Early-treatment stage for adolescents with depression and their parents: An IPSE qualitative study.

The period at the start of treatment of adolescents with depression is both crucial and complex. Adolescents' and parents' perspectives on that early-treatment stage are important but have not yet been explored. The present study explores the lived experience of the early-treatment stage among adolescents with major depressive disorder and their parents and aims to cross their perspectives. This French qualitative multicentre study followed the five stages IPSE approach. Semi-structured interviews with adolescents with depression and with their parents were conducted. Data collection by purposive sampling continued until we reached theoretical sufficiency. Forty-seven participants-20 adolescents, 27 parents-were included. Data analysis produced a structure of lived experience based on two axes: (1) what leads to care: what is shown, what is seen, describing a dynamic process of showing and seeing around the start of treatment and (2) the start of treatment: knowing and sharing everyone's explanations. Results suggest some early therapeutic alliance facilitators, that is, first to be able to see the depressive manifestations and directly address the issue of depression based on what is shown and seen, second to give the opportunity to both adolescents and parents to share their views and explanations about the adolescent's distress, and finally to explicitly name this distress depression to first agree on the term to use.

A specific method for qualitative medical research: the IPSE (Inductive Process to analyze the Structure of lived Experience) approach.

BACKGROUND: This paper reports the construction and use of a specific method for qualitative medical research: The Inductive Process to Analyze the Structure of lived Experience (IPSE), an inductive and phenomenological approach designed to gain the closest access possible to the patients' experience and to produce concrete recommendations for improving care. This paper describes this innovative method. METHODS: IPSE has five steps: 1) set up a research group, 2) ensure the originality of the research, 3) organize recruitment and sampling intended to optimize exemplarity, 4) collect data that enable entry into the subjects' experience, and 5) analyze the data. This final stage is composed of one individual descriptive phase, followed by two group phases: i) structure the experience, and ii) translate the findings into concrete proposals that make a difference in care. RESULTS: This innovative method has provided original findings that have opened up new avenues of research and have important practical implications, including (1) the development of patient-reported outcomes, (2) clinical recommendations concerning assessment and treatment, (3) innovative ways to improve communication between patients and doctors, and (4) new insights for medical pedagogy. CONCLUSIONS: IPSE is a qualitative method specifically developed for clinical medical research to reach concrete proposals, easily combined with quantitative research within a mixed-method study design and then directly integrated within evidence-based medicine.

The Lived Experience of First-Episode Psychosis: A Systematic Review and Metasynthesis of Qualitative Studies.

Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family's perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications.

Nursing Care in Dermatologic Oncology: a Qualitative Study.

Nurses in hospital dermatology departments must increasingly provide care for patients with skin cancer. Although the experience of oncology nurses in numerous specialties has been widely explored, no study has focused on the experience of nurses in dermatologic oncology. We aimed to explore how nurses experience their care for patients with skin cancer. This is an inductive, exploratory study employing semi-structured interviews and focus groups with nurses, followed by thematic analysis. The study included purposive sample of 14 nurses practicing in different sectors of this dermatology department. Data were collected via two focus groups of six nurses each and 14 individual, semi-structured interviews, both using a researcher-developed interview guide. Interviews were transcribed and analyzed with thematic analysis. The most illustrative quotes were translated into English. Nurses' experiences of providing care in dermatologic oncology are organized around two themes: (1) their practices for these patients and (2) their management of emotional distress as the major issue in care, especially at night. Our results show the predominant place of relationships with patients in nurses' practices and of their emotional distress due to their closeness to the patients. Specific and original aspects have also been demonstrated with practical implications to be drawn for nurses' supportive care role: the distress engendered by the specific and harrowing experience of nurses dealing with skin cancer, which can be both seen and smelled.

Physicians' Perspectives About Burnout: a Systematic Review and Metasynthesis.

BACKGROUND: Doctors' burnout is a major public health issue with important harmful effects on both the healthcare system and physicians' mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field. OBJECTIVE: To explore physicians' perspectives on burnout by applying a metasynthesis approach, including a systematic literature review and analysis of the qualitative studies. DATA SOURCES: Medline, PsycINFO, EMBASE, and SSCI from the earliest available date to June 2018 REVIEW METHODS: This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting doctors' perspectives on burnout. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. RESULTS: Thirty-three articles were included, covering data from more than 1589 medical doctors (68 residents and 1521 physicians). Two themes emerged from the analysis: (1) stress factors promoting burnout-ranked as organizational, then contextual and relational, and finally individual-factors and (2) protective factors, which were above all individual but also relational and organizational. CONCLUSIONS: The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors' burnout.

Double-hit or dual expression of MYC and BCL2 in primary cutaneous large B-cell lymphomas.

In nodal diffuse large B-cell lymphoma, the search for double-hit with MYC and BCL2 and/or BCL6 rearrangements or for dual expression of BCL2 and MYC defines subgroups of patients with altered prognosis that has not been evaluated in primary cutaneous large B-cell lymphoma. Our objectives were to assess the double-hit and dual expressor status in a cohort of 44 patients with primary cutaneous large B-cell lymphoma according to the histological subtype and to evaluate their prognosis relevance. The 44 cases defined by the presence of more than 80% of large B-cells in the dermis corresponded to 21 primary cutaneous follicle centre lymphoma with large cell morphology and 23 primary cutaneous diffuse large B-cell lymphoma, leg type. Thirty-one cases (70%) expressed BCL2 and 29 (66%) expressed MYC. Dual expressor profile was observed in 25 cases (57%) of either subtypes (n = 6 or n = 19, respectively). Only one primary cutaneous follicle centre lymphoma, large-cell case had a double-hit status (2%). Specific survival was significantly worse in primary cutaneous diffuse large B-cell lymphoma, leg type than in primary cutaneous follicle centre lymphoma, large cell (p = 0.021) and for the dual expressor primary cutaneous large B-cell lymphoma group (p = 0.030). Both overall survival and specific survival were worse for patients belonging to the dual expressor primary cutaneous diffuse large B-cell lymphoma, leg type subgroup (p = 0.001 and p = 0.046, respectively). Expression of either MYC and/or BCL2 negatively impacted overall survival (p = 0.017 and p = 0.018 respectively). As the differential diagnosis between primary cutaneous follicle centre lymphoma, large cell and primary cutaneous diffuse large B-cell lymphoma, leg type has a major impact on prognosis, dual-expression of BCL2 and MYC may represent a new diagnostic criterion for primary cutaneous diffuse large B-cell lymphoma, leg type subtype and further identifies patients with impaired survival. Finally, the double-hit assessment does not appear clinically relevant in primary cutaneous large B-cell lymphoma.

Patients' quality of life during active cancer treatment: a qualitative study.

BACKGROUND: Patients' quality of life has become a major objective of care in oncology. At the same time, it has become the object of increasing interest by researchers, working with both quantitative and qualitative methods. Progress in oncology has enabled more patients to survive longer, so that cancer is increasingly often a chronic disease that requires long-term treatment that can have negative effects on patients' quality of daily life. Nonetheless, no qualitative study has explored what patients report affects their quality of daily life during the treatment period. This study is intended to fill this gap. METHODS: We conducted a multicenter qualitative study based on 30 semi-structured interviews. Participants, purposively selected until data saturation, had diverse types of cancer and had started treatment at least 6 months before interview. Data were examined by thematic analysis. RESULTS: Our analysis found two themes: (1) what negatively affected for patient's quality of daily life during the treatment period, a question to which patients responded by talking only about the side effects of treatment; and (2) what positively affected their quality of daily life during the treatment period with three sub-themes: (i) The interest in having -investing in - a support object that can be defined as an object, a relationship or an activity particularly invested by the patients which makes them feel good and makes the cancer and its treatment bearable, (ii)The subjective perception of the efficacy of the antitumor treatment and (iii) the positive effects of relationships, with friends and family, and also with their physician. CONCLUSIONS: Patients must be involved in their care if they are to be able to bear their course of treatment and find ways to endure the difficult experience of cancer care. The support object represents an important therapeutic lever that can be used by their oncologists. They should be interested in their support objects, in order to support the patients in this investment and to help them to maintain it throughout the health care pathway. Furthermore, showing interest in this topic, important to the patient, could improve the physician-patient relation without using up very much of the physician's time.

Vemurafenib and concomitant stereotactic radiation for the treatment of melanoma with spinal metastases: A case report.

A 56-year-old man with BRAFV600E melanoma and spinal metastases treated with vemurafenib and stereotactic radiation showed a partial response without neurological, skin or mucosal toxicity, 8 months after completion of this combination. This case suggests that stereotactic radiation spares normal tissues and might be safer than conventional fractionated radiation with vemurafenib.

A digestive allergic reaction with hypereosinophilia imputable to docetaxel in a breast cancer patient: a case report.

BACKGROUND: Hypereosinophilia, defined by an absolute eosinophil count of more than 1500/mm3, is rarely observed in patients treated for cancer, and rarely imputable to anti-cancer agents. Drug-induced hypereosinophilia usually appears within a few weeks of the start of treatment and resolves after discontinuation of the medication. We report here a first case of hypereosinophilia with digestive allergic reaction imputable to docetaxel in a woman treated for breast cancer. CASE PRESENTATION: This patient, with a history of childhood atopic dermatitis and asthma, underwent surgery for breast lobular carcinoma, followed with chemotherapy including 3 cycles of the FEC100 protocol and 3 cycles of docetaxel. Ten days after the second cycle of docetaxel, she had abdominal pain with diarrhea, which increased after the third cycle of docetaxel at the same dose. The blood eosinophil count increased up to 4685/mm(3) at day 92. All biological tests were normal, except elevated seric IgE. The systematic biopsies of the upper and lower digestive tract showed diffuse edema of the lamina propria, lymphocytic infiltrate and CD117-expressing cells both in the epithelium and in the lamina propria. Electron microscopy showed a large number of degranulating mast cells, while the number of tissue eosinophils was small. The blood eosinophil count decreased after day 96, three months after the last injection of docetaxel. After day 182, the hypereosinophilia and symptoms resolved. This spontaneous evolution, the history of atopic dermatitis and asthma, and the negativity of all biological tests performed led us to hypothesize a diagnosis of a systemic digestive Type 1 drug-induced hypersensitivity reaction. Using two validated pharmacovigilance scales, we found that docetaxel had the highest imputability score compared to the other drugs. CONCLUSION: Recognition of allergic reactions imputable to docetaxel is important because it requires the drug to be discontinued. In the difficult setting of anti-cancer treatment, if reintroduction of the drug is needed, a close collaboration between oncologists, gastroenterologists and allergologists is required.

Assessment of chimerism in epithelial cancers in transplanted patients.

Cancer is now the most severe complication in the long term in transplant recipients. As most solid-organ or hematopoietic stem-cell transplantations are allogeneic, chimerism studies can be performed on cancers occurring in recipients. We summarize here the different methods used to study chimerism in cancers developing in allogeneic-transplant recipients, analyze their respective advantages and report the main results obtained from these studies. Chimerism analyses of cancers in transplant recipients require methods suited to tissue samples. In the case of gender-mismatched transplantation, the XY chromosomes can be explored using fluorescent in situ hybridization on whole-tissue sections or Y-sequence-specific PCR after the laser microdissection of tumor cells. For cancers occurring after gender-matched transplantation, laser microdissection of tumor cells enables studies of microsatellite markers and high-resolution melting analysis of mitochondrial DNA on genes with marked polymorphism, provided these are different in the donor and the recipient. The results of different studies address the cancers that develop in both recipients and in transplants. The presence of chimeric cells in these two types of cancer implies an exchange of progenitor/stem-cells between transplant and recipient, and the plasticity of these progenitor/stem-cells contributes to epithelial cancers. The presence of chimeric cells in concomitant cancers and preneoplastic lesions implies that the oncogenesis of these cancers progresses through a multistep process.

Intralesional cryosurgery to treat keloid scars: results from a retrospective study.

BACKGROUND: A variety of treatment modalities have been proposed to treat keloid scars, but outcomes are often disappointing. Intralesional cryosurgery may significantly reduce these scars. OBJECTIVE: To evaluate the clinical safety and efficacy of intralesional cryosurgery to treat keloid scars. Feedback from patients on pain, pruritus and aesthetic discomfort was recorded before and after treatment. METHODS: A total of 10 patients with 14 keloid scars resistant to conventional treatments were enrolled in a retrospective study between October 2007 and October 2013. The efficacy of this treatment was evaluated by measuring the reduction in scar surface. RESULTS: Scar surface was reduced by an average of 58.5% after intralesional cryosurgery treatment for all scars (average pre-operative keloid scar surface: 874.6 ± 954.1 mm2; average post-operative keloid scar surface: 505.8 ± 1,024.7 mm2; p = 0.002). Pain and aesthetic discomfort were significantly decreased after treatment in all patients (p = 0.008 and p = 0.012, respectively). CONCLUSION: Our data suggest that intralesional cryosurgery is an effective treatment for keloids.

Perspectives of French adolescents with ADHD and child and adolescent psychiatrists regarding methylphenidate use.

Many studies have demonstrated the short-term efficacy and tolerability of methylphenidate treatment adolescents with attention deficit hyperactivity disorder (ADHD). Qualitative literature on this matter focused on school outcomes, long-term side effects, family conflicts, personality changes and stigmatization. Yet, no qualitative study has crossed the perspectives of child and adolescent psychiatrists (CAPs) prescribing methylphenidate and adolescents with ADHD. This French qualitative study followed the five stages IPSE-Inductive Process to analyze the Structure of lived Experience-approach. Fifteen adolescents with ADHD and 11 CAPs were interviewed. Data collection by purposive sampling continued until data saturation was reached. Data analysis, based on a descriptive and structuring procedure to determine the structure of lived experience characterized by the central axes of experience, produced two axes: (1) The process of methylphenidate prescription, highlighting how this prescription was motivated from the exterior, experienced as passive by the adolescents and required commitment from the CAPs; and (2) the perceived effects of methylphenidate treatment, in three domains: at school, in relationships and in the sense of self. Findings raised both the issues of the epistemic position and social representation of the adolescents about ADHD and methylphenidate within this specific French context, and the self-awareness and perception of the adolescents with ADHD. We conclude that these two issues need to be regularly addressed by the CAPs prescribing methylphenidate to avoid epistemic injustice and prevent the harmful effects of stigmatization.

The experience of a program combining two complementary therapies for women with breast cancer: An IPSE qualitative study.

INTRODUCTION: The use of complementary therapies within oncology is a clinical issue, and their evaluation a methodological challenge. This paper reports the findings of a qualitative study exploring the lived experience of a French program of complementary therapies combining structured physical activity and MBSR among women with breast cancer. METHODS: This French exploratory qualitative study followed the five stages of the Inductive Process to analyze the Structure of lived Experience (IPSE) approach. Data was collected from February to April 2021 through semi structured interviews. Participants, purposively selected until data saturation. Inclusion criteria were: being an adult woman with breast cancer whatever the stage who had completed their treatment and were part of the program of complementary therapies. RESULTS: 29 participants were included. Data analysis produced a structure of experience based on two central axes: 1) the experience these women hoped for, with two principal expectations, that is to take care of their bodies and themselves, and to become actors in their own care; and 2) an experience of discovery, first of themselves and also in their relationship with the exterior, whether with others, or in society, and in the relationships with health-care providers. CONCLUSIONS: Our results from this French study reinforce the data described in other western countries about the needs of women receiving care in oncology departments for breast cancer: they need to be informed of the existence of supportive care in cancer by the health-care professionals themselves, to be listened to, and to receive support care. A systematic work of reflexivity about this redundancy in our results and in the qualitative literature, led us to question what impeded the exploration of more complex aspects of the experience of this women-the inherently emotional and anxiety-inducing experience of cancer, especially anxiety about its recurrence and of death-and to suggest new research perspectives to overcome these methodological and theoretical obstacles.

The sensory experiences of autistic people: A metasynthesis.

LAY ABSTRACT: Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions - physical, emotional, relational and social - experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.

Disclosing Child Sexual Abuse to a Health Professional: A Metasynthesis.

Objective: Sexual abuse is a major public health problem. Its disclosure to a health professional could help to reduce its impact on survivors' lives. The objective of this metasynthesis, combining a systematic review and an analysis of the qualitative studies, was to explore the qualitative literature concerning the experience of a survivor disclosing sexual violence experienced in childhood to a health professional, from the perspective of both. Methods and Data Sources: We used four databases and two journals (Medline, PsycINFO, EMBASE, and SSCI, and the Journal of Sexual Abuse and Child Abuse and Neglect) to identify studies concerning this disclosure of sexual abuse to healthcare professionals from the point of view of the survivors and the health professionals. After assessing the methodological quality of the articles with the "Critical Appraisal Skills Program (CASP)," we conducted a thematic analysis of the data extracted during the review. Results: This review includes 20 articles, covering the data of 612 participants: 291 who were adults at the time of the study but abused in childhood, 152 minors, 14 parents of adolescents, and 155 healthcare professionals. Two themes emerged from the analysis: (1) the disclosure as experienced by the professionals, and (2) the disclosure as experienced by the survivors. Conclusion: Our results show that survivors had a diachronic approach to the experience of disclosure. They suggest a change over time in how survivors experience disclosure: relief and release were seen only among the adult participants, at a distance from - long after - the disclosure. This study made it possible to identify new perspectives for research in the field of child psychiatry and to formulate concrete clinical proposals, in particular, by applying the principle of patient experts to involve now-adult survivors in training and increase the awareness of the healthcare professionals concerned.

Medical Students' Perspectives on Empathy: A Systematic Review and Metasynthesis.

PURPOSE: Some evidence indicates that physician empathy declines during medical training, which has made it the subject of much research. Qualitative studies are relevant in this context, focusing as they do on how students themselves conceive and understand empathy during medical school. The aim of this study was to explore medical students' perspectives on empathy by conducting a metasynthesis, including a systematic review of the literature and analysis of included studies. METHOD: The authors systematically searched 4 databases through June 17, 2019, for qualitative studies reporting medical students' perspectives on empathy in medical school. They assessed article quality using the Critical Appraisal Skills Program, and they applied thematic analysis to identify key themes and synthesize them. RESULTS: The authors included 35 articles from 18 countries in their analysis. Four main themes emerged: (1) Defining empathy, with a lack of understanding of the concept; (2) Teaching empathy, with a focus on the hidden curriculum and clinical supervisors; (3) Willingness to be an empathetic doctor, with ambivalence expressed by some study participants; and (4) Evolution of empathy during medical school, specifically its decline. CONCLUSIONS: Medical students are beset by theoretical confusion regarding the concept of empathy, and they express doubts about its utility and relevance. Instruction should focus on simpler concepts such as listening, and schools should leverage clinical supervisors' strong influence on students' empathy. Prioritizing certain types of knowledge (clinical facts) during medical education has a globally negative effect on medical students' empathy.

When primary care providers and smokers meet: a systematic review and metasynthesis.

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Workplace environment around physicians' burnout: A qualitative study in French hospitals.

OBJECTIVE: Burnout among physicians in public hospital has become a major public health issue in most Western countries. Qualitative literature has underlined the importance of interpersonal and group aspects in this context. Yet, no qualitative study has ever explicitly explored workplace direct environment's association with physicians' burnout. This study aimed to fill this gap. METHODS: This qualitative study used the five-stage inductive process to analyse the structure of lived experience (IPSE) approach and was conducted in French hospitals. We interviewed 45 participants - 16 with a lived experience of burnout and 29 of their colleagues - 19 women/26 men, (13 radiologists, 12 gastroenterologists, 10 gastrointestinal surgeons and 10 residents) from February 2018 to April 2019. Data analysis followed the IPSE analytic procedure and was conducted in two stages: three individual researchers carried out independent work and the group collectively pooled data. RESULTS: Three axes of experience were identified: (i) the loss of meaning, that is being a doctor, no longer has any meaning in the actual context of public hospitals; (ii) "the tower of Babel", the impossibility of dialogue with both management and colleagues; and (iii) physicians' daily interactions: too many conflicts, too much pressure and not enough recognition. CONCLUSION: Physicians in this study described being exposed to a deleterious atmosphere, experiencing both emotional abuse and structural violence within the workplace. They considered that such an environment could contribute to the development of burnout. Further research is necessary to assess this hypothesis.