Gespaltene Fürsorge : Sorgeberufe zwischen Professionalisierung und Freiwilligenarbeit

Im Kontext der Ökonomisierung von Sorgearbeit wird zunehmend auf freiwilliges Engagement zurückgegriffen. Das hat Folgen für Professionalisierungsprozesse in den weiblich typisierten Berufsfeldern. Anhand qualitativ-empirischen Datenmaterials zeigt der Beitrag, dass sich die Vergeschlechtlichung beruflicher Sorgearbeitstätigkeiten in Pflege und Sozialarbeit sowohl als Professionalisierungshemmnis wie auch als Mittel der Bewältigung eines Professionalisierungsdilemmas zu erkennen gibt: Ökonomisierungs- und Rationalisierungsprozesse erzeugen ein Spannungsverhältnis zwischen fürsorglichen und zweckrationalen Tätigkeitsanteilen, das mithilfe der hierarchisierenden Abspaltung und Auslagerung weiblich konnotierter und abgewerteter Beziehungsarbeit in das Engagement beantwortet wird. Die Folge ist eine einseitige Professionalisierung, die sowohl auf Kosten guter professioneller Sorgearbeit als auch zu Lasten Freiwilliger geht

Solidarität mit Geflüchteten und Fallstricke des Helfens

van Dyk S, Boemke L, Haubner T. Solidarität mit Geflüchteten und Fallstricke des Helfens. Berliner Journal für Soziologie. 2021;31(3-4):445-473.**Zusammenfassung** Der Beitrag untersucht am Beispiel des Engagements für Geflüchtete Stärken, Herausforderungen und Probleme freiwilligen Engagements und arbeitet zugleich die Spezifika dieser Form der Hilfe und Solidarität heraus. Die Analyse rekurriert auf eine qualitative Erhebung, die problemzentrierte Interviews mit Engagierten und Leitfadeninterviews mit Expert*innen sowie eine Dokumentenanalyse von politischen, medialen, zivilgesellschaftlichen und wissenschaftlichen Quellen für den Zeitraum von 2011 bis 2018 umfasst. Im Zentrum der Analyse stehen (1) der mediale und gesellschaftliche Außenblick auf die ehrenamtliche Flüchtlingshilfe, (2) multiple Grenzziehungen, -überschreitungen und -erfahrungen im Engagement sowie (3) die Bewältigung von Problemen und Herausforderungen seitens der Engagierten – durch den Ausstieg aus dem Engagement, die Kritik an Engagementbedingungen, die Verheimlichung des Engagements oder die Politisierung der Rolle freiwilliger Hilfe im Strukturwandel des Wohlfahrtsstaats.**Abstract** The paper turns to the example of voluntary assistance of refugees to explore the strong points, challenges, and problems of voluntary aid, in an attempt to map out the specifics of this form of assistance and solidarity. The analysis is based on a qualitative study which comprises problem centered interviews with volunteers and guided interviews with experts as well as a document analysis of sources from the spheres of politics, the media, civil society and science dating from 2011 to 2018. The investigation focuses (1) on the outside view on voluntary refugee aid articulated in the media and society at large, (2) on the multiple demarcations, transgressions and experience of limits in volunteering, and (3) on the ways in which volunteers deal with problems and challenges—by quitting volunteering, by criticizing the conditions of their commitment or by hiding it, or by politicizing the role voluntary assistance plays in the restructuring of the welfare state.**Résumé** Cet article étudie les forces, les défis et les problèmes de l’engagement bénévole à partir de l’exemple de l’engagement en faveur des réfugiés tout en mettant en évidence les spécificités de cette forme d’aide et de solidarité. L’analyse est basée sur une enquête qualitative comprenant des entretiens centrés sur un problème avec des personnes engagées, des entretiens semi-directifs avec des experts et des expertes ainsi qu’une analyse de documents de sources diverses (politique, médias, société civile, recherche scientifique) sur une période allant de 2011 à 2018. L’analyse est axée sur (1) la perception médiatique et sociale de l’aide bénévole aux réfugiés, (2) les multiples démarcations, transgressions et expériences limites dans le cadre de l’engagement ainsi que (3) la gestion des problèmes et des défis par les personnes engagées – par le désengagement, la critique des conditions d’engagement, la dissimilation de l’engagement ou la politisation du rôle de l’aide bénévole sur fond de transformation structurelle de l’État-providence

Incorporating Electronic Medical Record Hard Stops to Reduce Inappropriate \u3cem\u3eClostridioides difficile\u3c/em\u3e Testing at an Academic Medical Center: A Quality Improvement Study

Background: Clostridioides difficile is the most common pathogen causing healthcare-associated infections. This study highlights the multi-disciplinary efforts to reduce C. difficile infections (CDI) at a large, tertiary care teaching facility. Methods: A quality improvement study was performed between March 2017 and April 2018, using six Plan-Do-Study-Act cycles that included transmission prevention, diagnostic stewardship, education, and antimicrobial stewardship. Process measures included hand hygiene, isolation precautions, low-level disinfection compliance, number of tests ordered, lab cancelation of tests, and compliance with the Electronic Medical Record (EMR) hard stop for patients with laxative use, and negative C.difficile test in the past 7 days. Results: A total of 2,046 C. difficile tests were ordered during the initiative. Of the 124 patients with a positive C. difficile LabID event, 50% were male with a median age of 65 years (range: 11–92 years). A 53% reduction in C. difficile LabID events (7.5 to 4 events per 10,000 patient-days, P \u3c 0.001), with a pronounced decrease between cycle 4 and 5 (5.4 to 2.9 events per 10,000 patient-days, P \u3c 0.001) was achieved. The largest decrease in C. difficile lab tests ordered was seen after implementation of the EMR hard-stop (cycle 5), with fewer than 0.5 LabID events per 1,000 patient-days for each subsequent month after EMR hard-stop implementation. Frequent reasons for physician phone calls to Infection prevention department was related to chronic use of lactulose in patients with cirrhosis (30%) and unexplained diarrhea (70%). Based on provider feedback, EMR changes were made to remove lactulose from the hard-stop and offer infectious disease consultation upfront. There was 99% compliance with electronic medical record hard stop. There was a nonsignificant increase in lab cancelations due to inappropriate stool specimens over time (1.9% to 3.1% from cycle 1 to 6, P = 0.28) A 55% reduction in hospital-onset CDI surveillance events (from 6.9 to 3.2 per 10,000 patient-days, P \u3c 0.001) was noted. Conclusion: A multi-disciplinary Quality Improvement initiative is a successful strategy in reducing CDI events, with the largest decrease seen with introduction of EMR hard stops

Incorporating Electronic Medical Record Hard Stops to Reduce Inappropriate \u3cem\u3eClostridioides difficile\u3c/em\u3e Testing at an Academic Medical Center: A Quality Improvement Study

Background: Clostridioides difficile is the most common pathogen causing healthcare-associated infections. This study highlights the multi-disciplinary efforts to reduce C. difficile infections (CDI) at a large, tertiary care teaching facility. Methods: A quality improvement study was performed between March 2017 and April 2018, using six Plan-Do-Study-Act cycles that included transmission prevention, diagnostic stewardship, education, and antimicrobial stewardship. Process measures included hand hygiene, isolation precautions, low-level disinfection compliance, number of tests ordered, lab cancelation of tests, and compliance with the Electronic Medical Record (EMR) hard stop for patients with laxative use, and negative C.difficile test in the past 7 days. Results: A total of 2,046 C. difficile tests were ordered during the initiative. Of the 124 patients with a positive C. difficile LabID event, 50% were male with a median age of 65 years (range: 11–92 years). A 53% reduction in C. difficile LabID events (7.5 to 4 events per 10,000 patient-days, P \u3c 0.001), with a pronounced decrease between cycle 4 and 5 (5.4 to 2.9 events per 10,000 patient-days, P \u3c 0.001) was achieved. The largest decrease in C. difficile lab tests ordered was seen after implementation of the EMR hard-stop (cycle 5), with fewer than 0.5 LabID events per 1,000 patient-days for each subsequent month after EMR hard-stop implementation. Frequent reasons for physician phone calls to Infection prevention department was related to chronic use of lactulose in patients with cirrhosis (30%) and unexplained diarrhea (70%). Based on provider feedback, EMR changes were made to remove lactulose from the hard-stop and offer infectious disease consultation upfront. There was 99% compliance with electronic medical record hard stop. There was a nonsignificant increase in lab cancelations due to inappropriate stool specimens over time (1.9% to 3.1% from cycle 1 to 6, P = 0.28) A 55% reduction in hospital-onset CDI surveillance events (from 6.9 to 3.2 per 10,000 patient-days, P \u3c 0.001) was noted. Conclusion: A multi-disciplinary Quality Improvement initiative is a successful strategy in reducing CDI events, with the largest decrease seen with introduction of EMR hard stops

Development of a New Positron Emission Tomography Tracer for Targeting Tumor Angiogenesis: Synthesis, Small Animal Imaging, and Radiation Dosimetry

Angiogenesis plays a key role in cancer progression and correlates with disease aggressiveness and poor clinical outcomes. Affinity ligands discovered by screening phage display random peptide libraries can be engineered to molecularly target tumor blood vessels for noninvasive imaging and early detection of tumor aggressiveness. In this study, we tested the ability of a phage-display-selected peptide sequence recognizing specifically bone marrow- derived pro-angiogenic tumor-homing cells, the QFP-peptide, radiolabeled with 64Cu radioisotope to selectively image tumor vasculature in vivo by positron emission tomography (PET). To prepare the targeted PET tracer we modified QFP-phage with the DOTA chelator and radiolabeled the purified QFP-phage-DOTA intermediate with 64Cu to obtain QFP-targeted radioconjugate with high radiopharmaceutical yield and specific activity. We evaluated the new PET tracer in vivo in a subcutaneous (s.c.) Lewis lung carcinoma (LLC) mouse model and conducted tissue distribution, small animal PET/CT imaging study, autoradiography, histology, fluorescence imaging, and dosimetry assessments. The results from this study show that, in the context of the s.c. LLC immunocompetent mouse model, the QFP-tracer can target tumor blood vessels selectively. However, further optimization of the biodistribution and dosimetry profile of the tracer is necessary to ensure efficient radiopharmaceutical applications enabled by the biological specificity of the QFP-peptide