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Purpose: Lymphedema is a common late effect of head and neck cancer treatment that causes various symptoms, functional impairment, and poor quality of life. We completed a pilot, prospective, single-arm clinical trial to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema. In this study, we report patients' perceived treatment experience of PBM therapy and provide suggestions to better understand head and neck cancer survivors' experience of PBM therapy. Methods: Head and neck cancer patients who underwent PBM therapy completed face-to-face semi-structured interviews. Interviews were audio-recorded and then transcribed verbatim. Qualitative content analysis was used to analyze the transcriptions from the interviews. Results: Among 12 participants who consented for the study, 11 (91.7%) completed the PBM therapy. Participants described positive experiences and unique benefits about the PBM therapy, for example, decreased swelling, reduced tightness, increased range of motion, increased saliva production, and improved ability to swallow. Some participants ( n  = 5, 45.5%) delineated challenges related to traffic, travel time, and distance from study location. Many participants proposed suggestions for future research on PBM therapy, for example, research on internal edema and its relationship with swallowing, and indicated patients with severe lymphedema and fibrosis may be more likely to benefit. Conclusions: Findings from this study suggested the potential benefits of PBM therapy in treatment of chronic head and neck lymphedema. Rigorously designed clinical trials are needed to evaluate the effect of PBM therapy for head and neck cancer-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale-Revised, Functional Assessment of Chronic Illness Therapy-Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation ("should be used in clinical practice"), and 1 screen and 5 assessments received a B recommendation ("may be used in clinical practice"). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures., Impact: Health care providers should screen for and assess CRF using one of the tools recommended by this CPG., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Purpose: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors., Methods: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention., Results: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P  < .05)., Conclusion: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema., Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

Introduction: Learning is essential and life-long for faculty and students. Often students and teachers use ineffective learning strategies and are not aware of evidence-based strategies. Methods: A multicenter, international, cross-sectional, online survey-based assessment of awareness of evidence-based learning strategies among health professions students ( n  = 679) and faculty ( n  = 205). Results: Students endorsed many study habits which violate evidence-based principles, including studying whatever is due soonest (389/679, 57%), failing to return to course material once a course has ended (465/679, 68%), and re-reading underlined or highlighted notes (298.679, 44%). While the majority of faculty surveyed (125/157, 80%) reported recommending effective study strategies for their students, most students (558/679, 82%) said they did not study the way they do because of instruction from faculty. The majority of faculty (142/156, 91%) and students (347/661, 53%) believe students have different learning styles. Discussion: The results of this study demonstrate health professions students continue to use many ineffective study strategies, and both students and faculty hold misconceptions about evidence-based learning. While planning a curriculum, medical educators should focus on teaching students how to learn and use higher order thinking procedures in addition to teaching content.

Background: Datathons are increasingly organized in the healthcare field. The goal is to assemble people with different backgrounds to work together as a team and engage in clinically relevant research or develop algorithms using health-related datasets. Criteria to assess the return of investment on such events have traditionally included publications produced, patents for prediction, classification, image recognition and other types of software, and start-up companies around the application of machine learning in healthcare. Previous studies have not evaluated whether a datathon can promote affective learning and effective teamwork., Methods: Fifty participants of a health datathon event in São Paulo, Brazil at Hospital Israelita Albert Einstein (HIAE) were divided into 8 groups. A survey with 25 questions, using the Affective Learning Scale and Team-Review Questionnaire, was administered to assess team effectiveness and affective learning during the event. Multivariate regression models and Pearson's correlation tests were performed to evaluate the effect of affective learning on teamwork., Results: Majority of the participants were male 76% (37/49); 32% (16/49) were physicians. The mean score for learning (scale from 1 to 10) was 8.38, while that for relevance of the perceived teamwork was 1.20 (scale from 1 to 5; "1" means most relevant). Pearson's correlation between the learning score and perception of teamwork showed moderate association (r = 0.36, p = 0.009). Five learning and 10 teamwork variables were on average positively graded in the event. The final regression model includes all learning and teamwork variables. Effective leadership was strongly correlated with affective learning (β = -0.27, p < 0.01, R 2  = 75%). Effective leadership, team accomplishment, criticism, individual development and creativity were the variables significantly associated with higher levels of affective learning., Conclusion: It is feasible to enhance affective knowledge and the skill to work in a team during a datathon. We found that teamwork is associated with higher affective learning from participants' perspectives. Effective leadership is essential for teamwork and is a significant predictor of learning., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Controversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema, particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors., Methods: Publications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion criteria, 19 articles were selected for final review. Information on study design/objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence Classification., Results: Seven studies were identified addressing resistance exercise, seven studies on aerobic and resistance exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of varying modalities is not associated with the development or exacerbation of breast cancer-related lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise appear safe, but confirmation requires larger and more rigorous studies., Conclusions: Strong evidence is now available on the safety of resistance exercise without an increase in risk of lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for lymphedema., Implications for Cancer Survivors: With reasonable precautions, it is safe for breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during treatment.

Objective: To assess the feasibility of recruiting and retaining cancer survivors with lower-limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life., Design: Before-after pilot study with a duration of 5 months., Setting: University of Pennsylvania., Participants: Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study., Intervention: Twice weekly slowly progressive weight lifting, supervised for 2 months, unsupervised for 3 months., Main Outcome Measures: The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life., Results: Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months, respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement was noted in self-reported quality of life., Conclusions: Recruitment of patients with lower-limb-lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10 participants suggests additional study is required before concluding that patients with lower-extremity lymphedema can safely perform weight lifting., (Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To study pediatricians' assessments of the quality of their ethics education, the impact of various learning methods, and their confidence in confronting ethical dilemmas arising in pediatric practice., Design: Cross-sectional survey., Participants: Two hundred fifty physicians who completed pediatric or medicine/pediatric residency programs in 2004 were randomly selected from the American Medical Association Physician Masterfile. Evaluable responses were received from 150 of 215 eligible pediatricians (70%)., Results: Of 150 respondents, 44.7% rated their ethics education during residency as fair or poor. More than 80% reported that informal discussions with fellow residents and attending physicians had a moderate or major effect on their ethics education, whereas 53.3% reported that formal teaching conferences had a moderate or major impact. Most respondents (>60%) reported confidence in addressing 4 of 23 ethical challenges, a moderate proportion (40%-60%) reported confidence in addressing 8 of 23 ethical challenges, and fewer (<40%) reported confidence in addressing 11 of the ethical challenges. Areas associated with low confidence included ethics in end-of-life care and research ethics., Conclusions: Efforts are needed to augment formal and informal ethics teaching during residency. Additional studies at both the individual physician and residency program levels are needed to improve the ethics education that pediatricians-in-training receive.

One hundred patients had total hip arthroplasty (THA) with either a modified Hardinge approach or transtrochanteric lateral approach. Perioperative data showed that osteotomies resulted in significantly more blood loss but required shorter operative time. Postoperative pain, using a visual analog scale, showed no statistical difference between the two groups. Postoperative hip scores for pain, function, and range of motion (ROM), presence of limp, and abductor muscle strength scores showed no significant difference between groups at six months and one year. Roentgenographic follow-up evaluation showed a mean acetabular cup angle of 40 degrees and a neutral-to-valgus femoral stem position in all patients. Trochanteric union was present in 92%. Heterotopic ossification occurred predominantly in the Hardinge patients but was not functionally significant. Therefore, the ability to achieve adequate pain relief and function with THA is not affected by the type of approach.

The present study prospectively evaluated patient-controlled analgesia (PCA) in 94 postoperative primary total joint patients. Total knee arthroplasty patients had significantly higher pain scores than those undergoing total hip arthroplasty. Trochanteric osteotomy patients used less morphine (mean, 37.6 mg) than those undergoing a muscle-splitting (Hardinge) approach. Eighty-eight percent of patients would use PCA again. The authors recommend PCA as a potentially superior form of postoperative pain control in joint arthroplasty patients, but recommend antiemetic usage, generous additional intravenous administration of bolus doses on the floor, trials of higher set doses, and earlier administration of PCA in the recovery room.

One of the major issues confronting the contemporary hip surgeon is the choice of fixation. The correct decision as to the use or abandonment of cement is as yet unclear. The aim of this essay is to view those elements of the scientific process that would allow the surgeon to reach the correct conclusions during the next decade. General considerations are discussed that will help the reader analyze clinical series focused on this problem. Theoretical advantages and disadvantages of both cemented and cementless fixation are also discussed along with supporting data. The major reports of large series of cases pertinent to this issue suggest that results of cemented primary total hip arthroplasty (THA) are excellent in the short run but deteriorate with time. This is in contrast to the results of uncemented primary THAs, which are not only satisfactory in the short run but tend to improve with the passage of time. Uncemented primary THAs are a rational treatment in the young, active male. In revision surgery, cemented techniques are unsatisfactory. Uncemented techniques show promise but as yet remain unproven.

Survivorship analysis of 1,041 cemented Charnley total hip arthroplasties performed as a primary procedure revealed a probability of component survival at 10 years of 92%; the probability of acetabular cup survival was 99% and of femoral component survival was 96%. Three-zone acetabular demarcation was present in 16% of cases, as was migration of the cup greater than 5 mm. However, the acetabular revision rate was 1.65%, confirming the long-term clinical durability of the 22-mm internal diameter cup. Radiographic evidence of definite femoral component loosening was present in 9.6% and high-grade femoral bone-cement demarcation was present in 3.5%. The isolated femoral revision rate was 1.8%. Based on detailed survivorship analysis, a high-risk group of patients was identified for component failure and for femoral component loosening (radiographic). These patients were male, young (less than 50 years), heavy (greater than 170 pounds), and active (not Charnley class C). Given these findings, it is difficult to justify the widespread use of noncemented total hip systems, except in identifiable high-risk patients.

A major concern with the use of sublaminar wires for segmental spinal instrumentation is the risk of neurologic compromise associated with repeated passage of wires through the epidural space. Because of the inability to visualize the wire tip during its sublaminar passage, the surgeon is unable to appreciate the depth of wire penetration (DOWP). The purpose of this investigation was to determine, through direct measurement, the depth of intraspinal penetration during the passage of sublaminar wires. Using their model, the authors have been able to define the optimal parameters for safe wire passage. Careful attention to maintaining contact between the wire tip and the under-surface of the lamina, using a wire of optimal configuration, will result in minimal DOWP and reduce the possibility of neurologic compromise.

The authors compared 140 conversion with 433 primary total hip arthroplasties with a 40-month minimum follow-up period. All replacements were performed with a transtrochanteric technique. No conversion total hip arthroplasty had prior cementation. Pain was the indication for surgery. The average number of prior operations was 1.3 and the average number of months to total hip arthroplasty was 65.4. The patient characteristics for the two groups were similar. The overall results were uniformly good to excellent (94% or better) at greater than 6-year mean follow-up in both groups. The authors review important differences between the two groups. None of the differences are statistically significant. The overall results of conversion total hip arthroplasty were good to excellent, and the presence of a preoperative infection did not significantly alter the clinical results. The absence of prior bone cement in conversion total hip arthroplasty is proposed to explain these findings.

Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-year follow-up period to correlate the radiographic signs of aseptic loosening to clinical outcome, femoral cementing technique, and epidemiologic patient characteristics. High-grade femoral demarcation at the bone-cement interface (75-100%) correlated with a significantly higher incidence of unsatisfactory follow-up clinical scores. The incidence of high-grade femoral bone-cement demarcation and the associated radiographic signs of aseptic loosening had a direct correlation with the quality of the femoral cementing technique (P less than .01). Trochanter nonunion or trochanter separation demonstrated a highly significant correlation with high-grade femoral bone-cement demarcation (P less than .001). Patients having secondary total hip arthroplasty for failed cup arthroplasty or endoprosthesis had a higher rate of unsatisfactory pain and function scores, compared with those having arthroplasties performed after failed internal fixation. Male patients or patients with a high activity level demonstrated a twofold greater incidence of high-grade femoral demarcation (P less than .05). Patient weight by itself did not demonstrate any effect on radiographic outcome.