Ultrasound Assessment Of Diaphragmatic Function During Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Pilot Study.

Purpose: Impairment of diaphragmatic function is one of the main pathophysiological mechanisms of chronic obstructive pulmonary disease (COPD) and is known to be related to acute exacerbation. Ultrasonography (US) allows for a simple, non-invasive assessment of diaphragm kinetics. The purpose of this study was to investigate the changes in diaphragmatic function during acute exacerbation of COPD, by US. Methods: This single-center, prospective study included patients with acute exacerbation of COPD symptoms. US measurements were performed within 72 hrs after exacerbation and after improvement of symptoms. Diaphragmatic excursion and its thickening fraction (TF) were measured as markers of diaphragmatic function. TF was calculated as (thickness at end inspiration - thickness at end expiration)/thickness at end expiration. Results: Ten patients were enrolled. All patients were male, and the mean age was 79.8 years. The TF of the right diaphragm showed a significant increase from the initial to the follow-up values (80.1 ± 104.9 mm vs. 159.5 ± 224.6 mm, p = 0.011); however, the diaphragmatic excursion did not vary significantly between the initial and follow-up values (22 ± 6 mm vs 23 ±12 mm). The change in excursion between the stable and exacerbation periods was positively correlated with time to the next exacerbation and negatively correlated with the time taken to recover from the exacerbation. Conclusion: These data support the possibility that a defect in diaphragm thickening is related to acute exacerbation of COPD.

Transcultural Adaptation and Validation of the Family Satisfaction in the Intensive Care Unit Questionnaire in a Korean Sample.

BACKGROUND: A number of questionnaires designed for analyzing family members' inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. METHODS: The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). RESULTS: In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman's r = 0.84, p < 0.001). Cronbach's αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). CONCLUSIONS: The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members' satisfaction about ICU care.

Effectiveness of smoking cessation using motivational interviewing in patients consulting a pulmonologist.

BACKGROUND: We aimed to investigate the role of the physician in practice and the factors that influence the success rate of smoking cessation. METHODS: This study retrospectively analyzed 126 adult smokers who had visited the outpatient department of pulmonology, and received motivational interviewing with or without supplement drugs. The findings include continuous smoking abstinence rate, which was evaluated at 6, 12 and 24 weeks, and the factors associated with continuous abstinence for 6 months or longer. RESULTS: The patients with only motivational interviewing accounted for 57.9%, while the nicotine patch therapy was applied to 30.2%; and varenicline was prescribed to 11.9%. The smoking cessation success rates of at 6, 12, and 24 weeks were 55.6%, 47.6%, and 33.3%, respectively. However, even in the failure group at six months, tobacco consumption was decreased under 10 cigarettes per day in 42.1% (53/126). In multivariate logistic regression analysis, degree of Fagerstöm Test for Nicotine Dependence (p=0.034; odds ratio, 3.607; 95% confidence interval [CI], 1.102-1.807), the absence of smoking-related lung disease (p=0.008; odds ratio, 4.693; 95% CI, 1.497-14.707), and education level (p=0.001; odds ratio, 181.420; 95% CI, 8.414-3,911.502) were the predictors of successful smoking cessation. CONCLUSION: An improved continuous smoking abstinence rate can be obtained by motivational interviewing, regardless of the association with pharmacotherapy.