The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0-N1 Disease.

INTRODUCTION: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. MATERIAL AND METHODS: A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. RESULTS: Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). CONCLUSIONS: In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.

Usefulness of The Piko-6 Portable Device for Early COPD Detection in Primary Care. / Utilidad del dispositivo portátil Piko-6 para la detección precoz de la enfermedad pulmonar obstructiva crónica en atención primaria.

INTRODUCTION: COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS. METHODS: FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard. RESULTS: FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836-0.909), 0.729 (CI 064-0.795) and 0.947 (95% CI 0.928-0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78-0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97. CONCLUSIONS: Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined.

[Tobacco cessation. Action-stage result as a predictor of successful long-term maintenance]. / Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación.

OBJECTIVE: The paucity of long-term studies makes it difficult to evaluate the sustained abstinence over time of smokers who quit. The objective of the present study was to determine to what extent the results of tobacco cessation interventions are maintained after 5 years. PATIENTS AND METHODS: This was a longitudinal prospective study of 502 smokers. The design was quasi-experimental given that therapy was allocated according to the level of the patients' nicotine dependence: routine minimum intervention for smokers with mild addiction and those not in the preparation stage, and nicotine replacement therapy for patients with moderate-to-high dependence and/or a high level of tobacco consumption. RESULTS: Of the 267 patients followed for 5 years, 29.6% quit and were still abstinent at 1 year, and 18.0% remained abstinent after 5 years. Of those who had managed to stop smoking within 2 months of starting the intervention, 47.4% were still abstinent on follow-up at 5 years while 88.1% of those who failed to quit within 2 months were still smoking 5 years later. CONCLUSIONS: The results observed during the action stage could be of use in reorienting the treatment approach, and a planned schedule of follow-up contacts could help patients maintain the abstinence achieved in the course of the intervention.

Tobacco and diabetes: clinical relevance and approach to smoking cessation in diabetic smokers. / Tabaco y diabetes: relevancia clínica y abordaje de la deshabituación tabáquica en pacientes con diabetes.

Smoking is, together with diabetes mellitus, one of the main risk factors for cardiovascular disease. Diabetic patients have unique features and characteristics, some of which are not well known, that cause smoking to aggravate the effects of diabetes and impose difficulties in the smoking cessation process, for which a specificand more intensive approach with stricter controls is required. This review details all aspects with a known influence on the interaction between smoking and diabetes, both as regards the increased risk of macrovascular and microvascular complications of diabetes and the factors with an impact on the results of smoking cessation programs. The treatment guidelines for these smokers, including the algorithms and drug treatment patterns which have proved most useful based on scientific evidence, are also discussed.

[Results of the first program to reduce the prevalence of smoking in the staff of Salamanca Council, Spain]. / Resultados del primer programa para la reducción del tabaquismo en los trabajadores del Ayuntamiento de Salamanca, España.

BACKGROUND: Smoking is the most important risk factor for public health and one of the factors with the greatest economic repercussions for society. The aim of the present work is to publish the results of a programme to reduce smoking in the working environment. METHODS: A programme was designed in two stages. The first consisted of carrying out a survey to establish the prevalence of smoking and the attitudes towards smoking of staff working for Salamanca district Council. The second stage consisted of a specialized treatment programme for all the workers who wanted to try to give up smoking. RESULTS: A total of 384 workers answered the questionnaire. Of these, 135 (35.1%) were smokers of whom 80.5% (n = 113) wanted to give up smoking and to receive medical help to do so. A total of 73 workers started the programme. After one year of treatment, 41% of the workers who had started the programme had dropped out. An average of 2.9 of every 3 workers found the programme satisfactory. CONCLUSIONS: The prevalence of smoking in Salamanca District Council is similar to that described in the National Health Survey, 1997. Programmes to treat smoking in the working environment are useful to reduce the prevalence of smoking and are welcomed by the workers. Reducing the prevalence of smoking is the first step towards achieving smoke-free institutions.