Flow-chart.

<p>Flow-chart.</p

Results for patients with first visit (Primary Endpoints).

<p>Results for patients with first visit (Primary Endpoints).</p

Topical Nasal Anesthesia in Flexible Bronchoscopy – A Cross-Over Comparison between Two Devices

<div><p>Introduction</p><p>Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients.</p><p>Methods</p><p>Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA). Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD). After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS). At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee.</p><p>Results</p><p>Of the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32%) received both atomizers. Physicians reported better efficacy (p = 0.001) and fewer side effects (p< = 0.001) for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002) and fewer side effects (p< = 0.001, p = 0.029) for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20). No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device.</p><p>Discussion</p><p>Topical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD) offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA) in lung transplant recipients. Procedural costs were reduced by 0.34€ per procedure.</p><p>Trial Registration</p><p>clinicaltrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02237651?term=NCT02237651&rank=1" target="_blank">NCT02237651</a></p></div

Results of patients (n = 80) with returning visits (n = 160).

<p>Results of patients (n = 80) with returning visits (n = 160).</p

Atomizer Devices.

<p>Atomizer Devices.</p

Safety (Complications and Side Effects).

<p>Safety (Complications and Side Effects).</p

Results.

<p>Results.</p

Demographics.

<p>Demographics.</p

Conventional vs. Tablet Computer-Based Patient Education following Lung Transplantation – A Randomized Controlled Trial

<div><p>Background</p><p>Accurate immunosuppression is of critical importance in preventing rejection, while avoiding toxicity following lung transplantation. The mainstay immunosuppressants are calcineurin inhibitors, which require regular monitoring due to interactions with other medications and diet. Adherence to immunosuppression and patient knowledge is vital and can be improved through patient education. Education using tablet-computers was investigated.</p><p>Objective</p><p>To compare tablet-PC education and conventional education in improving immunosuppression trough levels in target range 6 months after a single education. Secondary parameters were ratio of immunosuppression level measurements divided by per protocol recommended measurements, time and patient satisfaction regarding education.</p><p>Design</p><p>Single-centre, open labelled randomised controlled trial.</p><p>Participants</p><p>Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.</p><p>Intervention</p><p>Tablet-pc education versus personal, nurse-led education.</p><p>Measurements</p><p>Calcineurin inhibitor levels in target range 6 months after education, level variability, interval adherence, knowledge and adherence was studied. As outcome parameter, renal function was measured and adverse events registered.</p><p>Results</p><p>Sixty-four patients were 1:1 randomised for either intervention. Levels of immunosuppression 6 months after education were equal (tablet-PC 58% vs. conventional 48%, p = 0.27), both groups improved in achieving a CNI trough level within target range by either education method (delta tablet-PC 29% vs. conventional 20%). In all patients, level variability decreased (−20.4%), whereas interval adherence remained unchanged. Knowledge about immunosuppression improved by 7% and compliance tests demonstrated universal improvements with no significant difference between groups.</p><p>Conclusion</p><p>Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.</p><p>Trial Registration</p><p>ClinicalTrials.gov NCT01398488 <a href="http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1" target="_blank">http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1</a>.</p></div

Demographics.

<p>Patient demographics and characteristics. Categorical variables were compared using a chi-square test and numeric values were shown as median with IQR, using student's t-test.</p