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Patient experience is an essential component of high-quality care often measured through the satisfaction of patients. This service evaluation draws on a model from customer service to help better understand patient expectations and what matters to them most when attending for an MRI. An online survey based on Kano's model of customer satisfaction was administered online. Participants assessed 28 attributes as part of undergoing an MRI scan, rating how important these were to their satisfaction and thereby their experience. Six hundred and fifteen patients responded, with the majority aged 55–74 years and having had an MRI before. Classification of the attributes shows how those deemed 'functional' in nature have more potential to dissatisfy if not present, whereas those considered 'relational' are thought to have more of an influence over enhancing satisfaction. The importance of relational aspects focused on communication and ensuring that patients are fully informed were highlighted as drivers for improving satisfaction within MRI. • Functional aspects of experience are most likely to dissatisfy if not met. • Relational aspects of experience drive increasing satisfaction with service. • Patients want to be informed about and supported through the experience. • Patients value the connection with imaging staff when undergoing an MRI. • Time is well acknowledged as a barrier to meeting patient needs in MRI. • Acknowledge, Introduce, Describe, Explain, Reassure, Take through next steps is proposed as an alternative communication framework to support rapid rapport and meet patient needs. [ABSTRACT FROM AUTHOR]

Agricultural land use in much of Brong-Ahafo region, Ghana has been shifting from the production of food crops towards increased cashew nut cultivation in recent years. This article explores everyday, less visible, gendered and generational struggles over family farms in West Africa, based on qualitative, participatory research in a rural community that is becoming increasingly integrated into the global capitalist system. As a tree crop, cashew was regarded as an individual man’s property to be passed on to his wife and children rather than to extended family members, which differed from the communal land tenure arrangements governing food crop cultivation. The tendency for land, cash crops and income to be controlled by men, despite women’s and young people’s significant labour contributions to family farms, and for women to rely on food crop production for their main source of income and for household food security, means that women and girls are more likely to lose out when cashew plantations are expanded to the detriment of land for food crops. Intergenerational tensions emerged when young people felt that their parents and elders were neglecting their views and concerns. The research provides important insights into gendered and generational power relations regarding land access, property rights and intra-household decision-making processes. Greater dialogue between genders and generations may help to tackle unequal power relations and lead to shared decision-making processes that build the resilience of rural communities. [ABSTRACT FROM AUTHOR]

Objective: Patients with medically inoperable nonsmall-cell lung cancer generally have limited staging of the mediastinum using computed tomography and combined positron emission tomography and computed tomography, before stereotactic radiosurgery. Historical data have demonstrated the superiority of tissue sampling techniques such as endobronchial ultrasonography and mediastinoscopy compared with imaging studies in accurately determining the nodal stage. We believe, that at a minimum, mediastinal interrogation with endobronchial ultrasonography should be performed before patients undergo stereotactic radiosurgery. Methods: A retrospective review of 59 consecutive patients undergoing bronchoscopic fiducial marker placement as potential candidates for stereotactic radiosurgery was done. All these patients had undergone endobronchial ultrasonography to assess the mediastinum. Transbronchial needle aspirates were taken using standard criteria defined by a lymph node size greater than 5 mm in diameter and/or in the appropriate lymph node drainage pathway. The biopsies were reviewed by the institution’s pathologists. Results: Mediastinal lymph node specimens were not taken in 9 patients because they did not meet our criteria. Of the 50 patients who underwent mediastinal lymph node sampling, 10 had evidence of nodal involvement. On review, 2 of these 10 patients had evidence of mediastinal adenopathy on computed tomography. After excluding those 2 patients, the mediastinal lymph nodes were positive for metastatic disease in 8 (16%) of 50 patients without previous radiographic evidence of disease. These patients were previously thought to be suitable candidates for stereotactic radiosurgery. Also 5 of 10 patients with endobronchial ultrasound-positive lymph nodes had had positron emission tomography-negative findings in the mediastinum. Finally, 10% of the patients suspected to have stage II or III were downstaged with endobronchial ultrasonography and considered for stereotactic radiosurgery. Conclusions: Endobronchial ultrasonography-transbronchial needle aspirates is more accurate than computed tomography and positron emission tomography in staging the mediastinum, can be performed with minimal morbidity, and should be considered for all patients considered candidates for stereotactic radiosurgery. [Copyright &y& Elsevier]

Abstract: This paper investigates the time–space practices of young people caring for their siblings in youth-headed households affected by AIDS in Tanzania and Uganda. Based on qualitative exploratory research with young people heading households, their siblings, NGO workers and community members, the article develops the notion of sibling ‘caringscapes’ to analyse young people’s everyday practices and caring pathways through time and space. Participatory time-use data reveals that older siblings of both genders regularly undertake substantial caring tasks at the very high end of the caregiving continuum. Drawing on rhythmanalysis, the paper explores how young people negotiate emotional geographies and temporalities of caring. The competing rhythms of bodies, schooling, work and seasonal agricultural production can result in ‘arrhythmia’ and time scarcity, which has detrimental effects on young people’s health, education, future employment prospects and mobility. Young people’s lifecourse transitions are shaped to a large extent by their caring responsibilities, resulting in some young people remaining in a liminal position for considerable periods, unable to make ‘successful’ transitions to adulthood. Despite structural constraints, however, young people are able to exercise some autonomy over their caring pathways and lifecourse transitions. The research sheds light on the ways that individuals embody the practices, routines and rhythms of everyday life and exercise agency within highly restricted broader landscapes of care. [Copyright &y& Elsevier]

Abstract: Background: The value of testicular cancer (TC) education, and in particular advice on testicular self-examination (TSE), has been widely debated by health professionals. One concern centres on its potential to cause unnecessary anxiety among the target population. Views outside the health professional community about TC education''s potential benefits and harms have not previously been described. The objective of this study was to investigate the range of views expressed by specific groups thought to have an interest in provision of TC education. Methods: One-to-one, in-depth interviews with 37 men and women were completed. Participants included TC patients, men with no prior diagnosis of TC, and parents and teachers of adolescent boys. Verbatim transcripts were analysed using the Framework approach to produce a thematic description of views expressed. Results: Participants were unanimously in favour of TC education. Key perceived benefits included earlier cancer detection through increasing knowledge of symptoms leading to better treatment outcomes, and motivating help-seeking by reducing emotional barriers such as fear of cancer or embarrassment. Anxiety was acknowledged as a possible harm but was not expected to be widespread or serious. Conclusion: TC education is viewed favourably by members of the public likely to be interested in its provision. Education''s potential to cause anxiety was not considered a disincentive to promoting disease awareness. [Copyright &y& Elsevier]

Abstract: In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers'' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers'' ability to provide the ‘good care’ that integrates the key ethical phases in ideal of the caring process. [Copyright &y& Elsevier]

Marriage practices in the Majority world may differ considerably from dominant cultural ideals in the Minority world of 'romantic love' and 'companionate marriage' based on monogamous relationships. Similarly, mourning in the 'Rest' of the world often diverges from assumptions within Anglophone bereavement studies of a 'grieving journey'. This paper provides a gendered, spatial, relational analysis of responses to the death of a spouse in Senegal, based on in-depth interviews with Serer women and men in rural and urban communities. A heightened sense of relationality with the deceased surrounded widows' bodies, with permeable boundaries that needed to be contained and "purified" through widowhood-mourning practices in order to restore social cohesion. For men, the space of the home was transformed, sometimes unbearably, by the loss of a wife and mother due to their central role in home-making practices, transforming men's relational being. 'Embodied relationality', alongside material constraints, also shaped perspectives on remarriage. The paper reveals the diverse material, embodied, spatial, and often explicitly gendered, ways that the effects of the death of a spouse may be manifested in the experience of the living person and draws attention to the permeable embodied boundaries of 'relational being' that encompass the living and the dead. • Embodied relationality with the dead was expressed through materiality of the home • Widowhood-mourning was a gendered, embodied, material expression of continuing bonds • Death of a spouse was experienced as loss of companionship, care, material support • The material dimensions of loss are inseparable from its emotional significance • Ambivalence about remarriage due to material constraints and embodied relationality [ABSTRACT FROM AUTHOR]

Following referral for investigation of urgent suspected cancer within the English National Health Service referral system, 7% of referred individuals are diagnosed with cancer. This study aimed to investigate the risk of cancer occurrence within 1–5 years of finding no cancer following an urgent suspected cancer referral. This national cohort study used urgent suspected cancer referral data for England from the Cancer Waiting Times dataset and linked it with cancer diagnosis data from the National Cancer Registration dataset. Data were extracted for the eight most commonly referred to urgent suspected cancer referral pathways (breast, gynaecological, head and neck, lower and upper gastrointestinal, lung, skin, and urological) for the period April 1, 2013, to March 31, 2014, with 5-year follow-up for individuals with no cancer diagnosis within 1 year of referral. The primary objective was to investigate the occurrence and type of subsequent cancer in years 1–5 following an urgent suspected cancer referral when no cancer was initially found, both overall and for each of the eight referral pathways. The numbers of subsequent cancers were compared with expected cancer incidence in years 1–5 following referral, using standardised incidence ratios (SIRs) based on matched age-gender distributions of expected cancer incidence in England for the same time period. The analysis was repeated, stratifying by referral group, and by calculating the absolute and expected rate of all cancers and of the same individual cancer as the initial referral. Among 1·18 million referrals without a cancer diagnosis in years 0–1, there were 63 112 subsequent cancers diagnosed 1–5 years post-referral, giving an absolute rate of 1338 (95% CI 1327–1348) cancers per 100 000 referrals per year (1038 [1027–1050] in females, 1888 [1867–1909] in males), compared with an expected rate of 1054 (1045–1064) cancers per 100 000 referrals per year (SIR 1·27 [95% CI 1·26–1·28]). The absolute rate of any subsequent cancer diagnosis 1–5 years after referral was lowest following suspected breast cancer referral (746 [728–763] cancers per 100 000 referrals per year) and highest following suspected urological (2110 [2070–2150]) or lung cancer (1835 [1767–1906]) referral. For diagnosis of the same cancer as the initial referral pathway, the highest absolute rates were for the urological and lung pathways (1011 [984–1039] and 638 [598–680] cancers per 100 000 referrals per year, respectively). The highest relative risks of subsequent diagnosis of the same cancer as the initial referral pathway were for the head and neck pathway (SIR 3·49 [95% CI 3·22–3·78]) and lung pathway (3·00 [2·82–3·20]). Cancer risk was higher than expected in the 5 years following an urgent suspected cancer referral. The potential for targeted interventions, such as proactive monitoring, safety-netting, and cancer awareness or risk reduction initiatives should be investigated. Cancer Research UK. [ABSTRACT FROM AUTHOR]

Abstract: Human papillomavirus (HPV) vaccination is now offered to adolescent girls in the UK. Adolescents over 16 years old are likely to make their own decision about the vaccination. The purpose of this cross-sectional study was to assess acceptability of HPV vaccination among female adolescents (16–19 years) and investigate socio-cultural variation in intended acceptance. Participants were recruited through two further-education colleges in England. They read information about HPV before responding to questions assessing acceptability, demographics and attitudes based on the Health Belief Model. There were 367 cases included in analyses. Most participants said they would be likely to accept HPV vaccination (89%). Ethnicity, religion and English as a first language were associated with acceptability (pseudo-R 2 =0.11). In multivariate analysis only religion remained significant, with girls from Muslim (OR=0.20, CI: 0.05–0.90) or Hindu/Sikh (OR=0.09, CI: 0.01–0.56) backgrounds less likely to accept vaccination. Perceived susceptibility, benefits and barriers were also associated with acceptability (pseudo-R 2 =0.25), but did not mediate the effect of the ethnicity-related variables. Interventions based on the health belief model may help encourage HPV vaccine acceptance among adolescents. Future research to understand the issues associated with HPV vaccination in different religious groups is needed. [Copyright &y& Elsevier]