Exploring aspects of physiotherapy care valued by breast cancer patients

OBJECTIVE: To explore the reported value of physiotherapy care received by patients who had accessed a Specialist Breast Care Physiotherapy Service. DESIGN: Exploratory qualitative study using in-depth interviews to explore aspects of physiotherapy care valued by breast cancer patients. Thematic network analysis was used to interpret the data and bring together the different experiences of the participants and identify common themes. SETTING: Physiotherapy Department at a NHS Foundation Trust Teaching Hospital. PARTICIPANTS: Nineteen participants were recruited and three were selected to take part in the in-depth interviews. All participants had received physiotherapy care from a Specialist Breast Care Physiotherapy Service and had been discharged within the last six months. RESULTS: Participants valued a patient-centred holistic approach to care and access to a Specialist Service with an experienced clinician. In particular the importance of the therapeutic alliance and the value of psychological, emotional and educational support emerged, with the participants feeling empowered in their recovery. CONCLUSION AND CLINICAL IMPLICATIONS: Participants reported an overall positive experience of their physiotherapy care. This study supports the need for service providers to evaluate their current physiotherapy provision and subsequently develop Specialised Services to meet the physiotherapy needs of breast cancer patients throughout all stages of their treatment pathway from the delivery of pre-operative care through to post-treatment follow-up

The influence of portfolio aims and structure on student attitudes towards portfolios as a learning tool: A Literature Review.

Background: Portfolios are widely used in undergraduate health professional education, however the majority of literature suggests that these are poorly received by students, in terms of being an effective learning tool. Objectives: to evaluate whether the aims/purpose or structure/level of standardisation/content of student portfolios influences their attitudes to and perceptions of its use as a learning tool. Major Findings: Aims/purpose and structure/level of standardisation/content of portfolios were analysed in relation to student responses in order to determine any relationship between these. The level of information provided in the studies was variable, making analysis difficult, however there appeared to be no clear link between any of these factors and student responses. The interplay of level of support and guidance, the time required for completion of the portfolio, and the role of assessment appear to have the greatest influence on student views. Conclusions: Considering the wide use of portfolios in health professional education, student support for these is limited, and further research is required to determine if alternative approaches to portfolio learning can positively influence student attitudes and perceptions

Experiences of disabled women during pregnancy, childbirth and early parenting services: implications for occupational therapy

The aim of this study was to understand the experiences of women with physical and sensory disability during their interaction with maternity services. The study was funded by a national charity whose previous research identified that disabled women had more negative experiences than non-disabled women (Birthrights, 2013). This paper specifically discusses implications for occupational therapy. Two-phase, inter-professional mixed methods research was used involving online surveys in phase 1 and narrative interviews in phase 2. Recruitment was through disability and parenting networks and social media. Survey data were analysed descriptively and open questions were themed. Phase 2 telephone interviews were audio recorded, transcribed verbatim and analysed thematically. Although overall satisfaction with care was scored highly in phase 1, negative experiences were described. Key challenges included a lack of continuity of carer; women feeling that they were not being listened to; feeling they were treated less favourably because of disability; and 56% feeling that maternity care providers did not have appropriate attitudes to disability. Interview themes echoed these, when women described implications of not being listened to, including that their judgement about their own bodies was ignored or undermined. The research revealed that occupational therapists did little to support women during this time. While some occupational therapy input was described, this focused on equipment provision. Minimal support with the occupations of parenting was described. The results suggest a clear need for interprofessional working and the need for occupational therapists to liaise between midwifery staff and disabled women

Understanding the value of a doctorate for allied health professionals in practice in the UK: a survey

Background The need to transform the United Kingdom’s (UK) delivery of health and care services to better meet population needs and expectations is well-established, as is the critical importance of research and innovation to drive those transformations. Allied health professionals (AHPs) represent a significant proportion of the healthcare workforce. Developing and expanding their skills and capabilities is fundamental to delivering new ways of working. However, career opportunities combining research and practice remain limited. This study explored the perceived utility and value of a doctorate to post-doctoral AHPs and how they experience bringing their research-related capabilities into practice environments. Methods With a broadly interpretivist design, a qualitatively oriented cross-sectional survey, with closed and open questions, was developed to enable frequency reporting while focusing on the significance and meaning participants attributed to the topic. Participants were recruited via professional networks and communities of practice. Descriptive statistics were used to analyse closed question responses, while combined framework and thematic analysis was applied to open question responses. Results Responses were received from 71 post-doctoral AHPs located across all four UK nations. Findings are discussed under four primary themes of utilisation of the doctorate; value of the doctorate; impact on career, and impact on self and support. Reference is also made at appropriate points to descriptive statistics summarising closed question responses. Conclusion The findings clearly articulate variability of experiences amongst post-doctoral AHPs. Some were able to influence team and organisational research cultures, support the development of others and drive service improvement. The challenges, barriers and obstacles encountered by others reflect those that have been acknowledged for many years. Acknowledging them is important, but the conversation must move forward and generate positive action to ensure greater consistency in harnessing the benefits and value-added these practitioners bring. If system-wide transformation is the aim, it is inefficient to leave navigating challenges to individual creativity and tenacity or forward-thinking leaders and organisations. There is an urgent need for system-wide responses to more effectively, consistently and equitably enable career pathways combining research and practice for what is a substantial proportion of the UK healthcare workforce

Prevention and early detection of prostate cancer

This Review was sponsored and funded by the International Society of Cancer Prevention (ISCaP), the European Association of Urology (EAU), the National Cancer Institute, USA (NCI) (grant number 1R13CA171707-01), Prostate Cancer UK, Cancer Research UK (CRUK) (grant number C569/A16477), and the Association for International Cancer Research (AICR

Blood pressure and risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition.

Elevated blood pressure has been implicated as a risk factor for renal cell carcinoma (RCC), but prospective studies were confined to men and did not consider the effect of antihypertensive medication. The authors examined the relation among blood pressure, antihypertensive medication, and RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). Blood pressure was measured in 296,638 women and men, recruited in eight European countries during 1992-1998, 254,935 of whom provided information on antihypertensive medication. During a mean follow-up of 6.2 years, 250 cases of RCC were identified. Blood pressure was independently associated with risk of RCC. The relative risks for the highest versus the lowest category of systolic (>/=160 mmHg vs. /=100 mmHg vs. <80 mmHg) blood pressures were 2.48 (95% confidence interval: 1.53, 4.02) and 2.34 (95% confidence interval: 1.54, 3.55). Risk estimates did not significantly differ according to sex or use of antihypertensive medication. Individuals taking antihypertensive drugs were not at a significantly increased risk unless blood pressure was poorly controlled. These results support the hypothesis that hypertension, rather than its medications, increases the risk of RCC in both sexes, while effective blood pressure control may lower the risk. Udgivelsesdato: 2008-Feb-1

Insulin-like growth factor-binding protein-2 promotes prostate cancer cell growth via IGF-dependent or -independent mechanisms and reduces the efficacy of docetaxel

Background: The development of androgen independence, chemo-, and radioresistance are critical markers of prostate cancer progression and the predominant reasons for its high mortality. Understanding the resistance to therapy could aid the development of more effective treatments. Aim: The aim of this study is to investigate the effects of insulin-like growth factor-binding protein-2 (IGFBP-2) on prostate cancer cell proliferation and its effects on the response to docetaxel. Methods: DU145 and PC3 cells were treated with IGFBP-2, insulin-like growth factor I (IGF-I) alone or in combination with blockade of the IGF-I receptor or integrin receptors. Cells were also treated with IGFBP-2 short interfering ribonucleic acid with or without a PTEN (phosphatase and tensin homologue deleted on chromosome 10) inhibitor or docetaxel. Tritiated thymidine incorporation was used to measure cell proliferation and Trypan blue cell counting for cell death. Levels of IGFBP-2 mRNA were measured using RT-PCR. Abundance and phosphorylation of proteins were assessed using western immunoblotting. Results: The IGFBP-2 promoted cell growth in both cell lines but with PC3 cells this was in an IGF-dependent manner, whereas with DU145 cells the effect was independent of IGF receptor activation. This IGF-independent effect of IGFBP-2 was mediated by interaction with β-1-containing integrins and a consequent increase in PTEN phosphorylation. We also determined that silencing IGFBP-2 in both cell lines increased the sensitivity of the cells to docetaxel. Conclusion: The IGFBP-2 has a key role in the growth of prostate cancer cells, and silencing IGFBP-2 expression reduced the resistance of these cells to docetaxel. Targeting IGFBP-2 may increase the efficacy of docetaxel.7 page(s

Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study

Objective To examine the association between pre-diagnostic circulating vitamin D concentration, dietary intake of vitamin D and calcium, and the risk of colorectal cancer in European populations