Epistemic fit and the mobilisation of management knowledge in health care

We discuss the mobilisation of management knowledge in health care, drawing on six qualitative case studies in a diverse range of health care settings. Drawing on theory about management knowledge and practices’ ‘fit’, and emergent theory about ‘epistemic stances’, we explain how cultural/institutional, political and epistemic fit and clashes between the norms, interests and epistemic stances of different communities affected knowledge mobilisation in these settings. We also highlight the key role of knowledge brokers in ‘fitting’ knowledge within contexts as part of their own identity work. Yet we note that knowledge brokers’ ability to mobilise and fit knowledge depended on having a senior role or senior level support, and credibility/legitimacy with dominant communities. We suggest that our novel concepts of ‘epistemic fit’ and ‘fitting’ are useful in explaining the process of knowledge mobilisation, particularly in complex pluralistic health care contexts containing multiple epistemic communities which produce, use and value knowledge in different ways

The political economy of management knowledge : management texts in English healthcare organizations

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations from the meso or middle level of analysis which examine diffusion processes within the public services field, and also more micro literature which focuses on agency from individual knowledge leaders

An investigation of the factors effecting high-risk individuals' decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC).

Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group.CRUKThis is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s10689-016-9910-8

Health information management professionals [Present circumstances and future expectations]

Health information management (HIM) is the heart of a health organization; with each beat, it supplies much-needed information to users such as physicians, staff nurses, allied health professionals, health administrators, insurance companies and government health departments. The traditional role of a HIM professional has been to maintain organized and accurate data, which is available for patient care and for management purposes. HIM professionals undertake numerous tasks to fulfil this goal. HIM specialists, therefore, need to integrate a variety of skills, such as a strong knowledge of medical terminology and disease processes, application of clinical classification systems, excellent managerial skills and computer and information technology (IT) expertise, to manage the range of health information and human services for which they are responsible. However, the growth in information technology has had a huge influence on HIM responsibilities. Technology has automated many of the routine functions of data collection and thus the role of the HIM professional has become more divergent and strategic in nature, particularly with the increasing development of electronic health records. Records must now be made available to increasing numbers of health care providers and various other parties simultaneously. The changing role of HIM personnel in health care has increased the need for HIM professionals who understand the use and meaning of health record information as well as the language used to describe the reality of clinical treatments and financial operations. In addition, more employment pathways and opportunities have become available for HIM professionals. However, many HIM experts still believe that providing a simple answer to the question, “What is HIM?” is one of the greatest challenges in the current electronic world. HIM professionals believe that, unless they can clearly articulate what they do and what makes them unique, the profession will struggle to convince others of their importance in the future. Other studies state that, in spite of the importance of HIM in protecting hospital and patient clinical information and ensuring appropriate hospital funding, it is considered a hidden profession. The aim of this paper is to outline the current strategic challenges facing the HIM profession and to explore what those challenges mean for reconfiguring the future workforce needs and professional enablers’ specific education. It is important for the HIM authorities to evaluate and identify the future needs of professionals and the role that they play, in order to maintain their sustainability

Livestock (Commencement) Amendment Act, 1999, No. 7

The last two decades have seen a shift in public services organizations from hierarchies to networks. Network forms are seen as particularly suited to handling ‘wicked problems'. We make an assessment of the nature and impact of this shift. Using recent evidence from the United Kingdom (UK) National Health Service (NHS), we explore the nature and functioning of eight different public policy networks. We are also interested in whether there has been a radical transition – or not – from hierarchical to network forms

Frequently Identified Gaps in Antibiotic Stewardship Programs in Critical Access Hospitals

Background: Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in various health care settings including resource limited settings like critical access hospitals (CAH). Little is known about the existing gaps in antimicrobial stewardship programs (ASP) of CAH. Hence, we decided to study the current level of ASP activities and factors associated with these activities in CAH. Methods: NE ICAP conducted on-site surveys in 36 CAH from October 2015 to February 2017. ASP activities related to the 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise (DE), action, tracking, reporting, and education were assessed using a CDC Infection Control Assessment Tool for acute care hospitals. Descriptive analyses evaluated CAH characteristics and frequency of CE implementation. Fisher’s exact, Mann–Whitney, and Kruskal–Wallis tests were used for statistical analyses examining the association of various factors with level of ASP activities. Results: The 36 surveyed CAH had a median of 20 (range 10–25) beds and employed a median of 0.4 (range 0.1–1.6) infection preventionist (IP) full-time equivalent (FTE)/25-bed. Frequency of CE implementation varied among CAH with action and LS as the most (69%) and least (28%) frequently implemented elements, respectively. Close to half (47%) of surveyed CAH had implemented ≥4 CE but only 14% of facilities had all 7 CE. Median bed size and IP FTE/25-bed were similar among CAH with 0–2, 3-5, or ≥6 CE in place. CAH with LS or accountability for ASP implemented higher median numbers of the remaining CE compared with CAH without LS or accountability (5 vs. 2, P \u3c 0.01 and 4 vs. 2, P \u3c 0.01, respectively). Facilities with The presence of LS, accountability and drug expertise were more likely to have all 4 remaining CE implemented than others (56% vs. 8%, P \u3c 0.01). Conclusion: LS, accountability, and DE are important factors for the implementation of the remaining 4 CE in CAH. Although LS was the least frequently implemented CE, when present was associated with implementation of most of the other CE. Acquiring LS will facilitate implementation of additional ASP efforts in CAH.https://digitalcommons.unmc.edu/asap_pres/1000/thumbnail.jp

Genome structural variation in Escherichia coli O157:H7

The human zoonotic pathogen Escherichia coli O157:H7 is defined by its extensive prophage repertoire including those that encode Shiga toxin, the factor responsible for inducing life-threatening pathology in humans. As well as introducing genes that can contribute to the virulence of a strain, prophage can enable the generation of large-chromosomal rearrangements (LCRs) by homologous recombination. This work examines the types and frequencies of LCRs across the major lineages of the O157:H7 serotype. We demonstrate that LCRs are a major source of genomic variation across all lineages of E. coli O157:H7 and by using both optical mapping and Oxford Nanopore long-read sequencing prove that LCRs are generated in laboratory cultures started from a single colony and that these variants can be recovered from colonized cattle. LCRs are biased towards the terminus region of the genome and are bounded by specific prophages that share large regions of sequence homology associated with the recombinational activity. RNA transcriptional profiling and phenotyping of specific structural variants indicated that important virulence phenotypes such as Shiga-toxin production, type-3 secretion and motility can be affected by LCRs. In summary, E. coli O157:H7 has acquired multiple prophage regions over time that act to continually produce structural variants of the genome. These findings raise important questions about the significance of this prophage-mediated genome contingency to enhance adaptability between environments

Arabidopsis thaliana telomeric DNA-binding protein 1 is required for telomere length homeostasis and its Myb-extension domain stabilizes plant telomeric DNA binding

Telomeres are specific protein–DNA complexes that protect the ends of eukaryotic chromosomes from fusion and degradation and are maintained by a specialized mechanism exerted by telomerase and telomere-binding proteins (TBPs), which are evolutionarily conserved. AtTBP1 is an Arabidopsis thaliana protein that binds plant telomeric DNA in vitro. Here, we demonstrated that lack of AtTBP1 results in a deregulation of telomere length control, with mutant telomeres expanding steadily by the fourth generation. DNA-binding studies with mutant AtTBP1 proteins showed that the Myb-extension domain of AtTBP1 is required for binding to plant telomeric DNA. Our results suggest that AtTBP1 is involved in the telomere length mechanism in A. thaliana and that the Myb-extension domain of AtTBP1 may stabilize plant telomeric DNA binding