Research interests identified at the coal-face: initial Delphi analysis of Australian radiation therapists' perspectives

Radiation therapists (RT) need to engage more in research for the benefit of their patients and their own professional development. However radiation therapy in Australia is new to research with an undeveloped research culture, so RTs need direction when wishing to embark upon research projects. This project is the first stage of a Delphi process aimed at defining RT areas of research interest. Questionnaires were sent to all Australian Departments of Radiation Oncology (n=41) asking for a group in each department to identify what problems they experienced while treating patients or working with colleagues and what areas of radiation therapy they felt required further research by radiation therapists. The response rate was 70.7%. Of the representative RTs who collected the data, 82.8% had greater than 10 years experience and 48.1% had postgraduate qualifications. Two of the researchers categorised the responses and derived a list of themes to describe the identified questions. 374 of 410 research questions were codable (91.2%). The categories defined were Staff Issues (58.3%), Technical Issues (28.9%) and Patient Related Issues (12.9%). The RTs were interested in many research areas, but it is of concern that the largest theme identified was Staff Issues, which could indicate some dissatisfaction in the work place. However it is clear that RTs are thinking about their practice and identifying gaps in knowledge in the technical and patient related areas. The second stage of this project was to create research areas that represented the themes identified in this first stage and send them back to the radiation therapy departments for prioritising; this data is currently being analysed

Technology in nephrology

Early nephrological referral allows for uncomplicated transition to dialysis and improves long-term survival. Peripheral veins require careful preservation for future vascular access in patients with renal disease. Improved biocompatibility of modern polysulphone and other membranes reduces the inflammatory response to dialysis. The increased permeability of these modern membranes improves the clearance of solutes but does require volumetrically controlled machines. Volumetric dialysis equipment allows the patient’s fluid balance to be very precisely controlled. Continuous dialysis therapies for acute renal failure allow for dialysis for acutely ill patients who would not tolerate standard intermittent haemodialysis. Continuous dialysis for acute renal failure allows for intensive nutritional support and improved and more stable metabolic and volume control than standard dialysis. Continuous dialysis is the treatment of choice for patients with raised intracranial pressure. Bicarbonate-buffered dialysis fluid provides better acid-base control than standard acetate dialysis. Advances in technology are expensive and cost control is of increasing importance

Emergence of Poplar Diseases or the “Arms Race” between Breeders and Diseases (Abstract)

Poplar cultivation is an example of highly artificialized and intensive woody plant production (clonal and evenaged cultivation) that resembles crop production more than it does forest production. Since the 19th century, breeders have created poplar varieties, especially interspecific hybrids selected on the basis of agronomic criteria (speed of growth, wood volume, straightness of stem, quality of wood). Because of the compromise between growth and resistance classically described for plants, the poplar cultivars have become a target of choice for many diseases (bacterial canker, scab, leaf blight, rust, Dothichiza, viral disease, etc.) and pests (borer, Saperda, wooly aphid, hornet moth, weevil, etc.). European poplar cultivation experienced several health crises in the 20th century that led breeders to select new varieties on the criterion of resistance to the main diseases. As a result, there were periods of massive use of certain varieties endowed with satisfactory resistance to a disease that were subsequently gradually abandoned as it became apparent that they were too susceptible to another emerging or re-emerging disease. In the particular case of poplar rust caused by the fungus Melampsora larici-populina, we have documented the existence of cycles in the use of certain varieties resistant to rust. Because the fungus is able to circumvent qualitative poplar resistance, a number of wholly resistant varieties became susceptible after just a few years of cultivation. We have shown that the implementation on a regional scale of certain poplar varieties that carry qualitative resistances had structured the M. larici-populina populations on the scale of France. In this way, the varietal distribution of poplar trees has influenced pathogen distribution. These feedback loops between host populations (poplar stands) and pathogen populations are similar to models of host/pathogen co-evolution with an “arms race” between the poplar tree (via breeders and poplar tree farmers) and the pathogens

Rating general practitioner consultation performance in cancer care: Does the specialty of assessors matter? A simulated patient study

Background: Patients treated for prostate cancer may present to general practitioners (GPs) for treatment follow up, but may be reticent to have their consultations recorded. Therefore the use of simulated patients allows practitioner consultations to be rated. The aim of this study was to determine whether the speciality of the assessor has an impact on how GP consultation performance is rated. Methods: Six pairs of scenarios were developed for professional actors in two series of consultations by GPs. The scenarios included: chronic radiation proctitis, Prostate Specific Antigen (PSA) ‘bounce’, recurrence of cancer, urethral stricture, erectile dysfunction and depression or anxiety. Participating GPs were furnished with the patient’s past medical history, current medication, prostate cancer details and treatment, details of physical examinations. Consultations were video recorded and assessed for quality by two sets of assessors- a team of two GPs and two Radiation Oncologists deploying the Leicester Assessment Package (LAP). LAP scores by the GPs and Radiation Oncologists were compared. Results: Eight GPs participated. In Series 1 the range of LAP scores by GP assessors was 61%-80%, and 67%-86% for Radiation Oncologist assessors. The range for GP LAP scores in Series 2 was 51%- 82%, and 56%-89% for Radiation Oncologist assessors. Within GP assessor correlations for LAP scores were 0.31 and 0.87 in Series 1 and 2 respectively. Within Radiation Oncologist assessor correlations were 0.50 and 0.72 in Series 1 and 2 respectively. Radiation Oncologist and GP assessor scores were significantly different for 4 doctors and for some scenarios. Anticipatory care was the only domain where GPs scored participants higher than Radiation Oncologist assessors. Conclusion: The assessment of GP consultation performance is not consistent across assessors from different disciplines even when they deploy the same assessment tool

What is the effect of a low literacy talking book on patient knowledge, anxiety and communication before radiation therapy starts? A pilot study

Introduction: Radiation therapy is a common cancer treatment, requiring timely information to help patients prepare for treatment. We pilot tested a low literacy, psycho-educational talking book (written booklet, with accompanying audio recording) to examine (i) the effect of the tool on knowledge, anxiety and communication; (ii) acceptability, and (iii) how it was used in appointments. Methods: A pre-post design was employed. Patients scheduled to receive radiation therapy for any cancer were recruited from two hospitals in Sydney, Australia. Participants were sent the talking book before treatment planning and completed baseline and follow-up surveys, before and after the intervention. Results: Forty participants were recruited, and 39 completed all study assessments. Overall, knowledge increased after receiving the talking book by 3.8 points from 13.9 to 17.7/20 (95% confidence interval (CI) 2.7, 4.8, P < 0.001). Anxiety and concerns were significantly lower after receiving the talking book (P = 0.015 and P = 0.004, respectively). Nearly half of participants (s = 17, 48%) reported using the book during appointments. Most reported finding it easier to communicate (n = 31, 89%) and to ask more questions (n = 21, 62%). Conclusion: The talking book shows promise in improving knowledge, reducing anxiety and enhancing communication. Strategies to support the implementation of the talking book are required. Further studies to translate the book into different languages are also planned

Supportive care of patients diagnosed with high grade glioma and their carers in Australia.

PURPOSE: This study aimed to: determine the supportive care available for Australian patients with High Grade Glioma (HGG) and their carers; identify service gaps; and inform changes needed to implement guidelines and Optimal Care Pathways. METHODS: This cross-sectional online survey recruited multidisciplinary health professionals (HPs) who were members of the Cooperative Trials Group for Neuro-Oncology involved in management of patients diagnosed with HGG in Australian hospitals. Descriptive statistics were calculated. Fisher's exact test was used to explore differences between groups. RESULTS: 42 complete responses were received. A majority of MDT meetings were attended by a: neurosurgeon, radiation oncologist, medical oncologist, radiologist, and care coordinator. Less than 10% reported attendance by a palliative care nurse; physiotherapist; neuropsychologist; or speech therapist. Most could access referral pathways to a cancer care coordinator (76%), neuropsychologist (78%), radiation oncology nurse (77%), or psycho-oncologist (73%), palliative care (93-100%) and mental health professionals (60-85%). However, few routinely referred to an exercise physiologist (10%), rehabilitation physician (22%), dietitian (22%) or speech therapist (28%). Similarly, routine referrals to specialist mental health services were not standard practice. Nearly all HPs (94%) reported HGG patients were advised to present to their GP for pre-existing conditions/comorbidities; however, most HPs took responsibility (≤ 36% referred to GP) for social issues, mental health, symptoms, cancer complications, and treatment side-effects. CONCLUSIONS: While certain services are accessible to HGG patients nationally, improvements are needed. Psychosocial support, specialist allied health, and primary care providers are not yet routinely integrated into the care of HGG patients and their carers despite these services being considered essential in clinical practice guidelines and optimal care pathways

International validation of the EORTC QLQ-PRT20 module for assessment of quality of life symptoms relating to radiation proctitis: A phase IV study

Background: Although patients experience radiation proctitis post radiotherapy no internationally tested instruments exist to measure these symptoms. This Phase IV study tested the scale structure, reliability and validity and cross-cultural applicability of the EORTC proctitis module (QLQ-PRT23) in patients who were receiving pelvic radiotherapy. Methods: Patients (n = 358) from six countries completed the EORTC QLQ-C30, QLQ-PRT23 and EORTC Quality of Life Group debriefing questions. Clinicians completed the EORTC Radiation Therapy Oncology Group scale. Questionnaires were completed at four time-points. The module’s scale structure was examined and validated using standard psychometric analysis techniques. Results: Three items were dropped from the module (QLQ-PRT23→QLQ-PRT20). Factor analysis identified five factors in the module: bowel control; bloating and gas; emotional function/lifestyle; pain; and leakage. Inter-item correlations were within r = 0.3–0.7. Test-Retest reliability was high. All multi-item scales discriminated between patients showing symptoms and those without symptomology. The module discriminated symptoms from the clinician completed scoring and for age, gender and comorbidities. Conclusion: The EORTC QLQ-PRT20 is designed to be used in addition to the EORTC QLQ-C30 to measure quality of life in patients who receive pelvic radiotherapy. The EORTC QLQ-PRT20 is quick to complete, acceptable to patients, has good content validity and high reliability. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN1260900097222

Researching Memory in Early Modern Studies

This essay pursues the study of early modern memory across a chronologically, conceptually and thematically broad canvas in order to address key questions about the historicity of memory and the methodologies of memory studies. First, what is the value for our understanding of early modern memory practices of transporting the methodologies of contemporary memory studies backwards, using them to study the memorial culture of a time before living memory? Second, what happens to the cross-disciplinary project of memory studies when it is taken to a distant period, one that had its own highly self-conscious and much debated cultures of remembering? Drawing on evidence and debates from a range of disciplinary locations, but primarily focusing on literary and historical studies, the essay interrogates crucial differences and commonalities between memory studies and early modern studies

A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings

© 2020, Society of General Internal Medicine. Background: Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient’s preferences and values. Little is known about patients’ experiences of these discussions. Objective: This study explored patients’ perspectives of the GOC discussion in the hospital setting. Design: An explorative qualitative design was used within a social constructionist framework. Participants: Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. Approach: Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient’s home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. Key Results: Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process. Conclusions: Effective communication, and patients’ values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions