Supporting self-management of radiation-induced bowel and bladder dysfunction in pelvic-cancer rehabilitation: An ethnographic study.

AIMS AND OBJECTIVES: To describe and understand strategies that oncological nurses use to support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients. BACKGROUND: Nurse-led self-management of radiation-induced bowel and bladder issues holds the potential to support cancer survivors. DESIGN: An ethnographic approach was applied in this study, which adhered to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS: Data collection was conducted in Sweden between October 2015-April 2018, involving observations of nurses' daily work, formal and informal interviews, individual and group interviews, and reviews of relevant documents used in the studied practice. Furthermore, 15 supportive nurse-patient talks were observed, and an ethnographic analysis was performed. RESULTS: The analysis identified the following three categories of nursing strategies that support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients: encouraging self-reflection, tailoring solutions together and keeping patients motivated. Nurses and patients jointly make sense of patients' symptoms using data that patients collect about themselves. Based on their shared understanding, they can co-create solutions to meet each individual patient's needs and develop routines to keep the patient motivated in performing the devised solutions. CONCLUSIONS: The results indicate that the strategies nurses use to support patients in self-management of radiation-induced bowel and bladder issues entail intertwining patients' experiences with their nurses' medical knowledge and specific clinical practice. Nurses' strategies build on their ability to connect patients' experiences and the elements of their own work practice. RELEVANCE TO CLINICAL PRACTICE: A deeper understanding of nurses' strategies to support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients can improve other self-management programmes, inform nurses' education and aid in the design of tools for pelvic-cancer rehabilitation support.

Learning aspects and potential pitfalls regarding detection of pulmonary nodules in chest tomosynthesis and proposed related quality criteria.

BACKGROUND: In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of an arbitrary number of section images of the chest, resulting in a moderately increased radiation dose compared to chest radiography. PURPOSE: To investigate the effects of learning with feedback on the detection of pulmonary nodules for observers with varying experience of chest tomosynthesis, to identify pitfalls regarding detection of pulmonary nodules, and present suggestions for how to avoid them, and to adapt the European quality criteria for chest radiography and computed tomography (CT) to chest tomosynthesis. MATERIAL AND METHODS: Six observers analyzed tomosynthesis cases for presence of nodules in a jackknife alternative free-response receiver-operating characteristics (JAFROC) study. CT was used as reference. The same tomosynthesis cases were analyzed before and after learning with feedback, which included a collective learning session. The difference in performance between the two readings was calculated using the JAFROC figure of merit as principal measure of detectability. RESULTS: Significant improvement in performance after learning with feedback was found only for observers inexperienced in tomosynthesis. At the collective learning session, localization of pleural and subpleural nodules or structures was identified as the main difficulty in analyzing tomosynthesis images. CONCLUSION: The results indicate that inexperienced observers can reach a high level of performance regarding nodule detection in tomosynthesis after learning with feedback and that the main problem with chest tomosynthesis is related to the limited depth resolution.

Rediscovering radiology: new technologies and remedial action at the worksite.

This study contributes to social studies of imaging and visualization practices within scientific and medical settings. The focus is on practices in radiology, which are bound up with visual records known as radiographs. The study addresses work following the introduction of a new imaging technology, tomosynthesis. Since it was a novel technology, there was limited knowledge of how to correctly analyse tomosynthesis images. To address this problem, a collective review session was arranged. The purpose of the present study was to uncover the practical work that took place during that session and to show how, and on what basis, new methods, interpretations and understandings were being generated. The analysis displays how the diagnostic work on patients' bodies was grounded in two sets of technologically produced renderings. This shows how expertise is not simply a matter of providing correct explanations, but also involves discovery work in which visual renderings are made transparent. Furthermore, the results point to how the disciplinary knowledge is intertwined with timely actions, which in turn, partly rely on established practices of manipulating and comparing images. The embodied and situated reasoning that enabled radiologists to discern objects in the images thus display expertise as inherently practical and domain-specific.

ALIGNING VIDEO-AND STRUCTURED DATA FOR IMAGING OPTIMISATION.

Imaging optimisation can benefit from combining structured data with qualitative data in the form of audio and video recordings. Since video is complex to work with, there is a need to find a workable solution that minimises the additional time investment. The purpose of the paper is to outline a general workflow that can begin to address this issue. What is described is a data management process comprising the three steps of collection, mining and contextualisation. This process offers a way to work systematically and at a large scale without succumbing to the context loss of statistical methods. The proposed workflow effectively combines the video and structured data to enable a new level of insights in the optimisation process.

Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms.

OBJECTIVES: This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes. DESIGN: Non-participant video-based observations. SETTING: Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR. METHODS: The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis. RESULTS: The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations. CONCLUSION: The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.

THE APPLICATION OF IMPROVED, STRUCTURED AND INTERACTIVE GROUP LEARNING METHODS IN DIAGNOSTIC RADIOLOGY.

This study provides an example on how it is possible to design environments in a diagnostic radiology department that could meet learning demands implied by the introduction of new imaging technologies. The innovative aspect of the design does not result from the implementation of any specific tool for learning. Instead, advancement is achieved by a novel set-up of existing technologies and an interactive format that allows for focussed discussions between learners with different levels of expertise. Consequently, the study points to what is seen as the underexplored possibilities of tailoring basic and specialist training that meet the new demands given by leading-edge technologies.

OPTIMISATION OF OCCUPATIONAL RADIATION PROTECTION IN IMAGE-GUIDED INTERVENTIONS: EXPLORING VIDEO RECORDINGS AS A TOOL IN THE PROCESS.

The overall purpose of this work was to explore how video recordings can contribute to the process of optimising occupational radiation protection in image-guided interventions. Video-recorded material from two image-guided interventions was produced and used to investigate to what extent it is conceivable to observe and assess dose-affecting actions in video recordings. Using the recorded material, it was to some extent possible to connect the choice of imaging techniques to the medical events during the procedure and, to a less extent, to connect these technical and medical issues to the occupational exposure. It was possible to identify a relationship between occupational exposure level to staff and positioning and use of shielding. However, detailed values of the dose rates were not possible to observe on the recordings, and the change in occupational exposure level from adjustments of exposure settings was not possible to identify. In conclusion, the use of video recordings is a promising tool to identify dose-affecting instances, allowing for a deeper knowledge of the interdependency between the management of the medical procedure, the applied imaging technology and the occupational exposure level. However, for a full information about the dose-affecting actions, the equipment used and the recording settings have to be thoroughly planned.