Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.

Combining Collaborative Networks and Knowledge Management: The SENAI Case

Part 19: Knowledge Management in Networks

A Qualitative Study of the Status of Children’s Play From the Viewpoints of Experts and Suggestions for Promotion Interventions

Background: The latest national census reports the population of Iranian children (1 - 8 years old) about 11 millions. On the other hand, the latest population policies approved by supreme cultural revolution council (SCRC) will make this population increase faster. Childhood development is one of the social determinants of health, of which “child’s play” is a part. Objectives: This study is an effort to identify difficulties and challenges of the plays influential on Iranian children’s health nationwide, in order to present enhancive strategies by utilizing the views of stakeholders and national studies. Patients and Methods: Analyzing children’s play stakeholders, main organizations were identified and views of 13 informed people involved in the field were investigated through deep semi-structured interview. A denaturalized approach was employed in analyzing the data. In addition to descriptions of the state, interventions development, and designing the conceptual model, national reports and studies, and other countries’ experiences were also reviewed. Results: Society’s little knowledge of “children’s plays”, absence of administrators for children’s play, shortage of public facilities for children’s play and improper geographical and demographic availability, absence of policies for Iranian “toy”, and little attention of media to the issue are the five major problems as stated by interviewees. Conclusions: The proposed interventions are presented as “promoting the educational levels of parents and selected administrators for children’s play”, “approving the play and toy policy for Iran 2025”, and “increasing public facilities for children’s play with defined distribution and availability”.

Community pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care: a questionnaire-based survey in Macao

Purpose: To explore the knowledge, attitudes, practice and perceived barriers of community pharmacists regarding provision of pharmaceutical care as well as provide recommendations on how to advance the service during the early stage of development in Macao. Methods: A questionnaire comprising 10 items was used to collect respondents’ demographic information and to evaluate their understanding of pharmaceutical care, attitude towards service provision, current practice and perceived barriers. Descriptive and comparative analysis of the results was conducted. Results: While 95 % of the participating pharmacists agreed that patients’ health was their primary responsibility, only 57 % believed that they can provide better pharmaceutical care in the future. The majority spent most of their work time counselling patients (90 %) and checking prescription (70 %). Only a small portion monitored adverse drug reaction and drug compliance (44 %), engaged in health screening or drug safety promotion (20 %) or maintained patient medication records (4 %). Insufficient communication with physicians (90 %), lack of time (79 %) and lack of physical space at the pharmacy (76 %) were considered the most significant barriers. Conclusion: A suboptimal level of pharmaceutical care is provided by pharmacists in Macao. Considering the barriers identified and integrating other country experiences, establishing an enabling atmosphere using policy and regulatory measures is the fundamental element for advancing pharmaceutical care by community pharmacists.

Prevalence of preterm labor in Iran: A systematic review and meta-analysis

Background: Preterm labor, which defines as live-birth delivery before 37 weeks of gestation is a main determinant of neonatal morbidity and mortality around the world. Objective: The aim of this study was to determine the prevalence of preterm labor in Iran by a meta-analysis study, to be as a final measure for policy makers in this field. Materials and Methods: In this meta-analysis, the databases of Thomson database (Web of Knowledge), PubMed/Medline, Science Direct, Scopus, Google Scholar, Iranmedex, Scientific Information Database (SID), Magiran, and Medlib were searched for articles in English and Persian language published between 1995 and 2014. Among the studies with regard to the inclusion and exclusion criteria, 14 studies (out of 1370 publications) were selected. Data were analyzed by using Stata software version 11. The heterogeneity of reported prevalence among studies was evaluated by the Chi-square based Q test and I2 statistics. Results: The results of Chi-square based on Q test and I2 statistics revealed severe heterogeneity (Q=2505.12, p-value < 0.001 and I2= 99.5%) and consequently, the random effect model was used for the meta-analysis. Based on the random effect model, the overall estimated prevalence of preterm in Iran was 9.2% (95% CI: 7.6 – 10.7). Conclusion: Present study summarized the results of previous studies and provided a comprehensive view about the preterm delivery in Iran. In order to achieve a more desirable level and its reduction in the coming years, identifying affecting factor and interventional and preventive actions seem necessary.

THE EFFECT OF EASTERN KENTUCKY COAL FIRES ON LOCAL AIR QUALITY AND PERSONAL HEALTH

The purpose of this project was to investigate student learning in the areas of earth science and environmental responsibility using the subject of coal fires. Eastern Kentucky, where this study was performed, has several coal fires burning that affect the local air quality and may also affect the health of people living near them. This study was conducted during the regular education of 9th grade Earth Science classroom in Russell Independent Schools, located in Russell, Kentucky. Students conducted internet research, read current articles on the subject of coal fire emissions and effect on local ecology, and demonstrated what they learned through summative assessments. There were several aspects of coalmines and coal fires that students studied. Students were able to take this knowledge and information and use it as a learning tool to gain a better understanding of their own environment. Using the local history and geology of coalmines, along with the long tradition of mine production, was a very beneficial starting point, allowing students to learn about environmental impact, stewardship of their local environment, and methods of preserving and protecting the ecosystem.

Technology, mining methods and landscapes of a placer mining district in Fairbanks, Alaska, 1900-1930

Placer miners in Alaska’s interior were part of the last great gold rush in North America. As word of gold in the Fairbanks Mining District traveled down the Yukon River, a wave of miners from the Klondike placer fields in Dawson, along with a assortment of speculators and inexperienced green horns from the Lower 48 converged on the confluence of the Tanana and Chena rivers hoping to strike it rich. The steamers coming from Dawson were integral; they carried miners with experience working the frozen subarctic placer deposits of the Klondike. These miners encountered new environmental challenges that required the development of new technologies and mining methods to efficiently harvest gold. These methods and machines were brought into Fairbanks and further perfected to account for the local conditions. This thesis describes the local mining technologies and methods employed in the Fairbanks district and the landscape patterns created during the placer mining boom years of 1903-1909, decline years of 1910-1923 and recovery of 1923-1930.

Change, stability and prediction of gross motor co-ordination in portuguese children

The knowledge about intra- and inter-individual variation can stimulate attempts at description, interpretation and prediction of motor co-ordination (MC). Aim: To analyse change, stability and prediction of motor co-ordination (MC) in children. Subjects and methods: A total of 158 children, 83 boys and 75 girls, aged 6, 7 and 8 years, were evaluated in 2006 and re-evaluated in 2012 at 12, 13 and 14 years of age. MC was assessed through the Kiphard-Schilling’s body co-ordination test and growth, skeletal maturity, physical fitness, fundamental motor skills (FMS), physical activity and socioeconomic status (SES) were measured and/or estimated. Results: Repeated-measures MANOVA indicated that there was a significant effect of group, sex and time on a linear combination of the MC tests. Univariate tests revealed that group 3 (8–14 years) scored significantly better than group 1 (6–12 years) in all MC tests and boys performed better than girls in hopping for height and moving sideways. Scores in MC were also higher at follow-up than at baseline. Inter-age correlations for MC were between 0.15–0.74. Childhood predictors of MC were growth, physical fitness, FMS, physical activity and SES. Biological maturation did not contribute to prediction of MC. Conclusion: MC seemed moderately stable from childhood through adolescence and, additionally, inter-individual predictors at adolescence were growth, FMS, physical fitness, physical activity and SES.

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

Effectiveness of Depression-Suicidal Behaviour Gatekeeper training among police officers in three European regions: outcomes of the Optimising Suicide Prevention Programmes and their Implementation in Europe (OSPI-Europe) study

Background: Gatekeeper training for community facilitators, to identify and respond to those at risk of suicide, forms an important part of multi-level community-based suicide prevention programmes. Aims: This study examined the effects of gatekeeper training on attitudes, knowledge and confidence of police officers in dealing with persons at risk of suicide. Methods: A total of 828 police officers across three European regions participated in a 4-hour training programme which addressed the epidemiology of depression and suicidal behaviour, symptoms of depression, warning signs and risk factors associated with suicidal behaviour, motivating help-seeking behaviour, dealing with acute suicidal crisis and informing bereaved relatives. Participants completed internationally validated questionnaires assessing stigmatising attitudes, knowledge about depression and confidence in dealing with suicidal persons pre- and post-training. Results: There were significant differences among countries in terms of previous exposure to suicidal persons and extent of previous training. Post-training evaluation demonstrated significant improvements in stigmatising attitudes, knowledge and confidence in all three countries. Conclusion: The consistently positive effects of gatekeeper training of police officers across different regions support inclusion of this type of training as a fundamental part of multi-level community-based suicide prevention programmes and roll-out, nationally and internationally.

Subject Ontogeny: Subject Access through Time and the Dimensionality of Classification

Classification schemes undergo revision. However, in a networked environment revisions can be used to add dimensionality to classification. This dimensionality can be used to help explain conceptual warrant, explain the shift from disciplinary to multidisciplinary knowledge production, and as a component method of domain analysis. Further, subject ontogeny might be used in cooperative networked projects like digital preservation, online access tools, and interoperability frameworks.

Epistemic, Ontic, Axiologic, and Praxic Constructs in Knowledge Organization Research

The work of knowledge organization requires a particular set of tools. For instance we need standards of content description like Anglo-American Cataloging Rules Edition 2, Resource Description and Access (RDA), Cataloging Cultural Objects, and Describing Archives: A Content Standard. When we intellectualize the process of knowledge organization – that is when we do basic theoretical research in knowledge organization we need another set of tools. For this latter exercise we need constructs. Constructs are ideas with many conceptual elements, largely considered subjective. They allow us to be inventive as well as allow us to see a particular point of view in knowledge organization. For example, Patrick Wilson’s ideas of exploitative control and descriptive control, or S. R. Ranganathan’s fundamental categories are constructs. They allow us to identify functional requirements or operationalizations of functional requirements, or at least come close to them for our systems and schemes. They also allow us to carry out meaningful evaluation.What is even more interesting, from a research point of view, is that constructs once offered to the community can be contested and reinterpreted and this has an affect on how we view knowledge organization systems and processes. Fundamental categories are again a good example in that some members of the Classification Research Group (CRG) argued against Ranganathan’s point of view. The CRG posited more fundamental categories than Ranganathan’s five, Personality, Matter, Energy, Space, and Time (Ranganathan, 1967). The CRG needed significantly more fundamental categories for their work.1 And these are just two voices in this space we can also consider the fundamental categories of Johannes Kaiser (1911), Shera and Egan, Barbara Kyle (Vickery, 1960), and Eric de Grolier (1962). We can also reference contemporary work that continues comparison and analysis of fundamental categories (e.g., Dousa, 2011).In all these cases we are discussing a construct. The fundamental category is not discovered; it is constructed by a classificationist. This is done because it is useful in engaging in the act of classification. And while we are accustomed to using constructs or debating their merit in one knowledge organization activity or another, we have not analyzed their structure, nor have we created a typology. In an effort to probe the epistemological dimension of knowledge organization, we think it would be a fruitful exercise to do this. This is because we might benefit from clarity around not only our terminology, but the manner in which we talk about our terminology. We are all creative workers examining what is available to us, but doing so through particular lenses (constructs) identifying particular constructs. And by knowing these and being able to refer to these we would consider a core competency for knowledge organization researchers.

Ethos and Ideology of Knowledge Organization: Toward Precepts for anEngaged Knowledge Organization

This paper provides rationale for considering precepts for an engaged knowledge organization based on a Buddhist conception of intentional action. Casting knowledge organization work as craft, this paper employs Žižek’s conception of vio- lence in language as a call to action. The paper closes with a listing of precepts for an engaged knowledge organization.

Form, Intention, and Indexing: The Liminal and Integrated Conceptions of Work in Knowledge Organization

This paper proposes a dual conception of work in knowledge organization. The first part is a conception of work as liminal, set apart from everyday work. The second is integrated, without separation. This talk is the beginning of a larger project where we will characterize work in knowledge organization, both as it is set out in our literature (Šauperl, 2004; Hjørland 2003 Wilson, 1968), and in a philosophical argument for its fundamental importance in the activities of society (Shera, 1972; Zandonade, 2004).But in order to do this, we will co-opt the conception of liminality from the anthropology of religion (Turner, 1967), and Zen Buddhist conceptions of moral action, intention, and integration (Harvey, 2000 and cf., Harada, S., 2008).The goal for this talk is to identify the acts repeated (form) and the purpose of those acts (intention), in knowledge organization, with specific regard to thresholds (liminal points) of intention present in those acts.We can then ask the questions: Where is intention in knowledge organization liminal and where is it integrated? What are the limits of knowledge organization work when considered at a foundational level of the intention labor practices? Answering such questions, in this context, allows us to reconsider the assumptions we have about knowledge organization work and its increasingly important role in society. As a consequence, we can consider the limits of classification research if we see the foundations of knowledge organization work when we see forms and intentions. I must also say that incorporating Zen Buddhist philosophy into knowledge organization research seems like it fits well with ethics and ethical responses the practice of knowledge organization. This is because 20th Century Western interpretations of Zen are often rooted in ethical considerations. This translates easily to work.

Change, stability and prediction of gross motor co-ordination in portuguese children

The knowledge about intra- and inter-individual variation can stimulate attempts at description, interpretation and prediction of motor co-ordination (MC). Aim: To analyse change, stability and prediction of motor co-ordination (MC) in children. Subjects and methods: A total of 158 children, 83 boys and 75 girls, aged 6, 7 and 8 years, were evaluated in 2006 and re-evaluated in 2012 at 12, 13 and 14 years of age. MC was assessed through the Kiphard-Schilling’s body co-ordination test and growth, skeletal maturity, physical fitness, fundamental motor skills (FMS), physical activity and socioeconomic status (SES) were measured and/or estimated. Results: Repeated-measures MANOVA indicated that there was a significant effect of group, sex and time on a linear combination of the MC tests. Univariate tests revealed that group 3 (8–14 years) scored significantly better than group 1 (6–12 years) in all MC tests and boys performed better than girls in hopping for height and moving sideways. Scores in MC were also higher at follow-up than at baseline. Inter-age correlations for MC were between 0.15–0.74. Childhood predictors of MC were growth, physical fitness, FMS, physical activity and SES. Biological maturation did not contribute to prediction of MC. Conclusion: MC seemed moderately stable from childhood through adolescence and, additionally, inter-individual predictors at adolescence were growth, FMS, physical fitness, physical activity and SES.