Online doctor diflucan

Latest Sleep News By Dennis Thompson HealthDay ReporterWEDNESDAY, April 20, 2022 (HealthDay News) The most common treatments for sleep apnea are mechanical -- CPAP machines, mouthguards online doctor diflucan and the diflucan success rate like. But researchers think they've found a drug that might ease sleep apnea in some. The drug online doctor diflucan sulthiame, normally used to treat epilepsy, appeared to reduce breathing pauses by more than 20 events an hour, on average, in obstructive sleep apnea patients, according to early clinical trial results. Those results are some of the strongest ever reported in a drug trial for sleep apnea, researchers said.

"For just over a third of patients in the study, only half of their breathing pauses were left, and in 1 in 5 the number fell by at least 60%," said lead researcher Dr. Jan Hedner, a professor of pulmonary medicine at the University of online doctor diflucan Gothenburg in Sweden. Sulthiame inhibits an enzyme that serves to maintain the balance of carbon dioxide in the body. Some people suffer from what doctors call a "high loop gain," an elevated sensitivity to blood levels of oxygen and carbon dioxide, said Dr.

Kannan Ramar, a sleep online doctor diflucan medicine expert with the Mayo Clinic in Rochester, Minn. High loop gain is believed to contribute to sleep apnea in about a third of patients with obstructive sleep apnea, Ramar said. These patients are more apt to experience a pause in breathing while asleep due to changes in their oxygen or carbon dioxide levels. "High loop gain makes the system very unstable," Ramar said online doctor diflucan.

"The medication blunts that response. It makes the system more stable, so it doesn't respond as dramatically to changes in carbon dioxide or oxygen levels. The breathing pauses then subsequently stop." In the United States, the Sleep Foundation estimates that between 2% and online doctor diflucan 9% of adults have obstructive sleep apnea. The sleep disorder contributes to daytime drowsiness and to heart disease, high blood pressure and stroke.

This early clinical trial was designed to test mainly for safety, and involved about 60 people with moderate or severe sleep apnea. Patients were randomly assigned to one of three groups -- one receiving a high dose of the drug, another online doctor diflucan receiving a lower dose, and a third receiving a placebo. After four weeks, researchers found that sulthiame reduced the number of breathing pauses during the night and promoted oxygenation of patients' blood. Sulthiame also proved relatively safe, with headache and a pins-and-needles sensation on the skin reported as the most common side effects.

Some high-dose online doctor diflucan patients also reported shortness of breath. No severe adverse events occurred, but six patients from the high-dose group dropped out due to their side effects. "We have online doctor diflucan decent effects with very few side effects," Hedner said. Several drugs have been tested over the years as potential treatments for sleep apnea, but none have yet proven useful, said Dr.

Jonathan Jun, a sleep medicine expert at Johns Hopkins Hospital in Baltimore. "I would say, yes, there's a signal that it reduces the frequency of the respiratory events, the episodes of blocked breathing or shallow breathing caused by sleep apnea," online doctor diflucan Jun said of the sulthiame trial. But Jun added that the results so far reflect "a partial solution" in which some patients barely responded to the drug while others did well. "I don't see that this would necessarily be a full solution or complete substitute for a therapy like CPAP [continuous positive airway pressure]," Jun said.

A CPAP machine consists of a motor, a hose and a mask fitted over the user's mouth and online doctor diflucan nose. Air is pushed through the hose to the mask and it keeps the user's airway open during sleep. The next phase of clinical trials has started for sulthiame, involving about 400 patients from five European countries, Hedner said. Researchers hope to wrap up that phase by late this online doctor diflucan year or early next.

Sulthiame is one of several drugs now being investigated to treat sleep apnea, Hedner said, and the drugs work in different ways. "Maybe there will be openings for combinations of drugs, or between mechanical therapies and different types of drugs if we find combinations that work well in patients," Hedner said. "It's a very, very exciting development." The trial results were online doctor diflucan published April 15 in the American Journal of Respiratory and Critical Care Medicine. More information The Sleep Foundation has more on sleep apnea treatments.

SOURCES. Jan Hedner, MD, PhD, online doctor diflucan professor, pulmonary medicine, University of Gothenburg, Sweden. Kannan Ramar, MBBS, MD, sleep medicine expert, Mayo Clinic, Rochester, Minn.. Jonathan Jun, MD, sleep medicine expert, Johns Hopkins Hospital, Baltimore.

American Journal of Respiratory and Critical Care Medicine, April 15, online doctor diflucan 2022 Copyright © 2021 HealthDay. All rights reserved.Latest Pet Health News By Amy Norton HealthDay ReporterWEDNESDAY, April 20, 2022 (HealthDay News) With marijuana now legal in many U.S. States, some veterinarians are seeing more cases of cannabis poisoning in dogs and other pets, according to a new survey. The poll, of 251 vets in Canada and the United States, found that those online doctor diflucan incidents usually end well.

Most animals recover quickly, without needing a hospital stay. But in some cases, online doctor diflucan more intense treatment is needed. And a small number of pets die after ingesting marijuana. Veterinarians who were not involved in the study said it all sounds familiar.

"We have seen an increase [in cannabis poisoning] in the past five online doctor diflucan years or so," said Dr. Tasia Ludwik, a critical care specialist at the University of Minnesota's Veterinary Medical Center, in St. Paul. "I'd say we average about five or six cases a week." Dogs, not surprisingly, account for most marijuana poisonings, though online doctor diflucan cats, ferrets and horses sometimes fall victim, too.

The typical incident involves a curious pup who finds brownies, butter or other tempting treats that have marijuana as a secret ingredient. In general, vets can readily spot the signs and symptoms of a "pot puppy," according to Dr. Elizabeth Rozanski, a critical online doctor diflucan care veterinarian at Tufts University's Foster Hospital for Small Animals, in Massachusetts. "They usually come in stumbling, disoriented and dribbling urine," Rozanski said.

It's a scary situation for owners, the vets said, since they often think their pup is suffering a life-threatening condition. But after some questioning — namely, whether the animal could've gotten hold of marijuana online doctor diflucan — the cause becomes clear. In the new study, published online April 20 in the journal PLOS ONE, most vets did not report any changes in the number of marijuana poisonings they'd seen in recent years. But about 40% did report a shift — almost always an increase.

That's in line with studies from the past few years that have found rising rates online doctor diflucan of cannabis poisoning among pets in the United States and Canada. Canada legalized recreational marijuana in 2018. In the United States, medical marijuana is legal in most states, while 18 states and Washington, D.C., have also legalized recreational use. A couple of things could be behind the increases in pet marijuana poisonings, according to Jibran Khokhar, the senior researcher on the current study online doctor diflucan.

For one, he said, the actual incidence could be rising because more people are using the drug, particularly in edible forms. Alternatively, people may be more willing to online doctor diflucan admit Fido got into the pot brownies because the drug is legal. "I don't think we really have a good handle on the 'why' yet," said Khokhar, of Ontario Veterinary College at the University of Guelph, in Canada. Rozanski thinks pet owners are now more forthright about having pot in the home.

"When it was illegal, it was harder to get online doctor diflucan them to admit," she said. "They thought we would report it to the police — which we wouldn't." In Khokhar's study, most vets described scenarios where pets accidentally got hold of edibles, or sometimes dried cannabis, when no one was looking. Of course, that was based on owners' admissions. Khokhar said it's unclear how often people online doctor diflucan might have given a pet cannabis for "medicinal" purposes.

Both Ludwik and Rozanski cautioned against that, saying people should only give their pets medicines that have been prescribed by their vet. Instead, they said, think of marijuana as any other substance you'd want to keep out of pets' reach. Vets in the survey said online doctor diflucan they were usually able to manage marijuana poisoning with outpatient monitoring. But a short hospital stay is needed in some cases — when an animal has a particularly low heart rate, for example.

Vets sometimes use IV lipid therapy to speed up excretion of the drug, Ludwik said. (Lipids are fats, and the active ingredient in marijuana is online doctor diflucan fat-soluble.) Ten veterinarians in the survey reported a total of 16 deaths they attributed to marijuana poisoning. However, Khokhar said, it's hard to know whether marijuana, per se, was to blame. Chocolate, for example, contains an ingredient that is toxic to dogs, so it could be the brownies, rather than the added pot, that proved lethal.

Regardless, all three experts stressed the importance of protecting your beloved pet from the misery of pot poisoning, and online doctor diflucan avoiding the expense of an emergency medical visit. SLIDESHOW When Animal (Allergies) Attack. Pet Allergy Symptoms, Treatment See Slideshow "Most dogs will recover," Rozanski said, "but you'd rather not see them go through this."More information The American Kennel Club has more on marijuana poisoning. SOURCES.

Jibran Khokhar, PhD, assistant professor, department of biomedical sciences, Ontario Veterinary College at the University of Guelph, Ontario, Canada. Tasia Ludwik, DVM, assistant professor, emergency/critical care services, Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, St. Paul, Minn.. Elizabeth Rozanski, DVM, associate professor, Cummings School of Veterinary Medicine at Tufts University, Foster Hospital for Small Animals, North Grafton, Mass..

PLOS ONE, April 20, 2022, online Copyright © 2021 HealthDay. All rights reserved. From Pet Health Resources Featured Centers Health Solutions From Our SponsorsLatest Depression News By Alan Mozes HealthDay ReporterWEDNESDAY, April 20, 2022 (HealthDay News) Millions of Americans take antidepressants to combat low moods. But a large, new study suggests that these medications over time may do little to improve overall quality of life.

"We found the change in health-related quality of life to be comparable or similar between patients that used antidepressant medications and those who did not use them," said study lead author Omar Almohammed, an assistant professor of clinical pharmacy at King Saud University in Saudi Arabia. The researchers were "surprised by the results," he admitted. However, "we are not saying that [antidepressants] are not helpful at all," Almohammed noted. Quality of life, he emphasized, is only one of many measures intended to assess health outcomes.

The research suggests patients and their doctors probably should not rely on antidepressants alone. "We still recommend that patients continue using their antidepressant medications," Almohammed said. "But they may also want to ask their health care providers to provide them with other nontherapeutic interventions, as this may have additional impact on their quality of life." Almohammed's team focused on a large pool of adult patients who participated in an annual health survey conducted by the U.S. National Center for Health Statistics at some point from 2005 to 2015.

In each of those years, about 17.5 million U.S. Men and women respondents were newly diagnosed with depression, at an average age of 48. Nearly 58% were prescribed an antidepressant. The study authors did not specify which antidepressants were used by which patients.

Nor did they distinguish between types of depression or differing levels of severity. Nearly 9 out of 10 patients in the study were white, most (63%) were middle-class or wealthy, and two-thirds were women. Women were more likely to be prescribed antidepressants than men (60% versus nearly 52%), the researchers said. Quality-of-life surveys were used to track both mental and physical health outcomes for each patient for two years following their diagnosis.

The surveys assessed physical issues such as overall physical function, physical limitations, pain, overall health status, energy levels and fatigue. Mental health issues were also tracked, including the ability to socialize, limitations due to emotional problems, psychological distress and overall well-being. The result. After two years, those taking antidepressants reported feeling no better with respect to either physical or mental quality-of-life issues than those not taking the drugs, the researchers said.

Almohammed said the findings suggest that clinicians "might be relying on the use of antidepressant medications, while underutilizing or underestimating the role and impact of non-therapeutic interventions." Yet he also stressed that the study did not specifically explore the benefit of other types of depression treatment, such as psychotherapy or cognitive therapy. And Almohammed said the investigation cannot dismiss the possibility that antidepressants might be helpful with respect to other measures of health, apart from quality of life. The study findings didn't surprise Dr. David Katz, founding director of the prevention research center at Yale University/Griffin Hospital, and president of the preventive medicine advocacy organization True Health Initiative.

"Overall," said Katz, "antidepressant drugs tend to be only nominally effective, even in the short term." Much of their impact can be chalked up to a nonmedicinal placebo effect, he added. At the same time, Katz -- who was not involved in the investigation -- pointed out the study pooled all kinds of depression patients together, even though "there may be many reasons why some people received these drugs and others did not." And those varying reasons, he said, might have affected how well those drugs worked. Still, Katz stressed that doctors' understanding of how the brain works -- and how best to treat mental health disorders -- is still "quite primitive." SLIDESHOW Learn to Spot Depression. Symptoms, Warning Signs, Medication See Slideshow While he agreed the study findings are "not a reason for patients to renounce pharmacotherapy," Katz also suggested that medications might best be thought of "as only one part -- and perhaps not the most important part -- of a more holistic treatment plan." The study results were published April 20 in PLOS ONE.

More information There's more on antidepressants at the U.S. National Library of Medicine. SOURCES. Omar Abdulrahman Almohammed, PhD, assistant professor, clinical pharmacy, Department of Clinical Pharmacy and Pharmaco-Economics research unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.

David L. Katz, MD, MPH, specialist, preventive medicine, and president, True Health Initiative, and CEO, Diet ID, and founding director, Prevention Research Center, Yale University/Griffin Hospital, New Haven, Conn.. PLOS ONE, April 20, 2022 Copyright © 2021 HealthDay. All rights reserved.

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How should I use Diflucan?

Take Diflucan by mouth. Do not take your medicine more often than directed.

Talk to your pediatrician regarding the use of Diflucan in children. Special care may be needed. Diflucan has been used in children as young as 6 months of age.

Overdosage: If you think you have taken too much of Diflucan contact a poison control center or emergency room at once.

NOTE: Diflucan is only for you. Do not share Diflucan with others.

Diflucan instructions

IntroductionTracing the implications of developments within genetic science has become a major area of research and debate http://begopa.de/google-maps/anfahrt-begopa-bochum/ within medical sociology and diflucan instructions allied disciplines (Martin and Dingwall 2010). Sociologists and bioethicists have long argued that technological developments are leading to an increasing ‘geneticisation’ of many aspects of health and healthcare (Lippman 1991). This can particularly be seen in the establishment and adoption of a ‘genomics diflucan instructions agenda’ within public health institutions (Mwale and Farsides 2021). Genomics involves the study of all of a person’s genes (the genome) and how genes interact with each other and the environment. The expansion of this area of medicine has been made possible by technological development, economic investment and the application of political capital.

Going beyond the individual gene offers new diagnostic and treatment possibilities—particularly for complex and rare conditions.Alongside these clinical opportunities, there are substantial social diflucan instructions implications. As Martin and Dingwall (2010, 514) have noted, one of the distinguishing features of genetics (and now, genomics) is its promissory discourse which relies on a mobilisation of ‘high expectations and social anxieties’. Such can involve a reconfiguring of expectations, hopes and fears about the future diflucan instructions (Martin and Dingwall 2010). As Parker (2012) argues, ethical problems within genetics emerge against, and need to be understood in the context of, a rich background of complex but largely day-to-day practice. This is also true for the experiences of those engaging with genomics as patients or carers.

An engagement with genomics is always mediated through, and interpreted against, peoples’ own lived (and diflucan instructions everyday) experience (Featherstone et al. 2006).Understanding the perspectives of those who engage with genomic medicine services is (or, should be) an important facet of social scientific enquiry. Particularly, as previous research has suggested that patients’ expectations and assumptions about ethical practice may not always be the same as those of healthcare professionals (Dheensa, Fenwick, and Lucassen 2016). However, as diflucan instructions Lewis et al. (2020) note, there are relatively few qualitative studies that explore the perspectives of parents who have been offered genomic sequencing to diagnose their child’s rare conditions in the UK.

As a result, we are less aware of how families see the impact diflucan instructions on their lives of the positive imagined futures presented by scientists, clinicians and policy makers. We might also be prone to reducing the experience of families down to that of travellers on the ‘diagnostic odyssey’ so often referred to in literature (Rosell et al. 2016). Our research aims diflucan instructions to collate rich accounts of lived experience in order to make visible the diverse, variable and multilayered everyday lives of patients and families and how these correspond with emerging, rapidly changing, and complex fields such as genomic medicine. While the application of genomic technologies has the potential to transform patients' lives, the excitement (or, ‘genohype’ (Kakuk 2006)) around these technologies mustn't eclipse the everyday experiences of the people who live with, and care for, those with genetic conditions.

As Kerr et al. (2021) have argued, these promissory claims are fragile and diflucan instructions contested, particularly when set against everyday encounters.Dealing with the uncertainty that the advent and subsequent mainstreaming of clinical genomics brings requires working in a way that empowers ‘voices at the margins so that they may help craft creative options and [create] opportunities for collective consensual decision-making that are respectful of difference’ (Baylis 2019, 175). This involves finding ways to speak ‘with’ rather than ‘for’, creating a way for the ideas and interests of stakeholder communities to rise to the fore, and hence, our interest in participatory-writing.Writing worldsWriting, as we see it, belongs at the heart of social research. It is diflucan instructions part of research. A research method in its own right.

A means of enquiry, exploration and articulation. (Phillips and Kara (2021, 8)Finding ways to understand, evoke and (re)present the experiences of research participants is at the heart of social scientific diflucan instructions inquiry. Methodological plurality and creativity is increasingly celebrated as allowing for more nuanced perspectives, different modalities of knowledge and more participatory approaches to doing research with (as opposed to simply, on) participants (DeLyser and Sui 2014). The challenge, as described by Deacon (2000) is to ‘find ways to make living systems actually come alive’. Given that ‘social researchers work with participants to explore their experiences and perspectives in their own words’ (Phillips and Kara 2021, 105) there are opportunities to think more creatively about how we come to elicit, diflucan instructions produce and obtain these words.

Written words, not just spoken.As Richardson (2000, 923) argues ‘writing is also a way of 'knowing'—a method of discovery and analysis’. Explorations of using writing as a mode diflucan instructions of inquiry have seen experimentation with different written forms (Eshun and Madge 2012. Lorimer 2018. Phillips and Kara 2021) as well as autobiographical accounts in the style of autoethnographic methods (Bochner and Ellis 2002). However, as Elizabeth (2008, 4) notes, such a use of autobiographical writing as a method remains underused and is ‘is largely confined to diflucan instructions those sociologists who choose to write personally.

Participants are rarely granted a similar opportunity’. Certainly, many such examples can be found of this style of academic writing, and obviously, this is not to downplay their contributions and insights, but to draw attention to the potential ways in which such methods can be extended diflucan instructions to engage with the knowledges of participants. There is perhaps something troubling about the way that ‘writing’ is something retained as the privileged territory of the researcher.Participatory methods have been invoked to great success across a diverse range of settings. Participatory drawing (Literat 2013), participatory photography (Prins 2010), participatory video (Kindon 2003) to name just a few. Yet there appears to remain a hesitancy to extending these principles of participation to diflucan instructions that staple of research.

Writing. Many of the benefits that have been identified as resulting from social researchers using writing as method (Phillips and Kara 2021. Richardson and diflucan instructions St. Pierre 2018) can also equally arrive from enabling those we research with to contribute illuminating understandings through the processual experience of writing. For example, in writing diflucan instructions about writing as a method of inquiry, Richardson and St.

Pierre (2018, 1428) emphasis original) reflect on the benefits of how ‘thought happened in the writing’. Similarly, Phillips and Kara (2021, 17) explain how ‘writing can help us to explore experiences and identify and express emotions’. Of course, such a generation of new ideas, understandings and connections through writing is not limited to those doing research, but extends to all those who might embrace and engage diflucan instructions in the exploratory and expressive acts and processes emerging from an engagement in writing.Asking participants to write is not an unusual method in and of itself. It is the core thing that we ask people to do when we send them qualitative questionnaires and include room for open-ended responses in our surveys. Diary methods have a rich history as an enlightening form of empirical investigation, capable of offering insights into everyday life (Latham 2003).

The Mass Observation Project and Archive similarly relies on participants becoming diarists and writers, responding in a written form and recording their experiences and thoughts (McGlacken and Hobson-West 2022 diflucan instructions. Smart 2011). Yet, despite diflucan instructions such utilisations of inscription, there still remains something of a sense of impropriety to the notion that research participants may write, rather than speak—one in conflict with, and challenging to, the privileged place which interviewing occupies within qualitative inquiry (Elizabeth 2008). In describing the Mass Observation Project, Smart (2011, 541) describes how, until more recently, sociological engagement with the written narratives produced through the Mass Observation Project has been limited ‘because the free way in which they wrote was not regarded as sufficiently rigorous for sociological analysis’. Attitudes have since changed however, to recognise the richness and depth of the narratives that many Mass Observation panellists produce (Smart 2011).There are substantial benefits in asking participants to write about their lives (Elizabeth 2008).

Using writing as a diflucan instructions method of inquiry raises the possibility for ‘producing different knowledge and producing knowledge differently’ (St. Pierre 1997, 175). Writing creates diflucan instructions a very different modality of representation. It allows research participants to ‘give the researcher their stories and words in an exact form’ (Deacon 2000). As Penn (2001, 50, emphasis original) argues, to write is an act of agency.

€˜when we diflucan instructions write we are no longer being done to. We are doing’. This can be a particularly important mechanism of representation for certain groups and narratives, particularly if writing about events where agency may have been lacking for the author. Writing thus provides a way of diflucan instructions transferring a level of control and ownership to participants ‘in a way that traditional interviews cannot’ (Burtt 2020, 7). This could simply be about enabling participants to take the time to narrate their experiences in their own terms.

This ‘giving time’ may be at odds with some forms of social science that prioritise and privilege the immediacy and synchronicity of the research diflucan instructions interview as a strategy for overcoming anxieties about ‘premeditation’. Yet for some topics and participants, the opportunity to respond carefully and thoughtfully allows a more sensitive immersion in research. Participants can spend as long as they need to complete their written reflections, considering carefully their responses in an atmosphere less structured by the pressures of direct questioning (Burtt 2020). Participatory-writing can provide windows on subjects that would otherwise be hard to diflucan instructions reach by virtue of their personal or sensitive nature (Phillips and Kara 2021). Writing can afford a level of safety in providing space, time and privacy to consider the framing and language in which disclosures and stories are told, navigating and articulating vulnerability and uncertainty.

Participants are able to craft their voice. Such crafting may diflucan instructions again be challenged by those concerned about the risks to the generation of ‘truthfulness’, though to assume that only through the imposition of questions on the spot during interviews are authentic and authorative accounts produced is flawed. To quote Elizabeth (2008, 14):Writing provides researchers with access to the unique, partial and situated perspectives of our participants. We gain insight into the discourses that circulate in their social milieu and the way in which these vie for our participants' subjectivities.Writing can enable people to overcome the effects of self-censorship, allowing diflucan instructions self-revelatory forms of expression (Elizabeth 2008). While oral research methods are often based on the dialogue between interviewer and interviewee, writing tasks, as Elizabeth (2008) describes, can put past and present selves into dialogue with each other.

Writing brings a level of flexibility that can aid progression beyond fixed questions and rigid categories and vocabularies introduced by the researcher, participants can employ their own concepts and terminology, and even, to certain extents, define the questions they wish to ask and answer (Burtt 2020). Similarly, participatory-writing as a method is less influenced by the mediating effects of the interviewer (or other diflucan instructions focus-group participants). Interjections, perceived cues, puzzled looks or requests to know that one’s narrative is making sense (Burtt 2020. Elizabeth 2008).This is not to claim that writing produces accounts that can be universally representative or the source for generalisations about the social world, rather the impact and intention of writing as a method is to be illustrative (Evans 2021. Phillips and diflucan instructions Kara 2021).

By collating multiple autobiographical accounts from participants with a shared connection, social researchers are left with a ‘method through which we might investigate that more conventional social space of the collective’ (Evans 2021, 14). This in itself allows for the inclusion of multiple ‘voices’ within the final written product of research, giving a platform to participants that has the potential to be less directly mediated and subject to academic meddling.This is not to position writing as an epistemologically ‘better’ method of inquiry than more conventional oral research diflucan instructions practices, but rather to recognise that writing can allow the production of very different kinds of personal revelations from participants than what may be forthcoming when spoken. That creative or autobiographical written accounts may result in omissions and imperfect interpretations of the self is well recognised (Evans 2021), but such critiques can likewise be applied to the majority of social research methods. The point is to understand how different methods can allow different facets of life and self to arise to the fore. Like all methods, participatory-writing has its diflucan instructions time and place (Phillips and Kara 2021).

Elizabeth (2008) suggests that there is great value in using writing exercises in conjunction with interview or focus group discussions.While embracing the ways that participants’ ‘crafted written work stands to provide eloquent answers to research questions and speak to research interests from original angles’ (Phillips and Kara 2021, 114) it is also important to remember that often the additional product of participatory-writing research are the conversations and reflections that occur along the way. Indeed, it is the practice and process of participating that can matter the most, rather than the outputs of words on a page—as useful and illuminating as they may be (Phillips and Kara 2021). The ethical bargain struck with participants may mean that on occasion the primary product (writing) is never seen nor shared, only the experience of producing it.While social science may not have a long tradition of encouraging diflucan instructions participants themselves to write as a mode of inquiry, as part of the rise of expressive and arts-based therapies there has been a renewed attention to writing as a therapeutic technique (Elizabeth 2008. Pennebaker and Chung 2007. Peterkin and Prettyman diflucan instructions 2009.

Robinson 2000). There are numerous studies that explore forms of expressive writing as a means for coping with a variety of situations (Bolton 2008. Gebler and Maercker 2007), yet few studies that take up Richardson (2000) challenge of using writing as a way of inquiring, understanding and ‘knowing’ more about such experiences—particularly in a fully participatory vein (though see Phillips and Kara (2021) diflucan instructions for an insightful volume that catalogues recent efforts to do just this). It is perhaps such codings of writing as having ‘therapeutic’ applications which has stifled experimentation by qualitative researchers. Similarly, the assumption that writing exercises have a therapeutic component diflucan instructions (by design, intention or as a predictable but unintended side effect) may make ethics committees cautious in their policing of such methods.

Though again, the ‘research interview’ is often structured by, and experienced as, a confessional (Crowe 1998) and therapeutic opportunity (Birch and Miller 2000).Of course, the open-endedness of writing presents challenges as well as opportunities (Phillips and Kara 2021). As Phillips and Kara (2021, 76) recognise, we write ‘within the means available to us’, with dominant discourses often infiating work that hopes to be creative, searching and illuminating, becoming more conventional or hegemonic. Writing obviously has the potential to be an exclusionary activity, with the possibilities for participation influenced by numerous factors diflucan instructions such as class, gender, health and cultural differences, alongside past educational experiences, language fluency, habit, practice and even time available. Participation can be challenging and uncomfortable, and may be prefigured by pre-existing attitudes and aptitudes to the written form—and the sharing thereof. As Phillips et al.

(2021, 54) poignantly note, ‘creative writing diflucan instructions is not for everyone, all of the time’. Rather than acting as a participatory method, instituting writing as the method by which people take part in research can deter participation (Phillips and Kara 2021). However, McMillan and McNicol (2021, 86) suggest rather than an imposition of what writing should be, there are ways of working that can diflucan instructions allow ‘a community’s existing ways of writing and knowing to come through’. Such can involve cultivating a sense of inclusion, safety and trust among participants (Phillips et al. 2021)—many of the core values of qualitative research at large, around building rapport and relationships are particularly applicable to using writing as a method of participatory inquiry.It is important to bear in mind that writing is directly affected by the nature of the intended audience, and particularly the levels to which any audience may be imagined to have been conferred with evaluative powers (Elizabeth 2008).

Similarly, and as with any form of qualitative research, accounts produced through writing are diflucan instructions shaped by the possibilities and desires for levels of anonymity for the authors involved. Further, we must recognise that writing fixes words—and as Elizabeth (2008) notes, hence also fixing constructions of selves and narratives. Though given that most interview research involves a subsequent transcription to an often equally fixed written form, this is perhaps not too dissimilar. Indeed, the opportunity for a level of editorial oversight of one’s own words and stories is one of diflucan instructions the benefits brought about through participatory-writing. However, while writing as a mode of inquiry can be less intrusive and less pressurised, especially when taking place in the writer’s own time and space, this also means there are also fewer opportunities for researchers to provide emotional support, reassurance or to steer questioning away from distressing topics (Burtt 2020).

There are thus complex ethical considerations prior to asking participants to write, to sit and mediate on a topic, in ways diflucan instructions that—though possibly enjoyable, comforting and self-revelatory, can also be frustrating and saddening (Elizabeth 2008. Phillips and Kara 2021).As well as affecting those doing the writing, writing also has the potential to affect readers in ways that formal academic writing cannot (Phillips and Kara 2021). Participants’ writings can be well suited to disseminating research, particularly as the expressive nature of a participant’s writing can be seen to be ‘evoking’ emotion rather than just ‘explaining’ emotion. Showing rather than diflucan instructions telling (Andrews 2018). Participant-produced stories have an ‘enlivening’ quality, and can have a valuable role to play as communicative resources, building—and bridging—empathy (Parr 2021).

Parr's work in particular demonstrates how stories can lead to changes in behaviours and styles of engagement within professional communities (Parr 2021).1Participatory-writing with people affected by rare genetic conditionsThis research is part of a larger participatory study working creatively and collaboratively with families touched by genetic conditions to explore the experiences of patients and participants in genomic medicine and research. Our aim is to identify the diflucan instructions overlaps and gaps between practitioner and patient accounts of ethically relevant issues as they occur in clinical genomics and find ways of supporting people to feel more comfortable when having challenging conversations. Our principal research question is whether accounts of patient experience might contribute to the preparedness of clinicians to deal with the ethical challenges of genomics practice.It was this ambitious research question that piqued our interest in participatory writing, with the hope that such narratives might express and evoke aspects of lived experience in productive and affective ways, beyond what was possible through more conventional social-scientific registers and/or participatory practices of ‘patient engagement’. As Frank (2012) notes, equipping healthcare professionals with a sense of ‘what to listen for’ can enhance diflucan instructions ‘professional listening’.Co-production is at the heart of the research project. Our research is directly informed and guided by people with lived experience.

We have a participatory steering group who attend project meetings, share their ideas and experiences, and contribute and comment on the design of research activities. This has allowed us to develop relationships with participants, build trust diflucan instructions and confidence, and demonstrate our commitment to confidentiality, giving people a voice, and effecting change. Thus, we see ‘patient and public involvement’ as a constant and continual process, rather than an initial involvement at the outset of the project. Our research involves continued dialogue and input from people with lived experience of genomics and the active enrolment of their expertise, feedback and insights diflucan instructions into the design of this project—in all its extents, including research questions, methodology, recruitment and dissemination. Our participants have acted as peer-researchers and had oversight of the writing of this article.Conversations with members of this steering group indicated an interest in, and encouragement to, explore ways of researching using arts-based methods.

Working with an author and life-writing tutor, we designed a participatory-writing programme that would encompass an hour-long online facilitated workshop on a weekly basis for 6 weeks. We were conscious of accommodating the diflucan instructions availability of people with often complex caring responsibilities (particularly during antifungal medication). Finding a mutually acceptable time to run the writing group was one of the largest challenges, although the extent to which individual participants committed to attending despite, and alongside, their commitments of caring and work (exacerbated by antifungal medication lockdowns) gave some insight into how much potential value people saw in this work. Aware of the online and disembodied nature of the groups, we sent participants a small ‘care package’ of stationery ahead of the meetings to show our appreciation and to help build a sense of occasion. We were aware that through writing (and reading others’ stories), people diflucan instructions would be brushing up against personal and emotional topics, which could cause, or even reveal, a level of upset and anxiety.

Our aim was that the writing groups might exist as a ‘safe space’ to explore these narratives. However, while we had hoped participants would find being involved in our research empowering and cathartic, we were keen to stress that our research activities did not diflucan instructions constitute a form of ‘art therapy’. In preparing for the possibility of distress, we appointed a colleague (external to the project) with extensive pastoral experience who could be called on to support participants (and researchers) should the experience become challenging.Initially, we recruited participants through our existing networks and relationships. A ‘purposive sampling’ technique (Sarantakos 2012) with our aim being ‘not to choose a representative sample, rather to select an illustrative one’ (Valentine 1997, 112). These were people who served as ‘patient representatives’ on ethical and governance panels relating to genomics diflucan instructions or who were active in patient led organisations.

These were people whose voices and expertise had already been sought out in different fora. Through a level of ‘snowballing’, these initial participants made suggestions for others within their advocacy networks and patient communities who they felt could contribute to—and enjoy taking part in—our research. The participant group was mixed in gender, though diflucan instructions with a larger number of women, and ages ranging from mid-30s to early 50s. All of our participants had direct experience of genetic disease within their families, with many having a significant level of caring responsibility as a result. Our participants had experience of diflucan instructions participating in large genomic medicine projects, such as the 100 000 Genomes Project and/or the Deciphering Developmental Disorders Study.

Many of the participants we were working with had an active blogging practice, and were keen to take part in research in a way that made use of their skills, interests and communicative strengths—but also to get something out of the research themselves, in learning new ways to hone their writing practice. Others took a little more convincing, and were particularly hesitant about how doing some writing could be scientifically productive or of value.Week by week, each session involved our professional writing tutor introducing different creative writing exercises, designed to enable both novice and experienced writers to begin to express ideas and thoughts with greater fluency. This included being introduced to, and trying out, techniques such as free-writing, narrative-distancing and writing in response to a given prompt (such as telling the diflucan instructions story of a cherished object). At the end of each session, participants were given a creative exercise to tackle in their own time. During the introduction and after each in-session activity participants were invited to reflect directly on their experience and the content of their writing.

Participants were invited, but never pressured, to share their writing with the group by diflucan instructions reading a short excerpt. Discussion was guided by the facilitator to focus on the experience of the process of writing, and to prompt the group to notice any thematic similarities or differences in written accounts. The emphasis throughout was on building confidence in expressing lived experience.Our first writing group—who affectionately became known as the ‘Thursday Writers’—consisted of five participants, alongside the life-writing tutor, and the first author (RG), who took a participatory role in the group, rather than solely an observational one.2 Our intent was that participants would read extracts from their diflucan instructions writing, and hopefully share it with the research team. However, participants were quickly very vocal about wanting to share their outputs in full among the other members of the group too, and we created a secure online space where people could upload what they had written in the sessions or as part of the ‘homework’. Some participants chose to use word processors, others uploaded photos of their handwritten pages.

Reflecting on the impact of reading other people’s writing and noting points of connection became a regular feature of discussions diflucan instructions (a point we will return to later on).Our ‘Thursday Writers’ were hugely supportive of the participatory-writing programme, and several participants supported us to recruit for a second 6-week programme with an additional seven participants (which also ended up running on a Thursday). All of the writing group sessions were recorded, with participants’ consent, which has allowed us to revisit and reflect on the types of narratives that were created and shared, alongside those which were uploaded to a ‘sharing folder’ (one for each group—it was key that the ‘safe space’ created for sharing writing was limited to the people who were in the online sessions together). Participants also consented to their written pieces being used in publications, a question which was revisited in the drafting of this article.After each 6-week programme, we arranged reflective interviews with participants, diflucan instructions giving everyone an opportunity to share their thoughts and experiences regarding participating in the writing groups. The written pieces that participants had produced throughout the course also served as an elicitory device during these conversations (Bagnoli 2009), allowing us to delve further into the context, meaning and emotions surrounding the participant’s writing, as well as asking them to reflect on what the piece represented or evoked that may be outside of view to others.We have specifically chosen not to attribute interview quotes nor written pieces to individuals. This is to aid confidentiality, which was an important theme for participants (see later discussion).

While we could have chosen to use pseudonyms or diflucan instructions participant codes, these can be reductive. Through not attributing quotes or pieces of writing to individuals, we are able to demonstrate commonalities across different and diverse rare genetic conditions.Engaging with the written pieces produced through participatory-writing involved paying close attention to the stories (and, processes of storying) that were written, aiming to better understand their impact and significance (Phillips et al. 2021). For us, diflucan instructions this involved drawing on aspects of dialogical narrative analysis (DNA) (Frank 2010, 2012). Such an analytical approach involves questioning:What is the storyteller’s art, through which she or he represents life in the form of a story?.

And what form of life is reflected in such a representation, including the resources to tell particular kinds of stories, affinities with those who will listen to and understand such stories, vulnerabilities including not being able to tell an adequate story, and diflucan instructions contests, including which version of a story trumps which other versions?. (Frank 2012, 33).DNA involves understanding stories as artful representations of lives. It involves considering why someone might choose to tell such a story and exploring how identities are being formed and sustained by the storying process. DNA’s concern is diflucan instructions how to speak with a research participant rather than about them, and show what is at stake in a story as a form of response. A central premise of DNA is that it does not seek to interpret stories or ‘discover truths’ that have ‘escaped the attention of the storytellers’ (Frank 2012), rather the intent is to witness stories, and enable voices to be both heard and evocative—often through positioning them into dialogue with other, but similar, diffuse voices.

Thus, the purpose of a dialogical narrative analysis is not to ‘display mastery over the story, but rather to expand the listener’s openness to how much the story is saying’ (Frank 2010, 88).Writing everyday storiesSimilarly to Phillips et al. (2021), our approach was not to extract stories from our participants, but enable them to diflucan instructions recount the stories that were of importance to them. Although we were interested in the dawn of genomic medicine and the sociotechnical imaginaries involved (Mwale and Farsides 2021), we were also interested in what everyday life is like for the people who live with, and care for, those with genetic conditions, and how genomics acts to reconfigure (or, perhaps, does not) aspects of people’s lives outside of the clinic. As Prainsack, Schicktanz, and Werner-Felmayer (2014, diflucan instructions 11) argue, genetics takes place ‘outside of the clinic as well as within. It takes place in families, patient groups, state organisations, on the Internet, and on the international market’.The phrase ‘everyday life’ is often associated with the ‘ordinary, routine and repetitive aspects of social life that are pervasive and yet frequently overlooked and taken-for-granted’ (Pinder 2011, 223).

Finding significance in the everyday and respect for the ‘mundane’ draws from a feminist commitment to understand the material conditions of people’s lived experience and practices (Hanson 1992). Attending to ‘everyday life’ allows a focus on those practices and aspects of life that are hidden by dominant narratives (Highmore 2002) diflucan instructions. An everyday perspective challenges privileging certain spaces, such as ‘the clinic’, as being the locus of how and where people experience genomic medicine, to instead explore that which exceeds these formalised encounters and overflows into other domains of life. For Lefebvre (1991, diflucan instructions 97), everyday life is ‘what is left over’. Our participants’ writing provided us with a viewpoint of those things which are ‘left over’ from accounts of genomics.

It draws our attention to the way that geneticisation (Lippman 1991) and genohype (Kakuk 2006) infiate everyday life, but also how, frequently, at an everyday level, these new sociotechnical regimes may have little impact. With genomics being presented as a cornucopia and salve for all manner of health and social challenges, diflucan instructions understanding ‘what is left over’ is an important effort in making visible the inconspicuous aspects of living with rare genetic conditions. As Nicholas and Gillett (1997) argue, to begin to appreciate the bioethical issues at stake, we need to fill in the gaps that exist within our understanding, something which cannot be done without narrative insights. Similarly, reflecting on genetics practice at large, Featherstone et al. (2006, xii) argue that ‘a sound appreciation of everyday diflucan instructions social reality is of profound importance for professional practice’.

Thus, as Frank (2012, 36) notes, ‘to describe the world may be the most effective way to change it’.Many of the pieces of writing that emerged from the groups touched on these sorts of everyday realities, and hidden complexities, of caring for people affected by rare genetic conditions.With ‘My Day Begins’, I just sat down, and I was typing rather than writing freehand because I’m faster. And yeah, there it was, and I diflucan instructions hardly had to change anything, after the first draft. I was really pleased with it, and you know I started off just trying to make it as factual as possible, as matter of fact as possible. And it wasn’t until I shared it with other people that then they went ‘Whoa’. And I diflucan instructions went ‘Whoa?.

Really?. This is life.’ And I thought that was very interesting.As one of our participants commented, writing these sorts of creative pieces allowed them to draw attention to the complexities involved in care—practical, emotional and identity-based complexities, not just medicalised complexities. As the author of ‘My Day Begins’ (figure 1) notes,'My Day Begins'—a piece of writing from one of our diflucan instructions writing groups. WAV, wheelchair accessible vehicle." data-icon-position data-hide-link-title="0">Figure 1 'My Day Begins'—a piece of writing from one of our writing groups. WAV, wheelchair accessible diflucan instructions vehicle.There’s stuff in there about the complexity of caring for somebody, the practical complexities, and there’s stuff about the emotional complexity of being part of a wider family unit and still having to cope.

And there’s this stuff in there about having to put aside your sense of self and be a parent or a carer. And I think a lot of people who don't have caring responsibilities would never think twice about that.Bury (1982, 169) noted how illness can result in ‘biographical disruptions’, where ‘the structures of everyday life and the forms of knowledge which underpin them are disrupted’. Such was diflucan instructions certainly present in the written pieces that our participants produced. Though, rather than a singular disruption, years with no diagnosis, potential misdiagnoses and potentially having to adapt to receiving a diagnosis for a condition different to what had been expected (Dheensa, Lucassen, and Fenwick 2019), means that genomics follows multiple disruptions to both forms of knowledge and everyday life. Figure 2 exemplifies this.'Freewriting, Session #3'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 2 'Freewriting, Session #3'—a piece of writing from one of our writing groups.Yet even in writing these representations, participants were keen to hold attention to these acts as being specifically everyday.

They were aware and quite critical of the possibility for acts diflucan instructions of interpretation to render their writing as something very different. One participant described the challenge of eliciting empathetic responses, rather than just solely sympathetic responses.Sometimes I feel in this juxtaposition about not wanting to be personified as a superhero, because we’re not, we are just doing what the majority of parents would do if they had to do it, that is how it is.As a route to enabling the possibility of empathetic response, many of those who took part in the participatory-writing sessions commented how their pieces perhaps captured aspects of their lives that they felt were outside the view and understanding of medical professionals. The lack of alignment between families and healthcare professionals as to what ethical practice around genomics might mean and require (Dheensa, Fenwick, and Lucassen 2016) can be produced in part by this lack of visibility and knowledge about what is important and what is experienced on an everyday level.‘They [healthcare professionals] tend to have a close in view diflucan instructions of it rather than a bird’s eye view of it, in a way all of that stuff and stress is invisible.’‘I think clinic doctors perhaps don't see anything like this side of things.’‘I’ve written quite a lot and I think other people have as well about how it feels to be a family with or without a diagnosis, rather than what the medics or what the team seems to think is important.’Noting things as being exterior to more commonplace comprehensions was not always presented as disenfranchisement or critique of healthcare professionals, but rather a way of drawing attention to the multiple forms of lived expertise that parents were called on to develop and mobilise. One piece, ‘Word Salad Counsellor’ (figure 3), in particular showcased how engagements with genomic medicine required patients and parents to develop new skills and knowledges, specifically in navigating the complex scientific languages through which clinicians enact and practice care.'Word Salad Counsellor'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 3 'Word Salad Counsellor'—a piece of writing from one of our writing groups.There is much to take away from figure 3. The use of humour to mask painful experiences.

The hyper awareness of space and environment diflucan instructions. The use of language, metaphors and similes. The lack of attention to important personal information diflucan instructions (e.g. Misgendering the child) in lieu of a focus on complex scientific information. The unfortunate use of the word ‘exciting’ when attached to what is in fact bad news for this family.In particular, this tongue-in-cheek piece highlights how accessing genomic medicine services can require quickly learning scientific vocabulary in order to interpret clinical communications and be confident in understanding, participating and obtaining, optimum care.

The challenges of the technical language surrounding genomics (and health information in general) diflucan instructions are well established (Stuckey et al. 2015). The onus is frequently on the patient to acquire the expertise to interpret the information being provided—as described in the quote below from an interview with the author.Yeah, I mean it’s amplified but it’s not amplified by very much at all. I took your world’s worst plausible genetic counsellor and diflucan instructions went from there. The surreal-ness of it actually comes from a lot of the stuff that’s real in a way because I went back to it and thought which bits really chimed?.

Of course, it’s all the stuff like, ‘Oh, yes, this is a diflucan instructions known variant of not a great deal of significance.’ All those kinds of things. To most people it sounds like Douglas Adams but it’s not, it’s just what arrives in the letter. Okay, should I worry about this?. Do I need to translate diflucan instructions it before I worry about it?. What are we doing here?.

… I’ve rapidly built on my A level biology knowledge which was already 30 years out of date. When I learnt my genetics the human genome hadn’t been diflucan instructions sequenced so it’s all happened in my lifetime really and it’s been a bit of a helter-skelter. In a way you’ve got to learn it … it’s all delivered in closed codes and so in order to pick any of the useful information out of that you’ve got to learn it quick.Although not the intended purpose of the writer, the original piece of writing and the follow-up discussion provide invaluable insight into the way theory and practice come together (or do not) in the clinic. The encounter highlights the centrality of what can be described as a ‘diffusion model’ (McNeil 2013) of public engagement diflucan instructions efforts around genomics. That is, the aspirations and follow on assumptions that groups will acquire scientific knowledge about new technologies via a ‘trickling down’ or ‘osmosis’ of information.

This is slightly different from—though, entangled with—ideas that suggest a ‘deficit model’ of public engagement, that takes as its starting point a deficiency in understanding that can be solved through more or better education (Marks 2016). A diffusion approach instead assumes that those encountering a new technology will actively seek, diflucan instructions access, comprehend and use related information. Institutionally, it is a passive (indeed, neoliberal) approach to public engagement that positions individuals as responsible for their own empowerment. In practice, the prevalence of a diffusion model of public engagement is potentially as equally problematic as the well-critiqued deficit model. Hoping that those engaging with genomics services diflucan instructions will have acquired the confidence, knowledge and skills to equitably participate through a wider diffusion of public understanding of genomics and/or a commitment to self-education is, at best, a sticking plaster.

More creative dialogical strategies for developing public engagement around genomics are still very much required (Samuel and Farsides 2018).Participants were keen to use the groups, and their writing, as an opportunity to craft narratives and representations that resisted and challenged what they frequently felt was expected (and indeed, imposed on them) by institutions—whether the wider genomics ‘industry’, or even patient support groups. As such, participants were aware of particular types of writing that would be well received and seen to have extrinsic value, but struggled to square that with the way in which they wanted to diflucan instructions tell their own stories and reflect those of their children.We’re thinking more about how our children are represented, and their awareness of themselves. It’s that thing that ‘this child is disabled and they’ve had a horrible life and they’re so sick and blah-blah-blah’, and then people give you funding … And I’ve had conversations with [charity] about it before because they’d written something for a funding bid and it said ‘a lot of these children will die’, and I thought, ‘Do you really need to say that?. €™, and they were like, ‘Yeah, because that’s what gets people…’. But when you’re thinking about your child and how you want the world to view them and how you want them to view themselves, it’s kind of a different thing I guess.Thus, many of the pieces diflucan instructions of writing that participants created aimed to tell positive stories, ‘normal’ stories, that resisted medicalisation and politicisation, even casting it to the margins, such as in ‘My Magical Girl’ (figure 4).

As one participant noted, ‘one of the things I really liked, one of the reasons that I write is to share the good stuff that happens’. Intertwined with this, we can witness how participants are keen to reclaim and recentre certain aspects of diflucan instructions their identities which perhaps they do not get the opportunity to voice in other (particularly, medical) contexts. As one participant reflected on their writing. €˜I think there is that bit of still being a mum and not being a carer or a medical secretary’. Parents of children with rare genetic conditions are often implicitly expected to become ‘expert caregivers’—something which healthcare systems rely on, though simultaneously struggle to acknowledge diflucan instructions (Baumbusch, Mayer, and Sloan-Yip 2018).‘My Magical Girl’—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 4 ‘My Magical Girl’—a piece of writing from one of our writing groups.Similarly, another participant reflecting on the writing groups explained:We did a narrative piece that I’m just looking at now and I think that does what I like to do, which is just show some of the normal stuff around living with someone with a rare condition.

Just trying to show that we do have a normal life and just showing that we do have things in common with other people, we do have things we can talk about and if you come and talk to us or read our writing, it doesn’t have to be about genetics!. We’ve got other things that are in our lives and are important to us.At first glance, some of the written excerpts appeared to describe aspects of life quite mundane and unremarkable. However, when read diflucan instructions through the context of rare genetic conditions, these pieces can draw attention to how such multiple aspects of everyday life are reconfigured and challenged. Indeed, one participant reflected that, ‘I don’t think I wrote particularly much about her condition per se, but then I think things leak out in whatever you’re writing about’. While another noted how ‘no matter what we write about, you can diflucan instructions always feel that parenting concern in the back of your mind.

The inability to be completely free of that.’. For example, the written piece ‘My Garden’ (figure 5), touches on the home adaptations and extensions often required to allow domestic spaces to become accessible, the exclusions that can be felt from public spaces lacking specialist play equipment and the vulnerabilities that a rare diagnosis can bring in diflucan times.'My Garden'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 5 'My Garden'—a piece of writing from one of our writing groups.Many of the pieces written as part of our two writing groups explored some of these other things, whether descriptions of gardens, fond memories or day-to-day conversations. Not all diflucan instructions of them were approached through the lens of rare conditions. Instead, caring responsibilities or medical paraphernalia featured as an absent-presence. Yet, many of these pieces of writing, even when not directly or explicitly mentioning rare disease, carried messages and themes that other participants took to be particularly meaningful when interpreted through their own lived experience of rare genetic conditions, such as ‘The Blanket’ (figure 6).'The Blanket'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 6 'The Blanket'—a piece of writing from one of our writing groups.The Blanket was amazing because it was that kind of completionist idea, the idea that the caring and dealing with the genetic odyssey is a never-ending saga and so you never get to complete anything because you’ve got to do it again from scratch tomorrow.

The blanket diflucan instructions more than anything else kind of touched me. It’s the one I really took away with me.Writing in this way gave participants scope and freedom to tell stories that they felt—as one participant described—‘could only happen by metaphor’. It provided a way diflucan instructions to represent aspects of their lives and experiences that exceeded what could be conveyed in oral recollections and explanations. The blank page and freedom to write about anything was an important way of creating a space where people felt comfortable to explore different narratives, centre different identities and challenge assumptions about life with rare conditions. As one participant explained:I was a bit worried that at the beginning, we would be invited to delve into points in our story that we felt were pivotal or particularly strong memories.

And I was very diflucan instructions glad that [the facilitator] didn't do that. She was very careful to say, this could be any of your experiences, write about any of it. And then, of course, you can choose how far you tip-toe into that or not. And that was good.With this in mind, we want to briefly turn our diflucan instructions attention to reflecting on the value that writing has had here, as a qualitative method, and how it has allowed us as researchers to explore the lifeworlds of families touched by genetic conditions.Reflecting on the value of participatory-writing for social researchParticipatory-writing has enabled us to learn about many of the things that mattered to our participants. It has given us an insight into their everyday lives.

The complexities, the diflucan instructions challenges, the frustrations. Writing (and the interlinked processes of sharing and reading) has allowed our participants to voice their narratives and representations in ways that they found to be important and authentic.The written pieces that were created—whether poem or prose—have been immensely evocative. We have included as many as possible, and in full. Particularly as, to quote Frank (2012, 36), ‘each story must be considered diflucan instructions as a whole. Methods that fragment stories serve other purposes’.

Herein lies one of the challenges of participatory-writing, in that what is produced does not lend itself well diflucan instructions to the demands and constraints of academic publishing!. Though we hope to also demonstrate what is achievable even when time is short. One of the largest challenges of the method that we and our participants reflected on were discussions around privacy and confidentiality.There’s a lot of stuff now that I have to be so careful, because of protecting the kids’ privacy. There’s stuff I’d like to talk about because it affects me, some of the conversations that we’ve had to have, I can’t put those anywhere and it’s not that I want to necessarily share that as such, it’s a difficult one in that sometimes it is just cathartic to diflucan instructions get it out and write it out but then I’m always mindful, who is reading this?. How can this come back in the future?.

How would that get back?. How would I feel if my kids, how would they feel if this diflucan instructions was out there?. Writing brings with it a greater sense of permeance and mobility. It produces a record in ways different diflucan instructions to that of conversation. In our research, we always ensured that people felt comfortable to not share what they had written—and indeed, some people did not.

Throughout the process we stressed the optional nature and modular approach to sharing, allowing people to choose what was shared with us as researchers, what was shared within the group, and what—if anything—could be shared more widely, for example, the pieces of writing featured in this publication. Participants assessed this issue on a piece-by-piece basis and knew that we as researchers wanted them to retain full control over everything they had written.It was encouraging that participants reflected on how writing had, as a method, both encouraged and enabled them to detail aspects of their experience that might not have come diflucan instructions to the fore had we relied solely on oral interviews. Writing, as one of our participants described, ‘really threw a light on those things that it’s really hard to explain under other circumstances’. Another participant described noticing that the written medium had encouraged them to ‘dig a little bit more’ into their feelings:[You] can twiddle with it, so like we might come out of this meeting now and I might think, ‘oh god, I wish I’d said that’. Whereas if you’ve got a week or so to actually play with it and add or take away from it or whatever, because sometimes you write something and it’s done, but then you start typing it up and you’ll just rephrase it in a diflucan instructions different way.

So, there’s that time to actually consider it.The opportunity to creatively use metaphors, write-between-the-lines, and crucially, take the time to craft and edit narratives gave our participants the opportunity to consider how they responded, and to convey what they felt was an added level of detail. For some, diflucan instructions it was particularly the opportunities that writing offered to make these narratives ‘more lively and interesting’ that was appealing. This liveliness is particularly important if we take seriously Vannini’s claims that social research ought to consider the ‘unique and novel ways it can reverberate with people, what social change or intellectual fascination it can inspire, what impressions it can animate, what surprises it can generate, what expectations it can violate, what new stories it can generate’(Vannini 2015, 12). This involves recognising the performative quality of words themselves and the intersubjective means by which knowledge is co-created by writer and reader (Anderson 2014), a shift from aiming to explain how something might ‘feel’ to instead attempting to expressively evoke how something might ‘feel’.Writing in this way has thus been a valuable method for us. But it diflucan instructions was also an approach which our participants valued and embraced.

Participants described the cathartic release of writing something and then ‘letting go of it’, something that also enabled them to have a level of distance from what was produced and represented.I’m usually writing something because I know that I’m going to put it somewhere somebody can read it. But this, I was just writing it. I suppose in some ways that was different […] in terms of the idea of a revelation and feeling things.Writing provided a way for participants to navigate and negotiate vulnerability on their diflucan instructions own terms. It produced a level of solidarity and sociality among the groups too, one that acted as a counter to what one participant described as ‘the isolation and loneliness that lots of carers feel’. We’d—perhaps naively—initiated this research in the hopes of producing material that would be engaging and informative to healthcare professionals, however, it quickly became apparent that reading other people’s writing was powerful and rewarding for other families affected by rare conditions too.I think being able to diflucan instructions connect to what other people were saying.

I know there was a piece in particular that [participant] wrote, and I felt like that could have been something that I actually could have written myself. The language that she used, the situation that it was about, it was definitely something that I thought, ‘Wow that’s my life, I could have written that.’ That was quite strange actually, it was nice though.This overlapped with what participants felt to be another strand of value in writing about their experiences. Being heard.There’s just something about knowing that people are listening and actually giving you a really nice way to diflucan instructions talk about things. It’s as far away from medicalised as you can get, isn’t it, just doing creative writing.The creativity of the medium, and its differentiation from the language and communication styles associated with more clinical discourse became something that in itself had a generative potential. Participants felt enabled to claim an ownership and validity diflucan instructions to their representations of experiences.

The written form had an authority and level of definition that empowered people to write about the more-than-medical realities that constitute life with rare genetic conditions. It provided an important outlet for people to voice their narratives—often stories that they felt had no place or might even undermine their expertise. As one participant diflucan instructions commented, ‘nobody asks me this stuff’. Another described how,I think people see you swan-like gliding along, having these silly ideas about how easy you’re making it look. They don’t see any of all of the bits that are going on behind it and writing about nappies and children being resuscitated and all of that kind of thing.

I suppose I feel it allows me to tell people what it’s really like.Again, it emphasises the value of taking an everyday approach, and considering what is ‘left diflucan instructions over’ (Lefebvre 1991), what exceeds or escapes more formalised representations of life with rare conditions, and what is absent from the genomic imaginaries and promissory discourses that are created and mobilised at a political level.ConclusionIn the spirit of dialogical narrative analysis, our aim has never been to ‘summarise our findings’, but ‘rather to open continuing possibilities of listening and of responding to what is heard’ (Frank 2012, 36). Stories are integral to medical care, as Nicholas and Gillett (1997, 296) argue, ‘in its representation of subjective experience, narrative gives us access to the perceptions and valuation of other human beings, and thus narrative bioethics is a means of thinking about the meaning of illness in the life of a patient and about the role of the physician in the patient-physician interaction’. The stories produced through our writing groups provide a window into the worlds of genomic medicine, the worlds outside of the diflucan instructions clinic. They are powerful, and exist as a reminder of the wider context in which families affected by rare disease are operating—the structural, social, administrative and bureaucratic challenges which must be navigated. Challenges that are compounded by one another.

But also, the joys, the diflucan instructions normality, the forgettability, the not-quite-all-consuming nature of rare conditions, and the opportunities that families find to resist a wholescale medicalisation or pathologisation of life. These stories do not provide answers or solutions. Instead, their value lies in helping to unfold the implications of experiences and illuminating what is often submerged or eclipsed by wider sociotechnical frames (Morris 2001). As Featherstone et al diflucan instructions. (2006, 149) argue ‘it is vital for researchers and practitioners alike to ground their work in an understanding of everyday family practices that is sensitive to their complexities’.We know that stories have lives, that stories travel, that stories remain memorable (Parr 2021).

We hope that the excerpts diflucan instructions we have showcased here, along with those that will be published elsewhere, might prompt greater understanding of the lived experiences of families whose lives have become entwined with the genomics agenda. Narratives can serve as a reminder of how medical practices are experienced by patients, but also how medical encounters are situated within, against and alongside everything else that happens in people’s lives (Nicholas and Gillett 1997). As Morris (2001, 55) has described, this is not a practice of thinking about stories, but rather a process of thinking with stories, ‘allowing narrative to work on us’.Data availability statementNo data are available. Due to the highly personal, sensitive and emotional nature of the qualitative data generated, and in order to respect participant’s preferences and consent, at this stage data is not being made diflucan instructions publicly available beyond what has been published in this article. Interested parties are welcome to contact the corresponding author for further details.Ethics statementsPatient consent for publicationNot applicable.Ethics approvalThis study involves human participants.

This project and other elements of the authors' research were granted ethical and research governance approval by The Brighton and Sussex Medical School Research Governance and Ethics Committee (ER/BSMS9KQM/2). Participants gave informed consent to participate in the study before taking part.AcknowledgmentsThe authors thank the peer reviewers and editors, diflucan instructions who provided deep engagement with their work and for the generosity, kindness and openness towards this manuscript.Notes1. There is a long tradition of using stories, narratives and writing as a way to prompt healthcare professionals to reflect on medical ethics (Jones 1999. Nelson 1997) diflucan instructions. This often takes literary sources as a starting point, though there is a growing interest in gathering stories from much more diverse places.

For example, Gualtieri and Akhtar (2013) describe how blogs written by patients can offer insights and rich narratives, and provide a means to reflect on the psychosocial and emotional consequences of chronic disease. Using ‘found’ material in this way however can create complexities around consent (Hookway 2008) and thus there are opportunities to think about more equitable and participatory ways of researching and writing with participants.2 diflucan instructions. RG has lived experience of a rare genetic condition themselves. The decision for RG to be present was discussed with potential participants who suggested they would be keen for them to be there..

IntroductionTracing the implications visit this site of online doctor diflucan developments within genetic science has become a major area of research and debate within medical sociology and allied disciplines (Martin and Dingwall 2010). Sociologists and bioethicists have long argued that technological developments are leading to an increasing ‘geneticisation’ of many aspects of health and healthcare (Lippman 1991). This can particularly be seen in the establishment and adoption of a ‘genomics agenda’ online doctor diflucan within public health institutions (Mwale and Farsides 2021).

Genomics involves the study of all of a person’s genes (the genome) and how genes interact with each other and the environment. The expansion of this area of medicine has been made possible by technological development, economic investment and the application of political capital. Going beyond the online doctor diflucan individual gene offers new diagnostic and treatment possibilities—particularly for complex and rare conditions.Alongside these clinical opportunities, there are substantial social implications.

As Martin and Dingwall (2010, 514) have noted, one of the distinguishing features of genetics (and now, genomics) is its promissory discourse which relies on a mobilisation of ‘high expectations and social anxieties’. Such can involve a reconfiguring of expectations, hopes and fears about the future (Martin and Dingwall online doctor diflucan 2010). As Parker (2012) argues, ethical problems within genetics emerge against, and need to be understood in the context of, a rich background of complex but largely day-to-day practice.

This is also true for the experiences of those engaging with genomics as patients or carers. An engagement with genomics is always mediated through, and interpreted against, peoples’ own lived (and everyday) experience online doctor diflucan (Featherstone et al. 2006).Understanding the perspectives of those who engage with genomic medicine services is (or, should be) an important facet of social scientific enquiry.

Particularly, as previous research has suggested that patients’ expectations and assumptions about ethical practice may not always be the same as those of healthcare professionals (Dheensa, Fenwick, and Lucassen 2016). However, as Lewis et al online doctor diflucan. (2020) note, there are relatively few qualitative studies that explore the perspectives of parents who have been offered genomic sequencing to diagnose their child’s rare conditions in the UK.

As a result, we are online doctor diflucan less aware of how families see the impact on their lives of the positive imagined futures presented by scientists, clinicians and policy makers. We might also be prone to reducing the experience of families down to that of travellers on the ‘diagnostic odyssey’ so often referred to in literature (Rosell et al. 2016).

Our research aims to collate rich accounts of lived experience in order to make visible the diverse, variable and multilayered everyday lives of patients and families and how online doctor diflucan these correspond with emerging, rapidly changing, and complex fields such as genomic medicine. While the application of genomic technologies has the potential to transform patients' lives, the excitement (or, ‘genohype’ (Kakuk 2006)) around these technologies mustn't eclipse the everyday experiences of the people who live with, and care for, those with genetic conditions. As Kerr et al.

(2021) have argued, these promissory claims are fragile and contested, particularly when set against everyday encounters.Dealing with the uncertainty that the advent and subsequent mainstreaming of clinical genomics brings requires working in a way that empowers online doctor diflucan ‘voices at the margins so that they may help craft creative options and [create] opportunities for collective consensual decision-making that are respectful of difference’ (Baylis 2019, 175). This involves finding ways to speak ‘with’ rather than ‘for’, creating a way for the ideas and interests of stakeholder communities to rise to the fore, and hence, our interest in participatory-writing.Writing worldsWriting, as we see it, belongs at the heart of social research. It is part of research online doctor diflucan.

A research method in its own right. A means of enquiry, exploration and articulation. (Phillips and Kara (2021, 8)Finding ways to understand, evoke and (re)present the online doctor diflucan experiences of research participants is at the heart of social scientific inquiry.

Methodological plurality and creativity is increasingly celebrated as allowing for more nuanced perspectives, different modalities of knowledge and more participatory approaches to doing research with (as opposed to simply, on) participants (DeLyser and Sui 2014). The challenge, as described by Deacon (2000) is to ‘find ways to make living systems actually come alive’. Given that ‘social researchers work with participants to explore their experiences and perspectives in their own words’ (Phillips and Kara 2021, 105) there online doctor diflucan are opportunities to think more creatively about how we come to elicit, produce and obtain these words.

Written words, not just spoken.As Richardson (2000, 923) argues ‘writing is also a way of 'knowing'—a method of discovery and analysis’. Explorations of using writing online doctor diflucan as a mode of inquiry have seen experimentation with different written forms (Eshun and Madge 2012. Lorimer 2018.

Phillips and Kara 2021) as well as autobiographical accounts in the style of autoethnographic methods (Bochner and Ellis 2002). However, as Elizabeth (2008, 4) notes, such a use of autobiographical writing as a online doctor diflucan method remains underused and is ‘is largely confined to those sociologists who choose to write personally. Participants are rarely granted a similar opportunity’.

Certainly, many such examples can be found of this style of academic writing, and obviously, this is not to downplay their contributions and insights, but to draw online doctor diflucan attention to the potential ways in which such methods can be extended to engage with the knowledges of participants. There is perhaps something troubling about the way that ‘writing’ is something retained as the privileged territory of the researcher.Participatory methods have been invoked to great success across a diverse range of settings. Participatory drawing (Literat 2013), participatory photography (Prins 2010), participatory video (Kindon 2003) to name just a few.

Yet there appears to remain a hesitancy to extending these principles of online doctor diflucan participation to that staple of research. Writing. Many of the benefits that have been identified as resulting from social researchers using writing as method (Phillips and Kara 2021.

Richardson and online doctor diflucan St. Pierre 2018) can also equally arrive from enabling those we research with to contribute illuminating understandings through the processual experience of writing. For example, in writing about writing as a method online doctor diflucan of inquiry, Richardson and St.

Pierre (2018, 1428) emphasis original) reflect on the benefits of how ‘thought happened in the writing’. Similarly, Phillips and Kara (2021, 17) explain how ‘writing can help us to explore experiences and identify and express emotions’. Of course, such a generation of new ideas, understandings and connections through writing is not limited to those doing research, but extends to all those who might embrace and engage in the exploratory and expressive acts and processes emerging from an engagement in writing.Asking participants to write online doctor diflucan is not an unusual method in and of itself.

It is the core thing that we ask people to do when we send them qualitative questionnaires and include room for open-ended responses in our surveys. Diary methods have a rich history as an enlightening form of empirical investigation, capable of offering insights into everyday life (Latham 2003). The Mass Observation Project online doctor diflucan and Archive similarly relies on participants becoming diarists and writers, responding in a written form and recording their experiences and thoughts (McGlacken and Hobson-West 2022.

Smart 2011). Yet, despite such utilisations of inscription, there still remains something of a sense of impropriety to the notion that research participants may write, online doctor diflucan rather than speak—one in conflict with, and challenging to, the privileged place which interviewing occupies within qualitative inquiry (Elizabeth 2008). In describing the Mass Observation Project, Smart (2011, 541) describes how, until more recently, sociological engagement with the written narratives produced through the Mass Observation Project has been limited ‘because the free way in which they wrote was not regarded as sufficiently rigorous for sociological analysis’.

Attitudes have since changed however, to recognise the richness and depth of the narratives that many Mass Observation panellists produce (Smart 2011).There are substantial benefits in asking participants to write about their lives (Elizabeth 2008). Using writing online doctor diflucan as a method of inquiry raises the possibility for ‘producing different knowledge and producing knowledge differently’ (St. Pierre 1997, 175).

Writing creates a very different modality of online doctor diflucan representation. It allows research participants to ‘give the researcher their stories and words in an exact form’ (Deacon 2000). As Penn (2001, 50, emphasis original) argues, to write is an act of agency.

€˜when we write online doctor diflucan we are no longer being done to. We are doing’. This can be a particularly important mechanism of representation for certain groups and narratives, particularly if writing about events where agency may have been lacking for the author.

Writing thus provides a way of transferring a online doctor diflucan level of control and ownership to participants ‘in a way that traditional interviews cannot’ (Burtt 2020, 7). This could simply be about enabling participants to take the time to narrate their experiences in their own terms. This ‘giving time’ may be online doctor diflucan at odds with some forms of social science that prioritise and privilege the immediacy and synchronicity of the research interview as a strategy for overcoming anxieties about ‘premeditation’.

Yet for some topics and participants, the opportunity to respond carefully and thoughtfully allows a more sensitive immersion in research. Participants can spend as long as they need to complete their written reflections, considering carefully their responses in an atmosphere less structured by the pressures of direct questioning (Burtt 2020). Participatory-writing can provide windows on subjects online doctor diflucan that would otherwise be hard to reach by virtue of their personal or sensitive nature (Phillips and Kara 2021).

Writing can afford a level of safety in providing space, time and privacy to consider the framing and language in which disclosures and stories are told, navigating and articulating vulnerability and uncertainty. Participants are able to craft their voice. Such crafting may again be challenged by those concerned about the risks to the generation of ‘truthfulness’, though to assume that only through the imposition of questions on the online doctor diflucan spot during interviews are authentic and authorative accounts produced is flawed.

To quote Elizabeth (2008, 14):Writing provides researchers with access to the unique, partial and situated perspectives of our participants. We gain insight into the discourses that circulate in their social milieu and the online doctor diflucan way in which these vie for our participants' subjectivities.Writing can enable people to overcome the effects of self-censorship, allowing self-revelatory forms of expression (Elizabeth 2008). While oral research methods are often based on the dialogue between interviewer and interviewee, writing tasks, as Elizabeth (2008) describes, can put past and present selves into dialogue with each other.

Writing brings a level of flexibility that can aid progression beyond fixed questions and rigid categories and vocabularies introduced by the researcher, participants can employ their own concepts and terminology, and even, to certain extents, define the questions they wish to ask and answer (Burtt 2020). Similarly, participatory-writing as a method is less influenced by the mediating effects of the interviewer (or other focus-group participants) online doctor diflucan. Interjections, perceived cues, puzzled looks or requests to know that one’s narrative is making sense (Burtt 2020.

Elizabeth 2008).This is not to claim that writing produces accounts that can be universally representative or the source for generalisations about the social world, rather the impact and intention of writing as a method is to be illustrative (Evans 2021. Phillips and Kara online doctor diflucan 2021). By collating multiple autobiographical accounts from participants with a shared connection, social researchers are left with a ‘method through which we might investigate that more conventional social space of the collective’ (Evans 2021, 14).

This in itself allows for the inclusion of multiple ‘voices’ within the final written product of research, giving a platform to participants that has the potential to be less directly mediated and subject to academic meddling.This is not to position writing as online doctor diflucan an epistemologically ‘better’ method of inquiry than more conventional oral research practices, but rather to recognise that writing can allow the production of very different kinds of personal revelations from participants than what may be forthcoming when spoken. That creative or autobiographical written accounts may result in omissions and imperfect interpretations of the self is well recognised (Evans 2021), but such critiques can likewise be applied to the majority of social research methods. The point is to understand how different methods can allow different facets of life and self to arise to the fore.

Like all methods, participatory-writing has its online doctor diflucan time and place (Phillips and Kara 2021). Elizabeth (2008) suggests that there is great value in using writing exercises in conjunction with interview or focus group discussions.While embracing the ways that participants’ ‘crafted written work stands to provide eloquent answers to research questions and speak to research interests from original angles’ (Phillips and Kara 2021, 114) it is also important to remember that often the additional product of participatory-writing research are the conversations and reflections that occur along the way. Indeed, it is the practice and process of participating that can matter the most, rather than the outputs of words on a page—as useful and illuminating as they may be (Phillips and Kara 2021).

The ethical bargain online doctor diflucan struck with participants may mean that on occasion the primary product (writing) is never seen nor shared, only the experience of producing it.While social science may not have a long tradition of encouraging participants themselves to write as a mode of inquiry, as part of the rise of expressive and arts-based therapies there has been a renewed attention to writing as a therapeutic technique (Elizabeth 2008. Pennebaker and Chung 2007. Peterkin and online doctor diflucan Prettyman 2009.

Robinson 2000). There are numerous studies that explore forms of expressive writing as a means for coping with a variety of situations (Bolton 2008. Gebler and Maercker 2007), yet few studies that take up Richardson (2000) challenge of using writing as a way of inquiring, understanding and ‘knowing’ more about such experiences—particularly in a fully participatory vein (though see Phillips online doctor diflucan and Kara (2021) for an insightful volume that catalogues recent efforts to do just this).

It is perhaps such codings of writing as having ‘therapeutic’ applications which has stifled experimentation by qualitative researchers. Similarly, the assumption that writing exercises have a therapeutic component (by design, intention or as a predictable but unintended side effect) may make ethics committees cautious online doctor diflucan in their policing of such methods. Though again, the ‘research interview’ is often structured by, and experienced as, a confessional (Crowe 1998) and therapeutic opportunity (Birch and Miller 2000).Of course, the open-endedness of writing presents challenges as well as opportunities (Phillips and Kara 2021).

As Phillips and Kara (2021, 76) recognise, we write ‘within the means available to us’, with dominant discourses often infiating work that hopes to be creative, searching and illuminating, becoming more conventional or hegemonic. Writing obviously has the potential to be an exclusionary activity, with the possibilities for participation influenced by numerous factors such as class, gender, health and cultural differences, alongside past educational experiences, language online doctor diflucan fluency, habit, practice and even time available. Participation can be challenging and uncomfortable, and may be prefigured by pre-existing attitudes and aptitudes to the written form—and the sharing thereof.

As Phillips et al. (2021, 54) poignantly note, ‘creative writing is not online doctor diflucan for everyone, all of the time’. Rather than acting as a participatory method, instituting writing as the method by which people take part in research can deter participation (Phillips and Kara 2021).

However, McMillan and McNicol (2021, 86) suggest rather than an imposition of what writing online doctor diflucan should be, there are ways of working that can allow ‘a community’s existing ways of writing and knowing to come through’. Such can involve cultivating a sense of inclusion, safety and trust among participants (Phillips et al. 2021)—many of the core values of qualitative research at large, around building rapport and relationships are particularly applicable to using writing as a method of participatory inquiry.It is important to bear in mind that writing is directly affected by the nature of the intended audience, and particularly the levels to which any audience may be imagined to have been conferred with evaluative powers (Elizabeth 2008).

Similarly, and as with any form of qualitative research, accounts produced through writing are shaped by online doctor diflucan the possibilities and desires for levels of anonymity for the authors involved. Further, we must recognise that writing fixes words—and as Elizabeth (2008) notes, hence also fixing constructions of selves and narratives. Though given that most interview research involves a subsequent transcription to an often equally fixed written form, this is perhaps not too dissimilar.

Indeed, the opportunity for a level of editorial oversight of one’s own words and stories is one of the online doctor diflucan benefits brought about through participatory-writing. However, while writing as a mode of inquiry can be less intrusive and less pressurised, especially when taking place in the writer’s own time and space, this also means there are also fewer opportunities for researchers to provide emotional support, reassurance or to steer questioning away from distressing topics (Burtt 2020). There are thus complex ethical considerations prior to asking participants to write, to sit and mediate on a topic, in online doctor diflucan ways that—though possibly enjoyable, comforting and self-revelatory, can also be frustrating and saddening (Elizabeth 2008.

Phillips and Kara 2021).As well as affecting those doing the writing, writing also has the potential to affect readers in ways that formal academic writing cannot (Phillips and Kara 2021). Participants’ writings can be well suited to disseminating research, particularly as the expressive nature of a participant’s writing can be seen to be ‘evoking’ emotion rather than just ‘explaining’ emotion. Showing rather than telling (Andrews 2018) online doctor diflucan.

Participant-produced stories have an ‘enlivening’ quality, and can have a valuable role to play as communicative resources, building—and bridging—empathy (Parr 2021). Parr's work in particular demonstrates how stories can lead to changes in behaviours and styles of engagement within professional communities (Parr 2021).1Participatory-writing with people affected by rare genetic conditionsThis research is part of a larger participatory study working creatively and collaboratively with families touched by genetic conditions to explore the experiences of patients and participants in genomic medicine and research. Our aim is to identify the overlaps and gaps between practitioner and patient accounts of ethically relevant issues as online doctor diflucan they occur in clinical genomics and find ways of supporting people to feel more comfortable when having challenging conversations.

Our principal research question is whether accounts of patient experience might contribute to the preparedness of clinicians to deal with the ethical challenges of genomics practice.It was this ambitious research question that piqued our interest in participatory writing, with the hope that such narratives might express and evoke aspects of lived experience in productive and affective ways, beyond what was possible through more conventional social-scientific registers and/or participatory practices of ‘patient engagement’. As Frank (2012) notes, equipping healthcare professionals with a sense of ‘what to listen for’ can enhance ‘professional listening’.Co-production online doctor diflucan is at the heart of the research project. Our research is directly informed and guided by people with lived experience.

We have a participatory steering group who attend project meetings, share their ideas and experiences, and contribute and comment on the design of research activities. This has allowed us to develop relationships with participants, build trust and confidence, and demonstrate our commitment to confidentiality, online doctor diflucan giving people a voice, and effecting change. Thus, we see ‘patient and public involvement’ as a constant and continual process, rather than an initial involvement at the outset of the project.

Our research involves continued dialogue and input from people with lived experience of genomics and the active enrolment of their expertise, feedback and insights online doctor diflucan into the design of this project—in all its extents, including research questions, methodology, recruitment and dissemination. Our participants have acted as peer-researchers and had oversight of the writing of this article.Conversations with members of this steering group indicated an interest in, and encouragement to, explore ways of researching using arts-based methods. Working with an author and life-writing tutor, we designed a participatory-writing programme that would encompass an hour-long online facilitated workshop on a weekly basis for 6 weeks.

We were conscious online doctor diflucan of accommodating the availability of people with often complex caring responsibilities (particularly during antifungal medication). Finding a mutually acceptable time to run the writing group was one of the largest challenges, although the extent to which individual participants committed to attending despite, and alongside, their commitments of caring and work (exacerbated by antifungal medication lockdowns) gave some insight into how much potential value people saw in this work. Aware of the online and disembodied nature of the groups, we sent participants a small ‘care package’ of stationery ahead of the meetings to show our appreciation and to help build a sense of occasion.

We were aware that through writing (and reading others’ stories), people would be brushing up against personal and emotional topics, which could cause, or even online doctor diflucan reveal, a level of upset and anxiety. Our aim was that the writing groups might exist as a ‘safe space’ to explore these narratives. However, while we had hoped participants would find being involved online doctor diflucan in our research empowering and cathartic, we were keen to stress that our research activities did not constitute a form of ‘art therapy’.

In preparing for the possibility of distress, we appointed a colleague (external to the project) with extensive pastoral experience who could be called on to support participants (and researchers) should the experience become challenging.Initially, we recruited participants through our existing networks and relationships. A ‘purposive sampling’ technique (Sarantakos 2012) with our aim being ‘not to choose a representative sample, rather to select an illustrative one’ (Valentine 1997, 112). These were people who served as ‘patient representatives’ on ethical and governance panels relating to genomics or online doctor diflucan who were active in patient led organisations.

These were people whose voices and expertise had already been sought out in different fora. Through a level of ‘snowballing’, these initial participants made suggestions for others within their advocacy networks and patient communities who they felt could contribute to—and enjoy taking part in—our research. The participant group was mixed in gender, though with a larger online doctor diflucan number of women, and ages ranging from mid-30s to early 50s.

All of our participants had direct experience of genetic disease within their families, with many having a significant level of caring responsibility as a result. Our participants online doctor diflucan had experience of participating in large genomic medicine projects, such as the 100 000 Genomes Project and/or the Deciphering Developmental Disorders Study. Many of the participants we were working with had an active blogging practice, and were keen to take part in research in a way that made use of their skills, interests and communicative strengths—but also to get something out of the research themselves, in learning new ways to hone their writing practice.

Others took a little more convincing, and were particularly hesitant about how doing some writing could be scientifically productive or of value.Week by week, each session involved our professional writing tutor introducing different creative writing exercises, designed to enable both novice and experienced writers to begin to express ideas and thoughts with greater fluency. This included being introduced to, and trying out, techniques such as free-writing, narrative-distancing and writing in response to a given prompt (such as telling the story of a cherished object) online doctor diflucan. At the end of each session, participants were given a creative exercise to tackle in their own time.

During the introduction and after each in-session activity participants were invited to reflect directly on their experience and the content of their writing. Participants were invited, but never pressured, to share their writing with online doctor diflucan the group by reading a short excerpt. Discussion was guided by the facilitator to focus on the experience of the process of writing, and to prompt the group to notice any thematic similarities or differences in written accounts.

The emphasis throughout was on building confidence in expressing lived experience.Our first writing group—who affectionately became known as the ‘Thursday Writers’—consisted of five participants, alongside the life-writing tutor, and the first author (RG), who took a participatory role in the group, rather than solely an observational one.2 Our intent was that participants would read extracts from their writing, and online doctor diflucan hopefully share it with the research team. However, participants were quickly very vocal about wanting to share their outputs in full among the other members of the group too, and we created a secure online space where people could upload what they had written in the sessions or as part of the ‘homework’. Some participants chose to use word processors, others uploaded photos of their handwritten pages.

Reflecting on the impact of reading other people’s writing and noting points of connection became a regular feature of discussions (a point we will return to later on).Our ‘Thursday Writers’ were hugely supportive of online doctor diflucan the participatory-writing programme, and several participants supported us to recruit for a second 6-week programme with an additional seven participants (which also ended up running on a Thursday). All of the writing group sessions were recorded, with participants’ consent, which has allowed us to revisit and reflect on the types of narratives that were created and shared, alongside those which were uploaded to a ‘sharing folder’ (one for each group—it was key that the ‘safe space’ created for sharing writing was limited to the people who were in the online sessions together). Participants also online doctor diflucan consented to their written pieces being used in publications, a question which was revisited in the drafting of this article.After each 6-week programme, we arranged reflective interviews with participants, giving everyone an opportunity to share their thoughts and experiences regarding participating in the writing groups.

The written pieces that participants had produced throughout the course also served as an elicitory device during these conversations (Bagnoli 2009), allowing us to delve further into the context, meaning and emotions surrounding the participant’s writing, as well as asking them to reflect on what the piece represented or evoked that may be outside of view to others.We have specifically chosen not to attribute interview quotes nor written pieces to individuals. This is to aid confidentiality, which was an important theme for participants (see later discussion). While we could have chosen to use pseudonyms or online doctor diflucan participant codes, these can be reductive.

Through not attributing quotes or pieces of writing to individuals, we are able to demonstrate commonalities across different and diverse rare genetic conditions.Engaging with the written pieces produced through participatory-writing involved paying close attention to the stories (and, processes of storying) that were written, aiming to better understand their impact and significance (Phillips et al. 2021). For us, this involved drawing on aspects of dialogical narrative analysis (DNA) (Frank 2010, online doctor diflucan 2012).

Such an analytical approach involves questioning:What is the storyteller’s art, through which she or he represents life in the form of a http://www.limosontime.com/specials/ story?. And what form of life is reflected in such a representation, including the resources to tell particular kinds of stories, affinities with those who will listen to and understand such stories, online doctor diflucan vulnerabilities including not being able to tell an adequate story, and contests, including which version of a story trumps which other versions?. (Frank 2012, 33).DNA involves understanding stories as artful representations of lives.

It involves considering why someone might choose to tell such a story and exploring how identities are being formed and sustained by the storying process. DNA’s concern is how to speak with a research participant rather online doctor diflucan than about them, and show what is at stake in a story as a form of response. A central premise of DNA is that it does not seek to interpret stories or ‘discover truths’ that have ‘escaped the attention of the storytellers’ (Frank 2012), rather the intent is to witness stories, and enable voices to be both heard and evocative—often through positioning them into dialogue with other, but similar, diffuse voices.

Thus, the purpose of a dialogical narrative analysis is not to ‘display mastery over the story, but rather to expand the listener’s openness to how much the story is saying’ (Frank 2010, 88).Writing everyday storiesSimilarly to Phillips et al. (2021), our approach was not to extract stories online doctor diflucan from our participants, but enable them to recount the stories that were of importance to them. Although we were interested in the dawn of genomic medicine and the sociotechnical imaginaries involved (Mwale and Farsides 2021), we were also interested in what everyday life is like for the people who live with, and care for, those with genetic conditions, and how genomics acts to reconfigure (or, perhaps, does not) aspects of people’s lives outside of the clinic.

As Prainsack, Schicktanz, and Werner-Felmayer (2014, 11) argue, online doctor diflucan genetics takes place ‘outside of the clinic as well as within. It takes place in families, patient groups, state organisations, on the Internet, and on the international market’.The phrase ‘everyday life’ is often associated with the ‘ordinary, routine and repetitive aspects of social life that are pervasive and yet frequently overlooked and taken-for-granted’ (Pinder 2011, 223). Finding significance in the everyday and respect for the ‘mundane’ draws from a feminist commitment to understand the material conditions of people’s lived experience and practices (Hanson 1992).

Attending to ‘everyday life’ allows a focus on those practices and aspects of life that are hidden by dominant narratives (Highmore online doctor diflucan 2002). An everyday perspective challenges privileging certain spaces, such as ‘the clinic’, as being the locus of how and where people experience genomic medicine, to instead explore that which exceeds these formalised encounters and overflows into other domains of life. For Lefebvre online doctor diflucan (1991, 97), everyday life is ‘what is left over’.

Our participants’ writing provided us with a viewpoint of those things which are ‘left over’ from accounts of genomics. It draws our attention to the way that geneticisation (Lippman 1991) and genohype (Kakuk 2006) infiate everyday life, but also how, frequently, at an everyday level, these new sociotechnical regimes may have little impact. With genomics being presented as a cornucopia and salve for all manner of health and social challenges, understanding ‘what is left over’ is an important effort in making visible the inconspicuous aspects of living with rare online doctor diflucan genetic conditions.

As Nicholas and Gillett (1997) argue, to begin to appreciate the bioethical issues at stake, we need to fill in the gaps that exist within our understanding, something which cannot be done without narrative insights. Similarly, reflecting on genetics practice at large, Featherstone et al. (2006, xii) argue that ‘a sound appreciation of everyday social reality is of profound importance for online doctor diflucan professional practice’.

Thus, as Frank (2012, 36) notes, ‘to describe the world may be the most effective way to change it’.Many of the pieces of writing that emerged from the groups touched on these sorts of everyday realities, and hidden complexities, of caring for people affected by rare genetic conditions.With ‘My Day Begins’, I just sat down, and I was typing rather than writing freehand because I’m faster. And yeah, there it was, and I hardly had to change anything, after the first draft online doctor diflucan. I was really pleased with it, and you know I started off just trying to make it as factual as possible, as matter of fact as possible.

And it wasn’t until I shared it with other people that then they went ‘Whoa’. And I went ‘Whoa? online doctor diflucan. Really?.

This is life.’ And I thought that was very interesting.As one of our participants commented, writing these sorts of creative pieces allowed them to draw attention to the complexities involved in care—practical, emotional and identity-based complexities, not just medicalised complexities. As the author of ‘My Day Begins’ (figure online doctor diflucan 1) notes,'My Day Begins'—a piece of writing from one of our writing groups. WAV, wheelchair accessible vehicle." data-icon-position data-hide-link-title="0">Figure 1 'My Day Begins'—a piece of writing from one of our writing groups.

WAV, wheelchair accessible vehicle.There’s stuff in there about the complexity of caring for online doctor diflucan somebody, the practical complexities, and there’s stuff about the emotional complexity of being part of a wider family unit and still having to cope. And there’s this stuff in there about having to put aside your sense of self and be a parent or a carer. And I think a lot of people who don't have caring responsibilities would never think twice about that.Bury (1982, 169) noted how illness can result in ‘biographical disruptions’, where ‘the structures of everyday life and the forms of knowledge which underpin them are disrupted’.

Such was certainly present in online doctor diflucan the written pieces that our participants produced. Though, rather than a singular disruption, years with no diagnosis, potential misdiagnoses and potentially having to adapt to receiving a diagnosis for a condition different to what had been expected (Dheensa, Lucassen, and Fenwick 2019), means that genomics follows multiple disruptions to both forms of knowledge and everyday life. Figure 2 exemplifies this.'Freewriting, Session #3'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 2 'Freewriting, Session #3'—a piece of writing from one of our writing groups.Yet even in writing these representations, participants were keen to hold attention to these acts as being specifically everyday.

They were online doctor diflucan aware and quite critical of the possibility for acts of interpretation to render their writing as something very different. One participant described the challenge of eliciting empathetic responses, rather than just solely sympathetic responses.Sometimes I feel in this juxtaposition about not wanting to be personified as a superhero, because we’re not, we are just doing what the majority of parents would do if they had to do it, that is how it is.As a route to enabling the possibility of empathetic response, many of those who took part in the participatory-writing sessions commented how their pieces perhaps captured aspects of their lives that they felt were outside the view and understanding of medical professionals. The lack of alignment between families and healthcare professionals as to what ethical practice around genomics might mean and require (Dheensa, Fenwick, and Lucassen 2016) can be produced in part by this lack of visibility and knowledge about what is important and what is experienced on an everyday level.‘They [healthcare professionals] tend to have a close in view of it rather than a bird’s eye view of it, in a way all of that stuff and stress is invisible.’‘I think clinic doctors perhaps don't see anything like this side of things.’‘I’ve written quite a lot and I think other people have as well about how it feels to be a family with or without a diagnosis, rather than what the medics or what the team seems to online doctor diflucan think is important.’Noting things as being exterior to more commonplace comprehensions was not always presented as disenfranchisement or critique of healthcare professionals, but rather a way of drawing attention to the multiple forms of lived expertise that parents were called on to develop and mobilise.

One piece, ‘Word Salad Counsellor’ (figure 3), in particular showcased how engagements with genomic medicine required patients and parents to develop new skills and knowledges, specifically in navigating the complex scientific languages through which clinicians enact and practice care.'Word Salad Counsellor'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 3 'Word Salad Counsellor'—a piece of writing from one of our writing groups.There is much to take away from figure 3. The use of humour to mask painful experiences. The hyper awareness online doctor diflucan of space and environment.

The use of language, metaphors and similes. The lack of attention to important personal online doctor diflucan information (e.g. Misgendering the child) in lieu of a focus on complex scientific information.

The unfortunate use of the word ‘exciting’ when attached to what is in fact bad news for this family.In particular, this tongue-in-cheek piece highlights how accessing genomic medicine services can require quickly learning scientific vocabulary in order to interpret clinical communications and be confident in understanding, participating and obtaining, optimum care. The challenges of the technical language surrounding online doctor diflucan genomics (and health information in general) are well established (Stuckey et al. 2015).

The onus is frequently on the patient to acquire the expertise to interpret the information being provided—as described in the quote below from an interview with the author.Yeah, I mean it’s amplified but it’s not amplified by very much at all. I took your world’s worst plausible online doctor diflucan genetic counsellor and went from there. The surreal-ness of it actually comes from a lot of the stuff that’s real in a way because I went back to it and thought which bits really chimed?.

Of course, it’s all the stuff like, ‘Oh, yes, this is a known variant online doctor diflucan of not a great deal of significance.’ All those kinds of things. To most people it sounds like Douglas Adams but it’s not, it’s just what arrives in the letter. Okay, should I worry about this?.

Do I need to translate it before online doctor diflucan I worry about it?. What are we doing here?. … I’ve rapidly built on my A level biology knowledge which was already 30 years out of date.

When I learnt my genetics online doctor diflucan the human genome hadn’t been sequenced so it’s all happened in my lifetime really and it’s been a bit of a helter-skelter. In a way you’ve got to learn it … it’s all delivered in closed codes and so in order to pick any of the useful information out of that you’ve got to learn it quick.Although not the intended purpose of the writer, the original piece of writing and the follow-up discussion provide invaluable insight into the way theory and practice come together (or do not) in the clinic. The encounter online doctor diflucan highlights the centrality of what can be described as a ‘diffusion model’ (McNeil 2013) of public engagement efforts around genomics.

That is, the aspirations and follow on assumptions that groups will acquire scientific knowledge about new technologies via a ‘trickling down’ or ‘osmosis’ of information. This is slightly different from—though, entangled with—ideas that suggest a ‘deficit model’ of public engagement, that takes as its starting point a deficiency in understanding that can be solved through more or better education (Marks 2016). A diffusion approach instead assumes that those encountering a new technology will actively seek, online doctor diflucan access, comprehend and use related information.

Institutionally, it is a passive (indeed, neoliberal) approach to public engagement that positions individuals as responsible for their own empowerment. In practice, the prevalence of a diffusion model of public engagement is potentially as equally problematic as the well-critiqued deficit model. Hoping that those engaging with genomics online doctor diflucan services will have acquired the confidence, knowledge and skills to equitably participate through a wider diffusion of public understanding of genomics and/or a commitment to self-education is, at best, a sticking plaster.

More creative dialogical strategies for developing public engagement around genomics are still very much required (Samuel and Farsides 2018).Participants were keen to use the groups, and their writing, as an opportunity to craft narratives and representations that resisted and challenged what they frequently felt was expected (and indeed, imposed on them) by institutions—whether the wider genomics ‘industry’, or even patient support groups. As such, participants were aware of particular types of writing that would be well received and seen to have extrinsic value, but struggled to square that with the way in which they wanted to tell online doctor diflucan their own stories and reflect those of their children.We’re thinking more about how our children are represented, and their awareness of themselves. It’s that thing that ‘this child is disabled and they’ve had a horrible life and they’re so sick and blah-blah-blah’, and then people give you funding … And I’ve had conversations with [charity] about it before because they’d written something for a funding bid and it said ‘a lot of these children will die’, and I thought, ‘Do you really need to say that?.

€™, and they were like, ‘Yeah, because that’s what gets people…’. But when you’re thinking about your child and how you want the world to view them and how you want them to view themselves, it’s kind of a different thing I guess.Thus, many of the pieces of writing online doctor diflucan that participants created aimed to tell positive stories, ‘normal’ stories, that resisted medicalisation and politicisation, even casting it to the margins, such as in ‘My Magical Girl’ (figure 4). As one participant noted, ‘one of the things I really liked, one of the reasons that I write is to share the good stuff that happens’.

Intertwined with this, we can witness how participants are keen to reclaim and recentre certain aspects of their identities which perhaps they do not online doctor diflucan get the opportunity to voice in other (particularly, medical) contexts. As one participant reflected on their writing. €˜I think there is that bit of still being a mum and not being a carer or a medical secretary’.

Parents of children with rare genetic conditions are often implicitly expected to become ‘expert caregivers’—something which healthcare systems rely on, though simultaneously struggle to acknowledge (Baumbusch, Mayer, and Sloan-Yip 2018).‘My Magical Girl’—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 4 ‘My Magical Girl’—a piece of writing from one of our writing groups.Similarly, another participant reflecting on the writing groups explained:We online doctor diflucan did a narrative piece that I’m just looking at now and I think that does what I like to do, which is just show some of the normal stuff around living with someone with a rare condition. Just trying to show that we do have a normal life and just showing that we do have things in common with other people, we do have things we can talk about and if you come and talk to us or read our writing, it doesn’t have to be about genetics!. We’ve got other things that are in our lives and are important to us.At first glance, some of the written excerpts appeared to describe aspects of life quite mundane and unremarkable.

However, when read online doctor diflucan through the context of rare genetic conditions, these pieces can draw attention to how such multiple aspects of everyday life are reconfigured and challenged. Indeed, one participant reflected that, ‘I don’t think I wrote particularly much about her condition per se, but then I think things leak out in whatever you’re writing about’. While another noted how ‘no matter what we write about, you can always feel that online doctor diflucan parenting concern in the back of your mind.

The inability to be completely free of that.’. For example, the written piece ‘My Garden’ (figure 5), touches on the home adaptations and extensions often required to allow domestic spaces to become accessible, the exclusions that can be felt from public spaces lacking specialist play equipment and the vulnerabilities that a rare diagnosis can bring in diflucan times.'My Garden'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 5 'My Garden'—a piece of writing from one of our writing groups.Many of the pieces written as part of our two writing groups explored some of these other things, whether descriptions of gardens, fond memories or day-to-day conversations. Not all of online doctor diflucan them were approached through the lens of rare conditions.

Instead, caring responsibilities or medical paraphernalia featured as an absent-presence. Yet, many of these pieces of writing, even when not directly or explicitly mentioning rare disease, carried messages and themes that other participants took to be particularly meaningful when interpreted through their own lived experience of rare genetic conditions, such as ‘The Blanket’ (figure 6).'The Blanket'—a piece of writing from one of our writing groups." data-icon-position data-hide-link-title="0">Figure 6 'The Blanket'—a piece of writing from one of our writing groups.The Blanket was amazing because it was that kind of completionist idea, the idea that the caring and dealing with the genetic odyssey is a never-ending saga and so you never get to complete anything because you’ve got to do it again from scratch tomorrow. The blanket more than anything online doctor diflucan else kind of touched me.

It’s the one I really took away with me.Writing in this way gave participants scope and freedom to tell stories that they felt—as one participant described—‘could only happen by metaphor’. It provided a way to represent aspects of their lives and experiences that exceeded what could be conveyed in oral recollections and online doctor diflucan explanations. The blank page and freedom to write about anything was an important way of creating a space where people felt comfortable to explore different narratives, centre different identities and challenge assumptions about life with rare conditions.

As one participant explained:I was a bit worried that at the beginning, we would be invited to delve into points in our story that we felt were pivotal or particularly strong memories. And I was very glad that [the online doctor diflucan facilitator] didn't do that. She was very careful to say, this could be any of your experiences, write about any of it.

And then, of course, you can choose how far you tip-toe into that or not. And that was good.With this in mind, we want to briefly turn our attention to reflecting on the value that writing has had here, as a qualitative method, and how online doctor diflucan it has allowed us as researchers to explore the lifeworlds of families touched by genetic conditions.Reflecting on the value of participatory-writing for social researchParticipatory-writing has enabled us to learn about many of the things that mattered to our participants. It has given us an insight into their everyday lives.

The complexities, online doctor diflucan the challenges, the frustrations. Writing (and the interlinked processes of sharing and reading) has allowed our participants to voice their narratives and representations in ways that they found to be important and authentic.The written pieces that were created—whether poem or prose—have been immensely evocative. We have included as many as possible, and in full.

Particularly as, to quote Frank (2012, 36), ‘each online doctor diflucan story must be considered as a whole. Methods that fragment stories serve other purposes’. Herein lies one of the challenges of online doctor diflucan participatory-writing, in that what is produced does not lend itself well to the demands and constraints of academic publishing!.

Though we hope to also demonstrate what is achievable even when time is short. One of the largest challenges of the method that we and our participants reflected on were discussions around privacy and confidentiality.There’s a lot of stuff now that I have to be so careful, because of protecting the kids’ privacy. There’s stuff I’d like to talk about online doctor diflucan because it affects me, some of the conversations that we’ve had to have, I can’t put those anywhere and it’s not that I want to necessarily share that as such, it’s a difficult one in that sometimes it is just cathartic to get it out and write it out but then I’m always mindful, who is reading this?.

How can this come back in the future?. How would that get back?. How would I feel if my online doctor diflucan kids, how would they feel if this was out there?.

Writing brings with it a greater sense of permeance and mobility. It produces a record in ways different online doctor diflucan to that of conversation. In our research, we always ensured that people felt comfortable to not share what they had written—and indeed, some people did not.

Throughout the process we stressed the optional nature and modular approach to sharing, allowing people to choose what was shared with us as researchers, what was shared within the group, and what—if anything—could be shared more widely, for example, the pieces of writing featured in this publication. Participants assessed this issue on a piece-by-piece basis and knew that we as researchers wanted them to retain full control over everything they had written.It was encouraging that online doctor diflucan participants reflected on how writing had, as a method, both encouraged and enabled them to detail aspects of their experience that might not have come to the fore had we relied solely on oral interviews. Writing, as one of our participants described, ‘really threw a light on those things that it’s really hard to explain under other circumstances’.

Another participant described noticing that the written medium had encouraged them to ‘dig a little bit more’ into their feelings:[You] can twiddle with it, so like we might come out of this meeting now and I might think, ‘oh god, I wish I’d said that’. Whereas if you’ve got a week or so to actually play with it and add or take away from it or whatever, because sometimes you write something and it’s done, but then you start typing it up online doctor diflucan and you’ll just rephrase it in a different way. So, there’s that time to actually consider it.The opportunity to creatively use metaphors, write-between-the-lines, and crucially, take the time to craft and edit narratives gave our participants the opportunity to consider how they responded, and to convey what they felt was an added level of detail.

For some, it was particularly the opportunities that writing offered to make these narratives online doctor diflucan ‘more lively and interesting’ that was appealing. This liveliness is particularly important if we take seriously Vannini’s claims that social research ought to consider the ‘unique and novel ways it can reverberate with people, what social change or intellectual fascination it can inspire, what impressions it can animate, what surprises it can generate, what expectations it can violate, what new stories it can generate’(Vannini 2015, 12). This involves recognising the performative quality of words themselves and the intersubjective means by which knowledge is co-created by writer and reader (Anderson 2014), a shift from aiming to explain how something might ‘feel’ to instead attempting to expressively evoke how something might ‘feel’.Writing in this way has thus been a valuable method for us.

But it was online doctor diflucan also an approach which our participants valued and embraced. Participants described the cathartic release of writing something and then ‘letting go of it’, something that also enabled them to have a level of distance from what was produced and represented.I’m usually writing something because I know that I’m going to put it somewhere somebody can read it. But this, I was just writing it.

I suppose in some ways online doctor diflucan that was different […] in terms of the idea of a revelation and feeling things.Writing provided a way for participants to navigate and negotiate vulnerability on their own terms. It produced a level of solidarity and sociality among the groups too, one that acted as a counter to what one participant described as ‘the isolation and loneliness that lots of carers feel’. We’d—perhaps naively—initiated this research in the hopes of producing material that would be engaging and informative to healthcare professionals, however, it quickly online doctor diflucan became apparent that reading other people’s writing was powerful and rewarding for other families affected by rare conditions too.I think being able to connect to what other people were saying.

I know there was a piece in particular that [participant] wrote, and I felt like that could have been something that I actually could have written myself. The language that she used, the situation that it was about, it was definitely something that I thought, ‘Wow that’s my life, I could have written that.’ That was quite strange actually, it was nice though.This overlapped with what participants felt to be another strand of value in writing about their experiences. Being heard.There’s just something about knowing that people are listening and online doctor diflucan actually giving you a really nice way to talk about things.

It’s as far away from medicalised as you can get, isn’t it, just doing creative writing.The creativity of the medium, and its differentiation from the language and communication styles associated with more clinical discourse became something that in itself had a generative potential. Participants felt enabled to claim an ownership and validity online doctor diflucan to their representations of experiences. The written form had an authority and level of definition that empowered people to write about the more-than-medical realities that constitute life with rare genetic conditions.

It provided an important outlet for people to voice their narratives—often stories that they felt had no place or might even undermine their expertise. As one participant commented, ‘nobody asks me this stuff’ online doctor diflucan. Another described how,I think people see you swan-like gliding along, having these silly ideas about how easy you’re making it look.

They don’t see any of all of the bits that are going on behind it and writing about nappies and children being resuscitated and all of that kind of thing. I suppose I feel it allows me to tell people online doctor diflucan what it’s really like.Again, it emphasises the value of taking an everyday approach, and considering what is ‘left over’ (Lefebvre 1991), what exceeds or escapes more formalised representations of life with rare conditions, and what is absent from the genomic imaginaries and promissory discourses that are created and mobilised at a political level.ConclusionIn the spirit of dialogical narrative analysis, our aim has never been to ‘summarise our findings’, but ‘rather to open continuing possibilities of listening and of responding to what is heard’ (Frank 2012, 36). Stories are integral to medical care, as Nicholas and Gillett (1997, 296) argue, ‘in its representation of subjective experience, narrative gives us access to the perceptions and valuation of other human beings, and thus narrative bioethics is a means of thinking about the meaning of illness in the life of a patient and about the role of the physician in the patient-physician interaction’.

The stories produced through our writing groups provide a window into the worlds of genomic medicine, the worlds online doctor diflucan outside of the clinic. They are powerful, and exist as a reminder of the wider context in which families affected by rare disease are operating—the structural, social, administrative and bureaucratic challenges which must be navigated. Challenges that are compounded by one another.

But also, the joys, the normality, the forgettability, the not-quite-all-consuming nature of rare conditions, and the opportunities that families find to resist a wholescale medicalisation or pathologisation of online doctor diflucan life. These stories do not provide answers or solutions. Instead, their value lies in helping to unfold the implications of experiences and illuminating what is often submerged or eclipsed by wider sociotechnical frames (Morris 2001).

As Featherstone et al online doctor diflucan. (2006, 149) argue ‘it is vital for researchers and practitioners alike to ground their work in an understanding of everyday family practices that is sensitive to their complexities’.We know that stories have lives, that stories travel, that stories remain memorable (Parr 2021). We hope that the excerpts we have showcased here, along with those that will be published elsewhere, might prompt greater understanding of the lived experiences of families whose lives have become entwined with the genomics online doctor diflucan agenda.

Narratives can serve as a reminder of how medical practices are experienced by patients, but also how medical encounters are situated within, against and alongside everything else that happens in people’s lives (Nicholas and Gillett 1997). As Morris (2001, 55) has described, this is not a practice of thinking about stories, but rather a process of thinking with stories, ‘allowing narrative to work on us’.Data availability statementNo data are available. Due to the highly personal, sensitive and emotional nature of the qualitative data generated, and in order to respect participant’s preferences and consent, online doctor diflucan at this stage data is not being made publicly available beyond what has been published in this article.

Interested parties are welcome to contact the corresponding author for further details.Ethics statementsPatient consent for publicationNot applicable.Ethics approvalThis study involves human participants. This project and other elements of the authors' research were granted ethical and research governance approval by The Brighton and Sussex Medical School Research Governance and Ethics Committee (ER/BSMS9KQM/2). Participants gave informed consent to participate in the study before taking part.AcknowledgmentsThe authors online doctor diflucan thank the peer reviewers and editors, who provided deep engagement with their work and for the generosity, kindness and openness towards this manuscript.Notes1.

There is a long tradition of using stories, narratives and writing as a way to prompt healthcare professionals to reflect on medical ethics (Jones 1999. Nelson 1997) online doctor diflucan. This often takes literary sources as a starting point, though there is a growing interest in gathering stories from much more diverse places.

For example, Gualtieri and Akhtar (2013) describe how blogs written by patients can offer insights and rich narratives, and provide a means to reflect on the psychosocial and emotional consequences of chronic disease. Using ‘found’ material in this way online doctor diflucan however can create complexities around consent (Hookway 2008) and thus there are opportunities to think about more equitable and participatory ways of researching and writing with participants.2. RG has lived experience of a rare genetic condition themselves.

The decision for RG to be present was discussed with potential participants who suggested they would be keen for them to be there..

Can i take diflucan with zoloft

Share this can i take diflucan with zoloft http://domainrealestatemanagement.com/amoxil-discount/. Focusing on strategies outlined in the US Department of Health and Human Services’ 2021 Health Workforce Strategic Plan, experts on workforce development shared their thoughts on addressing the statewide health labor shortage at the 2022 North Texas State of Reform Health Policy Conference in Dallas on September 27th. A panel comprised of Jenifer Tertel, North Texas Regional Vice President of Human Resources at Medical City Healthcare, Peggy Ceballos, PhD, Associate Professor of Mental Health Counseling and Higher Education at the University of North Texas, and Elizabeth Merwin, PhD, Executive Director of the University of Texas (UT) Arlington Center for Rural Health and Nursing discussed approaches the state could take to expand and distribute the health workforce to better meet demand.According to the panel, the state had a shortage of 20,000 nurses in 2018, a number can i take diflucan with zoloft that has grown during the diflucan to far outpace demand. Texas currently has the fourth worst nurse to population ratio at 9.25 registered nurses (RN) per 1,000 residents.

At current rates, the nursing gap is expected to reach 36,000 by 2025 can i take diflucan with zoloft and 60,000 by 2032. One of the challenges to recruiting and retaining nurses has been the shift in wage expectations, as those in the profession have come to expect higher pay. €œ[The diflucan] has created this escalated expectation of the wage rate and it is a daily issue,” Tertel said can i take diflucan with zoloft. €œThere [are hardly any days where] I’m not talking about nursing wage rates.

And despite ongoing investment, my organization between last year and this year is $50 million in, and we still just cannot keep up.The expectation of can i take diflucan with zoloft the nurse is, ‘I can go and make $181 an hour.’ The nurses in New York were making $250 an hour when we were in our various stages of the diflucan, but their expectation, it’s like they’ve had a taste of what it’s like to make that money … We’re just barely at the tipping point of being able to see some of that downward trend, but I don’t think it’s ever going to go back to what we saw in 2019.”Similar gaps exist for the region’s mental health care professions as the diflucan drove up demand for counseling services. Ceballos said along with increases in adolescent suicide attempts, emergency rooms saw a 20-fold increase in mental health-related visits for children aged 5 to 11 during the diflucan, a 31% increase for older children, and a 20% increase in visits from uninsured children. Meanwhile, the lack of cultural competency among mental health care professionals was exacerbated by those workforce constraints.“We need to start thinking about how we’re training the next generation of professionals that are going out into the communities on how they can better serve these underserved communities,” Ceballos said. €œHow we can continue to address legislation that can help us to meet the demands that are in the state of Texas for can i take diflucan with zoloft now.

The other part is how we [train] our mental health professionals in integrated care [and to be] able to work with primary physicians and nurses. How are we going to be able to now really come together to the can i take diflucan with zoloft table and look at patient health holistically?. €The UT Arlington Center for Rural Health and Nursing, the nation’s largest nonprofit school of nursing, has been committed to growing its pre-licensure program but has been limited in the number of applicants it can accept by proportion of clinical rotations available across the state. Merwin said the center has been focused on the can i take diflucan with zoloft shortage of professionals in rural areas but advocated for more investment to build clinical capacity.

€œWe have hired 5 masters-prepared or doctorally prepared nurses in 5 big regions of Texas,” Merwin said. €œTheir job is to develop relationships with rural communities that perceive a shortage of either can i take diflucan with zoloft nurses or health professionals and would like to work with us on developing implementation of our programs that are online for didactic coursework, and in clinical agencies in their home communities or at least in driving distance … We could solve the pre-licensure Bachelor of Science in Nursing program with resources, hiring faculty, preparing more faculty through graduate programs, and finding ways to build clinical sites.”In Texas, nurse practitioners are required by law to have a physician collaborator. Tertel called on the legislature to explore ways to take in more diploma and associate degree nurses and allow them to practice at the top of their licensure. Merwin argued that solutions around nursing can i take diflucan with zoloft should not compromise the standards and requirements to a 4-year Bachelor of Science in Nursing (BSN) degree.

One solution Merwin and Tertel offered was for providers to target candidates earlier in the hiring process by negotiating with students in the final year of their undergraduate or postgraduate nursing program regarding the terms of their employment in exchange for tuition relief. Finances remain a barrier to graduation for many, and by targeting relief earlier, providers would have more control and leverage over contracting wage and service time with new graduates. The panel also spoke to the can i take diflucan with zoloft lessons learned from the diflucan. The public health emergency forced health human resource managers to reevaluate team nursing models and look at alternative levels of care, utilizing licensed practical nurses (LPN), nursing students, and patient care technicians to support patient care collaboratively and in a more comprehensive way.

€œThere’s a little bit can i take diflucan with zoloft of a double edged sword with the LPN piece, because as we are all aging, and the demand for assisted living and nursing home care continues to increase,” Tertel said. €œWe’ve got to make sure that we’ve got those pathways to get those LPNs into that setting as well.”The University of North Texas has revamped its counselor training programs for students in social work, rehabilitation, and mental health, including those working in public schools, to focus on trauma-informed interventions and multicultural competency in their clinical rotations.“Our goal is to be able to continue to increase [holistic mental health care] in North Texas,” Ceballos said. €œWe’re doing the second study in our second year of the program can i take diflucan with zoloft. We have been collecting data, and it’s part of the program, and we’re hoping to see what the data shows 4 years from now, to see how much we have been able to have an impact.” Medical City Healthcare opened up a series of employee assistance programs aimed at supporting nurses dealing with trauma and burnout, including a mental health care hotline and time and space for decompression.“[Caregivers] have a clinical educator that they can call 24/7 when they get stuck into a clinical situation that maybe [they] don’t want to go to their clinical nurse supervisor about right away,” Tertel said.

€œIn the moment, they can tell their friend can i take diflucan with zoloft. So creating those easy non-judgmental pathways that reach out, to text or phone call that mentor [who] helps [them] for that particular situation that they find themselves.[Another option is] what we do in the hospital with compassionate rounds that doesn’t just focus on the patient for connected compassionate care but it is also for the caregivers. Now we have check-ins with our caregivers on a daily basis, and then if there’s a critical incident we do have critical incident response teams that come in to help address the loss of a patient, or a child in particular, so the staff can decompress.”Share this:.

Share this online doctor diflucan Amoxil discount. Focusing on strategies outlined in the US Department of Health and Human Services’ 2021 Health Workforce Strategic Plan, experts on workforce development shared their thoughts on addressing the statewide health labor shortage at the 2022 North Texas State of Reform Health Policy Conference in Dallas on September 27th. A panel comprised of Jenifer Tertel, North Texas Regional Vice President of Human Resources at Medical City Healthcare, Peggy Ceballos, PhD, Associate Professor of Mental Health Counseling and Higher Education at the University of North Texas, and Elizabeth Merwin, PhD, Executive Director of online doctor diflucan the University of Texas (UT) Arlington Center for Rural Health and Nursing discussed approaches the state could take to expand and distribute the health workforce to better meet demand.According to the panel, the state had a shortage of 20,000 nurses in 2018, a number that has grown during the diflucan to far outpace demand. Texas currently has the fourth worst nurse to population ratio at 9.25 registered nurses (RN) per 1,000 residents. At current rates, the nursing gap is expected to reach online doctor diflucan 36,000 by 2025 and 60,000 by 2032.

One of the challenges to recruiting and retaining nurses has been the shift in wage expectations, as those in the profession have come to expect higher pay. €œ[The diflucan] online doctor diflucan has created this escalated expectation of the wage rate and it is a daily issue,” Tertel said. €œThere [are hardly any days where] I’m not talking about nursing wage rates. And despite ongoing investment, my organization between last year and this year is $50 online doctor diflucan million in, and we still just cannot keep up.The expectation of the nurse is, ‘I can go and make $181 an hour.’ The nurses in New York were making $250 an hour when we were in our various stages of the diflucan, but their expectation, it’s like they’ve had a taste of what it’s like to make that money … We’re just barely at the tipping point of being able to see some of that downward trend, but I don’t think it’s ever going to go back to what we saw in 2019.”Similar gaps exist for the region’s mental health care professions as the diflucan drove up demand for counseling services. Ceballos said along with increases in adolescent suicide attempts, emergency rooms saw a 20-fold increase in mental health-related visits for children aged 5 to 11 during the diflucan, a 31% increase for older children, and a 20% increase in visits from uninsured children.

Meanwhile, the lack of cultural competency among mental health care professionals was exacerbated by those workforce constraints.“We need to start thinking about how we’re training the next generation of professionals that are going out into the communities on how they can better serve these underserved communities,” Ceballos said. €œHow we online doctor diflucan can continue to address legislation that can help us to meet the demands that are in the state of Texas for now. The other part is how we [train] our mental health professionals in integrated care [and to be] able to work with primary physicians and nurses. How are we going to be able to now online doctor diflucan really come together to the table and look at patient health holistically?. €The UT Arlington Center for Rural Health and Nursing, the nation’s largest nonprofit school of nursing, has been committed to growing its pre-licensure program but has been limited in the number of applicants it can accept by proportion of clinical rotations available across the state.

Merwin said the center has been focused on the shortage of professionals in rural areas but advocated for more investment to build clinical capacity online doctor diflucan. €œWe have hired 5 masters-prepared or doctorally prepared nurses in 5 big regions of Texas,” Merwin said. €œTheir job is to develop relationships with rural communities online doctor diflucan that perceive a shortage of either nurses or health professionals and would like to work with us on developing implementation of our programs that are online for didactic coursework, and in clinical agencies in their home communities or at least in driving distance … We could solve the pre-licensure Bachelor of Science in Nursing program with resources, hiring faculty, preparing more faculty through graduate programs, and finding ways to build clinical sites.”In Texas, nurse practitioners are required by law to have a physician collaborator. Tertel called on the legislature to explore ways to take in more diploma and associate degree nurses and allow them to practice at the top of their licensure. Merwin argued online doctor diflucan that solutions around nursing should not compromise the standards and requirements to a 4-year Bachelor of Science in Nursing (BSN) degree.

One solution Merwin and Tertel offered was for providers to target candidates earlier in the hiring process by negotiating with students in the final year of their undergraduate or postgraduate nursing program regarding the terms of their employment in exchange for tuition relief. Finances remain a barrier to graduation for many, and by targeting relief earlier, providers would have more control and leverage over contracting wage and service time with new graduates. The panel also spoke online doctor diflucan to the lessons learned from the diflucan. The public health emergency forced health human resource managers to reevaluate team nursing models and look at alternative levels of care, utilizing licensed practical nurses (LPN), nursing students, and patient care technicians to support patient care collaboratively and in a more comprehensive way. €œThere’s a little bit of a double edged sword with the LPN piece, because as online doctor diflucan we are all aging, and the demand for assisted living and nursing home care continues to increase,” Tertel said.

€œWe’ve got to make sure that we’ve got those pathways to get those LPNs into that setting as well.”The University of North Texas has revamped its counselor training programs for students in social work, rehabilitation, and mental health, including those working in public schools, to focus on trauma-informed interventions and multicultural competency in their clinical rotations.“Our goal is to be able to continue to increase [holistic mental health care] in North Texas,” Ceballos said. €œWe’re doing online doctor diflucan the second study in our second year of the program. We have been collecting data, and it’s part of the program, and we’re hoping to see what the data shows 4 years from now, to see how much we have been able to have an impact.” Medical City Healthcare opened up a series of employee assistance programs aimed at supporting nurses dealing with trauma and burnout, including a mental health care hotline and time and space for decompression.“[Caregivers] have a clinical educator that they can call 24/7 when they get stuck into a clinical situation that maybe [they] don’t want to go to their clinical nurse supervisor about right away,” Tertel said. €œIn the moment, they can tell online doctor diflucan their friend. So creating those easy non-judgmental pathways that reach out, to text or phone call that mentor [who] helps [them] for that particular situation that they find themselves.[Another option is] what we do in the hospital with compassionate rounds that doesn’t just focus on the patient for connected compassionate care but it is also for the caregivers.

Now we have check-ins with our caregivers on a daily basis, and then if there’s a critical incident we do have critical incident response teams that come in to help address the loss of a patient, or a child in particular, so the staff can decompress.”Share this:.

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