Researching the interplay between social work students' personal and professional identities, I found that, in talking about becoming professionals, students drew on a wide range of discourses. Three common usages of the term ‘professional identity’ are explored here: it can be thought of in relation to desired traits; it can also be used in a collective sense to convey the ‘identity of the profession’. Taking a more subjective approach, professional identity can be regarded as a process in which each individual comes to have a sense of themselves as a social worker. I argue that the variations in students' talk reflect a wide range of cultural understandings that are prevalent within the social work community and society in general, and conclude that professional identity is more complicated than adopting certain traits or values, or even demonstrating competence. The different meanings of professional identity all have something to offer, providing resources for students as they construct themselves as ...

/pdf/not-easily-put-into-a-box-constructing-professional-identity-48p9kkztcc.pdf

‘Not Easily Put Into a Box’: Constructing Professional Identity

Extracorporeal membrane oxygenation (ECMO) is increasingly being used for patients with severe respiratory failure and has received particular attention during the coronavirus disease 2019 (COVID-19) pandemic. Evidence from two key randomized controlled trials, a subsequent post hoc Bayesian analysis, and meta-analyses support the interpretation of a benefit of ECMO in combination with ultra-lung-protective ventilation for select patients with very severe forms of acute respiratory distress syndrome (ARDS). During the pandemic, new evidence has emerged helping to better define the role of ECMO for patients with COVID-19. Results from large cohorts suggest outcomes during the first wave of the pandemic were similar to those in non-COVID-19 cohorts. As the pandemic continued, mortality of patients supported with ECMO has increased. However, the precise reasons for this observation are unclear. Known risk factors for mortality in COVID-19 and non-COVID-19 patients are higher patient age, concomitant extra-pulmonary organ failures or malignancies, prolonged mechanical ventilation before ECMO, less experienced treatment teams and lower ECMO caseloads in the treating center. ECMO is a high resource-dependent support option; therefore, it should be used judiciously, and its availability may need to be constrained when resources are scarce. More evidence from high-quality research is required to better define the role and limitations of ECMO in patients with severe COVID-19. 

/pdf/respiratory-indications-for-ecmo-focus-on-covid-19-flr1fy0r.pdf

Respiratory indications for ECMO: focus on COVID-19

To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on in-hospital mortality. The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models. Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94–4.4]) but not thrombotic events (adjOR = 1.02[0.68–1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4–41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support. In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration. 

/pdf/bleeding-and-thrombotic-events-in-patients-with-severe-covid-3excng4i.pdf

Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Issues of professional identity in social work have been vexed by conceptual ambiguity, lack of 
consensus about core attributes and problems in identifying what counts in the constitution of 
identity. Studies have tended to focus on the following matters: social workers’ professional identity formation; the framing of key tensions around social workers’ professional identity; issues 
which convey the narrative represented by social workers in talking about their role, values and 
work; and the context in which professional identity is formed in preparation for front-line 
practice. This muddled terrain is further complicated by the fact that several competing theoretical perspectives have been deployed to help make sense of matters of professional identity. At a 
practical level, the extent to which front-line workers have to fulfil a narrow set of socially coded 
values, regulated by a professional body, as part of identity maintenance has been a troublesome 
and much debated matter for social work. As will be shown in this chapter, it is fair to say that 
issues of professional identity in social work are contestable. A mix of competing rationalities 
and values are involved in attempts to locate the specificities of front-line practice, social work 
education and policy which make up professional identity for social work.

/pdf/professional-identity-and-social-work-54so39wnt3.pdf

Professional identity and social work

The development of extracorporeal life support technology has added a new dimension to the care of critically ill patients who fail conventional treatment options. Extracorporeal membrane oxygenation (ECMO)—specialized temporary life support for patients with severe cardiac or pulmonary failure—plays a role in bridging the time for organ recovery, transplant, or permanent assistance. The overall patient outcome is dependent on the underlying disease, comorbidities, patient reaction to critical illness, and potential adverse events during ECMO. Moreover, the contact of the blood with the large artificial surface of an extracorporeal system circuit triggers complex inflammatory and coagulation responses. These processes may further lead to endothelial injury and disrupted microcirculation with consequent end-organ dysfunction and the development of adverse events like thromboembolism. Therefore, systemic anticoagulation is considered crucial to alleviate the risk of thrombosis and failure of ECMO circuit components. The gold standard and most used anticoagulant during extracorporeal life support is unfractionated heparin, with all its benefits and disadvantages. However, therapeutic anticoagulation of a critically ill patient carries the risk of clinically relevant bleeding with the potential for permanent injury or death. Similarly, thrombotic events may occur. Therefore, different anticoagulation strategies are employed, while the monitoring and the balance of procoagulant and anticoagulatory factors is of immense importance. This narrative review summarizes the most recent considerations on anticoagulation during ECMO support, with a special focus on anticoagulation monitoring and future directions.

/pdf/anticoagulation-strategies-during-extracorporeal-membrane-tjw2la2k.pdf

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

These guidelines for adult and pediatric anticoagulation for extracorporeal membrane oxygenation are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise. These guidelines do not take the place of physicians' and other health professionals' judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines. 

2021 ELSO Adult and Pediatric Anticoagulation Guidelines.

In a Master of Social Work study, looking at Continuing Professional Education (CPE) for social workers, it was found that the profession's status and image are linked to the status of continuing professional education. Other major findings were that the schools of social work have not inculcated the concept of CPE into undergraduates as a norm, and that until the recent establishment of the National Continuing Professional Education and Practice Standards Project, the profession itself had not accorded CPE a high status. Such long-term neglect has impacted on the position of social work in organisations and on the professional identity of workers. The study was undertaken from a qualitative perspective, with the data arising from the field. Interviews were held in focus groups which consisted of social workers in teaching hospitals at various levels: new graduates of less than two years experience, experienced workers of more than five years experience and co-ordinators of CPE programs. The interviews we...

Professional identity and continuing education: A study of social workers in hospital settings

More to Learn About Acquired Von Willebrand Syndrome.

Purpose of review This review summarizes the current literature surrounding the use of bivalirudin as an alternative anticoagulant for pediatric extracorporeal membrane oxygenation (ECMO) patients. Recent findings Recent single center studies describe that bivalirudin may be associated with decreased blood product transfusion, decreased cost and similar clinical outcomes for pediatric ECMO patients who have failed unfractionated heparin (UFH) anticoagulation. aPTT is the most common test to monitor bivalirudin but has several limitations. Other tests including dilute thrombin time (dTT) and viscoelastic assays are promising but more study is needed. Current evidence suggests that bivalirudin is a well tolerated and effective alternative anticoagulant for pediatric ECMO patients who have failed UFH anticoagulation but prospective studies are needed to confirm these results. Summary Bivalirudin is a promising alternative anticoagulant for pediatric ECMO patients who have failed UFH. Large prospective, multicenter studies are needed to confirm safety and efficacy.

Bivalirudin in pediatric extracorporeal membrane oxygenation

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2021 ELSO Adult and Pediatric Anticoagulation Guidelines.

Professional identity and continuing education: A study of social workers in hospital settings

More to Learn About Acquired Von Willebrand Syndrome.

Bivalirudin in pediatric extracorporeal membrane oxygenation