Multiple stakeholder perspectives of factors influencing differential outcomes for ethnic minority students on health and social care placements: a qualitative exploration.

BACKGROUND: Despite considerable efforts there continues to be a degree awarding gap within the United Kingdom (UK) between the proportion of White British students receiving higher classifications, compared to ethnic minority UK-domiciled students. Practice placement elements constitute approximately 50% of most health and social care programmes, yet surprisingly little research exists related to the factors which may contribute to ethnic minority student placement outcomes or experiences. This study bridges this evidence gap by exploring factors influencing differential placement outcomes of ethnic minority students from the perspectives of key stakeholders. METHODS: The study followed a descriptive qualitative research design and was multi-disciplinary, with participants drawn from across nursing, midwifery, social work and the allied health professions. Participants from four stakeholder categories (ethnic minority students, academic staff, placement educators and student union advisors) were invited to join separate focus groups. Focus groups were recorded and transcribed and analysed thematically. RESULTS: Ten separate focus groups [n = 66] yielded three primary themes: 1) recognition, which highlighted stakeholder perceptions of the issues [sub-themes: acknowledging concerns; cultural norms; challenging environments]; 2) the lived experience, which primarily captured ethnic minority student perspectives [sub-themes: problematising language and stereotyping, and being treated differently]; 3) surviving not thriving, which outlines the consequences of the lived experience [sub-themes: withdrawing mentally, feeling like an alien]. CONCLUSION: This study presents a rich exploration of the factors affecting differential outcomes of ethnic minority students on practice placements through the lens of four different stakeholder groups. To our knowledge this is the first study in which this comprehensive approach has been taken to enable multiple viewpoints to be accessed across a wide range of health and social care professions. The issues and challenges raised appear to be common to most if not all of these disciplines. This study highlights the urgent need to value and support our ethnic minority students to remove the barriers they face in their practice learning settings. This is a monumental challenge and requires both individuals and organisations to step up and take collective responsibility.

DNA Repair in Prostate Cancer: Biology and Clinical Implications.

CONTEXT: For more precise, personalized care in prostate cancer (PC), a new classification based on molecular features relevant for prognostication and treatment stratification is needed. Genomic aberrations in the DNA damage repair pathway are common in PC, particularly in late-stage disease, and may be relevant for treatment stratification. OBJECTIVE: To review current knowledge on the prevalence and clinical significance of aberrations in DNA repair genes in PC, particularly in metastatic disease. EVIDENCE ACQUISITION: A literature search up to July 2016 was conducted, including clinical trials and preclinical basic research studies. Keywords included DNA repair, BRCA, ATM, CRPC, prostate cancer, PARP, platinum, predictive biomarkers, and hereditary cancer. EVIDENCE SYNTHESIS: We review how the DNA repair pathway is relevant to prostate carcinogenesis and progression. Data on how this may be relevant to hereditary cancer and genetic counseling are included, as well as data from clinical trials of PARP inhibitors and platinum therapeutics in PC. CONCLUSIONS: Relevant studies have identified genomic defects in DNA repair in PCs in 20-30% of advanced castration-resistant PC cases, a proportion of which are germline aberrations and heritable. Phase 1/2 clinical trial data, and other supporting clinical data, support the development of PARP inhibitors and DNA-damaging agents in this molecularly defined subgroup of PC following success in other cancer types. These studies may be an opportunity to improve patient care with personalized therapeutic strategies. PATIENT SUMMARY: Key literature on how genomic defects in the DNA damage repair pathway are relevant for prostate cancer biology and clinical management is reviewed. Potential implications for future changes in patient care are discussed.

Early Career Resilience: Interdisciplinary Insights to Support Professional Education of Radiation Therapists.

BACKGROUND: A number of studies across a range of countries have indicated a proportion of the radiotherapy workforce may be experiencing burnout. Furthermore, current national attrition from UK radiotherapy training programs is approximately 36%. The consequence is a potential shortfall in qualifying practitioners. The loss of skilled practitioners from the workplace through burnout and a reduction in the numbers qualifying at a time of rising cancer referrals have implications on the ability of radiotherapy services to keep pace with demand. A report from the College of Radiographers on the factors affecting attrition from UK training programs recommends the development of emotional resilience as part of the educational preparation for therapists, but failed to identify specific interventions that may help. Radiation therapists are not unique in terms of their exposure to the potential of burnout, and other professionals share similar concerns. In this article, we report on an interdisciplinary study of professional resilience, which indicates that there is much we can learn from other professions that are engaged in emotional labour. The concept of "resilience" is important in retention studies, but research in this field is limited by a lack of detailed accounts of resilience in specific professional contexts with few accounts of strategies in professional education to develop resilience. AIM: The purpose of this study was to identify what supports and hinders the development of professional resilience in early career professionals and in professions involving emotional and moral challenge, such as radiation therapy, and what creative pedagogical approaches may help to develop resilience. METHODS: Using a mixed method design, more than 50 participants were invited to participate from radiotherapy, social work, and teacher education. A combination of survey research, interpretative interviews, and innovative group activities were used across four key groups; early career professionals, current students, higher education lecturers, and work-based professionals who support students. Purposive sampling was undertaken with codes, themes, and texts used iteratively to develop an understanding of professional resilience. Coding was informed by principles of constructivist grounded theory to allow for the identification of themes. Peer debriefing was used to agree on the coding structure, and member checking was used to confirm identified themes with research participants. RESULTS: Emergent themes indicate resilience is dependent on a complex interplay between individual and organizational (or situated) characteristics.The key concepts were (1) transitions: new identity demands; (2) organizational and systemic issues: being treated unfairly, team culture, difficult cases, feedback and support, and professional demands; (3) personal characteristics: personal actions and personal qualities (accepting, confidence, forms of reflection, interpersonal skills, and positive psychology); and (4) professionality: agency, commitment, moral purpose, and value. CONCLUSION: By addressing issues of resilience, course credibility is enhanced as a preparation for professional life, with a subsequent corollary of reduced attrition.The data from this study can be used to inform a creative curriculum to enhance professional resilience in students and early career professionals.

Genomic profiling defines subtypes of prostate cancer with the potential for therapeutic stratification.

The remarkable variation in prostate cancer clinical behavior represents an opportunity to identify and understand molecular features that can be used to stratify patients into clinical subgroups for more precise outcome prediction and treatment selection. Significant progress has been made in recent years in establishing the composition of genomic and epigenetic alterations in localized and advanced prostate cancers using array-based technologies and next-generation sequencing approaches. The results of these efforts shed new light on our understanding of this disease and point to subclasses of prostate cancer that exhibit distinct vulnerabilities to therapeutics. The goal of this review is to categorize the genomic data and, where available, corresponding expression, functional, or related therapeutic information, from recent large-scale and in-depth studies that show a new appreciation for the molecular complexity of this disease. We focus on how these results inform our growing understanding of the mechanisms that promote genetic instability, as well as routes by which specific genes and biologic pathways may serve as biomarkers or potential targets for new therapies. We summarize data that indicate the presence of genetic subgroups of prostate cancers and show the high level of intra- and intertumoral heterogeneity, as well as updated information on disseminated and circulating tumor cells. The integrated analysis of all types of genetic alterations that culminate in altering critical biologic pathways may serve as the impetus for developing new therapeutics, repurposing agents used currently for treating other malignancies, and stratifying early and advanced prostate cancers for appropriate interventions.