Why do we read illness stories? Paul Kalanithi’s When Breath Becomes Air (2016) read in the light of Rita Felski

Why do we read pathographies and why have they become so popular? These are the key questions in our paper. In answering these, we will introduce and discuss Rita Felski’s The Uses of Literature (2008) in connection to the American bestseller and Pulitzer prize finalist pathography When Breath Becomes Air (2016) by Paul Kalanithi. We chose Kalanithi’s book because we consider it in many ways typical of the pathographical genre with its first-person narrator, the frequent expression of shock, its reflections on meaning of the illness and the focus on daily life. Rita Felski’s The uses of literature reflects by means of the four concepts knowledge, recognition, shock and enchantment upon what makes us want to read a certain book or genre. However, when working with Kalanithi´s novel we soon found that Felski´s four modes were not only meaning-making for enlightening the question on why we as readers turn to this book. We soon also found that recognition, enchantment, knowledge and shock were concepts that were relevant used in connection with Kalanithi´s own experience of becoming ill and being a patient. The concepts, therefore, seem most useful for reflections on both the reader’s response and the author drives of the pathography genre

Personal continuity of GP care and outpatient specialist visits in people with type 2 diabetes: A cross-sectional survey

Background - Continuity of care is particularly important for patients with chronic conditions, such as type 2 diabetes (T2D). Continuity is shown to reduce overall health service utilization among people with diabetes, however, evidence about how it relates to the utilization of outpatient specialist services in Norway is lacking. The aim of this study was to investigate continuity of GP care for people with T2D, and its association with the use of outpatient specialist health care services. Methods - We used e-mail questionnaire data obtained from members of The Norwegian Diabetes Association in 2018. Eligible for analyses were 494 respondents with T2D and at least one GP visit during the previous year. By descriptive statistics and logistic regressions, we studied usual provider continuity (UPC) and duration of the patient-GP relationship and associations of these measures with somatic outpatient specialist visits. Analyses were adjusted for gender, age, education, self-rated health, and diabetes duration. Results - Mean age was 62.6 years and mean UPC was 0.85 (CI 0.83–0.87). Two thirds of the sample (66.0%) had made all visits to the regular GP during the previous year (full continuity). Among these, 48.1% had made one or more specialist visits during the previous year, compared to 65.2% among those without full continuity. The probability of outpatient specialist visits was significantly lower among participants with full continuity, compared to those without full continuity (Odds Ratio 0.53, Confidence Interval 0.35–0.80). The probability of visiting outpatient specialist services was not associated with duration of the patient-GP relationship. Conclusions - We conclude that continuity of care, as measured by Usual Provider Continuity, is high and associated with reduced use of somatic outpatient specialist services in people with T2D in Norway. Continuity and its benefits will become increasingly important as the number of older people with diabetes and other chronic diseases increases

“I base my life on sadness”: Apparently paradoxical sources of resilience among young Haitians

Haitian expressions of resilience also hold deep knowledge of human vulnerability. This longitudinal, qualitative study with young Haitians from urban shantytowns combines ethnographic and participatory methods to explore the complexities behind such idioms. Artistic and creative products made by or with the youth facilitated interviews, focus group discussions, and workshops. Through the life stories of participants and rich ethnographic material, this study presents locally situated idioms of resilience (and distress). By including local social ecology, the idioms were framed as historically and culturally rooted, thus shaping contextual, pragmatic, and gendered coping strategies grounded in embodied experiences of vulnerability and resistance. The study adds essential insights into Haitian resilience, revealing the local logics behind seemingly paradoxical statements. By drafting a conceptual framework for further studies on idioms of resilience, the study also makes a theoretical contribution to international resilience research

Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership

Background International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. Aim To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. Design and setting Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. Method Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. Results Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non- specific symptoms, primary care practitioner decision- making autonomy, direct access to investigations, and use of emergency routes. Conclusion Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice

Variation in suspected cancer referral pathways in primary care:comparative analysis across the International Benchmarking Cancer Partnership

BACKGROUND: International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. AIM: To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. DESIGN AND SETTING: Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. METHOD: Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. RESULTS: Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations, and use of emergency routes. CONCLUSION: Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

A doctor close at hand : a qualitative analysis of GPs' work in cancer care

Summary of thesis The core of medicine, even specialized and high-tech medicine, is a meeting, a consultation, between a human being asking for advice and another human being, whose knowledge and experience is expected to be helpful. This thesis explores how the suspicion of cancer can arise in such a consultation, how general practitioners (GPs) can contribute to cancer care and how GPs might accompany people with cancer towards the end of life. 25 qualitative interviews with Norwegian GPs about diagnosing and attending people with cancer through the course of illness were analyzed. Besides clinical assessments and paperwork, the GPs often acted as intermediaries between the patient and the hospital. They pushed for quick hospital appointments, interpreted and translated discharge letters and were asked for second opinions. In rural areas some GPs offered cytostatic treatments. Knowing the patient and preferably also the family was seen as a premise for being a good GP. In the researcher’s interpretation, the GPs were well acquainted both with the patients’ world and with the clinical world. They could act as guides for their patients, but their personal knowledge of patients could, even if it was clinically relevant, be given less weight when confronted with hospital routines and criteria. This could lead to conflicting loyalties for the GPs. During end-of-life care in the patients’ homes, existential conversations were seen as demanding but rewarding. Palliation of pain was an easy task compared to being a fellow human being, listening and attempting to comfort a person who is afraid to die

Agenda navigation in consultations covering multiple topics. A qualitative case study from general practice

Objective To explore how agenda navigation may be accomplished underway in consultations covering multiple topics, we identified and analyzed one GP’s communicative strategies. Design, setting, and subjects A qualitative observational case study with linguistic microanalysis of an exemplary consultation between a female patient with diabetes and her male GP. We used speech act theory to identify communicative actions that indicated agenda navigation by the GP in transitions between episodes concerning ten topics. Results Microanalysis revealed different aspects of agenda navigation by the GP using speech acts, especially ways of opening or closing an episode. The opening of episodes was characterized by speech acts accepting the patient’s request to discuss a topic, mostly at the beginning of the consultation. Speech acts to inform or to request information from the patient dominated later in the consultation. The GP closed all episodes using speech acts to instruct or appraise the patient, or to make agreements and plans. Conclusion and practice implications Skilful agenda navigation is an important tool for consultations covering multiple issues and could be further developed for medical education. The opening and closing of episodes were vital communicative strategies supporting patient-centered communication in a complex consultation while maintaining the focus of the consultation agenda.publishedVersio