professional Standards and Recognition for UK Personal Tutoring and Advising

The Higher Education and Research Act established both a regulatory framework and the Teaching Excellence Framework with associated metrics for student retention, progression and employability in the UK. As a key site in meeting these requirements, the significance of personal tutoring is clear. Despite this, according to existing institutional research, there is a need for developmental support, greater clarification on the requisite competencies, and adequate recognition for those undertaking this challenging role. Moreover, arguably compounding these concerns is the lack of distinct professional standards for personal tutoring and advising against which to measure effective practice, only recently addressed by the publication of The UKAT Professional Framework for Advising and Tutoring. Through a review of the literature supported by findings from a survey of practitioners, this paper discusses the need for such standards, and the skills and competencies populating them. Additionally, the usefulness of pre-existing standards pertinent to tutoring work (such as the UK Professional Standards Framework for Teaching and Supporting Learning in HE) are evaluated and the value and recognition with which personal tutoring standards could be associated are advanced. The survey supported the need for specific standards – represented by the UKAT framework - as evident from the literature. Justifications provided for both this and the opposing view are examined. Clarity for both individual practitioners and institutions was stipulated along with meaningful recognition and reward for this work which is considered highly important and yet ‘invisible’. The participants and literature reviewed identify relevant content along with illuminating the debate about the relationships between personal tutoring, teaching and professional advising roles. Valuable analysis of standards, recognition and reward also emerged. This is considered by discussing the connection between standards and changes to practice, responses to policy developments and the purpose of ‘standards’ in comparison to ‘guidance’. The paper proposes that the recent introduction and use of a bespoke framework is a necessary response to alleviate some of the current tensions which beset personal tutoring and advising in higher education.

Improving the efficiency of same-day ill calls.

56 Background: Burnout is a syndrome whose manifestations include pervasive emotional and physical exhaustion, depersonalization, a lack of motivation and an inability to complete tasks efficiently. We sought to use quality improvement (QI) methodology to approach problems contributing to burnout and workplace stress in our oncology care team. Methods: Through a broad survey of cancer center team members, we identified the coordination of same-day outpatient visits for acutely ill oncology patients as a source of excessive stress for team members across various disciplines including case managers, infusion clinic nurses, advanced practice providers, and physicians. We used the Plan-Do-Study-Act (PDSA) framework to identify a feasible, appropriate intervention to reduce the time required to coordinate visits with the specific aim of reducing the time to schedule an ill patients by 25%. We generated a cause and effect diagram to map the elements involved in the ill call scheduling process, and used a priority/payoff matrix to evaluate possible countermeasures that could streamline the process by re-designing/improving the efficiency of the workflow for scheduling ill calls. Our initial workflow involved paging individual practitioners at three locations. The process led us to the creation of a HIPPA-compliant group text to simultaneously coordinate scheduling of an ill call among/between three campuses in a more collaborative/efficient manner. We tracked time from patient call to time of scheduled appointment pre- and post-test of change (Voalte group text). We also tracked quantity of phone calls required to arrange a visit and perceived frustration with the process. Results: After one PDSA cycle, we found case manager time required to arrange a visit had decreased by 21%, number of calls required by 59% and frustration with the process by 41%. Conclusions: While we did not meet our specific aim of decreasing scheduling time by 25%, we feel use of a QI approach led to an easily implemented, yet effective modification to streamline a previously inefficient and disruptive workflow. The use of QI methodology ensured we understood the baseline process and involved all stakeholders before implementing a change and also ensured we followed data to understand the impact of our intervention on team members. Viewing sources of burnout and workplace frustration through the lens of QI may lead to more consistently high-yield interventions than traditional wellness-based, administrative approaches.

Social representation of PR activism: Perceptions of early career public relations professionals in South Africa

A critical, socio-cultural turn in the public relations research agenda has shifted attention away from a predominately organisational focus to include the individual practitioner, and their symbolic power relationships (Curtin & Gaither, 2005). This has resulted in critical interrogation of issues such as dissent, power and activism in professional role enactment with an emergent, activist stance that actively questions and resists existing power structures and normative practices (Holtzhausen, 2012). This turn requires PR as well as in a diverse range of other disciplines to find new forms of addressing some of the wicked problems of our time, such as the social and cultural influences that public relations practitioners are subject to in enacting culturally sensitive public relations roles in their practice. The positioning of the critical-cultural and postmodern paradigms lends itself to the application of social representation theory (SRT) as a framework for analysis and understanding (Bauer & Gaskell, 2008; p. 351). However, to date limited research has been conducted on the social influences public relations practitioners are subject to in enacting culturally sensitive public relations roles in their practice, especially in respect of public relations practitioners who occupy junior to mid-level positions in formal employment contexts. In particular, individual influence and agency of entry level or early career public relations practitioners in South Africa has been under researched. It is against this background that this study aims to determine the perceptions of early-mid career South African PRPs on how they socially represent their activism in a poly-contextual and diverse cultural context. This is especially important in a context where PRPs are required to justify the value their actions have in achieving social change. The findings suggest that South African activist public relations practitioner (PRP) role enactment may not only entail promoting the interests of those who are marginalised and excluded from social contexts, but also requires advocating for the legitimacy of their own activist role in their contexts of practice.

Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2

IntroductionNasogastric tube (NGT) insertion is essential for enteral feeding but can potentially cause significant injury to the lungs (1). Following a critical incident, we audited our practice of NGT insertion and the consequences of injury in patients with Severe Acute Respiratory Syndrome COVID-19 caused by the (SARS-CoV-2) virus.MethodsNGT insertion followed a local standard safety protocol and were inserted by consultants or senior registrars in anaesthesia and critical care medicine, or advanced critical care practitioners. Individual practitioners were able to choose their technique of insertion. All patients had their post-NGT insertion chest x-ray reviewed and those with misplaced NGTs had their case notes reviewed. Early in the outbreak, blind insertion was recommended in our institution to reduce aerosolisation, this was rapidly changed to direct visualisation with laryngoscopy as our experience managing SARS-CoV-2 patients increased.ResultsDuring the SARS-CoV-2 pandemic, a total of 135 NGTs were inserted into ventilated and/or extracorporeal membrane oxygenation (ECMO) patients. All of NGTs positioned were confirmed by a chest radiograph. Eleven (8.1%) were inadvertently endobronchial, of which four developed pneumothoraces (figure 1). Three patients (including both who had received ECMO) died and a fourth is currently undergoing a prolonged respiratory wean. No patients were fed or received drugs via a misplaced NGT.Chest radiograph of patient with inadvertent NGT placement in right lower lobe. Note the path of the tube suggests breech of the bronchial tree and direct injury to the lung parenchyma (arrowhead). A CT the following day showed a large pneumothorax (arrowhead), some haemothorax (black arrow) and severe ground glass changes consistent with SARS-CoV-2 (white arrow).DiscussionOur inadvertent endobronchial NGT rate is relatively high, compared to our previous clinical experience, which we believe may be related to the challenges of working with cumbersome personal protective equipment and/or changed practice to attempt to reduce transmission of SARS-CoV-2 (2). We suspect the lung parenchyma is particularly fragile in acute respiratory distress syndrome caused by SARS-CoV-2, which contributes to the high rate of pleural breech and subsequent poor outcome (3). We recommend experienced operators place NGTs and do so using direct or videolaryngoscopy to minimise the risk of incorrect placement.We would like to thank the families of our patients for their permission to share the images in this work.

The Hidden Curriculum of the COVID-19 Pandemic.

The Hidden Curriculum of the COVID-19 Pandemic.

Consequences of health condition labelling: protocol for a systematic scoping review

IntroductionWhen health conditions are labelled it is often to classify and communicate a set of symptoms. While diagnostic labelling can provide explanation for an individual’s symptoms, it can also impact...

Building on innovation and lessons learnt during the COVID‐19 pandemic

Building on innovation and lessons learnt during the COVID‐19 pandemic