Assessment of physical functioning in patients with chronic obstructive pulmonary disease (COPD) requiring long-acting dual bronchodilation in routine clinical practice.

OBJECTIVE: We aim to determine the effect of a fixed-dose combination (FDC) of tiotropium/olodaterol on Physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) in a real world setting. METHODS: COPD patients were prospectively enrolled to evaluate the effect of a FDC of tiotropium/olodaterol inhaler therapy via the Respimat® Soft Mist™ inhaler (SMI) on the physical functioning scale (PF-10), and the general condition of the patient as assessed by the physician (Physician's Global Evaluation, PGE), and the patient's satisfaction after 6 weeks of treatment. The primary end-point was the percentage of patients with therapeutic success at 6th week follow-up, defined as a ≥10-points increase in the standardised PF-10 score from baseline. RESULTS: A total of 257 patients from 57 sites were enrolled, and 234 completed the follow up. After 6 weeks of treatment, 155 out of 234 patients (66.2%) showed therapeutic success in the physical functioning score, coupled with significant improvement in PGE score: 78 (33.3%) patients with good/excellent PGE score at baseline, increasing to 172 (73.5%) at 6th week (p<0.0001). The patient's satisfaction was excellent: 77.2% reporting to be satisfied/very satisfied with the treatment, 79.9% with inhaling and 79.0% with the handling of SMI device. 1.6% of patients reported an investigator-defined drug-related adverse event. CONCLUSION: Treatment of COPD patients with a FDC of tiotropium/olodaterol SMI for 6 weeks resulted in significant improvements in the patients' condition as assessed by patients and physicians, with no new safety findings.

Tumour markers in serum, bronchoalveolar lavage and biopsy cytosol in lung carcinoma: what environment lends the optimum diagnostic yield?

BACKGROUND: The aim of this study was to assess the diagnostic yield of the tumour markers carbohydrate antigen (CA 125), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC) and specific tissue polypeptide antigen (TPS) in serum, bronchoalveolar lavage (BAL) and biopsy cytosol in a group of patients with bronchogenic carcinoma. METHODS: Serum, BAL and biopsy cytosol samples were collected in a group of 85 patients with benign or malignant pulmonary diseases. After appropriate processing, tumour markers were determined by enzyme immunoassay. The diagnostic yields (sensitivity, specificity and accuracy) in each environment (serum, BAL or biopsy) were obtained by using "ROC" curves. RESULTS: Determined individually, CA 125, NSE and SCC show the greatest diagnostic accuracy in cytosol. CEA and TPS do so in BAL. CEA is the most relevant marker in serum and BAL, and CA 125 in cytosol. When the different tumour markers are associated, they offer better overall yields for all except TPS. CONCLUSIONS: For the factors evaluated in this study, determination of CEA in BAL was clinically the most useful marker in comparison with serum and cytosol determinations, although the latter may also be helpful in certain situations. Although there is no specific tumour marker for lung cancer, the combination of several can be used to monitor most patients with lung cancer.

Medicina de familia: ¿la cenicienta del pregrado? Estudio de la opinión de los estudiantes de medicina sobre la especialidad de medicina familiar y comunitaria / Family medicine: the cinderella of undergraduate studies? Study of the views of medical students about the speciality of family and community medicine

Objetivo. Conocer la opinión de los estudiantes del último curso de medicina (EM) sobre la especialidad de medicina familiar y comunitaria (MFyC).Diseño. Estudio transversal mediante cuestionario autoadministrado. Emplazamiento. Facultades de medicina de las Universidades de Oviedo y Cantabria. Participantes. EM de sexto curso y con posibilidades de finalizar su licenciatura el año 2000.Intervenciones. Cuestionario de 22 preguntas de elección múltiple, incluyendo valoración sobre formación pregrado en MFyC y opinión sobre su inclusión como asignatura, elección de la especialidad en el próximo examen MIR, prestigio de la MFyC, selección de profesional para tratar patologías comunes en atención primaria y conocimiento de una actividad (gestión de incapacidad temporal) del médico de familia (MF).Resultados principales. De los 94 EM encuestados, un 73 por ciento no había tenido formación teórica en MFyC, pero un 89 por ciento sería partidario de incluirla en el programa de la licenciatura. Un 6 por ciento desearía ejercer como MF. Un 77 por ciento creía que el prestigio de la MFyC era equiparable a otras especialidades y el resto que era inferior, aunque aumentaría para la mitad de éstos si el MIR de MFyC durara 4 años. Un 50 por ciento no elegiría al MF para tratar patologías comunes en atención primaria de salud. Un 55 por ciento identificaba al MF como el profesional capacitado para dar la baja por enfermedad común. Conclusiones. La falta de formación en MFyC en el pregrado se perfila como la causa del desinterés, desprestigio y desconocimiento de esta especialidad entre los EM (AU)

DNA aneuploidy, S-phase fraction and nuclear p53 positivity in non-small cell lung carcinoma.

OBJECTIVES: Surgical resection currently offers the best option for managing non-small cell lung carcinoma (NSCLC) but its efficiency is limited by subsequent tumor recurrence. We evaluated whether flow cytometric study and the p53 gene staining pattern may be useful in this respect. DESIGN AND METHODS: We took biopsy samples of 40 patients with operable NSCLC to study the frequency of aneuploidy, proliferative activity, and alterations in the p53 tumor suppressor gene and compared them with clinicopathological parameters such as age, gender, smoking, histological type, tumor size, and degree of differentiation. To study DNA content, the nuclei were analyzed by flow cytometry using a FACS flow cytometer (Becton-Dickinson) equipped with an argon ion laser, with a propidium iodide excitation of 488 nm. We used the immunohistochemical technique for p53 analysis in samples of paraffin-embedded tissue corresponding to the same patients from whom fresh tissue was taken. RESULTS: Nuclear p53 staining was detected in 66.7% of the samples; 69.4% of the cases revealed aneuploid DNA histograms and 59% presented with an S phase fraction of more than 12%. Comparison with clinicopathological parameters showed that p53 protein was associated significantly with histological classification (p = 0.04), gender (p = 0.01), and smoking (p = 0.04). CONCLUSIONS: Immunodetection of p53 overexpression and DNA ploidy in the bronchial epithelium may be a useful tool in any future multifactorial analysis in such tumors for identifying previous lesions that may progress to malignancy.

Tumor markers in lung cancer: does the method of obtaining the cut-off point and reference population influence diagnostic yield?

OBJECTIVES: The aim of this study was to evaluate the clinical usefulness of the tumor markers CA125, CEA, NSE, SCC, and TPS in a group of patients with lung cancer. We estimated the influence of the method for choosing the cut-off point and of considering as a reference population either healthy controls or patients with some form of non-neoplastic pulmonary disease (NNPD). DESIGN AND METHODS: The tumor markers were determined using enzyme immunoassay techniques, and their diagnostic yield was evaluated using ROC curves and their correlation with the percentages between false and true positives. The diagnostic parameters of the tumor markers are presented in 116 patients with lung cancer and compared with a group of 25 healthy controls and another group of 80 patients with some form of NNPD. We determined on the one hand the cut-off points resulting from the best sensitivity-specificity balance in the ROC curves and on the other those resulting from considering a specificity of 95%. With the two cut-offs we studied the different diagnostic parameters: sensitivity, specificity and accuracy or area below the ROC curve. RESULTS: Optimum diagnostic yield is obtained when we choose the cut-off point determined by the best balance of sensitivity and specificity in the ROC curves and take a healthy population as a reference group. The cut-off values for CA125, CEA, NSE, SCC, and TPS were 24 U/mL, 2.8 ng/mL, 9.8 ng/mL, 1.6 ng/mL, and 67.8 U/L, respectively. CONCLUSIONS: Our results suggest that in future studies on tumor markers, a group of healthy subjects should be used as a reference population and ROC curves should be used to obtain the optimum cut-offs.

Changes in the relationship between child support payments and educational attainment of offspring, 1979-1988.

We examine changes over the 1980s in the effect of child support payments on the educational attainment of children age 16 to 19 in the United States, and why child support has a stronger impact than other sources of income. We use 1979 and 1988 Current Population Survey data, covering a period when improvements in enforcement should have increased the proportion of reluctant fathers paying support. We hypothesize and find that the positive effect of child support on education diminished somewhat over this period, both absolutely and in relation to other income.

[Difficult patient in dentistry. Construction of a model of personal attributes for identification]. / El paciente dificil en odontologia. Elaboracion de un modelo de atributos personales para identificarlo.

The communication between the dentist and the patient, or what we have called dentist-patient relationship constitute itself a clue to solve primary problems derived of the professional practice. In this relationship with patients, the dentist may face what we have called difficult patient. This difficult patient have several behavioral characteristics which can alter the dentist emotional equilibrium, the capacity of making proper diagnosis and finally a successful treatment may not be obtain as an end result. The difficult patient behavior may be explained by a variety of factors such as: the type of pathology, the office environment, the community and/or institution to which the patient belongs, the dentist emotional circumstance and at last the patient life style. In this research work, we interview 50 professionals from the metropolitan area with an average of 18 years in practiCe, each dentist explained situations in which the patient behavior could be typified as difficult. A number of 202 difficult patient cases were obtained and they were classified into 14 categories. 5 categories presented a higher frequency: a) Schedule and/or appointment timing. b) Patients not following instructions and/or altering treatment. c) Anxious patients. d) Patients unhappy with their treatment. e) Authoritarian patients or patients without good manners. This 5 categories were present in the 60% of the situations and can be taken as a model with specific behavioral characteristics as to identify the difficult patient. This is valuable in order to manage this type of patients and be successful.