Feasibility and Efficacy of Inspiratory Muscle Training in Patients with Head and Neck Cancer receiving Concurrent Chemoradiotherapy.

OBJECTIVES: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) often experience pulmonary symptoms. This study evaluated if a 7-week inspiratory muscle training (IMT) program during CCRT is feasible, adherent, and safe in patients with HNC. This study also evaluated the effect of IMT on diaphragm thickness, mobility, and cardiorespiratory parameters in patients with HNC receiving CCRT. METHODS: Ten participants with advanced stage HNC receiving CCRT were recruited for the study. Feasibility, adherence, and safety of the intervention were the primary outcomes. Changes in diaphragm thickness and mobility, maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, forced expiratory volume in first second and functional capacity using 6-MWT were measured at baseline and post 7 weeks of CCRT. IMT was performed at one session per day for 5 days a week for 7 weeks. Eight sets of two minutes of inspiratory manoeuvres with one minute rest period between them with intensity of 40% MIP were given. RESULTS: Ten participants  were included in this study out of the 13 patients screened, indicating the feasibility to be 76.9%. Participants completed a total of 260 training sessions out of the 350 planned sessions denoting the adherence level as 74%. Diaphragm thickness and MEP remained significantly unchanged while significant decline was seen in diaphragm mobility, MIP,FVC, FEV1 and 6-MWD at the end of 7 weeks. No adverse events were reported following the intervention. CONCLUSION: Inspiratory muscle training did not show significant effect on the diaphragm thickness, mobility, and cardiorespiratory parameters; however, it was feasible, adherent, and safe in patients with HNC receiving CCRT.

Perception and practice regarding infection control measures in Radiology department during pre-COVID and COVID times-A survey among radiologists and a review of current concepts and literature.

AIM: In this study, we aim to evaluate the perception and practice of IPC measures by Radiologists during pre-COVID and present COVID times, while conducting a thorough review of current concepts and literature, to provide a standard operating procedure (SOP) for radiology operations. METHODS: This study was conducted by Department of Radiodiagnosis and Imaging, Kasturba Medical College, MAHE, Mangalore. After obtaining approval from the institutional ethics committee, and other required permissions, the Google form questionnaire was sent to 350 Radiologists via email and text during the period of May 2020. Data was collected by time-based sampling in the period of fifteen days during the end of the total lockdown time. RESULTS: 54% (n = 152) reported never attending a training session on (Infection Prevention & Control) IPC prior to the COVID-19 outbreak. The perception regarding IPC were found to be good among radiologists as majority of the respondents were correctly able to answer questions regarding IPC. 86% (n = 152) of the respondents believed that their knowledge on IPC has improved during the COVID-19 pandemic. However, it was revealed that majority of the respondents only started to practice appropriate contact and droplet / procedural precautions only after the COVID-19 outbreak. CONCLUSION: The present COVID-19 scenario coupled with the lack of knowledge and training regarding IPC amongst radiologists evident from the results of our survey, highlights the need for proper training and establishing standard operating procedures and best practices in IPC pertinent to modern radiology practice.

Role of Physiotherapy in Hospice Care of Patients with Advanced Cancer: A Systematic Review.

OBJECTIVE: To review the role of physiotherapy and its effects in hospice care of patients with advanced cancer. METHODS: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, CINAHL and PEDro. The search strategy was devised, articles were screened, and 2 independent reviewers conducted data extraction. Eligible studies were methodologically assessed for quality rating using modified Downs and Black's checklist. The extracted data was summarized according to site/stage of cancer, details of intervention, outcome measures and the results. RESULT: The total number of screened articles were 2102, out of which 9 were identified as suitable for the purposes of comprehensive review. The studies included exercise therapy, massage therapy, relaxation therapy, compression bandaging and use of TENS as the various physiotherapy interventions under consideration. Studies were generally of low to moderate quality. A broad range of outcomes were employed including physical symptoms like loss of function, pain, fatigue, edema, sleep disturbances and quality of life. The findings of the studies supported the benefits of the interventions. CONCLUSION: A structured exercise protocol, massage therapy, TENS and compression bandaging are useful in alleviating the symptoms experienced by patients with advanced cancer in hospice care. The reduced symptom burden has reflected as an improvement in their quality of life. However, there is a further need for high quality studies to strengthen the findings of this review.