Supporting practitioners to talk about sexual wellness and pleasure during radiotherapy for gynaecological cancer.

INTRODUCTION: Radiotherapy treatment for gynaecological cancer has significant negative effects on sexual wellness and pleasure (1-3). Patients undergoing radiotherapy for gynaecological cancers have more sexual dysfunction and experience more sexual and depressive symptoms than those who undergo surgery alone (4). The World Health Organization defines sexual health as a crucial part of health and wellbeing and recognizes the importance of positive and respectful approaches to sexuality, alongside safe and pleasurable sexual experiences free from violence and coercion (5). METHODS: Taking a sex critical approach to sexual wellness and pleasure, this project aimed to support practitioners to have improved and impactful conversations with people receiving radiotherapy treatment for gynaecological cancers. A series of three professional development workshops were held to explore language, unpack assumptions and develop key competencies for practitioners. A fourth workshop involved co-development of resources for use by other practitioners. RESULTS: The group united, sharing insights, learning, and developing practices through reflection developing critical awareness about damaging silences around sexual wellness and pleasure. Co-created resources included conversation cards and a poster. CONCLUSION: The project aimed to build and extend research findings to develop practitioner skills in supporting sexual wellness and pleasure for people receiving gynae-radiotherapy. The study shows the benefits of discussing norms and harms associated with biomedically focused conversations in gynae-radiotherapy to acknowledge diversity and validate concerns about sexual wellbeing and pleasure. IMPLICATIONS FOR PRACTICE: A sex critical approach to sexual wellness and pleasure should be considered a core principle of care for patients during their treatment for gynaecological cancers. Conversations are a key (free) resource within the practitioner-patient relationship that can address and improve patients' psychosocial wellbeing.

[Research applications in digital radiology. Big data and co]. / Forschungsanwendungen in der digitalen Radiologie. "Big data" und Co.

Medical imaging produces increasingly complex images (e.g. thinner slices and higher resolution) with more protocols, so that image reading has also become much more complex. More information needs to be processed and usually the number of radiologists available for these tasks has not increased to the same extent. The objective of this article is to present current research results from projects on the use of image data for clinical decision support. An infrastructure that can allow large volumes of data to be accessed is presented. In this way the best performing tools can be identified without the medical data having to leave secure servers. The text presents the results of the VISCERAL and Khresmoi EU-funded projects, which allow the analysis of previous cases from institutional archives to support decision-making and for process automation. The results also represent a secure evaluation environment for medical image analysis. This allows the use of data extracted from past cases to solve information needs occurring when diagnosing new cases. The presented research prototypes allow direct extraction of knowledge from the visual data of the images and to use this for decision support or process automation. Real clinical use has not been tested but several subjective user tests showed the effectiveness and efficiency of the process. The future in radiology will clearly depend on better use of the important knowledge in clinical image archives to automate processes and aid decision-making via big data analysis. This can help concentrate the work of radiologists towards the most important parts of diagnostics.

The relative influence of team climate, team norms and social network norms on health professionals' implementation of a national recommendation to offer service-users diagnosed with schizophrenia family intervention therapy.

Social influence is an important variable influencing health professionals' adoption of clinical recommendations. Different theories conceptualise social influence in different ways. This study operationalised three different forms of social influence--team climate, team norms (descriptive and injunctive) and social network norms (descriptive and injunctive), and compared their ability to predict mental health professionals' self-reported intention to adopt a national, clinical recommendation. A cross-sectional survey was developed, measuring the constructs in relation to intention to offer service-users family an intervention therapy, as part of a larger, theory-based implementation study. The survey was administered to all mental health professionals in one mental health trust. Using multiple regression, descriptive network norms were found to be the only significant predictor of intention. This suggests that behaviour change interventions in this context may benefit from promoting descriptive network norms, for example, emphasising the adoption behaviour of influential peers. Given the high degree of overlap found between network and team members in this study, and the potential challenges of targeting behaviour-change interventions at informal, more difficult to identify networks, future research is needed to evaluate the feasibility of targeting behaviour-change interventions at social networks compared with formal teams.

Health information search to deal with the exploding amount of health information produced.

OBJECTIVES: This focus theme deals with the various aspects of health information search that are necessary to cope with the challenges of an increasing amount and complexity of medical information currently produced. METHODS: This editorial reviews the main challenges of health information search and summarizes the five papers of this focus theme. RESULTS AND CONCLUSIONS: The five papers of the focus theme cover a large part of the current challenges in health information search such as coding standards, information extraction from complex data, user requirements analysis, multimedia data analysis and the access to big data. Several future challenges are identified such as the combination of visual and textual data for information search and the difficulty to scale when analyzing big data.

Multiple outcome measures and mixed methods for evaluating the effectiveness of theory-based behaviour-change interventions: a case study targeting health professionals' adoption of a national suicide prevention guideline.

Interest in behaviour-change interventions targeting health professionals' adoption of clinical guidelines is growing. Recommendations have been made for interventions to have a theoretical base, explore the local context and to use mixed and multiple methods of evaluation to establish intervention effectiveness. This article presents a case study of a behaviour-change intervention delivered to community mental health professionals in one Primary Care Trust, aimed at raising adherence to a national suicide prevention guideline. A discussion of how the theory-base was selected, the local context explored, and how the intervention was developed and delivered is provided. Time series analysis, mediational analysis and qualitative process evaluation were used to evaluate and explore intervention effectiveness. The time series analysis revealed that the intervention was not effective at increasing adherence to the guideline. The mediational analysis indicates that the intervention failed to successfully target the key barrier to adoption of the guidance, and the qualitative process evaluation identified certain intervention components that were well received by the health professionals, and also identified weaknesses in the delivery of the intervention. It is recommended that future research should seek to further develop the evidence-base for linking specific intervention strategies to specific behavioural barriers, explore the potential of theories that take into account broader social and organisational factors that influence health professionals' practice and focus on the process of data synthesis for identifying key factors to target with tailored interventions. Multiple and mixed evaluation techniques are recommended not only to explore whether an intervention is effective or not but also why it is effective or not.

Morphological operators on the unit circle.

Images encoding angular information are common in image analysis. Examples include the hue band of color images, or images encoding directional texture information. Applying mathematical morphology to image data distributed on the unit circle is not immediately possible, as the unit circle is not a lattice. Three approaches to solving this problem are presented. First, difference-based operators are studied (e.g., gradient, top-hat). Second, a definition of grouped circular data is suggested, and "pseudo" morphological operators, which operate only on grouped data, are introduced. Finally, processing using pixel labeling is presented, leading to the development of a cyclic opening operator. Applications for treating the hue band of color images and for finding perturbations in wood texture are given.

Molecular analysis of HLA DP and DQ genes associated with dermatitis herpetiformis.

HLA class II DQ and DP genes from dermatitis herpetiformis patients were amplified and analyzed using molecular probes and compared to those from celiac disease patients and to an HLA and ethnically matched control group. In dermatitis herpetiformis, as in celiac disease, the strongest association of disease was with the DQ subregion alleles DQB1*0201 and DQA1*0501 that are linked to the DRB1*0301 allele. DQB1*0201 determines the DQw2 serologic marker whereas DRB1*0301 determines the DRw17 serologic marker (formerly termed DR3). A DP subregion allele DPB1*0301 was increased and a constellation of DPB1 alleles that included DPB1*0202, *0901, and *1301 was decreased in dermatitis herpetiformis. DPB1*0101, an allele reported to be increased in celiac disease, was not increased in dermatitis herpetiformis. DP beta chains that lack a negatively charged amino acid residue at position 69 of the DP beta chain are significantly over-represented both in dermatitis herpetiformis and celiac disease patients with the DRw17, DQw2 haplotype, compared to healthy controls with that haplotype. These data favor a multigenic model for the contribution of HLA class II D region genes to dermatitis herpetiformis susceptibility. Further, they indicate that a specific DQ molecule, when present in combination with the product of one of several different DPB1 alleles, may contribute to susceptibility to the intestinal lesion, which is common to dermatitis herpetiformis and celiac disease.