Burnout in therapy radiographers in the UK

The 2007 UK National Radiotherapy Advisory Group report indicated that the number and type of staff available is one of the "rate-limiting" steps in improving productivity in radiotherapy departments. Retaining well-trained, satisfied staff is key to meeting the objectives of the report; burnout is an important factor linked to satisfaction and attrition. The results of a survey measuring burnout in a sample of radiotherapists (therapy radiographers) are presented and considered against norms for the health sector and burnout in therapists from Canada and the USA. Case study methodology was used studying six radiotherapy departments selected because of close geographical proximity and differing vacancy rates for radiotherapists. An anonymous survey of radiotherapists used the Maslach Burnout Inventory (MBI) and other workforce-related measures (e.g. job satisfaction scales, measures of professional plateau, intentions to leave, job characteristics and demographic data); the results of the burnout questionnaire alone are presented in this paper. A total of 97 completed questionnaires were returned (representing a 28% response rate). The average score for emotional exhaustion was higher than the MBI norms, with 38% of respondents reporting emotional exhaustion (an element of burnout). The data presented support and validated a previous qualitative study, and highlighted key areas of concern requiring further study. A correlation between burnout and job dissatisfaction and intention to leave was identified; managers may want to consider encouraging role extension and good leadership qualities in treatment unit leaders to minimise the potential for burnout.

Revision of total elbow replacement by exchange cementing

We report the effectiveness of revision of total elbow replacement by re-cementing. Between 1982 and 2004, 53 elbows in 52 patients were treated with re-cementing of a total elbow replacement into part or all of the existing cement mantle or into the debrided host-bone interface, without the use of structural bone augmentation or a custom prosthesis. The original implant revision was still in situ and functional in 42 of 53 elbows (79%) at a mean of 94.5 months (26 to 266) after surgery. In 31 of these 42 elbows (74%) the Mayo Elbow Performance Score was good or excellent. Overall, of the 53 elbows, 18 (34%) required re-operation, ten (19%) for loosening. A classification system was developed to identify those not suitable for revision by this technique, and using this we have showed that successful re-implantation is statistically correlated to properly addressing the bone deficiency for both the humeral (p = 0.005) and the ulnar (p = 0.039) components.

P1-07-21: Analysis of Molecular Markers by Immunohistochemistry (IHC) Method on Formalin Fixed Paraffin Embedded (FFPE) Tissues Could Predict Shorter Recurrence Free Survival (RFS) and Overall Survival (OS) among Patients Who Have Received Adjuvant Chemotherapy for Early Breast Cancer

Background: Various molecular markers assessed by IHC (ER, PR, HER2) and gene expression profiling (e.g. Oncotype Dx) have been developed as prognostic and predictive tools for breast cancer. Gene profiling is said to be superior to IHC but at a considerable cost with limited availability. IHC is relatively inexpensive and more readily available. If early breast cancer patients who are going to relapse within 5 years of curative surgery despite adjuvant chemotherapy could be identified by IHC on FFPE tissue alternative adjuvant therapies could be explored. In this context, here we evaluate IHC for expression of a panel of molecular markers implicated in: growth signalling pathways (ER, PR, HER2, EGFR, CD71, Ki67, MCM2), cell survival (Bcl-2, Bag 1), angiogenesis (PDGFRa) and cell cycle progression (Aurora A, MCM2). Of note, this study includes markers of breast cancer molecular subtype (ER, PR, HER2, Ki67, EGFR, also CK5/6) and several proteins encoded by genes in the Oncotype Dx test (ER, PR, HER2, Ki 67, Bcl2, Bag1 and CD68).

Materials and Method: 72 cases (R) relapsing within 5 years of curative surgery, 72 controls (C), relapse free > 5 years were identified from the hospital records. All patients had adjuvant chemotherapy. Controls were matched to cases by Adjuvant! recurrence risk (ARR). Optimised IHC was performed on FFPE TMA slides using a Ventana autostainer. Protein expression was evaluated on digitalised images (Mirax scanner). Survival analysis by molecular markers expression and also 5 molecular subtypes, Luminal A (LA = ER/PR+, HER2−, Ki67-), Luminal B (LB = ER/PR+, HER2/Ki67+), HER2 enriched (H = ER-, PR-, HER2+), Core Basal (CB = ER-, PR-, HER2−, CK5/6/EGFR+) and 5-negative (5N = negative for ER,PR,HER2,EGFR,CK5/6)], were performed. SPSS 16v. was used for statistical analysis.

Findings: All but four cases had died at the time of analysis. Four controls developed relapse at 83.8, 90.6, 107.7, 127.6 months respectively. Two controls died from non-breast cancer causes. Median (m) follow-up for the controls group (ie. mOS)was 104.9 mo (72.8 - 164.4). For cases, mRFS and mOS were 23.2 (4.5 - 59.9) and 39.7(8.1 - 129). mRFS and mOS for IHC molecular subtypes were: Subtype LA = not yet & not yet; LB = 58.1 & 86.1; CB = 15.4 & 30.4; H = 28 & 55.9; 5N = 19.9 & 26 (p < 0.0001 & <0.0001 by Log rank test). Better RFS and OS were found for positive Bcl2 (p = 0.036 & 0.058) and MCM2 (p = 0.022 & 0.048), negative Aurora A (p = 0.01 & 0.001) and PDGFRa (p = 0.07 & 0.086) expressions. For this study cohort there was no correlation between ARR and survival outcome or molecular subtypes. Result of ongoing multivariate analysis and correlation between survival and CD68, CD71 and Bag 1 expressions will be presented in the conference.

Discussion: Subtypes CB & 5N, negative Bcl-2 & MCM2, positive Aurora A & PDGFRa expression as measured by IHC were predictive of poor RFS and OS. While these findings need to be verified in an independent cohort, IHC profiles nevertheless have potential to stratify different risk groups for clinical trials and effective adjuvant treatments.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-07-21.

Imaging for target volume delineation in rectal cancer radiotherapy--a systematic review

The global move towards more conformal radiotherapy for rectal cancer requires better imaging modalities that both visualise the disease accurately and are reproducible; to reduce interobserver variation. This review explores the advances in imaging modalities used in target volume delineation, with a view to make recommendations for current clinical practice and to propose future directions for research. A systematic review was conducted using MEDLINE and EMBASE. Articles considered relevant by the authors were included. Planning with orthogonal films is being replaced by computed tomography (CT) simulation. This is now considered the 'gold standard' and allows conformal three-dimensional planning. Magnetic resonance imaging (MRI) has been shown to overcome some of the limitations of CT and can be used either as a diagnostic image to visually aid planning, or as a 'planning' MRI carried out in the treatment position and co-registered with the planning CT. The latter approach has been shown to change the treated volumes compared with CT and in prostate cancer patients has been shown to reduce interobserver variation. There are remaining issues with four-dimensional motion that are yet to be fully appreciated or overcome. 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography/CT co-registered with planning CT results in smaller volumes than CT alone and also reduces interobserver variation, but requires further validation before routine implementation. Experimental work utilising novel positron emission tomography tracers and diffusion-weighted MRI shows promise and requires further evaluation. Rigorous quality assurance is important with processing of newer imaging modalities. Further work needs to be conducted into both interobserver variation and the formal evaluation of the clinical benefits of newer imaging modalities. Developments in image-guided radiotherapy are also required to ensure that improvements in target definition at the planning stage are reproducible throughout treatment.

Factors influencing children's judgments of overweight peers

OBJECTIVE

This study assessed children's perceptions of an overweight or non-overweight target of name-calling.

METHODS

Participants were 4(th) and 5(th) grade students. Children selected a line drawing of an overweight or a non-overweight child as a target. After this, they viewed each line drawing again and rated each child's social attraction, niceness, experience of negative emotions, size, and popularity (whether others would like the child). Finally, children provided ideas for improving acceptance of the line-drawing they selected as a target of name-calling.

RESULTS

Findings from regression analyses indicated that children who reported higher levels of victimization and selected the overweight child as a target reported higher social attraction for this target. Children's weight status and their victimization interacted to influence ratings of niceness and negative emotions. Children reported that peers would like the overweight line drawing less than the non-overweight one.

CONCLUSIONS

Children tended to report that an overweight child would be a target of name-calling and be less accepted. Our findings provided partial support for the idea that children's own victimization status influenced ratings of social attraction, niceness, and negative emotions. Longitudinal studies will provide information on change in perceptions over time.

Walking for fitness: is it enough to maintain both heart and bone health?

Exercising at levels of whole body accelerations exceeding 3.6 g has been shown to have positive effects on cardiovascular fitness, bone density and balance. This pilot research project evaluated the whole body accelerations and cardiovascular challenge provided by selected walks in the Canberra region of Australia to determine if walks could be ranked according to potential level of impact on both cardiovascular fitness and bone health. Nine participants, who described themselves as walking at least 3 km, three times per week, wore a data logging device recording heart rate, acceleration and GPS position while walking three outdoor tracks: (1) the running track of an athletics stadium; (2) on a hill climb path through bushland; and (3) on a route through suburban streets. There was a significant difference (P < 0.05) for heart rate, distribution of whole body accelerations and average walking speed between track 2 and tracks 1 and 3. There was a significant difference for heart rate, distribution of whole body accelerations and average walking speed between the walks. The running track and the suburban walk provide a moderate exercise challenge, with the hill climb walk providing progressively greater vertical height challenge, resulting in an increased cardiovascular exercise challenge. No participant effectively exceeded the threshold for achieving a positive impact on bone density (100 or more accelerations/day >3.6 g) on track 1, and only two of the nine participants intermittently achieved this threshold on tracks 2 and 3.

Hydrogeological study for improved nature restoration in dune ecosystems--Kleyne Vlakte case study, Belgium

In dune slacks a close coupling exists between changes in the hydrology and changes in species composition and vegetation structure. Consequently, there is a need to underpin nature restoration projects not only with ecologically relevant knowledge but also with scientifically sound hydrogeological data. In this paper, this necessity is illustrated through a study of the Flemish Nature Reserve 'The Zwindunes and Zwinpolders' (Belgian coastal plain) as an example. The management plan for the nature reserve suggests rewetting part of it to enhance its ecological value. The groundwater aspect was studied by means of field observations and mathematical modelling. First, fresh water head observation showed a mean groundwater flow from the nature reserve to the adjacent polder. Secondly, groundwater quality was studied with borehole measurements and water samples, resulting in a map of the fresh-salt water distribution and of water types. All available information was then put together in a density dependent groundwater flow model. The aim of this model was the description of current flow and fresh-salt water distribution and to simulate the impact of three possible rewetting scenarios. Rewetting will be accomplished by the infiltration of water in a depression, different lay-outs for which are considered. A zoomed in flow model based on a regional model was used to incorporate both local scale, which is of importance to ecology, and the larger scale, which determines general groundwater flow and fresh-salt water distribution. This modelling indicated differences between scenarios and was used to decide on the best rewetting strategy.