Organisational challenges to wellbeing in nuclear medicine technologists: Professionalism, burnout and pragmatic growth

INTRODUCTION

Occupational risk for burnout in nuclear medicine technologists globally, and particularly during disaster demands on the profession, is poorly researched. This idiographic study explored the lived experience of nuclear medicine technologists during COVID-19 in a regional city in Australia.

METHODS

Data was collected from five participants using semi-structured interviews and transcribed and analysed according to the protocols of Interpretative Phenomenological Analysis (IPA).

RESULTS

Four group experiential themes were identified: Systemic Contraindications, Professional Strengths and Limitations, Pragmatic Growth, and Covid Rollercoaster. For these participants a dichotomous health care system, impacted by COVID-19, risked career longevity and burnout. Through empathic connection with vulnerable patients, they redefined their priorities, re-engaged in supportive connections with colleagues, and sought new pathways.

CONCLUSION

Multiple workplace stressors compounded by COVID-19, risked mental wellbeing, in these participants. Nevertheless, these challenges provided opportunities for reflection around career trajectory and longevity precipitating personal growth, job satisfaction and work-life balance.

IMPLICATIONS FOR PRACTICE

This study provided a lens on the risk factors inherent for nuclear medicine technologists in Australia, exacerbated by the COVID-19 pandemic. Current, and disaster protective practices, to ensure wellbeing and prevent burnout risk are recommended for future research.

Risk of burnout, psychological growth, longevity of career and making sense of Covid-19 in senior Australian radiation oncologists

INTRODUCTION

Senior radiation oncologists in hospital/organisational settings, are repetitively and vicariously exposed to others' traumatic distress-perpetuating risk of burnout. Little is known of the additional organisational burdens of the Covid-19 pandemic on their mental well-being for career longevity.

METHODS

Using Interpretative Phenomenological Analysis, semi-structured interviews provided positive and negative subjective interpreted data from five senior Australian radiation oncologists during Covid-19 lockdowns.

RESULTS

One superordinate theme, Vicarious risk, hierarchical invalidation, redefining altruistic authenticity, overarched four subordinate themes: (1) Vicarious contamination of caring, (2) The hierarchical squeeze, (3) The heavy burden of me and (4) Growth of authenticity. For these participants, juxtaposed challenges to career longevity and mental well-being were 'self' as empathic carer to vulnerable patients, and ever-increasing burdens of the organisation. Sensing invalidation, they experienced periods of exhaustion and disengagement. However, with experience and seniority, self-care was prioritised and nurtured through intrapersonal honesty, altruism and relational connectedness with patients and mentoring forward junior colleagues. Focusing on mutual well-being, a sense of life beyond radiation oncology became acceptable.

CONCLUSIONS

For these participants, self-care became a relational joining with their patients separate from the lack of systemic support which heralded an early termination to their career for psychological well-being and authenticity.

'If I don't Do It, I'm Out of Rhythm and I Can't Focus As Well': Positive and Negative Adult Interpretations of Therapies Aimed at 'Fixing' Their Restricted and Repetitive Behaviours in Childhood

Restricted and repetitive behaviours (RRBs) are observed in many children presenting with characteristics of autism and are frequently the targets of psychological interventions. This study used Interpretative Phenomenological Analysis (IPA) to identify positive and negative interpretations from four young adults who received behavioural interventions in their childhood designed to 'fix' RRBs. Two superordinate themes were identified: (1) Doubt, stigma and being fixed according to others, and (2) Embracing Authenticity. They highlighted juxtaposed positions from exclusion, rejection, criticism, and self-doubt in childhood, to rejecting societal censure and embracing authentic growth in adult life. As adults, though the participants recognised themselves as neurologically different from others, they redefined themselves through a lens of neurodiversity, and therefore as not needing to be fixed.

Relentless, aggressive, and pervasive: Exploring gender minimization and sexual abuse experienced by women ex-military veterans

OBJECTIVE

Contextually embedded and sanctioned gender minimization and sexual abuse toward female personnel within the military appears widespread. Left unabated, mental health complications of female personnel will challenge care responsibilities for military organizations.

METHOD

Interview data from six ex-military women that sought positive and negative interpretations of gender minimization and sexual abuse while in the military was analyzed using interpretative phenomenological analysis.

RESULTS

Analysis revealed two superordinate themes: (a) Immature Culture, and (b) Ejection and Growth. These overarched four subordinate themes that explored fostered patriarchy and male privilege in the military. Participants expressed experiencing relentless belittling that eroded early adolescent goals of success and aborted their ability to thrive psychologically. By association, interpersonal violence compounded by organizational complicity triggered internalized shame and narcissistic defenses. Discharging from the military is remembered as a painful, isolated struggle for these participants as they sought to make sense of their fragmented identities as women. With time, all participants acknowledged pride in skills achieved during military life, and the strength to speak out against embedded organizational abuse. A persistent ruminative struggle to make sense of complex systemic biases against women that allowed organizational abuse to flourish facilitated posttraumatic growth.

CONCLUSIONS

For these participants, personal experiences of gender minimization and sexual abuse in the military incubated a betrayal of hope and moral safety. As women, they felt violated at an organizational level seemingly orchestrated by male privilege and patriarchy. Clinical priorities include reparative validation and holistic trauma support underpinned by trauma and posttraumatic growth frameworks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Making meaning of irreconcilable destruction of innocence: National humanitarian professionals exposed to cybercrime child sexual exploitation in the Philippines

BACKGROUND

Sex-cybercrimes against children in the Philippines rose by over 400 % during the first year of the Covid-19 pandemic exponentially increasing challenges for carers of children, law enforcers, and prosecutors.

OBJECTIVE

Burnout, primary, and secondary traumatic stress are some of the potential mental health risks for child protection carers. How longevity of career is sustained, is unknown.

PARTICIPANTS AND SETTING

This idiographic study explored both positive and negative interpretations of frontline workers in the Philippines exposed to sex-cybercrimes against children.

METHODS

The protocols of Interpretative Phenomenological Analysis guided data collection through semi-structured interviews, transcription, and analysis.

RESULTS

One superordinate theme: Irreconcilable destruction of innocence, mercy and justice, and the passionate self; highlights the integral struggle that emerged from these participants' roles in child protection. Their faith philosophy of compassion and forgiveness contrasted with the unfathomable corruption and exploitation they witnessed, and their role in removing child victims from perpetrator family members to serve justice. These internal conflicts necessitated a critical need to self-care against psychological vulnerability. Longevity of career emerged from a co-existence of traumatic distress and psychological growth allowing them to redefine their faith and confront the unfathomable with hope, self-valuing, and purpose.

CONCLUSIONS

Justice and mercy were juxtaposed integral conflicts threatening the psychological wellbeing of these participants. Ineffective organisational support aggravated their traumatic distress as did the lethargy with which world governments' engage in effective controls against online crimes of child sexual exploitation which has meteorically risen as a result of the global coronavirus pandemic.

Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review

BACKGROUND: Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE: The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. METHODS: A scoping review methodology was conducted using the Arksey and O’Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. RESULTS: The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. CONCLUSION: Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

Burnout in the disciplines of medical radiation science: A systematic review

OBJECTIVE

Burnout is seen as an occupational phenomenon related to workplace stress. Professional groups within medical imaging and radiation science have been reported to suffer from burnout in the past, however research into the profession has been limited. This systematic review aims to evaluate literature measuring levels and prevalence of burnout in the professional groups within medical imaging and radiation science (MIRS). These being radiographers (radiological technologists), sonographers, radiation therapists (therapeutic radiographers) and nuclear medicine technologists.

METHODS

Electronic databases including Medline, Embase, Psycinfo and CINAHL were searched to locate studies published in English from 2000 that used a questionnaire/survey to measure burnout in the MIRS population. Also included were studies that measured burnout in a larger healthcare group that included MIRS professionals, as long as the MIRS professionals were reported as a separate group.

RESULTS

Sixteen articles met the inclusion criteria; two of these articles reported the same data and therefore were combined to leave 15 studies to review. Of the radiation therapy group, seven of the nine studies reported low or moderate burnout amongst their participants. One study reported high levels of burnout in the emotional exhaustion and depersonalisation domains, and another reported high emotional exhaustion levels. Within the other MIRS professions, five of the six studies reported moderate burnout. One group of sonographers had high levels of burnout in the emotional exhaustion domain.

CONCLUSION

For the past 20 years, levels of burnout in MIRS professionals has remained relatively steady, with the majority of studies reporting moderate levels of burnout. However, more research is needed in radiographers, sonographers and nuclear medicine technologists.

IMPLICATIONS FOR PRACTICE

Even though the review indicates moderate level of burnout, this needs addressing on an organisational and individual level to ensure stress in the workplace is managed before burnout becomes a significant issue.

Isolation, self-blame and perceived invalidation in aid personnel: identifying humanitarian-specific distress using the PostAID/Q

Objective

Humanitarian-specific psychological distress following deployment can elude detection using contemporary measures of trauma-related stress. This study assesses the unidimensional structure and convergent validity of the Post-deployment Altruistic Identity Disruption Questionnaire (PostAID/Q), an 18-item questionnaire underpinned by the construct Altruistic Identity/Disruption (AI/AID).

Method

Humanitarian aid personnel (N=108) completed an online web survey, inclusive of the Moral Injury Questionnaire (MIQ), Posttraumatic Distress Disorder Checklist (PCL-5), Psychological Well-Being Posttraumatic Changes Questionnaire (PWB-PTCQ) and Social Provisions Scale (SPS).

Results

A confirmatory factor analysis suggested a single factor structure providing further support for the conception of AI/AID as a unidimensional construct. Convergent validity was demonstrated through (1) utility for predicting a posttraumatic stress disorder (PTSD) diagnosis assessed by the PCL-5, and (2) moral injury assessed by the MIQ. The PostAID/Q was further moderately and negatively associated with the availability of social support (assessed by the SPS) and lower self-reports of psychological well-being post trauma (assessed by the PWB-PCTQ). Finally, the PostAID/Q demonstrated evidence of incremental validity in predicting humanitarian specific psychological distress over and above the PCL-5. Specifically, the PostAID/Q predicted increased moral injury on the MIQ, and decreased psychological well-being post trauma.

Conclusions

The PostAID/Q can assist in identifying humanitarian specific psychological responses post deployment guiding support for personnel, over and above more traditional measures of posttraumatic stress.

Dementia families: Relinquishing home care to aged care services: Guilt, traumatic loss and growth

BACKGROUND AND OBJECTIVES

Few studies explore both negative and positive perspectives of family members who relinquish home care of a family member with dementia for systemic aged care.

RESEARCH DESIGN AND METHODS

This phenomenological study sought the 'lived' experience of relinquishing the role of home carer for a family member with mild to severe dementia to others within care home settings, by seeking to understand the impact of aged care on family members' psychological well-being. Using semi-structured interviews, positive and negative subjective interpretations from 17 families (27 individuals) provided data for analysis, following the protocols of interpretative phenomenological analysis.

RESULTS

One superordinate theme, mistrust/integrity, overarched oscillation between mistrust of the aged care system and a struggle for personal integrity in caring for these participants. Two sub-themes emerged: intrinsic trauma and extrinsic trauma. Intrinsic trauma explained feelings of helplessness and guilt, and internally directed responses that triggered a retreat into submission ultimately reducing the participant's role in advocacy. Extrinsic trauma represented externally directed responses such as anger and frustration, where family members became more engaged and watchful and recognised a need for vigilance and advocacy. Paradoxically oscillating between these personal struggles, participants exhibited growth, a third theme that defined assertive/advocacy utilised to nurture hope, gratitude, courage and change.

DISCUSSION AND IMPLICATIONS

Family members experienced complex distress as they relinquished home care to others within systemic aged care for a member with dementia. By developing adaptive responses as appropriate, for example, advocating for their family member or accepting compliance with treatment, collaborative care between family and staff created better outcomes for the family member with dementia.

Cross-sectional survey of Chinese-speaking and Thai-speaking female sex workers in Sydney, Australia: factors associated with consistent condom use

Background Previous studies have described inconsistent condom use in Chinese- and Thai-speaking female sex workers in Sydney, Australia. In the present study, we describe the demographics and safe sexual practices in the Chinese- and Thai-speaking female sex workers attending the Sydney Sexual Health Centre (SSHC) in 2014-15.

METHODS

A self-completed 60-item anonymous questionnaire, adapted from previous surveys conducted in 1993 and 2003, was translated into Chinese and Thai and administered to female sex workers attending the SSHC or seen on outreach.

RESULTS

In all, 488 surveys were distributed, of which 435 were returned; 43% in Chinese and 57% in Thai. Most women did not plan on sex work before their arrival in Australia. Compared with Chinese-speaking women, Thai-speaking women rated themselves higher on English language literacy, had better knowledge of the transmission of HIV and sexually transmissible infections (STIs) and were more likely to practice 100% condom use. Overall, 72% of the sex workers surveyed reported consistent condom use for vaginal sex at work.

CONCLUSIONS

Consistent condom use for vaginal sex at work among Chinese- and Thai-speaking female sex workers has decreased slightly from that reported in a similar survey conducted by the SSHC in 2003, when 85% of sex workers reported consistent condom use. There are significant differences between Chinese- and Thai-speaking sex workers in terms of both knowledge and safer sex practices. Ongoing health promotion efforts should focus on providing culturally appropriate education around STIs and safe sex practices not only to workers, but also to parlour owners, managers and consumers.

Violation and hope: Refugee survival in childhood and beyond

BACKGROUND

The psychological complexity of refugee status for children is poorly understood. Alone or with family members, child refugees are exposed to multiple and potentially traumatic events, including conflict and human rights deprivation in their country of origin, perilous and life-threatening escape journeys, years of statelessness, and isolation and discrimination in their new host country.

AIMS

This phenomenological study explored the positive and negative interpretations of four adults as they sought to make sense of their experiences of refugee status as children.

METHOD

Interpretative Phenomenological Analysis (IPA) guided the development of semi-structured interview for data collection and analysis.

RESULTS

One superordinate theme, Violation and Hope, overarched three subordinate themes, Violent detachment, Refugee identity, and Resourcefulness and reciprocity. One divergent theme also emerged: Clashing identities. These themes provide unique insight into the interpreted experiences of escaping oppression and persecution in each participant's country of origin as children, and the ensuing bleak interval as refugees, belonging nowhere. They identify the risk of becoming pawns of opportunism without human rights protection. Once stateless, survival was not guaranteed, producing a stark merging of acceptance of mortality and determined resourcefulness as children. Avoidant coping became a positive tool for surviving ever present threat, and was crucial in defining a life philosophy that was future oriented as they entered adulthood.

CONCLUSION

These participants rejected a 'refugee victim' identity, emphasising a legacy of resourcefulness, hope, gratitude and reciprocity, domains of post-traumatic growth which are unreported aspects of refugee well-being that can provide future therapeutic and research direction.

Zika and travel in the news: a content analysis of US news stories during the outbreak in 2016-2017

OBJECTIVES

This study aimed to understand what information the US media communicated about Zika virus (ZIKV) and travel in 2016 and 2017.

STUDY DESIGN

We conducted a content analysis of news coverage about ZIKV and travel from April 5, 2016 to March 31, 2017.

METHODS

We obtained a stratified, random sample of English language, US print newspaper and television news coverage about ZIKV and travel. We developed a coding scheme to assess key messages in the news, including how ZIKV is transmitted, the symptoms and outcomes of ZIKV infection, and recommended prevention behaviors.

RESULTS

Almost all news stories mentioned mosquito-borne transmission (96.8%) and just over half mentioned sexual transmission (55.3%). News stories were more likely to talk about ZIKV outcomes (78.8%) than ZIKV symptoms (40.6%). However, outcomes affecting babies were mentioned more frequently than outcomes affecting adults. Recommendations included a wide array of protective behaviors, such as delaying or avoiding travel (77.6%) and using mosquito repellent (41.0%). However, few studies (10.9%) mentioned barriers to practicing ZIKV prevention behaviors.

CONCLUSIONS

Public health organizations and professionals can use these findings to help improve communication about future outbreaks of mosquito-borne illnesses. We also recommend conducting real-time monitoring of news media and frequent content analysis of news stories to ensure coverage provides the information the public needs.

Moderate dementia: relational social engagement (RSE) during family visits

OBJECTIVE

This qualitative study seeks evidence of retained social awareness in individuals with moderate dementia residing in care-homes, when engaged in interactive family visits.

METHOD

Speech/non-speech data collected from 10/15-minute video-recorded family interactions of five family groups (12 individuals; 2 sessions per family group) were coded using thematic analysis.

RESULTS

Interactional patterns embedded in familiar bonds provided the context for the superordinate theme: relational social engagement (RSE). This overarched two subthemes: in-step and out-of-step; highlighting that RSE, can occur as a result of both positive and negative familial communication patterns. When familial communication was in-step, despite changed communication pathways, the resident's attempts at social engagement appeared open, relaxed, and responsive. A sense of trust, and familiarity appeared to facilitate reciprocal understanding and the striving of resident family members to retain family group membership. When familial communication was out-of-step, active attempts at reciprocity or open engagement from visiting family members were not observed. At such times, communication became discordant, and frustrated in their efforts to remain an integral part of the family group, the resident appeared disinterested or guarded often retorting with annoyance at visiting family members.

CONCLUSION

The construct of RSE appears specific to prior meaningful relationships, where optimal social awareness and communication, positive and negative, can occur. Currently, dementia assessment and care does not include RSE during family interactions. Implications are discussed.

Severe dementia: relational social engagement (RSE) during family visits

OBJECTIVE

Few studies have utilised observation to investigate retained awareness when individuals with severe dementia interact with family members. Seeking evidence of retained awareness in those with severe dementia, interactive family visits in care homes were observed and analysed.

METHOD

Five family groups (14 individuals) completed 10/15-minute video recorded family interactions. Speech and non-speech interactions were analysed using Thematic Analysis.

RESULTS

One superordinate theme: Distinctive family bonds; overarched two subthemes, in-step and out-of-step describing positive and negative familial interactions. In-step interactions revealed family groups reciprocating social support, having fun together, and willing to go on the ride together. Out-of-step interactions characterised social frustration, non-reciprocity, and sidelining of members with dementia. Although awareness fluctuated, complex awareness was observed in the speech/non-speech expressions of those with dementia. In response, visitors appeared to treat those expressions and behaviours as understandable. Observed outcomes were out-of-step when visitors sought to retain the familiar and in-step when visitors sought to optimise all communication possibilities.

CONCLUSION

Video recorded family interactions and analysis revealed: (a) awareness was retained in the participants with severe dementia beyond assessed levels; and (b) Relational Social Engagement (RSE) occurred within family groups despite positive or negative interactions. Implications are discussed.

Holding on while letting go: trauma and growth on the pathway of dementia care in families

OBJECTIVES

Limited research explores the medical model of residential care in dementia from the family caregiver's perspectives.

METHOD

This study sought subjective interpretations of nine family caregivers who experienced relinquishing their status as primary caregiver to a medical model, dementia care residential setting. Following semi-structured interviews and transcription data was analysed using interpretative phenomenological analysis.

RESULTS

One superordinate theme, navigating 'system' control, overarched three subordinate themes: connecting/disconnecting, windows closing, and capacity for sensation. Navigating system control reflected participants' experience of circumnavigating a medical system fraught with hierarchical challenges inclusive of a complex maze of contradictions that appeared threatening, yet appeared comforting; authoritarian, yet often humane. For them, care of self, while advocating for a family member with dementia, required vigilance to manoeuvre a system of care that imposed its uninvited authority at will. Connection/disconnection highlights the enduring struggle for inclusivity in caregiving despite the omnipresent trauma of windows closing. Psychological growth came to these participants through an unexpected capacity for sensation which offered a unique lens to communication with the family member with dementia primarily through sensory exchange.

CONCLUSIONS

Models of dementia care and therapeutic interventions could inclusively involve dementia family caregivers who may be experiencing traumatic distress, and associated guilt, stigma, loss, and grief. Co-existing psychological wellbeing, however, is possible when family members are encouraged to transition communication to sensory awareness and exchange as windows close.

Stigma, the medical model and dementia care: Psychological growth in senior health professionals through moral and professional integrity

Minimal research explores the impact of a career in dementia care on senior health professionals. This study sought positive and negative subjective interpretations from seven senior health professionals regarding their experiences in dementia care. Data from semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). One superordinate theme, Honouring stigmatised self, overarched four sub-themes: Systemic stigma, Invalidated, Self-respect and Moral integrity and Growth. Stigma was interpreted as systemically entrenched minimisation of aged care and the aged-care workforce, including poor remuneration and training. Participants experienced peer invalidation particularly when attempting to resolve complex professional and moral challenges in dementia care. These often occurred in the context of efforts to individualise care, constrained within a medical model. Paradoxically, external invalidation motivated a search for redefining ‘self’ and moral integrity. By wisely acknowledging career experience, growthful domains of self-respect, optimism, humility and innovation defined professional practice and personal choices. Implications are discussed.

Shame, hope, intimacy and growth: Dementia distress and growth in families from the perspective of senior aged care professionals

Minimal research explores the impact of dementia and a dementia diagnosis on families from the unique vantage of senior health professionals. The participants of this study, eight senior aged care professionals, provided unique interpretative insights into family dynamics and sense-making on the journey with dementia, and their own role in that journey. Both positive and negative perspectives were sought. Data from semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). One superordinate theme, Dementia naiveté; redefined intimacy, overarched Embarrassed shame; Maintaining hope; Redefining a model of intimacy; and Redefined relational intimacy and growth. Within these themes, the participants shed light on hurtful embarrassment and shame experienced by families associated with the diagnostic label given to a loved one. This label was perceived to either trigger separation, hurt and immobility through ignorance, or precipitate a frenzy of naive yet hopeful energy for seeking that elusive cure. The participants saw their role as one of enacting a new way of connecting what was with what could be. Thus, they modelled advocacy, integral care and relational intimacy. Validation came in witnessing a redefining of intimacy in many families who were able to embrace that holistic and empathic approach to the shifting presentation of dementia. Psychological well-being was observed to occur when families embraced growthful domains, e.g. acceptance, hope, relational closeness and altruistic concern for other families. Implications for future care models are discussed.

Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed.

Synthesis of Meaning

A paucity of research explores both negative and positive changes for family members supporting a loved one with dementia, especially when communication by speech and awareness of others diminishes. This qualitative study sought the views of family groups concerning their experiences over the past 10 years supporting a loved one with dementia. A focus group sought negative and positive subjective interpretations of this phenomenon. One superordinate theme: Synthesis of Meaning emerged from the data using interpretative phenomenological analysis. This overarched two subordinate themes: (a) Steps backward—encompassing those times when relatives hovered uncertainly, missed opportunities to engage due to advancing dementia, and felt regret and (b) Steps forward—encompassing moments of unexpected rewards, acceptance, self-forgiveness, and empathic connection with others on a similar journey. This study highlights that although often fraught with distress, positive aspects of the dementia journey are possible and offer opportunity for psychological growth and well-being.

Psychological Growth in Aging Vietnam Veterans

This study offers alternative interpretations of war-related distress embedded within the social and political context of the Vietnam War. Subjective interpretations from aging Vietnam veterans were analyzed using interpretative phenomenological analysis. A central theme— Moral authenticity: Overcoming the betrayal and shame of war—overarched five subordinate themes. Four subordinate themes encapsulated layers of war-related betrayal associated with shame. Shame was likely to be described as either (a) internal/sense of personal failure, with no acts of rage; or (b) external/reckless or threatening acts of others, engendering rage. A fifth theme, reparation with self, reflected humility, gratitude, and empathy, currently undefined domains of the growth construct.

Early Life Loss and Trauma

The onset of an eating disorder in middle-age men is poorly researched as are eating disorders in men generally. Therefore, life events that influence eating disorders in men, including delayed onset of an eating disorder remains unknown. Given the limited understanding of males with eating disorders and limited access to large samples of men with eating disorders, an in-depth analysis of a single case of a male in middle age with an eating disorder was chosen to gain insight and understanding into this phenomenon. A Life History approach explored the case of Joseph (pseudonym), who was diagnosed at age 44 years with an Eating Disorder Not Otherwise Specified. Data were collected through (a) life course open-ended questioning through interviews, (b) written statements, and (c) comments on transcripts. Three themes emerged, loss and unworthiness, becoming bigger, and wanting to change reflecting eating behaviors associated with attachment disruption, loss and trauma, body dissatisfaction, and negative affect. Later in life, an emotional “tipping point” precipitated an eating disorder. Results indicate traumatic loss leading to early attachment disruption as influential in Joseph’s delayed onset of an eating disorder. The value of thorough narrative life histories during therapy when eating disorders occur late in life is discussed as well as the significance for men.

The dance of communication: retaining family membership despite severe non-speech dementia

There is minimal research investigating non-speech communication as a result of living with severe dementia. This phenomenological study explores retained awareness expressed through non-speech patterns of communication in a family member living with severe dementia. Further, it describes reciprocal efforts used by all family members to engage in alternative patterns of communication. Family interactions were filmed to observe speech and non-speech relational communication. Participants were four family groups each with a family member living with non-speech communication as a result of severe dementia. Overall there were 16 participants. Data were analysed using thematic analysis. One superordinate theme, Dance of Communication, describes the interactive patterns that were observed during family communication. Two subordinate themes emerged: (a) in-step; characterised by communication that indicated harmony, spontaneity and reciprocity, and; (b) out-of-step; characterised by communication that indicated disharmony, syncopation, and vulnerability. This study highlights that retained awareness can exist at levels previously unrecognised in those living with limited or absent speech as a result of severe dementia. A recommendation for the development of a communication program for caregivers of individuals living with dementia is presented.

Liver transplantation using Chagas-infected donors in uninfected recipients: a single-center experience without prophylactic therapy

Organ shortage is the first cause of death on liver transplant waiting lists. As a consequence, we recently decided to expand liver acceptance to those organs that could potentially transmit infectious diseases to their recipients. On January 2010, we initiated a prospective protocol using livers from Chagas-infected donors for transplanting uninfected recipients without using prophylactic therapy. During a 13-month period, 9 of 37 (24%) liver transplants were performed within this protocol. After transplant, each recipient was sequentially and strictly monitored for infection transmission using the Strout method and promptly treated with benznidazole if this occurs. During follow-up, two patients died without Chagas infection and only two (donor-derived T. cruzi transmission rate: 2/9; 22%) patients developed donor-derived Chagas transmission without clinical symptoms. The median follow-up time of the seven live patients was 15 months (range: 13-20). At present, all are symptoms-free with excellent allograft function and without evidence of Chagas disease. In conclusion, we consider that Chagas-infected donors are a promising source of liver grafts that could reduce the growing mortality on liver waiting lists in America. Relevant data from larger prospective studies are required to confirm these preliminary excellent results.

ASPM and microcephalin expression in epithelial ovarian cancer correlates with tumour grade and survival

BACKGROUND

The clinico-pathological and molecular heterogeneity of epithelial ovarian cancer (EOC) complicates its early diagnosis and successful treatment. Highly aneuploid tumours and the presence of ascitic fluids are hallmarks of EOC. Two microcephaly-associated proteins, abnormal spindle-like microcephaly-associated protein (ASPM) and microcephalin, are involved in mitosis and DNA damage repair. Their expression is deregulated at the RNA level in EOC. Here, ASPM and microcephalin protein expression in primary cultures established from the ascites of patients with EOC was determined and correlated with clinical data to assess their suitability as biomarkers.

METHODS

Five established ovarian cancer cell lines, cells derived from two benign ovarian ascites samples and 40 primary cultures of EOC derived from ovarian ascites samples were analysed by protein slot blotting and/or immunofluorescence to determine ASPM and microcephalin protein levels and their cellular localisation. Results were correlated with clinico-pathological data.

RESULTS

A statistically significant correlation was identified for ASPM localisation and tumour grade, with high levels of cytoplasmic ASPM correlating with grade 1 tumours. Conversely, cytoplasmic microcephalin was only identified in high-grade tumours. Furthermore, low levels of nuclear microcephalin correlated with reduced patient survival.

CONCLUSION

Our results suggest that ASPM and microcephalin have the potential to be biomarkers in ovarian cancer.

Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

BACKGROUND

In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL).

METHODS

Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL.

RESULTS

The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001).

CONCLUSIONS

After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

Vicarious Growth in Wives of Vietnam Veterans

There is a paucity of research understanding the “lived experience” of psychological growth following vicarious trauma. This idiographic study explores the phenomenological experiences of wives of Vietnam veterans exposed to vicarious combat trauma over decades. Using semistructured interviews, data were collected from wives of Australian veterans and analyzed using interpretative phenomenological analysis. Two main themes emerged: (a) “Living with the distress of vicarious trauma” and (b) “Vicarious growth.” The first theme describes the distress and struggle to interpret and understand the “what” of vicarious trauma by these women. The second theme highlights “how” they brought meaning to these experiences. Of interest are the domains of humility, love, gratitude, and empathy aspects of posttraumatic growth that are not captured by existing standardized psychometric tools. The importance of the insider’s perspective into the ongoing lived experience of family members exposed to vicarious combat distress over decades is discussed.