Relación entre la autoeficacia para dejar de fumar, la voluntad propia y quién envía a los pacientes / Relationship between self-efficacy to quit smoking, own will and who referred patients

Objetivo: Comprobar si el grado de autoeficacia (AE) para dejar de fumar es diferente según quién remita al fumador a la consulta de tabaquismo y evaluar si el grado de AE medida según procedencia tiene impacto en el resultado (éxito o fracaso). Método: Estudio observacional, longitudinal (cohorte prospectiva), multicéntrico, en consultas para dejar de fumar de España y Argentina. Para valorar la motivación, fueron utilizados test cuantitativos (Richmond, Henry Mondor de Paris y Khimji Watts) y una escala semicuantitativa. La AE se midió con una pregunta de dos cuestionarios distintos (pregunta 4 del cuestionario de Richmond y pregunta 3 del cuestionario de Khimji-Watts). El análisis estadístico incluyó modelos descriptivos, de asociación y de regresión. Resultados: Muestra de 182 sujetos (90 [49,5%] mujeres, edad media 51,4 años [DE: 11; IC 26-77]). Con la pregunta 3 de AE del test Khimji-Watts se encontró asociación con la procedencia en los varones: acudir por voluntad propia incrementa la AE frente a los que acuden enviados desde atención primaria o desde otras especialidades. Ninguna de las variables de AE presentó asociación con el resultado en dejar de fumar, pero las mujeres que acudieron por voluntad propia o enviadas desde atención primaria tienen más probabilidades de dejar de fumar. Los varones procedentes de otras especialidades y con edades medias tienen más probabilidades de fracaso. Conclusiones: Los varones que acuden a dejar de fumar por voluntad propia presentan puntuaciones más altas de AE que aquellos que acuden enviados por atención primaria y otras especialidades. No hemos encontrado una mayor abstinencia final según la puntuación de AE y la procedencia.(AU)

Objective: To check whether the degree of self-efficacy to quit smoking is different depending on who refers the smoker to the smoking cessation clinics, considering as origin: primary care, from another medical specialist or by the patient’s own volition, and to assess whether the degree of self-efficacy measured by who refers the patient has an impact on the ­outcome (success or failure). Methods: Observational, longitudinal (prospective cohort), multicentre study in smoking cessation clinics in Spain and Argentina (daily clinical practice). Quantitative tests (Richmond, Henry Mondor de Paris and Khimji Watts) and one semiquantitative test were used to assess motivation. Self-efficacy was measured with one question from two different questionnaires (question 4 of the Richmond questionnaire and question 3 of the Khimji-Watts questionnaire). Statistical analysis included descriptive, association, and regression models. Results: 182 subjects [90 (49.5%) women, mean age 51.4 years (11; 25-77)]. With question three of the auto-efficacy of the Khimji-Watts test an association was found with the origin in men: attending of their own free will increases self-efficacy compared to those who attend sent from primary care or from other specialties. None of the self-efficacy variables was associated with the outcome of quitting smoking, but women who attended of their own free will or referred from primary care are more likely to quit smoking. Men from other specialties and with middle ages are more likely to fail. Conclusions: Men referred for QS by his OV have higher SE scores (KWT3 question) than those referred by PC and OS. We did not find a higher final abstinence according to SE score and source.(AU)

Is the motivation to quit smoking a predictor of abstinence maintenance?

INTRODUCTION: The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. METHODS: This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. RESULTS: Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the 'result' variable, when other variables intervened in certain circumstances. CONCLUSIONS: None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.

Predictors of mediastinal staging and usefulness of pet in patients with stage IIIA (N2) or IIIB (N3) lung cancer.

OBJECTIVE: To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it. PATIENTS AND METHODS: We analyzed data collected prospectively in a database that included patients with non-small cell lung cancer (NSCLC) who underwent EBUS-TBNA. Prior to EBUS-TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS-TBNA, mediastinoscopy or surgical lymph node dissection. RESULTS: One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68. CONCLUSION: In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS-TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.

Realidad del riesgo oncológico del tabaquismo. A propósito de 2 casos clínicos de neoplasias primarias múltiples / Reality of the oncological risk of smoking habit. Based on 2 clinical cases of multiple primary neoplasms

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Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study.

A large number of COPD patients are smokers. The particular characteristics of this group as well as their need to quit usually require psychological counselling and pharmacological treatment to achieve abstinence and, often, intensively. Little information is available about this issue.  The main objective of the study was to evaluate the effectiveness of varenicline after 24 weeks of treatment, with continuous abstinence between weeks 9 and 24.  This study was a post-authorization, open label, observational study of prospective follow-up. Patients included were smokers with severe or very severe COPD criteria who were treated with varenicline for 24 weeks, i.e. with a 12-week extension over the usual treatment.  The outcomes in the population of subjects completing 24 weeks of follow-up were at week 24: continuous abstinence 36.8%, 7 days point prevalence abstinence 65.7%, and continuous smoking 31.5%.The outcomes in the intention-to-treat population included at baseline were: continuous abstinence 17.7% of patients, 7 days point prevalence abstinence 31.6%, continuous smoking 15.1% and not valid/unknown 51.8%.  The mean CAT score at week 24 was 15 and reduction from the baseline was 3.77 (paired T test, p<0.01). The most common adverse events reported were nausea, vivid dreams, stomach ache, insomnia, headache and vomiting.  Patients included in VALUE were active smokers despite all of them had a severe COPD which suggests a very high degree of dependence. Although the study do not allow to infer the results to the global population of smokers with severe COPD, the outcomes have shown that, at 24 weeks follow up 36.8% of the patients were successful in quitting but from 79 patients enrolled initially only 17.7% quit.

Tratamiento del tabaquismo en fumadores con enfermedad pulmonar obstructiva crónica / Treatment of Smoking in Smokers With Chronic Obstructive Pulmonary Disease

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[Chronic pulmonary histoplasmosis diagnosed in a nonimmunosuppressed patient 10 years after returning from an endemic area]. / Histoplasmosis pulmonar crónica en un paciente no inmunodeprimido, residente 10 años antes en una zona endémica.

We report the case of a Spanish nonimmunosuppressed patient who was a chronic alcoholic and who developed chronic cavitary pulmonary histoplasmosis. He had been living in Venezuela until 10 years ago. The diagnosis was established when Histoplasma capsulatum was cultured from bronchoscopy samples. The patient was treated with itraconazole and progressed favorably until cure. This case suggests that histoplasmosis can reactivate years after exposure, even when significant immunodeficiency is not present. In the absence of another immunosuppressive factor, alcoholism may have played a role in the development of the condition.

Histoplasmosis pulmonar crónica en un paciente no inmunodeprimido, residente 10 años antes en una zona endémica / Chronic pulmonary histoplasmosis diagnosed in a non immunosuppressed patient 10 years after returning from an endemic area

Se presenta el caso de un paciente español, no inmunodeprimido,con alcoholismo crónico e histoplasmosis pulmonarcavitaria, crónica, que había residido 10 años antes en Venezuela.El diagnóstico se estableció por cultivo de Histoplasmacapsulatum en muestras de broncoscopia y el tratamientoconsistió en itraconazol, con buena evolución y curación.Este caso apoya la posibilidad de que la histoplasmosis puedareactivarse años después de la exposición y sin que hayainmunodepresión clínicamente importante. Se plantea que,en ausencia de otro factor inmunodepresor, el alcoholismopodría haber desempeñado algún papel en el desarrollo delcuadro

We report the case of a Spanish non immunosuppressed patient who was a chronic alcoholic and who developed chronic cavitary pulmonary histoplasmosis. He had beenliving in Venezuela until 10 years ago. The diagnosis wasestablished when Histoplasma capsulatum was cultured frombronchoscopy samples. The patient was treated withitraconazole and progressed favorably until cure. This casesuggests that histoplasmosis can reactivate years afterexposure, even when significant immunodeficiency is notpresent. In the absence of another immunosuppressivefactor, alcoholism may have played a role in the development of the condition

Adecuación del aislamiento respiratorio e influencia del tratamiento en lamicrobiología del esputo en pacientes con tuberculosis / No disponible

Objetivo: Evaluar la adecuación del aislamiento y la respuesta microbiológica al tratamiento en pacientes con tuberculosis (TB).Métodos: Determinaciones: 1. Adecuación del aislamiento: hospitalario (sospecha diagnóstica y aislamiento desde la admisión en la planta de hospitalización) o domiciliario (diagnóstico y tratamiento tras el alta en urgencias y aislamiento en el domicilio 15 días). 2. Influencia del tratamiento en el estado bacteriológico del esputo. Resultados: 1. De 100 pacientes consecutivos con TB, 50 tenían baciloscopia +, 37 de ellos tenían aislamiento correcto (28 hospitalario, 9 domiciliario). En los 13 restantes el aislamiento fue incorrecto,3 domiciliario (dos alta sin aislamiento y retraso diagnóstico de 7 y 10 días, otro con aislamiento 10días) y 10 ingresados (retraso de 1-14 días, media 4.5; en 5 retraso de un día y en los 5 restantes retraso de 3 a 14 días). 2. De 50 pacientes con baciloscopia + en 14 se realizó control microbiológicoal mes del inicio del tratamiento (todos baciloscopia +, 10 cultivo +). En 25 con control al 2º mes, 8baciloscopia +, 7 Cultivo +.Conclusiones: 1. Se ha objetivado que en el 13% de los pacientes con TB no se realizó el aislamiento correctamente. 2. En pacientes con TB bacilífera, tras uno o dos meses de tratamiento existe un número importante con baciloscopia y cultivo +. Se deben controlar la política de aislamiento y la respuesta microbiológica al tratamiento por la influencia que pueden tener en la transmisión de la TB (AU)

Aim: To know 1º. The respiratory isolation policy, 2º. The effect of treatment on the sputum bacteriologic status in patients with tuberculosis (TB).Methods: 1. Description of isolation policies. We defined correct isolation in hospital as diagnosis suspicion and isolation on admission and duration no less than 15 days and correct domiciliary isolation as diagnosis in emergency room with recommendation of treatment and stay at home at least 15days. 2. Follow-up of sputum status after treatment. Results: 1. 100 consecutive patients, sputum smear + in 50, 37 with correct isolation (28 in hospital and 9 domiciliary). In 13 with incorrect isolation, 3 were outpatients (2 without diagnosis neither isolation and delay in diagnosis of 7 and 10 days and another with domiciliary isolation of 10 days). In10 inpatients the diagnosis delay was 1 to 14 days (mean 4.5). 2. Fifty positive smear patients were followed-up for bacteriology controls. First month control on 14 showed positive smear for all and positive culture for 10 of them. Second month control was performed on 25, 8 of them were smear positive and 7 culture positive. Conclusions: 1. In 13% of patients with TB we did not perform the isolation correctly. 2. There was a high rate of positives smear and culture after one and two months of treatment within TB patients with initial positive smear. We must control isolation policy and bacteriologic response to treatment because of the influence that can have in TB transmission (AU)