The impact of dysphagia prehabilitation on swallowing outcomes post-chemoradiation therapy in head and neck cancer: A systematic review.

INTRODUCTION: This study aimed to summarise research findings on dysphagia prehabilitation initiated before chemoradiation therapy (C)RT in head and neck cancer (HNC) including its impact on three swallow-related outcomes at distinct time points. METHODS: A comprehensive search was completed in PubMed, Embase, Web of Science and CINAHL. Inclusion criteria were studies of adults with HNC with an exercise-based prehabilitation programme beginning before (C)RT. Methodological quality was rated using the Downs and Black checklist. The Template for Intervention Descriptions and Replication (TIDieR) checklist was used to evaluate how well studies were reported. RESULTS: Eight studies (three randomised control trials) involving 295 adults with HNC were included. The largest participant group (63%) were Stage III/IV head and neck squamous cell carcinoma (HNSCC). Prehabilitation was completed independently at home (100%) and typically began 2 weeks before CRT (75%). Studies evaluated the impact of dysphagia prehabilitation across functional (n = 6), quality of life (n = 5) and physiological (n = 4) domains. Prehabilitation significantly altered physiological (25%), functional (66%) and quality of life (50%) outcomes. Fifty per cent of studies included long-term (>1 year) outcomes. Quality of included studies ranged from poor (25%) to good (38%). Six (75%) studies reported sufficient details of exercise programmes. CONCLUSION: Limited evidence supports exercise-based dysphagia prehabilitation before (C)RT to improve swallow-related outcomes, and long-term benefits remain unclear. Further high-quality research using core outcome sets is required.

Oropharyngeal dysphagia among patients newly discharged to nursing home care after an episode of hospital care.

BACKGROUND: Oropharyngeal dysphagia (OPD) is a common but under-recognized problem among older residents in nursing homes. If not detected and properly managed, it is a risk factor for failure to thrive and aspiration pneumonia. Discharge to nursing home from hospital may provide an opportunity for detection and subsequent management. OBJECTIVE: To assess the extent of transfer of communication of swallow disorders in patients newly discharged to nursing homes from a university teaching hospital and catalogue recommendations suggested at discharge. SETTING: University teaching hospital METHOD: Speech and language therapy (SLT) consultation notes of referrals from 100 consecutive patients discharged to nursing homes for the first time are reviewed for presence of a swallow disorder. The discharge documentation was then assessed to determine transfer recommendations for management of swallow disorders. RESULTS: Fifty-three patients had been referred to SLT for suspected OPD during hospitalization. At time of discharge, 35 (35%) continued to present with OPD and swallow recommendations were made as part of the management plan. An SLT report was transmitted to the nursing home in 80% of these cases. CONCLUSIONS: OPD is present at discharge in over one-third of patients newly discharged to nursing home following a hospital admission, and this may be an under-estimate. This is significant in terms of planning of future care of management in nursing homes. It is important that the syndrome is duly noted in transfer documentation and that appropriate multi-disciplinary support arranged for residents in nursing homes with OPD.

EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy.

INTRODUCTION: Scintigraphic evaluation of the thyroid gland enables determination of the iodine-123 iodide or the 99mTc-pertechnetate uptake and distribution and remains the most accurate method for the diagnosis and quantification of thyroid autonomy and the detection of ectopic thyroid tissue. In addition, thyroid scintigraphy and radioiodine uptake test are useful to discriminate hyperthyroidism from destructive thyrotoxicosis and iodine-induced hyperthyroidism, respectively. METHODS: Several radiopharmaceuticals are available to help in differentiating benign from malignant cytologically indeterminate thyroid nodules and for supporting clinical decision-making. This joint practice guideline/procedure standard from the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) provides recommendations based on the available evidence in the literature. CONCLUSION: The purpose of this practice guideline/procedure standard is to assist imaging specialists and clinicians in recommending, performing, and interpreting the results of thyroid scintigraphy (including positron emission tomography) with various radiopharmaceuticals and radioiodine uptake test in patients with different thyroid diseases.

The Eating Assessment Tool-10 Predicts Aspiration in Adults with Stable Chronic Obstructive Pulmonary Disease.

Adults with COPD frequently present with dysphagia, which often leads to clinical complications and hospital admissions. This study investigates the ability of the Eating Assessment Tool (EAT-10) to predict aspiration during objective dysphagia evaluation in adults with stable COPD. Thirty adults (20 male, 10 female; mean age = 69.07 ± 16.82) with stable COPD attended an outpatient dysphagia clinic for a fiberoptic endoscopic evaluation of swallowing (FEES) in an acute teaching hospital (January 2015-November 2016). During evaluations, individuals completed an EAT-10 rating scale followed immediately by a standardised FEES exam. Aspiration status during FEES was rated using the penetration-aspiration scale by clinicians blinded to EAT-10 scores. Data were retrospectively analysed. Significant differences in mean EAT-10 scores were found between aspirators (16.3; SEM = 2.165) and non-aspirators (7.3; SEM = 1.009) (p = 0.000). The EAT-10 predicted aspiration with a high level of accuracy (AUC = 0.88). An EAT-10 cut-off value of >9 presented a sensitivity of 91.67, specificity of 77.78 with positive and negative likelihood ratios of 4.12 and 0.11, respectively. Positive and negative predictive values were 73.30 and 93.30, respectively. Diagnostic odds ratio was 38.50 (p < 0.01, CI 3.75-395.42). EAT-10 is a quick, easy to administer tool, which can accurately predict the presence of aspiration in adults with COPD. The scale can also very accurately exclude the absence of aspiration, helping clinicians to determine the need for onward referral for a comprehensive dysphagia evaluation. This may ultimately reduce clinical complications and hospital admissions resulting from dysphagia in this clinical population.

Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.

History of the Royal College of Chiropractic Sports Sciences (Canada): the early years.

In 1978 the Canadian Chiropractic Association recognized the need to establish an organization that would prepare chiropractors to treat athletic injuries and promote these services to sports organizations. Dr. Adrian Grice approached three chiropractors to establish such an organization. The Canadian Chiropractic Sports Academy (CCSA) was established in 1978. This was the start of the chiropractic sports movement which has seen chiropractors playing prominent roles as team doctors to professional and amateur teams and athletes and in the delivery of care at major national and international competitions. This paper will show the work done by the original founders of the CCSA which has helped to pave the way to the present level of acceptance of chiropractic sports injury management and performance enhancement and as the progenitor of the Royal College of Chiropractic Sports Sciences Canada.

En 1978, l'Association chiropratique canadienne a reconnu la nécessité de créer une organisation qui préparerait les chiropraticiens à traiter les blessures sportives et proposerait ces services à des organisations sportives. Le Dr Adrian Grice a approché trois chiropraticiens pour établir une telle organisation. Le Canadian Chiropractic Sports Academy (CCSA) a été créé en 1978. Ce fut le début du mouvement sportif en chiropratique qui a vu les rôles importants joués par les chiropraticiens en tant que médecins d'équipe auprès d'équipes et d'athlètes professionnels et amateurs, et dans la prestation de soins pendant les principaux événements sportifs nationaux et internationaux. Cet article présente le travail effectué par les fondateurs initiaux du CCSA qui a contribué à ouvrir la voie au niveau actuel d'acceptation de la gestion des blessures sportives en chiropratique et l'amélioration des performances et, comme le prédécesseur du Collège royal des sciences du sport chiropratique (Canada).

Performance characteristics of a new levetiracetam immunoassay and method comparison with a high-performance liquid chromatography method.

BACKGROUND: Although levetiracetam is recognized for ease of dosing and being well tolerated, therapeutic drug monitoring is potentially useful in certain clinical situations. High-performance liquid chromatography has been commonly used for measuring levetiracetam. Recently, a homogeneous immunoassay for levetiracetam measurement in serum and plasma was introduced by ARK Diagnostics, Inc. The goal of this work was to validate this assay on a random access instrument. DESIGN AND METHODS: This immunoassay was established on the Siemens ADVIA 1200 automated chemistry analyzer. The intraday precision was assessed by 10 replicates of two levels of quality control materials in a batch, whereas interday precision was estimated by assaying the same materials one set per day for 20 days. Linearity was evaluated by serially diluting the highest calibrator and a high patient specimen run in triplicate, whereas the lower limit of quantification was confirmed by 10 measurements of a low-level specimen diluted from a calibrator and another from a diluted patient specimen. This method was compared with a commercial high-performance liquid chromatography method (Chromsystems) using 63 specimens from patients who were on levetiracetam therapy. RESULTS: The assay cycle was 10 minutes with a theoretical throughput of 800 per hour. The intra- (n = 10) and interday (n = 20) coefficients of variation were 8.1% or less for the two levels tested. The manufacturer-claimed analytical measurable range (2.0-100.0 µg/mL) was confirmed by serial dilution and lower limit of quantification experiments. Among the 63 patient samples studies, four showed levetiracetam levels below 2.0 µg/mL by both methods. Deming regression using the remaining 59 paired patient results by ARK immunoassay and the high-performance liquid chromatography method showed a correlation coefficient of 0.9962, a linear regression slope of 0.98, and an intercept of 0.61 with a mean bias of 0.04%. CONCLUSION: The ARK immunoassay is suitable for clinical use of monitoring levetiracetam levels in serum/plasma on an automated chemistry analyzer (Siemens ADVIA 1200).

The so-called stunning of thyroid tissue.

UNLABELLED: When thyroid tissues exhibited concentrations of therapeutic (131)I that appeared to be less than that predicted by data from the preceding diagnostic (131)I, the phenomenon was called stunning. We hypothesized that stunning arose from the early effects of the therapeutic dose of (131)I and that the initial uptake of (131)I, observed within the first day, was not impaired by the diagnostic dose. METHODS: The hypothesis was tested by 2 types of studies. In each type, the fractional concentrations of (131)I in residual neck thyroid tissues of patients with papillary thyroid carcinoma were quantified. In the first study, fractional concentrations of diagnostic and therapeutic (131)I were measured at 2 d, a time when stunning has been observed, and expressed as ratios of radioactivity: therapeutic/diagnostic (Rx/Dx). Three different doses of diagnostic (131)I were prescribed to assess a dose response. In the second study, patients were prospectively recruited and tested to record disappearances of radioactivity from thyroid tissues. Diagnostic doses were 1.0 mCi (37 MBq) in all; therapeutic doses were 150 and 30 mCi (5,550 and 1,110 MBq), each to half of the patients. The disappearance curves were extrapolated to the period between 0 and 1 d, an interval when maximum uptake of ingested (131)I would be expected. The fractional concentrations of (131)I at 2 d and at 0-1 d were compared in terms of Rx/Dx ratios to assess changes at each time point. RESULTS: In the first study, after diagnostic doses of 2, 1, and 0.5 mCi (74, 37, and 18.5 MBq), mean 2-d Rx/Dx values in 24, 29, and 17 patients were 0.35, 0.50, and 0.46 (P = 0.087). Of all patients, 74% exhibited Rx/Dx <0.6. In the second study, 6 of 10 patients exhibited disappearance curves of (131)I in which Rx/Dx was <0.6 at 2 d; 5 of the 6 had Rx/Dx values >0.97 at the 0- to 1-d point. In 1 patient the Rx/Dx was 0.54 at 2 d and 0.66 at the earlier time point. The other 4 patients had disappearance curves in which Rx/Dx values were >1.0 throughout or were above 0.6 and did not greatly change. CONCLUSION: Two days after the administration of (131)I, the mean fractional concentration of radioactivity in thyroid tissues after a therapeutic dose is <60% of the diagnostic dose in most patients, but no correlation of Rx/Dx with the mCi in the diagnostic dose was seen. In 5 of 6 patients in whom the Rx/Dx at 2 d was <0.6, the maximum fractional concentrations of therapeutic and diagnostic (131)I (i.e., the tissue uptakes during the first day) were similar; this pattern was most apparent after therapies with 150 mCi. These results support the hypothesis that "stunning" of thyroid tissues, often observable by 2 d, is primarily the consequence of early destructive effects from therapeutic (131)I.

Reproductive endocrine dysfunction in Atlantic croaker exposed to hypoxia.

Although there is extensive evidence for impaired endocrine function in fishes exposed to environmental chemicals, information is currently lacking on reproductive endocrine effects of other environmental stressors such as hypoxia. The effects of ten weeks exposure to low dissolved oxygen (DO: 2.7 ppm and 1.7 ppm) on reproductive morphometric and endocrine responses in female Atlantic croaker (Micropogonias undulatus) were investigated in controlled laboratory studies, and compared to the effects observed in fish collected from hypoxic sites in Mobile Bay, Alabama. Exposure of croaker to moderate hypoxia during ovarian recrudescence, both in the laboratory and at the field sites, caused significant impairment of ovarian growth as well as decreased production of fully grown oocytes, resulting in dramatic reductions in the number of viable gametes (fecundity). Ovarian dysfunction was associated with significant decreases in endocrine indicators of the estrogen signaling pathway regulating production of vitellogenin, the yolk protein precursor sequestered by the growing oocytes. The results indicate that reproductive morphometric and endocrine biomarkers in croaker are sensitive to moderate hypoxia, and are potentially useful as early warning indicators of reproductive failure.

Increasing efficacy and safety of treatments of patients with well-differentiated thyroid carcinoma by measuring body retentions of 131I.

UNLABELLED: There is no consensus on the amount of (131)I for treatment of patients with well-differentiated thyroid carcinoma; usual amounts vary widely. Body retention of (131)I has been shown to be a valuable index of radiation toxicity. If a broad range of body retentions occurs among patients, then high and low retentions will be a basis for modifying the usual prescriptions for (131)I to ensure safety and increase efficacy. METHODS: After withdrawal of thyroid hormone in 87 patients, the fractional retention of diagnostic (131)I in each body was measured at 2 d by a scintillation probe. In 43 patients, the retention was measured 2 d after therapeutic (131)I. RESULTS: Diagnostic retention varied from 0.01 to 0.51, with a median of 0.15. These retentions did not correlate with any index of health, thyroid hormone, or carcinoma status. Seventeen patients, previously treated with (131)I, exhibited a significantly lower mean retention. In 43 patients, retention of diagnostic (131)I was highly correlated with retention of therapeutic (131)I: diagnostic predicted therapeutic retention with a mean error of 0.04. In 10 patients receiving thyroxine, the mean retention of diagnostic (131)I after recombinant human TSH (rhTSH) was strikingly lower, 0.06, with a range of 0.016-0.16. CONCLUSION: Body retentions of (131)I are easily measured and vary considerably among patients. Because increased therapeutic (131)I will impart greater irradiation of tumor, and body retention has been accepted as an index of toxicity from (131)I, the use of body retention could enable prescriptions of therapeutic (131)I that enable increased efficacy while ensuring safety. If tumor retention is not proportionally decreased with the body retention of (131)I after rhTSH, then rhTSH may enable increased therapeutic efficacy.