Advanced chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe — below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort.Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe - below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort

The incidence of chronic obstructive pulmonary disease in advanced non-small cell lung cancer patients

Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients.Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients

Zaawansowana postać przewlekłej obturacyjnej choroby płuc

Przewlekła obturacyjna choroba płuc (POChP) jest jedną z najczęstszych przewlekłych chorób i czwartą przyczyną zgonów na świecie. Zaawansowane postaci (ciężka - w przypadku wskaźnika FEV1 poniżej 50% należnej normy - i bardzo ciężka - poniżej 30%) z reguły prowadzą do inwalidztwa oddechowego i przedwczesnego zgonu. Rokowanie chorych na zaawansowane postaci POChP nie różni się od rokowania u chorych na raka płuca. Na przebieg choroby znaczący wpływ mają jej zaostrzenia oraz schorzenia współistniejące, takie jak choroby układu sercowo-naczyniowego, cukrzyca, rak płuca i choroba wrzodowa. Cele leczenia obejmują: zahamowanie postępu choroby, zapobieganie zaostrzeniom i uśmierzanie dokuczliwych objawów, do których należą przede wszystkim duszność, przewlekły kaszel i zmniejszająca się tolerancja wysiłku

Postawy wobec palenia tytoniu wśród studentów I i VI roku medycyny z rocznika studiów 2002-2008

Wstęp: Zjawisko palenia tytoniu wśród studentów medycyny wskazuje, że studia medyczne nie stanowią wystarczającej bariery przed kontynuowaniem, a nawet rozpoczynaniem palenia. Celem badania była ocena postaw wobec palenia wśród studentów I i VI roku Wydziału Lekarskiego Gdańskiego Uniwersytetu Medycznego z rocznika studiów 2002-2008. Materiał i metody: Wśród studentów rocznika studiów 2002-2008 dwukrotnie, na I i VI roku, rozprowadzono ankietę zawierającą pytania na temat kwestii związanych z paleniem tytoniu. W ankiecie adresowanej do studentów VI roku zawarto dodatkowe pytania, umożliwiające ocenę zmian w postawach studentów wobec palenia w trakcie studiów, a także poznanie opinii respondentów na temat nauczania na studiach rozpoznawania i leczenia zespołu uzależnienia od tytoniu (ZUT) oraz ich samooceny posiadanej wiedzy w tym zakresie. W badaniu wzięło udział 287 studentów I roku i 175 studentów VI roku badanego rocznika. Wyniki: Wraz z końcem studiów studenci istotnie rzadziej regularnie palili papierosy niż na I roku (13% v. 21%; p = 0,022), jednak co piąta paląca osoba (20%) zaczęła palić papierosy w trakcie studiów medycznych. Odsetek palaczy, którzy palili bez większego skrępowania, był istotnie niższy, niż na początku studiów (31% v. 70%; p = 0,0006), stwierdzono także znacząco wyższe odsetki palaczy deklarujących chęć porzucenia nałogu (91% v. 61%; p = 0,013) oraz codziennych palaczy, którzy chcieliby poddać się leczeniu uzależnienia od tytoniu (54% v. 22%; p = 0,001). Ponad połowa studentów VI roku przyznała, że nie ma żadnej wiedzy na temat rozpoznawania i leczenia ZUT lub ich wiedza na ten temat jest bardzo słaba lub słaba (57%). Aż 43% badanych stwierdziło, że studia medyczne w ogóle nie były dla nich źródłem wiedzy o ZUT. Wnioski: Studia medyczne wpływają na pozytywne zmiany postaw studentów wobec palenia tytoniu. Jednak część osób podejmuje palenie na studiach, co sugeruje dominujący udział czynników genetycznych nad środowiskowymi w rozpoczynaniu palenia w tym okresie życia. W opinii przyszłych lekarzy studia medyczne nie są wystarczającym źródłem wiedzy o ZUT.Introduction: The prevalence of smoking among medical students indicates that studying medicine is an insufficient protection from tobacco use. The aim of the study was an analysis of medical students’ attitudes towards smoking at the first and sixth year of their studies. Material and methods: A questionnaire on tobacco smoking was distributed among medical students of the study year 2002-2008 at the first and sixth year of their studies. The questionnaire used on the sixth year students included additional questions designed to assess changes in their attitudes towards smoking during their studies, to ask their opinion of the teaching of diagnostics and treatment of tobacco dependence (TD), and to discover how they evaluated their knowledge of the issue. The numbers of students who participated at the two points of the study were 287 and 175 respectively. Results: Students in their sixth year significantly less frequently smoked cigarettes regularly than those starting their medical education (13% v. 21%; p = 0.022). However, 20% of smokers started smoking during their studies. The proportion of smokers saying they were not embarrassed by their smoking habit was significantly lower among sixth-year students compared to first-year students (31% v. 70%; p = 0.0006), as were the numbers who said they wanted to quit smoking (91% v. 61%). Those who wished to undergo treatment for TD (54% v. 22%) were significantly higher among sixth year students group (p = 0.013 and p = 0.001, respectively). More than half (57%) the sixth-year students claimed that they had no knowledge of the diagnostics and treatment of TD, or that their knowledge on this issue was poor or very poor. In the opinion of 43% of students, the medical curriculum was not a good source of knowledge on TD. Conclusions: Medical studies induce positively students’ attitudes towards smoking. However, a proportion of individuals start smoking during studies, which may suggest dominance of genetic influences on smoking initiation in this period of life. In sixth-year students’ opinion, medical studies are not a sufficient source of knowledge on TD

Tobacco smoking among the first-year medical students

The studies have shown that despite studying medicine the rate of tobacco smokers among students is still high. Moreover, in Poland the incidence of smoking is increasing among the youngsters. The study was designed to assess the rate of smokers among the first-year students of two consecutive courses at the Medical University of Gdańsk and define their attitudes towards tobacco smoking. The voluntary, multiple-choice questionnaires were distributed among 412 students. The rate of response was 100%. Twenty one percent of responders were current smokers (17% females and 28% men), whereas 7% declared previous smoking. There was no correlation between incidence of smoking among students and their parents (p = 0.11). 61% of smokers declared the will to give up their habit and of those 94% were aware of the negative impact of cigarettes on their health. In the group which did not declare the will to quit smoking only 75% knew what the impact of cigarettes on their health was; p = 0.02. Only 23% of smokers considered anti-nicotine therapy effective. Almost a half of smokers considered nicotine replacement therapy ineffective for them in quitting cigarette smoking. Conclusion: The rate of smokers among the first-year medical students is lower than in general population, but it is still relatively high. However more than a half of smokers wants to give up their habit. Of those who are not willing to, 25% is not aware of the cigarettes’ impact on their health. These results call for further anti-nicotine actions

How do relatives remember the dying of lung cancer patients after 2-8 years? A qualitative study based on in-depth interviews with family members

Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years.Background. The aim of our study was to assess how relatives remember the dying of lung cancer patients several years after their death. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with 2 researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire and to score the Quality of Dying Apgar. Results. Family members of 15 of the patients stated recognizing the dying of their loved one. They concluded this on the basis of exacerbation of symptoms, "typical" appearance, change in behaviour or particular words the patient said to them. The median score of the quality of dying was 6.5/10 (range 3-9). Lower scoring was observed for patients who died in hospital, without the family present at the moment of death and with uncontrolled symptoms. Only 5 of the relatives assessed pain and other symptom control as satisfactory. Other family members remembered pain (n = 9), dyspnoea (n = 8), delirium (n = 4) and other symptoms as disturbing the dying in a severe or moderate way. Three relatives assessed that their loved one's dying was not "dignified", mostly due to the severe physical suffering, the nursing being crucially remiss at the hospital and the patient's being alone at the moment of death. All family members were able to describe the healthcare professionals' attitudes and even repeat the statements they heard from them. Conclusion. We have demonstrated that several years after death many of the words and the behaviour of the dying patients were still alive in their relatives' memories. The family members remember how the healthcare professionals behaved and what they said to them. While caring for dying people, we should bear in mind that the way in which we behave may either give strength to the family or destroy their peace of mind for many years

The last months of lung cancer patients’ lives, in the memory of their relatives. A qualitative study based on in-depth interviews with family members

Background. The aim of the study was to assess how family members remember the final months of their loved ones 2–8 years after their death. We focused particularly on their recognition of the patients’ physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1–11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with “anticancer” herbs, or homeopathy, or by bioenergotherapy. From the relatives’ perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care.Background. The aim of the study was to assess how family members remember the final months of their loved ones 2–8 years after their death. We focused particularly on their recognition of the patients’ physical, psychosocial and spiritual needs. Methods. The family members of 45 non small-cell lung cancer patients who died up to 7 years after radical surgical treatment were telephoned and asked to meet the research team. Only 20 of them agreed to talk about the dying and death of their relatives; for the rest the issue was still too painful. During the meeting with two researchers, participants were asked to comment freely on the points of the Assessment of Dying in Lung Cancer Patients questionnaire. Results. Almost all the relatives interviewed in our study were able to recognize the beginning of the terminal phase. They connected the beginning of dying with the deterioration of the physical and/or psychological status of patients, such as the exacerbation of weakness and/or other symptoms or with clearly distinguished incidents such as cancer recurrence or hip fracture. The majority were able to define the length of this phase as being several months (median = 3, range 1–11 months). The most common physical symptoms mentioned by the relatives interviewed were, in sequential order: pain (n = 13) and fatigue (n = 13), anorexia (n = 9), dyspnoea (n = 7) and cachexia (n = 7). Of the 20 decedents, 18 regularly received painkillers at least at some period during their final months. Apart from medicines prescribed by the doctors, 9 patients were treated with “anticancer” herbs, or homeopathy, or by bioenergotherapy. From the relatives’ perspectives, the main approach was focused on the physical aspects of care while there was a lack of psychological and social support, the latter often causing severe financial burden. Most relatives believed that chaplains are the main source of spiritual comfort and there was easy access to such a service both in their parish and in the hospice or hospitals. Conclusion. Our study showed that the families remembered feelings of loneliness and helplessness when confronted with the psychological suffering of their loved ones and the financial burdens caused by the caregivers. Professionals involved in palliative care should acknowledge that holistic care requires sensitivity, not only to the physical but also to the psychosocial and spiritual aspects of end-of-life care

Coexistance of lung cancer and chronic obstructive pulmonary disease

Wstęp. Celem niniejszego opracowania było określenie częstości występowania przewlekłej obturacyjnej choroby płuc (POChP) u chorych na zaawansowanego raka płuca. Materiał i metody. Badaniem objęto kolejnych 51 chorych na zaawansowanego (stopień IIIB i IV) raka płuca - 13 kobiet (25%) i 38 mężczyzn (75%) w wieku 40-80 lat (średnia wieku: 63 lata). Wyniki. Wśród 51 chorych na zaawansowanego raka płuca w 18 przypadkach (35%) rozpoznano POChP. W tej grupie u niemal 3/4 osób (72%) występowała umiarkowana, a u 28% ciężka i bardzo ciężka postać choroby. Związek między POChP a rakiem płuca był najsilniejszy u chorych na raka płaskonabłonkowego (współczynnik korelacji Spearmana: r = 0,43; różnica w porównaniu z pozostałymi typami: p = 0,002). Wykazano, że współwystępowanie raka płuca i POChP wiązało się z większym narażeniem na dym tytoniowy, jednak zależność ta nie osiągnęła znamienności statystycznej (p = 0,072). Nie stwierdzono korelacji między obecnością POChP w badanej grupie a innymi klinicznymi cechami, takimi jak wiek, płeć i zaawansowanie choroby nowotworowej. Wnioski. Współwystępowanie raka płuca i POChP jest częste. Wydaje się, że uwzględnienie współistniejących pneumonologicznych schorzeń w opiece paliatywnej nad chorymi w końcowej fazie choroby nowotworowej pozwoliłoby poprawić jakość ich życia.Background. The aim of the study was to evaluate the frequency of coexistance of lung cancer and chronic obstructive pulmonary disease. Material and methods. Fifty one patients (13 women and 38 men, aged from 40 to 80 years, range: 63 years) with diagnosed advanced lung cancer (stage IIIB and IV) were included into the study. Results. The chronic obstructive pulmonary disease was diagnosed in 18 cases (35%), including 72% moderate and 28% with severe and very severe disease. The chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other subtypes (p = 0.002). There was also a tendency to coexistence of lung cancer and the chronic obstructive pulmonary disease in patients with higher exposure to cigarette smoke (p = 0.072).Conclusion. Coexistence of lung cancer and the chronic obstructive pulmonary disease is frequent, thus it is important to include treatment for the chronic obstructive pulmonary disease in palliative care of advanced lung cancer patients

What's happening? : uma plataforma de eventos

Os eventos são uma presença constante no nosso dia a dia e são divulgados através dos meios de comunicação, anúncios publicitários ou através de conversas entre amigos. A era digital trouxe consigo uma data de mudanças significativas no mundo das comunicações e consequentemente, a divulgação de eventos é facilitada devido às redes sociais que desempenham um papel importante na proliferação destes. No entanto, a procura de eventos, quer no tempo ou no espaço, não é uma tarefa fácil nos dias que correm. Apesar da evolução tecnológica ter permitido a criação de novas plataformas para divulgação de eventos, ainda existe dificuldade em saber o que está a acontecer em redor da nossa localização. Atualmente, um grande número de eventos sociais é criado e promovido nas redes sociais. Com o aglomerado de informação que estas redes geram, a experiência de procurar eventos não é a mais consistente para o utilizador porque os resultados obtidos nem sempre refletem os interesses do utilizador. Este trabalho propõe um novo conceito para uma plataforma de divulgação de eventos, intitulada de What’s Happening? com o objetivo de melhorar a experiência do utilizador na procura e recomendação destes. Em particular, é proposta uma arquitetura para a plataforma que utiliza técnicas de machine learning para classificar eventos provenientes de redes sociais populares, e.g. Facebook, com o objetivo de os categorizar. Tendo em conta que os serviços utilizados para a obtenção de eventos apresentam modelos de dados diferentes, é proposta a ontologia LODSE (Linking Open Descriptions of Social Events), tendo como base a ontologia LODE (Linking Open Descriptions of Events), com o objetivo de facilitar a integração dos dados obtidos dos serviços externos, modelar um evento social para ser posteriormente classificado e melhorar a classificação de eventos. Como forma de validação das técnicas de machine learning na arquitetura proposta bem como o modelo de dados criado a partir da ontologia LODSE, foram realizadas duas avaliações experimentais. A primeira avaliação experimental demonstrou que o melhor algoritmo para classificar os datasets de eventos criados é o Random Forest obtendo 83,33% de eventos corretamente classificados. A segunda avaliação experimental demonstrou que o modelo de dados baseado na ontologia LODSE traz benefícios na classificação de eventos demonstrando uma melhoria de 12,4% de eventos corretamente classificados bem como uma melhoria de 5,9% no tempo de processamento quando comparado com o modelo de dados baseado na ontologia LOD