BACKGROUND: The objective of this study was to explore the 10-year plus outcomes of Intensity Modulated Radiotherapy with concomitant chemotherapy (CRT) combined with preventive swallowing rehabilitation (CRT+) for head and neck cancer (HNC).METHODS: Subjective and objective swallowing, trismus, and speech related outcomes were assessed at 10-year plus after CRT+. Outcomes were compared to previously published 6-year results of the same cohort.RESULTS: Fourteen of the 22 patients at 6-year follow-up were evaluable. Although objective swallowing-related outcomes showed no deterioration (eg, no feeding tube dependency and no pneumonia), swallowing-related quality of life slightly deteriorated over time. No patients had or perceived trismus. Voice and speech questionnaires showed little problems in daily life. Overall quality of life (QOL) was good.CONCLUSIONS: After CRT with preventive rehabilitation exercises for advanced HNC, swallowing, trismus, and speech related outcomes moderately deteriorated from 6 to 10 years, with an on average good overall QOL after.
A systematic operation, maintenance, and rehabilitation program is an essential element in the management of a wastewater collection system. Effective inspection, cleaning, and rehabilitation are key processes for optimizing the proper functioning of a collection system. 7-1 7.1 Methods and Equipment The following information outlines the methods and equipment frequently utilized to inspect and clean gravity collection systems and pumping stations. Frequent inspection and cleaning is essential for normal functioning and problem identification. Information is also presented regarding spare parts and equipment necessary for effective operation. 7.1.1 Gravity Collection Systems Physical Inspection A physical inspection is vital to an O&M program. Without it, a maintenance program cannot be implemented in a systematic way since system problems cannot be quantified. Elements of a physical inspection program include visual and equipment-based techniques that use established industry methods of system evaluation. Physical inspections should be performed on a regularly scheduled basis as a part of the preventive maintenance program. The purpose of conducting inspections is to: • Identify what is in the system (inventory). • Identify the location of the system's components. • Determine the condition of the components (assessment). • Prevent problems from developing. Before acceptance of a newly constructed collection system, O&M personnel should conduct a physical inspection to verify the accuracy and completeness of the record drawings. Inspection before acceptance will also ensure that the new components are clear of construction debris and rocks.
Objectives: The primary objective was to determine the responsiveness of the Dutch version of the 13-item Tampa Scale for Kinesiophobia for cardiac patients (TSK-NL Heart). The secondary objective was to assess changes in kinesiophobia during cardiac rehabilitation.Methods: Kinesiophobia was measured pre- and post-cardiac rehabilitation using the TSK-NL Heart questionnaire in 109 cardiac patients (61 years; 76% men). The effect size of kinesiophobia score changes was calculated for the full population. A measure that is responsive to change should produce higher effects sizes in patients in whom kinesiophobia improves. Therefore, effect sizes were also calculated for patients who did or did not improve on selected external measures. For this step, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were completed as external measures in a subsample of 58 patients.Results: The effect size of the TSK-NL Heart for the full study population was small (0.29). In line with the study hypothesis the effect size was higher (moderate) for patients with improved CAQ (0.52) and HADS scores (0.54). Prevalence of high kinesiophobia levels decreased from 40% pre-cardiac rehabilitation to 26% post-cardiac rehabilitation (p = 0.004).Conclusion: The TSK-NL Heart has moderate responsiveness and can be used to measure changes in kinesiophobia. Improvements in kinesiophobia were observed during cardiac rehabilitation. Nevertheless, high levels of kinesiophobia were still highly prevalent post-cardiac rehabilitation.
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