Cultivating Compassion through analysis of online patient narratives

Compassion is at the forefront of national and international healthcare policy, practice and educational debates as a result of a series of recent reports (Mid Staffordshire NHS Foundation Trust Inquiry, 2010, Lown et al 2011, Mannion, 2014). Arguably, this emphasis on compassion is in juxtaposition to an increasingly complex technological healthcare system focused upon outcomes, efficiency, productivity and competence. Within this fast paced and time pressured environment innovative strategies are required to cultivate and sustain compassion among healthcare professionals.

Understanding the person’s experience of illness and making an emotional connection are key processes in cultivating compassion (Dewar, 2013). The exponential growth in unsolicited patient narratives has the potential to provide invaluable insight into what matters to patients and their experience of illness. For many patients these stories ‘reclaim’ their illnesses from the traditional biomedical model of disease and reveal otherwise hidden aspects of their experience. The content though freely accessible, is however unedited and lacks safeguards in relation to the quality or accuracy of the information provided. Despite these concerns, healthcare professionals are now challenged to pay attention to these unsolicited patient stories and to consider how they can inform and improve patient care.

This paper discusses the use of online patient narratives in undergraduate nurse education to cultivate compassion. Critical analysis of online patient narratives is advocated as a potential educational strategy to cultivate compassion among future health care professionals.

References
Dewar,B. (2013) Cultivating compassionate care Nursing Standard 27, (34) 48-55

Lown B, Rosen J, Martilla J.(2011) An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Affairs (Millwood) 30, 1772–8.
Mannion,R. (2014) Enabling compassionate healthcare: perils, prospects and perspectives International Journal of Health Policy and Management 2, 115-7
Mid Staffordshire NHS Foundation Trust Inquiry (2010). Independent Inquiry into care provided by Mid Staffordshire NHS Foundation London: Stationery Office.

Online health information - what the newspapers tell their readers: a systematic content analysis

Background: This study investigated the nature of newspaper reporting about online health information in the UK and US. Internet users frequently search for health information online, although the accuracy of the information retrieved varies greatly and can be misleading. Newspapers have the potential to influence public health behaviours, but information has been lacking in relation to how newspapers portray online health information to their readers.

Methods: The newspaper database Nexis (R) UK was searched for articles published from 2003 - 2012 relating to online health information. Systematic content analysis of articles published in the highest circulation newspapers in the UK and US was performed. A second researcher coded a 10% sample to establish inter-rater reliability of coding.

Results: In total, 161 newspaper articles were included in the analysis. Publication was most frequent in 2003, 2008 and 2009, which coincided with global threats to public health. UK broadsheet newspapers were significantly more likely to cover online health information than UK tabloid newspapers (p = 0.04) and only one article was identified in US tabloid newspapers. Articles most frequently appeared in health sections. Among the 79 articles that linked online health information to specific diseases or health topics, diabetes was the most frequently mentioned disease, cancer the commonest group of diseases and sexual health the most frequent health topic. Articles portrayed benefits of obtaining online health information more frequently than risks. Quotations from health professionals portrayed mixed opinions regarding public access to online health information. 108 (67.1%) articles directed readers to specific health-related web sites. 135 (83.9%) articles were rated as having balanced judgement and 76 (47.2%) were judged as having excellent quality reporting. No difference was found in the quality of reporting between UK and US articles.

Conclusions: Newspaper coverage of online health information was low during the 10-year period 2003 to 2012. Journalists tended to emphasise the benefits and understate the risks of online health information and the quality of reporting varied considerably. Newspapers directed readers to sources of online health information during global epidemics although, as most articles appeared in the health sections of broadsheet newspapers, coverage was limited to a relatively small readership.

HPV16 Down-Regulates the Insulin-Like Growth Factor Binding Protein 2 to Promote Epithelial Invasion in Organotypic Cultures

Cervical cancer is a multi-stage disease caused by human papillomaviruses (HPV) infection of cervical epithelial cells, but the mechanisms regulating disease progression are not clearly defined. Using 3-dimensional organotypic cultures, we demonstrate that HPV16 E6 and E7 proteins alter the secretome of primary human keratinocytes resulting in local epithelial invasion. Mechanistically, absence of the IGF-binding protein 2 (IGFBP2) caused increases in IGFI/II signalling and through crosstalk with KGF/FGFR2b/AKT, cell invasion. Repression of IGFBP2 is mediated by histone deacetylation at the IGFBP2 promoter and was reversed by treatment with histone deacetylase (HDAC) inhibitors. Our in vitro findings were confirmed in 50 invasive cancers and 79 cervical intra-epithelial neoplastic lesions caused by HPV16 infection, where IGFBP2 levels were reduced with increasing disease severity. In summary, the loss of IGFBP2 is associated with progression of premalignant disease, and sensitises cells to pro-invasive IGF signalling, and together with stromal derived factors promotes epithelial invasion.

Freshwater reservoir effect (FRE) on re-dating of the prehistoric Eurasian Steppe cultures

There is a major problem with dating human skeletal material in Eurasian
steppe, possibly due to the freshwater reservoir effects (FRE). The goal of the
project is to examine the extent of the FRE in key areas of Siberia and
Kazakhstan through AMS 14C dating and stable isotope (δ13C, δ15N, δ34S)
analysis of c. 150 archaeological and modern samples. Here, we present the
very first results of the tests. We hope that within next years the study will
provide advanced knowledge of FRE across the region; improved 14C sampling
protocols for 14C and isotopic studies; new data on the chronology, diet and
isotopic ecology of particular archaeological sites, and a database on the
extent and variability of the FRE in the region

Freshwater Reservoir Effect on Re-Dating of Eurasian Steppe Cultures: First Results for Eneolithic and Early Bronze Age North-East Kazakhstan

Freshwater reservoir effects (FRE) can cause a major problem with radiocarbon dating human skeletal material in the Eurasian steppe. We present the first results of research into the extent of the FRE in the sites of Borly 4 (Eneolithic), and Shauke 1 and 8b (Early Bronze Age), North-Eastern Kazakhstan. AMS 14C dating and stable isotope (δ13C, δ15N) analysis of associated groups of samples (32 samples, 11 groups in total) demonstrate that: a) the diet of the humans and fauna analysed was based on the C3 foodchain with no evidence of a C4 plant (such as millet) contribution; aquatic resources apparently were a continuous dietary feature for the humans; b) the first 14C dates obtained for the Upper and Middle Irtysh River region attribute the Eneolithic period of the area to the 34th-30th c. BC, and the Early Bronze Age – to the 25th-20th c. BC; there is a ca. 450 years hiatus between the two periods; c) the maximum fish-herbivore freshwater reservoir offset observed equals 301±47 14C yrs. As such, 14C dates from aquatic and human samples from the area need to be interpreted with caution as they are likely to be affected by the offset (i.e. appear older).
The paper also discusses the effect of a sodium hydroxide (NaOH) wash on δ13C, δ15N, C:Natomic levels and collagen yields of the bone samples. Our results indicate a minor but significant effect of NaOH treatment only on C:Natomic ratios of the samples.

Freshwater Reservoir Effects on the Re-Dating of the Eurasian Steppe Cultures: New Data for the Prehistoric Sites of Kazakhstan and South of Siberia

Freshwater reservoir effects (FRE) can cause a major problem with radiocarbon dating human skeletal material in the Eurasian steppe. Recent research has demonstrated that, for the Eneolithic to Early Bronze Age sites of North-Eastern Kazakhstan, the maximum fish-herbivore freshwater reservoir offset observed equals 301±47 14C yrs, as such indicating that 14C dates from aquatic and human samples from the area apparently need to be interpreted with caution as they are likely to be affected by the offset. The current paper presents the new data on the FRE of the Eneolithic to the Early Iron Age sites of Kazakhstan and South of Siberia.

Science, the Arts and Palliative Care: bridging the two cultures

Invited keynote presentation

Spectacles of military urbanism in online representations of the Elite Squad of the military police of Rio de Janeiro: a multimodal approach

This paper presents a multimodal analysis of online self-representations of the Elite Squad of the military police of Rio de Janeiro, the Special Police Operations Battalion BOPE. The analysis is placed within the wider context of a “new military urbanism”, which is evidenced in the ongoing “Pacification” of many of the city’s favelas, in which BOPE plays an active interventionist as well as a symbolic role, and is a kind of solution which clearly fails to address the root causes of violence which lie in poverty and social inequality. The paper first provides a sociocultural account of BOPE’s role in Rio’s public security and then looks at some of the mainly visual mediated discourses the Squad employs in constructing a public image of itself as a modern and efficient, yet at the same time “magical” police force.

Speaking Out Online:The Benefits and Risks of Speaking About Sexual Violence for Young People

Speaking out about sexual violence has been a fundamental part of feminist politics since the 1970s. The practice of narrating experiences of violence, either publicly or to friends and family aims to combat the culture of silence and stigmatisation that surrounds sexual violence while also helping individuals to gain a sense of empowerment and connect with other survivors. However, speaking out also contains inherent risks, especially for young people. Survivors may meet with stigmatising or disbelieving responses, and they may lose control over who knows their story and the way in which it is told and retold.
These risks and benefits are altered, and potentially exacerbated, in an online environment. While social media may increase survivors’ ability to contact and connect with others with similar experiences it also makes it harder to control when and how their story is shared. The disjuncture between online and offline environments may also increase feelings of stigmatisation and isolation.
There is a need to explore the specific risks and benefits of speaking out online given both young people’s extensive use of social media for social interactions and the increasing tendency for support and educational services targeted at young people to make use of social media and online environments. This paper draws on literature and some preliminary research to consider both risks and benefits of speaking out online and to open a conversation about the creation of supportive spaces and mechanisms for young people to speak about sexual violence in online environments.