Management of metastatic spinal cord compression: awareness of NICE guidance.

OBJECTIVE: The spine is the most common site for bony metastases. It can lead to the development of significant complications and morbidity if appropriate treatment is not provided. National Institute for Health and Clinical Excellence (NICE) issued new guidance in 2008 with regard to the management of patient with metastatic spinal cord compression (MSCC) to assess the awareness of the NICE guidelines for MSCC. METHODS: We contacted doctors in oncology, trauma and orthopaedics, palliative care and general medicine and assessed their knowledge of MSCC using a questionnaire based on the salient points of the NICE guidance. This was a UK-wide questionnaire. RESULTS: We contacted 96 trainee doctors (oncology, palliative care, general medicine and orthopaedics) and found that 74 % felt adequately informed to diagnose metastatic cord compression although only 11 % considered a sensory level as a potential sign of cord compression. Neurological symptoms (91 %) were the main reason for referral to a tertiary spinal service. MRI was the investigation of choice. There was a poor knowledge of metastatic scoring systems and only 8 % would consider assessing the patient's fitness for surgery. Most of the respondents felt that they had been poorly taught at undergraduate and postgraduate level on MSSC. CONCLUSION: Our audit shows that MSCC is poorly understood in general and that greater understanding of the NICE guidance is required to allow for better management of these patients and more prompt referral for appropriate surgical assessment.

Components of effective clinical-nutrition training: a national survey of graduate medical education (residency) programs.

A national survey was conducted by The American Society for Clinical Nutrition's Committee on Medical/Dental School and Residency Nutrition Education to assess the context in which nutrition training is provided in medical residency programs. Accreditation guidelines for residency programs suggested eight nutrition components that were endorsed by content experts for inclusion in residency training. Directors and nutrition educators from all accredited residencies in the United States were surveyed to determine the perceived importance of the components and the extent to which the components were actually present. The eight components appear to be relevant for exemplary nutrition training at the residency level. An important identified need is to train and involve more clinical-nutrition faculty members in residency programs.