Practice Paradigm Research Articles

Metaphorical application of the concept ‘paradigm’ to the public relations domain

The aim of this conceptual analysis of Kuhn’s paradigm theory was to explore whetherthe concept of paradigm could be applied to the public relations domain—specificallywith regard to concepts such as dominant paradigm, paradigm debate, paradigm struggleand scientific revolution. Based on the findings, the author suggests that the first three models of public relationsare the theory that represents the origins of public relations as a (social) science; thatthe dominant paradigm of normal science practice in public relations is persuasion; andthat alternative paradigms debated are about inter alia professionalism, ethicalperformance, conflict, chaos and pluralism. Furthermore, an important paradigm debateis currently taking place between eminent US scholars (relationships) and Europeanscholars (reflection). However, the real paradigm struggle is seen to be betweenpersuasion and two-way symmetrical communication (regarded by some as a strugglebetween symbolic and behavioural relationships). The author’s conclusion is that publicrelations is currently suffering an identity crisis which could, with a number of alternativeparadigms available, lead to a scientific revolution in the discipline.

GI multisociety strategic plan on environmental sustainability.

GI multisociety strategic plan on environmental sustainability.

Robotic-Assisted Kidney Transplantation from Living Donors: Single Center Experience

Introduction: Robotic-assisted kidney transplantation (RAKT) is being adopted for renal transplantation in obese patients with ESRD. Methods: Consecutive RAKT procured via robotic live donor nephrectomy at our center between June 2018 and August 2021 were retrospectively analyzed. Our first 20 cases (Group I) were compared (student’s t-test and Fisher’s exact test, p < 0.05 significant) to the later 20 cases (Group II). Results: There was no difference in donor age (39.6±10.51 vs 38.4±12.14 years) or BMI (27.46±4.64 vs 29.48±4.06) between the two groups. 75% of recipients in both groups received a left kidney. A majority (>60%) of recipients in both groups were African Americans. Recipients in Group II were significantly older than in Group I. There was no significant difference in patient or graft survival or serum creatinine (1.67±0.99 mg/dL vs 1.93±0.55 mg/dL) at 1-year post-RAKT. One patient in group I died from respiratory failure due to COVID-19. The anastomosis times (35.16±7.75 vs 32.00±7.32 mins) were not significantly different, though the re-warming time was a significantly longer in our early experience (47.75±9.59 vs 42.00±6.55 mins, p = 0.016). The incidence of post-op washout (10%), ileus (10%), incisional hernia (5%) and delayed graft function (20%) were similar in both groups. Conclusion: Our early and more recent experience demonstrates that RAKT from living donors can be safely performed with excellent outcomes in obese, predominantly African American patients with ESRD. Practice paradigms are evolving to offer RAKT to patients with BMI >40 who may otherwise be considered ineligible for kidney transplantation.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases.

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

일본의 죽음준비교육에 관한 연구 - 알폰스 데켄(Alfons Deeken)의 죽음준비교육을 중심으로 -

This study aims to explore a new practice paradigm for death education in Korean society by examining Deeken's death education, which laid the foundation for the study of death studies in Japan. Deeken argued that the purpose of death education is to apprehend specific methodologies that can resolutely respond to the death of oneself and others. And Deeken's death education was appropriated and carried out in the following three social movements in Japanese society. First, the necessity of death education was widely disseminated to the general public. Second, it led to the qualitative improvement of the hospice movement for terminally ill patients. Third, he advocated for various activities in the healing community for overcoming the grief associated with death. Through this, he contributed to the formation of mature death culture in Japanese society that can sublimate the time to death into a process of ‘fulfillment of a dignified human being’. It is hoped that death preparation education will help people realize that “death is a part of one's life, and that death that suits one's life is the last task one has to challenge oneself.”

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice.

Therapeutic EUS has witnessed exponential growth in the last decade, but it has been considered investigational until recently. An increasing body of good-quality evidence is now demonstrating clear advantages over established alternatives, adding therapeutic EUS to management algorithms of complex hepato-pancreato-biliary (HPB) and gastrointestinal (GI) conditions. In this review, the available evidence and clinical role of therapeutic EUS in established and evolving applications will be discussed. A Graphical Summary for each scenario will provide (1) technical steps, (2) anatomical sketch, (3) best-supporting evidence, and (4) role in changing current and future GI practice. Therapeutic EUS has accepted well-established applications such as drainage of symptomatic peripancreatic fluid collections, biliary drainage in failed endoscopic retrograde cholangiopancreatography, and treatment of acute cholecystitis in unfit-for-surgery patients. In addition, good-quality evidence on several emerging indications (e.g., treatment of gastric outlet obstruction, local ablation of pancreatic solid lesions, etc.) is promising. Specific emphasis will be given to how these technical innovations have changed management paradigms and algorithms and expanded the possibilities of gastroenterologists to provide therapeutic solutions to old and emerging clinical needs. Therapeutic EUS is cementing its role in everyday practice, radically changing the treatment of different HPB diseases and other conditions (e.g., GI obstruction). The development of dedicated accessories and increased training opportunities will expand the ability of gastroenterologists to deliver highly effective yet minimally invasive therapies, potentially translating into a better quality of life, especially for oncological and fragile patients.

Person-Centered Practice in Hospitalized Older Adults with Chronic Illness: Clinical Study Protocol.

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice.

Professionalism and narrative medicine

This work is a bibliographical review of the challenges of professionalism in medical training. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. By virtue of the changes in the practice of medicine during the last years, professionalism values emerge as qualities that should reshape medicine. Several medical associations are redefining professionalism and insist that this issue should be included in the training curriculum. Thus, several medical education institutions are pursuing strategies to teach and assess professionalism. Modeling is still relevant as a learning strategy, but it must be tutored and directed. Also, timely and formative feedback appears as the most frequently suggested evaluative action. Both processes incorporate a personal reflective practice. Several recent studies suggest that a reflective experience is relevant for the formation of a professional identity. Narrative Medicine methodology emerges as an innovative strategy to address this issue, as it seeks to deliver valuable learning experiences to the students through reflection and the search for a new paradigm for medical practice.

Sphere of hospitality: modern scientific and practical paradigms. Review of the collective monograph of A. Poplavska, L. Gonchar, I. Komarnitskyi, A. Belyak «Hospitality sphere: ensuring economic and financial stability»

Sphere of hospitality: modern scientific and practical paradigms. Review of the collective monograph of A. Poplavska, L. Gonchar, I. Komarnitskyi, A. Belyak «Hospitality sphere: ensuring economic and financial stability»

Shortening door-to-puncture time and improving patient outcome with workflow optimization in patients with acute ischemic stroke associated with large vessel occlusion

ObjectiveWe aimed to evaluate door-to-puncture time (DPT) and door-to-recanalization time (DRT) without directing healthcare by neuro-interventionalist support in the emergency department (ED) by workflow optimization and improving patients’ outcomes.MethodsRecords of 98 consecutive ischemic stroke patients who had undergone endovascular therapy (EVT) between 2018 to 2021 were retrospectively reviewed in a single-center study. Patients were divided into three groups: pre-intervention (2018–2019), interim-intervention (2020), and post-intervention (January 1st 2021 to August 16th, 2021). We compared door-to-puncture time, door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), last known normal time to-puncture time (LKNPT), and patient outcomes (measured by 3 months modified Rankin Scale) between three groups using descriptive statistics.ResultsOur findings indicate that process optimization measures could shorten DPT, DRT, PRT, and LKNPT. Median LKNPT was shortened by 70 min from 325 to 255 min(P < 0.05), and DPT was shortened by 119 min from 237 to 118 min. DRT shortened by 132 min from 338 to 206 min, and PRT shortened by 33 min from 92 to 59 min from the pre-intervention to post-intervention groups (all P < 0.05). Only 21.4% of patients had a favorable outcome in the pre-intervention group as compared to 55.6% in the interventional group (P= 0.026).ConclusionThis study demonstrated that multidisciplinary cooperation was associated with shortened DPT, DRT, PRT, and LKNPT despite challenges posed to the healthcare system such as the COVID-19 pandemic. These practice paradigms may be transported to other stroke centers and healthcare providers to improve endovascular time metrics and patient outcomes.

“Translate” as a Paradigm of Design Practice

Cet article aborde la question du traduire à partir de recherches en design et en ethnopsychiatrie. En comparant les méthodologies, on constate qu’elles mettent en œuvre des confrontations entre humains et non-humains hétérogènes afin de créer de nouvelles propositions, représentations, significations. Cette mise en dynamique d’hétérogènes donne lieu à des solutions non prédéterminées par les univers des participants au processus psychanalytique ou de design. Les solutions sont rendues possibles par l’agencement d’un « dispositif » dont nous analysons les propriétés et les effets à partir de l’observation de la pratique de design des personas et de l’expérience de la Clinique de la multiplicité. Nous proposons de définir le traduire en particulier comme la mise en œuvre d’une situation de médiation qui s’emploie à défaire les conjonctions, c’est-à-dire à disjoindre les éléments fortement liés dans des situations, des discours, des objets. Les participants aux situations de design comme ceux de la Clinique de la multiplicité ne font pas qu’accueillir l’altérité ; ils sont occupés aussi bien à altérer la situation convoquée au sein du dispositif ou appareil qu’à se laisser altérer par elle dans un va-et-vient constant entre démarche empirique et conceptualisation. Le dispositif du traduire permet d’accueillir une montée en puissance des hétérogènes qui peuvent être recomposés entre eux grâce à un « principe organisateur » qui aura surgi des interactions et donne lieu à des solutions. Ainsi, traduire s’entend ici comme ce processus qui, par-delà l’altérité du déjà donné d’un texte, se définit comme l’actualisation de ce qui se trouve en puissance d’exister à partir de multiples matériaux qui viendront s’organiser autrement. Produit de ces altérations successives, le traduire est donc indissociable d’un processus créatif.

Disabled Practices for the Architectures of the Countercollapse

This essay discusses the designed nature of ableism and calls for architecture to learn from disability in order to illuminate new paradigms of practice. It explores the architectures of the countercollapse as a challenge to the spatial and political regimes of austerity that shatter the networks of support on which life depends. As an alternative, these architectures make assistance both visible and valuable and enhance interdependence as central to worldly coexistence. They do not seek to legitimize architecture as a lone profession responsible for rehabilitating the disabled body or repairing a broken world but rather promote engaged, networked, and assisted practices, just as disability itself.

The Psychoanalyst and the “Transsexual”: Transgender Identities as Personal-Political Subjectivities

In his two part series on psychoanalysis and “homosexuality,” William Meyer lays out a sordid history of psychoanalysis wielded against gender and sexual minorities. The present article is an extension on that work into the realm of “transsexuality.” Analyzing the work of Freud, Rado, Bieber, Socarides, Ovesey, Stoller, and Money, the psychoanalysis of “transsexuality” demonstrates a parallel history to the psychoanalysis of “homosexuality.” From a critical departure from psychoanalytic inquiry as presented by these authors, transgender activists and theorists have presented a model of transgender subjectivities arising from the tradition of the feminist personal-political challenge to the divided private and public spheres. Pointing toward a transformation of psychoanalysis, transgender subjectivities recenter the somatic and political within the relationality of analyst and analysand. The article concludes a direction for psychoanalytic practice with transgender people thus maintains: (1) a personal-political paradigm of liberation practice, (2) an investment in somatic treatment, and (3) a relational practice establishing mutual personal-political struggle.

Practices in transitions: Review, reflections, and research directions for a Practice Innovation System PIS approach

Social Practice Theories (SPT) can contribute to transition studies by deepening our understanding of the key social mechanisms and dynamics underpinning transitions in everyday life and the role of agency and collective action in processes of social change. Several studies have applied SPTs with concepts from transition studies, and these connections merit attention. The review presented here shows five ways how SPT are applied in studies of system change in transition studies by (i) considering change and continuity in practice elements, niches and regimes, (ii) connecting consumption and production, (iii) going beyond user practices, (iv) mapping diffusions of innovations in daily life and (v) examining policy implications and interventions. Reflecting on this, I argue that the studies in the review show promises of using SPT for transition studies to study system change by linking consumption and production, normality and novelty, stability and instability, micro and macro change, social and technical change, and flat and hierarchal levels. Based on this and a discussion of the need for a practice paradigm of local actions in the MLP, I propose concretising the connections between SPTs, MLP and innovation systems approaches to form a Practice Innovation System framework for future research directions.

Making a difference in educational inequality: reflections from research and practice

ABSTRACT This article is a reflective, research-informed, commentary on educational disadvantage from two lecturers in Education who have spent large proportions of their professional lives working in ‘DEIS’ school settings before transitioning into teacher education. This reflection intends to problematise the concept of educational disadvantage and will then proceed to explore, through literature and some empirical findings, possibilities for changing paradigms of policy and practice in marginalised school settings. Most research and writing on educational disadvantage in Ireland has focused upon policy, statistics, and the problems that accompany marginalisation. We intend to explore possibilities for change at the level of policy and practice, considering interventions in terms of curriculum, pedagogy and assessment; and how we can address inequalities in educational experiences. We will explore possibilities around key areas such as: disrupting ‘cultural deficit’ theories and fixed ideas of ability related to educational disadvantage; consider nuanced intersectional understandings of inequalities in education; framing ‘funds of knowledge’ perspectives in curriculum, pedagogy and assessment; and encouraging critical pedagogical approaches amongst teachers. We are hopeful that this article will support teachers in schools, researchers and policy makers as they endeavour to make a difference in their work with marginalised communities.

Four urban health paradigms: The search for coherence

Scholars, practitioners and policymakers view urban health based on their foundational ontologies, or paradigms, which provide a framework of norms that specifies the policy goals or research questions, the preferred policy instruments or research methodologies, and defines the nature of the urban health issue. This paper identifies four paradigms in current research and practice that address the links between the urban built environment and human health: the ‘medical-industrial city’, ‘urban health science’, ‘healthy built environment’ and ‘health social movement’ paradigms. We argue that scholars, practitioners and policymakers must recognise their diverse and sometimes contradictory views in order to create an opportunity for coherence in understanding knowledge generated from different paradigms.

Integrating Multicultural Orientation into Cancer Care for Sexual and Gender Minorities: A New Paradigm for Leadership, Practice, and Research

The American Society of Clinical Oncology’s (ASCO) 2017 position statement drew attention to the need to address cancer care disparities experienced by sexual and gender minority populations (SGM). In response to the ongoing disparities in cancer care faced by sexual and gender minorities, we adapt the Multicultural Orientation (MCO) framework as a needed paradigm to actualize affirmative cancer care. MCO has been studied in psychotherapy and supervision process and outcome research, demonstrating promise for improving treatment outcomes. The MCO framework encourages providers to convey cultural humility, recognize and respond to cultural opportunities, and self-reflect on their level of cultural comfort. Building upon the extensive body of MCO research in psychotherapy, we present how the MCO framework can be applied in oncology leadership, practice, and research with SGM communities. More specifically, we outline how cultural humility can prompt cancer care leaders, providers, and researchers to examine the structural and societal factors that contribute to disparate cancer care conditions. Cultural opportunities exist in leadership priorities, in how clinical care is structured, and in the research that is conducted. Transformational and authentic leadership styles and intersectionality can be infused into these cultural opportunities to address cancer care disparities faced by the SGM populations. Further, self-reflexivity at the level of leaders, providers, and researchers is key to creating affirmative SGM cancer care environments.

A 3‐D approach to personalised nutrition

A <scp>3‐D</scp> approach to personalised nutrition

Middle Managers and Dilemmas in the Organisation

Middle managers, it turns out, can assist a business in implementing significant changes and achieving its vision and goals by facilitating top management’s communication with lower managers or subordinates. This study aims to analyse bibliometric measures relevant to middle managers and dilemmas by examining publishing trends, delving into information about the trending of authors’ keywords, probing into conceptual evolution, and determining future research directions for this subject using the Scopus database. This study uses three bibliometric software to analyse the bibliographic data: ScientoPy, VOSviewer, and SciMAT. Over 56 years, this study found that publication growth is minimal, with the number of top publications being 32 in 2020. Scopus bibliographic databases depicted the United States as the most active country, with 114 publications co-authored by authors from the United Kingdom, Canada, Russian Federation, Italy, and Hong Kong. Denmark has published 29% of the total publications based on the last two years’ publications. The analysis of the authors’ keywords found that “Middle-managers”, “Leadership”, “Middle Management”, “Management,” and “Organisational change” were enumerated in the top five. The keyword “Middle-managers” has a close association with “leadership”, “management”, and “organisational change”. Based on thematic evolution, “Health”, “Anchoring-effect”, “Developing-countries”, “Communication-skills”, and “Health-care” became the newly emerging themes found from 2011 to 2022. In conclusion, this study could contextualise prior research on this subject and build a scientifically sound evidence-based practice paradigm for future research. Also, this study will expand our understanding of middle managers and associated dilemmas.

Sarecycline Demonstrates Clinical Effectiveness against Staphylococcal Infections and Inflammatory Dermatoses: Evidence for Improving Antibiotic Stewardship in Dermatology.

Tetracycline class antibiotics are widely used for multiple skin diseases, including acne vulgaris, acne rosacea, cutaneous infections, inflammatory dermatoses, and autoimmune blistering disorders. Concerns about antibiotic resistance and protecting the human/host microbiome beg the question whether broad-spectrum tetracyclines such as doxycycline and minocycline should be prescribed at such a high rate by dermatologists when a narrow-spectrum tetracycline derivative, sarecycline, exists. We evaluated the clinical effectiveness of oral sarecycline against cutaneous staphylococcal infections, eyelid stye, and mucous membrane pemphigoid to determine whether sarecycline is a viable option for clinicians to practice improved antibiotic stewardship. We observed significant improvement in staphylococcal infections and inflammatory dermatoses with courses of oral sarecycline as short as 9 days, with no reported adverse events. These clinical findings are consistent with in vitro microbiological data and anti-inflammatory properties of sarecycline. Our data provides a strong rationale for clinicians to use narrow-spectrum sarecycline rather than broad-spectrum tetracyclines as a first-line agent in treating staphylococcal skin infections and inflammatory skin diseases for which tetracyclines are currently commonly employed. Such advancement in the practice paradigm in dermatology will enhance antibiotic stewardship, reduce risk of antibiotic resistance, protect the human microbiome, and provide patients with precision medicine care.