Lisa Wood

Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial.

PURPOSE We wanted to confirm the benefit of mometasone furoate (MF) in preventing acute radiation reactions, as shown in a previous study (Boström et al, Radiother Oncol 2001;59:257-265). METHODS AND MATERIALS The study was a double-blind comparison of MF with D (Diprobase), administered daily from the start of radiation therapy for 5 weeks in patients receiving breast radiation therapy, 40 Gy in 2.67-Gy fractions daily over 3 weeks. The primary endpoint was mean modified Radiation Therapy Oncology Group (RTOG) score. RESULTS Mean RTOG scores were significantly less for MF than for D (P=.046). Maximum RTOG and mean erythema scores were significantly less for MF than for D (P=.018 and P=.012, respectively). The Dermatology Life Quality Index (DLQI) score was significantly less for MF than for D at weeks 4 and 5 when corrected for Hospital Anxiety and Depression (HAD) questionnaire scores. CONCLUSIONS MF cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. For the first time, we have shown a significantly beneficial effect on quality of life using a validated instrument (DLQI), for a topical steroid cream. We believe that application of this cream should be the standard of care where radiation dermatitis is expected.

The reconfiguration of triage by introduction of technology

Triage is the process of sorting patients by order of treatment necessity in large scale emergencies. Usually, a paper tag is attached to each patient containing their classification and the results of an initial, quick diagnosis. Several projects have aimed to electronically augment the process by using ubiquitous computing components. In this paper we present drawbacks of introducing technology to the process, which have not been discussed elsewhere, based on an extensive set of expert workshops discussing the employment of technology in triage with the aid of technology probes. Our main finding is that the common set of functionalities of electronic triage systems involves unwanted reconfiguration of triage processes. By presenting a set of implications for the design of these mobile technologies, we show how potential negative effects can be mitigated.

How to follow the information?:a study of informational mobilities in crises

This article discusses mobile methods of “following the information” to contribute to a new politics of sociological method and inform the development of new design philosophies for information technologies. The approach is motivated by the increasing informationalization of everyday life in general and crisis management in particular. At this juncture social and political principles of privacy and solidarity are being transformed in ways that undermine fundamental values of equality and freedom. Crisis management is a particularly important site for such transformations. By showcasing different ways in which we have followed information in different crisis management settings through tracking, retrospective go-alongs, shadowing and tracing, we show how technologies designed with the ambition to enable “direct interconnection,” “one stop” access and “collect-all” ambitions eliminate control for many data subjects. The studies we present contribute to alternative information system design philosophies that actively support human sensory and social practices of making and making sense of data.

An architecture for using commodity devices and smart phones in health systems

The potential of patient-centred care and a connected eHealth ecosystem can be developed through socially responsible innovative architectures. The purpose of this paper is to define key innovation needs. This is achieved through conceptual development of an architecture for common information spaces with emergent end-user applications by supporting intelligent processing of measurements, data and services at the Internet of Things (IoT) integration level. The scope is conceptual definition, and results include descriptions of social, legal and ethical requirements, an architecture, services and connectivity infrastructures for consumer-oriented healthcare systems linking co-existing healthcare systems and consumer devices. We conclude with recommendations based on an analysis of research challenges related to how to process the data securely and anonymously and how to interconnect participants and services with different standards and interaction protocols, and devices with heterogeneous hardware and software configurations.

Work on the move : editors’ introduction to the special issue

Abstract This article provides an editorial introduction to a special issue of Applied Mobilities on mobile work and work on the move. Drawn from an open call for articles at a workshop held at Lancaster University in March 2015, contributors interpreted the workshop theme in a number of different theoretical and contextual perspectives. This introduction provides some of the overarching context for the study and theorising of mobile work and explores some of the connecting themes and possible future directions relating to the physicality of work.

Organising the machine: material-discursive practices and mobile medical equipment engineers

Abstract In this paper, I consider the mobile work of medical equipment engineers to reveal material-discursive practices during the installation of a Cone-Beam Computerised Tomography system. In doing so, I draw together elements of organisation studies and mobilities to explore movement in relation to matter, meaning and materialisation. I use the medical equipment engineers’ work to explore materialities of organising in physical spaces that are continually changing and examine how mobile work shapes, and is shaped by, context, ordering and potentiality. Drawing on ethnographic fieldwork with medical equipment engineers, the data are interrogated to elucidate these highly mobile working practices, specifically drawing out practices and materialities that relate to ordering and space making. The analysis describes the way in which engineers temporarily “own” spaces in which their work takes place whilst also being shaped by the organisation in which they are placed. I discuss the technologies of ordering (or control), which take the form of plans or protocols (physical or virtual), and material elements, such as signage, that shape, influence and control but also facilitate, enable and authorise mobile work to take place. Modes of ordering, or strategies, are unpacked to reveal how mobilities influence material-discursive becomings and thus how the mobilities of the engineers become internal to the sociomaterial ordering of the machine. Through this empirical paper, I demonstrate how the mobilities paradigm can help understand these circulations of knowledge and thus understand how mobile work shapes sociotechnical assemblages.

Conceptualising Decadent Technology: A Case Study of Path Dependence in Radiotherapy

Abstract Large-scale investments in health technologies often have limited evidence for effectiveness when first introduced. Nevertheless, professional and public discourses often present the advantages of such investments, with unknown risks, as necessary and entailing significant improvement. Such discourses are evident with the introduction of the Linac Adapted Conebeam Imager (LACI), introduced to improve the accuracy of radiotherapy treatments. From one perspective, the introduction of such technologies can be considered to be decadent since there is limited, if any, evidence of improvement of current standards and procedures, yet they are promoted as the latest and best technologies for solving societal problems. Connecting the concepts of decadence to those of path dependence, through the case of the LACI, enables the exploration of the ‘technical interrelatedness’ of technological changes. Building on the concept of path dependence, it is possible to demonstrate how introducing a closely related technology does not only become a low-risk course of action. Rather change is demanded (but not determined) as well as potential alternative systems being obscured. With decadent technologies, any future changes are not only dependent upon past introductions; but also they create a need for future changes. Such a view demonstrates how these technologies may not necessarily offer any improvements, but rather contribute to the creation of ongoing demand for unproven technologies. As a result they may encourage the introduction of increasingly complex technologies.

Shaping the Field: A Reflexive Account of Practitioner Interference During Ethnographic Fieldwork in Radiotherapy

Drawing on ethnographic fieldwork at two UK hospitals during periods of technological change, I explore the multiplicity of roles performed when a practitioner turns ethnographer: from confidante, resource, bystander, friend, lunch buddy and observed. I describe how the situated body becomes part of procedures and relations in the field and how denying this is to deny intuition, feelings and position as part of research relationships. This reflexive approach acknowledges the researcher’s own knowledge production and epistemic practices required to work through the difficulties and tensions that emerge from practitioner relationships. I conclude that, through reflexive analysis that avoids self-absorption, practitioner ethnographers can clarify findings and provide a trace of intellectual and social paths that lead to conclusions made.

Experimental subjects and partial truth telling during technological change in radiotherapy

Background: Cone Beam Computed Tomography (CBCT), the focus of a number of radiotherapy fundraising campaigns in the mid-2000s, was introduced accompanied by a fanfare of newness and discourses of ‘hope’, ‘inspiring clinical confidence’ and ‘accuracy’. The CBCT system, used in the delivery of Radiotherapy treatment, was incorporated into strategic planning priorities across the United Kingdom based on a rationale of self-evidence. During this time, the way in which the new system was discussed with patients was variable. Research objectives: The purpose of this study was to uncover how experimental practices were embedded and enacted during the use of a new technological system, specifically relating to how patients were enrolled during introductory phases of technology adoption. Research design and context: Drawing on ethnographic work and interviews with staff members in one hospital, the study examines staff discussions prior to the introduction of the Cone-Beam CT imaging system in radiotherapy. It considers how staff views were at odds with practices that occurred during the ‘experimental’ stages of use and how these were shared with patients. Ethical considerations: Approval was obtained from the Local National Health Service Research Ethics Committee and National Health Service Main Research Ethics Committee (REC 07/Q1308/16) for the interview and ethnographic stages, respectively. All names have been changed and participants signed a consent form. Findings: Staff reported a lack of evidence, absence of proof and perturbing doubts with the X-ray volumetric imaging. Both patients’ and practitioners’ partial understanding about the risks and benefits of the system created incommensurable ideas regarding its use and what the patients’ role was during these introductory stages. Conclusion: Maintaining partial truth telling renders patients’ experiences of new treatment at odds with ‘experimental’ practice. This has wide-reaching implications for practice.