Summary Diarrhoea induced by chemotherapy in cancer patients is common, causes notable morbidity and mortality, and is managed inconsistently. Previous management guidelines were based on poor ...evidence and neglect physiological causes of chemotherapy-induced diarrhoea. In the absence of level 1 evidence from randomised controlled trials, we developed practical guidance for clinicians based on a literature review by a multidisciplinary team of clinical oncologists, dietitians, gastroenterologists, medical oncologists, nurses, pharmacist, and a surgeon. Education of patients and their carers about the risks associated with, and management of, chemotherapy-induced diarrhoea is the foundation for optimum treatment of toxic effects. Adequate—and, if necessary, repeated—assessment, appropriate use of loperamide, and knowledge of fluid resuscitation requirements of affected patients is the second crucial step. Use of octreotide and seeking specialist advice early for patients who do not respond to treatment will reduce morbidity and mortality. In view of the burden of chemotherapy-induced diarrhoea, appropriate multidisciplinary research to assess meaningful endpoints is urgently required.
Both gemcitabine (GEM) and fluoropyrimidines are valuable treatment for advanced pancreatic cancer. This open-label study was designed to compare the overall survival (OS) of patients randomly ...assigned to GEM alone or GEM plus capecitabine (GEM-CAP).
Patients with previously untreated histologically or cytologically proven locally advanced or metastatic carcinoma of the pancreas with a performance status <or= 2 were recruited. Patients were randomly assigned to GEM or GEM-CAP. The primary outcome measure was survival. Meta-analysis of published studies was also conducted.
Between May 2002 and January 2005, 533 patients were randomly assigned to GEM (n = 266) and GEM-CAP (n = 267) arms. GEM-CAP significantly improved objective response rate (19.1% v 12.4%; P = .034) and progression-free survival (hazard ratio HR, 0.78; 95% CI, 0.66 to 0.93; P = .004) and was associated with a trend toward improved OS (HR, 0.86; 95% CI, 0.72 to 1.02; P = .08) compared with GEM alone. This trend for OS benefit for GEM-CAP was consistent across different prognostic subgroups according to baseline stratification factors (stage and performance status) and remained after adjusting for these stratification factors (P = .077). Moreover, the meta-analysis of two additional studies involving 935 patients showed a significant survival benefit in favor of GEM-CAP (HR, 0.86; 95% CI, 0.75 to 0.98; P = .02) with no intertrial heterogeneity.
On the basis of our trial and the meta-analysis, GEM-CAP should be considered as one of the standard first-line options in locally advanced and metastatic pancreatic cancer.
This paper makes connections between the EPSRC AREA Framework for Responsible Research Innovation (RRI) and sociological, feminist and post-positivist methodological contributions to consider how the ...interpretive frames central to these traditions can bring valuable insights to practices of RRI. We argue that taking this interdisciplinary approach enables understanding the research process as a form of proficient craftwork or techne. Techne allows the richness of research methods debates to inform ways in which epistemic protocols can be strategically adjusted and reconfigured to more fully embed RRI principles in every stage of the research process. This enhances researchers’ capacity to minimise some of the undesirable and potentially harmful side effects of research practice and strive towards social good. We draw on fieldwork notes produced as part of our research on industrial cleaning robotics to illustrate how our craftwork approach to RRI is conducted in practice.
Effective communication between clinicians and their patients has a positive impact not only on clinical outcomes but also on their experience of care. Communication skills are a core clinical skill, ...which can be taught by a number of methods. Understanding the impact of one’s own communication skills has on a patient and their family can help hone a clinician’s skills to improve both patient and clinician satisfaction.
This special issue of Asian Anthropology gathers five studies that deal with how the Covid-19 pandemic disruptions impacted on a distinctive social group in a particular geopolitical context: white ...migrants in China. While the articles reveal in fascinating detail how this combination of people and place is in many ways unique in terms of their experiences of, and responses to, the pandemic, the collection also speaks to larger themes of migration, citizenship, inequality, precarity and vulnerability, and the role of race within these.
Contemporary imaginations of the impact of new digital technologies (NDTS) are dominated by utopian visions of a ‘revolution’ in productivity and efficiency, contrasted with dystopian views of ...declines of work and human skills, and distrust of artificial intelligence's efficacy. This article explores imaginations of digital futures in the infrastructure sector through case study research of a global engineering organisation. Drawing on a practice approach, a typology is generated from interviews with engineers and managers to reveal that three broad imaginations compete within the organisation: technodeterminism; technoscepticism; and human‐centric, all with utopian and dystopian variants. Clear relationships exist between the diverse imaginary positions taken by employees with their different roles, biographies and levels of the organisational agency. Those with relatively higher levels of agency tended towards technocentric utopianism while those with lower levels of agency displayed a resolutely dystopian version. Conversely, while the outward‐facing image of the organisation promotes a utopian imagination of a technologically driven future, those with the very highest levels of the organisational agency remain technosceptic. This means that real change is slow. However, an encouraging manifesto for the future is suggested by those who are innovating NDTS to reimagine alternative infrastructure futures through improved human‐centric social outcomes.
This paper explores strategies deployed by a sample of white, British-born South Africans to account for their positions during apartheid and post-apartheid. Whereas literature on white racism ...identifies denial as a key strategy towards racial discrimination and the maintenance of privilege, the historical and political 10 context of South Africa makes this tactic implausible. The paper contributes to understandings of pluralism within white identifications through investigation of diverse discursive strategies used to frame the overtly racist, apartheid regime and the present post-apartheid, supposedly, 'post-race' state. A range of positions attempting to minimise individual implication are identified. 15 A common feature however is to reimagine the structure of social relations in order to diminish responsibility for the sins of the past or the success of the future; suggesting profound difficulties in adjusting to the new social reality.
In this article, we focus on “digital organizational storytelling” as a communicative practice that relies on technologies enabled by the Internet. The article explores the dialogical potential of ...digital organizational storytelling and considers how this affects the relationship between online storytellers and audiences. We highlight the importance of network protocols in shaping how stories are understood. Our analysis is based on a case study of an organization, which produces online animated videos critical of corporate practices that negatively affect society. It highlights the network protocols of amateurism, affinity, and authenticity on which the plausibility of digital organizational storytelling relies. Through demonstrating what happens when network protocols are breached, the article contributes toward understanding digital organizational storytelling as a dialogical practice that opens up spaces for oppositional meaning making and can be used to challenge the power of corporations.
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