Lung cancer screening using low-dose CT and FDG-PET in liver transplant recipients.

To address the feasibility of implementing a lung cancer screening program in liver transplant recipients (LTR) targeted to detect early-stage lung cancer one hundred twenty-four LTR (89% male, 59.8+/-8.8 y old), who entered the lung cancer screening program at our hospital were reviewed. The results of the diagnostic algorithm using low-dose CT and F-18-fluorodeoxyglycose positron emission tomography (FDG-PET) were analyzed. Lung cancer was detected in 12 LTR (9.7%), most of which corresponded to the non-small cell subtype. Two of the 12 lung cancers were detected in the baseline study (prevalence of 1.6%), whereas 10 patients were diagnosed with lung cancer in the follow-up (incidence of 8.1%). Considering all cancers, 10 of 12 (83.3%) were diagnosed at stage I, one cancer was diagnosed at stage IIIA, and another one at stage IV. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of F-18-fluorodeoxyglycose positron emission tomography to detect malignancy in our cohort were 81.8%,100%, 99.3%, 100%, and 99.3%, respectively. A carefully followed multidisciplinary lung cancer screening algorithm in LTR that includes F-18-fluorodeoxyglycose positron emission tomography and low-dose CT allows lung cancer to be diagnosed at an early stage while reducing unnecessary invasive procedures.

Validation of the Jefferson Scale of Patient Perception of Physician Empathy Spanish (Spain) Version in Primary Care.

BACKGROUND AND OBJECTIVES: Empathy is considered a prerequisite for a successful physician-patient relationship. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) is a regularly-used, patient-rated measure of physician empathy. The aim of this study is to translate and analyze the reliability and validity of the JSPPPE Spanish (Spain) version (Sp-JSPPPE) in primary care in order to use it with medical trainees. METHODS: After translation and back translation of the JSPPPE, 369 patients from 21 primary care physicians in Pamplona (Navarre, Spain) completed the Sp-JSPPPE, a sociodemographic questionnaire, the Spanish (Spain) Consultation and Relational Empathy Measure (Sp-CARE), and a question about overall satisfaction. We studied internal reliability (Cronbach's α and ordinal α), homogeneity (corrected item-total correlations), construct validity (confirmatory factor analysis [CFA]) and concurrent validity (Spearman's correlation) of Sp-JSPPPE. RESULTS: Cronbach's α and ordinal α were 0.870 and 0.919, respectively, for the Sp-JSPPPE, and all corrected item-total correlations exceeded the accepted cutoff of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The total score for the Sp-JSPPPE was significantly correlated with sp-CARE (Spearman's ϱ 0.651, P<.001) and with overall patient satisfaction (Spearman's ϱ 0.504, P<.001). CONCLUSIONS: The results support the reliability and validity of the Sp-JSPPPE in primary care. Sp-JSPPPE could be useful in empathy assessment of medical trainees, both graduate and postgraduate, in the Spanish context.

Reliability and validity of the Spanish (Spain) version of the consultation and relational empathy measure in primary care.

BACKGROUND: Empathy is an essential competence in the medical field. There are no validated patient-rated empathy measures in Spanish (Spain). The Consultation and Relational Empathy (CARE) measure is a widely used patient-rated measure of physician empathy. OBJECTIVE: To analyse the reliability and validity of the Spanish (Spain) version of the CARE measure in primary care. METHODS: After translation, back translation and pilot testing, a convenient sample of 369 patients recruited through 21 primary care physicians in five primary care centres in Pamplona (Navarre, Spain) completed the Spanish (Spain) CARE (Sp-CARE) measure. The number of 'does not apply' or blank responses was calculated to assess acceptability. We analysed internal reliability by means of Cronbach's alpha and ordinal alpha and homogeneity with corrected item-total correlations. The construct validity was examined by confirmatory factor analysis (CFA) and concurrent validity by Spearman's correlation. RESULTS: We observed high acceptability; only 37 (1%) responses were marked 'does not apply' and only 3 (0.08%) were left blank. Cronbach's alpha and ordinal alpha for the Sp-CARE measure were 0.953 and 0.970, respectively, and all corrected item-total correlations exceeded the accepted cut of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The Sp-CARE measure total score was significantly correlated with overall patient satisfaction (Spearman's rho 0.45, P < 0.001). CONCLUSION: The results support the reliability and validity of the Sp-CARE measure as a patient-rated empathy measure in the primary care setting.

Effect of contrast dose in the quantification of myocardial extra-cellular volume in adenosine stress/rest perfusion cardiac magnetic resonance examinations.

Background Diffuse myocardial fibrosis can be quantified by calculating extra-cellular volume (ECV) from native and post-contrast T1 values using dedicated single bolus contrast medium injection protocols. Purpose To evaluate differences in T1 maps and myocardial ECV measurements in routine stress/rest perfusion cardiovascular magnetic resonance (CMR) examinations after injection of single and double dose of contrast medium. Material and Methods Thirty-seven consecutive patients (30 men; mean age, 62 ± 13 years) underwent clinically indicated adenosine stress/rest perfusion CMR examination to rule out myocardial ischemia following a conventional split-dose contrast medium injection strategy. Native and post-contrast T1 mapping was performed 15 min after the first (0.1 mmol/kg) and second (0.1 mmol/kg) dose of contrast medium using a breath-held Modified Look-Locker Inversion recovery (MOLLI) sequence. Student's t-test for paired samples, Bland-Altman plots, and concordance-correlation coefficients (CCC) for agreement between T1 and ECV calculations after single and double dose of contrast medium were calculated. Intra- and inter-observer agreement for measurements was also analyzed. Results Myocardial T1 values after single and double dose of contrast medium significantly differed (mean difference of 114.1 ± 19.9 ms, P < 0.01). A single dose of contrast agent provided slightly higher ECV values (mean difference of 2.3 ± 1.1%). CCC for ECV calculations was 0.66. Intra- and inter-observer agreement for all measurements was excellent (CCC ≥ 0.83). Conclusion Quantification of myocardial ECV on conventional stress/rest perfusion CMR examination is feasible. T1 maps obtained 15 min after 0.1 mmol/kg of contrast medium provide slightly higher myocardial T1 measurements and ECV values compared with T1 maps obtained after a total dose of 0.2 mmol/kg.