Objective: To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients.

Background: Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for de-escalation strategies.

Methods: Embase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed.

Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5-16.8, P<0.005) and 24.2% (95% confidence interval: 12.1-36.3, P<0.005), respectively. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities.

Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated. ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. The findings support the continued drive to de-escalate axillary surgery.

Objective: To describe headache characteristics over time in patients with traumatic brain injury (TBI).

Setting: Patients enrolled and followed at the National Institutes of Health Clinical Center between 2011 and 2020.

Participants: There were 147 patients with TBI, with 74 mild TBI (mTBI), 49 moderate (modTBI), 24 severe (sTBI), and 20 individuals without brain injury (IWBIs).

Design: Regular surveys of headache characteristics in patients with TBI were conducted. Patients were enrolled as early as 30 days post-injury and followed up to 5 years, for 419 total visits and 80 patients with multiple return visits.

Main Measures: Surveys of headache characteristics, including headache severity, were measured on a 0- to 10-point Likert scale and headache frequency quantified as headaches per month. Patients with migraine-type headaches (n = 39) were identified by a clinician-administered tool. Functional outcomes were measured using the Glasgow Outcome Scale-Extended (GOS-E) and quality of life by the Satisfaction with Life Scale (SWLS) and the 36-item Short Form Survey (SF-36).

Results: At their initial visit, patients with TBI had more severe and frequent headaches than IWBIs (median 5 vs 2.5, P < .001; median 2 vs 0.2, P < .001), as did patients with mTBI compared with modTBI/sTBI (all P <= .01). Migraines were associated with lower SWLS and SF-36 scores. Migraines and young age were associated with higher headache severity and frequency across time points. Longitudinally, time post-injury correlated with improvement in headache severity and frequency without differences by injury severity. However, time post-injury did not correlate with improvement in headache characteristics in a patient subgroup with moderate/severe headaches.

Conclusion: Our findings suggest that patients with mild, moderate, or severe TBI see improvement in headaches over time. However, patients should be counseled that improvement is modest and seen more in patients with milder headache symptoms. Patients with migraine headaches in particular are at risk for worse headache characteristics with greater impact on quality of life.

Introduction. Male breast cancer is rare and frequently diagnosed at later stages of disease with low survival rates. There is a lack of knowledge of how breast cancer impacts men’s occupations. Objectives. This study is aimed at understanding the lived experiences of men with breast cancer and their changes in occupation. Methodology. Twenty-four men with breast cancer participated in semistructured phone interviews. Data was open-coded and analyzed for themes. Findings. The six major themes are as follows: (1) death as a reality, (2) unique personal insights, (3) social environment, (4) interactions with the healthcare system, (5) decreased engagement in occupations, and (6) finding meaning in new occupations. Conclusion. The healthcare team can improve the patient experience by discussing and responding to the client’s experience throughout the diagnosis, intervention, and survival continuum. The scope of occupational therapy is well suited to address the needs of men with breast cancer to maintain optimal levels of functioning.

Background
Dysphagia can have serious health implications including choking and respiratory infection leading to poorer quality of life. People with intellectual disabilities are at higher risk of dysphagia related health complications and early death. Robust dysphagia screening tools are vital for this population.

Method
A scoping review and appraisal of the evidence for dysphagia and feeding screening tools for use with people with intellectual disabilities was undertaken.

Results
Seven studies (using six screening tools) met the review inclusion criteria. Mostly studies were limited by no defined dysphagia criteria, no verification of tools with a gold reference standard (e.g., videofluoroscopic examination) and lack of participant diversity (small samples, narrow age range, severity of intellectual disability or limited settings).

Conclusions
There is urgent need for development and rigorous appraisal of existing dysphagia screening tools to meet the needs of a wider range of people with intellectual disabilities (particularly mild-to-moderate severity) and in wider settings.

With an estimated 5 million breast cancer survivors in 2030,1 it is important for the breast specialist to understand the impact recommended treatments have on patients to lessen the unwanted effects and improve the overall quality of life. This article explores what patients need beyond good outcomes to maintain a satisfactory quality of life. Quality of Life scoring systems cannot fully describe the subjective effects of cancer and its treatment. These metrics instead reflect the degree of patients’ social support and lend evidence to patients’ resilience. Subjective scores are minimally affected by measurable morbidities as patients adjust to their new baseline tolerating the side effects of treatment and minimizing the impact on their daily life. Instead of discussing the quality of life scores, this article aims to review the intangible effects of breast cancer treatment, the more concrete side effects of systemic and local therapy, and offer strategies to mitigate them.

Dr O’Riordan, a breast cancer surgeon who is also a breast cancer survivor, offers her insights from the patient’s perspective, discussing those aspects of patient care that aren’t easily measured or often discussed—that is, sex, intimacy, and fear of recurrence. This is followed by a more didactic review of the commonly investigated side effects of systemic and local treatment. We hope to arm the clinician with the tools necessary to discuss strategies that support behavior modifications and interventions to improve the quality of life for our patients with breast cancer.

Background: Research has shown that individuals diagnosed with lung cancer suffer from decreased exercise capacity and health-related quality of life. There is a need to determine the effect of specific exercise intervention on exercise capacity and health-related quality of life in the non-small cell lung cancer population in order for exercise to be incorporated into the standard of care.

Purpose: The purpose of this systematic review was to determine the effects of exercise training on exercise capacity and quality of life in patients who have undergone treatment for non-small cell lung cancer.

Methods: Three databases were searched for articles that met the inclusion criteria. The search resulted in a total of 332 articles with 16 that met the criteria for inclusion.

Results: Eight of the 16 studies showed significant improvement in exercise capacity and 4 showed significant improvement in quality of life with exercise training.

Discussion and Limitations: This review provided limited evidence that exercise training in addition to usual care will provide improvement in overall exercise capacity and quality of life in this population. Limitations included reports of small sample size in the articles included, few databases searched, and heterogeneity of exercise programs.

Conclusions: This systematic review supports exercise training as a method for improving exercise capacity and health-related quality of life in patients who have been diagnosed with non-small cell lung cancer. Further research must be done with more subjects and exercise protocols to make specific recommendations for exercise training in this population.

Objective
The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables.

Methods
Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care).

Results
Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the “Timed Up and Go” Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects.

Conclusion
The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise.

Impact
The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.

Abstract: The aim of this study was to compare the effectiveness of two treatment modalities for patients diagnosed with borderline personality disorder (BPD). A total of 100 psychiatric patients diagnosed with BPD participated in this study. Among them, 50 patients were outpatients who attended the Reason and Emotion (RIO) program, and the remaining 50 were inpatients who were treated on psychotherapeutic ward at the same hospital. All the participants filled out the following battery of tests when entering the program/psychotherapy ward and 3 months later: Rosenberg's Self-Esteem Scale, Tennessee Self-Concept Scale (2nd ed), Barratt Impulsiveness Scale, The COPE Inventory, and the WHOQOL-BREF scale. The results showed significant positive effects of both treatment modalities on patients' self-esteem, different domains of self-concept, impulsivity, and different domains of subjective quality of life. No significant changes were observed in terms of coping strategies. Thus, the results speak in favor of the outpatient RIO program, which is more cost-effective than the inpatient ward treatment.

Learning objectives: After completing this activity, practitioners will be better able to:

* Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"

* Set up a process for providing effective interventions for the increased number of patients with adolescent depression

* Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand

Abstract: Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.

Objective: To systematically review the problem of appetite loss after major abdominal surgery.

Summary of Background Data: Appetite loss is a common problem after major abdominal surgery. Understanding of etiology and treatment options is limited.

Methods: We searched Medline, Cochrane Central Register of Controlled Trials, and Web of Science for studies describing postoperative appetite loss. Data were extracted to clarify definition, etiology, measurement, surgical influence, pharmacological, and nonpharmacological treatment. PROSPERO registration ID: CRD42021224489.

Results: Out of 6144 articles, we included 165 studies, 121 of which were also analyzed quantitatively. A total of 19.8% were randomized, controlled trials (n = 24) and 80.2% were nonrandomized studies (n = 97). The studies included 20,506 patients undergoing the following surgeries: esophageal (n = 33 studies), gastric (n = 48), small bowel (n = 6), colon (n = 27), rectal (n = 20), hepatobiliary (n = 6), and pancreatic (n = 13). Appetite was mostly measured with the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30, n = 54). In a meta-analysis of 4 randomized controlled trials gum chewing reduced time to first hunger by 21.2 hours among patients who had bowel surgery. Other reported treatment options with positive effects on appetite but lower levels of evidence include, among others, intravenous ghrelin administration, the oral Japanese herbal medicine Rikkunshito, oral mosapride citrate, multidisciplin-ary-counseling, and watching cooking shows. No studies investigated the effect of well-known appetite stimulants such as cannabinoids, steroids, or megestrol acetate on surgical patients.

Conclusions: Appetite loss after major abdominal surgery is common and associated with increased morbidity and reduced quality of life. Recent studies demonstrate the influence of reduced gastric volume and ghrelin secretion, and increased satiety hormone secretion. There are various treatment options available including level IA evidence for postoperative gum chewing. In the future, surgical trials should include the assessment of appetite loss as a relevant outcome measure.

Primary caregivers face constant challenges because of changes in the clinical situation of the person receiving palliative home care. These changes can alter the health-related quality of life and all its dimensions. This study aimed to describe the health-related quality of life of 137 primary caregivers of people enrolled in a palliative home care program in Bogota, Colombia, applying a quantitative, descriptive, and cross-sectional research design. The Caregiver's Quality of Life Instrument, initially developed by Ferrell, and the sociodemographic characteristics form for caregivers of people with chronic disease, both previously validated in the Colombian population, were used. The results showed that the primary caregivers have a good and adequate overall health-related quality of life; however, they presented some alterations in the physical, psychological, and social dimensions. Therefore, nursing and interdisciplinary palliative care teams should aim their interventions not only at patients but also at primary caregivers during palliative home care.

Nous connaissons les effets de l’activité physique sur notre corps. Il en va de même pour notre cerveau, pour qu’il soit en santé, il faut bouger?! Sous l’effet de la pratique régulière de l’exercice, notre cerveau transforme littéralement sa structure avec de nouveaux vaisseaux sanguins, des neurones tout neufs et même un hippocampe plus gros, protégeant ainsi nos fonctions cognitives et notre mémoire des effets du temps qui passe.?Ce qui a pour effet de nous rendre durablement plus «?zen?», moins stressés, moins anxieux, moins déprimés, meilleur dormeur, plus concentré et moins dépendant de certains comportements et substances nuisibles.

Dans l'autisme, la transition vers l'âge adulte est très souvent un moment difficile. Difficile tout d'abord pour la personne concernée, mais aussi éprouvante pour ses proches.. Cette période s'inscrit en effet dans un contexte de transformations personnelles et contextuelles, où il va s'agir de s'adapter, de modifier ou de fabriquer des environnements nouveaux.. Les transformations personnelles concernent tout à la fois les modifications neuropsychologiques et somatiques observées durant l'adolescence, que les évolutions cliniques du trouble, dans lesquelles on note souvent l'apparition de nouvelles associations avec d'autres psychopathologies (anxiété, dépression...). Et, pour certains sujets, beaucoup plus rares, c'est aussi l'annonce d'un diagnostic tardif, avec toutes ses conséquences.. Mais l'entrée dans l'âge adulte, c'est aussi une profonde modification de l'environnement du sujet : recherche d'une formation ou d'un emploi, d'un logement, d'un partenaire. Ces contraintes, surdéterminées par le poids des normes sociales, vont nécessiter la mise en place de soutiens, de programmes, d'interventions qui vont mobiliser les parents, la fratrie, mais aussi les employeurs, les personnels éducatifs, et parfois nécessiter des aménagements législatifs et sociétaux concernant ce que certains nomment un « handicap ».. Ce livre, à partir d'une revue de la littérature internationale centrée sur ce thème, et même si beaucoup d'articles concernent l'autisme sans déficience intellectuelle, aborde toutes ces questions.. Il n'y a pas à ce jour de réponses « clés en main ». Chaque pays, parfois chaque région apporte son lot de solutions. Mais, dans tous les cas, une synthèse méritait d'être proposée aux personnes concernées ou intéressées par cette problématique..

There have been no quantitative studies on dysphagia and its impact on quality of life (QOL) of adults with cerebral palsy (CP). In this cross-sectional study, we aimed to investigate the characteristics of dysphagia symptoms and their impact on QOL in adults with CP on a full oral diet compared with healthy adults. Additionally, we aimed to determine the factors affecting dysphagia-related QOL in this population. We enrolled adults with CP on full oral diet (N = 117) and healthy individuals (N = 117) and interviewed them using the swallowing-quality of life (SWAL-QOL) questionnaire which includes 14 items regarding dysphagia symptoms and 30 items regarding swallowing-related QOL. The functional status of each participant with CP was evaluated using the gross motor function classification system, the manual ability classification system (MACS), and the Functional Oral Intake Scale (FOIS). Among pharyngeal symptoms, choking on food was reported most frequently (sometimes or more 76.9%), followed by coughing and choking on liquid. Among oral symptoms, chewing problems were reported most frequently (sometimes or more 59.8%), followed by food dribbling from the mouth (sometimes or more 53.8%). Compared to healthy adults, those with CP reported worse QOL across all SWAL-QOL items, with the lowest scores obtained for meal duration, followed by communication, burden, fatigue, sleep, and eating desire. On multiple linear regression analysis, higher MACS level, lower FOIS level, and older age were predictors of worse SWAL-QOL score. Among adults with CP, it is necessary to evaluate swallowing function and establish an active intervention plan even if a full oral diet is established.

[Purpose] The purpose of this study was to examine the effects of time-use intervention on the quality of life of outpatients with chronic stroke. [Participants and Methods] This study randomly allocated 31 chronic stroke outpatients into an experimental group (n=16) and a control group (n=15). The experiment group was given general rehabilitative therapy three times per week for eight weeks, and time-use intervention through counselling once per week for eight weeks. The control group was given general rehabilitative therapy only for three times per week for eight weeks. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to measure the changes in the quality of life of the participants. [Results] After the intervention, the experimental group showed a significant improvement in the overall quality of life in comparison with the control group. Looking at specific categories, the experimental group showed significant improvements in the physical, spiritual, and environmental areas in contrast to the control group. [Conclusion] The findings of this study demonstrated the positive effects of time-use intervention on an improvement in the quality of life of outpatients with chronic stroke.