Distress Screening in Head and Neck Cancer Patients Planned for Cancer-Directed Radiotherapy

OBJECTIVE/HYPOTHESIS

To estimate the prevalence of baseline clinically significant distress (distress score ≥ 4) in head and neck cancer patients planned and treated with radical intent radiotherapy using the National Comprehensive Cancer Network Distress Thermometer (DT) and assess factors predictive of distress.

STUDY DESIGN

Cross-sectional study.

METHODS

This was a cross-sectional study evaluating distress in 600 head and neck cancer patients undergoing radiation therapy. The DT was used to screen patients for distress at baseline before radiotherapy.

RESULTS

The median distress score of the entire cohort was 4 interquartile range (IQR) (IQR: 3-5), and 340 patients (56.7%) had clinically significant distress. On univariate analysis, the causal factors predictive of distress were low socioeconomic status (P = .04), presence of proliferative growth at presentation (P = .008), site of the tumor (oral cavity, P = .02), comorbidity (P = .04), and presence of Ryle's tube or tracheostomy tube at baseline (P = .01). Low socioeconomic status was significant (P = .04) on multivariate analysis for high levels of distress.

CONCLUSIONS

Among head and neck cancer patients, 56% of patients had clinically significant baseline distress, and patients with low socioeconomic status had high distress. There is a need for interventions to mitigate distress.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:2023-2029, 2021.

A survey of the practice of stereotactic body radiotherapy for hepatocellular and pancreatic malignancies in India

Background

Stereotactic body radiotherapy (SBRT) is increasingly being performed for hepatocellular cancer and liver metastases. The purpose of this study was to review the practice of SBRT for hepatocellular, pancreatic cancer and liver metastases in India.

Methods

A survey comprising of 25 questions was designed and served to radiation oncology professionals at two major conferences. The survey consisted of 25 multiple choice questions on SBRT infrastructure and caseload, simulation methods and immobilizations, organ motion control methods, simulation and delivery, indications of liver and pancreatic SBRT and prescribed dose. The responses were analyzed using descriptive statistics.

Results

From January to June 2017, about 200 professionals were approached and 71 professionals responded with a response rate of 35.5%. The duration of the SBRT practice among respondents was less than 3 years in 53% with 32% having formal training in SBRT. The most common sites for the use of SBRT were lung and brain followed by liver and spine. Liver SBRT was practiced by 29 (59.2%) for hepatic oligometastases, hepatocellular carcinoma (HCC), and cholangiocarcinoma. The most common fractionation used was 50-60 Gy/6 fractions and 45 Gy/3 fractions. Pancreatic SBRT was practiced by 37%, mostly for medically inoperable or locally advanced pancreatic cancer. SBRT was not practiced by 22 (31%) of the respondents, and the main reasons were lack of infrastructure and structured training.

Conclusion

The SBRT for liver has increased with a usage rate of over 50% amongst respondents. Pancreatic SBRT use is infrequent and limited to inoperable or advanced cases. Lack of infrastructure and training are the main challenges in the routine adaptation of SBRT.

Interprofessional Education and the Diagnostic Radiography curriculum: Students' perceived value of a case-based, whole day activity

INTRODUCTION

This study aimed to examine Diagnostic Radiography (DR) students' perceptions and attitudes towards the Health Collaboration Challenge (HCC), as an interprofessional learning opportunity.

METHODS

DR students participated in the HCC, an annual intensive interprofessional collaboration and assessment activity involving case-based learning. Students' attitudes towards Interprofessional Education (IPE) were measured using a modified version of the Interprofessional Socialisation and Valuing Scale (ISVS-21) and a bespoke questionnaire with items relating to the HCC. Subsequent focus groups explored students' experience of IPE within the HCC context.

RESULTS

Survey results (n = 30) suggested a mostly positive attitude towards IPE alongside other health care students, acknowledging the value of interprofessional teams in patient health care. Qualitative themes from focus group participants (n = 8) revealed that DR students, while appreciating the value of shared-decision making, found the HCC assessment distracting. Challenges included the intensive nature of the HCC, roles that DR students undertook in addressing assessment criteria, case complexity and opportunities for DR students to showcase their knowledge.

CONCLUSION

Results suggest that the intensive and assessable nature of the HCC can overshadow the value of IPE for DR students, and immersive or staggered approaches to IPE could better align with DR professionals' unique role within the patient care spectrum.

IMPLICATIONS FOR PRACTICE

Revised IPE models for DR students could include a more immersive environment, conducted over a longer period of time, with meetings at semi-regular intervals to promote an interprofessional-focus over a task-focus approach.

Radiotherapy management of rectal cancer in the backdrop of the COVID pandemic

Background

COVID‐19 outbreak was declared as a pandemic by the World Health Organization in March 2020. Over the last 3 months, the pandemic has challenged the diagnosis and treatment of all cancer, including rectal cancer. Constraints in resources call for a change in the treatment strategy without compromising efficacy.

Recent Findings

Delivery of shorter treatment schedules for radiotherapy offers advantages like short overall treatment time, improved throughput on the machine, improved compliance and reduced risk of transmission of COVID 19. Other strategies include delaying surgery, reducing the intensity of chemotherapy and adoption of organ preservation approach.

Conclusion

The curative treatment of rectal cancer should not be hindered during the COVID pandemic, and modifications in the multi‐modality treatment will help achieve quality care.

Impact of COVID-19 on oncology education and training in India

Coronavirus disease-19 was declared a pandemic and global emergency in March 2020. Oncology education and training has been on a rollercoaster ride ever since. Despite major changes in the work environment, training for postgraduates in oncology has continued with various challenges. We discuss the changes brought about in education, training and assessments for oncology residents.

Dark-field signal extraction in propagation-based phase-contrast imaging

A method for extracting the dark-field signal in propagation-based phase-contrast imaging is proposed. In the case of objects consisting predominantly of a single material, or several different materials with similar ratios of the real decrement to the imaginary part of the complex refractive index, the proposed method requires a single image for extraction of the dark-field signal in two-dimensional projection imaging. In the case of three-dimensional tomographic imaging, the method needs only one image to be collected at each projection angle. Initial examples using simulated and experimental data indicate that this method can improve visualization of small sharp features inside a larger object, e.g. the visualization of microcalcifications in propagation-based x-ray breast cancer imaging. It is suggested that the proposed approach may be useful in other forms of biomedical imaging, where it can help one to obtain additional small-angle scattering information without increasing the radiation dose to the sample.

The impact of COVID-19 upon student radiographers and clinical training

Introduction

To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning.

Methods

Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases.

Results

1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were ‘Not at all worried’ about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be ‘Not worried at all’ compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use.

Conclusion

Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience.

Implications for practice

As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.

Trimers Conjugated to Fibrin Hydrogels Promote Salivary Gland Function

New strategies for tissue engineering have great potential for restoring and revitalizing impaired tissues and organs, including the use of smart hydrogels that can be modified to enhance organization and functionality of the salivary glands. For instance, monomers of laminin-111 peptides chemically conjugated to fibrin hydrogel (L_1pM-FH) promote cell cluster formation in vitro and salivary gland regeneration in vivo when compared with fibrin hydrogel (FH) alone; however, L_1pM-FH produce only weak expression of acinar differentiation markers in vivo (e.g., aquaporin-5 and transmembrane protein 16). Since previous studies demonstrated that a greater impact can be achieved when trimeric forms were used as compared with monomeric or dimeric forms, we investigated the extent to which trimers of laminin-111 chemically conjugated to FH (L_1pT-FH) can increase the expression of acinar differentiation markers and elevate saliva secretion. In vitro studies using Par-C10 acinar cells demonstrated that when compared with L_1pM-FH, L_1pT-FH induced similar levels of acinar-like cell clustering, polarization, lumen formation, and calcium signaling. To assess the performance of the trimeric complex in vivo, we compared the ability of L_1pM-FH and L_1pT-FH to increase acinar differentiation markers and restore saliva flow rate in a salivary gland wound model of C57BL/6 mice. Our results show that L_1pT-FH applied to wounded mice significantly improved the expression of the acinar differentiation markers and saliva secretion when compared with the monomeric form. Together, these positive effects of L_1pT-FH warrant its future testing in additional models of hyposalivation with the ultimate goal of applying this technology in humans.

Health and fertility of ICSI-conceived young men: study protocol

STUDY QUESTIONS

What are the long-term health and reproductive outcomes for young men conceived using ICSI whose fathers had spermatogenic failure (STF)? Are there epigenetic consequences of ICSI conception?

WHAT IS KNOWN ALREADY

Currently, little is known about the health of ICSI-conceived adults, and in particular the health and reproductive potential of ICSI-conceived men whose fathers had STF. Only one group to date has assessed semen parameters and reproductive hormones in ICSI-conceived men and suggested higher rates of impaired semen quality compared to spontaneously conceived (SC) peers. Metabolic parameters in this same cohort of men were mostly comparable. No study has yet evaluated other aspects of adult health.

STUDY DESIGN SIZE DURATION

This cohort study aims to evaluate the general health and development (aim 1), fertility and metabolic parameters (aim 2) and epigenetic signatures (aim 3) of ICSI-conceived sons whose fathers had STF (ICSI study group). There are three age-matched control groups: ICSI-conceived sons whose fathers had obstructive azoospermia (OAZ) and who will be recruited in this study, as well as IVF sons and SC sons, recruited from other studies. Of 1112 ICSI parents including fathers with STF and OAZ, 78% (n = 867) of mothers and 74% (n = 823) of fathers were traced and contacted. Recruitment of ICSI sons started in March 2017 and will finish in July 2020. Based on preliminary participation rates, we estimate the following sample size will be achieved for the ICSI study group: mothers n = 275, fathers n = 225, sons n = 115. Per aim, the sample sizes of OAZ-ICSI (estimated), IVF and SC controls are: Aim 1-OAZ-ICSI: 28 (maternal surveys)/12 (son surveys), IVF: 352 (maternal surveys)/244 (son surveys), SC: 428 (maternal surveys)/255 (son surveys); Aim 2-OAZ-ICSI: 12, IVF: 72 (metabolic data), SC: 391 (metabolic data)/365 (reproductive data); Aim 3-OAZ-ICSI: 12, IVF: 71, SC: 292.

PARTICIPANTS/MATERIALS SETTING METHODS

Eligible parents are those who underwent ICSI at one of two major infertility treatment centres in Victoria, Australia and gave birth to one or more males between January 1994 and January 2000. Eligible sons are those aged 18 years or older, whose fathers had STF or OAZ, and whose parents allow researchers to approach sons. IVF and SC controls are age-matched men derived from previous studies, some from the same source population. Participating ICSI parents and sons complete a questionnaire, the latter also undergoing a clinical assessment. Outcome measures include validated survey questions, physical examination (testicular volumes, BMI and resting blood pressure), reproductive hormones (testosterone, sex hormone-binding globulin, FSH, LH), serum metabolic parameters (fasting glucose, insulin, lipid profile, highly sensitive C-reactive protein) and semen analysis. For epigenetic and future genetic analyses, ICSI sons provide specimens of blood, saliva, sperm and seminal fluid while their parents provide a saliva sample. The primary outcomes of interest are the number of mother-reported hospitalisations of the son; son-reported quality of life; prevalence of moderate-severe oligozoospermia (sperm concentration <5 million/ml) and DNA methylation profile. For each outcome, differences between the ICSI study group and each control group will be investigated using multivariable linear and logistic regression for continuous and binary outcomes, respectively. Results will be presented as adjusted odds ratios and 95% CIs.

STUDY FUNDING/COMPETING INTERESTS

This study is funded by an Australian National Health and Medical Research Council Partnership Grant (NHMRC APP1140706) and was partially funded by the Monash IVF Research and Education Foundation. L.R. is a minority shareholder and the Group Medical Director for Monash IVF Group, and reports personal fees from Monash IVF group and Ferring Australia, honoraria from Ferring Australia, and travel fees from Merck Serono, MSD and Guerbet; R.J.H. is the Medical Director of Fertility Specialists of Western Australia and has equity in Western IVF; R.I.M. is a consultant for and a shareholder of Monash IVF Group and S.R.C. reports personal fees from Besins Healthcare and non-financial support from Merck outside of the submitted work. The remaining authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

TRIAL REGISTRATION DATE

Not applicable.

DATE OF FIRST PATIENT’S ENROLMENT

Not applicable.

Diagnostic radiographers' experience of COVID-19, Gauteng South Africa

Introduction

As of July 2020, South Africa (SA) had the fifth highest number of COVID-19 infections in the world, with the greatest contributor of these infections, being the province of Gauteng. Diagnostic radiographers in Gauteng providing chest CT, chest radiograph and MRI services are frontline workers experiencing these unprecedented times. Therefore, this study undertook to explore diagnostic radiographers’ experiences of COVID-19.

Methods

A qualitative approach using an asynchronous opened-ended online questionnaire was used to explore diagnostic radiographers’ experiences of COVID-19. Responses from purposively sampled diagnostic radiographers in Gauteng SA, underwent thematic analysis.

Results

Sixty diagnostic radiographers representing both the private and public health sector responded to the questionnaire. Thematic analysis revealed three themes: new work flow and operations, effect on radiographer well-being and radiographer resilience.

Conclusion

Besides experiencing a shift in their professional work routine and home/family dynamics, diagnostic radiographers’ well-being has also been impacted by COVID-19. Adapting to the “new way of work” has been challenging yet their resilience and dedication to their profession, providing quality patient care and skill expertise is their arsenal to combat these challenges.

Implications for practice

Understanding the impact of COVID-19 on diagnostic radiographers will allow radiology departments’ management, hospital management, professional bodies and educational institutions to re-evaluate provision of resources, training, employee wellness programs as well as policies and procedures.

"I realised it weren't about spending the money. It's about doing something together:" the role of money in a community empowerment initiative and the implications for health and wellbeing

Community initiatives aiming to reduce health inequalities are increasingly common in health policy. Though diverse many such initiatives aim to support residents of disadvantaged places to exercise greater collective control over decisions/actions that affect their lives - which research suggests is an important determinant of health - and some seek to achieve this by giving residents control over a budget. Informed by theoretical work in which community capabilities for collective control are conceptualised as different forms of power, and applying a relational lens, this paper presents findings on the potential role of money as a mechanism to enhance these capabilities from an on-going evaluation of a major place-based initiative being implemented in 150 neighbourhoods across England:The Big Local (BL). The research involved semi-structured interviews with 116 diverse stakeholders, including residents and participant observation in a diverse sample of 10 BL areas. We took a thematic constant comparative approach to the analysis of data from across the sites. The findings suggest that the money enabled the development of capabilities for collective control in these communities primarily by enhancing connectivity amongst residents and with external stakeholders. However, residents had to engage in significant 'relational work' to achieve these benefits and tensions around the money could hinder communities' 'power to act'. Greater social connectivity has been shown to directly affect individual and population health by increasing social cohesion and reducing loneliness. Additionally, supporting enhanced collective control of residents in these disadvantaged communities has the potential to improve population health and reduce health inequalities.

Addition of short course radiotherapy in newly diagnosed locally advanced rectal cancers with distant metastasis

AIM

To study the outcomes of patients presenting with locally advanced rectal cancers with distant metastasis (mLARC), treated with short course radiotherapy (SCRT).

METHOD

Between May 2012 and August 2015, 70 patients diagnosed with mLARC, treated with SCRT (25 Gy/5#) and three to six cycles of CAPOX chemotherapy (CT), were assessed for surgical feasibility for the primary and metastatic sites.

RESULTS

Sixty-five patients could complete the planned SCRT and three to six cycles of CT. Response rate and disease control rate for the primary was 68% and 97%, respectively. Radiologically, CRM became free in 44 (72%) patients out of 61 initially involved. Fifty-two (74%) were planned to receive treatment with a potentially curative intent and 18 (26%) with palliative intent. Of those treated with curative intent, 34 (65%) underwent primary tumor resection (PTR). Successful intervention for metastatic disease was done in 27 (52%) patients. At a median follow up of 43 months, the median overall survival (OS) for patients undergoing PTR was 36 months versus 12 months for those in which the tumor was still unresectable or had distant progression (P < .001). Of the operated patients, 56% were alive at the end of 3 years. The median pelvic recurrence free survival was 29 months. Symptom control in the form of pain and bleeding control was observed in 80%.

CONCLUSION

The addition of SCRT to CT in mLARC can downstage the primary tumor to undergo surgery, thereby, achieving better loco-regional control and survival. It achieves good palliation in patients unable to undergo surgery due to extensive primary or metastatic disease.

Determination of Patulin in Apple Juice by Liquid Chromatography: Collaborative Study

An AOAC International-International Union of Pure and Applied Chemistry-International Fruit Juice Union (AOAC-IUPAC-IFJU) collaborative study was conducted to evaluate a liquid chromatographic (LC) procedure for determination of patulin in apple juice. Patulin is a mold metabolite found naturally in rotting apples. Patulin is extracted with ethyl acetate, treated with sodium carbonate solution, and determined by reversed-phase LC with UV detection at 254 or 276 nm. Water, water-tetrahydrofuran, or water-acetonitrile was used as mobile phase. Levels determined in spiked test samples were 20, 50,100, and 200 μg/L. A test sample naturally contaminated at 31 μg/L was also included. Twenty-two collaborators in 10 countries analyzed 12 test samples of apple juice. Recoveries averaged 96%, with a range of 91-108%. Repeatability relative standard deviations (RSDr) ranged from 10.9 to 53.8%. The reproducibility relative standard deviation (RSDR) ranged from 15.1 to 68.8%. The LC method for determination of patulin in apple juice has been adopted first action by AOAC INTERNATIONAL.

Enzymatic Method for Determination of (1→3)(1→4)-Beta-D-glucans in Grains and Cereals: Collaborative Study

The McCleary enzymatic assay for mixed linkage (1→3)(1→4)-beta-D-glucans has been modified to apply to oat and barley fractions and ready-to-eat (RTE) cereals. The proposed method involves lower sample concentrations; stirring the samples; a longer, warmer lichenase digestion; and longer beta-glucosidase digestion. These changes result in higher recovery of beta-glucan. This modification expands on the American Association of Cereal Chemists (AACC) Method 32-22 by the addition of a desugaring procedure, which is necessary for RTE cereals. Results from collaborative studies sponsored by AACC and AOAC demonstrate good precision for an enzymatic assay. The average relative standard deviation for reproducibility (RSDR, a measure of inter laboratory variation) for 20 oat, barley, and cereal samples was 9.7%. The average RSD for repeatability (RSDr, intralaboratory variation) was 5.0%. The enzymatic method has been adopted first action by AOAC International for determination of beta-glucans in oat and barley fractions, and ready-to-eat cereals.

Rumen digesta and products of fermentation in cows fed varying proportions of fodder beet (Beta vulgaris) with fresh pasture or silage or straw

Context Fodder beet (FB) is a popular feed for dairy cows in temperate climates due to its high yields, high digestibility, low nitrogen (N) content in the dry matter (DM) and convenience of feeding (grazing in situ). However, the risk of ruminal acidosis requires research to design feeding regimes that capture these benefits without compromising animal health. Aims To understand aspects of rumen function when FB is offered in conditions representative of practical feeding in temperate pastoral systems. Methods Two indoor experiments were undertaken; one with cows in late lactation fed fresh perennial ryegrass with three proportions of FB (0, 0.23 and 0.45) and another with non-lactating cows fed pasture silage with 0.65 FB or barley straw with 0.86 FB. Measurements included rumen pH, short-chain fatty acid (SCFA) and ammonia concentrations determined at 2-h intervals, as well as daily individual cow intakes, estimates of microbial growth and rumen dynamics. Key results The inclusion of 0, 0.23 and 0.45 FB with fresh pasture in the did not affect daily DM intakes (~14.6 kg), milk yield (~10.7 kg), microbial synthesis (129 g of N/d) or fractional outflow rates of digesta (0.16/h; 11.2 L/h) of lactating cows. The non-lactating cow ration comprising 0.86 FB with straw was inappropriate and resulted in low intakes and insufficient dietary N. Microbial growth was approximately one-third of that in cows fed pasture silage with 0.65 FB. The ruminal pH reached lower values in all treatments where FB was offered. Rumen ammonia concentrations averaged 4.4 mmol/L in cows fed pasture but was sometimes undetectable in lactating cows fed 0.45 FB and in non-lactating cows. The amount of FB in the diet affected the extent of the circadian changes in molar proportions of SCFA. Conclusions Based on the results presented here, feeding fresh FB to dairy cows should not exceed ~0.4 of their DMI with pasture (late lactation), or ~0.6 of their intake with silage (non-lactating). Implications These findings could support evidence-based recommendations for FB use, considering its effects on aspects of rumen function, such as microbial protein synthesis and pH.

Testicular torsion treatment: the horns of a dilemma?

INTRODUCTION

Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales).

MATERIALS AND METHODS

Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire.

RESULTS

Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available.

DISCUSSION AND CONCLUSION

General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.