Medical students benefit from learning about patient safety in an interprofessional team.

CONTEXT: Safe clinical practice is inextricably linked to team-working. Delivering patient safety education interprofessionally heightens students' awareness of the importance of effective team-working for safe care and care delivery. METHODS: We conducted a comparative study using mixed-method analysis among medical students learning about patient safety, either uni- or interprofessionally, towards the end of their training. Emphasis is placed on the detailed analysis of qualitative data relating to student perceptions of the event before and afterwards. RESULTS: All medical students, whether working uni- or interprofessionally, increased their knowledge across all eight learning outcomes (P = 0.001). Although students said they felt more comfortable when learning alongside other medical students, those who learned with other disciplines gained added value from these interactions and were able to frame their thinking more clearly within the context of safe interprofessional team-working. CONCLUSIONS: Designing a team-based patient safety event to take place towards the end of medical education can enable students to assimilate all aspects of their curriculum relevant to safety. The link between team factors and the safety agenda is increased when students learn interprofessionally.

Consent for childhood cancer tissue banking in the UK: the effect of the Human Tissue Act 2004.

The obtainment, storage, and use of human tissue taken from children for research purposes is an area that is notable for its complexity and legal uncertainties. In the UK, the controversy surrounding organ retention prompted radical legislative change in the form of the Human Tissue Act 2004, which came into force from September, 2006. This Review paper explores the effect of the Human Tissue Act on consent, in the context of childhood tissue banking. We take as our case study the UK Children's Cancer Study Group tumour bank. Although the Human Tissue Act provides a new, detailed statutory framework, it does not, by itself, resolve all the relevant issues in this area. Researchers and clinicians must, therefore, continue to work alongside the existing principles of common law relating to this issue. Consent for the removal of tumour tissue during a surgical procedure should be distinguished from consent for the retention of the tissue for future use in research or for other specified uses. Consent to surgery is regulated by the same common law procedures used for consent to treatment. By contrast, the requirements for consent to storage and specified uses of samples are predominantly, but not exclusively, regulated by the Human Tissue Act. Although the Human Tissue Act might, at first, seem to promote clarity, the new legislative provisions and resultant Codes of Practice on consent could possibly lead tumour banks to reassess the nature and process of obtaining consent for the use of samples from children in research.

A systematic review of molecular and biological tumor markers in neuroblastoma.

PURPOSE: The aim of this study was to conduct a systematic review, and where possible meta-analyses, of molecular and biological tumor markers described in neuroblastoma, and to establish an evidence-based perspective on their clinical value for the screening, diagnosis, prognosis, and monitoring of patients. EXPERIMENTAL DESIGN: A well-defined, reproducible search strategy was used to identify the relevant literature from 1966 to February 2000. RESULTS: A total of 428 papers studying the use of 195 different tumor markers in neuroblastoma were identified. Small sample sizes, poor statistical reporting, large heterogeneity across studies (e.g., in cutoff levels), and publication bias limited meta-analysis to the area of prognosis only; MYCN, chromosome 1p, DNA index, vanillylmandelic acid:homovanillic acid ratio, CD44, Trk-A, neuron-specific enolase, lactate dehydrogenase, ferritin, and multidrug resistance were all identified as potentially important prognostic tools. CONCLUSIONS: This systematic review forms a knowledge base of the tumor markers studied thus far in neuroblastoma, and has identified some of the most important prognostic markers, which should be considered in future research and treatment strategies. Importantly, the review has also highlighted some general problems across primary tumor marker studies, in particular poor and heterogeneous reporting. These need to be addressed to allow better clinical interpretation and enable more appropriate evidence-based reviews in the future. In particular, collaboration of cancer research groups is needed to enable bigger sample sizes, standardize methods of analysis and reporting, and facilitate the pooling of individual patient data.

Representing childhood cancer: accounts from newspapers and parents.

We present an analysis of newspaper accounts and parents' accounts of childhood cancer. Newspaper accounts construct cancer as a threat to the entitlements and category-bound activities of childhood. Newspaper discourses around children with cancer are predominantly eulogising, constructing children as courageous, stoical and inspirational. Parents are characterised as confederates in the 'battle' against cancer; as fund-raisers; and as guardians of their children's identities. Little attention is given to parents' own needs. Parents' in-depth interview accounts suggest that newspapers are selective and privilege certain types of representations. Parents' accounts, like those in newspapers, construct childhood cancer as an assault on the rights of childhood. Parents also characterise themselves as having a range of obligations founded on dominant discourses about parenting. However, parents' descriptions bear little resemblance to newspaper accounts. Rather than the cheerful, uncomplaining and 'brave' newspaper representations of children, parents report that children can be distressed, anguished and difficult to manage, especially when being encouraged to submit to painful and frightening medical interventions. Parents themselves experience a range of quality of life impairments, including severe role strain, but find it difficult to voice these because they have to negotiate prevailing discourses about the duties of parenthood. Parents' accounts do not allow unproblematic access to some external reality; these accounts are just as constructed as newspaper accounts. Both newspapers and parents may draw on common discourses about parenting, childhood and illness, but newspapers are more likely to represent children in idealised ways and to marginalise parents as resources solely for their child's benefit.

Managing communication with young people who have a potentially life threatening chronic illness: qualitative study of patients and parents.

OBJECTIVES: To examine young people's and parents' accounts of communication about cancer in childhood. DESIGN: Semistructured interviews analysed using the constant comparative method. SETTING: Paediatric oncology unit. PARTICIPANTS: 13 families, comprising 19 parents (13 mothers, six fathers) and 13 patients aged 8-17 years, recruited from one paediatric oncology unit. The patients had cancer or brain tumour. RESULTS: Most parents described acting in an executive-like capacity, managing what and how their children were told about their illness, particularly at the time of diagnosis. Their accounts were shaped by concerns to manage their identity as strong and optimistic parents and to protect their child's wellbeing. The patients identified elements of their parents' role that both facilitated and constrained their communication, and while they welcomed their parents' involvement, some expressed unease with the constraining aspects of their parents' role. Some young people described feeling marginalised in consultations and pointed to difficulties they experienced in encounters with some doctors. CONCLUSIONS: There are difficulties in managing communication with young people who have a chronic, life threatening illness. Health professionals need to be aware of how the social positioning of young people (relative to adults) and the executive role of parents can contribute to the marginalisation of young people and hamper the development of successful relationships between themselves and young patients.

Parenting in a crisis: conceptualising mothers of children with cancer.

Much research on the experiences of parents of children with cancer has been conducted within a discourse of psycho-pathology, or has tended to see parents mostly as a proxy source of information on the well-being of their children. Using empirical data from semi-structured interviews with 20 mothers of a child with cancer, in one area of the UK, we draw on sociological literatures on motherhood, childhood, caring, and chronic illness to suggest a more helpful and informative way of understanding their experiences. We suggest that mothers, although not ill themselves, experience many of the consequences of chronic illness. Biographical disruption begins for them when they first notice something wrong with their child, and intensifies with diagnosis, altering their sense of self and their social identity. The diagnosis brings with it a set of new responsibilities and role expectations, including an obligation of 'proximity'-being physically close to their child at all times to provide 'comfort' and 'keep-watch'. For mothers, caring evokes an intense emotional interdependence with their sick child, and involves a range of technical tasks and emotional work, including acting as 'brokers' of information for their child and managing their cooperation with treatment. Managing these obligations was achieved at high cost to the mothers themselves, and resulted in severe role strain by compromising their ability to function in other roles, including their role as the mother of their other children. Against the backdrop of a severe and life-threatening illness, everyday concerns about their child's diet or appropriate discipline take on a new significance and carry a heightened potential for generating conflict and distress for mothers. In presenting their accounts, mothers draw on prevailing cultural discourses about motherhood, childhood and cancer, and these clearly influence the context in which they care for their child, and shape their reflexive constructions of their experiences. Caring for a child with cancer had many adverse implications for the quality of life of the women we studied. Mothers of a child with cancer warrant study in their own right, and such study benefits from interpretive perspectives.

Identity and role in parenting a child with cancer.

In this paper we suggest that the needs and roles of parents of children with cancer have been inadequately conceptualized by traditional approaches to investigating the psychosocial aspects of chronic childhood illnesses such as cancer. Conducted mainly within discourses of psychopathology, traditional approaches have tended to characterize parents' experience of their child's illness in terms of 'maladjustment' and 'coping', but have done little to illuminate the processes involved in how parents live with their child's illness. In other areas, the research literature treats parents solely as proxy sources of their children's views, and the complexity of their roles as caregivers and individuals in their own right has been ignored. We attempt to re-characterize parenting a child with cancer, drawing attention to how the roles, identities and social obligations of parents position them in relation to the medical world, and highlight the emotional work carried out by parents, including protection of their own and their child's identity. Drawing on various bodies of empirical and theoretical work, including the developing field of childhood studies and the literature on informal carers, we suggest ways of rethinking our understanding of the experience of parenting a child with cancer. In doing so, we consider how the narratives of parents can inform the development of measures to assess the impact of the childhood cancer on the quality of parents' lives, and the role that social and organizational aspects of services can play in ameliorating some of the difficulties involved in parenting a child with cancer.