Assessing the effectiveness of the COPD Assessment Test (CAT) to evaluate COPD severity and exacerbation rates.

AIMS: The CAT is a short, simple eight-item questionnaire for assessing and monitoring COPD. It is not known how reliable the CAT scores are for COPD patients who are frequently exacerbated. The effectiveness of the CAT for assessing COPD severity and exacerbation rates was evaluated. METHODS: This study enrolled 165 stable COPD patients who completed the CAT between April 2011 and February 2012. RESULTS: Patients had a mean forced expiratory volume in one second (FEV1) equal to 43.7% of the predicted value and a mean CAT score of 21.2 (± 7.56) units. There was a good association between the FEV1 (percentage of predicted value) and CAT scores (p < 0.0001). Frequent exacerbators had significantly higher CAT scores than infrequent exacerbators (24.8 ± 6.7 versus 17.5 ± 6.5, p < 0.0001). Also, as the frequency of the COPD exacerbations increased, CAT scores (p < 0.0001) significantly increased. There was a significant association between the frequency of hospitalization and the CAT scores (p = 0.001). CONCLUSIONS: We observed a good relation between the CAT, FEV 1, and disease severity in patients with COPD. We found that the baseline CAT scores are elevated in frequent exacerbators.

Patterns of drug resistance in pulmonary tuberculosis cases in the Izmir district, Turkey.

Antituberculosis drug resistance patterns were investigated among the new and previously treated pulmonary tuberculosis (TB) cases in Izmir district, retrospectively. Proportions of resistance patterns were determined using a number of resistant cases using as a denominator. Resistance to at least one drug was found in 304 (29.7%) patients in 1023 a total of tuberculosis cases. 182 new and 82 previously treated consecutive pulmonary tuberculosis cases were investigated. Patterns were examined as single and/or probable combinations of isoniazid (H), rifampicin (R), ethambutol (E) and streptomycin (S). Single drug resistance mode, mono S, and HS resistance patterns were the highest proportions in comparison with other modes and patterns in both new and previously treated cases. HRS pattern showed a significant proportion and proportions of quadruple mode were higher than triple mode in previously treated cases. Proportions of patterns associated with R were detected more than expected. Surveillance of proportions of anti-TB drug resistance is important as well as surveillance of resistance rates.

Patient attitudes towards chemotherapy as assessed by patient versus physician: a prospective observational study in advanced non-small cell lung cancer.

BACKGROUND: In the treatment of advanced cancer, a physician's ability to accurately identify a patient's attitude towards treatment is critical. This paper describes the extent of any differences observed between patient attitudes towards chemotherapy for advanced non-small cell lung cancer (NSCLC) as assessed by patients themselves versus their physicians. PATIENTS AND METHODS: Patients with stage IIIB or IV NSCLC who received gemcitabine plus cisplatin or carboplatin were enrolled into this prospective observational study. Patients and their physicians completed questionnaires containing descriptions of seven patient-specific attitudes. A pre-defined algorithm was used to categorize patients into one of the three 'need' categories based on the questionnaire responses: (A) "maximum extension of survival with acceptance of high toxicity", (B) "maximum extension of survival only if coupled with normal life style", and (C) "relief of symptoms". Each patient was categorized based on his own response, as well as his physician's response. RESULTS: A total of 1895 patients were enrolled from 19 countries across 3 continents. Data from 1884 patients were analysed. Based on patient versus physician responses, respectively, the distribution of patients was 60% versus 39% in need category A, 26% versus 33% in B, and 14% versus 29% in C. Patient self-assessed versus physician-assessed need category identification was aligned for 891 patients (47.3%): 541 (29%) in A, 218 (12%) in B, 132 (7%) in C. While there was slight agreement between the identification of 'need' categories by physicians and patients (kappa=0.18, 95% CI: 0.15-0.21), physicians also tended to place patients further down the scale (towards C) than patients placed themselves (P<0.001). CONCLUSIONS: Patients have varying needs from cancer chemotherapy and it may not always be correctly identified by the treating physician. Physicians may underestimate patient's desire for extended survival compared with symptom relief.

Association of duration of sleep and cardiovascular and metabolic comorbidities in sleep apnea syndrome.

Background/Aim. Previous population-based studies found association between duration of sleep and cardiovascular and metabolic comorbidities. Our aim was to investigate the association between the duration of sleep and cardiovascular and metabolic comorbidities in OSAS. Patients and Methods. The study enrolled 312 patients, who had polysomnography (PSG) during 2006-2007 and responded to a telephone-administered questionnaire providing information on characteristics of sleep on average 12 months after PSG. Results. Of the patients, 90 were female (28.8%), 173 (58.5) received the diagnosis of OSAS, 150 (45%) had no comorbidities, 122 had hypertension (HT), 44 had diabetes mellitus (DM), and 38 had coronary heart disease (CHD). Mean ± SD of age in years was 47.2 ± 10.6, 56.5 ± 9.3, 53.2 ± 8.9, and 59.9 ± 9.0 for the no comorbidity, HT, DM, and CHD groups, respectively. Reported duration of sleep was not associated with any of the comorbidities in the overall group. In the analysis restricted to OSAS patients, sleep duration ≤6 hours was significantly associated with CHD after the adjustment for age, gender, and other associated factors (OR: 5.8, 95% CI: 1.0-32.6). Conclusions. Confirmation of the association between shorter duration of sleep and CHD will provide prognostic information and help for the management of OSAS.