Comparison between electronic and paper versions of patient-reported outcome measures in subjects with chronic obstructive pulmonary disease: an observational study with a cross-over administration.

OBJECTIVES: A wide range of electronic devices can be used for data collection of patient-reported outcome (PRO) measures in subjects with chronic obstructive pulmonary disease (COPD). Although comparisons between electronic and paper-based PRO measures have been undertaken in asthmatics, it is currently uncertain whether electronic questionnaires work equally as well as paper versions in elderly subjects with COPD. The aim of this study was to compare the responses to paper and electronic versions of the Evaluating Respiratory Symptoms in COPD (E-RS) and the COPD Assessment Test (CAT). DESIGN: A randomised cross-over design was used to compare the responses to paper and electronic versions of the two tools. The interval between the two administrations was 1 week. SETTING: Electronic versions were self-administered under supervision using a tablet computer at our outpatient clinic (secondary care hospital in Japan) while paper questionnaires completed at home were requested to be returned by mail. It was intended that half of the patients completed the electronic versions of both questionnaires first, followed by the paper versions while the other half completed the paper versions first. PARTICIPANTS: Eighty-one subjects with stable COPD were included. RESULTS: The E-RS total scores (possible range 0-40) were 6.8±7.4 and 5.0±6.6 in the paper-based and electronic versions, respectively, and the CAT scores (possible range 0-40) were 10.0±7.4 and 8.6±7.8. In both questionnaires, higher scores indicate worse status. The relationship between electronic and paper versions showed significant reliability for both the E-RS total score and CAT score (intraclass correlation coefficient=0.82 and 0.89, respectively; both p<0.001). However, both the E-RS total and CAT scores were significantly higher in the paper versions (p<0.05). CONCLUSIONS: In both cases, the two versions of the same questionnaire cannot be used interchangeably even though they have both been validated.

Balloon overtube-guided colorectal endoscopic submucosal dissection.

AIM: To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection (ESD) using a gastroscope. METHODS: The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center. In preoperative evaluation of access to the lesion, difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloon-guided ESD group. A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility. Colorectal ESD was performed following standard procedures. A submucosal fluid bleb was created with hyaluronic acid solution. A circumferential mucosal incision was made to marginate the lesion. The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives. The success of colorectal ESD, procedural feasibility, and procedure-related complications were the main outcomes and measurements. RESULTS: The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%. En bloc excision of the lesion was successfully achieved in 13 of the 15 patients (86.7%) in the balloon overtube-guided colorectal ESD group, which was comparable to the results of the standard ESD group with better accessibility to the lesion (30/30, 100%, not statistically significant). CONCLUSION: Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.

[A patient with recurrent sigmoid colon cancer in whom pleural effusion and ascites resolved after FOLFOX 4 therapy].

We performed combination therapy with oxaliplatin/l-LV/5-FU (FOLFOX 4) in a patient with recurrent colorectal cancer (a 58-year-old man) who had pleural effusion and ascites. This resulted in disappearance of the pleural effusion and ascites, as well as negative tumor markers. Surgery was performed for sigmoid colon cancer on September 29, 2004. In February 2006, abdominal swelling was observed, and CEA increased to 15 ng/mL with multiple intraabdominal tumor nodules. The patient was diagnosed as having peritonitis carcinomatosis associated with recurrent sigmoid colon cancer, and was treated with FOLFOX 4. CEA was 134.9 ng/mL before treatment, but became negative after six courses, while his pleural effusion and ascites disappeared after 10 courses of treatment. This treatment also appeared to be useful for recurrent colorectal cancer with peritoneal dissemination.