Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment.

OBJECTIVE: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema. METHODS: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005. RESULTS AND CONCLUSIONS: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2-3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women.

Using statistical process control methods to improve herd performance.

Statistical process control (SPC) is a set of analytic methods that uses the theory of variation as a means of explaining with statistical certainty when process performance is improving, staying the same, or getting worse. SPC techniques have been used successfully for 80 years in manufacturing as a quality management tool. It is apparent that these techniques can be applied equally well to livestock production systems. The availability of large amounts of automatically collected data, the advances in computer capability, and the obvious need for more timely fact-based information for day-to-day management make SPC application the next step in improving herd management quality.