Mark Philp’s notes on the form of knowledge In social work revisited

In social work literature some papers might matter more than others. We assume this might be the case with ‘Notes on the form of knowledge in Social Work’, written by Mark Philp. Even though it was written in 1979, this paper recurrently keeps appearing on and off through writings and footnotes of many scholars in social work and beyond. In brief, Philp might have been pioneering discours analysis on social work literature and practices and suggests there is an underlying constitution of everything that is said and done in social work. This constitution he argues, creates knowledge in social work but also limits social worker to this very knowledge. His analysis draws on Marxist, Foucauldian theories and is utterly ‘historical’ as social work knowledge “is created by historically located shifts in discursive relations“ (Philp, 1979: 103). However, there might be more continuity, as he positions social work historically as mediator between objectified individuals and subjectivity. A stance, which we assume, might still be acknowledged in social work today. In this respect we wondered how scholars in social work today would read and comprehend this seminal paper. What aspects of Philps’ hypothesis, analysis and arguments would they find relevant for social work analysis today and why? In what way might his ‘notes’ enable us to challenge social works knowledge base and positioning? Our analysis is based on two distinct research methods. Firstly, we read through some of his references in order to get more familiar with his thoughts, sources and time. Secondly, we held two discussion panels: one in Antwerp (B) and one held in Ghent (B). Participants, 16 in sum, were selected based on their contribution to social work practice, social work education or research. They have scholarly backgrounds in social work, philosophy, criminology, history, pedagogy and psychology. In our presentation and drawing on Philps' analysis and the comments of Belgian scholars, we will focus on the question if social work should preferably should be seen as a mediator. Or is this positioning no longer relevant or tenable in social work today as society since 1979 has changed dramatically

Outreach Social Work : from managing access to practices of accessibility

A recurring feature of outreach work is that outreach tries to reach people who are left without care and not effectively reached by existing services. In this article, we discuss the importance of outreach practices in the context of changes in society. We suggest that the pressure on the managing of access to social services is increasing along with the demand to avoid an unnecessary inflow, and make a distinction between a residual and structural approach to social work and social service delivery. In a residual approach, outreach social work can be seen as a strategy to manage access or as a strategy to link clients with appropriate services. In this sense, they ensure that people meet predefined criteria of social services. From a structural approach, however, the focus lies on how practices possibly contribute to the realization of human dignity in social interactions and might lead to a socio-political analysis of those situations in which social work intervenes. On a conceptual level, outreach practices thus appear as practices of accessibility. From this perspective, existing problem constructions and dynamics of inclusion and exclusion in social services but also more broadly in society might be questioned and ultimately changed

Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation:A nationwide cohort study

Background: Although non-vitamin K antagonist oral anticoagulants (NOACs) are recommended over vitamin K antagonists (VKAs) in atrial fibrillation (AF) management, direct long-term head-to-head comparisons are lacking. Therefore, their risk-benefit profiles were investigated compared to VKAs and between NOACs. Methods: AF patients initiating anticoagulation between 2013–2019 were identified in Belgian nationwide data. Inverse probability of treatment weighted Cox regression was used to investigate effectiveness and safety outcomes and were additionally stratified by NOAC dose. Results: Among 254,478 AF patients (328,796 person-years of follow-up), NOACs were associated with significantly lower risks of stroke or systemic embolism (stroke/SE) (hazard ratio (HR) 0.68, 95% confidence interval (CI) (0.64–0.72)), all-cause mortality (HR 0.76, 95%CI (0.74–0.79)), major or clinically relevant non-major bleeding (MB/CRNMB) (HR 0.94, 95%CI (0.91–0.98)) and intracranial hemorrhage (HR 0.73, 95%CI (0.66–0.79)), but non-significantly different risks of myocardial infarction, gastrointestinal and urogenital bleeding compared to VKAs. Despite similar stroke/SE risks, dabigatran and apixaban were associated with significantly lower MB/CRNMB risks compared to rivaroxaban (HR 0.86, 95%CI (0.83–0.90); HR 0.86, 95%CI (0.83–0.89), respectively) and edoxaban (HR 0.91, 95%CI (0.83–0.99); HR 0.86, 95%CI (0.81–0.91), respectively), and apixaban with significantly lower major bleeding risks compared to dabigatran (HR 0.86, 95%CI (0.80–0.92)) and edoxaban (HR 0.79, 95%CI (0.72–0.86)). However, higher mortality risks were observed in some risk groups including with apixaban in patients with diabetes or concomitantly using digoxin compared to dabigatran and edoxaban, respectively. Conclusion: NOACs had better long-term risk-benefit profiles than VKAs. While effectiveness was comparable, apixaban was overall associated with a more favorable safety profile followed by dabigatran

Effectiveness and safety of oral anticoagulants in older patients with atrial fibrillation : a systematic review and meta-analysis

Background and Objective: Atrial fibrillation (AF), the most common cardiac arrhythmia, typically increases with age. Oral anticoagulants (OACs) are the cornerstone of treatment to reduce the associated risk for systemic thromboembolism. Four large randomized controlled trials (RCTs) have shown that non-vitamin K antagonist oral anticoagulants (NOACs) are non-inferior to vitamin K antagonists (VKAs) in preventing stroke and systemic embolism, as well as regarding their risk for major bleeding. However, as vulnerable geriatric patients with AF were largely underrepresented in these trials, physicians are faced with the challenge of choosing the right anticoagulant for geriatric patients in real-life clinical practice. In this vulnerable patient group, NOACs tend to be underused or underdosed due to concerns of excessive fall-related intracranial bleeding, cognitive impairment, multiple drug-drug interactions, low body weight or impaired renal function. As life expectancy continues to rise worldwide, the number of geriatric patients substantially increases. Therefore, there is an urgent need for a critical appraisal of the added value of NOACs in geriatric patients with AF at high thromboembolic and bleeding risk. Methods and Results: This systematic review provides an overview of the literature on the impact of increased age (≥75 years), multimorbidity, polypharmacy, increased falling risk, frailty and dementia on the effectiveness and safety of NOACs as compared to VKAs, after searching the Medline database. Moreover, a meta-analysis on the impact of increased age ≥75 years old was performed after pooling results from 6 post hoc analyses of RCTs and 6 longitudinal observational cohort studies, highlighting the superior effectiveness (hazard ratio (HR) 0.83, 95% confidence interval (CI) [0.74–0.94] for stroke/SE; HR 0.77, 95%CI [0.65–0.92] for mortality) and non-inferior safety (HR 0.93, 95%CI [0.86–1.01] for major bleeding; HR 0.58, 95%CI [0.50–0.67] for intracranial bleeding; HR 1.17, 95%CI [0.99–1.38] for gastrointestinal bleeding) of NOACs versus VKAs in older AF patients. Conclusion: Across geriatric subgroups, apixaban was consistently associated with the most favourable benefit-risk profile and should therefore be preferred in geriatric patients with AF. However, research gaps on the impact of increased falling risk, frailty and baseline dementia were identified, requiring careful consideration while awaiting more results