Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients

Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD). Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). The present study is designed to investigate the benefits of a short outpatient program of IMT on inspiratory muscle performance, exercise capacity, perception of dyspnea, and the inspiratory fraction (IF). Thirty patients (24 males, 6 females) with significant COPD (forced expiratory volume in one second [FEV1] = 46.21% ± 6.7% predicted, FEV1 = 33.6% ± 8.04% predicted) were recruited for this study and had 3 months of IMT (30 minutes/day for 6 days/week) in an outpatient clinic. Following IMT, there was a statistically significant increase in inspiratory muscle performance (an increase of the maximal inspiratory pressure from 59% ± 19.1% to 79% ± 21.85% predicted; p = 0.0342), a decrease in dyspnea (from 5.8 ± 0.78 to 1.9 ± 0.57; p = 0.0001), an increase in the distance walked during the 6 minute walk test, from 245 ± 52.37 m to 302 ± 41.30 m, and finally an increase in the IF (the new prognostic factor in COPD) from 27.6 ± 9.7% to 31.4% ± 9.8%. The present study concludes that in patients with significant COPD, IMT results in improvement in performance, exercise capacity, sensation of dyspnea, and moreover an improvement in the IF prognostic factor

Does the availability of positron emission tomography modify diagnostic strategies for solitary pulmonary nodules? An observational study in France

International audienceBACKGROUND: Previous studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. We aimed to describe the benefits of (PET) in the management of solitary pulmonary nodules (SPNs) in a population level, in terms of the number of diagnostic and invasive tests performed, time to diagnosis and factors determining PET utilization. METHODS: In an observational study, we examined reports of computed tomography (CT) performed and mentioning "spherical lesion", "nodule" or synonymous terms. We found 11,515 reports in a before-PET period, 2002-2003, and 20,075 in an after-PET period, 2004-2005. Patients were followed through their physician, who was responsible for diagnostic management. RESULTS: We had complete data for 112 patients (73.7%) with new cases of SPN in the before-PET period and 250 (81.4%) in the after-PET period. Patients did not differ in mean age (64.9 vs. 64.8 years). The before-PET patients underwent a mean of 4 tests as compared with 3 tests for the after-PET patients (p = 0.08). Patients in the before-PET period had to wait 41.4 days, on average, before receiving a diagnosis as compared with 24.0 days, on average, for patients in the after-PET period who did not undergo PET (p < 0.001). In the after-PET period, 11% of patients underwent PET during the diagnostic process. A spiculated nodule was more likely to determine prescription for PET (p < 0.001). Multivariate analysis revealed that patients in both periods underwent fewer tests when PET was prescribed by general practitioners (p < 0.001) and if the nodule was not spiculated (p < 0.001). The proportion of unnecessary invasive approaches prescribed (47% vs. 49%) did not differ between the groups. CONCLUSION: In our study, 1 year after the availability of PET, the technology was not the first choice for diagnostic management of SPN. Even though we observed a tendency for reduced number of tests and mean time to diagnosis with PET, these phenomena did not fully relate to PET availability in health communities. In addition, the availability of PET in the management of SPN diagnosis did not reduce the overall rate of unnecessary invasive approaches

Pratiques diagnostiques pour les nodules pulmonaires isolés et le cancer du poumon non à petites cellules (caractérisation, déterminants et évaluations médico-économiques de l'introduction de la tomographie par émission de positon)

Nous avons étudié les pratiques diagnostiques en oncologie, broncho-pulmonaire, et les conséquences médico-économiques: de l'introduction de la Tomographie par Emission de positon (TEP) lors du diagnostic du nodule pulmonaire isolé NPI et du bilan d'extension médiastinale du cancer du poumon non à petites cellules (CPNPC). Dans le premier axe de recherche, une revue de la littérature jnternationale a permis de constat l'absence d'études dans lesquelles les auteurs auraient analysé les variations des pratiques diagnostiques et de bilan d'extension du CPNPC. Nous avons analysé les pratiques diagnostiques pour la prise en chargé du NPI en nous appuyant sur des donnnées issues de la phase Avant du Programme d'évaluation médico-économique de l'implantation des caméras TEP en cancérologie dans l'Inter-région Nord-Est. Nous avons identifié huit chemins cliniques selon lesquels les tests diagnostiques sont prescrits et nous avons montré que les pratiques diagnostiques du NPI sont longues, complexes et très hétérogènes. Dans un deuxième axe de recherche, nous avons utilisé la technique de l'analyse décisionnelle pour modéliser les pratiques diagnostiques en oncologie broncho-pulmonaire après l'introduction de la TEP. Les résultats ont montré que dans le cas du diagnostic du NPI et du bilan d'extension médiastinale du CPNPC, les stratégies diagnostiques utilisant la TEP sont coût-efficaces par rapport à des stratégies conventionnelles. Les résultats des modèles restent robustes après l'analyse de sensibilité sur plusieurs paramètres clés des modèles. Nous proposons un cadre dans lequel les informations produites par ces modèles peuvent aider pour la formulation de recommandations de "bonne pratique" en oncologie broncho-pulmonaire et favoriser la coordination des différents prestataires qui participent à la prise en charge de cette pathologie.NANCY1-SCD Medecine (545472101) / SudocSudocFranceF

Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts-0

Aspiration biopsy; Wang: Wang needle biopsy; SUR: surgery; CRT: chemoradiotherapy).<p><b>Copyright information:</b></p><p>Taken from "Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts"</p><p>http://www.biomedcentral.com/1471-2407/8/93</p><p>BMC Cancer 2008;8():93-93.</p><p>Published online 10 Apr 2008</p><p>PMCID:PMC2373300.</p><p></p

Economic Impact of Migraine and Other Episodic Headaches in France: Data from the GRIM2000 Study

Background: Migraine is a prevalent and incapacitating condition that affects individuals in the prime of their productive life, thus generating an economic burden for both society and healthcare systems. The direct annual healthcare costs of migraine in France were assessed over 10 years ago, and the current study updates these figures. Objective: The objective of this study was to determine the economic cost (primarily direct costs) of migraine and other episodic headache in France based on a general population survey of headache, the GRIM2000 (Groupe de Researche Interdisciplinaire sur la Migraine). Design: From a representative general population sample of 10 Results: The prevalence of migraine (including migrainous disorder) was determined to be 17%. Total annual direct healthcare costs were estimated to be Conclusions: The direct healthcare costs of migraine do not seem to have risen significantly over the past decade. A small minority of individuals with more severe headaches consume most of the healthcare resources devoted to migraine, while most individuals generate relatively low direct costs. The total annual direct costs in France for migraine are almost 10-fold higher than those of other episodic headache.Analgesics, Antimigraines, Cost-of-illness, Headache, Migraine