Work Of Practitioners Research Articles

ОЦЕНКА И ПРОГНОЗИРОВАНИЕ РИСКА ПАЦИЕНТСКОГО НОН-КОМПЛАЕНСА В СИСТЕМЕ СПЕЦИАЛИЗИРОВАННОЙ ФАРМАЦЕВТИЧЕСКОЙ ПОМОЩИ НАСЕЛЕНИЮ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Cardiovascular, oncological and other diseases occupy a significant place in the structure of morbidity and causes of death of the population, the growth of which largely depends on lifestyle and risk factors. Identification of risk factors contributing to the development of cancer is one of the main achievements of epidemiology of the 21st century. Subsequent research helped scientists to build multifactorial algorithms for predicting the risks of cancer and mortality from them, which greatly facilitated the work of practitioners in the field of risk stratification. The above indicates that the research results of many foreign and domestic authors confirm that significant predictors of cancer are risk factors such as old age, pre-existing cancer in blood relatives, smoking, obesity, alcohol, certain types of viral infections, certain chemicals, ionizing radiation, including UV rays of the sun and others. It is known that reducing the influence of risk factors leads to a decrease in morbidity and mortality from cancer. An important condition in the treatment of oncological diseases is the rational and effective use of medicines. Pharmaceutical specialists play an active role in this process. In the treatment of long-term or lifelong diseases, such as cancer, great importance is attached to the process of daily pharmacotherapy, compliance with the rules of adherence to treatment or compliance. Thus, problems with patients performing medical appointments are based on a complex of factors, including psychological and behavioral ones, including patients' adherence to treatment.

Occupation and stress: professional burnout of GPs depending on the profile of the medical institution in situations of high epidemic risk

Introduction. In the context of the COVID-19 pandemic, medical workers turned out to be the most vulnerable category of the population in terms of the risk of developing psycho-emotional disorders. Objective. To establish the characteristics of the psycho-emotional state among general practitioners of COVID hospitals, multidisciplinary hospitals, and polyclinics during the COVID-19 pandemic. Material and methods. The study included: group 1 – general practitioners of COVID hos pitals (n=111); group 2 – internists of multidisciplinary hospitals (n=106); group 3 – GPs working in polyclinics (n=102); group 4 – control group (healthy) (n=190). The assess ment of professional burnout was carried out by means of the Maslach Burnout Inventory, developed by American psychologists C. Maslach and S.E. Jackson, in adaptation by N.E. Vodopyanova and E.S. Starchenkova, as well as using V.V. Boyko’s questionnaire. The study utilized an integrative anxiety test to investigate the formation of psycho-emotional disorders in internists during the pandemic of the novel coronavirus infection. The quality of life was determined by means of the SF-36 questionnaire. The processing of the ob tained data was carried out using the Statistica package from StatSof t (USA). Results. It has been established that the work of general practitioners during the COVID-19 pandemic was associated with the impact of occupational stress related to caring for in fected patients on medical workers, as well as with significant changes in work regarding aspects of organization and safety, which contributed to an increase in the levels of oc cupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Conclusions. The work of general practitioners of specialized COVID hospitals, internists of multidisciplinary hospitals, and GPs of polyclinics is associated with an increase in the levels of occupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Notably, psychological changes are most pronounced in employees of specialized COVID hospitals. It is necessary to continue research on the emotional state of medical personnel in order to timely carry out preventive treatment to preserve the health of medical workers.

Взаимосвязь доверия к власти и гражданского участия

Purpose. To determine the limits of the integrative nature of the category “trust in government” and analyze the mutual influence of the level of trust in government and management and the level of civic activity of the population, as well as raise the question of the dual influence of the process of strengthening trust in government. Methodology: dialectics, analysis. Conclusions. On the one hand, trust is a factor in the stability of the state system and a predictor of active civic participation. Strengthening trust in the authorities on the part of the population is permanently necessary. But, on the other hand, a high level of trust in the authorities reduces the indicators of civil participation of the population in solving the affairs of society and the state. Due to the fact that increasing the level of trust, as practice shows, reduces the civic activity of the population, it is necessary to look for ways to activate the participation of citizens in the affairs of society and the state, to create a culture of participation in society while strengthening trust in the activities of government bodies. Scientific and practical relevance: scientific and practical significance. The article is aimed at raising questions for the research activities of legal scholars and the work of practitioners about finding directions for activating civic participation, a balance between measures to increase trust in authorities and maintaining citizens’ interest in participation, co-production and management.

Racial and Ethnic Disparities in Emergency Department Use Among Older Adults With Asthma and Primary Care Nurse Practitioner Work Environments.

Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care. We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices. In 2018-2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs' work environment, and race and ethnicity using logistic regression. More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care sensitive condition ED visits between Black and White patients. Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap.

THE MYTH OF "PROXIES" (REPLACERS) AND THE SO-CALLED PHENOMENA OF CONSTELLATIONS

In Hellinger's family constellations, as well as in the (systemic) constellation work of practitioners who do not directly refer (or no longer refer) to Hellinger, the concept of substitution plays a central role. Its roots go back to occult ideas. It is assumed that in constellations, the participants, called "substitutes", act as true representatives of the real members of the system and are supposedly able to reliably reflect their internal states and relationships with each other. In this article, we will critically examine this assertion, which is fundamental to the constellation process and has been called the "constellation phenomenon". Contrary to the assertion that we are dealing with a phenomenon that is incomprehensible from a naturalistic point of view, it is shown that the process of constellations can be easily explained with the help of psychological mechanisms, some of which have been known for a very long time, as well as in the light of recent discoveries about so-called mirror neurons. According to this, there is no mysterious "transfer of information" between the participants in the constellation and the members of the family system, but rather a creative and highly error-prone simulation in order to reconstruct the depicted system.

Racism in psychiatry and the case of presentism

Acknowledging the impact of imperialist and colonialist attitudes on the development of psychiatry allows for the recovery of the work of practitioners whose contribution may have been overlooked, as well as recognising racist attitudes in predominant thinking. These combined approaches aid in the construction of a more complete critical history.

Artificial Intelligence as an opportunity or a curriculum trajectory in the 21st century? Towards embracing unfamiliar discourses

This theoretical paper contributes to the ongoing debate on Artificial Intelligence (AI) in relation to curriculum and implementation in post-colonial South Africa. We contend that AI, as perceived, conceived, and implemented within the curriculum space, presents an ambivalent terrain marked by fear, uncertainty, and anxiety among stakeholders, as its presence has interfered with the everyday work of educational practitioners. Cognizant of this problem, we locate our theorisation within the framework of Sustainable Learning Environments and address two questions: (1) What are the opportunities of AI in relation to the curriculum in post-colonial South Africa? (2) What challenges are faced in the implementation of AI, especially in rural contexts where technological opportunities are not equivalent to those in urban areas? In this paper, we highlight that while AI tools like ChatGPT may appear daunting for integration into teaching and learning—potentially undermining educators' authority and raising ethical concerns—there is an urgent need to rethink and restructure teacher education. This restructuring should align with the evolving demands of an AI-enhanced curriculum and address the shifting expectations in educational contexts.

Adapting the Nurse Practitioner Primary Care Organizational Climate Questionnaire for Acute Care Nurse Practitioners.

Background and Purpose: This study adapted the Nurse Practitioner Primary Care Organizational Climate Questionnaire to measure the organizational climate of nurse practitioners in acute care settings and validated the Nurse Practitioner Acute Care Organizational Climate Questionnaire (NP-ACOCQ). Methods: We used a three-phase instrument adaptation design. In phase 1, experts assessed face and content validity. In phase 2, pilot testing enabled item analysis and preliminary reliability testing. In phase 3, field testing supported exploratory factor analysis. Results: The NP-ACOCQ had a three-factor structure representing subscales. The subscales had Cronbach's alphas of 0.87, 0.90, and 0.94. The subscales, Institutional Visibility, Interprofessional Relationships, and Organizational Autonomy each had between 5 and 13 items. Conclusions: The NP-ACOCQ is a valid and reliable measure to assess organizational factors determining the acute care nurse practitioner work environment.

“Everyone has a weight complex”: Experiences of participation in physical activity in regional, rural and remote Australia

ABSTRACT There are many complex and interrelated personal and structural benefits and constraints to being physically active. In this research, we invited people living in regional, rural and remote (RRR) environments of Australia to share their experiences of being active both currently and historically via an in-depth open-ended online survey. This study focuses on the perspectives of 139 participants, 92 of whom identified as female, 43 identified as male and 2 identified as gender fluid. Our participants were aged 18–76 years. By using an interpretivist lens and applying the feminist, weight inclusive Well Now approach (Aphramor, 2018) as a framework to understand these experiences, we identified that this group of people enjoyed the benefits of being active that included physical, mental, and emotional health benefits, as well as social benefits. Participants also shared stories about exclusion, discrimination, and reluctance to participate in various forms of physical activity. Our findings may help inform the work of practitioners who seek to use a weight inclusive approach in RRR areas and highlight the need to support individuals to find safe spaces and meaningful opportunities to be active.

“If you don’t have rapport, you haven’t got anything really”: affective intensities, relationality and rapport building in the work of CVE Intervention Practitioners

ABSTRACT Countering Violent Extremism (CVE) continues to be a topic of national and international concern; however, within the field of research, there has been limited engagement with the daily work of CVE intervention. The article presents findings from a study which aimed to better understand the strategies CVE Intervention Practitioners employ, specifically rapport building and the fostering of mutual trust. Drawing upon the accounts of 12 practitioners currently working in Australia, we focus on the complex affective negotiations underpinning the client–practitioner relationship. Our analysis foregrounds relationality, a sense of connectedness and explores the affective labour involved in this work. In theorizing the work of CVE intervention, as a form of affective labour, the paper presents three key themes present in the data 1) rapport building to leverage; 2) transparency to build trust and change mindset; 3) versatility/adaptability.

Oropharyngeal candidiasis — interdisciplinary aspects of childhood medicine

Scientific research in recent years has increased the interest of clinicians in the role of microorganisms in maintai­ning health and the occurrence of diseases. In most cases, fungal lesions of the oral mucosa are a manifestation of numerous somatic diseases and the results of their treatment and contri­bute to complications. To write this article, the information was searched ­using the databases Scopus, Web of Science, Med Zine, Pub Med, Google Scholar, the new version of the International Classification of Diseases (ICD-11) and the Standards of Care “Rational use of antibacterial and antifungal drugs for therapeutic and prophylactic purposes” (2023) were taken into account. The review presents data from the world literature on the role of fungal infection in the development of oropharyngeal candidiasis in children, current perspectives on the mechanism of its formation, clinical manifestations and diagnosis. A comparative characterization of the recommendations of national and foreign guidelines and a generalization of retrospective analyzes on the feasibility of prescribing systemic antifungal drugs for candidal lesions of the oral mucosa and possible methods of correction for mycoecological disorders in children are given. In the context of the presented problem, an integrated approach of a primary care physician, dentist and pediatrician to the diagnosis and treatment of oropharyngeal candidiasis in children is recommended. Timely diagnosis of oropharyngeal candidiasis in children, individual selection of antifungal drugs, synbiotics and multicomponent agents based on probiotics should be a priority area of joint work of general practitioners — family physicians, pediatricians and dentists.

Qualitative-archival research on migration is not just preservation

Qualitative-archival research is needed to support effective policies and the work of practitioners working in the field of migration. This Open Letter helps readers to understand how this happens in different contexts, as more than 150 stakeholders among researchers, policymakers, practitioners, migrant associations, governments, civil society/non-governmental organisations and migrants in seven countries around the Mediterranean contributed to discuss this topic, during the H2020 project ITHACA - Interconnected Histories and Archives for Migrant Agency. Three main key findings emerge. Qualitative-archival research is not just “preservation”: it shows the potential of providing dynamic and interlinked information, including legal frameworks, policy documents, historical context, and original narratives, capable of supporting policies in the long term. Besides this, it is a potential tool to foster the agency of migrants. Qualitative-archival research can be a powerful tool for social innovation, as conducting qualitative research, based on individual and collective narratives, is a necessary basis to non-emergency policies and to social work planning and evaluation. Research helps to explain the reasons behind the migration phenomena and to contextualise them where it is most needed, whether in political, educational, labour, health or reception settings. Space, time and people are the three main enablers. for better qualitative and archival research-policy relations: qualitative archival research offers contextual and comparative tools to investigate in-depth local features and to possibly extend them to the national and international levels.

Challenging agricultural norms and diversifying actors: Building transformative public policy for equitable food systems

Food systems governance regimes have long been spaces of “thick legitimacy” (Montenegro de Wit & Iles, 2016), where embedded norms benefit pro­duc­tivist agricultural practices. Within governance regimes, the science-policy interface and the scien­tists who occupy this space are integral in today’s public policy processes. Often treated as objective science, technical disciplines have become a power­ful source of legitimatizing in decision making. Without the contextualization of lived experience or diverse ways of knowing, these siloed spaces can lead policymakers towards an action bias (e.g., a rush to short-term solutions) that neglects the underlying causes and concerns of our current crises. Current governance arrangements in the science-policy interface demonstrate the bias toward technical science (e.g. economics) and short-term solutions. However, by challenging productivist agriculture norms reformed public policy processes may shift from a space of repres­sion to one of possibility. This reform can happen through investigatiing dominant actor coalitions and identifying tools to reconfigure these power arrangements. Public policy theory, such as the advocacy coalition framework (ACF), helps organ­ize relations within current agricultural policy arenas. The work of practitioners and other disci­plines offer tools that can support transformative action by food systems advocates in the pursuit of changing the way public policy is made. In part, understanding how power is organized and who may influence policy processes is critical to change. This reflective essay ends with tools and strategies for those wishing to engage governments in this shift. The proposed tools and strategies focus on how people (e.g. policy champions), processes (e.g. policy leverage points), and partnerships (e.g. ally­ship) generate ways in which advocates can, and do, engage governments in transformative change.

Implementing Library Maker Projects Outside of the Makerspace

The popularity and relevance of the library makerspace has been well-established and documented in the previous decade of researcher and practitioner work, including numerous hands-on guides from a variety of dimensions relevant to starting and operating a makerspace. Less studied, however, and the focus of this work are the applications of maker technologies within wider library work. Prior qualitative research conducted by the author included interviews with librarians to understand and document their use of maker technologies, such as the Raspberry Pi single-board computer, to support broader library work outside of the makerspace. The findings indicated that common use cases included running library display screens and collecting patron traffic numbers and environmental data. The objective of this subsequent case study is to examine the potential for wider use of such projects by librarians in an academic library setting, by introducing these projects into a new library setting and assessing the related code and educational materials developed by the researcher. This work reports on the findings of the case study, in which the projects were successfully operated in several usage contexts, as well as the challenges and broader implications for adoption within libraries of all types.

Inclusivity and sustainability in language practitioner researcher development: A sociocultural ecological framework

Transformative practitioner research enables teachers to create or contribute to their own knowledge base. Recently, this research field has flourished, with numerous studies exploring how practitioner researchers develop knowledge, agency and identities, particularly through action research (AR) and exploratory practice (EP). Despite important work on the content or outcomes of language practitioner researcher development (LPRD), there is less conceptualization of how LPRD is manifested in relation to environments where language practitioners work. In this contribution to the special issue on inclusive practitioner research, we draw on sociocultural and ecological systems theories to present a framework for understanding what enables LPRD to flourish in terms of sustainability and inclusivity. Our framework considers how sustainability through inclusion can be achieved within micro, meso and macro ecological systems, and how these systems interrelate. We exemplify our framework using illustrations of individual teachers and their interactions with a specific AR program and their institutions. While we focus on AR, this framework may apply to EP and other forms of practitioner research which strive for inclusive LPRD. We conclude with practical implications for teacher educators and professional development coordinators about fostering inclusive LPRD within institutional environments.

The hidden work of general practitioners: An ethnography

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that ‘hidden work’ was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term ‘hidden care work’ more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, ‘caring’ care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity.

A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees.

Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.

Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting.

General practitioners (GPs) work in an ill-defined environment where diagnostic errors are prevalent. Previous research indicates that aggregating independent diagnoses can improve diagnostic accuracy in a range of settings. We examined whether aggregating independent diagnoses can also improve diagnostic accuracy for GP decision making. In addition, we investigated the potential benefit of such an approach in combination with a decision support system (DSS). We simulated virtual groups using data sets from 2 previously published studies. In study 1, 260 GPs independently diagnosed 9 patient cases in a vignette-based study. In study 2, 30 GPs independently diagnosed 12 patient actors in a patient-facing study. In both data sets, GPs provided diagnoses in a control condition and/or DSS condition(s). Each GP's diagnosis, confidence rating, and years of experience were entered into a computer simulation. Virtual groups of varying sizes (range: 3-9) were created, and different collective intelligence rules (plurality, confidence, and seniority) were applied to determine each group's final diagnosis. Diagnostic accuracy was used as the performance measure. Aggregating independent diagnoses by weighing them equally (i.e., the plurality rule) substantially outperformed average individual accuracy, and this effect increased with increasing group size. Selecting diagnoses based on confidence only led to marginal improvements, while selecting based on seniority reduced accuracy. Combining the plurality rule with a DSS further boosted performance. Combining independent diagnoses may substantially improve a GP's diagnostic accuracy and subsequent patient outcomes. This approach did, however, not improve accuracy in all patient cases. Therefore, future work should focus on uncovering the conditions under which collective intelligence is most beneficial in general practice. We examined whether aggregating independent diagnoses of GPs can improve diagnostic accuracy.Using data sets of 2 previously published studies, we composed virtual groups of GPs and combined their independent diagnoses using 3 collective intelligence rules (plurality, confidence, and seniority).Aggregating independent diagnoses by weighing them equally substantially outperformed average individual GP accuracy, and this effect increased with increasing group size.Combining independent diagnoses may substantially improve GP's diagnostic accuracy and subsequent patient outcomes.

Assessing the Recordkeeping Quality at the School of Dental Sciences, Universiti Sains Malaysia.

Dental records are an essential part of dental practice. The quality of dental recordkeeping is paramount in ensuring the delivery of high-quality dental care and is also important for medico-legal reasons. Should there be any dispute or need for review, detailed and well-maintained records can provide evidence of the care provided and the decision-making process. The study aimed to assess the quality of dental recordkeeping and dental charting practice at the dental clinic School of Dental Sciences. The study was conducted in a retrospective manner reviewing dental records of patients treated by specialists, dental officers, and postgraduate and undergraduate students at the Hospital Universiti Sains Malaysia over a five-year period. Eight key components of clinical dental records i.e.date of charting, legibility on the odontogram, no blank on the odontogram, whether any mistakes have been strikethrough and initials, medical history, dental history, investigation, and treatment plan were assessed. A modified CRABEL scoring system was used to assess the quality of data retrieved from dental records. The study involved the analysis of 324 case files. Among these, 90 files obtained scores ranging from 60% to 80%, with 7.7% attributed to undergraduates, 9.6% to dental officers, 6.8% to postgraduates, and 3.7% to specialists. The remaining 234 files achieved scores between 80% and 100%, with a breakdown of 17% from undergraduates, 15.4% from dental officers, 18.2% from postgraduates, and 21.3% from specialists. Even though the overall quality of recordkeeping in this study is good,with most records achieving a CRABEL score of 80% and above, it's important to acknowledge that ideally, each component assessed should achieve a perfect score of 100%, as it will reflectthe practitioners's work.

Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners’ experiences

Background Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. Aims The study aimed to explore healthcare practitioners’ experiences of implementation of a NP service in a rural setting. Methods Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. Findings Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. Conclusion Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.