Multidisciplinary Team Meetings as Care in Practice: an ethnography of hospital and community palliative care in the UK

Background: Palliative care often involves the use of Multidisciplinary Team Meetings (MDTs), aimed at improving quality and continuity of care. Key to these meeting is the communication about complex cases; yet within the meetings, specific problems may go unresolved and categorical decisions may not be made. Therefore, what are the MDTs for and what do they do? Aims: We take the MDTs of two palliative care teams within the same UK NHS (National Health Service) Trust covering acute and community settings as an ethnographic object, to explore what kind of work is done within them and with what effects. We seek to better understand if and how these meetings and teamwork provide care for patients at the end of life. Methods: This paper draws on the analysis of over 60 MDTs, observed as part of a larger ethnographic study about forms of care within palliative care. This research, spanning 17 months since May 2018, consisted of shadowing of staff members, and interviews with staff members and patients. Fieldnotes of the meetings were written up during or after the meeting. Emerging themes were identified through coding and memo-ing the material in NVivo 12, informed by practice theory. Results: The primary practice takes the shape of ‘feeling one’s way’ together through: complex cases; individual and the team members’ needs to continue performing under mounting work and resource pressures; anticipations of future demands of measuring the work the team provides. While acknowledged and appreciated by all team members as a central part of their daily work, this MDT work is not readily captured as a visible form of patient care, both from patient and carer perspectives, nor from resource planning measures that determine the staff levels. Discussion: We argue that there is a need to appreciate and articulate this work as care for different and shifting set of recipients: the patient, the individual team members, the team process, and the meeting itself

Multidisciplinary team meetings in palliative care: an ethnographic study

Objectives Multidisciplinary team meetings are a regular feature in the provision of palliative care, involving a range of professionals. Yet, their purpose and best format are not necessarily well understood or documented. This article describes how hospital and community-based palliative care multidisciplinary team meetings operate to elucidate some of their main values and offer an opportunity to share examples of good practice. Methods Ethnographic observations of over 70 multidisciplinary team meetings between May 2018 and January 2020 in hospital and community palliative care settings in intercity London. These observations were part of a larger study examining palliative care processes. Fieldnotes were thematically analysed. Results This article analyses how the meetings operated in terms of their setup, participants and general order of business. Meetings provided a space where patients, families and professionals could be cared for through regular discussions of service provision. Conclusions Meetings served a variety of functions. Alongside discussing the more technical, clinical and practical aspects that are formally recognised aspects of the meetings, an additional core value was enabling affectual aspects of dealing with people who are dying to be acknowledged and processed collectively. Insight into how the meetings are structured and operate offer input for future practice

Apert syndrome: the Paris and Rotterdam philosophy

Introduction: Apert syndrome is a rare type of syndromic craniosynostosis. Patients have an explicit phenotype with craniofacial dysmorphologies and severe symmetrical syndactyly of the hands and feet. This review includes background information about the syndrome and several aspects of the treatment. Areas covered: The cause of Apert syndrome is found in unique mutations in the Fibroblast Growth Factors Receptor (FGFR) 2 gene in 99%. It results in cranial suture fusion, craniofacial dysmorphologies and severe symmetrical syndactyly of the hands and feet. Patients with Apert syndrome are at risk for mental retardation, mobility impairment and intracranial hypertension (ICHT). This is the result of a complex interaction between (1) abnormal skull growth, (2) ventriculomegaly, (3) venous outflow obstruction and (4) obstructive sleep apnea (OSA). Mental retardation is mainly determined by the FGFR2 mutation and treatment is directed at protecting the intrinsic potential of neurocognition. Expert Opinion: To prevent ICHT, we prefer an occipital expansion in the first year of life. Screening on ICHT and its underlying causes is necessary at least until the age of ten by means of skull circumference measurements, fundoscopy, optical coherence tomography, MRI and polysomnography. Multicentre studies on long-term outcome are required to validate the rationale of different clinical protocols

Students' attitudes towards the introduction of a Personal and Professional Development portfolio: potential barriers and facilitators

Peer reviewedPublisher PD

Governing and accelerating transformative entrepreneurship: exploring the potential for small business innovation on urban sustainability transitions

The alluring yet nebulous concept of transformative change is increasingly gaining traction in conversations about pathways to more sustainable futures. As such, new conceptual tools are needed to illuminate variety of actors, interests, and capacities at play in potentially radical experiments. This paper draws upon multi-level governance theory, sustainability transitions scholarship, and sustainability entrepreneurship literature, to interrogate the transformative potential of small and medium-sized enterprises (SMEs). We (1) identify characteristics of SMEs that might make them relatively more able to produce radical innovations, (2) explore dimensions of the broader socio-political context that influence the likelihood of this potential to be translated into action in urban spaces, and (3) discuss implications of these dynamics for transformative sustainability governance

Governing and accelerating transformative entrepreneurship: exploring the potential for small business innovation on urban sustainability transitions

The alluring yet nebulous concept of transformative change is increasingly gaining traction in conversations about pathways to more sustainable futures. As such, new conceptual tools are needed to illuminate variety of actors, interests, and capacities at play in potentially radical experiments. This paper draws upon multi-level governance theory, sustainability transitions scholarship, and sustainability entrepreneurship literature, to interrogate the transformative potential of small and medium-sized enterprises (SMEs). We (1) identify characteristics of SMEs that might make them relatively more able to produce radical innovations, (2) explore dimensions of the broader socio-political context that influence the likelihood of this potential to be translated into action in urban spaces, and (3) discuss implications of these dynamics for transformative sustainability governance

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers

Introduction: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. Methods: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. Results: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. Conclusions: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.Peer reviewe