Background and purpose: Oral mucositis is an expected complication of radiotherapy in the management of carcinoma of the head and neck. The Common Terminology Criteria for Adverse Events (CTCAE) Version 3 (V3) and related systems based on mucosal appearance have been used in clinical trials historically. More recently, Version 4 (V4) which is based on patient symptoms has been employed. This study compares the use of V3 and V4 in the grading of mucositis in patients undergoing radiotherapy with or without concurrent systemic therapy for carcinoma of the oral cavity and oropharynx. Methods: Oral mucositis was graded prospectively in patients receiving radiotherapy with or without concurrent systemic therapy using both V3 and V4. Grading was recorded during and after completion of therapy. Results: Between November 2014 and November 2015, 555 measurements were taken from 73 patients. Mucositis scores were equal in both versions in 327 (59%) measurements. Significant differences between V3 and V4 were seen in patients receiving cetuximab-based concurrent therapy (p < 0.001) and beyond 8 weeks from the start of radiotherapy (p = 0.004). Conclusion: Differences in grading of mucositis scored by V3 and V4 are frequent. Relationships between biologically effective dose and rates of grade 3 mucositis have historically been based on mucosal appearances. It is not known whether the same relationships apply when mucositis is graded based on symptomatic grading systems. Both V3 and V4 should be used in clinical trials to improve understanding of mucositis and its relationship to quality of life and late mucosal toxicity.
This paper explores the perceptions of degree students at two UK universities regarding their work placement and part-time working activities, to assess if the two activities converge. The research comprises three stages: interviews for preliminary exploration of students' perceptions towards work placement and part-time work; interviews to examine how placement opportunities link with career aspirations; a survey of students who had completed a placement, and those currently on placement. Students acknowledged part-time working helped their placement activity, providing transferable skills beneficial to both study and career aspirations. A significant finding was with respect to time: the closer to the placement activity the data was collected, the stronger the impact of appreciating the value of placement. The paper therefore highlights the value of timing in the assessment of work placement. It also offers value for universities' by providing insight into students' perceptions regarding embedded external work activities that can enhance graduate employability and career prospects.
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