Short- and long-term effectiveness of a supervised training program in spirometry use for primary care professionals.

INTRODUCTION: Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries. METHODOLOGY: Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction. RESULTS: 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P<.05). CONCLUSIONS: A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time.

Exposure to residential radon and lung cancer in never-smokers: the preliminary results of the LCRINS study.

INTRODUCTION AND OBJECTIVE: Residential radon is the second most important risk factor for lung cancer and the first among never-smokers. The objective of this study is to report the concentrations of residential radon in a series of never-smoker cases recruited in a multicenter study of cases and controls in northwestern Spain. In this study, all the hospitals in the Spanish province of Galicia and one from Asturias participated. PATIENTS AND METHODS: The present article includes a series of cases with residential radon measurements. All the subjects were personally interviewed, 3 ml of blood were taken from each, and they were each given instructions about how to place a residential radon detector in their homes. RESULTS: Sixty-nine case subjects were recruited, 84% of whom were women with a mean age of 71, and 81% of whom had adenocarcinoma. The average concentration of residential radon in the cases was 237 Bq/m(3), while the average concentration in the Galician population is 79 Bq/m(3). No relationship was observed between the concentration of residential radon and either sex or age at the time of diagnosis of the cases, but there was a tendency towards having a greater concentration in those diagnosed with small-cell and large-cell carcinoma. CONCLUSIONS: The concentrations of residential radon in the cases included are very high at about three times the average concentration of residential radon to which the general population of Galicia is exposed.

Intramural hematoma of the pulmonary artery and hemopneumomediastinum after endobronchial ultrasound-guided transbronchial needle aspiration.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective technique for the sampling of mediastinal and hilar adenopathies. We describe the first reported case of pulmonary artery intramural hematoma after EBUS-TBNA puncture of this artery. The complication was visualized by ultrasound and resolved spontaneously.

[Assessment of the portable COPD-6 device for detecting obstructive airway diseases]. / Validación del dispositivo portátil COPD-6 para la detección de patologías obstructivas de la vía aérea.

OBJECTIVES: To evaluate the agreement and the association with FEV(1), FEV(6) and FEV(1)/FEV(6) measured with the Vitalograph-COPD-6 portable device and the FEV(1), FVC and FEV(1)/FVC by conventional spirometry, and to analyse the validity of this device to detect obstruction. METHODOLOGY: A cross-sectional, descriptive, prospective study, that included 180 subjects. A conventional spirometry and one with the Vitalograph-COPD-6 were sequentially performed on them. The agreement was analysed [kappa index and interclass correlation coefficient (ICC)], as well as the association [Pearson correlation coefficient (r)], area under the ROC curve (AUC) of the FEV(1)/FEV(6) in detecting obstruction, and the sensitivity, specificity, predictive values (PPV and NPV), and probability ratios (PR+ and PR-) of the different FEV(1)/FEV(6) cut-off points in the detection of obstruction. RESULTS: The prevalence of obstruction was 47%. The kappa index was 0.59 when an FEV(1)/FEV(6) < cut-off point of <0.7 was used. The ICC and the r between the FEV(1) measured by the two instruments, FEV(6) and FEV(1)/FEV(6) measured by the Vitalograph-COPD-6 and the FVC and FEV(1)/FVC determined by the spirometer were all greater than 0.92. The ROC AUC was 0.97. To detect obstruction, if the cut-off point of FEV(1)/FEV(6) (for COPD-6) was <0.70, the sensitivity, specificity, PPV, NPV, CR+ and CR- were, 58%, 100%, 100%, 73%, infinity and 0.42, respectively. For a cut-off point of <0.8, they were 96%, 76%, 78%, 96%, 3.8 and 0.05, respectively. CONCLUSIONS: The portable Vitalograph-COPD6 device is precise for the detection of airway obstruction. The best sensitivity/specificity of FEV(1)/FEV(6) was obtained with cut-off points greater than 0.7.