What do patients think after lung-transplantation about their self, body, and social network? A quantitative analysis of categorical interview data

Objective: Psychosocial aspects have been investigated in transplant medicine mainly by the means of various structured questionnaires. To date only few interview data are available on patients thoughts about their self, the transplanted lung or the medication, and the relationship between these thoughts and compliance or gender. Methods: Twenty patients were interviewed after transplantation about their perceptions on self, body, transplanted lung, medication and social network. Their compliance was rated by the attending physicians. The overall interrater-reliability for the category groups was Kappa=.8. The article presents quantitative results of the content analysis. Results: Statements were made most frequently about the patients' social network and their self, and significantly less frequently about their body, lung and medication. "Closeness", "distance" and "depression" where main issues that these patients were dealing with. "Closeness" and "distance" played major roles in interpersonal relationships as well as in the relationship to the new lung. Depression mainly had to do with health burdens and the psychosocial consequences of the transplantation (e.g. financial worries). Women made significantly more statements about their social network than men; furthermore they formulate more accented emotional evaluations. Patients with low compliance were more frequently preoccupied with their self, their body as well as the experience of "dependence" and "achievement" than patients with high compliance; also low compliant patients made more critical statements. Conclusions: For lung transplant recipients social relationships are the prime topic of their daily experience. With respect to compliance behaviour, special attention should be paid to the patients' self and body perception as well as to their experience of dependence. These results should be confirmed in studies with larger sample sizes

Serum microrna biomarkers for detection of non-small cell lung cancer

Non small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality world-wide and the majority of cases are diagnosed at late stages of disease. There is currently no cost-effective screening test for NSCLC, and the development of such a test is a public health imperative. Recent studies have suggested that chest computed tomography screening of patients at high risk of lung cancer can increase survival from disease, however, the cost effectiveness of such screening has not been established. In this Phase I/II biomarker study we examined the feasibility of using serum miRNA as biomarkers of NSCLC using RT-qPCR to examine the expression of 180 miRNAs in sera from 30 treatment naive NSCLC patients and 20 healthy controls. Receiver operating characteristic curves (ROC) and area under the curve were used to identify differentially expressed miRNA pairs that could distinguish NSCLC from healthy controls. Selected miRNA candidates were further validated in sera from an additional 55 NSCLC patients and 75 healthy controls. Examination of miRNA expression levels in serum from a multi-institutional cohort of 50 subjects (30 NSCLC patients and 20 healthy controls) identified differentially expressed miRNAs. A combination of two differentially expressed miRNAs miR-15b and miR-27b, was able to discriminate NSCLC from healthy controls with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100% in the training set. Upon further testing on additional 130 subjects (55 NSCLC and 75 healthy controls), this miRNA pair predicted NSCLC with a specificity of 84% (95% CI 0.73-0.91), sensitivity of 100% (95% CI; 0.93-1.0), NPV of 100%, and PPV of 82%. These data provide evidence that serum miRNAs have the potential to be sensitive, cost-effective biomarkers for the early detection of NSCLC. Further testing in a Phase III biomarker study in is necessary for validation of these results. © 2012 Hennessey et al

Chronic obstructive pulmonary disease guidelines in Europe: a look into the future.

Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

'Medications are bombs' - metaphor use of lung transplant patients with high and low compliance

Following organ transplantation, complex psychological processes take place. This study investigated patients' use of metaphors relating to their experience of lung transplantation as well as differences in the use of these metaphors between patients with either high or low compliance

The effect of simulated obstructive apnea and hypopnea on aortic diameter and BP.

BACKGROUND: Preliminary evidence supports an association between obstructive sleep apnea (OSA) and thoracic aortic dilatation. The mechanisms through which OSA may promote thoracic aortic dilatation are incompletely understood. Therefore, we studied the acute effects of simulated apnea and hypopnea on aortic diameter and BP in humans. METHODS: The diameter of the aortic root was measured in 20 healthy volunteers by echocardiography, and peripheral BP was continuously recorded prior, during, and immediately after simulated obstructive hypopnea (inspiration through threshold load), simulated obstructive apnea (Müller maneuver), end-expiratory central apnea, and normal breathing in randomized order. RESULTS: Proximal aortic diameter increased significantly during inspiration through a threshold load (+6.48%; SE, 3.03; P = .007), but not during Müller maneuver (+3.86%; SE, 2.71; P = .336) or end-expiratory central apnea (+0.62%; SE, 2.94; P = .445). Maneuver-induced changes in mean BP were observed during inspiration through a threshold load (-10.5 mm Hg; SE, 2.2; P < .001), the Müller maneuver (-8.8 mm Hg; SE, 2.4; P < .001), and end-expiratory central apnea (-4.2 mm Hg; SE, 1.4; P = .052). There was a significant increase in mean BP on release of threshold load inspiration (+8.1 mm Hg; SE, 2.9 mm Hg; P = .002), Müller maneuver (+10.7 mm Hg; SE, 2.9; P < .001), and end-expiratory central apnea (+10.6 mm Hg; SE, 2.5; P < .001). CONCLUSIONS: Simulated obstructive hypopnea/apnea and central apnea induced considerable changes in BP, and obstructive hypopnea was associated with an increase in proximal aortic diameter. Further studies are needed to investigate effects of apnea and hypopnea on transmural aortic pressure and aortic diameter to define the role of OSA in the pathogenesis of aortic dilatation

Persönlichkeit, subjektive Krankheitsvorstellungen und Lungenfunktion (FEV1) bei 50 Patienten nach Lungentransplantation

Objective: After lung transplantation little attention has been devoted to patient's personality and illness perceptions, although the importance of illness perceptions (e.g. to the psychosocial status of health) as well as the relationship between personality and illness perceptions is well-known from other areas of medicine. Methods: Fifty patients more than one year after lung transplantation were surveyed by the NEO Five-Factor Inventory (NEO-FFI) as well as the "control" and "consequences" scales of the Illness Perception Questionnaire (IPQ). Medical data included the diagnoses of the underlying lung diseases and the pulmonary graft function as measured by the forced expiratory volume in one second (FEV1). Results: In our patients, mean values of the personality factors "extraversion" (p=.003), "openness to experiences" (p<.001), "agreeableness" (p=.035), and "conscientiousness" (p<.001) were significantly higher compared to the normal population. "Openness to experiences" correlated positively and "neuroticism" negatively with the illness perception "control". There was no correlation between illness perceptions and lung function.Conclusion: In lung transplant recipients, personality traits are more relevant to illness perceptions ("control") than current graft function.Hintergrund: Persönlichkeit und subjektive Krankheitsvorstellungen bei Patienten nach einer Lungentransplantation fanden bisher kaum Beachtung, obwohl die Bedeutung subjektiver Krankheitsvorstellungen (z.B. hinsichtlich des psychosozialen Verlaufes einer Erkrankung) wie auch die Beziehung zwischen Persönlichkeit und subjektiven Krankheitsvorstellungen aus anderen Gebieten der Medizin wohl bekannt sind.Methodik: 50 Patienten, bei denen vor mehr als einem Jahr eine Lungentransplantation durchgeführt worden war, wurden anhand des Neo-Fünf-Faktoren-Inventar (NEO-FFI) sowie der beiden Skalen "Krankheitskontrolle" und "Konsequenzen" des Illness Perception Questionnaire (IPQ) untersucht. Die medizinischen Daten umfassten die Diagnosen der zu Grunde liegenden Lungenerkrankung und die aktuelle Lungenfunktion (FEV1). Ergebnisse: In unserer Stichprobe lagen die Mittelwerte der Persönlichkeitsfaktoren "Extraversion" (p=.003), "Offenheit für Erfahrungen" (p<.001), "Verträglichkeit" (p=.035) und "Gewissenhaftigkeit" (p<.001) signifikant höher als in einer Vergleichs-Stichprobe der Allgemeinbevölkerung. "Offenheit für Erfahrungen" korrelierte signifikant positiv, "Neurotizismus" negativ mit der subjektiven Krankheitsvorstellung "Kontrolle". Keine Korrelation bestand zwischen subjektiven Krankheitsvorstellungen und aktueller Lungenfunktion.Schlussfolgerung: Nach einer Lungentransplantation sind Persönlichkeitsmerkmale für die Gestaltung subjektiver Krankheitsvorstellungen ("Kontrolle") bedeutsamer als die aktuelle Lungenfunktion