Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study

Background: Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care. Methods. Phases 1 and 2: a telephone survey mapping multidisciplinary teams' parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children's kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory. Results: Professionals spoke of the challenge of explaining to each other how they are aware of parents' understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated. Conclusions: For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents' support needs, and may help them to negotiate with parents and accelerate parents' learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions. © 2013 Swallow et al.; licensee BioMed Central Ltd

Using focused ethnography in paediatric settings to explore professionals’ and parents’ attitudes towards expertise in managing chronic kidney disease stage 3–5

Background: Interactions between parents and healthcare professionals are essential when parents of children with chronic conditions are learning to share expertise about clinical care, but limited evidence exists on how they actually interact. This paper discusses the use of focused ethnography in paediatric settings as an effective means of exploring attitudes towards expertise. Methods: The paper draws on repeated observations, interviews and field-notes involving the parents of six children with chronic kidney disease, and 28 healthcare professionals at two, tertiary, children's hospital-based units. Data were analysed using the Framework approach and the concepts of expertise and self-management. Results: Our study highlighted rewards and challenges associated with focused ethnography in this context. Rewards included the ability to gain a richer understanding of the complex phenomena of mutual acknowledgement of expertise that occurs during parent/ healthcare professional interactions. Challenges related to gaining informed consent and ensuring potential participants had an adequate understanding of the purpose of the study. Two dimensions of parental expertise around their child (personal and clinical) were evident in our data. Parents' and professionals' expertise about the child and their condition was acknowledged and exchanged as parents learnt to share clinical-care with the multi-disciplinary team. Healthcare professionals acknowledged parents' need to understand aspects of each of the eight disciplinary knowledge bases relating to their child' s management and recognised parents' expert knowledge of their child, found ways to mobilise this knowledge, and wove parents' expertise into the management plan. Parents spoke of the degree to which their own expert knowledge of their child complemented healthcare professionals' clinical knowledge. However, ambivalence around expertise was evident as both parents and healthcare professionals questioned what the expertise was, and who the expert was. Our discussion focuses on the ways healthcare professionals and parents share expertise around the child's condition as parents take on responsibility for home-based clinical care. Conclusions: Our findings point to focused ethnography being an effective way of capturing new insights into parent and professional interactions in a paediatric setting and mutual acknowledgement of expertise; these insights may help redress the reported limitations of previous, retrospective studies

Using conjoint analysis to estimate farmers' preferences for cattle traits in West Africa

This paper estimates the preferences of farmers for cattle traits in southern Burkina Faso using Conjoint analysis, a survey-based system for measuring preferences for multiple-attribute goods. Here the technique is used in the context of a West African country where literacy is low, where cattle perform multiple functions, where low-input management is the norm, and where cattle are exposed to a number of tropical diseases and other environmental stresses. The results reflect the production practices of the region, suggesting that important traits in developing breed improvement programs should include disease resistance, fitness for traction and reproductive performance. Beef and milk production are less important traits. The study shows the potential usefulness of conjoint analysis for quantifying preferences in less developed countries for livestock and for the wide variety of other multiple-attribute goods. Distinguishing differences in preferences between groups of respondents in connection with specific locations and production systems can be used to promote conservation-through-use of breeds at risk of extinction

Distributed expertise: Qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease

© 2014 The Authors. Background: Long-term childhood conditions are often managed by hospital-based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional-parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain. Methods: We conducted semi-structured, qualitative interviews with a convenience sample of 112 professionals (clinical-psychologists, dietitians, doctors, nurses, pharmacists, play-workers, therapists and social workers), exploring accounts of their parent-educative activity. We analysed data using framework and the concept of distributed expertise. Results: Four themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co-exist within MDTs, with participants using the term 'we' both as the intra-professional 'we' (relating to the professional identity) when describing expertise within a disciplinary group (for example: 'As dietitians we aim to give tailored advice to optimize children's growth'), and the inter-professional 'we' (a 'team-identification'), when discussing expertise within the team (for example: 'We work as a team and make sure we're all happy with every aspect of their training before they go home'). Conclusions: This study highlights the dual identifications implicit in 'being professional' in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions

Measurements of the Decay KL→e+e−γK_L \to e^+e^-\gamma

The E799-II (KTeV) experiment at Fermilab has collected 83262 $K_L \to e^+e^-\gamma$ events above a background of 79 events. We measure a decay width, normalized to the $K_L \to \pi^0\pi^0\pi^0_D$ (\pi^0 \to \gamma\gamma, \pi^0 to \gamma\gamma, \pi^0_D \to e^+e^-\gamma) decay width, of $\Gamma($K_L \to e^+e^-\gamma$)/\Gamma(K_L \to \pi^0\pi^0\pi^0_D) = (1.3302 \pm 0.0046_{stat} \pm 0.0102_{syst}) \times 10^{-3}$. We also measure parameters of two $K_L \gamma^{\ast}\gamma$ form factor models. In the Bergstrom, Masso, and Singer (BMS) parametrization, we find \caks = -0.517 \pm 0.030_{stat} \pm 0.022_{syst}. We separately fit for the first parameter of the D'Ambrosio, Isidori, and Portoles (DIP) model and find \adip = -1.729 \pm 0.043_{stat} \pm 0.028_{syst}.Comment: 5 pages, 3 figures, submitted to PR

Improved KL->pi e nu Form Factor and Phase Space Integral with Reduced Model Uncertainty

Using the published KTeV sample of 2 million KL-> pi e nu decays and a new form factor expansion with a rigorous bound on higher order terms, we present a new determination of the KL->pi e nu form factor and phase space integral. Compared to the previous KTeV result, the uncertainty in the new form factor expansion is negligible and results in an overall uncertainty in the phase space integral (IKe) that is a factor of two smaller: IKe = 0.15392 +- 0.00048 \.Comment: 3 pages, 2 figures, submitted to PRD Rapid Communicatio

Detailed Study of the KL -> 3pi0 Dalitz Plot

Using a sample of 68 million KL -> 3pi0 decays collected in 1996-1999 by the KTeV (E832) experiment at Fermilab, we present a detailed study of the KL -> 3pi0 Dalitz plot density. We report the first observation of interference from KL->pi+pi-pi0 decays in which pi+pi- rescatters to 2pi0 in a final-state interaction. This rescattering effect is described by the Cabibbo-Isidori model, and it depends on the difference in pion scattering lengths between the isospin I=0 and I=2 states, a0-a2. Using the Cabibbo-Isidori model, we present the first measurement of the KL-> 3pi0 quadratic slope parameter that accounts for the rescattering effect.Comment: accepted by Phys. Rev

Search for the Rare Decay K_{L}\to\pi^{0}\pi^{0}\gamma

The KTeV E799 experiment has conducted a search for the rare decay $K_{L}\to\pi^{0}\pi^{0}\gamma$ via the topology $K_{L}\to\pi^{0}\pi^{0}_D\gamma$ (where $\pi^0_D\to\gamma e^+e^-$). Due to Bose statistics of the $\pi^0$ pair and the real nature of the photon, the $K_{L}\to\pi^{0}\pi^{0}\gamma$ decay is restricted to proceed at lowest order by the CP conserving direct emission (DE) of an E2 electric quadrupole photon. The rate of this decay is interesting theoretically since chiral perturbation theory predicts that this process vanishes at level $O(p^4)$. Therefore, this mode probes chiral perturbation theory at $O(p^6)$. In this paper we report a determination of an upper limit of $2.43\times 10^{-7}$ (90% CL) for $K_{L}\to\pi^{0}\pi^{0}\gamma$. This is approximately a factor of 20 lower than previous results.Comment: six pages and six figures in the submission. Reformatted for Physics Review

Determination of the Parity of the Neutral Pion via the Four-Electron Decay

We present a new determination of the parity of the neutral pion via the double Dalitz decay pi^0 -> e+ e- e+ e-. Our sample, which consists of 30511 candidate decays, was collected from K_L -> pi0 pi0 pi0 decays in flight at the KTeV-E799 experiment at Fermi National Accelerator Laboratory. We confirm the negative pi^0 parity, and place a limit on scalar contributions to the pi^0 -> e+ e- e+ e- decay amplitude of less than 3.3% assuming CPT conservation. The pi^0 gamma* gamma* form factor is well described by a momentum-dependent model with a slope parameter fit to the final state phase space distribution. Additionally, we have measured the branching ratio of this mode to be B(pi^0 -> e+ e- e+ e-) = (3.26 +- 0.18) x 10^(-5).Comment: 5 pages, 4 figures. Typographical error in radiative branching ratio (Eq. 6) correcte