Studies Of Excellent Quality Research Articles

Rehabilitation Interventions in Head and Neck Cancer: A Review

<h3>Objective(s)</h3> To investigate the evidence and quality of rehabilitation interventions on functional outcomes in head and neck cancer (HNC). <h3>Data Sources</h3> PubMed, EMBASE, and CINAHL electronic databases were searched for "head and neck neoplasms" and "rehabilitation" limited to English language and human studies from 5/1/2017 - 7/22/2020. Additional interventional studies from 1/1/1990 - 4/30/2017 were sourced from our previously published scoping review (Parke et al. 2019). <h3>Study Selection</h3> Included studies were interventional trials with majority HNC population and rehabilitation-specific interventions and outcomes. Exclusion criteria included surgical, dental, economic, or smoking interventions. Studies were screened for inclusion by two independent authors. Sixty-nine of 1176 studies retrieved met inclusion criteria. <h3>Data Extraction</h3> Pairs of authors independently extracted data and evaluated study quality with the PEDro tool. <h3>Data Synthesis</h3> Studies were organized by intervention category, population, setting, timing, and study quality. The largest intervention categories included jaw exercise (13 studies), swallow exercise (11), and whole body exercise (13). Most interventions occurred in the outpatient setting for oropharyngeal cancer. Timing was predominantly post-treatment in the restorative Dietz category (51). Median study sample size was 50 (range 15 to 399). Median study quality was 5 with no studies of excellent quality. Major limitations included lack of therapist blinding (97%), lack of concealed allocation (64%), lack of intention to treat analysis (59%), and high participant drop out (58%). <h3>Conclusions</h3> Most interventional trials in HNC rehabilitation are focused on restorative exercise for the jaw, swallow, or the whole body. Most studies have substantial methodological weaknesses. Higher quality interventional studies in HNC rehabilitation are needed. <h3>Author(s) Disclosures</h3> None.

Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions.

To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.

Interpreting Epidemiologic Research: Lessons From Studies of Childhood Cancer

In recent years, the public has shown concern about trends in incidence rates, the occurrence of clusters, and the role of certain environmental exposures in the cause of childhood cancers. A front-page news story in the New York Times 1 stimulated a dramatic upswing of public anxiety about these issues. Hearings by the US Senate Environment and Public Works Committee on a cluster of 11 childhood acute lymphoblastic leukemia (ALL) cases (since increased to 13) among the 8200 residents of a town in Nevada over a 3-year period led to a featured article in USA Today 2 describing legislation under consideration to enhance the federal government’s role in responding to apparent cancer outbreaks in US communities. Compared with 1.22 million cancers (excluding non-melanoma skin cancers) diagnosed annually among adults in the United States (corresponding to an average annual incidence rate for all cancers of 398 per 100 000 person-years),3 there are only ∼8700 diagnosed per year among children younger than 15 years and 12 400 among children and adolescents younger than 20 years (corresponding to average annual incidence rates of 13.4 per 100 000 and 14.9 per 100 000 person-years, respectively).4 Carcinomas predominate among adults, and the major pediatric tumors are nonepithelial. The most common pediatric neoplasms are the leukemias (representing 30.2% of all cancers diagnosed in children younger than 15 years), brain and central nervous system cancers (21.7%), and lymphomas (10.9%); these 3 categories (together constituting 63%) and the remaining 37% of pediatric malignancies are characterized by substantial histologic and biological diversity.5–7 Instead of the anatomic site-based categories used for adult malignancies, a more appropriate classification system developed for pediatric neoplasms8 was recently updated and designated as the International Classification of Childhood Cancer.9 This article includes 3 components. The first section focuses …

Clinical Validation of an Edge Detection Algorithm for Two-Dimensional Echocardiographic Short-Axis Images

The purpose of this study was to validate an edge detection algorithm for short-axis two-dimensional echocardiographic studies in a protocol that stimulated its implementation at multiple clinical laboratories. Six short-axis two-dimensional echocardiographic studies were solicited from each of five clinical laboratories. A single cardiac cycle from each of the resulting 30 studies was entered into the computer system. Five expert observers came to the laboratory on separate occasions and traced endocardial borders from the short-axis studies on 2 separate days. The computer algorithm generated borders on each frame of the cardiac cycles on the basis of regions of search defined by the observers. Of the 30 original studies, five were considered excellent, seven were good, nine were poor, and nine were technically inadequate by consensus of the five observers. The correlation coefficient for computer-defined borders with manually defined borders in the excellent quality studies was 0.985. Interobserver variability was expressed as the mean percent area difference for all possible pairings of observers. The mean percent area differences were decreased from +/- 9.8% to +/- 5.3%, +/- 12.5% to +/- 8.4%, and +/- 17.4% to +/- 15.6% when comparing observer with computer-generated borders in the excellent, good, and poor quality studies, respectively. Intraobserver variability was expressed as decrease in mean percent area difference on corresponding frames between days 1 and 2. Intraobserver variability was decreased from +/- 6.5% to +/- 4.5%, +/- 10.8% to +/- 7.0%, and +/- 14.0% to +/- 11.9%, respectively. All reductions in variability were statistically significant at p less than 0.01. Observer acceptance of computer-defined borders was estimated at 94%, 93%, and 97% for excellent, good, and poor quality studies, respectively. Once the observer defined a region of search, computer process time to generate all borders in the cardiac cycle was approximately 4 minutes. The conclusion is that the algorithm produces accurate, reliable, and acceptable borders.

Three-dimensional echocardiographic reconstruction: how does it stack up?

In conclusion, the data shows that in excellent quality studies such as those obtained in vitro, 3D echocardiography is as accurate in describing the volume of the left ventricle as is angiography. When excellent quality images are obtained, the endocardial wall motion, wall thickening and thinning are better described. This, in addition to echocardiography's promise of visualizing coronary perfusion regions using contrast agents and of detecting ultrasound tissue signatures of diseased myocardium give 3D echocardiography a very bright potential in research. Since ACCURACY is of utmost importance in defining the extent of wall motion defects for evaluation of therapeutic interventions, 3D reconstruction in the short term can only be beneficial in those patients who have excellent quality studies. In the evaluation of patients with valvular disease where changes in absolute volume may herald deterioration before change in ejection fraction, 3D echocardiography may find a more immediate role. In this situation, although there is still a degree of variability, predicted volumes are as good as those predicted from any other technique.

105mm serial photofluorography of the coronary arteries.

Coupling of a modern dual mode image intensifier with a l05mm spot-film camera has resulted in resolution approaching that available in studies obtained with large film-changers. In comparison to the large film-changer techniques, use of this system in the investigation of coronary artery disease has yielded studies of excellent quality with greater safety and less expense to the patient. Recommendations are made concerning radiological techniques and processing. The 105mm photofluorographic technique may be applied in other forms of selective arteriography when the area of interest is relatively small.