Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role

INTRODUCTION

Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers.

METHOD

A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied.

RESULTS

Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers.

CONCLUSION

Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge.

IMPLICATIONS FOR PRACTICE

Role development and changes in education for therapeutic radiographers.

P152 Poor sleep quality, individual experiences and increased risk of self-harm – A multi-method study

Introduction

The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk.

Methods

N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm.

Results

Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps<.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps<.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p<.0001) after controlling for demographic variables.

Discussion

Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.

The public health community's use of social media for policy advocacy: a scoping review and suggestions to advance the field

OBJECTIVES

This study aimed to investigate the extent and key characteristics of academic research and scholarship on the public health community's use of social media for policy advocacy purposes. This will enable an evaluation of extant research and provide insight into directions for future research.

STUDY DESIGN

This study was a scoping review of academic literature.

METHODS

A scoping review of academic literature published between 1 January 2011 and 31 December 2020 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Boolean searches were conducted using a university library platform, which included databases, such as EBSCO host, Informit, Scopus, and ScienceDirect. Data were extracted using an a priori code frame, and publication, content, and disciplinary characteristics were analysed. The results of coding and screening comparison checks were within acceptable limits.

RESULTS

In total, 2672 works from around the world were identified and screened for inclusion. Twenty-two English language articles were included in the final analysis. The public health community's use of social media for policy advocacy purposes has largely been approached from a health perspective, despite research and scholarship about social media in communication and policy disciplines (among others). Reported research aims or questions emphasised functional rather than theoretical contributions. Most analysed works used empirical or case study-based methods and were produced by authors in Western geographies. Among the health issues discussed, tobacco and tobacco control were discussed most frequently. While recognising issues with social media, most publications framed social media as more of an opportunity than a problem.

CONCLUSIONS

The public health community's use of social media for policy advocacy purposes is an emerging field. There is considerable potential to expand scholarship and research in this field internationally, especially by integrating transdisciplinary knowledge and perspectives and by applying social media to foster policy change around identified global health challenges. Greater representation of authors from institutions in the Global South is also encouraged, as are applied and theoretical contributions.

The gut-microbiome-endocannabinoid axis and anhedonia/amotivation: A mediation analysis in a general population cohort

Introduction

General-population studies investigating the biological correlates of anhedonia/amotivation might be informative for treatment breakthroughs for a number of clinical conditions. Reduced gut-microbial diversity might lead to an anhedonic/amotivational syndrome (“sickness behaviour”). However, how gut-microbial diversity contribute to this clinical phenotype is a key gap in knowledge. We hypothesised the endocannabinoid system would be at play.

Objectives

We tested the hypothesis that the endocannabinoid system mediates the association between gut-microbial diversity and anhedonia/amotivation

Methods

Secondary data analysis on 786 volunteer twins (TwinsUK). Measures of gut-microbiome, faecal endocannabinoid metabolites, and anhedonia/amotivation were collected over five years. To test our hypothesis we used a multilevel mediation model using alpha diversity as predictor, faecal levels of the endocannabinoid palmitoylethanolamide (PEA) as mediator, and anhedonia/amotivation as outcome. Analyses were adjusted for obesity, diet, antidepressants, and sociodemographic covariates.

Results

Mean age was 65.2±7.6; 27% were obese and 4.7% were on antidepressants. Alpha diversity was significantly associated with anhedonia/amotivation (β=-0.37; 95%CI: -0.71 to -0.03; P=0.03). Faecal PEA levels mediated this association: the indirect effect was significant (β=-0.13; 95%CI: -0.24 to -0.01; P=0.03), as was the total effect (β=-0.38; 95%CI: -0.72 to -0.04; P=0.03). The direct effect of alpha diversity on anhedonia/amotivation was attenuated fully

Conclusions

We provided the first evidence showing that the association between gut-microbial features and anhedonia/amotivation is mediated by the endocannabinoid system. These findings shed light on a new therapeutic target in an area of unmet clinical need.

Disclosure

No significant relationships.

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

African-Caribbean Cancer Consortium Scientific and Training Conference 2017

The sixth International African-Caribbean Cancer Consortium (AC3) Conference was held 6-9 October 2017 in Miami, Florida, U.S.A. The conference was open to all researchers, trainees, clinical and public health professionals, and community members, and served as an international hub for the United States, the Caribbean, and Africa. Sessions included AC3 collaboration meetings, cancer surveillance and research skills training workshops, and a community cancer prevention conference.

6LiF:ZnS(Ag) Neutron Detector Performance Optimized Using Waveform Recordings and ROC Curves

We used Gaussian separation and receiver operating characteristic (ROC) curves to optimize the neutron sensitivity and gamma rejection of an ultra-thin ⁶LiF:ZnS(Ag)-scintillator-based neutron detector paired with a silicon photomultiplier (SiPM). We recorded the waveforms while operating the detector in a monochromatic cold neutron beam and in the presence of isotopic ¹³⁷Cs and ⁶⁰Co gamma sources. We used a two-window charge comparison (CC) pulse-shape discrimination (PSD) technique to distinguish the neutron capture events from other types of signals. By feeding the recorded waveforms through variants of this algorithm, it was possible to optimize the duration of the integration windows [(0-100 ns) for the prompt window and (100-2300 ns)] for the delayed window. We then computed the detector's ROC curve from waveform recordings and compared that with the experimental performance. We also used this procedure to compare a series of detector configurations to select the optimal bias voltage for the SiPM photosensor.