RESUMO
Percutaneous cervical cordotomy (PCC) is a recognized procedure for control of pain due to thoracic malignancies. Caution with PCC in those with precarious lung function has previously been advised. Thirty-five patients were studied in a prospective study of respiratory function before and after PCC for control of pain from pleural mesothelioma or other thoracic malignancy using standard, easily applied tests. Mean duration of survival was 83 days (range 3-360 days). FEV1.0 and FVC did not alter significantly after the procedure. There was no relationship between any of the respiratory function variables measured and survival. Transient nocturnal hypoxemia occurred during the night immediately following PCC in 6 patients. Unilateral PCC does not worsen respiratory function in patients with pleural mesothelioma or other thoracic malignancies. Poor respiratory function before PCC does not predict survival or complications. It should not be a barrier to use of PCC.
Assuntos
Vértebras Cervicais/cirurgia , Cordotomia/efeitos adversos , Dor/etiologia , Dor/cirurgia , Complicações Pós-Operatórias , Transtornos Respiratórios/etiologia , Neoplasias Torácicas/complicações , Neoplasias Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/mortalidade , Transtornos Respiratórios/mortalidade , Testes de Função Respiratória , Taxa de Sobrevida , Neoplasias Torácicas/mortalidadeRESUMO
AIM: The original purpose of this study was to determine the Minimal Important Difference for the Asthma Control Questionnaire (ACQ) but an unexpected tendency of clinicians to overestimate improvements in asthma control thwarted the endeavour. We describe the observed clinician bias and discuss its implications for clinical practice and research. METHODS: Ninety-four adults with inadequately controlled asthma received a full clinical consultation with one of nine asthma specialists. Medications were adjusted according to clinical needs. Four weeks later the same clinician estimated change in asthma control on a 15-point scale (-7 = a very great deal worse, 0 = no change, +7 a very great deal better). All patients completed the ACQ before each consultation but responses were not shown to the clinician. RESULTS: Clinicians consistently recorded that patients improved more than their change in ACQ scores suggested (p = 0.018). CONCLUSION: Clinicians should be aware of potential biases that may occur when estimating change in asthma control compared with measuring absolute status at each visit.