Breast cancer and hair loss: Experiential similarities and differences in men and women's narratives

The file attached to this record is the author's final peer reviewed versionBackground: There are relatively few studies comparing men and women’s breast cancer experiences. Furthermore, men’s experiences of cancer treatment-induced alopecia have received scant academic attention compared to those of women. Objective: To explore experiences of treatment-induced alopecia in both sexes and highlight ways in which they might be supported when undergoing breast cancer treatment. Methods: Qualitative interviews and photographic data taken from two separate experiential inquiries were analysed together, focussing on references made to treatment-induced alopecia in women’s and men’s breast cancer accounts. Results: Hair loss was described as distressing by both sexes, affecting gendered identities and relationships. Men typically discussed losing body hair, whereas women rarely referred to body hair explicitly, underlining gendered aspects of their experiences. Differences were noted in coping strategies, with men using humour and asserting their masculinity. Women were better able to disguise hair loss, while men were forced to reveal their hairlessness. Conclusions: The findings contribute a nuanced understanding of the experience of treatment-induced alopecia for both men and women, which will help to improve their care during cancer treatment. Implications for Practice: Healthcare professionals should provide information about the possible implications of cancer-related alopecia for identities and social relationships for both sexes. Highlighting marked gender differences in cancer-related hair loss, advice and support specific to men’s needs would be particularly beneficial, enabling greater gender equality in clinical practice. Understanding the coping strategies employed by both sexes in relation to hair loss will help healthcare professionals to identify and address any underlying patient distress

The Good, the Bad and the Ugly: Femininity and the ‘need’ for breast implants

In 2011, the Poly Implant Prothèse (PIP) scandal generated a public debate in which the deliberate fraudulent actions of a company that profited through the production and sale of a dangerous medical device came to include a questioning of the morality of, and sometimes even vilification of, those who had had such devices implanted in their bodies. In this debate, the social meanings that attach to breasts and to breast implants came to the fore. This paper draws on empirical research with women who have had breast augmentation surgery to consider the various ways in which they position themselves in relation to these debates, and so with the imagined boundaries between‘cosmetic’ and ‘reconstructive’ breast surgery, and between medicine and beauty. It argues that women face risks and dangers if they have or do not have breast surgery, for the lines drawn in relation to breast surgery reflect and reinforce boundaries between good and bad femininity

VOICE: A communication skills training intervention using conversation analysis and simulated interaction

This manual describes the process of developing simulation training to be used in a communication skills training course. The underpinning principle is the use of conversation analysis to enhance simulated interactions. The training uses scenarios based on video data of actual interactions along with transcripts that have been closely examined. The aim is to create authentic experiential learning opportunities for people who want to improve their communication skills

The RETurn to work After stroKE (RETAKE) trial: findings from a mixed-methods process evaluation of the Early Stroke Specialist Vocational Rehabilitation (ESSVR) intervention.

Introduction: A key goal for working age stroke survivors is to return to work, yet only around 50% achieve this at 12 months. Currently, there is limited evidence of effectiveness of early stroke-specialist vocational rehabilitation (ESSVR) interventions from randomised controlled trials. This study examined fidelity to ESSVR and explored social and structural factors which may have influenced implementation in the RETurn to work After stroKE (RETAKE) randomised controlled trial. Methods: Mixed-methods process evaluation assessing intervention fidelity and incorporating longitudinal case-studies exploring stroke survivors’ experiences of support to return to work. Normalisation Process Theory, and the Conceptual Model for Implementation Fidelity, informed data collection and analysis.Results: Sixteen sites across England and Wales participated in RETAKE. Forty-eight occupational therapists (OTs), supported by 6 mentors experienced in vocational rehabilitation (VR), delivered the intervention (duration 12 months) between February 2018 and April 2022. Twenty-six participants (15 ESSVR, 11 usual care (UC)) were included in longitudinal case-studies. An additional 18 participants (8 ESSVR and 10 UC) were interviewed once. Nineteen OTs, 6 mentors and 19 service managers were interviewed. Fidelity was measured for 39 ESSVR participants; mean fidelity score was 78.8% (SD:19.2%, range 31-100%). Comparison of the experiences of ESSVR and UC participants indicated duration and type of support to return to work were perceived to be better for ESSVR participants. They received early, co-ordinated support including employer liaison and workplace adjustments where appropriate. In contrast, UC participants reported limited or no VR or return to work support from health professionals. Typically, UC support lasted 2-8 weeks, with poor communication and co-ordination between rehabilitation providers. Mentor support for OTs appeared to increase fidelity. Service managers indicated ESSVR would enhance post-stroke services.Conclusions: ESSVR was valued by participants and was delivered with fidelity; implementation appeared to be facilitated by mentor support for OTs. <br/

Managing knowledge and managing knowledge work: what we know and what the future holds

In this paper we review the recent IS literature on knowledge and consider different assumptions that underpin different approaches to this broad research area. In doing this we contrast those who focus on knowledge management with those who focus on knowing as practice and examine how contexts, processes and purposes need to be considered whichever approach to knowledge one is adopting. We also identify how recent IT developments, especially in relation to social software and the digitization of everything, are presenting new opportunities (and challenges) for how organizations can manage both knowledge and knowledge work. This presents IS scholars with new research agendas for examining and understanding the relationships between technology, organization and society

Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis

IF 79.258 (2017)International audienceBackgroundAcute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial.MethodsIn a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy). The failure stage of the RIFLE classification system is characterized by a serum creatinine level 3 times the baseline level (or ≥4 mg per deciliter with a rapid increase of ≥0.5 mg per deciliter), urine output less than 0.3 ml per kilogram of body weight per hour for 24 hours or longer, or anuria for at least 12 hours. The primary outcome was death at 90 days.ResultsThe trial was stopped early for futility after the second planned interim analysis. A total of 488 patients underwent randomization; there were no significant between-group differences in the characteristics at baseline. Among the 477 patients for whom follow-up data at 90 days were available, 58% of the patients in the early-strategy group (138 of 239 patients) and 54% in the delayed-strategy group (128 of 238 patients) had died (P=0.38). In the delayed-strategy group, 38% (93 patients) did not receive renal-replacement therapy. Criteria for emergency renal-replacement therapy were met in 17% of the patients in the delayed-strategy group (41 patients).ConclusionsAmong patients with septic shock who had severe acute kidney injury, there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal-replacement therapy and those who were assigned to a delayed strategy. (Funded by the French Ministry of Health; IDEAL-ICU ClinicalTrials.gov number, NCT01682590.

Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review

Abstract Background This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery. Methods Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training. Discussion Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one’s feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. Summary We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods