No abstract

The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.

This paper evaluates the concept of evidence-based practice (EBP) and appraises critically the implementation process of the EBP initiative, noting its consonance with the aspirations of the dominant political culture and offering a critique of the inherent contradictions and ethical dilemmas associated with it. A critical evaluation of the implications for practitioners and service users is offered and the authors argue that while the concept of EBP is a laudable one, there is a need to exercise caution about uncritical acceptance and evidence that a more eclectic and less reductionist approach to EBP is essential for quality service development.

This paper is drawn from a piece of empirical research which set out to give three women the opportunity to speak on their own behalf about how they experience having cancer in a sexual organ, using a feminist methodology to produce autobiographical stories. The stories describe the process of diagnosis and treatment and also convey the catastrophic nature of a diagnosis of cancer, which leads to a painful, existential crisis and feelings of bewilderment, powerlessness and isolation. The work was prompted by attendance at a workshop about cancer, body image and sexuality for sufferers and carers, which had indicated a depth of pain greater than is usually acknowledged. This pain suggested a fundamental link between body image and the posited concept of woman image; the existence of a common identity through the category woman as it is traditionally structured in society. This link is explored in relation to the evident changes in body image and the compromised sexualities of the women. The disabling consequences of female sexual stereotyping are elaborated and discussed as synergistic with the more fundamental stigma shadow cast by the prospect of dying. The paper discusses possible reasons for this in the context of a transformative rather than restorative model of living with cancer. It suggests that being thrown into self-conscious living could be a source of energy for renegotiation for women especially. The inadequacy of the medical model of disease is exposed and a more holistic approach is shown to be essential to address the needs of cancer patients, as is a critical appraisal and adjustment of existing social attitudes and relations.

While professionalization and role development appear to have benefited both professions and service users in the short-term, their adoption and institutionalization by policymakers are influencing its direction in ways which both may ultimately find troublesome.