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PURPOSE: For many patients with cancer, the frequency of surveillance after primary treatment depends on the risk for cancer recurrence or progression. Lack of risk-aligned surveillance means too many unnecessary surveillance procedures for low-risk patients and not enough for high-risk patients. Using bladder cancer as an example, we examined whether practice determinants differ between Department of Veterans Affairs sites where risk-aligned surveillance was more (risk-aligned sites) or less common (need improvement sites). METHODS: We used our prior quantitative data to identify two risk-aligned sites and four need improvement sites. We performed semistructured interviews with 40 Veterans Affairs staff guided by the Tailored Implementation for Chronic Diseases framework that were deductively coded. We integrated quantitative data (risk-aligned site v need improvement site) and qualitative data from interviews, cross-tabulating salient determinants by site type. RESULTS: There were 14 participants from risk-aligned sites and 26 participants from need improvement sites. Irrespective of site type, we found a lack of knowledge on guideline recommendations. Additional salient determinants at need improvement sites were a lack of resources (“the next available without overbooking is probably seven to eight weeks out”) and an absence of routines to incorporate risk-aligned surveillance (“I have my own guidelines that I've been using for 35 years”). CONCLUSION: Knowledge, resources, and lack of routines were salient barriers to risk-aligned bladder cancer surveillance. Implementation strategies addressing knowledge and resources can likely contribute to more risk-aligned surveillance. In addition, reminders for providers to incorporate risk into their surveillance plans may improve their routines.

Critical illness resulting in a pediatric intensive care unit (PICU) admission is a profoundly stressful experience for a child and their family. Increasing evidence for emotional and behavioral sequelae post-PICU emphasizes a need to provide better support for families throughout this period of care and recovery. The aim of this qualitative investigation was to identify salient and modifiable aspects of a critical care experience that can be addressed to better support families of critically ill children. Individual semi-structured interviews were conducted with 26 caregivers of children who survived a PICU admission. Interviews were audio-recorded and transcribed verbatim; themes were identified via thematic analysis. Caregivers were enrolled using convenience sampling from seven tertiary care PICUs in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Themes from caregiver interviews were identified within two overarching categories containing three themes each. Advice for future PICU families: (1) Be intentional about caring for your own well-being, (2) speak up, ask questions, and challenge decisions you’re not comfortable with, and (3) continue to engage with your child. Characteristics of a satisfactory PICU experience: (1) A caregiver–provider relationship of mutual trust established through clear communication and respectful collaboration, (2) hospital environments that provide physical and social supports to maintain humanity in healthcare, and (3) preparing families for care transitions. Targeted, interdisciplinary approaches to partner with families during critical care may improve their PICU experience and contribute to improved long-term outcomes for PICU survivors.

Women and girls have long been confronted with unrealistic, unattainable body image norms. Additionally, the 'ideal feminine' body has been subject to constant change over the last centuries and decades. With the proliferation of the internet, women and girls are continuously exposed to advice from heteronormative discourses of womanhood. Demand for cosmetic surgery has dramatically increased and is still expanding. Recently, women's and girls' awareness has shifted towards how they should 'improve' the aesthetic appeal of their labia, 'optimise' their vaginas, and generally make their vulva 'healthier', leading to a growing popularity of female genital cosmetic surgery. Proponents of surgical interventions (falsely) claim them as agentic methods of self-expression and promise 'improvement' beyond the individual's control. The marketing of these procedures is predicated on shame and has been described as aggressive. Our postmodern era brings new visions of desired body image, and a rise of internet-based digital connections between people. This means new body image 'norms' are instantly circulated and changed, and body image is continuously scrutinised and shamed. Coupled with increased accessibility of internet-based nudity and pornographic material, and prevailing associations of shame and taboo about female genitalia, consequences particularly for young women's perceptions of body image are drastic. This chapter discusses the internet's role in the recent desire by young women and girls to seek genital cosmetic surgery.