In recent years, we have seen the integration of magnetic resonance imaging (MRI) simulators into radiotherapy centres and the emergence MR linear accelerators (MR-linac). Currently, there are limited studies to demonstrate the clinical effectiveness of MRI guided radiotherapy (MRIgRT) treatment for breast cancer patients. The objective of this scoping review was to identify and map the existing evidence surrounding the clinical implementation of MRIgRT for breast cancer patients. We also identified the challenges and knowledge gaps in the literature. The scoping review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews reporting guidelines. Titles and abstracts were screened by two independent reviewers. Quantitative and qualitative data were extracted and summarised using thematically organised tables. Results identify that accelerated partial breast irradiation (APBI) is the most common form of treatment for MRIgRT. The presence of the magnet does not affect target coverage or violate organ at risk (OAR) constraints compared to standard radiotherapy methods. Consideration is advised for skin and chest wall (CW) due to the electron return effect (ERE) and areas such as armpit and chin due to the electron stream effect (ESE). Clinically, bolus has been used to protect and prevent unwanted dose in these areas. Overall treatment for APBI on the MR-linac is feasible.

Purpose To report on rectal dosimetric and toxicity outcomes of intermediate and high-risk prostate cancer patients undergoing combined high-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT) with or without hydrogel spacer (HS) insertion. Material and methods A total of 97 patients were analyzed in this study, with 32 patients (33%) who had HS insertion compared with a preceding group of 65 patients (67%) without HS. HS safety, the dosimetric effects on organs at risk (rectal, urethral, penile bulb, and bladder) as well as gastrointestinal (GI) and genitourinary toxicity were evaluated and compared between the two groups. Results The median prostate-rectal separation achieved with HS was 10 mm (range, 5-14 mm). There were no post-operative complications following HS insertion. Patients with HS had significantly lower radiation dose to the rectum across all rectal dose volumes from rV30 to rV80, whether in absolute volume (cc) or as percentage of contoured OAR (p < 0.001). There was also significantly less acute > grade 1 GI toxicity (12.5% vs. 30.8%, p = 0.05) and a trend towards less late grade 1 GI toxicity (0% vs. 7.7%; p = 0.11) in the HS group compared to the non-HS group. Conclusions Insertion of HS in prostate cancer patients receiving combined HDR and EBRT is safe and has resulted in a significant radiation dose reduction to the rectum, resulting in significantly less acute GI toxicity and a trend towards less late GI toxicity.

IntroductionBurn care represents a healthcare and economic burden to patients internationally. Choice of the most clinically effective treatment strategies requires evidence which is best obtained through high-quality randomised controlled trials (RCT). The number of published RCTs of burn care is increasing. However, trial quality and reporting standards are unclear. This study will assess the risk of bias and adequacy of reporting in recent burn care RCTs using tools endorsed by the Cochrane Collaboration.Methods and analysisA systematic literature review will be undertaken, assessing parallel group RCTs evaluating therapeutic interventions for patients with cutaneous burns. Literature searches will use Ovid Medline, Ovid Embase, Web of Science and the Cochrane Library. Separate searches for each database will include medical subject heading and free text terms including ‘burn’, ‘scald’, ‘thermal injury’ and ‘RCT’. Two reviewers will independently assess each study for inclusion. Risk of bias (RoB) will be assessed with the revised tool (RoB 2) and reporting completeness with the CONsolidated Standards of Reporting Trials (CONSORT) 2010 guidelines. We will report a narrative synthesis of all studies, including domain specific, and overall risk of bias for the primary outcome of each trial. Inter-rater agreement for RoB 2 will be reported using Fleiss’s Kappa. For adherence to the CONSORT guidelines, we will generate a completeness of reporting index for the five domains.Ethics and disseminationNo ethics approval is required because published documents will be used. Findings of the study will be disseminated in a peer-reviewed journal and presented at conferences.PROSPERO registration numberCRD42018111020.

Background: An increasing number of systematic reviews are published on an annual basis. Although perusal of the full text of articles is preferable, abstracts are sometimes relied upon to guide clinical decisions. Despite this, the abstracts of systematic reviews have historically been poorly reported. We evaluated the reporting quality of systematic review abstracts within hand and wrist pathology literature. Methods: We searched MEDLINE®, EMBASE and Cochrane Library from inception to December 2017 for systematic reviews in hand and wrist pathology using the 12-item PRISMA-A checklist to assess abstract reporting quality. Results: A total of 114 abstracts were included. Most related to fracture (38%) or arthritis (17%) management. Forty-seven systematic reviews (41%) included meta-analysis. Mean PRISMA-A score was 3.6/12 with Cochrane reviews having the highest mean score and hand-specific journals having the lowest. Abstracts longer than 300 words (mean difference [MD]: 1.43, 95% CI [0.74, 2.13]; p <0.001) and systematic reviews with meta-analysis (MD: 0.64, 95% CI [0.05, 1.22]; p = 0.034) were associated with higher scores. Unstructured abstracts were associated with lower scores (MD: –0.65, 95% CI [–1.28, –0.02]; p = 0.044). A limitation of this study is the possible exclusion of relevant studies that were not published in the English language. Conclusion: Abstracts of systematic reviews pertaining to hand and wrist pathology have been suboptimally reported as assessed by the PRISMA-A checklist. Improvements in reporting quality could be achieved by endorsement of PRISMA-A guidelines by authors and journals, and reducing constraints on abstract length.

The importance of a multidisciplinary collaborative approach to urological radiation complications is highlighted in a recent study by Ma et al. 1. Their single-centre retrospective study adds to the existing body of knowledge, and the controversy in the field, regarding radiotherapy complications and toxicities from the urological perspective. The work provides some meaningful information about a subsection of patients presenting to one of the largest urology units in Australia. Furthermore, the study is well critiqued by the accompanying editorial that underscores many of the issues 2. The Austin urology unit has a strong partnership in uro-oncology with radiation and medical oncology. Consequently it has developed considerable expertise in the management of uro-oncology complications. Nevertheless, some aspects of this study could be improved to produce more robust data. One such aspect is the number of patients included in the case series, which represented only a 6-month snapshot of patients who had a median (interquartile range) time to onset of complications of 4 (1–9) years. Furthermore, the sample represented only a small fraction of patients from one discipline rather than the entire department, which is made up of multiple disciplines including radiation oncology and medical oncology. The severe complication rates across the oncology disciplines, surgery, chemotherapy and radiotherapy are similar but they differ in their type and timing. Defining late radiotherapy complications can be difficult, particularly without radiation oncology input, including dosimetry, because they can occur years after treatment and can be confused with disease progression or other traumatic events. Notably, the urology unit represents one of the largest in the state and has a strong collaborative relationship with radiation oncology. Thus, it expertly manages radiotherapy complications from many other large centres besides the Austin centre. This would imply that the published sample was not truly reflective of the patients treated solely by the Austin Radiation Oncology Department. The editorial notes that almost two-thirds of patients were treated with standard external beam radiotherapy. It also highlights that <20% were treated with intensity-modulated radiotherapy, a superior technique that has been shown to reduce toxicity, which is further diminished with image-guided radiotherapy 2. The Austin centre has treated all patients with prostate cancer with intensity-modulated radiotherapy and image-guided radiotherapy for more than a decade. Consequently, measures of frequency, incidence and prevalence; that is, how common the complications are, cannot be calculated because the denominator in terms of patients at risk and period of time is unknown. As late effects of radiotherapy occur over many years and radiotherapy is used frequently for pelvic malignancies, including the most common male cancer (prostate cancer), the denominator is likely to be large. Highlighting information on the fistula rates was also potentially misleading, given a previous analysis and audit of prostate radiotherapy at the Austin Uro-Oncology department 3. This showed a low toxicity profile and a low fistula rate among patients that was consistent with the published literature, which is 0.1% 4, not dissimilar to the reported 30-day mortality rate after prostatectomy 5 and similar to the severe urinary stricture rate after external beam radiotherapy alone. These severe complication figures would be more useful and more lessons would be learned if their occurrence were examined in light of the concomitant surgical procedures or endoscopic interventions 6. Severe late radiation complications are more common when external beam radiotherapy is associated with prostatectomy and brachytherapy. Sometimes, despite best intentions, irradiated tissues do not behave normally as a result of incoherent vessels, poor oxygenation and a greater propensity for scarring and are therefore more prone to severe strictures and fistulae. Hence instrumentation and endoscopic procedures, including TURP, bladder neck incisions and rectal biopsy, should be undertaken with the necessary consideration of these risks. The radiotherapy environment is often compromised and there is a small risk that such interventions will precipitate a major complication, such as severe stricture and fistula. Appropriate care should be taken and meticulous technique applied to radiotherapy-affected tissues as wound healing can be impaired and there is a risk of radiation necrosis of surrounding tissues. These collaborative lessons have been well learnt in other areas, such as dental work after head and neck radiation and surgery after preoperative radiotherapy for rectal cancer. In summary, the existence of late urological complications after radiotherapy reported by Ma et al. should not be a reason to potentially dismiss the value of radiotherapy in the management of prostate cancer, given the low overall toxicity profile reported by our group. While it was perceived that radiotherapy complications are more common than previously thought for the short time period defined, the true incidence cannot be calculated without the appropriate denominator. Previous department audits have shown the rate to be low, consistent with the existing literature, and similar to severe complication rates after surgery and chemotherapy. Radiotherapy has been shown to be an effective treatment of prostate cancer, similarly to surgery 7), both in the non-metastatic setting and recently at the oligometastatic stage 8. If anything, the study by Ma et al. highlights the importance of maintaining accurate patient records, the need for more ongoing clinical trials and the establishment of strong multidisciplinary exchange among health professionals as to why these variations of frequency may be occurring and how we could work together to minimize and manage the potential adverse effects of all uro-oncology treatments. This is particularly important with radiotherapy as serious toxicity can occur years after treatment, unlike surgery where the severe complications occur during or shortly after the procedure. Urologists play the primary and crucial role in the expert treatment of urological radiotherapy side effects, thereby supporting radiation oncology; however, just as they manage severe urological complications referred from fellow urologists and other surgeons, collaboration and discussion with a radiation oncologist is also important to ensure correct diagnosis and appropriate documentation, and that other medical treatments, such as hyperbaric oxygen, are considered. None declared.

To evaluate the methodological quality and reporting standards of systematic reviews in radiation dermatitis. Computerized searches were performed using Ovid MEDLINE (1946-2019), Ovid EMBASE (1947-2019) and The Cochrane Library (2005-2019) for systematic reviews relevant to radiation dermatitis using medical subject headings and free-text terms such as ‘radiodermatitis’, ‘radiation-induced skin injuries’, ‘systematic review’ or ‘meta-analysis’. Manual searches of the reference lists of relevant reviews were also conducted. Methodological quality was evaluated using the 16-item A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) tool and reporting quality evaluated using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) checklist. In addition, we used the seven critical domains in AMSTAR-2 (Q2: registered protocol, Q4: adequate literature search, Q7: justification for excluding studies, Q9: risk of bias from individual studies, Q11: appropriateness of meta-analysis, Q13: risk of bias when interpreting review results & Q15: publication bias) and the four classification rankings (high, moderate, low and critically low) to rate the overall confidence in the review findings. Our initial search revealed 37 systematic reviews, of which 24 were excluded leaving 13 reviews to form the basis of this study. With the AMSTAR-2 critical domains, only four reviews reported on a priori design and the literature search (31%), while 5 described study exclusion (38%). Conversely, the impact of risk of bias on results was reported in nine reviews (63%). With PRISMA, most reviews described study rationale (n=12, 92%), objectives (92%), eligibility criteria (100%), study selection (85%), study characteristics (100%) and study results (85%). Overall, 12 reviews were classified critically low or low quality by having more than one critical flaw, making it impossible to be seen as an accurate summary of the available studies. Only one study was ranked as high making it an accurate and comprehensive summary of the results of the available studies Even with the availability of checklists, there is still need for ongoing development by clinicians in systematic review methodology. Additional demands for systematic review training along with journal editors adhering manuscripts to higher methodological reporting standards is warranted.

INTRODUCTION:To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients.METHODS:Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan-Meier method. Regression analysis was conducted to identify important predictors of outcomes.RESULTS:A total of 24 patients received an initial HDR-BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58 months. The 5-year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%.CONCLUSION:The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.

PURPOSE:The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed.MATERIALS AND METHODS:A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients.RESULTS:No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV70) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm.CONCLUSION:The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to “maim, disfigure, torture or kill” [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.

PURPOSE:The purpose of this study was to characterize retracted studies within the field of radiation oncology. METHODS AND MATERIALS:Computerized searches were performed in Ovid MEDLINE, PubMed, Ovid EMBASE, and the Cochrane Library up to May 2017 looking for retracted studies using the terms "retraction note," "retracted note," "withdrawn" and "radiotherapy," and "radiation oncology." Additional studies were identified by hand-searching 10 discipline-specific journals. Two authors independently screened papers and then extracted author demographics, journal characteristics, and retraction-specific variables. RESULTS:Of the 58 studies identified, the most common reasons for retraction were misconduct (43%), methodological error (21%), authorship issues (5%), unknown causes (5%), and journal (administrative) errors (3%). A total of 13 systematic reviews or protocols (22%) were withdrawn from the Cochrane Library for being out-of-date or redundant. All but one retracted study and retraction notice were available in portable document format. Of the 57 retrieved papers, 79% were identified as retracted via in-text notations or watermarks. Overall median time to retraction was 44 months (interquartile range, 11-98 months). However, 42 studies (72%) were still cited after retraction notices were published. CONCLUSIONS:A retracted study within the field of radiation oncology remains a relatively uncommon event. Although promising, our data suggest that the majority of these retracted articles continue to be cited as valid research. As such, there is still a need for clinicians to remain vigilant with their academic rigor and good clinical research practices. There is an urgent need for publication houses to foster universal publishing standards along with discipline-specific retraction guidelines.

Objective To report on the dosimetric benefits and late toxicity outcomes after injection of hydrogel spacer ( HS ) between the prostate and rectum for patients treated with prostate radiotherapy ( RT ). Patients and Methods In all, 76 patients with a clinical stage of T1–T3a prostate cancer underwent general anaesthesia for fiducial marker insertion plus injection of the HS into the perirectal space before intensity‐modulated RT ( IMRT ) or volumetric‐modulated arc RT ( VMAT ). HS safety, dosimetric benefits, and the immediate‐ to long‐term effects of gastrointestinal ( GI ) toxicity were assessed. Results There were no postoperative complications reported. The mean (range) prostate size was 66.0 (25.0–187.0) mm . Rectal dose volume parameters were observed and the volume of rectum receiving 70 Gy ( rV 70 ), 75 Gy ( rV 75 ) and 78 Gy ( rV 78 ) was 7.8%, 3.6% and 0.4%, respectively. In all, 21% of patients (16/76) developed acute Grade 1 GI toxicities, but all were resolved completely by 3 months after treatment; whilst, 3% of patients (2/76) developed late Grade 1 GI toxicities. No patients had acute or late Grade ≥2 GI toxicities. Conclusion Injection of HS resulted in a reduction of irradiated rectal dose volumes along with minimal GI toxicities, irrespective of prostate size.

AIM:This study aimed to evaluate and compare the performance of two methodological instruments to appraise systematic reviews and to identify potential disagreements of systematic review authors regarding risk of bias (RoB) evaluation of randomized controlled trials (RCTs) included in systematic reviews on peri-implant diseases.MATERIAL/METHODS:We searched Medline, Web of Science, Cochrane Library, PubMed Central, and Google Scholar for systematic reviews on peri-implant diseases published before July 11, 2017. Two authors independently evaluated the RoB and methodological quality of the systematic reviews by applying the Risk of Bias in Systematic Reviews (ROBIS) tool and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist, respectively. We assessed the RoB scores of the same RCTs published in different systematic reviews.RESULTS:Of the 32 systematic reviews identified, 23 reviews addressed the clinical topic of peri-implantitis. A high RoB was detected for most systematic reviews (n=25) using ROBIS, whilst five systematic reviews displayed low methodological quality by AMSTAR. Almost 30% of the RoB comparisons (for the same RCTs) had different RoB ratings across systematic reviews.CONCLUSIONS:The ROBIS tool appears to provide more conservative results than AMSTAR checklist. Considerable disagreement was found among systematic review authors rating the same RCT included in different systematic reviews.

OBJECTIVES:To comprehensively report on the characteristics of retracted publications in the field of dentistry. METHODS:We searched MEDLINE (via PubMed), PubMed Central, Web of Science and Google Scholar databases for dental retracted articles from database inception to 02 July 2018. In addition, we scanned the search engine Google Scholar, and the website, Retraction Watch (www.retractionwatch.com), for retracted dental articles. Two researchers independently screened titles, abstracts and full text of search results. Descriptive data was collected on each retracted article including reason for retraction, study type, journal impact factor, and time between publication and retraction. Regression models were used to evaluate the association between journal impact factor and retraction characteristics. RESULTS:A total of 138 retractions of dental articles were included. Reasons for retraction were misconduct (N = 100, 72.5%), with the most frequently reported misconduct being overlap/plagiarism and innacurate/falsified conducting and reporting (N = 53, 38.4%). In vitro (N = 39, 28.3%), case reports (N = 29, 21%) and narrative reviews (N = 19, 13.8%) were study design most frequently identified in retracted articles. The median time between article publication and date of retraction notice was 1 year (interquartile-range [IQR] = 0-2 years). More than half of the retracted articles (n = 82, 59.4%) were cited post-retraction. A retracted article reporting a randomized controlled trial was more likely to appear in journal with higher impact factor than a retracted case report (mean difference [MD] = 2.2; 95% confidence interval [CI] = 1.2,3.1. Articles retracted after 2012 were likely to appear in journals with a lower impact factor (MD=-1.3; 95%CI=-1.8, 0.8). CONCLUSIONS:Research misconduct is the main reason for retraction of dental articles. A substantial proportion of these articles were still being cited after their retraction. CLINICAL SIGNIFICANCE:This report of dental retraction articles informs that more transparency is needed with data reporting in dentistry to improve writing practices in dentistry. A more complete report of retractions and their causes would provide more accurate information to inform researchers and editors to avoid or reduce future cases of retractions. More complete and accurate reporting would increase the overall trust in dental research.

Este artigo examina a dinâmica acerca da negociação e articulação da relação corpo-tecnologia caracterizando necessariamente a experiência de ser-na-cidade. Em nenhum outro lugar a experiência cotidiana é mais mediada pela tecnologia do que na cidade. Ser-na-cidade envolve o ser encarnado pela tecnologia em níveis que vão do micro ao macro. Apesar do fato de que a tecnologia é constantemente desenvolvida no espaço da cidade, relações com a tecnologia tendem a se tornarem rapidamente normalizadas – mundanas – transparentes. Dada esta normalização, assim como a omnipresença da tecnologia na constituição do espaço da cidade, é importante examinar as formas como a tecnologia vem moldar os contextos experienciais da vida cotidiana. No espaço urbano tecnologias resultam em novas cenas a serem vistas, sons a serem ouvidos, aromas a serem cheirados, gostos a serem saboreados, texturas a serem sentidas, bem como modos totalmente novos de experienciar o cotidiano. Ao explorar a dinâmica em torno da negociação e articulação contínua em várias camadas da relação corpo-tecnologia que caracteriza necessariamente a experiência de ser na cidade, uma perspectiva fenomenológica é adotada. Os escritos de Heidegger sobre tecnologia, os de Merleau-Ponty sob corporeidade e percepção e os de Don Ihde sobre o corpo e a tecnologia, contribuem para o quadro teórico para um exame fenomenológico das implicações experienciais do Ser-na-cidade, uma ecologia tecnológica.

The objective of this study was to assess methodological and reporting quality of systematic reviews in hand and wrist pathology. MEDLINE, EMBASE and Cochrane Library were searched from inception to November 2016 for relevant studies. Reporting quality was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and methodological quality using a measurement tool to assess systematic reviews, the Assessment of Multiple Systematic Reviews (AMSTAR). Descriptive statistics and linear regression were used to identify features associated with improved methodological quality. A total of 91 studies were included in the analysis. Most reviews inadequately reported PRISMA items regarding study protocol, search strategy and bias and AMSTAR items regarding protocol, publication bias and funding. Systematic reviews published in a plastics journal, or which included more authors, were associated with higher AMSTAR scores. A large proportion of systematic reviews within hand and wrist pathology literature score poorly with validated methodological assessment tools, which may affect the reliability of their conclusions. Level of evidence: I

Systematic reviews may provide less biased evidence than narrative reviews because they observe a strict methodology, similarly to primary studies. Hence, for clinical research questions, systematic reviews should be the study design of choice. It would be important to evaluate the prevalence and characteristics of narrative and systematic reviews published in prominent medical journals. Researchers and clinicians give great value to articles published in such scientific journals. This study sought to evaluate the prevalence and characteristics of narrative and systematic reviews in the five highest-ranked general medical journals and investigate the associations among type of review, number of citations, and impact factor (IF).

Objective: Diphoterine is a hypertonic, amphoteric, polyvalent and chelating decontamination solution used in the treatment of cutaneous and ocular chemical burns. Due to infrequent use by emergency physicians along with the small number of available studies, its debate in the literature as to its efficacy and safety remains inconclusive. Methods: A structured literature search was performed in MEDLINE, EMBASE BIOLOGICAL ABSTRACTS and TOXNET to June 2016 for original English-language studies reporting on the safety and effectiveness of Diphoterine. Methodological and reporting quality of pre-clinical animal studies was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tool and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Clinical studies were assessed using Chambers' criteria. Results: 13 studies (seven in the pre-clinical, five in the clinical setting and one mixed) met the study inclusion criteria. Pre-clinical studies showed a faster resolution of pH and reduced tissue necrosis with Diphoterine. Clinical studies showed reduced tissue necrosis/severity of symptoms, faster pH resolution and a reduction in pain when using Diphoterine. No adverse events were attributable to Diphoterine. Reporting and methodology of the studies was poor or showed a high risk of bias. Conclusions: Diphoterine appears to be safe to use and is probably superior to other rinsing solutions. However, immediate decontamination is imperative and if Diphoterine is not available a different rinsing solution should be used. The methodology of the published literature for Diphoterine is generally poor and future publications should use the frameworks given as templates. Crown Copyright (C) 2017 Published by Elsevier Ltd. All rights reserved.

This paper examines dynamics surrounding the negotiation and articulation of the body-technology relationship necessarily characterizing the experience of being-in-the-city. Nowhere is everyday experience more mediated by technology than in the city. Being-in-the-city involves being embodied by technology at levels ranging from micro to macro. Despite the fact that technologies are constantly evolving in city space, relations with technology tend to become quickly normalized — mundane — transparent. Given this normalization as well as the sheer pervasiveness of technology in constituting city space it is important to examine the ways in which technology comes to shape the experiential contexts of everyday life. In urban space, technologies result is new sights to be seen, sounds to be heard, smells to be smelt, textures to be felt, as well as altogether new modes of experiencing the everyday. In exploring the dynamics surrounding the ongoing, multi-layered negotiation and articulation of the body-technology relationship necessarily characterizing the experience of being-in-the-city a phenomenological perspective is adopted. Heidegger’s writing on technology, Merleau-Ponty’s writing on embodiment and perception, and Don Ihde’s writing on the body and technology contribute to a theoretical framework for a phenomenological examination of the experiential implications of being-in-the-city, a technological ecology.

Background Skeletal muscle spasticity is a major physical complication resulting from traumatic brain injury (TBI), which can lead to muscle contracture, joint stiffness, reduced range of movement, broken skin and pain. Treatments for spasticity include a range of pharmacological and non-pharmacological interventions, often used in combination. Management of spasticity following TBI varies from other clinical populations because of the added complexity of behavioural and cognitive issues associated with TBI. Objectives To assess the effects of interventions for managing skeletal muscle spasticity in people with TBI. Search methods In June 2017, we searched key databases including the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid) and others, in addition to clinical trials registries and the reference lists of included studies. Selection criteria We included randomised controlled trials (RCTs) and cross-over RCTs evaluating any intervention for the management of spasticity in TBI. Only studies where at least 50% of participants had a TBI (or for whom separate data for participants with TBI were available) were included. The primary outcomes were spasticity and adverse effects. Secondary outcome measures were classified according to the World Health Organization International Classification of Functioning, Disability and Health including body functions (sensory, pain, neuromusculoskeletal and movement-related functions) and activities and participation (general tasks and demands; mobility; self-care; domestic life; major life areas; community, social and civic life). Data collection and analysis We used standard methodological procedures expected by Cochrane. Data were synthesised narratively; meta-analysis was precluded due to the paucity and heterogeneity of data. Main results We included nine studies in this review which involved 134 participants with TBI. Only five studies reported between-group differences, yielding outcome data for 105 participants with TBI. These five studies assessed the effects of a range of pharmacological (baclofen, botulinum toxin A) and non-pharmacological (casting, physiotherapy, splints, tilt table standing and electrical stimulation) interventions, often in combination. The studies which tested the effect of baclofen and tizanidine did not report their results adequately. Where outcome data were available, spasticity and adverse events were reported, in addition to some secondary outcome measures. Of the five studies with results, three were funded by governments, charities or health services and two were funded by a pharmaceutical or medical technology company. The four studies without useable results were funded by pharmaceutical or medical technology companies. It was difficult to draw conclusions about the effectiveness of these interventions due to poor reporting, small study size and the fact that participants with TBI were usually only a proportion of the overall total. Meta-analysis was not feasible due to the paucity of data and heterogeneity of interventions and comparator groups. Some studies concluded that the intervention they tested had beneficial effects on spasticity, and others found no difference between certain treatments. The most common adverse event was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all outcomes. Authors' conclusions The very low quality and limited amount of evidence about the management of spasticity in people with TBI means that we are uncertain about the effectiveness or harms of these interventions. Well-designed and adequately powered studies using functional outcome measures to test the interventions used in clinical practice are needed.