A systematic review of upper extremity responses during reactive balance perturbations in aging

BackgroundBalance responses to perturbations often involve the arms in an attempt to either restore balance or protect against impact. Although a majority of research has been dedicated to understanding age-related changes in lower limb balance responses, there is a growing body of evidence supporting age-related changes in arm responses. This systematic review aimed to summarize differences in arm responses between older and younger adults under conditions requiring counterbalancing, reaching to grasping, and protection against impact.MethodsFollowing a systematic review and critical appraisal of the literature, data regarding the arm response in studies comparing young and older adults was extracted. The resulting articles were also assessed for quality to determine risk of bias.ResultsFifteen high quality studies were identified. The majority of these studies reported delayed onsets in muscle activation, differences in arm movement strategies, delayed movement timing, increased impact forces, and greater grasp errors in older compared to young adults. These differences were also identified under varied visual and cognitive conditions.ConclusionsThe studies included in this review demonstrate age-related differences in arm responses regardless of the direction and nature of the perturbation. These differences could provide insight into developing more targeted rehabilitation and fall prevention strategies. More research is needed to assess whether the identified age-related differences are a necessary compensation or a contributory factor to balance impairments and fall risk in older adults     

Failure modes in stereotactic radiosurgery. A narrative review

ObjectivesStereotactic radiosurgery (SRS) refers to an advanced radiotherapy technique that requires a high level of precision and accuracy and a flawless workflow. Failures within the SRS process can lead to serious consequences due to high doses delivered per treatment. This narrative review aimed to identify the riskiest failure modes (FMs) and the stages at which they occur in the SRS process, as well as the strategies applied to mitigate the risks. It was based on the analysis of published failure mode and effects analysis (FMEA) data.Key findingsFrom the literature search in PubMed and Scopus, 7 articles met the eligibility criteria for inclusion in the qualitative synthesis. In total, 9 radiotherapy departments conducted FMEA in the SRS process. 4 of them were community hospitals and 5 were academic centers. Overall, 54 high-risk FMs were identified with treatment planning (FMs: 18), treatment delivery (FMs: 12), consultation and patient registration (FMs: 10) being the riskiest stages. 10 FMs were stereotactic specific, while the remaining 44 could be met in any radiotherapy technique. Failures associated with contouring, medical records review, target reirradiation, and patient positioning were mostly outlined. Risk mitigation strategies included timeouts, double-checks, checklists, training and changes in the working practice.ConclusionOur review demonstrated that crucial FMs can occur in all SRS stages. Although generalisations were challenging, the FMs analysis provided a significant source of information about potential high risks and continuous improvement strategies that can be applied both in the SRS and other radiotherapy processes.Implications for practiceThe results of this research will assist radiotherapy facilities in proactive risk management studies and will allow radiotherapy professionals to reflect on their practice and learn from others’ experiences.     

An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction?

IntroductionSkin toxicity is a clinically significant side effect of external beam radiation; moist desquamation is particularly prevalent for breast patients, mainly in the axilla and inframammary fold (IMF). The aim of this audit was to assess if there is a correlation between patient breast size and the presence and extent of radiotherapy skin reaction in the IMF.MethodsBetween 22/12/2017 and 31/05/2018 forty patients undergoing standard whole breast radiotherapy using 3D planned medial and lateral tangential fields had their skin reaction recorded weekly, whilst on treatment, using the Radiotherapy Oncology Group (RTOG) scoring system. Skin reactions were also documented at three and eight weeks post radiotherapy. A measurement of the patients IMF length and bra size were also noted. Statistical analysis was carried out using IBMÒ SPSS Statistics 24.ResultsSix patients presented with grade ≥2 during week three of radiotherapy. The mean IMF length of six patients with adverse reactions 6.1 cm (±3.6 cm). As the length of the IMF increases, severity of skin reactions also increases; a positive correlation was identified between the two at both week three of radiotherapy and three weeks post radiotherapy (r = 0.401, n = 34, p = 0.05 and r = 0.671, n = 29, p = 0.00 respectively). Only one patient displayed grade 2 at eight weeks post radiotherapy (IMF length 7.5 cm).ConclusionThe findings from this study would suggest that larger breasted patients do present earlier, and with more severe radiation-induced skin reactions.Implications for practiceChanges to skin care practice could be considered for patients with larger breasts. This could be in the form of more frequent check-ups during treatment or proactive side effect management rather than reactive management.     

The relationship between static and dynamic foot posture and running biomechanics: A systematic review and meta-analysis

BackgroundMedial longitudinal arch characteristics are thought to be a contributing factor to lower limb running injuries. Running biomechanics associated with different foot types have been proposed as one of the potential underlying mechanisms. However, no systematic review has investigated this relationship.Research questionThe aim of this study was to conduct a systematic literature search and synthesize the evidence about the relationship between foot posture and running biomechanics.MethodsFor this systematic review and meta-analysis different electronic databases (Pubmed, Web of Science, Cochrane, SportDiscus) were searched to identify studies investigating the relationship between medial longitudinal arch characteristics and running biomechanics. After identification of relevant articles, two independent researchers determined the risk of bias of included studies. For homogenous outcomes, data pooling and meta-analysis (random effects model) was performed, and levels of evidence determined.ResultsOf the 4088 studies initially identified, a total of 25 studies were included in the qualitative review and seven in the quantitative analysis. Most studies had moderate and three studies a low risk of bias. Moderate evidence was found for a relationship between foot posture and subtalar joint kinematics (small pooled effects: −0.59; 95%CI −1.14 to − 0.003) and leg stiffness (small pooled effect: 0.59; 95%CI 0.18 to 0.99). Limited or very limited evidence was found for a relationship with forefoot kinematics, tibial/leg rotation, tibial acceleration/shock, plantar pressure distribution, plantar fascia tension and ankle kinetics as well as an interaction of foot type and footwear regarding tibial rotation.SignificanceWhile there is evidence for an association between foot posture and subtalar joint kinematics and leg stiffness, no clear relationship was found for other biomechanical outcomes. Since a comprehensive meta-analysis was limited by the heterogeneity of included studies future research would benefit from consensus in foot assessment and more homogenous study designs.     

Psychological factors and future performance of football players: A systematic review with meta-analysis

ObjectivesThis systematic review had 3 key objectives: (1) to investigate whether psychological factors were associated with future football performance (e.g., progression to professional football, better game statistics during the next season); (2) to critically review the methodological approaches used in the included studies and summarize the evidence for the current research question; (3) to provide guidelines for future studies.DesignSystematic review.MethodsElectronic databases (SPORTDiscus, PubMed and PsycINFO) and previously published systematic and scoping reviews were searched. Only prospective studies were considered for inclusion.ResultsEleven published studies that reported 39 effect sizes were included. Psychological factors; task orientation, task-oriented coping strategies and perceptual-cognitive functions had small effects on future performance in football (ds = 0.20–0.29). Due to high risk of bias there were low certainty of evidence for psychological factors relationship with future football performance.ConclusionsPsychological factors investigated showed small effects on future football performance, however, there was overall uncertainty in this evidence due to various sources of bias in the included studies. Therefore psychological factors cannot be used as a sole deciding factor in player recruitment, retention, release strategies, however it would appear appropriate to include these in the overall decision-making process. Future, studies with more appropriate and robust research designs are urgently needed to provide more certainty around their actual role.     

Optimisation of radiographic acquisition parameters for direct digital radiography: A systematic review

IntroductionThe objective of this systematic review was to uncover and synthesise all available literature regarding appropriate acquisition parameters for direct digital radiography. It sought to either confirm current practices as optimal, or to uncover practices that may produce more optimised results.MethodsA comprehensive search of published and unpublished literature was undertaken to find studies that evaluated how adjustment of different acquisition parameters affected subjective image quality and patient radiation dose. Eight hundred and fifty-eight studies were retrieved for title and abstract screening. Eighty-nine studies were retrieved for full-text screening, and 23 were included for review and methodological quality screening.ResultsNarrative synthesis of the 23 included studies revealed limited evidence to guide any potential change or acceptance of currently accepted best practice. Meta-analysis was unable to be performed for any of the included studies due to high levels of methodological heterogeneity. A key finding of this review was that the goals of optimisation research varied greatly across the included studies.ConclusionSignificant methodological heterogeneity in the included studies limited the number of clinically relevant findings that would give evidence to an acceptance of, or suggest changes to, currently accepted best practice. Improving consistency in approach across future works of technique optimisation will ensure future systematic reviews will be able to provide strong evidence and meta-analysis will be able to be performed.Implications for clinical practiceThis review highlights that in the literature, studies of optimisation of radiographic acquisition parameters have varying goals. This methodological heterogeneity limits the applicability of systematic reviews and precludes the use of meta-analysis. The authors recommend that a framework for optimisation research be produced as a priority to help improve homogeneity in future research.     

Effectiveness of Violet LED alone or in association with bleaching gel during dental photobleaching: A Systematic Review

AimsTo conduct a systematic review to determine the efficacy of violet led in promoting dental bleaching by itself or accelerating dental bleaching when associated with peroxides.MethodsClinical and in vitro studies were identified by a search on November 27th 2020 in the PubMed and Scopus databases. Inclusion criteria were: 1) studies related to bleaching; 2) studies related to violet LED Light (405-410nm); and 3) studies that analyzed efficacy. The authors assessed the studies for risk of bias independently. Authors extracted outcomes including color change evaluation and pain assessment independently.ResultsDuring the search process, 895 articles were found in the previously cited databases. After the first screening consisting of title and abstract evaluations, 18 articles were selected. Finally, 13 articles met the eligibility criteria and were included in this review, being 5 clinical trial/case series and 8 in vitro studies. In vitro studies showed a high risk of bias and interventional studies showed a low risk of bias.ConclusionThe violet Led seems to have the potential to bleach teeth without peroxides, with a clinical perceptible color alteration. However, the effect is small in comparison to bleaching using peroxides. When Violet Led is used in association with peroxides, it seems to potentialize the bleaching result. However, due to the high heterogeneity between studies, a small number of clinical studies, and the high risk of bias of the in vitro included studies, the results are not definitive, and further well-designed studies are needed to reach safe evidence.     

A systematic review of non-pharmacologic interventions to reduce anxiety in adults in advance of diagnostic imaging procedures

ObjectivesAnticipation of a diagnostic imaging (DI) procedure, particularly one involving advanced technology, can provoke feelings of anxiety in patients. Anxiolytics (anxiety reducing drugs) can be used to reduce pre-procedural anxiety in patients, however there are several known disadvantages to this approach. The aim of this systematic review was to identify and evaluate any preparatory non-pharmacological interventions used to reduce patient anxiety in advance of DI procedures.Key FindingsDatabase searches revealed twelve studies met the eligibility criteria and were included in the review. A narrative synthesis identified three intervention categories: patient information/education, cognitive strategies (i.e. guided imagery, breathing techniques, imaginative visualisation) and music therapy.ConclusionThe current review demonstrates that despite the existence of a number of studies providing some evidence for the effectiveness of a range of anxiety reducing interventions for patients prior to DI, the small number and overall low quality of studies identified makes it difficult to draw firm conclusions regarding the application of a specific intervention in clinical practice.Implications for practiceThe majority of interventions included in this review were shown to be practical for inclusion in the clinical setting and did have some positive effect on patient anxiety levels. As a result those professionals working with adults undergoing advanced technology DI procedures may consider implementing some of the strategies that have been discussed within their practice.     

Biomechanical and physiological implications to running after cycling and strategies to improve cycling to running transition: A systematic review

ObjectivesThis systematic review summarises biomechanical, physiological and performance factors affecting running after cycling and explores potential effective strategies to improve performance during running after cycling.DesignSystematic review.MethodsThe literature search included all documents available until 14th December 2021 from Medline, CINAHL, SportDiscus, and Scopus. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 7495 articles identified, fulltext screening was performed on 65 studies, with 39 of these included in the systematic review.ResultsThe majority of studies observed detrimental effects, in terms of performance, when running after cycling compared to a control run. Unclear implications were identified from a biomechanical and physiological perspective with studies presenting conflicting evidence due to varied experimental designs. Changes in cycling intensity and cadence have been tested but conflicting evidence was observed in terms of biomechanical, physiological and performance outcomes.ConclusionsBecause methods to simulate cycle to run transition varied between studies, findings were conflicting as to whether running after cycling differed compared to a form of control run. Although most studies presented were rated high to very high quality, it is not possible to state that prior cycling does affect subsequent running, from a physiological point of view, with unclear responses in terms of biomechanical outcomes. In terms of strategies to improve running after cycling, it is unclear if manipulating pedalling cadence or intensity affects subsequent running performance.     

Radiographers' and students' experiences of undergraduate radiotherapy practice placement in the United Kingdom

IntroductionA three-phased, mixed-methods study was conducted to explore the experiences of undergraduate radiotherapy students and their supervising practice educators within U.K. radiotherapy practice placement.MethodsQualitative data were gathered from focus groups/interviews with volunteer participants to elicit in-depth perceptions about experiences of practice placement. Data were transcribed, verbatim, and manually coded and analysed by the researcher using the applied research methodology of framework analysis, enabling the investigation of the a priori theme ‘practice placement model’, and recommendations were made for improvement.ResultsTwo radiotherapy placement models are confirmed, i.e. the single student model, and the paired student model, and advantages and disadvantages are identified for each. Study findings suggest that neither radiotherapy model is superior to the other in terms of placement education and experience. Previous and current experience of either model appears to bias students and practice educators towards that model, despite recognition of its disadvantages.ConclusionThe experiences of students and practice educators using the radiotherapy models are consistent with the experiences of other AHPs and nursing using similar practice placement models. It is recommended that all students should have access to peer-assisted learning on placement to improve critical thinking skills, to enable time for reflection, and to consolidate learning.     

The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: A systematic review and meta-analysis

BackgroundThe purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided.ResultsTwo hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias.ConclusionAntimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.     

Quality Reporting of Systematic Review and Meta-Analysis According to PRISMA 2020 Guidelines: Results from Recently Published Papers in the Korean Journal of Radiology

ObjectiveTo evaluate the completeness of the reporting of systematic reviews and meta-analyses published in a general radiology journal using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.Materials and MethodsTwenty-four articles (systematic review and meta-analysis, n = 18; systematic review only, n = 6) published between August 2009 and September 2021 in the Korean Journal of Radiology were analyzed. Completeness of the reporting of main texts and abstracts were evaluated using the PRISMA 2020 statement. For each item in the statement, the proportion of studies that met the guidelines’ recommendation was calculated and items that were satisfied by fewer than 80% of the studies were identified. The review process was conducted by two independent reviewers.ResultsOf the 42 items (including sub-items) in the PRISMA 2020 statement for main text, 24 were satisfied by fewer than 80% of the included articles. The 24 items were grouped into eight domains: 1) assessment of the eligibility of potential articles, 2) assessment of the risk of bias, 3) synthesis of results, 4) additional analysis of study heterogeneity, 5) assessment of non-reporting bias, 6) assessment of the certainty of evidence, 7) provision of limitations of the study, and 8) additional information, such as protocol registration. Of the 12 items in the abstract checklists, eight were incorporated in fewer than 80% of the included publications.ConclusionSeveral items included in the PRISMA 2020 checklist were overlooked in systematic review and meta-analysis articles published in the Korean Journal of Radiology. Based on these results, we suggest a double-check list for improving the quality of systematic reviews and meta-analyses. Authors and reviewers should familiarize themselves with the PRISMA 2020 statement and check whether the recommended items are fully satisfied prior to publication.     

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

BackgroundAppendicitis is the most common cause of acute abdominal pain requiring surgical intervention in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed by CT, where paediatric appendicitis is suspected. However, high operator dependency and diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application. This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging modality.MethodA systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed Central and Google Scholar was undertaken supplemented by a review of reference lists, author searching and review of NICE evidence base for existing guidelines. Included studies were assessed for bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully designed electronic data extraction proforma.ResultsSeven studies were included in final review. The age range of participants extended from 0 to 19 years. Only one study with a patient age range of 0–14 used sedation. Sensitivity estimates from the included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant variation in the number and type of sequences was noted between the studies.ConclusionMRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice recommendations have been provided to facilitate the translation of evidence into practice.     

鼻咽癌同期放化疗中急性皮肤黏膜反应的临床观察及其相关因素分析

目的 探讨鼻咽癌患者同期放化疗中急性皮肤及黏膜反应的影响因素,对主要相关因素进行分析。方法 对85例接受同期放化疗的鼻咽癌患者进行研究,观察并记录BMI、每周放疗剂量、口腔黏膜及颈部皮肤反应情况、血常规等15项临床指标及实验室指标,并进行单因素分析和多因素分析,筛选决定性影响因素。结果 与急性放射性口腔黏膜反应发生密切相关的危险因素,有吸烟史（OR=3.467,P<0.05）和原发灶GTV单次量>2.15Gy（OR=3.393,P<0.05）;与急性放射性皮肤反应发生密切相关的危险因素,有糖尿病史（OR=87.859,P<0.05）,放疗前1周血红蛋白值>130g/L（OR=21.404,P<0.05）。结论 对于同期放化疗的鼻咽癌患者,吸烟史和原发灶GTV单次量为急性放射性口腔黏膜反应的独立影响因素,糖尿病史和放疗前1周的血红蛋白值为急性放射性皮肤反应的独立影响因素。     

The role for vaginal cuff brachytherapy boost after external beam radiation therapy in endometrial cancer

PURPOSETo evaluate the role and technique of a vaginal cuff brachytherapy (VB) boost to adjuvant external beam (EB) radiation for endometrial cancer through a systematic review.METHODS AND MATERIALSRelevant trials were identified through a systematic search of the literature.RESULTSA total of 21 prospective and retrospective studies which had a patient cohort undergoing EB + VB was identified to evaluate for rates of vaginal and pelvic recurrences, overall survival, and toxicity. Additional database studies were utilized to demonstrate differences in local control and overall survival between EB and EB + VB.CONCLUSIONSWhile there is limited prospective evidence to guide the use of a VB boost after EB, the evidence suggests that patients with a higher risk of a vaginal recurrence such as those with cervical stromal involvement in select Stage III patients may derive local control and survival benefits from a VB boost. Additional individual risk factors such as grade, histology, extent of invasion, margin status, age, and the use of lower doses of EB should be considered when deciding when to add a VB boost.     

Complications and side effects of high-dose-rate prostate brachytherapy

PurposeTo describe technical challenges and complications encountered during and after high-dose-rate prostate brachytherapy (HDR-BT) and review management of these complications.Methods and MaterialsThe authors performed a systematic review of the literature on toxicities encountered after prostate HDR-BT +/− external beam radiotherapy. A total of 397 studies were identified, of which 64 were included. A focused review of literature regarding the management of acute and late toxicities also performed.ResultsMost acute toxicities include grade 0–2 genitourinary and gastrointestinal toxicity. Overall, Grade 3+ Common Terminology Criteria for Adverse Events toxicity after HDR-BT was low [genitourinary: 0–1%; gastrointestinal 0–3%]. Rates of fistula formation were <1%, and radiation cystitis/proctitis were <14% and more commonly reported in cohorts treated with HDR-BT boost and external beam radiotherapy.ConclusionsHDR-BT both as monotherapy or combined with external beam radiotherapy for prostate cancer is well tolerated. Serious complications are rare.     

Injury prevention strategies specific to pre-elite athletes competing in Olympic and professional sports — A systematic review

ObjectivesTo describe and evaluate injury prevention interventions for pre-elite athletes who compete in an Olympic or professional sport.DesignSystematic review.MethodsThis review was prospectively registered (PROSPERO CRD42017065083) and a systematic electronic search was conducted in May 2017. The following inclusion criteria were applied: (1) studies including and analysing data specific to pre-elite athletes (determined by the T3/T4 levels of the FTEM model); (2) featured injury prevention interventions; (3) provided sufficient data related to injury such that the effect can be analysed e.g. injury rates, incidence, prevalence, injury rate ratios; (4) featured randomised and non-randomised controlled trials or prospective cohorts.ResultsA total of 13,480 articles were retrieved with 121 titles identified and 11 studies satisfying the inclusion criteria. No studies demonstrated a low risk of bias. Four different interventions were identified: exercise (n = 7, 64%), psychological (n = 2, 18%), equipment (n = 1, 9%), nutrition (n = 1, 9%). Of the seven exercise interventions, four showed a protective effect and three found no significant effect, providing conflicting evidence. Caution is advised due to high risk of bias, low intervention reporting and minimal evidence for implementation planning in all seven studies.ConclusionsThere is limited evidence from level 2 and 3 studies suggesting exercise and psychology interventions may prevent injury in pre-elite athletes. There is an absence of evidence to support the use of equipment and nutrition interventions in pre-elite athletes. There is a need for quality research designs confirming the clinical impact of existing injury prevention interventions for pre-elite athletes.