A case scenario study for the assessment of physician's behavior in the management of COPD: the WHY study

WOS: 000443757800002PubMed ID: 30233165Purpose: COPD diagnosis is mainly based on clinical judgment of physicians. Physicians do not also refer to COPD guidelines in their daily practice. This study aimed to assess attitudes of physicians regarding COPD diagnosis, treatment, and follow-up and to identify the factors influencing physicians' decisions in clinical practice. Patients and methods: Fifty physicians were selected from 12 EuroStat NUTS 2 regions and asked to assess seven fictitious case scenarios. The following five scenarios described patients with COPD: Case Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-smoker and Case GOLD A-nonsmoker were previously undiagnosed patients presenting with dyspnea, Case GOLD D-smoker and GOLD B-exsmoker were COPD patients presenting with exacerbation, Case GOLD B-smoker was a previously diagnosed COPD patient with dyspnea in stable phase, Case asthma-COPD overlap syndrome, and Case obesity hypoventilation syndrome. Patients' history, physical examination findings, pulmonary function tests, and X-ray images were prepared before the study by an experts' committee and provided to the physicians upon their request, until they reached a final decision. The physicians completed a questionnaire including information about their clinical practices and institutions. Results: According to the GOLD 2015 recommendations, of the physicians, 44% performed guideline-concordant diagnosis in the first five scenarios, who were all COPD patients, and 6% performed guideline-concordant diagnosis in all cases. There was a negative correlation between high workload and making a guideline-concordant diagnosis (P=0.038, rho =-0.417). Even when the physicians made a guideline-concordant diagnosis of COPD, only a minority (10%-22%) used the GOLD classification. Logistic regression analysis revealed that working in a tertiary health care center was a significant factor in favor of establishing a guidelineconcordant diagnosis of COPD (P=0.029, OR = 6.139 [95% CI: 1.20-31.32]). Conclusion: Management of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians' clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.Novartis Pharmaceuticals, TurkeyWe thank Clinical Research Manager Clinical Research Organization who provided editorial support and performed statistical analysis funded by Novartis Pharmaceuticals, Turkey

Reclassification of Hereditary Cancer Genes Variants

In this study, pathogenic, likely pathogenic and variant of uncertain significance/variant unknown significance (VUS) identified in the Hereditary Cancer Panel Genes between 2016 and 2017 and specified in the report are re-examined in 2022 and shown whether they have changed over time.METHODS Containing 26 genes in 2016-2017 variants of patients with pathogenic/likely pathogenic/VUS detected in the Hereditary Cancer Panel were analyzed again in 2022 on Clinvar (https://www.ncbi.nlm.nih.gov/ clinvar/) and other databases. RESULTS The results of a total of 137 patients, 137 women and 2 men, were evaluated. While no pathogenic/ likely pathogenic/VUS variant was detected in the results of 95 patients, at least 1 variant was detected in 42 female patients. A total of 58 variants were detected in 42 patients, and we found that 24 variants among them fell into a different class. While 12 more variants were included in the lower pathogenicity subgroup, 5 of them were higher in pathogenicity. We saw that 6 variants that were not yet identified in 2016-2017 were identified, except for 1 of them.CONCLUSION We have seen that the pathogenicity of the variants written in patient reports, which can cause serious changes in the patient's life, can change over time. While giving genetic counseling about these variants, it should be stated that much more comprehensive research and information should be given to the patient, this information was given to the patient under the current conditions and that there may be a possibility of change in the future

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study

WOS: 000366030500001PubMed ID: 26622176Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in > 70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.Novartis Pharmaceuticals TurkeyThe study is funded by Novartis Pharmaceuticals Turkey. We thank Cagla Ayhan, MD and Prof Sule Oktay, MD, PhD from KAPPA Consultancy Training Research Ltd, Istanbul who provided editorial support and Mehmet Berktas, MD, MICR from KAPPA Consultancy Training Research Ltd, Istanbul who performed statistical analysis funded by Novartis Pharmaceuticals Turkey

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study

Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean {[}standard deviation] age: 62.6 {[}9.9] years, 85.7\% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1\% of patients were assigned to GOLD A, while 13.2\% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0\%). Over-treatment was noted in > 70\% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected