99 research outputs found

    Fixing change – An ethnographic study of child protection practice

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    This thesis is concerned with the methods that accomplish a central project of child protection social work, parental self-transformation. Face-to-face practice in child protection has rarely been described in terms of the lived organisational detail of the professional methods in and through which it is accomplished. That this detail is missed is a central analytic matter, but also results in misplaced exhortations to practitioners that fail to incorporate the realities of practice. This thesis recovers the situated detail of ‘change methods’ in child protection practice by describing the interactional work through which change, or lack thereof, is achieved. ‘Change methods’ refer to the methodical ways in which social workers, parents and professionals accomplish parental selves as workable objects. These include the interactional forms in which allegations of deviance are produced and dealt with, and those through which institutional trajectories of change, or lack thereof are accomplished. The term ‘fixing’ here refers to the work that goes into accomplishing a parental identity as workable, or not, by making it appear static, as a basis from which to proceed. This thesis contributes to rethinking existing approaches to social work research by drawing together ethnographic and ethnomethodological insights. Through ethnomethodological ethnography, it pays close attention to the ‘change methods’ in and through which parental transformation is accomplished interactionally over time. Shadowing social workers as they worked with five families over the course of ten months made it possible to stay with the phenomenon of child protection change methods. Attending to members’ categorisation practices made it possible to show 1. How social workers delimit and enable parental change; 2. How accounts of parental change are achieved in and through normative categorisation practices over time; and 3. Some of the professional methods involved in charting and accounting for such change. Through describing the observable professional logics in action, it is possible to see that the moral work of parental self-transformation, is not simply ‘done by’ social workers but is the very stuff of child protection social work

    Normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery (thermic-2):study protocol for a randomized controlled trial

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    BACKGROUND: During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body (“perfusion”) while the heart is stopped. Typically the blood is cooled during this procedure (“hypothermia”) and warmed to normal body temperature once the operation has been completed. The main rationale for “whole body cooling” is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body’s metabolic rate and decreasing oxygen consumption. However, hypothermic perfusion also has disadvantages that can contribute toward an extended postoperative hospital stay. Research in adults and small randomized controlled trials in children suggest some benefits to keeping the blood at normal body temperature throughout surgery (“normothermia”). However, the two techniques have not been extensively compared in children. OBJECTIVE: The Thermic-2 study will test the hypothesis that the whole body inflammatory response to the nonphysiological bypass and its detrimental effects on different organ functions may be attenuated by maintaining the body at 35°C-37°C (normothermic) rather than 28°C (hypothermic) during pediatric complex open heart surgery. METHODS: This is a single-center, randomized controlled trial comparing the effectiveness and acceptability of normothermic versus hypothermic bypass in 141 children with congenital heart disease undergoing open heart surgery. Children having scheduled surgery to repair a heart defect not requiring deep hypothermic circulatory arrest represent the target study population. The co-primary clinical outcomes are duration of inotropic support, intubation time, and postoperative hospital stay. Secondary outcomes are in-hospital mortality and morbidity, blood loss and transfusion requirements, pre- and post-operative echocardiographic findings, routine blood gas and blood test results, renal function, cerebral function, regional oxygen saturation of blood in the cerebral cortex, assessment of genomic expression changes in cardiac tissue biopsies, and neuropsychological development. RESULTS: A total of 141 patients have been successfully randomized over 2 years and 10 months and are now being followed-up for 1 year. Results will be published in 2015. CONCLUSIONS: We believe this to be the first large pragmatic study comparing clinical outcomes during normothermic versus hypothermic bypass in complex open heart surgery in children. It is expected that this work will provide important information to improve strategies of cardiopulmonary bypass perfusion and therefore decrease the inevitable organ damage that occurs during nonphysiological body perfusion. TRIAL REGISTRATION: ISRCTN Registry: ISRCTN93129502, http://www.isrctn.com/ISRCTN93129502 (Archived by WebCitation at http://www.webcitation.org/6Yf5VSyyG)
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