[Polynesian adaptation of the Mini-Mental State Examination]

This study aimed to develop and validate a Polynesian version of the MMSE (Mini-Mental State Examination). For this study a sample (n=112) of healthy people were evaluated with the French version of the consensual version of the MMSE, to target and modify some inadequate items for French Polynesia. Subsequently, a second sample (n=112) with the same characteristics (age, educational level) as well as 46 healthy people aged 60 years and more were evaluated with the adaptive version of the MMSE (P-MMSE). This version was then applied to 17 participants with Alzheimer disease. The control subjects were selected according to their age and educational level. The variables gender and evaluation sites were checked. An analysis of the results showed a significant dissociation between the two versions as well as a meaningful effect on global performance of the variables age (r=-0.45) and educational level (r=-0.25). Cut-off scores taking into consideration these variables were defined. The sensitivity and specificity values of the new cut-off scores were much greater than 0.5. Various global cut-off scores were also analyzed. A general cut-off score (≤23) was defined and yielded 82 % sensitivity and 75 % specificity in detecting Alzheimer disease.

Audit of the job satisfaction levels of the UK radiography and physics workforce in UK radiotherapy centres 2012

OBJECTIVE

Workforce planning reports identify a staff shortfall that jeopardizes the ability of UK radiotherapy centres to meet future demands. Obtaining an understanding of the work experiences of radiotherapy professionals will support the development of strategies to increase job satisfaction, productivity and effectiveness.

METHODS

A quantitative survey assessed job satisfaction, attitudes to incident reporting, stress and burnout, opportunities for professional development, workload, retention and turnover. Clinical oncologists were not included, as the Royal College of Radiologists, London, UK, had recently assessed their members' satisfaction. All questions were taken from validated instruments or adapted from the "UK National Health Service Staff Survey".

RESULTS

The survey yielded 658 completed responses (approximately 16% response rate), from public and private sectors. Over a third (36%) of respondents were classified as satisfied for job satisfaction with 11% dissatisfied and the remaining 53% ambivalent. A significant proportion of clinical staff (37.5%) report high emotional exhaustion. Presenteeism was an issue with 42.4% attending work despite feeling unable to fulfil their role.

CONCLUSION

Radiotherapy professionals are prone to the effects of compassion fatigue and burnout. Attention must be paid to workload and its impact on practitioners' job satisfaction. Professional development that is supported and informed by a performance development review is a simple and effective means of enhancing satisfaction. Individuals have a responsibility to themselves and their colleagues as their behaviours and attitudes influence job satisfaction.

ADVANCES IN KNOWLEDGE

This work identifies areas for future research to enhance the professional resilience of practitioners, in order to provide high-quality treatments.

The relationship between subchondral sclerosis detected with MRI and cartilage loss in a cohort of subjects with knee pain: the knee osteoarthritis progression (KOAP) study

PURPOSE

To assess the association between subchondral sclerosis detected at baseline with MRI and cartilage loss over time in the same region of the knee in a cohort of subjects with knee pain.

METHODS

163 subjects with knee pain participated in a longitudinal study to assess knee osteoarthritis progression (KOAP). Subjects received baseline knee radiographs as well as baseline and 3-year follow-up MRI examinations. Baseline subchondral sclerosis and bone marrow lesions (BMLs) were scored semiquantitatively on MRI in each region from 0 to 3. Cartilage morphology at baseline and follow-up was scored semiquantitatively from 0 to 4. The association between baseline subchondral sclerosis and cartilage loss in the same region of the knee was evaluated using logistic regression, adjusting the results for age, gender, body mass index, and the presence of concomitant BMLs.

RESULTS

The prevalence of subchondral sclerosis detected by MRI in the regions of the knee varied between 1.6% (trochlea) and 17% (medial tibia). The occurrence of cartilage loss over time in regions varied between 6% (lateral tibia) and 13.1% (medial femur). The prevalence of radiographically-detected subchondral sclerosis in compartments varied from 2.9% (patellofemoral) to 14.2% (medial tibiofemoral). In logistic regression models, there were no significant associations between baseline subchondral sclerosis detected by MRI and cartilage loss in the same region of the knee.

CONCLUSION

Baseline subchondral sclerosis as detected by MRI did not increase the risk of cartilage loss over time.

The association between chewing and swallowing difficulties and nutritional status in older adults

BACKGROUND

The aim of this study was to investigate the associations of chewing and swallowing dysfunctions to nutritional status in older adults.

METHODS

This cross-sectional study comprised a convenience sample of 1065 community-dwelling older adults living in rural United States. Dietary assessment included the Block Full Length Food Frequency Questionnaire, 24-hour Food Intake Recall and Mini Nutritional Assessment. Classification of chewing and swallowing difficulties was determined by a criterion of outlined factors.

RESULTS

In our sample, 113 (11%) had chewing difficulties, 51 (5%) had swallowing difficulties, and 11 (1%) had both. Compared to the Dietary Reference Intakes (DRIs), the study population was deficient in calories and several nutrients. Mean daily intake in individuals reporting chewing, swallowing, or difficulties with both were 1489 ± 360, 1461 ± 374 and 1374 ± 240 calories respectively. There was no statistically significant difference between the groups. Vitamin A, vitamin E and manganese were significantly lower in those with chewing difficulties while vitamin E and magnesium were significantly lower in individuals with swallowing difficulties (p < 0.05).

CONCLUSIONS

These results emphasize the importance of chewing and swallowing difficulties in modulating nutritional outcomes in older adults. These co-morbidities should be monitored in this population and intake of nutrient dense foods should be increased in those at risk.

The impact of a new acute oncology service in acute hospitals: experience from the Clatterbridge Cancer Centre and Merseyside and Cheshire Cancer Network

The 2008 National Confidential Enquiry into Patient Outcomes and Death highlighted an urgent need to improve the quality, safety and efficiency of care for cancer patients following emergency presentation to acute general hospitals. A network-wide acute oncology service (AOS) was therefore commissioned and implemented on the basis of recommendations from the National Chemotherapy Advisory Group (NCAG). Through a continuous programme of raising awareness regarding both the role of the AOS and the necessity of early patient referral to acute oncology teams, we have been able to establish an AOS across all acute trusts in our cancer network. The network-wide AOS has improved communication across clinical teams, enabled rapid review of over 3,000 patients by oncology staff, reduced hospital stay, increased understanding of oncology emergencies and their treatment, and enhanced pathways for rapid diagnosis and appropriate referrals for patients presenting with malignancy of undefined origin (MUO). These achievements have been made by developing a network protocol book for managing common oncology emergencies, by introducing local pathways for managing MUO and by collaborating with palliative care teams to introduce local acute oncology (AO) multi-disciplinary team (MDT) meetings.

Abstract P4-13-04: Estrogen and Avoidance of Invasive Breast Cancer, Coronary Heart Disease and All-cause Mortality. Public Health Impact of Estrogen Guidelines for Women entering Menopause

BACKGROUND. Estrogen [E] for women entering menopause is not perceived beneficial for either iBrCa or CHD. However, data from RCTs suggest that use of Estrogen reduces: a. rates of invasive breast cancer [iBrCa], andb. atherogenesis, vessel pathology and in certain age groups, coronary heart disease [CHD].

OBJECTIVES: To estimate the population-level impact of Estrogen as part of hormone replacement therapy [HRT] for women entering menopause on rates of iBrCa, CHD and all cause mortality [AC- Mort] that could result from a change of Practice where Estrogen would be recommended for women entering menopause.

METHODOLOGY. Annualized rates of iBrCa, CHD and AC-Mort in women age 50–59, and annualized iBrCa rates for all participants and those without Past History of Benign Breast Disease [PHBBD] extracted from the results of the Women's Health Initiative trial [E] alone vs placebo [Refs 1,2], were applied to estimate the reduction in the Number of Avoided Events per 100,000 female population per annum [NAE].

The [NAE] over 10 years follow up was calculated as: NAE = (P − E) × 100,000 × 10 where P was the annualized rate among placebo participants and E was the annualized rate among Estrogen participants.

RESULTS. [Table 1]. Taking 100,000 exposed versus unexposed women age 50–59, and rate reduction due to [E] of −41% [HR=0.59], −20% [HR=0.80] and −27% [HR=0.73] for CHD, iBrCa and AC-Mort [Ref 1,2], respectively, there will be annual avoidance of −130 cases of CHD, −60 of iBrCa, and −130 of deaths from any cause. iBrCa annual avoidance for women any age, and those without PHBBD, were −80 and −150 events, respectively.