Physiological changes to the swallowing mechanism following (Chemo)radiotherapy for head and neck cancer: a systematic review

Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study’s inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC

A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer

Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1–T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4–6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4–6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB

Inflation and the World Demand-for-Money Function

The aim of this study is to test at world level for the period 1957 to 1971 the contention that, in accordance with the monetarist inflation thesis (i. e. the money growth-inflation relationship), world inflation can be controlled by controlling the world money supply. In this connection the present paper investigates (a) the hypothesis that under a fixed exchange rate regime, national inflation rates converge, moving in a systematic and predictable fashion consistent with purchasing power parity, and (b) the demand-for-money function at the level of the aggregate of fourteen advanced countries (as a proxy for the world). The work presented here is an extension and integration of previous research by the authors published in earlier issues of Kredit und Kapital (1977 and 1979). The results indicate that the world demand-for-money function significantly depends on both income and interest rates but that its form changed between the mid-1960s and 1971. Thus the elasticities determining this function are unstable and pedictions based on them would therefore be unreliable. One might argue, of course, that there are a number of additional determinants that ought to be included in any world demand-for-money function relating to the period close to the 1970s. Hence is these influences are not included in the function, we are bound to get unstable elasticities. The resulting policy implication of this analysis for the design of an anti-inflation policy is that it is highly doubtful whether world inflation can in fact be controlled in a predictable fashion by simply controlling the world money supply. (This is not to say that a reduction in the rate of increase of the world money supply would have no beneficial effect on world inflation.) The paper further challenges the interpretation of the function in the late 1960s und early 1970s. The fact that a simple autoregressive scheme can explain so much implies that it is not economic criteria which govern the function. If a lagged endogenous variable ends up by absorbing the greatest portion of the dependent variable’s variation, the whole function boils down to being determined by an autonomous growth. Through this process, the world demand-for-money function evaporates