Effect of Integrated Survivorship Model on Physical Health for Breast Cancer Survivors in Rural Area.

OBJECTIVE: The objective of this study was to evaluate the effect of the integrated survivorship model on the physical health of breast cancer survivors in rural areas. METHODS:  Ninety-two patients who were breast cancer survivors were selected as per inclusion criteria and divided into two groups (control group and intervention group). The participants were randomly allotted to two groups of 46 each. A 12-minute walk test, assessment of quality of life, and difficulty in return to work were used as outcome measures. The integrated survivorship model was implemented in one group for 3 months while the other group was a supporting group and was involved in household activities only. Pre-assessment and post-assessment were taken to evaluate the effect of the integrated survivorship model. All the statistical analysis was done using SPSS statistical Software (version 23.0 for Windows; SPSS, Inc., Chicago, USA) and the results were obtained. RESULTS: The results revealed that the assessment of the 12-minute walk test, physical well-being, social/family well-being, functional well-being, and difficulty in returning to work showed extremely significant results in the intervention group with a p-value of less than 0.0001. Similarly, emotional well-being and additional concern domains showed significant results in the intervention group. Hence, the findings of this study revealed significance in post-assessment in all the outcome measures of the experimental group. CONCLUSION: The study showed that all the outcome measures such as the 12-minute walk test, assessment of quality of life, and difficulty in return to work were impaired in both groups before the study. The effect of the model showed a significant improvement in the intervention group after implementing the intervention.

Effect of Neural Tissue Mobilization on Sensory-Motor Impairments in Breast Cancer Survivors with Lymphedema: An Experimental Study.

BACKGROUND: Breast surgery, Axillary Lymph Node Dissection (ALND), radiation and chemotherapy may develop several complications such as axillary web syndrome, frozen shoulder, numbness, shoulder pain and range of motion restriction, lymphostasis, and lymphedema. Up to 77% report sensory disturbance in the breast or arm after breast surgery. These short- and long-term consequences have dramatic impact on physical function and quality of life in this population. AIMS: The aim of the study was to determine the effect of neural tissue mobilization on sensory-motor impairments in breast cancer survivors with lymphedema. SUBJECTS AND METHODS: This study was carried out by analyzing total 100 breast cancer survivor women, with lymphedema aged between 30-65 years of age who had undergone breast surgery mostly lumpectomy along with chemotherapy or radiation therapy. Participants were divided into two groups by random allocation. One group underwent neurodynamic mobilization and the other group conventional physiotherapy.The treatment protocol was given for 6 weeks. Parameters such ROM, pain, lymphedema and sensory-motor impairments were assessed at the baseline before the treatment and 6 weeks after the treatment. RESULT: The result from this study shows that there is significant improvement (p<0.0001, t-value 4.69) in mTNS of patients undergoing neural tissue mobilization,whereas there was no significant improvement (p=0.05, t-value 1.951) seen in patients undergoing conventional physiotherapy. CONCLUSION: This study concludes that effect of neural tissue mobilization has significant impact on sensory motor impairments as compared to conventional treatment protocol in breast cancer survivors with lymphedema.Pain and ROM showed similar difference with both the treatment protocols. It was also observed that patients with mild and moderate lymphedema showed significant improvement as compared to patients with severe lymphedema.

Estimation of Temporomandibular Joint Dysfunction in Oral Cancer Survivors.

BACKGROUND: The Objective of this study was estimation of Temporomandibular joint dysfunction in oral cancer survivors. METHODS: The hundred patients with oral cancer who had undergone radiotherapy or chemotherapy were randomly selected as per inclusion criteria. Range of motion of temporomandibular joint(TMJ), visual analogue scale (VAS), Manual muscle testing (MMT), Auscultation test, Chvostek test and swelling over orofacial muscles were used as the  Outcome measures. RESULTS: The findings of this study revealed that the Temporomandibular joint was significantly dysfunctional. The group analysis demonstrated statistically significant impairments in all the Outcome measures. VAS (p<0.0001), ROM for all four motions (p<0.0001), Manual muscle testing (p<0.0001), Provocation test (52%), Auscultation test (92%), Chvostek Test (4%), and swelling (56%) were all shown significant dysfunction of TMJ. CONCLUSION: This study showed that pain was increased during activity than at rest based on the findings of VAS pain rating scale. It was found that the range of motion of TMJ was significantly reduced; however muscular strength was minimally affected. Majority of survivors were tested positive for the provocation test and auscultation test and few for Chvostek test which indicated the involvement of facial nerve.

Estimation of Neural Tissue Mobility in Breast Cancer Survivors with Lymphedema.

BACKGROUND: Lymphedema in breast cancer survivors is a very common condition which progressively may lead to entrapment  neuropathy. In lymphedema there is accumulation of fluid due to removal of lymph nodes which causes stretching of nerve fibres within the skin, compression on top of the nerve bundle leading to nerve entrapment. This will increase the neural mechanosensitivity and functional impairment of shoulder as a protective neural response to movement or traction. METHODS: This study was carried out by assessing the total 72 breast cancer survivor women, with lymphedema. Out of 72, 28 of women underwent lumpectomy, 12 underwent quadrantectomy and 32 underwent unilateral mastectomy.  These subjects were assessed for neural tissue mobility by taking pain assessment using visual analogue scale (VAS), range of motion (ROM) using goniometer, lymphedema measurement using an inch tape. The neural tissue mobility for  median nerve, ulnar nerve and radial nerve was measured using limb tension test. RESULT: The result obtained from this study showed that neural tissue mobility was significantly impaired in breast cancer survivors with lymphedema. The result of the upper limb tension tests showed 32 women with mild lymphedema had median nerve affected on the involved side 54.1%, about  21 women had moderate lymphedema with 75% of women had median and 25% ulnar nerve affected with median nerve affected in majority of women. Only 19 women with severe lymphedema had all the three nerves affected. CONCLUSION: This study of women who have undergone surgical intervention for breast cancer concludes that there was significant amount of neural tissue impairment noted to mechanical provocation test post operatively after 6 months of surgery. The study suggests that severity of lymphedema was directly related to the nerves affected due to neural tissue impairment.

Experimental validation of optimized fast terminal sliding mode control for level system.

This research article presents a process control application of a single-input single-output (SISO) level control system using the combination of fast terminal sliding mode control (FTSMC) and optimization method. Non-dominated sorted genetic algorithm-ii (NSGA-ii); a modern optimization technique is used to optimized the parameters of FTSMC. Here, a comparative analysis of conventional sliding mode control (SMC), FTSMC, NSGA tuned FTSMC and NSGA-ii tuned FTSMC has being carried out through MATLAB/ Simulink. The performance indices such as integral absolute error (IAE), integral square error (ISE), and integration of weighted errors have been considered as the objective functions. The robustness of the controller is tested through real-time experimentation. The stability is obtained by using Lyapunov stability criteria. Simulation and experimental results show that NSGA-ii tuned FTSMC method outperforms the conventional methods and the error is converging to zero in a finite-time. Also, NSGA-ii tuned FTSMC provides better-estimated setpoint and disturbance rejection responses.

Analysis of Spinal Dysfunction in Breast Cancer Survivors with Lymphedema.

BACKGROUND: To study and analyse the spinal dysfunction in breast cancer survivors with lymphedema. METHODS: This study was carried out by analysing total 116 breast cancer survivor women, who were having lymphedema. Out of 116 subjects, 39 undergone radical mastectomy (RM), 39 undergone modified radical mastectomy (MRM) and 38 undergone breast conserving surgery (BCS). Thesesubjects were assessed for spinal function bytaking range of motionusing goniometer, lymphedema measurement usinginch tape, spinal stability test and functional rating index. RESULTS: The spinal range of motion wassignificantly reduced in patients suffering from lymphedema in breast cancer survivors. The strength and endurance were significantly reduced in abdominals, extensors and lateral muscles of spine. There wasmarked effect seen on quality of life of patients assessed by using functional rating index due to spinal dysfunction in lymphedema patients. CONCLUSION: This study showed that there is statistically significant spinal dysfunction caused due to lymphedema in breast cancer survivors.

Early access programs: Benefits, challenges, and key considerations for successful implementation.

Early access programs, (EAPs) are adopted by an increasing number of pharma companies due to several benefits offered by these programs. EAPs offer ethical, compliant, and controlled mechanisms of access to investigational drugs outside of the clinical trial space and before the commercial launch of the drug, to patients with life-threatening diseases having no treatment options available. In addition to the development of positive relationships with key opinion leaders (KOL), patients, advocacy groups and regulators, the data captured from the implementation of EAPs supports in the formulation of global commercialization strategies. This white paper outlines various circumstances to be considered for the implementation of EAPs named patient programs, the regulatory landscape, the benefits and challenges associated with implementing these programs and the key considerations for their successful implementation.