Quality of care assessment in COPD. AUDIPOC: the Spanish audit experience

There is now general knowledge illustratinga gap between the health care that patients rece-ive and the practice that is recommended by clinical guidelines [...

Differences in the use of spirometry between rural and urban primary care centers in Spain

Objectives: The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. Methods: An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. Results: Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P,0.01). The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. Conclusion: This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these area

Estudio comparativo cuantitativo del rendimiento de plataformas de E-learning libres

La presente investigación contará con una estructura cuantitativa pre-experimental donde se presenta un estudio comparativo cuantitativo del rendimiento de plataformas de e-learning libres. El objetivo principal fue diseñar una metodología para la evaluación de rendimiento de las plataformas e-learning libres y aplicarlas para determinar si las plataformas e-learning libres Atutor, Claroline, Chamilo, Moodle y Sakai tienen mayor rendimiento en términos de uso de recursos técnicos, conectividad en la red y seguridad de la Información. La muestra está conformada por cinco plataformas libres. El modelo de estudio será descriptivo y el diseño no experimental transversal-descriptivo. Por tal motivo, las plataformas se probarán en dispositivos con idénticas características de hardware y software dentro de una red, donde serán sometidas a pruebas de rendimiento como lo indican las siguientes dimensiones: (a) Utilización de recursos técnicos, (b) Conectividad en la red, (c) seguridad de la Información, (d) Usabilidad. De la misma manera se enuncian los indicadores usados en la investigación: (i) Tasa de uso de CPU, (ii) Tasa de uso de memoria RAM, (iii) Tasa de uso en el disco duro, (iv) Medida de throughput, (v) Medida de latencia, (vi) ataques denegados, (vii) Cantidad de vulnerabilidades, (viii) Accesibilidad del estudiante, (ix) número de usuario concurrentes. Dichas dimensiones e indicadores ayudarán a estudiar sus variables de comportamiento para una buena elección de una plataforma en institutos, colegios, etc

Reproductibilidad de un cuestionario que valora la actividad física en adolescentes escolares

Introducción: Los cuestionarios de actividad física por lo general son los instrumentos más sencillos y fáciles de aplicar a grandes poblaciones, sin embargo, la capacidad de reproductibilidad varía entre las poblaciones. Objetivo: Analizar la fiabilidad de un cuestionario que valora la Actividad Física en una muestra de escolares adolescentes que viven a elevada altitud por medio de consistencia interna y test re-test. Diseño: Descriptivo-Transversal (Survey). Institución: Universidad Nacional del Altiplano, Puno, Perú. Participantes: Adolescentes escolares de 12 a 17 años. Intervenciones: Fueron seleccionados de forma sistemática 109 escolares de ambos sexos. Se valoró las medidas antropométricas de peso, estatura, estatura sentada y circunferencia del abdomen. Además se aplicó un cuestionario de actividad física con 11 preguntas (test y re-test) con un intervalo de 7 días. Principales medidas: Valoración de la capacidad de reproductibilidad por consistencia interna y estabilidad. Resultados: Los valores de alpha de Cronbach (Consistencia interna) mostraron valores de 0,73 a 0,77 para ambos sexos. El Error Técnico de Medida (ETM) fue de 0,50 a 1,61% y el coeficiente de correlación de Spearman  osciló entre 0,91 a 0,95. Conclusión: El cuestionario de actividad física muestra altos valores de confiabilidad, tanto en su consistencia interna como en la estabilidad de las medidas. Introduction: Physical activity questionnaires usually are the most simple and easy to apply to large populations, however, reproducibility capacity varies between populations. Objective: To analyze the reliability of a questionnaire to assess physical activity in a sample of school adolescents living at high altitude through internal consistency and test re-test. Design: Descriptive, transversal (Survey). Institution: Universidad Nacional del Altiplano, Puno, Peru. Participants: School Teens 12 to 17 years. Interventions: There were systematically selected 109 students of both sexes. We evaluated anthropometric measurements of weight, height, sitting height and circumference of the abdomen. In addition we applied a physical activity questionnaire with 11 questions (test and re-test) with an interval of 7 days. Main measures: capacity rating for internal consistency, reproducibility and stability. Results: Cronbach's alpha values ??(internal consistency) showed values ??from 0.73 to 0.77 for both sexes. Measuring technical error (SEM) was from 0.50 to 1.61% and the Spearman correlation coefficient ranges from 0.91 to 0.95. Conclusion: The physical activity questionnaire shows high values ??of reliability, consistency both internally and in the stability of the measures

Research highlights from the 2018 European Respiratory Society International Congress: Airway disease

The annual European Respiratory Society (ERS) International Congress (held in Paris in 2018) was once again a platform for discussion of the highest-quality scientific research, cutting-edge techniques and innovative new therapies within the respiratory field. This article discusses only some of the high-quality research studies presented at this year’s Congress, with a particular focus on airway diseases including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and cough, as presented through Assembly 5 of the ERS (Airway Diseases: Asthma and COPD). The authors establish the key take-home messages of these studies, compare their findings and place them in the context of current understanding.Health Research Boar

Identification of oxidative stress related proteins as biomarkers for lung cancer and chronic obstructive pulmonary disease in bronchoalveolar lavage

Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) commonly coexist in smokers, and the presence of COPD increases the risk of developing LC. Cigarette smoke causes oxidative stress and an inflammatory response in lung cells, which in turn may be involved in COPD and lung cancer development. The aim of this study was to identify differential proteomic profiles related to oxidative stress response that were potentially involved in these two pathological entities. Protein content was assessed in the bronchoalveolar lavage (BAL) of 60 patients classified in four groups: COPD, COPD and LC, LC, and control (neither COPD nor LC). Proteins were separated into spots by two dimensional polyacrylamide gel electrophoresis (2D-PAGE) and examined by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/TOF). A total of 16 oxidative stress regulatory proteins were differentially expressed in BAL samples from LC and/or COPD patients as compared with the control group. A distinct proteomic reactive oxygen species (ROS) protein signature emerged that characterized lung cancer and COPD. In conclusion, our findings highlight the role of the oxidative stress response proteins in the pathogenic pathways of both diseases, and provide new candidate biomarkers and predictive tools for LC and COPD diagnosis

Mixed Th2 and non-Th2 inflammatory pattern in the asthma-COPD overlap : a network approach

Altres ajuts: The authors are grateful to all the patients who participated in the study. A number of investigators contributed to the study logistics and they are listed in the Supplementary materials. The project was endorsed by the COPD and Asthma Research Board (PII de EPOC y asma) of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR).The asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical condition that combines features of those two diseases, and that is difficult to define due to the lack of understanding of the underlying mechanisms. Determining systemic mediators may help clarify the nature of inflammation in patients with ACO. We aimed at investigating the role and interaction of common markers of systemic inflammation (IL-6, IL-8, and tumor necrosis factor-α), Th2-related markers (periostin, IL-5, and IL-13), and IL-17 in asthma, COPD, and ACO. This is a cross-sectional study of patients aged ≥40 years with a post-bronchodilator forced expiratory volume in the first second/forced vital capacity 10 pack-years in a patient with a previous diagnosis of asthma or by the presence of eosinophilia in a patient with a previous diagnosis of COPD. Clinical, functional, and inflammatory parameters were compared between categories using discriminant and network analysis. In total, 109 ACO, 89 COPD, and 94 asthma patients were included. Serum levels (median [interquartile range]) of IL-5 were higher in asthma patients than in COPD patients (2.09 [0.61-3.57] vs 1.11 [0.12-2.42] pg/mL, respectively; p =0.03), and IL-8 levels (median [interquartile range]) were higher in COPD patients than in asthma patients (9.45 [6.61-13.12] vs 7.03 [4.69-10.44] pg/mL, respectively; p <0.001). Their values in ACO were intermediate between those in asthma and in COPD. Principal component and network analysis showed a mixed inflammatory pattern in ACO in between asthma and COPD. IL-13 was the most connected node in the network, with different weights among the three conditions. Asthma and COPD are two different inflammatory conditions that may overlap in some patients, leading to a mixed inflammatory pattern. IL-13 could be central to the regulation of inflammation in these conditions

Triple therapy for COPD: A crude analysis from a systematic review of the evidence

We systematically reviewed the current knowledge on fixed-dose triple therapies for the treatment of chronic obstructive pulmonary disease (COPD), with a specific focus on its efficacy versus single bronchodilation, double fixed dose combinations, and open triple therapies. Articles were retrieved from PubMed, Embase, and Scopus up to 3 August 2018. We selected articles with randomized controlled or crossover design conducted in patients with COPD and published as fulllength articles or scientific letters, evaluating triple therapy combinations in a single or different inhaler, and with efficacy data versus monocomponents, double combinations, or open triple therapies. Our systematic search reported 108 articles, of which 24 trials were finally selected for the analysis. A total of 7 studies with fixed dose triple therapy combinations, and 17 studies with open triple therapies combinations. Triple therapy showed improvements in lung function [trough forced expiratory volume (FEV1) ranging from not significant (NS) to 147 ml], health status using the St. George’s Respiratory Questionnaire [(SGRQ) from NS to 8.8 points], and exacerbations [risk ratio (RR) from NS to 0.59 for all exacerbations] versus single or double therapies with a variability in the response, depending the specific combination, and the comparison group. The proportion of adverse effects was similar between study groups, the exception being the increase in pneumonia for some inhaled corticosteroid (ICS) containing grou

COPD Clinical Control : predictors and long-term follow-up of the CHAIN cohort

Control in COPD is a dynamic concept that can reflect changes in patients' clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394-3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758

Machine Learning-Based Analysis in the Management of Iatrogenic Bile Duct Injury During Cholecystectomy: a Nationwide Multicenter Study

Background Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. Methods This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. Results We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. Discussion Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients