An exploration of the use of infant observation methods to research the identities of severely learning disabled adolescents and to enhance relationship-based practice for professional social work practice

This paper considers how infant observation methods may be adapted to explore and research the identities of severely learning disabled adolescents, a group of young people whose experiences are poorly represented in the literature. Through focusing on emotion and relationship, this ‘practice-near’ research method also offers a way for social workers to develop their reflective capacity in relation to the often hidden, uncomfortable emotions aroused by experiencing impairment and difference, but without the defences usually involved in assuming the professional role. The importance of taking time to get on a disabled child’s ‘wavelength’ is illustrated through extracts from the research which show how a young person’s agency and identity can be appreciated. The method also has the potential to develop social workers’ awareness of the powerful undercurrent of emotions apparent at times within families of severely disabled young people and tentative suggestions are made about the projective processes and hidden hostilities at work within one of the families observed as part of the research project. Professionals may be able to use this knowledge to become resilient and reflective practitioners and the observation method itself has something to offer by way of a containing experience for families

First-line therapy for ovarian cancer with carboplatin followed by paclitaxel-gemcitabine (SCOTROC5): A feasibility study and comparative analysis of the SCOTROC series

Background: We have conducted a series of four feasibility studies in stage Ic–IV ovarian cancer exploring six sequential first-line schedules with the same entry criteria in a total of 339 patients. Here we present the results of the sixth study, and an analysis of the overall series. Methods: In this trial patients received 4 cycles of carboplatin AUC 7 every 3 weeks, followed by 4 cycles of concurrent paclitaxel 175 mg/m2 (day 1) and gemcitabine 1000 mg/m2 (days 1 and 8) every 3 weeks. The primary end-point of the trial was feasibility of administering all cycles of planned chemotherapy to >60% of patients. Results: Fifty-four patients were recruited to the trial between June 05 and June 06. A total of 40 (74.1%) patients received all 8 cycles of treatment. Reasons for early discontinuation included toxicity (n = 8) and disease progression (n = 4). The overall response rate was 73.7%, and the median progression free survival (PFS) was 14.2 months with a median follow-up of 24 months. A comparative analysis of all six regimens from the SCOTROC series suggests that the sequential schedule in which paclitaxel was given weekly (median PFS 19.5 m) is most effective.1 Conclusion: The sequential schedule explored in this trial is feasible, but comparative efficacy analysis suggests that trials involving weekly paclitaxel should be prioritised for further study

No supportive evidence for clinical benefit of routine follow-up in ovarian cancer: a Dutch multicenter study

Contains fulltext : 97161.pdf (publisher's version ) (Closed access)INTRODUCTION: Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival. METHODS: All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method. RESULTS: The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P = 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P = 0.26). CONCLUSIONS: Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias