Impact of multimedia information on bronchoscopy procedure: is it really helpful?

In this study, we aimed to investigate the effect of written informed consent and comprehensive multimedia information on the anxiety level of patients, consumption of sedatives, difficulties during bronchoscopy, complications and duration of procedure. 150 patients undergoing bronchoscopy were included to this study. They were randomized into two groups Multimedia information group [MIG, n = 75] and written-informed consent group [WICG, n = 75]]. Signed written informed consent was obtained from all patients. Patients in MIG group watched comprehensive multimedia presentation. State anxiety scores of all patients were evaluated with State and Trait anxiety inventory [STAI-S]. STAI-S score of patients in MIG [40.31 +/- 8.08] was lower than patients in WICG [44.29 +/- 9.62] [P = 0.007]. Satisfaction level was higher in MIG [P = 0.001]. Statistically higher difficulties during "passage through vocal cords" and "interventions during bronchoscopy" were present in WICG group [P = 0.013 and P = 0.043, respectively]. Total midazolam dose during bronchoscopy, and duration of bronchoscopy were statistically lower in MIG patients [P < 0.001 and P = 0.045, respectively]. Difficulties during "waiting period", "passage through nasal/oral route", "applications of local anesthesia" and "complication frequency" were similar in both groups. Besides reducing the state anxiety, multimedia information can reduce the dose of sedation, shorten the processing duration and reduce the difficulties during bronchoscopy

Comprehensive out-patient pulmonary rehabilitation: treatment outcomes in early and late stages of chronic obstructive pulmonary disease

The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation [PR] in chronic obstructive pulmonary diseases [COPD] and to establish whether in early disease stage PR is as effective as in late stages of disease. A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To elucidate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council [MRC]], body composition [body mass index [BMI], fat free mass [FFM], fat free mass index [FFMI]], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life [HRQoL] with St. George Respiratory Disease Questionnaire, psycohological status [Hospital anxiety-depression [HAD] scale] were evaluated before and after PR. At the end of PR in the early disease stage group, the improvement in forced vital capacity [FVC] reached a statistically significant level [P< 0.05]. In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements[P<0.001]. HRQoL and exercise capacity were significantly improved for the two groups [P<0.001]. Psychological status evaluated with the HAD scale improved after PR [P<0.001] both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program

Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis

Invasive procedures such as bronchoscopic biopsy, bronchial washing, and bronchial brushing are widely used in diagnosis of lung cancers. The mean diagnostic rate with bronchoscopic forceps biopsy is 74% in central tumors. This study was designed to evaluate the efficacy of cryobiopsies in histopathological diagnosis. Forty-one patients who had interventional bronchoscopy were included in this study. Three forceps biopsies and one cryobiopsy with cryorecanalization probe were obtained from each subject. Biopsies interpretations were done by one expert pathologist. Hemorrhage was the only complication in both procedures. There was no significant difference between these two procedures in the incidence of hemorrhage [P > 0.05]. Mean diameters of samples taken with forceps biopsy and cryoprobe biopsy were 0.2 and 0.8 cm, respectively [P < 0.001]. Thirty-two patients [78%] were diagnosed with forceps biopsies, and 38 patients [92.7%] were diagnosed with cryoprobe biopsies [P = 0.031]. We concluded that cryoprobe biopsies were more successful than forceps biopsies in diagnosis. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy