Creative and Performativity Policies in Primary Schools

Primary schools face a new situation, one in which policies promoting creativity no longer have to be fought for but are being promoted at government and national educational level alongside policies that focus on the assessment of school performance in inspections and national tests and encourage target setting. We sought to ascertain how these policy discourses, the contents of which have been perceived as conflicting (Jeffrey and Woods 1998), were affecting primary school management, teachers and learners. In this climate of accountability schools appeared to embrace performance and act innovatively and creatively. Our professional primary school teachers were team players who contributed to the presentation of the school as a unified, creative, inclusive and effective managerial organisation. The merging of the two policies was not pervasive across schools or within schools but there were some examples involving cross-curricular projects. More prominent was a ‘bolt on’ activity of creative teaching and learning such as special creative curriculum weeks or days. Schools found it necessary to ensure success in national tests by institutionalising lengthy SATS preparation for, in some cases, the whole of the Spring term. However, performativity as a progression from one achievement to the next was valued. Teachers, learners and parents considered it beneficial to have information about levels because, in a spirit of openness, all knew what to expect. Professional Identities The stress levels found in the 1990s, (Menter, Muschamp et al. 1997; Osborn, McNess et al. 2000; Troman and Woods 2001) appear to have dissipated along with any resistance from teachers who appeared to be more focused on coping strategies such as team building and appropriating testing and target setting for their own professional benefit. The performativity imperatives were internalised and sometimes generated guilt if they were unrealised but teachers sought to ameliorate these tensions or to resolve them. Where resolution was not possible they accepted the tension and lived with it, (Jones, Pickard et al. 2008) facing daily dilemmas, tensions and constraints but acting creatively with colleagues to manipulate the situation. Conclusion The creativity and performativity policies were integrated at an organisational level through the construction of a school culture of performance and institutional positioning in an open market but less integrated at the level of pedagogy. Where the merging of the two pedagogies did take place – as in 'smart teaching' - teaching creatively was the preferred form over teaching for creativity. The progression narrative was a major feature around which curriculum and pedagogies were organised but where external performativity dominated such as national testing creative teaching was marginalised to ‘bolt on’ fun time slots

Prospective cohort study of the predictive value of inflammatory biomarkers over clinical variables in children and young people with cancer presenting with fever and neutropenia

Introduction Fever during chemotherapy induced neutropenia is a common and potentially life-threatening complication of the treatment of childhood cancer. Predictions of poor outcome could be enhanced by incorporating serum biomarkers of inflammation at presentation and reassessment. Methods A prospective cohort study was conducted of children under 18 years old, being treated for cancer or a cancer-like condition, who presented with fever (≥ 38.0°C) and neutropenia (neutrophil count < 0.5*10 9/L). Clinical features were recorded, along with three experimental inflammatory biomarkers: procalcitonin (PCT), interleukin-6 (IL-6) and interleukin-8 (IL-8). Outcomes included serious medical complications (SMC): any infection related mortality, critical care and organ support, severe sepsis, septic shock, significant microbiologically defined infection, or radiologically confirmed pneumonia. Results Biomarker assessments were undertaken in 43 episodes of fever and neutropenia, from 31 patients aged between four months and 17 years old (median six years): 20 were female and 22 had acute leukaemia. Five episodes of SMC were noted. PCT, IL-6 and IL-8 had poor individual discriminatory ability (C-statistic 0.48 to 0.60) and did not add to the value of clinical risk stratification tools. Insufficient data were collected to formally assess the value of repeated assessments. Conclusions Incorporating serum biomarkers of inflammation at presentation of episodes of fever with neutropenia in childhood does not clearly improve risk stratification. The value of serial assessments requires further investigation

Quest for certainty regarding early discharge in paediatric low-risk febrile neutropenia : a multicentre qualitative focus group discussion study involving patients, parents and healthcare professionals in the UK

OBJECTIVES: A systematic review of paediatric low-risk febrile neutropenia found that outpatient care is safe, with low rates of treatment failure. However, this review, and a subsequent meta-ethnography, suggested that early discharge of these patients may not be acceptable to key stakeholders. This study aimed to explore experiences and perceptions of patients, parents and healthcare professionals involved in paediatric febrile neutropenia care in the UK. SETTING: Three different centres within the UK, purposively selected from a national survey on the basis of differences in their service structure and febrile neutropenia management. PARTICIPANTS: Thirty-two participants were included in eight focus group discussions. PRIMARY OUTCOMES: Experiences and perceptions of paediatric febrile neutropenia care, including possible future reductions in therapy. RESULTS: Participants described a quest for certainty, in which they attempted to balance the uncertainty involved in understanding, expressing and negotiating risk with the illusion of certainty provided by strict protocols. Participants assessed risk using both formal and informal stratification tools, overlaid with emotional reactions to risk and experiences of risk within other situations. The benefits of certainty provided by protocols were counterbalanced by frustration at their strict constraints. The perceived benefits and harms of previous inpatient care informed participants' appraisals of future treatment strategies. CONCLUSIONS: This study highlighted the previously underestimated harms of admission for febrile neutropenia and the paternalistic nature of decision making, along with the frustrations and challenges for all parties involved in febrile neutropenia care. It demonstrates how the same statistics, generated by systematic reviews, can be used by key stakeholders to interpret risk differently, and how families in particular can view the harms of therapeutic options as different from the outcomes used within the literature. It justifies a reassessment of current treatment strategies for these children and further exploration of the potential to introduce shared decision making

UK paediatric oncology Pneumocystis jirovecii pneumonia surveillance study

BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) is a serious infective complication of immunosuppressive therapy. There are insufficient data concerning the incidence or mortality rate in children undergoing treatment for malignancies and how these may be influenced by prophylaxis. OBJECTIVE: Prospective collection of clinical information for all suspected and proven cases of PJP in children with cancer in the UK and Ireland. DESIGN: A surveillance survey was undertaken using a key contact at each paediatric oncology Principle Treatment Centre (PTC). MAIN OUTCOME MEASURES: To describe the mortality, outcomes and use of prophylaxis in this at-risk group. RESULTS: The study confirms that PJP is rare, with only 32 cases detected in the UK over a 2-year period reported from all 20 PTCs. No deaths were directly attributed to PJP, in contrast to previously reported high mortality rates. Breakthrough infection may occur despite prescription of ostensibly adequate prophylaxis with co-trimoxazole; 11 such cases were identified. Six infections occurred in patients for whom prophylaxis was not thought to be indicated. Two infections occurred in patients for whom prophylaxis was specifically omitted due to concerns about potential bone marrow suppression or delayed engraftment. CONCLUSION: PJP in children treated for malignant disease is rare. Breakthrough infection despite prophylaxis with co-trimoxazole may represent pathogen resistance or non-compliance. Further consideration of the use of PJP prophylaxis during acute myeloid leukaemia and non-Hodgkin's lymphoma treatment is warranted, alongside appraisal of the clinical implications of the possible marrow suppressive effects of co-trimoxazole and its interactions with methotrexate