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Navigating ‘not doing’ in primary care: could more explicit guidelines on record keeping help to ease clinician anxiety?
No full textElectronic health records (EHRs) serve several key purposes: they remind healthcare professionals (HCPs) of consultation details, support continuity of care by sharing information, and provide evidence of care quality or potential deficiencies should clinical practice be scrutinised.1 As primary care (PC) professionals develop record-keeping skills, they may be influenced by preregistration training, advice from peers and mentors, observing others’ record entries, audit feedback, and published guidelines. Given the various ways these skills are acquired and the lack of a widely adopted gold standard, documentation practices differ across UK PC. This inconsistency may complicate record interpretation for multidisciplinary healthcare teams (MDTs), complaint investigators, and patients who view them.
There are increasing concerns about medical overuse, including over-prescription, overdiagnosis, unnecessary referrals, and a recognition of the harm it could cause patients. Medical overuse is complex, driven by time pressures, care discontinuity, patient expectations, team culture, misuse of guidelines, fear of complaints, and peer criticism.2 HCPs often worry more about being criticised for ‘not doing’ than unnecessary interventions, despite the risks associated with both scenarios.2 Anxiety over patients’ decisions to ‘not do’ something, along with fear of reprisals, may fuel defensive practices. Robust record keeping could be an important facilitator in reducing clinician anxiety and decreasing medical overuse.
The concept of ‘not doing’ in PC is more nuanced than it might initially appear. While it suggests inaction, consultations are inherently active. For example, advising patients to watch and wait is rarely passive; it ideally encompasses careful consideration, communication, and shared decision making (SDM), offering patients the opportunity to voice their concerns and nurturing therapeutic relationships. In this article, ‘not doing’ refers to decisions that do not involve contemporaneous prescriptions, treatments, referrals, tests, or diagnoses, acknowledging that these decisions are a complex, active therapeutic process
Mapping and Mitigating the Pains of Responsible Artificial Intelligence Implementation: An Analysis of Swiss Organizations
Get PDFDespite the proliferation of Responsible Artificial Intelligence (RAI) principles, organizations struggle to translate them into practical implementation. This study investigates the challenges Swiss organizations face in implementing RAI through qualitative interviews with industry professionals and academic experts, complemented by a multi-stakeholder workshop. We first identify five critical pain points hampering RAI implementation: economic constraints, structural and procedural barriers, conceptual and technical challenges, cultural and behavioral resistance, and regulatory uncertainty. Then we propose the Control-Tangibility Framework, a novel framework that maps pain points along two fundamental dimensions: organizational control and challenge tangibility. Our framework provides organizations with a structured methodology to prioritize RAI efforts by considering both their ability to influence change and their capacity to observe aspects of the challenges. Furthermore, we provide practical insights for developing targeted implementation strategies that bridge the gap between ethical principles and operational practices. Our findings suggest that successful RAI implementation requires moving beyond compliance-focused approaches toward a comprehensive organizational transformation, supported by systematic assessment and prioritization of implementation challenges
Distinction Between Hydration and Fertigation Events in Plant Tetrapolar Bioimpedance Measurements
Get PDFIn this study, we assess the appropriateness of tetrapolar bioimpedance needle plant sensors for interrogating the full plant stem and for differentiating between hydration (watering) and fertigation (feeding) events in herbaceous plants. Our sensor features a tetrapolar configuration of needle electrodes arranged in 'paired pairs'. The goal is to develop a bioimpedance-based sensor that automatically monitors watering and fertigation status in tomato plants, offering optimal performance, easy installation, and cost-effectiveness. We detail our design methodology using COMSOL FEM simulations to assess the needle geometry in terms of its ability to effectively interrogate the stem across its diameter. The tomato stem's bioimpedance was modelled as a lumped-impedance equivalent circuit, with R and C values computed from experimental data. The theoretical model indicated similar characteristics to those extracted experimentally. Experiments were carried out over 27 days with impedance magnitude and phase periodically monitored for ten frequencies, with the results clearly indicating watering and feeding events, which were accurately classified using a PCA-based clustering algorithm
Does the ‘right to request’ flexible work policy influence men’s and women’s uptake of flexible working and well-being: findings from the UK Household Longitudinal Study
Get PDFBackground
The ‘right to request’ flexible working policy has been gradually extended and, by 2014, extended to cover all workers with at least 26 weeks of continuous employment. The impact of these policy changes is unclear. This research aims to assess the effects of the 2014 policy reform on the uptake of flexible working and its impact on health and well-being, focusing on gender differences.
Methods
Data were drawn from waves 2, 4, 6, 8 and 10 of the UK Household Longitudinal Study (2010–2020). We employed a doubly robust difference-in-differences method to estimate the average treatment effects on the treated of the 2014 policy reform. This analysis examined the effects on the uptake of flexible working, mental and physical health, and satisfaction with life, job and leisure.
Findings
The 2014 policy reform increased women’s uptake of reduced hours work arrangements, with the effect growing stronger over time. However, no increase in uptake was observed among men. No strong effects were found for flexitime or teleworking arrangements for either men or women. Additionally, the policy reform resulted in a reduction in psychological distress and improved life satisfaction among women.
Conclusions
The reduction in women’s psychological distress and improved life satisfaction might be partly explained by the increased women’s uptake of reduced hours arrangements, which may have enabled women to better meet their family care demands. However, even the gender-neutral policies on flexible working may inadvertently exacerbate gender inequalities in labour force participation by pushing women more into part-time work
A Study on IoT Device Authentication Using Artificial Intelligence
Get PDFDesigning reliable authentication mechanisms for IoT devices is increasingly necessary to protect citizens’ private information and data. One of the most significant issues in today’s digital age is authentication. As IoT device technology advances and data grow rapidly, machine learning techniques improve the accuracy and efficiency of authentication and offer advantages over traditional methods, making them valuable in both academia and industry. Device authentication aims to verify legitimate computing devices and identify impostors based on their behavioral data. This paper explores research that applies artificial intelligence algorithms to enhance device authentication mechanisms. We discuss AI authentication models, including deep learning algorithms, convolutional neural networks, and reinforcement learning. We also highlight research challenges and provide recommendations for future studies to support innovation in this field
“Our lives don’t matter”: an exploration of the experiences of Black trainee counselling psychologists studying on a doctoral course in the UK
No full textBlack individuals continue to be underrepresented in counselling psychology (CoP) training in the U.K., despite documented and anecdotal evidence supporting the importance of having a diverse mental health workforce in the country. There is a scarcity of empirical research seeking to gain a better understanding of the experiences of Black CoP trainees and systemic disparities within the field. This paper presents qualitative research which explored the experiences of Black trainee CoPs enrolled in doctoral courses in the UK. Using interpretative phenomenological analysis (IPA), eight semi-structured interviews were conducted. Findings yielded four superordinate themes, each with two-four sub-themes: a) Identity, b) Black and in training, c) The challenge of balancing various professional and personal demands, d) Recommendations and suggestions to improve access and representation of Black individuals within the CoP field. Implications for CoP practice, training and the profession are discussed
Learn the Rules Like a Pro, so You Can Break Them Like an Artist: How Michelin-Starred Chefs Create a New Robust Tradition
Get PDFThis study delves into the artful equilibrium elite chefs maintain between tradition and innovation in the realm of haute cuisine, ensuring that heritage thrives alongside fresh creativity. Through 18 interviews with Michelin-starred chefs and key figures from two countries, we introduce the concept of “robust tradition.” This idea captures how entrenched culinary practices and rituals not only safeguard the legacy of top-tier restaurants but also provide a versatile foundation for innovation and adaptation. Our findings reveal how robust tradition supports both stability and change, offering valuable strategies for leaders to harness long-standing principles to inspire organizational innovation. We discuss the broader implications of these findings for strategic management and organizational theory, especially in settings where maintaining authenticity is as vital as embracing innovation
Near-Infrared Spectroscopy for Oedema Quantification: An Ex Vivo Porcine Skin Model
Get PDFOedema is a common clinical finding in critically ill neonates and may reflect systemic illness such as congestive heart failure, hepatic cirrhosis, nephrotic syndrome, sepsis, and acute kidney injury. Oedema is characterised by tissue swelling due to water accumulation in the interstitial space. Currently, the gold standard in clinical practice is visual assessment, which is subjective and limited in accuracy. Alternative methods, such as ultrasound and bioimpedance, have been explored; however, they are unsuitable in neonates and do not provide direct water quantification. Near-infrared spectroscopy (NIRS) is a non-invasive optical method that could measure water content through light interaction between near-infrared light and OH particles within the tissue. This study validated NIRS for oedema assessment using an ex vivo porcine skin model, where controlled oedema was induced by phosphate-buffered saline (PBS) injection. Continuous spectroscopic data were collected via optical fibres positioned perpendicularly and parallel to the tissue. Regression models were developed and evaluated using the spectral data, with partial least squares (PLS) regression outperforming ridge regression (RR) and support vector regression (SVR). Notably, spectra acquired in the parallel configuration yielded superior results (R2 = 0.97, RMSE = 0.15). These findings support the potential of NIRS as a reliable, quantitative tool for neonatal oedema assessment
How to Reduce Microaggression and Other Negative Racial Experiences at Work with Continuous Improvement
Get PDFWhile government regulation or company policy can be used to curtail discrimination at work, it is hard to regulate away negative experiences such as microaggression or perceptions of discrimination in hiring and promotion in the workplace against minority employees. Using interview data from interviews of minority ethnic staff at a UK university, I present evidence of microaggression and minority employees feeling excluded and posit that perceptions of discriminatory policy engender negative perceptions of the organization. I also show the link between employee engagement and organizational performance and propose that negative minority employees’ experiences and perceptions lower job and organizational engagement and, eventually, organizational performance. I then offer a solution through enterprise-wide CI programs to improve organizational performance directly by improving business processes and indirectly by improving minority employees’ experience, perceptions, and engagement
Postcapitalist Planning and Urban Revolution
Get PDFThrough the logistical state, which we bring into novel conversation with Henri Lefebvre’s work on planetary urbanisation and the production of space, this paper argues that postcapitalist forms of planning will arrive, if ever, through an urban revolution, through struggles over urban everyday life, the logistical state, which we bring into novel conversation with Henri Lefebvre’s work on planetary urbanisation and the production of space, this paper argues that postcapitalist forms of planning will arrive, if ever, through an urban revolution, through struggles over urban everyday life. We suggest that future investigations into the possibilities for a democratic economic planning beyond capitalism should attend to actually-existing empirical struggles over the urban – as the spatial mediator of capitalist relations – and look for inspiration to historical and contemporary examples of municipalist praxis aiming to reinvent the commune
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