MRI and PET/CT in the assessment of lymph node metastases in head and neck cancer.

The aim of this study is to present the diagnostic accuracy of MRI and PET/CT in the evaluation of cervical lymph nodes in patients with head and neck cancer (HNC). Data of 114 patients who underwent MRI and PET/CT prior to surgery in the time period between January 2010 and September 2021 in our center is analyzed retrospectively. Histopathological results of surgical preparations serve as the gold standard. The mean time from MRI to surgery is 22.9 (± 18.7) days, and from PET/CT to surgery 21.7 (± 19.9) days. Sensitivities of 80.4% and 80.4%, specificities of 85.7% and 87.3%, PPVs of 82.0% and 83.7% and NPVs of 84.4% and 84.6% are registered for MRI and PET/CT, respectively. 37 false results are further analyzed with respect to side and level of the affected lymph node, as well as intersections of the two imaging modalities. In 29 patients (25.4%), additional findings are described in PET/CT, 7 (6.1%) of which were histologically confirmed to be further malignancies. A combination of both MRI and PET/CT imaging modalities could improve diagnostic accuracy, especially with regard to sensitivity. A notable number of additional findings in whole body acquisition leads to the potential diagnosis of further malignancies.

Long-Term Outcome and Comparison of Treatment Modalities of Temporal Bone Paragangliomas.

INTRODUCTION: Temporal bone paragangliomas are rare tumors with high vascularization and usually benign entity. A variety of modalities, including gross total resection, subtotal resection, conventional or stereotactic radiotherapy including gamma-knife, embolization, and wait-and-scan strategy can be considered. The aim of this study was to compare long-term outcomes of different primary treatment modalities in temporal bone paragangliomas. MATERIALS AND METHODS: Patients with temporal bone paragangliomas treated between 1976 and 2018 at a tertiary referral center were retrospectively analyzed in this study. Collected patient data of 42 years were analyzed and long-term results including interdisciplinary management were assessed. Patient outcomes were compared within the different therapy modalities according to tumor control rate and complications. Clinical characteristics, radiological imaging, tumor extent and location (according to Fisch classification), symptoms, and follow-up were evaluated and a descriptive analysis for each treatment modality was performed. Tumor recurrence or growth progression and respective cranial nerve function before and after therapy were described. RESULTS: A total of 59 patients were treated with a single or combined treatment modality and clinical follow-up was 7 (13) years (median, interquartile range). Of the included patients 45 (76%) were female and 14 (24%) male (ratio 3:1) with a patient age range from 18 to 83 years. Total resection was performed on 31 patients, while 14 patients underwent subtotal resection. Eleven patients were treated with conventional primary radiotherapy or gamma-knife radiosurgery. Pulsatile tinnitus (n = 17, 29%) and hearing impairment (n = 16, 27%) were the most common symptoms in our patient group. Permanent lower cranial nerve deficits were observed only in patients with large tumors (Fisch C and D, n = 14, 24%). Among the 45 patients who were treated surgically, 88% of patients with Fisch A and B paragangliomas had no recurrent disease, while no tumor growth was perceived in 83% of patients with Fisch C and D paragangliomas. CONCLUSION: In conclusion, we propose surgery as a treatment option for patients with small tumors, due to a high control rate and less cranial nerve deficits compared to larger tumors. Although patients with Fisch C and D temporal bone paraganglioma can be treated surgically, only subtotal resections are possible in many cases. Additionally, frequent occurrence of cranial nerve deficits in those patients and tumor growth progression in long-term follow-up examinations make a combination of the therapy modalities or a primary radiotherapy more suitable in larger tumors.

[How do community-based mental health staff in Austria perceive their job? -- a qualitative study]. / Wie erleben Professionelle der gemeindepsychiatrischen Versorgung in Osterreich ihre Tätigkeit? -- Eine inhaltsanalytische Studie.

OBJECTIVE: The aim of this study was to explore, using a simple qualitative design, how community mental health staff in Austria perceive their job. METHOD: 195 community-based mental health professionals answered seven open questions on how they perceive their job. The main areas covered were the most important tasks of the job, skills necessary to perform these tasks, as well as positive and negative aspects of the job. Answers were subjected to thematic content analysis. RESULTS: For most professionals, contact with clients and team colleagues were the major rewards of the job. Aspects experienced as stressful were the clients' illness, role ambiguity, team conflicts and lack of time. Necessary skills many respondents did not feel competent in were specialised knowledge and psychosocial skills. CONCLUSIONS: It might be useful to revise existing forms of collaboration within multiprofessional teams. The responsibility for difficult patients may be shared by several members of the team, who should contribute their specific knowledge. Training should be tailored towards the needs of the different professional groups and focus on those skills that are required in community mental health care.

[Job satisfaction and burnout in professionals in austrian mental health services]. / Jobzufriedenheit und Burn-out bei Professionellen der gemeindepsychiatrischen Versorgung in Osterreich.

OBJECTIVE: The aim of this study was to explore job satisfaction, professional role and burnout among community mental health staff in Austria. METHODS: The Minnesota Job Satisfaction Questionnaire, the GHQ-12, the Maslach Burnout Inventory and a questionnaire exploring staff's professional role and team identity were administered to 195 community-based mental health professionals in two Austrian regions. Staff's job perception was assessed in open questions. Predictors of burnout scores were identified in multivariate analyses. RESULTS: While the mental health professionals had elevated scores on the GHQ-12, their levels on the three burnout subscales were low. Social workers and psychologists showed the lowest job satisfaction, social workers also had low role identity scores. Being in the current job for a short time and disposing of psychosocial skills were predictors of high job satisfaction. High burnout scores were predicted by the lack of basic psychosocial competence and a lack of general knowledge in mental health care. The effect of caseload on psychological well-being was positive as well as negative. CONCLUSIONS: Even if the mental health professionals in our study show high levels of general stress, they seem to have less emotional problems resulting from extensively dealing with troubled individuals. Improving basic psychosocial competence and general expertise in mental health care might have a protective effect against developing a burnout syndrome.